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October 2018 >> $5 ON ROUNDS Easy to See Where This Doctor’s Love Story Was Headed Dr. Sonal Mehr climbed the highest mountain . . . well, one of them, anyway. But it had nothing to do with love. She already was in love . . . with geriatrics. Her climbing adventure and her passion for geriatrics make an interesting story.

Profile on page 3.

Tough Construction Ventures Lead To Creative Solutions When several large healthcare construction projects posed some complicated problems recently, resourceful Memphis designers responded with unusually innovative answers.

Story on page 4.

Memphis Researchers Target Triple Negative Breast Cancer Progress Yields Optimism for Better Treatment Options

By BETH SIMKANIN what it is not, but we are mov ing away from that. Now we   Clinical researchers at are trying to define it by what it West Cancer Center and the is in order to find out additional University of Tennessee Health ways we can treat it.” Science Center (UTHSC) Triple negative breast canbelieve they may be close to cer is diagnosed when breast a breakthrough in determincancer cells test negative for ing not only the factors that the three most common types increase the risk of a particular of protein receptors -- estrogen, type of breast cancer, but also progesterone and hormone epideveloping alternative theradermal growth factor receptor pies. 2 (HER-2), which are known to While the advancements fuel breast cancer growth. of clinical research have had Because the tumor isn’t a positive impact in the treatsupported by these receptors, ment of breast cancer during triple negative breast cancer the past 30 years, some types doesn’t respond to traditional remain a stubborn challenge, hormonal therapy and specific such as triple negative breast Dr. Greg Vidal speaks at a patient education event. Next to him are targeted cancer therapies. Usucancer, a lesser-known, more Dr. Lee Schwartzberg, Wendy Allen and, at the far left, Carrie Anderson. ally a patient is given chemoaggressive kind. therapy to shrink the tumor, “We are still in the infancy stages of research,” said Dr. Lee followed by surgery to remove it. As a result, the cancer has a higher Schwartzberg, MD, executive director and co-founder of West Cancer reoccurrence rate and is more likely to become metastatic. Center. “Traditionally, we’ve defined triple negative breast cancer by (CONTINUED ON PAGE 6)


The Letters ‘GIGO’ Signify a Problem That Needs Fixing

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In a number of places the computer science term “garbage in; garbage out” has come to indicate poor quality. Especially at times in a poorly designed or improperly executed clinical trial. However, that may be coming to an end as a “Quest for Quality” is underway.


Aging is an inevitable process – and a challenge that grows along with the large population of baby boomers now reaching senior status. But Ken Cope, president of Home Instead Senior Care’s Memphis and North Mississippi franchises, embraces the situation

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Doctor Knows Exactly Why She Picked Geriatrics ‘It’s a Wonderful Population To Be Able To Help’ By LAWRENCE BUSER

Most doctors will go the extra mile for their patients . . . and then there’s internist Dr. Sonal Mehr whose practice is geriatrics. In 2015 she joined some friends who, in response to a birthday wish, decided that climbing Mt. Kilimanjaro in Tanzania might be a good way to celebrate. Along the way to the summit of the world’s highest free-standing mountain, Dr. Mehr learned a thing or two about herself and her patients.  “It took six nights and seven days, and it was one of the most challenging things I’ve ever done,” she says of the trek to reach the thin air at the top, which is more than 19,000 feet above sea level. “I learned that if I put my mind to anything, I could do it. I also learned how some of my patients with respiratory problems feel. I learned we are a very small part of something much bigger, and I was humbled by my experience.” With a practice that focuses on the special problems of the elderly, Dr. Mehr often finds herself being a life coach and family counselor as much as a physician and healer. “We have medical students who rotate through our office and they’ll honestly be surprised that in a day the youngest person we may see will be 83,” says Dr. Mehr, who practices with Dr. Robert Burns at the Geriatrics Group of Memphis. “I think the other day I had maybe seven patients who were between the ages of 89 and 96. I do have patients in the 100s. I think the oldest patient I’ve ever had was 107. “I think our patients appreciate when we tell them that it’s okay that this (medical issue) is going on and that we don’t have to fix everything and we can work with this. Just having that reassurance and seeing them leave the office with 10 pounds less weight on their shoulders is always a happy moment.” Dr. Mehr was born in Milwaukee, raised in Memphis and attended Germantown High School. She initially was interested in a career in physical therapy, but decided that becoming a doctor would be more interesting. “My dad (Dr. Vanraj Modhvadia) has been a dentist for 33 years and I used to go to his office with him all the time,” recalls Dr. Mehr, adding with a laugh that she resisted her father’s recruitment efforts. “I was never really interested in going into dentistry, but my dad tried. He really wanted me to go into dentistry.” She majored in biology at Drury University in Springfield, Missouri, went to medical school at St. Louis University and did internship and residency programs in internal medicine at the Univermemphismedicalnews


Dr. Mehr climbing Mt. Kilimanjaro

sity of Tennessee Health Science Center in Memphis. “When I decided to go into internal medicine, my grandmother got very sick and she was in the hospital and I saw all the processes that took place while she was there, and she did not have a good experience,” Dr. Mehr recalls. “At the

same time, I did a rotation with Dr. Burns when I was a resident and just fell in love with geriatrics and decided that’s what I wanted to do. It’s a wonderful population to be able to help.” It’s also a growing population. According to census figures, the ninecounty Memphis metropolitan area

showed a 25 percent increase – 35,216 - in persons 65 and older from 2010 to 2016. In the same period, overall growth was 2.3 percent. Seniors now make up 13.1 percent of the area population, up from 10.6 percent in 2010. Dr. Mehr notes that treating seniors also is about much more than diagnoses and lab work and medicines. “With internal medicine generally and geriatrics particularly, it’s easy to lose focus on the patient as a whole,” she says. “We tend to focus on their heart or kidneys, but sometimes we have to step back and look at the big picture and see where they are in life and what their goals are. “If you’re 89 years old, your goals are going to be different than when you’re 45 years old. Sometimes families forget to change their goals for their loved ones and patients forget to change their goals for themselves. We don’t have to necessarily fix everything, but we can try to help them lead a more comfortable life. I try to explain to them as tactfully as I can that now you’re at a stage in your life where you need to try to enjoy every moment you can and live every day to the fullest.” While dealing with the increasing requirements of insurance companies and Medicare checklists is both necessary and annoying, Dr. Mehr says she and Dr. Burns share the same philosophy in their practice. (CONTINUED ON PAGE 14)

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New Projects Integrate Creative Architectural Design   At Two Memphis Facilities, the Goal Was a Positive Patient Environment By MADELINE PATTERSON SMITH

In healthcare, not all the extraordinarily complex problems come exclusively to physicians. Sometimes those types of questions can come to the people who design the buildings. In fact, when recently faced with unusually complicated construction challenges, the designers of two newly completed major healthcare facilities responded with unique design ideas. The applications proved to be a boon to St. Jude Children’s Research Hospital and Church Health at the Crosstown Concourse. The design challenge presented by Church Health’s move to the Crosstown Concourse was to consolidate 13 facilities and different services under one roof, according to Ann W. Langston, Church Health’s Senior Director of Strategic Partnerships and Opportunities. From its first location, a home at 1210 Peabody opened in 1987, Church Health has strived to welcome patients and deliver medical care in a positive environment, or, as Langston said, “To combine efficiency and beauty as a way to express our respect for every person

coming through the doors for care.” In preparing for the move from the Peabody location, Langston said, “The first realization was that due to the huge size of the Crosstown Concourse buildAnn W. Langston ing, Church Health staff and operations would be closer together if stacked on three floors instead of spread out on one floor. “The next good idea was designing the three floors of Church Health around the West Atrium.  Standing in the West Atrium, patients and visitors can see or be directed to most areas of Church Health.” The Welcome Center near the front doors of the West Atrium help visitors navigate the space from a central location. Meredy Dahlgren of Looney Ricks Kiss architecture worked with Church Health on the space. “With such an extensive range of services, the visual connectedness created through and across the West Atrium has been key to the planning and





wayfinding process,” she said. Church Health founder and CEO Dr. Scott Morris wanted anyone coming into the West Atrium to “see wellness happening,” Langston said, so the Nutrition Hub Teaching Kitchen and Classroom have glass walls, as do areas in the Church Health YMCA. The glass walls are also aesthetically pleasing, and, as Langston said, they help the West Atrium create “a sense of Church Health place.” When designing patient care space, the team used the pod concept, with a provider serving patients in each pod. Pods have three exam rooms and a “swing” room that can be used for specialists such as health coaches, social workers and others. “Because the medical clinic is large,” Langston said, “triage, procedure, immunization and supply rooms, as well as mini-labs, are located throughout the pod sections of the clinic.” Beyond the logistical challenge of integrating healthcare services that range from dental care to nutrition and a teaching kitchen, Church Health did not want to lose its welcoming feel when it moved into the cavernous Crosstown Concourse building. “A warm, comfortable, welcoming patient-centric environment has always been top priority for Church Health,” Dahlgren said. “The big move to Crosstown Concourse offered so many opportunities for Church Health to unite their total care of mind, body and spirit all under one roof — but could fail if those they serve did not feel Church Health’s familiar embrace immediately. By understanding Church Health’s core values, culture and mission, we, as designers, strived to create a physical environment that reinforces that identity and brand, from beginning to end -- through careful space planning, color, materials and lighting selections, as well as graphics.” “We have been allowed to be intentional when using the space as we are serving patients. For instance, we have windows in PT and Behavioral Health where patients may be depressed and need natural sunlight,” said Tiffiny Wright and Jennifer Buhler, both nurses at Church Health.  John Curran, Director of Design and Construction at St. Jude Children’s Research Hospital, echoed a similar sentiment about the importance of natural light and nature for pediatric patients. He estimates over the past 10 or so years, St. Jude has increased the percentage of windows on outside walls by 35 percent to allow more sunlight into patient rooms and research labs. The 650,000-square-foot Advanced Research Center is scheduled to open in 2021, and Curran is excited about the seven-story internal atrium, which is made possible by windows on both sides of the building so light and views of the grounds are visible through the space. Because plants pose an issue to researchers due to

their spores and molds, the windows will provide views of the trees and landscaping outside, which is helpful for patients who are indoors during their treatment. Curran said patients also react John Curran positively to the art that St. Jude works to include in every space. From genome sculpture in the Chili’s Care Center to the giant kinetic mobile in the atrium, there are surprise views from patient rooms and research spaces. Curran said, “We try to incorporate art in the architecture just about anywhere we go, and in just about any project we do.” Curran heard a patient comment on the new colored disc mobile, saying “waking up to that every day made them feel good, even though they were going through a bone marrow transplant, just seeing the space come to life really motivated them.” One of the toughest design challenges during Curran’s tenure at St. Jude was the 2015 building of the Red Frog Events Proton Therapy Center with a 400-person auditorium on top. “The proton therapy center at St. Jude is radiation treatment, very direct targeted radiation treatment, as accurately as anybody does it in the world,” he said, and it is the first proton therapy dedicated to pediatrics. To build the vault-like structure to house the 250-ton equipment, the team dug 68 feet into the ground to accommodate the three-story structure. As Curran describes the center, “It’s like a very huge racquetball court, and on top of that we put our auditorium. We were told it couldn’t be done, and I don’t know that anyone else would have tried it!” Church Health nurses Wright and Buhler describe design in healthcare as more than a pretty building or a lot of windows. In a response they composed together when asked their thoughts about the building, the two nurses wrote, “More than just having a lot of glass, it is our patients’ perception that we are partners in their care. They can see the YMCA and know that we want them to have a safe and comfortable space to exercise. They can see the nutrition kitchen and know that we are serious about teaching them how to cook healthy and delicious meals. “Lastly, they can see the Model for Healthy Living, which is important to us as a clinic. “The patients and families can see for themselves where they fall in this model, where they need to improve, and know that we will be with them every step of the way.” memphismedicalnews


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Memphis Researchers Target Triple Negative Breast Cancer, continued from page 1 “Currently chemotherapy is the typical treatment option,” Dr. Schwartzberg said. “The survival rate of patients with triple negative breast cancer is less because only traditional chemotherapy is used to treat the cancer cells. There aren’t any other successful drug treatment options available for triple negative breast cancer at this time.” According to, a nonprofit organization that provides information about breast cancer online, the five-year survival rate for triple negative breast cancer is 77 percent – a dramatic departure from the norm. According to the American Cancer Society, the current fiveyear relative survival rate for most types of breast cancer is about 93 percent. Based on preliminary research, researchers know that triple negative breast cancer affects primarily African-American women with an inherited breast cancer susceptibility gene mutation. Additionally, it’s more likely to occur in women before age 50. Dr. Schwartzberg said while researchers are aware that this type of cancer is more commonly found in African-American women, the reasons why aren’t fully known. According to Athena Starlard-Davenport, Ph.D., assistant professor of genetics, genomics and informatics at UTHSC, research is being done in the Memphis area to determine what factors increase the cancer risk in African-American women. “Triple negative breast cancer is one of

the most aggressive types of breast cancer, but it’s not seen as often,” Starlard-Davenport said. “It accounts for only 20 percent of the breast cancer found in women. Not much is known about it. Clinical researchers have access to the right demographic to research it in the Memphis area. We are trying to determine if certain biological or environmental factors, or a combination of both, increase the risk of this type of cancer among African-American women.” Starlard-Davenport is conducting a research study to understand molecular and environmental causes of breast cancer disparities in African-American women. She says she focused on the Mid-South because the breast cancer mortality rate among African-American women in Memphis is one of the highest in the nation. A study conducted four years ago by the Avon Foundation for Women found that African-American women are twice as likely to die from breast cancer as white women in Memphis. Starlard-Davenport, in collaboration with West Cancer Center, has collected saliva, blood and tissue samples from African-American women over the age of 18 to determine if there is biological evidence that could increase the risk of cancer. She says the laboratory results will be revealed soon. Additionally, Starlard-Davenport is collaborating with the department of pharmacy at UTHSC to look at how MicroRNA can be targeted to treat triple negative breast cancer cells, which are

resistant to a certain type of chemotherapy called doxorubicin. Clinical researchers at West Cancer Center are conducting several clinical trials looking at possible drug therapy options for triple negative breast cancer. One trial, currently in its third phase, is looking at how patients with relapsed and refractory metastatic triple negative breast cancer respond to sacituzumab govitecan, an investigational antibody drug conjugate, which is designed as a targeted therapy to treat patients with metastatic cancer. Researchers have seen favorable clinical activity in patients, and the drug is under priority review by the Food and Drug Administration (FDA). If approved, sacituzumab govitecan would be the first antibody drug conjugate approved for the treatment of metastatic triple negative breast cancer. Dr. Gregory Vidal, MD, Ph.D., medical oncologist and hematologist at West Cancer Center and assistant professor of medicine at UTHSC, is conducting a clinical trial looking at how patients with metastatic triple negative breast cancer without an overexpressed HER-2 protein, but an activated HER-2 pathway, which is termed HER-2 signal positive, may respond to traditional HER-2 targeted medication, neratinib, which is designed to treat a different type of breast cancer. “We are attempting to repurpose a current drug in an area where it wasn’t intended to be used,” Dr. Vidal said. “We

are hopeful we will be able to offer more therapy options for patients. Additionally, there are numerous other drugs being studied at the West Cancer Center for triple negative breast cancers, including immune activating drugs already proven effective in numerous other tumor types.” Dr. Vidal says that through clinical research, researchers have discovered there are various subtypes of triple negative breast cancer, which open the door for additional therapy options for patients. “We now know through clinical research that there are four or five different subtypes of triple negative breast cancer,” Dr. Vidal said. “We are working to identify them to treat these specific subtypes with the hope that we will be able to be more successful in treating all types of triple negative breast cancer and have better outcomes. Currently, there aren’t any FDA-approved drugs to treat triple negative breast cancer, but I believe at this time next year, physicians will have two available to use.” All three experts agree that because of the research taking place in the Mid-South, researchers are getting closer to giving physicians more treatment options for patients. “Our ultimate goal is to cure all types of breast cancer in women, and we have made tremendous strides in the last 25 years,” Dr. Schwartzberg said. “The mortality rate has decreased 41 percent since 1991, but we still have a long way to go to identify therapies, especially in the area of triple negative breast cancer.”

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The Quest for Quality in Clinical Trials By CINDY SANDERS

“GIGO,” or “garbage in; garbage out,” was coined as a computer science term for the flawed output that comes from inputting flawed data. Over the years, the GIGO principle has been broadly applied to other areas of analysis where flawed logic impacts outcomes. Perhaps nowhere is that more evident than in a poorly designed or improperly executed clinical trial. Earlier this year, Jody Black, deputy director of the Office of Extramural Research at the National Institutes of Health, introduced the acronym ‘SCT’ at the annual meeting for the Association of Clinical Research Professionals. Although the NIH has supported their fair share of ‘small, crappy trials’ over the years, the national funding source has spent the last decade enhancing oversight, monitoring, reporting and transparency to improve the quality of trials, which in turn improves the quality and credibility of research findings. While some poorly designed, executed or reported trials are simply a waste of dollars, others have deadly consequences. Faulty ‘research’ published in 1998 linking vaccines to autism is still widely disseminated online. To this day, there are a significant number of fearful parents who refuse to vaccinate their children, which has led to the reemergence of several serious infectious diseases.

Research GIGO

Jim Kremidas, executive director of the Association of Clinical Research Professionals (ACRP) said the not-forprofit organization works to enhance and improve the grassroots implementation of clinical research by supporting the individuals involved. “A poorly designed trial has a negative impact … but so does a poorly Jim Kremidas executed trial,” noted Kremidas. He added writing a protocol might seem simple, when in reality the wording has the potential to taint the entire process. “It’s so critical that you ask the question correctly so that you get an answer that actually means something,” he stressed. “We don’t want spin in science.” Operational concerns and execution can also derail a clinical trial. “You could have a brilliant, scientifically designed study, but operationally you couldn’t do it,” he pointed out. Kremidas said he has seen trials with such narrow inclusion crimemphismedicalnews



teria that it becomes difficult, to the point of nearly impossible, to find patients to enroll. Even with a trial that is well designed, he continued, “If the people executing the trial aren’t doing it correctly, you won’t get the data needed.” Kremidas added, “I think the key to getting rid of those SCTs is we have to have the right experience and expertise in the people designing and implementing these studies.”


Dr. Mehr went to medical school at St. Louis University and did internship and residency programs in internal medicine at the University of Tennessee Health Science Center in Memphis. She practices Geriatric Medicine at the Geriatrics Group of Memphis, 2714 Union Avenue Extended, Suite 150.

Developing Skills

While there have been a number of advances in technology and processes to improve the quality of trials, Kremidas said the people on the frontlines are often overlooked. Outside of major academic centers, those doing the heavy lifting on clinical research often aren’t specifically trained in the exacting tasks that come with being a principal investigator or study coordinator. “Historically there haven’t been any standards set for who can be a clinical researcher,” he explained. “Study coordinators . . . most of them just fell into the job. It’s been totally serendipity how people came into the field.” He continued, “About half of the doctors who do a clinical trial only do it once. Clinical practice is not the same as clinical research.” To drive the organization’s mission of research excellence, Kremidas said much of the ACRP’s focus has been on education and development. “We’re trying to grow the workforce, and we’re also trying to help individuals keep up with changes in the industry,” he explained. “If you’re going to be a principal investigator, you need to be trained appropriately . . . you need to have certain competencies,” Kremidas pointed out. To that end, the organization has created a competency framework. “We think it will help people transition into better clinical researchers if they know what they’re getting into,” he said. Kremidas continued, “We also do certification of clinical researchers. We’re now offering subspecialty designations. We just launched one this year for project management and had more than 200 sign up for the exam already.” Available certifications include ACRP-CP (certified professional), CCRC (certified clinical research coordinator), CCRA (certified clinical research associate), and CPI (certified principal investigator).

Growing the Workforce

Another area of emphasis for the ACRP is on workforce growth. As science explodes, so does the need for quali-

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West Cancer Center Charts ‘New Model,’ New Partnership


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West Cancer Center, with its “40year legacy of innovation,” will begin 2019 on a new course, ending its affiliation with Methodist Le Bonheur and starting a relationship with a new partner, OneOncology. Officials at West say it is “evolving into a new model – one that will be a patient-centric, physician-driven and technology-powered center with a mission to improve the lives of those living with and beyond cancer.” West’s announcement last month explained that its new partner “is solely dedicated to community cancer care. This enables West Cancer Center to retain its singular focus on making physician-driven decisions to do what is best for patients, the community and the future of adult cancer care in Memphis and the MidSouth.” The announcement stated that when the new affiliation begins in January, it will allow West to “continue pursuing National Cancer Institute (NCI) designation and investing resources in Academic and Research Programs both locally and nationally. ‘West Cancer Center patients will benefit from even greater access to new treatment protocols, the latest clinical trials and cutting-edge research.” Dr. Lee Schwartzberg, West’s executive director, said, “We’re excited to join

the dynamic new model at OneOncology. Today’s challenging and complex healthcare landscape requires that we build new solutions that advance our mission to provide dedicated, clinical excellence with a focus on the latest, most innovative personalized treatment plans. This is a natural next chapter for us and maintains patients at the center of all that we do.” On its webDr. Lee Schwartzberg site OneOncology describes itself as “a partnership of oncologists and industry leading experts driving the future of community-based cancer care in the United States. “We are more than just a network. We are a partnership of independent community oncologists working together as one to deliver comprehensive cancer care with compassion to our patients and their families, close to home. “We empower oncologists to learn from their peers and leverage their collective experience to address the pressures facing community oncology today and to innovate for the future of cancer care delivery.”

The Quest for Quality in Clinical Trials, continued from page 7 fied researchers to oversee clinical trials. “We just recently announced a new initiative – Partners in Workforce Advancement (PWA),” he said of the effort to raise awareness of clinical research as a career path by reaching out to medical students and nursing students about the importance of field. The PWA motto is: In clinical research, people are everything. The literature associated with the initiative points out that without an adequate pipeline of qualified, competent professionals, the clinical trial community will fail to

both sustain the workforce and improve the efficiency and quality of medical discovery. “Medical technology is advancing so fast,” noted Kremidas. “There’s an exponential growth in clinical trials, but there’s only a linear growth in PIs, CRCs, and CRAs . . . the people who actually do the trials.” Without a robust workforce, he continued, “That leads to slower introduction of new therapies to the market, and that . . . in my opinion . . . is a public health problem.”

Save the Date for ACRP 2019 The premiere education and networking event for clinical research professionals is coming to the Southeast next spring. ACRP 2019 is scheduled for April 12 to 15 in Nashville. Registration for the 2019 conference opens online on October 15, 2018, at



Physician Compensation Plans: Understanding the Group Culture Is a Crucial Element By MICHAEL CASH, MHSA, FACMPE

Physician compensation in a private solo practice is simple: The physician receives any profits after expenses are paid as compensation. The physician generally takes a monthly draw and has periodic bonus distributions. When two or more physicians join the practice, the compensation variables change. Open communication and planning can help avoid conflicts that might arise from one partner’s feeling as though the compensation formula is inequitable. Understanding the physician group culture is one of the most important elements when designing a compensation formula. How does the group communicate? Is there a shared vision, and what are the norms that help shape the way the group operates? This helps the group determine what is important and what they want to incentivize in a compensation formula. For example, Medical Practice Services consulted with a urology group that distributed everything equally. To learn more about the practice and culture, we interviewed each of the physicians to determine what was important to them. They had a strong team-based approach that they wanted to maintain, which tied into the equitable distribution of compensation. Every group should spend some time assessing the financials and key performance indicators before addressing physician compensation. This includes reviewing each physician’s productivity by assessing his or her charges and payments. It may also be helpful to review worked RVUs or encounters as a productivity measure. Additionally, every group should review their accounts receivable and collection ratios to determine if the revenue cycle is efficient. Medical Practice Services consulted with a multispecialty group to assist with recommendations regarding compensation design. In this process, we learned that there were changes in their billing operations within the last year; they had outsourced their billing and then they brought it back in house. Their collection ratios were below industry benchmarks. We recommended that they spend more resources improving collections before attempting to redistribute compensation. Finally, we recommended that the group spend some time reviewing the income statement. The income statement should easily reflect the overhead, which is the expense before allocating physician expenses. If the financials and key performance indicators are not optimal, then variations in compensation design will not benefit the group. Before developing a new compensation formula, it is important to spend some time assessing the physicians’ understandmemphismedicalnews


ing of the current formula and what they hope to achieve with it. During this process, the group may identify any unique expenses or revenue associated with a provider in the group. Other considerations involve allocating profits from advanced practitioners, ancillary services, and valuebased payments. Groups should consult with legal counsel to ensure that ancillary profit distributions comply with Stark regulations. Many payers reimburse valuebased payments at the tax ID level. Some groups allocate the value-based payments internally based on their patient panel or on quality performance metrics. Some options for allocating advanced practitioner profits include distributing revenue after only direct salary and benefits are covered or including a percentage of the general overhead to the provider. There are many different compensation formula structures. Most involve a distribution of physician compensation by allocating a portion of the expenses equally and a portion by productivity. Some groups may be very detailed in their approach, allocating all revenue and expense directly to the physician. The downside to this approach is that it takes more accounting resources to allocate everything at the physician level. On the other end of the spectrum is the group that pays every physician equally. This works well for a group where each physician has a similar expense and productivity structure. However, conflicts arise when one physician wants to slow down, work more, or utilize additional services. In larger groups with multiple departments and services, it is common to have a system of allocating shared administrative expenses equally, while allocating site expenses based on physician productivity and overhead at that site. Some groups allocate expenses entirely on productivity. The downside to this approach is that the highest producer in the group pays more overhead expenses. Another option involves allocating a percentage of the expenses equally and a percentage based on productivity. In general, about 80% of the cost within a medical group is fixed cost or cost that does not change with patient volume. Some examples include rent, employees, and utilities. About




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‘Next Generation’ Brain Imaging Technology Installed at Le Bonheur MEGIN, a leading manufacturer of functional brain imaging technology, has installed TRIUX™ neo, the next generation of magneto encephalography (MEG) technology for functional brain imaging, at Le Bonheur Children’s Hospital. TRIUX neo, a highly sensitive, noninvasive method for mapping the human brain, is used to assess complex neurological disorders. Company officials said Le Bonheur is the first hospital in the world to install TRIUX™ neo. The installation was completed in late September. TRIUX neo can detect and localize neural events that are generated in the brain with millimeter accuracy and millisecond resolution. When this information is merged with structural MRI imaging, it provides a view to critical areas of the brain such as those areas responsible for the ability to see, talk, or move. Using this kind of information can confirm a diagnosis when other imaging modalities are inconclusive, thereby increasing the accuracy of surgical intervention and minimizing risk of neurological deficit. “Le Bonheur Children’s has a world-class neuroscience program. They are leaders in implementing innovative technologies that translate to better care and improved outcomes,” said Janne Huhtala, CEO of MEGIN. “We are honored to be working with their amazing team of clinicians and researchers as we look to expand the clinical impact of our technology.” “We provide excellent care to children with neurologic diagnoses using advanced technology, clinical expertise and state-of-the-art facilities. As one of the

nation’s best pediatric neuroscience programs according to U.S. News & World Report, we are looking forward to incorporating this new technology,” said James Wheless, MD, chief of Pediatric Neurology for the University of Tennessee Health Science Center and co-director of Le Bonheur›s Neuroscience Institute. “Using MEG, we determine the focus of seizures and can map sensory and motor areas,” said Frederick Boop, MD, chair of the Department of Neurosurgery for the University of Tennessee Health Science Center and co-director of the Neuroscience Institute. «This has allowed us to perform brain surgery in children more safely and with fewer complications. It has also allowed us to extend our surgical capabilities in children with epilepsy to those who might not have been recognized as surgical candidates in the past. This new technology will help us continue this important work.» Based in Helsinki, Finland for over 29 years, MEGIN has been the leading manufacturer of magneto encephalography (MEG) technology for functional brain imaging used for presurgical evaluation of epilepsy, brain tumors, or other lesions, and surgical planning for localization of sensory information. TRIUX neo, a fourth-generation system, the most recent technology to be introduced, has been developed to support medical professionals in the delivery of quality care and improved outcomes. In July 2018, MEGIN was acquired by York Instruments, forming the new global leader of functional brain imaging technology. memphismedicalnews


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Senior Care Is Personal For Home Instead’s Cope, continued from page 1

suit. They’re examining different payment models that encourage more care at home, which is less costly than care in other places.” Time As the former System Executive Director of Sales and Marketing for moves on; Baptist Home Care Inc., a division of memories Baptist Memorial Healthcare Corporashould not tion, Cope oversaw sales, market and admissions for Baptist’s home health and hospice agencies. He accepted the job, in fact, after recognizing the care that Baptist had provided for his mother-in-law when she was very ill, helping keep his wife’s promise never to let her mother go to a nursing home. After five years with Baptist, Cope chose to make a difference in a smaller Take part in this journey with us to learn more company, where he could make decisions about Alzheimer’s without going through numerous channels. The TAURIEL Study will look at an investigational medication for people with mild Alzheimer’s disease (The “smaller company” descriptor or people who have problems with memory. The study will help determine how safe the investigational medication is and whether or not it works in affecting Alzheimer’s disease. applies only to Cope’s local jurisdiction, however. Home Instead is the nation’s We are looking for approximately 360 people who The study could last up to 3.5 years, depending may be able to join this study. on how long you choose to participate. All studylargest non-medical home care comcare will be providedmedication at no cost. The TAURIEL Study will look at anrelated investigational pany, consisting of more than 800 offices The TAURIEL Study might be right for you if you: in the U.S. and, according to Forbes, is with or people who We are enrolling people nowhave — ¢for are people 50 to 80 years of agemild Alzheimer’s disease the largest senior care organization in the want to know more? ¢problems have mild Alzheimer’s disease or problems with memory. The study will help determine how safe with memory world.) If you are interested, please contact: is and whether or not it works in ¢the haveinvestigational somebody who can be amedication reliable study Cope points out that Medicare is partner or caregiver and who can come to some affecting Alzheimer’s disease. looking at various types of quality meastudy visits with you and answer questions about your health. surements, including re-hospitalizations, We are looking for approximately 360 people who may be able to and considering rewarding hospitals that help manage care that keeps patients at join this study. The TAURIEL Study might be right for you if you: home. • are 50 to 80 years of age He notes that home care technol• have mild Alzheimer’s disease or problems with memory ogy is also evolving rapidly. Recently it’s become possible for patients’ vital • have somebody who can be a reliable study partner or statistics to be monitored from home caregiver and who can come to some study visits with you by physicians in their offices; now video and answer questions about your health. aspects are being added. And things like an Alexa device that reminds seniors to take their medications and a home mediThe study could last up to 3.5 years, depending on how cation dispensary that alerts a nurse to long you choose to participate. All study related care will be visit when meds aren’t being taken out The TAURIEL will look at an investigational medication for people with mild Alzheimer’s disease provided at Study no cost. are on the horizon, maybe three to five or people who have problems with memory. The study will help determine how safe the investigational years away, he speculates.   medication is and whether or not it works in affecting Alzheimer’s disease. The most misunderstood aspect of senior healthcare is the popular assumpWe are looking for approximately 360 people who The study could last to everything 3.5 years, will depending tionupthat be taken care of may be able to join this study. on how long you choose to participate. studywhen the person is older,Allsaid Cope, “so URIEL Study will look at an investigational medication for people with mild Alzheimer’s disease related care will bethey provided at no cost. — financially don’t plan accordingly ple who have problems with memory. The study will how safe the investigational The TAURIEL Study behelp rightdetermine for you if you: and physically. It’s a tragedy. People wait If youmight are interested, please contact: tion is and whether or not it works in affecting Alzheimer’s disease. till care is needednow and then We are enrolling people — they start ¢ are 50 to 80 years of age searching.” Neurology Clinic, looking for approximately 360 people who The study could last upP.C. to 3.5 years, depending have mild Alzheimer’s disease able to join this¢study. on how or longproblems you choose to participate.want All study-to know more? Information concerning care for an Dr. Lee Stein, Dr. Kendrick Henderson, with memory related care will be provided at no cost. aging loved contact: one is increasingly accessible: If you are interested, please URIEL Study might be right for you if you: Dr. Thomas Arnold, Medicare’s website compares quality out¢ have somebody who canWe be are a reliable studypeople now — enrolling 50 to 80 years of age comes for nursing homes or rehab centers, Dr. David Pritchard, Dr. Barbra O’Brien, partner or caregiver and want who can come more? to some to know e mild Alzheimer’s disease or problems and for home health agencies; geriatric Cara Pendley study visits Dr. withJoshua you andLennon, answer Dr. questions memory If you are interested, please contact: consultants offer professional guidance for about your health. e somebody who can be a reliable study a fee; but Cope, who serves as an informa-

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tional speaker on critical aging issues and how they affect families, employees and employers, is happy to share his knowledge of the field. “I can guide people to resources that don’t cost anything, in order to find the solutions — or the professional advice — they might need.” He points to the Daughters in the Workplace website developed by Home

Instead for professionals who are juggling their careers along with helping to take care of a loved one. “It gives tips and ideas on how to talk to your employer. Most employers are used to people needing to take off for child care, but … it’s becoming more common that people need to take off to take care of a senior loved one.” Home Instead’s 2017 survey of 1,001 working women ages 45 to 60 who are caregivers for at least one parent or in-law found that 91 percent have had to take some action to accommodate being both a caregiver and an employee; 83 percent say caregiving has strained their ability to manage their work/life balance. “It’s very common for us to receive multiple calls in a given week,” Cope said. “People just don’t understand what’s available, so they’ll call us for help — and we’re happy to help.” Cope reports “substantial growth” over the last four years, with an average of about 10 percent more clients being served each year, as the senior population continues to grow the need for the company’s home care services. Although Home Instead’s services are not currently reimbursed by Medicare, that potential exists: “People at our corporate office are lobbying for more government payors for the type of services that we provide,” he said. “There is some talk from Medicare that they’re looking into that.” His greatest challenge is finding and retaining good quality workers to employ to maintain a staff of 200-250 caregivers. “It’s not an easy job, and our industry is known for a fairly high turnover. We find that the best people for the job are those who consider it a calling or a passion. It takes a strong heart to go from taking care of a senior for five years and watching them pass away, and realizing a few days later that a new client needs you.” He acknowledges that his greatest professional accomplishment isn’t measured just by revenue growth, but the realization that thousands of families have been helped by the teams that he has supported. “I can go home and know that there are more and more people whose lives truly have been impacted, who are able to stay at home longer, who don’t have to go to a nursing home, because of what my team has done,” he said.              His goals as the leader at Home Instead are to make sure his employees are both happy and encouraged — and thus more productive. His door is always open, and he stresses the importance of caring for them as people, and showing it in small ways, like a personal note sent to their home. An avid turkey hunter, Cope is married and has three grown daughters. “My proudest accomplishment has been to raise them to be Christian ladies; I think we’ve done that.” memphismedicalnews


GrandRounds Saint Francis Volunteer Program Adds Pet Therapy Dog The volunteer program at Saint Francis Hospital-Memphis has added 11 new volunteers, including one four-legged fur baby named Lily, and her handler, Richard Herbert. According to the Saint Francis volunteers, Lily, “a Coton du Leon breed, brings joy and smiles to the faces of the patients with whom she visits.” According to the volunteers, the interaction with a gentle, friendly pet has significant benefits. For physical health, pet therapy helps in a number of ways, including: • Lowers blood pressure. • Improves cardiovascular health. • Releases endorphins (oxytocin) that have a calming effect. • Diminishes overall physical pain. • The act of petting produces an automatic relaxation response, reducing the amount of medication some folks need. Lily, a new volunteer

Physician Compensation Plans, continued from page 9 20% of the expense within a practice is variable which changes with volume. Supplies, both administrative and medical, are some examples of variable expenses. Groups can use this as a starting point for discussion. Finally, it is best to keep the compensation formula simple and easy to understand. Keep in mind what you are trying to incentivize, as the formula will influence the group’s culture. The more productivity-based the formula is structured, the less team-oriented the group will be. Conversely, an equal distribution of compensation in the group does not benefit the physician who wants to work more to earn additional income. Finding the right physician income distribution formula depends on the dynamics of the group. Once you have completed your compensation analysis, continue to evaluate but do not let the monthly financial minutia derail your strategic objectives. Focus on patient care, improving operations, and building your practice. In return, you will earn more compensation.  

About the Author

Michael Cash graduated from the University of Central Arkansas with a Bachelor of Science degree and from the University of Arkansas at Little Rock with a Masters Degree in Health Service Administration. He completed an Administrative Fellowship at Staten Island University Hospital. He has held a variety of analyst, clinic director and director of clinic operations roles and is a Fellow in the American College of Medical Practice Executives and a Past President of the Arkansas Medical Group Management Association.



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Pathways to Success: CMS proposes accelerated shift to provider risk in ACOs By Denise Burke and Jesse Neil To facilitate the American healthcare system’s transformation from volumebased to value-based payment, CMS is requesting public comment regarding its newly proposed rule that would shift the amount of risk participants in Accountable Care Organizations (ACOs) assume under the Medicare Shared Savings Program (MSSP). An ACO is a group of physicians, hospitals, and other healthcare providers that care for a group of beneficiaries under Medicare Parts A and B. The core principles of the system are to streamline care and reduce costs within a cohesive structure. Under the current MSSP framework, ACOs may join one of three tracks with each differing primarily on the amount of risk each ACO opts to assume. Currently, 561 of the 649 ACOs are members within one of the tracks, with eighty-two percent of the 561 being enrolled in Track 1. Under Track 1, the ACOs only experience “upside-risk,” which means the ACO members are eligible to receive any achieved savings but are not financially responsible if the ACO incurs a loss. (Tracks 2 and 3 consist of only eighteen percent of enrollees with varying degrees of two-sided risk. Track 3 becomes the ENHANCED approach in the proposed rule.) CMS Administrator Seema Verma, however, recently opined that “[t]he results show that ACOs that take on regular levels of risk show better results for cost and quality over time.” As a result, CMS is requesting comment on a new proposed rule, entitled “Pathways to Success,” to shift more of the downside risk to providers to incentivize more efficient care and across-the-board savings. The proposed framework establishes two tracks: (1) BASIC and (2) ENHANCED. Each ACO would be permitted to choose the track that best fits its needs while also being able to enter into five-year agreements as opposed to three-year. This would enable the ACOs to adjust to the risk that will need to be assumed over time while also learning to manage the associated costs. The BASIC approach will permit the ACOs to assume risk over a five-year period with the first two years being upside-only risk with a “glide path” into years three, four, and five with increasing risk assumption. One caveat to the glide path is that ACOs currently within an upside-only risk plan, such as Track 1, would be limited to one of the two years of upside-only risk under the BASIC track. However, after year five, this newly-assumed risk would qualify the ACO as an Advanced Alternative Payment Model (APM), permitting the ACO to receive additional incentive payments for meeting quality The Authors: thresholds. Under the ENHANCED approach, ACOs may enter the program immediately qualifying as an APM at a set risk amount for the entire five-year period as long as the risk is greater than year five of the BASIC approach. On the other hand, ACOs that have had no experience under a two-sided risk approach may enter into any of the BASIC’s glide paths or enroll into the ENHANCED model from the start. Denise D. Burke Due to the differences that exist between low revenue (i.e., physician practices) and high revenue (i.e., hospitals) entities, those who qualify as low revenue would be eligible to reapply for another fiveyear BASIC program at the highest level of risk. High revenue entities would be required to move into the ENHANCED track and assume additional risk. Some stakeholders may see a competitive advantage to an accelerated move to downside financial risk. For others, it could lead them to Jesse Neil withdraw from participation in the program altogether. Regardless, it is a critical moment in the transition to a value-based system, and these programs will benefit immensely from thoughtful, practical feedback from the physicians, hospitals, payors, and even investors that are trying to lead the way. CMS is accepting comments until 5:00 pm EST on October 16, 2018. Nashville









GrandRounds Gilda’s Club to Hold Free AllDay Event on October 25 Gilda’s Club Memphis will hold a charter ceremony at 10:30 am Thursday, October 25, at the First Tennessee Foundation Visitor Center at Shelby Farms Park. The event will be the start of an all-day open house which will be free and open to everyone. The remainder of the day will feature a “Cooking for Wellness” workshop at 1 pm, a Caring Art Workshop at 2 pm as well as a Restorative Yoga at 3 pm. The

day will conclude with cocktails and conversation at 6 pm. Those wanting more information should call 901-833-1543 or visit gildasclubmemphischarter.brownpapertickets. com. Gilda’s Club is a place where those affected by cancer and their families and friends can come to be supported, encouraged, and understood. It is a “welcoming community of support when cancer places individuals into a group they never expected or wanted to belong to.”

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UTHSC Researcher Receives $600,000 Grant for Chlamydia Study John V. Cox, PhD, an associate professor in the Department of Microbiology, Immunology and Biochemistry, and associate dean in the College of Graduate Health Sciences at the University of Tennessee Health Science Center (UTHSC), has been awarded a $600,000 grant from the National Science Foundation (NSF) for his research of Chlamydia, one of the most frequently diagnosed sexually transmitted infections (STIs). Women who are infected can develop a wide range of serious reproductive health problems, including infertility and ectopic pregnancy. “The goal of the research that is funded by this NSF grant is to define mechanisms that regulate the novel cell division process of Chlamydia,” Cox said. “Once we understand these processes, we may be able to develop specific therapies to eliminate Chlamydia genital tract infections and avoid the unwanted consequences of broad-spectrum antibiotic therapies.” Cox’s research project is entitled, “Collaborative Research: Mechanism of Polarized Budding in Chlamydia.”

Doctor Knows, continued from page 3

That means trying to spend as much quality time as possible with their patients in the office or in the nursing homes. “We have to maintain that approach the best we can because sometimes we’re the only people they talk to in a day,” she says, adding that depression often comes with old age. “They may be the only living member of their family or they may have family that is not involved or they’re just alone. We see that all the time. “I try to point out the positives to them because sometimes you get stuck on what’s not right, like they’re taking 25 pills or their knees are hurting or their back is hurting. I try to tell them, yes, that’s going on, but there are still so many things you can enjoy each day. Sometimes I make a contract with them and say, ‘OK, you’re going to leave the house at least once a

week or you’re going to go to church once a week.’ People are looking for a different type of guidance for their health or their loved ones’ health.” Dr. Mehr and her husband, Sujit, have a 9-year-old girl and a 12-year-old boy. She sometimes takes them to nursing homes to make cards for Valentine’s Day or Christmas. The family enjoys traveling, especially to Tanzania and her husband’s home country of Zambia. After her long climb into the thin air at the top of Mt. Kilimanjaro, she also began competing in the St. Jude half marathon each year. “I had never run before, but after Kili I knew I could do it,” Dr. Mehr says. “It was after that that I started training for half marathons. Climbing Kili was absolutely amazing.”  memphismedicalnews


GrandRounds St. Jude Promotes Tricia Spence to Manager of Volunteers Tricia Spence has been promoted to Manager of Volunteers and Special Events in the Volunteer Services Department at St. Jude Children’s Research Hospital. Spence, who has worked for nine years at St. Jude, was previously responsible for Tricia Spence recruiting, screening, placing, supervising and providing training for a staff of 70 volunteer. She was also responsible for tracking retention rates for and compliance for volunteers. In her new position, she will provide oversight of the hospital’s volunteer programs, and will supervise the volunteer coordinator and student interns to maintain quality and design, while launching new ways for volunteers to positively impact St. Jude patients and families. Spence has a degree in journalism from the University of Memphis. She joined St. Jude in 2008 as Volunteer and Special Events Coordinator. She was previously a volunteer coordinator and program assistant with United Cerebral Palsy of the Mid-South.

TMA to Hold Insurance Workshop on October 17 The Tennessee Medical Association, the state’s largest professional organization for physicians, will hold its 38th annual Insurance Workshop in Memphis on Wednesday, October 17, at the Holiday Inn University of Memphis, 700 Central Ave. The workshop will be open to Physicians, Practice Managers and Medical Support Staff. TMA’s Insurance Workshop brings

the state’s biggest payers directly to Memphis practice managers and medical office staff, and provides updates on claim filing, disputes and appeals, policy changes, prior authorizations and more. Attendees can earn 6 CEUs while hearing from Amerigroup, BCBST, Bureau of TennCare, Cigna/CignaHealthspring, Palmetto GBA and UnitedHealthcare at the workshops this fall. New for 2018: • National Alliance of Medical Auditing Specialists (NAMAS) will present strat-

egies on compliance and reimbursement. • Tennessee Department of Finance and Administration, Office of Inspector General will be on site with information about TennCare fraud. • Tickets are $179 for TMA members, Medical Group Management Association (MGMA) members, or staff of members; each additional attendee is $139. Nonmember tickets are $229 each. Those wanting to register should visit

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James Downing to Present Hematology Donnall Thomas Lecture The American Society of Hematology (ASH) will honor James R. Downing, MD, president and CEO at St. Jude Children’s Research Hospital with the 2017 E. Donnall Thomas Lecture and Prize for his discoveries related to the hematopathology and molecular biology of childhood leukemia, the most common pediatric cancer. Dr. Downing will present his lecture, “The Molecular Pathology of Pediatric Acute Leukemia,” on Monday, December 11, at the 59th ASH Annual Meeting and Exposition in Atlanta. His lecture will focus on progress that has been made over the last 15 years in advancing our understanding of pediatric acute leukemia and how this information is increasing cure rates.  This lectureship and prize is named after the late Nobel Prize laureate and past president of ASH E. Donnall Thomas, MD. The E. Donnall Thomas Lecture and Prize recognizes pioneering research achievements in hematology that represent a paradigm shift or significant discovery in the field.  Dr. Downing, who began his career in 1981 after graduating from the University of Michigan with undergraduate and medical degrees, has focused his work on acute lymphoblastic leukemia and acute myeloblastic leukemia with a particular emphasis on the so-called core-binding factor leukemias. He pioneered the concept that the tools of advanced genomics could be used to better predict disease prognosis.



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Bartlett Area Chamber of Commerce members and Saint Francis Hospital-Bartlett staff prepare for the ribbon cutting to officially designate the Women’s Center as a Baby-Friendly facility.

Saint Francis and Bartlett Chamber Celebrate Designation Saint Francis Hospital-Bartlett and the Bartlett Area Chamber of Commerce marked the hospital’s recently acquired babyfriendly designation with a ribbon-cutting ceremony at the hospital’s women’s center last month. Baby Friendly USA is the accrediting body for the Baby-Friendly Hospital Initiative. A global program for the World Health Organization and the United Nations Children’s Fund (UNICEF), the initiative is designed to set the standards for the best possible breast-feeding support for mother and infant in the maternity setting.

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Martin Croce, MD, has been named senior vice president and chief medical officer of Regional One Health. As chief medical officer, Dr. Croce will oversee quality, medical research, medical staff services, regulatory readiness and inMartin Croce fection prevention for the system. Dr. Croce transitioned to this administrative role after a lengthy and distinguished career in one of the busiest trauma centers in the United States, the Elvis Presley Trauma Center at Regional One Health. “Dr. Croce has been a valuable as-

set to this health system and this community, providing exceptional trauma care to countless patients over the past 30 years,” said Reginald Coopwood, MD, president and CEO of Regional One Health. “ Dr. Croce earned his medical degree from the University of Tennessee Health Science Center (UTHSC). He completed a surgical critical care fellowship at the University of Miami, Jackson Memorial Hospital in Florida, and then returned to Memphis. He completed a residency and internship with UTHSC that started his career in the Trauma Center at Regional One Health, where he has served as medical director since 2000. Dr. Croce will focus heavily on quality initiatives, enhancing the physician/ administration relationship and exploring new opportunities for patient care.

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GrandRounds UTHSC Launches Diversity Business Enterprise Initiative The University of Tennessee Health Science Center (UTHSC) has launched a Diversity Business Enterprise Initiative to assist and encourage more small businesses and businesses owned by minorities, women, veterans, and those with disabilities to pursue business opportunities with the university. UTHSC hosted workshop last month to acquaint business owners with the initiative and with procurement practices at the university and with the UT System. Representatives from many area businesses attended. Departments throughout UTHSC will be encouraged to seek out disadvantaged business enterprises for purchases under $10,000, which are not handled through Procurement Services. UTHSC departments will be expected to solicit at least one such business for purchases between $10,000 and $49,999. Formal purchases handled through Procurement Services will identify disadvantaged business enterprises that will be invited to participate in the solicitation.

capacities and partnerships for tackling childhood cancer, this collaboration provides a platform to support in-country implementation efforts for childhood cancer control. The effort combines St. Jude expert technical support and a designated programmatic investment of US$15 million with WHO authority working with governments and leaders across health systems regionally and globally. Activities will include supporting clinical care for the most vulnerable children, ensuring all children with cancer can access high-quality medicines

and technologies, and strengthening training programs by developing centers of excellence. For a sustainable, global initiative, this collaboration hopes to catalyze a broader effort that allows vital inputs from in-country leaders and organizations dedicated to improving outcomes for children with cancer. “St. Jude was founded on the idea that no child should die in the dawn of life,” said James R. Downing, MD, St. Jude president and CEO. “While we have been able to advance this vision

for many children with cancer, the bitter reality is that in most places around the world, 4 out of 5 children with cancer are still dying of their disease. We have the ability to change that. This initiative will provide the tools and resources to shape how childhood cancer is addressed globally, encouraging national health systems to make childhood cancer a priority and dramatically improving cure rates for children with cancer.”

World Health Organization, St. Jude Collaborate St. Jude Children’s Research Hospital has established a five-year collaboration with World Health Organization aimed at transforming cancer care worldwide to cure at least 60 percent of children with six of the most common types of cancer by 2030. This collaboration seeds a global initiative that will bring together stakeholders in childhood cancer from around the world to increase access to care for children with cancer, enhance quality of care by developing national centers of excellence and regional satellites, and influence the integration of childhood cancer into national policies to ensure the greatest chance of survival for all affected children. Each year, approximately 300,000 children and adolescents are expected to be diagnosed with cancer. About 8 in 10 of these children live in low- and middle-income countries, where cure rates are often estimated at only 20 percent. This is in stark contrast to higherincome countries, where cure rates exceed 80 percent, largely because of the medical advances and specialized multidisciplinary care for children with cancer established over the past 50 years. This divide in survival rates between higher-income countries and low- and middle-income countries is among the greatest disparities in health outcomes worldwide. Limited access to high-quality, affordable medicines and the risk of financial catastrophe from out-of-pocket payments are hallmarks of the childhood cancer challenge many countries face. Bringing together the strengths of St. Jude and WHO to expand services, memphismedicalnews


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GrandRounds UTHSC Researcher Wins $1.1 Million Grant to Study Post-Stroke Disability Ansley Grimes Stanfill, PhD, RN, assistant professor in the Department of Advanced Practice and Doctoral Studies at the University of Tennessee Health Science Center, has been awarded a $1.1 million grant to study how social, clinical, and genetic factors affect one’s risk for developing severe disability after subarachnoid hemorrhage, aiming to also give insight into the disparities for this outcome seen between Caucasian and African- American patients. Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating form of stroke, striking relatively young individuals and carrying a mortality rate of almost 40 percent. About 30 percent of those who do survive will experience severe long-term disability and require skilled care for the remainder of their lives “African Americans are disproportionately affected by aSAH, are affected at a younger age (often under 40 years old), and are at greater risk for severe disability compared to Caucasians,” Stanfill said. With a background as a bedside critical care, neurology, and neurosurgery nurse and guided Ansley Grimes Stanfill, left, and Claire Simpson, an assistant professor at UTHSC. by strong pilot data, Stanfill and her research team aim to develop a multivariate model encompassing social, clinical, and genetic factors which they hypothesize will provide a sensitive and specific prediction of 12-month disability outcomes for Caucasians and African Americans. They are also looking to evaluate whether, and to what degree, racial differences influence the prediction of outcomes. Stanfill says the work will have a “significant impact because it is expected to advance and expand our understanding of possible factors related to long-term disability and the disparate outcomes PUBLISHER seen in these two races. Lack of such Pamela Z. Haskins knowledge hinders the development of critically needed individualized and mulEDITOR tidimensional intervention approaches Bob Phillips to reduce post-stroke disability and prove outcomes.” ADVERTISING INFORMATION 501.247.9189 Pamela Z. Haskins

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