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PHYSICIAN SPOTLIGHT PAGE 2

Robert Hamm, MD

Some Answers in Short Supply During ‘Day on the Hill’ Event leaving 200,000 to 300,000 lives uncovered. “These people cannot qualify for tradiAttendance was up approximately 20 tional Medicaid or vouchers or buy insurpercent for this year’s Day on the Hill, the ance on the free market. Most are working annual one-on-one meeting in Nashville of part-time in service industries, are seasonal legislators and physicians, nurses and healthhelp, or are PRN in health care,” he said. care administrators for the opportunity to Anderson said they were not given a reaexchange opinions and concerns about issues son for the two-year window. He explained affecting healthcare. it might just be a political cycle. The reason The two chief issues for the physicians given for the failure of the measure, he said, and administrators involved during last was discontent with the Affordable Care Act month’s gathering, according to Keith G. which is what was perceived as the driver of Anderson, MD, were Governor Bill Haslam’s this plan, and that this was a statement from failed Insure Tennessee effort and the Payor the local legislature. He cited a heavy, orgaAccountability Act. nized coalition against Insure Tennessee that Anderson, a cardiologist with Sutherland had protested on the hill before the vote was Clinic and the new president of the Tennestaken. see Medical Association (TMA), observed, “It was a very well-written plan and I “One of our priorities as a medical commucommend Governor Haslam for his hard Keith G. Anderson nity has been to promote Insure Tennessee, work on it. The time and effort put into crebut this year, since it’s already been voted ating it was tremendous. I’m just so sorry it down, we went with a ‘What happened? Can you give us the details failed so quickly in the legislature,” Anderson said. of why Insure Tennessee did not pass?’ mindset.” The Payor Accountability bill, addressed in the 109th General Anderson, a physician for 25 years, expressed his discontent that Assembly, was promoted by physicians to legislators during Day on such an initiative is prohibited from coming up again for two years, (CONTINUED ON PAGE 8) By GINGER H. PORTER

ON ROUNDS

Healthcare Real Estate Market Solid In Spite of Economic Challenges Hillary Clinton famously said, “It takes a village.” For behavioral health providers, that concept – played out in communities all across Tennessee – has proven to be true ... 3

Marijuana, Medicine & Addiction A conversation with ASAM President Dr. Stuart Gitlow With three states plus the District of Columbia sanctioning recreational use of marijuana and virtually all other states either allowing for or considering decriminalization and/or medical use of the drug, the great marijuana debate has become ... 5

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HealthcareLeader Lisa Piercey, MD Vice President, Physician Services, West Tennessee Healthcare By SUZANNE BOyD

As though being the mother of four – three of which are triplets – would not be challenging enough, try also being a pediatrician who is one of only six in the state sub-boarded in child abuse. Add to that being vice president of physician services for West Tennessee Healthcare, which involves overseeing more than 700 em-

ployees across more than 27 locations in nine counties throughout West Tennessee. If that is not enough to make you feel challenged, try being an active triathlete as well as serving on the boards of several community organizations. At the very heart of Piercey is her love of kids, family and her West Tennessee roots. The Trenton native was born in the flagship hospital (CONTINUED ON PAGE 4)

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PhysicianSpotlight

Robert Hamm, MD By SUZANNE BOyD

Variety is the spice of life and is a good description of the career of Board certified psychiatrist Robert Hamm, MD. From New York to Florida to East Tennessee, he has practiced in both the outpatient and inpatient side of psychiatry as well as in private practice. Today, as medical director for Lake Haven Behavioral Health Center at Henry County Medical Center, Hamm is drawing from his past experiences as he steers the program and builds a private practice in Paris, Tennessee. The New York native, who has several relatives who are physicians, always knew he would pursue medicine as a career. He realized his interest in psychology as an undergraduate at the University of Buffalo in New York. “I was double majoring in biology and psychology and realized of the two, I really enjoyed psychology,” said Hamm. “I really excelled in psychology which boosted my GPA and I thought it would increase my chances of getting into medical school. Ironically it was studying psychology that made me realize how much the mind and how it processes emotions and stressors of daily life interested me.” Medical school was in Dominica at Ross University School. After a year and a half of classroom instruction, he returned to Brooklyn, New York to complete the clinical rotations portion of his training. Prior to entering the match for a residency spot, he returned to Ross University to teach problem-based learning. Hamm kept his mind open to special-

ties as he went through medical school. “I wanted to experience all the rotations with no preconceived notions so that I could really get into all of them to see what I liked the most at the end,” he said. “I had really enjoyed my psych rotation and it was something I had always excelled in. I narrowed my choices down to primary care and psychiatry and applied for both in the match process. When I pre-matched at East Tennessee State University for psychiatry, it took the pressure off of having to go through the match process and was the answer I was looking for.” After completing his residency training in Johnson City, Tennessee in 2011, Hamm took a position in Panama City, Florida working in an outpatient clinic and with an inpatient crisis stabilization unit.

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He followed that with six months working for Covenant Health at Fort Sanders Regional Medical Center in Knoxville, Tennessee. While at Fort Sanders, Hamm started doing some locum tenens work at Brookhaven Retreat, a private pay facility for women nestled in the foothills of the Smoky Mountains in Seymour, Tennessee. He later joined the staff full time. When a recruiter contacted Hamm about the medical director position at Lake Haven and for an outpatient unit, his interest was piqued. “I came to Paris to interview and found that I not only liked the facility but I also really liked the people there,” said Hamm. “After that, things just all seemed to fall into place and in September 2014 I joined the staff at Henry County Medical Center. My private practice is located in the Medical Arts Building on the campus of Henry County Medical Center and I see most of my patients there on an outpatient basis.” As medical director of Lake Haven, which is the hospital’s 20-bed inpatient unit, Hamm works with Donald Gold, MD, seeing patients on the unit. “Plans are to convert all the psychiatric inpatient rooms to single occupancy on the unit that will become a geriatric-psychiatric unit,” said Hamm. “A General Psychiatry floor below the unit will house another eight patients. The program treats mainly adults. While I am not an adolescent or child psychiatrist, I have definitely worked with them and have seen some on an outpatient basis.” While moving can be one of the biggest stressors a person can face in life,

Hamm has learned to take it in stride. He says the transition to life in a small town, especially after living in New York, Miami and Knoxville, has been on of the easiest transitions of his life. “I have sort of an advantage when it comes to transitioning since I have basically moved about every six to twelve months since I was 17, but it was necessary due to my career path,” he said. “I really like Paris, it is easy to get around, there is no traffic, the cost of living is great and the people are so friendly. It is a wonderful home base and a nice place to settle.” Even though he has been on the move quite a bit over his career, Hamm does like the fact that psychiatry allows him to get to know his clients. “It is a good experience when you see someone who initially was not doing well, can with various interventions and therapy, improve and have meaningful relationships,” he said. “The field of psychiatry is always evolving which is also interesting.” Travel is a passion for Hamm and one that has taken him to Europe, the Mediterranean, Costa Rica, Puerto Rico and all the Caribbean islands. “Travel introduces you to new places, new foods and new cultures,” said Hamm. “It also gives you a new perspective on things and reminds me to always have an open heart and mind.”

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APRIL 2015

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Healthcare Real Estate Market Solid In Spite of Economic Challenges

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By BETH SIMKANIN

In spite of tight budgets and other economic challenges, the healthcare real estate market in the Memphis area remains on an upward trend, according to decision makers involved in the business. Development and building expansion continues to grow in all areas of the MidSouth with emphasis on providing patients with multi-specialty services, convenience and accessibility. The trend is expected to continue the next two to three years, according to Kelly Truitt, executive vice president of CB Richard Ellis Memphis, LLC. “There are plenty of opportunities for continued future expansion in the MidSouth,” Truitt said. “Larger projects led by area hospitals that have been recently completed will lead to smaller projects such as medical office buildings. There are in-fill areas around major campuses where primary care facilities could emerge. The locations are convenient and easy accessible.” An example is Regional One Health’s East Campus at 6555 Quince. The 110,000-square-foot building is under renovation and will house 50,000 square feet of clinical space, which will include a comprehensive imaging center, multi-specialty clinic, rehabilitation medicine center and reproductive clinic. The campus will open in phases throughout 2015, starting with the reproductive clinic, which will open later this month. “Our goal for the facility is comprehensive integrated care,” said Bret Perisho, vice president of finance and chief business development officer for Regional One Health. “The future in healthcare is to offer a one-stop-shop model that has the capability to provide multi-service specialties. We needed a centralized location that provided a full range of specialists. We don’t want patients to bounce around from place to place. We want them to have an efficient patient experience.” Visibility and accessibility were factors in choosing the location for the East Campus, according to Perisho. The hospital system performed a study on driving habits. According to the study’s findings, 900,000 people can drive to the 6555 Quince location in 20 minutes or less. “The East Campus is an easy access point,” Perisho said. “It’s easily accessible from Bill Morris Parkway, and over 150,000 cars drive by our building every day. There are many routes a person can take to get here. Even Mississippi residents can drive here quickly by driving into Memphis on Riverdale Road.” Regional One Health owns 40 acres of land west of the building. Space is there for over 1 million square feet of additional medical development. There are no immediate plans to develop the land, but Perisho can foresee a need for an outpatient surgery center or medical office group within the next five years.

Leeyla Woods enjoys watching fish in large tank in the lobby of the newly completed Spence and Becky Wilson Baptist Children’s Hospital adjacent to the Baptist Memorial Hospital for Women. The hospital’s 17,000 squarefoot emergency room features 10 bays for patient care, and a 2,000 square-foot diagnostics area.

Also in East Memphis is the Spence and Becky Wilson Children’s Hospital at 6225 Humpreys Boulevard. The 19,000-square-foot pediatric emergency room and diagnostics area opened earlier this year. Additional pediatric services will be available over the next several years, including a 12-bed inpatient unit, outpatient pediatric surgery and a pediatric eye center. “We will have multi-specialty services on the top floor where parents can consult with various doctors for chronic issues,” said Anita Vaughn, the hospital’s CEO and administrator. “We want to make it convenient for parents and their children by having doctors with different specialties located there under one roof.” This accessible, multi-specialty expansion trend isn’t just happening in East Memphis. It’s occurring in all areas of the Mid-South from Olive Branch, Miss., to downtown Memphis. Methodist Le Bonheur Healthcare will open an $11 million medical office building downtown this fall. The 54,000-squarefoot, three-story building at the northwest corner of Adams Avenue and Dunlap across from Le Bonheur Children’s Hospital will provide about 200 offices for physicians, freeing up clinical space in the hospital and nearby clinical buildings, said Dave Rosenbaum, vice president of facilities management for Methodist Le Bonheur Healthcare. “Our goal is to provide the most patient-friendly care we can,” Rosenbaum said. “It’s better for our patients and for doctors if our medical services are located in one place. The patients can receive better care.” Crosstown Concourse, formerly the vacant Sears Crosstown building at 495 North Watkins, is scheduled to open downtown in January 2017. The 1.1-million-square-foot, $200 million health and wellness development will house tenants

from various healthcare-related entities such as Methodist Le Bonheur Healthcare, St. Jude Children’s Research Hospital, ALSAC/St. Jude and Southern College of Optometry. Additionally, the Church Health Center will be the building’s largest

tenant, occupying 150,000 square feet. “We have a good working relationship with hospital entities,” said Marvin Stockwell, communications director for the Church Health Center. “We can be the connector and meeting ground so hospitals can provide shared services, which in turn provides better health. We will be able to provide shared efficiencies with this space and become better connected to the people we serve. ” Methodist Le Bonheur Healthcare plans to relocate some of its non-clinical administration functions to Crosstown Concourse, but the locations haven’t been determined, Rosenbaum said. Olive Branch will be a key area for medical expansion in the Mid-South for the next few years due to vast residential growth, according to Parrish Taylor, vice president of retail services for CB Richard Ellis, LLC. Methodist Healthcare opened Methodist Desoto Hospital, a five-story, 100-bed building, in 2013. The area is underserved in medical development, according to Truitt. “There isn’t as much mature growth in Olive Branch,” he said. “There is lots of surrounding land for development such as (CONTINUED ON PAGE 4)

Healthcare is Changing.

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Healthcare Leader: Lisa Piercey, MD, continued from page 1 of West Tennessee Healthcare, JacksonMadison County General Hospital and spent her early teenage days being a candy striper at the Gibson General Hospital in Trenton. She went to college at David Lipscomb University in Nashville on academic and tennis scholarships. She married a boy from Milan. For medical school and her residency, she went to East Tennessee State University in Johnson City. While in pediatric training at East Tennessee State University, where she earned her medical degree and completed her pediatric residency, Piercey was encouraged to work in a child abuse clinic by a faculty mentor. “Initially I was reluctant to do it but after I got over the normal emotional reactions during the first few weeks, I really gravitated to it,” she said. “Mostly because it was and still is such an underserved specialty for children. At that time, there were no accredited fellowship training programs in existence, so I gathered my formal training through various academic and educational venues, as well as years of hands-on experience with mentoring and peer review. The American Board of Pediatrics formally recognized the subspecialty board certification a few years ago, and based on my training and experience, I was able to sit for the exam and ultimately was certified in 2013.” When it came time to enter into practice Piercey returned to West Tennessee to join the Jackson Clinic. “All my family as well as my husband David’s still live in the area and we always knew we wanted

The decision was made to tailor services in the three cities to meet what the population in that area needed. Milan would maintain inpatient services and surgical services. Humboldt would transition into an extension of the Emergency Department in Jackson. Trenton would become an urgent care and primary care location. to be close to them,” said Piercey. “And since at the time I joined the clinic we had a three year old and three month old triplets, being close to family was important. We actually moved to Jackson two days after the triplets were released from the hospital.” During her time at the Jackson Clinic, Piercey felt she needed an academic challenge and decided to pursue a Master of Business Administration degree through Bethel University. In order to complete her practicum in a real world setting she turned to Dave Roberts, MD, CMO at West Tennessee Healthcare to collaborate on a healthcare improvement project. “I loved how business and healthcare intersected,” said Piercey. “After finishing my practicum, I decided to split my time between private practice and working in administration at the hospital since I felt like I could affect a bigger change on a more strategic level,” said Piercey. “That eventually was the motivation for me to make the leap to full time administration. While I miss the one on one everyday interaction with patients and families in the clinic, I know I can have an affect on a community and regional level.” In 2010, Piercey became assistant medical director under Roberts focusing on case management utilization and some quality initiatives. In 2011, she became a vice president overseeing the development of The LIFT Wellness Center, which opened in 2013. Today she is Vice President of Physician Services where she is responsible for the West Tennessee Medical Group employed physicians, Sports Plus Rehab Centers, The LIFT, senior services and employers’ services. Piercey’s responsibilities span not only across clinics but across county lines as well, which means she is on the go quite a bit. “I am in every clinic or facility that I oversee at least once each quarter. It is very important to me to try to make staff meetings as well as celebrations at each location, so I am pretty much heading somewhere each day,” said Piercey. “I also think it is important to live by and use

the services I am always touting to others. I believe in them and know they are the best.” Although she oversees a wide range of employees from physicians to pool techs to physical therapists, Piercey says her management style is the same across all. “I think autonomy and empowerment are crucial,” she said. “It is my role to set the parameters but it is the folks in the trenches that need to figure out the details. They know the minute workings better than I. I am always happy to help in any way but sort of see my role as greasing the wheels and removing barriers for them to be successful.” Though she may not don a white coat and stethoscope everyday, Piercey has not given up her role as a child abuse pediatrician in the area. She serves as the medical director for the Carl Perkins Child Abuse Center and sees patients in their local clinic one afternoon a week as well as does inpatient consultations for patients at the hospital. “There are very few resources in the state for these patients and being able to fill that need is very rewarding,” said Piercey. “It also helps build some credibility with the physicians I manage because I know all the hoops they have to jump through and the issues they deal with.” One challenge Piercey has faced as an administrator is one that hit very close to home and her heart, realigning three hospitals in Gibson County where she had grown up. “The Gibson County realignment had personal implications for me. My family is still there and I have friends there but there was also a business side. Any decision made would impact employees and patients,” she said. “We had to look closely at the services that were actually being utilized and what could be done to maintain a presence in Gibson County and be viable. In my home town of Trenton, we found the facility was not being used as a traditional inpatient model and the Emergency Department was not being used by and large for true emergencies because less acute issues were presenting there.”

Healthcare Real Estate Market Solid, continued from page 3 medical office buildings.” There is also an emerging need for urgent care facilities in the area, according to Taylor. “Compared to the rest of the country, the Memphis area is underserved in the availability of urgent care facilities,” he said. “I see this area of the medical market expanding as residential growth occurs and as long as there is growth in the local economy and in the retail segment.” Eastern Desoto County is a key submarket where there has been fast residential growth and medical has struggled to keep up, he said. “It will, though. You will see more of these medical retail operations opening up in the next year,” Taylor said. “These urgent care facilities are convenient, cheaper, easily accessible and they are quick to get in and out of.” This ties in with the trend that smaller medical projects may be on the rise. “We will see continued growth in the Mid-South, just not on as grand of a scale, but the projects will not be any less significant,” Truitt said.

APRIL 2015

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Marijuana, Medicine & Addiction A conversation with ASAM President Dr. Stuart Gitlow By CINDY SANDERS

With three states plus the District of Columbia sanctioning recreational use of marijuana and virtually all other states either allowing for or considering decriminalization and/or medical use of the drug, the great marijuana debate has become a legislative hot topic over the last three years. For Stuart Gitlow, MD, MPH, DFAPA, however, talk of medical benefits associated with inhaling the plant is just smoke and mirrors. Gitlow, who concludes his term as presiDr. Stuart dent of the American Gitlow Society of Addiction Medicine this month, said there are two major issues with the drug … addiction and toxicity. The double boardcertified psychiatrist, who has a private practice in Rhode Island, is concerned by the possibility of adding marijuana to the mix of alcohol and tobacco as yet another substance with the potential to do more harm than good.

The Drug

Marijuana refers to the dried leaves, flowers, stems and seeds from the hemp

plant Cannabis sativa, which contains the mind-altering chemical delta-9-tetrahydrocannabinol (THC), along with other compounds. The National Institute on Drug Abuse (NIDA) has found marijuana to be the most common illicit drug in America and one for which usage is on the rise. The national organization stated marijuana’s popularity, particularly since 2007, has coincided with a diminishing public perception of the drug’s risks. However, at the same time risk perception has been declining, the drug’s potency has actually been on the rise. In looking at the amount of THC in marijuana samples confiscated by the police, the THC concentration averaged close to 15 percent in 2012 as compared to around 4 percent in the 1980s, according to the NIDA fact sheet on marijuana. Gitlow agreed, saying, “The marijuana that is available today is much different, much more potent, than the marijuana that was available in the ‘60s. More research needs to be done to see if there are even more long-term issues with this more potent form.”

addictive … that’s a given,” he said. “It’s like any other psychoactive drug … it’s not addictive to the majority of those using it once or twice.” However, he continued, “There’s no way of knowing if a person is going to have a problem with the drug until they try it … and then they are playing Russian roulette.” Gitlow explained, “Addictive disease is not about the drug, it’s about a brain abnormality. It exists before somebody picks up the drug.” The three factors required for addiction, he said, are a genetic abnormality, environmental trigger and the drug. “Addictive disease is in only, give or take, 15 percent of the population.” He added popular consensus is that about 9 percent of adults and 17 percent of adolescents who use marijuana become addicted. In addition, NIDA’s marijuana fact sheet noted addiction rates jump in daily users, with as many as 25-50 percent becoming addicted.

Addiction

Toxicity

Gitlow noted marijuana works like any other addictive drug. “There’s not debate at all within the medical community that it’s

“There’s a second issue with marijuana, and it’s independent of addiction. Marijuana has toxic ramifications,” Gitlow

said. “Marijuana makes you stupid,” he stated bluntly. “It lowers IQ. It causes slowing of the processing speed. It causes abnormalities of attention and focus. It basically dumbs you down, and it does that more or less universally.” When marijuana is smoked, the THC passes quickly from the lungs into the bloodstream and to the brain. THC targets cannabinoid receptors, which have a higher density in areas of the brain that influence pleasure, memory, concentration, coordination, thinking and time perception. Addi(CONTINUED ON PAGE 8)

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Survey Says … A Digital Disconnect Exists Between Patients, Practices r a t e

By CINDy SANDERS

Patients increasingly want to access online services to enhance convenience and communication with providers, according to a recent national survey conducted by TechnologyAdvice Research. Yet, the majority of respondents in the “2015 Trends in Patient Engagement” survey said a number of digital solutions that would be helpful are not offered by their primary care practices. “Only 19 percent said their physician offered online appointment scheduling,” noted Cameron Graham, survey author and managing editor for TechnologyAdvice, a company that conducts research and analysis of IT products in a number of industries including healthcare. “Only 17 percent said their physician offered online bill pay.” In addition to scheduling and payment functions, Graham said viewing test results or diagnoses online also ranked high among survey participants. However, only 27.8 percent Cameron said their physician proGraham vided that option. Graham pointed out all three of the most desired digital services are fundamental patient portal features. With that in mind, he continued, “There’s a big discrepancy between what patients report having access to and the EHR adoption

among physicians.” Graham said electronic health record adoption rates are in the “high 70s, low 80s” by office-based physicians in the United States. “A lot of those systems should have online appointment and bill pay capabilities,” he said, adding some of the older systems might not have those options but virtually all newer products offer robust patient portal resources. “I think one of the big takeaways is that the patients don’t seem to be aware of the tools their physicians probably have,” he said. The other option, Graham continued, is that offices have these capabilities but are not using them. Either answer could spell trouble for practices. “When we asked how important these services were when people were choosing a physician, 60.8 percent said it was ‘important’ or ‘somewhat important,’’

Graham said. “If physicians are offering these in-demand digital services, a more proactive approach to promoting them is needed and could create an advantage in attracting and retaining patients.” Graham added he also believes physicians need to more fully embrace digital services. “Patients value them a lot. Physicians think of them as an extra or addon.” With meaningful use requirements staged to increase health information exchange and promote patient engagement, Graham noted the effective use of patient portals could help practices hit the necessary benchmarks to access incentives. However, he noted, there probably won’t be a ‘one size fits all’ solution when it comes to patient engagement. “We did find age played a role in which services patients wanted their physicians to offer,” he said. Not surprisingly, the demand was much higher by younger adults than in the senior population. “Among the 25- to 34-year-old demographic, almost 40 percent said they would like to have a smart phone app for scheduling appointments; but among the 65 and older demographic, only 3.8 percent said that would be something they’d want.” Similarly, 35.3 percent of patients ages 25-34 would like for their physician practice to offer secure messaging outside of office hours compared to just 11.5 percent of those ages 65 and older. Of the six digital services listed on the survey (online appointment scheduling, smartphone app for scheduling, online test results/diagno-

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ses, online bill pay, secure messaging, and health resources/educational material), 23.5 percent of those ages 25-34 reported they didn’t want their physician to offer any of the services, while 44.2 percent of participants 65 and older had that same response. Graham continued, “I think it’s important for physicians to be aware of what these different demographic groups want.” He added such information could help providers tailor their message accordingly when discussing the different ways patients could access the practice and engage with providers. Another disconnect highlighted by the survey was provider follow-up. While 68.6 percent of respondents said it was either ‘very important’ or ‘somewhat important’ that a physician follow up with them, only 30 percent reported receiving any follow-up from the practice that wasn’t tied to bill pay. “They’re very good about following up related to money,” Graham pointed out, but patients want more than that. In addition to building rapport with a patient, Graham said digital communication offers an easy way to make sure instructions were understood and are being followed, check on medication adherence, share prevention tips, and remind patients about the need to schedule routine screenings and services. The “Trends in Patient Engagement” survey included responses from more than 400 adults across the United States regarding their digital experience at primary care practices. The survey was conducted Jan. 5-7, 2015. A download of the survey whitepaper is available at technologyadvice.com/research. TechnologyAdvice, which is headquartered in Brentwood, Tenn., offers free, neutral research and analysis of IT products to connect businesses with technology options that best address each company’s specific needs. The company works with businesses and practices looking for the right software for just a few people up to large enterprises in need of solutions for thousands and has assisted Apple, Oracle and HP in selecting new technology. Last year, TechnologyAdvice was named to the top half of the Inc. 5000 list of America’s fastest-growing private companies.

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APRIL 2015

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Gearing up for ICD-10

CMS confirms Oct. 1 switch; healthcare consultant offers cautionary notes By JULIE PARKER

Successful completion of a full week of end-to-end testing of the new ICD-10 coding shows the healthcare industry is ready for the next step toward total conversion from ICD-9 coding, Marilyn Tavenner,

former administrator of the Centers for Medicare and Medicaid Services (CMS) said before her departure from the federal agency earlier this year. To promote the healthcare industry’s smooth transition from ICD-9 to ICD10, CMS is conducting a comprehensive program of testing. In the first full week of testing -- from Jan. 26 to Feb. 3 – CMS received nearly 15,000 test claims from 660 providers. “Testing allows us to identify areas of improvement, and we’ll work with outside entities and stakeholders to improve those very small deficiencies identified,” she said at the time. “And we’ll continue to do testing, especially in those areas we identify as needing improvement.” Tavenner added, “Because ICD codes are required on medical bills, we want healthcare providers to be confident they can submit Medicare claims and get paid as the nation switches to ICD-10.” CMS also identified a point that’s prompted some confusion among the

October healthcare community. Acting Administrator Andy Slavic has reiterated ICD-9 coding is to be used for services provided before the Oct. 1 deadline; ICD-10 coding will be used for services provided on or after Oct. 1. Prior to Oct. 1, ICD-10 can be used only for test purposes. However, once we hit Oct. 1, 2015 only ICD-10 can be used for services rendered on or after that date. But claims submitted after Oct. 1, 2015, for services provided before that date, must still use ICD-9 codes. Margie Maley, BSN, MS, coding educator and consultant with KarenZupko & Associates Inc., a national consulting firm based in Chicago, said she’s strongly advising clients that bill directly to Medicare to apply for end-to-end testing. “If you don’t get accepted for end-to-

end testing, at the very least conduct acknowledgement testing,” she said, noting that applications for the next available end-to-end testing (midJuly) became available on all carrier websites (MACs) on March 13. “Medicare is only accepting up to 850 providers per testing week, so act fast,” urged Maley. “Even our ortho- Margie Maley pedic clients who must deal with the greatest increase in ICD-10 codes and reorganization have jumped onto the testing bandwagon successfully.” Maley pointed out that claims testing highlights more than ICD-10 issues. “Medicare says that 6 percent of testing errors were due to ICD-10,” she emphasized. “Yet more than twice that – 13 percent – were due to provider-preventable errors, such as incorrect NPI or submitter ID, or invalid place of service or HCPCS codes.” Carrier software bugs are also being caught in the testing phase. “A lot of this is just the nature of software development … not necessarily a coding issue,” Maley said. “Everyone is creating new features to deal with ICD10 and they need to be tested so bugs

are caught and fixed before the deadline. So make sure your practice is part of the testing process. You never know what you might learn about your own processes.”

CMS is clearly ready for ICD-10, emphasized federal officials. “And thanks to our many partners — spanning providers, health plans, coders, clearinghouses, professional associations and vendor groups — the healthcare community at large will be ready for ICD-10 on Oct. 1,” Tavenner promised before stepping down. “I appreciate the tremendous efforts and achievements of health professionals as we work together to realize the benefits of ICD-10 and other advances toward the ultimate goal of improving the quality and affordability of healthcare for all Americans.” For healthcare providers unable to complete the necessary systems changes to submit claims with ICD-10 codes by Oct. 1, CMS has provided free billing software via MAC websites. This billing software has been updated to support ICD-10 codes to offer submitters an ICD-10 compliant claims submission form; coding assistance isn’t provided. Alternatively, all MACs websites provide internet portals; a subset of those portals offer claims submission.

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As aa regional regional community community hospital, hospital, we we are are committed committed As As a regional community hospital, we are committed athe regional hospital, we committed areDr. committed to providing providing best incommunity care to tohospital, our neighbors. Hamm, As aAs regional community we are to the best in care our neighbors. Dr. Hamm, to providing the in to care to neighbors. our Dr. Hamm, to providing theneighbor, best inbest Dr. Hamm, our newest has joined theneighbors. medicalDr. team at Henry Henry to providing the best incare care toour our neighbors. Hamm, our newest neighbor, has joined the medical team at our newest neighbor, has joined the medical team at Henry our County newest neighbor, has joined the medical team at Henry Medical Center, servingthe asmedical our newest newest Psychiatrist at our newest neighbor, has serving joined teamPsychiatrist at Henry County Medical Center, as our at County Medical Center, serving as our newest Psychiatrist at County Medical Center, as our newest Psychiatrist County Medical Center,serving serving asand ouropening newest Psychiatrist at at Lake Haven Behavioral Center and opening his own ownpractice, practice, Lake Haven Behavioral Center his own practice, Lake Haven Behavioral Center and opening his LakeParis Haven Behavioral Center and opening hisown ownpractice, practice, Lake Haven Behavioral Center and opening his Mental Health, to serve outpatient psychiatric needs. Paris Mental Health, to serve outpatient psychiatric needs. Paris Mental Health, to serve outpatient psychiatric needs. Mental Health, toserve serveoutpatient outpatient psychiatric needs. ParisParis Mental to psychiatric needs. Dr.Health, Hamm received his undergraduate degree from Dr. Hamm received his undergraduate degree from Dr. Hamm received his undergraduate degree from Dr. Hamm received his undergraduate degree from Dr. Hamm received his undergraduate degree from the the University at at Buffalo ininBuffalo, Buffalo, NY, studying Biology University Buffalo Buffalo, NY, studying studying Biology the University at Buffalo in NY, Biology the University at Buffalo in Buffalo, NY, studying Biology the and University at Buffalo inreceived Buffalo, NY, studying Biology Psychology. HeHe received his medical degree fromRoss Ross and Psychology. his medical degree from and Psychology. He received his medical degree from Ross and Psychology. He received his medical degree from Ross andUniversity Psychology. He received his medical degree from Ross School ofMedicine Medicine ininthe the Dominica and then University School of Medicine the Dominica and then University School of Medicine in Dominica and then University School of in the Dominica and then University School of Medicine in the Dominica and then completed his residencey atEast East Tennessee State University completed hisresidencey residencey at East Tennessee State University completed his at at East Tennessee State University completed his residencey Tennessee State University Quillen College of Medicine in Psychiatry. He has worked completed his residencey at East University Quillen College ofMedicine Medicine inTennessee Psychiatry. He worked has worked in Quillen College ofof in Psychiatry. HeState has in inin Quillen College Medicine in Psychiatry. He has worked Panama Beach, as well Knoxville, TN. He isiscurrently Quillen College of Medicine inwell Psychiatry. He worked in Panama CityCity Beach, FL as well asasKnoxville, Knoxville, TN. He currently Panama City Beach, FLFL asFL well as as Knoxville, TN. has He is currently Panama City Beach, as TN. He is currently accepting new patients. To make an appointment, appointment, contact Panama City Beach, FL as well as Knoxville, TN. Hecontact is currently accepting new patients. To make an contact accepting new patients. ToTo make an an appointment, accepting new patients. make appointment, contact Paris Mental Health at 731-644-8441. accepting new patients. To make an appointment, contact Paris Mental Healthatat at 731-644-8441. Paris Mental Health 731-644-8441. Paris Mental Health 731-644-8441. Robert Hamm, Paris Mental Health at 731-644-8441. Robert W.W. Hamm, MDMDMD Robert W. Hamm,

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Some Answers in Short Supply, continued from page 1 the Hill as well. The legislation was filed, heard and passed in numerous committees in 2014. Bill sponsors felt continued discussions were warranted and TMA staff and members spent the last half of 2014 meeting with insurers to try to reach a compromise. The bill requires the insurers contracting with physicians honor their financial commitments to those physicians for at least one year, allowing one fee schedule change. The TMA’s position on the issue behind the bill is that the constant rule-changing has made it impossible for physician practices to run a sound business model. “All providers have the right to be paid what they were promised when contracts were signed,” said Julie Griffin, director of government affairs, TMA. The TMA’s position is that staffing and other financial decisions are based on the fee schedule and changes not only affect the way they do business but also affect patients. “If that is changed 10 times, then it interrupts our business and can sometimes end our contracts prematurely, making patients sit out,” said Anderson. Another priority, according to Anderson, was the introduction of a bill for Physician-Led, Team-based Care. The bill is a response to an opposing bill by the Tennessee Nursing Association (TNA) to change the scope of practice such that advanced practice nurses (APNs) could practice without physician supervision.

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He said there is strong research to support that patients like seeing nurse practitioners, but they want a physician available to head their care. “We work very closely with mid-level practitioners and we feel they need to be part of a team with a physician at the head of it. In our bill, instead of calling it ‘supervisory,’ we are calling it physician-led,” he said. One of the arguments for more independent nurse practitioners has been access to physicians. Anderson does not see this as a problem in Tennessee. “In Idaho, where you might not have a physician within 400 miles, there is a problem,” he said. “In Tennessee, we need more primary care docs like everywhere else, and doctors are there and overworked, but they are there.” A petition with approximately 200

Marijuana, Medicine, continued from page 5 tionally, THC’s chemical makeup is similar to a naturally occurring brain chemical called anandamide. That similar structure lets THC be ‘recognized’ by the brain, allowing the outside compound to alter normal brain communication. Of major concern is the affect marijuana has on brain development when used heavily among adolescents. A recent study showed marijuana users who began in adolescence had fewer connections in the areas of the brain that control memory and learning. A large, long-term New Zealand study found those who began heavily smoking marijuana in their teens lost an average of eight IQ points between ages 13 and 38. However, that impact on IQ wasn’t replicated in the study among those who didn’t begin smoking until adulthood. NIDA also cited issues with cardiopulmonary and mental health. Gitlow said, “There’s a five-fold increase in psychotic disorders among those who use marijuana as compared to those who don’t.”

Alcohol vs. Tobacco, Marijuana

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APRIL 2015

supporters, says the opposite. The petition asks Senator Ken Yager and State Representative Dennis Powers to vote yes on HB456 and SB680 to allow full practice authority for nurse practitioners and no to HB861/SB521, which is the Physician-Led Team Based Care Act. Elizabeth Chadwell of Sharps Chapel, Tennessee, signed and said “I’m an NP and believe it’s time for change. Patients deserve better access to care and this change will help assure such access.” Another nurse practitioner, Lucille Vara, of Knoxville, asserted that “Research shows patient outcomes under NPS are as good as, even better than under physicians.” Wendy Owen, from Murfreesboro, claimed her APN saved her life on more than one occasion, as she is uninsured and was sent home from the hospital.

Last month, results of a new study stating marijuana is 114 times less lethal than alcohol made the media rounds and became fodder for late night comics. Gitlow said comparing the two is like comparing apples and oranges. “They affect different parts of the brain,” he said. Gitlow also noted it is possible to ingest enough alcohol in one sitting to kill you, which isn’t really true of marijuana or tobacco. “So I could make the argument that cigarettes are safer than alcohol,” he said. However, there aren’t many physicians recommending a patient give up the occasional glass of wine and take up smoking tobacco instead. “We’re not prohibitionists,” Gitlow continued. “No one at the American Society of Addiction Medicine says alcohol should be banned, but all these drugs collectively are an enormous burden on the American public from an economic and health-related standpoint.” Considering the dangers of tobacco and alcohol, Gitlow said he couldn’t fathom

why, as a country, we would want to add marijuana to the mix. “Why would we want to make our burden worse?” he questioned.

Possible Benefits

Gitlow reiterated his frustration at claims of marijuana being a medical marvel. “There is no medical purpose. No one has ever proven through a double-blinded trial a medical benefit of marijuana.” He continued, “That’s not to say there aren’t components within the plant that might not have medical application.” However, Gitlow said breaking down the more than 100 components in marijuana would require scientific investigation just like any other drug in this country seeking approval from the Food and Drug Administration. He added marijuana lobbyists bringing anecdotal evidence to legislators interested in the bottom line doesn’t constitute a thorough research endeavor. NIDA’s viewpoint is similar, noting that so far clinical evidence does not show the therapeutic benefits of marijuana outweigh the health risk. In it’s assessment of the drug, the national organization stated, “To be considered a legitimate medicine by the FDA, a substance must have welldefined and measurable ingredients that are consistent from one unit (such as a pill or injection) to the next. As the marijuana plant contains hundreds of chemical compounds that may have different effects and that vary from plant to plant, and because the plant is typically ingested via smoking, its use as a medicine is difficult to evaluate. “However, THC-based drugs to treat pain and nausea are already FDA approved and prescribed, and scientists continue to investigate the medicinal properties of other chemicals found in the cannabis plant – such as cannabidiol, a non-psychoactive cannabinoid compound that is being studied for its effects at treating pain, pediatric epilepsy, and other disorders.” With the increased attention being given to marijuana around the country, it’s a safe assumption that opponents and proponents will continue the debate. westtnmedicalnews

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MedicalEconomics BY BILL APPLING

Healthcare Industry Facts… Some low cost generic drugs that have “helped restrain” healthcare costs for decades are seeing unexpected price spikes of up to 8,000 percent. “If generic drug prices continue to rise, people all over this country who are sick and need medicine and will not be able to buy the medicines they need. (Senate subcommittee on Primary Health and Aging) An example: the antibiotic doxycycline hyclate rose more than 8,280 percent during a six- month period from $20 per bottle to $1,849 per bottle. (Associated Press, Nov. 21, 2014) 2,333,972 American military personnel had been deployed to Iraq, Afghanistan or both, as of Aug. 30, 2011. 711,986 have used VA healthcare between fiscal year 2002 and the thirdquarter fiscal year 2011. 38 per 100,000 of these Veterans using the VA healthcare committed suicide during the latest data available. There is very little information about veterans who did not use VA healthcare. Compare that to 11.5 deaths per 100,000 for the general public. (VA’s Iraq and Afghanistan Veterans of America – Non-profit organization.) $2,077 is the average balance in health savings and health savings reimbursement accounts in 2014, compared with $1,356 in 2008. (Modern Healthcare, Feb. 2015) “While there is a reported trend of physician employment with hospitals and health centers, we have seen some of those medical groups going back to private practice during the past two years. This phenomenon not only plagues medical group and physicians, it affects groups that join and merge with other private practices to form larger single-specialty or multispecialty groups. Unfortunately, many hospitals and medical groups believe that performing financial due diligence of a practice and then focusing on compensation considerations is sufficient to successfully negotiate a deal.” (“20-20 hindsight: Choosing hospital employment and returning to Independence.” Nick Fabrzio, PhD, FACMPE, FACHE; MGMA Connection Magazine, March, 2015) The adage that culture eats strategy every day of the week is certainly true with integration. The primary reasons for returning to private practice were the desire to stay involved in decision-making and ensure physician satisfaction. In hindsight, physicians said they wished they had spent more time talking about how decisions were made at the hospital and learning more about what their level westtnmedicalnews

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of involvement would be before they sold their group. While compensation is often the primary motivation, it is a necessary but not a sufficient condition for successful relationships. The prevalence and costs of Alzheimer’s disease are expected to grow substantially over the next few decades as the nation’s elderly population swells. • 5.4 million; estimate number of Americans living with Alzheimer’s in 2012, a figure expected to triple by 2050. ( Alzheimer’s Association ) • 17.7 billion; Number of unpaid hours of care provided by relatives and friends in 2013 to those with Alzheimer’s valued at an estimated $220 billion (Journal of the American Geriatrics Society) • $10,748; Average annual perperson payment for acute inpatient services for Medicare beneficiaries with dementia in 2013, compared with $4,321 for beneficiaries’ without dementia. (CMS) • 75 percent; Percentage of people living in a nursing home by age 80 who are expected to have Alzheimer’s. (Alzheimer’s Disease and Associated Disorders.) Dr. Karen DeSalvo heads up the Office of the National Coordinator for Health Information (ONC). ONC Tenure: January 13, 2014 to present. Observations about ONC So Far: There have been five coordinators, (former ONC chiefs over the last 10 years). Former ONC chiefs have differing views “about the role of government and the ONC in a national HIT strategy generally. Everyone is trying to solve the same three issues. They are capturing data, freeing it appropriately and then putting it to use. And everyone sort of sees a different way to do it.” Dr. DeSalvo has been impressed with the reach that the regional extension centers have in communities. (Apparently she has not been talking to the individuals and looking at the data that I have.) ONC’s Future: A top priority by the end of this year is to update the national health IT strategic plan and include provisions for patient-generated data. “The technology in that area, because it is so consumer and market driven, is advancing fast,” says DeSalvo. (Not true – it’s because of all the roadblocks and various silos impeding its progress.)

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 j.william.appling@ outlook.com.

APRIL 2015

What Does UnitedHealth’s Latest Move on Hysterectomies Mean?

Nation’s largest health insurer stiffens rules on hysterectomy coverage By JULIE PARKER

UnitedHealth Group, the nation’s biggest player in the health insurance market, recently announced a policy change to narrow the rules on hysterectomy coverage. Even though the insurer’s plan to impose tighter restrictions on the use of the morcellator has garnered the most attention – many hospitals ceased using the laparoscopic surgical device after the FDA reported in April 2014 the fast-spinning blade can actually spread uterine sarcoma in some women undergoing hysterectomies – the squeeze is also being felt on the performance of hysterectomies in general. UnitedHealth (NYSE: UNH), the insurer of 40 million patients based in Minneapolis, Minn., now requires specific authorization before most types of hysterectomies are performed. Only vaginal hysterectomies – the least invasive and inexpensive option – done on an outpatient basis are exempt. The policy doesn’t affect hysterectomies performed in cancer treatment. Approximately half a million hysterectomies are performed annually in the United States. Before UnitedHealth announced its policy decision, Anthem was the only major commercial insurer requiring pre-authorization for hysterectomies. Cigna and Aetna haven’t indicated they will follow suit. An Aetna spokesperson said the decision is “best left up to the physician and patient based on clinical circumstances,” a position also adopted by the American College of Obstetricians and Gynecologists (ACOG). Days after UnitedHealth’s announcement, ACOG members buzzed about the issue at an ACOG national leadership conference. “It’s been good fodder for discussion, though we’re taking it very seriously,” said Ravi Johar, MD, an OB/GYN from St. Louis, Mo., past president of the St. Louis Metropolitan Medical Society. “For UnitedHealth to reverse course, no one knows exactly what it means.” Johar, council chair of the Missouri State Medical Association, said OB/ GYNs are certainly accustomed to the pre-certification process. “We’ll do what we’ve always done,” he said. “We’ll discuss with patients all of the options and go from there. The decision is between the patient and physician. My job is to provide the best medical care possible. How that affects them financially is a big impact, but it’s not my area of expertise.” UnitedHealth is a good weathervane in the post Affordable Care Act era, with 10

APRIL 2015

its combination of market power, community support, and access to exceptional data, said Jay Wolfson, DrPH, JD, Distinguished Professor of Public Health, Medicine and Pharmacy at the University of South Florida (USF) Morsani College of Medicine. “In this case in particular, it’s important Dr. Jay to recognize that UnitWolfson edHealth, over the past couple of years, has been the most aggressive of the health insurers in tightening up their markets,” he said. “They began eliminating a lot of physicians and hospitals from their panels in many communities.” For example, said Wolfson, cancer and children’s hospitals were removed from UnitedHealth’s list of risk providers, based on the argument of cost being significantly higher at those healthcare facilities than others. “Procedures in hospitals like MD Anderson, Sloan Kettering and Moffitt may cost 50 percent more than non-specialty, community facilities,” he said. “That’s to be expected because they’re teaching hospitals.” Wolfson also pointed out that UnitedHealth acquired Optum, a healthcare technology firm established in 2010, which he considers one of the “best staffed analytic division of third parties.” “Optum focuses on quality, outcome and cost-effective analyses of United’s (and other available) databases” said Wolfson. “Their research translates into what, to whom and how much United will pay.” That influence has infiltrated the healthcare industry in many ways. In January 2013, while outsourcing work with Optum before bringing the firm in-house, UnitedHealth Group’s Center for Health Reform and Modernization proposed the use of predictive modeling software, particularly in Medicare and Medicaid programs, as tools for care management and information security as a possible solution to both healthcare fraud and preventable hospitalizations. “As part of the ACA, they’ll continue to drill down and drive down costs and utilization and attempt to be as directive as they can to their patients, physicians, hospitals … to optimize cost, utilization and safety while also reducing liability,” said Wolfson. Some hospital systems are adopting a tough stance against UnitedHealth’s culling process and policy changes they view as unfavorable. “Three years ago, BayCare (Health System, Tampa Bay’s dominant nonprofit hospital chain), went up against

UnitedHealth over reimbursement issues,” noted Wolfson. “Unlike most standoffs, there was no last minute negotiation and 450,000 members in Tampa Bay had to change hospitals and physicians because BayCare stood its ground against this healthcare delivery powerhouse.” Wolfson also sees a trend of separate policy issues, in part led by UnitedHealth, that are shaking up the medical device manufacturing industry and the pharmaceutical sector. “Until recently, pharmaceutical companies have had a tremendous influence in medical schools and communities concerning what medications physicians prescribe,” he said. “Now some medical schools across the country like ours have gone ‘drug-free’ and no longer allow pharmaceutical reps to teach in our classrooms or offer ‘educational’ program lunches.” The same cycle holds true for manufacturers of medical devices, Wolfson said. “The device manufacturing industry has also heavily affected medical practice,” he said. “Their significant influence is waning.” In response to UnitedHealth’s policy change on hysterectomies, medical schools will place a stronger emphasis on technical skills to perform vaginal hysterectomies. “We’ve developed a generation of surgeons who don’t know how to do vaginal surgery, quite frankly,” said Neil Finkler, MD, an OB/GYN in Orlando and CMO at Florida Hospital Orlando. “So many physicians stopped using vaginal hysterectomies and it’s not being taught very much,” Wolfson added. “Our younger medical students don’t have the skills. It’s easier to use a device, which generates more revenue and becomes a standard. Most clinicians interviewed say it’s safer, less complications, but it’s not done because it’s just not being done. That’ll change.”

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GrandRounds Dyersburg Regional Medical Center Appoints Chief Executive Officer Dyersburg Regional Medical Center has appointed Reba Celsor Chief Executive Officer. Celsor most recently worked as Chief Operating Officer at Raleigh General Hospital a 300-bed hospital in Beckley, West Virginia for three years. Reba Celsor Celsor joined Raleigh General as Chief Nursing Officer and also served as Interim CEO before being appointed to her most recent position. During her tenure, she enhanced the hospitalist program, helped the hospital achieve Level III Trauma Designation, opened a urological center and achieved Chest Pain Accreditation. She also contributed to the recruitment of physicians in several specialties such as orthopedic surgery, general surgery, interventional cardiology, internal medicine and family medicine. Celsor has held a variety of roles during her nearly 30-year healthcare career, beginning as a registered nurse and progressing into leadership positions of increasing responsibility at hospitals in Florida, Kentucky and Tennessee. Ceslor received a master of business administration from Colorado Technical University and a bachelor’s degree in management and human resources from Trevecca Nazarene University in Nashville. She also has an associate’s degree in Applied Science of Nursing from the University of Kentucky.

West Tennessee Healthcare Foundation Announces New CFO The West Tennessee Healthcare Foundation proudly announces the hiring of a new Chief Financial Officer. Stephanie Fowler joined the Foundation staff on April 6. Fowler’s credentials include a degree in accounting, certification Stephanie as a Certified Public AcFowler countant and a member of the Tennessee Certified Public Accountants. A graduate from Union University, Fowler has been employed by Horne, LLP since 2006. Fowler served as a college intern and was hired to work at Horne following her graduation. She has volunteered in the community as a committee chair for the Horne Relay for Life committee and is the current Vice President for Finance for the Jackson Arts Council. Frank McMeen, President of the Foundation said her immediate initiatives will include: 1) enhancing accounting services to achieve timelier reporting 2) upgrading on-line system for westtnmedicalnews

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donors and volunteers 3) enhancing internal controls that would protect funds and their charitable interests.

Area Families Asked To Participate In Research Study Healthy Start and Healthier Beginnings of West Tennessee Healthcare are looking for expectant moms to participate in a research study that could help families across the nation. The pregnant women should be at least eight weeks away from their due date and more than

15 years of age. The study called MIHOPE-Strong Start is designed to evaluate and measure, mother and infant home visiting and outreach programs. The programs look at improving birth outcomes, maternal and infant health, and all health care costs in a child’s first year. More than 15,000 families in 20 states are expected to participate in the study. MIHOPE is sponsored by the U.S. Department of Health and Human Services’ Center for Medicare and Medicaid

Innovation at the Centers for Medicare and Medicaid Services, in partnership with the Administration for Children and Families, Office of Planning, Research and Evaluation; and the Health Resources and Services Administration’s Maternal and Child Health Bureau. For more information or to find out how expectant moms can participate, contact Healthy Start/Healthier Beginnings at 731-541-6954.

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