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April 2020 >> $5 ON ROUNDS Novel Virus Bringing Uncertainty and Change
Dr. Phillip Lieberman acknowledges a new learning curve is underway Dr. Phillip Lieberman’s ofﬁce phone is ringing a little more often in these days of worldwide concern over the fastspreading coronavirus, Covid-19.
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Making Sense of a Quickly Changing Healthcare Scene If you have sensed an acceleration of change in the healthcare landscape, you would be correct. The evidence has been many recent events in Memphis and over the last two weeks perhaps none greater than the COVID-19 challenges, responses and new realities. How should it all be viewed?
AARDA: Addressing Autoimmune Disorders through Awareness, Advocacy & Action By CINDY SANDERS
When it works efficiently, the immune system is an elegant masterpiece of defense mechanisms warding off foreign invaders, including bacteria, cancers and the current novel coronavirus. For as many as 50 million Americans, however, a glitch in the system leads to chronic disease that can be difficult to identify and harder to manage. “The body literally turns on its own tissues with a disproportionate overreaction,” noted Randall Rutta, president and CEO of the American Autoimmune Related Diseases Association (AARDA). That internal attack manifests in scores of ways with targeted assaults on organs, tissues, joints, glands or the entire body. “We now believe there are at least 130 separately identifiable autoimmune diseases,” said Rutta.
AARDA was founded in 1991 by Virginia Ladd, who herself has autoimmune disease and was a leader in the lupus (CONTINUED ON PAGE 4)
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Eric Schnapp, MBA, JD, CEO-Mays & Schnapp Pain Clinic & Rehabilitation Center By JUDY OTTO
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When Dr. Kit S. Mays and Dr. Moacir Schnapp, pioneers in the field of pain management, first established the Mays & Schnapp Pain Clinic and Rehabilitation Center in 1985, Schnapp’s son Eric was only two years old. In 2019, Eric Schnapp, MBA, JD, stepped into the role of CEO at Mays & Schnapp – after first following a career path that led him through experiences in (CONTINUED ON PAGE 6)
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Making Sense of a Quickly Changing Healthcare Scene If you have sensed an acceleration of change in the healthcare landscape, you would be correct. The evidence has been many recent events in Memphis and over the last two weeks perhaps none greater than the COVID19 challenges, responses and new realities. How should it all be By Bill Breen viewed? As a pessimist you might say, “well I was waiting for such a moment to explode the myth that we were prepared for large scale infectious disease.’ As an optimist you might point to the breakneck speed innovation and retooling of people, plant and equipment under the fire of a pandemic. Perhaps a realist might agree with both points of view. Regardless of the place on the spectrum we fall, I would suggest the most important future lens by which to measure the macro and micro strategies in healthcare is value. Value for the patient is often described as achieving BOTH lower costs
and better outcomes. Yes, perhaps you may continue to buy or build bricks and mortar facilities, distribution channels, service lines and the like. A marketplace rewarding value will not wipe out entire categories of healthcare overnight or at all. But what it will do is tilt the playing field. When you read of purchases, divestiture, layoffs, closures, strategy changes and the like, ask yourself what role value plays in these developments. If I had a dollar to divide up in investment in healthcare, I would lean heavily toward value as a deciding factor of where to put my money. The government has signaled a strong effort to reward value. Because of COVID - 19 we are seeing obstacles to digital health (examples are telemedicine and remote monitoring) vanish and the beginning of a decreased reliance on bricks and mortar, whether it be the Primary Care office space or an Emergency Room. Any entity that is both highly leveraged or ultimately reliant on today’s access points and relatively inefficient care models will face pressure to conform. To be successful, future business models must ask the question, ‘Does this replace something more expensive? Does this provide greater
access? Does this empower the patient?’ Over the last few years, I sensed a great deal of cans being kicked down the road on this subject. It might take the form of a hospital saying, ‘well I agree, but until the incentives change and I’m not rewarded by volume, I’m going to keep working to acquire volume. It might sound like a doctor saying, ‘well, I agree, I need to change but I’m retiring in a few years, I won’t have to deal with much of that.’ The status quo and the familiar environment can prove to be a powerful incentive to stay put. But through the value lens you can understand key strategic decisions. Like why a large specialty group would basically take control their part of the premium dollar. They must be accountable and be able to control input costs like facility expenses and implantable hardware. Through the value lens you can better understand why a GI group would have endoscopy centers and take ownership over expenses related to their specialty. These moves may create margin, true, but if they replace a more expensive service, they are driving value. In many healthcare circles we have long thought that to be fair we had to be unfair. Deny such changes or drag it out to protect
Protecting Our Medical Supplies from Foreign Dependence There is one thing the Coronavirus Pandemic has brought to everyone’s attention. The United States is far too dependent upon China and other Asian countries for our drugs and medical equipment. I am calling upon the President and Congress to create a Strategic Medical Stockpile, (SMS). This is a matter of National Security, to protect the health and lives of Americans. The SMS would be like our Strategic Petroleum Reserve, it would be drawn down for use in the United States when there is a disruption in the supply chain of critical medical supplies. Generally, the SMS would provide a supply of our most necessary prescription drugs, Active Prescription Ingredients, (API) and medical devises, for a period of time until U.S. manufactures could obtain the necessary materials to provide our supplies. Since the 1990s, U.S. companies have increasingly imported pharmaceutical products from China and India. The ingredients and labor are cheaper, and regulations are fewer in those countries. Result, we are now heavily dependent upon these countries for our drug and medical supplies. The basic facts about our supply chain of drugs in the county is: • China is a large exporter of drugs, biologicals, (drugs from natural sources) to the U.S. • China is the largest supplier of medimemphismedicalnews
cal devises. - Class 1: Bandages and Gloves - Class 2: Scissors, forceps and other surgical supplies - Class 3: Pacemakers and ventilators - Class 4: Imaging Devices • About 80 percent of Active Pharmaceutical Ingredients come from China and India • The U.S. relies upon China for 90 percent of our generic prescription medicine • India provides over 40 percent of the over-the-county drugs to the U.S. • India depends heavily upon China for the ingredients in their drug production From a supply chain perspective, India is dependent upon China. Factories in China have been closed to deal with the coronavirus, so India has been forced to slow production of its products coming to the U.S. Further, the Indian government has stopped the export of twenty-six pharmaceutical products, mostly antibiotics to ensure adequate supplies remain in their own country. This decision makes drug shortages a potential here in the U.S. particularly, antibiotics. We know the Federal Drug Administration, (FDA) has asked drug companies to evaluate their supply chains with China and India and take steps to mitigate potential shortages. The question is, are U.S.
manufacturers gearing up to compensate for the foreign shortfalls. Do we know the time required to start up production and to make an impact on the U.S supply for prescription and OTC drugs? The dependence upon foreign countries for drugs in not the only medical supply item impacted. There are major medical devices that are manufactured in China. Firms in the medical devise manufacturing industry produce diagnostic, medical monitoring, and treatment equipment. Surgical masks are also predominately made in China, and testing kits are made in Europe. Finally, the Center for Disease Control warns that we are in short supply of masks and testing kits. The United States needs to ensure that the American people are provided for in times national health emergencies or other national impactful health events. The Department of Health and Human Services, (HHS) should seek Congressional approval and funding to create a Strategic Medical Stockpile, which is constantly replenished and kept separate from the Strategic National Stockpile. I have listed six steps to set up the Strategic Medical Stockpile, and I encourage you to evaluate my solutions. https://www.realsolutionsfortn.com/ strategicnationalmedicalsupply — George S. Flinn, Jr., MD, Republican Candidate U.S. Senate
the greater good. Regardless, I believe the scales are falling off our eyes and we are going to see value more clearly. One of the most noticeable environments where you can expect change is primary care. I believe we are going to witness a resurgence in the value and accountability of the primary care physician and practice. No provider can benefit more from a move to value than primary care. The convergence of an aging population, Medicare Advantage growth and valuebased reimbursement models are driving a change in how we view the primary care practice and evaluate future opportunities for improvement. Payers are increasingly eyeing primary care as a true partner to gain elusive performance on cost and quality. Note the recent introduction of organizations like Chen Med and Oak Street Health. These are value-based primary care organizations. In some ways they are a glimpse into the future. Every health care provider and ancillary vendor needs to revisit their strategy and build in valuebased change. And when it seems crazy out there, and it is sometimes, remember to view it all through the value lens. You can count on value for the patient to be a viable true north for strategy. William R. (Bill) Breen, Jr., DSc, is Market President for the Mid-South for Prime East, LLC. Prior to joining Prime East, Breen was Senior Vice-President of Physician Alignment at Methodist Le Bonheur Healthcare (MLH) from 2010 to 2018. Prior to LBH, Breen was CEO of Health Choice from 1997 to 2010. Prime is a division of Premier, a Dallasbased Prime East and Premier focus on building physician-owned, physician-led and patient-focused healthcare organizations. Contact firstname.lastname@example.org.
AARDA: Addressing Autoimmune Disorders, continued from page 1 movement. Although support organizations and research efforts existed for a number of the more well-known autoimmune diseases including lupus, type 1 diabetes and rheumatoid arthritis, Ladd began to wonder why there wasn’t an umbrella organization to advocate for all the diseases that fall into the autoimmune category. “We needed to understand the common denominator of those diseases,” Rutta said Randall Rutta of the impetus to form AARDA. “Sadly, to this day, we still don’t fully understand the underlying causes of autoimmune disease.” While there are still many mysteries, Rutta said a lot has been discovered over the ensuing decades. Autoimmune disease primarily impacts women, often in their late teens, 20s, 30s and 40s as they are building careers and families. There is a familial component to developing autoimmune disease and having one disorder increases the risk of developing others over a lifetime. “Thirty percent of people who have a single autoimmune disease will actually have two or more,” explained Rutta, adding support for those with multiple conditions is exactly why AARDA is so unique and important.
Even with an increasing body of sciis accurately measuring levels of fatigue. entific evidence, pinpointing a specific While everyone does get tired at times, those Supporting the Science autoimmune disease is often a difficult with autoimmune disease typically face endeavor for both patients and providers. overwhelming fatigue that can make it difWith so many unknowns about the underlying cause or causes of autoimmune Although conditions dia- Rutta ficult tothe even getway outtooffind bedanswers at times. Rutta disease,some AARDA Presidentlike andtype CEO1Randall said best is to betes have the definitive markers, most diseasesAARDA saidpromotes AARDA is proposing a collaborasupport researchers asking questions. innovation and discovery a number ofspectrum grants andare programs. in through the autoimmune much tion with the Patient-Centered Outcomes Direct research investment includesto the Virginia T. LaddInstitute Young Investigators more difficult to identify. “The journey Research (PCORI) to better Program, Rose to Scientific Johns Hopkins Autoimmunity Awareness diagnosis canNoel takeR.three five to Colloquia, seven … andunderstand how fatigue is being identified and Intern Diversity. or even 10 … years,” said Rutta. “It’s the as a first step toward improving measureThe Autoimmune Network – isand a registry of more than rare person who on first Research referral gets to the– ARNet ment benchmarking of22,000 the common patients that serves as a common databank for researchers and clinical trials. Created in specialist who will ultimately treat them.” symptom. conjunction with other autoimmune disease groups, the goal is to improve representation Rutta noted getting the right combination in clinical trials, which often have exclusion criteria preventing those with chronic or of referral, treatment remains Advances multiple diagnosis conditionsand from participating. Additionally, the goal is to increase equity by tough for many Americans. “One of AARDespite ongoing diagnostic difficulties encouraging greater participation along gender, race, age and ethnicity. DA’s key objectives is shortening that time education in autoimmune Rutta said, “It’s still AARDA also supports science through by hostingdisease, physician conferences to diagnosis,” he added. an area, from medicaltoscience to share information and foster greater collaboration, as well as aseminars educateperspecand empower patients and While providers arefamilies. more aware of tive, that’s advanced leaps and bounds.” autoimmune disorders now, diagnosing still relies heavily on a process of elimination. “Fatigue is a shared condition across almost all autoimmune disease,” said Rutta. However, AARDA found the way fatigue is interpreted varies significantly by gender. Rutta said the organization funded a study several years ago focused on fatigue. Men who told providers they felt constantly fatigued were taken seriously. The women were often told everyone gets tired and were labeled chronic complainers. “There’s definitely a gender bias there,” Rutta stated. One of the problems, he continued,
After years without targeted medication options, there have been significant advances more recently. “Increasingly, physicians can choose from multiple treatment options,” said Rutta. “Previously, the only option was to manage symptoms with steroids – often with severe side effects and lasting damage.” He continued, “What we have seen that has been life-changing advancements in biologics. These are breakthrough medicines produced by living organisms.” Rutta added the field has advanced to a point where biosimilars are beginning to become
available, making treatments more widely accessible and affordable than the original branded biologics. “Gene therapies hold a lot of promise that are just coming on the horizon,” continued Rutta. He noted with excitement that these newer developments could potentially lead to cure rather than symptom management. Newer rules and regulations for orphan and rare drugs have also helped. Through the FDA fast track program for breakthrough drugs, teprotumumab-trbw has just been approved to treat thyroid eye disease (TED), most commonly associated with Graves’ disease. The rare condition causes the muscles and fatty tissue behind the eyes to become inflamed, causing the eyes to push forward and bulge outwards. Previously, the only hope to slow the disease was steroid injection or to surgically scrape sockets to try to make more room for the eye. “If this new drug is administered to someone during the five-year active phase of the disease, the result for many patients is to stop progression and even reverse harmful effects,” said Rutta. He continued, “This also speaks to why the journey to diagnosis needs to be faster.” To that end, Rutta also is encouraged by the discovery of more biomarkers and advancing diagnostic tools to improve time to treatment. (CONTINUED ON PAGE 6)
CMS Issues New Wave of Infection Control Guidance to Protect Patients, Healthcare Workers The Centers for Medicare & Medicaid Services (CMS) has issued a series of updated guidance documents focused on infection control to prevent the spread of the 2019 Novel Coronavirus (COVID-19) in a variety of inpatient and outpatient care settings. The guidance, based on Centers for Disease Control and Prevention (CDC) guidelines, will help ensure infection control in the context of patient triage, screening and treatment, the use of alternate testing and treatment sites and telehealth, drive-through screenings, limiting visitations, cleaning and disinfection guidelines, staffing, and more. The guidance is designed to empower local hospitals and healthcare systems, helping them to rapidly expand their capacity to isolate and treat patients infected with COVID-19 from those who are not. Critically, the guidance released today includes new instructions for dialysis facilities as they work to protect patients with End-Stage Renal Disease (ESRD), who, because of their immunocompromised state and frequent trips to health care settings, are some of the most vulnerable Americans to complications arising from COVID-19. The guidance is part of the unprecedented array of temporary regulatory waivers and new policies CMS issued on March 30, 2020 that gives the nation’s healthcare system maximum flexibility to respond to the COVID-19 pan4
demic. “CMS is helping the healthcare system fight back and keep patients safe by equipping providers and clinicians with clear guidance based on CDC recommendations that reemphasizes and reinforces longstanding infection control requirements,” said CMS Administrator Seema Verma. The guidance is particularly timely for dialysis facilities. Dialysis facilities care for immunocompromised Americans who require regular dialysis treatments and are therefore particularly susceptible to complications from the virus. Today’s updated guidance has multiple facets, including the option of providing Home Dialysis Training and Support services – to help
some dialysis patients stay home during this challenging time – and establishment of Special Purpose Renal Dialysis Facilities (SPRDFs), which can allow dialysis facilities to isolate vulnerable or infected patients. These temporary changes allow for the establishment of facilities to treat those patients who tested positive for COVID-19 to be treated in separate locations. In addition to dialysis facilities, the infection control guidance affects a broad range of settings including hospitals, Critical Access Hospitals (CAHs), psychiatric hospitals, Ambulatory Surgical Centers (ASCs), Community Mental Health Centers (CMHCs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Outpatient Physical Therapy or Speech Pathology Services (OPTs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs). For hospitals, psychiatric hospitals and CAHs, the revised guidance, for example, provides expanded recommendations on screening and visitation restrictions, discharge to subsequent care locations for patients with COVID-19, recommendations related to staff screening and testing, and return-to-work poli-
Similarly, for hospitals and CAHs, the revised guidance on the Emergency Medical Labor and Treatment Act (EMTALA) includes a detailed discussion of: patient triage, appropriate medical screening and treatment; the use of alternate testing sites; telehealth; and appropriate medical screening examinations performed at alternate screening locations, which are not subject to EMTALA, as long as the national emergency remains in force. This step will allow hospitals and CAHs to screen patients at a location offsite from the hospital’s campus to prevent the spread of COVID-19. For outpatient clinical settings, such as ASCs, FQHCs, and others, guidance discusses recommendations to mitigate transmission including screening, restricting visitors, cleaning and disinfection, and closures, and addresses issues related to supply scarcity, and Federal Drug Administration (FDA) recommendations. In addition, CMS encourages ASCs and other outpatient settings to partner with others in their community to conserve and share critical resources during this national emergency. Updated guidance for ICF/IIDs, and PRTFs include practices related to screening of visitors and outside health care service providers, community activities, staffing, and more. memphismedicalnews
Novel Virus Bringing Uncertainty and Change
Dr. Phillip Lieberman acknowledges a new learning curve is underway By LAWRENCE BUSER Dr. Phillip Lieberman’s office phone is ringing a little more often in these days of worldwide concern over the fast-spreading coronavirus, Covid-19. Actually, the phone is ringing a lot more often. “It’s affected the practice by having to institute screening measures for each phone call so we can follow CDC guidelines as to what a patient should be told when they call in for a visit,” said Dr. Lieberman of Family Allergy & Asthma on Poplar in East Memphis. “We have a number of screening questions about their symptoms, whether specifically they’ve had fever and to what degree. Those patients with increased scores may be true candidates for having corona. “They’re encouraged not to come in because the only therapy we can offer is supportive therapy which we can do by telephone without increasing the risk of spreading to other patients in the office, or to the health care providers in the office.” As an expert in asthma and immunology, Dr. Lieberman believes sufferers with chronic lung disease possibly are more susceptible to contracting corona and are likely to be in for a worse time if they do get the virus. “We have known from other corona viruses, like SARS or MERS, that chronic lung conditions, while they may not necessarily contract it more frequently, when they get sick with those viruses in many cases it’s worse than in those with normal lungs,” the doctor said. “This particular epidemic, to my knowledge, has not demonstrated that asthmatics per se are more severely afflicted, but common sense tells us that anyone with asthma who has diminished lung function would be more severely afflicted. So recently we have considered these patients to be at increased risk, not for contraction but for a more-serious episode if one does contract the disease.” Higher on the risk scale are the elderly, whose immune systems have been put to the test again and again over a lifetime, fighting off all manner of infections and microscopic foreign invaders for decade after decade. All of those biologic battles take a toll on the immune system which, like every other part of the body, becomes less effective as a person advances toward senior status. “Age itself is an independent risk factor, probably because the immune system undergoes with age what we call senescence,” Dr. Lieberman said. “One can see the visible effects of aging on a person’s appearance and those same effects occur memphismedicalnews
internally where we can’t see it, especially in the immune system. Its ability to fight infection diminishes with age and the older one gets the more accentuated it becomes.” This makes the elderly easy targets for all manner of diseases and ailments. “The other reason the elderly are more susceptible to severe attacks,” Dr. Lieberman adds, “is that there’s a very strong correlation between chronic diseases and aging and additional medication use, so older people are more commonly afflicted with heart disease, lung disease, diabetes, all the conditions which we know lower our resistance to the viral infections. It also makes the cases that are contracted worse.” While researchers believe leading a healthy lifestyle – proper diet, exercise, sleep, stress management – can give important support to the immune system, Dr. Lieberman says there’s no way to actually strengthen or improve the system itself. “I wish there were, but the effects of aging can’t be altered acutely and once you’ve reached a certain point there’s no way to reverse that,” he said. “With this particular virus, when you’ve reached age 60 you have increased your risk for contraction, but more importantly for severe disease. At age 70 there is a prominent increase and then at 80 you’re at the highest level. There’s very strong statistical sig-
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nificance to these decades. Severe episodes are far more frequent the older one gets.” Respiratory infections, influenza, and particularly pneumonia have long been a leading cause of death in people over 65 worldwide, but the rapid spread of the Covid-19 virus has surprised even experts like Dr. Lieberman, the former president of both the American Academy of Allergy, Asthma and Immunology, and the American Association of Certified Allergists. “I’ve not lived through an epidemic like this in my 50-something years of practice,” he said. “For those of us who finished medical school quite a while ago, we’re relearning the basic principles of epidemiology as this virus hase transformed our lives. This is a novel experience for all practicing physicians today.” He said the most common defenses – social distancing and quarantine – remain the best strategies for slowing the corona spread while researchers work on developing drugs or vaccines, both of which will take considerable time.
Where Covid-19 is headed and where it will end remains a mystery, the doctor says. “It depends on several factors, the most important one being whether this virus is seasonal, or non-seasonal and ever-present,” Dr. Lieberman said. “If it’s seasonal, we’re probably pretty lucky because then it will burn itself out just like the flu does, usually around the end of May when the weather gets warm. Not all respiratory viruses are seasonal, though, so we don’t know how this one is going to behave.” Yellow fever claimed more than 5,000 lives in Memphis in the 1870s, a seasonal epidemic that spread unchecked until the cold months of winter arrived when there were no more mosquitoes. That connection was not recognized until years later. “Of course, we are far better off today,” said Dr. Lieberman, “except back then people understood that if they left the city they could get away from the disease. When you were here it was just a disaster.”
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Bringing Law, Order and Expansion to a Time-Honored Institution, continued from page 1 entrepreneurship as well as healthcare law and pharmaceutical and medical device product liability litigation in nationally recognized legal departments.. Armed with an MBA from Vanderbilt University’s Owen Graduate School of Management, and a JD from Emory University School of Law, he has served as district attorney special prosecutor, litigated numerous trials across the country, and has managed and operated businesses in addition to creating and managing his own “Media Butler” enterprise, which created customized audio-visual media rooms for corporate presentations. “Growing up with this clinic,” Schnapp reflects, “participating in dinner table conversations every night, I had always enjoyed science and, later, working with healthcare cases; but what was lacking for me at the law firm was the business side of things. I was still very much an entrepreneur and very much enjoyed the business aspect of it, so I wanted to marry those two together.” The opportunity arose when he joined Mays & Schnapp in 2019. “I had always counseled them throughout the years with my knowledge of health, law, and business, but that was unofficial – until we recently decided to make it official.” The timing was right: For nearly 35 years, he points out, this was a practice with two physicians and an administrator. “It wasn’t big enough to warrant someone operating in a CEO’s capacity. But within the past year or two, it has grown to such a proportion that the position itself was needed.” Today, the practice has seven providers, including three physicians; and Schnapp oversees a staff of more than 55, including support personnel across clinical operations, physical therapy, and the ambulatory surgery center. Patient volume continues to grow, which has motivated Mays & Schnapp to locate a new clinic in Southaven, scheduled to open within the next two months. The greatest challenge he faces, says Schnapp, is continuing to grow and expand care to additional patients while still maintaining the philosophy that has made Mays & Schnapp the oldest and most highly-regarded pain management
facility in the Mid-South. That philosophy holds that chronic pain is best treated using a multimodal approach that includes a number of nonopioid therapies in concert with each other to provide the best possible pain relief. Since no two patients are alike, successful solutions often require a unique combination of modalities, including physical therapy and clinical methods. “Keeping our philosophy is important,” Schnapp stresses. “Spending time with our patient is what differentiates us from other places.” Accredited in 1989 by the Commission on Accreditation of Rehabilitation Facilities (CARF), today Mays & Schnapp is the only outpatient interdisciplinary pain rehabilitation program in Tennessee and the tri-state region to maintain that accreditation. The founders’ early success was built on their pioneering work in designing, developing and producing rehabilitation instruments including the iPosture, an electronic posture-correcting device, as well as the first computerassisted therapies for the treatment of complex regional pain syndrome (CRPS). Like his father, Eric Schnapp enjoys problem-solving. “That was always a hobby of mine and Dr. Schnapp’s since I was little,” he recalled “We invented probably a thousand new devices or businesses, just the two of us – just sitting and talking.” It’s a habit that supports the Mays & Schnapp longstanding commitment to finding ways to help their patients, whether traditional conventional ways or creating something new. That “something new” is often a combination of components that work best together to generate the greatest impact on pain: e.g. spinal cord stimulators interacting with nerve blocks, in concert with a regimen of physical therapy. After a rigorous vetting process by the unit’s creators, Mays & Schnapp was recently approved as one of only two independent sites in the U.S. to perform non-surgical peripheral nerve stimulator (PNS) therapy, used for neuropathic pain, Schnapp noted. PNS benefit patients with hard-to-manage postoperative shoulder or knee pain, post-amputation pain, and patients with mononeuropathies in
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which pain results from a single damaged nerve. Has pain evolved along with our lifestyles? Schnapp notes that while they may see different underlying causes for pain – like carpal tunnel syndrome that was unheard of 50 years ago – pain itself isn’t changing. “Pain will always exist,” Schnapp noted. “And ways are needed to help alleviate that pain and improve function for the patients.” Their focus remains on finding new ways of addressing its different forms, which may range from back and neck pain, sciatica, shingles, arthritis, bursitis, RSD, multiple sclerosis and fibromyalgia to peripheral neuropathy from diabetes. Has research shown us anything new about pain? “Last year a Health and Human Ser-
vices task force put together a large report about pain,” Schnapp recalled, “and one of their main findings was that providers should refer to pain earlier. Primary care or other physicians may not necessarily be equipped to understand what’s needed and to provide an appropriate level of treatment. Left untreated, chronic pain that continues over time becomes harder to eradicate or alleviate,” he warned. “It’s very important to address this early, and to refer pain patients sooner rather than later.” Schnapp and his wife – also an attorney – have two children under four who keep them busy, tired, and fit. Together they enjoy traveling and exploring: Schnapp has climbed Mount Kilimanjaro and taken his family to Morocco, Colombia, the Azores, and more. “If we find a place to go to and there’s a nonstop flight, I’ll go!”
AARDA, continued from page 4 COVID-19
“We knew right away when the CDC started talking about underlying conditions, those with autoimmune disease would be included,” said Rutta. However, he added, much of the public messaging has focused on diabetes, heart disease and respiratory illnesses. Part of AARDA’s task has been getting the word out that everyone with any form of autoimmune disease is at higher risk for more severe disease with the current coronavirus. AARDA established a dedicated COVID-19 resource on the website to ensure accurate information is available. On the treatment front, he said, “COVID-19 has been very disruptive. For most people sheltering in place, they couldn’t just ask for an extra 30-day supply of medicine.” Drugs and biologics to treat autoimmune disorders are often expensive with high co-pays that could make it cost prohibitive to prepay for extra months, even if a patient could get it approved. Additionally, a lot of patients receive infusions or injections at hospital-based clinics. Between overwhelmed hospitals and patients trying to steer clear of potential coronavirus hot spots, it has made it difficult to receive treatment. Rutta said AARDA applauds emerging actions by the government and insurers to help patients stick with their treatment regimens during the pandemic, through extra refills, options for home treatment, and telemedicine. “Then, along comes the idea that hydroxychloroquine might treat the coronavirus, and all of a sudden lupus patients and Sjogren’s patients, who also rely on it to survive, call their pharmacies and can’t get it,” said Rutta. “Those are real challenges for people with autoimmune disease. It’s causing fear and stress. If there’s one thing we know about autoimmune disease, it’s that stress exacerbates their condition.” AARDA, on behalf of the National Coalition of Autoimmune Patient Groups, is co-hosting a virtual national briefing with
the CDC in early April to discuss aspects of the pandemic that are of particular relevance to their constituency. Additionally, Rutta said AARDA is actively talking to legislators about ensuring access to medications and approving additional sites of care, potentially even in a patient’s home, during the pandemic.
Ensuring patients have access to needed treatments isn’t uniquely a COVID- challenge. Instead, it is an ongoing battle for many. “Too often insurance plans and PBMs (pharmacy benefit managers) use step therapy – utilization management practices and policies designed to control costs that are medically appropriate for the general population,” explained Rutta. He added these policies often “cause unwarranted suffering and lasting damages for patients forced to take medicines they know will not help them or delay effective and prescribed treatments.” AARDA also looks to physicians to craft the coordinated, integrated care needed to manage autoimmune disease, and Rutta said treatment decisions should always be made by physicians in consultation with patients. “Providers must take a patient-centered view … trust the patient in their description of their condition,” he noted, adding it’s also critical to engage patients as active partners and advocates in their own health and wellness. Rutta urged employers, payers, legislators, providers and other decision-makers to keep those with autoimmune diseases in mind when crafting policies, treatment regimens and regulations. “If we can all understand autoimmune disease is a natural part of the human condition, we should make sure we aren’t putting any barriers in place to inhibit people from living their best lives as we look for cures or therapies to manage symptoms,” he concluded.
Orthopedic Surgeon Replicates Nashville Practice in Rural West Tennessee By SUZANNE BOYD
Watching rural healthcare decline around him, orthopedic surgeon Michael Calfee, MD, found himself with an opportunity to not only be able to provide the best care possible to the residents of Obion, Tenn., and surrounding counties, but to also provide them with access to care that they may have otherwise had to look to the city to find. In 2009, Calfee, who was practicing in Michael Calfee Huntingdon at the time, had an opportunity to purchase a medical office building in Union City and took it, relocating his family to Union City as well. By 2012, he was practicing full time in Union City. “Before I came to Union City, there had been four orthopedists here, but that number was rapidly dwindling down,” said Calfee. “I was pretty much the only one in town and my practice has evolved tremendously over the years.” When he made the move to Union City, Calfee envisioned hiring a partner and he added physical therapy to his practice. The growth he expected did not pan out which meant he did not need a partner. In 2016, he also closed the physical therapy side of his practice and discontinued the athletic trainer component. All to allow him to focus more on his strengths and his practice. Just as doors were closing around his practice, one other closing in town resulted in a huge opportunity for Calfee. “In 2016, as I was closing down some of the elements of my practice, the Union City Surgery Center was also closing and I owned the building,” he said. “I needed something in there to generate revenue, but it would require a partner. I started calling everyone to help me restart it. And it was going to be a heroic effort because I would also have to convince Baptist to let me re-open it.” Calfee’s search let him to David DeBoer, MD, in Nashville. “His was a name I had heard forever since lots of people from the area were going to him, so I approached him about helping me re-open the surgery center and he said yes,” said Calfee. “It took a heroic effort to jump through all the hoops and to get Baptist Memorial Healthcare to let us reopen it, but we did.” Partnering with DeBoer, says Calfee, has been a blessing. “He is in practice with six orthopedic surgeons who were memphismedicalnews
well experienced in total joint replacement surgeries,” said Calfee. “We were able to draw upon their experience and evidence-based practices from Centennial Hospital in Nashville and replicating it in Union City. Since doing our first case in 2017, we have a zero infection rate and our results have been really good. We have been tracking outcomes since day one. We typically have total knee or hip patients walking within an hour of their procedure and out the door in two which is outstanding. People are happy and we are providing a really good service to our patients.” The center has done about 150 total joint replacement surgeries in the past three years. Calfee anticipates additional growth in 2020 since Medicare has approved outpatient total knee replacements in an ambulatory setting. “This has really helped these types of surgeries in an ambulatory setting take off,” he said. “Literature such as Becker’s Hospital Review indicates that in five years 50 percent of all total joint procedures would be performed in an outpatient setting such as an ambulatory surgery center.” In addition to podiatrists, Thomas Hodgekiss, MD, a pain management and regenerative medicine specialist is also a part of the team at the center. “He is an interventional radiologist that deals with pain management that does not involve narcotics. He also provides epidural pain treatments,” said Calfee. “He does a lot of spinal cord stimulation for chronic pain and is having really good results. If he was not here, patients would be having to go to Nashville for this type of treatment.” Calfee grew up in Cleveland Tennessee and earned a bachelor’s degree in Biology and Religious Studies from The University of Tennessee at Knoxville in 1991. He was accepted to medical school in his junior year and attended the University of Tennessee at Memphis for Medical School. He completed his residency at Campbell Clinic in Memphis. The following year, he completed a fellowship in foot and ankle medicine. “There was really nothing I cared about but orthopedics. In fact I was not really sure I was meant to be a doctor as I was to be an orthopedic surgeon. I really like to be able to help people and it is pretty amazing what modern orthopedic medicine can do when we get it right,” said Calfee. “I feel like rural healthcare is on the decline. Having the Surgery Center and bringing the experts we’ve been able to bring in, means we can still provide a high level of care in the rural setting. I truly want to take care of the people of Obion County and surrounding areas as best I can.”
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GrandRounds UTHSC College of Medicine Produces Video for Health Care Workers and Public on Procedure for Collecting Nasal Samples for COVID-19 Testing The University of Tennessee Health Science Center’s College of Medicine has produced a training video detailing the proper protocol for collecting nasopharyngeal samples to test for coronavirus infection. The video is intended for distribution to hospitals, clinical care providers, and testing sites, as well as the public, as a guide to ensure proper procedure is used at the various sites in the city and across the state. The UTHSC College of Medicine, working with the Shelby County Health Department and the City of Memphis, opened a drive-thru testing site at Tiger Lane at the Mid-South Fairgrounds in Memphis March 20. The site is staffed primarily by UTHSC medical students under the supervision of physician faculty. The site is now performing approximately 150 to 200 tests a day by appointment. “As we all work together to combat the challenge presented by COVID-19, we realized that people were using diverse testing procedures to swab for the virus,” said Scott Strome, MD, executive dean of the UTHSC College of Medicine. “In order to facilitate appropriate testing, we prepared a short educational video that we hope will be helpful.” Sanjeet Rangarajan, MD, M.Eng., assistant professor and director of the Division of Rhinology and Endoscopic Skull Base Surgery at UTHSC, worked on the video. “A nasal swab can be an anxiety provoking experience for both patient and clinician alike, especially when trying to determine COVID-19 status,” he said. “We developed this video to demonstrate the relevant nasal anatomy and proper process for obtaining a sample in order to build confidence and familiarity with the process for our patients and team alike. The establishment of the UTHSC Mobile Testing Center in Memphis has allowed us to provide much-needed diagnostic
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capacity for patients who can get tested from the comfort of their car.” The video, which features scenes from the Tiger Lane testing site, is available at the UTHSC coronavirus resource page at https://uthsc.edu/coronavirus/ resources.php.
Free Online Mental Health Resource for TN Healthcare Providers Situations like the current COVID crisis illustrate the need for more resources to help Tennessee’s medical workforce cope with the intensity of the times. A new free online mental health resource is now available to address increased incidence of suicide, depression, burnout, and other mental health problems among Tennessee’s licensed health professionals. The Tennessee Professional Screening Questionnaire, or TN PSQ, launched in February and is available to health professions served by the Tennessee Medical Foundation’s Physician’s Health Program (TMF-PHP). Those include physicians (MDs and DOs), residents, interns, and students, as well as physician assistants, optometrists, podiatrists, chiropractors, x-ray technicians, clinical perfusionists, and veterinarians, both licensed and in training. The tool is accessible at tn.providerwellness.org and e-tmf.org/tnpsq. Physicians and other health professionals are on the front lines of this crisis and are stressed out, and that may not reach a peak for several months according to TMF Medical Director Michael Baron, MD. Interactive Tool This new statewide resource utilizes the Interactive Screening Program (ISP), an online tool created by the American Foundation for Suicide Prevention (AFSP). Initiated by the TMF with support from the Tennessee Board of Medical Examiners, Tennessee Medical Association, Tennessee Hospital Association, and State Volunteer Mutual Insurance Company, the TN PSQ is intended to help connect struggling health professionals with available mental health
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resources in their area. There are known barriers to getting help for mental health problems among doctors and other licensed health professionals. Confidentiality and existing stigma over seeking help, fears of career implications, and the perceived time and cost involved are all factors that can stop them from reaching out when they probably need it the most added new TMF Administrator Jennifer Rainwater. . Key Principles The TN PSQ will be used strictly as a NON-crisis service, offering an anonymous, confidential online mental health screening that will result in referrals to
appropriate mental health resources and optional interaction with a program mental health professional. This tool will be totally anonymous, voluntary, and the outcome completely driven by the user. The tool went live on February 3 and is being shared in a phased rollout by the TMF, state health professional licensing boards, TMA, THA, SVMIC, health professional organizations, regional and specialty societies, medical schools, and other partnering entities. Questions? For more information, contact the TMF at 615-467-6411 or online at e-tmf. org.
UTHSC Team Awarded $2.27 Million for New Breast Cancer Therapy Research A research team at the University of Tennessee Health Science Center has been awarded $2.27 million to study a potential next-generation treatment for late-stage breast cancer. Wei Li, PhD, professor of Pharmaceutical Sciences and director of the UTHSC College of Pharmacy Drug Discovery Center, and Tiffany Seagroves, PhD, professor of Pathology in the UTHSC College of Medicine and vice chancellor for Research Core Labs, are dual principal investigators on the Department of Defense grant. Duane Miller, PhD, Professor Emeritus in the Department of Pharmaceutical Sciences, is a co-investigator. The project is titled “Discovery of Orally Bioavailable Tubulin Inhibitor to Overcome Taxane Resistance in Metastatic Breast Cancer” and focuses on VERU-111, a first-in-class selective small molecule that targets and disrupts microtubules in cancer cells. Both in vitro and in vivo animal studies conducted by the team demonstrate the molecule’s ability to inhibit tumor growth and metastasis, as well as overcome multidrug resistance. Nonclinical studies show that VERU-111 does not appear to cause nerve damage (neurotoxicity), a serious side effect of chemotherapy agents (taxanes) currently used against triple negative breast cancer. Dr. Seagroves is excited that the compound would provide an effective oral alternative to IV treatments, and that it also delays progression of established metastatic lesions. VERU-111 will improve patient quality of life, and could be an effective treatment option for those patients who have failed taxanes according to Seagroves. VERU-111’s ability to bypass taxane resistance will ultimately increase patient survival by continuing to supress metastatic outgrowth, the cause of mortality in breast cancer. VERU-111 originated in the lab of Dr. Li, who worked with Dr. Miller and James Dalton, PhD, dean of the Univeristy of Michigan, College of Pharmarcy, for over 10 years to develop the molecule. VERU-111 has been licensed by VERU, Inc., which has been conducting clinical trials in prostate cancer patients since late 2018. The trials are going very well, as far as I know from our monthly discussions with VERU says Dr. Li. While VERU-111 is highly promising, improving its anticancer potency and metabolic stability by further optimizing its structures would allow lower, more effective doses. The team intends to work with VERU closely to help bring a more effective tubulin inhibitor to metastatic breast cancer patients within five years.
GrandRounds Methodist Le Bonheur Healthcare Responds to COVID-19, Warns of Unnecessary Emergency Department Visits Methodist Le Bonheur Healthcare has announced additional precautions aimed at better protecting the safety of its patients, Associates and others in our community. Actions include: • Asking those concerned about whether they may have been exposed to the Coronavirus to avoid emergency departments unless you need hospital care; • Enacting new screening procedures at all its facilities; travel history, COVID-19 exposure, fever and/or respiratory illness; • Limiting access points to its hospitals; • Restricting the number of visitors to two per patient. Children under 12 will not be allowed to visit at this time; • Temporarily suspending all onsite, non-Methodist Le Bonheur Healthcare meetings, events and tours of facilities; • Posting signs at clinic entrances with instructions for patients with fever or symptoms of respiratory infection to alert staff so appropriate precautions can be implemented; • Encouraging individuals to visit Methodist Le Bonheur Healthcare COVID-19 website for latest information. It is important to understand that unlike influenza, there is no treatment for COVID-19. Most people with COVID-19 will not be hospitalized but will recover at home. CDC is encouraging patients with mild respiratory illness to stay home. Methodist continually evaluates its processes to best meet the needs of our patients, and we are collaborating with the Centers for Disease Control and local and state Health Departments. Additional precautions will be put into place as needed. General Health Measures As always, to prevent the spread of COVID-19 or other viruses and infections, please remember to practice good overall respiratory hygiene. This includes frequent and thorough handwashing, refraining from touching your face, covering coughs and sneezes with a tissue or your elbow, and staying home when you are sick. Please call your primary care physician if you have been exposed to the new coronavirus or travelled internationally and have symptoms such as fever, chills or cough. Your physician will help guide you to the appropriate resources for testing and/or treatment. For more information, please visit our Your Health by MLH Blog. If you need a primary care physician, visit methodisthealth.org/primarycare. Stay up-to-date with us on social media – Facebook, Twitter and Instagram MEMPHISMEDICALNEWS
OrthoSouth Offers 24/7 Urgent Orthopedic Telehealth Amid Coronavirus Crisis OrthoSouth has announced the immediate expansion of its urgent care access for patients in the Greater Memphis Area by now offering 24/7 urgent care telemedicine triage. Individuals with fractures, sprains, and emergent orthopedic injuries who might otherwise visit the emergency department may call OrthoSouth to speak directly with a board-certified orthopedic surgeon at any hour, day or night. The physician will listen to the patient’s complaint, may perform a telehealth visit, and will then direct the patient on the best course of action – including whether to make an appointment the next day, self-treat at home, or if necessary, meet the physician at a clinic or at the ER for expedited emergency care. Kim Jenkins, OrthoSouth CEO, explained that they challenged themselves to think critically about how to best utilize the expertise of their 35 board-certified orthopedic surgeons to aid both patients and the community during this crisis. This comprehensive expansion of urgent care triage is part of the answer. By offering around the clock urgent care access, they hope to help keep injuries out of the ER, reduce the likelihood of orthopedic patients’ exposure to the novel coronavirus in a medical setting, and help preserve emergency department resources for the sick and severely injured patients who truly need them. To access OrthoSouth’s 24/7 OrthoStat urgent care, patients should simply call (901) 261-STAT (7828) at any time.
Tennessee Doctors Unite in Opposition to Bill that Would Allow Nurses to Practice Without Physician Oversight A dozen healthcare advocacy groups are banding together as a coalition to ask the Tennessee General Assembly to reject legislation that would sever critical relationships between physicians and advance practice registered nurses and threaten patient safety and quality of care. The bill, SB 2110 / HB 2203, is sponsored by Sen. Jon Lundberg and Rep. Bob Ramsey. The sponsors and proponents, including the Tennessee Nurses Association, propose to change state law to remove requirements for nurses to maintain a collaborative relationship with a physician. Tennessee doctors say that while the current regulatory environment may be improved to create more efficiency for healthcare teams, existing laws provide a necessary framework for physicians, nurses and other healthcare providers to work together in delivering
patient care. Each member of the healthcare team plays a vital role and should be able to work to the fullest extent of his or her education and training, but team members are not equivalent or interchangeable. Doctors have much more education, training and experience than any other team members and should remain responsible for determining safe, appropriate levels of autonomy according to Dr. Elise Denneny, a Knoxville otolaryngologist and current President of the Tennessee Medical Association. SB 2110 / HB 2203 is the linchpin of a renewed push by the Tennessee Nurses Association that seeks complete independent (unsupervised) practice for advance practice nurses in Tennessee. TNA has been unsuccessful in its repeated attempts for independent practice since 2014. TMA and other physician advocacy groups, meanwhile, are calling for more integrated and coordinated healthcare delivery, not more silos. Allowing nurses to diagnose and treat patients and prescribe medications without any collaborative relationship with a physician would create more fragmentation in healthcare when the entire industry is moving in the opposite direction. Teamwork helps prevent misdiagnoses and missed diagnoses. It increases the capacity of our limited healthcare manpower in Tennessee. It makes us more efficient and effective in delivering quality care at the lowest possible cost added Dr. Denneny. Scope of practice is one of TMA’s top legislative priorities in 2020. The state’s largest physician advocacy organization has assembled a coalition of medical specialty associations to identify and promote best practices for physician-led, team-based healthcare delivery in Tennessee. The Coalition for Collaborative Care spent the past several months meeting with representatives of the nursing profession in good faith efforts to modernize collaboration rules but was unable to reach an agreement, as APRNs made clear they are unsatisfied with anything less than independent practice. The Coalition now has turned its efforts to educating lawmakers and the general public about the unnecessary risks associated with nurse independent practice, and alternative solutions for more efficient healthcare, particularly in rural, underserved areas of the state. The emergence of telemedicine, for instance, allows for more frequent and effective collaboration between physicians and the rest of the healthcare team despite geographic challenges. TMA is part of another coalition supporting a bill (SB 1892/HB 1669) that would define certain regula-
tions and reimbursement protocols for telehealth in Tennessee. In 2019, TMA also led advocacy efforts that added $8.7 million in graduate medical education funding to the state budget. The additional funding will allow Tennessee to train and retain more doctors in Tennessee instead of exporting them to other states, and improve primary care access in underserved areas. The Coalition is also working on ways to address specific complaints by nurses about the availability and cost of collaborating physicians in rural areas. The vast majority of nurse practitioners in Tennessee practice in hospitals or group medical practice environments where team-based structures are the norm. The faction of APRNs who choose to establish their own clinics, however, are required by law to have a formal, collaborative working agreement with a physician and claim that they have difficulty finding doctors in rural areas to review charts and oversee patient care, or that the negotiated fees are unreasonable. The Coalition is advocating for the state medical boards to maintain a registry of physicians who are willing to collaborate with nurses in rural areas, and for the boards to set some parameters for appropriate fees.
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GrandRounds Ronald Cowan, MD, PhD, Named Chair of the Department of Psychiatry at UTHSC Scott Strome, MD, executive dean of the College of Medicine at the University of Tennessee Health Science Center (UTHSC), has named Ronald Cowan, MD, PhD, Harrison Distinguished Professor and Chair of the Department of Psychiatry. He will begin his new role at UTHSC Ronald Cowan in July.Dr. Cowan has served as a professor in the Department of Psychiatry and Behavioral Sciences at Vanderbilt University School of Medicine for the last 6 years, along with secondary appointments with the Department of Radiology and Radiological Sciences at the Vanderbilt University Medical Center and the Department of Psychology at Vanderbilt University. As chair, Dr. Cowan will oversee all activity in the department to ensure the goals and objectives of the department are met, including developing the vision of growth for both the clinical and academic aspects of the department. Dr. Cowan has close to 20 years of funded research, primarily focusing on neuroimaging, depression, drug abuse, and pain processing in aging and dementia. He is currently the principal investigator on two National Institute on Aging (NIA) grants. Dr. Cowan has served as the director of the Residency Training Program in the Department of Psychiatry and Behavioral Sciences for the past six years, as well as an attending psychiatrist for the Vanderbilt Psychiatric Hospital for the past 18 years. Dr. Cowan grew up in West Tennessee and obtained his undergraduate degree in Biology from Christian Brothers University. He earned a PhD in Neuroscience in the Department of Anatomy and Neurobiology at UTHSC in 1990, as well as his medical degree from Weil Cornell University Medical College in New York City in 1994. He completed his internship in internal medicine at the Massachusetts General Hospital/Harvard Medical School in Boston and his residency in general adult psychiatry at the McLean Hospital/Harvard Medical School in Belmont and Boston. He has authored or co-authored over 80 articles in peer-reviewed journals including the Journal of Alzheimer’s and Dementia, Synapse, the Journal of Nuclear Medicine, and the Journal of Neuroscience. Dr. Cowan currently serves on the editorial board of Synapse, and formerly served on the editorial board of the Journal of Addiction.
College of Medicine Names New Assistant Deans of Student Affairs Catherine Womack, MD, associate dean of Student Affairs and Admissions
for the University of Tennessee Health Science Center College of Medicine, has named Sara Cross, MD, Deirdre James, MD, and Andrew Olinger, MD, as the new Sara Cross assistant deans of Student Affairs. As assistant deans, they will assist in the writing of Medical Student Performance Evaluations (MSPEs) and help with recruitment Andrew Olinger and fundraising. In addition, they will provide guidance at new student orientations and graduations, work to develop and execute multiple student-focused programs across campus including MPOWER and the Financial Literacy Program, as well as provide mentorship and career counseling for all students in order for them to be prepared to select the career with the best fit for them. Dr. Sara Cross, an associate professor of Medicine/Infectious Diseases and Medical Education, teaches infectious disease courses to first- and secondyear medical students. She also has a clinic on HIV and general infectious diseases. Dr. Cross completed her fellowship in infectious diseases at Washington University and her internship and residency in internal medicine at Washington University/Barnes-Jewish Hospital. She was recently named to Governor Bill Lee’s Coronavirus Task Force, as well as awarded the Golden Apple teaching award for the infectious diseases sub-specialty. Dr. Deirdre James, an assistant professor of Medicine, specializes in endocrinology. Dr. James, originally from Pensacola, Florida, is a graduate of Florida State University. She earned her medical degree from Meharry Medical College in Nashville, later moving to Memphis where she completed her residency in Internal Medicine, her chief residency, and endocrine fellowship at UTHSC. Dr. Andrew Olinger, an assistant professor in Internal Medicine, specializes in primary care and medical education. Dr. Olinger is a graduate of Millsaps College and attended medical school and completed his residency at the University of Tennessee. He is originally from Memphis and has a passion for the city and its history.
IAC Associates launches Integrated Addiction Care via Telemedicine IAC Associates & Baptist Center of Excellence in Addiction has launched a comprehensive telemedicine program for patients with drug and alcohol addictions. Our integrated addiction patient care team of physicians, therapists, and social workers are available now for online visits. As Memphians struggle with Co-
vid-19 and Stay-at-home orders, negative emotions are soaring as social isolation, stress, anxiety, and fear grip us. Negative emotions have always been a trigger for addictions and stimulate drug seeking behavior. So how do we take care of these patients in the current environment? The answer is telemedicine. As part of the state of emergency declared by the President, many of the regulations which have impeded telemedicine for addiction have been removed. Telemedicine allows patients and addiction medicine specialists to connect quickly from any smart phone, tablet, or computer in the privacy of their home or car. Telemedicine provides a means of treatment which is confidential, convenient and obviates the need for person-to-person interaction. There are strong advantages for telemedicine in addiction treatment. First, the stigma of addiction diminishes the will for patients to seek treatment in public because of the fear of “disgrace” and “humiliation” by our society and healthcare workers. Secondly, telemedicine fits into the flow of the patient’s life so that treatment is not disruptive. The latter is especially relevant in the context of a chronic relapsing disorder, such as addiction. One question remains regarding the growth of telemedicine for addiction. Will patients embrace telemedicine? The answer has been an astounding yes for us. In the last two weeks, the addiction medicine practice of IAC has shifted from 95 percent in-person service to 95 percent telemedicine. Patients have embraced telemedicine. Our patient care team is led by an addiction specialist physician and supplemented by the efforts of an experienced therapist and social worker. Follow-up by FaceTime or telephone between visits adds “glue” between visits, enhancing our interaction with patients. The number of patients seeking treatment has increased and they are embracing telemedicine. Discover more on www.iacassociates.com
UnitedHealth Group Commits Initial $50 Million to Combat COVID-19 and Support Affected Communities UnitedHealth Group (NYSE: UNH) will invest an initial $50 million to fight the COVID-19 pandemic and support those most directly impacted by the public health emergency, including health care workers, hard-hit states, seniors and people experiencing food insecurity or homelessness. This initial investment of $50 million will support that effort, as we continue to mobilize the full strength of our resources, deep clinical expertise, and compassionate team to deliver the best
care for patients, support our members and care providers, and deliver innovative solutions that will benefit the entire health care system. Through several national and local partnerships that will be announced in the coming weeks, UnitedHealth Group and the United Health Foundation will invest approximately: ▪ $30 million in efforts to protect and support health care workers. ▪ $10 million to support states where COVID-19 is having an outsized impact, starting with New York, New Jersey, Washington, California and Florida. ▪ $5 million to address social isolation among seniors.
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GrandRounds MidSouth Imaging Welcomes New Physicians MidSouth Imaging has announced that two new physicians have been added to the staff in the practice of Interventional Radiology and Diagnostic Radiology at Baptist Memorial Hospitals – Memphis, Collierville, DeSoto, Tipton, Women’s, Huntingdon, John D Braun and NEA. John D Braun, MD, Dr. Braun is a graduate of University of Arkansas for Medical Sciences and completed Diagnostic Radiology Residency training at Udaykamal Barad Allegheny Health Network, Pittsburgh. Dr. Braun completed an Interventional Radiology Fellowship at University of Pittsburgh. Dr. Braun is Board Certified in Diagnostic Radiology. His special interests are in peripheral vascular disease and interventional oncology. Udaykamal Barad, MD, is a graduate of B J Medical College and completed Diagnostic Radiology Residency training at Civil Hospital, B J Medical College, Ahmedabad, India. Dr. Barad completed Fellowships in Diagnostic and Pediatric Neuroradiology, Head and Neck Imaging, and Abdominal Radiology, at Indiana University School of Medicine, Indianapolis, IN and also completed an Interventional Radiology Fellowship at Mallinckrodt Institute of Radiology at Washington University, St. Louis. Dr. Barad is Board Certified in Diagnostic Radiology and CAQ Certified in Neuroradiology. Dr. Barad has special interests in Advanced Neuroradiology and Head and Neck Imaging
Urgent Team – Bartlett Welcomes New Nurse Practitioner Urgent Team Walk-In Urgent Care welcomes nurse practitioner Stacy Gibson to the healthcare team in Bartlett. Gibson earned a Master of Science in Nursing from The University of Memphis. She most recently served as a nurse practitioner at Stacy Gibson Fast Pace Urgent Care in Millington, providing urgent and primary care to patients of all ages. Urgent Team – Bartlett is located at 8350 Hwy. 64, Suite 103. The center is open seven days a week; please visit UrgentTeam.net for hours of operation. Walk-ins are welcome or for added convenience, patients can schedule a same day or next day visit online with Hold My Spot™.
St. Jude Experimental Antimalarial Drug Shows Promise in First Clinical Trial A fast-acting anti-malarial compound discovered at St. Jude Children’s Research Hospital was well tolerated and showed promising anti-malarial effects in the first study in humans. The findings appear online first this week in the journal Lancet Infectious Diseases. The results support further development of the compound SJ733 as a fast-acting component of combination anti-malarial therapy said corresponding author Aditya Gaur, MD, of the St. Jude Department of Infectious Diseases.The drug was well tolerated and well absorbed with a rapid anti-parasitic effect. Gaur and James McCarthy, MD, MBBS, of QIMR Berghofer Medical Research Institute, Australia, are the cofirst authors. Researchers are exploring ways to increase and/or extend blood levels of SJ733 to maximize its effectiveness in patients. Guy led the anti-malarial drugdiscovery effort and preclinical development of SJ733 while chair of the St. Jude Department of Chemical Biology and Therapeutics. The preclinical trials showed that SJ733 worked against malaria parasites that are resistant to current frontline drugs. The research effort reflects the global reach of this disease, Gaur said. He noted that the work involved scientists working collaboratively and seamlessly exchanging information on three continents and across multiple time zones. SJ733 is one of the first in a new class of anti-malarial compounds to reach clinical trials. It works by disrupting the malaria parasite’s ability to remove excess sodium from red blood cells. As sodium builds up, infected cells become less flexible. The cells are removed by the immune system or get caught in small blood vessels. A total of 38 healthy volunteers were recruited as part of the Phase 1a study in Memphis and Phase 1b study in Brisbane, Australia. The 23 healthy volunteers in Memphis received increasing doses of SJ733 as part of the first-in-human study to understand SJ733 dosing, safety profile and metabolism, including absorption. Based on those results the 15 Australian volunteers received SJ733 after being infected with malaria to understand the anti-malarial effectiveness of this new drug. The participants later received a curative dose of conventional anti-malarial combination therapy. No significant SJ733 treatment-related side-effects were identified in any of the volunteers. The research was funded by the Global Health Innovative Technology Fund; Medicines for Malaria Venture; and ALSAC, the fundraising and awareness organization of St. Jude.
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