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Alice Cherqui, MD

PAGE 3

PHYSICIAN SPOTLIGHT

ONLINE:WESTTNMEDICALNEWS.COM

By SUZANNE BOyD

One may say Dale Humphrey’s career has been one that he certainly did not choose, but one that chose him. A 1988 graduate of Belmont University with a Business Administration de-gree, his fi rst job was as a pathology lab assistant and one that made quite a lasting impression on him. Although it was a clinical position and one that was new to him, he learned that if he applied himself he could learn to do something he was

unfamiliar with and even enjoy it. Today, he is the CEO of the 45-bed Henderson County Com-munity Hospital.

“While working toward fi nishing my degree at Belmont, I had taken a part-time job at a pa-thology laboratory in the evening, backing up their computer accounting system. When they found out I was graduating, they offered me a full-time position just on the clinical side of things as a pathologist assistant,” said Humphrey. “I

(CONTINUED ON PAGE 8)

HealthcareLeader

Dale HumphreyCEO, Henderson County Community Hospital

The MED Opens New $9-Million Surgery Center Regional One Health hopes to attract physicians as it expands services

The success of the new Regional One Health outpatient surgery center – and to an extent the newly renamed Regional One Health system – will hinge on whether it can attract business through area physicians and keep them happy ... 4

A Look at the State’s CON ProgramLast year, members of the 108th Regular Session of the Tennessee Legislature voted unanimously to extend the life of the Health Services and Development Agency through June 30, 2017. This action ensured the state’s certifi cate of need (CON) program would continue, uninterrupted, into its 44th year ... 6

FOCUS TOPICS NEUROLOGY/STROKE HEALTHCARE DESIGN/CONSTRUCTION

‘Clock Is Ticking’ On SGR RepealDeadline to overturn fl awed reimbursement system is March 31

By EMILy ADAMS KEPLINGER

Memphis-area physicians, like others across the country, are anxiously waiting to see what happens with the proposed Sustainable Growth Rate Repeal and Medicare Provider Payment Modernization Act. For some doctors, it may dictate whether they have a future in private practice. For all doctors, it will affect their practice of medicine, in one way or another.

In 1997, when the Sustainable Growth Rate (SGR) was originally formulated and approved, it was intended to give the federal government an equation by which it could control what was paid to doctors who treated Medicare patients.

Jerome Thompson, MD, a pediatric ENT surgeon on the faculty at the University of Tennessee Health Science Center, also holds an MBA degree in economics from UCLA. His back-ground in both medicine and economics gives him insights into the pending ramifi cations of the SGR repeal being enacted – or not.

“The formula was supposed to include an annual increase in Medicare expenses,” Thompson said. “But there was a caveat that the

(CONTINUED ON PAGE 10)

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

w e s t t n m e d i c a l n e w s . c o m MARCH 2014 > 3

By SUZANNE BOyD

Driven, focused and dedicated are words that describe Alice Cherqui, MD, neurosurgeon and mother to a 17-month old daughter. It was her drive and focus that got her through rigorous medical training. It is her dedication to not only her patients but her family, as well, that is at the heart of who she is.

“I am very close to my family. My parents moved to Jackson when I started practicing here. My brother is a physi-cist in Seattle but we visit one another frequently,” said Cherqui. “I was born in Paris, France but moved to Houston, Texas when I was six because my parents were unhappy with the way things were going in France. My mom was a nurse but worked mainly during our time in France. My dad had an art gallery in Houston. We attended an international school through-out our primary education.”

At the University of Houston, Cher-qui graduated with a double major in bi-ology and Latin and Greek. “When I was young, I was fixated with medical school. It was where I knew I would end up,” said Cherqui. “In college, the biology was to get in medical school but the other was just for me. I like to stay intellectually challenged and am very independent.”

Cherqui completed her medical school training at the University of Texas Medical Center in Galveston in 2003. “When I got to medical school, I had it in my mind that I would pursue ophthalmol-

ogy, but really when you enter med school you have no idea what you will like. You just really have to go through it and see what piques your interest,” said Cherqui. “I had more of a surgeon mentality and although surgery was a hard rotation, I loved it. When I got to my neurosurgery rotation, I knew it was for me. I have found that in life you have to dictate what you want and not let someone else try to do that for you.”

Neurosurgery, says Cherqui, is very complex and exercises her mind. “You have to stay current with technology and the latest in the field. It is a challenge and is never boring or routine, which makes

the day go by quickly. It fits my type A go-getter type personality very well,” she said. “There is a trade off; there is more call and the residency is long and difficult but I have never felt like it was a job. I feel like this is what I am supposed to be doing with my life. It is good to know I can help people, alleviate pain and at times save their life.”

When it came time for her residency, Cherqui spent her first year in Kansas City at the University of Kansas Medical Cen-ter completing the general surgery portion of her residency then transferred to the program at Louisiana State University. For the next six years, Cherqui worked to complete her neurosurgery residency training at the Louisiana Health Science Center in New Orleans. She then com-pleted a one-year complex spine fellow-ship at the Medical College of Wisconsin in Milwaukee. “Training is tough because you have no control over your life,” said Cherqui. “But I just dedicated myself to it and stayed focus on the end result.”

For the next six years, Cherqui worked to complete her neurosurgery residency training at the Louisiana Health Science Center in New Orleans. She then completed a one-year complex spine fel-lowship at the Medical College of Wis-consin in Milwaukee. “Training is tough because you have no control over your life,” said Cherqui. “But I just dedicated myself to it and stayed focused on the end result.”

At the end of her fellowship training in mid 2011, Cherqui started to look for

a place to begin her practice, limiting her search to the South. A physician recruiter contacted her regarding a position in Jack-son with West Tennessee Neurosciences. “At first I thought I would just talk to them and see what I thought. It sounded like a great opportunity but when I came to visit I was amazed,” said Cherqui. “The hospital offered a level of care you would expect to find in a large city but it was in a small town. It was also close to Memphis and Nashville so I had access to the big city without having to live in the hustle and bustle of the big city. Nobody outside of this place knows what a great gem we have here.”

Having completed a complex spine fellowship allows Cherqui to be what she calls a ‘community’ neurosurgeon. . “The fellowship training allows me to treat the wide spectrum of spinal disorders and as-sume the vast majority of neurosurgical care in the community,” said Cherqui

With a 17-month year old daughter at home, Cherqui tries to be very effi-cient at work so that she can be home at a reasonable time each day. “I have a lot of support at home from my family and I chose a great place to work with sup-portive partners. My call schedule is not crazy and there are hospitalists who can help out when needed,” she said. “I do have to work some weekends but I really do not think I am any different than other women who work; you just have to find balance. I am lucky. I really think I have the best job possible.”

Alice Cherqui, MD PhysicianSpotlight

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Read Medical News Online:

WESTTNMEDICALNEWS.COM

By AMy FRENCH

The success of the new Regional One Health outpatient surgery center – and to an extent the newly renamed Re-gional One Health system – will hinge on whether it can attract business through area physicians and keep them happy.

If Dr. Michael Van Vliet’s impres-sions are any indication, the surgery cen-ter is off to a solid start.

Van Vliet was one of the fi rst sur-geons to try the $9-million center, which opened in December and has three oper-ating rooms available. A fourth is avail-able to equip when demand grows. The center occupies roughly 18,000 square feet of previously undeveloped space attached to the Regional Medical Center in down-town Memphis, commonly known as The MED.

“Now that I’ve used this surgery cen-ter, I will not go to any other,” said Van Vliet, who is also director of critical care for Firefi ghters Regional Burn Center, which is also attached to The MED. “I would operate there every day if I could.”

The surgery center is a key compo-nent in a strategy to boost awareness of MED-affiliated services beyond acute care; branding research has shown that much of the community is unaware of

outpatient and long-term care offerings. To emphasize the overall organization’s multi-faceted appeal, leaders last month announced a new name for the system: Regional One Health.

Outpatient surgery is not a new ser-vice for Regional One. In the past, physi-cians who partner with the system to staff its outpatient clinics have scheduled both inpatient and outpatient surgeries in a central surgical unit.

The new outpatient surgery center

is taking over the outpatient operations and is technically a hospital outpatient department. That means the center can call upon MED-based specialists and re-sources whenever needed.

But the surgery runs on the model of a freestanding ambulatory surgery center. That means surgeons across the commu-nity who get credentials are able to use it as an extension of their practices – with the center’s anesthesiologist and staff of nurses, surgical technicians and business personnel to support them.

“Our folks get to know these surgeons and their preferences, and they’re just on it,” said surgery center administrator Jana Jones. “They’re able to schedule surgeries back-to-back with very little turnaround time, which doctors love because their time is so valuable.”

The surgery center can handle cos-metic and reconstructive, orthopedic, ENT, gynecologic, urologic and general surgeries. Leaders expect to add neurol-ogy and possibly oral surgery soon and have set a goal of 1,100 surgeries in the fi rst year.

After 30 operations, Van Vliet, who specializes in cosmetic and reconstructive surgery, said the center had exceeded his expectations.

“I think the number one thing is that the patients are treated exception-ally well, with great service and excellent outcomes,” he said. “It really has a Ritz-Carlton sort of approach. There’s top-of-the-line technology, and everything runs effi ciently and on schedule -- like a well-orchestrated symphony, a well-oiled ma-chine.”

Snazzy features include advanced

Lumenis lasers, customizable operating rooms and a large-screen monitor in the waiting room on which patients’ loved ones can follow their progress. Ameni-ties also include free parking, Wi-Fi and easy access to laboratory and pharmacy services, as well as access to a physicians’ lounge with a gym and conference room.

Flash back to a few years ago, and it’s hard to imagine a MED-affi liated facility being likened to a swanky hotel.

The expertise and care available through the system were widely regarded as top-notch, even unparalleled in the Mid-South, particularly in the areas of burn treatment, neonatal care and trauma care. But a large percentage of patients were in-sured through Medicaid or not at all.

That helped to foster a perception that outside of the MED’s famed centers of excellence, its services were only for people who couldn’t afford better.

“When I got here, the perception was if you have a bad acci-dent, go to the MED, but as soon as you’re stable, get transferred to Meth-odist or Baptist,” said Reginald Coopwood, MD, who took over as system CEO four years ago. “That was kind of a community understanding.”

Coopwood sought to change percep-tion and improve his organization’s fi nancial outlook with “a serious focus on the patient experience” at every level.

Examples: • The hospital did not have private

rooms. All rooms are now private, includ-ing those in the long-term rehab facility and long-term acute care facility.

• Waiting areas weren’t comfortable for overnight stays. Now, updated features for patients’ loved ones include reclining chairs, shower areas and Wi-Fi Internet access.

• Support staff didn’t always win praise as friendly or accommodating. Now, staff is trained on service-oriented expectations and held accountable if those expectations are not met.

• Patient evaluations of service have improved drastically, Coopwood said. Also, he said, it has become rare for pa-tients exiting critical care to transfer into competing facilities for long-term care.

That’s progress.Building a clientele for the outpatient

surgery center is part of the next phase. To broaden and diversify Regional One’s patient base, it’s important for physicians and healthcare consumers who haven’t looked to Regional One in the past to give it a try.

“That is exactly where we are right now,” Jana Jones said. “We are trying to fi ll up this surgery center, and we would love to have interested doctors from out-side The MED come and use the facility. It’s a beautiful facility.”

Regional One Health Opens $9 Million Surgery CenterNew center hopes to attract physicians as it expands services

Jana Jones, surgery center administrator, with the new center in the background.

Dr. Reginald Coopwood

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PROMPT AND PERSONAL – IT’S HOW REGIONS KEEPS THE WHEELS OF PROGRESS TURNING FOR SMALL BUSINESS. Dr. Susana Leal-Khouri began her relationship with Regions in 1996 at the suggestion of her personal accountant. She was just starting her private practice, the Miami Dermatology Center, and needed to furnish the offi ces. “Regions has been very helpful in allowing us to be able to start and grow the practice. They’ve also helped make it possible for us to hire the right people,” says Dr. Leal-Khouri.

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

By CINDy SANDERS

Last year, members of the 108th Regu-lar Session of the Tennessee Legislature voted unanimously to extend the life of the Health Services and Development Agency through June 30, 2017. This action ensured the state’s certifi cate of need (CON) pro-gram would continue, uninterrupted, into its 44th year.

History of Tennessee’s Program

Melanie M. Hill, executive director for the Tennessee HSDA, noted the state has relied on a CON program to drive the orderly creation and expansion of health fa-cilities and services since 1973, a year prior to a federal mandate for such programs. In Tennessee, the Health Facilities Commis-sion administered the CON program until 2002 and was the predecessor to the cur-rent agency. Hill joined the Health Facili-ties Commission in 1998 and was named to the director’s post in 2001. The following year, the Tennessee Legislature passed the Health Services and Planning Act of 2002, which created HSDA.

“Our sole responsibility is the certifi cate of need program and related activities,” Hill said, adding that includes providing techni-cal assistance and collecting data on certain medical equipment including MRIs, PET scanners, CT scanners and linear accelera-tors, among others. “There is a requirement in the statute that the equipment be regis-tered with the agency and that owners re-

port usage data annually.”After establishing CON programs na-

tionwide through the 1974 National Health Planning and Resources Development Act, the law was repealed in 1987, eliminating federal funding assistance for state planning offi ces. However, CON programs remain in place across much of the country. “There are 36 states plus the District of Columbia that have certifi cate of need programs,” Hill stated. She added each state is different with some having more stringent requirements than others.

According to the American Health Planning Association’s website, there are 30 coverage areas for which state programs might choose to require a CON. On one end of the spectrum, Vermont requires an application be made for all 30 of those options from acute hospital beds and air ambulances to medical offi ce buildings and ultrasound. On the opposite end of the spectrum, Ohio requires an approved CON only when adding skilled nursing/long-term care beds for projects exceed-ing $2 million in cost. With 20 service and equipment areas covered by CON regu-lations, Tennessee falls a little right of the middle.

Application TrendsThe economy and uncertainty over

the Affordable Care Act have impacted the number of CON applications being fi led in the state. Hill said, “We used to aver-age 100-120 applications annually.” Now, she continued, “We’re probably looking

more in the range of fi ve full applications a month.”

She added, “In 2008, we dropped from 121 applications to 56 in 2009.”

After rebounding slightly to 62 CON applications in 2012, the number dipped down to 51 last year.

Gaining Approval for a CONAt the heart of the approval process is

the need to meet three criteria:• Answering a healthcare need,• Proving a plan is economically fea-

sible, and• Showing how the plan contributes to

the orderly development of adequate and effective healthcare facilities and services.

Actually, Hill noted, “Most applica-tions are approved. It’s a fairly strenuous process so you really have to have your information together by the time you fi le.”

Prior to fi ling an application, Hill said her agency could provide technical assis-tance to help navigate the process, impor-tant background information regarding utilization for those considering adding equipment or services, and insight into needs outlined in the state health plan.

Although applications are assessed against the state health plan, which outlines the numbers that would indicate a commu-nity might need to add a facility or service line, Hill was quick to add there are valid reasons to override those numbers … or lack thereof. “That’s why it is guidance and not set in stone,” she said of the health plan. Hill added, “I hope we’re never strictly ‘just

numbers.’ There are certainly circum-stances in each community that are unique to that community.”

For example, she said population fi g-ures alone might not warrant the addition of a second MRI in a community. However, she continued, if the owner of the current MRI doesn’t accept many insurance plans, or doesn’t participate in TennCare, or has excessive wait times for appointments, then circumstances could demonstrate a need for a second MRI operator in that area.

Hill added the monthly CON meet-ings are open and transparent … and highly participatory. She said those for and against an application are welcome to come to the meeting and are given an opportu-nity to speak. She added that when an ap-plication is controversial, her team has even held town hall meetings to allow residents to voice concerns. She noted this extra step isn’t requested very often, though.

Ultimately, an 11-member board de-cides the fate of a CON application. There are three consumer appointees – one each from the speaker of the house, governor and lieutenant governor. Three more board members are state offi cials with the comp-troller, commissioner for Commerce and Insurance and the director of TennCare each designating an appointee. The re-maining fi ve board members are chosen by the governor with one each being selected to represent home health, surgery centers, nursing homes, hospitals and physicians. While the related associations often provide a list of possible appointees, the selection is at the governor’s discretion.

The Big PictureAlthough various groups have looked

to limit or abolish the CON process, par-ticularly during years when HSDA is under sunset review, there are many staunch sup-porters of the system. The Tennessee Hos-pital Association listed keeping the CON program running in its current format among its top legislative priorities last year.

“In Tennessee, we’ve had a CON pro-gram for 40 years. It’s a very stable process, and it’s one the healthcare industry un-derstands,” Hill said. “I think it’s a growth management tool, and also it’s a cost sav-ings tool.”

Hill said perhaps one of the most im-portant functions of her agency is to help ensure quality programming is available in Tennessee. The impact of the CON process on cardiovascular surgery outcomes has been the focus of a number of studies. Hill said, “A 2002 report from the University of Iowa College of Medicine showed states without CON programs for open heart surgery had a 21 percent higher mortality rate.”

Similarly, she continued, when the Pennsylvania CON law expired, the state saw an infl ux of open heart surgery pro-grams … quickly growing from 35 to 62. “They saw morbidity and mortality in-crease,” Hill said. “Any time you see that dramatic growth, you are decreasing vol-ume for surgeons.” Less volume … less ex-perience, she pointed out.

Hill concluded, “You still have people who say the CON process is anti-competi-tive, but it’s really not … it provides a level playing fi eld.”

A Look at the State’s CON Program

FacilitiesThreshold: A modifi cation, expansion or renovation in excess of $5 million for a hospital or $2 million for other healthcare facilities.

• Hospital

• Nursing Home

• Recuperation Center

• Ambulatory Surgery Center

• Mental Health Hospital

• Intellectual Disability Institutional Habilitation Facility

• Home Care Organization (Home Health & Hospice)

• Outpatient Diagnostic Center

• Rehabilitation Facility

• Residential Hospice

• Nonresidential Substitution-based Treatment Center for Opiate Addiction

• Birthing Center

Addition of Services• Burn Unit

• NICU

• Open Heart Surgery

• Positron Emission Tomography

• Swing Beds

• Home Health

• Psychiatric (Inpatient)

• Rehabilitation (Inpatient)

• Hospital-based Alcohol & Drug Treatment (for adolescents under a program of care exceeding 28 days)

• Extracorporeal Lithotripsy

• MRI

• Cardiac Catheterization

• Linear Accelerator

• Hospice

• Opiate Addiction Treatment (provided through a facility licensed as a nonresidential substitution-based treatment center)

ActionsIn addition to the cost triggers listed under facilities, the following actions also require CON approval. Go online for details.

• Change to the bed makeup of a healthcare institution.

• Change in location or replacement of existing or certifi ed facilities providing healthcare services, major medical equipment, or healthcare institutions.

• Change of parent offi ce of a home health or hospice agency from one county to another county.

• Acquisition of major medical equipment with a cost in excess of $2 million.

• Discontinuation of obstetrics.

• Closure of any hospital that has been designated a critical access hospital or the elimination of any services for which a certifi cate of need is required in those hospitals.

What Requires a CON?As outlined by Tennessee code, certain facilities, services and actions trigger the need for an approved certifi cate of need before proceeding. Visit Tennessee.gov/hsda for more information.

Prior Approval or Notifi cationAdditionally, there are some actions that require individuals to notify or seek prior approval from the Tennessee HSDA even though a formal CON is not required. Details are available on the HSDA website.

w e s t t n m e d i c a l n e w s . c o m MARCH 2014 > 7

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

It’s easier than ever for someone to give his or her two-cents-worth. In 140 characters you can say whatever you want about almost anything to just about everyone. But hey, times have changed and the cost of an idea is a little higher than it used to be. So if you’re going to say it, make it count. And so we will.

Sleep. That’s it. Sleep. Okay if you want your 99-cents-worth, the Sleep Cycle Alarm Clock App for your iPhone or An-droid phone.

What does an alarm clock have to do with what we write about here? Well, this particular idea involves you, your patient community, your use of social media and mobile. We talk about those things here every month. But this time, instead of talking about it we’re going to do some-thing together.

The wellness benefits of a good night’s sleep are well documented and so no matter your specialty, there’s an ap-plication for your use of this app and a health benefit to be realized by you and your patient.

Practice Family Medicine? When you’re sleep deprived, you

often feel “worn down” – and that’s a clue that your body is vulnerable to infection. “Not getting enough sleep makes you more vulnerable to picking up illnesses and not being able to fight them off,” said Donna Arand, PhD, DABSM, clinical director of the Kettering Sleep Disorders Center in Dayton, Ohio. Can’t convince yourself or your patient that one or the other isn’t get-ting enough sleep? Let the app help.

Cardiology your area of expertise? Then you know the story. But does

your patient? Former President Bill Clin-ton confessed that he thinks lack of sleep had a lot to do with his hospitalization to unblock a clogged artery (okay, maybe the Big Macs were part of it too, but he’s on to something) “I didn’t sleep much for a month, that probably accelerated what was already going on,” Clinton said.

He’s probably right. “When you don’t get enough sleep, you have an in-flammatory response in your cardiovas-cular system – in the blood vessels and arteries – and that’s not a good thing!” said Arand. “We see the same thing in hypertension. If that sleep deprivation continues long term, chronic inflamma-tion has been linked to things like heart attack, stroke, and diabetes.”

In the Mid-South and Delta Region we’re all aware of the diabetes, okay I’ll say it, epidemic. The key underlying problem in Type 2 Diabetes is insulin re-

sistance, where the body does not make proper use of this sugar-processing hor-mone. Guess what? When you’re sleep deprived, your body almost immediately develops conditions that resemble the in-sulin resistance of diabetes.

And it’s not just in those we can spot walking down the street. “In one study of young, healthy adult males, they de-creased their sleep time to about four hours per night for six nights,” says Arand. “At the end of those six nights, every one of those healthy young men was showing impaired glucose tolerance, a precursor to developing diabetes.”

Another study found that people in their late 20s and early 30s who slept less than 6.5 hours per night had the insulin sensitivity of someone more than 60 years old.

So, what’s this got to do with the app? Many of us lack the discipline to do even the simplest things to improve our health. But a recent survey found that 9 out of 10 smartphone owners wake up with their smartphone. Maybe we can use that infor-mation do something powerful.

You, your patients, our friends, and me are invited to participate in our Wake Up Better Y’all experiment. It’s not neces-sarily scientific but certainly a fun and well-intentioned effort to see if what we do here together can be good for us.

Besides, one of the main features of the app is to wake you up at the right time. Not just the time you set the alarm for but in your lightest sleep phase. When that happens you’re more likely to awake renewed and on the ‘right side of the bed.’ And everyone around us will appreciate that.

For more information on the Wake Up Better Y’all experiment and the Sleep Cycle App visit http://www.wakeupbetteryall.com or hit me up on twitter.

Hat tip to the good people at webMD and Donna Arand, PhD, DABSM, clini-cal director of the Kettering Sleep Disor-ders Center in Dayton, Ohio.

Hey Doc, Wake Up Better

8 > MARCH 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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had to quickly learn a lot of medical termi-nology, as well as the technical aspects of the job, in order for the pathologists to make an accurate analysis. It made an impression on me that how well I did my job could have a huge impact on the health and well being of another person.”

As he progressed in the company out-side of the lab, Humphrey took a market-ing position making sales calls to hospital CEO’s. “When I saw how many different skills it took to be a good hospital admin-istrator it gave me a lot of respect for what they did,” said Humphrey, who earned his Masters degree in Health Services Admin-istration from Austin Peay State University in Clarksville, Tennessee. “When the lab company was bought out, I went to work as a physician liaison with Baptist Hospital, which really solidified for me that I wanted to be in a hospital setting.”

Humphrey went on to work for Health-Trust as the physician liaison for their Nash-ville facility, which was ultimately bought by Columbia HCA. “Instead of being the main tertiary referral hospital for the system, we became one of five hospitals and were the new one in the family,” said Humphrey. “I moved into the Columbia HC Network calling on small hospitals across Tennessee to try to get them to join the Independent Practice Association (IPA).”

In an effort to move closer to his fam-ily and his wife’s, whom he had met while with HealthTrust, Humphrey took the po-sition of director of physician recruitment/practice relations and business development with Gateway Health System in January 1999. Ten years later he joined the staff of another Community Health System af-filiate, Regional Hospital of Jackson, where he has served as chief operating officer and interim CEO. In August 2013, he took the reins of CHS’s facility in Lexington, Hen-derson County Community Hospital.

“The hospital was not growing, we had lost physicians and services,” said Humphrey. “I came in to turn things around. In the first six months of being here we have had a 25 percent growth in volume. It is a smaller hospital than what I had been in but there is a lot to do here and great people to work with. The transi-tion has been wonderful, the staff, board and community have been very welcom-ing.”

Humphrey’s management style, which he attributes to his mentors, is one of motivating and encouraging his team in a positive manner. “I believe to be happy working in healthcare you have to have true compassion for caring for others. Hos-pital staffs contain a wide variety of skill sets, different levels of education and train-ing, and numerous outside pressures and regulations, yet everyone plays an equally important role when it comes to taking care of patients,” said Humphrey. “I feel my job is to see that everyone has the right tools and skills to do their jobs effectively, and I believe that if we are going to make patients feel as if we truly care about them, the employees must feel that way as well.”

As with many leaders, Humphrey sees healthcare as one of the most dy-

namic industries in existence. “In addition to being highly political, few industries are as regulated by so many different local, state, and federal authorities. The indus-try is also ever changing by way of merg-ers and acquisitions,” he said. “By far the biggest challenge however, has been and will continue to be adapting to Healthcare Reform’s impact on how hospitals deliver care. Declines in reimbursement mean we have to be much more efficient and delib-erate in how we offer services and at the same time we must increase the quality, safety, and level of satisfaction of the pa-tients we serve.”

One area Humphrey is focusing on is securing the hospital as an irreplace-able asset for the community. “Part of that requires being visible and engaged in the community so we find ways to partner with local government and industry to ensure we are meeting their needs,” said Humphrey. “Not only does that require we have the right physician specialties and hospital services available, but we also have to do a better job engaging patients in the process so that we are optimizing their health instead of just dealing with the con-sequences of poor health-related decisions. In addition we are continuing to invest in the facility itself so that we continue to offer the latest technology in a clean, safe, and inviting atmosphere. My short-term goal is to make HCCH a busy, high-quality com-munity hospital that is a trusted partner for the community.”

When looking over all he has accom-plished in his career, Humphrey counts being able to balance things with his family as one his most important. “My wife Gloria is a very talented and successful physician recruiter who has been willing to move and make other sacrifices in order to advance my career,” he said. “My 14-year old son Rob is active in sports, the outdoors and is working toward becoming an Eagle Scout. My 11-year old daughter Mary is active in the performing arts and beauty pageants. Even though our schedules are crazy with activities, they’re both great students and are doing well.”

For the facilities he has worked in Humphrey has been successful not only in growing the hospitals, but also improv-ing the quality of care, patient satisfaction and employee satisfaction. He also counts among his blessings that he has been able to continue to advance in his career during difficult times for the economy and within the healthcare industry.

Humphrey says his passion is building relationships. “It requires time and effort but it pays such big rewards. There are so many outside pressures in healthcare that without developing a level of trust with those you work with as well as those you serve it is hard to succeed,” he said. “The team consists of everyone from the physi-cians and nurses to the support services staff, the administrative staff as well as pa-tients and their families. It’s proven that outcomes are better for those who have a trusting relationship with their caregivers and when you really come down to it, we exist solely to take care of others.

Healthcare Leader, continued from page 1

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Around the 1890’s, brain-storming was a medical term for “mental explosion.”

Brain-storming seems to be almost a contradiction in terms since the brain is associated with intelligence and thought while the word “storm” conjures up images of total chaos. And yet brain-storming came to mean a new and, usually. a very creative idea.

In 1953, advertising executive, Alex Osborn, described brainstorming in his book, “Applied Imagination” as having four key components:

• Focusing on the quantity of ideas• Withholding criticism • Welcoming unusual ideas • Combining and improving ideas• According to experts, the challenge

with brain-storming is that it doesn’t work very well. “Decades of research have consistently shown that brain-storming groups think of far fewer ideas than the same number of people who work alone and then later pool their ideas,” says Keith Sawyer, a psychologist at Washington University.

“Brain-storming is dead and alternative thinking is here,” he’s quoted as saying in the MGMA, Connection Magazine from Nov/Dec 2013.

Many caregivers and physicians shy away from techniques that could take them out of their comfort zone. With this in mind, the following three techniques are viable alternatives for generating fresh group ideas in the healthcare setting:

• Kill a stupid rule• Use a different lens• Incorporate blockersThis article states that according to

Lisa Bodell, the founder of Futurethink, an innovation and foresight firm in New York, to implement the “kill a stupid rule” tool, employees gathered into two or three person teams and then, “If you could kill or change all the rules that get in the way of better serving your customers or just doing your job, what would they be and how would you do it?” After 10 to 20 minutes of exchange, everyone is asked to write their favorite stupid rule on sticky note and then place their rules on a white board grid that has two axes: Y is ease of implementation and X is degree of impact. The group then picks a few easy-to-implement, high-impact rules to kill on the spot.

A medical group stumbled upon a slight variation of kill a stupid rule. It began when team distributed a short employee survey asking about experiences with the organization and recommendations for improvement. The survey was originally meant to serve as input for operational planning. What they got back was a list of “things they hate.” Rather than disregard the negative response as sour grapes they identified frustration patterns and selected a few quick wins for implementation. Implementing these quick wins has contributed to a culture that encourages staff to speak up and increases the

perception that they have been heard.A second approach to generating

ideas is to view the problem through different lens. One approach is to use role-playing. Some say that role-play helps increase participation in individuals who have a fear of speaking up and challenging opinions.

A third approach to generating ideas expands on role-playing by incorporating a blocker, a voice of dissent, to help generate ideas and prevent “groupthink” -- a phenomenon that occurs when a group wishing to stay harmonious produces poor decision-making results.

Groupthink is often cited as playing a key role in the Challenger space shuttle explosion of 1986. Engineers knew about faulty parts months before takeoff but feared negative press, so they pushed ahead with the launch.

The Citrin Group, an Alabama-based investment advisory, uses the blocker to disagree with their top executive team on every key issue. This process results in deeper conversation and multiple perspectives instead of a room full of agreement, according to Josh Linkner in his book Disciplined Dreaming.

We have multiple challenges in our industry, and although brainstorming is commonly used it is not the silver bullet to problem- solving. We must consider viable alternatives to generate better solutions. By incorporating kill a stupid rule, viewing issues from a different lens and using blockers, we may be able to stimulate ideas that will better address our problems. Also, we must be cognizant of group settings to maximize participation and idea generation, according to the Connection Magazine article.

One last thing on a different subject: Affordable Health Care. Could someone please tell me where they are hiding the affordable part?  As you know, most lab work that comes from a physician’s office is required to be sent out to a reference lab per most all insurance companies. Recently I had some lab work ordered by my physician and of course, it had to be sent out to a reference lab.  I had a new insurance company, but my previous insurance company was billed. I received a bill from the lab telling me I was not insured under the insurance plan submitted, so I was personally responsible.  Now, I do not have a problem paying my bills, but this bill was $1,222.55.  I called the billing office of this lab and gave them the correct information so they could re-bill with the correct insurance company.  I received a new bill for $213.39.  I was pleased but it made me think. Affordable? To whom?  Why the insurance company, of course.

Brain-Storming, a “Mental Explosion”

by Bill Appling

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

10 > MARCH 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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amount of increase could not exceed the growth of the Growth Domestic Product (GDP), the market value of all officially recognized goods or services produced within a year within a given country. And therein lies the problem.”

Given the economic downturn that the country has experienced, that doesn’t leave much room for growth for the reim-bursement payments.

Mike Cates, executive vice president of the Memphis Medical Society, explains, “In March of every year since 1997, the SGR has been updated. The way a doctor is paid is by calculating relative value units that are converted into dollars. The inten-tion of the implementation of the SGR was to make those costs more predictable so that the government could budget for those costs year to year. The end result has left doctors scrambling to manage their own budgets as the impact has threatened to decrease the amount of reimbursement doctors receive from treating Medicare pa-tients by as much as 24 percent in 2014.”

“The SGR formula is inherently flawed,” Thompson said. “It allows the federal government to cut into physicians’ practices from two different directions. First it allows cuts by specialty for doc-tors in private practices. Then it allows an overall cut, of 20 percent or more, to all doctors in private practice by reim-bursing the hospitals more than they re-imburse individual doctors. For example, private practice cardiologists received a 47 percent cut in their Medicare reimburse-

ments for cardiac imaging, while hospitals received only a 2 percent reduction.”

And in the bigger picture, it is not just the amount of Medicare reimbursements that have been taking a dive. Typically, private insurance follows the same path set by Medicare, about a year later. So picturing an annual 20 percent cut from Medicare, with private insurers to follow suit, does not bode well for physicians. Not for their incomes. Not for their patients.

With approximately 20 percent of the U.S. population’s healthcare provided for by Medicare, if the SGR repeal is not successful, the result is likely to be a downgrading of healthcare to a lower-cost provider. Medicare patients can still re-ceive high-quality care, but it will likely be administered through charity at a facility that is either county-subsidized or church-subsidized.

The number of people on Medicare has increased under the new Obamacare health program. Without the SGR repeal, doctors in private practice will continue losing money on every Medicare patient they treat. Subsequently, as has happened with some forms of insurance, those physi-cians in private practice may have to make the choice to stop seeing Medicare pa-tients or, at the very least, begin reducing their number of Medicare patients. Each physician would be tasked with enacting their own limits. If that happens, those Medicare patients are likely to add to the already overcrowded patient load of emer-gency rooms at area hospitals. Ultimately,

this issue will become another poverty issue that will impact communities.

Indeed, the SGR formula is flawed. Instead of a small, steady growth over the years, it has shown a huge decrease in the reimbursement payments for doctors. In some past years, the federal government has enacted the equivalent of a temporary Band-Aid.

“In 2013, physicians were facing a 21 percent cut in their Medicare reimburse-ment payments,” Thompson said. “The American Medical Association (AMA) and others in the legislature successfully lobbied and actually got a 2 percent in-crease.”

Although this action stemmed the bleeding last year, without the proposed SGR repeal, there will still be hemorrhag-ing in the medical community. So while joint bipartisan committees have come up with a new way to focus on Medicare re-imbursements to physicians by proposing the SGR repeal, it still must receive ap-proval from the Senate and the House of Representatives. Then it has to be signed into law by President Obama.

“And the clock is definitely ticking,” Cates said. “The deadline for this deal is March 31, 2014. If the repeal is not suc-cessful, the new reimbursement rates will decrease by 24 percent and go into effect on April 1, 2014. If successful, the system will be replaced with stable payment up-dates of 0.5 percent through 2018. The overall goal is to shift Medicare to a system based on value vs. volume of care.”

‘Clock Is Ticking’ On SGR Repeal, continued from page 1

GrandRounds

Hospital Recognized For Leadership In Improving Infant Health

Jackson-Madison County Gen-eral Hospital has been recognized by the Tennessee Hospital Associa-tion’s (THA) Tennessee Center for Patient Safety for its leadership in reducing the number of babies born electively between 37 to 39 weeks. There is a greater risk of complica-tions associated with births prior to 39 weeks, and waiting until 39 weeks allows for better growth and development of vital organs such as the brain, lungs and liver.

Jackson-Madison County Gen-eral Hospital successfully met its goal of decreasing the number of babies delivered electively between 37 to 39 weeks gestation to 5 per-cent or less and has maintained this goal for a minimum of six con-secutive months. This dramatically increases the chances for good physical and developmental health of babies. It also allows for better health and safety of the mother. The hospital is being awarded a congratulatory banner to recognize its team’s outstanding effort by the

Tennessee Center for Patient Safety. Jackson-Madison County Gen-

eral Hospital is part of a statewide Healthy Tennessee Babies Are Worth the Wait initiative launched less than two years ago to increase awareness of the benefits of full-term delivery. In May 2012, nearly 16 percent of all Tennessee deliveries that occurred prior to 39 weeks ges-tation were considered elective. To-day, that number has been reduced by almost 85 percent. Among other activities, Jackson-Madison County General Hospital adopted a strict hard-stop policy that prohibits early elective deliveries before 39 weeks unless there is a clear medical risk to the mother or the baby.

The Healthy Tennessee Babies Are Worth the Wait program is a partnership of the local hospital, the Tennessee Department of Health, THA, Tennessee Initiative for Peri-natal Quality Care, March of Dimes and Tennessee Center for Patient Safety. For more visit: www.healthy-tennesseebabies.com.

American Cancer Society Sets Annual Gala

The American Cancer Society will present the Great Gatsby Gala on August 16, 2014, at The Columns at One Commerce Square in down-town Memphis from 7-11pm. Spon-sorships are available ranging from $1,000 to $50,000. Tickets are $250 per person.

The American Cancer Society is the nation’s largest health char-ity and the largest non-governmental investor in cancer research. With our support, Tennessee researchers – in-cluding those at St. Jude Children’s Research Hospital, the University of Tennessee Health Science Center, and Vanderbilt University – are fo-cusing on new discoveries to help achieve the Society’s goal of eliminat-ing cancer as a major health problem.

The total amount of active can-cer research grants based in Mem-phis was over $3.73 million and $8.07 million in the state of Tennessee (as of January 2014.)

For more details, contact Sonja Ray at Sonja.Ray@cancer.org.\ UT Medical Group Expands Nephrology Services

w e s t t n m e d i c a l n e w s . c o m MARCH 2014 > 11

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GrandRounds

Henry County Medical Center Recognizes the Department Manager of the Quarter Cathy Gniewek

Henry County Medical Cen-ter is pleased to announce Cathy Gniewek, RN, Nursing Director of LakeHav-en Behavioral Health, Critical Care, and Car-diac Rehab, as the De-partment Manager of the Quarter. Gniewek received the title and was recognized at the January De-partment Managers’ meeting.

Cathy Gniewek was recog-nized as Department Manager of the Quarter for October through December for her work as the lead person in the nursing department during the time between Stephen O’Neal’s departure and the arrival of James Caldwell, HCMC’s new Chief Nursing Officer.

Gniewek has worked at HCMC for 9 years, starting in 2005. She is married to Ricky Gniewek and they reside in Bruceton, TN. She stays busy during her free time with her family, including her grandchildren, Mason, Braxton, and Dalton How-ard.

HealthSouth Cane Creek Rehabilitation Hospital Names CEO

Amy Vieth, PT MBA joined the administrative team at HealthSouth Cane Creek Rehabilitation Hospital as the CEO in Febru-ary. Vieth brings 18 years of healthcare ex-perience to this role in Martin, Tenn. Born and raised in Missouri, she initially joined Health-South as the Director of Therapy Operations Rusk Reha-bilitation Center in Columbia, Mo. in 2010 and most recently completed 6 months in the HealthSouth Devel-oping Future CEO training program at HealthSouth in Columbia, S.C.

Cane Creek, is the only free-standing rehabilitation hospital in West Tennessee between Memphis and Nashville according to Vieth.

Kirkland Cancer Center And Ayers Children’s Medical Center Receive Gala Proceeds

The West Tennessee Healthcare Foundation presented $55, 813.55 each to the Kirkland Cancer Center and the Ayers Children’s Medical Center, during the West Tennessee Healthcare Board of Trustees meet-ing tonight. The money was raised at the 24th annual Charity Gala in

November, the largest West Ten-nessee Healthcare Foundation fun-draiser each year.

The Ayers Children’s Medical Center Endowment also received a check for $78,170 from friends and family of Jim Ayers, who was the 2013 Tigrett Award recipient at the Gala. Ayers family surprised him at the Gala in honor of his 70th birth-day. Since 2006, the Foundation has presented the Tigrett Award

to an outstanding Tennessean who has greatly contributed to society through his talents and leadership locally, nationally and abroad.

The West Tennessee Healthcare Foundation has provided services to the community for 29 years at lit-tle or no cost. Foundation President Frank McMeen said, “The Founda-tion helps people put their passion into action through support of won-derful causes from the arts to edu-

cation to healthcare.” Funds can be established to provide annual sup-port or endowments can be set up to ensure ongoing support. Contri-butions to either are tax-deductible and allow the donor to receive the greatest taxable benefit.

You can learn more about estab-lishing a fund or an endowment by calling McMeen at the West Tennes-see Healthcare Foundation at Frank.McMeen@wth.org.

Cathy Gniewek

Amy Vieth

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