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December 2009 >> $5 PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 ONLINE: M.MEMPHIS MEDICAL NEWS.COM ON ROUNDS PRINTED ON RECYCLED PAPER July 2014 >> $5 VA Offers Attractive Alternatives to Private Practice Is understaffing caused by inability to hire physicians? The Memphis VA Hospital has been flagged as part of the ongoing Veterans Administra- tion investigation involving long wait time for care. In order to partially ease that situation, pa- tients have now been given the green light to use VA funds to see local physicians, rather than wait their turn at the VA. ... 11 Why Doctors Should Become Involved in the Political Process Manoj Jain, MD, shares with readers his thoughts on the importance of a community- wide vision for area healthcare and responsible living and how a voice from the medical profession is needed to achieve those goals ... 15 FOCUS TOPICS PEDIATRICS DERMATOLOGY BY JUDY OTTO There’s always been something special about Saint Francis Hospital-Bartlett, ac- cording to Jeremy Clark, its CEO. Clark says it’s more than just the youthful energy and enthusiasm that makes the hospital – currently celebrating its 10 th anniversary — a unique source of pride for the firm that owns it. Although there are more than 80 hos- pitals in Tenet Healthcare Corporation’s national chain, “there has always been a buzz about Saint Francis-Bartlett within the company,” Clark said. “It was one that (CONTINUED ON PAGE 10) HealthcareLeader Jeremy Clark, CEO, Saint Francis Hospital-Bartlett Polishing a jewel in Tenet’s crown Kathryn Schwarzenberger, MD PAGE 3 PHYSICIAN SPOTLIGHT The Car. The City. One of a kind. Hospital Acquisitions Of Practices Apparently Slowing in Memphis Merged Gastro One remaining independent BY GINGER H. PORTER Healthcare systems across the United States have been express- purchasing physician practices in great quantity during the last two or three years. Now, with the Medical Group Management As- sociation estimating the median loss for employing a physician at $176,463 each in 2013, national experts predict a purchase slowdown across the country as forces stabilize. In Memphis, Methodist Le Bonheur Health Systems is taking time out from its acquisitions (250-plus providers representing 26 specialties) to work on some basics. “We started acquiring practices at the request of physicians wanting us to come up with a new business model,” said Bill Breen, senior vice president of physician alignment, Methodist. “The market kind of out-requested our ability to perform on this, and the result strained our infrastructure. We wanted to get that right-sided quickly.” (CONTINUED ON PAGE 8)
Page 1: Memphis Medical News July 2014

December 2009 >> $5







July 2014 >> $5

VA Offers Attractive Alternatives to Private PracticeIs understaffi ng caused by inability to hire physicians?

The Memphis VA Hospital has been fl agged as part of the ongoing Veterans Administra-tion investigation involving long wait time for care. In order to partially ease that situation, pa-tients have now been given the green light to use VA funds to see local physicians, rather than wait their turn at the VA. ... 11

Why Doctors Should Become Involved in the Political Process

Manoj Jain, MD, shares with readers his thoughts on the importance of a community-wide vision for area healthcare and responsible living and how a voice from the medical profession is needed to achieve those goals ... 15



There’s always been something special about Saint Francis Hospital-Bartlett, ac-cording to Jeremy Clark, its CEO.

Clark says it’s more than just the youthful energy and enthusiasm that makes the hospital – currently celebrating its 10th

anniversary — a unique source of pride for the fi rm that owns it.

Although there are more than 80 hos-pitals in Tenet Healthcare Corporation’s national chain, “there has always been a buzz about Saint Francis-Bartlett within the company,” Clark said. “It was one that



Jeremy Clark, CEO, Saint Francis Hospital-BartlettPolishing a jewel in Tenet’s crown

Kathryn Schwarzenberger, MD



The Car. The City. One of a kind.

Hospital Acquisitions Of Practices Apparently Slowing in MemphisMerged Gastro One remaining independent


Healthcare systems across the United States have been express-purchasing physician practices in great quantity during the last two or three years. Now, with the Medical Group Management As-sociation estimating the median loss for employing a physician at $176,463 each in 2013, national experts predict a purchase slowdown across the country as forces stabilize.

In Memphis, Methodist Le Bonheur Health Systems is taking time out from its acquisitions (250-plus providers representing 26 specialties) to work on some basics.

“We started acquiring practices at the request of physicians wanting us to come up with a new business model,” said Bill Breen, senior vice president of physician alignment, Methodist. “The market kind of out-requested our ability to perform on this, and the result strained our infrastructure. We wanted to get that right-sided quickly.”


Page 2: Memphis Medical News July 2014

2 > JULY 2014 m e m p h i s m e d i c a l n e w s . c o m

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Page 3: Memphis Medical News July 2014

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Just over a year ago, Kathryn Schwarzenberger, MD, left her job as pro-fessor of medicine in the Division of Der-matology at the University of Vermont College of Medicine. Her destination was the University of Tennessee Health Sci-ence Center, where in May 2013 she took over as the first chair of the new Kaplan-Amonette Department of Dermatology in the College of Medicine.

The department, upgraded from a division under the leadership of David Stern, MD, executive dean of the College of Medicine, takes its name from three supporters and benefactors – Robert Ka-plan, MD; Rex Amonette, MD; and his wife, Johnnie Amonette, chairman of the Board of Directors of the UTHSC Foun-dation.

Schwarzenberger arrived at UTHSC amid a swirl of change. Within the new department, located in the same build-ing as the Hamilton Eye Institute at 930 Madison, is a new dermatopathology lab-oratory, UT DermPath. Also, the facility includes a new UT Dermatology Clinic.

Born in Texas, Schwarzenberger lived in several parts of the country grow-ing up, as her father was in the defense industry. Her mother was a teacher. The doctor earned her medical degree at the University of Texas Medical Branch in Galveston and completed residencies at Duke.

At the request of Memphis Medical News, Schwarzenberger took time to an-swer questions about her upbringing, her career and even a question about her rather long last name.

What kinds of things did you like to do as a youngster?

I guess I was a tomboy, although I never set out to be one. We had a wonder-ful group of kids in our small town, most of whom were boys, so we played a lot of sports. I recall playing baseball and riding our bikes all over the place. I also loved to read and spent many afternoons lost in a book. Life seemed a bit simpler back then.

When and why did you decide on a career in medicine?

My mother always wanted to be a doctor, and she swore that she used to whisper “be a doctor” in my ear every night when I was asleep. I learned to love science from a special teacher in sixth grade; he challenged me to think in a way few other teachers ever have. As I pro-gressed through my education, I consid-ered other career opportunities. I actually started college as journalism major, but I always felt myself drawn back to medicine.

Why did you decide on dermatology as a specialty?

I was halfway through my internal medicine residency when I realized that the diseases that really caught my inter-est, such as autoimmune and infectious diseases, often involve the skin. I was amazed by the skill of some of the derma-tologists I worked with who could walk in the room, look at the patient and make a diagnosis just by looking at the skin. I was also impressed by the fact that most of the dermatologists I know really, really love their jobs.

When you were at the Vermont College of Medicine, how did you learn that UTHSC was interested in bringing you to Memphis?

Dr. Rex Amonette, a phenomenal

Memphis dermatologist and one of our profession’s most respected senior mem-bers, sought me out at a meeting and told me about an “amazing opportunity in Memphis” that he thought I might want to consider. He was right! Our executive dean, Dr. David Stern, took over the re-cruitment, after which I had no choice but to say “yes!”

Were you ready for the next stage of your career, or was it difficult to tear yourself away from Vermont?

We loved our time in Vermont, but both my husband, Dr. Roger Young, an OB/GYN, and I were excited about the many opportunities for personal and pro-

fessional growth that we saw here in Mem-phis. The University of Tennessee Health Science Center is an amazing place, with many talented physicians and researchers with whom we collaborate. We both hope that we can do some good here.

What are your feelings about Memphis now, a year or so later?

We love it here. It is a beautiful city (OK, in full disclosure, I am not thrilled with some of the drivers here) and I think Memphians are some of the most sincere and kind people I have ever had the privi-lege of being with. And who can argue with the ribs?

You arrived to oversee a new Department of Dermatology, a new dermatopathology laboratory and a new UT Dermatology Clinic. Sounds like a daunting challenge. How would you describe it?

It is a privilege to work here. I have wonderful colleagues who share my pas-sion for building a well-rounded de-partment that will help provide for the dermatologic needs of all of Memphis and the surrounding areas.

Has any of them been a bigger or more time-consuming challenge than the others?

No, not really. On any given day, my energies may be focused on one aspect of the department more than another. When I first arrived, my main thrust was getting our new clinic at 930 Madison built and our clinical enterprise fully launched. Now that our clinic is up and running and we

Kathryn Schwarzenberger, MDDermatologist Oversees Sweeping Changes at UTHSC


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Page 4: Memphis Medical News July 2014

4 > JULY 2014 m e m p h i s m e d i c a l n e w s . c o m

It happened to her the same way it happens to many women. The Baptist mobile mammography vehicle was in the parking lot of her employer, Medtronic, and it was time for her check-up. She de-cided to take a few minutes and get the routine screening. After all, she was a race chair volunteer for Komen – she of all people should set a good example. This young mother in her early 30’s with two children and no family history of cancer expected free and clear results.

But afterwards . . . she got the call. She had breast cancer. Scary news in-deed. Fortunately, it’s less scary when caught early. There have been major im-provements in the treatment of early stage breast cancer in the last three decades. In 1980, survival chances were about 80 per-cent. Today, that percentage is 99 per-cent. And that’s the number one reason for women today to get regular screenings

or diagnostic mammograms.

How Big is the Problem?Breast cancer treatment has come a

long way, but still in 2014 there will be 40,000 breast cancer deaths in the United States. One in eight women in the United States will be diagnosed with breast can-cer in their lifetime. Older females are the most at-risk. In the state of Tennessee, it is estimated that for every 100,000 women, 129 will be diagnosed with breast cancer.

Breast cancer in men is rare, but it happens. It is estimated that 430 men in the United States will die from breast can-cer in 2014.

The biggest problem in the Mid-South and anywhere else is that poverty and breast cancer go hand-in-hand. The primary reason seems to be that women in impoverished areas don’t get the regu-lar screenings they need and even when a problem is detected, they hold back. That’s why the Memphis Komen orga-nization has been working since 1992 to raise money and get grants to the various medical entities that can assist the local underserved female population.

This past May, Memphis Komen awarded over $500,000 in grants to Baptist Memorial Hospital for Women, Regional

One Health, Julie B. Baier Foundation via the Mroz Baier Breast Care Clinic, Baptist Memorial DeSoto, Methodist Healthcare Foundation, Church Health Center, Bap-tist Medical Group, Alliance Charitable Foundation, New Bethel M. B. Church and Urban Health Education and Sup-port Services. Because of this, more than 6,500 people will receive breast care and treatment and over 17,000 will receive educational materials.

Speaking of grants, it’s no secret that the national Komen organization went through a public relations nightmare in 2012 when it announced a decision to dis-continue giving voluntary fi nancial grants to Planned Parenthood. There was a huge shake-up with the organization’s top executives. Fundraising suffered and participation in their renowned Race for the Cure® slowed down signifi cantly. Be-cause of that nightmare they reversed the decision and hired a new CEO, Dr. Judith Salerno, then the COO of the Institute of

Medicine. There seems to be dueling own-ership of Komen’s funding troubles. In ad-dition to Planned Parenthood supporters who continue to hold a grudge, pro-lifers are not happy that Komen reinstated their Planned Parenthood grants.

Regardless, the group has since been on the road to recovery. What the Mem-phis Komen Affi liate executive director, Elaine Hare, wants you to know about this is that the local affi liates are independently owned and operated – like a franchise. They have a separate grants committee that decides how grant funds will be al-located. Since the local Planned Parent-hood organization has never applied for a grant from the local Komen organization, it was never involved in a decision to deny a grant. Komen Memphis has suffered along with the entire Komen brand, she says. However, they are gradually re-gaining ground.


DonateYour donations help Komen Mem-

phis reach their primary goal of getting breast care to women in our local under-served areas. 75 percent of the money they receive goes to grants as outlined above. The remaining 25 percent goes to research. There are many ways to do-nate and all are outlined on their website: www.komenmemphis.org/make-a-do-nation. Donations help save the lives of all the women in your life – mothers, sisters, wives, daughters, aunts, cousins, nieces, friends and neighbors!

Participate in the Race This year’s race will take place on

Saturday, October 25th, at 9 a.m., at Car-riage Crossing in Collierville. It is the 22nd annual race put on by Komen Memphis. This year’s fundraising goal is $500,000 and fundraisers can earn prizes such as luggage, power tools, cookware and TVs. Check out the website for more informa-tion: www.komenmemphis.org/komen-race-for-the-cure

Become a RACE SPONSORWhy not have your organization step

up and help sponsor this upcoming race? For more information, please contact Mandy Powell at 901-757-8686.

VOLUNTEERVolunteers are the lifeline of this or-

ganization. You can assist with outreach or offi ce-based projects or with special events. There’s a volunteer application online at:


Do you have a favorite non-profi t or charity you’d like to see spotlighted in Memphis on the Mend? Send it to me at [email protected].

Komen Memphis – Saving Lives in the Mid-South Since 1992



Get the current online edition of Memphis

Medical News delivered to

your desktop.



Page 5: Memphis Medical News July 2014

m e m p h i s m e d i c a l n e w s . c o m JULY 2014 > 5

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*All loans are subject to credit and collateral approval. Some restrictions apply. For a first lien, non-escrowed 30-year term conventional loan to be held in First Tennessee’s portfolio, the APR may be as low as 3.99%. When the maximum CLTV does not exceed 100%, you have a minimum FICO of 720, a new or existing First Tennessee deposit account with enrollment in payment auto-debit. Rate offer good for applications through 7/31/14. At 3.99% APR for 30 years, your payment for a $250,000 loan would be $1097.75 per month. The payment does not include amounts for taxes, property insurance or flood insurance, where required. Payment amounts will vary if you select a different term or qualify for a different rate. Rates and terms are based on repayment period, loan amount and borrower qualifications and are subject to change. Medical professional defined as an M.D., D.O., or O.M.S. To qualify for the loan, one of the following must be completed: Receive a financial plan prepared by one of First Tennessee Bank’s CERTIFIED FINANCIAL PLANNER™ professionals; have an appointment with an investment adviser from FTB Advisors, Inc.; or have a trust business development officer from First Tennessee Bank work with you and your attorney or accountant to prepare an estate plan for you. © 2014 First Tennessee Bank National Association. www.firsttennessee.com


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Page 6: Memphis Medical News July 2014

6 > JULY 2014 m e m p h i s m e d i c a l n e w s . c o m

By GINGER H. PORTER The emergence of a steel frame on the

east side of Baptist Memphis, adjacent to Baptist Hospital for Women, marks that health system’s most aggressive venture into pediatrics. The four-story pediatric wing will be completed in phases, with an existing pediatric emergency department moving there to open in January. The hos-pital system has also hired its first pediatric surgeon.

“Our pediatricians, our pediatric spe-cialists, our moms and dads have continu-ously asked for this,” said Anita Vaughn, RN, BA, MPA, administrator and chief ex-ecutive officer, Baptist Memorial Hospital for Women. “We’ve been open 12 years, delivered 65,000 babies, and we want to be able to provide that continuum of care in east Memphis.”

The new surgeon, Fawn Lewis, MD, has just started and will be spearheading a pediatric surgery initiative in phases as well as playing a key role in developing the pediatric program. She will serve the entire 14-hospital sys-tem, but most of her prac-tice will be concentrated at Baptist Memorial Hos-pital for Women.

Lewis came from Nemours Children’s Clinic in Pensacola, Fla., where she served as division chief of pediatric surgery. She also was medical director of pediatric trauma services at Sacred Heart Hospital in Pensacola. She has been in pediatric sur-gery 11 years and trained in general surgery five years previously. She is also educated in surgical critical care and ECMO (extra-corporeal membrane oxygenation). After a nationwide search for a general surgeon, Vaughn described Lewis as an “ideal fit.”

“The opportunity here is very exciting to be able to bring additional services to a market that certainly has a need,” Lewis said. “Le Bonheur and St. Jude have excel-lent services, but the area demand outstrips the need they can provide coverage for, so we can meet the need of the Baptist com-munity and the eastern portion of Memphis providing services that were difficult to ob-tain previously.”

The goal for Baptist is to create an ex-perience where general pediatric services and subspecialty offerings are integrated and access is convenient for both the pe-diatrician, the patient and the parent — a seamless experience. It can be frustrating to get all of that done well in a system, Lewis explained. She says surgery areas will in-clude chest, abdomen, head and neck. “Re-ally everything except for the heart, brain and bones. We’ll do everything else.”

There are 12 inpatient pediatric rooms at Baptist Hospital for Women. The pediat-

ric emergency department is housed within the adult emergency department at Baptist Memphis. An outpatient pediatric diagnos-tic area, P.D. Perch, exists in the women’s hospital for now.

The expanded emergency department will grow from five exam rooms to eight within the new building. The ED and P.D. Perch area will occupy the 18,500-square-foot bottom floor of the new pediatric wing. The 2nd through 4th floors are for future expansion (a total of 36,000 square feet for the three floors). Within the next year after the opening of the emergency department in January, Baptist will be moving the inpa-tient rooms to the new area and filing for a certificate of need for a pediatric intensive care unit.

Baptist officials say the hospital is not in competition with existing pediatric services within the area.

“We are not competing with Le Bon-heur for the very high-end and acute-care services,” Vaughn said. “The hearts, the neuro — those type things. But for the general care we as parents all face at a time when a fever isn’t being controlled, asthma, dehydration, they need to be seen in the emergency room and some need to be ad-mitted for further stabilizing there. That’s where we are.”

Baptist has 120 pediatric physicians on its roster, both general and in such special-ties as ophthalmology, cardiology, endocri-nology, general surgery, otolaryngology, orthopedics and neurology -- to name a few. Vaughn explained that other services will be evaluated as they move forward and plan strategically while construction contin-ues.

“We have tremendous support from the community — a family advisory group, a physician and clinical advisory group and just community parents and pediatricians who have been a tremendous support,” Vaughn said. “We have wanted this to be a women’s and children’s hospital from day one, so being this close to meeting our dream is very exciting.”

A survey of Methodist Le Bonheur Germantown, the closest pediatric presence to Baptist in east Memphis, showed it had 12 pediatric inpatient beds and pediatric emergency and urgent care services. Sara Burnett, a Le Bonheur spokesperson, said pediatric patients triaged there and needing an additional level of care are transferred to Le Bonheur Hospital in the medical center. She also said there will be a Le Bonheur Children’s Outpatient Center East opening in 2016. The center will employ 25 people and be near Baptist on Humphreys Boule-vard. It will include pediatric clinics, pediat-ric rehabilitation, diagnostic imaging (MRI, CT), general diagnostics and therapies for pediatric patients, as well as a dozen special-ties. Le Bonheur officials were unavailable to comment.

Baptist Awaits New Pediatric WingSystem’s first pediatric surgeon already on board

Dr. Fawn Lewis

Marketing Where Customers Are

If you are reading this column, you probably fit one of these descriptions: physician, advance practice registered nurse, physician assistant, hospital administrator, practice administrator, Medical Group Management Association member, corporate healthcare executive or healthcare association leader. At least, that is the subscriber list detailed on the Memphis Medical News webpage that solicits advertisers.

With that group in mind, I recently profiled the advertisers over five issues of Memphis Medical News to get a feel for whether those advertising make sense given the people who read the MMN – those the ads are targeting.

The breakdown is pretty interesting. Fifty-five percent of the ads are for medical practices. Nineteen percent of the ads are for medical services (services within the medical realm that a medical practice can use); financial services ads make up nine percent of the ads. Ads for cars, entertainment and real estate each account for 4.5 percent of the ads. And rounding out the list are ads for special events, personnel ads and law firm ads. Nothing seems out of line. In fact, I can make an argument for every one of those categories trying to reach one or more of the readership groups listed by the publication.

The first half of one of the most basic rules of marketing is to go where your potential customers are. That applies to where you advertise, what kind of community events you get involved with, where you try to get stories placed in the media and which bloggers you might want on your side. Social media has a little different twist to it, because in that case, the goal is to post/discuss/share things that keep customers coming back to your posts. That might mean your social channels need to be divided between target audiences, because what an end-user patient might be interested in is different from what a referring doctor might be interested in.

Back to the ads. While the advertisers didn’t surprise me, the tone of quite a few of the ads did. Many of the ads offered by medical practices give a basic message about what the practice does and could just as easily been in any other kind of publication. Those ads are more consumer awareness oriented than anything else: come to Practice A/Hospital B for your specific ailment. Trouble is; average consumers looking for treatment are not in the reader profile of the publication. I would guess the leap of faith is that other medical practices will see these ads and brand awareness will be developed in a way that referrals and references might be generated. Orthopedic doctors learn about cancer practices, cardiologists learn about eye care, family physicians learn about neurology groups, and so on.

The second half of that basic rule of marketing about “go where your customers are” is to “give them a call to action.”

My point is that brand awareness is good. Brand awareness with a target audience who can do something with that awareness is even better. Brand awareness with a direct call to action as to what the target audience should do is best. Business-to-Business advertising is different than consumer advertising. The awareness you are trying to raise in a B-to-B publication is different than in a consumer publication. The difference can be subtle or the message can be very direct, but it does need to be different. “Fellow doctors, if your oncology patient needs an orthopedist, have them call us because we can help.” Maybe not that direct, but you get the idea.

As for the 45 percent of advertisers in this publication who are selling cars, theater tickets, banking services, legal services, office space and medical support services; well done. The readers here are your direct business or personal consumers. You know where your customers are, and the call to action is clear.

— Ralph Berry, Executive Vice President, Public Relations,

Sullivan Branding,[email protected]

To learn more about Ralph Berry or Sullivan Branding, visit www.sullivanbranding.com

Your Practice – Your Brand

Page 7: Memphis Medical News July 2014

m e m p h i s m e d i c a l n e w s . c o m JULY 2014 > 7


In mid-spring, the Federation of State Medical Boards released a long-awaited model policy that provides the group’s first guidance on telemedicine since the early 2000s.

Even though some healthcare pro-viders may underrate its significance, it’s widely assumed that all licensing boards will soon adopt or borrow liberally from the fed-eration’s “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine,” which covers details from e-prescribing, to patient disclosures, to charting/record keeping.

More specifically, the new policy pro-vides guidance to state medical boards regu-lating the use of telemedicine technologies and the practice of medicine, and educates licensees to the appropriate standards of care in the patient-direct delivery of medi-cal services via telemedicine technologies, noted Mike Sacopulos, JD, president of Medical Risk Institute.

“This model policy casts a broad net,” he emphasized, “and will impact tens of thousands of physicians.”

Application of the Model RuleThis policy applies to “…the practice of

medicine using electronic communication, information technology or other means of interaction between a licensee (physician) in one location and a patient in another loca-tion with or without an intervening health-care provider,” said Sacopulos.

“The rule then goes on to state that typically it involves the application of the secure video conference technology,” he said. “However, video conferencing isn’t a mandatory element of telemedicine under the model rule. What’s clearly excluded: communication between physicians. It seems that certain uses of a patient portal would fall under the model policy.”

Establishing Physician Patient Relationship

The model policy begins by stating that it may be difficult in some circumstances to precisely define when a physician-patient relationship is established. It then goes on to state that a relationship “… is clearly estab-lished when a physician agrees to undertake a diagnosis and treatment of the patient and the patient agrees to be treated.”

“Physicians are next cautioned to verify and authenticate the location and identity of the patient in question,” he said. “Then they must validate their own identity and credentials to the remote pa-tient. Finally, they must obtain appropri-ate consents and requests after disclosures from the patient.”

LicensureThe model policy plainly states “a phy-

sician must be licensed by, or under the ju-

risdiction of, the medical board of the state where the patient is located,” said Sacopu-los.

Online Disclosures and Necessary Practice Infrastructure

The model policy spends a good amount of time describing what a practice has to do when involving itself in telemedi-cine, and requires half a dozen disclosures to achieve informed consent in telemedi-cine, ranging from hold harmless clauses for technical failure to disclosure of physicians credentials, said Sacopulos.

“The model policy then moves on to mandate the physician to have a continuity of care plan and an emergency service plan in place for patients engaging via telemedi-cine,” he said.

The model policy calls for written poli-cies and procedures to be created by the practice to address seven different areas, ranging from privacy to quality and over-sight mechanisms. It also mandates that all physician/patient email and other patient electronic communications be stored in the patient’s medical record.

“Here’s a requirement that seems to directly prohibit texting patients,” he said. “Although texting may be allowed, some-how the text messages must be secure and incorporated into the patient chart under this model rule. Finally, the model rule sets forth 14 types of disclosures that should be made on physicians providing medical services using telemedicine technologies. These disclosures would seem to need to be set forth on a website.”

LinksAn interesting part of the model policy

states that physician advertising and links on websites can be considered an “implied endorsement” of the information, services or products offered from those sites, said Sacopulos.

“Here, the model policy is address-ing revenue generate from sites and non-compensated links that providers place on websites,” he said. “Although not fully ex-plained, there seem to be significant legal implications for ‘implied endorsements’ on physician websites.”

PrescribingThe model policy finally turns to pre-

scribing for patients, noted Sacopulos. “Following actions we’ve seen by

boards such as the Oklahoma Board of Medicine, tight restrictions as to patient identity and pharmacy selection are set forth,” he added. “Physicians would be wise to implement the disclosure and web notices set forth in the model policy even if they consider their practice outside the definition of telemedicine. It seems certain that we’ll see state medical boards begin to adopt and use all or at least a large part of the model policy in the near future.”

Incorporating the New Telemedicine Model Policy

Page 8: Memphis Medical News July 2014

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REPRINTS: Want a reprint of a Medical News article to frame? A PDF to enhance your marketing materials? Email [email protected] for information.

Breen explained that Methodist is financially prepared to carry the burden of the purchases. It’s the billing and col-lecting, electronic medical records, qual-ity initiatives, and risk management that they want to optimize for all the groups of PCG (Primary Care Group), SPG (Spe-cialty Care Group) and UTMP (Univer-sity of Tennessee Methodist Physicians) within their umbrellas.

Daniel Gentry, PhD, MHA, profes-sor and director of health systems man-agement and policy at the University of Memphis, said this situation is not like the 1990s where hospitals grossly overpaid for physician practices and the system unrav-eled in response to managed care, health maintenance organizations and preferred provider organizations.

“This time around, hospitals have tried to look at the data and put a more realistic value on physician practices. There is also a consensus among policy makers, researchers and administration practitioners and leaders—this is more of a long term investment,” he said.

St. Francis currently employs about 60 physicians and just acquired Memphis Surgery Associates. They have no plans to slow down or stop acquiring groups, according to Marilynn Robinson, senior vice president.

Jim Boswell, president and CEO of Baptist Medical Group and vice president of physician services for Baptist Memorial Health Care, said Baptist is being more strategic about its purchases and is slow-ing down from its “hyper-growth” period of the last two to three years. BMG now employs 550 providers representing 44 specialties.

“We will continue to recruit to our existing practices, strategically acquire practices as necessary, make strategic in-vestments in operations in order to main-tain the highest performing physician group practice with the best physicians in our market in our three-state region,” he said.

Boswell also echoed Methodist’s initiative to focus on infrastructure, ref-erencing the implementation of Baptist OneCare medical records systems and de-velopment of a new primary care model in midtown.

“Managing practices are not what physicians are trained to do – dealing with insurance companies and electronic health records and other infrastructure,” Gentry said. “The amount of money and time private practices have to invest to keep up is incredibly challenging. And, the younger generation of doctors wants better work/life balance anyway.”

The challenges for hospitals involved in practice purchases are not just manage-rial, but cultural as well.

“All of these practices are entrepre-neurial businesses that don’t find com-bining with a health system to be easy or natural,” said Breen. “Doctors were en-trepreneurs in a day when being a doctor didn’t mean being three extra FTEs to get the administrative work done. We’ve been about a cultural effort to make the physi-cians feel they are part of the health sys-tem. We recognize how hard it is to make that journey.”

As everyone adapts, has the Memphis market achieved “purchase saturation?” Dr. Gentry said that some markets across the country are reaching a threshold, as all the doctors who want their practices pur-chased have been bought. In Memphis, we may be headed that direction eventu-ally, but recent purchases belie that we are there now.

For those who want to maintain inde-pendence, there are other avenues.

Consolidated Medical Practices of Memphis (CPMC), PLLC, was created in 2008 to maintain independence from competing markets in the industry while addressing financial issues faced by private practice doctors. Fifteen physicians/physi-cian groups are a part of CPMC.

Then, there are mergers of large practices. The recent joining of Gastro One and Memphis Gastroenterology Group is not an attempt to remain inde-pendent of hospital systems, said Michael Dragutsky, MD, but to retain flexibility for patients—citing their doctors hav-ing privileges at Baptist, Methodist and St. Francis. The practice is retaining the name Gastro One.

“We each feel that the Memphis area will benefit from a regional independent practice of our size as is the trend in most major metro areas. Independence means the highest level of flexibility for our pa-tients in terms of facilities, insurance and choice,” he said. “It follows a national GI services trend of creating regional ambu-latory service centers with deep resources for treatment, research and subspecial-ties.”

Dr. Gentry agreed that there are sig-nificant mergers within specialties in other markets, particularly trending in gastro-enterology groups and orthopedic groups. He explained the power in numbers re-quired to negotiate with large insurance companies and health systems is a plus for mergers, as well as the efficiencies to be gained in management and infrastructure.

Richard Aycock, MD, of Memphis Gastroenterology Group, said there had been talk about a merger at this level for a few years, and the combination with Gastro One presented a great fit for both practices. Both Gastro One and Mem-phis Gastroenterology Group had been approached by hospitals before and had passed on the opportunities.

Hospital Acquisitions of Practices Apparently Slowing in Memphis, continued from page 1

T Cell Based Therapy Reveals Promise by Peter W. Carter, MD

In 1890 the German physician Paul Erlich began immunologic research in Berlin ( later in Frankfurt ), at the Institute of Experimental Therapy. He did so at the entreaty of Dr. Robert Koch. The hope was that they would be able to ascertain the mechanisms by which innate immunity could be enhanced in such a way that it would be an effective treatment for both infectious and neoplastic diseases. At the time they possessed neither the knowledge, nor the technology to make this approach a reality. Nevertheless, a century on, the situation has improved considerably. The latest success in early clinical studies has taken a novel approach by using genetically modified T cells. Most of the initial research has been done at the NCI and University of Pennsylvania in the setting of advanced lymphoid neoplasms.

The procedure involves removing T cells from individual patients after which they are bioengineered. The lymphocytes are then genetically modified so as to express an anti-CD 19 chimeric antigen receptor which enables the cells to specifically target the B cell antigen CD 19 which is present on many lymphoid malignancies. After infusion back to the patient, they bind to tumor cells and simultaneously undergo expansion and rapid proliferation. The antitumor activity persists for many months.

Out of one group of 13 patients with advanced diffuse large B cell lymphoma, primary mediastinal lymphoma and chronic lymphocytic leukemia, there were 5 partial and 7 complete responses. The primary toxicity consisted of acute cytokine release syndrome and activation of macrophages which induced high fevers, hypotension, and dyspnea. Interestingly, the effects of the cytokine cascade responded well to infusions of the anti-Interleukin-6 monoclonal antibody Tocilizumab.

The results of 2 additional trials with a total of 32 CLL patients have reported 15 partial and 7 complete responses. Similar outcomes have been seen in adults and children with B cell ALL. The use of chimeric antigen receptor T cells (CART therapy), albeit experimental, leads to several conclusions which are compelling and provocative. One significant finding is the realization that it is indeed possible to eradicate large volume tumors using an “all biological approach.” Moreover, the toxicity, though pronounced, is both reversible and short-lived. Several patients with malignant lymphoma and CLL who have received CART therapy have remained disease-free for close to 4 years. These results are in contrast to the unrefined and nonspecific immunotherapy that was attempted during the 1970’s. After the failure of those trials, it was felt that immune-based treatment for malignancy was unlikely to ever be a realistic option. Consequently, a myriad of aggressive, high-dose chemotherapy/bone marrow transplant protocols were designed and came to be regarded as the most promising treatment for advanced, refractory malignancies. Ultimately, this proved not to be the case and yet ,owing to remarkable advances in genetic engineering and development of monoclonal antibody therapy during the past 2 decades, the immunologic approach favored by Dr. Ehrlich has finally become possible.

Clinical research with the new adoptive T cell method is ongoing and given the promising results achieved thus far, optimism is justified. Furthermore, the results suggest that over the next few years biological therapies will increasingly be on the ascendant, while concurrently, the older cytotoxic chemotherapy based programs will follow a similar but inverse path.


Memphis Bartlett Dyersburg Southaven Oxford

Dr. Carter is an oncologist who has practiced in Tennessee for more than

two decades. He joined The Family Cancer Center in the fall of 2009.

Page 9: Memphis Medical News July 2014

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people were always talking about because of the growth it was seeing and the care and service it was delivering to its patients. It was a real honor for me to be selected as this hospital’s CEO in 2012.”

Clark is proud of the role he has played in its recent growth, as well. He points to a newly completed two-year ex-pansion that effectively doubled the size of the hospital, adding operating suites and a cardiac cath lab and an expanded ICU, and increasing the number of licensed beds to 196, with 33 beds in the ER. The hospital recently added the latest Intuitive da Vinci® robotic surgical system and also has gained national certifi cation for its chest pain center.

Such strides have not gone unno-ticed. As a result, Clark and his crew have been collecting awards and recognition from such organizations as the American Heart Association; the Leapfrog Group, which issued one of only four “A” grades

awarded to Memphis hospitals; and Con-sumer Reports, which assessed Saint Fran-cis-Bartlett the highest safety score of any Memphis-area hospital.

“Given the high-quality hospitals that are in this area, this is real kudos,” Clark said. “It’s exciting for me to see that the hard work we’re putting into the quality of care we’re delivering is paying off.”

He says overall development of ser-vices is also exciting.

“We’re growing our robotic surgery program and attracting some of the top general surgeons, urologists and OB/GYNs in Memphis to practice at this hos-pital.”

With about 500 physicians on staff, Saint Francis-Bartlett employs between 50 and 60, and Clark is actively recruit-ing more.

“It’s important for people in this com-munity to have access to good primary care. So over the next 12 months,” he predicted, “you’re going to see us employ more physicians, and a lot of them are going to be in primary care centers in areas throughout northeast Shelby County and beyond. We’re talking to a lot of physi-cians right now who are not only excited about what we’re doing, but want to be-come employed with Saint Francis.”

When he assesses the hospital’s po-tential and develops future strategies, Clark speaks from experience: His initial love affair with the hospital industry de-veloped during his college internship in

hospital administration at the National Naval Medical Center at Bethesda, Md. Since then, the native of Birmingham, Ala., has worked with Merit Health Sys-tems and Blue Cross and Blue Shield in Washington, D.C., and earned his MBA from Duke. He went on to serve as vice president and chief of staff to Trevor Fet-ter, Tenet’s president and CEO, along the way serving as associate administra-tor at Brookwood Medical Center in Bir-mingham and as chief operating offi cer at Good Samaritan Medical Center in West Palm Beach, Fla.

Clark joined Tenet in 2004, and as chief of staff at its Dallas home offi ce, he assisted in strategy development and led projects on behalf of the senior leader-ship team. As he observed, “I learned a lot through interacting on a daily basis with some really incredible people — but I always knew I wanted to be back in a hospital.”

The opportunity to take the helm of the dynamic young Bartlett hospital was an answer to that wish. Clark fi nds, however, that its youth also creates a chal-lenge.

“There are a lot of great hospitals and healthcare systems in this town. We can-not afford to be just as good as, we’ve got to be better. So we’re constantly trying to develop services and improve the quality of care that we deliver to set us apart, and it’s exciting to see some of those results coming to fruition.”

There’s no secret behind the hospi-tal’s success, Clark said. It starts with at-tracting great and talented people at all levels, including top area physicians, and building strong relationships through vis-ibility and interaction daily, throughout the hospital. Hard work and cost-effective data-driven decisions also lead to better patient care, he believes.

His strategy seems to be working — fueling plans to continue developing the hospital’s cardiovascular program and attracting more leading physicians to provide better community access to care through both primary care and urgent care centers.

In the longer term,” Clark said, “I re-ally see us becoming a premier healthcare organization in a city already full of really great healthcare institutions.

“It’s a very challenging time for healthcare, and we’re certainly not im-mune to those challenges, but at the same time it’s a very exciting time for this hos-pital. We’re growing; we’ve invested well for future growth. We’re part of a grow-ing and vibrant community that has been incredibly supportive of this hospital, and the quality of care that we’re delivering and the service that we’re providing to both patients and physicians makes us a really great place to practice.”

Clark and his wife, Amanda, enjoy spending time with their 2-year-old daughter and they love to travel; a trip to Portugal is on their agenda.

Healthcare Leader, continued from page 1

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The Memphis VA Hospital has been flagged as part of the ongoing Veterans Administration investigation involving long wait time for care. In order to par-tially ease that situation, patients have now been given the green light to use VA funds to see local physicians, rather than wait their turn at the VA.

In addition, Department of Veterans Affairs’ (VA) Medical Center and Health Care System directors have begun con-ducting monthly in-person reviews of scheduling practices in every clinic within their jurisdiction to ensure all policies are being followed to deliver timely care to veterans.

Understaffing has received the major share of the blame for the long wait time for care. If that is indeed the major cause of the problem, it raises the question, is there a major difficulty in hiring physi-cians?

“American Federation of Govern-ment Employees (AFGE) has said all along that understaffing and inadequate funding of front-line services have been main causes of long wait times for vet-erans seeking care at VA facilities,” said AFGE National President J. David Cox Sr. “Even though Congress has made ef-forts to provide the agency with the budget it needs to carry out its mission, the agency consistently fails to allocate appropriate resources to direct patient care and sup-port functions, fostering an environment for ‘wait list gaming.’ At the same time, the VA continues to add more positions to HR, system redesign, labor relations, and numerous other management positions that involve zero patient care.”

Cordell Walker, executive director of Alpha Omega Veterans Services, Inc. in Memphis sees the long wait problem ema-nating from another source.

“It isn’t so much mismanagement resulting in understaffing, as it is a sharply escalating volume of veterans in need of medical services,” Walker said. “Due to the fact that we have recently participated in two wars, Afghanistan and Iraq, that combat involvement has resulted in an in-creased number of veterans suffering from traumatic brain injury and other war-re-lated disorders and disabilities. The sheer number of wars and conflicts that have occurred, dating back to Viet Nam, has escalated the number of veterans needing services through the VA health facilities. Simply put, we’ve been involved in nu-merous conflicts so there are more veter-ans in need of services.”

Still, why would doctors choose to practice through the VA system, rather than go into private practice? Accord-ing to recruitment information posted on the U. S. Department of Veterans Affairs website, there are a myriad of strong rea-sons to entice doctors to practice medicine at a VA health facility.

As government employees, VA physi-cians are eligible for federal benefits.

“They don’t have to carry personal liability insurance, a considerable cost savings. To that end, physicians get to keep more of what they actually earn,” said Mike Cates, executive director of the Memphis Medical Society. “They are cov-ered under a federal umbrella that takes the place of personal malpractice insur-ance.”

According to the Veterans Affairs website, “As Federal employees, our health care professionals are protected by the Federal Government in instances of al-leged malpractice or negligence resulting from the performance of their duties in, or for the Veterans Health Administration of the Department of Veterans Affairs. The United States Government accepts re-sponsibility and liability for its employees’ negligent or wrongful acts or omissions during the exercise of their official duties. This applies when employees’ actions are in accordance with the policies of the insti-tution in which they are practicing.”

The VA website highlights the phrase “People not Paperwork,” meaning that since VA physicians are part of the federal government system, they have their ad-ministrative burdens lightened. VA physi-cians don’t have to worry about employee scheduling or payroll. The VA system touts that it “allows physicians to spend more time on medicine, and less time on business tasks. It also provides predictable scheduling for nurses. And for physicians, it means reduced paperwork, the elimina-tion of billing hassles, and lifting the bur-den of liability coverage,” according to its recruitment materials.

Physicians who work for VA hospitals do not have to bear the overhead expense of equipment costs. Through government funding, doctors have access to the latest technology, which often results in im-proved patient outcome. It also supports innovative research projects.

As for their own professional develop-ment, the VA system has a comprehensive education support system in place.

“Continuous learning is essential to medical professionals’ ability to provide top-notch patient care. We understand

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are seeing patients every day, I am able to focus on helping build the department with several key faculty recruitments. In the next year, we hope to add a pediat-ric dermatologist, who will be based at Le Bonheur, a surgical dermatologist, and at least one additional medical dermatolo-gist.

After a little over a year on the job, what has surprised you? What has pleased you the most?

I have been both surprised and de-lighted to experience the incredible spirit of philanthropy that Memphians have. Our department has been the re-cipient of many gifts that are helping us grow in many ways.

What is going on at the Department of Dermatology that is interesting and noteworthy?

A goal of our department is to have every faculty member develop an area of clinical expertise that will offer specialized dermatologic care that might not other-wise be available in the community. In some cases, this will allow us to collabo-rate with other healthcare providers to care for our patients. For example, Dr. Kris Fisher in our group has a growing expertise in the management of cutaneous lymphomas, a type of cancer. He works closely with several cancer specialists in the community. Dr. Tejesh Patel has done research into causes of itch. I have a background in immunology and often see patients who have autoimmune dis-eases that affect the skin. I am also doing extended patch testing to help diagnose patients with chronic eczema who might have developed an allergic contact der-matitis. We are recruiting a pediatric der-matologist who we hope will help enhance the local care for children with vascular lesions, including hemangiomas. We hope to develop our clinical research program as our facu lty grows.

What is going on there now that wasn’t possible before the Division of Dermatology was upgraded?

The university has been incredibly generous in its support of the department, which has and will continue to allow us to grow. We have also had amazing sup-port from our department namesakes, Dr. Robert J. Kaplan and Dr. Rex and Mrs. Johnnie Amonette. They have provided support on so many levels, not the least of which has been fi nancial. Without their support, we would not be here.

What is the biggest challenge or concern for dermatologists in 2014?

The practice of medicine is changing rapidly and many of the challenges faced by dermatologists are being experienced by all physicians. One of my biggest con-cerns is the potential impact of electronic health records on our practice. While EHRs do have defi nite benefi ts, I worry that bringing a computer into the room requires that I spend more time looking at a screen than my patient. Much of what I do, and what I love most about being a doctor, is interacting with my patients. I worry that the computer may interfere with that special relationship.

Is there an honor or award that you’ve received that you’re most proud of?

Before I left Vermont, I was integrally involved in a successful effort to get the Vermont Legislature to ban minors from using indoor tanning devices. As a derma-tologist and mother, this is an issue that I am very passionate about. We are seeing a frightening increase in the incidence of the most deadly form of skin cancer, mela-noma, particularly among young women. We believe that indoor tanning is a sig-nifi cant risk factor for this and other types of skin cancer. The American Cancer Society gave me a lovely plaque thanking me for my efforts. I hope that our efforts will prevent at least a few individuals from having to face this potentially devastating diagnosis.

Your husband, Roger Young, is an OB/GYN researcher on the faculty at UTHSC. After marriage, you kept your birth name profes-sionally. Do you have children, and if so, are any old enough to be in healthcare or thinking about a ca-reer in medicine?

Schwarzenberger is my family name. I got married in mid-career and fi gured there would be too much paperwork to change it. We have one child, Jackson, who goes to school at Lausanne. He plays baseball and has absolutely no intention of going into medicine. He plans to be a corporate CEO someday.

Silly question, but has anyone ever called you Schwarzenegger by accident?

All the time! I can only wish . . .

Physician Spotlight, continued from page 3

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Since my last few columns have pretty much been to the point, I decided to provide some history and comedy this month. In previous columns, I talked about generational differences and their impact in the future. I enjoy reading about the different generations and their personal and professional thoughts on different things.

A few weeks ago I had a few of my high school friends over at my house to grill on the back deck (BYOB). We graduated from high school in 1972. So I grilled out with some fellow high school buddies who are also baby-boomers. I wish I had thought to film it – it would have gone viral.

In looking at our 1972 yearbook, we noticed how many people signed, “Don’t ever change. Stay just the way you are!”

What a strange valediction to give each other on the threshold of life. (Boomers, born between 1946-1964.) We are the generation that changed everything. Of all the eras and epochs of Americans, ours is the one that made the biggest impression on… ourselves.

We sat around and talked about where some of our other high school friends were, including some of the teachers and then reminisced about who went to detention hall after school. (I was reminded by these friends that I was one of those.)

Of course, we had to talk about the hardest and meanest teachers at our high school.

We started with Ms. Aste’s history class. I believe she advised me to drop her class after the first two weeks.

History is full of generations that had too many problems. We are the first generation to have too many answers. Well, back to Ms. Aste’s class…

I remember to this day one of her lectures. She said, “Consider the people who have faced up squarely to the deepest and most perplexing conundrums of existence. Leo Tolstoy, for example. He tackled every one of them. Why are we here? What kind of life should we lead? The nature of evil. The character of love. The essence of identity. Salvation, Suffering, Death.” I raised my hand. After all I was a boomer.

I asked Ms. Aste, “What did it get him? Dead, for one thing. And off his rocker for the last 30 years of his life. Plus, he was saddled with a thousand-page novel about war, peace, and everything else you can think of.”

Years later though, I reflected about that lecture. I thought what a life. If Leo Tolstoy had been one of us he could have entered a triathlon, invented a baby boom innovation of the middle 1970s. By then, it was starting to sink in that we couldn’t run away from our problems.

We now number more than 75 million, and we’re not only a diverse generation, but take thorny pride in our every deviation from the norm (even though we’re in therapy for it.) We are all alike in that each of us is unusual.

Then, in Mr. Garret’s class, he went on at length about the New Frontier. It was full of Comanche’s, gunfighters, and cattle

stampedes. Kirby, one of my friends in high school said, “I couldn’t picture myself dramatically wounded and bleeding to death while bravely urging Sargent Shriver to leave me behind and repair the village.” Well, he had just popped the top on his third beer.

One of my guests was the type we many times referred to as a hippie; long hair and always smelled of incense. I wouldn’t have remembered him from high school if someone hadn’t had told me. The word retire had barely been uttered when this classmate said, “We can’t retire. The mortgage is underwater. We’re in debt to the Rogaine for our son’s college education.” Funny stuff.

I have a confession. This article would never have been written if it weren’t for two books I have read. P.J. O’Rourke’s “The Baby Boom, How It Got That Way And It Wasn’t My Fault And I’ll Never Do It Again.” And “Millennial Momentum” by Morley Wingrad and Michael D. Hais.

In case you haven’t read any of his books, O’Rourke says in the very beginning, “Herein is a ballad of the Baby Boom, not a dissertation on it. A rhapsody, not a report.

A freehand sketch, not a faithful rendering. That is to say, I am – it is a writer’s vocation and the métier of his age cohort-full of crap.”

Think of the baby boomer presidents that we’ve had so far – Bill Clinton, George W. Bush, and Barack Obama. They are spread as far across the political map as you can get without going to Pyongyang.

According to Mr. O’Rourke, “Baby

Boomers who are younger or female will vote for the Silly Party, Boomers who are older or male tend to vote for the Stupid Party. Then there are the Independents, product of the fact that they don’t know which is which.”

Remember folks, these are Mr. O’Rourke’s words not mine.

And yet we are the best generation in history. Which goes to show that history stinks. But at least we are fabulous by historical standards.

Our passionate belief in change hasn’t altered, going from “got spare change?” to “Hope and Change.”

We’re still opposed to prejudice, poverty, war and injustice. We’re a generation that doesn’t appreciate consequences. And we appreciated consequences even less after the Vietnam War, which had 47,415 of us killed in combat, not counting 153,303 wounded.

In conclusion: We bother and control our older children and interfere in every aspect of their lives because we don’t want them horning in on the fun of being a juvenile, which rightfully belongs in perpetuity to the baby boomers.

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

The Boomer Ballad: “Don’t Ever Change”BY BILL APPLING


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Editor’s Note: Manoj Jain, MD, is an infectious disease specialist who is running for Shelby County commissioner for District 13. He has con-tributed articles to various publications including the Memphis Commercial Appeal and the Wash-ington Post. Professionally, Jain serves as medical director of quality at QSource, Tennessee’s Quality Improvement Organization, and is an adjunct faculty member at Rollins School of Public Health.

While the Memphis Medical News does not endorse candidates running for public offi ce, the newspaper does include thoughtful commentary. The newspaper feels Jain’s commentary is timely and of special interest to its readers.

“I think you need to get a CT scan of your head,” a colleague recently responded to me as we stood in the doctor’s lounge after I told him my intention to run for pub-lic offi ce. “Why would you ever do anything like that?” he added, a bit astonished at what I had just told him.

The answer is complicated. I began by telling him about a morbidly obese patient who comes from an underserved neighbor-hood and is now hospitalized with cellulites and is going into kidney and respiratory fail-ure. Then I mentioned a truck driver who is diabetic and lacks health literacy and now has an ulcer which may result in amputation of his right foot.

“Each day, I feel like I am pulling people out of a river to prevent them from drowning, while upstream there is bridge with a hole where people are falling,” I say.

The problems are upstream – the un-derlying problems are not with the hospitals or clinics, but in the community, and we as health providers need to address them and be involved in the political process.

Today the Shelby County Commission has 13 members and none has a healthcare background, and yet they sign off on the budget and determine policies for the Shelby County Health Department and Regional One Health, formerly called The MED.

More importantly the Commission sets the vision for economic growth and educa-tional progress – all of which impacts our community’s health. But today as we look at Memphis and Shelby County we see no vi-sion for the growth and educational progress which has occurred in other cities such as Atlanta and Nashville. Often we see com-missioners mired in petty bickering or angry outbursts, all of which lacks civility, credibil-ity and respect. And all of this takes precious time away from the necessary growth and development our county needs.

There is much a doctor can add to the commission. Over the past decade the healthcare industry has transformed and is using the principles of total quality improve-ment, something which Toyota and FedEx have been successfully using for decades to improve quality and effi ciency. “Why can’t government use the same principles of Plan, Do, Study, Act?” I ask my colleague. In fact my research shows local governments in

Florida and Minnesota are doing this very thing and showing success.

Also, as doctors we understand the importance of accountability for our ac-tions better than anyone else. Citizens need to hold their political leaders ac-countable. This can be tricky with so many unpredictable circumstances. It may not be possible to hold leaders ac-countable to “outcome measures” such as the job growth over the past six years (less than one percent in Memphis compared to almost 10 percent in Nashville). Yet the public can hold the leaders accountable to individual “process measures” – for ex-ample, how many new businesses did the commissioner meet with each month to foster economic and job growth? A focus on accountability can help reshape our thinking of politics and politicians, espe-cially as the electorate becomes more In-ternet savvy and data driven.

As doctors we can address important issues of personal responsibility and encour-age patients to take responsibility for their health. Similarly, we can encourage the general public to be more responsible. Par-ents need to take the initiative to make sure their children do their homework and un-employed workers must make an effort to re-train themselves for the changing workforce.

Few would disagree with the ideas of effi ciency in government, accountability for leaders and responsibility of citizens. But

how do we translate these goals to real-world actions and help people such as the obese patient and ailing truck driver?

Here’s how. On a recent quiet Satur-day afternoon on the hospital fl oor, a nursing assistant told me about her broken family – two half-brothers in and out of jail, a cousin on drugs, and another in a gang. She relates how her mother was able to take her out of the projects and help her not only fi nish high school, but get into vocational school. Now a decade later, this nursing assistant is making sure her kids get an education. All of which will help fi ght poverty, illiteracy, and health problems such as obesity and diabetes which run in her family. We need to help the majority of our county residents “upstream” with better education and job opportunities in order to better their health. All are inter-related.

Doctors’ work is changing. Healthcare is moving out of the hospital and clinics and into the communities. Hospital admissions are decreasing, and preventive health is being prioritized with emphasis on diet and exercise. Local government can help by pro-moting walkable paths, more availability of healthy fruits and vegetables, and advance-ment of antismoking policies, which all con-tribute to an environment of better health.

“The future of healthcare is in the com-munities and we need healthcare profession-als to have a voice,” I tell my colleague. He smiles and cancels my would-be CT scan.

Why Doctors Should Become Involved in the Political Process

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Page 16: Memphis Medical News July 2014

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


We’ve been meeting together here for almost two years. I’ve shared a few thoughts with you and though the medium doesn’t allow you to share things with me, many of you have through phone calls, email and social media. Want to know what your peers are talking about? I thought you might. So, here are the Top 10 Things The Doctor Next Door Says to (Me) About Social Media (whew, that title):

I’m not sure how to say what needs to be said. Sure you are. You say it every day. Start there: the blinking cursor is simply a patient who has asked you an important question about her care. Patients like doctors with good bedside manner.

It’s too hard to keep up but I need to appear timely.

Well then, use social media to follow sources that you trust. Simply share or retweet their posts. You’ll appear helpful and connected. Patients like connected health care providers.

Just sharing data makes me sound robotic but I can’t share patient information.

Ah, the HIPAA excuse. You’re right. But you can provide insight on common problems through your per-sonal story. Patients like other humans.

There’s so much misinformation.

I don’t want to be part of that crowd.

Good for you but by not being there you’re part of the problem. Use social media to dispel common myths patients may have about treatment options by shar-ing truths. Patients like a trusted source. And to them, that’s always been you.

I just want to practice medicine.You can. Use social media to help pa-

tients cope with their conditions by provid-ing tips for managing common problems. There you go, practicing medicine. No pa-perwork to complete.

I want to be part of the community.

Then create one. You have built in neighbors. Use the “groups” feature in Facebook to build a wall around your neighborhood. Or, run it open allowing your patients to invite their friends and family to participate. Patients like to con-nect their friends to someone who knows and cares about them and people like them.

I’m focused on patient retention. I don’t have time for social media.

That Doc, is a direct contradiction to the power of social media. Not being present demonstrates indifference. Here’s a poem I wrote for a physician friend of mine:

Act like you give a damn.Show that you care.Lose the indifference.And you’re half-the-way-there.

Thanks for indulging my inner-poet.

I need to prove exponential return on investment for any investment we make in social media.

Me, too. Let’s make building a com-munity, also known as developing follow-ers, the first factor in return on investment. And no, that’s not some sales guy talking. We both know we need to be in the market before we can do business development. People, yeah even patients, like to know that you’re investing in them and getting to know them before we start asking of them.

I want to make a viral video.Did you see the one featuring win-

dow-washers in super hero costumes? Look for moments that resonate with your inner child. Most viral videos work be-cause they make us smile. Hey Doc, you don’t have to be funny but you can laugh.

I don’t have time.I know. But we meet here once a

month and to me, I’d give up our time to-gether if you’d spend it with your patients via social media. Patients, okay doctors too, like people who make time for them.

Hey Doc, Because You Askedthat and encourage VA employees to pursue higher education by offering one of the most comprehensive education sup-port programs in the nation,” per the VA website.

Many of the doctors at the VA in Memphis chose to work there, instead of going into private practice, because they wanted to teach and to do research. They say the VA hospital, which grants them the status of being University of Tennes-see faculty, helps them fulfill their mission of patient care and teaching new physi-cians.

The VA’s Office of Academic Affili-ations website provides a comprehensive look at the educational incentive programs the VA affords its employees and trainees.

Personal support is offered through a focus on achieving a work/life balance, beginning with the assurance that physi-cians’ work weeks don’t advance past 60-hours. There’s also the offer of generous vacation time, as well as personal accom-modations (i.e., The Family and Medical Leave Act and the Family Friendly Leave Act).

When it comes to actual pay, the VA claims to offer employees salaries that are competitive with the private sector. For instance, for most health care occupa-tions, the starting salaries and pay scales are “recommended by a professional stan-dards board and are based on education, training, and experience.” Additional pay incentives include the possibility of a re-cruitment bonus that can equal up to 25 percent of the rate of basic pay. The same amount is possible as a relocation bonus, and as a retention bonus for remaining with the government. And these are just a few of the forms of government-offered incentive pay and awards.

Overall, the benefits packages offered through the federal government are bet-ter than most in the private sector. Vision and dental are standard offerings, along with the option of using Flexible Spending Accounts which allow employees to use tax-free dollars to pay for medical, dental and vision care expenses that are not re-imbursed by their health insurance plan. Term life insurance, family and additional coverage options are also available, with the cost shared by the Federal Govern-ment. The Thrift Savings Plan offers the government’s version of the private sec-tor’s 401(k) plan to help employees build their retirement funds. And VA employees are part of the Federal Employees Retire-ment System (FERS). Under FERS, they are eligible for monthly retirement ben-efits after just 5 years of federal service. If they leave federal employment, this retire-ment system is portable.

So the system seems to be in place to provide doctors with the tools and the time to focus on their practice of medi-cine. The compensation packages seem to be commensurate with or better than those offered in the private sector. And a cap on the number of hours in a workweek seems to be a gateway into living a bal-anced work life.

VA Offers,continued from page 11

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Baptist Memorial Announces Leadership Changes

Baptist Memorial Health Care an-nounced leadership changes that mark several firsts for the organization: for the first time, a physician, Dr. Paul DePriest, has been named executive vice president and chief operating officer; Baptist recruited Rev. Keith Norman as its first ever vice presi-dent for government affairs; and Dana Dye has been tapped to lead Baptist’s flagship facility, Baptist Memorial Hospital-Memphis.

DePriest came to Baptist Memorial in 2012 as the organization’s senior vice presi-dent and chief medical officer. One of his primary responsibilities in that role was op-erational process design for the system and communication and collaboration between physicians and Baptist leadership. That re-sponsibility will be enhanced in his new position, where he will serve as second in command to Baptist Memorial’s President and CEO, Jason Little. DePriest’s promotion is the next step in Baptist Memorial’s tran-sition from a hospital-led organization to a hospital and physician-led organization.

Norman, the pastor of First Baptist Church—Broad, has been named Baptist Memorial’s vice president of government affairs. In this role, he will establish and maintain relationships with government of-ficials and strengthen Baptist’s community outreach partnerships.

Dye, Baptist Memorial’s vice president and chief nursing executive, will lead Bap-tist Memphis, the city’s largest hospital. A 706-bed regional referral center, the facility houses the Baptist Heart Institute and of-fers a wealth of advanced medical services. A Baptist colleague since 2007, Dye be-gan her Baptist Memorial career as Baptist Memphis’ chief nursing officer. In 2012, she was promoted to vice president and chief nursing executive for the Baptist Memo-rial system. She will remain a vice president after she assumes her new role at Baptist Memphis.

Dye will replace Derick Ziegler, who will be promoted to vice president and head of regional operations for Baptist Memorial. After spending 23 years in health care ad-ministration for the U.S Army, Ziegler came to Baptist Memorial in 2008 to lead Baptist Memorial Hospital-Union City in Union City, Tenn. Two years later, he became Baptist Memphis’ administrator and CEO.

Ziegler will assume the role held by Randy King, a 31-year Baptist colleague who will become vice president and head of metro-Memphis operations for Baptist Memorial. King started his Baptist Memo-rial career in the materials management department for Baptist Memorial Hospital-Tipton and worked his way up to his current role. Along the way, he served as Baptist Memorial Hospital-DeSoto’s administrator and CEO.

King’s predecessor in his new role, Zach Chandler, is being promoted to ex-ecutive vice president and chief strategy officer. After completing his Frank Groner administrative fellowship at Baptist Memo-rial, Chandler held several leadership roles within the organization, including serving as CEO and administrator at four Baptist Memorial hospitals. Chandler has been with Baptist for 15 years.

Cardenas & Doss join Semmes-Murphey Clinic

Semmes-Murphey Clinic has an-nounced the addition of two distinguished physicians to their clinic as of July 1, 2014. They are Dr. Raul J. Cardenas and Dr. Vinodh T. Doss. Dr. Carde-nas is a fellowship-trained neurosurgeon with a fellow-ship in minimally invasive spine surgery. Dr. Doss is a Neurologist who is fellow-ship-trained in stroke and neurointerventional surgery. Beginning July 1, he will also be the Stroke Medical Director at Baptist Memorial Hospital-Memphis.

Dr. Cardenas, who is fluent in Spanish, is the third generation in his family to practice neurosurgery. Af-ter graduating from Chris-tian Brothers University, Dr. Cardenas attended Medical School in Nashville, TN and completed his Neu-rological Surgery Residency at Louisiana State University Health Science Center. He ultimately finished his training at the Semmes-Murphey Clinic in Memphis, with a fellowship in Minimally Invasive Spine Sur-gery with Dr. Kevin T. Foley. The Semmes-Murphey Clinic is the same place where his father had finished his residency many years earlier.

Dr. Doss, a first generation American, was born and raised in the mountains of southwestern Virginia. He completed his undergraduate studies at Virginia Tech. He then attended medical school at the Virginia College of Osteopathic Medicine, also in Blacksburg, VA. He completed his Internship in Internal Medicine at Virginia Tech-Carilion Clinic in Roanoke, VA, and his Residency in Neurology at Medical College of VA Hospital/Virginia Commonwealth University Health System, in Richmond, VA. He followed this with a Fellowship in Vas-cular Neurology at University of Tennessee Health Science Center in Memphis, and a Fellowship in Endovascular Surgical Neu-roradiology, at Semmes-Murphey Clinic/UTHSC, also in Memphis.

Dr. Raul J. Cardenas

Dr. Voinodh T. Doss

Saint Francis Bartlett Celebrates 10 Years

During the recent 10 Year Celebration, Trevor Fetter (Right) CEO of Tenet Health-care Corporation speaks with his former chief of staff, Jeremy Clark, now the CEO of Saint Francis Bartlett Hospital. In his com-ments, Clark thanked the Bartlett commu-nity for embracing and supporting the hos-pital and also acknowledged the pride and support the hospital receives from the Tenet Corporation.

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Page 18: Memphis Medical News July 2014

18 > JULY 2014 m e m p h i s m e d i c a l n e w s . c o m

Memphis Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2014 Medical News Communications. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.

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GrandRoundsSt. Jude Children’s Research Hospital renewed as NCI-designated Comprehensive Cancer Center

St. Jude Children’s Research Hospital’s designation as a Comprehensive Cancer Center has been renewed by the National Cancer Institute (NCI), earning the highest possible score of “exceptional.” St. Jude remains the first and only NCI-designated Comprehensive Cancer Center that is de-voted solely to children. St. Jude has been designated as an NCI cancer center since 1977. The hospital was named a compre-hensive cancer center in 2008.

St. Jude Children’s Research Hospital

officials also announced the appointment of three internationally recognized physician-scientists to leadership positions.

Mitchell Weiss, M.D., Ph.D., has been named chair of the St. Jude Department of Hematology. He was recruited to the institution from the University of Pennsylva-nia (UPenn) Perelman School of Medicine and the Children’s Hospital of Philadelphia (CHOP), where he is a professor of pediat-rics and holds an endowed chair.

J. Paul Taylor, M.D., Ph.D., who joined the St. Jude Department of Developmental Neurobiology in 2008, has been appointed chair of the new St. Jude Department of Cell and Molecular Biology. He will also hold the Edward F. Barry Endowed Chair in Cell and

Molecular Biology.Kim Nichols, M.D., has been selected

to launch the new Division of Hereditary Cancer Predisposition in the St. Jude De-partment of Oncology. She currently directs the CHOP Pediatric Hereditary Cancer Predisposition Program. She is also an as-sociate professor of pediatrics at the UPenn Perelman School of Medicine.

Campbell Clinic Set To Expand In Cordova

Campbell Clinic has announced plans for expansion with the upcoming addition of a fifth clinic location.

The newest clinic, located at 8000 Centerview Parkway in the bustling Walnut Grove Road corridor of Cordova, will pro-vide an additional site of orthopaedic medi-cal offices and physical therapy for the Mid-South’s largest group of musculoskeletal specialists. The space includes more than 17,000 sq. feet and is expected to be opera-tional by late in the fourth quarter of 2014.

The new facility is the latest in a string of additional site and service enhancements for Campbell Clinic. The group opened its second ambulatory surgery center on April 28 and began offering evening scheduled physician appointments at the beginning of this year.

Specific operational plans for the ad-ditional clinic will be announced later this summer, but clinic leaders are exploring multiple possible opportunities for the ex-pansion.

George Hernandez, Campbell Clinic chief executive officer said the expansion serves two needs. It will first address exist-ing patient volumes and provide added convenience for residents of eastern Shelby County, and it will also allow for design of space for specific needs in the future.

The existing floor space will be built out and finished with specific clinical goals in mind. The new space will feature 16 exam rooms, approximately 4,000 sq. feet of physical therapy space, and a unique waiting area complete with patient informa-tion kiosks, a computer and reading room, and other unique patient amenities.

Saint Francis Fall Conference in Destin

Saint Francis Hospital-Memphis has announced dates for its 10th Annual Fall Update Continuing Medical Education (CME) Conference. It will be held at the Hilton Sandestin Beach and Golf Resort in Destin, Florida. The dates are Thursday, Friday and Saturday, October 9, 10, and 11. While Fall Update 2014 targets primary care physicians, other physicians are welcome. Physicians attending all three days can earn up to 14 CME credits.

The 2014 conference will feature lec-tures on Heart Disease in Women, Mi-graines, Prescription Drug Abuse, Derma-tology, Gout, Genomics and the Future of Medicine, Rheumatoid Arthritis, and other topics. This year’s conference also features an optional 4-hour workshop entitled PDR: Psychologically Designed Resiliency. The conference faculty is composed of local, regional and national speakers with excep-tional reputations in their respective fields. With lectures scheduled from 7:30 AM to 12:45 PM, the conference is structured to allow attendees to time to enjoy the many amenities offered in the Destin area.

The conference agenda is planned by the hospital’s CME physician committee, with input from previous conference attendees regarding topic and speaker selections. The committee is chaired by Michael Threlkeld, MD, Infectious Disease, with members rep-resenting various medical specialties.

Anyone interested in more information can email [email protected]

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Loans | Treasury Management | Can-Do Attitude

© 2014 Regions Bank. All loans and lines subject to credit approval.

Since opening PHC Health in 1986, Dr. Hugh Durrence had envisioned creating a multiservice medical company to provide all

levels of care – from medical equipment and in-home nursing to outpatient rehab services – throughout the community. His vision

is now a reality, but as his business grew so did his banking needs. Finding most banks slow and infl exible, he turned to Brian

Ball, a Regions Business Banker who helped the company navigate the process of acquiring a new location. Finding such a smart,

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Page 20: Memphis Medical News July 2014

Loving daughter. Dental student. Conquered breast cancer at 22.Cancer will pick a � ght with anyone, including students like Savanah, who got picked on by cancer about the same time she was picking a dental school. Family and friends are important to Savanah, so she chose West Cancer Center to help her � ght back. Pioneering leaders in cancer research, the doctors at West combine groundbreaking technology with years of expertise to treat cancer, of all types, at every level. Perhaps best of all, their world-class resources are here in the Memphis area; this kept Savanah close to home as she got closer to pursuing her lifelong dream of becoming a dentist.

The � ght against cancer is here at home. See Savanah’s remarkable story and those of others who are � ghting cancer, and � nd more information about West Cancer Center at WestCancerCenter.com or by calling 901.683.0055.