Memphis Medical News August 2014

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Getting the Message Out Is More Important Than EverAuthor documents growing need for pervasive marketing

Richard K. Thomas has seen paradigm shifts in the health-care system since his initia-tion as a medi-cal sociologist in 1970. After completing a PhD in medi-cal sociology in 1982 and working in Baptist Memorial Health Care Corporation in health services research ... 4

Qsource to Spearhead Signifi cant ChangesIn CMS’ Restructuring Of QIO ProgramsThe widespread reform of the nation’s healthcare has trickled down to create signifi cant changes for area healthcare providers; changes that begin this month ... 22

FOCUS TOPICS ORTHO/SPORTS MEDICINE PHYSICIAN/HOSPITAL ALLIANCE HEALTHCARE MARKETING

By JUDy OTTO

Change isn’t always the key to growth. When you’re at the helm of an organization that’s already world-renowned, it’s wiser to commit to a proven philosophy that has contributed to strong, steady growth throughout an impressive history of more than 100 years, according to Campbell Clinic CEO George Hernandez.

In his nearly 20 years with the clinic –

fi rst as Chief Financial Offi cer and, more recently, in fi ve years occupying the CEO’s chair – Hernandez has seen it grow from 26 physicians and three offi ces to 47 physicians and soon to be fi ve offi ces and two ambula-tory surgery centers, largely by focusing on core competencies.

“We haven’t deviated much from the rich tradition that Dr. (Willis) Campbell and his partners started – we’re just doing a

(CONTINUED ON PAGE 10)

HealthcareLeader

George HernandezCEO, Campbell Clinic

Kevin Coates, MD

PAGE 3

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New ‘Medical Center’ Continues to Grow

By EMILy ADAMS KEPLINGER Germantown, with its current expansion of

treatment facilities, continues to build its reputa-tion as a rapidly growing Memphis-area medical center.

Extending from Methodist Germantown to Baptist Memphis (formerly known as Baptist East), the Germantown Medical Corridor has undergone steady growth and development, es-pecially along Wolf River Parkway.

Most recently, Cypress Realty Holdings Co. has begun construction on the second phase of its Medical Arts Complex. Its fi rst project, Medical Arts I at 7550 Wolf River, was com-

(CONTINUED ON PAGE 8)The exterior of the Medical Arts I building on Wolf River Blvd. The Medical Arts II building, currently under construction, will have an identical appearance.

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Wolf River tenants line up to upgrade older buildings

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By RON COBB

With Army tours of Afghanistan and Iraq behind him, Kevin Coates probably isn’t going to be fazed by much of what he sees from day to day as an orthopedic sur-geon at Memphis Orthopaedic Group.

From his childhood in a coal-mining town near Pittsburgh, he hasn’t been one to shy away from tough challenges. He wrestled and was runner up for the state championship in high school. He played football in college at Duquesne and was an Academic All-American linebacker.

After earning a Master’s degree in physical therapy, Coates joined the Army while in medical school at the University of Pittsburgh. He did his orthopedic surgery internship and residency at Brooke Army Medical Center at Fort Sam Houston in Texas.

After completing his residency, and while stationed at Fort Belvoir in Virginia, he was deployed to Afghanistan from Janu-ary to July 2009 as an orthopedic surgeon. His deployment to Iraq came two years later, from May to September 2011.

After leaving the Army, Coates did a fellowship in orthopedic surgery sports medicine at Wake Forest, where he also served as assistant team physician for the university’s sports teams. From there, it was on to Memphis, and now he is one of 12 physicians with Memphis Orthopaedic Group, a division of MSK Group, P.C. He keeps a hand in sports by serving as team doctor for Munford and Brighton high schools.

Coates, the father of three, recently took time to answer some questions from Memphis Medical News.

Why did you combine your med-ical career with military service?

I joined the Army in my first year of medical school, but I had considered it be-fore even starting. Every generation of my family since immigrating in the late 1800s had served in some capacity (almost all draftees, and certainly no career military men). My older brother did not serve and I knew that my younger sister would not be, either. I felt that I could not let that line of service end.

Obviously you’re risking your life by going to Afghanistan, but how dangerous was your time there?

There are varying degrees of safety. Centrally located large facilities like Ba-gram Airfield outside of Kabul are gener-ally the safest areas. I was deployed with a forward surgical team to Kunar Province.

The town of Asadabad and our FOB (forward operating base) was only five miles from the Pakistani border. That was where most of our rocket and mortar attacks came from. We would receive incoming indirect fire a few times per week – all pretty poorly

aimed. We only took direct fire once in my time there, although in previous years there was a soldier killed by a sniper while run-ning on the FOB.

It also makes it difficult as there are no real lines of battle and it is nearly impos-sible to tell friend from foe. The local Af-ghani who cleaned our gym is an example. I used to talk to him daily and generally liked him. Toward the end of my tour, he brought in his uncle with a terrible forearm injury. As it turns out, his entire family was Taliban, and the forearm injury came in an Apache helicopter strike that was intended to kill him, but was successful in killing his sons, who were also Taliban commanders.

All of that said, I had several close calls

but made it through unscathed.

This is a broad question, but how would you describe your service there?

I had a wide range of activities that I did while in Afghanistan. At least 80 per-cent of my operative load was actually on the local population. From the town of Ja-lalabad through the northeast extension of Afghanistan that extends to China, I was the only orthopedic surgeon. Therefore, I saw many conditions that we typically only see in textbooks here in the U.S.

Once you served in Afghanistan, why did you have to go to Iraq? Your

choice or the Army’s?That’s a complicated question, but the

answer is both. It is not typical for an or-thopedic surgeon to deploy more than once in four years. There are approximately 120 active duty orthopedic surgeons, so there are plenty of numbers to fill deployment slots. I was the chief of orthopedic surgery and rehabilitation at DeWitt Army Com-munity Hospital, Fort Belvoir, Virginia, at the time. I received a tasker (notification of upcoming deployment) for one of my junior surgeons. Unfortunately, he had to retake his board exam, so I asked if the de-ployment could be put off until later. The response I received was that it could be put off, but I needed to supply the surgeon to fill his slot. Since I was the one that brought that upon us, I volunteered to take the slot.

How did your experience there compare to Afghanistan? Did you do the same things?

My experience in Iraq was quite dif-ferent from Afghanistan. I was very busy in Afghanistan taking care of the local population. But when I was in Iraq it was 2011 and we had moved into Operation New Dawn. The responsibility for care was passed on to the Iraqis.

Our team was stationed along Main Supply Route to provide care for anyone injured while leaving Iraq. However, there was not much direct contact with insurgent forces at that time.

What was your family situation during those two deployments?

When I deployed to Afghanistan, I left the day after Christmas 2008. I was

Kevin Coates, MDArmy tours prepared orthopedic surgeon for just about anything

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Dr. Kevin Coates in the mountains of Afghanistan with an Afghan National Army soldier.



To The Editor:All of us in the medical community enjoy your newspaper tremendously. It is a

shame however that you gave Dr.Manoj Jain the bully pulpit in your July edition. (Dr. Jain is running for Shelby County commissioner, District 13.) To be fair you should give equal time to his opponent, Steve Basar.

Not all physicians care for Dr. Jain’s progressive-liberal, government knows best agenda. When you read his columns in other forums and the one he wrote for your paper he is all about cradle-to-grave government control of your life. He wants the government to tell you what to eat, where to eat it and how to eat it. That is also how he sees his role as a physician. He believes he is smarter than the majority and thus must tell you how to lead your life.

He states as we look at Memphis we see no vision for the growth and educational progress that has occurred in Atlanta and Nashville. He then goes on to describe many things that would make the city better for sure but unfortunately his solution is bigger government which means more waste, more tax money that is wasted and ineffi ciency.

His paternalistic tone in his columns is insulting and demeaning and typical of so many that want to control the masses (see our present President). Thanks again for your very good medical newspaper and in the future remember to be fair and give equal time to the other side if you choose to let politicians like Jain have the bully pulpit.

Sincerely,Guy Voeller, M.D.,FACS

Editor’s Note: The Memphis Medical News welcomes letters. To be published, letters must be signed and the writer’s contact information should be included. Letters, comments and suggestions should be sent to [email protected].

Letter to the Editor

MEMPHIS MEDICAL NEWS

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By GINGER H. PORTER

Richard K. Thomas has seen para-digm shifts in the healthcare system since his initiation as a medical sociologist in 1970. After completing a PhD in medi-cal sociology in 1982 and working in Baptist Memorial Health Care Corporation in health services research, he be-came a healthcare con-sultant and has remained one for the last 20 years. His book, Marketing Health Services, third edi-tion, dated 2015, comes out this fall. The fi rst edition was published in 2007.

“Healthcare in upcoming 2015 is radi-cally different than 2007,” he said. “Not only has healthcare changed during this last decade, but so has marketing.”

Thomas is an adjunct professor in the department of preventive medicine at the University of Tennessee Health Science Center and a part-time instructor at Uni-versity of Mississippi-Southaven Campus. His pathway to healthcare marketing au-thorship came after he wrote articles for the Journal of the American Marketing Association, then became its healthcare editor. Then he started writing books, most targeted at marketing administrators or cer-tain target audiences.

Marketing Health Services has been the most successful of his more than 20 books, becoming a text for healthcare administra-tion education programs across the coun-try. Approximately 125 universities are reviewing the text for use in their programs. Thomas describes it as drastically different from the 2007 edition – containing only 30 or 40 percent of the original material. The

chapters have been thoroughly updated, and a chapter on social media is included as well as multiple case studies.

“Healthcare marketing has matured pretty dramatically in the last 10 years,” he said. “Healthcare marketing as a discipline has only been around 20 or 30 years. Even in the 2000s there were reservations on the part of large healthcare organizations about advertising, as doctors were still hesitant about the ethics.”

Healthcare marketing has not only be-come acceptable, Thomas said, it has be-come survival. Marketing is pervasive and affects everyone from the corner offi ce to the front desk.

“It has gone from some last-minute ‘oh, we need someone to do some market-ing for us’ — to the boardroom. Marketers are involved in day-to-day decision making and policy,” he said.

Where the prevailing opinion used to be market to the patients, now healthcare organizations are marketing to insurance companies. The discipline has become more relationship-oriented, Thomas said. Before you wanted to fi ll a hospital bed and

compete for a $5,000 procedure. Now, if a person is going to spend approximately half a million dollars in their lifetime on healthcare, you want that patient for life, he said.

Then, if you are an insurer, you are gambling on which services a patient will use, and mistakes could put you out of busi-ness.

“For any number of reasons, health-care administrators have to know much more about consumers than we did in the past,” Thomas said. “The object of the game is we get reimbursed and regulation and cost are issues. The end result is we

Getting the Message Out Is More Important Than EverAuthor documents growing need for pervasive marketing

Richard K. Thomas


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By GINGER H. PORTER

Ryan Ramkhelawan remembers the exact moment the idea came. Frustrated by seeing surgical instru-ments returning to the operating room dirty despite several steps of decontamination, he thought there had to be a better way.

And then he thought of one. One he believed could save time and money. The idea became a customized instrument washing tray that made the journey to prototype, proposal and then a Bioworks Zeroto510 project, which then became the foundation product of Restore Medical Solutions – all in a three-year time span.

Zeroto510 is a program enabling en-trepreneurs with innovative medical device ideas to learn the business and take a fast track to market. At the time of his idea, Ze-roto510 was not on Ramkhelawan’s radar.

He was a surgical first assistant and then became credentialed as an organ

transplant perfusionist. He was trying to get surgical in-struments into an automated tray after the hand-washing stage for the autowasher stage – so that they might get optimal cleaning before sterilization and packaging. Positioning was crucial.

“There is a way to get these instruments through the pre-clean cycle in an up-right and open position in optimal angles to get them the cleanest possible. It also allows technicians to put things together faster in the highest quality possible and get it back to surgery 60 percent faster,” he said.

The selling points: Dirty instruments are a liability and harmful. Delays due to dirty instrument replacement during surgery are costly. The reduction in time used to clean instruments means higher ef-ficiency and less overtime.

Ramkhelawan partnered with his friend Shawn Flynn, manager of the sterile processing department at the trauma cen-

ter in Georgia where he worked. A proto-type was built in Ramkhelawan’s garage. It was called a modular sterilization tray. They rolled out their invention to potential customers for feedback. There were sug-gested revisions, from small ones to huge ones. The partners filed for a provisional patent, putting up $50,000 of investment money.

“I filed the original patent and had the first run of units made – 25 prototypes,”

R a m k h e l a w a n said. “From idea to research to product was eight months. I knew it wasn’t going to be perfect, but the goal was to get it in my hand so I could move for-ward faster.”

Flynn and R a m k h e l a w a n needed more cap-ital. They didn’t realize most peo-ple didn’t have

the money to get to the point they were and had no patent filed.

“We had the prototypes in the trunk and went to meet with venture capitalists in the Atlanta area. We couldn’t get past the secretaries,” Ramkhelawan said. “A friend’s friend had a marketing company just outside of Memphis. We came here to get marketing materials, and he just kept telling us about Memphis and the medical

Idea for Cleaner Instruments Spawns New CompanyZeroto510 program provides needed boost to get product to market


Ryan Ramkhelawan


Campbell Clinic Surgeons Offer New Option in Fight against Pediatric Scoliosis

MAGEC Rod Helps Limit Number of Surgeries While It Grows with the Patient

Over the past several generations, pediatric scoliosis has greatly ham-pered the quality of life for hundreds of thousands of children across the U.S. and the world. Thanks to a new innovation in surgical intervention and treatment offered right here in Memphis, patients and families have a new weapon in the fight against the disease.

The MAGEC (MAGnetic Expansion Control) pro-cedure is offered by the pediatric spine surgeons at Campbell Clinic, and it has been a true “game-changer” in the way we treat severe cases of scolio-sis in young children.

MAGEC offers a unique alternative to traditional growing rods, which typically require 8-10 repeated operations to lengthen the devices during a child’s growing years. The MAGEC device allows surgeons to straighten and correct the spine gradually and noninvasively.

MAGEC was approved by the FDA and released earlier this year to a limit-ed number of U.S. centers. Campbell Clinic is the only orthopaedic spine team in the region who can implant and use the MAGEC device. Our team, along with the staff at Le Bonheur Children’s Hospital, performed only the 10th insertion of a MAGEC rod in the United States since it gained FDA approval earlier this year. We’ve since implanted two more. Based on the success we’ve seen during its utilization, I expect many more lives to be changed for children in our region through the use of this technology.

Using external magnets to control a rod implanted in the spine, this type of procedure will revolutionize the way we care for children diagnosed with progressive early-onset scoliosis. Saving a child from surgery every six months will have a significant, positive impact on their physical and emotional care and recovery. This will also minimize time out of school for children and work for parents.

Candidates for the MAGEC device undergo an initial surgery to implant an adjustable magnetized growing rod. Once the rod is implanted, it can be lengthened externally with a hand-held magnetized device, which eventually straightens the spine. This rod-lengthening process is per-formed in the office without the need for anesthesia and is painless. It takes about 15 minutes and is performed on patients every three to six months, eliminating the need for additional surgeries during the same time span. Patients see their surgeon for the first post-operative follow-up visit three months after the initial surgery where the device is implanted.

In the past, severe cases of scoliosis not only meant a significant reduction in activity levels, but also the potential for development of life-altering cardiac and respiratory problems. Approximately three percent of all chil-dren have some degree of scoliosis. While many children with scoliosis function with little or no pain or limitations, early-onset scoliosis with curves that approach or exceed 40 degrees carry not only severe health risks, but may also result in numerous trips to the doctor and numer-ous surgical procedures. Left untreated, scoliosis can continue to stunt a child’s growth and development through adolescence and can inhibit many basic functions throughout adulthood.

Jeffrey R. Sawyer, M.D.

Campbell Clinic is the only orthopaedic practice in the region authorized to implant MAGEC rods. For more information, or to find out if your child or patient is a candidate for this procedure, please contact Dr. Jeffrey Sawyer at (901) 759-5404.

FFB Driving the Research to Fight Blindness

MEMPHIS on the MEND

BY PAMELA HARRIS

When Alessandro Iannaccone, MD, was recruited in 2005 by Barrett Haik, MD, to come to the University of Ten-nessee Health Science Center’s Hamilton Eye Institute in Memphis, he knew he was following his passion, but little did he know that this move would lead him to be the first in the world to treat a five-year-old girl diagnosed with Best’s macular dys-trophy with a procedure (normally only performed on adults) that would save her vision.

But that is just what happened.The girl’s vision is now 20/20 in one

eye and 20/60 in the other. She is being monitored closely since what she received is a treatment and not a cure. There are less than 50 cases like hers in the world.

As a researcher, Iannaccone has long been involved with organizations that have helped fund the research. He gave credit to the MidSouth Lions organization for buying the instruments he needed to diagnose patients for retinal degeneration when his office was located at Le Bonheur Children’s Hospital years ago.

Today, Iannaccone, who was born in Rome, Italy, is president of the Mid-South Chapter of Foundation Fighting Blindness (FFB), an organization that draws mem-bers from the tri-state area in which we live. Its mission is to drive the research that will provide preventions, treatments and cures for people affected by retinitis pigmentosa (RP), macular degeneration, Usher syndrome, and the entire spectrum of retinal degenerative diseases.

Recent developments supported by FFB include gene replacement therapy trials and research that has led to the ap-proval of artificial retina devices. FFB also backs ongoing drug treatment trials that aim to halt the destructive effects of certain forms of RP.

Iannaccone says gene therapy in mice is successful. In addition, veterinary ophthalmology publications report that gene therapy trials are facilitating a path to treating humans.

How Big is the Problem?According to Foundation Fighting

Blindness, in Tennessee, Arkansas and Mississippi, more than 350,000 people are challenged by blindness caused by retinal diseases such as macular degen-eration and retinitis pigmentosa. Across the United States, more than 10 million of

every age and race suffer vision loss from blinding diseases.

The FFB Mid-South Chapter hosts periodic special presentations on eye dis-eases and research. The next one is sched-uled November 2, 2014, at the UTHSC Auditorium. There will be presentations by David Wilson, MD, Oregon Health & Science University on Gene Therapy and Orli Weisser-Pike and the UTHSC’s Low Vision Rehabilitation Center. For more information, call Dr. Iannaccone at 901-448-7831.

How Can You Help?DonateYour donations help fund the re-

search needed to translate the success of animal blindness research involving gene therapy into human clinical trials. Ian-naccone and his fellow researchers at UTHSC are one of only six sites in the country working on a drug based trial for retinitis pigmentosa.

Your gift could save someone else’s sight! Send donations to Mid-South Chapter of FFB, Attn: Janice Caudill, 9200 Longwood Lane, Germantown, TN 38139.

PARTICIPATE, SPONSOR and VOLUNTEER

This October 25th, the Seventh An-nual VisionWalk will be held at Shelby Farms Park to raise money for FFB. This is their big fundraiser and their goal for this year is to raise $55,000. There are many ways to participate:

Form a Walk Team: Rally your medical practice employees around this cause and build collegial office relation-ships!



pleted in July 2008 with 44,000 square feet and now boasts 100 percent occupancy.

Tenants include Trumbull Labs, Krause Internal Medicine, Results Physio-therapy, Mid-South Internal Medicine and Wells Fargo.

Steel is already in the ground next door, with completion of Medical Arts II expected next spring. Phase II is being built in the same two-story style using the same building materials utilized in Phase I. Prov-ing there is a demand for such space, the new facility was already 45 percent leased before construction even began.

Addressing the financial confidence of the developers, Joe Jarratt, principal of Cypress Realty Holdings, said, “Land-wise, nothing is comparable to the space avail-able in the Germantown Medical Corridor. There has been no new inventory added in the last few years, not in that corridor, not since the local economy took a downturn in 2008. We’ve held off developing our land since then, waiting on the market to improve, and we just broke ground in July for our new property.”

The stability of the market develop-ment is readily evident. Unlike the scenario in retail, medical-related occupancies never experienced much of a drop during the re-cent local economic downturn. Another factor contributing to the interest in the new construction is that older buildings are becoming outdated.

Jarratt added, “Regardless of the type of medical service being offered, lots of tech-nological changes have been introduced. It is easier and more cost-efficient to integrate that technology into new construction than it is to retrofit it into older buildings. Almost all of our tenants in the Germantown Medi-cal Corridor have local offices that they are expanding or consolidating.”

William Tuttle, vice president of Bap-tist Memorial, commented on the expan-sion saying, “The growth in this medical corridor is being spurred on by the general population growth’s moving eastward. An-other factor that has impacted growth in this area is the support of elected govern-mental officials, especially in Germantown, who have been deliberately supportive of the expansion of medical services in their city planning processes. There’s now a nucleus of medical services and providers, whether it be hospital-based or physician practices, that offers a very broad and com-prehensive grouping of medical services.”

So this building boom really does fol-low the logic of “If you build it, they will come…” Medical professionals are opting to upgrade from older buildings to new ones offering the benefit of new technology options and the quality of a Class A prod-uct. And some of those upgrades apply to both the medical professionals and their patients. Moving to an off-campus location offers increased visibility and ease of access.

For example, the Medical Arts build-ings on Wolf River offer five parking spaces per 1,000 square feet, which is more than is usually available with on-campus park-ing. This translates to more available park-ing as well as shorter distances for patients to get to their care providers. This trend is being spurred on by another convenience

factor, the access to both primary care and specialists in a centralized area.

Charles Lock, executive director of Sutherland Cardiology (which is now part of the Methodist Healthcare System), said his clinic looked at its space on Wolf River in 2005-2006 “and we saw it as a great op-portunity to be part of that medical corridor. Although our patient base has expanded in other parts of the city as well, many of our patients already lived out east in the county. When we decided to move to Germantown years ago, it put us in closer proximity to a large number of our patients.”

Medical Arts II will offer 36,000 square feet to medical professionals and is being designed to include an imaging clinic, with care provided by West Ten-nessee Imaging and Mid-South Imaging and Therapeutics.

Rounding out the corridor are medi-cal organizations Stern Cardiovascular, Sutherland Cardiology Clinic, Gastro One, The Light Clinic, Campbell Clinic, Baptist Oncology Campus, UT Medical Group and Baptist Rehabilitation Hospital (cur-rently under construction). Not only does the list of tenants speak to the growing vari-ety of medical services being offered in the Germantown Medical Corridor, but the occupancy rate of the medical buildings in that submarket is 95 percent, and is maxed out at 100 percent from Germantown Parkway west to Baptist Hospital.

New ‘Medical Center’ continued from page 1

The Germantown Medical Corridor•More than 1 million square feet of

rentable space in the East Memphis submarket

•Approximately 20 percent of the market share of the Memphis Medical market

•As of the end of 2013, vacancy rate of only 12.5 percent

•Class A medical buildings have occu-pancy of nearly 95 percent

•No new inventory (rentable office space) added for more than 5 years

•Most vacancy in the marketplace is in older buildings (10 to 30 years old)

•Our estimates show that potential de-mand in the submarket exceeds supply by more than 225,000 square feet

Medical Arts II location•Baptist Memorial Hospital, Memphis –

2.5 miles•Methodist Le Bonheur Germantown

Hospital – 2.4 miles•Campbell Clinic – 0.7 miles•Baptist Rehabilitation Hospital, Ger-

mantown – 2.4 miles•Sutherland Cardiology Clinic – 0.2

miles•Baptist Oncology Campus – 0.9 miles•UT Medical Group – 0.9 miles

Medical Arts II Signed Future Tenants to date:•West Tennessee Imaging•Mid-South Imaging and Therapeutics•Medical Arts I is 100 percent leased

All data from independent research done by Integra Realty Resources

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lot more of it on a much larger scale,” he said.

Perhaps “marathon scale” would be an appropriate term, in view of Hernan-dez’s leisure-time commitments. An avid endurance runner, he aspires to run 100 marathons before age 100. He recently completed No. 57 – the Midnight Sun Marathon in Anchorage, Alaska – and has run marathons in nearly 25 states, includ-ing Massachusetts, where he has qualified five times for the prestigious Boston Mara-thon.

A modest, self-described “middle of the pack runner, sliding more toward the second third than the top third,” he joked, Hernandez runs for the excitement and the fun and doesn’t pay much attention to his times. Like his career commitment, he’s in it for the long run.

Married, with in-laws in the Memphis area, Hernandez is originally a North-easterner who earned master’s degrees in healthcare administration from Trinity University in San Antonio and business administration from then Memphis State. He served hospitals in California, Wash-ington and Kentucky before relocating to Memphis and ultimately joining Campbell Clinic in 1995 as CFO. After CEO John Vines’ retirement in 2009, Hernandez was promoted to fill his position.

His primary leadership challenge re-sults from the multiplicity of the clinic’s focuses, stressing excellence in orthopedic care, the education of orthopedic surgeons through an in-house residency program, the production of scholarly publications and continuing pursuit of musculoskeletal research.

“The traditional private practice medical group is probably 95 percent fo-cused on just the patient care component, whereas we have to devote our energies to all four of those different activities,” he said.

Pursuing and evaluating different types of technology to fulfill clinical, edu-cational and research needs adds to the challenge, but also offers exciting oppor-tunities to work alongside a large group of renowned, world-class orthopedic sur-geons. He believes those opportunities contribute to a distinctive Campbell Clinic culture that engenders self-motivation in its staff.

“From the orthopedic surgeons who work at the Regional One Health trauma center putting people back together who come in with virtually every bone in their body broken, to those who serve 85-year-old grandmothers who need a second total hip replacement following an origi-nal 10-year-old surgery, kids with play-ground fractures and weekend warriors who overstress aging bodies ... the gratifi-cation of being part of that team, even at administrative/clerical levels, and seeing the near-miraculous results, is incredibly rewarding.”

Hernandez testifies from firsthand experience: In an effort to understand the organization from every level and to ex-perience physicians’ and employees’ roles from a hands-on perspective, he arranged when he first became CEO to step in as

the “not-so-undercover boss” – and serve side by side with virtually every physician at each of the clinic’s locations, doing every job that he was able to safely and legally learn to perform.

“It was a tremendous experience,” he said, “because I got to see firsthand what goes on on the front lines. I learned more than I ever imagined.”

Among the projects he’s currently shepherding is the imminent opening of a fifth Campbell Clinic office in Cordova, while simultaneously developing a master plan for a vacant five-acre portion of its Germantown campus. In late 2013, he also supervised the acquisition of the for-mer Midtown Surgery Center, which was reopened in April as a “100 percent or-thopedic surgery center just for Campbell Clinic.”

In addition, “we’re just now embark-ing on the 13th edition of Campbell’s Opera-tive Orthopaedics, which many people refer to as the bible of orthopedics,” Hernandez said. (The textbook was originally written by Dr. Campbell in the 1940s and is up-dated every five to seven years.)

Clinic physicians are working with local manufacturing companies to develop proprietary new products and implants; since their 40 residents are required to work with faculty physicians on a project, 40 research projects are in progress at any given time, Hernandez said.

He points to advanced clinical services in which Campbell Clinic physicians are blazing a trail – e.g. the MAGEC (MAG-netic Expansion Control) spinal bracing and distraction system, a non-invasive al-ternative to the emotionally and physically painful scoliosis treatment regimen that relies on traditional growing rods and re-peated lengthening surgeries. Alternative VEPTR (vertical expandable prosthetic titanium rib) procedures enable implanted VEPTR devices to be lengthened and the spine straightened incrementally as the child grows.

Campbell Clinic doctors are also lead-ing the way by performing more total joint replacement surgeries for knees, hips and shoulders in their specialized ambulatory surgery centers, often allowing patients to go home safely the same day of surgery.

“We like to take a really strategic ap-proach to our entire growth,” said Her-nandez, who analyzes regional demand for orthopedic surgery and national trends that help predict increased demand. Total joint replacements are projected to in-crease by nearly 300 percent over the next decade, he said.

He stressed the Campbell Clinic’s re-newed commitment to seek out and evalu-ate the needs of its customers: The After Hours Clinic, started four years ago in Germantown to improve patient access, has been so successful that the same pro-gram was added in their Southaven office. Recently, Saturday morning hours were added, and evening appointments are now offered at all locations.

Active in the community, Hernandez also serves as a reserve police officer for the city of Germantown. “I’ve got my hand in a lot of things,” he said with a smile.

Healthcare Leader, continued from page 1

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Recently a six-year-old donkey named Nestle visited Methodist Le Bonheur Germantown Hospital. And no, this was not some political event. Nestle is part of the Mid-South Therapy Dogs and Friends, whose members visit patients in several hospitals in the region. The reaction from patients when they see the Sicilian miniature donkey is unparalleled, Debb Tayor, Nestlé’s owner said.

“Kids all smile, no matter if they’re afraid,” she said. “One man at a senior living facility held Nestlé’s head in his lap for 10 minutes, placing his own head on top of hers.”

William Kenley, a long-time friend, big part of the community and CEO of Methodist Le Bonheur Germantown Hospital, realized Nestle was not running for political offi ce. (It was obvious that Nestle had better things to do and left the politics to other donkeys).

William got a picture with the donkey, and joked, “I am sure there would be some future use for it.”

Well, William, your prediction came true. “It makes a big difference in the lives of

not just our patients, but our staff as well,” Kenley said of the animal’s visits. Really this fi ts taking care of the total patient and total family.”

In the column I wrote in Memphis Medical News’ InCharge, (December, 2013), I said that I had noticed more service dogs and friends groups being formed with the purpose of helping humans.

Equine Therapy is a form of experiential therapy that involves interactions between patients and horses. The goal of equine therapy is to help the patient develop needed skills and attributes, such as accountability, responsibility, self-confi dence, problem-solving skills, and self-control.

Equine therapy has been successfully integrated into treatment programs, for substance abuse, addictions, and behavioral disorders, and mood disorders, eating disorders, learning differences, ADD/ADHD, autism, Asperger, grief/loss, depression and others.

About the time that the judicial system and medical system was about to give up on a teenager who was in and out of the penal system and was on prescribed drugs and therapy, a gentleman named Tom Reed, who has a ranch outside of Jackson, Tennessee, had a thought. What if he had this young man come and visit his ranch? Both the sheriff and the physician (who knew Reed well) said, “Why not, we have exhausted our resources.”

Tom took the time to work with this young man, using a certain horse on his range. It was a slow process. The young man had been abused, physically and mentally all these years and the effort was going to take a lot of time. You could see at every encounter with these two that a strong bond was building. His learning disabilities, self

control and his lack of trust were slowing going away and his self esteem appeared strong. Both the sheriff and the physician said it was a miracle.

The real “miracle” was that this young man graduated with honors from high school and was accepted into the U.S. Air Force Academy and is now an offi cer in the United States Air Force. Thank you, Tom Reed, for not giving up on this young man.

Now, back to the canines. There are 220 million olfactory cells in a canine’s nose, compared with 50 million for humans; dogs have long helped in search-and-rescue

missions. Now, a growing body of evidence supports the possible use of canines by clinicians.

The largest study done on canines in a clinical diagnostic trial was in prostate cancer detection.

“Our study demonstrates the use of dogs (olfactory) might represent in the future a real clinical opportunity if used together with common diagnostic tools,” said Gian Luigi Taverna, the author of the prostate cancer research reported at the American Urological Association in Boston. Taverna, who is also the head of urology pathology at Istituto Clinico Humanities in Rozzano, Italy, said, “ Our standardized method is reproducible, low cost and noninvasive for the patients and for the dogs.” Taverna, said,

“The results may one day be used to help develop an electronic nose that follows natures in how a canine nose works.”

The University of Pennsylvania researchers say they used a canine to help identify the scent of ovarian cancer in tissue samples, opening a new window on a disease with no effective test for early detection.

A recent article in the Memphis Commercial Appeal headlined, “Dog is more than best friend to Veteran,” talked about Melissa Maher of Bartlett, an Iraqi War Veteran coping with post-traumatic stress

disorder. Maher was given a golden retriever from the K9s for Warriors; Chauncey.

Maher said, “the physical stress reaction when you start getting nervous: The heart beats faster. You breathe faster. May start fi dgeting or pacing. Chauncey picks up these cues before I am aware of it. He can bring it to my attention so that I can remove myself from the triggering situation or use coping skills.” Sometimes all it takes is for him to look at her with his expressive face, including a raised eyebrow. Chauncey will lean into her or paw at her if he senses her growing anxiety and wakes up Maher when he senses the anxiety spurred by her nightmares. Before Chauncey, Maher could hardly attend her children’s school functions, go into a store and talk to a clerk without breaking out into a cold sweat. She said these anxiety/ meltdowns would last up to two days.

With the help of Chauncey, Maher has now returned to school, getting an associate degree from Southwest Tennessee Community College and enrolling at the University of Memphis.

In conclusion, why do you think God told Noah to gather two of each type of animal to go on the Arc? God didn’t say anything about two Jones or two Smiths. Sometimes we’re better off with the animals around.

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].

When Donkeys Fly BY BILL APPLING

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made a return trip to Memphis for meetings with some people of influence. One told them about Bioworks. This was right before the Zeroto510 program launched. There were two meetings with Bioworks before Allan Daisley, director of entrepreneurship and sustainability, told them to complete an application for Zeroto510. The next month was May 2012, and they started with the inaugural class of six groups.

The program is an intense 12-week “boot-camp style” adventure, Daisley said, including classroom activity, mentoring and hands-on exercises. Mentors guide participants on manufacturing at top ef-ficiency, with a machine shop on site at Bioworks. Zeroto510 groups spend most of their time on market validation and proofs of concept. Since Flynn and Ramkhelawan had already moved forward in those areas, they spent a lot of time on venture capital, presentations and preparing for the U.S. Food and Drug Administration’s 510(k) approval and even opted to seek ISO cer-tification. They eventually received both approvals.

Medical devices just made sense for Zeroto510 and the Memphis area, with a thriving medical center and Medtronic, Smith and Nephew and Wright Medi-cal. The goal of the program is economic growth. It also draws on the medical brain trust available. The program is focused on clear, simple innovation and movable ideas on the fast track. It is in its third year.

“It takes a village to grow a startup,” Daisley said. “We don’t go for more com-plex ideas that require $100 million to execute, but those smaller, focused things that can reach significant gains quickly. We would like for a project to be able in a year or so to file financial papers and be in the market within months after that.”

Innova and MB Venture Partners back Zeroto510, which gives each partici-pating group $50,000 to get started and get through phase I of the program. Investors decide whether participants go to phase II and receive an additional $100,000.

Zeroto510 has several physicians and hospital administrators who do sessions, mentor participants, and determine if there is a viable product. Sometimes physicians are even participants themselves, Daisley said. The first program of its kind, Ze-roto510 comes at a good time.

“Increasing regulation has made more startups hesitant to move ahead, but it has raised the value of programs like ours,” he added.

Applicants come from all over the country and beyond. Applications have come from Spain, Russia and Algeria, along with a visit from an Australian group considering the program model.

Thanks to opportunities through Ze-roto510, Restore Medical Solutions got its big break. They did not make the phase II $100,000 prize. Instead, they were awarded $2.5 million from Innova and MB Venture Partners to take their product all the way to production. Nearly a whole floor of the Bioworks building is devoted to the RMS Modular Sterilization Tray’s

assembly and distribution, as are facilities in Rhode Island and Atlanta. Company of-fices are located at One Commerce Square downtown.

Restore Medical Solutions and one other company from the inaugural class, Ecosurge, a manufacturer of foam position-ers for patients undergoing surgery, are at the end point of selling product and helping patients. RMS has four hospitals using its products, with three in Memphis and one in Durham, N.C.

“At one hospital, we were able to go from an initial meeting to a full trial in three days,” Ramkhelawan said. “When we meet with a hospital, we assess the department for free and show them our product costs, but we also identify exactly where they are going to save money and increase quality.”

About 15 other hospitals are in various states of proposal, he added. RMS has 10 employees and anticipates hiring five more in the next two quarters. It will be launch-ing another product line next year and an-other to follow that.

What are the best things Zeroto510 taught Flynn and Ramkhelawan? How to talk with venture capitalists, how to maxi-mize dollars and how to move super-fast strategically, Ramkhelawan said.

Idea for Cleaner Instruments, continued from page 6

married for six years at the time and had a 2-year-old daughter. I will never forget hugging and kissing her and then walking away. At that point, it was the hardest thing I had ever had to do.

When I deployed to Iraq, Megan (my oldest) was 4 and Delaney (my middle child) was less than 1. When my wife dropped me off at Reagan National to fly off, I couldn’t even turn around to look at them after I said goodbye.

My wife, Gina, my daughters Megan (7) and Delaney (3) and my son Andrew (3 months) all live in Germantown.

What did your service over there contribute to the kind of doctor you are today?

It has made me more appreciative of life and the little things that go along with it. It has also made me comfortable in just about any situation I can find myself. I learned how to improvise and make do with the equipment that I have available. I’m not sure there is another orthopedic surgeon that has performed an emergent craniectomy.

How did you wind up at Mem-phis Orthopaedic Group?

Both my wife and I are from Pittsburgh originally but have not lived there since I graduated from medical school. My wife had no desire to move back to Pittsburgh, so that eliminated that as a destination and left us with no geographical ties. We have lived in San Antonio, Northern Virginia and North Carolina and have grown at-tached to the South. After searching for jobs, I liked the opportunity at MOG the best, so here we are!

Physician Spotlight, cont. from page 3


By CINDy SANDERS

In an effort to improve patient access to appropriate, evidence-based care, the North American Spine Society (NASS) recently released detailed policy recom-mendations for coverage of 13 common spine care treatments, procedures and diagnostics.

The fi rst-of-their-kind reference doc-uments outline when it is … and when it is not … appropriate to utilize each of the options based on an ex-tensive review of current literature by a multidisci-plinary team of experts.

William Watters, MD, president of NASS, said, “Maintaining pa-tient access to high-quality, evidence-based and ethical spine care is the single most important part of NASS’ mission. It is our hope that payers, spine specialists and their patients will use these evidence-based coverage recommenda-tions as a reference to advocate for ap-propriate care for patients.”

Watters added the society was uniquely positioned to take the lead on such an extensive project because of the multispecialty nature of the organization,

NASS Takes a Proactive Approach to Evidence-Based Coverage Decisions

Dr. William Watters

Dr. Christopher Kauffman

Coverage Policy RecommendationsTo access the documents for each of the procedures listed below, go online to www.spine.org and click on the “Policy & Practice” heading.

• Cervical artifi cial disk replacement

• Endoscopic discectomy

• Epidural cervical spinal injections

• Interspinous device without fusion

• Interspinous fi xation with fusion

• Laser spine surgery

• Lumbar artifi cial dis replacement

• Lumbar discectomy

• Lumbar fusion

• Lumbar laminotomy

• Lumbar spinal injections

• Percutaneous thoracolumbar stabilization

• Recombinant human bone morphogenetic protein (rhBMP-2)

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which includes the ex-pertise of surgeons and allied health profession-als. “We cover the full spectrum of spine care,” he noted.

Watters, who is a board certified or-thopaedic surgeon in private practice at the Bone & Joint Clinic of Houston and a clinical associate professor at both the University of Texas Medical Branch in Galveston and Baylor College of Medicine, said the society already had experience weighing the evidence at the request of physicians, patients and pay-ers. “NASS began a number of years ago becoming involved in third party payer coverage decisions,” he noted. However, he continued, the turnaround time was often tight and the number of studies to consider extensive.

“We decided to proactively create our own coverage decisions based on the best evidence available … and where evi-dence was lacking, based on the expertise in this group,” he explained. “We came up with what we feel is the most sound group of recommendations based on the best evidence available at this point and time.”

Watters continued, “One of the hopes that we have is that we bring a bit of uniformity to the whole process of spi-nal care.”

Christopher Kauffman, MD, health policy council director for NASS, con-curred. He said allowed treatments and diagnostics vary by state and by payer. These recommendations outline the scope and clinical indications for a therapeutic measure when a patient meets appropri-ate inclusion criteria. They also clearly state scenarios in which employing the measure is not indicated.

While not recommending payers re-imburse for every procedure under every circumstance might be controversial among some providers, Kauffman said, “People who understand where medicine is going with outcome measures get it. So far, the response has been overwhelmingly positive.”

He added, “People may confuse cov-erage with medical appropriateness. The two are not equal. People assume pay-ment equals medical appropriateness. I can’t stress enough this isn’t true. Payment equals treatments where the literature has reached a certain bar of evidence.”

Kauffman, a board certifi ed ortho-paedic surgeon in practice at Premier Orthopaedics in Nashville, said, “For


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By CINDy SANDERS

Chikungunya and new strains of in-fluenza are among a list of emerging in-fectious diseases that have grabbed recent headlines, but reemerging diseases including measles and pertussis are also causing epi-demiologists concern across the nation.

“There are newly emerging diseases and reemerging diseases … and both are disturbing,” stated Tim Jones, MD, state epidemiologist for the Tennessee Department of Health (TDH). Jones, whose past experience includes working in the Centers for Disease Con-trol and Prevention’s Epidemic Intelligence Services, recently pro-vided insight into the old and new. He also shared his thoughts on why we’re seeing a resur-gence of some diseases, such as polio, that the medical community thought would be a distant memory at this point in history.

“Internationally, we had hoped that polio would be eradicated by the turn of the century, but here we are in 2014 with it ex-panding into additional countries,” he said.

Jones, who is the immediate past presi-dent of the Council of State and Territorial Epidemiologists, noted the spread of new diseases and return of some of the older ones is multifactorial with global mobility and increasing refusals to be vaccinated contributing to the problem.

Emerging Infectious Disease“The majority of these new diseases

are what we call zoonotic. As the name suggests, they are diseases that have jumped from the animal world into humans,” Jones explained, adding examples include SARS, West Nile Virus and H1N1.

The most recent mosquito-borne dis-ease to make its way to the United States is chikungunya. “We just started seeing it in the last few months,” Jones noted of the disease’s migration primarily from the Ca-ribbean where there have been large out-breaks. “Our first cases in Tennessee were in May. We’d never seen it before. As of today, there are 37 suspected cases, and all of them are people who have recently re-turned from the Caribbean.”

Jones added, “This new one, chikun-gunya, luckily does not have a reservoir out in the wild.” He explained the viral disease doesn’t live in birds or other animals and only transmits between mosquitos and humans. “For me to get it, the mosquito would have to bite an infected person and then me. So far we haven’t seen any jump from infected travelers to someone local, but that’s what we’re afraid of.”

(Editor’s Note: At the time of the interview in early July, there had not been any cases of chikun-

gunya originating in the United States. However, the CDC has since confirmed the first cases of the virus being locally acquired. The virus is transmit-ted through two species of mosquitoes, Aedes ae-gypti and Aedes albopictus, which are found in a number of regions across the country including the Southeast.)

Primary symptoms include joint pain and fever. Although there is no vaccine, Jones noted, “It’s rarely fatal, but it makes you feel terrible for about a week, and 10 to 15 percent of people will have very bad arthralgias for up to a year.”

Dengue is another mosquito-borne virus that epidemiologists are closely moni-toring. “Generally, it’s pretty endemic in the Caribbean and South and Central America, but it seems to be moving north,” Jones said. “As these vector-borne diseases move into new areas, it raises concerns as to whether it could be related to climate change.”

With no vaccine or treatment, dengue is a leading cause of illness and death in the tropics and subtropics and is caused by any of four related viruses transmitted by mos-quitos. “Unfortunately, dengue you can get more than once, and if you get it a second time, it’s usually much more severe,” Jones said, adding it’s nickname is ‘breakbone fever’ because the intense joint and muscle pain can cause those with dengue to have contortions.

The first 2014 human case of yet an-other mosquito-borne disease, West Nile Virus, was confirmed in Tennessee in late June. WNV has been present in the state since 2001.

The common thread with all three of these viruses is that there is no vaccine so prevention remains the best way to con-tain the spread of the virus. The TDH lists a number of recommendations on their website for individuals to prevent mosquito bites including the use of insect repellants and elimination of standing water near homes.

Reemerging DiseasesAlthough ‘officially’ eradicated from

the United States in 2000, measles is still present in other regions of the world and has begun to reappear in this country. In fact, the CDC recently announced they have confirmed more cases of measles in the United States so far in 2014 than in any other year in the past two decades.

This spring, the TDH identified the first case of measles in the state in three years. As with most cases now seen in this country, the virus was traced to an inter-national traveler and then spread to those who weren’t immune to the disease.

“We had one person who returned from overseas from an area that was hav-ing an outbreak, and we ended up having five people infected before we got it under

Emerging & Reemerging Infectious Diseases

Dr. Tim Jones



Tim C. Nicholson is the President of Bigfi sh, LLC. His Memphis-based fi rm 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 @timbigfi sh or email tim@gobigfi shgo.com

By TIM NICHOLSON You attended years of school and

training. But by now you know that there’s more to being a doctor than what you learned in the classroom. Sure, a suture can heal and the right medication can manage the in-between time. But a smile goes a long way toward the same and a word of encouragement moves a patient toward their best outcome.

So, what have we learned about social media that might make a difference in your practice? After all, there’s more to doing it right than merely creating an account and updating your Facebook status or Twitter feed. The technology is several years into its use life. You’d think most doctors would have fi gured this out by now. But a recent review of the top healthcare brands in our community taught me that they haven’t.

However, you can demonstrate social media savvy and connect with patients by using these Best Practices as a guide:

Enable More Voices.It’s diffi cult to build community with-

out conversation. Creating good content isn’t good enough. Invite trusted sources to guest post on your page. Host a Facebook Q&A with a physician from your team. Get a conversation started. And don’t be afraid of what you hear. Helping people get it right makes you the most valuable voice in

the community.

Avoid Broadcasting.Announcements don’t compel inter-

action (see Just One Voice). If your social media presence is largely dedicated to an-nouncements regarding offi ce hours, new staff members and new services – you’re Charlie Brown’s school teacher. Sure she had important information to share but all the kids heard was, “Wah, wah, wah.”

Patients Look for Themselves.I’m sorry to report this but people want

to know if your brand advocates (those who like your social media pages) have anything in common with them. Potential new pa-tients are smart and have learned to use your Facebook wall as a place to fi nd out who makes up your community. If they don’t see people like themselves, they’ll be less inclined to connect. We’re clearly not advocating excluding any one. We are encouraging you to be intentional in your marketing. A grandmother who likes a pediatrician’s page is not nearly as good a match to potential new patient as a young woman who does.

Raise Your Hand.Okay, that’s code for “buy some ads.”

Facebook advertising is relatively inexpen-sive but there is a right and wrong way to do it. Here’s a simple truth: Facebook

changed the algorithm that determines what percentage of your target audience sees your posts shrinking your natural reach. If you want all, most or more than a single digit percentage to connect with you there, you’re going to have to buy ads and boost your posts with ad dollars.

But more than anything else it’s about this,

Know What They Want. If your OB/GYN practice wants to

reach women, maybe you should share some content from SELF Magazine. But it’ll be more meaningful if a member of your phy-sician staff has a commentary on the subject and can connect it to those in your practice community in a personal way. What they want is to know what you think.

Maybe you’ve heard some of this be-fore, but by judging the social media pages of your peer network, nobody’s listening. You can be a leader in empowering a healthcare community, who in turn advo-cates for your brand and sees you as among the best practices.

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For more information go to the FFB website: www.fightingblindness.org/MemphisVisionWalk.

“We are fortunate to have an active and engaged chapter board that car-ries the spirit of FFB’s Co-Founder and Chairman of the Board Gordon Gund. His vision is our vision: We will save and restore sight by funding vital research,” said Iannaccone. “Losing vision cripples one’s abilities to interact with other people and limits the ability to enjoy life. To be able to see the faces of your children and grandchildren is priceless.”

If you have a charity or non-profi t that you would like to see spotlighted in Memphis on the Mend, please send your nomination to [email protected].

FFB, continued from page 7

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control,” Jones said. Transmittable through the air, he added, “Measles is very serious and really, really easy to spread.”

Although the state has a very high rate of compliance for the measles vaccine, Jones pointed out that the vaccine was really only recommended for those born after 1957 since many older citizens were exposed to measles in childhood. A two-part vaccine, Jones said the state probably only has 2-3 percent of the population that isn’t fully im-munized.

Pertussis, or whooping cough, is an-other disease spreading throughout the country. Although Jones said Tennessee has only had light activity with 100-200 cases per year, other parts of the country have been much more heavily affected. “There are some states in the Midwest and now California that have had many hundreds and thousands.”

The problem, Jones continued is a combination of under-immunization and the fact that it isn’t a perfect vaccine. Because of some concern about the im-munization wearing off, a booster is now recommended. “In the last couple of years, we began recommending all adults that haven’t had this new Tdap (tetanus, diph-theria and acellular pertussis) vaccine get a dose no matter when the last time they had a tetanus shot,” Jones said.

In Tennessee, the continuing concern over tuberculosis comes with some good news and some bad news. “For the first time this year, Tennessee is below the national

average, which is exciting … but as the numbers go down, the complexity of each case is going up,” Jones said.

He added, “While we’re having a real impact on domestic TB, now nationally the majority of TB cases are in the foreign-born population. We’re seeing much more imported TB.”

Although contagious, Jones said it takes close, prolonged contact rather than casual proximity to spread the disease. In the absence of a good vaccine for TB, test-ing becomes important … particularly for

healthcare workers. A major issue with reemerging diseases

is a lack of recognition by healthcare pro-viders since they are so rare. “There are very few physicians in the U.S. who have ever seen a true case of measles,” Jones said. “Likewise for TB … most physicians are never going to have seen a real case, and that makes it challenging.” He added, “With TB, for example, we’re increasingly seeing people who went to a healthcare professional and were treated for bronchi-tis, smoker’s cough, etc. We’ve got to keep

these diseases in the back of our minds as possibilities.”

Jones said education and awareness are key to catching infectious diseases early. The CDC has extensive information on both emerging and reemerging public health threats. Likewise, the TDH provides resources and local updates about diseases present in Tennessee. For more informa-tion, go online to cdc.gov and to the TDH section on communicable and environmen-tal diseases and emergency preparedness (CEDS) at health.state.tn.us/ceds.

Emerging & Reemerging Infectious Diseases, continued from page 14

everything we recommend, we think the evidence does reach the bar for coverage. This is what we think should be covered by any payer.”

However, he continued, it doesn’t mean other treatments being employed don’t have therapeutic benefits. “You can’t ever throw out the art of medicine.” Yet, Kauffman noted, “If you’re falling outside the clinical guidelines, you have to expect that you’re going to do a peer-to-peer review, or it might not be a covered service.” He added the recommendations would be routinely revisited to incorporate new evidence.

In addition to the 13 coverage pol-icy recommendations published in May, Watters said NASS is already in process or planning to create documents for 14

additional diagnostic and therapeutic mo-dalities including annular repair, cervical and lumbar radiofrequency neurotomy, cervical fusion, cervical laminectomy and laminoplasty, minimally invasive lumbar fusion, SI joint fusion and injec-tions, DNA-based scoliosis test and elec-trical stimulation for bone healing, among others. “The remainder will be released within a year,” he said.

“The plan is to reassess the literature at least every two years,” he continued, emphasizing the need to stay current as new studies are published and new treat-ment options become available. “This has to be a living document.”

He added it’s a nearly impossible task to ask physicians, surgeons, nurses, therapists and other providers to wade

through all the literature required to prac-tice evidence-based, contemporary medi-cine. Having the committee go through the best, most soundly crafted studies to create each of the 5-30 page recommen-dations, which include supporting details behind the rationale and a thorough list of references, simplifies the process for prac-titioners and their patients. “These turned out to be remarkably educational docu-ments,” Watters stated.

Both Kauffman and Watters stressed at the end of the day, the coverage rec-ommendations are an effort to ensure patients have equal access to the best pos-sible treatments.

“It’s making sure that good spine care is available for patients across the U.S.,” Kauffman concluded.

NASS Takes a Proactive Approach, continued from page 13


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By LyNNE JETER

A thriving city rich in history, perched on the brow of the picturesque James River, has once again captured the uncov-eted title as the most challenging place to live with asthma.

For the second consecutive year, and four of the last fi ve years, Richmond, Va., took the title perch, with worse than aver-age ratings for prevalence factors (crude death rate for asthma), risk factors (annual pollen score, poverty rate, the uninsured, and public smoking laws), and medical factors (emergency room visits for asthma).

Medical News markets located across the South and Midwest were represented in “Asthma Capitals 2014,” the 11th an-nual research project released by the Asthma & Allergy Foundation of America (AAFA). Boston Scientifi c Corporation (NYSE: BSX) sponsored this year’s report.

Medical News market rankings, with 2013 rankings in parentheses:

No. 2: Memphis, Tenn. (3)No. 6: Chattanooga, Tenn. (2)No. 22: New Orleans, La. (24)No. 26: St. Louis, Mo. (55)No. 27: Little Rock, Ark. (31)No. 38: Nashville, Tenn. (32)No. 41: Knoxville, Tenn. (10)No. 42: Jackson, Miss. (47)No. 48: Birmingham, Ala. (23)No. 49: Orlando, Fla. (62)No. 50: Tampa, Fla. (57)No. 55: Lakeland, Fla. (60)No. 64: Daytona Beach, Fla. (76)No. 65: Baton Rouge, La. (79)No. 75: Sarasota, Fla. (87)No. 81: Raleigh, NC (91)No. 87: Charlotte, NC (86)Most Metropolitan Statistical Areas

(MSAs) in Medical News markets im-proved over 2013, collectively dropping 45 spots. The St. Louis market showed the least improvement, moving up 29 spots among the most challenging places to live with asthma. The most improved MSAs

for easier asthma living: Knoxville, Tenn., sliding down 31 spots, followed closely by Birmingham, Ala., which dropped 25 spots.

MethodologyAnalytical data from the 100 most-

populated MSAs in the United States de-termined the ranking system. Researchers and medical specialists focused on three primary areas – prevalence, risk, and medical factors – that include 13 unique factors, with non-equal weights applied to each data set in individual factor groups. Total scores were calculated as a compos-ite of all factors, refl ecting each factor’s relative impact on exposure to asthma triggers, quality of life, costs and access to care.

Prevalence factors included the predicted population with asthma, self-reported population with asthma, and re-corded death rates for adults and children from asthma. Risk factors included com-prehensive annual pollen measurements, average length of peak pollen seasons, out-door air quality, poverty and uninsured rates, state school inhaler access laws, and smoke-free public laws.

Medical factors included ER visits for asthma, rescue medication use, controller medication use, and the number per pa-tient of board-certifi ed adult and pediatric allergists and immunologists, and pulmo-nologists.

ER visits represent a signifi cant chunk of asthma care-related costs.

“Many ER visits are from people with severe asthma, but not all of them,” said Mario Castro, MD, professor of medicine and pediatrics at Washington University School of Medicine in St. Louis, discuss-ing the average of more than 2,300 visits to ERs for asthma in each U.S. city, with one in four admitted to a hospital. “Many people with less severe asthma show up to the ER, too. But much of this is avoidable with new treatments for severe patients and better prevention and care for those with less severe disease.”

Making StridesEarlier this year, the Supreme Court

upheld the U.S. Environmental Protection Agency’s (EPA) Cross-State Air Pollution Rule, which aims to reduce the amount of pollution drift from certain states into oth-

ers, prompting health issues for residents in those states. The Supreme Court also noted the rule is an effective way to con-trol emissions, and melds with the EPA’s mission under the Clean Air Act.

The AAFA is collaborating with state chapters to mandate or improve on the requirement of stocking epinephrine in schools for severe allergic reactions. For example, California is considering legisla-tion to strengthen its existing epinephrine-stocking law to require schools to stock the medication and train a volunteer to administer it. Illinois is considering legis-lation to require, rather than simply allow, schools to stock epinephrine. All states in Medical News markets have epinephrine-

stocking school policies in place, with the exception of North Carolina, which at press time had pending legislation.

The AAFA has banded with other national health advocacy groups to sup-port increased research funding, which includes lobbying against proposed budget cuts for the National Institutes of Health, Centers for Disease Control and Preven-tion (CDC), Agency for Health Resources and Quality, and other agencies with re-search relevant to asthma and allergic diseases.

For example, the CDC’s National Asthma Control Program has helped decrease asthma mortality rates by more than 45 percent since its inception in 1999.

“There are many things that we can improve now to make life better for people with asthma,” says AAFA spokesperson and asthma patient, Talisa White. “Our Asthma Capitals report helps to shed light on the asthma burden in each city, but it also pro-vides a roadmap for improvements.”

Taking Your Breath Away How do cities fare in the latest annual asthma report?

Providing High-Quality, Patient-Centered Asthma CareU.S. Asthma Guidelines list six key steps for physicians with asthma patients:

• Assess asthma severity.• Provide a written asthma action plan.• Direct patients how to properly use inhaled corticosteroids (ICS). • Show patients and their families how to control environmental triggers at home,

work or school.• Schedule follow-up visits.• Assess and monitor asthma control care.

SOURCE: AAFA.

Fast Facts about AsthmaEvery day in the United States,

44,000 people have an asthma attack;

36,000 kids miss school due to asthma;

27,000 adults miss work due to asthma; and

4,700 people visit the emergency room due to asthma;

1,200 people are admitted to the hospital because of asthma; and,

9 people die from asthma.

SOURCE: AAFA.

REPRINTS: If you would like to order a reprint of a Medical News article in a PDF format or request an additional copy of an issue, please email: [email protected] for information.


Apply at: https://jobs.etsu.eduInquiries can be directed to: Stephen Geraci, M.D., Professor and Chairman of

Internal Medicine via Karen A. Heaton, Quillen College of Medicine, Box 70622,

Johnson City, TN 37614. Phone (423)439-6367; email: [email protected].

Academic Internal Medicine Opportunities

Quillen College of Medicine, Department of Internal Medicine at East Tennessee State University is seeking BC/BE (at time of hire) Internists to join their groups in Johnson City and Kingsport, Tennessee at the Assistant/Associate Professor level. Responsibilities include teaching residents and medical students ambulatory care in our University practices, with in-patient attending at our community partner teaching hospitals, and the opportunity for clinical research. Scholarship is an expectation of all faculty with protected time for scholarly activities. Competitive pay, comprehensive benefits package, CME allowance and relocation support provided. Women and minorities are encouraged to apply. AA/EOE

Quillen College of Medicine is a community-based medical school whose mission emphasizes primary care. Located in the beautiful mountains of northeast Tennessee, Quillen College of Medicine serves the healthcare needs of over 1 million people. The Tri-cities area boasts low crime rate, low cost of living, award-winning public school systems and no state income tax.

By LyNNE JETER

In 2010, CellScope was birthed in tech-savvy San Francisco with the mission of creating a home medical kit of smart-phone-friendly devices. Its debut offering – Oto, an otoscope that takes digital im-ages of the ear canal – was promoted as a way to reduce up to 30 million offi ce visits annually for ear infections in the United States. Oto represents an early wave of players threatening to bulldoze the healthcare landscape in the $2.8 trillion, consumer-slanting New Health Economy.

“We’re our own construction workers and we can do our own contracting jobs. We’re our own travel agents. We’re our own movie producers. We’re accepting all of these technologies to do things for our-selves and … healthcare is the next fron-tier,” CellScope CEO Erik Douglas told the Health Research Institute (HRI) for the recently released report, “Healthcare’s New Entrants: Who will be the industry’s Amazon.com?”

“Dramatic change has been pre-dicted for the healthcare industry many

times over,” wrote HRI. “This time, the environ-ment is finally ripe for that transfor-mation. Revenue will circulate dif-ferently, and to many new play-ers. Consum-ers, spending more of their own money, are exerting greater inf luence and going beyond the traditional industry to fi nd what they want and need. In the New Health Econ-omy, purchasers increasingly will reward organizations providing the best value, whether it’s an academic medical center, a tech company with a great app, or a healthcare shopping network.”

At play: Sharp new recruits versus healthcare incumbents. Potentially disrup-tive entrants to the playing fi eld include well-established companies outside the

industry expanding to the medical fi eld, and non-

traditional compa-nies creating new

modes of care.Case in

point: At the JP Morgan H e a l t h c a r e Conference in January, Wal-

green CEO Gregory Was-

son, a Purdue-trained pharmacist,

reminded investors that “hardly anyone went

to a drugstore for a fl u shot” fi ve years ago. Now it’s a mini-healthcare center.

Another example of the ripple effects of slight shifts in the $2.8 trillion pie: If half of all patients choose new alternatives for some dozen medical procedures, such as an at-home strep test, it could impact roughly $64 billion of traditional provider revenue, according to a December 2013

HRI-commissioned consumer survey.Here’s the rub: Even though the

U.S. healthcare system is known for pi-loting life-saving medical interventions, it’s failed in attempts to produce effi cient business models to deliver outcomes pro-portionate to cost. The trend leaves an opening for power players traditionally outside the medical sector. For example, of the 38 Fortune 50 companies listed in 2013 with a major stake in healthcare, 24 are new entrants. Of those, 14 are tradi-tional healthcare organizations, seven are retailers, fi ve are technology companies, four are fi nancial fi rms, three are tele-communications companies, and two are automakers. One of those is developing services such as chronic condition man-agement while driving.

Companies that already possess im-peccable consumer credentials, such as Walgreen, with its active customer base of 74 million, are poised to upend the health sector via cost-saving products and ser-vices:

Apple was issued a U.S. patent in 2013 for a “seamlessly embedded heart rate monitor” for iPhone and other de-vices.

AT&T opened its mHealth platform to developers in 2012, hoping to become the essential component in healthcare’s game-changing apps. Nasrin Dayani, executive director for AT&T ForHealth Solutions, told HRI, “We believe the ulti-mate jury … is the consumers themselves. It won’t be decided by the providers or payers.”

CVS Caremark, a 7,600-store chain, made a splash in February with a revised strategy to brand itself a healthcare com-pany that includes having tobacco-free pharmacies by year’s end.

Google last year rolled out Calico, a company with expertise in both health-care and consumer-oriented technology that focuses on aging and associated ill-nesses.

Samsung unveiled its new Galaxy S5 smartphone earlier this year, with a built-in heart rate monitor.

Time Warner Cable recently re-vealed a “virtual visit” pilot project with Cleveland Clinic caregivers to interact with patients via telemedicine.

Who’s going to grab the biggest slice of the lucrative market?

“Is it going to be some random startup or … your doctors?” Target CMO Joshua Riff, MD, questioned. “You have the infrastructure. You have the knowl-edge. You have the experts. You need to be leveraging these technologies.”

Understanding the Power Shift in the New Health EconomyHRI shows why the industry is ripe for picking; players compete to be healthcare’s new Amazon.com

times over,” wrote HRI. “This time, the environ-ment is finally ripe for that transfor-mation. Revenue will circulate dif-ferently, and to

more of their own money, are exerting greater inf luence and going beyond the traditional industry to fi nd what they want and need. In the New Health Econ-

industry expanding to the medical fi eld, and non-

traditional compa-nies creating new

modes of care.

point: At the JP Morgan H e a l t h c a r e Conference in January, Wal-

green CEO Gregory Was-

son, a Purdue-trained pharmacist,

reminded investors that “hardly anyone went

to a drugstore for a fl u shot”

At play: Sharp new recruits versus healthcare incumbents.

Potentially disruptive entrants to the playing fi eld include well-established companies outside

the industry expanding to the medical fi eld, and non-

traditional companies creating new modes

of care.


Chronic elbow pain for tennis players, golfers, and fly fishing enthusiasts can usually be resolved with rest, physical therapy, bracing, injections, and/or medication in about 90% of patients. But in 10% of patients, this elbow pain is progressive and doesn’t resolve with conservative measures. In the past, this group of patients had to make a choice whether to undergo a big surgery or forgo their favorite activities. Now, these patients have a minimally invasive surgical option called the FAST (Focused Aspiration of Scar Tissue) procedure. OrthoMemphis’ fellowship trained upper extremity surgeons, Drs. Jeffrey Cole & Daniel Fletcher, are the only surgeons in the Mid-South performing this minimally invasive surgical procedure for patients with chronic elbow pain or tennis elbow. For those patients who have failed conservative measures, the FAST procedure was developed to speed up recovery time. The FAST procedure uses conventional ultrasound to visualize the location of the diseased tissue. Then a toothpick sized instrument is inserted into the diseased tissue and delivers precise ultrasonic energy to break up and remove the diseased tissue. Since the average time for the procedure is 20 minutes with a topical anesthetic, the FAST procedure is done in a surgery center as an outpatient procedure. “The older procedure used to require us to disturb the healthy tendon just to get to the unhealthy

portion of tendon. This required much more tissue dissection, the patient being put to sleep, and the recovery was slow and far more painful. Our early results of the FAST procedure are very promising. So far, our patients have been able to recover much quicker than those who have undergone the

traditional open procedure. The FAST procedure has the potential to reduce the recovery time dramatically” said Dr. Cole. Dr. Fletcher comments, “Since this technology was used in cataract surgery for years, we know that it works well. It is just a smarter way to perform the definitive treatment for patients with chronic tennis elbow. This technique is really the future of tendon repair in other areas of the body as well.”

For more information on the FAST procedure, check out Dr. Cole’s video at: www.facebook.com/OrthoMemphis Discover more about our team and how we can get you back to an active lifestyle by visiting us at www.orthomemphis.com or call for an appointment at 901-259-1600.

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Jeffrey Cole, M.D. Daniel Fletcher, M.D.

By LyNNE JETER

The New Health Economy poses a major dilemma for traditional providers: compete or partner?

In its recently released report, “Health-care’s New Entrants,” the Health Research Institute (HRI) discussed ways to move healthcare entities to the forefront of this labyrinth and highly-regulated new ecosys-tem, with the as-yet-undefined third-party payment system as a significant barrier.

In a nutshell: Understanding mar-ket needs, consumer desires, regulatory requirements, and reimbursement com-plexities are required to succeed. Perhaps a hospital with a value-based care contract may find it cost-effective to dispatch pa-tients to local retail clinic partners instead of surgeons to have post-operative stitches removed.

The New Health Economy is spin-ning off innovative collaborations with sometimes unlikely players. The Health Council of East Central Florida (HCECF) is working with the Viera VA Outpatient Clinic to secure pilot funding for Chronic Care Brevard, a model built around the Poly-Chronic Care Network (PCCN). It provides communities with a safety net boost for residents with multiple or poly-chronic diseases and represents only one of various HCECF-initiated programs to help communities in its four-county service area – Brevard, Orange, Osceola, and Seminole – adapt to the New Health Economy.

“We’re exploring innovative ways to improve the health of populations and the patient experience of care, all at a re-duced per-capita cost as we move along the ecosystem journey,” said HCECF executive director Ken Peach. “For example, we’re work-ing on another program, predicated on one un-derway at the Satellite Beach Fire Department, where they’ve success-fully reduced hip fractures by up to 50 percent. In their community of 12,000, paramedics on the fire depart-ment staff follow up with recently hospital-ized residents and, with their permission, survey their homes to assess fall risks inside and out. Most women fall inside a home; the majority of men fall outdoors. It’s im-portant to take the entire property into ac-count. Their program has been successful for a number of years.”

HCECF, Osceola County Health Department, Florida Hospital, and Com-munity Vision are developing a promis-ing, new “Phone to Home” program for Osceola County.

“When appropriate, every time the EMS responds to a call, the paramedics give the person a healthcare guide link-ing all Osceola County support services,” explained Peach, noting the health coun-cil picked that area because of the higher number of incomplete runs. “If a person re-

fuses transport, there’s no reimbursement, so hopefully this can reduce those incom-plete runs, and therefore reduce costs.”

Among the overall suggestions from the study:

Start with the consumer and work backwards. When health organizations fully compre-hend patient needs, they might require an overhaul of operating hours, clinician avail-ability via digital devices, and pricing and quality transparency. For example, one-

third of Walgreen’s immunization traffic takes place outside traditional office hours.

Focus on the business model. Base it on value-generation in the New Health Econ-omy.

Understand that not all innovation is created equal. “Aspire for disruptive leaps as pa-tients reward truly transformative services and products. Embrace a fast, frugal, fre-quent, failure model to quickly develop and test ideas,” noted HRI.

Be flexible. Healthcare organizations should develop strategies for production-based and value-based models.

Engage risk management early. Traditional rules of healthcare still apply. Involve regu-latory, legal and compliance counsel early in the process. For example, Airbnb took a calculated risk by launching its travel rental business in 2008 before many communities had determined whether it fit local ordi-

Compete or Partner?The New Health Economy poses major dilemma for traditional providers

Ken Peach



nances; today, the company serves more than 11 million guests in 192 countries.

Collaborate. Blend the best of emerging ventures and incumbents, filling skill and asset gaps.

Think bigger than a website. Healthcare’s next-generation consumer is mobile and thrives online. “It will take more than a website and a grip on social media services to thrive in the New Health Economy,” noted HRI.

Don’t go solo. Success in the new reign will require intrinsic knowledge of the com-plex and fragmented healthcare system,

technological expertise and strong con-sumer ties. “Few organizations possess all of these,” according to HRI.

Integrate. Consumers haven’t embraced electronic health records, perhaps because of privacy and security concerns. Integra-tion and accessibility of data will be pivotal in the design of a seamless, coordinated health system.

Compete in cyberspace. Even though half of American adults own a smartphone, 80 percent of young adults (aged 18 to 34) do! Developing efficient, affordable solutions for healthcare delivery to consumers’ de-

vices will be a critical step in the overhaul. For traditional healthcare organiza-

tions, the industry transformation necessi-tates the consumer at its core, and requires evaluating all processes from operating hours to clinician availability via digital de-vices to transparency of pricing and quality. It also requires them to “figure out what matters most,” such as commodity revenue versus new revenue models rooted in core capabilities while also investing in new ones, noted HRI.

New entrants should focus on two pri-mary goals: getting paid, and knowing the

stakeholders. The industry transformation also requires them to develop a new con-sumer-focused value equation, and empha-size quality via innovative approaches like virtual networks of second opinion experts.

“Within a decade, healthcare will feel very different,” concluded the HRI report. “The players will be different, with partner-ships between new entrants and traditional organizations. And this New Health Econ-omy will have … its Amazon.com.”

Compete or Partner? continued from page 19

keep them out of the hospital as much as possible and managing the care in the most efficient manner. You are being measured on outcomes.”

Another area that used to be purely marketing oriented was research. Now, research directs policy and should be built into the administration of the hospital as an ongoing process, he said. Thomas added that whether it is patient satisfaction surveys, staff satisfaction surveys or report-ing data detailing where patients originate, there must be an integrated approach.

“The marketing function needs to have their fingers on the numbers such as length of stay, payor mix and the like. We have all gotten better at that aspect of it,” he said. “What we haven’t gotten better at is marrying that data with the external market data. Outside the walls, the popula-tion is moving around and becoming redis-tributed.”

Thomas says future new patients are going to look a lot different. They will have different needs. He cites baby boomers who have different ideas than previous genera-tions about healthcare and are used to hav-ing their way. Quality care is paramount to this market segment, as are the benefits of technology at a fair price.

The information explosion produces an environment where a patient with a sickness can discuss it with other people who have the same condition and evaluate what treatments work. He or she also can slam a doctor on a ratings page. A patient can rant about a doctor’s office or a hos-pital stay on Facebook, as well as research drug side effects on the Internet.

“It is now a dangerous thing – not being aware of what is being said about you out there. Healthcare organizations and physicians are becoming more sensi-tive to that and trying to control messages,” he said.

However, he notes that the electronic age makes marketing easier in terms of get-ting messages out quickly and cheaply on websites, through social media, email and other avenues.

Thomas’ basic message? The market-ing function in healthcare should be per-vasive, especially in this climate of change. “Every development I see in healthcare means an increased role for the marketing function.”

Getting the Message, continued from page 4


The most frequent cause of chronic hip pain is arthritis. Hip arthritis can be treated with medication, physical therapy and other conservative methods to help relieve pain. But for patients who are still in pain despite conservative treatment, total hip replacement may be recommended. Total hip replacement helps relieve pain and may allow patients to perform some activities that were previously limited. Historically, doctors had advised patients to put off hip replacement operations as long as possible due to limited life expectancy of the prostheses. However, Americans rising expectations of quality of life have meant having surgery sooner. Fewer people are willing to tolerate years of pain or limited activity. And with newer, more advanced technology and longer lasting prostheses, getting a hip replacement at a younger age is an option. Each patient is different and has different needs, so surgical approaches are chosen with those needs in mind. However, the direct anterior approach (from the front) for hip replacement is gaining in popularity. For the patient, there is reduced tissue trauma and less muscle damage, because an interval between the muscles is used—the muscles actually spread apart. So, unlike other hip surgical approaches, there is no detachment or cutting of the muscles during surgery. The hip has more normal mechanics because you have not disrupted muscle connections, and the patient can have a more normal gait (walk). There is usually a smaller incision and less scarring, less usage of pain medication, a quicker return to function, reduced physical therapy requirements and a reduced dislocation rate.

Benefits of this approach to surgery include: potentially an easier recovery since the muscles have not been cut, allowing the patient to get a head start with physical therapy; lying on the back instead of the side; using X-rays during surgery to ensure proper alignment of the prostheses; better equalization of leg length during the procedure; decreased chance of dislocation. The standard risks for a hip replacement regardless of

the type of procedure are: bleeding, infection, scar tissue, dislocation, blood clots, and weakness. With anterior hip replacement, one risk factor is lessened—the chance of sciatic nerve damage. The surgeon is not near the sciatic nerve since it is located on the back side of the hip joint. I tell my patients that it is not wrong to do the surgery one way or the other. This is just another technique to use. Physicians are taking extra courses and visiting other physicians to learn the

direct anterior approach. This technically difficult procedure has gotten easier due to new technology and modifications in hip replacement tools. Refinements in implants lend themselves better to placement from the direct anterior approach. All of these modifications mean a less invasive procedure for the patient. Discover more about relief options for chronic hip pain at:www.orthomemphis.com.

Advances in Hip Replacements for a Faster RecoveryBy JARED PATTERSON, M.D.



Jared Patterson, M.D. Fellowship Trained Orthopaedic Surgeon

By CINDy SANDERS

There’s no question healthcare deliv-ery is in the middle of a transformational period highlighted by unprecedented con-solidation. While there are a number of factors impacting alignment decisions, Paul Keckley, PhD, boiled the equation down to its simplest terms, “Economics drives be-havior.”

Keckley, managing director for Navi-gant’s Center for Healthcare Research & Policy Analysis, said physicians are having to assess their practices in light of a new re-ality that requires efficiency, effectiveness and contracting clout to survive.

“If you’re of a view that the economics favors you being independent for the rest of your practice, you go that route,” he stated. However, the noted healthcare expert who has published three books and more than 250 articles on the industry and health re-form, said that practice model is becoming increasingly rare.

For many, Keckley said practice deci-sions take a step-wise progression. Option A finds two small practices within a specialty banding together. Option B brings multiple specialties together to form a large group. Option C has physicians or practices join-ing forces with a hospital or payer under some type of employment, joint venture, or managed services organization (MSO) agreement.

“I think most doctors are past Option A. I think most doctors realize circling the wagons around a single specialty isn’t real-istic,” said Keckley. “Two out of three pri-mary care doctors have already cast their lot,” he continued of aligning with hospitals, payers or very large groups.

“Frontline specialists have already gone to bigger groups. Now they are moving to the next option … most look like they’re going to hospitals,” he added of orthope-dists, ENTs and OB/GYNs. As for other specialists, he said the decision to remain in-dependent, merge or consolidate is all over the board and is specialty dependent.

Going forward, Keckley said, “I think we’re going to end up with a very few pri-vate doctors in practice independently.” He predicts seeing a few more very large, mul-tispecialty practices. “I think the majority end up employed in the hospitals because of these new payment mechanisms.”

In fact, he noted, “It’s been incentiv-ized for the hospitals to hire physicians.” Clinical integration, outcomes-based re-imbursement and bundled payments have created an environment where hospitals and doctors are increasingly co-dependent.

Although hospital administrators and clinicians have always had to work together, Keckley said this new closeness highlights areas that must be addressed to maximize effectiveness. Three key stressors are ad-ministrative decisions, clinical performance, and … of course … allocation of money.

“There’s always going to be tension around operations,” he said of administra-tive decisions. “Each presumes the other’s operating is simpler than it really is,” he continued of the chasm between blue suits and white coats.

With reimbursement tied to outcomes, he said physicians and hospitals face tougher decisions around strategy. One issue is how

to address physicians not practicing effec-tively. “The hospital suits don’t do a very good job of changing the behavior of doc-tors. It takes peers,” he noted.

The biggest cause of tension is ex-pected to be around allotting payments to each of the partners in a vertically inte-grated delivery system. “And then you get down to money, and that’s where it gets ugly,” Keckley stated. However, he con-tinued, too often the perception among ad-ministrators is that it’s all about the money when it comes to physicians. “If it was just about money, there are a lot of better ways

to make money … and easier, by the way. Most doctors don’t go into it to be wealthy. It’s hard work. The average medical career is 30 years, and it’s a hard 30 years.”

That said, he added physicians do want to be successful, have a sense of satisfaction around their career choice and be well com-pensated for their work. However, Keckley noted, “There’s such a difference between the way doctors think things should be and the way they are.”

Keckley said too many physicians tend to dismiss data as unreliable or believe their patient is an outlier. Yet, he added, “The

table stakes are you’ve got to have data. You can’t just have a bunch of opinions.” To bridge that gap, Keckley said he believes it is going to take physicians willing to step into the hot seat and take criticism from their colleagues as the profession adapts to new economic realities.

“I think physician leadership is prob-ably going to be a theme over the next 10 years,” Keckley said. “The medical profes-sion is well respected and well compensated … that doesn’t change … but how that pro-fession plays in the delivery system is very much a work in progress.”

Partnering in a New Paradigm


The widespread reform of the na-tion’s healthcare has trickled down to cre-ate significant changes for area healthcare providers; changes that begin this month.

The changes are underway where Qsource, Tennessee’s longtime Quality Improvement Organization (QIO), has spearheaded a partnership effort under the consortia name “atom Alliance” to win a five-state Quality Innovation Net-work (QIN)/Quality Improvement Orga-nization (QIO) contract from the Centers for Medicare & Medicaid Services (CMS). Under provisions of Qsource’s five-year, $51 million dollar contract, atom Alli-ance will work to improve healthcare quality for Medicare patients and families throughout Alabama, Kentucky, Missis-sippi, Tennessee and Indiana.

The move comes as part of CMS’s two-phased restructuring of the traditional QIO program, which required organiza-tions to bid on regional coverage areas and also required bidders to choose between two lines of work: separating beneficiary complaint, case review and monitoring activities from quality improvement tech-nical assistance activities. Qsource and its atom Alliance chose to pursue the quality improvement work and, as of August 1, 2014, no longer works with providers on case review activities.

New Protocol in Place CMS named two Beneficiary and

Family-Centered Care (BFCC) QIO con-tractors to support the program’s case review. KEPRO, located in Seven Hills Ohio, will conduct case review activities for Tennessee and will be responsible for ensuring consistency in the review process with consideration of local factors impor-tant to beneficiaries. Qsource has provided the following notification to providers:

Beginning August 1, 2014, all current and future beneficiary quality review case work and appeals will be conducted by KEPRO.

Healthcare providers and Medicare

beneficiaries must now contact KEPRO toll-free at 1 (844) 430.9504 for all appeal requests and Quality of Care concerns. All outstanding Higher-Weighted DRG medical record requests after the above date should be mailed to: KEPRO; Rock Run Center; 5700 Lombardo Center, Suite 100; Seven Hills, Ohio 44131. If you would like more information from KEPRO during the transition, call the Provider Helpline toll-free at 1 (800) 385-5080. http://www.keproqio.com/

These changes are part of the CMS QIO program transformation effort which aims to improve the effectiveness, effi-ciency, economy, and quality of care for

Medicare beneficiaries. If a patient’s case is currently under

review or in process, please be assured that every effort has been made to ensure a seamless transition for Medicare benefi-ciaries with no disruption in case review services.

New Alliance Quality Improvement

The newly restructured QIN-QIO contract is part of an unprecedented over-haul of CMS’s Quality Improvement Or-ganization (QIO) program and aligns with the goals of the National Quality Strat-egy’s (NQS) three broad aims to better care, better health and lower costs through improvement. Under the new structure, atom Alliance will work with healthcare providers and communities on multiple, data-driven quality initiatives to improve patient safety, reduce harm and improve clinical care. Organizational members of atom Alliance include AQAF (Alabama), IQH (Mississippi) and Qsource (Tennes-see, Kentucky and Indiana).

The atom Alliance will focus on sev-eral key initiatives during the next five years, with an emphasis on the entire region’s rural health needs, according to Qsource Chief Executive Officer, Dawn FitzGerald.

Qsource to Spearhead Significant ChangesIn CMS’ Restructuring Of QIO Programs

Effective August 1, 2014, KEPRO will be the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) in the Centers for Medicare & Medicaid Services (CMS) Areas 2, 3 and 4. Healthcare providers and Medicare beneficiaries should use the contact information below, or visit www.keproqio.com for additional information.

*TTY users in CMS Areas 2, 3 and 4 should call 855-843-4776.

CMS Area Address Local Phone

Numbers Toll-free

Phone Number Fax

Numbers Area 2: DC, DE, FL, GA, MD, NC, SC, VA, WV

KEPRO 5201 W. Kennedy Blvd., Suite 900 Tampa, FL 33609

813-280-8256 844-455-8708 844-834-7129

Area 3: AL, AR, CO, KY, LA, MS, MT, NM, ND, OK, SD, TN, TX, UT, WY

KEPRO 5700 Lombardo Center Dr., Suite 100 Seven Hills, OH 44131

216-447-9604 844-430-9504 844-878-7921

Area 4: IA, IL, IN, KS, MI, MN, MO, NE, OH, WI

KEPRO 5201 W. Kennedy Blvd., Suite 900 Tampa, FL 33609

813-280-8256 855-408-8557 844-834-7130

Publication No. A234-1-07/2014. This material was prepared by KEPRO, a Medicare Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

9th Annual Conference and Vendor FairFriday, September 12, 2014

Holiday InnUniversity of Memphis

3700 Central Avenue | Memphis, TN

To register call or email:McKeen Butler 901.201.8655 | [email protected]

Tammy Ellard 901.761.3013 x 13 | [email protected]

ATTENTION MEDICAL PRACTICE MANAGERS:

Join Us For Upcoming Educational Luncheons

For more information about membership, meeting dates/times and topics/speakers

VISIT MIDSOUTHMGMA.ORG

August 21: Thomas Stearns, VP of Medical Practices SVMIC

September 18: Reginald Coopwood, MD, CEO Regional One Health

Chair, Tennessee Hospital Association

October 16: Mitch Graves, President & CEO Healthchoice

November 20: Ed Rafalski, PhD, MPH, FACHE SVP Planning & Marketing Methodist LeBonheur Healthcare


Most people have “twisted” an ankle at some point in their life. It hurts for a few moments and then you are able to “walk it off”. However, if your ankle becomes swollen and painful after you twist it, you have most likely sprained it. An ankle sprain is an injury to the ligaments in the ankle. These ligaments are structures that control excessive movement of the joint. When an ankle sprain occurs, the ligament is stretched too far and is either partially or completely torn. An ankle sprain is a very common injury. It is estimated that there are 25,000 ankle sprains per day making it one of the most common orthopaedic injuries. This affects many people during a wide variety of activities, such as sports and physical fitness. It can also happen when one simply missteps off a curb or an uneven surface. Even though ankle sprains are common, they are not always minor injuries. Some people with repeated or severe sprains can develop long-term joint pain and weakness. Therefore, proper treatment of a sprained ankle should be sought to prevent ongoing ankle problems. The most common type of sprain is an inversion injury which means the foot rolls underneath the ankle. Patients will have pain, bruising, and swelling on the outside of the ankle. Depending on the severity of the sprain, a person may or may not be able to put weight on the foot. It is important to note that a broken bone or fracture can have similar symptoms, so x-rays are taken to make sure that the bone has not been broken and the ligament has not been torn completely. Ankle sprains are more common in people who have high arches or heels that turn to the inside (hindfoot varus) and people with weak peroneal muscles that run along the outside of the ankle. These injuries are also more common in people who have sustained a severe sprain in the past. Ankle sprains can be diagnosed fairly easily given that they are common injuries. However, it is very important not to simply dismiss any ankle injury as a sprain because other injuries can occur as well. For example, the peroneal tendons can be torn. There can also be fractures in other

areas of the leg or foot. In very severe or chronic cases, an MRI may be obtained to rule out other problems in the ankle such as cartilage or tendon damage. However, an MRI is not necessary to diagnose a sprain. The severity of the injury and the patient’s ability to walk will dictate treatment. Those that can walk normally after the injury are likely to return to activities very quickly.

In contrast, patients who cannot walk comfortably are treated in a removable walking boot until they can walk without a limp. In either case, physical therapy is an important part of treatment to restore range of motion, strength, and flexibility. It is important to incorporate motion during the healing process to prevent stiffness. Motion may also aid in being able to sense position, location, orientation and movement of the ankle, which is called proprioception. An ankle brace should be used until the ankle is strong enough to return to activity without it. Outcomes for ankle sprains are generally quite good. Most patients

heal from an ankle sprain and are able to return to their normal activities. However, some patients who do not properly rehab their ankle or have a severe injury may develop chronic instability. Chronic instability can be dangerous because repeated sprains can lead to damage within the joint. These patients should be identified and considered for surgical repair. Surgery may also be needed in a patient who has cartilage or tendon damage. Surgical options include arthroscopy, where a small camera is used to look inside the joint for loose fragments of bone or cartilage, or ligament reconstruction to improve stability. Following surgery, a good physical therapy protocol will speed up the recovery and return patients back to an active lifestyle. Discover more about ankle sprains and instability at www.orthomemphis.com.

Ankle Sprains Vary in Severity and TreatmentBy MATTHEW B. MASSEY, M.D.



Matthew B. Massey, M.D. Fellowship Trained Orthopaedic Surgeon

By CHRIS DREVALAS

For employers, the cost of healthcare is skyrocketing. In fact, employer health-care costs are projected to increase by about 9 percent in 2014, and they’re ex-pected to continue to rise in 2015 as well. With no signs of health cost increases slowing down any time soon, it’s become more important than ever before for em-ployers to take extra measures to keep their medical costs to a minimum. One of the most effective means for achieving this is through utilizing the services of a medi-cal bill review company.

How can a medical bill review com-pany help keep your business’s healthcare costs down? It’s simple — hospitals, doc-tors and healthcare providers all bill you for the services rendered to your employ-ees. Often times, mistakes are made in the billing process. That’s no exaggeration — the billing process is quite confusing. It’s not at all out of the ordinary for a hos-pital bill to include charges for services not actually rendered or for a payer to be double-billed for the same service. It’s also not out of the ordinary for the billing de-partment to input the wrong billing codes when creating a bill, leading to incorrect, exorbitant charges.

Unfortunately, many employers don’t have a process in place for auditing their medical bills. They blindly pay the bills, not realizing that they could be overpay-ing. That’s where a medical bill review company becomes such an important asset. By hiring professional bill auditors to review your bills, you’ll have someone devoted to catching mistakes and ensur-ing your bills are reduced to their absolute lowest possible cost.

Not All Medical Bill Review Companies are the Same

When it comes to choosing a medi-cal bill auditor, it’s important to do your research. Not all medical bill review com-panies are created equally. You need to ask the right questions to make sure you’re choosing the most capable service pro-vider that will produce the best results.

Here are some key questions to ask when choosing your bill review partner:

Who will be reviewing my bills? It’s absolutely essential to make certain the people auditing your bills are experienced, well trained professionals who will do a thorough job. The best medical bill audit-ing companies employ Certified Profes-sional Coders who know all of the medical billing codes and have the ability to spot errors quickly and accurately.

Are you familiar with my state’s laws? Every medical bill you receive is subject to various requirements at the fed-eral, state and local levels. These require-ments can vary significantly from state to state, so it’s critical to ensure your medi-cal bill reviewers have a complete under-standing of your state’s regulations so your

bills are audited accurately.Do you understand which billing

errors to look for? Medical bill coding is complex, and billers often tend to make specific mistakes that an untrained eye might not notice. Your bill auditors should be well versed in medical bill coding, and they should be familiar and current with the most common billing errors that lead to overcharging.

How do you ensure accuracy? If you’re paying someone to review your medical bills, you certainly want to make sure they’re doing the job properly. Oth-erwise, you’re not going to see a return on the investment. Ideally, your medical bill auditing service should use multiple qual-ity assurance checks to ensure every bill is properly audited and no errors go un-noticed.

When you take the time to ask the right questions, you’ll be able to find a medical bill auditor that will streamline the payments process and help your com-pany spend less on healthcare.

Chris Drevalas works at Alpha Review Corporation as Vice President of Marketing & Finance. For over ten years, he has helped companies with their workers compensation issues.

Read This Before Choosing Your Medical Bill Review Company


Addition Regarding our July Physician Spotlight feature on Kathryn Schwarzenberger, MD, we want to mention that her dermatology practice is with UT Medical Group. For more information call 901.866.8805.

GrandRounds

Dr. Kenan Arnautovic, neurosurgeon at Semmes-Murphey Clinic, and two esteemed physicians from Sarajevo and Croatia, were course directors and lectured at the Sixth Interna-tional B HAAAS Neurosurgical/Spine Symposium. The one-day symposium titled, “Update in tumor, vascular and spine neurosurgery” was held in Bosnia-Herzegovina. Dr. Vinodh Doss and Dr. Daniel Hoit, also with Semmes-Murphey, attended the symposium. Access was free for area neurosurgeons, spine surgeons, and all medical practitioners and students with a ca-reer interest in neurosurgery. The group of neurosurgeons and neurologists attending, wore 3D glasses to enhance viewing of a recorded surgical demonstration. Shown from left on the first row: Dr. Arnautovic, then Dr. Omerhodzic, Sarajevo Dept of neurosurgery. Second row from left: Dr.Doss and Dr. Hoit.

Memphis Obstetrics and Gynecological Association Welcomes Dr. Jason Williams

The physicians of Memphis Obstetrics and Gynecological Association, PC (MOGA) are pleased to announce the addition of Dr. Jason Williams to their medical staff.

Dr. Williams graduated from the University of Ten-nessee at Knoxville in 2004 with a B.S. in Chemistry. During his college tenure, he also spent a semester at Curtin University in Perth, Aus-tralia, through a study-abroad program. He obtained his medical degree from the Uni-versity of Tennessee College of Medicine in 2010 and recently completed his residency.

Dr. Williams grew up in a healthcare-focused family. His father works as a pulmo-nologist and his mother was a NICU nurse. He has a son who is ten years old, and en-joys attending his soccer and basketball games. Additionally, he enjoys mountain bike riding, running, sailing, and following the University of Tennessee’s football and basketball teams. His favorite travel desti-nation is the Caribbean.

LifeLinc Announces Promotion LifeLinc Anesthesia is pleased to an-

nounce the promotion of Drew Eaton to HR/Provider Relations Man-ager. In his new position, Eaton will head the HR de-partment and contribute to LifeLinc’s goals through planning, implementing and evaluating employee relations and human resource policies, pro-grams andpractices. His department cur-rently provides services for 25 corporate staff members, 50 clinical providers (anes-thesiologists and nurse anesthetists) and maintains a network of over 50 on-call anes-thesia providers.

Eaton began working in HR for LifeLinc in March of last year as a graduate assistant. He graduated from the University of Mem-phis, this spring, with his Masters in Health-care Administration (MHA) and was present-ed the award for the highestgrade-point average in the full-time MHA program. He also holds his Bachelor’s of Business Ad-ministration from the University of Missis-sippi and his Associate’s Degree in Radio-logic Technology. Eaton brings five years of clinical experience to LifeLinc, providing an appreciation for the dedication involved in patient care.

Dr. Jason Williams

Drew Eaton


Football season and fall soccer season have just begun. Given the amount of cutting, twisting and pivoting in these sports, we are seeing a higher incidence of knee injuries among participants. Of all major injuries to the knee, anterior cruciate ligament (ACL) tears are the most common. These knee injuries can adversely affect a player’s long term involvement in the sport and lead to long term knee issues. The incidence of ACL tears is 2-8 times higher in female athletes compared to male athletes participating in the same sport. There are many theories trying to explain this ranging from hormonal differences to anatomic risk factors such as a narrower opening for the ACL, differences in the shape and slope of the bones, differences in knee laxity, and neuromuscular differences. The highest incidence comes in women’s team sports such as soccer and basketball. Obviously, preventing an ACL tear is ideal. There are some ACL Prevention rehab protocols that strive to improve neuromuscular control, coordination, and core stability to try to prevent the injury from occurring.

bone (tibia) to the thigh bone (femur). The function of the ACL is to help stabilize the knee by resisting translational and rotational forces acting on the knee. If you are performing straight ahead activities like running, the ACL plays a minor role. However, with cutting, twisting, and pivoting activities, the ACL plays a major role. The ACL is the primary restraint to resist forward (anteriorly) directed forces of the shin bone (tibia) on the thigh bone (femur). It is also the primary restraint resisting rotational forces about the knee. Your knee also has secondary restraints which include the meniscal cartilages, the shape and contour of the bones, and the collateral ligaments. When the forces applied to the knee are greater than the forces that the ligament can handle, the ligament tears. This can be seen not only in contact injuries, but also increasingly in non-contact injuries where approximately 70% of ACL tears occur. When the ligament tears, the patient will typically feel a giving way, shifting, or buckling type of sensation. This shifting sensation is not only felt, but many times is also heard as a loud pop. Other symptoms include pain with standing or walking, swelling, decreased range of motion, and a feeling of looseness about the knee. Every time that the knee gives way, there is a 70% chance that some other structure in the knee will also be

injured. The other structures include the ends of the bone and soft tissues such as the meniscal cartilages, the joint surface, and other ligaments. These injuries can be evaluated with a thorough history, physical exam, and imaging studies such as an MRI. Repeated episodes of instability can lead to devastating consequences over time including osteoarthritis for young people. Therefore, if your goal is to return to cutting, twisting and pivoting type activities, stabilizing the knee is crucial. There are various methods of treatment to stabilize the knee ranging from conservative, nonoperative measures to operative treatment. Conservative treatment includes

type activities. Braces tend to work well with lower level activities; however, you can still have giving way episodes with higher level activities. Bracing also does not address related injuries such as meniscal tears or joint surface injuries. Operative treatment involves anatomic reconstruction of the ACL. Surgery is followed by an extensive rehab program. Typical time to return to play is six to nine months. Reconstruction does not guarantee returning to sport at the same level, but in general gives you your best chance to return to your sport. If you have concerns that you may have injured your knee, I would recommend that you be seen and evaluated by a fellowship trained Sports Medicine Orthopaedic Surgeon with extensive experience treating knee injuries. At OrthoMemphis, your treatment program will be tailored to your individual needs. One particular service we offer during football season is our Friday Night Football Clinic for non emergent injuries occurring during the games. Clinic hours are from 9:00-11:00PM on Friday nights August 23 – November 8. You or your child will be evaluated by a fellowship trained Orthopaedic Sports Medicine Specialist. Discover more on knee injuries or our Friday Night Football Clinic, visit www.orthomemphis.com

Football & Soccer Score Highest in ACL InjuriesBy DAVID DENEKA, M.D.

David Deneka M.D. Fellowship Trained Orthopaedic Surgeon

23 Aug–08 Nov

9-11 PMEVERY FRIDAY

6286 BRIARCREST AVE.MEMPHIS, TN 38120

P / 901.261.STAT (7828)ORTHOMEMPHIS.COM

UTHSC College of Medicine Forms New Department

David M. Stern, MD, executive dean of the University of Tennessee Health Sci-ence Center (UTHSC) College of Medicine, has announced the formation of a new de-partment on the Memphis campus, the Department of Genetics, Genomics and Informatics (GGI). Professor Robert W. Williams, PhD, the UT-ORNL Governor’s Chair in Computational Ge-nomics, will serve as the de-partment’s founding chair.

GGI will focus on three areas of bio-medical research:

• Genetics, with a focus on the causes of variation in disease risk in humans -- both genes and the environment;

• Genomics, defined broadly to in-clude many types of research ques-tions and high throughput molecular approaches including DNA sequenc-ing; and

• Informatics, defined to include bio-informatics and clinical health infor-matics.

Starting with five core faculty with pri-mary appointments, the plan is to grow by offering joint appointments to faculty in many other departments, colleges, cam-puses and institutions — including St. Jude Children’s Research Hospital and the Uni-versity of Memphis.

A faculty member in the UTHSC De-partment of Anatomy and Neurobiology for 25 years, Dr. Williams is a renowned experimental neurogeneticist, founder of the Complex Trait Consortium, and editor-in-chief of Frontiers in Neurogenomics. His current research is funded by three NIH in-stitutes, the National Institute on Aging, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Mental Health, as well as by the Oak Ridge National Laboratory.

Sherman Joins Campbell Clinic Orthopaedics As Physician

Campbell Clinic Orthopaedics has hired Henry “Hank” Sherman, M.D., as a sports medicine family prac-tice physician. He will work from the group’s Southaven clinic.

Dr. Sherman comes to the clinic after having served as Medical Director for The University of Mississippi’s athletic program since 2012. While serving the Rebels’ student-athletes, Sherman also filled the role of Assistant Professor for The University of Mississippi Medical School’s Department of Orthopae-dic Surgery and Rehabilitation.

A graduate of The University of Chica-go and The University of Illinois College of Medicine, Sherman completed a residency at Methodist Family Practice in Peoria, IL in 2000. He also completed a fellowship in Pri-mary Care Sports Medicine with Methodist Sports Medicine in Indianapolis, IN. .

EMG Clinics of Tennessee Opens Germantown Location

EMG Clinics of Tennessee opened a nerve and muscle testing location in Ger-mantown. Dr. Ronald C. Bingham and Dr. Miles M. Johnson bring their expertise with 24 years of experience and state-of-the-art equipment to a new location.

Dr. Bingham and Dr. Johnson are board-certified physicians by the American Board of Physical Medicine and Rehabilita-tion and the American Board of Electrodi-agnostic Medicine. All of EMG Clinics’ tech-

nologists are certified through the American Association of Neuromuscular and Electro-diagnostic Medicine (AANEM). EMG Clinics of Tennessee holds the prestigious Electro-diagnostic (EDX) Laboratory Accreditation with Exemplary Status.

Dr. Bingham founded EMG Clinics of Tennessee, PLLC in 1989. The practice spe-cializes in nerve and muscle testing (elec-tromyography or EMG). In addition to the Germantown location, EMG Clinics of Ten-nessee has clinics in eight West Tennessee/North Mississippi communities.

SVMIC Receives RatingState Volunteer Mutual Insurance

Company (SVMIC) has again received an “A” (Excellent) financial strength rating from A.M. Best Company. SVMIC has maintained an “A” or better rating for more than 30 years.

The A.M. Best Company is the old-est, most experienced rating agency in the world and has been reporting on the finan-cial condition of insurance companies since 1899.

GrandRounds

Dr. Robert W. Williams

Dr. Hank Sherman


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GrandRounds

Edward M. Rafalski

Chris Ruscitto

Pediatrics East Adds Two New Pediatricians

Pediatrics East announces the addition of Andrew Irwin, MD and Daniel Chatham, MD.

Dr. Irwin received his medical degree from the University of Tennessee Health Science Center. He then completed his pedi-atric residency through the University of Tennessee, training at Le Bonheur Chil-dren’s Hospital, St. Jude Children’s Research Hospi-tal, and the Regional Medi-cal Center.

Dr. Chatham gradu-ated medical school from the University of Tennessee Health Science Center. He completed his pediatric residency at Le Bonheur Children’s Medical Center through the University of Tennessee where he was awarded the Rus-sell Chesney Award for Excellence in Pedi-atrics.

Edward Rafalski Appointed to TNCP Board of Examiners

Edward M. Rafalski, Senior Vice Presi-dent for Strategic Planning and Marketing for Methodist Le Bonheur Healthcare, has been ap-pointed by the Board of Directors of the Tennessee Center for Performance Excellence (TNCPE) to the 2014 Board of Examin-ers. Each year, the TNCPE award program recognizes local, regional, and statewide organizations that demonstrate excellence in business operations and results.

As an examiner, Rafalski is responsible for reviewing and evaluating organizations that apply for the TNCPE Award. The Board of Examiners comprises experts from all sectors of the regional economy, includ-ing health care, service, nonprofit, manu-facturing, education and government. All members of the Board of Examiners must complete extensive training in the Baldrige Criteria for Performance Excellence.

MSK Group, P.C. Announces CFOMSK Group, P.C., an integrated ortho-

paedic group of 36 physicians, with 9 area offices known as Memphis Orthopaedic Group, OrthoMemphis, and Tabor Orthopaedics, is pleased to announce that Mr. Christopher M. “Chris” Ruscitto joined the group on July 10, 2014, as the Chief Financial Officer (CFO). Mr. Ruscitto was se-lected after an exhaustive national search. He has served in a similar capacity for sev-eral large multi-specialty groups including The Christ Hospital Physicians, Southcoast Physician Group, and was mostly recently CFO of a 300 physician practice outside of Boston, Massachusetts. Chris and his wife, Tara, have four children and two of them will relocate here to complete high school.

Dr. Andrew Irwin

Dr. Daniel Chatham

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CALL 901 377 4733WWW.LAKESIDEBHS.COM

Lakeside BHS is pleased towelcome the Fellows and Residents of the Departmentof Psychiatry. While atLakeside, Fellows andResidents will participate in patient care activities, inaddition to learning thebasics of acute inpatient andoutpatient psychiatry. Both Lakeside and the University look forward to benefi ting from the participation of residents under thesupervision from University faculty physicians.

GrandRounds

Walgreens Healthcare Clinics Open in Collaboration with Baptist Medical Group

Healthcare Clinics at select Walgreens in collaboration with Baptist Medical Group, which offers coordinated and expanded health care services, officially begins.

Baptist Medical Group, Baptist Me-morial Health Care’s wholly-owned multi-specialty physician organization, will work with11 Memphis-area Healthcare Clinics at select Walgreens to handle care needs outside the clinics’ scope of practice and help manage the treatment of chronic dis-eases. While Walgreens strongly encourage all patients to have a designated primary care physician and medical home for on-going needs, the collaboration will pro-vide patients access to quality care seven days a week overseen by Baptist Medical Group. The collaboration will include direct communication between Baptist Medical Group physicians and Healthcare Clinics nurse practitioners to facilitate care coordi-nation, sharing of patient information and enhanced awareness of Baptist Medical Group services.

With health care plans and needs evolving, both organizations will be working to help keep the community healthy.

Walgreens Healthcare Clinics partner-ing with BMG include:

• 1501 Goodman Rd. W, Horn Lake, Miss., 38637

• 1863 Union Ave, Memphis, Tenn.,

38104• 4154 Elvis Presley Blvd, Memphis,

Tenn., 38116• 6697 Stage Rd, Bartlett, Tenn., 38134• 6958 Goodman Rd, Olive Branch,

Miss., 38654• 8001 Winchester Rd, Memphis,

Tenn., 38125• 8046 Macon Rd, Cordova, Tenn.,

38018• 4680 Poplar Ave, Memphis, Tenn.,

38117• 4625 Summer Ave, Memphis, Tenn.,

38122• 43 Tabb Dr., Munford, Tenn., 38058• 3177 S. Perkins Rd., Memphis, Tenn.,

38118

Methodist Names Schearer VP Cardiovascular Services

Sue Schearer, RN, has joined Method-ist Le Bonheur Healthcare as Vice President, Cardiovascular Services. In this role, she will lead the de-velopment and implementa-tion of a system-wide cardio-vascular strategic plan.

Schearer comes to Methodist from OSF Health-care in Peoria, Ill., where she led the development of a system-wide CV Service Line. She is a 6 Sigma Black Belt with more than 30 years of healthcare experience in Nursing, Case Management and other leadership areas.

She holds a Master’s of Health Servic-es Administration from the College of Saint Francis in Joliet, Illinois, and a Bachelor’s of Science degree in nursing from Bradley University in Peoria.

Sue Schearer, RN

Campbell Foundation Celebrates 2014 Graduation The University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and

Biomedical Engineering and the Campbell Foundation celebrated the graduation of the Class of 2014 Orthopaedic Surgery Residents and Orthopaedic Fellows in June at the Mem-phis Country Club.

The graduating residents presented the Willis C. Campbell Aesculapian Award for Teaching Excellence to William A. Albers, MD. The Aesculapian Award recognizes the most outstanding contribution to resident education in orthopaedic surgery, and the recipient is selected by the orthopaedic surgery residents. Dr. Albers, Associate Professor of Orthopae-dic Surgery, retired June 30.

During the ceremony, Chief Resident Robert F. Murphy, MD was given the Hugh Smith Research Presentation Award for his presentation, “Morbid Obesity Increases the Risk of Systemic Complications in Patients with Femoral Shaft Fractures,” presented at the 2014 In-gram Memorial Lecture. The award was established by the family of former Campbell Clinic Chief-of-Staff, Dr. Hugh Smith, in tribute to him and his belief in the transformative power of research and innovation.

Pictured, Left-to-Right: Seated, Front Row: Robert F. Murphy, MD (Resident), Robert A. Kinzinger, MD (Trauma Fellow), Adam P. Baker, MD (Foot & Ankle Fellow), Sameer M. Naranje, MD (Pediatric Fellow), Christopher M. Johnson, MD (Hand Fellow), Norfleet Thompson, MD (Resident), Thomas W. Throckmorton, MD, Residency Program Director, Frederick M. Azar, MD, Chief of Staff Standing, Back Row: S. Terry Canale, MD, Chairman, UT-Campbell Clinic Department of Orthopaedics, Marc D. Biggers, II, MD (Resident), Thomas C. Alexander, Jr., MD (Resident), Joshua B. Sykes, MD (Resident), Anthony M. Hollins, MD (Resident), Michael H. Amini, MD (Resident), Mark P. Smyth, MD (Resident), Nicolas S. Bonnaig, MD (Sports Medicine Fellow)

UNITED IN PURPOSE. COMMITTED TO EXCELLENCE.

Numerous Specialists. Seven Locations. One Mission.

Gastro One and Memphis Gastroenterology Group have combined our strengths, our expertise and our commitment to unparalleled digestive care into a singular focus — you.

This newly minted partnership means more convenience, with seven locations spanning the Memphis metro area. It also means an expanded roster of some of the most well-respected

gastroenterologists, accompanied by the latest advancements in diagnostic technology, treatment and prevention.

All of us at Gastro One are extremely excited about this partnership and look forward to serving you with the most personal and comprehensive digestive care in the Mid-South.

www.gastro1.com

It’s official!

8000 Wolf River Blvd.Suite 200Germantown, TN 38138901.747.3630Richard S. Aycock, M.D.Joseph G. Baltz, Jr., M.D.Alex E. Baum, M.D.Edward L. Cattau, Jr., M.D.Conar P. Fitton, M.D.Randall C. Frederick, M.D.Terrence L. Jackson, Jr., M.D.Michael J. Levinson, M.D.Myron Lewis, M.D.Christopher D. Miller, M.D.Bryan F. Thompson, M.D.T. Carter Towne, M.D.Gary A. Wruble, M.D.Lawrence D. Wruble, M.D.

1324 Wolf Park Dr.Germantown, TN 38138901.755.9110Michael S. Dragutsky, M.D.Farees T. Farooq, M.D.Rolando J. Leal, M.D.Randolph M. McCloy, M.D. (retired)Alan D. Samuels, M.D. (retired)John D. Ward, M.D.Robert S. Wooten, M.D.

2999 Centre Oak WayGermantown, TN 38138901.684.5500Daniel E. Griffin, M.D.W. Zachary Taylor, M.D.Ziad H. Younes, M.D.

7668 Airways Blvd.Building BSouthaven, MS 38671MS: 662.349.6950TN: 901.766.9490Christopher M. Griffith, M.D.William G. Hardin, M.D.Eric J. Ormseth, M.D.Geza Remak, M.D.

3350 N. Germantown Rd.Bartlett, TN 38133901.377.2111Raif W. Elsakr, M.D.James H. Rutland, III, M.D.David D. Sloas, M.D.Carles R. Surles, Jr., M.D., M.P.H.

1325 Eastmoreland Ave.Suite 365Memphis, TN 38104901.377.2111David D. Sloas, M.D.

76 Capital Way Cv.Atoka, TN 38004901.377.2111 Raif W. Elsakr, M.D.James H. Rutland, III, M.D.Carles R. Surles, Jr., M.D., M.P.H. Bryan F. Thompson, M.D.

Documents

Memphis Medical News August 2014