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What a privilege it was for Memphis Medical News to interview Scott Morris, MD, of the Church Health Center for this issue. If there’s anyone in tune with Memphis’ impoverished communities, it is Dr. Morris ... 7

As Their Numbers Decline, Nurses’ Workloads IncreaseExtra training, education can bring more

In light of the economic constraints affecting healthcare in the last fi ve years, there have been reductions in nursing staffs across the country, and the scenario is no different in Memphis. However, unlike what’s happening in most of corporate America, the decreasing staff ... 8

FOCUS TOPICS WOMEN’S HEALTH HIT NURSE RECOGNITION

By JUDy OTTO

“Jesus said the poor will always be with you. So far he’s been right,” Scott Morris, CEO and founder of the Church Health Center.

Thus, despite the impressive strides the Center has made during more than a quarter-century of service, and the thou-

sands of lives it has touched, Morris is far from complacent. Asked if he has suc-cessfully executed the plan he brought to Memphis 28 years ago, he is quick to reply that he’s “nowhere close! We’ve made progress; we’ve gotten started.”

A graduate of the University of Virginia, with a Master of Divinity de-

(CONTINUED ON PAGE 10)

HealthcareLeader

G. Scott Morris, MDCEO, Church Health Center

MEMPHIS on the MEND

BY PAMELA HARRIS

Kelley Smith

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Doctors Say:Ask Memphis physicians about interactions with nurses and

how the work environment might be improved, and they all agree with the nurses: communication and respect are primary. How-ever, responses differ about how much autonomy the nurse should have in this relationship.

A recurring topic was questioning a doctor in front of the patient.

Nurses, Doctors Agree on Rx For Improved Work Environment

By GINGER PORTER

What do nurses think of doctors? What do doctors think of nurses? More to the point, what do they admire about one another, what do they do to irritate one an-other, and what can they do to improve their working re-lationship?

Memphis Medical News posed these questions to ex-perienced doctors and nurses in the Memphis area, and we hope their candid answers in

these two stories help to pro-mote a better understanding between the disciplines.

In order to receive the most frank and honest com-ments, we made an exception to our policy of not using un-named sources. We offered the nurses and doctors ano-nymity so that they could talk most freely.

Some of the opinions ex-pressed here may sting, but they also may open some eyes

and elicit productive discussion.

Nurses SayWhen the Memphis Medical News asked nurses what physicians

could do to improve their working relationship, good lines of com-munication was one of the factors most mentioned.

“I like the doctors the patients like – the ones who have some savvy or charisma in dealing with people,” was the response from one nurse. “The ones who communicate well with patients, patient families, nurses, everyone,” said a 25-year veteran ICU and recov-

(CONTINUED ON PAGE 12)(CONTINUED ON PAGE 12)

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By RON COBB

Editor’s note: This month, instead of our regular Physician Spotlight, in honor of nurses we focus on an outstanding nurse who represents the quality of care provided by the profession.

What are the odds? Kelley Smith was working at the Regional Medical Center (now Regional One Health) as a neonatal nurse when she became pregnant in 1997 with her first child. Well-accustomed to caring for other people’s premature babies, she still was caught by surprise by her own early delivery. Her child, Reid, was born at 29 weeks, weighing 3 pounds, 4 ounces.

What are the odds again? Three years later, Kelley and her husband, Jon, had another baby on the way. Daughter Mary Dreyer also arrived early, at 32 weeks, weighing 3 pounds, 14 ounces.

Both children are thriving today. Reid, 16, is a sophomore at Memphis University School and plays golf and basketball. Mary Dreyer, 13, is a seventh-grader at St. Agnes and plays volleyball and basketball.

Having two premature babies was not exactly something Smith wanted, but the experience made her all the more valuable in her role as a nurse in the NICU. Having gone through what her patients are going through, she said, “does develop some sense of trust. It helps them to know that I understand what they are going through.”

Today, Smith is Regional One’s nurse manager, supervising a staff of 110 other nurses providing care for, on aver-age, more than 60 babies born prema-turely. These infants come into the world early for a variety of reasons.

“While there are many things that can cause premature births – such as teen pregnancy, multiple pregnancy such as twins, being underweight or obese, heavy smoking, drug abuse, poor nutrition, fetal birth defects, emotional stress such as do-mestic violence and severe poverty, previ-ous preterm birth or labor, or any uterine or bladder infections – there are also those with no known risk factors who can still

deliver prematurely.”Smith fell into the latter group when

she gave birth early.“It was defi nitely something I had not

prepared for,” she said. “I took very good care of myself, ate the right things, exer-cised and had prenatal care. Once I knew that delivery was imminent, I began tell-ing the nurses in the delivery room what all they needed to have prepared for the birth of my baby. They knew I was a neo-natal nurse.

“Of course, once (her baby) was admitted to the NICU, all I could think about was all the things that could go wrong. He was a white male born at 29 weeks. Among all of the races, they tend to do the worst. From an emotional stand-point it can be a roller-coaster.

“You have to take one day at a time. My son was discharged 3 ½ weeks after he

was born. Although I was a NICU nurse, I was still very nervous about taking him home. I can’t imagine how our parents who have never cared for a premature baby must feel on the day of discharge.”

Then, three years later, along came her daughter.

“I was very worried with my second pregnancy,” Smith said. “After I passed 30 weeks, I actually thought I would make it to term. But my daughter had a different plan. She came at 32 weeks. She only had to stay in the hospital for 10 days. Fortu-nately, in the case of both of my children, they did very well and did not have any complications.”

Smith is a native of Columbus, Mis-sissippi, whose father was co-founder and owner of Tom Soya Grain Co. in West Point, Mississippi. She earned her BSN in nursing from Ole Miss in 1988.

She originally set her sights on medi-cal school.

“I began my major in premed until my mother had a stroke my freshman year in college,” she said. “It was at that time, after seeing how dedicated and compas-sionate the nurses were, that I decided to switch my focus to nursing.”

After stops in Birmingham and At-lanta, Smith and her husband moved to Memphis after he graduated from Emory University School of Law. She wanted to be closer to her family, including two sis-ters who live in Memphis.

Regional One Health, she said, “was the fi rst place I interviewed, and I imme-diately knew that’s where I wanted to be.”

Working in a neonatal unit comes

with highs and lows. The lows include “knowing that you put your whole heart and soul into caring for a baby, only to have them pass away. We have to remem-ber that it’s in God’s hands.”

The highs come “when you see a family walk out the door with their baby and a huge smile on their face. It is so re-warding and the families are so apprecia-tive of all you have done to give them that experience, especially when they thought there was no hope.”

In her effort to improve quality in the NICU and reduce risks, Smith leads initiatives such as working with the Ver-mont Oxford Network, an organization of NICUs around the world that share knowledge and practices.

She also is devoted to the March of Dimes and is heavily involved each year in the March for Babies.

“The March of Dimes has done so much to help prevent premature births as well as develop other means to help premature babies and families,” she said. “They were instrumental in the develop-ment of surfactant, which helps reduce lung disease in the preterm infant.

“ While I love my job very much, I would very much like to see the incidence of premature births decrease. I wouldn’t mind being put out of a job if it meant that babies would be born full term without complications and could live to see their fi rst birthday.”

“With Shelby County having the highest infant mortality rate, it is our re-sponsibility to do what we can to improve the lives of our most vulnerable patients.”

Kelley SmithRegional One’s nurse manager and mother of two preemies offers valuable insight

NurseSpotlight

Memphis Medical News

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By CINDy SANDERS

Despite the fact that heart disease is the number one killer of women in America and stroke the leading cause of disability, women often don’t identify with the very real dangers the disease holds for their gender, accord-ing to Robert Wood Johnson Foundation Clinical Scholar Lisa Rosenbaum, MD.

“We all know men drop dead of heart at-tacks … we don’t think of women dropping dead of a heart attack,” the Uni-versity of Pennsylvania cardiologist noted of the masculine attributes often attached to heart disease.

Furthermore, women tend to fear other diseases, notably breast cancer, more than heart disease. The Healthy-Women 2010 survey, in partnership with the National Stroke Association and the American College of Emergency Physi-cians, found that women believe breast cancer is five times more prevalent than stroke, and 40 percent of those surveyed were ‘only somewhat’ or ‘not at all’ con-cerned about experiencing a stroke. Yet, stroke is significantly more prevalent in

women than in men, and stroke kills twice as many women as breast cancer each year.

“There’s a certain sort of female solidarity around breast cancer,” Rosenbaum stated. In a perspective piece published earlier this year in the New England Journal of Medicine, Rosenbaum wrote about an encounter with a middle-age woman with high blood pressure and hyperlipidemia. When Rosenbaum asked the new patient what was the number one killer for women, she noted the patient “answered in a way that sticks with me: ‘I know the right answer is heart disease,’ she said, eyeing me as if facing an irresist-ible temptation, ‘but I’m still going to say breast cancer.’”

Rosenbaum is quick to say breast cancer is a valid concern, but the emo-tions linked to the disease go beyond just the facts. She pointed to the controversy surrounding mammography as a clash be-tween data and identity at the social level. Despite a recommendation from the U.S. Preventive Services Task Force to de-crease mammography frequency for most women under age 50 based on decades of data, Rosenbaum wrote, “So intense was the outrage over these evidence-based rec-ommendations that a provision was added to the Affordable Care Act specifying that

insurers were to base coverage decisions on the previous screening guidelines.”

No matter where you stand on mam-mography, most healthcare professionals are united in agreeing lifestyle modifica-tions and appropriate use of medications have been proven to prevent heart disease and save lives. However, Rosenbaum con-tends that facts alone aren’t enough. In-stead, she said the healthcare community needs to find a way to tap into the emo-tional aspects of heart disease as success-fully as has been done with breast cancer.

In the her perspective piece, Rosen-baum wrote that although the first decade of educational campaigns such as Go Red for Women “led to a near doubling of women’s knowledge about heart disease, in the past few years, such efforts have failed to reap further gains.”

She told Medical News, “Our default in medicine is to give people facts, and then we don’t know what to do when we hit the

wall. We know how to disseminate facts … we don’t know how

to change feelings.”Complicating

the issue with heart disease

is that in so many cases it is pre-

ventable, and therefore comes

with built-in guilt. Risk factors, which have been well pub-licized, include smoking, obesity, high blood pressure, high cholesterol, and sedentary lifestyle. “All of these are em-bedded with a sense of not taking care of yourself,” Rosenbaum said. “You should have done something differently.”

Conversely, breast cancer is imbued with a sense of having a terrible disease visited upon a victim, which is true. Also, because breast cancer kills more women at a younger age than heart disease, there are multiple media images of beautiful, strong heroines fighting and surviving … or succumbing … to a disease that attacks a body part that is so uniquely feminine. Rosenbaum pointed out Angelina Jolie’s message about breast cancer resonated with women across the nation who saw

Identity as a Risk FactorHeart disease and the feminine mystique

Dr. Lisa Rosenbaum



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

By TIM NICHOLSON

You’ve been there. On a flight between somewhere and home, seated next to a stranger on their way to some other place. Con-versations are usually light if they happen at all. We’re often trying to catch a nap or speeding our way through some sort of work on the laptop before touchdown. But this time I was seated next to a doctor who was winding down a practice he’d only recently sold and headed into what he called “halftime.” His plan was to start a new career. I couldn’t help asking him what he found the most rewarding about the one he was exiting.

The doctor had been the chief medical officer of a fifteen physi-cian general practice with some areas of specialization but his primary focus was family medicine. I asked, “What do you think have been the top medical advances during you tenure?” His answer was winding until he decided to focus on the most recent 10 years or so and people.

He was hopeful about the big picture advances like the 2003 announcement that scientists had completed a draft se-quencing of the human genome, or all the genes that make up our DNA.

The doctor appreciated the increased application of minimally invasive surger-ies, laparoscopic surgery has become the norm for many operations, including gall bladder removal, hernia repair and ap-pendectomies among other things.

And, medications like those that ad-dress sexual dysfunction, “in the way that Viagra is used to treat erectile dysfunc-tion,” he said.

I thought out loud, ”That’s quite a

journey from mapping the human genome to the bedroom. Do those things have anything in common?”

His answer was quick, “peo-ple.”

Of course, people.It turns out that “relationship”

is the thing he will miss most about practicing medicine. He made the connection this way:

Experts say sequencing each person’s genome would be benefi-cial to prevent a variety of heart ailments and even obesity. “Just knowing they have a higher risk of obesity could be enough motiva-tion for patients to lead a healthier lifestyle,” he said, adding that it was one of the Top 3 issues his clinic addressed with patients.

Laparoscopic surgery matters because patients generally endure

less pain, smaller scars and a shorter re-covery period. “Patient types who might have tried to live with their conditions in the past were more inclined to seek treat-ment now. They feared missing work and losing jobs. Less recovery time means less time off the job.”

The pilot interrupted our chat to an-nounce our descent into Memphis. So I asked, “Our time together is limited. I get the people part of the genome and surgi-cal advances but where’s the people part intersect with Viagra?” I felt like an eighth grader.

“Relationships are about people. Medications like Viagra have helped to restore intimate relationships between husbands and wives.” He smiled and said, “These medications aren’t about feeling manly like some TV commercial might suggest. I’ve prescribed them to couples

that had drifted apart. During counsel-ing sessions I’d learned that they were no longer having sex and that it was often about the husband’s being physically in-capable of performing. Men and women have written to tell me that a prescription to address erectile dysfunction saved their marriage.”

Relationships. People. Of course, it’s why any advance in medicine is relevant. And it’s also why social media matters. People want access to information that might be helpful in treatment of a con-dition they’re trying to manage or that might inform their ability to be useful to a friend or family member who suffers a medical condition.

Access to information from a trusted voice, like their doctor, could be the ad-vance in medicine that makes the biggest difference in the life of someone in your patient community.

Map their genome? You may not be doing a personalized sequencing but we’re all learning from those who are.

Prescribe the right medication? Sure, that’s most likely within your realm of au-thority.

Sharing information that’s helpful? You can. You’re one of the most impor-tant people or relationships in a patient’s life. And advances in the use of social media for that purpose have made it one of (what may someday prove to be among) the top advances in medicine.

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Again, she stated, it isn’t ‘bad’ that breast cancer has pushed its way to the front of female consciousness. It’s smart … and perhaps it’s the type of message the field of cardiology should consider to reach more women.

However, Rosenbaum said it isn’t fair to ask healthcare providers to try to change identity beliefs in a brief office visit. Instead, she said the subject requires research regarding social values and group identity. Ultimately, Rosenbaum added, cultural messaging will likely come from a variety of sources including media outlets.

Today, she said, “Our biggest chal-lenge is translating what we know into better health of our population. The next phase of evidence based-medicine should be as much about figuring out how to communicate that evidence to our pa-tients … to do that we have much to learn from the methodological approaches of

the social sciences.”Rosenbaum added the starting point

to address women’s perceptions of heart disease should be to conduct focus groups to evaluate where emotional beliefs cur-rently stand and assess the impact of fram-ing messaging in different ways. “This is decades worth of work,” she stressed, “to ultimately understand not just how they feel and where those feelings come from, but to evaluate whether there are ap-propriate interventions that help women adopt more heart-healthy behaviors.”

While heart disease might have a de-cidedly masculine feel, there’s no reason why research can’t point to ways to soften the message and appeal on an emotional level to women, as well. After all, women are often identified with their capacity to love … the trick will be finding the right words to help a woman celebrate her big heart while being cognizant of the dangers that come with having an enlarged one.

Identity as a Risk Factorcontinued from page 4


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What a privilege it was for Memphis Medical News to interview Scott Morris, MD, of the Church Health Center for this issue. If there’s anyone in tune with Memphis’ impoverished communities, it is Dr. Morris. He said something that really stuck with me. He quoted Jesus, who said, “The poor will always be with you.”

I think that we all have a well-inten-tioned but perhaps false hope that some-day we’ll be able to completely eliminate poverty in Memphis. But as Dr. Morris stated, the number has grown since he began his mission and it continues to grow. Currently we have about 2,000 homeless people in Memphis on any given day. It is essential for Memphis to be equipped with sustainable programs to help those in need.

Sheneka was one of those home-less people. She was homeless as a child, and then as a teenager she found herself homeless and pregnant. Lucky for her,

she reached out to Agape Child & Fam-ily Services. Their Families in Transition program (FIT) gave her “wraparound” services, support and “intentional” friend-ships. Her life turned around. She found full-time employment and housing and finished college -- graduating magna cum laude from the University of Memphis. Today, she is studying for the LSAT en-trance exam for law school.

This is just one success story rising out of the Christian-centered ministry of Agape Child & Family Services. On April 1 of this year, they celebrated their 44th anniversary of partnering with local con-gregations, non-profits, corporations and other resources to serve the homeless, the fatherless and the under-resourced neigh-borhoods of Memphis.

Agape has three primary programs:

• Adoption & Foster Care Ser-vices

Agape’s Adoption Support Center is the only one of its kind within a 200-mile radius of Memphis. It serves anyone touched by an adoption, whether it be the birth parents, the adoptive parents or the individuals who have been adopted. The mission is to help all those involved have healthy, successful families and re-lationships. This is a place for expect-

ant mothers who are in crisis or facing an unplanned pregnancy to help them make difficult decisions about their future. Whether they choose to parent their child or have their child adopted, Agape pro-vides the assistance that can make their choices succeed.

There are more than 1,100 chil-dren in the foster care system in Shelby County today. Writer Starra Neely Blade describes the needs of a foster child in this quote, “She did not want much, wanted very little; a kind word, sincerity, fresh air, clean water, a garden, kisses, books to read, sheltering arms, a cozy bed. And to

love and be loved in return.”Agape’s Foster Care Services makes

sure children get what they need while their biological parents get back on their feet. Many things may contribute to birth parents being unable to care for their chil-dren: lack of financial resources, home-lessness, substance abuse, employment obstacles. Regardless, parents like this can arrange for their children to enter tem-porary custody with Agape. And while Agape works to reunite these children with their biological parents, they provide them with a safe and nurturing home until their

Agape Child & Family Services, Inc.Sustainable programs can turn lives around

MEMPHIS on the MEND

BY PAMELA HARRIS



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By EMILY ADAMS KEPLINGER

In light of the economic constraints affecting healthcare in the last fi ve years, there have been reductions in nursing staffs across the country, and the scenario is no different in Memphis. However, un-like what’s happening in most of corporate America, the decreasing staff numbers have not come from reductions in force (RIFs) but from simple attrition.

When nurses leave a job, they are not being replaced as readily. That was not the case a few years ago when a staff open-ing for a nurse was typically fi lled within a couple of weeks. Now the process is much lengthier, with many more steps involved for approval due to a tighter economic bot-tom line. And often the position is simply not refi lled.

In an informal survey of area nursing professionals by the Memphis Medical News, one thing becomes clear: a decrease in staff-ing results in additional duties for the re-maining nursing staff. The patient load is the same, or even increased. January and February usually see higher patient loads due to fl u and upper respiratory infections. And there are fewer hands to carry the load. This change in staffi ng levels is bring-ing about another trend in nursing: nursing managers are tending to pick up some of the direct clinical care as needed in order to manage the workload.

Additionally, to optimize nurse staff-ing, hospital quality-improvement teams now can generate data to correlate nurse staffi ng levels with patient outcomes in emergency departments preoperative services and prenatal services as part of NDNQI®, a quality-improvement solu-

tion of the American Nurses Association (ANA). That data can assist the teams in developing staffi ng plans and strategies to improve outcomes, such as reductions in patient falls and infections that result from hospitalization.

“Optimal nurse staffi ng is a critical component in improving the quality of pa-tient care and preventing avoidable com-plications,” said ANA President Karen A. Daley, PhD, RN, FAAN. “The expansion of the NDNQI®, staffi ng measures to these new areas will give hospitals a complete view of their performance when develop-ing their staffi ng plans.”

Another change in nursing is the result of changing technology. A nurse in a hos-pital setting is involved in regular patient care, as was true before. But now the re-quired documentation of that care is chang-ing with the implementation of the ICD-10 system. This switch in electronic coding of medical records is more time-intensive on two levels. First, nurses are required to un-dergo training in order to successfully use the new system, which is federally man-dated to be in place by Oct. 1, 2015 (origi-nally scheduled for Oct. 1, 2014). Secondly, the new system is far more detailed, requir-ing more code specifi city and more time on the part of nurses to perform the coding tasks correctly. The good news is that with ICD-10, nurses will capture much more useful patient information.

Additionally, some of the pressures of the job have been affected by the reduced staffi ng levels. Nurses are often working 12-hour shifts, vs. what were once standard eight-hour shifts. The physical demands are more taxing due to the extended time-frame. And for nurses who are parents, other issues, like fi nding 12-hour child care, become stressors.

But along with the diffi culties come new opportunities. Many nurses recognize the value of increasing their knowledge base, whether for patient care or techno-logical profi ciencies. As the expectations of hospitals expand, more nurses are fi nding value in additional education, as it opens more opportunities for advancement. One trend is that as staffi ng levels are declining, top-rated nurses are being offered higher-level positions. Nurses with years of nurs-ing and case management experience, as well as advanced degrees in nursing, are being promoted as a means of retention.

In general, more nurses are moving away from two-year degrees in favor of four-year degrees. They are also seeking additional certifi cations in specialty areas.

As Their Numbers Decline, Nurses’ Workloads IncreaseExtra training, education can bring more opportunities


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Physicians in Tennessee have been encouraged by the Tennessee Medical Association (TMA) to “continue improv-ing clinical documentation” in prepara-tion for ICD-10 changes despite the fact that the U.S. Senate on the last day of March voted to delay the implementa-tion of ICD-10 until October 1, 2015.

The Senate vote of 64-35 led to the passage of a House-approved measure that would delay a scheduled 24 percent cut to Medicare physician reimburse-ment rates and push the ICD-10 compli-ance deadline to 2015.

A statement issued by the TMA shortly after the Senate’s action stated, “We encourage physicians to continue improving clinical documentation to not only transition into ICD-10, but also meet new requirements for value-based reimbursement, ACOs and other emerg-ing payment models. TMA will continue supporting Tennessee’s medical practices in these efforts through education, legis-lative advocacy, special events and other programs.

“For the past three years, TMA has provided education and other resources to help our members fully prepare for the October 2014 deadline. Practices that were on track to successfully transition are now ahead of the curve. For others, this latest delay means more time to pre-

pare.”U.S. healthcare organizations are

working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures. The switch means that healthcare provid-ers and insurers will have to change out about 14,000 codes for about 69,000 codes.

Before Congress’ action last month, the ICD-9-CM code sets that currently are used to report medical diagnoses and inpatient procedures would have been re-placed by ICD-10. The looming changes raised the question, would the Memphis medical community be ready for the change?

Since so many people and organi-zations would have been affected, that question was an important one. The users of the codes include practitioners, insurance carriers, government regula-tory bodies and healthcare research per-sonnel. Other entities that would have been impacted include hospitals, phar-macies, physical therapy providers, home healthcare providers and skilled nursing facilities.

The TMA expects all practices in the state to incur additional testing timelines and costs. The organization says it will communicate related updates as they are available.

TMA expects the transition from ICD-9 to ICD-10 to bring drastic changes to a physician’s practice. It fore-casts the increase in coding will jump from 16,000 to 68,000 alone. All “cov-ered entities” – as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) – will be required to adopt ICD-10 codes for use in all HIPAA transactions.

To avoid disruptions in patient care and reimbursement, TMA suggests phy-sicians must be prepared. A successful transition from ICD-9 codes to ICD-10 codes will require significant planning. At minimum, organizations should consider the following:

• Ensure top leadership understands the scope and significance of the ICD-10 implementation and transition

• Assign responsibility and decision-making authority for managing the tran-sition

• Plan a comprehensive and realistic budget

• Ensure involvement and commit-ment of all internal and external stake-holders, and

• Adhere to a well-defined timeline.The TMA says it can help with this

transition through online courses, access to experts and ICD-10 transition toolkit and software.

Update on ICD-10


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gree from Yale and a medical degree from Emory University, Morris is a board-certi-fi ed family practice physician and also an ordained minister. He sees patients four days a week at the Center and also serves as associate pastor at St. John’s United Methodist Church. In 1986, the native of Atlanta brought to Memphis the dream of providing healthcare for the working unin-sured, and promoting healthy bodies and spirits.

But that “start” has transformed the Memphis-based Center into an interna-tional organization that inspires, heals and educates thousands. The scope of its out-reach and global impact are a surprise to many, Morris said.

“The Church Health Center is not just a little clinic on the corner of Peabody and Bellevue anymore. Most people don’t know that along with our clinic and our wellness center that provide direct patient services, the Church Health Center publishes a mag-azine called the Church Health Reader, we run Perea Preschool, and we are also the home of the International Parish Nurse Re-source Center (IPNRC), which has trained over 15,000 nurses worldwide to work in churches and communities of faith. They look to us for their training and resources to do their work; 148 nursing schools world-wide use the curriculum that we designed and control.”

Although the IPNRC began in Chi-cago 30 years ago, its roots are now fi rmly at the Center. “People look to Memphis for their marching orders on how to work with and prepare parish nurses,” he said.

In addition to the 60,000 people in Shelby County whom the Center cares for, it promotes the exchange of ideas and shares models of faith community nursing through events such as the Westberg Symposium, which the Center hosted here in April. Guests from Canada, Europe, the Philip-pines, Korea, China, Ukraine and Swazi-land attended the conference, Morris said.

Locally and regionally, the Center also serves a desperate need that continues

to grow.“I see over and over again women

who were working 40 hours a week — and when the world fell apart in 2008, they had their hours cut back to 24 hours a week,” he said. “They now have to live off less money. When they went below 30 hours a week, they lost their benefi ts. They still have chronic disease, hypertension, dia-betes — yet they can’t afford to go to the doctor.”

A typical patient, Morris said, would be a 50-year-old woman — black, white, Hispanic, Ethiopian or Chinese — doing a job that nobody else is willing to do and supporting multiple people from two or three families with that income. “I think for many people it would be surprising to real-ize the number of persons that one income can sometimes support,” Morris said.

The poor will, indeed, always be with us if current projections are correct. “When we opened our doors in 1987,” Mor-ris said, “there were 26 million uninsured Americans; they announced (in April) that if the Affordable Care Act were to be fully implemented, in 2024 there would be 30 million uninsured Americans — more than when we began!”

That’s one reason the Church Health Center’s greatest physical goal now is to move into the Sears Crosstown building over the next two years — no small task, Morris acknowledged. He anticipates groundbreaking in late May and looks for-ward to occupying 150,000 square feet on the fi rst three fl oors of the building, which boasts 1.5 million square feet and is larger than the Chrysler Building, and fi ve times the size of the Clark Tower.

The building itself represents a $185 million project, but Morris is confi dent. “We’re going to turn it into the jewel of Memphis!”

Morris is also anticipating — pending accreditation in May — the opening of a family practice residence within the build-ing, created and operated in partnership with Baptist Hospital. A July 2015 opening is planned.

The Center recently added new presi-dent Antony Sheehan, formerly a leader in Great Britain’s National Health Service and CEO of a 7,000-employee hospital system. “People have been asking me for 20 years who will be my successor,” Morris explained. “I just had my 60th birthday, and we’ve now addressed that question! Antony definitely has the experience, knowledge and talent to run a growing organization that has international roots.”

Grateful for the 27 years of support the Center has received from the Memphis Medical Society and its physicians who volunteer to help the working uninsured, Morris commented, “I am proud that my colleagues have stepped up to the plate to take care of the people who work to make our lives comfortable.”

The need is not diminishing. Noting that 52 of their sub-specialty clinics are now operated with retired doctors, Morris appeals to younger doctors in active prac-tice to help meet that need. Volunteers can serve in several ways, and “nobody is asked to do more than they are willing to.”

G. Scott Morris, MD, continued from page 1


By CINDy SANDERS

From April 24-27, physicians from across the state gathered in Middle Ten-nessee to discuss issues impacting medicine, attend targeted educational courses, vote on key policy resolutions, install new offi cers, network with colleagues, and support Al-zheimer’s awareness during MedTenn 2014.

The annual con-vention of the Tennes-see Medical Association featured more than 20 speakers and 20 sessions over four days. TMA Pres-ident Russ Miller said the theme of ‘bringing medi-cine together’ speaks to the association’s focus on collaborative practice and communication around patient-centered care.

“We feel it’s very important to continue to advocate for doctors and patients to bring everyone together,” he said, adding the an-nual conference has become more of a true medical convention with a ‘big tent’ feel that includes other medical specialty societies. The multi-specialty meeting included coor-dinated events, education and activities with Cumberland Pediatric Foundation, Tennes-see Academy of Ophthalmology, Tennessee Association for Long-Term Care Physicians, Tennessee Chapter of the American Acad-

emy of Pediatrics, Tennessee Chapter of the American College of Surgeons, Tennessee Geriatrics Society and Tennessee Psychiat-ric Association.

The four-day conference included hot topics impacting patients and providers in Tennessee. Featured courses included ICD-10 implementation strategies, proper prescribing, workers compensation law changes, personalized medicine, depression secondary to critical illness, health reform, Medicaid expansion, and emerging pay-ment and employment models.

Miller noted TMA is keenly focused on the changing paradigm of payment for episodes of care. He added the change from volume to value isn’t threatening to physi-cians but is concerning in terms of how quality is counted and measured. “Doctors are always about quality and comparative data,” he stressed, adding it is important that decisions are based on clinical data and not just on claims data.

The TMA is keeping a close eye on innovation grants tied to TennCare with the recognition that payment reform will ultimately expand to commercial payers, as well. “We realize the success of these pilots is directly in the hands of the physicians doing the work,” Miller said. “We’ve got to get it right at the onset. If we need to take a little extra time to make sure what we measure

TMA Installs Volunteer LeadershipThe pomp and ceremony surrounding the presidential succession of the Tennessee

Medical Association is always a highlight of the annual meeting. This year was certainly no exception as the gavel passed from Chris Young, MD, to Doug Springer, MD, who was installed as TMA’s 160th president with John Hale, MD, stepping into the president-elect position.

President: Douglas J. Springer, MD, FACP, FACG, is a gastroenterologist from Kingsport. Originally from Canada, he moved to Tennessee in 1978 as part of a young physicians’ program to move doctors to underserved areas of the state. Now a naturalized U.S. citizen, Springer has practiced his specialty for 35 years in Upper East Tennessee.

A Fellow of the American College of Physicians and American Col-lege of Gastroenterology, Springer has been actively involved in several professional medical associations and is a past president of the Sullivan

County Medical Society and past chair of TMA’s membership committee. He also has held professional service positions including reviewer for examinations for the American Board of Internal Medicine and chairman for the Department of Medicine at Indian Path Medical Center and Holston Valley Medical Center.

Springer received his medical degree from the University of Calgary, Alberta, where he also completed his residency in Internal Medicine. He then undertook a fellowship in Gastroenterology at Queen’s University in Kingston, Ontario, Canada. He is board certi-fi ed in both Internal Medicine and Gastroenterology.

President-Elect: John W. Hale, Jr., MD, is a family medicine practitio-ner in Union City. Hale has been actively involved with the TMA since his student affi liation while at East Tennessee State University (ETSU). A three-time member of the TMA Board of Trustees, Hale has served in the House of Delegates (HOD) for 22 years. Immediately prior to his new po-sition, Hale completed terms as speaker of the HOD and chair of TMA’s legislative committee. He is a past chair of the young physicians group and past AMA delegate in that role. Additionally, Hale has served as a

past president and secretary of the Northwest Tennessee Academy of Medicine and is a past IMPACT board member.

Hale earned his medical degree from ETSU’s Quillen College of Medicine and com-pleted his residency at Jackson-Madison County Hospital.

Russ Miller

MedTenn 2014Bringing Medicine Together



“Some patients get the impression by the nurse’s body language or interaction with me that they are questioning my de-cision,” said a neurosurgeon with decades of service. “That causes a crisis with pa-tient confi dence. Nurses should respect the physician and understand that carry-ing out orders instills patient confi dence. They don’t need to imply they know bet-ter.”

This same physician had great respect for a nurse’s intuition and wanted them to “take more ownership” with patients. It seemed the input would be welcomed had there not been an audience.

This theme con-tinued in the feedback gleaned from a seasoned dermatologist, who advised questioning the doctor in front of the patient produces confusion on the part of the patient and causes them to second guess everything. He said this advice also goes for physicians of other specialties.

“Double checking work and discuss-ing opinions are fi ne if the issue is worked out respectfully privately and then pre-sented to the patient,” he said.

One general practitioner of 30-plus years explained, “There will always be some bumping of heads, and everyone has to remember they all have the patient’s best interests at heart.

“I know there are doctors that tend to be know-it-alls, and I know a lot feel threatened when questioned. Nurses are afraid to speak up and feel they will get in trouble. If they complain, they could be let go or get bad shifts, and I think that’s a shame,” he said.

Another doctor interviewed said, “Like we could get nurses in trouble. The hospital is always going to take the nurse’s side.” He cited the nursing shortage and ways hospitals can discipline doctors as reasons for his statements.

Over and over there was a call for nurses to use their training and clinical skills. A six-year veteran in inpatient re-habilitation encouraged nurses not to be afraid to use their clinical judgment to problem-solve before calling a doctor, she said. “Have a proposed solution when you call me. Think it out and present it to me so we can intervene.”

One hospitalist with experience in a variety of areas expressed displeasure over the content of his messages while taking call.

“Sometimes I will get a call at 5 a.m. over whether to administer an over-the-counter medication. If they were at home, they could do that. If a patient gets trans-ferred to another room, they will call me—and I ordered the transfer. It gets to the point of harassment,” he said. “They have six patients, and I have 60.”

He said the way the hospital uses nurses can put stress on the physician-nurse relationship, and that nurses should not feel that they have to call for every

little thing. He encourages nurses to use their training, but he believes they are constrained by hospital policies.

Other doctors blame electronic chart-ing for communication problems between nurses and doctors. An internal medicine physician for 36 years pined for the days of written records.

“I used to be able to ask if a patient had a problem in the night,

if they pooped, if they slept—I defy anyone to

fi nd that in electronic charts now,” he said. “Nurses need to be able to present a simple history sex, age, presents with these symptoms,

appearance, here is pertinent history, here

are labs being done—like in the ER. Now we

are shotgunning people with 50 types of labs to see what falls

out.”The role of the nurse practitioner was

a hot topic. Repeatedly, it was expressed that supervising NPs should not imply to doctors they know all that doctors do. Also said was that the accountability of nurse practitioners was not there. One 30-plus-year anesthesiologist recounted a story he heard from a colleague about a patient who accessed a freestanding clinic in a drugstore with severe abdomi-nal pain. The NP administered antibiotics for a UTI. The next day the patient was near death in the ED with a ruptured di-verticulum.

“A physician in that spot would be in jeopardy of losing his license. The Board of Medical Examiners has a lot of criteria and a long, arduous process for licensure but the nursing board feels a nurse can do anything a doctor can do by taking a weekend course,” he said.

An internist echoed his opinion, com-paring 2500 nursing training hours with what he cited as 25,000 training hours for the standard beginning intern. Speaking of statewide legislation proposed to allow NPs to function without doctor oversight, he said, “It is foolhardy to think nurse practitioners can function without physi-cian supervision.”

Citing the need for nurse practitio-ners due to primary physician shortages, he continued, “We need to have a more symbiotic relationship. As a whole, my peers respect NPs.”

There were lots of compliments about “good” nurses, described as those who used their intuition and clinical skills, took ownership in their jobs, went the extra mile and were friendly and ap-proachable. A rehab physician said, “The ones who are not just clocking in, passing meds and going home are the best to work with. It’s usually very obvious who those nurses are that take extra steps with their patients.”

A hospitalist said, “I am usually around nurses who are bright, funny, good to be around and good at what they do.”

Doctors Say, continued from page 1 Nurses Say, continued from page 1ery nurse and nurse educator. She said this goes for physicians, regardless of age and gender.

Indeed, communication and respect were key issues mentioned in every in-terview. The nurse quoted in the above paragraph said she has prayed for doctors to ask her opinion. “I am at the bedside 24/7. I know the specialty patients I take care of well. We could take much better care of the patient if doctors would just ask me my opinion, listen and communicate.”

As for most of the nurses interviewed, internists and family practice physicians were preferred to specialists because of the respect they have for nurses and their people skills. The most temperamental specialty described was surgery.

“One highly respected doctor has called us ‘nothing more than trained mon-keys,’” said an almost 30-year nursing vet-eran currently working in an ambulatory surgery center. “If you would not talk to your wife, daughter or mother in the rude manner you fi nd yourself talking to me, then do not talk to me in that manner.”

One hospital surgeon was described as “berating nurses and residents over pretty much everything. He is intention-ally intimidating and downright mean to everyone he deems not as important as himself,” said a 16-year pre-op nurse with 33 years cumula-tive hospital experi-ence. She described instances of whin-ing, complaining and temper tan-trums from many doctors, resulting in a real lack of re-spect for the doctor and decrease in pro-ductivity by the staff.

“I have defi nitely had some doctors who have had a sense of entitlement, and are rude or ar-rogant,” said a nurse practitioner with 10 years’ experience. “Or, they don’t see the value of nurses and nurse practitioners. NPs are there for the benefi t of the pa-tient. It’s not that we want to be a physi-cian. If that was the case we would have gone to medical school.”

A MED/SURG nurse of 16 years said she knows all specialties are busy, but she would like more physician communi-cation with patient families. She has been on both sides, recently losing a family member after several months-long hospi-tal stays. She said at fi rst, she would keep her profession a secret from her loved one’s doctors, but eventually her nursing experience would be found out. Commu-nication would improve after that, and she thinks that openness in communication should be the same for everyone.

Communication between physician colleagues is important to the hospital nurse, said a 27-year nursing veteran. There can be confl icting discharge or-ders, different medication choices, or one doctor may start one thing and another physician discontinue it. In these cases her concern is consistency.

Blanket concerns have to do with the stressed health care system, such as nurse shortages, new reporting practices and in-creases in policies and procedures. Nurses say it is always helpful if doctors under-stand the limited staff and limitations put on nurses by competing demands.

“I realize there are not enough ex-perienced nurses anymore. I know the newer ones will call a lot in the middle of the night and we are using less supervisory docs in my area,” one NICU nurse said. “But I have 25 years’ experience. If I call you in the middle of the night because I have a concern, it is something. It’s not my call whether we save this baby or not. You are the professional. It’s your call.”

A growing number of physicians and nurses are becoming effi cient at new elec-tronic charting and reporting systems. One nurse said that new computerized charting systems, although a learning curve at fi rst, will help streamline health-care – making treating patients safer and interpreting orders easier. Another ex-plained that verbal orders are hard to do with new computer systems, and said she wishes that physicians would adhere to the new electronic guidelines.

Nurses also pointed out they also have their physician heroes. A

nurse practitioner in psy-chiatry had a diffi cult

patient threaten her and then fi le a griev-

ance against her and threaten to kill her. The psy-chiatrist told her to walk away from the situation and

let him handle it, telling her he had her

covered and it was ul-timately his responsibility

as the attending. It meant a lot to her and she felt much safer.

A 24-year oncology nurse explained she was extremely happy where she worked.

“I work with some of the most in-telligent people in the world, world-re-nowned, and they are not too big to talk to patients, patient families, or nurses,” she said. “They are very respectful of every-one and it facilitates the best patient care possible.”

Self-suffi cient, kind, friendly, quick to thank those who help him and very com-plimentary is the way one pre-op nurse described her favorite anesthesiologist.

“Typically, the doctors who get the best work from nurses are the ones who treat them with kindness and respect,” she said. “They show occasional appreciation or interest in you as a person or your life outside work. It’s validation.”

They don’t need to imply they know bet-

This same physician had great respect for a nurse’s intuition and wanted them to “take more ownership”

had there not been

This theme con-tinued in the feedback gleaned from a seasoned dermatologist, who advised questioning the doctor in front of

“I used to be able to ask if a patient had a problem in the night,

if they pooped, if they slept—I defy anyone to

fi nd that in electronic charts now,” he said. “Nurses need to be able to present a simple history sex, age, presents with these symptoms,

appearance, here is pertinent history, here

are labs being done—like in the ER. Now we

are shotgunning people with 50 types of labs to see what falls

“Nurses need to be able to present a simple history sex,

age, presents with these symptoms, appearance, here is pertinent history,

here are labs being done—like in the ER. ”

ally intimidating and downright mean to everyone he deems not as important as himself,” said a 16-year pre-op nurse with 33 years cumula-tive hospital experi-ence. She described

doctors, resulting in a real lack of re-spect for the doctor and decrease in pro-ductivity by the staff.

“I have defi nitely had some doctors who have had a

Nurses also pointed out they also have their physician heroes. A

nurse practitioner in psy-chiatry had a diffi cult

patient threaten her and then fi le a griev-

ance against her and threaten to kill her. The psy-chiatrist told her to walk away from the situation and

let him handle it, telling her he had her

covered and it was ul-timately his responsibility

as the attending. It meant a lot to her and she felt much safer.

“I have 25 years’ experience. If I call you

in the middle of the night because I have a

concern, it is something. It’s not my call whether we save this baby or not. You are the professional.

It’s your call. ”

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


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By CINDy SANDERS

Consider yourself warned.

A white paper released earlier this year by SANS, a global leader in cybersecu-rity research, training and certification, painted a bleak picture of where those in the healthcare industry currently stand in terms of keeping pro-tected information safe and secure. The report was created using healthcare-specific data provided by Norse, a live threat intelligence and security solutions firm, from September 2012-Octo-ber 2013. The eye-opening results underscored the vulnerability of providers, payers, business associates and patients.

Authored by Barbara Filkins, a senior SANS analyst and healthcare specialist, the report detailed the widespread prob-lem. In analyzing the Norse data collected during the 13-month sample, the intelli-gence found:

• 49,917 unique malicious events,• 723 unique malicious source IP

addresses, and• 375 US-based healthcare-related

organizations compromised … averaging about one a day.

Filkins wrote, “The data analyzed was alarming. It not only confirmed how vul-nerable the industry had become, it also revealed how far behind industry-related cybersecurity strategies and controls have fallen.”

Furthermore, the analysis made it clear that the threats aren’t unique to any one type of healthcare company, but pro-viders are seemingly the most vulnerable. In looking at the sectors compromised by malicious traffic, healthcare providers led the way with 72 percent. Business as-sociates accounted for 9.9 percent of the malicious traffic, health plans 6.1 percent, healthcare clearinghouses 0.5 percent, pharmaceuticals 2.9 percent, and other related entities 8.5 percent. Most alarm-ing, noted Filkins, was the level of activity found in what was just a sample set.

Speaking to Medical News from her California office, Filkins said ‘malicious events’ are defined as an outside threat or event that might have penetrated the system and could range from hijacking contacts to pushing sensitive information outward. She noted that many compa-

nies, practices and facilities have policies in place warning employees not to click on an unknown email or link. (And who hasn’t received a suspicious link under the guise of coming from a friend or colleague?) Yet, she said, “People need to be looking at not only what comes into their network, but what goes out of their network.”

To find and address malware typi-cally requires a HIT professional. “A lot of times an attacker will use a very common protocol so it might look like someone is browsing the web, but you might have to dig a little deeper under the covers,” she noted of finding and locating problems. “A lot of these events continued not just for days … but for months,” she added.

Locking the Front Door, Leaving the Back Wide Open

Oftentimes the point of entry for at-tackers was not the main information sys-tem. Instead, those with malicious intent entered through peripheral surfaces like network printers, call contact software, routers, medical devices, and … ironi-cally … security cameras. While the main system was securely locked and password protected, many times, Filkins said, the default password remains on these add-on surfaces. Finding the admin password, she continued, is as easy as doing a quick Internet search for the device in question.

“There are some very basic things that can be done to get started with pro-tection,” Filkins noted. The most obvious … but clearly overlooked … is to change those default passwords. However, she continued, changing to an easily deci-phered password isn’t much help. Avoid using your children’s names, street ad-

SANS Cyberthreat White Paper Shows Dark Clouds on HIT HorizonWidespread Security Issues Put Systems, Patients at Risk



biological family gets back on their feet and can resume care.

• Families in Transition (FIT)FIT is an Agape program that helps

single homeless pregnant women and other single parenting women fi nd hous-ing and get back on the road to self-suf-fi ciency.

Some of the services they offer are:

• Life skills classes• Case management• Personal and career development• Mentoring• Parenting classes• Substance abuse servicesMany local congregations and or-

ganizations partner with Agape to make this program succeed. To see a full list of these partners, please go to: www.agape-

meanslove.org/families-transition-home-less-women

• Powerlines Community Network

This is a unique, site-based service model for the city of Memphis, where Agape counselors and social workers have set up shop in three apartment complexes to serve those in need, where THEY LIVE. In Whitehaven, Agape is at Bent

Tree and the Summit Park Apartments. In the Hickory Hill area of southeast Memphis, Agape is at the Autumn Ridge, Wingood Manor and Bella Vista apart-ment complexes. And in the Raleigh/Frayser area, Agape is at the Ashton Hill and Todd Creek Apartments.

By being on site in these communi-ties, Agape staff can connect with resi-dents, build trust and access needs so that they can offer Christ-centered services, education and advocacy, therefore truly transforming lives.

How Can You Help?DONATESomething as simple and affordable

as a monthly donation of $25 ($300 an-nually) can make such a big difference in someone’s life. If you’re inclined to help Agape, here’s what that amount would do:

• Fund three life skills classes for women

• Fund school supplies for six children• Supply two weeks of emergency

food• Send three teens to Christian campYou can donate online at http://

www.agapemeanslove.org/donate/or mail a check to: 111 Racine Street, Mem-phis, TN 38111.

VOLUNTEER If you’re interested in volunteering in

any of the Agape programs, there is a two-hour volunteer training session scheduled for May 29 at 5:30 p.m. To sign up, or for more information, please call Lori Hum-ber at 901-323-3600, ext. 13.

ATTEND FUNDRAISING EVENTS

Heartlight – August 15Agape will host their 16th annual

HeartLight event on Friday, Aug. 15 at 7 p.m. at Hope Presbyterian Church (8500 Walnut Grove Road). This year’s featured speaker will be world-renowned education reformer Dr. Geoffrey Canada, president/CEO and founder of Harlem Children’s Zone (HCZ).

Liz’s Ride for Agape – September 13

Many of you may know David LaVelle, MD, of Campbell Clinic. This event honors Dr. LaVelle’s daughter, who was tragically killed in 2010. Liz had a huge heart for orphaned children, and this event raises support and awareness for or-phaned children.

Contact Tim Rainey at 901-378-1096 or Brian Hoover at 901-323-3600, ext. 13 for more information.

Agape Child & Family Services, Inc.continued from page 7

The result is a nursing workforce that is in-creasingly academically trained, vs. primar-ily being clinically trained.

Certifi cation and increased education are valued more and more. And with this additional education, nurses are better able to assist physicians. This is leading to an-other trend, a change in the healthcare pro-viders. Some care that was once rendered solely by a physician is now being offered by physician assistants and nurse practi-tioners. In the last three months, Baptist Hospital has begun having nurse practitio-ners oversee 11 of its Walgreens clinics in Shelby County. (The Tennessee Board of Nursing defi nes an advanced practice nurse (APN) as a registered nurse with a current registered nursing license, a master’s degree or higher in a specialized area of nursing and national certifi cation as a nurse prac-titioner, nurse anesthetist, nurse midwife, or clinical nurse specialist.) The result goes back to economics, with this arrangement being a more economical method for doc-tors and hospitals to provide primary care and a more cost-effective option of treat-

ment for the consumer. For example, if a patient goes into one

of the Baptist/Walgreens clinics with symp-toms of an upper respiratory infection, nurse practitioners can not only diagnosis the condition and offer over-the-counter medications, but they can also prescribe antibiotics. In another scenario, if a pa-tient’s history includes long-term smoking, the nurse practitioner might diagnosis the condition as COPD and refer the patient to a specialist, in this case a pulmonologist, for ongoing treatment of a chronic disease.

In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched a two-year ini-tiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a re-port that would make recommendations for an action-oriented blueprint for the future of nursing. Through its deliberations, the com-mittee developed four key messages:

Nurses should practice to the full ex-

tent of their education and training.Nurses should achieve higher levels

of education and training through an im-proved education system that promotes seamless academic progression.

Nurses should be full partners, with phy-sicians and other healthcare professionals, in redesigning healthcare in the United States.

Effective workforce planning and pol-icy making require better data collection and information infrastructure.

ANA is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent and state nurses as-sociations and its organizational affi liates.

ANA advances the nursing profession by fostering high standards of nursing prac-tice, promoting the rights of nurses in the workplace, projecting a positive and realis-tic view of nursing, and by lobbying Con-gress and regulatory agencies on healthcare issues affecting nurses and the public. The Tennessee Nurses Association is the profes-sional association representing Tennessee’s 88,000 registered nurses.

As Their Numbers Decline, continued from page 8

MedTenn 2014, continued from page 11

matters, it will benefi t the patient and pro-fession.”

From a public health standpoint, Miller said, “There are a couple of issues that need resolution in short order.” One, he contin-ued, is Tennessee’s prescription drug prob-lem. “I think we’ve got awareness at a high level,” he said of past efforts to draw notice to the problem. “Now, our attention is more

focused on providing solutions to the misuse and abuse of prescription drugs.”

TMA has been closely involved in crafting continuing medical education sem-inars tied to prescription drugs and opioid use in the state. The latest CME iteration was launched during MedTenn ’14 in re-sponse to recent legislative requirements pertaining to controlled drug prescrib-

ing and licensure renewal. The two-hour course also will be presented around the state in the coming weeks.

Another public health issue on the front burner is the expansion of Medicaid in Tennessee. “As doctors in Tennessee, TMA believes it’s the right thing to do at the end of the day. It’s documented that people with access to healthcare and health insurance lead longer, healthier, more productive lives,” Miller said. He contin-ued, “Healthcare supports expansion … politics has to fi gure out how to pay for it. Our position comes from what’s right for patients, but we’re going to continue to work with legislators to fi nd a solution we can all live with.”

In addition to tackling the serious business of medicine, attendees also got to have a little fun and give back at the same time. Miller noted TMA opted to forego the traditional banquet following the presidential gavel exchange in favor of a fundraiser this year benefi tting the Pat Summitt Foundation, which pro-vides grant funding in the fi ght against Alzheimer’s disease. Miller said physi-cians generously give of their time and resources throughout the year. The TMA team thought it was highly appropriate to support that spirit by giving back as an organization to a medical issue impacting millions of families across the country.

The Economic Impact of Tennessee Physicians

A report released last month by the America Medical Association in conjunction with state medical societies underscores the enormous infl uence physicians have on national and state economies.

Looking at approximately 720,000 physicians in the United States primarily engaged in patient care (as opposed to physicians focused on research and teaching), the study found physicians create healthy communities in ways that extend far beyond the delivery of medical care. Nationally, patient care physicians contributed $1.6 trillion in economic activity and supported 10 million jobs in 2012.

“Physicians carry tremendous responsibility as skilled healers, trusted confi dants and patient advocates, but their positive impact isn’t confi ned to the exam room,” said AMA President Ardis Dee Hoven, MD. “The new AMA study illustrates that physicians are strong economic drivers that are woven into their local communities by the jobs, commerce and taxes they generate.” She added those dollars support schools, housing, transportation and other public services in local communities.

In Tennessee, patient care physicians support more than 143,000 jobs and more than $11.7 billion in wages and benefi ts. Additionally, those physicians contribute to a total of $618.8 million in local and state tax revenues and generate $20.1 billion in economic activity for Tennessee. On average, each physician supported 10.21 jobs with an average of more than $834,000 in total wages and benefi ts, contributed more than $44,000 in local and state tax revenues, and generated more than $1.4 million in direct and indirect economic output.

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dress, pet names, combined physician names, name of the practice, or other easily discernable choices. The best pass-words, Filkins said, include numbers and unique characters.

Mobile devices can also cause head-aches … in part because of unrealistic expectations and policies. “Everyone uses mobile devices,” Filkins stated. “Rather than trying to bury that and say, ‘oh, we never use mobile devices,’ maybe relax the punitive policies and instead say, ‘let’s get honest and figure out how to make them more secure.’”

Measures to Improve Security“Know what’s on your network,”

Filkins said. “Make sure your network is configured properly and devices are con-figured properly.” She added it’s impor-tant to know who is using what, and how it’s being used. Having a strong password policy is critical to proper configuration.

“Think like an attacker,” she contin-ued. “And if you can’t do it, get someone who can.” There are numerous resources and companies that can help with this task. It boils down to being aware, Filkins noted. “It’s basic awareness but in a digital world.”

She continued, “Know what your net-work pathways are for your organization.” Filkins said that often there’s an emphasis on protection for “bad things coming in”

… but if something does penetrate the system, there isn’t much monitoring of outbound traffic. Egress filtering is as im-portant as ingress protection.

The Cost of FailureThe healthcare industry is particu-

larly attractive to cyber attackers because of the type of information housed on serv-ers. With medical identity theft, the vic-tim is responsible for costs related to a compromised medical insurance record. A survey by the Ponemon Institute last year estimated that cost to be $12 billion in 2013.

Security breaches also represent major costs to the compromised entity. Steep fines, incidence handling, victim notification, credit monitoring for victims, and potential legal action represent direct out-of-pocket expenditures. In addition, a data breach could also significantly harm reputation and future business opportuni-ties.

The greatest cost, however, is to a pa-tient who winds up with inaccuracies in his medical record that could result in a misdi-agnosis or wrongly prescribed medication.

The Takeaway“Today compliance does not equal

security,” Filkins wrote. “Organizations may think they’re compliant, but this data shows that they are not secure.”

By LyNNE JETER

A conversation several years ago about the delayed but still looming ICD-10 conversion and other billing and cod-ing challenges prompted Mike Sacopulos, JD, to create affordable compliance plans for small to midsize physician practices.

“ICD-10 is a game changer,” said Sacopulos, founder and president of the Medical Risk Institute (MRI), based in Terre Haute, Ind. “As practices struggle to adapt to ICD-10 standards, we should anticipate mistakes and difficulties will arise. A coding and billing compliance plan will assist the practice in this time of transition. Compliance education and self-evaluation through software analysis will also reduce exposure to the practice.”

Sacopulos became intrigued with put-ting together a coding and billing compli-ance package with a reasonable price tag after talking with a colleague, Karen Zupko of KarenZupko & Associates, a na-tionwide consulting firm that works with hundreds of practices on proper coding procedures.

“We noticed that many practices needed compliance plans, but there wasn’t a cost-effective solution on the market,” he said. “Larger practices and hospitals have the infrastructure to establish compliance plans and proper training. But those tasks are far more difficult for small to medium size practices. Also, the Office of Inspector

General’s stepping up enforcement efforts – a record number of claims were brought by the OIG for coding and billing fraud and failures to comply with applicable standards in 2013 – provided a good base. To me, the need and the timing seemed to merge to call for an affordable solution.”

The process starts with a practice completing a questionnaire geared toward determining its compliance needs. From this, a coding and billing compliance plan is tailored to meet the practice’s needs. Next, training is offered to staff on compliance issues. The package also makes use of a software tool that helps the practice see how its coding compares to other practice of the same specialty lo-cated in the same state. Additionally, the package includes ongoing support and education for a year, said Sacopulos.

“The idea is to provide a turnkey compliance service to practices,” he em-phasized.

Various companies, such as Medical Compliance Plus and Practice Support Resources Inc., offer compliance docu-ments in template form.

“We differ from this approach in that we fit the compliance plan to the prac-tice,” he explained. “In my opinion, a 180-plus page book full of template docu-ments is the legal equivalent of playing Go Fish. Practices are busy; this is a complex topic. That’s why (we) tailor documents and supplies ongoing support via a tele-

phone hotline. On the other end of the spectrum are specialty consulting or legal firms that can custom design documents and supply individualized auditing ser-vices. Some of these firms are top notch, such as Horne LLP, but they’re often beyond the financial reach of smaller practices. We try to balance the need for individual attention with economic real-ity.”

Around the same time the Office of Civil Rights (OCR) announced it was resuming random HIPAA audits, it dis-patched 1,200 notices following a pilot program that revealed nearly 90 percent of surveyed practices, hospitals and other covered entities weren’t HIPAA-compli-ant.

“We should expect heavy fines to be levied,” said Sacopulos. “The OCR claims to collect $8 to $9 for every dollar they spend/invest on enforcement. That alone should make us want to hide under our beds.”

Prior to 2012, there were no random HIPAA audits. The system was complaint and notice driven. In 2012, with the help of an outside consulting firm, OCR launched a pilot program of random au-dits of medical practices and other covered entities. Approximately 130 entities were audited, noted Sacopulos.

“That’s a small numerator when compared to the enormous denomina-tor of all the medical practices, hospitals … around the country,” he said. “We’re now seeing the expansion of the random audit program initially by a factor of about 10. We should expect these audits to be-come far more routine in the future.”

Outside the random audit program, MRI is seeing a significant interest in the enforcement of HIPAA regulations at both the state and federal level.

“OCR has trained every state’s At-torney General’s Office on enforcement,” said Sacopulos. “Recently, we’ve seen the Federal Trade Commission bring action against a medical provider for failure to safeguard patient information. If that wasn’t enough, plaintiff law firms are now filing private civil actions patterned from failures to meet HIPAA standards. Prac-tices need to place the review their HIPAA compliance effort towards the top of the to-do list.”

Sacopulos described ICD-10 conver-sion preparation and increased activities of the Office of Inspector General (OIG) as “mixing to create a perfect storm.”

“In large part, this is why we believe it’s never been more important to have a current and comprehensive approach to compliance,” he said.

Compliance Affordability a Sticking PointMedical Risk Institute provides affordable compliance solution for small to midsize practices

SANS Cyberthreat, continued from page 13


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When the Center for Medicare & Medicaid Services (CMS) reports were released April 1, the information concerning the amount of money physicians were making, it brought on the obvious reaction from the medical community, including me. In fact, I decided to use the same title for this article that I used in my letter to the editor that appeared in the Commercial Appeal, on April 14.

Physicians are all for transparency but the data which is used currently by CMS and the commercial payers is not accurately reflected. This type of data will cause patients to make inappropriate and potentially harmful treatment decisions. It will also result in unwarranted bias against physicians that can possibly destroy careers.

There are other areas of healthcare where the data is also misleading. Providers know that clinical data (not just cost data) is the true measure of clinical outcomes and that they need the clinical data to improve outcomes.

“The country is moving toward greater transparency in how healthcare institutions and providers charge patients and their insurance companies. Despite the attempt at clarity, the reimbursement data can mislead. The numbers may include staff payroll and equipment costs,” said Professor

Cyril Chang, director of the Methodist Le Bonheur Center for Healthcare Economics at U of M’s business college.

“A large part of the Medicare reimbursement okay expenses; medications, staff and equipment. Doctors are all for transparency, but comparing physicians’ outcomes with their peers and using quality measures are better strategies than using Medicare reimbursements,” said Keith Anderson, MD, board chairman of the Tennessee Medical Association.

“Sinai is one of a growing number of health systems across the country that has begun tackling the social, economic and environmental conditions in the communities they serve as part of their programs to reduce hospitals re-admissions and improve outcomes.” (Modern Healthcare, February 3, 2014)

“Cleveland Clinic CEO talks strategy, expansion and standardization.” (Modern Healthcare, February 3, 2014.)

Earlier this year the first Independent Mid-South Information Exchange (MSHIE) was formed as a partnership between Pediatric Independent Practice Association (PIPA), and MSHIE Systems, LLC. MSHIE Systems is a joint venture between two local Memphis companies, PCS Medical Solutions, LLC and Cornerstone

Technologies, LLC.The Mid-South Health Information

Exchange represents the first project of its kind in the Mid-Mid-South: a health information exchange that will connect providers of one specialty (Pediatrics) at the individual practice level.

“Other Exchanges have focused on multispecialty, and have involved connection at the hospital level,” said Dr. William Terrell, President of the Board of Governors of PIPA. PIPA made the decision a couple of years ago to move from a ‘messenger model IPA’ to ‘clinical model IPA.’ We identified that our technology was our greatest weakness. We have developed a great working relationship and are eager to move our partnership forward.

Carmon Heilmann, president of PCS Medical Solutions and chief manager of MSHIE said, “The effort is unique. Other exchanges have connected providers to hospital data; however hospital systems contain only isolated incidents or care; when a patient receives treatment at the hospital.”

By connecting to the practice EHR systems ( approximately 80 percent of the doctors in PIPA have EHRs), the Mid-South Health Information Exchange will contain much more of the patients medical record…the information that only exists in the patient’s chart at their doctors’ office. This represents a significant amount of clinical data available to providers and others. This will be real-time data (not claims or reimbursement data) to providers in the exchange showing the latest clinical findings for the patient whether the patient was last seen by that provider or not. This capability could also be extended to providers and facilities that aren’t necessarily members of PIPA. For example, critical care facilities, hospitals and others.”

Ultimately the HIE will provide a means to analyze these large quantities of patient data for the purpose of population health management and clinical integration. Identifying the highest risk patients and developing care plans and follow up for that group. Initially the exchange will focus on immunizations records and specific

disease types that are important in the pediatric arena; asthma (Memphis ranked fourth in the country), juvenile diabetes, ADHD and others. Development of care plans for these areas will aid providers in implementing cost saving plans for their highest risk, ultimately the most expensive patients, from a cost of care perspective.

Another unique aspect of this exchange is that PIPA will own a controlling interest in the local MSHIE. The exchange is physician driven. This will help keep the focus of the system on providing better care to their patients. MSHIE Systems is responsible for the development, implementation, training and maintenance of the exchange.

“Professionals in practices around the country are harnessing their own data to manage patient populations more effectively,” said Keith Wisenberg, MBA, CMPE.

The concept, discussed in a growing number of circles, has major implications for healthcare providers. During the 2013 Colorado Health Symposium sponsored by the Colorado Health Foundation, Denver, attendees were asked how comfortable they were with payers gathering and using patient data to incentivize healthy behavior. Consider the fact, the speaker said, that retail companies identify repeat customers with cell phone roaming devices, access customer time spent in front of displays and use data on their buying to customize future coupons. If supermarkets track food purchases with loyalty cards, gyms tally facility use, and credit card companies record every purchase, it might not be long before employers and payers use that data to create a picture of your health and tailor insurance premiums accordingly.

The question is not if you use it, but how to use it. (“The State of Medical Practice,” MGMA Connection, magazine.)

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].

Misleading Doc DataBY BILL APPLING

MedicalEconomics


Michael Ugwueke Named President of MLH; Gary Shorb Focuses on Role as CEO

After serving more than a year as exec-utive vice president and chief operating of-ficer, the MLH board has ap-proved Michael Ugwueke as president and COO of our parent company Method-ist Le Bonheur Healthcare, as well as president and CEO of Methodist Health-care Memphis Hospitals (MHMH). MHMH is the entity that includes the five Memphis hospitals licensed as one, including Methodist Germantown Hospital, Le Bonheur Children’s Hospi-tal, Methodist North Hospi-tal, Methodist South Hospi-tal and Methodist University Hospital. The move, effective May 1, is de-signed to help MLH become a stronger in-tegrated system to best serve our patients. Reporting directly to MLH CEO Gary Shorb, Ugwueke will be responsible for operations across the system.

Since being promoted to chief oper-ating officer for MLH in January of 2013, Michael has led the adult facilities through a challenging healthcare environment with a clear sense of purpose to provide the highest quality care to patients and their families according to Gary Shorb, CEO of MLH. Originally selected for the COO role because of his passion for patient- and fam-ily-centered care, his ability to build strong bonds with physicians, his commitment to excellent clinical quality and his dedication to community wellness, were the qualities that Shorb says will make Ugwueke an out-standing President/COO.

Minton Mayer Elected President of Memphis Jewish Home & Rehab

Memphis Jewish Home & Rehab (MJHR) announced Minton Mayer was elected for a one year term as president at its Annual Meeting on Monday, April 7th. The following officers were also elected for one year terms: Gregg Landau, vice president/president elect; Scott Notowich, vice president; Dr. Lee Stein, treasurer; Judy Royal, secretary.

Minton Mayer, AV Rated Attorney, is a partner with Wiseman Ashworth Law Group, PLC and focuses his practice on the defense of long-term care organizations including nursing homes, assisted living fa-cilities and other aging services providers. He regularly consults with long term care organizations regarding risk management, regulatory, operations, administrative and employment related issues. He has exten-sive jury trial experience throughout West Tennessee and has appeared before the

Tennessee Court of Appeals and Tennessee Supreme Court. Mr. Mayer is a member of the American Health Lawyers Association, Defense Research Institute, Tennessee Bar Association, Memphis Bar Association and is also a Fellow of the Memphis Bar Foun-dation.

In addition to the elected officers, Geri Lansky will continue on the executive com-mittee as immediate past president, and past presidents Dr. Jay Cohen, Barbara Ja-cobs, Nat Landau, and Steve Wishnia will serve as presidential advisors. Several new board members were also elected that eve-ning for two year terms: Dr. Gordon Gruen, Judy Moss, and Dr. Audrey Zucker-Levin. Re-elected for a second two-year term were Andy Sasalwsky and Herbert B. Wolf, Jr. Elected for a third two-year term were Maurice Buring, Jonathan Epstein, and Ber-nard Lipsey. The members of the nominat-ing committee were Dr. Jay Cohen (chair), Geri Lansky, Bernard Lipsey, Minton Mayer, and Judy Royal.

The presentation of MJHR’s 2013 Aar-on Brenner Distinguished Service Award was given to Minton Mayer. The award is given “in grateful appreciation for dedi-cated service to Memphis Jewish Home & Rehab”. In the words of Mr. Brenner, “The world is divided into people who do things and people who get the credit. Try, if you can, to belong to the first class; there is far less competition.” Mr. Mayer was honored for his leadership during executive director search process.

In addition, Mayer announced the be-ginning of a strategic planning process for MJHR.

GrandRounds

Michael Ugwueke

Gary Shorb

Minton Mayer

Saint Francis-Bartlett Honors Physician of the Year on Doctor’s DaySaint Francis Hospital-Bartlett employees recently honored the hospital’s physicians at

their annual Doctors’ Day luncheon. The theme of this year’s event was “10 Years of Olympic Service.” The Olympic theme incorporated lunch dishes from around the world, while other activities included a departmental Doctors’ Day poster contest and chair massages for the physicians.

The celebration was also a time to honor two individual physicians, as the Physicians of the Year and Physician Leadership awards were presented.

Ben Gibson, M.D., was named the Physician of the Year. Gibson is a general surgeon and has been on the hospital’s medical staff since 2005. He has served as Saint Francis Hospital-Bartlett’s Vice Chairman of Surgery as well as the Chairman of the Bylaws Committee. He was named the hospital’s Physician of the Month in March 2013.

The medical staff voted Margarita Lamothe, M.D., as the recipient of the Physician Lead-ership award. Dr. Lamothe is an infectious disease specialist and has been on the hospital’s medical staff since 2004. She has served the hospital as the Chairman of the Quality/Perfor-mance committee and a member of the Medical Executive Committee.

Pictured (l to r): Margarita Lamothe, M.D., Physician Leadership award recipient; Jeremy Clark, Saint Francis Hospital-Bartlett chief executive officer; Ben Gibson, M.D., Physician of the Year.


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GrandRounds

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

Hospitalists Join Methodist Olive Branch Hospital

John W. Allen, Jr. M.D., and Shailesh Patel. D.O., have joined Methodist Olive Branch Hospital as hospitalists. They spe-cialize in caring for patients who are admit-ted to the hospital.

Dr. Allen says as a hospitalist he enjoys having all of the services his patients might need right there. He can respond immedi-ately to a medical issue by sending a patient for a CAT scan or order a biopsy and get immediate results.

He became a hospitalist because he likes the variety of cases. Hospitalists treat a wide range of illnesses from a simple stom-ach virus to pneumonia and other respira-tory illnesses to life threatening ailments.

Dr. Patel chose hospital medicine be-cause he enjoys caring for adult patients and feels this is an area where he can make a difference.

Given that hospitalists function exclu-sively in the hospital setting, they have a unique opportunity to see patients more than once a day. This enables the physicians to provide a higher level of efficiency in the care that is provided and helps reduce the amount of time patients need to stay in the hospital.

Through their commitment to provid-ing high-quality transitional care to a pa-tient’s home or community setting, hospital-ists help reduce the number of readmissions to the hospital. They achieve this by coordi-nating timely follow up outpatient appoint-ments with a patient’s primary care doctor or specialist. For patients who do not have a regular physician, and there is concern the patient may be at risk for readmission, the hospitalists may see a patient for a follow up appointment at the hospital to make sure the course of recovery is proceeding well. Taking the proactive approach to provid-ing a follow up visit gives hospitalists the opportunity to help identify any potential medical challenges and provide additional care quickly.

Allen graduated with a Bachelor of Arts degree in biology from the University of Mississippi, Oxford, and earned his medical degree from the University of Mississippi, Jackson, Miss. He is board certified by the American Board of Internal Medicine.

Patel attended the University of Missis-sippi, Oxford, where he earned a Bachelor of Arts in pharmaceutical sciences and a Doctor of Pharmacy. He received his Doc-tor of Osteopathic Medicine from Kansas City University of Medicine and Biosciences, Kansas City, Mo. He is board certified by the American Board of Internal Medicine and the American Osteopathic Board of Internal Medicine.

Health Gap Between Adult Survivors Of Childhood Cancer and Siblings Widens with Age

Adult survivors of childhood cancer face significant health problems as they age and are five times more likely than their siblings to develop new cancers, heart and other serious health conditions beyond the age of 35, according to the latest findings from the world’s largest study of childhood

cancer survivors. St. Jude Children’s Re-search Hospital led the research, results of which appear in the March 17 issue of the Journal of Clinical Oncology.

Key Points• As a record number of childhood

cancer survivors head into middle age, re-searchers have identified a widening health gap between survivors and their siblings who were not diagnosed with cancer in childhood. Investigators found that survi-vors age 35 and older were five times more likely than siblings to have experienced severe, disabling, life-threatening or fatal health problems.

• By age 50, more than half of child-hood cancer survivors had at least one se-rious health conditions, compared to less than 20 percent of siblings. More than 22 percent of survivors had at least two serious health problems, and about 10 percent had three or more chronic conditions. The con-ditions included new cancers as well as dis-eases of the heart, lungs, liver and kidneys.

• Among healthy survivors who reached age 35 without serious health con-ditions, more than 25 percent developed life-altering medical problems by age 45.

• The study included 14,350 adult survi-vors of childhood cancer and 4,301 siblings. The survivors included 5,604 who were age 35 and older. The survivors were diagnosed with different childhood cancers between 1970 and 1986. They were treated at St. Jude and 25 other medical centers in the U.S. and Canada. All survived at least five years.

• The results highlight the importance of lifelong medical care for childhood can-cer survivors. The care should include risk-based health screenings to look for signs of heart disease, new cancers and other prob-lems. The goal is to catch conditions early when the chances of treatment success are often greatest.

• The findings also add to evidence that some survivors may experience accel-erated aging.

Dr. Paul Brezina Named Director of Reproductive Genetics at Fertility Associates of Memphis

Fertility Associates of Memphis has named Dr. Paul Brezina Director of Repro-ductive Genetics, joining Dr. William Kut-teh, Director of the Center for the Study of Recurrent Pregnancy Loss, and Dr. Ray-mond Ke, Director of In Vitro Fertilization services. Dr. Brezina is a Clinical Assistant Professor in the Division of Reproductive Endocrinolo-gy, Department of Obstetrics and Gynecol-ogy at Vanderbilt University Medical Center and is a Consulting Gynecologist at St. Jude Children’s Research Hospital.

Dr. Brezina is board certified in Re-productive Endocrinology and Infertility as well as Obstetrics and Gynecology by the American Board of Obstetricians and Gy-necologists. In 2012, he completed his fel-lowship in Reproductive Endocrinology and Infertility at the Johns Hopkins School of

Medicine in Baltimore. Dr. Brezina earned his undergraduate degree from the Univer-sity of North Carolina at Chapel Hill. He has an MD/MBA degree from the Brody School of Medicine at East Carolina University in Greenville, N.C., where he also completed his residency in Obstetrics and Gynecology.

In his role as Director of Reproductive Genetics, Dr. Brezina coordinates preim-plantation genetic testing with the goal of reducing the risk of transmitting genetically inherited diseases. He also adds important guidance for couples with genetic factors contributing to pregnancy loss at the Cen-ter for the Study of Recurrent Pregnancy Loss. His main area of research has focused on genetic testing as it relates to assisted reproductive technologies.

Dr. Brezina will be directing a course at the Annual Clinical Meeting of the Ameri-can College of Obstetricians and Gynecolo-gists this year. This is the largest meeting of Obstetricians and Gynecologists in the country, where physicians learn the latest updates in clinical care.

UTHSC Online Art Auction Grosses More Than $70,000

The online auction by the University of Tennessee Health Science Center (UTHSC) of more than 300 works by internation-ally known Memphis artist Paul Penczner grossed more than $70,000. The sale, which opened for bidding March 4, and finished with a rapid, rolling auction, drew 158 bid-ders. Works auctioned are part of a collec-tion of 400 pieces donated by the artist’s widow, Jolanda Penczner, after his death in 2010 to the UTHSC College of Medicine to establish an endowment in his name in the Department of Physiology. All proceeds go for cardiovascular research at UTHSC. Zach Pretzer, director of development for the UTHSC College of Medicine proclaimed the auction a huge success.

Memphis Mental Health Institute Announces New Nurse Executive

Memphis Mental Health Institute is pleased to announce Lori Minor, RN, MSN, MSHSA has joined the staff as the facility’s Nurse Execu-tive. Ms. Minor’s educational background includes a Mas-ter of Science in Nursing Management and Leader-ship and a Master of Science in Health Service Adminis-tration. She has practiced as a Nurse since 1999 holding various positions of leadership and management in Nursing Services. Ms. Minor brings to MMHI a wealth of experi-ence from practice throughout the United States including Kaiser Permanente Hos-pital, Honolulu, HI; University Community Hospital, Tampa, FL; Memorial Hospital of Gulfport, Gulfport, MS and The Regional Medical Center, Memphis, TN.

Dr. Paul Brezina

Lori Minor


GrandRounds

Congressman Blackburn visits Results Physiotherapy Clinic to Discuss Proposed Healthcare Bills

On April 14, Congressman Marsha Blackburn (R-TN) visited Results Physiotherapy’s Franklin, Tennessee clinic to tour the facility and discuss several healthcare related bills cur-rently being considered with federal lawmakers.

Jason Richardson, PT, DPT, OCS, Sr. VP of Clinical Operations with Results Physiotherapy, coordinated the visit on behalf of the patients Results Physiotherapy serves.

The April 14th visit focused on legislation that would preserve patient access to a physi-cal therapist under the Medicare program. The first centered on a permanent fix to a flawed Sustainable Growth Rate (SGR) formula (method used by Medicare to control spending) and permanent repeal of Medicare therapy caps which arbitrarily obstruct some Medicare pa-tients from obtaining necessary PT services beyond a monetary threshold. On March 31, Congress passed a legislative “patch” to SGR which prevents physician cuts for Medicare ser-vices and extends the current therapy cap exceptions process until March 2015. Congress-man Blackburn has been a long-time supporter of eliminating the therapy caps to preserve access of needed services to Medicare beneficiaries.

Richardson also shared with Congressman Blackburn that under current law, physical therapists in private practice are not able to bring in another licensed PT through the Medi-care program to temporarily cover the caseload of a PT who must take leave due to illness, pregnancy, vacation or continuing clinical education. The ability to bring in a temporary pro-vider is known as locum tenens, an arrangement some other providers are currently eligible for in the Medicare program. For many physical therapists in private practice, this means that they may be unable to take these absences or patient care can be interrupted. Richardson urged Congressman Blackburn to consider support for the bipartisan bill, “Prevent Interrup-tions in Physical Therapy Act (HR 3426)”.

Repeal of the therapy cap and support for legislation that would permit locums tenens for PTs under Medicare will assist in assuring Medicare patients have access to cost-effective care that facilitates health, independence, and a pain free active lifestyle according to Rich-ardson.

1 in 8.That’s your chance of developing

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Copyright ©2013 Takeda Development

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Dr. Frederick Azar of Campbell Clinic Named President of American Academy of Orthopaedic Surgeons

Dr. Frederick M. Azar, Campbell Clinic chief of staff, was named president of the American Academy of Orthopaedic Sur-geons (AAOS) at the orga-nization’s annual meeting, held March 11-15 in New Orleans.

Dr. Azar becomes the eighth Campbell Clinic phy-sician to serve as president of the AAOS board of direc-tors since the academy’s es-tablishment in 1933, when Campbell Clinic founder Dr. Willis Campbell was elected its first board president. Over his yearlong

term, Dr. Azar will oversee management of AAOS affairs, heading up the administrative body and directing activities and policies related to both the academy and its asso-ciation.

In addition to his work at Campbell Clinic, Dr. Azar is a professor and director of the Sports Medicine Fellowship Program at the University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery, where he previously served as research director. He currently serves as the team physician for various professional and amateur athlet-ic programs in the Mid-South, including the Memphis Grizzlies, University of Memphis and Christian Brothers University. He pre-viously served as first vice president of the AAOS board of directors last year.

Dr. Frederick Azar

Memphis Vascular Center, working closely with several OB/Gynecologists in the area, has successfully diagnosed and treated pelvic disorders such as Pelvic Vascular Conges-tion Syndrome (PVCS), May-Thurner Syndrome, and Uter-ine Fibroids. It has been stated that 30 percent of patients with pelvic pain have no clear etiology.

Common symptoms of PVCS are heaviness in legs, pain, varicose veins, and swelling. PVCS typically presents itself once a woman has been on her feet for long periods of time. The symptoms are all caused by venous hyperten-sion. Other clinical signs are varicosities in the vulva, dis-coloration of the cervix and ovarian point tenderness dur-ing pelvic exams.

A good screening test is a CT of the pelvis with contrast to demonstrate the dilated parametrial veins. Treatment for this syndrome starts with a venogram in interventional ra-diology. As x-ray dye is injected into the veins under � uo-roscopy, the radiologist will identify venous insuf� ciency or re� ux in the veins.

Once the veins that are re� uxing are identi� ed, a catheter will be used for localization and embolization. This proce-dure is performed as an outpatient procedure and usually takes an hour. “Ovarian vein embolization has also shown to have no effect on luteinizing hormone levels, follicle-stimulating hormone levels or menstrual patterns,” accord-ing to Ason Levy, MD, Director of Interventional Radiology at Northside Hospital in Atlanta.

May-Thurner syndrome is a disease process that involves deep venous thrombosis typically involving the left leg. This is a result of chronic compression of the left common iliac vein by the overlying right common iliac artery. Screening procedures for May-Thruners, include Doppler ultrasound or CT venography to demonstrate the abnormal � ow and anatomy of the disease as well as the possibility of venous thrombosis. As an outpatient procedure, May-Thruner Syn-drome can be treated by performing a venogram in inter-ventional radiology. As x-ray dye is injected in the veins under � uoroscopy, the radiologist will identify the DVT and stenosis. Thrombolysis of the clot is initially performed us-ing a � brolytic medicine called tPA. A wire is then used to cross the stenosis and a balloon will be in� ated or stent deployed across the stenotic area to sustain an open path-way in the vein.

Another common disease process we see in the Memphis area is uterine � broids. This disease process mainly affects

African-American females. Most commonly, uterine � broids are diagnosed with ultrasound or physical exam. One of the possible treatments is hysterectomy. MVC offers a uterus sparing procedure to eliminate uterine � broids. This procedure is called Uterine Fibroid Embolization or UFE.

In 1998, MVC became the � rst group to perform a Uterine Fibroid Embolization procedure in Memphis. MVC physi-cians have been doing this procedure for more than 15 years. Judy Carney, MD with MidSouth OB/GYN, has seen many patients experiencing symptoms of � broids such as cramping, heavy bleeding, and bloating. Dr. Carney’s deci-sion concerning which patients may be candidates for UFE is the most critical.

“Endometrial ablation is also a good option for treating heavy periods, but it is usually reserved for patients with smaller � broids,” states Dr. Carney. When discussing treat-ment options for uterine � broids, Dr. Carney has found, “many patients are not aware of uterine � broid emboliza-tion. The procedure has been a great alternative for pa-tients who want to avoid traditional hysterectomy. In the past, patients with large � broids have had larger incisions, longer hospital stays, increased blood loss, and a longer recovery period.”

UFE is an outpatient procedure performed in the interven-tional radiology suite. It involves placing a catheter in the uterine arteries and injecting contrast to evaluate the blood � ow to the � broids. Once identi� ed, these arteries are se-lected with the catheter and an embolic material is injected. This material only affects the � broids and small surrounding areas. Typical recovery time for this procedure is anywhere from 7 to 10 days. We have experienced over a 90 percent clinical success rate with UFE and typically � broids will de-crease in size by 40-70 percent over a six-month period.

Dr. Belvia Carter and Dr. Deidrea Grandberry, with Wom-an’s Physician Group in Memphis, have had many patients undergo the UFE procedure as an alternative to hysterec-tomy. They both agreed that the shorter recovery time has been very bene� cial for their patients to get back to their normal activities.

Dr. Carter and Dr. Granberry state, “Many of our patients have such good outcomes that they typically share their experiences with their family and friends. “This is a col-laborative effort between MVC and OB/Gynecologists. We strive to bring the most current techniques when treating your patients.

Collaborativecare

For more information, please visit us at memphisvascular.com or call 901-683-1890.

The Memphis Vascular Center (MVC) consists of a group of board certifi ed and

sub-specialty trained Interventional Radiologists and offers comprehensive patient

care that includes consultation, evaluation and diagnosis, as well as percutaneous

and endovascular therapy. MVC has been on the forefront of collaborative care for

many diseases affecting women in the Mid-south for more than 15 years.

African-American females. Most commonly, uterine � broids are diagnosed with ultrasound or physical exam. One of the possible treatments is hysterectomy. MVC offers a uterus sparing procedure to eliminate uterine � broids. This

In 1998, MVC became the � rst group to perform a Uterine Fibroid Embolization procedure in Memphis. MVC physi-cians have been doing this procedure for more than 15 years. Judy Carney, MD with MidSouth OB/GYN, has seen many patients experiencing symptoms of � broids such as cramping, heavy bleeding, and bloating. Dr. Carney’s deci-sion concerning which patients may be candidates for UFE

“Endometrial ablation is also a good option for treating heavy periods, but it is usually reserved for patients with smaller � broids,” states Dr. Carney. When discussing treat-ment options for uterine � broids, Dr. Carney has found, Image of pelvic congestion syndrome

clinical success rate with UFE and typically � broids will de-

Dr. Belvia Carter and Dr. Deidrea Grandberry, with Wom-an’s Physician Group in Memphis, have had many patients undergo the UFE procedure as an alternative to hysterec-tomy. They both agreed that the shorter recovery time has been very bene� cial for their patients to get back to their

Dr. Carter and Dr. Granberry state, “Many of our patients have such good outcomes that they typically share their experiences with their family and friends. “This is a col-laborative effort between MVC and OB/Gynecologists. We strive to bring the most current techniques when treating

UFE involves injecting embolic beads to cut off blood supply to the uterine fi broids.

tion. The procedure has been a great alternative for pa-tients who want to avoid traditional hysterectomy. In the past, patients with large � broids have had larger incisions, longer hospital stays, increased blood loss, and a longer

UFE is an outpatient procedure performed in the interven-tional radiology suite. It involves placing a catheter in the uterine arteries and injecting contrast to evaluate the blood � ow to the � broids. Once identi� ed, these arteries are se-lected with the catheter and an embolic material is injected. This material only affects the � broids and small surrounding areas. Typical recovery time for this procedure is anywhere from 7 to 10 days. We have experienced over a 90 percent clinical success rate with UFE and typically � broids will de-

ment options for uterine � broids, Dr. Carney has found, “many patients are not aware of uterine � broid emboliza-

Image of pelvic congestion syndrome

May-Thurner’s disease is characterized by the compression of the left iliac vein by the right iliac artery

Documents

Memphis Medical News May 2014