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Collaboration Is Key for Hospitals, Insurance FirmsBottom line for both sides is quality, affordable healthcare

With eight months of pointed contractual negotiations between Saint Francis Hospital and Blue Cross/Blue Shield of Tennessee fi nally completed in November, the question remains in this new healthcare world order, “What has to change for local hospitals and insurance companies to work and contract together?” ... 7

Ramping Up ‘Heart Studies v2.0’New coalition to connect and expand historic cardiovascular disease investigation

The American Heart Association (AHA) recently debuted a coalition establishing formal research ties between the University of Mississippi and Boston University and their renowned population studies of cardiovascular disease, the Jackson and Framingham heart studies ... 9

Kirkland Cancer Center Brings New Hope to Patients

By SUZANNE BOyD

The vision of better care for cancer patients in West Tennessee that started nearly four years ago with a $5 million gift is now a re-ality. The Alice and Carl Kirkland Cancer Center has opened its doors in Jackson on the medical campus of West Tennessee Healthcare. The 82,000 square foot state-of-the-art facility provides not only more treatment options and support for patients, it is also providing new hope in a setting unlike any in the region.

At the heart of the three-story center, are the patients it will serve. “We were very strategic and inten-tional in every detail of this project to insure that everything about this building is designed around the patient and the patient experience. Patients were included in focus groups on various aspects of the center such as the types of chairs used in treatment areas,” said Catherine Kwasigroh, vice president of Hospital Services for West Tennessee Healthcare. “The Kirkland Cancer Center provides the same level of care received in a hospital environment

(CONTINUED ON PAGE 6)

FOCUS TOPICS PUBLIC HEALTH EYE CARE

By CINDy SANDERS

For the past several years, the state has been slowly but steadily moving the needle on the health status of Tennesseans. While still far from where the leadership of the Tennessee Department of Health would like to be, there is a conviction that programming and partner-ships truly are making a real difference in real lives all across the state.

David Reagan, MD, PhD, chief medical offi cer for the Tennessee Department of Health, recently spoke with Medical News to refl ect on 2013 efforts and discuss focal points for the coming year.

Health AssessmentTennessee Department of Health 2013 Review, 2014 Preview

(CONTINUED ON PAGE 4)

2 > JANUARY 2014 w e s t t n m e d i c a l n e w s . c o m

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“Regions is always there when I have questions. My relationship with my Regions banker is personal and I have her on my speed dial.”

What started as a single location has grown to three with a full-time staff of 17 employees. These days, the Miami Dermatology Center utilizes a wide range of Regions banking tools, from Business Analyzed Checking and Treasury Management to loans and lines of credit.Dr. Leal-Khouri plans to expand parking at her Coral Gables location, and Regions is part of those plans too. To learn more about the Miami Dermatology Center and how Regions can assist your business, visit regions.com/success.

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By SUZANNE BOyD

For upstate New York native, Matthew Hughes, some insight-ful advice from his father led him to a career help-ing others maintain their sight. Rather than being a traditional eye care clinic, the Hughes Eye Center in Jackson, focuses on managing and treating advanced ocular and sur-gical needs of patients. His patient-centered model for his practice, dedication to patients and the optometry profession has even earned him top honors from the state’s leading optometry organization. In 2012, out of 1100 practicing optometrists in the state of Tennessee, Hughes was named The Tennessee Association of Optometric Physi-cians Optometrist of the year. He has also been named top eye doctor by the Jackson Sun’s Readers Choice Awards.

Many optometrists’ practices are built on performing primary eye health exami-nations and prescribing eyeglasses. Instead of concentrating on the basic elements of eye care, Hughes limits his practice to the treatment and management of medical and surgical eye disease, including glaucoma, cataracts, macular degeneration, diabetic retinopathy and traumatic eye conditions.

“Rather than competing with medical and optometric practices, we accept referrals from other providers when they have a pa-tient with an advanced eye care need. Our practice centers on strong communications between eye care and medical providers,” said Hughes.

Because the South has a high incidence of hypertension and diabetes that can lead to eye disease, the area is riddled with it. “We have about 75 optometrists that refer patients to our clinics and about 70 percent of my practice is glaucoma, but there is still a high preponderance of other eye diseases for us to treat,” said Hughes. “We treat pa-tients like family, but realize and respect the important relationship they have with their local eye doctor and medical providers. As a result, we have worked to become a trusted partner for providers throughout the region who want to offer the highest quality medi-cal eye care for their patients.”

Hughes found his way to the South during his residency and fellowship training. His undergraduate degree in Biology/Pre-Med is from Allegheny College in Mead-ville, Pennsylvania. Based on advice from his father, Hughes chose to pursue optometry and went to Chicago for his training at The Illinois College of Optometry and Illinois Eye Institute in Chicago.

“My dad recommended the eye profes-sion because it was not directly dependent on the economy,” said Hughes. “He said people would always need to see no matter what the market is doing. He also encour-aged me to have a good life and always pro-vide for my family, which was good advice. I went to a medical-based eye school, which

was in Chicago. While doing external rotations at the Veteran’s Administra-tion Hospital there, I real-ized I wanted to expand my knowledge of advanced oc-ular disease. Which meant several years of additional training after optometry school.”

Hughes moved south to Memphis to complete a one-year residency and two-year fellowship in advanced ocular disease and pathol-ogy through the Southern College of Optometry. “In

the early 1990’s, there were only 54 resi-dencies in the country for advanced ocular disease with about 1000 applicants, so you really don’t have a lot of say in where you go. If you get in, that is where you land,” said Hughes. “In my post-graduate train-ing I worked at Omega Eye Care Center in Jackson, Tennessee.”

After completing his fellowship, Hughes remained at Omega Eye Care. While there he was the first therapeutic OD in the state certified in the delivery of ocular injec-tion and injectable agents. He also was the clinical instructor for the state of Tennessee and Mississippi’s advanced ocular disease, glaucoma certification and ocular injection course. Besides being the center director for Omega, he also served as regional vice president for Omega Health Systems before going out on his own.

In 2001, he opened the Hughes Eye Center. Today, in addition to the main lo-cation in Jackson, the center has locations in McKenzie, Dyersburg, Savannah, Lexing-ton, Huntingdon, and Selmer, Tenn. Besides Hughes, the staff includes two additional residency trained optometrists who evaluate, manage and treat ocular disease and pathol-ogy. The center also offers cataract surgeries, LASIK and other laser surgical procedures, performed by David Underwood, MD. Spe-cialty services offered include oculoplastic sur-gery and retina specialists.

Growing up in rural upstate New York, Hughes was an avid snow skier and hockey player, playing all four years and the captain of the team in his junior and senior years at Allegheny College. While West Tennes-see does not offer much hope for skiing or playing ice hockey, Hughes has found solace in running, working out and golf. Although a long way from home, Hughes still roots for his Buffalo Bills and satisfies his love for hockey with a Nashville Predators game when he can. “I also try to get back up North when I can in search for powder snow skiing,” he said.

With two boys, Hughes and his wife Marigene, stay busy running from game to game during the baseball season. “Logan, a senior at USJ, has started on the Varsity team three of his four years in high school and is considering playing baseball in col-lege,” said Hughes. “Our other son, Colby, plays for the Coyote travel baseball team and also enjoys playing basketball, so we are rarely without a game to go to.”

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Compounded MedicationsThe fungal meningitis outbreak, identi-

fi ed in the fall of 2012, continued to play out in 2013 in a number of ways.

In assessing response to the discovery of the tainted batches of the preservative-free steroid injections, Reagan noted, “It took eight days from the fi rst report of a case to the Tennessee Department of Health to the national recall of the three lots of contami-nated medication — methylprednisolone acetate — nationwide.” The quick reaction, he continued, “prevented, we estimate, 368 exposures … 368 patients in Tennessee who did not receive contaminated steroids. We believe it probably prevented 69 deaths.”

Unfortunately, 750 individuals nation-wide, including 150 in Tennessee with 16 deaths, were impacted before the lots were pulled from the New England Compound-ing Center. To try to prevent a future trag-edy, Reagan said a number of steps have been taken on a state and federal level “to make sure Tennesseans receive the safest possible compounded medication.”

On Nov. 27, 2013, President Obama signed into law the Drug Quality and Secu-rity Act, which more clearly defi nes the role of the U.S. Food & Drug Administration and state health offi cials in the oversight and regulation of compounding pharma-cies. Reagan said the Tennessee Depart-ment of Health worked closely with Sen. Lamar Alexander (R-TN), one of the bill’s chief authors.

In Tennessee, a number of changes were approved by the State Board of Phar-macy to improve the oversight and safety of state-licensed compounding facilities. However, a ruling by the attorney general called one of the measures into question. The cease-and-desist provision was deemed to be in confl ict with Tennessee’s Admin-istrative Procedures Act. More work will undoubtedly be done on both an adminis-trative and legislative level in 2014 to reach a balance between access to needed medi-cations and public safety.

Prescription Drug AbuseAddressing the prescription drug abuse

epidemic, a number of improvements to the Controlled Substance Monitoring Database (CSMD) and new requirements for pre-scribers were implemented last year.

“Effective Jan. 1, 2013, all prescribers were required to register with the CSMD,” noted Reagan. He added that on April 1, prescribers were required to search the database prior to prescribing controlled substances to look for patient red fl ags. “What we’ve seen is a three-fold increase in searches since before the law was imple-mented, and there has been a 50 percent decrease in doctor shoppers from August 2012 to July 2013,” he said.

In addition, Reagan said a number of steps have been taken to improve the technology for clinical users. “We’ve imple-mented two signifi cant groups of improve-ments and a third group is being tested now to make an excellent experience for clini-cians using the database,” he said. “The average search only takes a few seconds.”

Making it simple to identify patients at high risk for addiction and abuse is critical, he continued. Reagan said the latest data

showed 1,093 overdose deaths in 2012. “That’s more than the number of deaths from motor vehicle accidents and more than the number of homicides,” he said. “When you look at the breakdown, the great majority of those deaths are accidental overdoses that involved opioid analgesics.”

Also of note in 2013, Tennessee forged collaborative database agreements with Virginia, South Carolina and Michigan. In 2014, the state will actively working on similar agreements with other states, par-ticularly those contiguous to Tennessee.

Pain Management GuidelinesIn a related matter, the Department of

Health reached out to pain management specialists in Tennessee to convene an ex-pert panel looking at the best methods to help patients while curbing medication ad-diction.

“We’re working really hard on estab-lishing chronic pain management guidelines in Tennessee,” Reagan noted. He said the guidelines are a compilation of innovative ideas and best practices from Tennessee and other states’ programming, as well as national pain society recommendations.

Reagan added the practice guidelines should be ready this month. “These guide-lines will be a signifi cant help to practicing clinicians who are caring for patients re-questing pain medicines in increasing num-bers.”

Newborn HealthNeonatal Abstinence Syndrome (NAS): In

2013, an emphasis was placed on identify-ing and curbing the number of babies suf-fering from NAS, which occurs when the mother is taking opioids while pregnant. “It’s very traumatic for the child,” Reagan stated, adding, “It’s something that should be rare because it is nearly completely pre-ventable.”

With the mindset that you must know the scope of the problem to effectively com-bat it, Reagan said, “We made neonatal ab-stinence syndrome a reportable condition in Tennessee in 2013, and I think we were the fi rst state in the country to do so.”

By early December, there were more than 800 documented cases of NAS in Ten-nessee. Recognizing there could be report-ing bias with the change in requirements, he said the 2013 fi gure appeared to be a 25 percent increase over numbers gathered in 2011 through hospital discharge diagnoses data. Additional education, combined with the new pain management guidelines for caring for pregnant patients, will be a focus in 2014.

Screenings: “We screened about 85,000 newborns in 2013 with a panel of 54 dif-ferent screenings for genetically-based ill-nesses,” Reagan said.

A law passed in 2012 and implemented in 2013, added bedside pulse oximetry to the panel to screen primarily for a treatable cardiac birth defect prior to an infant be-coming symptomatic. “We’ve already had babies who have benefi ted from this, receiv-ing critical medical care in a timely way,” he said.

Reagan noted he anticipated adding another new screen to the panel in 2014.

Eliminating Elective Early Deliveries: One of the Department of Health’s most effective partnerships has been focused on eliminat-ing elective deliveries before 39 weeks. The collaboration between the state, March of Dimes, Tennessee Hospital Association and TIPQC (Tennessee Initiative for Perinatal Quality Care) led to the support of every birthing hospital in Tennessee and included the educational initiative, ‘A Healthy Baby is Worth the Wait.’

“The last month for which I have data is September 2013. There were only fi ve early elective deliveries in the entire state,” Reagan said with clear excitement. “And that compares to 96 in May of 2012.”

He said it was a joint effort with all of the hospitals and their staff members pull-ing together to create a culture change to “make sure babies born in Tennessee have the best opportunity not only to survive their fi rst year of life but to enjoy the best health possible throughout their lives.”

Safe Sleep: The ABCs of Safe Sleep cam-paign — Alone, on their Back, in a Crib — kicked off in 2012 and has continued to grow since then. Planned in 2014 are con-

America’s Health RankingsTennessee Holds Steady in 2013

The latest iteration of the annual ‘America’s Health Rankings’ from the United Health Foundation was released at the end of 2013. Tennessee ranked 42nd in the nation, which equates to no change in the overall ranking for the state when this year’s new methodology is applied to last year’s data set. The change makes it impossible to do a surface ‘apples to apples’ comparison between 2013 and 2012 without adjusting past data to the new methodology. Contributing to Tennessee’s ranking were: obesity in adults (40th), infant mortality (47th), physical inactivity among adults (45th), low birth weight (41st) and high violent crime rate (50th ... making Tennessee the worst in the nation with 644 offenses per 100,000 population). To see the full rankings and Tennessee trend data, go online to www.americashealthrankings.org. County-specifi c data is also available courtesy of the Robert Wood Johnson Foundation at www.countyhealthrankings.org.

Health Assessment, continued from page 1

(CONTINUED ON PAGE 8)

w e s t t n m e d i c a l n e w s . c o m JANUARY 2014 > 5

Carpal tunnel syndrome (CTS) is the result of a “pinched” median nerve at the wrist and is the most common cause of hand numbness. The median nerve, branches out to the fi ngers like the limbs on a tree. These branches go to the skin of the fi ngers and some of the muscles in the hand. When this nerve is “pinched,” it can cause the fi n-gers to become numb or tingle. It also can create weakness or pain of the hand. These symptoms are usually worse at night. This pain can radiate to the forearm and shoulder. In milder cases, a wrist splint worn at night can help. In more advanced cases, a small surgical procedure is necessary.

Ulnar Nerve Impingement: The ulnar nerve, or the “funny bone nerve”, begins in the neck and runs all the way to the hand. When it becomes irritated at the elbow, it can cause numbness in the ring and little fi ngers, or weakness in the hand. It is uncertain how the nerve becomes irritated, but it is often associated with a hard blow to the elbow or repetitive elbow bending, such as weight lifting. Sleeping with the elbow bent or repeated pressure of the elbow on a desk or chair may also injure the nerve. If you work with your elbows on the desk, try an elbow pad. Splinting the elbow in the straight or extended position at night might also help. A splint can be fashioned from a pillow or towel and tape. If your con-dition is uncomfortable or seems to be progressive, see your health care provider. Sometimes a surgical procedure is required.

Pinched Nerve in the Neck (Radiculopathy): Radiculopathy results from a herniated disc in the neck or from a bony con-striction where the nerve exits the neck. A herniated disc means that some of the material between two of the bones in the neck has protruded and is pinching a nerve. Usually, patients will say that the pain begins in the back of the shoulder and radiates into the arm, forearm and hand, and often will raise their hand over their head for relief. Several types of treatment are avail-able before surgery is considered.

Nerve Disease (Neuropathy): A generalized disease of the nerves can cause numbness or tingling in the hands or feet. The most common causes are diabetes and hereditary condi-tions. Neuropathy usually affects the feet fi rst and then the hands. The numbness usually involves the entire hand rather than only certain fi ngers and might extend up into the forearm. Numerous medications are available that can minimize the symptoms.

An EMG will allow your health care provider to determine if you are suffering from one of these conditions.

Numbness and tingling of the hands is a common complaint. Although carpal tunnel syndrome is the most common cause there are many conditions that can mimic this. The four most frequent disorders are outlined below.

Miles M. Johnson, M.D. Ronald C. Bingham, M.D.

Memphis • Southaven • Jackson • Union City • Paris

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Carpal Tunnel Syndrome& Other Causes of

Numbness and Tinglingby Ronald C. Bingham, M.D. Physical Medicine & Rehabilitation

Whatever the term “du jour” is, it still comes down to Population Health Management or Community Health Management. It is what it is. It is a concept. In my column that appeared in the August, 2013 issue, of Memphis Medical News, “Hurdles on the Track of the Affordable Care Act,” I mentioned two challenges cited in a survey and study conducted by the MGMA that couldn’t have illustrated this concept any better.

The number one challenge on applicability scale is “assessing current operations to identify opportunities for improvement,” and the number one challenge on intensity scale is “preparing for reimbursement models that place a greater share of financial risk on the practice.”

“We have an unprecedented access to information and exponential growth in computing speed and data storage. Experts predict that each of these factors will continue to double every 18 months. Our ability to connect to the Internet is becoming ubiquitous, creating expectations that information should be instantly accessible from any point on earth. The Internet is transforming the way people learn, interact, and conduct daily business, and undoubtedly it will continue to play an increasingly critical role in all aspects of our lives.” (“Top-Performing Healthcare Organizations,” Greg Butler and Chip Caldwell)

The top 10 jobs of 2010 were jobs that didn’t even exist in 2004. Many students are preparing to work for companies that do not exist today, to use technologies that have yet to be created, and to solve issues we have not yet identified as problems. (Fisch and McLeod, 2007)

So What? So if we wait until the next new

intelligent phones and newest retina/finger print activated iPads, and move further past the “clouds,” then our Healthcare DNA will continue: Paralysis by Analysis.

Maybe there is something we can learn from the tech companies on how to affect and change consumer behavior. But healthcare is not as fun as Game Boy.

Let’s get our heads out of the clouds, (no pun intended), and bring it back down to earth.

Of course, the objective is a healthy

community/population. When the physicians in the Pediatric Independent Practice Association (PIPA) were in the due diligence phase of our secured physician portal, here are some of the “take always” (which also fit into the adult community.) For the most part here is what we learned, regarding perceived health:

• 80 percent of the population is healthy

• 10 percent of the population are “worried well”

• 5 percent of the population are undiagnosed

• 5 percent of the population is ill and take up 50 percent of all medical costs (source: American College of Healthcare Executives

Disease Management Outcomes: Top 3 percent users as percent of budget – 49 percent --43 percent = $5,000,000/year savings. (2013 Congress on Healthcare Leadership)

Information Technology – Patient Centered Medical Home – Chronic Disease Management help the pieces together but not without the proper management team. And every team member must think:

• All Hands On Deck• Coordinated Information Systems • Obsessive Focus on Continuum

of Care• Drive Care to the Lowest Level• Reduce Admissions• Provide Wellness at Every

Healthcare “TOUCH POINT”As I mentioned in my previous

article, “Are We Listening?” I will ask the question again.

Are we listening? Generational differences sometimes

cause clashes among workers on teams, but each generation brings a unique perspective to handle related tasks. If we don’t talk about why we’re different and have different perspectives, we don’t reach the best decisions. The more people are willing to invest in honest communication about the issue, the better the outcome.

We Live in Exponential Times

by Bill Appling

Bill Appling, FACMPE, ACHE is founder and president of J William Appling and Associates. He serves on the Medical Group Management board of directors. He is a national speaker, presenter and a published author. He serves as an adjunct professor at the University of Memphis and Chair of Harrah’s Hope Lodge board, and serves on the board of Life Blood. For more information contact Bill at appj54@aol.com.

6 > JANUARY 2014 w e s t t n m e d i c a l n e w s . c o m

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but delivers it in a spa-like environment. We utilized the Disney concept of keep-ing support and staff work areas behind the scenes to minimize the impact on the patient experience.”

As the Center’s staff and family mem-bers play a large role in the patient’s expe-rience, their needs were also considered in the design. “Working with cancer patients takes special people and many see it as a calling that they take very seriously. To allow them some downtime, each floor has areas away from patients and patient care areas for staff members,” said Gina Myracle, executive director of the Kirk-land Cancer Center. “Family members are often here for every visit so we wanted their experiences to be positive as well. We added lots of little extras like Wi-Fi, rocking guest chairs in treatment areas and amenities in personal patient dress-ing rooms to make family members more comfortable.”

To enhance the spa experience, the center utilizes lighting, textured walls and colors reflective of water. “We could not physically bring water elements into the interior design of the building,” said Myracle. “But that did not stop us from in-corporating components that have the re-laxing and calming effects of water such as a wave element that is prevalent through-out the interior design of the building.”

In the main lobby of the center is a retail pharmacy for cancer patients, a boutique, resource center, chapel and support services. The Inspirations Bou-tique addresses the special needs of cancer patients, especially breast cancer patients. The boutique, which will be open during the Center’s normal business hours, will be staffed with certified fitters experienced in fitting breast forms, mastectomy bras, post-surgical camisoles, swimsuits, lymph-edema sleeves and other mastectomy ap-parel.

Just outside the side doors of the main lobby is the Healing Garden. This serene space includes a water feature and an in-spirational sculpture that will serve as an honorarium. Located on the third floor are a conference room and community room for meetings as well as a café. No detail was left to chance; even the parking garage has a decorative brick motif on the exterior to mask it being a garage. Each parking space in the garage is visible by security cameras.

The center’s radiation oncology clinic located at the back of the first floor, in-cludes three linear accelerators, one of which will be a new state of the art lin-ear accelerator which will provide more options and capabilities of treatment types for the administration of radiation therapy than are currently available. The accelerators are housed in identical suites featuring hardwood wall and ceiling tiles, wood grain flooring and soft lighting. Sup-plies and equipment are hidden from the patient’s view, as are staff work areas. In-floor scales ease accessibility for patients. Private patient dressing rooms include televisions and are designed for a family member to remain there during a patient’s treatment. Once a patient has completed

their final radiation treatment, they will ring a captain’s bell to celebrate the mile-stone.

For patients requiring chemotherapy, the infusion area on the second floor has four private rooms, 21 semi-private treat-ment areas and two community treat-ment areas with a total of twelve chairs. “Patients can choose to receive their che-motherapy in one of our individualized treatment bays that has an inspiring name such as ‘Hero’, ‘Champion’ and “Super-star’ or choose to socialize in one of our group treatment settings. All bays have TVs and a majority of the bays have natu-ral sunlight and feature large windows, providing views of the center’s atrium or Healing Garden,” said Kwasigroh. “To celebrate patients’ milestones in treat-ment, we have a 24-inch gong on the floor that they get to strike with a mallet after their last treatment allowing the entire floor to hear the beautiful, majestic sound vibrations. We spent a lot of time theming the building around victory with the goal of providing hope for every patient to win in the battle against cancer. ”

The medical clinic on the third floor has some unique design features that focus on privacy for the patient while keeping staff workspace hidden. “Patient rooms have two doors, one from the hallway that the patient will use to enter the exam room. The other door is from an interior work area that physicians and staff will use,” said Myracle. “Physicians will also have office space in the clinic.”

The layout of the center is very simple by design so that visitors can easily find their way to their destination. “Upon entering the building, patients and family members check in at the same place before proceed-ing to the patient care areas,” said Myra-cle. “We have made it as straight forward as possible for patients to move through the building. Once a patient comes off the elevator, they will enter the waiting room for that floor’s services. Even the flooring throughout the building is designed to help patients find their way.”

The opening of the Kirkland Cancer Center marks a new level of cancer care in West Tennessee. All the oncology ser-vices and resources needed by a newly di-agnosed patient or long-term survivor and their caregivers are now housed in the same building. One of the goals of the Kirkland Cancer Center is to help patients and their families through the entire process of care from diagnosis to treatment decision com-ponents. A patient navigator will serve as an advocate to assist patients, families, and caregivers throughout their course of care.

“We visited centers around the re-gion, took away the best of what we saw but knew we wanted to raise the design to a higher level. Our architect and design firms were on board for that as well,” said Kwasigroh. “Our team was kept small on purpose and consisted of just ten people who were all on point on this project as to what we wanted to accomplish. We were striving for perfection and landed on ex-cellence. We are very happy and proud of the building and are excited about sharing this project with the community.”

Kirkland Cancer Center, continued from page 1

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Methodist Launches Physician Academy

By RON COBB

The Physician Leadership Acad-emy, a new program to strengthen doc-tors’ leadership skills, is under way at Methodist Le Bonheur Healthcare. Classes started in September and are held for four hours once a month, except December. Topics include “Building a High Performance Culture,” “Facilitating Change as a Physician Leader” and “Ef-fective Physician Leadership.”

Michael Ugwueke, COO of Method-ist Le Bonheur Healthcare, says his goal in opening the academy was to create the next generation of physicians who excel both as leaders and healers. When hospi-tals team up with physicians, he says, great things in healthcare can be accomplished. Ugwueke worked with the UT Center for Executive Education in Knoxville and the American College of Physician Executives in Tampa to develop the program.

“We work closely with our phy-sician partners, and the Physician Leadership Academy will allow us to strengthen that partnership,” he said. “As we expand our collaboration with our doctors, it will enhance our ability to provide the family and patient-centered care that we are committed to afford-ing each and every patient and family.” The first class, consisting of 24 physi-cians, is scheduled to graduate in August. A new class will start in September. The program, conducted by Ugwueke, is by invitation only and is limited to doctors from Memphis and surrounding commu-nities who are affiliated with Methodist. The doctors are recommended to Ug-wueke by Methodist’s CEOs or another Methodist physician leader.

In addition to the content that Ug-wueke has developed, speakers come in to talk about topics such as “understanding your behavior and leadership style,” “build-ing a high-performance culture” and “facili-tating change as a physician leader.”

“I have been serving as president of the medical staff for the past year, and thus I am very aware of the challenges that come with a leadership role,” said Heather Swanson, MD, a hospitalist with Methodist University Hospital. “I am so thankful to Methodist and Michael Ug-wueke for putting together a program to give me the tools I need to be a more ef-fective leader.”

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By GINGER PORTER

With eight months of pointed con-tractual negotiations between Saint Fran-cis Hospital and Blue Cross/Blue Shield of Tennessee finally completed in November, the question remains in this new health-care world order, “What has to change for local hospitals and insurance companies to work and contract together?”

According to insurance payers, hospi-tals need to realize insurers are constrained by cost. According to hospitals, the con-sensus is that they don’t want insurance companies to go to the lowest bidder.

“I think the payers are going to go to the lowest common denominator — the ones charging the least,” said Craig Becker, president of the Tennessee Hos-pital Association. “It’s not always fair, because frequently a hospital might have higher cost because it may have more intense services, and it may have more uncompensated care. It’s going to im-pact negatively those hospitals providing care for our most vulnerable populations. That’s my biggest fear.”

Roy Vaughn, vice president of cor-porate communications, Blue Cross/Blue Shield of Tennessee, said that is not always the case. Citing Centers for Medicare and Medicaid Services (CMS) data, he said Saint Francis is one of the most expensive hospitals in the state, and they were able to reach an agreement even after greatly strained relations.

“Consumers want and need us to work together,” Vaughn said. “We pre-fer a collaborative approach that achieves quality, affordable care for our members and fair compensation for the providers in

our networks. We have always considered Saint Francis facilities valued partners in the Memphis area. We are pleased to have reached an agreement that allows us to keep our members’ coverage affordable.”

Explaining that it will work diligently to resolve any contractual negotiations, Saint Francis’ senior vice president and spokeswoman, Marilynn Robinson, said the hospital is “focused on the outcome.”

“We will work so our patients can have the care they deserve. The bottom line is we want to be able to serve the com-munity,” she said.

Serving the community in this rapid-fire change environment has produced a new philosophy of contractual negotiation for a few of the larger local hospital sys-tems.

“In partnership with our physicians, we work in collaboration with our health insurance partners to meet the challenges of the changing environment,” said Donna Abney, executive vice president, Method-ist Le Bonheur Healthcare. “We think the only way to meet individual and purchaser needs and expectations is through a cul-ture of collaboration, innovation and trust. We work very hard to achieve that.”

That philosophy was echoed by Vaughn, who cited a “preferred partner-ship” with Methodist Le Bonheur. The model they espouse is more integrated, less fee-for-service, which is where experts say the market is headed.

“We are moving toward a popula-tion-based model where insurance com-panies will say ‘we are going to make you responsible for following these 20,000 cov-ered lives. We are going to pay you one flat fee for their healthcare,’” Becker said.

“Therefore, hospitals are going to spend a lot more time trying to keep people ap-propriately out of the hospital and keep them healthy. That’s the idea behind it. Whether it will work or not, we will see.”

The Regional Medical Center at Memphis agreed, explaining the market demands proactivity rather than reactiv-ity.

“I think the insurance industry needs to be more forward looking and help pro-viders transition into an environment of wellness and preventable care,” said Rick Wages, chief financial officer. “Rather than waiting until people get sick and come to the ERs, we do things as they are identified rather than waiting until they are catastrophic and expensive. Maybe those insurance companies are willing to pay for a different kind of service on the front end. Maybe we jump that chasm of the way healthcare is perceived and deliv-ered.”

All sources interviewed kept using a key word: collaboration. The collaborative approach paves the way for more give-and-take from both sides, more physician input, more effective patient-care plan-ning, more efficiency. Baptist has coined a name for its version of this partnership: Select Health Alliance.

Officials explained it is a clinically in-tegrated network developed in response to the impending population-based health-care model. “We have partnered with physicians and brought the first payer con-tract to the table (Aetna) and have had a different conversation between physician-hospital-payer,” said David Elliott, vice president of managed care. “We focus on

Collaboration Is Key for Hospitals, Insurance FirmsBottom line for both sides is quality, affordable healthcare

(CONTINUED ON PAGE 8)

8 > JANUARY 2014 w e s t t n m e d i c a l n e w s . c o m

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

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Tim C. Nicholson is the President of Bigfish, LLC. His Memphis-based firm connects physicians, clinics and hospitals to patients and one another through healthcare social media solutions, branding initiatives and websites. His column, “Hey Doc”, appears here monthly. Find him on twitter @timbigfish or email tim@gobigfishgo.com

By TIM NICHOLSON

We live in the future. And you know it’s true. This past weekend I was watch-ing some reruns of shows from my child-hood. I saw the Jetsons. I saw Star Trek. And that’s when it occurred to me, we live in the future.

I watched as Mr. Spacely called George Jetson on his television. Well that’s what we thought it was at the time. Little did we know that there would be Skype, Google Hangouts and FaceTime that would allow us to talk to someone face-to-face miles away or just around the corner. We can now see and converse with others without leaving our homes. Without leav-ing our offices. At the convenience of the caller and at the convenience of the one called.

I saw Star Trek and I’m sure it’s oc-curred to you before now, that the “com-municator” in the hand of Mr. Spock or Captain Kirk was actually a lot like a smartphone. Spock’s ability to turn that handheld device into something that would read the environment or Dr. McCoy’s abil-ity to use it, or something like it, to scan a body was beyond belief. Now we have apps that power our iPhones and Android devices to do similarly futuristic things.

Look, it’s easy to get bogged down in the rules and regulations of an industry.

They’re there to protect us all. Comply. But what if we allow our imaginations to lead for a minute as it relates to the part of doctoring that really matters to us most, patient engagement.

We’d find ways to connect with those who can’t get from their homes and to our offices.

What if we find ways to empower pa-tients to tend to themselves, to know more about the environment that they’re in and how it affects their health?

We’d have smarter patients and bet-ter health outcomes.

Okay enough of the hyperbole it’s time to get real. We live in the future. But we practice too much in the past.

So here’s what a savvy doctor’s going to do this year: tap into that Jetsons tele-vision thing and enable patients or col-leagues to communicate via Skype or Apple’s FaceTime to explore what needs to be explored.

My twitter-friend, Dr. Howard Luks (@HJLuks on Twitter), says that he finds this approach to telemedicine useful in consulting with his patients and would in-vite conversation, by FaceTime no doubt, with doctors who might be trying to find their way toward the future.

Speaking of exploration, savvy doc-tors will learn how to use mobile devices and apps that run on them to help pa-

tients communicate with their doctor and to help the patient and doctor know more about the environment that they are in and how such circumstances affect their well-being.

Last March I met Dr. Daniel Kraft, MD, (@daniel_kraft on Twitter) at SXSWi (South by Southwest Innovation conference). He was there to speak on healthcare innovation powered by smart-phones. It was cool. And it would have seemed like “future talk” were it not for the number of people in the room already using one or more of the diet, exercise, sleep monitoring, cardio, diabetes and anxiety management apps he spoke of there.

Look, George Jetson would get out on the now ever so commonplace tread-mill to exercise his dog. Maybe this is the year to exercise your medical practice. Maybe this is the time to rethink patient engagement so that we can get off this crazy thing called the status quo and into the future. Some of us are already there.

Hey Doc, We Live in the Future

tinued distribution of door hangers to re-mind babysitters of the rules, bus signs and billboards, and distribution of a new book on the subject. The latter, Reagan said, is in partnership with the Tennessee Hospital Association. The short, easy-to-read book was written by a Tennessee physician who lost a child to a sleep-related death.

In 2011, the campaign resulted in at least 22 fewer sleep-related deaths in the state. Although not a huge number, Reagan was quick to point out it’s an entire kinder-garten class.

Breastfeeding: “Breastfeeding is quite simply, for at least the first six months, the best nutrition you can provide for your baby,” Reagan said. He noted it improves the immune function and is associated with better child health outcomes and decreased rates of obesity even into adulthood. “The benefits are so compelling,” he stated.

In 2013, a breastfeeding hotline was piloted, and Reagan said the plan is to roll the toll-free number out statewide in 2014. Michael Warren, MD, who spearheads breastfeeding efforts for the Department of Health, also is working to make sure em-ployers and companies serving the public understand how beneficial breastfeeding is. Leading by example, the new Department of Health offices include a mother’s room where employees and visitors can breastfeed in comfort.

Infant Mortality: In combination, these programs along with other efforts — in-cluding a new partnership with First Lady

Crissy Haslam that kicked off in the fall of 2013 to support new moms — have helped the state see a steady decrease in infant mor-tality rates over the past eight years.

Reagan said, “Our infant mortal-ity rate decreased to 7.2 per thousand live births, which is the lowest it’s ever been but is still above the national average … so there is still more work to be done.”

Primary PreventionLast … but certainly not least … are

efforts aimed at stopping problems before they start.

“Primary prevention is the happiest kind of medicine,” said Reagan, adding it is also generally considered to be the most cost effective way to spend health dollars.

He noted the Department of Health has increased its emphasis on collaborating with community partners to address needs. In addition to running its own program-ming, health officials across the state also worked on more than 250 community proj-ects in 2013 addressing obesity, tobacco ces-sation, infant mortality, immunizations and substance abuse.

Reagan added his office has been work-ing with Governor Haslam’s Foundation for a Healthier Tennessee and expects to see more programming roll out around the topic of obesity in 2014. He also noted the food code was updated in 2013. “That’s really going to be helpful in the 25,000 food establishments we inspect across the state to protect the safety of the public better,” he concluded.

Health Assessment, continued from page 4

initiatives like in high-tech radiology, we do the right test the first time and reduce duplicate testing. We are doing that with all three parties at the table instead of try-ing to impose something on each other. Less inefficiency.”

Meanwhile, market forces, insurance exchanges, the Affordable Care Act, cost shifting and so many unknowns loom for both sides as they strive to be more effi-cient to stay afloat. In particular, entities like The MED are keeping close to gov-ernmental authorities for their perspective to be heard.

“We are more a safety net, high-level tertiary care hospital in terms of the trauma and the high risk and sick baby nursery we run,” Wages said, “and then we are also a safety net for more of the indigent population for the Shelby County area. We are keeping our conversations going with the governor’s office and the commissioner’s office in TennCare, talk-ing with our state and local legislators so they can understand what we are faced with.

“We just need to work together to create win-win opportunities. We all need to be in business to provide quality care to our patients and we must be innovative and creative in how we do that.”

Collaboration Is Key, continued from page 7

w e s t t n m e d i c a l n e w s . c o m JANUARY 2014 > 9

Hey Doc, We Live in the Future

By LyNNE JETER

The American Heart Association (AHA) recently debuted a coalition es-tablishing formal research ties between the University of Mississippi and Boston University and their renowned population studies of cardiovascular disease, the Jack-son and Framingham heart studies.

“We’ll be transferring that success into 21st century genomics developments and network medicine,” said Joseph Loscalzo, MD, PhD, chairman of the AHA’s Science Oversight Group for this AHA-sponsored relationship.

The collaboration, with a place-holder name of Heart Studies v2.0, will add dimensional breadth to the two major population studies, allowing researchers to more deeply analyze genetic and other pa-tient information collected in the studies’ extensive data banks.

Such research holds the promise of more effective and personalized medi-cal treatments based on an individual’s genetic makeup, environment, history, particular disease sub-type and other vari-ables.

“This collaboration will allow the continued development of the science to better understand the causes of heart disease and stroke,” said Uni-versity of Mississippi chancellor Dan Jones, MD, and former Jack-son Heart Study (JHS) principal investigator. “It moves us closer to the day when this leading cause of death can be prevented in more people.”

Representatives from the AHA, Bos-ton University, the University of Missis-sippi, and other scientific thought leaders appointed by the collaboration’s Scientific Oversight Group will govern the new re-search pact.

“This research collaborative provides an opportunity for scientists in Mississippi to work with scientists from around the country,” Jones noted. “And it enlarges opportunities for participants in the Jack-son Heart Study and others in Mississippi to benefit from the best science minds in our country.”

The Framingham Heart Study, founded in 1948 at Boston University, is the nation’s longest-running cardiovascu-lar disease investigation. Its researchers have collected massive amounts of health data over decades from seven cohort groups comprised of thousands of partici-pants.

Framingham has published several crucial findings, including identification of risk factors for heart disease and stroke, and insights on the effects of these factors,

including smoking, obesity, blood pres-sure, cholesterol and physical activity.

The JHS is the largest study in history to focus on the genetic factors related to cardiovascular diseases in African-Ameri-cans, a group that faces increased risk for heart disease and stroke.

It’s an extremely important study, because, while the Framingham study has provided decades of important data, its subjects have lacked racial diversity, said Jones, who helped establish the JHS in the late 1990s and served as AHA president from 2007-08.

The JHS draws together the Univer-sity of Mississippi Medical Center, Jackson State University (JSU) and Tougaloo Col-lege. The study has followed 5,300 Afri-can-Americans in Jackson for more than a decade, compiling data from voluminous medical tests, scans, exams and interviews, while also analyzing the effects of lifestyle factors such as diet and community – and church involvement – on their overall health.

“The University of Mississippi Medi-cal Center is proud to work with its part-ners at JSU and Tougaloo College in the Jackson Heart Study,” he said.

JHS researchers have identified links between social conditions and specific risk factors for diseases, uncovered differences in metabolic syndrome between races, and identified how location of fat in the body affects African-Americans – a topic previ-ously characterized mainly in Caucasians.

The new research collaborative is just getting under way, but major results could come in the next decade, maybe a few years sooner, said Loscalzo, also chairman of the Department of Medicine and phy-sician-in-chief at Brigham and Women’s Hospital and editor-in-chief of the AHA journal, Circulation.

Ramping Up ‘Heart Studies v2.0’New coalition to connect and expand historic cardiovascular disease investigation

Dr. Dan Jones

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West Tennessee Healthcare Joins Vanderbilt Health Affiliated Network

West Tennessee Healthcare has joined the Vanderbilt Health Affiliated Network, the largest provider-organized network of doctors, regional health sys-tems and other healthcare providers in Tennessee and surrounding states.

Known as VHAN, the network in-cludes more than 3,000 physicians in more than 350 practice locations who ac-tively collaborate to provide patients with high-quality, efficiently coordinated and cost-effective healthcare services.

VHAN’s mission is to lead the need-ed transformation of the healthcare sys-tem nationally while meeting the health-care needs of local communities. As the healthcare system moves toward a pop-ulation-based model of care, VHAN puts the leadership of care coordination in the hands of healthcare providers, work-ing closely with employers and insurance companies.

In addition to keeping employees healthy and productive, VHAN aims to reduce employers’ costs for healthcare by creating new, more efficient care models and reducing variation in practice. For instance, a recent pilot project between VHAN and Cumberland Pediatric Alliance (CPA) improved coordination of care and saved more than 9 percent of expected cost of healthcare services for children in

Vanderbilt University’s employee health plan.

VHAN includes a rapidly growing number of like-minded regional health systems and other providers covering each of the Grand Divisions of Tennes-see. These include Vanderbilt Univer-sity Health System, Williamson Medical Center, Maury Regional Medical Center, NorthCrest Medical Center, and Cookev-ille Regional Medical Center in Middle Tennessee; Mountain States Health Al-liance in East Tennessee; and West Ten-nessee Healthcare in West Tennessee.

Milan General Hospital Welcomes Dr. Misty Allen

Milan General Hospital is proud to announce the addition of a new hospital-ist program. Misty Allen, MD is the new hospitalist.

A hospitalist is a phy-sician whose practice is dedicated to caring for pa-tients while they are in the hospital. They specialize in the supervision of inpa-tients’ care and consult with the patients’ primary care physicians as needed. Hos-pitalists do not provide care for patients outside of the hospital setting.

Milan General Hospital offers a broad range of medical care including: Surgery, Med-Surg Unit ICU, Radiology, Mam-mography, Dexascan, Inpatient Physical

Therapy and an Emergency Department.Dr. Allen has been a hospitalist at

Jackson-Madison County General Hospi-tal since 2007. She is a Family Medicine physician with special training and ex-perience in critical care. Allen graduated Summa Cum Laude in May of 2005 from the University Of Tennessee College Of Medicine and did her internship and her residency at Jackson-Madison County General Hospital.

Humboldt General will be trans-formed into an emergency center. It will operate as a north campus of the Jackson Madison County General Hospital emer-gency room. It will be renamed Humboldt Medical Center and will include the con-tinuation of all Sports Plus Rehab services, outpatient lab and imaging services.

Gibson General is transitioning into a primary care facility with walk-in after hours care, post-discharge follow-up pa-tient care, screenings, and on-site lab and x-ray. It will be renamed Trenton Medical Center.

When Our Children Die Conference

Jennifer McBride, MA, FT, DM, is the founder of the HeartLight Center in Den-ver, Colorado and Grieflink, a worldwide resource to help people find grief support and education. She was on the front lines in helping to care for the families of seven who died at Columbine High School as well as seven who were killed in the Au-rora theatre shooting. Since 1996, Jenni-fer has served as a “bridge” to individuals and families, helping them to assess their needs in regard to the process of grief, and connecting them with the broad net-work of support within the Denver metro area. She is one of two Vice Presidents and employee-owners at Horan & McCo-naty in Aurora, Colorado.

Friday, January 24th at 7:00p.m, families who have lost a child will gather at the J. Walter Barnes Conference Cen-ter at Jackson-Madison County General Hospital to hear Jennifer address the unique grief associated with child-loss. In addition to the keynote speaker there will be facilitated breakout sessions and a memorial service to close the evening. Parents, grandparents, and other family members are all invited to this free com-munity event.

Saturday, January 25th from 8:00 a.m.-4:00 p.m., healthcare professionals, law enforcement, clergy, counselors, and other first responders will have the oppor-tunity to learn effective methods for com-municating with and caring for families who have lost a child, as well as effective methods for managing their own grief.

Continuing education credit and training hours are available. Registration fee is $25 for the event on Saturday, Janu-ary 25th and to register, go to https://www.regonline.com/whenourchildrendie. For additional information, call 731-426-1735 or 731-660-1185.

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