FOCUS TOPICS PULMONOLOGY • MENTAL ILLNESS • DIAGNOSTIC EQUIPMENT • 2020 FINANCIAL OUTLOOK
November 2019 >> $5 ON ROUNDS The Time Was Right For Pulmonologist And Local Sleep Labs For Memphis and pulmonologist Dr. Neal Aguillard it was the right place and the right time to help the city with its sleep lab shortage.
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Increased Workload, More Technology Mean Higher Salaries An aging population, sicker patients, and an emphasis on technologies have driven up the demand – and pay – for skilled clinicians, administrators and industry executives.
Report on Page 5.
Self-Care is the Prescription By BETH SIMKANIN
With the demand to perform in a stressful, and sometimes chaotic, environment for long hours at a time, physician and nurse burnout has become such a concern in recent years that several Memphis-area health institutions now offer solutions to increase the resilience of medical students, physicians and nurses in the classroom and the workplace. From compassion fatigue rooms to meditation classes, local healthcare entities acknowledge the growing problems associated with burnout and are providing tools and implementing programs to assist medical professionals in achieving a healthy work/life balance. “Many health professionals don’t have a history of self care,” said Kathy Gibbs, assistant vice chancellor of the office of student (CONTINUED ON PAGE 6)
Goal of Delta’s CEO: Focus on Expertise
Fall’s Arrival Brings Important News To St. Jude Researchers
By JUDY OTTO
For St. Jude Children’s Research Hospital, the arrival of the fall season brought with it a powerful new device and an invitation to participate in a significant national project.
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Andre Cromwell, Delta Medical Center’s new CEO, usually selects education as his tool of choice for resolving many of the challenges healthcare professionals face today as they attempt to deliver the best possible patient care. Atlanta-born, Cromwell pursued his own education at Washington Adventist University, where his undergraduate studies in healthcare administration led to an MBA and, later, a
Master of Science degree in nursing and business leadership (MSN-BL). Work as a business analyst for an IT firm and also for Blue Cross-Blue Shield of North Carolina expanded his perspective from both sides of healthcare reimbursement. He subsequently served as Chief Nursing Officer at Millwood Hospital in Arlington, Texas — a comprehensive behavioral health center — before making the move to Delta in August. (CONTINUED ON PAGE 4)
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Perfect Timing for Memphis Pulmonologist
Right Place and Time for Neal Aguillard to Help with Sleep Lab Shortage By LAWRENCE BUSER
When Louisiana native Dr. Neal Aguillard was completing his fellowship in pulmonary disease and critical care during the late 1980s at the University of Tennessee Health Science Center (UTHSC), he knew there was a critical need for pulmonologists in Memphis. The city was also a one-lab town for patients with sleep disorders, a subspecialty field of medicine which at that time was largely unrecognized and had an underserved patient population. “When I finished medical school in 1984 at LSU, the only thing we had on sleep was a one-hour lecture on narcoleptic dogs, and that was it,” Dr. Aguillard recalled. “While I was doing my fellowship, the man who ran the only sleep lab in town, Dr. Helio Lemmi, was at Baptist, and I just called him and said ‘I think I’m going to go to Methodist Hospital and I need to spend time in a sleep lab because I would like to take the sleep board exam.’ “At that time there was no formal fellowship training, but if you wanted to study for and take the exam you could become board-certified. Dr. Lemmi was very gracious. He said, “You can spend as much time in my lab as you want.’ So part of my fellowship I spent in a sleep lab.” In clinics at the Veterans Hospital or at the Gailor Clinic, it was well known there was only one place to be tested for sleep apnea, and that was at Baptist. “Everybody knew I was interested in it, so I would see all those patients, call Dr. Lemmi, get them tested and then go over and read their sleep studies,” Dr. Aguillard said. “There was no other place interested in seeing them or testing them.” Now with Mid-South Pulmonary Specialists at 5050 Poplar, Dr. Aguillard is one of six board-certified sleep medicine physicians who see roughly 1,000 patients a month and conduct some 3,000 sleep studies annually. The practice recently began construction on its own Sleep Disorders Center. They are still partners with Methodist Healthcare for inpatient pulmonary and critical care. However, with the addition of several new physicians to the group in 2019, they simply outgrew the current sleep center model. “It was just a model that didn’t fit anymore,” Dr. Aguillard said. “It’s almost the same situation orthopedic surgery was in 20 years ago at a hospital. Now it’s much cheaper to do orthopedic surgery at an out-patient ambulatory surgical center. The cost is much less doing it at an offcampus place.” The pulmonology practice is opening a 12-bed sleep lab at the Poplar office, MEMPHISMEDICALNEWS
Dr. Neal Aguillard
where it occupies the sixth, seventh and eighth floors. “We can evaluate and test all age ranges, from little babies up to senior adults,” Dr. Aguillard said. “Kids can have problems like bed wetting, walking or talking in their sleep, night terrors and other disorders that you don’t see as much in adults. With older people, you’re going to see obstructive sleep apnea, excessive daytime sleepiness, snoring or insomnia from other medical problems.” “The amount of sleep a person needs changes with age,” he added. Newborns typically need 14 to 17 hours of sleep per day. An active teenager should be getting around eight to 10 hours of sleep, but that drops to around seven to nine hours in middle-aged adults. “As you get older you still need that amount of sleep, but you end up sleep-
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ing less per amount of time you spend in bed,” Dr. Aguillard said. “You might need to lay in bed nine hours to get seven hours of sleep because you have a hard time getting to sleep, or you might wake up because you’re hurting or you need to go to the bathroom. “Some people tell me ‘I get by on four hours of sleep.’ Well, no, they’re not getting by on four hours of sleep. They’re functioning very poorly because they force themselves to do only four hours of sleep, and then on the weekend they end up sleeping 10 hours.” Sleep experts estimate that more than 100 million people of all ages fail to get a good night’s sleep, and there are at least 84 medically identified reasons why, ranging from restless leg disorder to Circadian rhythm disorders to the No. 1 problem, obstructive sleep apnea. Sleep is important to almost every other area of mental and physical health, and affects productivity and quality of life. Lack of sleep also can endanger public safety by contributing to traffic and industrial accidents. “We see more commercial airline pilots than any other sleep lab in the U.S. by virtue of FedEx being here,” said Dr. Aguillard. “The No. 1 profession we see are over-the-road truck drivers. In some cases it’s mandated, but in others a physician might think a pilot or driver is at risk of having sleep apnea (and) he’ll send them to our sleep lab. We also have patients who are self-referred. We evaluate you and then provide the necessary sleep testing all in one location.” A sleep lab study may include measuring the body’s responses while awake and asleep; recording a patient’s snoring, teeth grinding, chewing and talking; and monitoring body movements with infrared cameras while the patient is asleep.
Dr. Aguillard says sleep medicine has advanced tremendously since his fellowship days more than 30 years ago, including in awareness by both the public and primary care physicians, better medications, surgical options and more sophisticated equipment. “The medications that are available have a side-effect profile that is so much lower than it once was,” he said, “and the machinery has drastically changed. The CPAP (Continuous Positive Airway Pressure) machine we use adjusts itself while you’re sleeping. It will even email us reports to let us know how the patient slept.” Dr. Aguillard himself tries to fit in a little sleep when he is not working or pursuing one of his many other interests. He’s a ham radio licensee and flies a singleengine Cherokee to inspect two rice farms that he leases out in Arkansas. He also has a degree from William R. Moore School of Technology in tool and die manufacturing, and spent another year in night school to learn welding. “We live on 60 acres right outside of town, and I make implements and accessories for my tractor,” said Dr. Aguillard, who grew up on a farm in the small French Catholic town of Eunice in southern Louisiana. “People also bring by lawn mowers, trailers and other things for repair.” He met his wife, Dr. Susan Aguillard, at LSU medical school “over a cadaver in anatomy lab.” She is on the board of governors at St. Jude Children’s Research Hospital and chairs the annual Dream Home Giveaway raﬄe that her father, Dr. Donald Mack, started in Shreveport in 1991. It has now spread to more than 40 cities. They have a daughter in Washington, D.C. “We’re expecting our first grandchild,” said Dr. Aguillard, “so all is right with the world.”
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Goal of Delta’s CEO: Focus on Expertise, continued from page 1
Cromwell plans to implement Acadia Healthcare’s high-level vision for Delta, blending it with his own vision and goals. His vision embraces a plan for a new Delta state-of-the-art facility on the current campus within the next two or three years. Delta’s closure of its ER on June 30 acknowledges this community’s need for enhanced behavioral health services, and reflects its intent to lean more on its psych capabilities, Cromwell explains. “There’s no need to try to compete with Methodist, Baptist or other big med/ surge (medical-surgical) acute care hospitals. We have the expertise in behavioral health to provide the services that are needed in our community— and within a 50-mile radius.” He shares statistics that confirm the growing need: One in five individuals will suffer a mental illness, one in 25 adults will suffer a major mental illness, and suicide is on the rise among adolescents. Educating the community about those dangers – and Delta’s enhanced ability to address them – is key to addressing them. Ironically, the highest suicide rates are among psychiatrists, he said. He believes meeting the demand of providing good quality care while balancing difficult reimbursement limitations is “like trying to provide champagne service on a beer budget.” Cromwell suggests that dealing with
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patients’ problems as well as their own stresses –which can include the nurse shortage and the 34 percent burnout rate among behavioral health nurses – could contribute to the pressures on physicians and healthcare executives, as well as psychiatrists. Cromwell teaches that balance is essential. “You have to find a way to decompress, to talk to someone else about your own issues,” he said. “Any executive has to try to maintain a healthy work-life balance to avoid burnout; it takes a concerted effort, because it’s hard.” Cromwell’s own life-balance relies on faith, fitness and family — his wife and 3-year-old son. Although the Bureau of Labor Statistics projects a 15 percent increase in nursing careers by 2026, Cromwell thinks fewer people are interested in pursuing a psychiatric nursing specialty. “Most individuals don’t look at behavioral health as something glamorous — like ER or critical care,” he said. “But experienced psych nurses can educate new nurses, explaining that the co-morbidities of our patients can also manifest themselves in psychosis, when it’s actually an underlying medical issue they’re experiencing. It’s really important for new nurses to learn that their assessment skills are needed 110 percent more in behavioral health than in ER or med/ surge nursing.” He also points out that chronic health issues like hypertension, diabetes and high cholesterol “don’t disappear because you have mental health issues. So it’s really incumbent upon us in the industry to educate individuals to understand that the need is great in our arena as well, for good, qualified professionals with varied experiences to understand what an impact they can have on the whole patient, not only medically but psychiatrically.” Patients will benefit from Cromwell’s plans to enhance group offerings at Delta, specializing and strengthening their programming. “We want to give patients a good clinical outcome by really providing education that includes the coping skills necessary to survive what they’re dealing with,” he said.
Is the missing
The community will benefit, too, from Cromwell’s plans to involve it in prevention through education. While the American Psychiatric Nurses Association, the American Nurses Association and other professional groups are lobbying for change to prevent mass tragedies, Delta plans to offer grass roots-level community group education seminars on what to look for in someone who might be struggling with depression. “We’re committed to making Delta a premier place,” Cromwell vows, “not only for patient care but also for staff. Staffs want a place to grow their career and finish their career.” And because Delta is under the umbrella of Acadia Healthcare, those advancement and leadership opportunities are possible, he points out. Succession planning is essential, he emphasizes. “Identifying the next set of leaders is something I’ve talked about to my senior leadership team. I think the lack of us spending time with that next generation of leaders is another contributing factor to executive burnout across the board. When executives approach the end of their careers and turn around and (realize) there’s no bench strength — no one to come up and take their position — that’s a stressor in itself.” Dedicated to the education and development of his staff at all levels, Cromwell identifies his most important lifetime accomplishment as the numerous employees who have grown into leadership positions and gained advanced degrees under his tutelage. “I’m big on teaching, mentoring and development,” he said. “That’s where I really get my true satisfaction, knowing I’ve helped someone else and expect them to pay it forward themselves.” He said Delta’s employee profile of 300-plus includes four generations ranging from veterans to tech-savvy young people who appreciate being actively involved and engaged in creative problem-solving while gaining experience and knowledge from their co-workers. Then he added, “I want people to come along on this journey,” as Delta begins another 40 years of growth and service in a new state-of-the-art hospital coming soon!”
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Healthcare Trends: Compensation Still Rising
Execs, Physicians Among Those Seeing Increases By CINDY SANDERS
It’s a simple case of supply and demand. An aging population, sicker patients, move to new models of care and emphasis on technologies to increase efficiency have driven up the demand for skilled clinicians, administrators and industry executives. A shortage of providers across multiple disciplines and a tight labor market have made finding and retaining knowledgeable staff a priority … and that comes at a price.
“In general, there’s been greater compensation delivered over the last one to two years as the economy has improved,” said Bill Hopkins, senior manager with Global Reward Services for KPMG, LLP. Over the past few years, he said salary increase budgets have inched up from the 2.5 percent to 2.7 percent range. “Those increase Bill Hopkins budgets are now creeping back up to the 3 percent level,” he added. “And general increases for higher earners and performers tend to be above that 3 percent level.” Hopkins continued, “Turnover is very costly to organizations, especially in healthcare.” Employers have to factor in both the cost to recruit and train a new hire and lost productivity during the time it takes to get that new physician or manager up to speed. “Bringing in physicians is particularly costly because it takes time to build up a practice. A new physician isn’t going to produce at the same level as the one that left,” noted Hopkins. “Highly productive, high performance physicians are in high demand. Organizations, when looking at compensating them and making increases, want to make sure they retain them,” he said of the demand for competitive salaries and benefits. Hopkins added the same sentiment applies to any employee with institutional knowledge, with the stakes rising as you move up the organizational chart.
Physician Compensation Trends
At the end of May, the Medical Group Management Association (MGMA) released its 30th annual Provider Compensation and Production Report, a comprehensive view of compensation across the country with data from more than 147,000 physicians and non-physician providers (NPPs). Pointing to the latest data, Andrew Hajde, CMPE, assistant director of Association Content memphismedicalnews
for MGMA, noted primary care physicians saw a 3.40 percent increase in median total compensation from 2017 to 2018. Specialists saw a 4.41 percent increase on average, and NPPs Andrew Hajde, realized an increase CMPE of 2.95 percent. The Midwest and South reported the largest compensation for physicians last year. The report also showed the largest increases in total compensation for established providers were for the medical specialties of diagnostic radiology, general obstetrics and gynecology, neurological surgery, noninvasive cardiology and neurology. Hajde said providers have seen around a 7 to 11 percent increases in total compensation over the last five years. In comparison, inflation rates have been right around or below 2 percent since 2012. “They (providers) are continuing to be better off year-0ver-year,” he noted. However, he said it might not always seem that way from the physician’s perspective. “What it doesn’t take into account is the amount of effort they have to put in to achieve that salary,” Hajde explained. “Is it worth it to get that extra few percent if it takes 25 percent more effort?” Cristy Good, MPH, MBA, CPC, CMPE, senior industry advisor with MGMA, said compensation is being driven by competition and those numbers extend beyond physicians. Other providers also are being actively recruited with good wages and benefits Cristy Good to fill gaps in care. “We’ve seen an increase in NPPs,” said Good. She said there is both a greater need for advanced practice providers in the wake of physician shortages and more capacity for individuals to become physician extenders with expanded programming at colleges and universities. “It allows a physician to be effective in a different way,” she added of the increased need for these clinicians. Both Hajde and Good said they expect to see continued high demand and tight supply of physicians and other providers in the near term.
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BURNOUT, continued from page 1 academic support services and inclusion at the University of Tennessee Health Science Center (UTHSC). “Life happens while students are here, and it will continue to happen when they Kathy Gibbs become physicians. We want to help them develop healthy ways to cope and manage stress while maintaining a healthy work/life balance.”
Medical Students and Physicians
According to a survey published this year by the American Medical Association, the Mayo Clinic and Stanford University School of Medicine, 43.9 percent of physicians exhibit at least one symptom of burnout. Burnout is defined as long-term unresolvable job stress, which leads to exhaustion, a lack of joyfulness, a reduced ability to show empathy toward patients, job dissatisfaction, a sense of failure and depression. Another survey conducted this year by the National Academy of Medicine, which released its results last month, stated the percentage is much higher for medical students – almost 60 percent. The report from the survey stated that physicians are “more prone to burnout because of the workload, pressure and chaos they deal with each day.” “Doctors are under a lot of stress and make hard decisions every day,” said Kimberlee Strome, wellness and yoga director for the Mind Body Wellness Center at UTHSC. “They are interacting with patients and their families and then must come home whole to their families. It’s a demanding proKimberlee Strome fession.” To assist in combating the national problem, the report suggested that medical and nursing schools should train students to deal with burnout. According to Gibbs and Strome, UTHSC has developed many initiatives over the past year to tackle medical student and resident burnout. Last September, UTHSC launched the #takecare program, an initiative designed to support the emotional health and well being of medical students by focusing on early intervention to help them successfully cope with the emotional, academic, social and physical demands of pursuing an advanced health science degree. UTHSC added counseling personnel, improved student access to mental health services and destigmatized mental health care by marrying it with academic support services and moving it 6
out of a clinical setting. According to Gibbs, whose department oversees the program, the purpose is for students to recognize that they must take time for self care. Besides offering counselors to students and residents, the university provides faculty panels from various colleges to discuss skills and techniques to better manage and handle the demands of medical school. Last December, UTHSC hosted a speaker to provide suicide prevention training to faculty, students and UTHSC staff. “The rates of depression, anxiety and suicide are high for health professionals,” Gibbs said. “They are 10 to 30 percent higher for medical students than the rest of the population. One physician commits suicide in the U.S. each day. It’s extremely important to feel wellbalanced. We have to communicate that they need to be cared for, so they can show caring for others. Counselors are trained to see how the student is doing emotionally. For instance, is the student using alcohol or drugs to calm down or sleep?” UTHSC set up an online portal where faculty, staff and students can anonymously share concerns 24 hours a day. Additionally, the university provides educational specialists to assist medical students in developing good study habits. “Students come to medical school academically strong, and some haven’t had to spend a lot of time studying,” Gibbs said. “They haven’t developed good study habits, and when they enter medical school, it’s like drinking out of a fire hose. There is more to learn and less time to learn. They start to question their abilities and whether or not they should be here. This environment is dysfunctional. It’s tough and stressful, and the students must maneuver and learn to thrive in this environment to become successful health professionals. This initiative is designed to be preventive. We want students to feel comfortable to reach out if they are overwhelmed.” To assist students in managing overall wellness, UTHSC dedicated 3,214 square feet for its new Mind Body Wellness Center, which is under construction on the second floor inside the university’s student-alumni center. The center will house a fully equipped studio for yoga, barre and pilates classes, a meditation studio and balcony study area. The student-alumni center also houses a kitchen, which will be used to demonstrate healthy cooking habits for students. All services will be free to students and faculty. “We are giving medical students the tools to shut out the world for five or 10 minutes and calm their minds, which will give them a new perspective when they go back to their studies,” said Strome, who is the director of the center and the wife of the executive dean of UTHSC’s College of Medicine. “My hope is that this helps students long-term as they become physicians and must learn to be present for each patient. A simple mind body exercise can help sharpen concentration. I’m giving them tools they can do
at work before they see a patient.” Wellness programming began in April for students with a 90-minute yoga hike at Shelby Farms Park, yoga classes at Health Sciences Park marketed through the Memphis Medical District Collaborative and a happiness workshop. “As a wife of a physician, I understand how demanding this profession can be,” Strome said. “This is a gift we are giving students.” The UTHSC Mind Body Wellness Center is scheduled to open in January.
It’s not just physicians and medical students who are affected by burnout. Studies show there is statistical significance between nurse engagement and patients having better experiences. The National Nursing Engagement Report, which was completed by a national healthcare market research company, said 15.6 percent of nurses reported feelings of burnout. The percentage rose to 41 percent for nurses who are unengaged. Earlier this year, Shelley Shellenbarger, director of cardiology services and the neurology telemetry unit at Saint Francis Hospital, Bartlett, was completing her final project for her master’s degree in nursing. She looked at studies on nurse burnout and compassion fatigue. “Nurse burnout and retention Shelley Shellenbarger are national issues, and I wanted to see what we could do to reduce compassion fatigue,” Shellenbarger said. After much research, she discovered that nurses could benefit from a “serenity room,” a quiet, calm environment where nurses could take a moment during a demanding shift. She saw benefits of a similar room for nurses at St. Jude Children’s Research Hospital. “Sometimes all nurses need is a few minutes to reflect or regroup during a long, 12-hour shift,” Shellenbarger said. “The hospital was supportive of my idea. It’s a little thing that makes a big impact. It benefits the quality of service at the hospital while being sensitive to the needs of the nurses and staff.” Shellenbarger presented her idea to Saint Francis Hospital leadership in February. One month later, the hospital created two compassion fatigue rooms for hospital staff. The rooms, which are on the second and third floors of Saint Francis Hospital, Bartlett, are painted pale blue. Essential oils, water bottles, snacks and a massage chair are available for employees to use. Shellenbarger says every hospital leader has key card access to the rooms and is trained to recognize someone who may be experiencing compassion fatigue during a shift. They can offer use of the room. Additionally, any hospital staff employee can request to
visit the compassion fatigue room. The average break time is 15 minutes. Other Mid-South hospitals, including Baptist Memorial Health Care and Methodist Le Bonheur Healthcare, offer employee assistance programs where employees and their families have access to professional counseling services. Methodist launched a Mindfulness Based Stress Reduction Program in 2015, which consists of a six-week mindfulness and meditation course for its employees. Offered five times a year, the course focuses on meditation techniques. According to Donna DiClementi, director of the employee assistance program for Methodist Le Bonheur Healthcare, the hospital system receives resilience feedback from an internal survey each year. Hospital officials say Methodist Le Bonheur’s resilience score is “well above the national average benchmark.” According to Melissa Wilkes Donahue, director at concern employee assistance program for Baptist Memorial Health Care, Baptist is in the process of launching telehealth counseling for employees. All Baptist employees will be able to conference with a licensed counselor over their smart phone through a mobile app. Regional One Health has a pastoral care department, which is made up of chaplains who can provide spiritual support to hospital employees in times of crisis. Lisa Schafer, executive vice president and chief nursing officer for Regional One Health, said pastoral care coordinates Code Lavender, which provides emotional and spiritual support, grief counseling and crisis debriefing when a team or nurse needs additional support. “Members of pastoral care have carts of soft, treasured things like candy or something soft to hold,” Schafer said. “Because we are a level one trauma center, our nurses are constantly bombarded with tragic circumstances, one right after another. They may need a moment to recover in a debriefing room.” Schafer says the hospital provides a day course for nurses on de-escalating aggressive behavior in the hospital. As part of nurse orientation, nurses interact with actors in a simulation lab and learn how to handle aggressive behavior. “We support our nurses and focus on gratitude, but we can do a lot more,” Schafer said.
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An Impressive Period for St. Jude
Hospital to Lead National Research Team; Gains Powerful Device PHOTO COURTESY OF ST. JUDE CHILDREN’S RESEARCH HOSPITAL
The past few months have The vaccine is less effective been notable ones for St. Jude for those at greatest risk. These Children’s Research Hospital. include children with cancer, First it was announced in people over 65, and those who September that the hospital are pregnant or obese. Also, at had acquired the first Ascend risk are those who have chronic 1.1 GHz Nuclear Magnetic illnesses, including diabetes and Resonance Spectrometer asthma. Scientists at St. Jude and (NMR). It is the largest and the University of Georgia have most powerful device of its kind, been selected to help change that. according to hospital officials. Goal: Improve Vaccines Then in late October it “The goal is to develop was learned that St. Jude will vaccines that are more broadly participate in a partnership protective against multiple flu to create more effective flu strains. Our priority is vaccines to vaccines. The effort was brought safeguard populations we know by the approximately $51 million will develop more severe disease in total first-year funding by the if infected,” said Stacey SchultzNational Institute of Allergy and Cherry, PhD, of the St. Jude Infectious Diseases (NIAID). Department of Infectious Diseases. NIAD is part of the She also co-directs the Center of National Institutes of Health Excellence for Influenza Research which initiated the Collaborative and Surveillance at St. Jude. Influenza Vaccine Innovation Schultz-Cherry and Ted Centers (CIVICs) program, a Ross, PhD, of the University of new network of research centers The NMR is the centerpiece of the Structural Biology Department’s expansion, which is being led by Charalampos “Babis” Kalodimos, Georgia, will lead the new Center that will work together in a Ph.D., department chair (left). On right is Youlin Xia, director, Center for Influenza Vaccine Research coordinated, multidisciplinary for Biomolecular NMR Spectroscopy, Structural Biology. for High Risk Populations. A effort. seven-year NIAD contract of up According to St. Jude, room to improve. In a good year, flu shots to $130 million will fund the work. The influenza vaccines remain the best way to prevent infections in 70 to 90 percent of project will encompass 14 universities and protect against flu infections and serious, healthy children and adults under age 65. research institutes. even deadly complications. But there is
In discussing the effort, NIAID Director Anthony S. Fauci, MD, said, “To more effectively fight influenza on a global scale, we need better influenza vaccines that are more broadly protective. With the CIVICs program we hope to encourage an exchange of ideas, technology and scientific results across multiple institutions to facilitate a more efficient and coordinated approach to novel influenza vaccine development.” The CIVICs centers will conduct multidisciplinary research that supports the development of vaccine candidates through testing in preclinical studies, clinical trials and human challenge studies. The CIVICs network also will explore approaches to improve seasonal influenza vaccines, such as by testing alternative vaccine platforms or incorporating new adjuvants (substances added to vaccines to boost immunity). These advances could substantially reduce influenza hospitalizations and deaths in the future. The CIVICs program will include three Vaccine Centers, one Vaccine Manufacturing and Toxicology Core, two Clinical Cores, and one Statistical, Data Management, and Coordination Center (SDMCC). (CONTINUED ON PAGE 8)
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An Impressive Period, continued from page 7 Magnet Will Aid Research
St. Jude’s acquisition of the first Ascend 1.1 GHz Nuclear Magnetic Resonance Spectrometer will allow its researchers to study proteins, DNA, RNA and other biomolecules to improve their understanding of the development of catastrophic diseases. The device was made by Bruker Corporation, an American manufacturer of scientific instruments for molecular and materials research, as well as for industrial and applied analysis. It is headquartered in Billerica, Massachusetts. The NMR will be used extensively by St. Jude’s Structural Biology Department using the most advanced technologies to tackle important biological systems with the goal to understand health and disease at the molecular and atomic level. It is the centerpiece of the department’s expansion, which is being led by Charalampos “Babis” Kalodimos, PhD, the department chair. “This 1.1 GHz system provides unprecedented capabilities and opportunities for us to answer challenging biological questions,” Kalodimos said. “It will be our most important tool to perform research in the area of dynamic molecular machines that are otherwise not amenable to other technologies.” With NMR technology, biological samples are placed inside the device’s magnet, where they are bombarded with radio waves. This results in the emission of signals that are read by the spectrometer
and translated into images, which provide a visual of how protein structures change and interact with other cellular molecules. Cells release signaling molecules that bind to receptors inside other cells that create changes. Abnormal messages can result in the creation of abnormal proteins that don’t respond to normal cell signals and can grow unchecked. That growth is what causes cancer. In addition to the NMR, Kalodimos has overseen other technological upgrades and enhancements to the department, which utilizes four frontline techniques to examine biomolecular structures: cryogenic electron microscopy and tomography, NMR spectroscopy, X-ray crystallography and single molecule imaging. Structural biologists combine the results from the use of each technique to understand the structures of complex biomolecular systems. James R. Downing, MD, St. Jude president and CEO, said the addition of the NMR will significantly increase the technological infrastructure within the Structural Biology Department. “With the expansion of the Structural Biology Department, we are creating the world’s most comprehensive research center for defining the structure of the molecular machines that carry out basic functions within cells,” Dr. Downing said. “This information will enhance our ability to understand what drives pediatric cancer and other catastrophic diseases of childhood, and, ultimately, advance cures for these diseases.”
GrandRounds Methodist Le Bonheur Healthcare Names Communications VP Tabrina Davis is the new vice president for marketing and communications at Methodist Le Bonheur Healthcare. She will be responsible for developing and implementing marketing and communications strategies for the health system. Tabrina Davis Davis comes to MLH with more than 25 years of experience developing campaigns, employee engagement initiatives and crisis communications programs. Previously, she was a senior consultant and vice president of Strategic Communications with Wyn-Win Communications in Chicago. She has also served as vice president of communications for Northrop Grumman. Davis holds a bachelor’s degree in journalism and mass communications from Illinois State.
Sally Deitch Appointed CEO of Saint Francis Healthcare Sally Deitch, RN, FACHE, has been appointed Chief Executive Officer of Mid-South Group, Memphis market and Saint Francis Hospital by Tenet
Healthcare Trends: Compensation Still Rising, continued from page 5 Ownership vs. Employment
Citing a 2019 American Medical Association report, Hajde noted the national organization’s Physician Practice Benchmark Surveys found that fewer physicians are now owners than employees. The AMA Policy Research Perspective by Carol Kane, PhD, stated, “2016 was the first year in which less than half of practicing physicians (47.1 percent) had an ownership stake in their practice. With this report a new milestone has been reached — 2018 marked the first year in which there were fewer physician owners (45.9 percent) than employees (47.4 percent).” The report also found the distribution of physicians continues to slowly shift from very small practices to much larger ones. The reasons for the changes, which have been part of a longer trend, are multifactorial. Good said there is certainly a “hassle factor” when it comes to addressing myriad regulatory requirements as an owner, but she also sees the move as a generational shift. “There’s probably more of a security factor in going to an employed model rather than starting your own practice,” she pointed out. “To start a private practice and to build your patient base when you’re up against all these big organizations, it’s challenging.” She also noted supply and demand play a big role in employed physician recruitment. Quite simply, she said if a hospital or health system has a need for a particular specialty, “then you may see 8
them reaching out to private practices to entice those physicians into employment.” Finding a work/life balance is another consideration between being employed and owning a practice. Hajde noted physicians have to consider whether they are willing to see patients 40-50 hours a week and then spend another 30 hours a week being a business owner.
The Impact of Tax Reform
Could tax reform turn the tide on the trend towards employment over ownership? Do new tax rules benefit private practices? The trio agreed it’s too early to determine the answer to the first question. However, Hopkins noted, “The spirit of Section 199A and the way it’s designed should give solo practices and smaller groups, especially those in the rural areas, more incentive to stay independent.” Hajde agreed, “If they have more money than ever before in their pockets, they aren’t going to be as prone to seek out a different situation.” As for the overall employed physician trend, Hajde continued, “I expect, at the very least, it may slow down. Will it reverse? I don’t think we have the data to know that, yet.” He added monetary considerations are only one part of the equation in any decision to leave an ownership position for an employment model. As for whether tax reform benefits pri-
vate practices, the answer is quite possibly. Hopkins said considering median incomes for many physicians, the Section 199A deduction for pass-through organizations could be beneficial to practice owners. “As long as their taxable income as an individual is below $157,500, they get the full benefit of the 20 percent deduction. From $157,500-$207,500, they get part of the deduction; and over $207,500, you’re out of the deduction,” he explained. However, Hopkins continued, those numbers double for married providers. Anything below $315,000 of taxable income (considering both partners) receives the full 20 percent deduction, with the deduction phasing out between $315,00-$415,000. Hopkins added the income threshold is based on taxable income so all other deductions should be considered first. He also said providers in private practice might want to weigh the benefits of taking time off to stay under the cap compared to making extra income. If the additional income pushes a provider past the deduction levels, it might be a win/win to earn a little less but realize a greater net income by keeping the deduction while achieving a better work/life balance. Tax implications also impact company decisions in structuring benefit packages. “Both tax exempt and for-profit healthcare companies are looking at bonus, retirement and tax deferred payment plans to make sure they are designed to be efficient given tax reform changes,” said Hopkins.
Healthcare. Deitch will be responsible for overseeing all clinical, operational and growth strategies for Tenet’s two Memphis hospitals as well as four hospitals in South CaroSally Deitch lina. Deitch will fill the position held by Dr. Audrey Gregory, who was recently promoted to president of Detroit Medical Center and CEO Adult Central Campus. Deitch has been with Tenet for 12 years and has served in multiple CEO roles in the El Paso, Texas, market. She was the Group CEO El Paso and Rio Grande Valley, and most recently was Tenet’s Chief Nursing Officer and Vice President of Patient Care Services. She is a recipient of four Tenet Circle of Excellence awards. Deitch said she plans to build on the foundation established under Dr. Gregory’s leadership. The hospital recently celebrated its 15th anniversary of its bariatric program and achieved Advanced Thrombectomy-Capable Stroke Center certification from the Joint Commission.
Burnout & Balance
While compensation is always important, Good and Hajde reiterated it isn’t the only consideration driving change. Burnout is very real for physicians and practice administrators. There is a growing sense of frustration over the ‘other things’ that get in the way of caring for patients. While administrative simplification has been a rallying cry for MGMA and provider organizations – and has even gained traction in D.C. – the promise has yet to become reality. When asked if there are any significant steps forward, Good noted, “We keep hoping, but I think from the physician’s perspective, they would say ‘no.’” While some physicians are all about the work 24/7, Hajde said some newer physicians are rethinking the model with a view toward achieving a better balance. “It’s very much a generational expectation in terms of what it means to be a physician,” he said. For those who want a distinct division between work and life, Hajde noted they tend to hover closer to the MGMA median of compensation. Those in the 75th percentile and up typically are working longer hours. “It can be done, but it’s a bit more difficult to have it all,” he said. On the flip side, it’s possible compensation evens out over time if those with somewhat shorter hours have longer careers by avoiding burnout. “It really depends on the individual philosophy of the physician,” Hajde added of the best path to take. memphismedicalnews
GrandRounds Researcher Gains Grant to Study Muscle Loss in Older Adults
Marthinus Zeeman, MD, Joins UT Addiction Medicine Practice
Qi Zhao, MD, PhD, assistant professor in the Department of Preventive Medicine at the University of Tennessee Health Science Center (UTHSC,) has been awarded approximately $3 million to research improvements in the prevention, diagnoQi Zhao sis, and treatment of sarcopenia. Characterized by the age-related, involuntary loss of muscle mass and strength, sarcopenia is one of the primary causes of physical functional decline and loss of independence in older adults. The causes of sarcopenia are largely unknown and no FDA-approved medications are currently available to treat this ailment. Dr. Zhao’s study will examine indicators associated with sarcopenia-related traits such as muscle mass, strength, and function in adults over the age of 60, using a state-of-the-art metabolomics approach. Dr. Zhao will identify new groups of small molecules associated with these key traits, helping discover new metabolic pathways that can be targeted for medication testing.
Marthinus Zeeman, MD, has joined the staff of UT Addiction Medicine a practice of the University of Tennessee Health Science Center (UTHSC,) a clinical practice meeting the needs of substance use disorder patients. He joins the Marthinus Zeeman practice after completing his fellowship at UT Addiction Medicine. He earned his medical degree from Ross University Medical School, in North Brunswick, New Jersey, then completed his residency in Family Medicine at UTHSC.. Dr. Zeeman, who is originally from South Africa, specializes in addiction disorders of alcohol, opioid, cocaine, stimulant, cannabis and as well as in the evaluation of impaired professionals. He and his wife, an ER nurse, have three children.
Healthcare Organizations Call for Ban on Flavored Vaping Some of Tennessee’s largest healthcare advocacy organizations are urging Gov. Bill Lee and the Tennessee Gen-
eral Assembly to take swift action in response to the emerging public health issues associated with electronic nicotine delivery systems. In a letter to Gov. Bill Lee, more than a dozen associations petitioned the governor to implement “. . . an emergency temporary measure to restrict Tennessee youth from obtaining vaping products,” and encourage the Tennessee General Assembly to “. . . take more permanent legislative action when it convenes in 2020.” The letter was initiated and coordinated by the Tennessee Medical Association. The groups cite an outbreak of vaping-related illnesses as cause for immediate governmental intervention, pointing to three dozen cases in Tennessee and more than 1,000 cases nationwide. Vaping use among teenagers continues to climb. Public health advocates are most concerned about flavored products that are intentionally packaged to mimic candy, juices or other kid-friendly products and marketed directly to adolescents.
UTHSC Researcher Wins Grant to Study Opioid Addiction Karen J. Derefinko, PhD, an assistant professor in the Department of Preventive Medicine at the University of Tennessee Health Science Center
(UTHSC), received a $3.3 million grant from the National Institutes of Health (NIH) to develop psychological methods designed to help individuals with opioid use disorder through Karen J. Derefinko medication assisted treatment. The United States Department of Health and Human Services estimates that more than 130 people die every day from opioid-related drug overdoses. Although treatment for opioid addiction is available, more than half of patients struggle to adhere to buprenorphinenaloxone, a form of medication assisted treatment, particularly during the early stages. Derefinko’s research program, the Get Solid Initiative, includes a series of projects focused on the prevention of opioid exposure and misuse. According to the 2018 National Survey on Drug Use and Health, 10.3 million people in the United States misused prescription opioids, with the majority of them abusing doctor-prescribed doses of hydrocodone and oxycodone. Derefinko believes her work in educating the public about the risks of opioid exposure is critical because of how easy it is to develop an addiction to opioids.
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GrandRounds Unity Taps Dr. Jethanandani for Double Duty Unity Psychiatric Care announced Dr. Vijay Jethanandani has been named medical director for the Unity Psychiatric Care hospital in Memphis and will also serve as medical director for its 16-bed psychiatric hospital in Martin, Tennessee. Dr. Jethanandani Dr. Vijay will provide clinical Jethanandani oversight for the psychiatric nurse practitioners and support local AHC skilled nursing facilities, which are owned by American Health Partners, the parent company of Unity Psychiatric Care. He is board certified by the American Board of Psychiatry and Neurology in both general psychiatry and geriatric psychiatry and has more than 30 years experience treating mental illness and brain disorders in adults, with a special emphasis on older individuals. In addition to working directly with patients in the Martin facility, Dr. Jethanandani is specially trained in tele-psychiatry, which enables him to conduct remote video diagnostic evaluations for patients who otherwise might not be able to see a geriatric psychiatrist. Dr. Jethanandani also taught university classes, acted as a clinical preceptor, and volunteered with numerous international nonprofit and government agencies, including the World Health Organization.
UTHSC Selects Levine Dental Sleep Director
Clinic Expands Focus to Treat Children Mitchell R. Levine, DMD, has been named director of the Dental Sleep Medicine Clinic in the College of Dentistry at the University of Tennessee Health Science Center (UTHSC). Boards certified as an orthodontist and in dental sleep medicine, Dr. Levine plans to make the Dental Sleep Medicine Clinic a collaborative partner with other fields at the university and with clinical partners to treat sleep disorders and apnea in children and adults across the region. The clinic focuses on oral device therapy for adults and orthodontic approaches with oral devices for children. In adults, these custom-fitted oral appliances hold the lower jaw in a slightly forward position preventing collapse of the airway. Worn during sleep, an oral appliance fits like a sports mouth guard or an orthodontic retainer. The patient is fitted with the device that best suits the mouth shape and the breathing issue. For children, orthodontics and jaw growth can be utilized to change the size, shape, and position of the jaw, resulting in better management of the breathing problem. For children, sleep-breathing concerns center around the neurological, psychosocial, and decision-making de-
velopment. Children with sleep-breathing problems are a new focus of the clinic. As a sleep-trained orthodontist, Dr. Levine is well-versed in treating children and will collaborate with physicians at Le Bonheur Childrenâ€™s Hospital to help manage these breathing problems, which may also affect quality of life and school performance. The typical treatment options for obstructive sleep apnea in adults include CPAP (continuous positive airway pressure) machines worn during sleep, surgical interventions to improve airflow, and less-invasive oral appliance therapy. In children, treatment options have included the removal of adenoids and tonsils if necessary.
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GrandRounds Flinn Joins Flinn Imaging Centers Phillip Flinn, MD, has joined Flinn Imaging Centers, a comprehensive multi-modality outpatient imaging center. Dr. Flinn graduated from Georgia Tech in 2009 with a BS in management and completed his medical education at Phillip Flinn the University of Tennessee Health Science Center (UTHSC) in 2013. He trained at UTHSC/Methodist Healthcare diagnostic radiology residency program, finishing in June, 2019.
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ers of nature – the sights, sounds and smells of the outdoors - to families and give them a place to gather to relax, share life and escape the emotional challenges of hospitalization.” Le Bonheur Green will include a prayer labyrinth, which is an ancient practice used to facilitate prayer, meditation and spiritual transformation. A walking path in the shape of the heart is a nod to the Le Bonheur heart. A front porch gathering space encourages families to gather and an open green leaves space for children to run and play.
Stephanie Cowan, director of nursing in the critical care unit at Saint Francis HospitalMemphis was named Clinical Nurse of Distinction, by the Tennessee Hospital Association during its 2019 Annual Meeting in Nashville Cowan, who has Stephanie Cowan more than 38 years of experience in nursing and is described by Saint Francis leadership as a resultsdriven nurse leader. In 2018, she led the intensive care unit team to reducing urinary tract infections and stage III and stage IV pressure ulcers to zero, which were leading factors in helping the hospital increase its Centers for Medicare and Medicaid Services star rating from a two to a three.
Medical Society Expands ‘Money & Medicine’ Program
Cody Scarbrough Joins Staff at Mays & Schnapp
The Memphis Medical Society is expanding its new financial education program, Money & Medicine, to include seminars for physicians in all career stages. Clint Cummins, Medical Society CEO, who encourages members to attend the free lectures and workshops, said, “Physicians know planning for the future is extremely important; however, taking the time to sit down and map out your wishes is key.” Future classes and seminars will be posted on the organization’s website, www.mdmemphis.org. Topics will include medical coding, contracting and future recommendations. All UTHSC medical students are welcome to attend.
Construction for Le Bonheur Green Has Begun Le Bonheur Green construction work has begun following a groundbreaking ceremony at Le Bonheur Children’s Hospital main lawn at 848 Adams Ave. According to a news release from the hospital, “Le Bonheur Green is designed to bring the therapeutic powmemphismedicalnews
EXCHANGE STUDY multiple sclerosis
MJHR Opens 24,000-SquareFoot Addition The Memphis Jewish Home & Rehab (MJHR,) a not-for-profit organization that provides care to people of all faiths who are seeking rehabilitation services and long-term care, has opened a $7.5-million, 24,000 square foot addition. Named the Belz Family Foundations Rehabilitation Facility, the new addition is home to the Moss Rehab Gym, which is believed to be the largest rehab gym in the area. Built specifically with seniors in mind, it includes a multitude of features to help users in their physical, occupational, and speech therapy sessions. A walking track is inside the gym as well as three speech therapy rooms and three private treatment areas. With help from several foundations and many individuals in the community, more than $7.7 million has been raised so far to build the facility and add needed equipment. Located on 77 acres in Cordova, the 92-year old MJHR cares for more than 1,000 seniors every year on a short and long term basis.
Saint Francis Nurse Honored With TSA Award
IRB Approved at the Protocol Level Jul 25, 2019
Cody Scarbrough, MD, has joined the Mays & Schnapp Pain Clinic and Rehabilitation Center, a provider of pain relief treatment in the Mid-South. Dr. Scarbrough recently completed an ACGME-accredited pain medicine fellowship at Wake Forest Baptist Medi- Cody Scarbrough cal Center/Carolinas Pain Institute, as an Interventional Pain Fellow in the Department of Pain Medicine & Anesthesiology. He grew up on a small farm in Pinson, Tennessee, and earned a BS degree at the University of Memphis then University of Tennessee Health Science Center for his MD. He completed his anesthesiology residency at the Ochsner Clinic Foundation in New Orleans, where he was elected Chief Resident in his final year. He has presented at national and international conferences for anesthesiology and pain medicine co-authored a textbook chapter for spinal cord stimulation trial lead placement.
Help us build on our understanding of advancing relapsing multiple sclerosis Join this clinical study to research a medication under investigation for people with advancing relapsing multiple sclerosis The EXCHANGE Study is looking at a medication under investigation for people with advancing relapsing multiple sclerosis (RMS). The medication under investigation for this study has been approved for use in the United States. You, or someone you care for, may be able to take part if you/they: •
are a man or woman, 18–65 years of age
have advancing RMS (where symptoms are getting worse over time)
have been continuously treated with an MS medication (eg, beta-interferons, glatiramer acetate, fingolimod, dimethyl fumarate, or teriflunomide) for at least 3 months.
The EXCHANGE Study will involve 6 study visits over a period of up to 6 months. If you are interested in learning more, please contact:
Neurology Clinic, P.C. 901.507.3535 email@example.com Patient Poster [V02 USA]
Novartis Pharmaceuticals Corporation East Hanover, New Jersey 07936-1080 © 2019 Novartis 5/19 C-MZT-1375836
A MESSAGE FROM OUR CEO, ANDRE CROMWELL Since arriving at Delta Medical Center in Memphis, I have been amazed at the long tenures of many of the employees and the rich history of the hospitalâ€™s commitment to care in the community. As we adjust our primary focus to the treatment of people with mental health concerns, we plan on continuing to provide the excellent care the community has come to expect. Our mission is to become the provider of choice for individuals who seek care, and we will achieve this by offering evidence-based care that focuses on the individual and their various support systems. Join Delta as we embark on this journey. Thank you, and I look forward to serving you or your loved one.
For more information about Delta Medical Center visit or call:
www.DeltaMedCenter.com | (901) 979-7902
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