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Bob Souder, MD

PAGE 2

PHYSICIAN SPOTLIGHT

To promote your business or practice in this high profile spot, contact Pamela Harris at West TN Medical News.

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FOCUS TOPICS MEN’S HEALTH PATIENT CARE MODELS GASTROENTEROLOGY

Skyrocketing Cost of Prescription Drugs Must Be Reversed, Says Dermatologist

By JAMES DOWD As baby boomers grow older and live longer – with the youngest members of that generation having already

passed the half-century mark – perhaps it isn’t surprising that prescription drug use continues to rise.But of increasing concern to a growing number of healthcare professionals is the

skyrocketing cost of prescription drugs, both name brand and generic. In fact, one Mid-South doctor – Dow Stough, MD, a practicing dermatologist for more than 20 years – has actively begun urging lawmakers and drug manufacturers to make medications more affordable.

Stough, who has private practices in Hot Springs, Ar-kansas, and Dallas, Texas, also is the founder and medical director of Hot Springs-based Burke Pharmaceutical Research. Founded in 2000, Burke Pharmaceutical has grown from a small clinical trials unit within a dermatology practice to what its website says is “a national leader in clinical trials of skin disease.”

“With the increase in price of generic and trade-name drugs, everyone is alarmed,” said Stough, who completed his internship

(CONTINUED ON PAGE 6)

By SUZANNE BOyD

Standing on the sideline and complaining is taking the easy way out says John Hale, MD. Taking a leadership role means you have no one else to blame but yourself, so after 24 years involvement in the Tennessee Medical Associ-

ation, Hale knew it was time for him to take the reins as president. Leadership is nothing new to Hale, who started honing his leadership skills in high school when he was president of his class. In college he was active in student gov-ernment. As president of the Tennessee Medi-


HealthcareLeader

West Tennessee Physician Takes TMA HelmJohn Hale Displays Dedication to Practice of Medicine

Researcher Optimistic About Prostate Cancer StudyOral Contraceptive Ormeloxifene May Inhibit Growth of Cells

Nine months after receiving a federal grant to study how a current drug can be used to inhibit the growth of cancer cells in the prostate, a Mid-South researcher is one step closer to a possible breakthrough ... 4

Arrival of New ED Drugs Helps Ease Doctor-Patient ConversationConversations about sexual dysfunction between men and their doctors once were strained and diffi cult, if they took place at all. Now urolo-gists fi nd they can hardly avoid requests from their patients for common erectile dysfunction (ED) drugs such as Cialis and Viagra ... 5

2 > JUNE 2015 w e s t t n m e d i c a l n e w s . c o m

By SUZANNE BOyD

Medical training started well before medical school for Bob Souder, MD. Working in high school with his uncle Harold Al-sobrook, MD, gave him a clear picture of the work ethic a medical career required and rather than di-minish his interest, the experience only heightened it. After practic-ing gastroenterology in Jackson for over 35 years, Souder’s love for the career he chose to pursue in high school is as strong as ever.

Growing up in Alamo, Souder was a multi-sport star athlete who spent his junior and senior year of high school working in his uncle’s dermatology clinic on Saturdays and in the summer. “He knew I was inter-ested in medicine and wanted me to know what the life of a doctor entailed. No mat-ter what time I came in from football on Friday night, he got me at 6 am the next morning to round at the hospital and then we went to the clinic,” said Souder. “He taught me the basics like taking a patient’s history, about fungi and bacteria as well as let me look at skin disorders under a mi-croscope. It was a real learning experience that taught me the discipline medicine re-quires.”

Not one to waste time, Souder finished his undergraduate studies in pre-med at

the University of Tennessee at Knoxville in less than four years and received early admission to medical school. He chose the University of Tennessee Center for Health Sciences in Memphis. Halfway through his medical school training, Souder found himself faced with another learning oppor-tunity that would help to shape his career in medicine.

“Midway through medical school students were given a three month break. Many classmates traveled during this time but I needed a job. I approached gastro-enterologist Dr. Jeremiah Upshaw but was told he was not hiring students. I looked into several other jobs but no one wanted someone for just three months, so I asked Dr. Upshaw if I could just shadow him,” said Souder. “He had a patient with a gas-

trointestinal bleed due to esophageal variceal bleed. I made a suggestion of a new way to administer the med-ication based on my medical school training, the patient quit bleeding and I got the job.”

After graduating medical school at the age of 24, Souder completed his internal residency in 1977 at John Gaston Hospital (The MED) in Memphis. While he was accepted into fellowship programs for derma-tology and gastroenterology, it was his time with Dr. Upshaw that tipped the scale for him. He remained in

Memphis and completed his GI fellowship in 1979. He is board certified in both inter-nal medicine and gastroenterology.

While he had offers to go to other places, Souder made the decision to prac-tice in Jackson because it was close to family and at the time there were no board certi-fied gastroenterologists there. “Dr. Clyde Smith, an oncologist, came with me and we started Medical Specialty Clinic,” said Souder. “At the time there were no board certified subspecialists in Jackson. We re-cruited Drs. Larry Carruth, Joe Blanken-ship, Charlie Hertz. Tom Ellis and Wood Deming. Dr. Ram Chary came to town a year later and started his own clinic. We purchased, along with seven other doctors, what is now the West Tennessee Surgery Center, which we later sold to Jackson-

Madison County General Hospital.” In 1990, Souder left Medical Specialty

Clinic and founded TransSouth Health-care. In 1992 it moved into its current site on Physicians Drive. Prompted by Bill Clin-ton’s office’s proposal that a referral from a generalist was required to see a specialist, Souder began opening primary care clin-ics in areas adjacent to Madison County. In 1994, a Certificate of Need was granted to add a surgery center and a digestive dis-eases clinic. Two surgeons were hired. A urology clinic and a hepatolgy clinic were also added. Souder was also instrumental in bringing Cancer Care Centers of America to Jackson, which was eventually acquired by Dr. Permenter.

“I felt we needed some competition in the area. It was good business at the time,” said Souder. “Today we have down-sized, the primary care clinics were sold last year and our focus is digestive disease. The clinic offers full service radiology and lab services, including CT. We have our own pathology lab that works in conjunction with GI Pa-thology in Memphis. We have connections with several different entities such as West TN Anesthesia so that our patients can really one stop shop with us for their GI needs.”

Souder attributes much of his success to those around him. “I have been blessed to have great people to work with, that work well together, take care of one an-other and are always willing to help. I hon-estly don’t know what I would do without them. I have over ten employees that have been with me for over 25 years,” he said. “I work primarily at Jackson General and being able to share call there with other GI doctors has been good. We cover for one another which allows us all to have a break and get some down time.”

Downtime for Souder includes family. He and his wife Ashley enjoy time at their place in Pickwick skiing and boating with family. Although he may not be actively involved in sports, Souder still makes time to work out. Two of his three children live in the Nashville area and one lives in Colo-rado. With three grandchildren under the age of two, Souder is busy playing grand-dad every chance he gets.

One may think that after 35 years in practice, Souder would be considering retiring – not so. “I still work 12-14 hour days. I love to talk to my patients many of whom I have known a long time and con-sider friends. Coming from a small town I think has helped me relate to my patients and I have always tried to make them feel comfortable,” said Souder. “I can honestly say I love medicine and I love what I do. I go to all the meetings I can so that I can stay current on all the new technology. I wake up every morning excited and raring to go. I don’t know what I would do if I didn’t practice medicine and as long as I am healthy I don’t plan on finding out.

PhysicianSpotlight

Starting Early and Still Going StrongBob Souder Founder of TransSouth Healthcare

To promote your business or practice in Memphis Medical News, please contact Pamela Harris at 501.247.9189 or [email protected].

Never before have physicians and other healthcare professionals been so strapped for time. And never before has so much information been vital for them to be in the loop on. Medical News, America’s largest network of healthcare newspapers, plays a role in providing important information on national topics and showcasing local trends – all written specifically for healthcare professionals.

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Emphasis on InnovationA Look at the Tennessee Health Care Innovation Initiative

By CINDy SANDERS

The move away from fee-for-service healthcare is sweeping across the coun-try as payers and providers come together to search for innovative ways to improve outcomes while lowering costs. With Tennessee’s ro-bust resources, the state is well positioned to take a lead role in transforming the de-livery of healthcare.

“In 2013 Governor Haslam launched the Tennessee Health Care Innovation Ini-tiative to move from volume to value,” said Brooks Daverman, director of Strategic Planning and Innovation for the Tennes-see Division of Health Care Finance and Administration (HCFA). “Our mission is to reward providers for the outcomes that we want – high quality and efficient treatment of medical conditions and bet-ter health over time.”

Key Stakeholders & Background

During a joint session of the Ten-nessee Legislature in the spring of 2013, Gov. Haslam pledged Tennessee would become “a model for what true health-care reform looks like.”

Central to achieving this goal is the involvement of key players representing payers, providers, patients and purchasers across the state. “We’re trying to create an aligned approach for all the stakehold-ers,” noted Daverman. He added that by late May 2015, he and his team had held more than 440 meetings with interested parties to share information and receive input. From consumer groups like the Common Table Health Alliance to em-ployer organizations including the Mem-phis Business Group on Health and East Tennessee’s HealthCare 21 Business Co-alition, Daverman said payment reform could not occur in a vacuum.

Ongoing meetings with payers, pro-viders and workgroups are used to design strategies to be broadly implemented across the state. Routine meetings are held with major provider organizations including the Tennessee Medical As-sociation (TMA), Tennessee Hospital Association (THA), Hospital Alliance of Tennessee (HAT) and Tennessee Nurses Association (TNA), along with a host of specialty statewide organizations repre-senting family physicians, physician assis-tants, pediatricians, children’s hospitals, mental health organizations, primary care providers, and medical education. In addition, Amerigroup, BlueCross BlueShield of Tennessee, Cigna, and UnitedHealthcare meet regularly with the team.

While the initiative took off in May 2013, Daverman said the roots of pay-

ment reform go back even further to a vision task force, which included mem-bers of TMA, THA, Darin Gordon from HCFA, and others. “It was a group of likeminded, influential people in the state thinking about how we can move things forward in terms of healthcare payment and delivery,” Daverman noted. “I think the strategies we have chosen are all ones that were discussed in those meetings.”

As a result of stakeholder input, strat-egies in three key areas are being imple-mented: primary care transformation, episodes of care, and long-term services and supports. There is a Technical Advi-sory Group (TAG) for each strategic area to provide guidance on quality measures and program design.

Primary Care TransformationDaverman noted this component

focuses on the “primary care provider – preventing illness, managing chronic illness and coordinating with other pro-viders such as specialists.” He continued,

“This is rewarding activities that are very important in primary care that aren’t necessarily paid

for now.”Daverman pointed

out coordinating with a specialist takes time and effort for the pri-mary care provider but

isn’t necessarily reim-bursable. Yet, the results

of that coordination are often critical to a patient’s health.

“With all our strate-gies, we want to put the

doctor in the driver’s seat,” he said. Daverman added this focus

on outcomes might require changes in communication, clinic hours, phone staffing, and other patient engagement activities in order to improve health and cut down on expensive emergency room visits. “If it results in better outcomes for quality and utilization, we want to reward that.”

Although he praised with work being done by ACOs, Daverman stressed the primary care transformation strategies are different and easily scalable. “All of our strategies are feasible for providers without making significant changes to business relationships,” he said.

The starting point is with patient centered medical Homes (PCMH), health homes for SMPI (serious and per-sistent mental illness) patients, and pro-vider alerts for hospital and emergency department admissions, discharges and transfers. “We’ll start with about a dozen practices and want to go statewide within a couple of years,” Daverman said of programming, which is slated to launch in mid-2016.

Whether or not providers are in a PCMH, those who sign up can tap into the web-based statewide alert system. “We’re going to work to have real-time notices every time a patient goes to the emergency room of a hospital,” Daver-man said of the data being populated by participating payers. In addition, he said the system would be able to generate a ‘gaps in care’ report and alert providers to their patients’ drug fills. “It’s really, re-ally important information to have if you want to manage your patients.”

Episodes of Care“This is the strat-

egy that’s the furthest along,” Daverman noted of aligning incen-tives with desired out-comes. Episodes reward high quality care, pro-mote the use of clinical pathways and evidence-based guidelines, and encourage coordination to reduced inef-fective or inappropriate care. Under the initiative, episode-based payment is being rolled out in waves with the goal of imple-menting 75 episodes by the end of 2019.

Wave 1 launched in May 2014 with three episodes of care: acute asthma ex-acerbation, perinatal, and total joint re-placement. For six months, more than 500 providers received detailed preview reports from TennCare and commercial payers before the wave went live in 2015.

“Providers are getting new informa-tion they’ve never had before in quality reports,” Daverman explained. “They can see how they compare to their peers on cost, and we break down those costs into categories to make it actionable.”

Brooks Daverman



For more information, contact J. Neal Rager at 731-661-6340 or [email protected].

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By BETH SIMKANIN

Nine months after re-ceiving a federal grant to study how a current drug can be used to inhibit the growth of cancer cells in the prostate, a Mid-South re-searcher is one step closer to a possible breakthrough.

The Department of Defense awarded $562,500 last September to Subhash Chauhan, PhD, a profes-sor in the Department of Pharmaceutical Sciences in the College of Pharmacy at the University of Tennes-see Health Science Center, to research new therapies for advanced-stage prostate cancer.

The key to the study is to determine whether a drug called Ormeloxifene, a non-steroidal oral contraceptive, can be repurposed to inhibit the growth of ad-vanced-prostate cells and to treat meta-static prostate cancer.

“Our goal is to inhibit the wnt/beta-catenin signaling pathway so we can in-

hibit other downstream cancer-causing cellular pathways, block metastasis and stop the cancer from spreading,” Chau-han said. “Ormeloxifene is already in human use for a different purpose in 28 countries worldwide. If everything goes OK, then its translation to human use will be easy compared to a newly discovered treatment modality.”

According to Chauhan, Ormeloxi-fene, a birth control drug primarily used in India, suppresses cell proliferation in the uterus for fertilization. He suspects that the drug will inhibit the growth of cancer cells in the prostate.

“Prostate cancer is the most com-monly diagnosed cancer in men and the second-leading cause of cancer death in the United States,” Chauhan said. “De-tection of the cancer is easy through exist-ing diagnostic methods, but treatment is diffi cult.”

Current treatment for advance d-stage prostate cancer occurs either by surgically removing the tumor or through chemotherapy.

According to Chauhan, surgery does not guarantee that all of the cancer can be removed if it has spread to other parts of the body. In addition, he said, chemother-apy, although the most common method used to treat cancer, has not proven to be very successful for metastatic prostate cancer.

The study, which Chauhan labeled “A Novel Therapeutic Modality for Pros-tate Cancer,” focuses on the treatment of metastatic prostate cancer, which oc-curs when cells break away from the tumor in the prostate. The cancer cells can travel through the lymphatic system

or the bloodstream to other areas of the body such as the bones, liver or lungs.

The American Cancer Society states that one in seven men are diagnosed with prostate cancer in their lifetimes. Prostate cancer is rarely found in men before age 40, while six in 10 cases are diagnosed in men 65 and older. The average age at the time of diagnosis is 66.

Also, the American Cancer Society estimated that roughly 233,000 men in the United States will be di-

agnosed with prostate cancer this year and 29,480 will die from it.

The grant, called the “Prostate Can-cer Idea Development Award,” supports new ideas that represent innovative ap-proaches to prostate cancer research and have the potential to make an important contribution to the fi eld of prostate cancer research.

“The process is very competitive, and only 10 to 15 grants are awarded,” Chau-han said.

Chauhan and his team of four re-searchers must submit a progress report to the DOD at the end of every year over the three-year period as part of the grant’s funding requirements.

Testing for the study takes place on the University of Tennessee Health Sci-ence Center campus. Mice are injected with Ormeloxifene in a vivarium and monitored to see how the drug affects the cancer. If this proves to be successful, Chauhan and his team will try to procure funding to do additional testing once the initial study is complete

Chauhan is hopeful that Ormeloxi-fene will be the breakthrough needed in the treatment of metastatic prostate can-cer.

“I suspect the drug will stop the can-cer from growing and the results will be that the cancer will die easily,” Chauhan said. “If our fi ndings prove to be success-ful, this drug could be in human hands in the next fi ve to seven years.”

Chauhan received his doctorate in reproductive endocrinology from the Central Drug Research Institute in India. He has been an independent faculty pro-fessor for nine years at various medical institutions in the United States. He re-located to Memphis and began a stint at UTHSC two years ago.

“We have been very pleased with the results so far in our research,” Chauhan said. “There has been positive data and it shows promising results. We are very excited.”

Researcher Optimistic About Prostate Cancer StudyOral Contraceptive Ormeloxifene May Inhibit Growth of Cells

Dr. Subhash Chauhan

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By PEGGy BURCH

Conversations about sexual dysfunc-tion between men and their doctors once were strained and difficult, if they took place at all. Now urologists find they can hardly avoid requests from their patients for common erectile dysfunction (ED) drugs such as Cialis and Viagra.

“Men are much more open about talking about erectile dysfunction than they were 15 years ago, 10 years ago,” said Robert W. Wake, MD, professor and chairman of the Department of Urology at the University of Tennessee Health Sci-ence Center and residency program direc-tor. “It’s no longer a taboo subject at all.

“It’s very common, even when they bring in their wives. And sometimes if they don’t mention it, the wives will say, ‘Remember you wanted to talk about that other thing?’ . . . Often wives want to take control of the samples.”

Doctors say easy access to informa-tion about ED on medical sites such as WebMD, as well as the prevalence of tele-vision ads for Cialis and Viagra, make it easier for patients to bring up the subject. (Some of the TV ads are so provocative, critics say, they shouldn’t be watched by children. One contributor to Forbes mag-

azine called on Viagra to withdraw one of its ads last year, writing that a message featuring a blonde on a bed had strayed too far from the “initially subtle” TV cam-paigns that employed spokesmen such as former U.S. Sen. Bob Dole, who had un-dergone a prostatectomy.)

Wake called the new dialogue a healthy one for men.

“We’re happy about that,” he said. “The majority of patients between the ages of 40 and 80 years old are interested in getting information about ED drugs. Their interest allows the physician to have a realistic discussion about which patients would benefit from these medications ver-sus those patients who may just want it as a performance enhancer, which is not the intent for these ED drugs.”

David A. Gubin, MD, of The Urol-ogy Group, with offices in Memphis and Southaven, called the request for samples “universal” among his patients.

“It doesn’t matter what the reason was they came in the office to see you, the last thing they ask when they leave the of-fice is, ‘Hey, doc, you have any samples of some of those drugs?’” Gubin said. “They can come in for kidney stones, doesn’t matter what the issue is, univer-sally I would say, they’re always asking. People have heard so much about it now that they’re very curious, and they want to experiment or try it.”

The downside is that the drugs cost $20 to $30 a pill, he said.

Insurance companies commonly don’t cover the cost of pills for sexual dys-function issues, Wake said. But the U.S. Food and Drug Administration has ap-

proved a low dose of Cialis for daily use to treat prostate enlargement -- or be-nign prostatic hyperplasia (BPH) – which can cause lower urinary tract symptoms including frequent or urgent urination, weak flow and straining to void. Insurance will pay for that treatment.

“People who have LUTS second-ary to BPH often have associated ED,” Wake said. “The exact relationship is not known, but both can be associated with aging due to hypertension, vascular dis-ease, diabetes and other co-morbidities often seen as we age.”

While the on-demand dose for ED drugs is 10 to 20 milligrams with Cia-lis and Levita and 50 to 100 milligrams for Viagra, when patients used a 2.5- or 5-milligram daily dose of Cialis, Wake said, “They saw that it did have some ef-ficacy in the lower urinary tract symptoms (LUTS) and it also had the benefit of help-ing their erectile dysfunction.”

He emphasized that low-dose Cialis is not the common treatment for LUTS. “It does have some efficacy, but it’s cer-tainly not as good as the first line treat-ment, which is the Alpha blockers that everybody’s familiar with -- Flomax, Uroxatral.” In his practice, 90 percent of

Arrival of New ED Drugs Helps Ease Doctor-Patient Conversation

Dr. Robert W. Wake



at Baptist Memorial Hospital-Memphis. “Doctors, patients, politicians, the media – everyone is looking into this situation to see what’s going on.”

What’s going on is that patients are spending more – much more – on prescriptions.

According to Tru-veris, a firm that ana-lyzes prescription drug pricing, last year patients spent nearly 11 percent more for name brand and generic drugs than they did in 2013. More recently, a study by the IMS Institute for Healthcare Informatics showed an even higher increase, indicating that spending on medicine in 2014 jumped 13.1 percent over 2013 levels, the highest rate since 2001 when spending growth jumped to 17 percent.

Key findings of the IMS report show:• Spending on new brands in-

creased by $20.2 billion in 2014, triple the previous level.

• Over 161,000 patients started treat-ment for hepatitis C in 2014, more than four times the previous peak, and nearly 10 times more than in the previous year.

• Specialty medicines now account for one-third of spending, driven by a wave of recent innovations in treatment for autoim-mune diseases, hepatitis C and cancer.

• Specialty medicine spending in-

creased by 26.5 percent to $124.1 billion in 2014.

• Increasing numbers of launches and growth in spending on specialty products in 2014 were driven by the growing research and development focus on specialty medi-cines over the past decade

The result was nearly $375 billion spent on prescription drugs in 2014. And with more brand-name drugs retaining their patents, fewer generic treatments were available.

In an interview with the Wall Street Journal, Murray Aitken, executive direc-tor of the IMS Institute, acknowledged, “It was a truly remarkable year. We had an unusual confluence of events.”

With fewer generics available in 2014, those on the market cost 5 percent more than a year earlier. And with a complex system from development to FDA approval to distribution, drug makers are seeing thinner profit margins, explained Stough, who also founded Burke Pharmaceutical research facility.

“The Unites States government has put in regulations that make competition very difficult, and now companies aren’t in it to bring low-cost medicine to patients,” Stough said. “The moment a trade name goes on field, within four months generic trials are going on. The patent life is too short, and the FDA development cost is too high.

“The government allows generics to come on the field before patents run out,

and the result is that during the last 20 years, generic drugs in the United States have increased from under 20 percent to 80 percent of all prescriptions.”

Stough maintains that the decreased barriers to generic drug development have allowed generic companies to flood the market with no-name drugs, which, in turn, has resulted in shrinking profit mar-gins for drug developers.

“Normal market forces are not in play, and that’s the problem,” he said. “There’s not enough competition, and fil-ing fees are too high for patents. For the pharmaceutical industry, as prices increase, market share drops, but revenue remains the same.”

As drug prices continue to rise, con-sumers are the ones paying the cost, Stough said. And while the pricing situation is complex, he does not believe a conspiracy exists between drug developers, lawmakers and medical personnel.

“This is a complicated system, created over years by a series of actions that were intended to drive down drug costs, but had an alternate effect,” Stough said. “Am I an expert? No, but I understand more than I did before I started researching this, and while 99 percent of doctors may throw up their hands and think there’s a smoking gun, that’s simply not true. There are not five guys in a back room somewhere ma-nipulating the price of drugs.”

Stough, who is in discussions with local

medical organizations to present a seminar in Memphis later this year on drug costs, acknowledges that there is no quick fix to the problem. But he does believe that by working together, drug developers, insurers and government officials can effect change.

For starters, Stough thinks fees for FDA approval should be decreased. And patients should be allowed to purchase drugs outside their insurance network if the prescriptions are cheaper elsewhere. And that includes outside the United States.

“We should open up the distribution channels to make Canadian drugs read-ily available and easily obtainable in the United States,” Stough said. “There are plenty of good foreign drugs, many of the same ones we have here, but under differ-ent names, that are incredibly cheaper than what’s on the market in the United States. Patients should absolutely have access to those more-affordable prescriptions.”

Looking ahead, it’s possible that spending may dip in the next few years as more trade-name drugs lose patent protec-tion and generics arrive on the field, Stough said. But parties involved in all facets of drug development, regulation and distribu-tion must work together to generate ben-efits for consumers.

“America has the highest prices for prescriptions in the world, and that’s ridic-ulous,” Stough said. “We created this mess, and the question before us now is are we going to do what it takes to fix it?”

Skyrocketing Cost of Prescription Drugs Must Be Reversed, continued from page 1

Dr. Dow Stough

By CINDy SANDERS

First the good news … providers are generally excited about the idea of moving to more holistic, integrated care with a focus on prevention, quality and outcomes. Now the not-so-good news … we have to figure out how to pay for it.

“Providers are on board for the po-tential benefits from changes to the way we provide care, which is different from the way we pay for care,” noted Dion P. Sheidy, a partner in KPMG’s Health Care Advisory Practice. “This is a little bit of the elephant in the room.”

Nashville-based Sheidy said the Cen-ters for Medicare and Medicaid Services have stated their plans to significantly in-crease value-based payments to providers over the next few years. In a fact sheet re-leased in late January, CMS noted improv-ing quality and affordability of healthcare was as much a pillar of the Affordable Care Act as expanding access. The goal, the memo continued, is to reward value (measured by quality of outcomes) and care coordination and efficiency rather than volume and duplication. To that end, the Department of Health and Human Services has adopted a framework of four categories of payment:

• category 1: fee-for-service with no link of payment to quality,

• category 2: fee-for-service with a link of payment to quality,

• category 3: alternative payment models built on fee-for-service archi-tecture, and

• category 4: population-based pay-ment.

Value-based purchasing includes pay-ments in categories two through four. The stated goal is to have 30 percent of Medi-care payments in alternative payment mod-els (categories three and four) by the end of 2016 and 50 percent by the end of 2018. Additionally, HHS hopes to have 85 per-cent of Medicare fee-for-service payments in categories two through four by the end of 2016 and 90 percent by 2018.

“Although they have put that out there, they have yet to put out guidance about how they expect to achieve it,” noted Sheidy. “These are huge jumps. We’re going to go from less than 10 percent in fis-cal year 2015 to 90 percent with some link to quality in fiscal year 2018.”

Sheidy added there is some ambiguity as to what CMS calls ‘alternative fee ar-rangements’ and that at this point there are a lot more questions than answers. While he doubts normal market forces would push payment reform fast enough to hit the HHS targets in the next three years, he said regu-latory changes could be the driver to hasten the transition to value-based payment.

“There are elements of the Affordable Care Act that have some pretty significant unknowns attached such as the Cadillac tax,” he continued. The chief unknown, he

continued, is “Does the Cadillac plan tax survive and get implemented as it stands today?” That question, he added, probably won’t be answered until after the presiden-tial election.

The 40 percent excise tax, which is currently scheduled to go into effect in 2018, is levied on healthcare benefits that exceed certain pre-set limits. Despite the name of the tax, Sheidy said its impact would be felt far beyond affluent circles. In fact, the thought is that a significant number of employers could wind up incurring the tax. “This cuts across political parties when it comes to the impact of this,” he said, noting teachers, labor unions and public officials often have strong healthcare ben-efit packages. “You’re talking about having an excise tax that indirectly impacts a sig-nificant amount of the population through employer-provided benefits.”

He continued, “If this Cadillac tax sur-vives, employers are going to be faced with having to change benefits, maintain benefit levels under a different cost structure, or pay the tax.” Sheidy added that since there doesn’t seem to be much enthusiasm for paying the tax, employers are going to look at how to bend plan design or the cost curve and will be more willing to consider value-based network designs.

“The government … through state-ments around the move to the 80 percent (value-based purchasing) along with the continuing lingering effects of the Afford-

able Care Act … has really set the industry up for the opportunity for some significant impact on payment reform over a fairly short time frame,” he noted. “On the payer side, CMS is looking to change the payment mechanism. On the commercial side, we’re looking at the Cadillac tax and how to get costs under control. And all of those things share the potential to come into play over the next several years. It’s almost like the perfect storm.”

It’s not that the industry hasn’t taken any steps to prepare for a move to a differ-ent type of payment mechanism. Sheidy said the industry is already involved in demonstration projects, quality reporting and capturing data points. However, he pointed out, the true impact on payment of all that collection and monitoring is still pretty narrow.

“People confuse population health with risk and payment,” he said. Now, we’re at the intersection of how to more effectively, efficiently manage the health of a population while simultaneously figuring out how to link payment to these new prac-tice models.

While the industry has floated along with a foot in both the fee-for-service and value-based worlds for quite a while, Sheidy said the drivers are now in place, barring any changes, to force the movement to a more outcomes-based payment methodol-ogy in a very short window of time.

The Competing P’s: Provision & PaymentChanging reimbursement for new models of care


By JULIE PARKER

The most influential demographic group – millennials, ages 21-32, empow-ered by advances in technology – is turn-ing America’s healthcare landscape upside down.

In a recently released survey commis-sioned by PNC Healthcare, more than 5,000 participants nationwide explored the impact of patient-centered care among vari-ous age groups, including millennials, Gen-eration X or Gen-Xers (ages 33-49), baby boomers (ages 50-71) and seniors (72+). The most signifi cant fi nding: online shopping for doctors, web-based diagnostic tools and re-search about treatment options have a role in healthcare decisions for millennials, re-placing the single-source, primary care phy-sician (PCP) favored by older generations. “As millennials overtake boomers as the nation’s biggest consumer buying group, they will expect more effi cient ways to make healthcare payments via digital channels that are consistent with their ex-periences in other industries,” said Shane Print, vice president of PNC Healthcare for Florida, Alabama and Georgia. “It’ll be important for payers and providers to work together to meet these payment ex-pectations by progressing further along the technology continuum, especially con-sidering that much of the growth in the healthcare payments industry has been driven by a rise in patient responsibility. Those insurers and healthcare providers that thrive will be those that adapt sooner than later to the preferences of this fast-paced, technology-driven generation.” Growing trends among the millennials that are driving change in healthcare include:

Speedy deliveryWhen it comes to the drive-thru gen-

eration, millennials prefer retail (34 percent) and acute care clinics (25 percent) double that of boomers (17 and 14 percent, re-spectively) and seniors (15 and 11 percent, respectively). On the fl ip side, seniors (85 percent) and boomers (80 percent) visited their PCP signifi cantly more than millenni-als at 61 percent.

For example in Florida, Print noted that urgent, specialty and retail clinics over the last four years have grown dramatically. “Quick Care” availability has been recog-nized as a top priority by many healthcare organizations, and even large retailers and several pharmacy chains. Millennials ex-pressed concern about this method of care and the quality of the patient’s care, based on who’s consulting with the patient (level of education), possible lack of patient’s ac-curate healthcare background, and pres-

sure of being a “quick appointment.”

Word-of-mouth marketingNearly 50 percent of millennials and

Gen-Xers use online reviews, such as Yelp and Healthgrades, when shopping for a healthcare provider, compared to 40 percent of baby boomers and 28 percent for seniors.

“The timely management of so-cial media is critically important to the growth and success of healthcare,” said Print. “Bad patient reviews can come too easy, so making sure positive reviews greatly outnumber the negative ones is a constant challenge for all practices. Get-ting happy patients engaged with shar-ing their positive experience will continue to be important for a practice’s success.”

Kick the tires online before buying

Half of millennials and 52 percent of Gen X-ers checked online information about their insurance options during their last enrollment period, compared to 25 per-cent of seniors, who prefer printed materi-als (48 percent) or a company representative (38 percent) before selecting their plan.

Good faith, upfront estimatesOne of fi ve people surveyed by PNC

listed unexpected/surprise bills as the No. 1 billing-related issue. With out-of-pocket costs on the rise, millennials are more in-clined (41 percent) to request and receive es-timates before undergoing treatment. Only 18 percent of seniors and 21 percent of boomers reported asking for or receiving in-formation on costs upfront. Unfortunately, 34 percent noted the fi nal bill was higher than the estimate; only 8 percent reported a

bill lower than estimate. “What we’ve found with our clients

in the southeast is that healthcare practices are now more motivated than before to improve the patient’s experience around billing, payment plans, and care and insur-ance coverage education due to the need to comply with healthcare reform require-ments and for the sake of improving the profi tability of the practice,” added Print.

Kicking care down the road.All age groups agreed that medical care

is too expensive (79 percent) and health-care costs are unpredictable (77 percent). But more than half of millennials (54 per-cent) and Gen-Xers (53 percent) reported delaying or avoiding treatment because of cost, compared to seniors (18 percent) and boomers (37 percent).

“What we’ve found locally,” added Print, “is that with many patients neglect-ing their care due to costs, practices are ad-dressing this issues by offering free/low cost healthcare clinics, healthcare education, and automated patient payment programs.”

PNC Healthcare is a member of The PNC Financial Services Group Inc. The survey was conducted by Shapiro+Raj in January.

Five Ways Millennials Have Shaken Up HealthcareThey prefer alternative to single-source, PCP favored by older generations

By JULIE PARKER

The most influential demographic group – millennials, ages 21-32, empow-ered by advances in technology – is turn-ing America’s healthcare landscape upside

In a recently released survey commis-sioned by PNC Healthcare, more than 5,000 participants nationwide explored the impact of patient-centered care among vari-ous age groups, including millennials, Gen-eration X or Gen-Xers (ages 33-49), baby boomers (ages 50-71) and seniors (72+). The most signifi cant fi nding: online shopping for doctors, web-based diagnostic tools and re-search about treatment options have a role in healthcare decisions for millennials, re-

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cal Association (TMA), Hale is working hard to make a difference while sharing his passion and belief in what the organi-zation can do for physicians and patients across the volunteer state.

Growing up in Halls, Hale’s fi rst job at the age of 13 was picking tomatoes for $1.25 an hour. Since it was a typical sum-mer in the South, the temperature was scorching and the humidity was nearly 100 percent. “I would bring the tomatoes into the sorting shed where my great aunt Myrtle was,” said Hale. “She asked me one day what I wanted to be when I grew up. I told her I thought I wanted to be a lawyer to which she quickly replied that I would go to hell. Given the heat I was working in that was a pretty good indica-tor of what it may entail. She then said I was smart and encouraged me to be a doctor. I’m a fi rm believer in the good Lord, faith and callings. I can say God put medicine in my way and everyday has pointed me toward where I am today. Medicine is my calling.”

Hale opted for a cooler environment for medical school, graduating from Quil-len College of Medicine at East Tennes-see State University in Johnson City in 1988. He completed his residency in fam-ily medicine in Jackson at the UT Family Medicine Program in 1991. Hale began his medical career at the clinic where he still practices today, Doctor’s Clinic in Union City, a clinic with quite a legacy with TMA. Kelly Avery, MD, who had retired when Hale joined the clinic, had served as TMA president in 1970 and was instrumental in the development of the State Volunteer Medical Insurance Company. Many of the older physicians had served on the Board of Trustees and some had been chairman.

“I was by far the youngest physician at the clinic at the time and when it came to my joining the TMA, there was really not a choice. The older partners had all been active in it for most of their careers and they made sure my dues were always paid. I attended my fi rst meeting three weeks after starting,” said Hale. “They engrained in me that this organization is the voice for doctors all across the state, all that this organization has done for physicians and their patients as well as the importance of membership.”

When it comes to passing that philos-ophy on, Hale has done his part. “I try to do the same thing with any new physician

we bring on staff, taking them to meetings and getting them involved. I think their eyes are opening up to what we are all about. I also encourage new members to attend our Leadership College, which is a great way to get an understanding of the TMA,” he said. “24 years ago, this orga-nization was pale and stale, but we have worked hard to overcome that. We don’t want to look to the past but rather build on it as we look to the future. We know as an organization it is important for us to connect with young physicians and fe-male physicians. In fact, the Chairman of our Trustees is a female as well as we have our fi rst female Speaker of the House.”

Hale, who started attending an-nual meetings in 1992, has followed in the footsteps of some of his mentors and has held various positions with TMA. “I started out being a judicial counselor, which hears complaints and governs the medical society on legal-type issues. I have served as Chair of the Young Physi-cians Delegates to the American Medical Association,” said Hale. “Additionally I have served on the Impact Board, both the Communications and Memberships committees as well as on the Board of Trustees. Before I ran for president, I was the vice speaker and then the Speaker of the House of Delegates.”

One has to wonder how a rural fam-ily medicine physician in a busy practice has time to not just be a member of TMA but to be president. Hale acknowledges that his level of involvement will take time from his busy practice and that not all his patients are thrilled at that. “Some of my patients are a little concerned about me taking this spot. They will congratulate me but ask if I am going to be out of the offi ce,” he said. “I will be out one day a week except during our peak months. I have four wonderful partners who are willing to take up the slack and a very sup-portive wife and family. Without them, I could not do this.”

TMA was founded in 1831 by the state legislature and is committed to the health of Tennesseans. Hale says there are many things the TMA has champi-oned that have gone unpublished. “TMA works on a legislative basis on Capitol Hill. Often, it is due to our efforts that keep things we know are not good for medicine from getting out of commit-tee. Legislators come to us seeking our opinions and asking our position on leg-islation. Sometimes they take our advice, sometimes they don’t. But if we don’t have someone speaking for us things would be a lot worse. Just think of the impact we could have if every physician belonged to organized medicine,” he said. “We’ve been a voice on tort reform, led a coali-tion to get caps on malpractice rates. We

have a physician present at every meeting on the Health Initiative and are work-ing with the Governor on what quality medicine is that is not based on econom-ics. There are lots of issues we have been a catalyst in that many do not know our level of involvement on.”

One area Hale knows organized medicine could have had a bigger impact is the adoption of electronic medical re-cords. “We started using them about a year and a half ago. It puts up a barrier to the patient. When I walk in a room I have a laptop with me and apologize to the patient that I have to login before we start,” said Hale. “I try to make sure they understand the good aspects of it but the bad thing is it does take some of my at-tention away from the patient. Commu-nication is vital. Patients today are better educated and want to be informed. You have to embrace them in the decision making process so they understand their options.”

Many doctors are frustrated with how tough the practice of medicine has become; so much so that many are sell-ing their practices to large organizations to avoid having to deal with the business side of medicine. “I know there are doc-tors reading this that can identify with this,” said Hale. “We have lost a lot of independent doctors because of the pres-sures that providing effi cient quality med-icine causes. The practice of medicine is so tough that you need group mentality to survive it seems. Our practice sold to Baptist. That arrangement has allowed us to have a new building and implement EMRs, which we could not have afforded otherwise. We have a great relationship with them and it has been a good thing.”

While preparing to take over as president, Hale participated in a transi-tion meeting where he was asked what he wanted to do over the course of his presidency. “At fi rst I thought ‘oh my goodness what have I gotten myself into,’ then realized the awesome responsibility I had placed upon me to serve as presi-dent of the voice for patients and doctors in this state,” said Hale. “Fortunately I have a lot of folks who will help me main-tain this organization and deal with the many issues we have ahead of us such as payment reform, scope of practice, the health initiative and telemedicine. I think my biggest goals are to be a voice for physicians and our patients, keep the organization moving forward and to edu-cate physicians on the value of member-ship in the TMA.”

In keeping with the changing land-scape of healthcare, Hale plans to speak to large groups that are buying up prac-tices and large practice groups across the state to see what they can achieve as a group. “Large groups are where a lot of medicine is heading and TMA needs to address the needs of these entities without sacrifi cing those of individual physicians and independent group practices,” he said. “The basis is quality medicine. With health initiatives we have to talk econom-ics and quality in the same sentence. We cannot continue to put as much in health-

care as we do but we cannot afford to sac-rifi ce quality.”

TMA is also working to be more accessible to doctors, especially those in rural areas. “We are trying to go where the doctors are rather than have them come to us,” said Hale. “We are tak-ing our ICD-10 seminars as well as our prescribing lectures on the road so that rural areas have easier access to them. We are also trying to capitalize more on the eight regions across the state and go with a more regional model that include the metro areas and then combine the rural areas outside those to make them not only more effective for the TMA but physi-cians as well.”

With a goal a making TMA a value based membership that is tangible to all, Hale wants doctors across the state to be proud of their organization and encour-ages members to wear their membership pins everyday. “So often patients believe the stereo typical idea that all doctors have fancy cars, a big house, belong to country clubs but when you ask them about their doctor, they will say he is car-ing, listens and is such a blessing to my family,” said Hale. “The same is true about the TMA, physicians may not re-ally think there is benefi t to membership but when you wear your pin it can start a conversation about what the organiza-tion can do for not only doctors but pa-tients as well. Wearing your membership pin signifi es that you are committed to quality healthcare and want the best for patients.”

To physicians who are not active and wonder why they should join, Hale says give him fi ve minutes. “I can tell them what TMA has done for them in the past fi ve years alone. What we have done in regard to tort reform alone saves them each year three times the cost of mem-bership,” he said. “You may think that all it takes to practice medicine in Tennessee is to go to med school, get licensed and be board eligible but it actually only takes so many votes in the legislature. We fi ght ev-eryday to make sure that folks who have not gone to medical school cannot get in on the practice of medicine. Without the TMA there would be so many more bar-riers between the patient and the physi-cian than there already are. There is a lot more interference in medicine today, which frustrates many doctors but the only way we can move forward and con-tinue to advocate for patients is through membership in TMA.”

When asked why he is so active and involved, Hale says simply someone has to do it. “The TMA is so important to me and I am not being cliché when I say it is such an honor for me to serve and it is something I really wanted to do,” he said. “So often doctors believe they need to just keep their CME’s up, do good work and go home but there are a lot of outside infl uences affecting patient care. TMA helps control those outside infl uences. It is a calling and we have to advocate for our patients and fellow physicians.”

West Tennessee Physician Takes TMA Helm, continued from page 1

Bill Appling’s Medical Economics column doesn’t appear this month because he’s enjoying a vacation. Bill will return in July.


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H E R S O U T H . C O M

L O V E ?N E E D A G I F T S H E W I L L

By JULIE PARKER

As the American culture shifts to grind more financial responsibility onto patients, hospitals are facing more costly hurtles.

A few sobering facts: 81 percent of true self-pay responsibilities are never re-covered; 75 percent of patient responsi-bilities are never collected; and self-pay is the third most frequent payment method after Medicaid and Medicare. On aver-age, only 10 percent of patient receivables is collected at the time of service. More than half of all bad consumer debt relates to medical bills, leading an unprecedented number of patients to file for bankruptcy protection.

“Hospitals have been dealing with self-pay for some time, but not in the vol-ume or dollars we see now,” said Sheila Schweitzer, CEO of PatientMatters, a 30-year veteran in healthcare adminis-tration – half on the payor side; half on the provider end. “The cash at stake is substantial and harder to collect than a third party. It’s imperative to have a pa-tient receivables strategy in place, or bad debt and charity care will continue to sky-rocket.”

David Shelton, COO of PatientMat-ters pointed out the predicament: “The challenge we must address is helping our hospitals adapt, and adapt quickly.”

For Schweitzer, PatientMatters was preceded by CareMedic Systems Inc., a healthcare technology revenue cycle firm with 1,600 hospitals and 1,000 ancillary

facilities at the time it was sold in 2009. CareMedic successfully brought to mar-ket the first enterprise class revenue man-agement system: the electronic Financial Record (eFR).

“Even though we focused on third-party billing and management, it became very obvious that patient receivables would be the next big challenge,” said Schweitzer, noting that in 2007, only 4 percent of revenues were coming from pa-tients. By 2011, patient revenues averaged 32 percent. “The problem was growing really fast. Hospitals and physicians just aren’t accustomed to healing patients and then asking for money. We felt there had to be a real behavior change of hospital staff and patients to improve the collection ratio of patient receivables.”

Schweitzer and her executive team researched the market and couldn’t find a company with the technology infrastruc-ture that adequately supported the data needed to convert patients’ complexities around their coverage.

“We found that even the tightest-run patient access departments are having difficulty getting their arms around the evolving patient receivable,” she said. “The fact is, though healthcare reform may be a notable accelerant, the issue runs much deeper. Hospitals are seeing their revenue sources change completely as patients leapfrog private insurance (as) the third-largest payor.”

Before opening PatientMatters, Sch-weitzer made two strategic acquisitions, including MASH (Medical Advocacy

Services for Healthcare), a Medicaid eli-gibility service since 1988, and Kramer Technologies, a technology firm.

“We took our time to really under-stand our market and hone our training, communications and processes to satisfy the hospitals and the patients,” she said. “We’re very bullish on where we are.”

Since the firm opened in 2012, rev-enues have reached $25 million and em-ployment tops 200. Based in Orlando, with offices in Houston and Ft. Worth, Texas, PatientMatters has hospital part-nerships across the United States. The most recent hospital contract inked was St. Luke’s Cornwall Hospital, with cam-puses in Newburgh and Cornwall, NY.

“We guarantee cost savings,” said Schweitzer. “We put resources on staff at the hospital. We only generate rev-enue after the hospital has seen an im-provement. We’re not subscription- or fee-based. We actually align with the hos-pital. We only win when they win.”

PatientMatters focuses strongly on the unique market of community hos-pitals, which cannot afford to have high patient receivables to continue to provide a sustained high level of care.

“We feel so strongly that community hospitals are vital to this country,” said Schweitzer. “They’re usually the largest

employer in the community and provide very good care. We worked on modeling our processes and approach for that mid-tier market.”

PatientMatters places personnel with significant hospital operations experience in contracted hospital roles such as execu-tive director of patient access and patient advocates.

“We bring in statements we’ve care-fully and thoughtfully designed with great input from focus groups of patients,” she explained. “On the back of the state-ment, we describe what everything means. We bring in many programs to help patients find ways to pay their bills. We find that most patients want to pay their bills if they understand what they’re being charged.”

The Challenge: Getting PaidThis partner in patient receivables doesn’t send invoices until hospitals save money

BPH patients are treated with the stan-dard Alpha blocker therapy. “And then they’re treating their erectile dysfunction on demand. So they’re not using the daily dose.”

Men may put up with a headache, facial flushing and nasal congestion when they use ED drugs on demand, Wake said, but it’s a different lifestyle choice if they take the daily low dose of Cialis. They might have continuous side effects while not treating their urinary tract symptoms as well as they could with Flomax.

Doctors have to oversee the ED pre-scription process carefully, Wake said. “If they think they’re functioning pretty good, then they see how good they can function on (ED drugs), they think they need it all the time, so you’ve got to be very careful,” he said. “In that 50-to-70 age group, al-most any of them will say, ‘Yeah, I’m not like I was – could I be?’ And the medica-tion can do that.”

The Mayo Clinic’s website points out, “In most cases, erectile dysfunction is caused by something physical.” Among the common causes the clinic lists are heart disease, atherosclerosis, high cho-

lesterol, high blood pressure, diabetes and obesity, as well as treatments for prostate cancer and enlarged prostate. Psychologi-cal causes of ED include depression, anxi-ety and stress.

“Usually erectile dysfunction is a sign of underlying issues,” said Gubin, of The Urology Group. “Penile arteries are smaller than the heart arteries, so where are you going to have issues initially show up? People who are dia-betics, or have hyperten-sion, et cetera, will show up with issues of erectile dysfunction, and that may be an underlying sign.

“So patients who come in complain-ing of that, one thing the doctor should do is see that they have a routine physi-cal and see their primary-care physician and make sure that nothing underlying is being missed. Psychological issues also do play a role, obviously. I don’t think we un-derstand everything associated with sexual dysfunction.”

Dr. David A. Gubin

Arrival of New ED Drugs Helps Ease Conversation, continued from page 5


HCMC Welcomes Dr. John Beddies

PARIS - Henry County Medical Center is pleased to announce that John Beddies, MD, Urology, has signed his contract to practice medicine at Henry County Medical Center with Ken-tucky Lake Urologic Associ-ates.

Dr. Beddies is origi-nally from Paris, TN and a graduate of Henry County High School. He attended Middle Tennessee State Uni-versity, where he received his Bachelor of Business Administration in Finance. While at MTSU, Beddies was a student athlete on the MTSU Golf Team. Dr. Beddies at-tended medical school at East Tennessee State’s James H. Quillen College Of Medi-cine. After completing Medical School, Beddies did his residency in Urology at the University of Tennessee School of Medi-cine, Knoxville.

Dr. Beddies is a Candidate Member of the American Urological Association and a Resident Member of the American Association of Clinical Urologists.

Dr. Beddies and his wife, Cati, enjoy spending time together outdoors. Dr. Beddies likes to hunt, fish and play golf in his spare time. Additionally, the couple enjoys spending time with their two cats.

Jackson-Madison County General Hospital Settles “Whistleblower” Lawsuit

JACKSON - The Jackson-Madison County General Hospital District and the U.S. Department of Justice have reached a settlement to resolve a 2007 lawsuit. The JMCGH Board of Trustees approved a resolution during its regular meeting in March to adopt and approve a settlement agreement that has been approved by the U.S. Department of Justice (DOJ).

The lawsuit asserted claims against JMCGH and others on behalf of the Unit-ed States for claims submitted to Medicare and TennCare resulting from the services of Elie Korban, M.D. (“Korban”), a physi-cian who treated patients in JMCGH’s cath lab from 2004 to 2011. The allegations were included in a lawsuit, “United States of America ex rel. Deming vs. Jackson-Madison County General Hospital, et al., filed against JMCGH and others by Wood M. Deming, M.D., a local cardiologist un-der the qui tam or “whistleblower” provi-sions of the False Claims Act. The DOJ elected not to take legal action against JMCGH following the investigation.

Under terms of the settlement agree-ment, Jackson-Madison County General Hospital (JMCGH) will pay $1,328,465 to the DOJ. As part of the settlement, JM-CGH will also pay the plaintiff’s reasonable attorney’s fees, estimated to be approxi-mately $205,000.

West Tennessee Healthcare And Healthsouth Corporation Announce Joint Venture To Build Inpatient Rehabilitation Hospital

JACKSON –West Tennessee Health-care and HealthSouth Corporation (NYSE: HLS) have signed an agreement to form a joint venture to own and operate a 48-bed inpatient rehabilitation hospital in Jackson, Tennessee. The agreement was approved by the Board of Trustees of Jackson-Madison County General Hospital District and calls for the relocation of the existing inpatient rehabilitation unit at Jackson-Madison County General Hospital to a freestanding hospital. In addition, the agreement provides for joint ownership of HealthSouth’s existing Cane Creek Re-habilitation Hospital in Martin, Tennessee.

The transition of ownership of both hospitals to the joint venture will take place upon completion of construction of the freestanding hospital in Jackson. The agreement establishes that HealthSouth will assume management of the existing rehabilitation unit on July 1, 2015, until the new 48-bed hospital is complete. The joint venture plans to begin building the new in-patient rehabilitation hospital pending the required state regulatory approvals.

The formation of the joint venture is subject to customary closing conditions, including regulatory approvals.

Baptist Hospice Receives Prestigious Honor

UNION CITY - Baptist Hospice-Union City has been named a 2015 Hospice Hon-ors recipient, a prestigious award recog-nizing hospices providing the best patient care as rated by the patient’s caregiver. This is the second consecutive year that Baptist Hospice-Union City has received this award.

Established by Deyta, this prestigious annual honor recognizes hospices that continuously provide the highest level of satisfaction through their care as mea-sured from the caregiver’s point of view. Deyta used the Family Evaluation of Hos-pice Care (FEHC) survey results from more than 1,700 partnering hospice agencies contained in Deyta’s FEHC database with an evaluation period of October 2012 through September 2013. Deyta identified Hospice Honors recipients by evaluating hospices’ performance on a set of eigh-teen satisfaction indicator measures. The set of questions included only indicator measures, omitting qualifying, leader and demographic questions. Individual hos-pice performance scores were aggregated for the evaluation period and were com-pared on a question-by-question basis to a national average score calculated from Deyta’s FEHC database.

Suzie McWherter, director of Baptist Hospice-Union City, credits staff team-work, physician engagement, and commit-ment to quality as factors for being named a 2015 Hospice Honors recipient.

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Dr. John Beddies

GrandRoundsHe continued, “Providers who have

the most expensive average episode cost for the year across the state are penalized by a portion of their excess cost.” How-ever, Daverman noted, the threshold for a penalty is set pretty high and is considered only after adjusting for exclusions such as high-risk patients or extraordinary events. Ultimately, the projection is the most ex-pensive 10 percent of providers will face a penalty. On the other hand, he said, “It’s very important we reward provid-ers who meet quality measures and pro-vide efficient care with shared savings.” Daverman predicted, “The majority of providers will have no change or will get rewarded.”

Preview reports for Wave 2 – acute COPD exacerbation, screening and sur-veillance colonoscopy, outpatient and non-acute inpatient cholecystectomy, and acute and non-acute PCI – began at the end of last month. The advisory group has just completed their process for Wave 3, which will roll out preview reports next year and go live at the beginning of 2017.

Long-Term Services & SupportsDaverman said the main premise of

this strategy is to tie payment to quality and acuity. “Some of the measures are around the patient experience, and some of the quality measures are around the caregivers,” he said.

Key points include implementing quality- and acuity-based payment for nursing facilities and home- and commu-nity-based services, value-based purchas-ing initiatives for enhanced respiratory care, and focusing on workforce develop-ment.

More InformationDetails on each of the strategies is

available online in the Strategic Planning and Innovation Group section of HCFA at tn.gov.

Emphasis, continued from page 3

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1118 Hampton Ave., St. Louis, MO 63139


GrandRounds

HCMC Physician Clinics Offer Patient Portal Provided by Greenway

PARIS – Henry County Medical Center Physician Practices is excited to announce the installation of our new Patient Portal where you can take care of many of your office visit needs in be-tween visits all online and in one place. HCMC Physician Practices has part-nered with Greenway Health to save you time and hassle as you navigate the healthcare system.

Through the Greenway Health Pa-tient Portal, patients are able to:

• Pay bills online• Access medical records in a time-

ly manner• Ask for prescription refills• Request appointments• E-mail staff and providers with

questions• Update personal information• View test resultsTo do this, you must give your email

address when checking in at the front desk. You will receive an invitation from “Greenway_internal” by email (be sure to check your spam folder) to access the patient portal account. There will be a link titled “Create My Patient Por-tal Account” that will take you to your PATIENT account. You will also be given a unique user name (usually your Last-Name.FirstName) and temporary pass-word by email. Once you receive your user name and password by email, you can use that to start your patient portal account. All information is secure. Once you access your PATIENT account, you will have 24/7 computer and smart-phone access to your patient informa-tion.

By providing around-the-clock ac-cessibility, we hope to provide a conve-nient, easy benefit to our patients. All it takes is an email address and a request from our patients to set them up.

HCMC Physician Practices offering this service include the following:

• Eagle Creek Clinic – Tonya Nash, PA-C

• Innovative Orthopedics – Mark Cutright, MD and Jill Cutright, PA

• Kentucky Lake Urologic Associ-ates – Joe Mobley, III, MD and John Beddies, MD

• Paris Mental Health Clinic – Rob-ert Hamm, MD

• Paris Women’s Center – Dennis Wieck, MD

• Signature OB/GYN – Lakisha Cri-gler, MD

• Transitions Health – Tammie Hol-comb, DNP-ACNP

• West TN OB/GYN – Paul Locus, MD

Jackson-Madison County General Hospital SANE Nurse Program Helps Victims

JACKSON - How frightened would you be if you were the victim of a sexual assault and then had to give evidence to a total stranger in an emergency room?

Jackson-Madison County Gen-eral Hospital has a SANE (Sexual As-sault Nurse Examiner) Program that helps hundreds of women and men get

through what could be the worst day of their lives. This program includes 15 nurses who are specially trained to col-lect swabs of evidence, collect clothing and get assistance for victims.

These nurses volunteer to be a part of the program and there is always a SANE nurse available. Molly Britt, RN, BSN, CEN, SANE-A, NREMT, is one of the SANE nurses. She says the pro-gram includes a special waiting area in the Emergency Room so that victims

can have privacy. They are given ac-cess to extra clothes, personal hygiene products and most importantly a nurse to talk to. Every victim has a dedicated SANE nurse who can gather evidence in a rape kit and give this kit to police to hold until the victim decides if they want to press charges.

Britt says hundreds of these kits are processed in a crime lab every year and the program has existed here for more than ten years.

We Have a Team of 131 DoctorsProviding Comprehensive Care inOver 25 Specialties and Subspecialties

731.422.0213 | 800.372.8221 | www.jacksonclinic.com

Anesthesiology

Cardiology

Convenient Care

Dermatology/Mohs Surgery

ENT/Otolaryngology

Family Practice

Gastroenterology

General, Thoracic &Vascular Surgery

Geriatrics

Hospitalist

Infectious Disease

Internal Medicine

Nephrology

Obstetrics & Gynecology

Oncology & Hematology

Ophthalmology

Orthopedic Surgery

Pediatrics

Plastic Surgery

Podiatry

Post Acute & LongTerm Care Medicine

Psychiatry

Psychology

Pulmonary & CriticalCare Medicine

Radiology

Sleep Medicine

Urology

Wound CareManagement

Call 731- 424-1001 or 800-243-9220 for appointments.Satellite locations in Camden, Paris, and Savannah

Sufiyan Chaudhry, M.D. Robert Hollis, M.D. Joel Levien, M.D. Brittain Little, M.D., Mihir Patel, M.D. Daniel Kayal, D.O. Melissa Bolton, ACNP

Specialized Care for Digestive Disorders

Serving West Tennessee with over 30 years of experience, all of our physicians are board certified in gastroenterology. Our

staff is committed to providing the highest quality of care and the latest technology with compassion and respect.

27 Medical Center Drive, Jackson, TN 38301www.WTGastro.org

west tn medical news june 2015

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