February 2017 MMN

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February 2017 December 2009 >> $5 ON ROUNDS This Doctor’s Literature Has Surprise Ending What began as a career in literature for Daniel Powell didn’t follow the script, but the surprise ending turned out well for him and the West Cancer Daniel Powell Center. As often happens, the early clues were there, it just took a while for him to see them. Read his story on page 3.

Balancing The Checkbook With Compassion The business of caring – balancing the checkbook with empathy is truly one of the most challenging parts of being a medical manager. Susan Childs Expert Susan Childs takes a close look at delivering compassion while collecting money. Consider her thoughts on page 5.

MACRA Drops Payment Program That Resulted in Cuts to Doctors Hopes to Replace Fee for Services with Coordinated Care BY BECKY GILLETTE

Much remains unknown about how the Donald Trump There are three Administration will impact healthcare. things both parties One of Trump’s first actions was to issue an executive agree with. One, we must order aiming to roll back the Affordable Care Act. But bend the cost curve. there is general agreement that steps must be taken to reTwo, fee for service duce costs for Medicare while improving care, said Doral Jacobsen, MBA, FACMPE, chief executive officer, Prosreimbursement is the per Beyond, Inc. in Asheville, North Carolina. enemy. Three, coordinated “There are three things both parties agree with,” Jacare is much better than cobsen said. “One, we must bend the cost curve. Two, fee uncoordinated care. for service reimbursement is the enemy. Three, coordinated care is much better than uncoordinated care. These three things are the case regardless of political affiliation.” Jacobsen said the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed sustainable growth rate (SGR) formula that had previously been used to calculate Medicare payments to physicians and had resulted in repeated proposals of severe payment cuts. She said that, generally speaking, MACRA provides a more predictable Medicare payment schedule and aims the Part B payment system away from a volume-based system toward a system that rewards value.



Brett Snodgrass Targets Pain, Serves as Leader, Advocate

Physicians Plan An Invasion


Doctors plan to invade ‘The Hill,’ an addiction center gains national attention, and a new CEO is named. Catch up on Memphis-area healthcare news by reading the items in Grand Rounds. Examine the briefs on pages 9 and 10.


Doral Jacobsen, MBA, FACMPE, chief executive officer, Prosper Beyond, Inc.

During her 12-plus years working with chronic pain patients, Brett Snodgrass has stepped into multiple leadership roles: working with the Tennessee state legislature in developing chronic pain guidelines for healthcare providers, acting as an advocate for nurse practitioners by representing Tennessee in the American Association of Nurse Practitioners,

and serving as director of clinical operations for LifeLinc Pain Centers. She is a pioneer – believed to be the nation’s first nurse practitioner to become a fellow of the Academy of Integrative Pain Management as an advanced credentialed pain practitioner. “Nurse practitioners really have to stay in the forefront,” Snodgrass said. “If you’re not

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Radiologist Took Path Less Traveled to MD Daniel Powell Was Literature Major Before Finding His Way to West Cancer Center BY RON COBB

Daniel K. Powell, MD, graduated from Yale University with a degree in literature – not the conventional preparation for a career in medicine. But he eventually made it to medical school and, as of July 2015, to West Cancer Center, where he is a radiologist specializing in interventional radiology and diagnostic radiology. There were early clues that a medical degree was in his future. Growing up in New York City, with a father who was an electrical engineer and a mother who was an architect, Powell took an interest in the arts and anatomy, at one point welding structures of the human skeleton up to 13 feet tall. “I was probably 8 or 9 when I first became interested in anatomy through my exposure to the arts and grade school animal dissection,” he said. Although he started thinking about medicine while he was at Yale after his father died of kidney cancer, Powell explored many of his other interests after graduating. “I was never thinking there would be a job out of literature,” he said. A job that he took in healthcare public relations helped lead to his decision to study medicine. He then pursued an increasingly common route of study in a one-year premedical post-baccalaureate program at Bryn Mawr College. “Those programs are designed to allow post-graduate students to complete the science requirements in a focused curriculum, which others perform throughout college as pre-med majors in preparation for med school,” he said. After earning his medical degree at Jefferson Medical College in Philadelphia and a radiology residency at Mt. Sinai-Beth Israel in New York, Powell completed his interventional radiology fellowship at New York Presbyterian-Columbia Medical Center. He joined West Cancer Center because of what he calls its “unique and compelling set-up . . . a great opportunity.” He describes interventional radiology as “minimally invasive procedures guided by imaging, which can describe what various surgical subspecialties do because more and more they’re using smaller cuts and using either optic imaging or some kind of non-invasive imaging.” With diagnostic radiology, on the other hand, “you’re not trying to create any effects in the body, treat or alter anything. It’s just gathering information.” At West, Powell sees the radiologists’ role as “a broad adjunct to the principal role played by the oncologist in treating cancer patients. I think we support them in many ways.” For instance, he said, “initial diagnoMEMPHISMEDICALNEWS


sis, biopsy confirmation of diagnosis, staging, surveillance after treatment and very early on being able to biopsy questionable lesions, to jump right back into treatment if there’s a reoccurrence. We have a hand in treatment by providing intravenous ports, where people get chemotherapy, a place where you can get a needle puncture over

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and over again for safe chemotherapy. “And we even do directed treatments where we burn tumors, inject radioactive material or block blood flow to tumors.” At age 37, Powell is early in his career, but he already has had a hand in a development that looks encouraging. “I’ve been able to bring a procedure that is somewhat new that I learned in training,” he said. “It’s called Y90, where we inject radioactive particles into the liver to treat primary or secondary liver cancer. Even during my training I got to see it develop, be introduced into practice and become more established. It’s an exciting and promising treatment modality. “It’s by no means a magic bullet or perfect as with all things in medicine, but it’s been exciting to see it evolve and make an impact. I think there’s some hope similarly about being able to translate some of the promise around cancer immunotherapy into a directed interventional procedure. Interventional radiology is a very exciting field in general because it tends to be innovative with lots of different tools and lends itself to constant expansion and refinement.” As a researcher, Powell was active

during his days in New York, where he was the recipient of the Associate Trustees St. Luke’s Roosevelt Small Grant Award for a pilot study on simulation training, “which I think can be particularly valuable in any interventional area,” he said. “Up until now there had been more study of simulation training for surgical trainees. Researchers have tried to explore how green doctors and students can best train with tools and computer programs before participating in procedures for patients. It’s partially about developing muscle memory and hand-eye coordination.” When asked if the staff at West ever discusses the sort of mythical “cure for cancer,” Powell said, “the oncologists here, like most oncologists, are involved in research and are very up-to-date on the latest treatment modalities and potential future trends, but that stills feels a bit like science fiction. “I think there is a spirit that it will be possible, but our best hope these days is on prevention and early detection.” Powell’s wife, Helena, is a fund-raiser for the American Red Cross. At home, the doctor likes to run, play with his dog and work on do-it-yourself home repair.

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To Offer Compassion While Collecting Money Is an Art First in a series BY SUSAN CHILDS, FACMPE

Note: Susan Childs, FACMPE, is a popular national speaker and noted healthcare consultant. Her talk at a recent MGMA meeting in Memphis was highly praised. She has graciously allowed the Memphis Medical News to print her message. The following is the first segment of her message. Ten million new patients have knocked on our doors in 2016! That is great access for people who would not otherwise be able to receive healthcare. In fact, 33 per cent of our Medicare patients are now on an advantage plan. The most important thing to remember is the power of your practice and how that is conveyed to your staff, patients and communities. You can reflect that value by knowing your numbers. Who are your patients, who are you affiliated with and what are your outcomes? As your teacher said, “You will be judged by the company you keep.” All future insurance fee schedules are based on outcomes and risk. Whether you are independent, clinic or system based, being familiar with your numbers will give you the power and allow you to realize the patterns and true value of your practice. Although we pay a fortune for our systems, most of us tend to go only as deep as we need to get the job done. Call your

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About Susan Childs Susan Childs is founder and president of Evolution Healthcare Consulting and is a Board Certified Fellow of the American College of Medical Practice Executives. Her experience includes Operations, Financial Controls, Staff Accountability and Role Definition, and Change Management. She has written for organizations such as Orthopaedics Today, Greenbranch Publishing and the AMA. Susan is an accomplished speaker and has served as local and state leadership and MGMA ACMPE Advancement Chair. Her passions are patient access, staff member pride and accountability, and increasing the value of the physician.

vendor today and ask about any nuances or updates to the system that you may either be not utilizing or unaware of. This may save you tons of time with operations and workflow. So where is our crystal ball? How may we best prepare for the next stage of our professional lives? Think about your future as a business. What choices can you make that can actually help you earn more money? Think in both short and long term goals. Any consideration should include a quick pro forma to get a ballpark idea as to true financial value of the option. When is the last time we reviewed missions and goals with staff members? We are so busy putting out fires over the little details of everyday life and getting a claim paid sometimes we forget why we are here. Most practices introduce missions and goals with the personnel manual that are quietly filed away with not much future reference. Personal investment turns into organizational investment that patients notice. As the practice leader, we have to live what we say and if you want staff to be a

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part of the change, invite them to help set the standards. Consider a retreat for you and your staff. It’s not just touchy-feely stuff. It includes business goals as well. Begin with your agenda. Invite staff to contribute. It is enlightening and cathartic. It helps you move onto the next step. It clarifies and confirms standards and values that you want in place. A retreat can also very quickly identify who will be there for the long run. During this retreat, also share your business goals. You don’t have to give away the farm, just enough to let them know what your goals are and how they may contribute towards that success. Of course anything that can result in increased income can also equal increased pay by the end of the year, which is something all employees can appreciate. A few tips? Mandatory attendance, including physicians. Have food, no recording and have an independent, and I mean independent, facilitator.

Provider Shortage

With physician training taking up to 10 years, this means we have a problem right now as the shortage is anticipated to begin in 2025, particularly due to the baby boomer generation. This represents and includes changes in rapid growth of the non-physician clinicians widespread adoption of new payment delivery models such as patient centered medical home and accountable care organizations, greater use of alternate settings, retail clinics and delayed physician retirement. Addressing the shortage will require a multi accessed approach including Innovation and delivery, greater use of technology, and improved and efficient use of health professionals on the care team, and an increase in federal support for residency training.

Concierge and Direct Pay

Are you tired of insurance companies dictating your care? Primary care, ophthalmology, gastroenterology, orthopedics and neurosurgery all have a presence with this updated approach to care. There are approximately 12,000 concierge and direct pay physicians in the United States with more than 80 percent accepting insurance within their practice. Most membership practices require patients to pay a fee upon each visit. The typical age of a direct pay patient is between 40 and 59 years of age. These practices typically seat six to 10 patients per day with blended practices usually higher. Female physicians fill concierge practices 30 percent faster than men and 58 percent of membership practices have 1 to 2 employees. While this may not be a current choice for rheumatology, do not discount this network of providers that can actually complement your services. They can offer another venue and patient base to care for.

Know Your Numbers

If anyone has doubts about the delivery of care with this model, please remember they exist because they are needed. Consider this yet another resource to complement the services you provide. These practices now comprise a decent part of your medical community and nothing to scoff at. This is another network that you may tap into. This is why it’s more than essential to know your numbers and your practice’s patterns of care and outcomes. Knowledge is power. Know your numbers!

Revenue Forecasting

There is an implied level of expectation of performance with any product that I purchase. I should be able to sit in a chair for a while before it breaks or the fabric tears. You know what you are (CONTINUED ON PAGE 6)






Ten Measures for the Prevention of Sudden Cardiac Death BY CINDY SANDERS

A joint report from the American College of Cardiology and the American Heart Association released at the end of 2016 outlines 10 quality and performance measures intended to prevent sudden cardiac deaths. Published Dec. 19, 2016 in both the Journal of the American College of Cardiology and Circulation: Cardiovascular Quality and Outcomes, the evidence-based, guidelineendorsed recommendations address key risk factors for sudden cardiac arrest (SCA) and interventions to prevent sudden cardiac death (SCD). “The scope of the issue is that SCD is the most common mode of death in the U.S., and despite many advances in resuscitation and other areas of SCA/SCD care, the survival rate of SCA victims is still low and the risk of SCD is still high,” Sana Al-Khatib, MD, FACC, co-chair of the writing committee and a profesDr. Sana Al-Khatib sor of Medicine at Duke University, explained of the need for this first comprehensive measure set for SCD prevention. Each year there are more than 350,000 out-of-hospital cardiac arrests in the United States. “While some people – such as patients with heart failure – are known to be at risk for sudden cardiac death, others are not,” Al-Khatib noted. “We need initiatives to improve the quality of care for those with a known risk but also for the victims of sudden cardiac arrest.” To move the needle on improving survival rates, Al-Khatib said the committee proposed performance measures and quality metrics that span different aspects of care ranging from prevention to resuscitation, as well as management of known conditions. The 10 performance measures (PM) and quality measures (QM) are:

Preventive Cardiology Measures

PM-1: Smoking cessation intervention in patients who suffered SCA, have ventricular arrhythmias, or are at risk for SCD. QM-1: Screening for a family history of SCD. QM-2: Screening for asymptomatic left ventricular dysfunction among individuals who have a strong family history of cardiomyopathy and SCD.

Resuscitation/Emergency Cardiovascular Care Measures

QM-3: Referring for CPR and AED education the family members of patients who are hospitalized with known cardiovascular conditions that raise the risk of SCA. memphismedicalnews


Heart Failure/General Cardiology Measures

PM-2: Use of ICD for prevention of SCD in patients with heart failure and reduced ejection fraction who have an anticipated survival of > 1 year. PM-3: Use of guideline-directed medical therapy (ACE-1 or ARB or ARNI, beta-blocker, aldosterone receptor antagonist) for prevention of SCD in patients with heart failure and reduced ejection fraction. PM-4: Use of guideline-directed medical therapy (see above) for the prevention of SCD in patients with myocardial infarction and reduced ejection fraction.



Electrophysiology Measures

PM-5: Documenting the absence of reversible causes for ventricular tachycardia/ventricular fibrillation cardiac arrest and/or sustained VT before a secondaryprevention ICD is placed. PM-6: Counseling eligible patients about and ICD. QM-4: Counseling first-degree relatives of survivors of SCA associated with an inheritable condition. Although guidelines exist for the prevention of sudden cardiac death, there has been an underutilization of public health initiatives, treatments and device therapies for at-risk patients. Al-Khatib said many of the measures the committee proposed are novel or not well established in the format proposed. “We have data on low use of these proven interventions in relation to most measures,” she said, adding the novel construct of the 10 measures should impact care if it put in place. “The hope is that most would use all of these measures, but even if a few of these measures are implemented, we still expect to make a difference,” she said. AlKhatib continued, “These measures were picked based on what is most important and what would be most impactful emphasizing the importance of the problem and gaps in care.” In addition, she said the committee, which was divided into smaller groups based on expertise, took into account validity and reliability of data sources and collection, usability and feasibility in terms of workflow to come to a consensus on the measures. “Despite the existence of many proven interventions, the use of these interventions is lacking in many areas and so the survival rates for SCA victims have not appreciably improved,” she said, again emphasizing that SCD is the most common mode of death in the nation. “A multifaceted approach to this problem is needed. Such an approach is achievable through the implementation of this set of performance measures and quality metrics,” Al-Khatib concluded.

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To Offer Compassion While Collecting Money Is an Art, continued from page 4 purchasing. As for practices and insurance companies, all we know is we have discounted our fees to be on a list of providers that a patient may choose according to his or her preferences. There are no guarantees. Insurance carriers for years also required global agreements to any product they would be offering at any given moment and time. Now there are narrow networks, usually associated with larger health systems not including independent physicians. Many long-time patients are told that

their practice suddenly is out of network for their plan. Now is the time to speak with payers and legislators regarding these concerns. As physicians, we should be able to care for our patients. As business people we have to watch out for ourselves. It is as simple as that. Consider the long-term implications and decisions we are making right now. Now that’s a business decision. As managers – many of you are financial wizards. Let’s utilize that. And never forget the subscriber’s voice to their insurance marketing departments that hear it

loud and clear when he or she calls in.


When the average age of an individual can vary seven years just within one county or two due to access to care, think of how easily we can improve the lives of patients, compliance and maintained wellness. The patient really could become engaged in this type care. On the other hand, how much can you really see in this venue when 49 percent of patients typically withhold information from their

doctor? You know your patients better than anyone and only you can answer this. We also should consider the availability of broadband support as well as insurance plan coverage for these kinds of visits. This of course depends upon your geographic area as well as insurance carrier plans. Be in touch with your insurance representatives to inquire about telemedicine and coverage for your area. It is growing rapidly in all specialties and only adds to access to care for patients. This, of course, can result in better outcomes, one of our major goals. We also know that happy patients often remit their bills sooner.

Politics, Politics

Culinary Medicine Continuing Medical Education

Just as with insurance companies, meeting with your local and state representatives is always a good move. In my state, we have an advocacy group that works with the state medical society where many of us get together and meet with local legislators. Let your local political representatives feel your pain. Ask them to spend time in your office observing. Attend a local medical managers group.

Saturday April 22, 2017 Church Health Demonstration Kitchen 1350 Concourse Avenue, Suite 142 Memphis,TN 38104

How Do We Stack Up?

These day patients view us as they view any other business. Our services are purchased contingent upon the patient’s preference. We are a commodity that can be selected and replaced with a newer model if need be. I believe we are like car repair shop – when patients need us, they really need us, and when they don’t, they would prefer to just stay away.

Join Certified Culinary Medicine Specialist Susan W. Warner M.D. and Church Health’s own Registered Dietitian Nichole Reed for an interactive cooking class! Along with preparing and eating a delicious, nutritious meal, you’ll gain the skills you need to integrate practical nutrition advice and counsel into your practice. Introduction to Culinary Medicine 9 a.m. - 12:00 p.m. An examination of how the Mediterranean and DASH diets can help treat diet-related illnesses Hypertension and Nutrition 1 p.m. - 4 p.m. Examine the research-based physiological effects of high-sodium diets and prevalence in the American diet. Learn cooking principles of flavor building and balancing without added sodium. Each module counts for 4 CME credit hours with completion of online and classroom portions.

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Dealing with Insurance Plans

No no, no, we are not like other businesses. We are not car salesman and we don’t manufacture washing machines. People don’t often look for cars when they’re sick. As we all know, healthcare is beyond personal. It goes to the core of our bodies. As a patient, what we expect can come from a very fearful space, especially when seeing a specialist. For example I may be your millionth patient but you are my first rheumatologist. Please respect both my invalid and valid concerns and fears. Take that extra special need for our profession and provide the level of stellar care in the most efficient way possible. Now take a moment and reflect upon each of your staff members. Is everyone really pulling his or her weight? Which employees do we need to speak with regarding their performance and potential for excellence? Are good employees leaving because we won’t get rid of bad employees? Every single staff member has value to the practices operations as well as the cost associated with that specific employee’s role. Next Month: Staff Accountability

1/13/2017 2:47:59 PM memphismedicalnews


Brett Snodgrass Targets Pain, Serves as Leader, Advocate, continued from page 1 at the table, you may not be represented appropriately.” Snodgrass describes the treatment of chronic pain as a relatively new specialty that has evolved within the last five to seven years. “Chronic pain has recently become a very hot topic with the United States’ opioid abuse issue. While pain specialists have been around, appropriate treatment has not been readily available because there were so few of them.” She served as an RN with local hospitals for several years, but her fascination with the field of chronic pain management developed during her 10 years within a practice that blended family care with pain management and palliative care. Recognizing that such treatment was largely unavailable during those early days, she became a chronic pain expert through hands-on learning. Their former collegial relationship and shared vision of how chronic pain management should look suited her for the leadership role that LifeLinc owner Eric Callan offered. The importance of appropriate diagnosis and evaluation of pain as well as multidisciplinary approaches are priorities that LifeLinc Centers recognizes while ensuring individualized treatment options — such as physical therapy, cognitive behavioral therapy, anti-inflammatory and other medications, epidural spinal injections, transforaminal and other injections, radiofrequency ablation, and more. Combating the popular conception that pain management is about dispensing opioids such as morphine, “We try everything we can to get rid of the opioids or lower them to the lowest effective dose,” Snodgrass explained, “often focusing on interventions because chronic back pain is the No. 1 diagnosis in chronic pain.” “Our goal is for patients to work and have families and fulfilling lives,” she added, “but the bigger picture is incorporating other things along with opioid therapy so they can lead as normal a life as possible with a chronic disease.” Monitoring patients for abuse is “a big job” that she helped to address when she gathered with others on Gov. Bill Haslam’s selected group of Tennessee pain-treating practitioners to develop Tennessee Chronic Pain Guidelines for patient treatment. The guidelines allow a minimal amount of opioids to be prescribed in primary practice; when higher doses are needed, it recommends that patients be referred to a chronic pain specialist, where patients are closely monitored. She admits that the guidelines aren’t perfect. “But we needed to do it because Tennessee was No. 2 in opioid overdose deaths in the U.S.” The Tennessee Controlled Substance Monitoring Database was already in place, but the 2015 guidelines mandated that all healthcare providers must not only register with the database but must also check it to prevent duplication if they are considering prescribing an opioid or controlled substance. Each year the state memphismedicalnews


sends a cautionary letter to the 50 highest prescribers of opioids on the list. “Unfortunately that has scared a lot of providers, who are now taking the stance that ‘I won’t write any pain medicine, period,’” she said. The guidelines further stipulate that every pain office in Tennessee must have a medical director who is a physician to provide supervisory oversight by signing 20 percent of the pain office’s charts within two weeks of the patient’s visit. Research shows that this level of oversight does not provide better patient care, Snodgrass said, and, in fact, increases costs by requiring nurse practitioners to pay a physician to oversee the practice — although the physician need not be in the office when patients are seen. “Twenty-three states currently have full practice authority for nurse practitioners, meaning that physician oversight is not required,” Snodgrass points out, “and we are working toward that in Tennessee.” Patients could benefit, she said, from the removal of economic barriers that would allow nurse practitioners to open much-needed practices. “So we’re encouraging and preparing more nurse practitioners to get pain training, fellowships and pain certifications.” Education, she added, is key — and one of her toughest challenges. A popular speaker on the subject of chronic pain, Snodgrass points out that, across the board, healthcare providers average four to six hours of chronic pain education in their entire program of study. “That’s why many providers have been quick to go to an opioid if somebody complains of pain,” she said. “We really push home that chronic pain doesn’t equal opioids. They’re just one component of chronic pain treatment.” A lifelong Mid-Southerner following in the footsteps of her mother, who grew up in healthcare, Snodgrass earned her degree in nursing from the University of Memphis and returned there to acquire her master’s in nursing with a specialty of family nurse practitioner in 2007. She takes pride in her contributions as a chronic pain expert and educator to her field, the state and the nation — and in the benefits her efforts bring to patients in appropriate pain assessment and therapy. She looks forward to collaborating with other healthcare providers and referral sources on their patient care, while guiding LifeLinc to pursue growth plans by seeking a nurse practitioner and a cognitive behavioral therapist to add to their team in the Germantown Pain Center, which she helped launch. LifeLinc has three locations – the other two are in Springfield, Tennessee, and Hopkinsville, Kentucky. Snodgrass serves as director of clinical operations for all three facilities. Snodgrass regards her family as her greatest accomplishment — daughters age 15 and 17 who are already planning careers in nursing and biomedical engineering, and a husband who supports her in her advocacy efforts.

CONSOLIDATED MEDICAL PRACTICES OF MEMPHIS salutes the work of Bashar A. Shala, M.D., as the founding physician of Memphis Cardiovascular Center. Dr. Shala has been practicing Cardiovascular Medicine in Memphis since 2000, and has received numerous awards and honors, including multiple Physician Recognition awards from the American Medical Association and the James Givens’ Award for Excellence from the University of Tennessee. He was recognized in 2007 by the National Committee for Quality Assurance for his excellence in cardiac care. He was also the recipient of Diversity Memphis ‘Humanitarian of the Year’ award in 2011. Outside of Memphis Cardiovascular Center, his contributions include participation in multiple professional organizations including fellowships in the American College of Cardiology (FACC), the American Society for Cardiovascular Angiography and Interventions (FSCAI), the American Society of Echocardiography (FASE), and the American Society of Nuclear Cardiology (FASNC). He is also a member of the American Society of Cardiovascular Computed Tomography.

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MACRA Drops Payment Program, continued from page 1 “Starting in 2017, providers will begin participating in either the MeritBased Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (AAPM) which will have financial impact (positive or negative) on Medicare payments,” said Jacobsen, who has made MACRA presentation to groups in Tennessee. “We are in the first performance period starting January of this year.” Jacobsen said from January 2016 through December 2019, all physicians will receive a 0.5 percent payment increase each year on Part B Medicare reimbursements. And, starting in 2019, this baseline will be the starting point for incentives from either the MIPS or APM payment track. Starting in January 2020,

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there will no longer be automatic baseline payment increases each year. “For those in the MIPS program, the payment adjustments will be exclusively based on performance within MIPS,” she said. “For those who participate in the AAPM track, from January 2019 through December 2024, physicians My best advice will receive an anis to start reviewing the nual 5 percent reports that are available lump sum bonus payment on currently such as the total Medicare Quality and Resource fee-for-service Use Report (QRUR), and reimbursements, their PQRS Feedback as well as any inReports. centives that are built into their APM (e.g. shared savings, etc.). Jackie P. Boswell, MBA, FACMPE, assistant vice president, SVMIC “Starting in 2026, physicians in the APM track will receive 0.75 to you (e.g., Patient Centered Medical percent and those in MIPS will receive Homes, Medicare Accountable Care 0.25 percent increase to Part B payments. Organizations, etc.),” she said. “Many of So, over the next seven years, the variance these provide support in a variety of ways, from highest to lowest reimbursement is such as technology, reporting measures estimated to grow to 36 percent for Medithat will be helpful in the future. If you care patients, which is an amount of revare not already, begin to participate in enue at risk we have never seen before.” PQRS and Meaningful Use programs. The implementation of MACRA will And review feedback reports available, as build upon the quality and efficiency metpart of the Value-Based Payment Modirics that are already being measured in fier program – Quality and Resource Use several Centers for Medicaid and MediReports are located at https://portal.cms. care Services (CMS) initiatives like PQRS, gov.” Meaningful Use and the Value Modifier Many physicians are not quite pre(VM) program. pared to comply with all the MACRA “As practices work to improve perreporting requirements, said Jackie P. formance in these programs, it will have Boswell, MBA, FACMPE, assistant vice a halo effect on several CMS quality propresident, SVMIC, in Brentwood, Tengrams across the continuum,” Jacobsen nessee. said. “The key to identifying the opportu“The Physician Quality Reporting nities lies in the data available through the System and Meaningful Use are current VM program (QRUR). Assisting providMedicare quality reporting programs and ers in understanding performance in this even those have been a challenge for proprogram benefits their practice and can viders,” Boswell said. “The Value-Based have a positive impact on many other Payment Modifier has been implemented reform programs (e.g., bundle payments, in the past few years and many providetc.)” ers are unaware that program exists even Jacobsen said steps a practice can though they face potential payment adtake to succeed in future programs include justments for scoring in the bottom perevaluating the MIPS and APM programs centile. to identify which program is the most fea“MIPS will replace these current prosible and advantageous program for your grams beginning January 1. CMS has repractice. laxed some of the initial MIPS reporting “Learn about the various current requirements and implemented a ‘Pick APM programs potentially available



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Your Pace’ program for the 2017 Performance Year. This modification allows providers who are not ready to just report something to avoid a penalty. CMS realizes providers are not prepared to comply with their new quality payment programs for a full year.” Boswell said it is important to get up to speed on MACRA because providers could end up being penalized eventually up to nine percent. She said there are many providers who are weighing the costs versus the benefits of complying with all of the requirements, and feel that the benefits may not outweigh the costs. “The reporting is very confusing,” she said. “Providers aren’t sure what quality measures they should be reporting or how to report each of the categories. Even though the payment adjustments will now be combined, providers may still have to report using different systems such as registry and electronic health records (EHRs). My best advice is to start reviewing the reports that are available currently such as the Quality and Resource Use Report (QRUR), and their PQRS Feedback Reports.” She encourages providers to talk to their EHR vendors to determine what capabilities they will have for MIPS reporting. She also recommends not reacting too quickly to pressures to spend large amounts of money to upgrade or replace their current systems. She encourages them to meet with their vendors and understand what solutions they will offer. “Vendors might make it sound like you have to upgrade right now,” Boswell said. “Physicians need to be thoughtful about the process.” Another reason it is so important for physicians to prepare for these quality payment programs is Medicaid and commercial payers have already begun implementing similar quality incentives and penalties. So in addition to the risk of non-compliance resulting in penalties from CMS, there is a risk of being eliminated or de-selected from commercial networks. “Basically, the payers are moving from a fee-for-service, volume based environment to pay-for-performance,” she said. There is a risk that some providers will be more selective accepting patients. Boswell said ideally the payers will be risk adjusting for patients with chronic conditions. She emphasized the importance of providers coding all chronic conditions, as well as patient non-compliance. Providers should familiarize themselves with the ICD-10 codes for patient non-compliance. Boswell said that the healthcare industry has begun the process of paying providers based on value instead volume. “And they are defining value as improving the quality of patient care and outcomes, better patient experience and lowering the cost of healthcare,” Boswell said. “The healthcare industry calls this the Triple Aim. Based on how the payer determines that the provider has performed in these three areas, he/she may receive an incentive or a penalty.” memphismedicalnews


GrandRounds Dermatologist Robert Kaplan Honored by UT President’s Council

The Urology Cancer Center at Saint Francis Hospital-Memphis will offer MRI fusion biopsy, a specialized type of biopsy which was the subject of a recent study in the Journal of the American Medical Association. The study reports promising results from a more targeted way to biopsy the prostate. Saint Francis is believed to be the first in the Memphis area to offer the procedure. “The MRI fusion biopsy has significantly improved the accuracy of diagnosing prostate cancer, the most common cancer in the American male,” said Walter Rayford, MD, PhD, MBA, Medical Director of The Urology Cancer at Saint Francis Hospital-Memphis.

Robert J. Kaplan, MD, a Memphis dermatologist, philanthropist, and longtime patron of the University of Tennessee, was awarded the Jim and Natalie Haslam Presidential Medal during the 2017 University of Tennessee President’s Council awards din- Robert J. Kaplan ner last month in Memphis. A 1973 graduate of the UT Health Science Center (UTHSC) College of Medicine, Kaplan practices medicine at Kaplan Dermatology in Memphis, and holds multiple leadership positions at his alma mater. He serves on the UTHSC Foundation’s board of directors and the UTHSC College of Medicine Alumni Council.

TMA’s ‘Doctors’ Day on the Hill’ Set for March 7 Approximately 300 physicians from across Tennessee are expected to convene at Legislative Plaza in Nashville on Tuesday, March 7, for the Tennessee Medical Association’s annual Day on the Hill. It will take place from 8 am to 3 pm. The free event is open to all physicians, medical office staff and healthcare administrators. For a list of TMA’s legislative priorities, visit tnmed.org/legislative.

AMA Publishes Newly Updated Code of Medical Ethics Completely updated after an eightyear modernization project, a revised edition of the Code of Medical Ethics is available from the American Medical Association (AMA) in hardcover or e-book. Those wishing to request a review copy should contact: AMA Media and Editorial at (312) 464-4430 or email media@ama-assn.org.

TMA Training New Class of Physician Leaders The Tennessee Medical Association is training 16 Tennessee physicians representing a variety of medical specialties through its 2017 Physician Leadership Lab. The Lab focuses on improving clinical teamwork with a multi-month series of webinars and live group sessions. As part of the program, each participant will complete an improvement project within his or her practice environment, making use of the tools and skills acquired in the program.

The Memphis-area members are: Lanetta Anderson, MD, Germantown – Obstetrics/Gynecology Robert Jean, MD, Memphis – Surgery Alim Khandekar, MD, Memphis – Thoracic and Cardiovascular Surgery Veronica Murphy, MD, Memphis – Child and Adolescent Psychiatry Joe Russo, MD, Memphis – Internal Medicine/Pediatrics Jawwad Yusuf, MD, Memphis – Internal Medicine

St. Jude’s Leslie Robison Honored by American Cancer Society Leslie L. Robison, chair of the department of epidemiology and cancer control at St. Jude Children’s Research Hospital, is one of three outstanding individuals to receive the 2016 American Cancer Society Medal of Honor Award. The Medal of Honor is awarded to those who have made the most valuable contributions and impact in saving more lives from cancer through basic research, clinical research, and cancer control. The other recipients include Joan S. Brugge, Ph.D., for Basic Research, and Charles L. Sawyers, M.D., America Cancer Society Medal of Honor recipients are for Clinical Research. (from left) Joan S. Brugge of Boston, Charles L. Sawyers of New Robison was selected in recYork, and Leslie L. Robison of Memphis. ognition of his lifetime contributions and dedication to pediatric oncology research. His career has been dedicated to research on the epidemiology and long-term outcomes of pediatric cancer survivors.


Saint Francis to Offer Specialized Prostate MRI Biopsy

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GrandRounds Memphis Medical Society Installs New Officers, Board Members Phillip R. Langsdon, MD, FACS a facial plastic surgeon at The Langsdon Clinic, has been officially installed as the 2017 president of the Memphis Medical Society during the annual dinner and installation ceremonies last month. Langsdon, who becomes the 2,215-member organization’s 140th president, replaces outgoing president Tommy J. Campbell. Others installed are president-elect Autry J. Parker, MD, pain management at Semmes-Murphey Clinic; vicepresident – Andrew T. Watson, MD, cardiovascular disease at Sutherland Cardiology Clinic; secretary - Danielle H. Hassel, MD, physical medicine and rehabilitation at Memphis VA Medical Center; and treasurer – Sri I. Naidu, MD, otolaryngology at Mid-South Ear, Nose & Throat. Returning board members are David L. Cannon, MD; Frederick A. Fiedler, MD; James E. Klemis, MD; Jimmie Mancell, MD; Justin Monroe, MD; Christopher M. Pokabla, MD; and Lisa S. Usdan, MD. Raymond R. Walker, MD, family medicine at Saint Francis Inpatient Physicians is the new board member.

UTHSC Addiction Center Gains National Attention The College of Medicine at the University of Tennessee Health Science Center (UTHSC) brought the national spotlight to Memphis when its new Center for Addiction Science was named the nation’s first Center of Excellence in Addiction Medicine. The center was cited by the Addiction Medicine Foundation, a national organization that accredits physician training in addiction medicine, for being the first in the country to bring together clinical care, research, education, and community outreach to address addiction and deadly substance use. Grim statistics tell the story of addiction across Tennessee. Eighty percent of the crimes in Tennessee have some drug-related link, according to the Tennessee Bureau of Investigation. At least 1,263 Tennesseans died from opioid overdose in 2014, and that same year, more than 1,000 babies in Tennessee were reported born with neonatal abstinence syndrome, the result of exposure to addictive drugs in the womb. The UTHSC College of Medicine

is taking a major step toward rewriting that story with the center led by Daniel Sumrok, MD, a former Green Beret and public health physician with more than four de- Daniel Sumrok cades of knowledge in treating the devastating consequences of substance abuse. Managed by University Clinical Health and located at 1325 Eastmoreland Avenue, the center provides clinical treatment services, including cognitive behavioral therapy, medication-assisted treatment, motivational-enhancement therapy, and 12-step program facilitation across all demographics for patients suffering from substance-related and addictive disorders.

Christ Community Health Services Names Leatherwood CEO Shantelle Leatherwood, who grew up in South Memphis and began working at Christ Community Health Services (CCHS) as an administrative assistant in 1999, is the organization’s new Chief Executive Officer. Leatherwood fills the Shantelle position that came open Leatherwood in December when Ed Roberson retired. Four years after being hired at CCHS, Leatherwood was promoted to practice administrator and since has served in several positions, most recently Chief Administrative Officer. Leatherwood earned a B.S. in Health Care Administration and Planning at Tennessee State University and a Master of Health Administration at the University of Missouri.

AMA’s Gurman Says Court Order Halts Bad Deal for Elderly Patients Andrew W. Gurman, MD, President, American Medical Association said a recent court order was good news for one large group of patients. “Elderly patients were the big winners as a federal court imposed an injunction on Aetna’s $37 billion acquisition of Humana,” he said of last month’s ruling. “The court ruling halts Aetna’s bid to become the nation’s largest seller of Medicare Advantage plans and preserves the benefits of health insurer competition for a vulnerable population

of seniors. “Aetna’s strategy to eliminate head-to-head competition with rival Humana posed a clear and present threat to the quality, accessibility and affordability of healthcare for millions of seniors. The AMA applauds the extraordinarily well-documented, comprehensive, fact-based ruling of U.S. District Judge John D. Bates, which acknowledged that meaningful action was needed to preserve competition and protect high-quality medical care from unprecedented market power that Aetna would acquire from the merger deal. Importantly, Judge Bates further concluded that the merger would unlawfully restrain competition in the sale of individual commercial insurance on the public exchanges in three counties in Florida identified in the complaint. “The court’s ruling sets a notable legal precedent by recognizing Medicare Advantage as a separate and distinct market that does not compete with traditional Medicare. This was a view advocated by the AMA, as well as leading economists. AMA also applauds the decision for protecting competition on the public exchanges. “The AMA’s stand against this anticompetitive merger shows again that when doctors join together, the best outcome for patients and doctors can be achieved. Given the troubling consolidation trends in health insurance industry, the AMA will continue to advocate on behalf of patients and physicians to foster more competitive health insurance markets.”

Tennessee Health Care Hall of Fame Requests Nominations The Tennessee Health Care Hall of Fame, an initiative to honor Tennessee’s finest healthcare leaders, is accepting nominations for its 2017 class via the organization’s website, www.tnhealthcarehall.com. Submissions will be accepted until March 10. With a mission to honor men and women who have made significant and lasting contributions to the health care industry, the Hall of Fame seeks to recognize the pioneers who have formed Tennessee’s healthcare community and encourage future generations of innovators and leaders. Created by Belmont University and The McWhorter Society and supported by the Nashville Health Care Council, a

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Methodist Wins Advanced Certification for Comprehensive Stroke Center Methodist University Hospital has earned The Joint Commission’s Gold Seal of Approval and the American Heart Association/American Stroke Association’s Heart-Check mark for Advanced Certification for Comprehensive Stroke Centers. The Gold Seal of Approval and the Heart-Check mark represent symbols of quality from their respective organizations. Methodist University Hospital underwent a rigorous onsite review in which Joint Commission experts evaluated compliance with stroke-related standards and requirements. Susan Childs

PUBLISHER Pamela Z. Harris pamela@memphismedicalnews.com EDITOR Bob Phillips editor@memphismedicalnews.com ADVERTISING INFORMATION 501.247.9189 Pamela Harris CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com GRAPHIC DESIGNERS Susan Graham, Katy Barrett-Alley CONTRIBUTING WRITERS Susan Childs Ron Cobb Becky Gillette Judy Otto Cindy Sanders All editorial submissions and press releases should be sent to editor@ memphismedicalnews.com Subscription requests can be mailed to the address below or emailed to pamela@memphismedicalnews.com. Memphis Medical News is now privately and locally owned by Ziggy Productions, LLC. P O Box 1842 Memphis, TN 38101- 1842 President: Pamela Harris Vice President: Patrick Rains

EMHC Celebrates 20 Years of Providing Ambulance Service EMHC, the Memphis area’s largest locally owned ambulance provider, marked its 20th year in the ambulance service industry. Beginning its operation in 1997 with three ambulances EMHC today has more than 30 ambulances and also offers air ambulance service. Founders, Michael and Bette Arndt, credit EMHC’s steady growth to “a commitment to provide superior compassionate, individualized care to patients and their families.

Hall of Fame Founding Partner, the Hall of Fame inducted its six-member 2016 class at a luncheon last year. Inductees included Frank S. Groner, president emeritus of Memphis’ Baptist Memorial Hospital.

Reproduction in whole or in part without written permission is prohibited. Memphis Medical News will assume no responsibility for unsolicited materials. All letters sent to Memphis Medical News will be considered the newspaper’s property and unconditionally assigned to Memphis Medical News for publication and copyright purposes.

Michael and Bette Arndt




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