BY SUZANNE BOYD Making a difference in people’s lives has been Sam Lynd’s goal since high school. When he dis- covered he could do that in healthcare his next step was to determine what his role should be in the healthcare arena. Today the Memphis native is realizing his goal as the CEO and administrator of Baptist Memorial Hospital-Tipton, a 100-bed facil- ity in Covington, Tennessee. “My first role in healthcare came about my se- nior year of high school as a pharmacy technician for Kroger when I replaced a friend who was mov- ing away for college,” said Lynd. “Everyone truly cared about our patients and loved spending time helping them. That passion was contagious, and it made me fall in love with healthcare and the people who work in healthcare.” After graduating high school, Lynd left Mem- (CONTINUED ON PAGE 8) HealthcareLeader Sam Lynd Chief Executive Officer & Administrator, Baptist Memorial Hospital-Tipton September 2014 >> $5 PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 ON ROUNDS PRINTED ON RECYCLED PAPER ONLINE: WESTTN MEDICAL NEWS.COM Project Advancing Personalized Medicine With the help of the thousands of infinitesimal clues to the origin and treatment of disease that have been excavated since the Human Genome Project was completed in 2003, doctors and researchers at St. Jude Children’s Research Hospital are discovering new information about the genetic variations of medicine in humans ... 5 Southern Exposure The Medicaid expansion haves … and mostly have nots … in the South Which region of the country has the fewest states that opted to expand Medicaid, the highest rate of uninsured nonelderly adults, leads the nation in chronic conditions such as obesity and diabetes, and finds the majority of its states have poverty levels above the national average? No surprises here … it’s the South ... 6 Dwight Kaufman, PhD, MD PAGE 3 PHYSICIAN SPOTLIGHT SPECIAL OFFERS FOR AMA MEMBERS Mercedes-Benz of Memphis Be the first to drive! THE ALL-NEW 2015 C-CLASS FOR ADDITIONAL FLEET PROGRAM DETAILS VISIT: mercedesmemphis.com/2015-c.htm Available for qualified customers only. AVAILABLE NOW FOR TEST DRIVE FOCUS TOPICS ONCOLOGY MEDICARE/MEDICAID PERSONALIZED MEDICINE Tennessee Facing Litigation Over Medicaid Delays in TennCare Determinations at Heart of Lawsuit BY CINDY SANDERS Tennessee became one of the first states in the nation to face litigation over its Medicaid prac- tices in the post-reform era when three advocacy groups filed suit on behalf of clients they say have waited far beyond the legal limit for a determination of TennCare eligibility. The Southern Poverty Law Center, Tennessee Justice Center and National Health Law Pro- gram filed suit on July 23 in the U.S. District Court for the Middle District of Tennessee. Darin Gor- don, Larry B. Martin, and Raquel Hatter, PhD, in their respective official capacities as director of (L-R) Attorneys Michele Johnson and Sam Brooke are joined by Melissa Wilson and Ricky Reynolds in announcing the lawsuit against TennCare. Wilson and Reynolds’ wife April are two of the plaintiffs who have waited more than five months without receiving any word on their enrollment applications. (CONTINUED ON PAGE 4)
Transcript
By SUZANNE BOyD
Making a difference in people’s lives has been Sam Lynd’s goal since high school. When he dis-covered he could do that in healthcare his next step was to determine what his role should be in the healthcare arena. Today the Memphis native is realizing his goal as the CEO and administrator of Baptist Memorial Hospital-Tipton, a 100-bed facil-ity in Covington, Tennessee.
“My fi rst role in healthcare came about my se-nior year of high school as a pharmacy technician for Kroger when I replaced a friend who was mov-ing away for college,” said Lynd. “Everyone truly cared about our patients and loved spending time helping them. That passion was contagious, and it made me fall in love with healthcare and the people who work in healthcare.”
After graduating high school, Lynd left Mem-(CONTINUED ON PAGE 8)
HealthcareLeader
Sam LyndChief Executive Offi cer & Administrator, Baptist Memorial Hospital-Tipton
September 2014 >> $5
PRSRT STDU.S.POSTAGE
PAIDFRANKLIN, TN
PERMIT NO.357
ON ROUNDS
PRINTED ON RECYCLED PAPER
ONLINE:WESTTNMEDICALNEWS.COM
Project Advancing Personalized MedicineWith the help of the thousands of infi nitesimal clues to the origin and treatment of disease that have been excavated since the Human Genome Project was completed in 2003, doctors and researchers at St. Jude Children’s Research Hospital are discovering new information about the genetic variations of medicine in humans ... 5
Southern ExposureThe Medicaid expansion haves … and mostly have nots … in the South
Which region of the country has the fewest states that opted to expand Medicaid, the highest rate of uninsured nonelderly adults, leads the nation in chronic conditions such as obesity and diabetes, and fi nds the majority of its states have poverty levels above the national average? No surprises here … it’s the South ... 6
Dwight Kaufman, PhD, MD
PAGE 3
PHYSICIAN SPOTLIGHT
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Tennessee Facing Litigation Over MedicaidDelays in TennCare Determinations at Heart of Lawsuit
By CINDy SANDERS
Tennessee became one of the fi rst states in the nation to face litigation over its Medicaid prac-tices in the post-reform era when three advocacy groups fi led suit on behalf of clients they say have waited far beyond the legal limit for a determination of TennCare eligibility.
The Southern Poverty Law Center, Tennessee Justice Center and National Health Law Pro-gram fi led suit on July 23 in the U.S. District Court for the Middle District of Tennessee. Darin Gor-don, Larry B. Martin, and Raquel Hatter, PhD, in their respective offi cial capacities as director of
(L-R) Attorneys Michele Johnson and Sam Brooke are joined by Melissa Wilson and Ricky Reynolds in announcing the lawsuit against TennCare. Wilson and Reynolds’ wife April are two of the plaintiffs who have waited more than fi ve months without receiving any word on their enrollment applications.
(CONTINUED ON PAGE 4)
2 > SEPTEMBER 2014 w e s t t n m e d i c a l n e w s . c o m
w e s t t n m e d i c a l n e w s . c o m SEPTEMBER 2014 > 3
By SUZANNE BOyD
After thirteen years with the National Cancer Institute in Bethesda, Maryland, the last four of which were as the deputy di-rector of the Division of Cancer Treatment, Dwight Kaufman, PhD, MD, moved closer to home to enter private practice. After nearly 20 years as an oncologist with the Jackson Clinic, he is put-ting some of his administrative knowledge into play as medical di-rector for the Alice and Carl Kirk-land Cancer Center.
Kaufman, a native of Pine Bluff, Arkansas, went to Ouachita Baptist University in Southwest Arkansas on a football scholarship. He majored in chemistry and had no intention of pursuing medicine initially. While completing his PhD in organic chemistry at Louisiana State University, Kaufman realized a degree in medicine offered him more options that would include research.
“At that time the job market for someone wanting to go into academic re-search was not very promising, and usually required three to four years of additional post doc experience” said Kaufman. “As I was fi nishing up my dissertation research I decided to pursue medical school and en-tered immediately after I graduated my PhD program.”
Returning to Arkansas, Kaufman re-ceived his medical degree from the Uni-versity of Arkansas for Medical Sciences in 1979. He chose to pursue oncology as his specialty primarily because of the exciting research options. The fi rst year of his in-ternal medicine residency was completed at the University of Texas Southwestern Medical Center at Dallas. He fi nal two years were completed at the University of Arkansas Medical Center.
“I spent my general oncology fel-lowship at the National Cancer Institute where I focused on clinical and bench research,” said Kaufman. “This was an exciting time to be at the NCI, where many of the most effective therapies still in use were developed. All the patients
I treated were research protocol patients, mainly lymphoma, breast, ovarian and testicular cancer. I was particularly inter-ested in lymphoma, breast and ovarian cancers. After my fellowship I remained at the NCI for ten more years teaching fellows and continuing clinical research, primarily with lymphoma patients, and continuing bench research in molecular biology of breast cancer initiated during my fellowship and starting a new program in the Radiation Biology Branch.”
His last four years were mainly ad-ministrative in nature due to his posi-tion as deputy director of the Division of Cancer Treatment. “While I continued to see patients as an attending physician
in the fellowship program, I real-ized that what I enjoyed most was contact with patients and I decided to make a change so that could be my primary focus,” said Kaufman. “Another factor in my decision was that my parents were elderly and it was also a good time for me to move closer to them.”
Kaufman looked into opportu-nities in Arkansas but found the best fi t for him was in Jackson, Tennes-see with the Jackson Clinic. “I liked what I found here and meshed well with Dr. Eugene Reese so I decided to come,” said Kaufman. “And I have been here nearly 20 years.”
Shortly after the Alice and Carl Kirkland Center opened for patients in January 2014, the Jackson Clinic relocated its oncology and chemo-therapy services to the center, a move Kaufman sees as positive for many reasons. “Our patients have access to a state of the art treatment facility as good as any other center
anywhere. Patients appreciate that. It also offers them many amenities and is aesthetically pleasing,” he said. “We had a cutting edge oncology practice when we were located in the Jackson Clinic so we just moved that a couple of blocks up the street. One big advantage to being in the Kirkland Center is the vast amount of space it offers us. We have more treat-ment chairs, beds and nurses to treat our patients.
One unique aspect of the Kirkland Center is that three oncology practices share clinical and treatment space. “Since the end of April, the Jackson Clinic’s four oncology physicians, Dr. Clyde Smith, who is employed by the hospital, and Drs
Archie Wright and Brian Walker of West Tennessee Oncology Consultants have worked together at the clinic and share weekend call,” said Kaufman. “I like to say that the center is clinic blind. We have always been friendly competitors and had a healthy respect for one another but there was no cross coverage or other spe-cifi c interaction between practices. Now, although our referral sources are different, our practice styles are similar enough that we cross cover on the weekends and regu-larly bounce things off one another.”
This cohesive approach is facili-tated further with weekly general cancer and breast cancer conferences. “Every Wednesday morning, the medical on-cologists, radiation oncologists, surgeons, pathologists and radiologists and other specialists meet for a general oncology conference. On Thursdays a similar con-ference is held that is dedicated to breast cancer,” said Kaufman. “Cases are freely discussed and criticized when there is dis-agreement. We work together to come to a consensus on the optimum treatment plan for each case. This is just one way we interact and cross consult across clinics. All of our offi ces are located on the third fl oor of the center, facilitating frequent in-formal discussion of patients.”
In his role as medical director for the Kirkland Cancer Center, Kaufman is re-sponsible for assisting in the administration of the building and initiating and oversee-ing quality and safety initiatives. “I have no qualms about the quality of the practices. If I did I wouldn’t have agreed to do the job when they asked me last winter,” said Kaufman. “The center also participates in clinical trials that are nationwide and I serve as the principal investigator on the clinical trials we have open.”
Dwight Kaufman, PhD, MD
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4 > SEPTEMBER 2014 w e s t t n m e d i c a l n e w s . c o m
the Bureau of TennCare, commissioner of the Tennessee Department of Finance and Administration and commissioner of the Tennessee Department of Human Services have been named as defendants.
In a conference call with statewide media representatives, lawyers for the plaintiffs alleged the state was playing politics by adopting policies that have de-prived vulnerable citizens of healthcare coverage for which they are eligible and kept others, who might or might not ulti-mately be eligible, hanging in limbo with no determination date in sight. The at-torneys said the Centers for Medicare and Medicaid Services have long required eligibility decisions be made within 45 days of an individual fi ling an application. However two of the plaintiffs, each facing
a health crisis, had already waited more than 140 days without receiving any de-termination.
“No one wants to be here today,” said Michele Johnson, co-founder and ex-ecutive director of the Tennessee Justice Center (TJC). “The state of Tennessee has failed its citizens. The results have been unimaginable and unacceptable.”
Sam Brooke, a senior staff attorney at the Southern Poverty Law Center, stated, “We have fi led a federal lawsuit today, Wilson v. Gordon, because Tennessee is frankly playing politics with the lives of their citizens.”
He added that Tennessee has made it more diffi cult than any other state in the nation to enroll in its Medicaid program. “They’re throwing a monkey wrench into their own Medicaid program so the can demonize the federal government. People in dire need of medical care are being sac-rifi ced,” Brooke said.
He noted the 45-day requirement for determining eligibility isn’t a new rule, nor is the requirement that calls for a hearing if a denial or no determination is made. “What is new is Tennessee’s decision to ignore both these requirements,” he as-serted. The attorneys said failure to render a decision or to offer a channel to settle a dispute violates an applicant’s right to due process.
The group added they have been meeting with TennCare offi cials for sev-eral months to address a variety of issues, several of which were outlined in a sternly
worded mitigation letter from CMS to TennCare in late June accusing the state of failing to meet six of seven critical suc-cess factors required by federal healthcare law. “To their credit,” said Brooke, “they have addressed some of the other issues but have drawn a line in the sand on this.”
Johnson said the backlog stems from a decision to end in-person assistance for residents trying to apply for TennCare. Tapping into federal funds, Tennessee has invested $35 million in an upgraded com-puter system that will hopefully alleviate the situation. However, Johnson said 100 people in county offi ces who served as in-person resources for applicants were laid off before seeing if the computer system functioned properly … it didn’t.
Now, TennCare offi cials seem unable to offer a timeline as to when the system will be operational. Instead all applica-tions for TennCare are being funneled through the federal marketplace website, healthcare.gov, which Johnson said was neither set up for nor intended to process and determine eligibility for TennCare’s 27 unique categories.
Jane Perkins, legal director for the National Health Law Program, noted, “It is clear Tennessee is a national outlier. We are monitoring enrollment in other states, and at this point, Tennessee is among the worst … if not the worst … offenders.” She added, “This is the fi rst case that has been fi led to challenge a state’s failure to process applications in a timely manner.”
The phones have continued to ring at the TJC as individuals share stories
of their battles with red tape and radio silence from anyone who could make a determination on their status. “We’ve got-ten about 160 calls in the last six weeks about this issue,” Johnson said last month. “We’d never gotten a call before Jan. 1 from someone who was waiting 45 days.”
While there were 11 plaintiffs in the original fi ling, the attorneys have asked the court to certify the suit as a class ac-tion. They are also seeking emergency help for those stuck in limbo. Johnson said they are asking for a court injunc-tion requiring a decision be made within 72 hours after it has been brought to the attention of TennCare offi cials that an in-dividual has waited more than 45 days for an eligibility determination.
“On August 14, the state responded and fi led a motion to dismiss the whole case,” Johnson continued. “They said we should have sued the federal govern-ment.” She added the state’s take on the situation seemed to be that the enrollment delays were tied to failings with the federal marketplace and healthcare.gov site cou-pled with the ongoing problems with the state’s new computer system. However, Johnson noted every other state has man-aged to get its computer system working except Tennessee. Other states also offer in-person assistance to help individuals navigate a complex system. Johnson re-iterated the federal online marketplace “was never meant to be the only door to obtain state coverage.”
A hearing on the requests by both the plaintiffs and defendants was set for Aug. 29. In the meantime, costs and frustra-tions continue to mount.
“Charity care clinics often require, rightfully so, some kind of proof that you’ve been denied coverage, but these folks can’t get that because they can’t get any answer,” said Johnson. “Tell them yes. Tell them no. But tell them something.”
For more information, contact J. Neal Rager at 731-661-6340 or [email protected].
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Tennessee Facing Litigation Over Medicaid, continued from page 1
The Impact on IndividualsTennessee has long had presumptive eligibility for newborns, but coverage is
now being terminated for a number of these tiny infants once they leave the hospital … even though this is in opposition to Tennessee’s own child health plan, CoverKids.
Michele Johnson, executive director of the Tennessee Justice Center, shared the story of one mother who called the TJC in utter frustration. Within hours of giving birth via C-section, the new mom was handed a computer and told to apply for her child’s coverage through healthcare.gov. One problem … you can’t apply without a Social Security number. Johnson said that makes perfect sense for adults seeking coverage in the federal marketplace but leaves newborns in limbo for several weeks while parents apply … and then wait for … a Social Security number to be assigned. It’s one example, Johnson said, of why the federal website was never intended to be the sole option to access state Medicaid coverage.
In another case, a newborn needed the services of the NICU. After growing stronger, the baby would have been allowed to go home but would still need oxygen. Although coverage was applied for on the day the baby was born, the application still hadn’t been processed weeks later. Without coverage, the parents couldn’t afford the oxygen, and the hospital couldn’t release the child. While everyone … including those with the state … agreed the child should be covered, it took intervention by the TJC before the issue was ‘mostly fi xed.’ At press time, the hospital, which had absorbed all the inpatient costs, was still waiting to hear if they would be reimbursed.
“Those are the kinds of calls we’re getting on a daily basis,” said Johnson. “We have so many people who are getting caught between the cracks.”
Michele Johnson
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By GINGER H. PORTER With the help of the
thousands of infinitesimal clues to the origin and treat-ment of disease that have been excavated since the Human Genome Project was completed in 2003, doctors and researchers at St. Jude Children’s Research Hospi-tal are discovering new in-formation about the genetic variations of medicine in hu-mans.
The St. Jude study is one example of how the treasury of re-sulting genetic discoveries is moving the medical community closer to personalized medicine, which the Food and Drug Ad-ministration defi nes as “tailoring medical treatment to the individual characteristics, needs and preferences of a patient in all stages of care, including prevention, diag-nosis, treatment and follow-up.”
St. Jude has transferred genetic knowledge into clinical practice through a personalized medicine study initiated in 2011 called PG4KDS. The aim is to even-tually enroll all patients in this research protocol focusing on pharmacogenetic tests, which measure genetic differences
in how people break down medicine in the body.
“The purpose of the study is to move pharmacogenetic test results from the lab into the patient medical record, so that the test results are available to pre-emptively infl uence prescribing,” said Mary V. Rel-ling, PharmD, chair, pharmaceutical department, St. Jude. “Only test results for which we have built adequate clini-cal decision support are moved into each patient’s electronic health care record. Clinical decision rules and alerts provide point-of-care support to clinicians so that they can use pharmacogenetics to guide prescribing.”
Study objectives are:• To test patients for hun-
dreds of genetic variations im-portant for drug use. Strong scientifi c evidence will move a few genes into the medical record if it shows the result can improve the prescribing of drugs for patients
• To estimate how often results are moved from re-search tests into a patient medi-cal record
• To use methods to choose which tests are to be included in the medical record
• To use computer-based tools in the electronic medical record to help doctors use gene test results when prescribing
• To measure patient and patient family concerns about genetic testing in-formation being included in their medical record.
The direct benefi t to the patient is that therapeutic care can be customized to the child’s genetic makeup, avoiding serious adverse effects of some medicines, optimizing the drug response and avoid-ing ineffective therapies. This medical information can then travel through the patient’s life so that fruitless treatments are not repeated.
Relling said St. Jude uses Clini-cal Pharmacogenetics Implementation Guidelines (CPIG) as well as the hospital’s Pharmacogenetics Oversight Committee to prioritize which drugs and genes are put into the medical record. There may be hundreds or thousands of gene variations important to drug use. The priority is to decide which ones are used for patient care. It is a painstaking process.
“We use an array-based approach to test for 230 genes, but only 14 of these are ready to use clinically now,” she said. “Thus far we have fi ve genes implemented for our patients.”
The fi ve “priority genes” are: Cy-tochrome P450 2C19 (CYP2C19); Cytochrome P450 2D6 (CYP2D6); Dihy-dropyrimidine Dehydrogenase (DPYD); SLCO1B1; and Thiopurine Methyltrans-ferase (TPMT).
For example, in the 1990s, St. Jude researchers associated life-threatening complications with the important fam-ily of cancer drugs linked to Thiopurine Methyltransferase (TPMT). TPMT is an enzyme metabolizing thiopurines, which include the medications 6-mercaptopu-rine (6-MP), 6-thioguanine (6-TG) and azathioprine.
The drugs 6-MP and 6-TG are useful
Project Advancing Personalized MedicineSt. Jude study helps transfer genetic knowledge into clinical practice
‘‘The purpose of the study is to move
pharmacogenetic test results from the lab into the patient medical record, so that the test results are available to pre-emptively infl uence
prescribing.’’— Dr. Mary V. Relling
(CONTINUED ON PAGE 9)
6 > SEPTEMBER 2014 w e s t t n m e d i c a l n e w s . c o m
Online Event Calendarwesttnmedical
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By CINDy SANDERS
Which region of the country has the fewest states that opted to expand Med-icaid, the highest rate of uninsured non-elderly adults, leads the nation in chronic conditions such as obesity and diabetes, and fi nds the majority of its states have poverty levels above the national average? No surprises here … it’s the South.
Jessica Stephens, a senior policy ana-lyst with the Kaiser Family Foundation’s Commission on Medic-aid and the Uninsured, has been instrumental in working on several KFF projects this year assessing coverage and care in Southern states, along with opportunities and challenges the region faces to provide increased healthcare access and equity. Stephens, who received both her undergraduate degree and master’s in Health Policy and Administration from Yale, is also part of the Disparities Policy Project for KFF.
In looking at expansion decisions by region, Stephens noted KFF uses the U.S. Census Bureau defi nition of the South, which includes 16 states – stretching west-ward to Texas and northward to Dela-
ware – plus the District of Columbia. “Six states including D.C. have
implemented the Medicaid expansion,” Stephens said, listing Delaware, Mary-land, the District of Columbia, Arkansas, Kentucky and West Virginia. “They’ve all taken slightly different approaches,” she noted. “Arkansas, in particular, has adopted a private option where they are using Medicaid funds to assist newly eligible adults pay for private cover-age through the marketplace,” Stephens added of a waiver granted by the Centers for Medicare & Medicaid Services to allow the state to provide premium assistance.
Nationally, Stephens continued, 26 states plus the District of Columbia have implemented Medicaid expansion, which means nearly half of the U.S. states elect-ing not to expand at this time are located in the South – 11 of the remaining 24. “In the West and Northeast, the majority of states have (expanded). In the Midwest, a larger number are not, but it’s still more than in the South.”
The reasons for not implementing expansion are multifactorial. Stephens said that in addition to general political opposition to the Affordable Care Act in many Southern states, there is also a con-cern over the sustainability of maintaining expanded Medicaid rolls even though the
phased down match rate of 90 percent is still much higher than the general Med-icaid population. And, she continued, “There are concerns over the Medicaid program overall … how it’s run in gen-eral.”
On the fl ip side, though, there is mounting concern over what the decision to not expand means for a large number of people. Stephens said more than a third of the nation’s population, 37 percent, live in the South, and the region is also home to 4 of 10 people of color. “The expan-sion was important, in part, because it was going to expand Medicaid to adults who were historically excluded from the pro-gram,” she said.
A very large percent of those who make too much for traditional Medicaid but not enough to qualify for federal sub-sidies reside in the South. “Overall in the South, there are 3.8 million people who fall into this gap, and nationally, there are 4.8 million … so nearly 80 percent of all those who fall into the gap nationally are in the South,” Stephens stated.
She added people are often surprised to fi nd out just how little a family could make in order to qualify for traditional Medicaid. Citing median levels, she noted, “For a family of three – one adult and two children – that family cannot earn more than approximately $12,000 a year for the parent to be eligible.” Stephens con-tinued, “Non-disabled, childless adults remain ineligible regardless of how much they earn.” Without expansion, she said, Medicaid eligibility for adults remains very limited.
Additionally, Stephens noted the de-cision not to expand Medicaid also further exacerbates healthcare disparities with people of color being disproportionately impacted by the choice. “Six in 10 blacks who would have been eligible for Medic-aid in the South, about 1.2 million people, are not because they fall into the coverage gap.”
Among states that did expand cov-erage, Stephens said reports are coming in that those states have been able to im-prove the effi ciency and function of their Medicaid programs by taking advantage of a number of ACA provisions. “We can tell the Affordable Care Act and the Med-icaid expansion has important potential
to change delivery,” she said. “It also has the potential to reduce disparities in access to coverage and care by race and ethnic-ity and also by geography if the Southern states would expand.”
Even without expansion, though, Ste-phens said outreach and consumer assis-tance is critically important to chip away at the 21 million in the region still lacking any type of coverage. About 48 percent of the South’s uninsured currently qualify for existing programs.
“Of the 21 million uninsured in the South, we have 7 percent who are Med-icaid-eligible adults, 11 percent who are Medicaid- or CHIP-eligible children, 30 percent who are eligible to obtain tax credits to purchase private coverage through the marketplace, 18 percent who are in the coverage gap, 21 percent who are ineligible for fi nancial assistance who have incomes above the tax credit limit or an offer of employer-sponsored coverage, and 13 percent who are ineligible due to their immigration status,” Stephens out-lined.
Ultimately, improving health out-comes will largely depend on the creation of dependable channels to access care … whether through the expansion of Medic-aid, implementation of other solutions to address the needs of the uninsured, or a combination of both.
Southern ExposureThe Medicaid expansion haves … and mostly have nots … in the South
Jessica Stephens
State Current Medicaid Expansion Decision
Alabama No
Arkansas Yes
Delaware Yes
District of Columbia Yes
Florida No
Georgia No
Kentucky Yes
Louisiana No
Maryland Yes
Mississippi No
North Carolina No
Oklahoma No
South Carolina No
Tennessee No
Texas No
Virginia No
West Virginia Yes
w e s t t n m e d i c a l n e w s . c o m SEPTEMBER 2014 > 7
TODD D. SIROKY, ATTORNEY
316 South Shannon Street Jackson, TN 38301
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Healthcare Law
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Business Law
Teaming Up to Turn the Tide on Pancreatic Cancer
Dr. Elizabeth M. Jaffee
Resources for Your Practice & Your Patients:National Cancer Institute: cancer.gov/cancertopics/types/pancreatic
NCI’s Scientific Framework for Pancreatic Ductal Carcinoma (Released February 2014): deainfo.nci.nih.gov/advisory/ctac/workgroup/pc/pdacframework.pdf
Pancreatic Cancer Action Network: pancan.org
PALS: The Pancreatic Cancer Action Network’s Patient and Liaison Services (PALS) offers one-on-one support and educational information. Patients and family members can call 877-272-6228 or email [email protected]. Additional information is also available online at pancan.org under the “Facing Pancreatic Cancer” tab.
Deadly and defiant, pancreatic can-cer was one of the major oncologic threats Congress hoped to address with passage of the “Recalcitrant Cancer Research Act,” which was signed into law at the beginning of 2013.
Garnering broad bi-partisan sup-port, the statute honed in on cancers with five-year relative survival rates below 50 percent. Starting with pancreatic and lung cancer, the law calls for the National Cancer Institute to develop a scientific framework and strategic plan to move the science forward at a more rapid pace to address these deadly diseases.
Leading the call to pass the legislation and increase research, collaboration and patient resources is the Pancreatic Can-cer Action Network (PanCAN). Formed in 1999, the California-based national or-ganization will have awarded almost $23 million in grants to 110 research scientists around the country by year’s end. Ad-ditionally, the Patient & Liaison Services (PALS) has shared current, reliable infor-mation with more than 80,000 patients and family members, including a compre-hensive clinical trials database to link pa-tients with the latest treatment options and research studies.
A PanCAN research study published in Cancer Research this past May predicted pancreatic cancer would become the sec-ond leading cause of cancer-related deaths by 2020 and also estimated the increase in liver cancer deaths would make lung, pancreas, liver and colorectal the top four cancer killers in the country by 2030.
“When we think of ‘big picture’ can-cers, we think lung, breast, prostate and colorectal,” said Lynn Matrisian, PhD, MBA, vice president of scientific and medical af-fairs for PanCAN. More than 800,000 Americans will receive a diagnosis of one of these types of can-cer this year (see box).
Yet, noted Matri-sian, pancreatic cancer, which is the 12th most commonly diagnosed cancer, is currently the fourth leading cause of cancer deaths in the United States. “Pancreatic cancer surpassed prostate cancer a couple of years ago and is expected to surpass breast can-cer in the next year or two and the colorec-tal cancers around 2020,” she explained.
While great strides are being made in lowering overall cancer death rates, Matri-sian said it has been much more difficult to gain traction in improving pancreatic can-cer survival. “For pancreatic cancer, we haven’t made any change much at all in the death rate since we began keeping re-cords. The five-year survival rate is 6 per-cent. An estimated 73 percent of patients die within the first year of diagnosis.” She added, “It’s the only one of the major can-
cers with that five-year survival rate in the single digits.”
The reasons for the high mortality rate are multifactorial and include a need to better understand the pathogenesis of the disease and to identify it earlier when treatment options have a greater oppor-tunity for success. “The pancreas is deep within your body. The symptoms are pretty vague and can be attributed to mul-tiple diseases so it’s often diagnosed quite late,” Matrisian said. She added, an aging and growing population is anticipated to increase the number of cases of pancreatic cancer in coming years, which in turn is expected to lead to pancreas cancer be-coming the number two cancer killer con-sidering its mortality rates.
Yet, she stressed, “It doesn’t have to happen if we can change things now.” Matrisian said she sees the information as a call to action and pointed to the pre-ventive, diagnostic and treatment suc-cesses that have occurred in many diseases through focused research efforts.
Stand Up To Cancer (SU2C) is an-swering that call with the formation of their second pancreatic cancer Dream Team. Announced in April, the SU2C-Lustgarten Foundation Pancreatic Cancer Con-vergence Dream Team is focused on immunother-apy and is being led by noted physician-scientist Elizabeth M. Jaffee, MD, professor of oncology at Johns Hopkins School of Medicine and co-director of the Gastrointestinal Cancers Program at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore.
University of Pennsylvania transla-tional research expert Robert H. Von-derheide, MD, DPhil, has joined Jaffee as co-leader of the project — “Transforming Pancreatic Cancer into a Treatable Dis-ease.” The multidisciplinary team includes seven other principals from around the country plus three patient advocate mem-bers. Funding for the $8 million, three-year
grant is a collaborative effort of SU2C, The Lustgarten Foundation and the Fox Family Cancer Research Funding Trust.
The Dream Team will use the grant to develop new therapies to engage a pa-tient’s own immune cells in the battle against pancreatic cancer. Jaffee has led the charge on creating an immunologic response, developing a novel pancreas cancer vaccine with colleagues more than a decade ago targeting pancreatic ductal adenocarninomas (PDAC), the most com-mon form of pancreatic cancer.
“Pancreatic cancer suppresses the body’s anti-tumor immune response,” Jaffee explained. “These tumors do not allow immune cells that can recognize and kill them to even enter the pancreas. We think we can use vaccination to acti-vate anti-tumor immune cells and then use other agents to get those cells into the pan-creas where they can attack the tumor.”
Most recently, she noted, “We tested our newer vaccine, which is a combination of two vaccines – the first primes the im-mune system and the second targets can-cer cells – and we now give a boost to the immune system.” She continued, “We’ve tested this in advanced patients who have failed all other chemotherapies, and we showed it significantly improved survival.”
Jaffe added the median survival dou-bled from three months to more than six-and-a-half months. “Patients who did well are doing well long-term,” she added, not-ing some of these advanced patients have now survived more than a year out from the immunotherapy. “There really aren’t side effects so the patients have a better quality of life,” she added of another plus. The outcomes have resulted in accelerated approval status from the Food & Drug Ad-ministration.
While Jaffee and her colleagues at Johns Hopkins have made important progress, she noted bringing the Dream Team together will enhance everyone’s work. “Each center has come up with a project based on the science they were developing,” she said of the two Phase I studies and three multicenter Phase 2 trials being launched. “We’re going to combine
now and share our technologies to analyze the different clinical trials. We’ll compare mechanisms to see if we should combine agents,” Jaffee continued.
Calling the Dream Team an “all out massive attack on pancreatic cancer,” Jaffee said it is a wonderful opportunity to bring experts from eight different centers together to advance pancreatic research. She also said it’s possible immunotherapy could be widely available to patients in the next two years pending outcomes of cur-rent trials.
While improved treatment clearly would be a critically important advance, Jaffee said there is another exciting devel-opment underway. She and her team have recently published their first paper show-ing prolonged progression of the disease in animal models.
“We don’t know when the first ge-netic changes are occurring and at what age,” Jaffee noted. However, she contin-ued, “Cancer starts to develop 20-30 years before you see it.” By looking for early changes, such as mutated KRAS, the hope is to target a pre-malignancy and keep it from ever developing into pancreatic can-cer.
“Our goal is to eventually prevent this disease from the start,” Jaffee concluded.
Dr. Lynn Matrisian
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phis to attend the University of Alabama where he majored in healthcare manage-ment, graduating in 2009. He then moved onto the University of Alabama at Birming-ham to attend graduate school where he earned his Master of Business Administra-tion degree in 2011 and Master of Science in Health Administration in 2012.
“While in school, I worked for the Uni-versity of Alabama Medical Center, Baptist Hospital-Pensacola and volunteered in the emergency department at Baptist Mem-phis. I consulted for nursing homes, evalu-ated markets and operations for acquisition purposes and worked as an anesthesia bill-ing clerk. Every one of those experiences
lends itself to my current role,” said Lynd. “I have tried to do as many things as pos-sible and learn as much as possible about healthcare while trying to remember to slow down enough to remember why I chose this path to begin with.”
In 2011, Lynd joined the Baptist Me-morial Health Care family as a Frank S. Groner Administrative Fellow, an experi-ence Lynd says has been invaluable and led to his next three roles in the Baptist System. “From June 2012 to February 2014, I served first as the assistant administrator of Baptist Union County in North Mississippi, and then as the assistant administrator of NEA Baptist Memorial Hospital in Jonesboro.”
When Lynd took the reins at Baptist-Tipton, he found that it presented chal-lenges all its own. “My team will tell you I often refer to us as a rural hospital com-peting in a metro market. We are truly a community hospital that exists to serve the needs of the people of Tipton County, but we are in close enough proximity to larger urban facilities within Greater Memphis that we have to evaluate strategies and compete like a metro hospital,” said Lynd. “Baptist-Tipton is a great place to work with a small team of talented individuals who are passionate about transforming healthcare delivery while delivering great care and ser-vice to our community. There is something
very special about small community hospi-tals and their role in our industry.”
Lynd credits his talent as an admin-istrator to the strength of his team and his passion for learning. “The relationships I have built over the last few years continue to pay off in dividends. Baptist is full of people willing to help you through whatever chal-lenges arise,” he said. “We have great tal-ent at each of our hospitals and corporate resources to assist us every day in reaching our goals. My passion for learning more about the needs of our teams, our patients, and our physicians means that we will con-tinue to seek opportunities to improve in every area of focus. What I hope to learn from this role is simply how to provide our teams what they need to be successful and support them in that journey.”
While it is early in his career, Lynd de-veloped his management style from many people in different management roles. “I have taken pieces from each of them that fit my personality and beliefs about manage-ment. One of my greatest mentors once told me to watch and learn how people establish their credibility when taking on a new role. Being as young as I am, this was incredibly insightful advice,” said Lynd. “I focus on lis-tening, learning and asking good questions. Whether managing an unfamiliar area or one with which you hold great expertise, asking lots of good questions will always help prepare you for making better decisions.”
The heart of Lynd’s management style revolves around loving people, be they customer or staff, setting expectations, using fair and consistent accountability, and coaching. “If you can be really good at those items then you have a good chance to be successful in whatever challenge you take on,” he said. “My strongest manage-ment quality is probably building relation-ships and trust. When you are open and honest about when you don’t know, people will pay attention when you tell them you do know.”
In regards to relationships, Lynd wants to continue to build relationships with key providers. “Only through growing these relationships can we put all of our talents together to deliver the service in this county that the patients deserve,” he said. “Com-munication is key. We are focused on con-necting with community providers and keeping them informed about what we are doing as the community hospital to im-prove the care delivered to Tipton County patients. This includes growing the skills of our leaders, growing the skills of our nursing staff, keeping up with the growth of technol-ogy, and providing forums for providers to interact with each other so they can have successful practices and we can serve as re-sources for their success.”
Being entrusted with the responsibil-ity of a hospital operation at this point in his career was something Lynd always dreamed of. “Keeping the focus on others has certainly paid off and will continue to for the remainder of my career,” said Lynd. “I have interacted with so many people with differing roles as part of the U.S. health sys-tem, but only just hit the tip of the iceberg in terms of what there is to learn. You have to focus on learning each and every day about the challenges people face no matter their role. It makes you a more balanced and well-rounded leader.”
Sam Lynd, continued from page 1
w e s t t n m e d i c a l n e w s . c o m SEPTEMBER 2014 > 9
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By EMILY ADAMS KEPLINGER In June, BlueCross BlueShield
(BCBS), the largest health insurance pro-vider in Tennessee, reorganized its offi ces in Jackson. Making a clean sweep of it, BCBS let its staff of fi ve go. Yet it did not close its operation.
What’s going on?According to Mary Danielson, di-
rector of corporate communications for BlueCross BlueShield of Tennessee, “The staffi ng changes were driven by business decisions concerning needs and service capabilities. Our Provider Network Con-tracting Team felt it could more effi ciently serve doctors and hospitals in the west Tennessee region by consolidating opera-tions in Memphis and Nashville.”
Formerly, there were three divisions in middle and west Tennessee: Memphis, Jackson and Nashville. However, in terms of staffi ng, the management and contract-
ing functions have been consolidated with Memphis and Nashville. But there is still a presence in Jackson.
In April, prior to the reorganization, BlueCross BlueShield of Tennessee ap-pointed Marc Barclay as vice president of provider networks and contracting. He is based in Nashville, where he is re-sponsible for the day-to-day operations associated with BlueCross’ extensive pro-vider networks, including contracting, and continued efforts to remain the pre-ferred insurance partner of providers in Tennessee. Barclay came to BlueCross after working with network management at CENTENE Corporation and United Healthcare of Tennessee, and provider contracting at Humana.
“Maintaining healthy, mutually benefi cial relationships with healthcare providers in Tennessee is critical as pay-ment models in our industry continue to shift from fee for service to a higher focus
on quality care,” said Larry Nall, senior vice president of provider network man-agement at BlueCross. “Our members want affordable access to their preferred doctors, and Marc will make sure we con-tinue to be able to offer them that peace of mind.”
BlueCross BlueShield did not replace the Jackson Provider Network Contracting employees with new employees. Instead, it redistributed the Jackson PNC team’s workload to existing BlueCross BlueShield Tennessee employees, specifically con-tracting and provider relations employees, already located in its Memphis and Nash-ville market offi ces.
The only new person brought in was Tom Winston. In August, Winston was named to fi ll the vacant director position of provider contracting for west and mid-dle Tennessee. In this role, he is respon-sible for defi ning and directing contracting strategies and negotiations for physicians, hospitals and other providers in these two regions. He is based in BlueCross’ Nashville offi ce. Prior to this appointment, Winston served as corporate director of revenue and relationship management for Novant Health, Inc., in Charlotte, N.C. Winston has returned to BlueCross after serving as a senior fi nancial analyst in the late 1990s.
When asked what the impact of the re-organization was on doctors and other pro-viders who utilize the BlueCross BlueShield system, Danielson said, “The answer is simply ‘none.’ There are no discernible differences that our providers should ex-
perience due to the recent changes in our Jackson offi ce. We are always trying to op-erate as effi ciently as possible in order to keep costs down for our customers.”
Danielson went on to explain, “Many of the people who functioned for the Jack-son offi ce were telecommuting in various capacities. On occasion they went to an actual facility for tasks such as holding a meeting or running reports. Since the con-solidation, the staff is based out of Mem-phis and Nashville. Yet our providers (doctors, hospitals and other medical care givers) sense no difference because so much of our business is conducted via email or telephone. Or business is conducted in person with a visit to the provider. That latter aspect remains the same, with the ex-ception that our staff may have to travel a little further. All said, in light of our recent changes, we are able to maintain the same relationships with our providers.”
Some of the effi ciencies created by the staffi ng changes, as cited by BlueCross BlueShield, included:
The BCBS Provider Network Con-tracting Team was able to take advantage of new technologies that allowed each em-ployee to take on more provider assign-ments -- without affecting service levels to those doctors and hospitals they serve.
The organizational changes actually allowed one of the former Provider Net-work Contracting Team staffers based in Jackson to fi ll a newly created role that deals with improving quality for its Medi-care Advantage members.
BCBS Consolidation Aims for Effi ciencyInsurance provider reorganizes its Jackson offi ce
in treating leukemia or lymphoma.Effi cacy and adverse effects differ in
patients due to variations in the TPMT gene, meaning that as many as one in 10 patients may need a lower dose of the drugs; one in every 400 individuals needs a substantially lower amount to avoid potentially deadly side effects. Everyone can be classifi ed into one of three possible genotype groups. St. Jude uses a different starting dose of 6-MP and 6-TG for these groups. Varying the dose based on a pa-tient’s genotype means there are fewer side effects due to low blood counts.
A more common drug example is the familiar codeine. About 10 percent of the population are genetically “poor metabo-lizers” who cannot activate codeine into morphine and get no pain relief from it. “Ultra rapid metabolizers” comprise 1 to 2 percent of the population, and they are at risk from toxic effects like respiratory depression.
“Some hospitals have removed co-deine from their formulary because, without genetic testing, one doesn’t know which patients will benefi t and which will not,” Relling said. “This is a problem, be-cause codeine is one of the few narcotics for which patients can get refi lls, so many of our clinicians wanted to maintain it on the formulary for the 88-89 percent of the patients who might benefi t. By using genetic testing, we were able to keep this valuable medication available to our pa-tients with pain.”
Work continues today to identify which of the estimated 18 million gene variations in the human population play an important role in drug response. One gene can impact the workings of 30 to 40 drugs. More pervasive usage of genetic re-search and lower costs for the blood tests required mean early treatment testing and less time lost on ineffective or more toxic
medications on patients.“Eventually, we don’t want pharma-
cogenetics to be delivered in a research protocol; we want it to be incorporated into routine healthcare. It is the future of medicine,” Relling said. “It will depend on healthcare changing so we have a univer-sal electronic healthcare record that fol-lows the patient from birth to death.”
Project Advancing, continued from page 5
10 > SEPTEMBER 2014 w e s t t n m e d i c a l n e w s . c o m
SOUTHCOMMChief Executive Officer Chris FerrellChief Financial Officer Patrick Min
Chief Marketing Officer Susan TorregrossaChief Technology Officer Matt Locke
Chief Operating Officer/Group Publisher Eric Norwood
Director of Digital Sales & Marketing David WalkerController Todd Patton
Creative Director Heather PierceDirector of Content /
Online Development Patrick Rains
westtnmedicalnews.com
GrandRounds
New Hybrid Operating Room Opens
A new hybrid operating room at Jack-son-Madison County General Hospital is bringing state-of-the-art surgical technolo-gy to rural West Tennessee. In mid-August, the hospital will open its new 1,000 square foot hybrid surgical suite designed spe-cifically for vascular and cardiothoracic pa-tients. The surgical suite can also be used for nearly any surgical procedure.
The new suite combines cutting edge surgical technology with the most sophis-ticated imaging capabilities so that it can be transformed from a minimally invasive surgery setting to a full open heart surgery operating room in minutes. The hybrid surgical suite allows for a multi-disciplinary approach to surgery so that medical spe-cialties can work together providing safer, quicker and more efficient services. This col-laboration of specialists improves the level of advanced care that can be provided to patients in West Tennessee.
The hybrid operating suite brings the latest technology for vascular procedures to West Tennessee and increases access to advanced vascular procedures for patients according to Dr. Heath Broussard, a vascular surgeon with the Jackson Clinic, who was a member of the planning and development team. Having the advanced imaging tech-nology in a large operating suite that will accommodate increasingly complex multi-specialty procedures will not only increase access for patients but also allows for the growth of multidisciplinary procedures that require a large operating team such as trans-catheter aortic valve replacement (TAVR).
The surgical suite is twice the size of a regular operating room and can accommo-date up to 25 medical personnel.
The hybrid surgical suite which opened in August, makes JMCGH one of only two hospitals in the country using the latest im-aging technology from Philips Healthcare. The interventional lab provides high quality imaging with low x-ray dose levels for pa-
tients. The fully digital system enables phy-sicians to capture and view detailed three-dimensional images of a patient’s arteries and vascular structure, facilitating faster and more accurate diagnosis and treatment.
The suite is taller than a regular oper-ating room to accommodate the infrastruc-ture required to support the weight of the equipment, which is mounted on a grid sys-tem in the ceiling. The suite is one of only twelve in the country that use a wide-track ceiling design to mount the equipment said Steve Austin, JMCGH Manager Surgical Support Services.
The hybrid OR utilizes FlexMove, a ceiling-mounted system designed to op-timize workflow for its X-ray system and other equipment. With FlexMove, the im-aging system can be moved laterally and longitudinally to perform a wide range of procedures without interfering with the care provided by other team members in the room. FlexMove allows the equipment to be in stand-by position for optimal access to the patient. The X-ray equipment can be moved quickly into place when needed or parked out of the way when not needed.
The suite is suited for a variety of spe-cialized surgeries including vascular and cardiovascular, as well as robotic procedures and procedures that require advanced im-aging which interventional radiologists and cardiologists perform. As the technology is evolving rapidly, Hampton expects to see other specialties begin to use the new less-er invasive technology for their procedures.
The high-tech operating suite required tremendous support and commitment on behalf of West Tennessee Healthcare. The cost of the suite, its construction, equip-ment and technology required a $4.2 mil-lion investment according to Tina Prescott, West Tennessee Healthcare Vice President/Chief Nursing Officer.
Surgeons are training in the new Hybrid Operating Room at Jackson-Madison County General Hospital which opens next week. This Hybrid Operating Room is among those leading in the nation to include this Philips high tech imaging system and the first of its kind in the state. Dr. Eric Sievers, M.D., cardiothoracic surgeon with the West Tennessee Heart and Vascular Center, Dr. Heath Broussard, M.D. a general and vascular surgeon with the Jackson Clinic and Dr. Tommy Miller, M.D. a cardiologist with the Mid-South Heart Center.
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Bone and Joint Specialists Merge with West Tennessee Bone & Joint Clinic, P.C.
Dr. Blake Chandler recently announced the merger of Bone and Joint Specialists (BJS) of Paris and Union City with West Ten-nessee Bone and Joint Clinic (WTBJC) of Jackson, Tennessee.
With similar organizational cultures and commitments to excellent patient care, the groups share a long standing history of mutual respect for one another. Recent changes in health care led to conversations about the benefits of merging practices and becoming one. The new organization will combine more than 14 Specialists and pro-viders in 10 locations throughout West Ten-nessee.
Aside from improved technology, Chandler emphasized that little about his practice will change. He will continue to see patients in the same office locations in Paris and Union City, and the same, skilled staff will remain in place, including nurse practi-tioner Clay Nolen. In addition, Chandler will continue to operate at Henry County Medi-cal Center and the Surgery Center in Paris. He and his staff will continue to provide their “signature hometown care.”
Chip Anderson, Practice Administrator, Bone & Joint Specialists emphasized that the clinic plans to address many aspects of this new affiliation including operational details, brand and marketing consolidation to strengthen the overall commitment to or-thopedic excellence for the West Tennessee communities.
GrandRounds
JMCGH Receives National Recognition Through Tennessee Surgical Quality Collaborative
Jackson – Jackson-Madison County General Hospital (JMCGH) has been na-tionally recognized for its participation in the Tennessee Surgical Quality Collab-orative (TSQC), which has reduced surgical complications by 19.7 percent since 2009. This reduction represents at least 533 lives saved and $75.2 million in reduced costs in Tennessee.
The recognition of JMCGH came as part of a presentation at the American Col-lege of Surgeons (ACS) National Surgical Quality Collaborative Improvement Pro-gram’s (NSQIP) national conference in New York City on July 28.
The hospital collaborative formed in 2008 as a partnership of the Tennes-see Chapter of the American College of Surgeons and the Tennessee Hospital As-sociation’s Tennessee Center for Patient Safety, with support from the Tennessee Health Foundation, the philanthropic arm of BlueCross BlueShield of Tennessee.
An earlier study based on TSQC data published in the Journal of the American College of Surgeons in 2012 showed the 10 TSQC members reduced complication rates and saved more than $8 million in ex-cess costs from 2009 to 2010. This new study shows TSQC hospitals continued to improve in the years after the program launched. In 2012, the collaborative expanded and now includes 22 Tennessee hospitals.
