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CARDIOVASCULAR CARE • INTEGRATIVE MEDICINE • LEGISLATIVE AGENDAS

February 2018 December 2009 >> $5 ON ROUNDS Important Decision By Le Bonheur Proves Rewarding Pediatric cardiovascular surgeons are difficult to find. There aren’t many of them. But Le Bonheur Children’s Hospital found a gem in Umar Boston, Umar Boston thanks to a key decision by the hospital.

Profile on page 3.

Skilled Leadership A Key Reason For UTMG Turnaround After finding talented leadership, the oncestruggling UT Medical Group seems to be on its way back to full health, moving forward as the recently Drew Botschner transformed and renamed University Clinical Health.

Story on Page 5.

Expert Welcomes Definition Changes By ACC and AHA The ACC and AHA have lowered the definition of hypertension and done away with the term ‘prehypertension’ in an effort to start interventions earlier. A nationally recognized expert discusses the significance of the decision.

Report on page 7.

Opioids Head Lawmakers’ List Of Critical Healthcare Issues Associations, Providers Weigh In with Their Agendas By BETH SIMKANIN

Of all the healthcare issues on the table at Tennessee’s legislative session currently  taking  place  in  Nashville, the stunning rise of opioid  abuse is dominating the discussion. The facts, supplied by the Tennessee Department of Health, are hard  to ignore: Drug abuse claims at least three lives every day in Tennessee and 1,600 residents died from drug overdoses in 2016, mainly due  to  opioid  abuse.    Understandably, lawmakers wasted little time focusing their attention on the crisis as soon as the session opened last month. Gov. Bill Haslam and Tennessee lawmakers unveiled a $30 million legislative and executive plan. Dubbed “TN Together,” the  plan, announced during the last days of January, will be funded with  federal and state money and consists of three components – preven-

tion, treatment and law enforcement. A large portion of the plan is  focused on treatment and recovery programs.  The plan was designed in partnership with the Tennessee General Assembly through its Ad Hoc Opioid Task Force, which was  established last year and announced its recommendations in September, based on feedback from state healthcare experts and public  offi  cials.  According to Nita W. Shumaker, MD, president of the Tennessee Medical Association (TMA), the state’s largest  professional  organization for physicians, it’s  too soon to tell how the proposed  legislation  will  aff ect  Mid-South  physicians,  hospitals  and  patients.  She  said the organization is reviewing  the  proposed legislation and will base its position on how  the proposed legislation will impact physicians and patients in the  state. (CONTINUED ON PAGE 4)

HealthcareLeader

Murrmann Embraces Rise Of Integrative Medicine By JUDY OTTO

A lifelong seeker of reasons and causes, Susan G. Murrmann, MD, FACOG, has found in integrative medicine not an answer but a way to fi nd more answers to better serve her patients. Co-founder of the McDonald Murrmann Women’s Clinic in 1996, and the McDonald Murrmann Center for Skin, Laser & Healthy Aging in 2003, she regards the businesses’ transformation into the current McDonald Murrmann Center for Wellness and Health as a natural evolution. As medicine changes and research reveals new fi ndings and new possibilities, Dr. Murrmann  — already recognized for her strides in pioneering, innovative care for women — is exploring  and embracing the practice and the promise of integrative medicine, which combines alternative  (CONTINUED ON PAGE 6)

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PhysicianSpotlight

Lending a Hand, and a Heart, to Children Le Bonheur’s Commitment to Transplantation Is Richly Rewarded Umar Boston, MD, a pediatric cardiovascular surgeon at Le Bonheur Children’s Hospital, has done approximately  100 heart transplants on children. None of  them was any more challenging than one he did almost a year ago. A baby was born with dextrocardiaheterotaxy  syndrome  with  congenital  heart block. In short, electrical activity was blocked between the upper and lower  chambers of the heart. Also, the baby’s heart was malformed. In a normal heart, the apex of the  heart points to the left and the major veins  that go into it come from the right. In this baby, it was the opposite – the heart  pointed to the right and the veins came in  from the left. In addition, the function of the heart was extremely poor. This combination, Dr. Boston said, is uniformly fatal. “So  we  offered  the  mother  two  things,”  the  doctor  said.  “You  can  take  your baby home and do nothing. Or we will go out on a limb and see if we can get the child to transplantation, knowing this  is a very rare type of transplant that the  baby would have to undergo.”  The mother opted for a transplant. In  surgery, the surgical team had to take a donor heart and place it in the opposite  confi guration  than  the  baby’s  previous  heart had been in. “It’s  one  of  the  more  complicated  operations one can imagine or perform,”  Dr.  Boston  said.  “The  child  is  now  10  months  out  from  transplantation,  and  she’s probably done the best of any transplant that I’ve ever taken care of.”  Dr. Boston is surgical director of the Heart Transplant and Mechanical Circulatory Program and surgical director of the Adult Congenital Heart Disease Program at Le Bonheur. Two unfortunate events –  a  death  and  a  hurricane  --  played  a  big  role in getting him to where he is today. Dr. Boston was born in the South American country of Guyana, and his family  moved  to  Papua,  New  Guinea,  when he was 5. The father, Derrick Boston, was a barrister in criminal law but was plagued by heart disease. He had his  fi rst  heart  attack  at  age  35  and  died  of  another at age 42. What he needed was a bypass operation, but Dr. Boston said his father was

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was about to go to New Orleans for an interview when Hurricane Katrina hit. One of the surgeons at Tulane suggested he try Le Bonheur instead. He got  the  job,  and  felt  fortunate  about it. “People  who  are  ‘crazy’  enough,  or  diligent  or  ambitious  enough  to  pursue  pediatric cardiac surgery – you study for  19 years after high school, and the surgical training is 12 years,” he said. “At the end  of that there is no guarantee of a job.  “The  number  of  pediatric  cardiac  surgeons in the United States is roughly  about 150. It’s a very, very highly specialized  and  highly  competitive  fi eld.  The  year I was training there were about 30 of us who were doing some form of pediatric  cardiac  fellowship,  and  there  were  only  three of us who got jobs.”  He started at Le Bonheur as the junior surgeon along with two other surgeons,  Dr.  Chris  Gilbert  and  Dr.  Jeff  Meyers. Within a year, Dr. Gilbert left for another job, and not long after that Dr.  Meyers took a job in Boston.  “This is a specialty where you need  good  mentorship  during  training  and,  even more important, after your training.  So I was by myself and had to carry the cardiac program here at Le Bonheur for  two or three years before I got some help.  “It was trying times, I would say.” 

PHOTO BY LISA BUSER COURTESY LE BONHEUR CHILDREN’S HOSPITAL

By RON COBB

Dr. Umar Boston with one of his transplant patients.

reluctant to go to a doctor and believed he could rely on medication. “When you’re  11  and  you  see  your  father die of a heart attack, you question whether anything else could have been done,” Dr. Boston said. “My initial ambition to pursue medicine was certainly born  out of the experience of having my father 

die at a very young age from cardiac disease.” Years later, after completing his cardiothoracic training at the Mayo Clinic, Dr. Boston was doing a fellowship at the  University of Alberta in Edmonton when  one of his mentors suggested he apply for  a  job  at  Tulane  University.  Dr.  Boston 

(CONTINUED ON PAGE 8)

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Clint Cummins

Keith Norman

Carla Kirkland

Tish Towns

Dave Chaney

Nita W. Shumaker

Opioids Head Lawmakers’ List Of Critical Healthcare Issues, continued from page 1 “We have made some progress in reducing initial opioid prescriptions but still have a long way to go,” Dr. Shumaker said in response to the governor’s proposed legislation. “We must continue to promote alternative pain management treatments that do not involve opioids while ensuring that treatments are covered by health insurance. We do need to reduce supply and dosage, particularly for new patients and acute episodes like the hospital ER. “At the same time, we want to make sure that any law(s) limiting physicians’ ability to prescribe have reasonable exceptions to continue giving relief to patients in legitimate need, such as chronic pain, oncology or hospice patients.” Legislation in the proposal, which was recommended by the task force and is of particular interest to Mid-South physi-

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cians, pharmacists and hospitals, includes limiting the supply of an initial opioid prescription to five days. According to several Mid-South medical professionals, many hospitals in the area follow this practice currently. Carla Kirkland, NFP, president of District One of the Tennessee Nurses Association, which includes Shelby and Fayette counties, said, “Many emergency rooms in the Mid-South are doing this already. Some ERs limit prescribing opioid medications to three days or less for patients with acute issues. Hospitals are taking the initiative already.” Keith Norman, vice president of government affairs for Baptist Memorial Health Care, said the goal of many hospitals in the near future will be to become opioid free, except in acute cases when an opioid medication is deemed necessary for the patient. “This is an important issue which affects everyone in healthcare in Tennessee,” Norman said. “You will see hospitals enact ‘opioid free’ policies and help patients seek alternative pain management.” Additionally, various state healthcare associations, such as the Tennessee Hospital Association (THA), Tennessee Nurses Association (TNA) and the TMA have announced their legislative agendas and plan to tackle a number of healthcarerelated legislative issues during the 2017 Tennessee General Assembly. Some of the key issues are: • Maintenance of Certification The TMA plans to file legislation for the second year in a row to prohibit hospitals and health insurance companies from requiring maintenance of certification (MOC) for physician credentialing for network participation. Currently, physicians must be board-certified through the American Board of Medical Specialties, the nation’s largest physician-led specialty certification organization, to receive privileges to practice at area hospitals. According to Clint Cummins, executive vice president of The Memphis Medical Society, physicians must spend “thousands of dollars of their own money” to travel to take the exam, creating the additional problem of losing time with patients. Additionally, the MOC exam covers areas of medicine that do not necessarily pertain to the physicians’ current specialties. Cummins compared the MOC exam to an attorney who practices criminal

defense law and must take an exam for real estate law. “It has become cumbersome and expensive to maintain the requirements,” said Dave Chaney, vice president for the TMA. “Right now physicians are forced to participate in the certification because hospitals require it for the physician to have privileges. This has become a revenue building operation, and we want physicians to have more options and other measures that aren’t generic and have more value to their current specialties.” The THA contests the TMA’s legislation because it “restricts or dictates the process hospitals use for granting privileges to physicians.” “We oppose this legislation and think the decision should be made by the local governing board of hospitals and not be placed in the legislative arena,” said Tish Towns, chief administrative officer for Regional One Health. Cummins said there isn’t another board-certification option for physicians currently, and he hopes that physicians, hospitals and insurance companies can agree on a solution. • Balance Billing Balance billing, also known as extra billing, is the practice of a healthcare provider billing a patient for the difference between what the patient’s health insurance chooses to reimburse and what the provider chooses to charge. Balance billing occurs when an out-of-network provider bills a patient separately, even when a patient receives treatment at an in-network hospital. Rarely is the patient told that the provider is out-of-network and he or she receives a “surprise bill” from a provider that contracts with the hospital. Farm Bureau Insurance of Tennessee has filed proposed legislation that would mandate that the hospitals or physician notify the patient ahead of a scheduled procedure that a provider is out-of-network or accept the in-network negotiated rate. The TMA wants a proposal that doesn’t place the responsibility on the provider, who may not have immediate access to the patient’s insurance information. The TMA opposes the legislation, which the organization sees as giving insurance companies more leverage to force providers to accept unfair contractual terms. • Extension of HSDA The Health Services and Development Agency (HSDA), which oversees Tennessee’s certificate of need (CON) program, is set to expire at the end of the

fiscal year. The THA wants a three-year extension of the agency and hopes to preserve the CON program for the state. According to the HSDA, a certificate of need is granted when a project will be deemed necessary to provide healthcare, will be profitable, will provide healthcare that meets appropriate quality standards, and will contribute to the orderly development of adequate and effective healthcare facilities in an under-served area. Baptist’s Keith Norman said he would like to see clarification from the agency on the definition of a free-standing emergency department. “We have been denied twice by the state for free-standing emergency departments in East Memphis and Arlington,” he said. “We feel there is a need in these locations, and we don’t feel there is enough clarity on the definition now. These are not hospitals, but eight to 10 emergency room centers which can treat up to level two trauma.” • School Nurse Requirements The TNA has proposed legislation for a minimum mandatory school-nurse-tostudent ratio of one nurse to 750 students in all public schools in the state. Currently, according to the TNA, there is one school nurse for every 3,000 students. “The Centers for Disease Control recommends a nurse-to-student ratio of one to 750,” the TNA’s Carla Kirkland said. “Tennessee doesn’t meet the standards of the CDC, and we want this to change.” • Indoor Tanning Legislation has been filed to prohibit minors under the age of 18 in the state from using indoor tanning facilities. The bill has received much support from the medical industry, including the TNA, THA, TMA, The Tennessee Dermatology Society and Le Bonheur Children’s Hospital. “This bill has a lot of support from various associations in the industry and state hospitals,” the Medical Society’s Clint Cummins said. “If passed, Tennessee will join 20 other states banning minors under 18 from indoor tanning.” There are other issues the healthcare industry hopes the General Assembly will address. Norman said it is unclear how many issues the General Assembly will tackle. “This is an election year, so we don’t know how many bills will come to a vote,” he said. “I suspect this session will be short.” memphismedicalnews

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Transformed by Skilled Leadership, UTMG Moving in Right Direction The New UCH ‘Financially Strong and Growing’ By JAMES DOWD

 Several years and what he described as “a lifetime ago,� Drew Botschner arrived in Memphis to oversee what he thought would be a temporary project at UT Medical Group (UTMG). At the request of longtime friend Dr. David Stern, medical school Drew Botschner dean and vice chancellor for clinical affairs for the University of Tennessee Health Science Center (UTHSC), Botschner agreed in late 2013 to move to the Bluff City to help turn around the beleaguered UTMG. The medical group, which had too many physicians and not enough cash flow, was reeling from a multi-million dollar lawsuit and in danger of declaring bankruptcy. With a law degree (as well as an undergraduate degree in economics and history) from Wake Forest University,

plus an MBA from Xavier University, Botschner was a wise choice. In addition, his previous experience included roles as general counsel at CarePoint Partners, LLC (2011-2013); chief legal officer at University of Cincinnati Physicians Inc. (2004-2010); private practice attorney, specializing in healthcare, corporate and transactional legal and business consulting services (2002-2004). His legal background combined with the successful track record of operating streamlined startups made him uniquely suited for the task and he looked forward to the challenge of transforming the organization. “David was very candid with me about the situation and asked if I’d come to Memphis to help UTMG through a difficult time,� Botschner remembered. “I’d just sold my company and I’ve always liked being entrepreneurial, so I looked at this as a way to help UTMG become something new, something better.� Shortly after arriving at UTMG, Botschner was promoted to president and CEO of the organization. He was given the latitude to explore myriad options to help the organization rebound, which led

to its new identity: University Clinical Health (UCH). “There were a lot of negative perceptions about UTMG and there was a lot of baggage associated with that name,� Botschner said. “They had worked with outside counsel and the insurer to negotiate a reasonable settlement for the lawsuit and that helped remove the litigation cloud, but we knew the name had to change.� Legal trouble began 2005, when a UTMG doctor performed a cesarean section that resulted in the baby suffering brain damage and cerebral palsy. A lawsuit was filed and nearly a decade later, a jury delivered a verdict of more than $30 million against UTMG and the doctor who performed the procedure. At about the same time, UTMG was going through a transition, spinning off physicians to medical practice groups at Le Bonheur, Methodist and Regional One. “There was a lot of activity concurrent to the verdict and UTMG was undergoing a substantial metamorphosis,� Botschner remembered. “It was difficult for physicians and personnel and the organization was cash-flow negative, to the tune of hundreds of thousands of dol-

lars every month. That model was simply unsustainable.� To help right the ship, Botschner implemented operational changes to drastically reduce costs and personnel while generating revenue. From a peak of nearly 450 physicians in 2012, today University Clinical Health counts about 100 physicians. In the last four years, UCH increased revenue by nearly 50 percent and eliminated its debt. Operations have been streamlined and IT costs are down by more than 60 percent. Dr. Brad Canada, chief medical officer for UCH since 2004 and assistant professor of medicine at UTHSC, says the transformation is nothing short of remarkable. “We’re looking at things differently now, with a vision Brad Canada of how to best serve our patients and operate in a sustainable manner,� said (CONTINUED ON PAGE 8)

  

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Murrmann Embraces Rise Of Integrative Medicine, continued from page 1 medicine with evidence-based medicine to effectively treat the whole person, making use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing. She said she regards the businesses’ transformation into the current McDonald Murrmann Center for Wellness and Health as a natural evolution. Murrmann, along with her partners, Dr. Mary McDonald and Dr. Heather Donato, have channeled their passion for women’s health into a new team-focused practice on the concept of complete and comprehensive patient care.  Murrmann said the decision to make the transition was unanimous among the three. “It is a team effort,” she said. “We started this practice by focusing on the practice and fighting the obstacles of separating from partners in this day and age. Now we all have faith in what we put into this concept. We have focused on building a better model – a well-overdue concept of patient care, and genuine love of what we do.” Dr. Murrmann’s early history at the Women’s Clinic reflects a commitment, even then, to reinventing gynecological care to include physical, mental and aesthetic aspects of women’s health, and to recognize the often unaddressed factors that impact patients’ wellbeing, such as stress, relationships, financial worries, etc.

Blanche Petty, ARNP, Susan Murrmann, MD, Heather Donato, MD, Mary McDonald, MD, Mariana Rizzo, ARNP

These factors can be the underlying causes of symptoms like pelvic pain, Dr. Murrmann said. “Just being able to talk to the patient and get a better perspective . .

. helped me figure out the right solutions for her.” “I’ve always been very curious and I’ve always asked why,” she continued.

“Coming out of residency, you’re excited and you have all this knowledge, but you realize over time there’s still a lot more to

(CONTINUED ON PAGE 8)

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CONSOLIDATED MEDICAL PRACTICES OF MEMPHIS WELCOMES Michelle Allmon, MD, Internal Medicine

Get with the Guidelines: Blood Pressure Edition ACC, AHA Redefine Hypertension By CINDY SANDERS

Apparently, it’s time to take another look at high blood pressure. The American College of Cardiology and American Heart Association has redefined the way clinicians and the public should think about ‘high’ blood pressure. After nearly three decades of decline, deaths from heart disease have been on the rise during the past several years. While there are multiple risk factors for cardiovascular disease, the good news is that a number of those risks are controllable, including decreasing blood pressure. Previously, stage 1 hypertension began at 140/90 mmHg. Now, patients with a blood pressure of 130/80 mmHg are considered to be hypertensive. Lowering the numbers has allowed clinicians to raise the warning flag sooner and institute lifestyle modifications and medication if warranted. “We’re getting aggressive in looking at how we define hypertension and making sure we’re not underselling blood pressure,” explained Walter Clair, MD, MPH, a nationally recognized expert in his field who leads Vanderbilt Heart in Nashville and holds national and regional committee appointments with the American Heart Association. Walter Clair, MD, “We’ve all agreed MPH for years that blood pressure is normal if it is less than 120 over 80,” he said. However, Clair continued, hypertension experts have anticipated the guideline change for several years as the science has shown not only cause for increasing concern with a systolic number of 130 and diastolic measurement above 80 but also a benefit from treatment. “Even when we can show a correlation between bad outcomes and hypertension, we still have to show that treatment memphismedicalnews

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is going to make a difference,” he said. With the science in place, these new numbers are the first change in blood pressure guidelines since 2003. Previously, patients with blood pressures between 120 and 139 systolic and/or a diastolic reading between 80-89 would have been classified as having ‘prehypertension.’ Now, anything greater than 120/80 is considered an elevated blood pressure. “It’s not ‘pre’ so we don’t say, ‘We’ll see you in a year,’” Clair said of the new trigger points. Instead, he continued, physicians should be intervening at that point and following up with patients more frequently to monitor improvement and sustainability. “Jumping all over it (hypertension) doesn’t mean you should necessarily start taking a drug for it,” he added in response to one concern some patients and physicians have voiced about the new guidelines. “But we begin to look more aggressively at cardiac risk factors … and you now have one, elevated blood pressure … so we should look at lifestyle, sodium intake, exercise, diet, smoking.” Realistically, Clair continued, lifestyle modification only achieves a decrease of about 11 millimeters of mercury so someone with a blood pressure of 160/90 probably won’t move the needle enough with lifestyle changes alone. However, he pointed out, those defined as having elevated blood pressure and stage 1 hypertension could quite likely get numbers back in the normal range without requiring medication. He was quick to add that doesn’t mean lifestyle modifications aren’t critical for everyone at any stage of hypertension. “Many people think because they are taking these blood pressure medications and controlling their blood pressure, they don’t have to give up that frequent flyer card to McDonald’s … yes, you do,” he stated. “You still have to do all of the other cardiovascular risk modification steps to get (CONTINUED ON PAGE 10)

We address the health care needs of those in the Dr. Michelle Allmon is a 1999 graduate of the Shelby County region University of Tennessee College of Medicine. She completed a residency in Internal Medicine at the and surrounding areas by University of Tennessee - Memphis in 2002 and is board certified by the American Board of Internal Medicine. She is also providing outstanding a 1995 graduate of Louisiana State University. She is a multi-year and compassionate care.Memphis Top Docs award. recipient of the Memphis Magazine, To refer patients to Dr. Allmon, please call Hanissian Healthcare, 574 Green Tree Cove in Collierville at 901.853.2021. Derene E Akins, MD

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Murrmann Embraces Rise Of Integrative Medicine, continued from page 6 learn. I  was  tired  of  seeing  patients  and  just treating them. I wanted to know why  they were getting endometrial cancer and having other hormonal issues. Getting to the root of the problem has been one of  my main interests.” Introducing the tenets of integrative medicine into her practice will allow her  and her practice partners to take gynecology to a new level, she said, by “looking  at our patients as more than just an organ  — taking into consideration other factors that might be contributing to their problems that are female-related.” Gut health, for instance, is regarded as the root cause of many disorders, she has learned during her current pursuit of  a fellowship in functional and metabolic  medicine off ered by the American Academy of Anti-Aging Medicine (A4M) in conjunction with the George Washington  University Medical School.   A4M was established 25 years ago and has had its share of naysayers and detractors within the medical community, she admitted. But things are changing and many more physicians are listening—and  participating—  including  the  Cleveland  Clinic, which also has a functional medicine clinic and a recently added fellowship  program. “I think it’s what patients are looking  for,” Dr. Murrmann said. “Because I see  so many patients on so many drugs for so  many diff erent causes, and the drugs are 

making them sick. We want to off er more  services to help them be more proactive  with  their  health,  as  opposed  to  being  reactive.” The A4M fellowship is based on disease  prevention  and  lifestyle  choices  and  offers what evidence-based medicine believes our bodies need at various stages of our lives, she explained. “One aspect, epigenetics, teaches that individuals can actually change the way their genes behave.” The  fellowship,  which  takes  two  to  three  years  to  complete,  explores  every  organ system and all available research, Dr. Murrmann said. She likens her current studies to layers of knowledge and estimates  that  she  penetrated  only  onefourth of the way in medical school. “Now  I’m studying the other three-fourths … a tremendous amount of knowledge and scientifi c research that has developed since I  went to medical school. This has been the biggest learning experience of my entire  life. It’s been eye-opening.”  “I’m  not  sure  that  healthcare  has  been progressing in a very positive way,”  she  continued.  “Insurance  has  forced  a lot of us to see more patients, shorten  the amount of time, address the problem,  and that’s it. That is not conducive to a healthier patient or a healthier nation. It’s  actually working backwards.” Her solution — spending more time  with patients and off ering additional services that make the Women’s Center more

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of a “one-stop shop” for patients — is not  necessarily better from a payor’s perspective.  “But  I  didn’t  get  into  medicine  for  the insurance reimbursement. I wanted to help people.” The  transformation  of  the  practice  is  physical  as  well  as  philosophical.  Renovations  to  the  7205  Wolf  River  Blvd. location were to begin Feb. 1 and will  re-adapt  existing  space  to  accommodate new imaging and mammography services. Skin and laser will expand  to off er more health-related services, and  Dr. Murrmann and Dr. McDonald, both experts in biodentical hormones, are interested in also expanding that area. Other  features include weight loss and lifestyle counseling,  andropause  healthcare  and  an  intuitive,  patient-friendly  portal  integrated with each fi tbit, which shares sleep  pattern, heart rate and step information  with doctors. An on-line dispensary allows  patients  to  order  doctor-recommended  probiotics or supplements based on their  shared information. Maintaining their own health profi le  through the portal puts patients in charge  of their own health — and equips them to 

deal wisely with it. A helper by instinct, Dr. Murrmann  served  as  a  lifeguard  and  hospital  volunteer,  but  “doctor  was  just  not  on  my  radar” due to a lack of role models in the  small town south of Chicago where she grew up. After two years of undergraduate  focusing on her major in psychology, she  began  exploring  pre-med  classes  alongside  a  friend,  which  pointed  her  toward  medicine  as  a  calling,  and  OB/GYN  as  her specialty.  The  fi rst  to  bring  minimally  invasive surgical options and robotic surgery  to Memphis for women, Dr. Murrmann  was also recognized as the Memphis Business Journal’s fi rst female Healthcare Hero  in 2005. An  enthusiastic  supporter  and  promoter of Memphis music, she also serves  on the Memphis and Shelby County Film  Commission, and supports the eff orts of  independent fi lm makers.  Her advice to other healthcare professionals?  “Never stop learning. Never  stop  asking  why.  Don’t  believe  everything you’re told — and always do your homework.”

Transformed by Skilled Leadership, continued from page 5 Canada, who joined the organization in  2004.  “Our  mission  is  to  serve  patients,  serve the community, teach, and support  research.  Our  goal  is  to  improve  health  and access to care.” In addition to rebranding and streamlining  operations,  UCH  has  benefi ted  from the expertise of a business development team, Botschner said. Far from its former identity as a bloated, bureaucratic medical  group  with  siloed  departments  and duplicate operations, today the organization occupies a smaller footprint that  produces a larger yield. “UTMG  did  not  function  well  and  its  cost  structure  was  unsustainable.”  Botschner  said.  “In  the  last  few  years,  we’ve been on a planned path of growth  in physicians and services, but we’re very  deliberate about that and we’re not just  adding services that are readily available elsewhere in our community.”

For example,  Campbell  Clinic  is  a  leader in orthopedics and serves the MidSouth well, Botschner said, so there has not been a demonstrated need for UCH  to enter that area. However, last year the group launched a rheumatology practice,  an  otolaryngology  practice,  and  added  specialists  in  dermatology,  hematology  and podiatry. “We’re at the forefront of quality and  innovation, which is the driving force of our organization,” Botschner said. “We’re  fi nancially strong and growing. I liken us  to a phoenix rising from the ashes.” Canada agreed. “Looking back on where we were, on  the verge of collapse, it’s wonderful to see  how far we’ve come and how much better we are today,” Canada said. “This has taken  a lot of eff ort by a lot of dedicated people,  but I believe we’ve turned the corner. We’re much better than we were before.”

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Balancing the Yuck and the Yum

West Tennessee Offers Just What One Cardiovascular Surgeon Wants By SUZANNE BOYD

Ask Ted Wright, MD, what would cause him leave a major academic medical center and move to West Tennessee and he will tell you, “Yuck and yum.” Then he will elaborate on what prompted the move from Lexington, Kentucky, to Jackson, Tennessee. “Life is a series of yum and yucks,” said Dr. Wright. “And you have to find a balance of the two. As a husband and an older father of twin five-year-old boys, as well as a busy cardiothoracic surgeon, I knew I needed to find that balance. The opportunity in Jackson gives me that and so much more. “Living in a community that is friendly and family-oriented is a way to balance the yum and the yucks. What I have found in Jackson is nice folks who are raising their families here and a great tradition of heart surgery. I was also impressed by the number of physicians who came here out of training thinking that maybe this was just a springboard and yet they are still here and so glad to be here.” While he may be finding the right balance between work and family in Jackson, he isn’t the only one benefitting from the move. As the newest cardiovascular surgeon to join West Tennessee Healthcare’s Heart and Vascular program, patients are benefiting from the additional treatments he brings with him that will expand the services offered in Jackson. Wright hails from Ashbury Park, New Jersey, which is on the Jersey Shore.

Dr. Ted Wright and his wife Saskia enjoy traveling with their five-year old twins, Oliver and Felix

His mother says he declared he would be a doctor – and a surgeon no less – as a youngster after a day on the playground. He attended Princeton, which was nearby, and took pre-med classes then attended the University of Virginia Medical School. While in med school, Wright was inspired by several physicians who not only impacted him personally but also influenced the path he would choose to follow. “I was inspired by these physicians who were skillful, thoughtful and

Lending a Hand, and a Heart, to Children, continued from page 3 In 2012, Dr. Boston left Le Bonheur to go to Washington University in St. Louis. A big reason was that Le Bonheur’s heart program, in his mind, wasn’t at the level where it needed to be. “We did not have a heart transplant program,” he said, “and one of my big interests is in transplantation of children with congenital heart disease. Washington U. and St. Louis Children’s Hospital provided that opportunity. I didn’t leave Le Bonheur with any ill feelings. I really wanted to build a transplant program.” In 2015, he got that chance. Le Bonheur upgraded its commitment and brought Dr. Boston back. “During the time I was gone, there was a change in plan,” he said, “and the direction was ‘OK, if we’re going to be a top-notch program, we need to provide all these services.’ They saw what the future of cardiac surgery was looking like.” While he was in St. Louis, Dr. Boston said, Le Bonheur sent him four to six transplant patients each year. But then the hospital demonstrated its commitment by hiring Dr. Jeffrey A. Towbin, who, Dr. memphismedicalnews

.com

Boston said, “is one of the big names in cardiomyopathy and transplantation in the country.” Dr. Towbin is now co-director of the Heart Institute at Le Bonheur. Upon Dr. Boston’s return, he said, “we knuckled down, built the infrastructure and obtained the resources that are required to start a heart transplant program.” “By October 2016 we did our first heart transplant,” Dr. Boston said. “By December 2016 we had performed two heart transplants and had put in two mechanical devices. And in 2017 we really exploded and did 12 transplants, probably some of the more complex heart transplants that we can do.” Donor hearts come primarily from remote sites within a 500-mile radius of Memphis, which encompasses a population of 92 million people. “The donor heart doesn’t last forever,” Dr. Boston said. “So within 20 years a baby will require another heart. I wouldn’t say transplantation is a cure. It provides a better quality of life for the child. Hopefully, with the development of advanced therapies, the donor heart may last longer.”

respected,” Dr. Wright said. “That was something I wanted to emulate. They were educators and trainers of residents and patients. They were people who were looked up to. They were role models and people I identified with in school.” Dr. R. Scott Jones, a surgeon at UVA, encouraged him to pursue surgery. “There is an immediacy to it,” said Dr. Wright. “There is a defined problem that you can fix, and lives are improved immediately. That was important to me.” Dr. Wright’s general surgery residency was completed in his hometown at the hospital where his parents first met: Monmouth Medical Center. Another physician, Dr. Charles Sills, a thoracic surgeon, inspired Wright to pursue cardiothoracic surgery. “I loved the anatomy of cardiothoracic surgery, there is a complex simplicity to it,”

Dr. Wright said. “You can’t get around it. You can’t stop in the middle – you have to follow it to the end. There is a sports aspect to it, the pre-game, the game and the postgame. You can reflect on what you have done which I think is good.” After his residency, Wright went to the University of Wisconsin for a fellowship in cardiothoracic surgery followed by a cardiopulmonary transplant fellowship at the University of California in San Francisco. He was then recruited by a cardiovascular surgery practice in Lexington, Kentucky, and headed to the Bluegrass state. When the practice became a part of the University of Kentucky Medical Center, Wright had the opportunity to be a part of the residency training program in addition to his practice. One aspect of the training program was the mortality conference which looks at poor outcomes, which drove home the fact that in the medical environment there is so much pressure that you have to have other aspects in your life that are good. One of the residents he had trained, Dr. Hetal Patel, had joined a cardiothoracic practice in Jackson and suggested Wright take a look at the practice. Of course, that’s where he found the yuk and yum. Although Wright just joined the practice in early January, he already delivered a wealth of knowledge and experience to the practice. “We had a great multi-disciplinary meeting with cardiology,” he said. “And have identified some areas where we feel we can expand services, especially surgical treatment of atrial fibrillation and minimally invasive services. We will be able to provide cutting-edge services that will mean patients won’t have to travel out of town to get them. We are well poised to serve this community very well and I am looking forward to doing it.”

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Get with the Guidelines, continued from page 7 the full benefi t. We continue to work to  get that message out.” In  addition  to  lowering  the  defi nition of high blood pressure, Clair said the  new guidelines also reemphasized the correct way to take a blood pressure reading  –  making  sure  the  person  is  seated  correctly, using the proper cuff  size, waiting  a few minutes after the patient arrives in  an  exam  room.  “We  kind  of  got  a  little  lazy about checking blood pressure over  the last few years,” he said.  Technology, he added, can also be an  important  tool  for  getting  an  accurate read on blood pressure – particularly  among a couple of specifi c groups. Mobile 

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technology, Clair noted, eliminates ‘white  coat hypertension,’ where patients experience a jump in blood pressure simply by  being in a medical setting. “We now have  the capability to actually look at people’s  blood pressure at home to see if they are  really normal or not,” he said. “The  other  group  is  people  who  are  suspected of having high blood pressure,”  Clair continued. “Those people … believe it  or not … actually have blood pressures that  look pretty good, but it’s labile.” While they  test normal at the physician’s offi  ce, they  actually have elevated numbers at home or work. “We have these two extremes of people – those who might be over-diagnosed  and those who might be missed.” The rising death rates underscore just how important it is to properly identify those at increased risk of heart disease. Additionally, Clair said, “We are worried  the increase in childhood obesity is a precursor of another surge in cardiovascular disease.” He  continued,  “For  many  years  in  cardiology, we have been striving to be the #2 killer … it’s a credit to our colleagues in oncology that cardiac disease and stroke remain #1 killers of both men and women in the U.S.”  Noting that being the leading cause of death isn’t a designation anyone wants, Clair said more aggressively monitoring and treating elevated blood pressure  is one important step toward improving  heart health.

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New OBGYN Practice Plans February Opening Three Memphis physicians who were associated with McDonald Murrmann Women’s Clinic plan to open an OBGYN practice in East Memphis this month. Drs. Kyle Martin, Helen Lee and Audrey Page have formed Martin, Lee & Page OB/GYN, PLC with a February opening at 6286 Briarcrest Avenue, Suite 308. Prior to forming the new practice, the three were partners at McDonald Murrmann. McDonald Murrmann Center for Women’s Health. “We have enjoyed our association with McDonald Murrmann Women’s Clinic very much, but it is our desire to see our patients at all stages of their OBGYN journey, from adolescence through pregnancy and into menopause” said Dr. Martin, who was with McDonald Murrmann for 13 years. The three physicians, who are women, said they are committed to “building their new practice widely on the future of healthcare for women, the choices women have, and new and emerging technology that exists.” The group indicated that with McDonald Murrmann Women’s Clinic, PLC in the process of changing its name to McDonald Murrmann Center for Women’s Health, the timing was right for their move. “We are excited to form our own group and to continue to provide gynecological care as well as deliver babies in the Mid-South,” said Dr. Lee, who has more than 20 years of practice in obstetrics and gynecology, running her own practice for nine years. The group’s website is www.mlpobgyn.com. See article about a new direction for McDonald Murrmann on Page One.

Patel Named Chair of UTHSC Department of Dermatology Tejesh Patel, MD, FAAD, has been named chair of the University of Tennessee Health Science Center College of Medicine’s KaplanAmonette Department of Dermatology. Patel, who previously served as interim chair, will oversee the clinical practice of the department, which is Tejesh Patel run by University Clinical Health.

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The clinic offers services, including medical and surgical care of diseases affecting the skin, hair, nails, and mucous membranes in adults and children. Certified by the American Board of Dermatology with a subspecialty in dermatopathology, Dr. Patel completed an internal medicine internship and a dermatology residency with the UTHSC College of Medicine, and fellowships with the Drexel University College of Medicine in Philadelphia, Pennsylvania. A native of London, England, Dr. Patel was drawn to practice dermatology because of the variety it offered, including the opportunity to treat patients across all age groups and conditions, while serving as a clinician, surgeon, and pathologist. This he says, is very unique to dermatology.

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 Ron Cobb, James Dowd, Judy Otto Cindy Sanders, Beth Simkanin PHOTOGRAPHER Greg Campbell 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 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.

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GrandRounds Study Reveals Tennessee’s Physicians Impact on State’s Economy Physicians add opportunity, growth and prosperity to the Tennessee economy by creating 175,831 jobs and generating $29.1 billion in economic activity, according to a new report, The Economic Impact of Physicians in Tennessee, released by the Tennessee Medical Association and the American Medical Association. The new study quantifies the economic boost that more than 14,000 Tennessee physicians provided to the state’s economy, producing a ripple effect that is felt statewide. The study measures physicians’ impact using four key economic indicators: Jobs: Physicians support 175,831 jobs in Tennessee – 12.5 for each physician, on average. Economic activity: Physicians generate $29.1 billion in economic output, comprising 9.2 percent of the Tennessee economy. Each physician generates $2.1 million for the state’s economy, on average. Wages & benefits: Physicians contribute $13.7 billion in total wages and benefits paid to workers across Tennessee, empowering a high-quality, sustainable workforce. Each physician contributes $970,098 to workers’ wages and benefits, on average. State and local tax revenue: Physicians’ contribution to the Tennessee economy generates $908.1 million in state and local tax revenue for their communities–translating to $64,420 for each physician on average–that enables communities to make additional investments in infrastructure, government services and civic programs. The report found that every dollar applied to physician services in Tennessee supports an additional $2.02 in other business activity. An additional 7.5 jobs, above and beyond the clinical and administrative personnel that work inside the physician practices, are supported for each $1 million of revenue generated by a physician’s practice.

Primary Care Specialists Joins Regional One Health Primary Care Specialists, a provider in the area of family medicine, has joined the Regional One Health family. Transitioning to Regional One Health means the physicians and nurse practitioners of Primary Care Specialists are now part of UT Regional One Physicians. “The acquisition of Primary Care Specialists is another indicator of our progress at Regional One Health and a positive for patients as we increase access to care,” said Reginald Coopwood, MD, president and CEO of Regional One Health. “Adding a primary care practice in the midtown area gives more health care options as we cover from downtown to east Memphis.” Primary Care Specialists is the memphismedicalnews

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fifth primary care site at Regional One Health, adding an important central location to the current sites in downtown, north Memphis, south Memphis and east Memphis. The office is located in the Chickasaw Oaks Plaza at 3109 Walnut Grove Road. Primary Care Specialists will continue to provide care for the whole family, including well-woman care, pediatrics, family and internal medicine, minor medical procedures and urgent care. Led by physicians Jeffrey Warren, MD and Bradford Pendley, PhD, MD, the practice also includes six nurse practitioners who have joined UT Regional One Physicians.  Dr. Warren earned his doctor of medicine degree from Duke University School of Medicine and is board Jeffrey Warren certified in family practice. In addition to family practice, Dr. Warren has been trained and certified in emergency medicine. Dr. Pendley earned his doctor of medicine degree from Bradford Pendley The University of Tennessee Health Science Center and his Ph.D. from Cornell University. Dr. Pendley is board certified in internal medicine.

UTHSC Selects First User of Innovation Lab Monica M. Jablonski, PhD, professor in the Department of Ophthalmology in the College of Medicine at the University of Tennessee Health Science Center (UTHSC), has been selected as the first user of the UTHSC Innovation Lab space. The UTHSC InMonica M. novation Lab will allow Jablonski Jablonski to further develop an ophthalmic microemulsion designed to combat the shortcomings traditionally linked to standard eye drops and improve treatment efficacy in certain ophthalmic diseases. Thanks to a recent partnership between Memphis Bioworks Foundation and UTHSC, the 420 square-foot turnkey space will be available to Jablonski for up to 12 months, at no cost to her, as she develops her intellectual property (IP) in anticipation submitting a Small Business Innovation Research (SBIR) and/or Small Business Technology Transfer (STTR) proposal. During the 12-month period of occupancy in the Memphis Bioworks building, Jablonski will have access to standard lab equipment (e.g., tissue culture hood), services, as well as consulting. New companies using the Innovation Lab will be required to submit at least one SBIR and/or STTR grant application during the year of occupancy.

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