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Alan DeJarnatt, MD

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PHYSICIAN SPOTLIGHT

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By SUZANNE BOyD

When you are a pre-med major that is grossed out by everything, it’s usually a good sign that you need to change career paths. Al-though Ben Youree changed his major to busi-ness, healthcare was obviously the fi eld for him. Today, just six years out of graduate school, You-ree is the CEO of Dyersburg Regional Medical Center.

Originally from Murfreesboro, Youree, who

went to Freed-Hardeman University on a base-ball scholarship, realized late in his college career that hospital administration may be a good fi t for him. “After graduating with a business degree, I decided to pursue dual master degrees in health and business administration at the University of Alabama at Birmingham,” said Youree, who has spent his career with Community Health Systems (CHS). “As a part of that program, I did an administrative residency with Community

(CONTINUED ON PAGE 4)

HealthcareLeader

Ben YoureeCEO, Dyersburg Regional Medical Center

None of the AboveGovernor Selects “Third Choice” on Medicaid Expansion

By CINDy SANDERS

When it came time to expand TennCare rolls to cover those up to 138 percent of the federal poverty level (FPL) or decline the offer that included a hefty federal match, Gover-nor Bill Haslam opted for ‘none of the above.’ Instead, the state leader chose to put forth a third option he has dubbed the Tennessee Plan.

Current estimates count a little more than 925,000 people in Tennessee among the uninsured. Of that group, approximately 475,000 should qualify for subsidies available to those between 100-400 percent FPL in the new insurance marketplace. The balance of the uninsured either earn too much to receive subsidies (an estimated 50,000 Tennesseans), or are currently eligible but not enrolled in TennCare (estimates vary from 60,000-100,000), or have no viable coverage solution in the absence of Medicaid expansion or ac-ceptance of the Tennessee Plan. The Kaiser Commission has placed that last group at 370,000 Tennesseans with the state estimating approximately 181,000 would have been expected to enroll in an expanded TennCare program over the next 5.5 years had the gov-

ernor opted to go in that direction.

How We Got to this PointAs written, the Affordable Care Act

(ACA) sought to signifi cantly reduce the number of uninsured Americans through the individual mandate requiring cover-age (with subsidies on a sliding scale to make such coverage more affordable) and by expanding Medicaid rolls. In 2012, the Supreme Court upheld the individual mandate but decided states could not be forced to accept a federal edict to expand Medicaid programs.

Since the law was created with both parts of the equation in place, the Supreme Court’s decision to uphold one but strike down the other has left a gaping doughnut hole for citizens with the greatest need … non-pregnant, non-disabled adults under the age of 65 without minor children who are below 100 percent of FPL.

“In the ACA provisions, anybody between 100 and 400 percent of poverty level could shop the exchange and get premium assis-tance,” explained Beth Uselton, program offi cer overseeing ACA


Medicare Reimbursement Cuts Create Long-Term ConcernWest Tennessee-area physicians say they will not change how they do business because government-funded programs have suffered budget cuts. But the tension is increasing for a long-term resolution ... 5

IT AccelerationMedEvolve fi nds ‘sweet spot’ niche providing PM and EMR software and RCM services to physician practices nationwide LITTLE ROCK – When Bill Hefl ey, MD, was a junior partner at a Little Rock orthopedic practice more than two decades ago, he was tasked with choosing a new information technology (IT) system to replace an antiquated one ... 9

FOCUS TOPIC HEALTHCARE REAL ESTATE

Governor Bill Haslam

, MD

2 > MAY 2013 w e s t t n m e d i c a l n e w s . c o m

The last few years have represented a fast-paced and sometimes controversial time in the field of urology. This era has included ongoing debate and now governmental task force involvement in PSA testing. The advent of promising new biologic agents in the fight against metastatic prostate cancer, and the advent of robotic technology. Robotic-assisted radical prostatectomy represents cutting edge technology for the surgical treatment of prostate cancer. The use of this technology has increased at a nearly exponential pace over the last decade. At The Jackson Clinic Department of Urology, we remain excited about the results we continue to see in our patients who choose this approach to a cancer cure. Robotic technology is only as good as the hands that control it. Just as high performance race cars are meant to be driven by professional drivers, robotic surgical technology is meant to be operated by skilled and experienced surgeons. As recent data indicates, one should not underestimate the importance of a high-volume robotic surgical group such as The Jackson Clinic. With the novelty of robotic-assisted surgery wearing off, it is time for urologists to further assess the impact of surgical volume on patient outcomes. As of March 2013, surgeons at Jackson-Madison County General Hospital have completed over 2,100 robotic surgical procedures, with over 75% of these procedures being performed by Jackson Clinic surgeons. Additionally, surgeons at The Jackson Clinic represent the only three Intuitive-Certified Instructors in robotic surgery in West Tennessee.

The outcomes of robotic radical prostatectomy are highly dependent on the surgeon’s technique and most important, experience. Sexual and urinary function outcomes, as well as cancer-specific results (particularly positive surgical margins) have a strong association with the case volume. I can certainly attest to this fact, as The Jackson Clinic Robotic Urology Program has matured over the years, patients have benefitted from improved outcomes, especially in the area of cancer margins and continence rates. Our positive surgical cancer margin rate is equal, and in many cases superior, to reported statistics from the larger urologic cancer centers in the United States.

While recent studies suggest an advantage for perioperative complication rates in robotic-assisted radical prostatectomy, they have failed to appropriately account for the volume-outcome relationship. In the April issue of Journal of Urology, one of the largest studies to date was published comparing robotic-assisted and open radical prostatectomy as a function of volume-outcome relationship. 77,616 men who underwent radical prostatectomy were evaluated. Overall, patients treated with the robot-assisted procedure experienced a lower rate of adverse outcomes than those treated with the open procedure for measured categories. Lower volume institutions experienced inferior outcomes relative to the highest volume centers irrespective of approach. The Jackson Clinic continues to lead the way in providing advanced treatment through robotic assisted surgery in West Tennessee. This technological advantage, along with our technical experience, helps improve outcome and results for all our patients.

The New Era In Prostate Cancer Treatment: Advanced Treatment Through Robotic Assisted Prostatectomy At The Jackson Clinic Department Of Urology: Highlighting The Importance Of A Large Volume Center

700 West Forest Avenue, Jackson, TN 38301

731-422-0330Hours: Mon - Fri 8am - 5pmTimothy C. Davenport, M.D. John H. Meriwether, M.D. John L. Shaw, Jr., M.D.

Jackson ClinicUrology

Department

By Timothy C. Davenport, M.D.2012 Doctor of the Year, Tennessee Men’s Health Network

w e s t t n m e d i c a l n e w s . c o m MAY 2013 > 3

By SUZANNE BOyD

Combining an interest in science with a passion for solv-ing puzzles is ‘nothing to sneeze at’ for Alan DeJarnatt, MD, who has been treating West Tennes-see patients suffering from aller-gies and asthma for more than 20 years. The Fayetteville, Ten-nessee native has found the per-fect match in his practice as an allergist and immunologist at the Allergy and Asthma Care Clinic in Jackson.

DeJarnatt, who graduated with a biology degree from Abilene Christian University in Texas, had always had an inter-est in science and knew early on he would pursue a medi-cal degree. “There were family friends who were in medicine that I would say had some in-fluence on me,” said DeJarnatt. “But my perspective was limited to the general practitioner who took care of my family so I always thought that is what I would end up doing.”

In medical school at the University of Tennessee Center for Health Sciences in Memphis, DeJarnatt deviated from primary care toward internal medicine due to the problem solving aspects of the specialty. “I like to solve puzzles and problems which fit very well with internal medicine but what it lacked was treat-ing children,” said DeJarnatt. “As I went through my internal medicine residency at Texas A&M and Scott & White Hospi-tal in Temple, Texas, the allergy and im-munology rotations were so interesting to me. With immunology, there is research that is going in 100 different directions and there is something new being discov-ered almost continually. It affects every system of the body and is a unifying disci-pline. Allergies affect all age groups which meant I would get to treat kids. It also in-volves a lot of problem solving which is fun to me.”

After practicing internal medicine for a year, DeJarnatt returned to Texas in 1990 to complete a two year allergy and immunology fellowship at the University of Texas Medical Branch in Galveston. When he completed his fellowship De-Jarnatt and his wife, Leigh Anne, who is from Fort Worth, were looking for a place to land that was not too far from family. When some friends from medical school who were practicing in Jackson, Tenn., invited them to take a look at opportuni-

ties there, the DeJarnatts found it was a good fit for them and he joined the Jack-son Clinic. In 2007, DeJarnatt joined Al-lergy and Asthma Care, a seven member allergist group which also has offices in Memphis.

Over the course of his career, DeJar-natt has seen the prevalence of asthma and allergies in the general population increase as well as advancements in the treatment of these ailments. “Peanut allergies, which were uncommon when I was in fellowship, are very prevalent now and can lead to significant lifestyle changes,” said DeJar-natt. “Asthma has also increased and the use of inhaled medications has expanded greatly over the last 20 years. Interestingly

though, severe asthma that is difficult to treat is less common now. This may prob-ably have more to do with how we treat it since it does not seem to be proportionally as severe as it used to be.”

Researchers have many theories as to why the prevalence of allergies and asthma has increased. One area of study includes the general environment as a factor. “We live in a much more sterile world and have become more urbanized,” said DeJarnatt. “Our homes are tighter, more insulated. It’s called the hygiene hypothesis.”

Farm kids, who are exposed more to dirt and the natural environment, tend to have fewer allergies. As another ex-ample, two generations ago most homes

had hardwood floors. Today, most homes have carpeting. “We know that carpeted and insulated homes have more dust mites,” said DeJarnatt. “We are changing the interface our immune system has to the outside world.”

The good news, DeJarnatt says is that a lot of kids with se-vere allergic disorders can lose a lot of them as they get through their school years. “Unfortu-nately, they are also likely to re-gain some of those as they enter their adulthood,” he said. “But with that being said, a person’s sensitivity to an allergen can come on at any age. What turns those things on and off is still a mystery. Fortunately, most al-lergies will respond to treatment and get better with it. My job is to solve the puzzle and find the right treatment.”

DeJarnatt and his wife have four children, one girl and three

boys who range in age from 20 to 26. While none of the children have entered the medical field yet, their youngest son is on a pre-med track in college. Leigh Ann will retire this spring from a school office job that she took while the kids were in school allowing her to be a full-time mother.

DeJarnatt, an elder in his church, enjoys staying active in the life of church members. “There is always a lot going on at our church and we want to put more of our focus there,” said DeJarnatt. “I have done some medical mission work, going to Panama twice as well as inner city mis-sion work while in college. I am thinking there may be more of that coming in my future.”

Alan DeJarnatt, MD PhysicianSpotlight

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In my April column, we discussed a world led by economic force – a force that is primarily driven by job creation and quality GDP growth. Students don’t want to merely graduate; they want an education that results in a good job without taking on overwhelming debt.

Earlier this year the University of Tennessee Health Science Center participated in a focus group initiative, “Accelerating Change in Medical Education.”

The event announced a new competitive grant to change the way future physicians are trained. As part of this new initiative, the AMA will provide $10 million over the next five years to fund 8 to10 projects that support a significant redesign of undergraduate medical education.

As discussed in the previous month’s column, at the Fogelman College of Business and Economics, Dean Grover reflected that the evolving model of higher education needs to address the 21st-century needs with 21st-century methods. “Before, there was this mindset that every student who wanted to get a business degree had to take a lot of prerequisite courses and follow a path that was largely academic training when in fact very few students were preparing for academic careers,” said Dean Grover.

“We had all these requirements in areas such as economics, say, that would have been appropriate for a student who wanted to earn a Ph.D. in economics, but had little relevance for someone who wanted to earn an MBA, and go to work in a corporate setting,” Grover continued. “We’re changing all that.”

Grover has worked to boost community and corporate support and build the school’s reputation. One way

he’s done that is by eliminating some barriers such as those pesky course requirements for students interested in MBA programs. “We embrace diversity. If you’re an English major or studied math or medicine you can earn a business degree without wasting time on some courses that, in all honesty, you probably will not put to use. Our degrees are functional.

Jim Clifton, author of The Coming Jobs War, said, “If you were to ask me, from all of Gallup’s data and research on entreprenerushi0p, what will most likely tell you if you are winning or losing your city, my answer would be, fifth to twelfth graders’ image of and relationship to free enterprise and entrepreneurship. The better the image, the more likely your city will win. If your city doesn’t have a growing economic energy in your fifth through twelfth graders, you will experience neither job creation nor city GDP growth.”

Some American might believe that government has to spend more on education. Many leaders agree that this is the silver bullet. But Gallup continues to find, as for more than 75 years, that lots of money is rarely the solution to the big problems.

Sometimes, in fact, the bigger the problem the less expensive the solution. What’s expensive is trying to fix after-the-fact outcomes rather than creating strategies that get at the behaviors and cause.

But one thing seems clear and that is: education needs changing.

Accelerating Change in Education

by Bill Appling

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

Health Systems at their hospital in Ruston, Louisiana where I was the associate admin-istrator. After a year there, I was offered the Assistant CEO position here at Dyersburg Regional Medical Center in 2008.”

Two years later Youree moved to the CHS facility in Lexington, Tenn. where he served as the interim CEO for a few months before coming back to Dyersburg to take the CEO position. In March 2012, he was promoted to CEO.

Youree says his management style is a work in progress. “I am a high energy per-son who is on go all the time and likes to be out and about. I am definitely not laid back, not very structured and handle a lot of business on the fly. Fortunately that is the way our business is and we have to operate as such,” he said. “I think my management philosophy is evolving and have been very lucky to have worked for three very ener-getic CEOs. They were likeable but very respected which is something I admired. I think it is easy to be liked but you have to earn people’s respect.”

Although at 31, he is one of the young-est members of his management team, Youree does not see age as an issue. “I have one person at the director level younger than me, the rest are older but it has never been an issue. People joke about it but I probably joke as much as anyone. I feel like I have aged in the last five years because this industry is getting tough,” said Youree. “I have an open door policy. I think it is important to have the right answers and solutions so people will listen to you. They want support, for someone to back them up and help them work through problems and that is what I do.”

Employee satisfaction is an area that Youree has emphasized while at Dyers-burg and his efforts are paying off. “I had a mentor in Rustin that emphasized to me that when employees and physicians are happy they are more productive,” said Youree. “When I came, employee satisfaction was 19 percent very satisfied overall, last year it was at 70 percent. For physicians it was 16 percent initially and is now up to 60 percent last year. We have had several campaigns and are constantly looking for recognition and reward oppor-tunities. We listened to our staff and physi-cians to learn what the problems were. If we could fix them we did, if not, we didn’t lie about it.”

As with hospitals across the nation, Dyersburg Regional Medical Center is facing the issue of payors not paying for services they have in the past which means the staff must be more efficient. “Just like anyone when their income goes down, their family has to tighten their belt and we have to do that too,” said Youree. “The care we provide is still as good as ever, we just have to be more efficient in how we provide it.”

In the past five years, the 60 year old facility has undergone some major reno-vations including gutting the inside of the facility, new paint and tile on every floor as well as completely renovating the outside of the building and grounds. A cardiac cath-eterization lab, emergency department, and med-surg floor have also been added.

With the addition of the cath lab, Dyers-burg Regional has moved into the second phase of expanding its cardiology services and is working to become a certified chest pain center by the end of the year. Once certification is achieved the next phase will be to make capital purchases and recruit-ment of staff and medical personnel in a move toward providing interventional car-diology services.

Capitalizing on the regional portion of its name, Dyersburg Regional Medi-cal Center has expanded its market into the Missouri Bootheel. “We recognized this was an area that was underserved and knew we could help alleviate that,” said Youree. “We have added three providers in that area and are looking to add one in Blytheville.”

As with many facilities, physician re-cruitment is an ongoing project. Recently a female OB/GYN, a cardiologist and a nephrologist joined the medical staff. Cur-rent recruitment efforts are on primary and emergency care physicians. “Recruit-ing is something I enjoy which is good since it takes up a lot of my time. Most of our physicians are employees of the hospital so that brings another element, contract ne-gotiations, into the process. It sometimes gets very close to being a sales job and I think we have a good product to sell,” said Youree. “We look for someone attracted to towns the size of Dyersburg. We have to look for the right person and get to know that person because we will not settle for someone we think will not be happy here.”

The hospital has five pillars for which goals are set each year: safety, quality, fi-nance, people and growth. “We work to-ward these goals all the time. When we look at our business plan, one of the first things we evaluate is the progress being made on each goal as well as what we achieved in the year prior. It is a part of our strategic plan and keeps us moving forward,” said Youree. “My goal every day is to reach my goals be they personal, professional or spiritual and I take reaching my goals very personally.”

Youree strives to end his work day by 5:30 pm as much as possible so that he can get home to what he calls his greatest ac-complishment, his family. Wife Carra, who hails from Tupelo, is a dietician at a hospi-tal in McKenzie and is expecting their sec-ond child. Son Luke, is into everything and has impacted Youree’s golf game.

“Our favorite vacation is skiing, which is not surprising since I met my wife Carra when I literally ran into her on the slopes in Steamboat, Colorado while in gradu-ate school,” said Youree. “Besides skiing, I have always played sports in high school and college and play golf as much as I can. Although Carra says I play too much, my golfing has gone downhill since Luke came along and I guess with another one on the way, my golfing career may just end.”

Being a CEO at the age of 31, Youree sees as quite an accomplishment for anyone regardless of the industry. “I have been in the right place and had great opportuni-ties presented to me,” he said. “And I have done a lot with the opportunities I have been presented with.”

HealthcareLeader, continued from page 1


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By JONATHAN DEVIN

West Tennessee-area physicians say they will not change how they do business because government-funded programs have suffered budget cuts. But the tension is in-creasing for a long-term resolution.

The cuts, caused by Congress’ failure to avert sequestration, included a 2 percent cut in Medicare reimbursements that began April 1. Most physicians were disappointed, but not surprised

“If (physicians) are members of the Tennessee Medical Association, they weren’t surprised,” said Wiley Robinson, MD, immediate past president of the Ten-nessee Medical Association. He also runs Inpatient Physicians of the Mid-South, a group of 22 hospitalists.

“We’ve been keeping physicians well informed over the last several years and we’ve been working hard to lobby Congress to either withhold or reduce any cuts in re-imbursements in order to preserve care for Medicare recipients.”

The fear is that at some point physi-cians may begin to retire early, stop ac-cepting new Medicare patients into their practices, or stop seeing Medicare patients altogether, lowering the availability of qual-ity healthcare for aging baby boomers and people with disabilities.

The percentage of Medicare patients in an individual practice varies from specialty to specialty, but Robinson said Medicare re-cipients represent 35 to 50 percent of prac-tices in most specialties.

There are still some questions about how the 2 percent cut will directly affect physicians, particularly if some are not al-ready seeing large amounts of Medicare patients.

“We’re not completely sure how the 2 percent cut is going to affect individual physicians, whether it’s a 2 percent across the board cut, which I don’t believe it is,” Robinson said. “I think it’s a 2 percent cut to CMS. Some physicians might see a small increase, but others might see a larger de-crease.”

Some are staunch in their resolve to continue offering quality healthcare services.

“Although the dollars we’re paid are important to us, it’s not something that we would immediately change the way we practice relative to Medicare patients,” said Chuck Woeppel, COO of UT Medical Group.

“Our goal is to make sure that we stay focused on those people seeking our help and provide continuity of care. Within the group we’re probably going to feel some strain, but that’s not going to change the way we’re practicing at this point in time.”

But down the road, the path is not so clear. Robinson said the real fear behind the recent Medicare cuts is that Congress may change the way it does business altogether.

“If the law continues which is requiring reduction in Medicare cuts as part of what is called the Sustainable Growth Rate package that Congress passed a few years ago, we’re

facing signifi cant reduction of up to 25 or 30 percent,” Robinson said.

“That is huge. If your practice is 50 per-cent Medicare, you can’t make that up. You

can’t reduce your overhead to make that up. No one we’ve talked to in Congress believes that’s going to go through. They believe that new legislation will go through between now and this time next year to change that cut.”

But then, until earlier this year, no one imagined that sequestration might take place either.

“I think the bigger problem is that the government has always found a way to try

Medicare Reimbursement Cuts Create Long-Term Concern


“I think the bigger problem is that the government has always found a way to try to protect physicians, and now with the way the changes are occurring, that could be going away completely.

— Chuck Woeppel, COO, UT Medical Group


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By JONATHAN DEVIN

Doctors may feel a little uncertain about the healthcare market these days, but real estate experts have no doubts about medical offi ces. They are hot prop-erty.

Even sequestration can’t slow a rush of investors hoping to cash in real estate made available by physicians’ groups aligning with hospitals.

“Can anyone explain why the stock market’s gone up 10 per-cent in the last 90 days?” said Larry Jensen, presi-dent and COO of Com-mercial Advisors and an executive committee member of Cushman & Wakefield’s Healthcare Practice Group.

His point is that while it may seem counter-intuitive, the political risks associated with healthcare — namely cuts to Medicare reimbursements and uncertainty about components of the Affordable Care Act — are not stifl ing in-vestments in healthcare real estate.

“We’ve been taught that uncertainty translates into risk, and the more uncertain things are, the less inclined investors will

be to invest,” Jensen said. “That’s just not the case in healthcare.”

Cushman & Wakefi eld/Commercial Advisors developed its Healthcare Practice Group to keep up with a rise in that sec-tor of commercial real estate. There are a number of reasons for the increase, begin-ning with the availability of space due to the trend of physicians aligning with hos-pitals.

“On a local level, what seems to be fueling the real estate transactions is pri-mary healthcare providers, namely Meth-odist, Baptist and, to a lesser extent, Saint Francis going out and purchasing practice groups,” said Jeb Field, vice president of Commercial Advisors.

“Some of those practice groups own their own buildings. There’s some redundancy built into their systems, so (the hospitals) are trying to reallocate those resources across the market for bet-ter coverage.”

And who’s buying?“On the investor side, it’s been pretty

robust,” said Scott Mason, exec manag-ing director and leader of the Healthcare Practice Group for Cushman & Wakefi eld.

“In the last 12 to 18 months, capitalization rates have come down a little bit, so the valuations are quite high.

“Even some of the national REITS are carving out and selling their medical offi ce building components because the prices are so good. Healthcare REITs’ stock values have gone up the most of any component in the REIT structure, prob-ably 40 percent in the last 12 to 18 months in comparison to other stocks.”

REITs, or Real Estate Investment Trusts, are required to distribute the li-on’s share of their earnings as dividends, so they prefer a secure market, explained Rosemarie Fair, principal of One Source Commercial.

As more medical office buildings come under the umbrella of major regional healthcare providers, the investments in those buildings become more secure.

“REITs like the sale and lease back of medical offi ce buildings because the hos-pital would have the master lease on it,” Fair said. “REITs are aggressively looking for medical offi ce buildings. They have already picked the low-hanging fruit of medical offi ces on hospital campuses.”

Fair added that markets in Tennessee, Arkansas and Mississippi are prime mar-kets for REITs because the coastal markets have already been bought up.

When a REIT buys and leases back a medical offi ce building of a physician’s group in alignment with a hospital, it’s usually a win-win for the investors and the sellers, Jensen said, because hospitals want

to get rid of redundant space so they can move services in high-traffi c retail spaces.

“Memphis Orthopedic Group just completed a lease on space that’s under construction at the 4515 Poplar Building,” Jensen said. “It’s an offi ce building, but it’s located for retail. Baptist just bought the postal service building on Union Avenue. They haven’t announced what they’re going to do there, but it’s obvious that they want a location that’s high-traffi c retail where they can do some kind of a physi-cian offi ce building.”

Jensen also pointed out the success of Campbell Clinic in turning the German-town Pkwy/Wolf River Blvd. corridor into prime space for medical offi ces even though there are no immediately adjacent hospitals.

“(Medical patients) are becoming as much customers as patients,” Jensen said. “It’s all about the experience. The health-care system is adapting to that slowly.”

“That’s a microcosm of what’s unfold-ing nationally,” Mason said. “Real estate in healthcare has become strategic. Histor-ically it’s been tactical. It’s been co-located with a hospital. Retail is the right word for it now. You’re looking for high-traffi c, high-visibility locations.”

That’s also true around the region. Gary Taylor, commercial developer for Gary A. Taylor Investment Company, just completed the fi rst LEED silver certifi ed hospital administrative building for Com-munity Health Services in Jackson, Tenn.

The rural market continues to grow, Taylor said, not only because of the high valuation of property but because of grow-ing patient needs.

“When you look at the demograph-ics in West Tennessee, we have one of the highest levels of adult onset diabetes in the nation,” Taylor said. “With that comes a tremendous amount of required care.

“Our market (in Jackson) is a little more concentrated in some areas. Mem-phis is the healthcare mecca of four or fi ve states in this region, and we are a small Memphis because we’re a healthcare mecca of a seven-county region.”

But then there’s a common-sense side to investing in healthcare real estate right now, he said, while other investments are faltering.

“CD rates and treasury rates are at an all-time low,” Taylor said. “If an older couple has $2 million in investments and it’s only drawing them 2 percent, it’s dif-fi cult to live off of. They don’t want a lot of risk, but they want some return.”

West Tenn. Healthcare Real Estate Defi es TrendInvestors grab what’s available after doctors align with hospitals

Larry Jensen

Jeb Field

“Our market (in Jackson) is a little more concentrated in some areas. Memphis is the healthcare mecca of four or fi ve states in this region, and we are a small Memphis because we’re a healthcare mecca of a seven-county region.

— Gary Taylor, commercial developer for Gary A. Taylor Investment Company


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outreach and planning for the Baptist Healing Trust. “The law assumed any-one who was under the 100 percent FPL income threshold would get cov-erage through expanded state Medicaid.” The Supreme Court decision last summer left the low-est income group without any guaranteed assis-tance to secure coverage, explained Uselton.

For states that opted to expand Med-icaid, the federal government will cover 100 percent of costs for the newly en-rolled population from 2014-2016, phas-ing down to 90 percent by 2020 where the match rate is slated to remain. This rate is still significantly higher than what states receive for current Medicaid enrollees, which is 65 percent for TennCare partici-pants.

In the FY 2014 budget presentation prepared by Darin Gordon, Wendy Long, MD, and Casey Dugan of the Tennes-see Health Care Finance Administration (HCFA) and released prior to the gover-nor’s decision on expansion, the group estimated “the net cost of health reform to the state could be approximately $1.2 billion over the first five-and-a-half years (Jan. 1, 2014-June 30, 2019) depend-ing on programmatic/policy decisions.” However, the report added, “The major-ity of that cost is unavoidable and will be incurred by the state regardless of its deci-sion on Medicaid expansion.”

The vast majority of that increased cost over 5.5 years comes from the “Eli-gible but not Enrolled” (EBNE) popula-tion … those who currently qualify for TennCare but who haven’t been on the rolls. This group will pull down the cur-rent 65 percent match rate. The man-date requiring most individuals to carry coverage … coupled with screening tools in the online insurance marketplace that alert individuals to Medicaid eligibility … is anticipated to drive between 60,000-100,000 EBNE individuals to TennCare. The other significant cost to the state is

a new excise tax on health plans that in-cludes Medicaid managed care plans.

Had the state opted to expand TennCare to the 138 percent FPL thresh-old, the HCFA budget report estimated an additional $200 million in costs to the state over the next 5.5 years (state portion of coverage after 2016) and potentially an additional $100 million annually thereaf-ter presuming the 90 percent match rate for the expanded population stayed in place … and perhaps significantly more if the federal government reduced their payment portion in the face of budget pressures down the line. On the flip side, saying ‘no’ to the expansion means Ten-nessee turns down billions of dollars in federal funds over the next few years.

The Tennessee PlanIn announcing his decision on March

27 to say ‘no’ to TennCare expansion, Gov. Haslam unveiled his ideas of how to insure those who would otherwise be left out of coverage assistance.

He said expanding a broken Medic-aid system doesn’t make sense for Ten-nessee. “That’s why I’ve been working toward a third option: to leverage the federal dollars available to our state to transform healthcare in Tennessee with-out expanding our TennCare rolls,” he stated. “I’d like to put in place a program to buy private health insurance for Ten-nesseans that have no other way to get it by using the federal money. I fundamen-tally believe that people having healthcare coverage is better for our citizens and state than people not having coverage.”

The plan, which he said could cover up to 175,000 Tennesseans, calls for “co-pays for those that can afford to pay some-thing so,” as the governor put it, “the user has some skin in the game when it comes to healthcare incentives.” He added the state would work with providers to lower the cost of care and move toward a pay-for-performance model. He also said the plan would have a definitive sunset that could only be renewed with the blessings of the General Assembly when the fed-eral funding decreased. During the period

of 100 percent federal coverage, Gov. Haslam said there was a window of op-portunity to implement true payment re-form and reduce costs by working with the healthcare industry.

“We’d have a one-time opportunity to encourage their cooperation because healthcare providers will know that for the next three years, a portion of the popula-tion which had previously been receiving services with no reimbursement to the hospitals or doctors will now have insur-ance. But those same providers would clearly know that coverage for that popu-lation will go away unless they can prove to us that at the end of three years, when we start paying a percentage of the costs of the new population, our total costs would stay flat,” he said.

The ReactionWhen the ‘no expansion’ decision was

announced, Craig Becker, president of the Tennessee Hospital Association, released a statement noting his organization’s dis-appointment that the governor didn’t feel like he was able to get the information and assurance necessary from the Centers for Medicare & Medicaid to move forward but supportive of the Tennessee Plan.

The need to get more people cov-ered, however, is of critical importance to state hospitals. In negotiating ACA, hospitals gave up a significant chunk of funding with the expectation that most Americans would have insurance cover-age. Without the expanded Medicaid rolls, however, a large portion of the pop-ulation will remain uncovered and unable to pay for services.

“We’re giving away about $1.4 billion a year in cost to care for indigent people who are uninsured,” said Becker, stressing that figure was in hard costs rather than billable fees. “That’s our Achilles’ heel … the uncompensated care is the key to this whole thing.”

Although hopeful Gov. Haslam and CMS will come up with a consensus that the General Assembly will then approve, Becker said the alternative holds grim prospects for not only the hospital indus-try but also the state’s economy. “We’ve already seen one hospital close, and that’s Scott County,” noted Becker. “That’s a small rural hospital, and there are some who say it should close; but I don’t think the people of Scott County would agree.”

He added that like most hospitals, the northeastern Tennessee facility was a major employer for the county. “Health-care provides a lot of jobs and good paying jobs. If you had any other industry with job losses like this, there would be a huge hue and cry,” Becker noted.

Without expanding coverage, he said the THA anticipates additional contrac-tion within the state’s healthcare field. The economic factor, however, is only a part of the bigger picture, Becker said. Those with insurance, he noted, tend to be healthier because they receive primary care services and help managing chronic conditions. One of the biggest frustrations, however, would be losing access to federal funds if a deal isn’t struck soon.

“We’re already paying for this,” Becker said of the dollars the state would pass up if CMS doesn’t approve the Tennessee Plan. “It’s a redistribution of taxes. We’re getting cut $5.6 billion over 10 years,” he continued of money being diverted from the state’s hospitals under ACA. “So those dollars are going to D.C. Then, they distribute them to those who participate (in Medicaid expansion). Why should we send our dollars to California and New York when they should stay here in Tennessee?” he questioned.

Becker added the THA is very open to the governor’s option but nervous that the state could lose an entire year of fund-ing that would provide a necessary cush-ion while healthcare professionals make the changes in payment models and cost-cutting requested by Gov. Haslam. “If we’ve got the coverage and we show un-compensated care going down, then reform becomes a whole lot more palatable and easier to implement for hospitals,” he said.

Michele Johnson, managing attorney for the Tennessee Justice Center, wor-ries about whether or not the Tenness Plan will gain approval. She said CMS has now posted ground rules, and Tennessee is asking for concessions that have already been deemed a non-starter by the federal government. “If they are interested in succeeding in getting federal approval for the plan, they have to pro-pose something that’s real, and they have to negotiate in good faith with the federal government,” Johnson said of Tennessee’s leadership.

She said Gov. Haslam sought clari-fications from the federal government. “CMS responded by issuing guidance — Frequently Asked Questions, Medicaid and the Affordable Care Act: Premium Assistance.” That information, Johnson continued, makes it clear that the gover-nor can do much of what he proposes … but not everything.

Her concern is the state plan includes items like co-pays and an appeals process that differs from Medicaid, which CMS has clearly stated it wouldn’t allow in ne-gotiating Medicaid expansion funds to be used for purchasing insurance in the marketplace. “You can’t expect people to pay a co-pay they can’t afford,” she said of those under 100 percent FPL. On the flip side, the governor has also indicated he didn’t want to give on these items.

“With our administration, either they are really bad at negotiating, or they’re not serious about making this a reality for our state,” Johnson stated.

She continued, “We pray the gover-nor will do all in his power to make health coverage a reality for working Tennessee families. His ability to take advantage of this opportunity is vitally important for all Tennesseans — not just uninsured work-ing citizens but also the rest of us who will benefit from $6.6 billion dollars pumped into our economy and our healthcare in-frastructure.”

None of the Above, continued from page 1

Beth Uselton

Michele Johnson

to protect physicians, and now with the way the changes are occurring, that could be going away completely,” Woeppel said.

“Ultimately that means a very big cut in Medicare. The long-term effects of it could be very substantial. That’s what we have to take a look at. We think there’s going to be some changes in the strategy of how we’re paid. Right now we’re aligning ourselves with the hospitals as best we can so that these large changes can be protected.”

Robinson noted that some practices turned to the hospital systems because they were dealing with large amounts of debt or unsustainable overhead, which could po-tentially weaken them in the face of major Medicare cuts.

Robinson said physicians will not all move to salaried positions. Some will con-tinue on a fee-per-service basis and receive bonuses from CMS for improvements in

quality of service.The current economic climate might

actually be the unraveling of a system that began long ago.

“If you’ve been in practice for 30 years or more, you could say it’s not been like this before,” Robinson said. “I personally saw a huge shift occur when managed care came to town. That really has driven the change.”

UT Medical Group has a joint venture with Le Bonheur and is developing align-ment programs with Methodist Healthcare and The MED. Woeppel said now is a good time for asking questions.

“Are we doing things that we could be doing differently, that will cost less for the pa-tients and us as we move forward?” Woep-pel said. “Maybe there will be significant improvements in reimbursement because we’re lowering the cost of the insurance car-riers including Medicare over time.”

Medicare, continued from page 5


By LyNNE JETER

LITTLE ROCK – When Bill Hefley, MD, was a junior partner at a Little Rock orthopedic practice more than two decades ago, he was tasked with choosing a new infor-mation technology (IT) system to replace an an-tiquated one. After com-pleting due diligence on various options, he played it safe and purchased a new system from the na-tion’s largest vendor.

“It was a complete disaster,” recalled Hefley, noting the software was different than the demonstration version, the trainer was “preoccupied and disinterested,” and customer support was practically non-ex-istent. “Our practice collections soon ap-proached zero. I knew there had to be a better way.”

A hobbyist computer programmer, Hefley devoted his energies to filling the void in the marketplace. From it, he estab-lished MedEvolve as a truly collaborative industry partner to solidify the IT back-bone of medical practices. The success of MedEvolve’s practice management (PM) software – it not only organizes patient databases, scheduling and billing, but also allows extensive data reporting – led to the launch of its revenue cycle management (RCM) division. In a fairly crowded field of practice management software companies, MedEvolve stands out not only in software performance, but especially in a vital yet often overlooked area – customer service.

The Drawing BoardIn searching for a better solution in

the early 1990s, Hefley connected with Pat Cline, president of Clinitec International Inc., then a startup company based in Hor-sham, Pa., and a pioneer in the emerging field of electronic medical records (EMR).

“Intrigued, I became an early inves-tor and a development partner focused on orthopedic clinical content,” he said, not-ing that a small public company acquired Clinitec, which became known as NextGen Healthcare, now one of the world’s lead-ing healthcare IT companies. Hefley, an orthopedic specialist in minimally invasive surgeries for the knee, hip and shoulder using arthroscopic and joint replacement procedures, became a development part-ner with NextGen in 1994, working on the development of clinical content for ortho-pedists. “By 1997, I felt opportunities still existed in the physician PM software indus-try. While most physician practices were utilizing computerized billing and sched-uling, the available systems were DOS- or Unix-based and not taking advantage of the Windows GUI interface, much less the Internet. More importantly, healthcare IT vendors in the physician sector remained notoriously atrocious in delivering sup-port and customer service. I frequently heard my physician friends and colleagues recount horror stories of flawed software

systems with dismal support that were mak-ing it impossible to run their practices suc-cessfully. I remembered my personal bad experience with the large national vendor and the stellar reputation of a small local firm, MBS (Medical Business Services Inc.), which I’d also checked out.”

In 1998, Hefley and Steve Pierce of MBS, a 9-year-old IT firm with a mature DOS-based PM software product, founded MedEvolve with the vision of becoming the first Windows-based physician PM system that employed the Internet and delivered impeccable support and customer service.

“My practice became the beta site for the first version of our new Windows-based PM system,” recalled Hefley, MedEvolve’s president and CEO. “We began to sell our product regionally initially and eventually throughout the United States. We inte-grated our PM product with several spe-cialty-specific EMR systems to reach more physician practices. We continually worked to upgrade the software and deliver new, innovative functionality. By our tenth year, we had several thousand users nationwide.”

With the success of MedEvolve’s PM product, Hefley recognized a growing need among physician clients for expertise in RCM.

“Physicians were struggling with in-creasingly complex third-party payor systems, growing documentation require-ments, mounting government regulations, and threats of audits, fines and imprison-ment,” said Hefley. “Practices were search-ing for a partner with expertise in these areas that could relieve them of the burden of constantly attempting to stay abreast of the ever-changing rules and regulations. Physicians wanted to focus on the practice of medicine and leave the headaches to people that specialized in those matters.”

MedEvolve developed an RCM divi-sion, acquired three small RCM compa-nies, and now has a division that includes experienced practice administrators and dozens of billing and coding specialists.

“With specialization, scale, and great software, we’ve been able to produce some of the best results in the industry – 97 per-cent first-pass claims success, 27 percent average increase in practice revenue, and a 38 percent average reduction in accounts receivable days through MedEvolve RCM services,” he said. “By switching to MedE-volve’s RCM service, providers immedi-ately experience less hassle, lower costs and increased revenue that result in an improved bottom line and peace of mind.”

Health Reform Impact The 2009 American Recovery and

Reinvestment Act (ARRA) authorized the Centers for Medicare & Medicaid Ser-vices (CMS) to award incentive payments to eligible professionals who demonstrated Meaningful Use of a certified electronic health record (EHR) system.

“With the new criteria defined, MedE-volve saw a need for a modern EHR prod-uct designed from the ground up to meet Meaningful Use mandates and finally de-

liver on the industry’s promise of a cutting edge, customized solution that helps prac-tices save time and money and improve the quality of patient care,” said Hefley. “The resulting MedEvolve EHR is fully integrated with the MedEvolve PM system and is designed for the high volume prac-tice with an emphasis on fewer clicks, fewer screens, faster data input and faster data retrieval.”

Hefley has placed a strong emphasis on customer service as the bedrock prin-ciple of MedEvolve. It’s not just a catchy slogan; he rewards employees for “outra-geously excellent customer service” with WE (Whatever, whenever, Exceed expecta-tions) awards. The WE Award comes with a cash bonus and a new title on the em-ployee’s email signature. As a result, em-ployees strive to achieve the distinction of a “Four-time Recipient of the MedEvolve WE Award.”

“In the software business, that means several operators are at the ready for pe-riods of peak call volume,” he said. “We maintain support-to-client ratios above the industry norm. We design our software to be intuitive with online help so that less sup-port is necessary. In the RCM division, we work claims as much as necessary to ensure our providers are fully paid for the services they’ve performed. We’re not some de-

tached, impersonal entity; we partner with the practice in achieving their goals.”

Today, MedEvolve offers PM and EMR software and RCM services to phy-sician partners, and also electronic pre-scribing, data analytics and other ancillary products and services. With four offices, the company covers all specialties and the entire United States, from solo practitio-ners to practices with more than 50 physi-cians. Commitment to service has garnered MedEvolve a reputation of trust among physician partners, allowing the company to rise above the scores of small physician IT companies nationwide.

By year’s end, MedEvolve will out-grow its new corporate headquarters in downtown Little Rock, a refurbished red brick bakery built circa 1919, necessitating yet another expansion.

“We’re now in that sweet spot where we have the expertise and resources to meet our clients’ every need, and yet we remain nimble and able to move quickly in a rapidly changing healthcare environment,” he said. “We’re proud to be privately held so that we aren’t a slave to our stock price and quarterly reports, but rather free to do what’s right for our client. Our foremost concern remains the principles upon which the company was founded – elegant, user-friendly software and unparalleled customer service.”

IT AccelerationMedEvolve finds ‘sweet spot’ niche providing PM and EMR software and RCM services to physician practices nationwide

Dr. Bill Hefley


Shea Thweatt Joins Elmcroft Senior Living Community

Elmcroft Senior Living Community is pleased to welcome Shea Thweatt as their new Community Re-lations Director. She is a Jackson, Tenn. native and graduate of UT in Martin.

West Tennessee Healthcare Announces Changes to Board of Trustees

Leadership at West Tennessee Healthcare (WTH) announced that Sam-mie Arnold concluded his term at the end of March after serving 15 years on the WTH Board of Trustees.

Bobby Arnold, President and CEO of WTH said Sammie Arnold had been instrumental in the growth and success of the health system. His focus on pa-tient safety and clinical quality had been extremely important.

S. Arnold will be succeeded by Mrs. Vicki Burch, who was recently appointed to the Board by the Jackson City Coun-cil. Mrs. Burch currently serves as the President/CEO of West Tennessee Busi-ness College (WTBC), and also serves as President of New World Corporation, the parent corporation of WTBC. She has been associated with WTBC for 35 years and seen much success during that time. Mrs. Burch is very active in the Jack-son community, and has served on many

boards, including serving as President of the West Tennessee Healthcare Founda-tion’s Board of Directors from 2008 to 2011. She was recently named as “2013 Altrusa Woman of the Year” by Altrusa Club, Inc. of Jackson. She is married to Bruce Burch, and she and her husband reside in Jackson.

West Tennessee Healthcare’s Board of Trustees is composed of 5 members, appointed by the City of Jackson and Madison County. Board members serve 5-year terms.

UNOS Ranks Mid-South Transplant Foundation No. 1 in Country for Organs Transplanted

The United Network for Organ Sharing (UNOS) recognized Mid-South Transplant Foundation, the organ pro-curement organization (OPO) serving Western Tennessee, Eastern Arkansas and Northern Mississippi, in its most re-cent quarterly results report as the No. 1 OPO in the country for organs trans-planted per standard criteria donor (typi-cally healthy donors under the age of 60 without multiple health issues). This is the first time for Mid-South Transplant Foundation to achieve this honor.

UNOS data also ranks Mid-South Transplant as the No.1 OPO in the conti-nental United States for the percentage of African American donors in 2012.

Mid-South Transplant Foundation

is one of 58 OPOs across the country, which helps facilitate the procurement of organs from donors and the distribution of transplantable organs from donors to those who are the most suitable recipi-ents and those in the greatest need. The Memphis-based organization is one of the top OPOs in the United States with a strong record of service to the local com-munity.

TCPS to Partner with LifeWings Partners

The Tennessee Center for Patient Safety (TCPS) will be partnering with LifeWings Partners, LLC in 2013 in its on-going effort to make patient safety a pri-ority across the state of Tennessee. The aim of this partnership will be to advance the adoption of TeamSTEPPS, a patient safety program built on the best prac-tices from aviation to improve the reli-ability, safety and quality of care received by patients in Tennessee hospitals. The objectives of TCPS are to accelerate the adoption of evidence-based strategies that improve the safety and quality of care received by patients, and provide training for hospital leaders to advance their organizations’ culture of safety. The TCPS and LifeWings share in their com-mitment to increase patient safety, elimi-nate medical errors, and save lives.

In 1999, the Institute of Medicine (IOM), issued results of a study titled - To Err Is Human. This study stated the fol-lowing: Preventable medical errors ac-count for more deaths each year than breast cancer, automobile accidents or drownings. Poor communication among healthcare workers is the most common cause of these medical errors. Nearly 70 percent of sentinel events have commu-nication cited as a root cause. Despite efforts to change these statistics, com-munication failure has been cited as the number one contributing factor in reported sentinel events, over the past decade.

SVMIC Declares $10.0 M Dividend

In keeping with the tradition of a mutually owned company, the Board of Directors of SVMIC has declared a divi-dend of $10 million to be returned to all policyholders renewing in the twelve-month period following May 15, 2013.

This is the sixth consecutive year SVMIC has declared dividends for its physician policyholders. Policyholders will receive the dividend in the form of a credit on the renewal premium. Ad-ditionally, no adjustments were made for rates on policies renewing during this time.

John Mize, Chief Executive Officer, said that this represented the benefit of a mutual insurance company.

Since SVMIC’s inception, a total of $328 million has been returned to physi-cian policyholders.

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