Memphis Medical News January 2014

FOCUS TOPICS PUBLIC HEALTH FINANCIAL/TAX PLANNING OPHTHALMOLOGY

January 2014 December 2009 >> $5

PHYSICIAN SPOTLIGHT PAGE 3

Rolando Toyos, MD ON ROUNDS

MEMPHIS on the MEND

BY PAMELA HARRIS

Ronald McDonald House: A Welcome Gift at a Crucial Time It always seems to happen this way. One day, life is normal.

You’re raising a family with all the usual activities — school, soccer games, music lessons, family outings ... 4

Health Assessment

Tennessee Department of Health 2013 Review, 2014 Preview For the past several years, the state has been slowly but steadily moving the needle on the health status of Tennesseans ... 5

Healthcare Starts To Click At Baptist For doctors and patients in the Baptist Memorial Health Care network, care is getting a lot more clickable ... 13

ONLINE: M.MEMPHIS MEDICAL NEWS.COM

Collaboration Is Key for Hospitals, Insurance Firms Bottom line for both sides is quality, affordable healthcare

By GINGER PORTER

With eight months of pointed contractual negotiations between Saint Francis Hospital and Blue Cross/ Blue Shield of Tennessee finally completed in November, the question remains in this new healthcare world order, “What has to change for local hospitals and insurance companies to work and contract together?”

According to insurance payers, hospitals need to realize insurers are constrained by cost.

According to hospitals, the consensus is that they don’t want insurance companies to go to the lowest bidder.

“I think the payers are going to go to the lowest common denominator — the ones charging the least,” said Craig Becker, president of the Tennessee Hospital Association. “It’s not always fair, because frequently a hospital might have higher cost because it may have more intense services, and it may have more uncompensated care. It’s going to impact negatively those hospitals providing care for our most vulnerable populations.

(CONTINUED ON PAGE 12)

HealthcareLeader

Jason M. Little Executive VP, COO, Baptist Memorial Health Care

By JUDy OTTO

In May, Jason Little will step into the role of Baptist Memorial Health Care president and CEO, a job currently held by retiring Stephen Reynolds, who has left some pretty impressive footprints during his 20-year reign as chief of one of the largest not-for-profit healthcare systems in the United States. How Little will handle that responsibility is cause for speculation,

FLEET INCENTIVES FOR MEDICAL PROFESSIONALS

but clearly not concern.

As fifth president, Little has no question concerning the direction in which his philosophy will lead him through the potential changes that lie ahead: “I think the core values that guide us as a faith-based organization are still the same,” Little said.

“But certainly over the last couple of years healthcare has changed dramatically.

(CONTINUED ON PAGE 8)

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PhysicianSpotlight

Rolando Toyos, MD

Ophthalmologist had sights on sports and medicine

By RON COBB

Rolando Toyos, MD, is an exceptional person, not only in respect to his medical accomplishments but in his fortune to be able to say, “I have been extremely lucky that I have always enjoyed every work choice that I have ever made.”

Not many people would make that claim, but suffice it to say things have worked out well for him since he was born 47 years ago in New York City to immigrants – a Dominican mother and a Cuban father.

Toyos, an ophthalmologist, is the medical director and founder of Toyos Clinic, which has locations in Memphis, Southaven, Franklin and Nashville. He specializes in cataract surgery, LASIK and dry eye, with more than 25,000 cataract and 15,000 LASIK surgeries to his credit.

According to toyosclinic.com, the doctor was “the first surgeon to combine laser cataract surgery with Aqualase, creating a new laser for cataract surgery L4C procedure. He holds various patents, including one for a light-based technology used for treatment of dry eye. Toyos is the inventor of the Intense Pulse Light for dry eye procedure, also known as DELIT.” His interest in medicine was stirred at a young age.

“When I was little I wanted to be a doctor by day and then a shortstop with the Yankees by night,” he said.

His love for sports grew soon after his mother moved with him and his brother to Santa Rosa, California, when Rolando was 9. His father was a minor-league shortstop.

But Toyos’ love of education was equally strong. His mother and both grandparents were teachers.

In high school he was a starter in varsity basketball, baseball and football and won a scholar athlete award. He played basketball as a pre-med student at the University of California-Berkeley, but a knee injury occurred “about the same time I realized that I would not be able to do both to the level that would satisfy me. So I stopped playing basketball and concentrated on school.”

“I now had much more free time,” he said, “so I started doing research and coaching at the local high school. I found I loved teaching and coaching. I heard about a masters program at Stanford where I could coach, teach and do graduate-level research, and decided to see if that was my calling.

“I developed curriculum that would make science fun and informative for kids.

I also became involved with the National Teacher Assessment Project, a Carnegiefunded project, looking at the ways to improve the teaching profession. I represented the new teacher in the research project.”

For his development of a science curriculum and work with at-risk children,

Toyos won the National Teaching Award from Columbia University.

Despite his affinity for teaching and coaching, he knew he still wanted to be a doctor and went to medical school, where the University of Illinois selected him for “a special program for researchers who wanted to have bench research as part of their curriculum.”

Toyos was class president and graduated with James Scholar Honors. With the dean of students, Dr. William Wallace, “who shared my love of teaching and for inspiring inner-city kids,” they set up a program for med students to work with high school students who had an interest in healthcare.

“I loved my decision to go there,” he said, “because I was doing all the things I wanted to do.”

His research in medical school involved operating on mice utilizing a microscope.

“I had an aptitude for microsurgery, so my research mentor said I should look into ophthalmology,” he said. “I saw one surgery in ophthalmology and knew that is what I wanted as a profession.”

He did his internship in internal medicine at Illinois Masonic Hospital in Chicago and completed his ophthalmology residency at Northwestern University and Chicago Children’s Hospital. In 1998, he came to Jackson General Hospital and in

the same year opened Toyos Clinic.

“I came to Tennessee because a recruiter told me about a hospital that had built an NICU and needed an ophthalmologist to exam the babies,” he said.

“What attracted me most about the area is I felt needed. The hospital needed me and there was no one in the area doing modern cataract or LASIK surgery.”

From one doctor, the clinic has grown to a staff of seven. Doctors from more than 20 countries have come to the clinic to study and observe, and the clinic has rotations for students from the Southern College of Optometry and University of Illinois Medical School.

The Toyos Clinic has been named one of the 50 fastest-growing companies in Tennessee by the Tennessee Business Journal, and it was named by Inc. magazine as one of the 500 fastest-growing companies in the United States.

“I wanted to go somewhere and make a difference right away,” Toyos said.

“I love what I do, and I don’t think any changes in healthcare policy will change that passion. All of my role models – my mother, grandfather, Dr. Wallace – did something to give back to society, and that is what I continue to do by doing surgery, teaching and doing research.”

Toyos’ wife, Melissa Morrison Toyos, also is an ophthalmologist, and they have three young daughters.

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Ronald McDonald House: A Welcome Gift at a Crucial Time How Can YOU Help?

MEMPHIS on the MEND

Donate

BY PAMELA HARRIS

It always seems to happen this way.

One day, life is normal. You’re raising a family with all the usual activities — school, soccer games, music lessons, family outings. Then the next day your child gets sick. You assume it’s nothing serious, but then your pediatrician gives you the diagnosis: cancer. The next thing you know, you’re on your way to Memphis, Tennessee, to that place you’ve only heard about: St. Jude Children’s Research Hospital.

Under these circumstances, your primary concern is getting your child the care and treatment that you hope and pray will save his or her life. Wondering where you’re going to stay while that is happening may be a secondary thought, although once you find out that your child will need to be close to St. Jude for several weeks, it becomes essential.

The majority of St. Jude patients do not actually stay in a hospital room at the

St. Jude Patient Kenley Loves Ronald McDonald House!

hospital. Most patients simply come there for outpatient treatment. What a relief it must be to find out that St. Jude and Ronald McDonald House (RMH) have anticipated your needs. You and your family can stay at Ronald McDonald House – just a mile away from St. Jude – for the

HAPPY 2014!

HEALTHCARE IS CHANGING! We invite Practice Administrators to join us and stay on top of your game!

Executive Level Educational Luncheons Networking with Your Peers For more information about membership, meeting dates/times and topics/speakers

VISIT MIDSOUTHMGMA.ORG 4

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JANUARY 2014

duration of your child’s treatment. And, it’s free of charge.

During a tour of RMH you learn that others have thought of all the small and large things that will make your stay as enjoyable as possible. It’s a wonderful place that is set up to be a comfy home away from home. The 11.1-acre secured property holds a 66,000-squarefoot facility with 51 hotel-style rooms.

There are TV rooms, a game room, toy rooms, play areas, workout room, meditation room, two large kitchens and eating areas, pantries stocked with food, outdoor playgrounds and barbeque areas. Plus, a welcoming staff including a “house mother” named Sherry will be there to assist you with whatever you need.

During the past 22 years, RMH has hosted more than 500 families and 6400 children from 45 countries around the globe. This is made possible primarily with annual, local donations of more than $1.3 million. Much of this comes through fundraising events, the biggest being an annual radiothon every fall that raises about $300,000. In addition, local McDonalds franchise owners donate more than $430, 000 a year. Local corporations also provide key donations that keep RMH going.

“Local” is the key word for sustaining RMH because donations from Memphis citizens and businesses are literally what make it possible.

If you think about what it really means, this is Memphis’ gift to the world. We are home to St. Jude, which accepts patients from anywhere regardless of their ability to pay. The global impact on children with cancer cannot truly be measured. To top it off, Memphians, through donations and local volunteering host families of sick children from all over the world at our local RMH. We should all be proud of this accomplishment and do what we can to continue this vital support.

These are just some examples of how different dollar amounts can help a family in need: • $50 buys new pillows for one room or pantry supplies for one family during their stay.

• $108 pays for one family to stay one night at RMH. • $300 an annual gift or $25 a month is a sustaining gift that will earn you the title of “Home Hero.”

• $2,500 pays for one family’s average stay, somewhere between seven to 90 days.

• $5000 makes you a sponsor of a family bedroom for one year. A plaque with your name or dedication is placed outside the door.

Collect and donate pull tabs

This is a small thing you can do, but pop those soft drink tops and collect them.

Also tabs from pet food, soup and beer cans. These add an extra $30,000 in annual revenue for RMH.

Got extra tickets?

If you have extra tickets to a sporting event or concert, donate them to a RMH family to use during their stay.

Volunteer

There are so many ways to volunteer.

You can work the front desk, cook a meal, help with arts and crafts, or host a movie night. Imagine how fragile the immune systems of these patients are, so sanitizing toys at RMH is a key priority. This is a service provided by caring volunteers. Or have your medical practice bring in a special meal! This is a wonderful gift to families staying at RMH. To volunteer, you can fill out an application online at http:// rmhc-memphis.org/becomeavolunteer or call Dee Henderson at 901-312-7478.

What RMH Can Do For You

RMH has a beautiful “community room” that you can use free of charge. It seats about 24 people and has state of the art audio/visual equipment. They invite Memphis medical practices to use the room for off-site meetings and events. For more information call 901-529-4055.

If you know a worthy Memphis nonprofit or charity that I haven’t covered in this column, please send me a nomination, and I will consider spotlighting them in 2014. I look forward to hearing from you at pamela@memphismedicalnews.com.

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Health Assessment

Tennessee Department of Health 2013 Review, 2014 Preview

By CINDy SANDERS

For the past several years, the state has been slowly but steadily moving the needle on the health status of Tennesseans. While still far from where the leadership of the Tennessee Department of Health would like to be, there is a conviction that programming and partnerships truly are making a real difference in real lives all across the state.

David Reagan, MD, PhD, chief medical officer for the Tennessee Department of Health, recently spoke with Medical News to reflect on 2013 efforts and disDr. David cuss focal points for the Reagan coming year.

Compounded Medications

The fungal meningitis outbreak, identified in the fall of 2012, continued to play out in 2013 in a number of ways.

In assessing response to the discovery of the tainted batches of the preservativefree steroid injections, Reagan noted, “It took eight days from the first report of a case to the Tennessee Department of Health to the national recall of the three lots of contaminated medication — meth-

ylprednisolone acetate — nationwide.”

The quick reaction, he continued, “prevented, we estimate, 368 exposures … 368 patients in Tennessee who did not receive contaminated steroids. We believe it probably prevented 69 deaths.”

Unfortunately, 750 individuals nationwide, including 150 in Tennessee with 16 deaths, were impacted before the lots were pulled from the New England Compounding Center. To try to prevent a future tragedy, Reagan said a number of steps have been taken on a state and federal level “to make sure Tennesseans receive the safest possible compounded medication.”

On Nov. 27, 2013, President Obama signed into law the Drug Quality and Security Act, which more clearly defines the role of the U.S. Food & Drug Administration and state health officials in the oversight and regulation of compounding pharmacies. Reagan said the Tennessee Department of Health worked closely with Sen. Lamar Alexander (R-TN), one of the bill’s chief authors.

In Tennessee, a number of changes were approved by the State Board of Pharmacy to improve the oversight and safety of state-licensed compounding facilities. However, a ruling by the attorney general called one of the measures into

America’s Health Rankings Tennessee Holds Steady in 2013 The latest iteration of the annual ‘America’s Health Rankings’ from the United Health Foundation was released at the end of 2013. Tennessee ranked 42nd in the nation, which equates to no change in the overall ranking for the state when this year’s new methodology is applied to last year’s data set. The change makes it impossible to do a surface ‘apples to apples’ comparison between 2013 and 2012 without adjusting past data to the new methodology.

Contributing to Tennessee’s ranking were: obesity in adults (40th), infant mortality (47th), physical inactivity among adults (45th), low birth weight (41st) and high violent crime rate (50th ... making Tennessee the worst in the nation with 644 offenses per 100,000 population). To see the full rankings and Tennessee trend data, go online to www.americashealthrankings.org. Countyspecific data is also available courtesy of the Robert Wood Johnson Foundation at www.countyhealthrankings.org.

question. The cease-and-desist provision was deemed to be in conflict with Tennessee’s Administrative Procedures Act. More work will undoubtedly be done on both an administrative and legislative level in 2014 to reach a balance between access to needed medications and public safety.

Prescription Drug Abuse

Addressing the prescription drug abuse epidemic, a number of improve-

ments to the Controlled Substance Monitoring Database (CSMD) and new requirements for prescribers were implemented last year.

“Effective Jan. 1, 2013, all prescribers were required to register with the CSMD,” noted Reagan. He added that on April 1, prescribers were required to search the database prior to prescribing controlled substances to look for patient red flags. “What we’ve seen is a three-fold (CONTINUED ON PAGE 14)

Better cardiovascular and thoracic care for Memphis.

Baptist is proud to have Dr. Todd Robbins as director of surgical thoracic oncology and co-director of the thoracic multidisciplinary oncology service. Dr. Robbins has performed more than 1,200 minimally invasive thoracic surgical procedures and his minimally invasive robotic surgery volume ranks him in the top 5 in the Southeast and top ten nationally. He is helping lead Baptist’s multidisciplinary approach to cancer care that produces better outcomes and better quality of life for the patient.

6027 Walnut Grove, Suite 203, Memphis, TN 38120

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Whatever the term “du jour” is, it still comes down to Population Health Management or Community Health Management. It is what it is. It is a concept. In my column that appeared in the August, 2013 issue, of Memphis Medical News, “Hurdles on the Track of the Affordable Care Act,” I mentioned two challenges cited in a survey and study conducted by the MGMA that couldn’t have illustrated this concept any better.

The number one challenge on applicability scale is “assessing current operations to identify opportunities for improvement,” and the number one challenge on intensity scale is “preparing for reimbursement models that place a greater share of financial risk on the practice.”

“We have an unprecedented access to information and exponential growth in computing speed and data storage. Experts predict that each of these factors will continue to double every 18 months. Our ability to connect to the Internet is becoming ubiquitous, creating expectations that information should be instantly accessible from any point on earth. The Internet is transforming the way people learn, interact, and conduct daily business, and undoubtedly it will continue to play an increasingly critical role in all aspects of our lives.” (“Top-Performing Healthcare Organizations,” Greg Butler and Chip Caldwell) The top 10 jobs of 2010 were jobs that didn’t even exist in 2004. Many students are preparing to work for companies that do not exist today, to use technologies that have yet to be created, and to solve issues we have not yet identified as problems. (Fisch and McLeod, 2007) So What?

So if we wait until the next new intelligent phones and newest retina/ finger print activated iPads, and move further past the “clouds,” then our Healthcare DNA will continue: Paralysis

by Analysis.

Maybe there is something we can learn from the tech companies on how to affect and change consumer behavior. But healthcare is not as fun as Game Boy. Let’s get our heads out of the clouds, (no pun intended), and bring it back down to earth.

Of course, the objective is a healthy

community/population. When the physicians in the Pediatric Independent Practice Association (PIPA) were in the due diligence phase of our secured physician portal, here are some of the “take always” (which also fit into the adult community.) For the most part here is what we learned, regarding perceived health: • 80 percent of the population is healthy • 10 percent of the population are “worried well” • 5 percent of the population are undiagnosed • 5 percent of the population is ill and take up 50 percent of all medical costs (source: American College of Healthcare Executives Disease Management Outcomes: Top 3 percent users as percent of budget – 49 percent --43 percent = $5,000,000/year savings. (2013 Congress on Healthcare Leadership) Information Technology – Patient Centered Medical Home – Chronic Disease Management help the pieces together but not without the proper management team. And every team member must think: • All Hands On Deck • Coordinated Information Systems • Obsessive Focus on Continuum of Care • Drive Care to the Lowest Level • Reduce Admissions • Provide Wellness at Every Healthcare “TOUCH POINT” As I mentioned in my previous article, “Are We Listening?” I will ask the question again.

Are we listening?

Generational differences sometimes cause clashes among workers on teams, but each generation brings a unique perspective to handle related tasks. If we don’t talk about why we’re different and have different perspectives, we don’t reach the best decisions. The more people are willing to invest in honest communication about the issue, the better the outcome.

Bill Appling, FACMPE, ACHE is founder and president of J William Appling and Associates. He serves on the Medical Group Management board of directors. He is a national speaker, presenter and a published author.

He serves as an adjunct professor at the University of Memphis and Chair of Harrah’s Hope Lodge board, and serves on the board of Life Blood. For more information contact Bill at appj54@aol.com.

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Obesity: The New Chronic Disease?

Updated guidelines encourage PCPs to focus on obesity

By LYNNE JETER

The new obesity guidelines – updated for the first time in 15 years – are geared to primary care providers (PCPs) and offer an algorithm for managing obesity.

The protocol for the management of overweight and obese adults is among four updated guidelines commissioned by the National Heart Lung and Blood Institute, and developed by the American Heart Association and the American College of Cardiology to identify at-risk patients and prescribe appropriate interventions.

The timing coincides with the American Medical Association’s recent classification of obesity as a “disease.”

To guide weight management decision-making, an algorithm focuses on the identification of patients with excess body weight and those at risk for obesity-related health problems.

Most information is straightforward: Patients with a BMI of 30 or higher are considered obese and need treatment.

Patients with a BMI 25 to 30 are considered overweight and should be treated if they have additional risk factors, such as an elevated waist circumference of 35 inches or more for women, or 40 inches or more for men.

However, even though research soundly shows the higher the BMI, the greater the risk for cardiovascular disease, diabetes, and cancer, the question about the use of BMI as a screening tool has drawn debate.

Healthcare providers agree that every 5 to 10 percent of total body weight lost is a milestone that reaps health benefits. But with so many diet programs available – the guideline committee reviewed 17 different plans and concurred that as long as there’s a negative energy flow, and the intake of calories is reduced daily to 1,000 or less, it should work – determining the right one, and the amount of weight that’s safe to lose over the course of weeks and months, has also been the center of controversy.

The diet, guidelines say, should be a component of a comprehensive lifestyle intervention including physical activity and behavioral changes, delivered by a trained counselor. The guidelines suggest that patients meet with the interventionist 14 times in the first 6-month period.

Donna Ryan, MD, co-chair of the guideline committee and a professor emeritus at Pennington Biomedical Research Center in Louisiana, admitted the current approach is for PCPs to simply tell patients to lose weight but “they don’t really engage in helping patients achieve weight loss, either through referral or providing counseling or prescribing. They’ve memphismedicalnews

.com

been reluctant … but that’s changing.”

What’s not addressed: the reason why some patients make adjustments to lead a healthier lifestyle, but still cannot successfully reach a more optimal weight for their body frame.

“It’s not as simple as telling a patient, ‘you need to lose weight,’” said Gus Vickery, MD, a North Carolina family medicine physician. “Sometimes, it takes some investigating to determine the source. It might be thyroid issues, or a combination of medical problems. Unfortunately, we (PCPs) stay so busy … it’s helpful when patients come prepared. It’s OK for a patient to say, ‘I can’t lose weight and I don’t know why. It doesn’t always seem to be a matter of willpower.’”

After Vickery talked to a colleague about the colleague’s doctor-supervised weight loss clinic focusing on a wellrounded, low-calorie, low-carbohydrate food plan, he ditched his own in-house program and began referring patients there. One couple, patients of Vickery, lost a combined 140 pounds in less than a year. Other patients returned to Vickery tens of pounds thinner – and much healthier.

“My colleague,” said Vickery, “does the heavy lifting; I monitor the results.”

The impetus for the proactive movement of PCPs may be practice for the future, when they may be accountable for patients who haven’t made sincere efforts to lose weight to get healthier. Patients could eventually be penalized by insurers for not taking documented action to achieve a healthier weight.

“I could see (insurers) really increasing people’s premiums if they don’t follow certain preventive measures in the future,” said urologist Stan Sujka, MD, a partner of Orlando Urology Associates in Central Florida. “Unfortunately, Dr. Stan Sujka we’re becoming a society of regulations. A lot of people don’t seem to want take personal responsibility for their well-being.”

Recently, to set an example for patients and to improve his health, Sujka dropped 36 pounds in nine months with the assistance of a diet app on his smart phone, a practice he encourages patients to follow as a first course of action for losing excess weight.

“Your smart phone can serve as your personal coach to shed those unwanted pounds,” he said. “It’s easy, free, and studies show it works.”

The two most popular free apps are “Lose It” and “My Fitness Pal,” which al-

Delta Medical Center proudly welcomes the following Physicians

Dr. Gary D. Strasberg

Board Certified Internal Medicine Accepting new patients, including those with Medicare.

Dr. Paul Hill

Board Certified Psychiatrist Accepting new patients, including those with Medicare

Dr. Henry Barber

Board Certified Surgeon

The Physicians are all located at 3960 Knight Arnold in the Delta Medical Office Building

To schedule an appointment call 901-369-6030 www.DeltaMedicalCenter.com

(CONTINUED ON PAGE 9)

JANUARY 2014

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Healthcare Leader: Jason M. Little, continued from page 1 The advent of healthcare reform and reimbursement challenges, and the fact that we have not yet expanded Medicaid in the state — all of these add pressure to the hospitals. There is a call to be able to continue to work for ways to add value to the system and to maintain the highest-quality care, but also to do it at the lowest possible cost; and Baptist is not only a highquality provider but a very cost-effective one. We’re proud of that.”

In a prophetic statement to Memphis Medical News during a 2011 interview, Little said, “What has made us successful in the past is not necessarily what is going to make us successful in the future, so we are growing and developing a hospital organization with physician partners that lends itself to a multidisciplinary approach to care.”

Today, preparing to take the helm of the 14-hospital system, with 4,500 physicians in a three-state area, he points to the tremendous growth fostered by that strategy: “The number of physicians who are employed as part of the Baptist Medical Group is growing,” he said. “Over just the last 2½- or 3-year period we’ve grown from about 40 physicians at BMG to over 550, and we anticipate continued growth in this area.”

Little, who joined the Baptist team in 2002, expresses enthusiasm and pride regarding the progress of Baptist’s previously identified initiatives: (1) the continuing development of the new cancer

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center (2) the completion of the design phase and beginning of construction of the new Oxford hospital; and (3) last month’s ribbon-cutting at the new 181bed NEA Baptist Hospital in Jonesboro, replacing an overburdened existing hospital with a state-of-the-art facility he refers to as an “incubator for the future of healthcare.”

“I’m a big proponent of the team approach to caring for patients,” Little said, “and in Jonesboro we designed a facility from the ground up with integration in mind; every physician who practices in that hospital is on the team and employed

by Baptist. We have 36 medical specialties there, and the building was designed around that team concept.

“Just in the last year, we’ve recruited over 20 new physicians who have joined that medical group, so everything from rheumatology to oncology to neurosurgery to heart surgery is represented there.”

Added to Baptist’s other projects, the $400 million medical campus — the largest construction project in the state of Arkansas — brings its current construction investment to nearly $1 billion system wide, Little said. “It’s very unusual in this day and age to see an organization building this much. It’s simply a testament to our focus on patient care and delivering the best in technology to the patients we serve.”

Little’s philosophy stresses the importance of being innovative, and he promises

to deliver more innovations in 2014. “I think healthcare is changing so dramatically that innovation is part of staying on the forefront of healthcare,” he said. “We have a new ad campaign that I really like.

Our tag line is ‘Get better!’ For me that means three things that are very important to the future of Baptist: The first is that patients can come in and expect to get better — to get healed. It also connotes that patients have choices, and we want them to be able to get better choices in choosing Baptist.

“And lastly, ‘get better’ is a reminder to all of us on the Baptist team of our call to get better on a daily basis and to improve; we have lots of plans of how we are going to do that — and yes, you will see some of those in 2014.”

Among those plans are the new rehab hospital being built on the corner of Wolf River and Germantown Parkway with another partner who will work in the rehab space, and a new, comprehensive electronic medical record called Baptist OneCare — designed exclusively for Baptist

by Epic, the leading EMR system in the country, and scheduled to go live in its first stage this month.

“The ability to have all the physicians and all the records in all the hospitals — everything connected in one record — is a differentiation that’s not available currently in the marketplace, and something I think patients are going to quickly see the benefit of,” Little said.

He anticipates an estimated $500 million reduction in government funds for Baptist over a 10-year period in terms of the cuts to Medicare, sequestration and more. “Responding to that is a challenge,” he said. But it has fueled further innovations, including Select Health Alliance, Baptist’s clinically integrated organization, which will also debut this year.

“When you get everybody kind of rowing in the same direction — nurses, physicians, administrators, all members of the team thinking ‘reduced waste’ — and you bring more quality into the system, that’s really how we’re going to respond to reimbursement challenges,” he said.

Little enjoys golf, roots enthusiastically for the Vols, serves as a deacon and Sunday school teacher, and spends a lot of time with his three young children and wife, Allison, a vital supporter.

“It’s an awesome responsibility to be tapped to lead this fantastic team,” Little said. “But I’ve had the really good fortune of being able to learn from a legend and one of the true greats in healthcare, Steve Reynolds, and what a blessing that has been.”

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Obesity, continued from page 7 lows patients to meet pre-set calorie and exercise goals.

Sujka’s partner, Albert Ong, MD, gave him a kickstart on the new lifestyle modification by downloading the “Lose It” app on Sujka’s smart phone and programming it to lose one pound per week.

Sujka is now very close to his college weight goal of 200 pounds.

“Since losing weight, a lot of my patients have asked, ‘how did you do it?’

After explaining to them about using their (smart) phones to lose weight, many of them have come back to the office and told me their doctors for years have been telling them to lose weight but have never told them how,” explained Sujka. “They’ve told me they’ve found the app simple and effective. As a result, I wrote up the principle of using your smart phone to lose weight. A lot of patients appear more excited about losing weight than the effects of Viagra or Cialis!”

Overall, the guidelines don’t focus on specific obesity medications. Only orlistat (Alli or Xenical) was available during the committee review process. Since then, the FDA has approved new diet drugs – lorcaserin (Belviq) and phentermine/topiramate (Qnexa) – that are recommended for use as “an intensification approach.”

Bariatric surgery for weight loss was the fifth and final recommendation “when other interventions fail.”

Hey Doc, We Live in the Future

By TIM NICHOLSON

We live in the future. And you know it’s true. This past weekend I was watching some reruns of shows from my childhood. I saw the Jetsons. I saw Star Trek.

And that’s when it occurred to me, we live in the future.

I watched as Mr. Spacely called George Jetson on his television. Well that’s what we thought it was at the time. Little did we know that there would be Skype, Google Hangouts and FaceTime that would allow us to talk to someone face-toface miles away or just around the corner.

We can now see and converse with others without leaving our homes. Without leaving our offices. At the convenience of the caller and at the convenience of the one called.

I saw Star Trek and I’m sure it’s occurred to you before now, that the “communicator” in the hand of Mr. Spock or Captain Kirk was actually a lot like a smartphone. Spock’s ability to turn that handheld device into something that would read the environment or Dr. McCoy’s ability to use it, or something like it, to scan a body was beyond belief. Now we have apps that power our iPhones and Android devices to do similarly futuristic things.

Look, it’s easy to get bogged down in the rules and regulations of an industry.

They’re there to protect us all. Comply.

But what if we allow our imaginations to lead for a minute as it relates to the part of doctoring that really matters to us most, patient engagement.

We’d find ways to connect with those who can’t get from their homes and to our offices.

What if we find ways to empower patients to tend to themselves, to know more about the environment that they’re in and how it affects their health?

We’d have smarter patients and better health outcomes.

Okay enough of the hyperbole it’s time to get real. We live in the future. But we practice too much in the past.

So here’s what a savvy doctor’s going to do this year: tap into that Jetsons television thing and enable patients or colleagues to communicate via Skype or Apple’s FaceTime to explore what needs to be explored.

My twitter-friend, Dr. Howard Luks (@HJLuks on Twitter), says that he finds this approach to telemedicine useful in consulting with his patients and would invite conversation, by FaceTime no doubt, with doctors who might be trying to find their way toward the future.

Speaking of exploration, savvy doctors will learn how to use mobile devices and apps that run on them to help pa-

tients communicate with their doctor and to help the patient and doctor know more about the environment that they are in and how such circumstances affect their well-being.

Last March I met Dr. Daniel Kraft, MD, (@daniel_kraft on Twitter) at SXSWi (South by Southwest Innovation conference). He was there to speak on healthcare innovation powered by smartphones. It was cool. And it would have seemed like “future talk” were it not for the number of people in the room already using one or more of the diet, exercise, sleep monitoring, cardio, diabetes and anxiety management apps he spoke of there.

Look, George Jetson would get out on the now ever so commonplace treadmill to exercise his dog. Maybe this is the year to exercise your medical practice.

Maybe this is the time to rethink patient engagement so that we can get off this crazy thing called the status quo and into the future. Some of us are already there.

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 tim@gobigfishgo.com

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Changes to Tax Code Impact the Bottom Line at Work and Home

By CINDY SANDERS

As the clock ran down on 2013, a number of deductions healthcare providers have come to depended upon to lessen their tax burden expired. Last year also saw an increase in federal tax rates, including higher taxes on investment income and capital gains. This combination has accountants nationwide bracing for a widespread outbreak of severe sticker shock come April 15.

Tom McGuinness, CPA, CVA, of Reimer, McGuinness & Associates, PC in Houston said his firm has run tax scenarios for high net worth individuals for more than a year.

“We’re doing this as a service to prepare you for the blow … but the blow is coming,” he stated. For Tom one client whose income McGuinness hit the $2 million mark, there was a six-figure difference in taxes owed. “Looking at 2012 actual income data, the tax differential was 22 percent,” McGuinness said of the $860,000 that would be owed for 2013 as compared to $706,000 for 2012. “It is real money.”

He added that many of the changes in 2013 and 2014 will hit healthcare professionals and providers both as businesses and as individuals. McGuinness said at the beginning of 2013, Congress was upset about the fiscal cliff and proud of themselves for ‘fixing’ it. However, he continued, as 2013 tax bills come due, “It’s going to be the taxpayers turn to be mad because they are going to see how the fiscal cliff was avoided.”

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Beneficial depreciation options take

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a big hit in 2014. Changes to expensing qualified purchases, bonus depreciation, qualified leasehold improvements and a new IRS capitalization policy are all anticipated to impact many in the healthcare space.

“Congress did not extend the favorable 179 deduction, which allows a taxpayer to expense immediately the cost of an otherwise capitalizable asset,” said Scott Tomichek, JD, CPA, senior tax manager for Carter Lankford CPAs PC, located in Tennessee.

Scott “The 2013 Section 179 Tomichek deduction was $500,000 for purchases up to $2 million and is set to be reduced to $25,000 for purchases up to $200,000 in 2014.”

Accelerated depreciation, which has been heavily used by healthcare providers and facilities to make equipment purchases more affordable on the front end was another incentive that expired at the end of 2013. Tomichek noted that on the purchase of capitalizable assets in 2013, a taxpayer was allowed to deduct 50 percent of that asset in the year of purchase and then depreciate the remainder. The accelerated 50 percent goes away in 2014 and reverts to the regular rules of a more even-based depreciation schedule without Congressional intervention.

Another change is in the life of qualified leasehold improvements, which are defined as any improvement to an interior part of a building that is nonresidential property. “Qualified leasehold improvements were able to be depreciated using a 15-year life and included in the previous Section 179 and bonus depreciation calculation in 2013,” Tomichek explained.

In 2014, those improvements return to a 39-year depreciable life, which means the expenditures are depreciated at a much smaller annual amount over nearly four decades and no longer qualify for the other depreciation benefits.

Tomichek said the new IRS capitalization policy that went into effect on Jan. 1 is a bit of ying to the yang of losing the other deductions. “The most important part of the rule is the de minimis safe harbors that apply to not only improvements but to certain tangible property purchased,” he said. “The de minimis safe harbor allows a taxpayer to deduct purchases under a certain threshold. For taxpayers with audited financial statements, the threshold is $5,000 per invoice or per item as substantiated by invoice. For those without audited financial statements, the threshold is $500.” He noted that previously, these qualified items had to be depreciated but now can be expensed, which is a tax benefit. However, he added, “To qualify, the taxpayer must have a written accounting policy in place at the beginning of the tax year.”

Doug Funke, CPA, a partner with Honkamp Kroeger & Co. PC, a Midwest regional CPA firm headquartered in Iowa, noted a number of other general 2014 tax changes could impact medical practices and hospitals.

Doug Funke One example is the transit benefit allowance.

“The amount of transit fringe benefits that employers can provide to employees on a pre-tax basis for using public transportation and van pooling will drop from $245 per month in 2013 to $130 per month for 2014.”

He said dozens of other extenders, or tax incentives, including the work opportunity tax credit for hiring targeted individuals and the research tax credit, as well as various energy credits, expired at the end of 2013. A list of expired provisions is available through the Joint Commission on Taxation at www.jct.gov.

For exempt organizations, which includes many hospitals, Funke said the IRS is focusing on compliance, using information reported on Form 990. “Indicators of potential noncompliance that they have identified include the following relationships: • Large fundraising revenues and small fundraising expenses, • Large fundraising revenues and small charitable program services expense, • Large unrelated business income but no income taxes due on the unrelated business income, • Large total compensation to officers, directors, trustees and key employees and small annual gross receipts.”

Funke added, “An accurate Form 990 generally decreases the likelihood of being selected for examination.”

Also pertaining to some employers, Funke said, “The June 2013 U.S. (CONTINUED ON PAGE 15)

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“Regions is always there when I have questions. My relationship with my Regions banker is personal and I have her on my speed dial.”

What started as a single location has grown to three with a full-time staff of 17 employees. These days, the Miami Dermatology Center utilizes a wide range of Regions banking tools, from Business Analyzed Checking and Treasury Management to loans and lines of credit.

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Collaboration Is Key for Hospitals, Insurance Firms, continued from page 1 That’s my biggest fear.” munity,” she said.

Roy Vaughn, vice Serving the commupresident of corporate nity in this rapid-fire communications, change environment has produced a new Blue Cross/Blue Shield of Tennesphilosophy of consee, said that is not tractual negotiaalways the case. tion for a few of the larger local hospital Citing Centers for — Roy Vaughn, Medicare and Medsystems.

Blue Cross/Blue Shield of Tennessee icaid Services (CMS) “In partnership data, he said Saint Franwith our physicians, we cis is one of the most expensive work in collaboration with our hospitals in the state, and they were able health insurance partners to meet the to reach an agreement even after greatly challenges of the changing environment,” strained relations. said Donna Abney, executive vice presi“Consumers want and need us to dent, Methodist Le Bonheur Healthcare. work together,” Vaughn said. “We pre“We think the only way to meet individual fer a collaborative approach that achieves and purchaser needs and expectations is quality, affordable care for our members through a culture of collaboration, innoand fair compensation for the providers in vation and trust. We work very hard to our networks. We have always considered achieve that.”

Saint Francis facilities valued partners That philosophy was echoed by in the Memphis area. We are pleased to Vaughn, who cited a “preferred partnerhave reached an agreement that allows ship” with Methodist Le Bonheur. The us to keep our members’ coverage affordmodel they espouse is more integrated, able.” less fee-for-service, which is where experts Explaining that it will work diligently say the market is headed. to resolve any contractual negotiations, “We are moving toward a populaSaint Francis’ senior vice president and tion-based model where insurance comspokeswoman, Marilynn Robinson, said panies will say ‘we are going to make you the hospital is “focused on the outcome.” responsible for following these 20,000 cov“We will work so our patients can ered lives. We are going to pay you one have the care they deserve. The bottom flat fee for their healthcare,’” Becker said. line is we want to be able to serve the com“Therefore, hospitals are going to spend

“

Consumers want and need us to work together…

”

a lot more time trying to keep people appropriately out of the hospital and keep them healthy. That’s the idea behind it.

Whether it will work or not, we will see.”

The Regional Medical Center at Memphis agreed, explaining the market demands proactivity rather than reactivity.

“I think the insurance industry needs to be more forward looking and help providers transition into an environment of wellness and preventable care,” said Rick Wages, chief financial officer. “Rather than waiting until people get sick and come to the ERs, we do things as they are identified rather than waiting until they are catastrophic and expensive. Maybe those insurance companies are willing to pay for a different kind of service on the front end. Maybe we jump that chasm of the way healthcare is perceived and delivered.”

All sources interviewed kept using a key word: collaboration. The collaborative approach paves the way for more giveand-take from both sides, more physician input, more effective patient-care planning, more efficiency. Baptist has coined a name for its version of this partnership: Select Health Alliance.

Officials explained it is a clinically integrated network developed in response to the impending population-based healthcare model. “We have partnered with physicians and brought the first payer con-

tract to the table (Aetna) and have had a different conversation between physicianhospital-payer,” said David Elliott, vice president of managed care. “We focus on initiatives like in high-tech radiology, we do the right test the first time and reduce duplicate testing. We are doing that with all three parties at the table instead of trying to impose something on each other.

Less inefficiency.”

Meanwhile, market forces, insurance exchanges, the Affordable Care Act, cost shifting and so many unknowns loom for both sides as they strive to be more efficient to stay afloat. In particular, entities like The MED are keeping close to governmental authorities for their perspective to be heard.

“We are more a safety net, highlevel tertiary care hospital in terms of the trauma and the high risk and sick baby nursery we run,” Wages said, “and then we are also a safety net for more of the indigent population for the Shelby County area. We are keeping our conversations going with the governor’s office and the commissioner’s office in TennCare, talking with our state and local legislators so they can understand what we are faced with.

“We just need to work together to create win-win opportunities. We all need to be in business to provide quality care to our patients and we must be innovative and creative in how we do that.”

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Healthcare Starts To Click At Baptist Mobile apps allow doctors, patients easier access to records

By AMY FRENCH

For doctors and patients in the Baptist Memorial Health Care network, care is getting a lot more clickable.

On the first day of 2014, Baptist went live with Baptist OneCare, an electronic record-keeping system that will put patient information at physicians’ fingertips, no matter where they are, through mobile apps called Haiku and Canto. Different groups will be phased into the system during the year.

A third app, called MyChart, will similarly give patients easy access to their own records, as well as speedier means of communicating with the professionals helping them look after their health.

Baptist OneCare, sold by a vendor named Epic and customized in partnership with professionals across the Baptist network, is Baptist’s answer to electronic record-keeping and record-sharing requirements imposed by the Affordable Care Act. Previously, the doctors, hospitals and clinics in the network have used an array of record-keeping methods that didn’t always make sharing easy.

“Being able to share information does great things,” said Chris Hopper, one of the technical gurus directing Baptist’s development of and transition to Baptist OneCare.

“First of all, it makes things a lot safer for the patient. Because when the physicians and other caregivers have all of the patient’s information at their fingertips, they can make better decisions about how to address the patient’s issues.”

Say, for example, a physician gets a call from a patient on a Saturday morning while attending a child’s soccer game. The patient is experiencing painful indigestion but isn’t sure what medicine is safe to take, given possible interactions with other medications.

In the past, responding to such situations could be tricky and time-consuming.

To check the patient’s allergies, current prescriptions and other factors, the doctor might have to go to his or her office to view paper or electronic records. In some cases, the doctor might not be able to do much of anything without scheduling an office visit for the patient.

But a doctor with the Haiku or Canto app installed on a smartphone or tablet will not only be able to review the patient’s files, he or she will be able to arrange prescriptions remotely and schedule any needed follow-up care.

Being able to share information easily also has great potential for reducing healthcare costs without compromising quality, Hopper said. A patient who can arrange a

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prescription or get a question answered remotely might not need an office visit. And a physician who can get information quickly and reliably from a patient’s other caregivers might be able to avoid repeating diagnostic tests unnecessarily, or requiring a patient to fill out forms with the same information again and again.

“All of those types of things – the waste of time, the waste of resources, the waste of duplicate testing – all of that goes away because we’re able to share that information,” Hopper said.

William Light, MD, who has practiced internal medicine in East Memphis and Germantown for 26 years, is excited about Haiku and Canto – the mobile apps that physicians will use to check records. But he is perhaps even more excited about MyChart, the mobile app designed for patients.

“I’ve always felt that the patient record is not my record – it doesn’t belong to just me,” Light said. “It’s the patient’s record, their story, their healthcare, and this really empowers them to access it that way.”

MyChart includes features that enable patients to: • Schedule appointments for themselves or a dependent.

• Refill prescriptions.

• Keep a record of immunizations, allergies and test results.

• Get reminders when it’s time for a checkup, mammogram or other wellness visit.

• Get summaries of information from each office visit.

• Create an editable “wallet card” to make providers aware of key information in a MyChart profile.

Of course, not all patients will be immediately comfortable with the idea of communicating with their caregivers through an app.

“We recognize that while we want everyone to use MyChart, not everyone will, and that’s OK,” Hopper said. “We will still do things with those patients on paper or by phone or however they need.”

Find more information about Baptist OneCare and the mobile apps Haiku, Canto and MyChart at www.baptistonline. org/onecare/.

Meet Our New Minimally Invasive Thoracic Surgeon.

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Health Assessment, continued from page 5 increase in searches since before the law was implemented, and there has been a 50 percent decrease in doctor shoppers from August 2012 to July 2013,” he said.

In addition, Reagan said a number of steps have been taken to improve the technology for clinical users. “We’ve implemented two significant groups of improvements and a third group is being tested now to make an excellent experience for clinicians using the database,” he said. “The average search only takes a few seconds.”

an expert panel looking at the best methods to help patients while curbing medication addiction.

“We’re working really hard on establishing chronic pain management guidelines in Tennessee,” Reagan noted. He said the guidelines are a compilation of innovative ideas and best practices from Tennessee and other states’ programming, as well as national pain society recommendations.

Reagan added the practice guidelines should be ready this month. “These guidelines will be a significant help to practicing clinicians who are caring for patients requesting pain medicines in increasing numbers.”

Newborn Health

Making it simple to identify patients at high risk for addiction and abuse is critical, he continued. Reagan said the latest data showed 1,093 overdose deaths in 2012. “That’s more than the number of deaths from motor vehicle accidents and more than the number of homicides,” he said. “When you look at the breakdown, the great majority of those deaths are accidental overdoses that involved opioid analgesics.”

Also of note in 2013, Tennessee forged collaborative database agreements with Virginia, South Carolina and Michigan. In 2014, the state will actively working on similar agreements with other states, particularly those contiguous to Tennessee.

Pain Management Guidelines

In a related matter, the Department of Health reached out to pain management specialists in Tennessee to convene

Neonatal Abstinence Syndrome (NAS): In 2013, an emphasis was placed on identifying and curbing the number of babies suffering from NAS, which occurs when the mother is taking opioids while pregnant.

“It’s very traumatic for the child,” Reagan stated, adding, “It’s something that should be rare because it is nearly completely preventable.”

With the mindset that you must know the scope of the problem to effectively combat it, Reagan said, “We made neonatal abstinence syndrome a reportable condition in Tennessee in 2013, and I think we were the first state in the country to do so.”

By early December, there were more than 800 documented cases of NAS in Tennessee. Recognizing there could be reporting bias with the change in requirements, he said the 2013 figure appeared to be a 25 percent increase over numbers gathered in 2011 through hospital discharge diagnoses data. Additional education, combined with the new pain management guidelines for caring for pregnant patients, will be a focus in 2014.

Screenings: “We screened about 85,000 newborns in 2013 with a panel of 54 different screenings for genetically-based illnesses,” Reagan said.

A law passed in 2012 and implemented in 2013, added bedside pulse oximetry to the panel to screen primarily for a treatable cardiac birth defect prior to an infant becoming symptomatic. “We’ve already had babies who have benefited from this, receiving critical medical care in a timely way,” he said.

Reagan noted he anticipated adding another new screen to the panel in 2014.

Eliminating Elective Early Deliveries: One of the Department of Health’s most effective partnerships has been focused on eliminating elective deliveries before 39 weeks. The collaboration between the state, March of Dimes, Tennessee Hospital Association and TIPQC (Tennessee Initiative for Perinatal Quality Care) led to the support of every birthing hospital in Tennessee and included the educational initiative, ‘A Healthy Baby is Worth the Wait.’

“The last month for which I have data is September 2013. There were only five early elective deliveries in the entire state,” Reagan said with clear excitement. “And that compares to 96 in May of 2012.”

He said it was a joint effort with all of the hospitals and their staff members pulling together to create a culture change to “make sure babies born in Tennessee have the best opportunity not only to survive their first year of life but to enjoy the best health possible throughout their lives.”

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tinued to grow since then. Planned in 2014 are continued distribution of door hangers to remind babysitters of the rules, bus signs and billboards, and distribution of a new book on the subject. The latter, Reagan said, is in partnership with the Tennessee Hospital Association. The short, easy-to-read book was written by a Tennessee physician who lost a child to a sleep-related death.

In 2011, the campaign resulted in at least 22 fewer sleep-related deaths in the state. Although not a huge number, Reagan was quick to point out it’s an entire kindergarten class.

Breastfeeding: “Breastfeeding is quite simply, for at least the first six months, the best nutrition you can provide for your baby,” Reagan said. He noted it improves the immune function and is associated with better child health outcomes and decreased rates of obesity even into adulthood. “The benefits are so compelling,” he stated.

In 2013, a breastfeeding hotline was piloted, and Reagan said the plan is to roll the toll-free number out statewide in 2014. Michael Warren, MD, who spearheads breastfeeding efforts for the Department of Health, also is working to make sure employers and companies serving the public understand how beneficial breastfeeding is. Leading by example, the new Department of Health offices include a mother’s room where employees and visitors can breastfeed in comfort.

Infant Mortality: In combination, these programs along with other efforts — including a new partnership with First Lady Crissy Haslam that kicked off in the fall of 2013 to support new moms — have helped the state see a steady decrease in infant mortality rates over the past eight years.

Reagan said, “Our infant mortality rate decreased to 7.2 per thousand live births, which is the lowest it’s ever been but is still above the national average … so there is still more work to be done.”

Primary Prevention

Last … but certainly not least … are efforts aimed at stopping problems before they start.

“Primary prevention is the happiest kind of medicine,” said Reagan, adding it is also generally considered to be the most cost effective way to spend health dollars.

He noted the Department of Health has increased its emphasis on collaborating with community partners to address needs. In addition to running its own programming, health officials across the state also worked on more than 250 community projects in 2013 addressing obesity, tobacco cessation, infant mortality, immunizations and substance abuse.

Reagan added his office has been working with Governor Haslam’s Foundation for a Healthier Tennessee and expects to see more programming roll out around the topic of obesity in 2014. He also noted the food code was updated in 2013. “That’s really going to be helpful in the 25,000 food establishments we inspect across the state to protect the safety of the public better,” he concluded. memphismedicalnews

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Changes to Tax Code, continued from page 10 Supreme Court decision related to the Defense of Marriage Act recognizing same-sex marriages affects employers in states where same sex marriage is recognized. Employer-provided healthcare coverage for same-sex spouses get the same tax-favored treatment.” He added the IRS announced two special administrative procedures for employers to make claims of refunds or adjustments to employment taxes for certain benefits paid to same-sex spouses during 2013.

This Time It’s Personal

Much has been written about the higher tax brackets and rates, but McGuinness said a lot of people will still be surprised at the cumulative effect.

“The top tax rate went from 35 to 39.6 percent and that happens starting at $450,000 married filing jointly or $400,000 for single filers,” he explained.

However, McGuinness continued, that’s just one of six tax changes that will impact high income taxpayers. A 5 percent increase (from 15 percent to 20 percent) in capital gains and dividends tax has also been instituted for those at the same income levels as the highest tax bracket. For individuals starting at $200,000 and married filing jointly at $250,000, the Affordable Care Act added a 0.9 percent additional FICA tax on wages and a 3.8 percent Medicare tax on investment income.

“The rules regarding the 3.8 percent investment income are more complicated than you might think,” he explained in a recent blog for physicians. “You do not include income from S Corporations or a trade or business in which you are actively involved … but do include interest, dividends, annuities, royalties, rents and net gain from the disposition of non-business property.”

When looking at the combination of the increased investment income and capital gains taxes, McGuinness said, “What was being taxed at 15 percent is very possibly going to be taxed at 23.8 percent.”

Additionally in 2014, the sales tax deduction goes away … and for single wage earners beginning at $250,000 and married filing jointly at $300,000, itemized deductions and personal exemptions are being phased out.

“If you’re taking a deduction away from me, that’s a tax increase,” McGuin-

ness said of the bottom line for taxpayers.

He added the itemized deduction phaseout could be quite costly, particularly to those who give large amounts to charity and have significant home mortgage interest they were used to deducting. “The personal exemption is equal to $3,900 (in 2013) per exemption you claim, and all exemptions are lowered by 2 percent for each $2,500 of income above the numbers ($250,000 single, $300,000 married filing jointly),” he explained. “The larger your family, the larger the tax increase.”

McGuinness noted there is a growing feeling of frustration. At the same time many of his physician clients are paying significantly more in taxes, reimbursements are shrinking. The net result is people are having to work much harder simply to make the same money.

McGuinness said individuals should have already asked their tax advisors to provide estimates of what their 2013 tax burden will look like. If that hasn’t happened, he suggests doing it now to prepare for April 15, 2014. Quoting one of his colleagues, he said, “It’s not going to be pretty in a lot of cases … but better than finding out on April 10 that you need to either drain your savings or take out a loan to pay your tax bill.”

End Notes & Disclaimer

The experts who contributed information to this article are members of the National CPA Health Care Advisors Association. Headquartered in Nashville, HCAA is a nationwide network of CPA firms devoted to serving the healthcare industry and educating its members about the ever-changing financial and regulatory landscape impacting the industry.

The financial professionals stressed the importance of consulting a tax specialist to ensure advice is specifically tailored to your unique business or personal situation to minimize the tax burden while fully complying with state and federal mandates.

Additionally, the information in this article was provided prior to the end of 2013. It is possible that some of the expiring tax incentives could be extended through legislative action. However, the consensus opinion was that Congress is unlikely to reinstate all … or even very many … of the sunsetting extenders.

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JANUARY 2014

Methodist Launches Physician Academy

By RON COBB

The Physician Leadership Academy, a new program to strengthen doctors’ leadership skills, is under way at Methodist Le Bonheur Healthcare.

Classes started in September and are held for four hours once a month, except December. Topics include “Building a High Performance Culture,” “Facilitating Change as a Physician Leader” and “Effective Physician Leadership.”

Michael Ugwueke, COO of Methodist Le Bonheur Healthcare, says his goal in opening the academy was to create the next generation of physicians who excel both as leaders and healers. When hospitals team up with physicians, he says, great things in healthcare can be accomplished.

Ugwueke worked with the UT Center for Executive Education in Knoxville and the American College of Physician Executives in Tampa to develop the program.

“We work closely with our physician partners, and the Physician Leadership Academy will allow us to strengthen that partnership,” he said.

“As we expand our collaboration with our doctors, it will enhance our ability to provide the family and patient-centered care that we are committed to affording each and every patient and family.”

The first class, consisting of 24 physicians, is scheduled to graduate in August.

A new class will start in September. The program, conducted by Ugwueke, is by invitation only and is limited to doctors from Memphis and surrounding communities who are affiliated with Methodist.

The doctors are recommended to Ugwueke by Methodist’s CEOs or another Methodist physician leader.

In addition to the content that Ugwueke has developed, speakers come in to talk about topics such as “understanding your behavior and leadership style,” “building a high-performance culture” and “facilitating change as a physician leader.”

“I have been serving as president of the medical staff for the past year, and thus I am very aware of the challenges that come with a leadership role,” said Heather Swanson, MD, a hospitalist with Methodist University Hospital. “I am so thankful to Methodist and Michael Ugwueke for putting together a program to give me the tools I need to be a more effective leader.”

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GrandRounds Methodist Foundation Holds Cancer Center Luncheon The 12th annual and most recent Cancer Center Luncheon was presented

by Methodist Healthcare Foundation and Cigna. It was held on November 22 and featured Academy Award-winning actress, Sally Field. Ms. Field spoke to a sold out audience as Sally Field she spoke candidly about her life and art. With a crowd of over 1,000 guests in attendance, she shared inspirational thoughts and entertaining stories from her amazing 50 years in Hollywood.

All proceeds from this event benefited the West Cancer Center in Memphis.

Commission on Cancer Accredits Baptist The Commission on Cancer has awarded the academic cancer program of Baptist Memorial Hospital-Memphis, Baptist Memorial Hospital for Women and Baptist Memorial Hospital-Collierville full accreditation with commendation for three years.

CoC-accredited facilities must comply with 36 standards and demonstrate commitment to the community and cancer patients through their organization of cancer services, high-quality care and a program that improves access to care and patient outcomes.

Christ Community Health Breaks Ground on Frayser Site Christ Community Health Services has broken ground on the new Frayser Health Center located at the corner of Thomas St. and Frayser Blvd. The current location, at 3124 N. Thomas Street, has the ability to service approximately 50 patients per day or 6,400 annually. Once completed, the new health center will substantially increase the number of patients currently being seen in the Frayser clinic. Christ Community received $5 million grant to build the Frayser center and the land was purchased by a private donor. Scheduled to open late fall of 2014, the 19,000 square foot center will house a health clinic, dental and pharmacy services.

Dr. Stephen King has joined Regional Medical Center as the Chief Medical Information Officer. Dr. King is a member of the UT department of plastic surgery and has worked in plastic surDr. Stephen gery and burn at ReKing gional Medical Center for many years. In this new role, he will work closely with the senior executive staff and the Information Technology division to implement the many health information projects underway at the health system.

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GrandRounds Changes Come to SemmesMurphey Clinic Semmes-Murphey Clinic has announced the addition of three distinguished physicians and a Foundation research assistant as well as the retirement of a long-serving physician. The new physicians are Dr. John D. Brophy and Dr. LaVerne R. Lovell, formerly principals in the Brophy & Lovell Neurosurgical Clinic, and Dr. Vishad Kumar, a neurologist, formerly with the Wesley Neurology Clinic.

Dr. Brophy is a West Point graduate, earning his medical degree from the Medical College of Georgia. He completed a neurosurgical residency at the Walter Reed Army Hospital and served as Chief of Neurosurgery at Dr. John D. the Naval Medical CenBrophy ter, San Diego holding the rank of Lieutenant Colonel with 12 years of active duty. Dr. Brophy is a board certified neurosurgeon and has maintained a practice in Memphis since 1995. He is a Fellow of the American College of Surgeons, Member of the Tennessee Medical Association, Congress of Neurological Surgeons and the American Association of Neurological Surgeons.

Dr. Lovell graduated from the United States Naval Academy and earned his medical degree from the Uniformed Services University of the Health Sciences. He completed his neurosurgical residency at Bethesda Naval Hospital.

Lovell completed a 30-year R. military career, retiring with Dr. LaVerne Lovell the rank of Captain as the Chief of Neurosurgery, Portsmouth Naval Hospital. He is a board certified neurosurgeon and has maintained a practice in Memphis since 2000. Lovell is a Fellow of the American Association of Neurological Surgeons, Member of the Tennessee Medical Association and Congress of Neurological Surgeons.

Dr. Kumar completed his neurology residency at the University of Tennessee Memphis in 1998. Prior to that he graduated from King George’s Medical College, India and completed residency in internal medicine and neurology. He is a board certified neurologist by the American Board of Psychiatry and Neurology, and is a Clinical Assistant Dr. Vishad Professor, Department of Kumar Neurology at U.T. He did a Research Fellowship, at the Department of Neurology and Psychiatry at Vanderbilt University School of Medicine in Nashville, and is licensed to practice in Tennessee. He is also a member of the American Academy of Neurology, Tennessee Medical Association and Tennessee Academy of Neurology.

Andrew Ballard has joined the Semmes Murphey Foundation as a research assistant for the National Neurosurgical Quality Outcomes Database memphismedicalnews

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(N2QOD). In this role he will assist in gathering data as a quality outcomes initiative for improving patient care at Semmes Murphey Clinic.

Dr. Michael H. De- Andrew Ballard Shazo retired from the Semmes-Murphey Clinic at the end of 2013. In 1977 he finished his residency in Psychiatry and Neurology and was looking to a career in neuroscience. SemmesMurphey was the place to be. With this in mind, he Dr. Michael H. DeShazo began his long association with the clinic, which has extended through the whole of his career.

Dr. DeShazo has served as a Clinical Assistant Professor in the University of Tennessee Center for the Health Sciences Department of Neurology. He was President of Memphis Academy of Neurology from 1987 to 1988 and again in 1997 to 1998. He was on the Clinical Resource management Committee of Baptist Memorial Hospital in 1994 to 1995, and at the same time he was Chairman of the Communications and Outreach Strategic Initiative of the Neuro Strategic Planning Committee for Baptist Memorial Hospital.

His legacy will continue to inspire and encourage the physicians, staff and interns at Semmes-Murphey Clinic.

UT Medical Group Adds Specialist in Burn and Cosmetic Surgery Dr. Michael M. Van Vliet has joined the department of plastic surgery at UT Medical Group and been named assistant professor at the University of Tennessee Health Science Center.

He has also been appointed director of burn critical care for the Firefighters Regional Burn Center at Dr. Michael M. Van Vliet Regional Medical Center at Memphis (The MED).

Dr. William Hickerson, medical director for the Burn Center, said Van Vliet’s responsibilities there include training staff, establishing protocols, and bringing new technology to the center.

Van Vliet earned his medical degree from Albany Medical College in New York and completed plastic surgery training at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire. He furthered his training with a fellowship in burn surgery and critical care at the University of Southern California/Los Angeles County Hospital.

In addition to his expertise in burn surgery and reconstruction, Van Vliet has a special interest in laser resurfacing, microsurgery, and cosmetic surgery of the face, breast and body. He cares for patients at UT Medical Group’s offices in Germantown and in the Memphis Medical Center, in addition to the Firefighters Regional Burn Center.

Your Practice – Your Brand

A Fresh Start to Communicating in 2014

Don’t you love the fresh start that each New Year brings? It seems like everyone is thinking about potential and possibility. The New Year also typically brings a wide variety of lists for things to do, trends to watch and resolutions to keep. I am personally not much of a resolution guy. In fact, I am still keeping a New Year’s resolution made decades ago to never again make any New Year’s resolutions.

I am, however, someone who likes to look at trends and expectations, and what they can mean to your branding, marketing and communications.

I have read a number of marketing trends and projections articles over the last month and I think I can summarize them all into just a few key words: social, direct, consistent, integrated, strategic, valued and measurable. I just saved you from reading every article from every prognosticator in the communications industry. And guess what, I think the same list would have worked last year and will likely work a decade from now. What changes over the years are technologies and the vehicles.

What you do with those technologies and vehicles as they emerge, merge, mature and evolve sets the final stage for communications success.

Social: In a professional services business, who you know and the conversations about you has always been the number one awareness tool. The difference now is that the tool(s) are all highly visible and instantaneous. The cocktail party conversation about who took care of my tennis injury is still important. But a much more visible conversation is now taking place online.

People are talking about you online whether you are currently participating in the conversation or not. So, doesn’t it make since to at least dedicate the resources to monitoring, or better yet, to participate in the conversation.

Direct: Once again, electronic has surpassed all other tools in this communications category as well. With email and other online tools, you have incredible opportunities to talk directly to customers. While some customers/ patients will be one-time, most will see you – or a competitor – many times. It never hurts to remain top-of-mind.

Consistent: As you launch your new communications initiatives in 2014, don’t bite off more than you can chew. To come out strong and then quickly fade away won’t be much help in building your brand. Find a level of comfort and then consistently stick with it.

Integrated: Each marketing tool you utilize should integrate well with all of the others. Messages and platforms can feed off each other. They certainly should not fight each other. You should have one brand, one personality and one tone across messages. Make sure those messages cross all vehicles seamlessly.

Strategic: Moving to execution without strategy is often a waste of time and money. Start first with the basics. Who do you want to talk to? Why do you want to talk to them? What do you want them to know? What do you expect them to do with the information once they have it? That is a pretty basic start, but it will help you organize what you do, how you do it and when you do it.

Valued: We live in a world of information overload. If what you communicate is not of value, it will be ignored.

Measurable: Finally, if your “strategy” step was well founded, your measurable step will be much easier. But do set aside the time and budget to measure results.

That will make this time next year much less daunting.

Happy 2014. Consider this a fresh new opportunity for your practice’s marketing and communications. Develop goals and plans, and then execute them.

If you want to consider it a New Year’s Resolution, that’s up to you.

— Ralph Berry, Executive Vice President, Public Relations, Sullivan Branding,rberry@sullivanbranding.com To learn more about Ralph Berry or Sullivan Branding, visit www.sullivanbranding.com

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GrandRounds Baptist Memorial President and CEO Announces Retirement Stephen Reynolds, Baptist Memorial Health Care’s fourth president and CEO and a 42-year Baptist colleague, announced he will retire in May. Jason Little, Baptist’s executive vice president and chief operating officer, will be the organization’s next president and CEO. See related story on page one.

Reynolds began his Baptist career as an administrative resident in 1971 after serving as an officer in the United States Army. After holding a number of leadership positions for 23 years, he was promoted to Baptist’s president and CEO in 1994.

Under his leadership, Baptist opened two metro-Memphis hospitals – Baptist Memorial Hospital for Women and Baptist Memorial Hospital-Collierville – as well as the area’s first residential hospice facility and the Kemmons Wilson Family Center for Good Grief. Reynolds also oversaw the construction of the NEA Baptist Hospital in Jonesboro, Ark., and the creation of the Baptist Medical Group, one of the MidSouth’s largest physician management organizations. Today, Stern Cardiovascular, Family Physicians Group, Memphis Internal Medicine, the Light Clinic and the Boston Baptist Memorial Health Care’s Stephen Reynolds, left, and Baskin Cancer Foundation are among the groups that are part of BMG. Jason Little Little has been with Baptist since 2002. Before being promoted to his current position, he served as vice president and metro market leader, overseeing Baptist’s seven metro-Memphis hospitals and NEA Baptist Memorial Hospital. Before that, he served as administrator and CEO of three Baptist Memorial hospitals.

Plans for new West Cancer Center unveiled Methodist Le Bonheur Healthcare, in collaboration with The West Clinic and the University of Tennessee Health Science Center (UTHSC), today unveiled plans to consolidate cancer services from multiple sites into a single location, which will be called the West Cancer Center. A rendering of the planned center was unveiled today at the annual Methodist Healthcare Cancer Center Luncheon at the Peabody Hotel.

Methodist filed a Certificate of Need (CON) to consolidate the services for the West Cancer Center. A CON is a permit from the Tennessee Health Services Development Agency (THSDA) that allows for “the establishment or modification of a health care institution, facility or service at a designated location.”

L-R: Dr. David Stern, Executive Dean and Vice-Chancellor for Clinical Affairs for the University of Tennessee’s The proposed project includes a full array of College of Medicine and the University of Tennessee Health Science Center; Dr. Martin Fleming, Chief of Surgical Oncology and Associate Professor of Surgery, University of Tennessee Health Science Center; Gary cancer services and programs and involves apShorb, President and CEO, Methodist Le Bonheur Healthcare; Erich Mounce, CEO of the West Cancer Cenproximately 8,050 square feet of new space and ter and Senior Vice President of Oncology Services for Methodist Le Bonheur Healthcare; Dr. Lee Schwartzberg, Medical Director of the West Cancer Center; Dr. Kurt Tauer, Chief of Staff of the West Cancer Center; 101,235 of renovated space. Also included is the Dr. Bill West, Founder of The West Clinic; Cancer survivor, Shelby County Sheriff’s Deputy Mark Wagner. relocation of diagnostic equipment, including a PET scan, as well as MRI and CT services. In addition to two ambulatory surgery suites, the proposed plan includes the relocation of one linear accelerator and addition of a second.

This project does not involve inpatient beds or other services for which a CON is required. The estimated project costs are $60,554,193.

If approved, the facility will be located at 7945 Wolf River Boulevard in Germantown and will be operated as an outpatient department of Methodist Healthcare under the name West Cancer Center.

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