FOCUS TOPICS NEUROLOGY • REIMBURSEMENT • PAIN MANAGEMENT
June/July 2021 >> $5 ON ROUNDS
Memphis’ Semmes Murphey Clinic Now Has Two Members Recognized Among Neurosurgery’s Finest Dr. Frederick Boop and Dr. L. Madison Michael II of the Semmes Murphey Clinic have long been known to be among the best of the best in their highly complex ﬁeld of neurosurgery.
Profiles on page 3
Expanding Evidence-Based Care for Dementia
Alzheimer’s Association Creates Training, Certiﬁcation Program By CINDY SANDERS
The Alzheimer’s Association recently launched a new training program with certification exam to advance the deployment of evidence-based dementia care. Targeted to care professionals in both long-term and community-based settings, Person-Centered Dementia Care Training Program with essentiALZ Exam®, is based on the nationally recognized Dementia Care Practice Recommendations, which were updated in 2018.
Scope of Alzheimer’s
L. Madison Michael II
“Today in the United States, there are more than six million age 65 and older living with Alzheimer’s dementia,” said Monica Moreno, senior director of Care and Support for the Alzheimer’s Association. “So many of the general population believe developing Alzheimer’s is a normal part of aging, but we know that’s not the case.” (CONTINUED ON PAGE 4)
HFMA Offers Best Practices for Fair Debt Resolution
UTHSC Chancellor Steve Schwab Contemplates 2022 Retirement, Reﬂects on Tenure
It’s a subject no one really wants to discuss, but communication is key when it comes to addressing a patient’s Richard Gundling ﬁnancial responsibility for medical bills.
By JAMES DOWD
For the last decade, Steve Schwab, MD, not only witnessed impressive strides in the local medical community, but also played a significant role in that success while serving as chancellor of the University of Tennessee Health Science Center. Now, as Schwab prepares to transition to a different role at UTHSC – he recently announced plans to retire as chancellor in 2022
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and return to research and teaching – his focus is on ensuring that the school’s next leader will be equally successful in attracting and producing top candidates to serve Tennessee’s medical community. “I always like to say that we’re not where we need to be, but we’re better than where we were,” Schwab said. “Every job has a ‘use life’ and I’ve had a great experience as chancellor and I’m proud of what we’ve achieved. But there’s (CONTINUED ON PAGE 8)
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Memphis’ Semmes Murphey Clinic Now Has Two Members Recognized Among Neurosurgery’s Finest By LAWRENCE BUSER
Dr. Frederick Boop and Dr. L. Madison Michael II of the Semmes Murphey Clinic have long been known to be among the best of the best in their highly complex field of neurosurgery. Now, the prestigious Senior Society of Neurological Surgeons thinks so, too. The world’s first neurological society, founded in 1920, includes chairmen and residency program directors who train neurosurgeons for the future. As chairman of the neurosurgery residency program at the University of Tennessee, Boop has been a member for more than 20 years. Last year he nominated Michael for membership. Recently, the society announced his acceptance, giving Memphis two members recognized as being among the very brightest in their field. “When I became chairman in 2011, Madison became my residency program director,” said Boop. “Most of the program directors are invited to sit in on (society) meetings but are not members. To have both the chairman and the program director in membership speaks well for our program.” Michael, who was a college tennis player and volunteer firefighter in college, says his acceptance in the elite neurological surgery society is still sinking in. “My whole career has been dedicated to the field of neurosurgery and neurosurgical education,” he said. “I fully believe in the mission of the Senior Society – to drive the continuing development of the field of neurological surgery, including graduate and post-graduate education. I am incredibly humbled to be a part of this prestigious group. I consider this to be one of the highlights of my career.” Both doctors wear enough hats to stock a millinery shop. Dr. Boop also is co-director of the Neuroscience Institute and medical director of the Neurosurgical ICU at Le Bonheur Children’s Hospital; chief of pediatric neurosurgery at St. Jude Children’s Research Hospital; chairman and professor of neurosurgery at UTHSC, and leader of the joint pediatric brain tumor program among the four health systems. “I was an English major at the University of Arkansas and after I graduated, I got jobs throwing newspapers and painting houses,” said Boop, whose father was a neurosurgeon, and started a training program at the University of Arkansas Medical School at Little Rock. “I then went to work as an EEG tech for one of my dad’s partners, an epilepsy surgeon. We would go into the operating room where he would put electrodes on the brain, and I would record brain waves. To MEMPHISMEDICALNEWS
L. Madison Michael II
Birthplace: Clarksdale, Miss.
Medical School: University of Arkansas Medical School
Medical School: University of Tennessee College of Medicine
Who/What led you to the medical field: My father was a neurosurgeon and I worked as an EEG tech putting electrodes on the patient’s brain to record brain waves. That was so fascinating to me.
What/who led you to the medical field: Two events were crucial. The ﬁrst occurred during my years as a mountain/climbing guide. That was my ﬁrst profession. It was necessary to have my W-EMT (Wilderness-EMT) certiﬁcate. That exposure to the ﬁeld of medicine really ignited my passion to pursue it as a career. The second thing was my introduction to Dr. Jon Robertson. Then and now, he has been the person I looked up to as my mentor. He inspired me to pursue skull base surgery as my subspecialty profession. Following the completion of residency, Dr. Boop has been a major inﬂuence on my career.
First place to practice: Arkansas Children’s Hospital in Little Rock Biggest Accomplishment: My 35 years of marriage to my wife Lee Ann and our two great kids. My daughter is a nurse in East Tennessee and my son is a neurosurgery resident in Seattle. Interesting Hobbies: Bicycling, on both road bikes and mountain bikes. I love water sports. We have a lake house at Greers Ferry and every chance we get, we like to get away and play on the water. Favorite thing about Memphis: The most attractive thing about Memphis is the people. You can go to big cities all over the world and ﬁnd impoverished people, ﬁnd disharmony and so forth. You come to Memphis, and you see food banks, you see shelters, you see so much community support for unfortunate people. There’s the medical school here and Le Bonheur taking care of all these poor kids from poor uneducated families getting the same care as the rich people with good insurance. To me that’s very attractive.
(Dr. Robertson was Dr. Boop’s predecessor as chairman and was also a Senior Society member.) First place to practice: Memphis Biggest accomplishment: My three boys!
me that was so fascinating that I wanted to go to medical school. “At that, my dad’s advice was: ‘Do something other than medicine. There are a lot of easier things to do in life.’ I got into medical school and told him I wanted to be a neurosurgeon and he said, ‘Don’t do that. There are easier ways to make a living.’ His reverse psychology worked perfectly.” Dr. Michael’s path to neurosurgery also was not a direct one. He graduated from Sewanee with a degree in natural resources, and then spent the next several years working in forestry and geology. He also was a mountain guide, leading climbing tours in the Western U.S. and in Africa and South America. Somewhere out in the wilderness, his earlier interest in medicine returned. “I was in Alaska at the time on a climbing trip,” he recalled. “I saw an episode of Northern Exposure, and a light bulb went off. I wanted to be that doctor - a small town doc. Like the rest of my life, though, serendipity followed. In medical school, I was introduced to neurosurgery. I was hooked from the beginning.”
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Interesting hobbies: Climbing is my passion. Rock, ice, mountains. I have guided and climbed throughout the world. Although a lot slower and with a little more pain, I still climb regularly. Favorite thing about Memphis: I absolutely love Memphis. Every facet. If I had to settle on one thing, it’s the people. The Memphis community is an exceptional one. I am proud to be called a Memphian.
Bringing your retirement plan to life
Expanding Evidence-Based Care for Dementia, continued from page 1
Think carefully about how you would like to live as you approach the retirement years. If you’re closer to 60, you will probably find it easier to envision retirement than if you’re in your 20s or 30s. However, it’s Chirag Chauhan, important to be flexible and update your plan as your life changes. AIF®, CFP® • Depends on dependents: Do you have dependents who you will provide for in your 60s and 70s? • To retire or not: Do you need – or want – to keep working into your 60s and 70s – or longer? Is it your dream to retire earlier? • Home is where the heart is: Do you plan to stay in your current home? Will it be comfortable as you age?
While age is the greatest risk factor, most seniors do not develop Alzheimer’s while approximately 200,000 Americans under age 65 do. Gender and ethnicity also play a role in developing the progressive disease (see Facts & Figures box). Moreno added it’s important for people to know and understand the warning signs and to eliminate other health concerns. “You want to make sure your symptoms are getting addressed appropriately,” she said. Moreno pointed to urinary tract infections and thyroid disMonica Moreno ease as two potential issues that could cause symptoms that mimic some dementia behaviors.
Meet your financial goals.
When you think about your retirement, what do you picture? The possibilities are as unique as you are. Many aspects of your life will help shape your retirement strategy. The following steps are relevant to every adult’s initial retirement plan. Identify your goals and needs.
There are many options available and it’s important to find the best ones for your personal situation, such as: • Tax-deferred first: Retirement savings options, such as 401(k) and 403(b) plans and individual retirement accounts, allow you to contribute to a plan before you pay taxes on your income. • Assess other assets: If you’re already maxing out your annual contributions to a tax-deferred retirement savings plan, what are your alternatives? • Saving for college: 529 college savings plans are not tax-deferred, so contributions still come out of your income after taxes, but they aren’t subject to capital gains taxes, which can be an equally helpful tax benefit. • Life insurance: If you have dependents who you need to provide for in the event of your death, life insurance may be a worthwhile savings option. • Investing in a home: Homeownership can be viewed as a way of saving and as a potential future source of income. Use estate planning to ensure your wishes. Estate planning is important for everyone. There are several categories, many of which can be stated in a combination of a will and living will. • Assets: It’s important to express how you would like assets to be divided. You might also consider setting up trusts for minors or charitable causes. • Custody: If you have minor children or family members with special needs, it’s extremely important to have clear custody arrangements in place if you’re no longer able to take care of them. You can even specify your wishes for your pets. • Health: Stating what kind of medical care you want – or don’t want – if you’re unable to give consent, particularly in a life-threatening situation, is called a living will. This document can be especially helpful to relatives who might have to make difficult decisions for you. • People: Who is an appropriate executor for your will? Or the power of attorney for your financial accounts? Who will carry out decisions regarding medical care if you cannot make the decisions? Your financial plan should be as original as you are. Coming from a family of Doctors and medical professionals, I guess you could say I too was destined to help people. Today, with over 20 years in the industry, I have developed a forte with medical professionals and have a unique insight to their challenges. Once we work with our client to establish goals and obligations, we can then determine the role that their investments will serve in achieving the Financial Plans objective. Only then can we begin the process of constructing you a suitable investment portfolio. I look forward to helping you achieve financial wellness.
Chirag Chauhan | MBA, AIF®, CFP® Chirag@bluffcityadvisory.com or 901-365-3447. Chirag Chauhan is a founding partner of Bluff City Advisory Group in Memphis, Tennessee. For more info, please visit bluffcityadvisory.com.
“Alzheimer’s disease affects every person differently. That’s what makes it really challenging for caregivers,” noted Moreno. She added the new program is designed to educate caregivers on evidence-based best practices around assessment, detection and care planning including medical management, dementia-related behaviors, activities of daily living, supportive environments, transition and coordination of services and other recommendations. “All of that information can prepare and empower caregivers to be better prepared for the future,” pointed out Moreno. “They’re actually being proactive instead of reactive.” While many individuals with Alzheimer’s still live in the community, care needs do increase as the disease progresses. “Statistically, about 48 percent of nursing home residents have some form of dementia, and about 42 percent residing in assisted living have Alzheimer’s or another form of dementia,” said Moreno. It’s particularly important in longterm care settings where those providing care aren’t intimately familiar with someone’s history to make an effort to learn about the person as an individual. “The practice recommendations are grounded in person-centered care,” Moreno stated. “The diagnosis is only part of who they are … it’s not who they are.” Personal preferences and life experiences should shape approaches. Moreno cited an example of a resident who unlaced her shoes and tied the closet door shut each day. If caregivers touched her closet, she became extremely agitated. As it turns out, the woman had been forced to flee with the clothes on her back earlier in life. That experience impacted how she felt about her possessions. “She didn’t want them to even take clothes to the laundry, but it would not be serving her to allow her to wear soiled clothes,” Moreno recalled. “So, they devised a strategy to get her clothes while she was in an activity and get the clean clothes back before she even knew they were gone.” A simple accommodation, it made a big difference in the woman’s quality of life.
(CONTINUED ON PAGE 5)
The Latest Facts & Figures Alzheimer’s Disease Facts and Figures, an annual report released by the Alzheimer›s Association, reveals the burden of Alzheimer›s and dementia on individuals, caregivers, government and the nation›s healthcare system. The 2021 publication reports: Prevalence: An estimated 6.2 million Americans age 65 and older (11.3 percent, or 1:9) are living with Alzheimer’s today. That number is projected to hit 12.7 million by 2050. Risk: Women and people of color are disproportionately affected. Almost two-thirds of Americans with Alzheimer’s are women. Older Black Americans are about twice as likely and older Hispanic Americans about 1.5 times as likely to have Alzheimer’s or other dementias as older White Americans. Disparities: Despite increased risk for Alzheimer’s and other dementias, Black and Hispanic Americans are less likely to be diagnosed than White Americans. Half or more dementia caregivers – 63 percent of Native Americans, 61 percent of Black Americans, 56 percent of Hispanic Americans and 47 percent of Asian Americans – said they have faced discrimination while trying to navigate healthcare settings for their care recipient. People of color want healthcare providers who understand their unique experiences and backgrounds by fewer than 3 in 5 believe they have access to culturally competent providers. Mortality: One in three seniors dies with Alzheimer’s or another dementia. Between 2000 and 2019, deaths from heart disease decreased 7.3 percent. Deaths from Alzheimer’s have increased 145 percent. On top of that, just during the COVID-19 pandemic, Alzheimer’s and dementia deaths have increased 16 percent in the U.S. Cost: In 2021, Alzheimer’s and other dementias are projected to cost the nation $355 billion, including a combined $239 billion in Medicare and Medicaid payments. Without a treatment to slow, stop or prevent the disease, the figure is projected to rise to more than $1.1 trillion by 2050. Caregivers: More than 11 million Americans provide unpaid care for people with Alzheimer’s and other dementias. In fact, 83 percent of the help provided to older adults in the U.S. comes from family members, friends or other unpaid caregivers with nearly half of that group providing help to someone to someone living with Alzheimer’s or another dementia. Last year, those caregivers provided an estimated 15.3 billion hours of uncompensated care valued at nearly $257 billion.
Expanding, cont. from page 4 Creating the Program
“The training is reflective of the practice recommendations. While these recommendations were peer reviewed and evidence based, which was critically important, it wouldn’t move the needle if they just sat on a shelf,” Moreno said of the impetus to disseminate the information. “There’s really a larger footprint we’re trying to create.” The goal, she continued, was to access professionals across the full array of care settings – nursing homes, assisted living, home care, home health, adult daycare and hospice. At the end of 2020, the Alzheimer’s Association debuted the new online training, which has six modules and is selfpaced. Once completed, the essentiALZ Exam® tests the individual’s knowledge with a 45-question exam. Moreno said a score of 90 percent or higher results in a two-year certification. Individuals who wish to become certified can access the program and exam for less than $60. There are also packages for providers committed to training staff. And, Moreno continued, the association has a curriculum review program that compares an organization’s training program to the practice recommendations with feedback on how to address gaps in care. “It’s another channel to make sure direct care works have access to content that is reflective of these evidence-based practices,” she concluded.
FDA Approves Controversial Alzheimer’s Drug On June 7, the Food & Drug Administration approved Aduhelm (aducanumab) to treat Alzheimer’s patients, making it the first new drug approval for a disease impacting more than six million Americans in almost 20 years. While the Alzheimer’s Association strongly supported FDA approval, citing a 22 percent reduction in cognitive and functional decline in clinical trials, the drug by Biogen Inc. was approved without the recommendation of the Peripheral and Central Nervous System Drugs Advisory Committee. By mid-June, three members of the advisory panel had resigned in response to the controversial approval. In an article outlining the FDA’s process, Patrizia Cavazzoni, MD, director of the FDA Center for Drug Evaluation and Research, noted Aduhelm’s late-stage development program consisted of two phase 3 clinical trials where one study met the primary endpoint in showing reduction in clinical decline but the second trial did not meet that endpoint. “At the end of the day, we followed
our usual course of action when making regulatory decisions in situations where the data are not straightforward,” Cavazzoni wrote. “We ultimately decided to use the Accelerated Approval pathway — a pathway intended to provide earlier access to potentially valuable therapies for patients with serious diseases where there is an unmet need, and where there is an expectation of clinical benefit despite some residual uncertainty regarding that benefit. In determining that the application met the requirements for Accelerated Approval, the Agency concluded that the benefits of Aduhelm for patients with Alzheimer’s disease outweighed the risks of the therapy.” In response to the uproar, the
Alzheimer’s Association reaffirmed their support, noting their research experts and advisors are deeply familiar with the science that led to the approval and agreed with the decision. The organization also called on the confirmatory trial that was part of the approval process to begin promptly. The statement further reads: “Our focus has and will continue to be access to this treatment for all likely to benefit. Approval is the fundamental first step to access. The first drug in a category invigorates the field, increases investments in new treatments and encourages greater innovation. “Following approval, the manufacturer, Biogen, announced their intention to price Aduhelm at $56,000 per year. This price is simply unacceptable. For many, this price will pose an insurmountable barrier to access, it complicates and jeopardizes sustainable access to this treatment, and may further deepen issues of health equity. We call on Biogen to change this price.”
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COMPREHENSIVE CARE FOR YOUR PAIN. MEMPHISMEDICALNEWS
Treatment of Chronic Pain from Covid-19
Do you have generalized myasthenia gravis (gMG)? RA101495-02.301: A Phase 3 Study with Zilucoplan in Patients with Generalized Myasthenia Gravis Ra Pharma is developing an investigational drug, zilucoplan, for patients with gMG. Zilucoplan is designed to work by preventing the body’s attack on neuromuscular junctions by blocking a component, C5, of the body’s immune system called the complement system. The main purpose of this study is to test how well zilucoplan works and how safe it is for patients with gMG. This study is a placebo-controlled study with a 12-week study treatment period. Study participants will continue their standard of care treatment during the study and, in addition, will receive study drug as a self-administered (at home) subcutaneous injection once daily. Your participation in this study will last approximately 16 weeks and would include approximately 7 study visits. You will have an option to continue to receive zilucoplan in a long-term extension study (RAISE-XT) after completing this clinical trial. To participate in this study, you will need to meet the following main entry criteria: 1. ≥18 years and <75 years of age 2. Diagnosed with generalized Myasthenia Gravis (MGFA Class II-IV) 3. Presence of antibodies to acetylcholine receptor 4. No thymectomy within past 12 months 5. No treatment with immunoglobins or plasma exchange within 4 weeks *Other inclusion and exclusion criteria may apply.
For more information about this trial Please call Neurology Clinic, P.C. 901-747-1111 or email firstname.lastname@example.org
By now, we are all too familiar with the fatal devastation COVID-19 has wrought on this country, with hundreds of thousands dead. We view those who recovered from the virus as lucky, and most are. However, what we are learning and seeing now is that those patients’ stories don’t end when their obvious symptoms go away, or they By MOACIR walk out of the SCHNAPP, MD hospital on their own. Instead, many “recovered” COVID patients who have gotten back to their normal lives are finding themselves plagued by something unexpected: chronic pain. Chronic pain can develop after many viral infections, not just COVID-19. An example is mononucleosis, caused by the Epstein-Barr virus, which can cause long term pain and fatigue. Another, is the common flu virus; while most of us “get over” the flu, some affected individuals never recover completely. In general, there is a connection between the severity of a viral illness and the development of long-term symptoms such as pain. Neurological damage from direct brain involvement caused by the coronavirus or by the body misdirecting its defenses towards the brain are often blamed for chronic pain and fatigue. The so called “long Covid” may belong to that category, with tiredness, loss of concentration, sleep disturbances and a myriad of other problems. While the virus is gone, some of the sequelae or aftereffects persist. Even people with moderate illness - the kind that does not require medical care - can go on to develop chronic symptoms. A special neuropsychological condition called “central sensitization” can occur after viral infections such as COVID-19. Due to certain chemical and cell alterations in the central nervous system, a person’s body may become hypersensitive to pain, to the point that even touching the skin may hurt. While COVID-19 itself is responsible for many of the ongoing effects patients will experience, the treatment itself may similarly contribute to long lasting pain. Of those severely ill patients requiring hospitalization, many landed in the ICU, where prolonged bedrest can cause stiffness of the joints and severe loss of muscle mass (up to 10 percent in 10 days). Long stays in ICU may also cause peripheral neuropathy, a painful damage to the nerves in the legs and arms that can also lead to weakness and numbness. Invasive procedures such as chest tubes inserted between the ribs to expand the lungs and all sorts of procedures including IVs and catheters (common among the treatments required for COVID-19 patients) add to the problem.
Being in an ICU is very stressful, but it can be terrifying when you cannot count on the presence of family and friends due to infection precautions. Pain and suffering go hand in hand. Our mental health can deteriorate when we are sick or preoccupied with family members and isolated from friends and the community. The ensuing psychological changes may actually intensify chronic pain and vice versa. The treatment of any severe, chronic pain begins with a proper diagnosis. The rehabilitation of these individuals requires a multidisciplinary team of dedicated specialists including doctors, nurses, physical and occupational therapists, psychologists, and others. Such a team is responsible for the diagnosis of the specific needs of each individual and tailoring his or her treatment accordingly. Doctors commonly subdivide the pain into three categories: mechanical (bones, joints and ligaments), neuralgic (nerves and central nervous system), and visceral (lungs, gut etc.). This helps us choose the most effective treatment. For example, pain medication such as ibuprofen or codeine don’t do much for nerve pain but can help the bones and joints, while some drugs used for epilepsy, like gabapentin, are commonly prescribed for the treatment of neuralgias (nerve pain). Early intensive intervention with daily exercises, respiratory rehabilitation, psychological support and preparations to resume home and work activities are the mainstay of such a program. Despite the recent controversies regarding the use of strong pain medication, such as opiates, they remain an invaluable tool for the treatment of pain, and it can mean the difference between a person being independent or ending up confined to a wheelchair. It is worth remembering that the vast majority of deaths and overdoses from opiates in this country are due to the illegal use of these substances. One of the most effective therapies for chronic pain consists of injections around the affected nerves, known as nerve blocks. The purpose is to temporarily stop the pain, without causing damage to the nerve. We compare this to rebooting a computer that crashed, allowing the nerves and the central nervous system to “reset itself.” The vicious cycle of the pain may be so interrupted, facilitating the rehabilitation process. By reducing the pain from neuralgias, nerve blocks also improve the quality of sleep and allows for the reduction in pain medications. Typical of this type of treatment are epidural blocks, often used in the treatment of sciatica. In the past, mental health issues were labeled as “psychological” or “neurological.” Today, this distinction mostly disappeared and the treatment of depression, anxiety, and PTSD, among others, is best accomplished by combining counseling and medications. We understand now that (CONTINUED ON PAGE 8)
HFMA Offers Best Practices for Fair Debt Resolution By CINDY SANDERS
It’s a subject no one really wants to discuss, but communication is key when it comes to addressing a patient’s financial responsibility for medical bills. To help with those uncomfortable conversations, the Healthcare Financial Management Association (HFMA) recently released “Best Practices for the Fair Resolution of Patients’ Medical Bills.” Designed to be used by providers, their business affiliates and credit bureaus, the best practices were jointly published with the Association for Credit Collection Professionals. The 28-page report, published last fall, updates guidance originally released in 2014. The HFMA Medical Debt Collection Task Force – which includes diverse representation of providers, consumer advocates, collections agencies and credit bureaus – Richard Gundling reconvened in 2020 to update and add best practices, particularly financial assistance response to COVID-19 and future health emergencies. HFMA Senior Vice President for
Content & Professional Practice Guidance Richard Gundling, FHFMA, CMA, said strains from the pandemic, changes in collection laws, increased transparency expectations and available tools made it the right time to update the guidance. “Let’s make sure these are fresh, up to date and top of mind,” he said of reviewing the accounts receivable process. The release coincided with the upheaval surrounding the pandemic. “We saw a big spike in unemployment and loss of insurance. Hospitals were backing away from collection policies because communities were hurting,” said Gundling. Yet, he added, that’s the time to have solid processes in place. Gundling noted a job loss should serve as a trigger for provider entities to discuss options the patient might not know are available, including Medicaid eligibility, ACA Marketplace plans and financial assistance programs. The updated guidance provides detailed information on each step in the accounts receivable process from recommendations for pre-service financial communications and best practices for resolution of medical debt post-discharge to working with account resolution business affiliates and accounts sent to a collection agency. Gundling said the best opportunity to
avoid difficult conversations down the line is to clearly outline financial responsibility and collection procedures up front in the pre-service time frame whenever possible. “It’s all about communication. Everybody has such variable coverage and costs,” he explained. “You should be able to get a good estimate of what your cost will be. Can you afford that? If the answer is ‘no,’ then ask why.” He continued, “It’s not a matter of just giving them a laundry list of prices, you have to explain the costs.” Gundling added, this pre-service conversation provides a natural opportunity to discuss other coverage options, interest free medical financing, and financial assistance programs from pharmaceutical companies, manufacturers and provider entities. Even with coverage in place, provider participation changes over time, so it might warrant a discussion about finding an in-network provider. Timing for elective procedures or the course of treatment are also topics to be considered. Do two drugs work equally well with one being less expensive or covered on the patient’s plan? Those are options that can be explored on the front end. Even when there isn’t much opportunity to reduce pricing, Gundling said setting expectations is valuable. “It’s better to
know up front than to get home and have a bill you didn’t anticipate,” he pointed out. Of course, he added, emergency situations often don’t allow for pre-service conversations. In those cases, discussing financial responsibility has to come later. “You want (the conversation) as soon as possible in the course of treatment, but if the patient is not ready, then follow up when they are. Again, its communicating.” To that end, Gundling said provider entities should review their bills to ensure they are as clear and concise as possible without a lot of medical jargon. That said, bills should provide necessary information on treatment costs, patient’s financial responsibility and a contact number to call for clarification. “A patient is much more likely to pay a bill they understand and were expecting,” Gundling pointed out. The HFMA best practices report notes all account resolution efforts should follow the formally documented provider collection policies that have been approved by the board or other authorizing body. This is also true for all business affiliates under contract with providers. Additionally, affiliates need timely and accurate information to service accounts, making regular reconciliations between (CONTINUED ON PAGE 9)
Want to learn more about telehealth? The South Central Telehealth Resource Center (SCTRC) provides telehealth education and assistance to healthcare providers in Arkansas, Mississippi and Tennessee. The SCTRC website, LearnTelehealth.org, focuses on telehealth media and education, offering a range of items from podcasts, webinars, course modules, resources, telehealth training, and so much more. Join us for our monthly webinar, “Telehealth 101: The Easy Basics of Telehealth & Telemedicine” to get started on your telehealth journey! Register at UAMS.info/Telehealth101. Proud to be part of the National Consortium of Telehealth Resource Centers.
UTHSC Chancellor Steve Schwab Contemplates 2022 Retirement, continued from page 1 more work to be done and I believe this is a good time to bring someone else in to carry on that mission.” Schwab graduated from the University of Missouri School of Medicine and completed his internship/residency in internal medicine at the University of Kansas Hospitals and Clinics. He completed a fellowship in nephrology with Washington University at the Barnes Hospital and spent two decades at Duke University, serving as professor and vice chair of the Department of Medicine. Prior to his arrival in Memphis, Schwab was chair of the Dept. of Medicine and chief clinical officer at the Medical College of Georgia. He joined UT Health Science Center’s College of Medicine 15 years ago as executive dean and was appointed chancellor in 2010. In the years since, he guided the school through an impressive growth period. Under Schwab’s leadership, UTHSC boosted its enrollment by nearly 40 percent, growing to 3,300 students and 1,400 residents. Graduation rates and overall first-attempt board pass rates climbed to 95 percent. “[Schwab] had to be a brilliant doctor and researcher to earn his position, and he obviously is both of those,” UT President Randy Boyd said in a statement. “But in the role, he has proven to also be a great strategist and great leader. He is always honest and direct, has bold vision, and gets things done.” Schwab has demonstrated both day-to-
day leadership and long-range vision while in Memphis. During his tenure, UTHSC expanded its clinical partnerships across Tennessee and now boasts an integrated statewide organization across campuses in Memphis, Chattanooga, Knoxville and Nashville. “Our four-campus system is one of the reasons we’ve grown our residencies and fellowships,” Schwab said. “Medicine is a story of clinical rotation and after a couple years spent in Memphis, our students can traverse the state to continue their learning at any of these campuses.” The Memphis campus continues to expand to accommodate that growth, with some$300 million in construction projects that include the Translational Science Research building, the Center for Health Care Improvement and Patient Simulation, and renovations to the campus quadrangle. Clinical revenue has also soared under Schwab’s tenure, from $85 million when he became chancellor little more than a decade ago to more than $300 million today. Similarly, research funding has more than doubled and grant awards are projected to exceed $120 million this academic year. “We’re moving in an aggressive mode by building facilities, recruiting faculty and conducting research,” Schwab explained. “I truly believe that our research growth is really about to start in an even more significant way.” Under Schwab’s leadership, UTHSC continues to change and evolve its hospital partnerships. That includes forging an
MID-SOUTH MEDICAL GROUP MAAGEMET ASSOCIATIO
expansive partnership with Regional One Health while scaling back its longtime partnership with Methodist University Hospital. UTHSC is developing its cancer center at Regional One Health, where nearly a dozen of its oncology surgeons and medical oncologists will be based. “Partnerships change over time,” Schwab said. “While it’s always painful to retract and easier to expand these partnerships, we adapt to reflect our mission.” Although the partnership is expanding, the relationship between UTHSC and Regional One is longstanding. In 2014, the two organizations formed UTROP (UT Regional One Physicians) that includes more than 200 physicians and medical practitioners who provide both inpatient and outpatient care. “Our organizations have always had a strong relationship and Dr. Schwab has tried to codify and strengthen the relationship though his advocacy for clinical research at Regional One,” said Dr. Martin Croce, chief medical officer at Regional One Health. and a professor of surgery with UTHSC. “This is particularly important for UTHSC residents, who overwhelmingly say they cherish their time at Regional One. This generates a positive impact because residents who like where they’re learning do a better job, and that ultimately benefits their patients, their practices and their communities.” Schwab agrees, and expects the positive impact of UTHSC on Memphis and communities across the state to continue
after he steps down from his leadership post and returns to academic, clinical and research duties. The search for his successor is underway with an announcement by June, 2022, if not sooner. And Schwab is already planning for the next stage in his life. “I’ll enjoy teaching and doing more nephrology research and contributing in those areas,” Schwab said. “And when full retirement comes, I’ll be ready. I’m an avid kayaker and I love the outdoors and there are lots of places in Tennessee to explore. That’s still up ahead a bit, but I’m looking forward to it.”
Treatment, continued from page 6
both the severe stress from an illness and the brain impairment from a viral infection can lead to similar behavioral and personality changes. Hope can, however, be the greatest healer, but it hinges in great part on the support from family and friends and the encouragement from doctors, nurses, and therapists who are focused on reducing a patient’s pain and restoring function. The rehabilitation process can be arduous, tiresome and sometimes boring. Hope helps. Moacir Schnapp, MD, is a neurologist and Medical Director of Mays & Schnapp, Neurospine and Pain, the only CARF-accredited outpatient pain clinic in the Mid-South. Visit https://www.maysandschnapp.com
MID-SOUTH MEDICAL GROUP MANAGEMENT A S S O C I AT I O N
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WHO WE ARE The Mid-South Medical Group Management Association (MSMGMA) formed in 1987 when a group of practice managers across Memphis started meeting to discuss common experiences in their offices. The group has now grown to include more than 100 members from the Memphis area. MSMGMA is the premier association for professionals who lead Medical Practices. Through regular in-person and/or virtual educational meetings, networking events, and access to statewide webinars and conferences, our group serves as a powerful resource for Practice Executives.
WH MID SOUTH MGMA ? Healthcare is one of the most complex industries in the country. MSMGMA offers resources to every type of practice manager, whether you are in a private office or a hospital system. MSMGMA offers opportunities to learn from other practice executives and mentor those newly in their roles. We provide education opportunities, bringing in speakers from across our region to discuss applicable topics to your practices.
MID-SOUTH MEDICAL GROUP M Join A Ntoday A G for EM N Tmember/renewal ASSOCIA TION ourEnew discount through January 31, 2021.
BENEFITS OF MEMBERSHIP
Mid-South MGMA I 1067 Cresthaven Rd, Memphis, TN 38119 Education & Information Resources email@example.com Monthly meetings and annual spring and fall conferences Bi-monthly newsletter
Networking Membership Database & Members Only section on our website Monthly networking luncheons with educational speakers included
Easy access to industry news, job postings, and scholarship information Active guidance toward certification and fellowship in the American College of Medical Practice Executives
State and national information about legislative issues that impact your practice
MEMBERSHIP LEELS & DUES
Includes state-wide Tennessee Medical Group Management Association membership and local MSMGMA membership. Active Members are engaged in membership or leadership of a medical group practice formally organized for the purpose JUNE/JULY 2021of healthcare delivery or individuals that provide administrative or related support services to one or more medical group practices, such as management companies, consultants, billing, etc.
An affiliate Member is a vendor/supplier which supplies products or services to medical groups and will be entitled to a limited membership with no voting privileges, but will be permitted to attend meetings and participate in other activities of the MSMGMA. It is the hope of the MSMGMA that the MSMGMA and the affiliate member will each benefit mutually in the exchange of information, ideas and economic support. The MSMGMA does not in any way endorse the products, supplies or services of an affiliated member.
A student Member is a person who is currently enrolled full time through an accredited postsecondary college or university in a baccalaureate or masters level program that enhances or corresponds to the profession of medical practice management. Student members will be entitled to a limited membership with no voting privileges and cannot hold office but will be permitted to attend meetings and participate in other activities of the MSMGMA.
Join us at a new member discount! Join your physician colleagues in Shelby County in this professional organization dedicated to supporting, advocating and enriching the lives of physicians at home and in practice.
Join today, and you’ll soon learn the beneﬁts of organized medicine. WE ARE STRONGER TOGETHER
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• Wellness programs to reduce burnout and more YOUR PRACTICE
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GrandRounds Hella Ewing, RN, MSM Named Chief Nursing Officer at Le Bonheur Children’s Hospital Le Bonheur Children’s Hospital recently announced that Hella Ewing, RN, MSM, has been named chief nursing officer (CNO). Ewing has significant leadership experience at major children’s hospitals and
is a well-respected nursing leader. She most recently served as CNO at Lucille Packard / Stanford Children’s Hospital in California and prior to that was CNO at East Tennessee Children’s Hospital in Knoxville, Tenn. Ewing earned her Bachelor of Science in Nursing from Florida State University, and a Master of Science in Healthcare Administration Management from Troy State University. She is thrilled to come back to Tennessee, and excited to join the Le Bonheur team.
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West Cancer Center and Saint Francis Healthcare Announce Joint Relationship West Cancer Center and Research Institute and Saint Francis Healthcare have announced an agreement to advance and increase access to cancer care in the MidSouth. This collaboration is supported by multi-million dollar investments in cancer care at the Saint Francis Healthcare campuses. This will include a first-in-the-Mid-South cancer urgent care center at Saint Francis Hospital – Memphis, among other services. The cancer urgent care center will be open to all adult cancer patients for extended hours and includes a separate entrance to ensure that cancer patients receiving treatment, whose immune systems may be weak, are not exposed to the general emergency room. In addition to the cancer urgent care center, this project will emphasize a clear pathway for patients to access a specialized, oncology-focused hospital-within-ahospital, with dedicated oncology beds and an investment in the latest oncology technology and treatments, all staffed by professionals specifically trained in highquality cancer care. Along with the unique cancer urgent care center, Saint Francis Healthcare has the largest, singularly located fleet of surgical robots in the Mid-South, which the highly trained surgeons of the West Cancer Center use to perform minimally invasive surgeries that can lead to shorter hospital stays and faster recoveries. The West Cancer Center and Saint Francis Healthcare alliance also includes the future addition of a Margaret West Comprehensive Breast Center in Saint Francis Hospital - Memphis on Park Avenue, as well as the addition of West Cancer Center services at Saint Francis Hospital - Bartlett.
HFMA Best Practices, continued from page 7 the provider’s system and affiliate’s system critical to ensure balances are accurate and in sync. For accounts deemed a bad debt risk, those outstanding balances are often turned over to a collections agency after other steps have failed. “Work with collection agencies to make sure those agencies are also following best practices and the mission of the hospital,” Gundling said. Providers should have a formal policy established regarding the use of extraordinary collection actions (ECAs) as defined by the IRS. These ECAs could include a lien on property, wage garnishment or lawsuits. However, HFMA’s best practice document notes using ECAs is optional and must be weighed in light of potential negative impacts. The report includes a checklist of internal controls to consider memphismedicalnews
before moving to this step. “There’s always a balance with collections,” said Gundling. Providers, he continued, need resources to run but also want to make sure patients receive the care they need. “Providers need to have people who are empathetic and compassionate explain financial policies to people up front. I think they get tripped up by not being clear and trying to avoid an uncomfortable conversation.” “Best Practices for Resolution of Medical Accounts” is freely accessible on the HFMA website. From the hfma.org homepage, click on the Industry Initiatives tab and then select Healthcare Dollars and Sense for the report and additional resources. A direct link to the page is also available in the online version of this article on our site at MemphisMedicalNews.com.
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Process Simulation DaSilva Consulting is launching a new process simulation service to decrease the risk of process changes and implementation failures. The recent pandemic has exposed several process weaknesses across the healthcare system that was already strained. Considering this new reality, how do hospital and clinic decision makers best evaluate their current systems and plans to adapt to the post pandemic realities to meet patient care needs, community, and financial performance objectives? Healthcare needs an easier, more quantifiable, and reusable way of visualizing current practices, analyzing potential process & policy changes and planning the patient experience, future service lines and new strategic directions. Our highly-skilled Master Black Belt, Lean Six Sigma, and Data Scientists enable healthcare organizations to test their ideas and scenarios for cost reduction or other performance objectives in a virtual environment BEFORE they are implemented, reducing the risks of implementing costly and ineffective initiatives. Get in touch and join the select group of companies that use data to predict the future and make the best decisions! www.dsbusinessconsulting.com 5100 POPLAR AVE FL 27, MEMPHIS TN Phone: +1 855-501-9372
GrandRounds Jeffres Named Director of Operations at UTHSC Edwin Jeffres has been named director of Operations in the Facilities Department at the University of Tennessee Health Science Center. Jeffres leads all full-time, part-time and temporary university employees working within the department. He also
oversees the day-to-day planning, organizing, and direction of various crafts areas within the facilities administration office. Jeffres’ additional responsibilities include establishing policies and
Rajesh Ramachandran, M.D. Named 2021 “Doctor of the Year” by Tennessee Men’s Health Network Gastro One physician Rajesh Ramachandran, MD has been named Tennessee Men’s Health Network’s (TMHN) 2021 “Doctor of the Year.” Dr. Ramachandran was presented the award on Wear Blue for Men Friday (June 18, 2021) of National Men’s Health Week (June14-20, 2021).
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procedures, schedules, and department needs, providing day-to-day staff directives; managing departmental concerns and disciplinary actions; determining cost benefits and managing annual budgets; directing the maintenance, repair, and alteration of buildings and grounds; and ensuring optimal utilization of personnel and other resources. He reports to Kimberly Moore, MBA, assistant vice chancellor for Facilities at UTHSC. Jeffres, a Franklin, Virginia native, has been with UTHSC since 2015, initially coming on board as the superintendent for Custodial Services. He was promoted to interim director of the unit in 2019. Prior to that, Jeffres was the owner and CEO of Jeffres Building Systems for 18 years. The company specialized in commercial construction of structural steel and pre-fab building systems, serving government, corporate and private clients. Jeffres earned his associate’s degree in business management from Southwest Tennessee Community College and is attending the University of Memphis for his bachelor’s degree in business administration, concentrating in construction management. In 2019, Jeffres graduated from the Institute for Facilities Management. He is also a member of the APPA: Leadership in Educational Facilities and the Phi Theta Kappa Honor Society.
Methodist Le Bonheur Healthcare names Chief Academic Officer Methodist Le Bonheur Healthcare has named Robin Womeodu, MD, senior vice president and chief academic officer to lead the healthcare system’s office of Medical Education and Academic Affairs. She will strengthen academic partnerships, as well as medical Robin Womeodu student, residency and fellowship programs. Womeodu currently serves as chief medical officer for Methodist University Hospital. With a focus on delivering the highest quality of care to patients, Womeodu will collaborate with institutions of higher learning and community stakeholders to develop and implement strategic educational plans to foster learning opportunities in a variety of medical professional disciplines, including physicians. She also will lead system-wide research initiatives, including clinical trials. Womeodu also will oversee the organization’s collaboration with the University of Tennessee Health Science Center, the University of Memphis and Meharry Medical College to expand statewide education, training and research opportunities for medical trainees including medical students and residents. Since joining MLH in 2005, Wo-
meodu has led efforts to reach top decile compliance in quality and safety improvements. She also implemented interdisciplinary stroke teams representing case management, pharmacy, nutrition and rehabilitation to decrease the length of hospital inpatient stays and improve patient outcomes. Womeodu also advises Methodist’s Congregational Health Network and supports community outreach efforts to provide chronic disease management to residents in the high-risk 38109 zip code. Womeodu holds a Bachelor’s degree from Rutgers University in New Jersey and medical degree from Washington University Medical School in St. Louis.
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GrandRounds West Cancer Center & Research Institute Welcomes Mihaela Onciu, MD At West Cancer Center, personalized treatment is standard practice. Onciu promotes our culture of tailored care with customized specimen handling and reporting, direct communication with oncologists, and support for diagnostic techniques to serve each patient accurately and efficiently with (sometimes) smaller samples. Onciu will help establish West’s first hematopathology lab, which will provide integrated reporting, concentrating the results of all ancillary studies performed on every bone marrow sample in one final report with summarized diagnostic and prognostic significance. The goal of this initiative is to extend services beyond West Cancer Center, allowing the community to access this program, bringing a new realm of service across the MidSouth. Onciu brings over 20 years of pathologic evaluation experience to our network. Having worked in both academic and national lab settings, Onciu has gained in-depth understanding of oncology needs with respect to rapid, decisive, clear, and quality diagnosis of hematopoietic neoplasms, along with evaluation of the prognostic features specific to each disease.
Common Table Health Alliance & Center for Transforming Communities Agree to Consolidation The Board of Directors of Common Table Health Alliance (CTHA) and the Center for Transforming Communities (CTC) announce a consolidation of the nonprofits. CTC will continue CTHA’s ownership of assets, operations, and programs. This will allow CTHA’s work and commitment to health equity to continue as an effective neutral convener of community organizations that seek to improve health, reduce health disparities, and improve health care quality. CTHA has created innovative and effective programs that address healthrelated challenges in Memphis and Shelby County. CTHA’s five-year role as the administrative home of the Memphis Breast Cancer Consortium (MBCC) has been integral in a community-wide effort to decrease the mortality rate among African American women in Shelby County. The Better Together Youth Alliance is another effort that CTHA will move to CTC to continue the work of reducing childhood obesity, addressing the need for more quality health insurance for children, and increasing the number of immunized/vaccinated children, especially in Western Tennessee. The Center for Transforming Communities (CTC) works closely with residents and institutions to support equitable community change work through efforts to minimize the adverse impact of community development, power, memphismedicalnews
and capacity building support for residents, and more. CTC builds neighborhood democracies to channel shared decision-making practices that support the resiliency of the neighborhoods they serve. CTHA board member and past chair, Reggie Crenshaw, sees this as the next chapter for CTHA. As part of the consolidation, CTC Executive Director Justin Merrick will also become the CEO of CTHA.
Concorde Career CollegesMemphis Opens Sleep Lab Concorde Career Colleges and Mid-South Sleep have opened an on-campus sleep lab that provides diagnosis and care for the community and training opportunities for Concorde students. The Sleep Lab at Concorde is a five-bed Sleep and Neuro facility with state-of-the-art diagnostic equipment. Students in a variety of programs – including Neurodiagnostic Technology and Polysomnographic Technology – will get hands-on training at the center. It is one of three facilities for Jackson, Tenn.-based Mid-South, and all are accredited by the Joint Commission, nation’s oldest and largest standardssetting and accrediting body in health care. Concorde, which has 16 campuses in eight states, recently started the Neurodiagnostic Technology program on the Memphis campus. In Neurodiagnostic Technology, students learn to record and study electrical activity in the brain and nervous system and could become a sleep technologist, EEG technologist and more. The program takes about 16 months to complete (full time). In the Polysomnographic Technology program, students train to be a support team member for a certified sleep technologist or medical director. It is an 8-month diploma program. The Concorde-Memphis campus is at 5100 Poplar Ave., No. 132, between Audobon Square and White Station in East Memphis.
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MMDC selects Rory Thomas as New President MMDC announced the selection of Rory Thomas as the organization’s new President. Thomas brings a background in business and economic development coupled with extensive experience in finance, fundraising, and strategic planning. He previously served as the Executive Director of the Tennessee Small Business Development Center. Thomas becomes the second president of MMDC, selected from a nationwide pool of nearly 30 candidates. MMDC conducted the search over a four-month period after the passing of its inaugural president, Tommy Pacello.
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GrandRounds Dr. Scott Ferguson of West Memphis named Secretary of AMA The American Medical Association (AMA) has introduced the 21 members of its Board of Trustees for the coming year following elections held during the Special Meeting of the AMA House of Delegates. Gerald E. Harmon, M.D., a family medicine physician from Pawleys Island, S.C., was sworn in as the 176th president of the AMA. The other executive committee members on the Board of Trustees for 2020-2021 are: Scott Ferguson, M.D., a diagnostic radiologist from West Memphis, Ark., is secretary. Russ Kridel, M.D., a facial plastic surgeon from Houston, Texas, is immediate past chair. Bruce A. Scott, M.D., an otolaryngologist from Louisville, Ky., is speaker of the AMA House of Delegates. Members of the AMA Board of Trustees are elected by physicians and medical students representing more than 190 state and specialty medical societies who gathered virtually for the Special Meeting of the House of Delegates, the AMA’s policy-making body. The mission of the AMA is the promotion of the art and science of medicine and the betterment of public health.
Memphis Medical Society Congratulates this Year’s Graduating Medical School Class On May 19, this group of new doctors graduated medical school at the University of Tennessee Health Science Center College of Medicine. This class of 163 doctors has persevered through one of the toughest years. As an acknowledgment of this class’s perseverance through a year of COVID-19, the following sponsors pitched it to cover the costs of each student’s full doctoral regalia: Memphis Medical Society, Tennessee Medical Association, First Horizon Medical Private Banking and SVMIC. We can’t wait to see how this group shapes the future of healthcare!
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I choose Baptist Cancer Center to give my patients access to lifesaving clinical trials and advanced treatment options close to home. Certiﬁed by the Commission on Cancer and a member of the exclusive National Cancer Institute Community Oncology Research Program (NCORP), Baptist Cancer Center offers world-class cancer care in Tennessee, Mississippi and Arkansas communities across a vast network of locations. I choose Baptist Cancer Center’s progressive cancer treatment, compassionate care and hope for my patients. For a complete list of clinical trials, please visit baptistcancercenter.com/trials.
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