FOCUS TOPICS BREAST ONCOLOGY • CLINICAL TRIALS • PATIENT FRIENDLY OFFICE SPACE • MANAGING AGING PATIENTS
October 2019 >> $5 ON ROUNDS Changing Population Increases Demand For Geriatricians As the nation’s demographics continue to change, physicians such as Dr. Terinell Beaver of The Medical Group of Memphis will become more sought after.
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New Tool May Help Practice Managers Minimize Missteps A new virtual reality tool now is available that could help practice managers and providers remain compliant and mitigate risk in the highly regulated healthcare industry.
New Hope, More Options For Breast Cancer Patients
Advancements in Technology, Medicine Are Improving Outcomes By BETH SIMKANIN
A number of medical and surgical oncologists in the Memphis area who specialize in breast cancer say they believe local healthcare systems and cancer centers have moved a step closer to improving cure rates because of the recent addition of new technologies, surgical techniques, partnerships and marketapproved medications. The introduction of new surgical technology at Baptist Memorial Health Care and a newly formed partnership between the University of Tennessee
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BMG’s Vest Hopes to Help Physicians Extend Quality
New Waiting Rooms Are Making the Wait Easier, Less Stressful Hoping to make the wait easier for patients, some medical facilities are including amenities such as digital registration, Wi-Fi, and coffee bars in newly refurbished waiting rooms.
By JUDY OTTO
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Health Science Center (UTHSC) and Methodist Healthcare bring new technological advancements and expertise to the area. Recent medications, approved by the Food and Drug Administration, as a result of clinical trials conducted at West Cancer Center, give breast cancer patients additional treatment options. One new technological procedure that Baptist began offering in March to patients who are ideal candidates is intraoperative radiation therapy (IORT). According to Lindi VanderWalde, MD, surgical oncologist with Baptist Medical Group, IORT occurs in the operating room after a surgeon
When Robert Vest earned his law degree from the University of Tennessee, his plan was to pursue a career in community service in his hometown of Lenoir City, a Knoxville suburb. Serving as Chief Operating Officer of the Baptist Medical Group (BMG) in Memphis was beyond imagination.
Fate, however, in the form of a fellow law student from Memphis and his future wife, guided his attention toward her hometown, which she considered a great place to live and raise a family. His successful handling of a high-profile first-amendment case during his first year in a Loudon County legal firm led to additional litigation opportunities, Vest (CONTINUED ON PAGE 6)
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Need Grows for More Doctors Such as Terinell Beaver As the Population Shifts, Demand for Geriatricians Increases By LAWRENCE BUSER
The U.S. Census Bureau reminds us that by the year 2035, for the first time in American history, there will be more Americans over age 65 — some 78 million — than those under age 18 — an estimated 76.7 million. Today there are 52 million Americans over 65, and not enough geriatricians to treat their diverse medical issues. The imbalance shows no sign of improving. “We’re way short on geriatricians, especially fellowship-trained geriatricians,” said Dr. Terinell Beaver, a geriatrician with The Medical Group of Memphis. “As the baby boomers age, we’re going to be short of all primary care physicians, but especially geriatric physicians. It’s really not addressed or encouraged in medical schools, and I think that’s a big mistake.” According to the American Geriatric Society, the U.S. has 7,300 certified geriatricians today, but will need 30,000 by 2030. Dr. Beaver was drawn to geriatrics by circumstance while in medical school at the University of Tennessee Health Science Center (UTHSC) where she graduated in 1983. “I was a medical student looking for a rotation and this was sort of a new rotation I participated in and I really enjoyed it,” she recalls. “It involved some geriatric rehab at the old Lamar Unit hospital and working with the rehab team which included physical therapy and occupational therapy. I liked the fact that everyone had some input. We got to see aspects of patient care that you just don’t see if you just took internal medicine.” She is one of seven physicians at Baptist Medical Group, The Medical Group on Wolf River Blvd., and has gained an even greater appreciation for her elderly patients. “One thing I really enjoy about working with older people is that they’ve had a whole lot of life experience,” Dr. Beaver says. “They’re way more able and willing to put things into perspective. The
other part is that for the most part they’re realists, or they probably wouldn’t have made it to advanced old age. They understand that from here to the end it’s probably going to be increasing debility. “If you have someone with that kind of insight, you can appeal to their sense of humor, their experience and their ability to persevere under bad situations. That part I find rewarding.” Treating the elderly, she says, requires looking at the patient from a different perspective. “You have to consider the general debility, the nutritional status and the level of social support,” says Dr. Beaver. “You have to evaluate all of them together. You have to decrease your dose of medication and you have to be really mindful of side effects of medicine and guard against polypharmacy. “Falls and prevention of falls is another big issue,” she continued. “That can be very devastating. Also dementia or memory loss is a separate geriatric topic. Then you have nutrition, weakness, stability, incontinence, loss of hearing and loss of vision. Those are all big topics in treating elderly patients.” She says geriatricians have a constant duty to evaluate a patient’s medical issues without automatically attributing those
problems to old age. “There really is a difference between normal aging and symptoms of disease, so you have to be pretty diligent not to chalk something up to aging,” Dr. Beaver continues. “I think everyone deserves a diagnosis. Current advanced age and with the other diagnosis, but age is usually not the only diagnosis.” Dementia is a common problem among the elderly, and it is on the rise as the elderly population continues to increase. “As we’ve been more successful in treating other chronic diseases in patients that maybe in previous generations may have led to death, patients now are living longer so you’re seeing age-related memory decline,” Dr. Beaver says. “If you have dementia on top of medical problems, that becomes a very complex issue. “There’s really no good treatment for dementia. There’s a lot of research going on right now to identify dementia early and maybe do some prevention. I advise my patients in middle age that the
best way to prevent dementia in old age is to take really good care of your general health now and stay active both physically and mentally. The major quality of life issue for older patients is that they want to maintain their independence for as long as possible.” She said having good genetics is a plus for successful aging, though keeping a healthy lifestyle is no less important. “I don’t believe genetics is going to top lifestyle. You need both.” Dr. Beaver recommends that patients watch their weight, maintain control of blood pressure and, for diabetics, blood sugar, monitor cholesterol levels, don’t smoke, and drink in moderation. “For women that means one 5-ounce alcoholic drink per day and for men it’s two,” Dr. Beaver says. “And I tell patients ‘That doesn’t mean you can save it up for Saturday night and have 14.”’ She currently has two patients over age 100, including a woman who is approaching her 110th birthday and has (CONTINUED ON PAGE 8)
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RiskView’s 360-degree virtual tour walks users through regulatory mandates and best practices by utilizing audio scripts and links to downloadable resources to help practices stay compliant.
New SVMIC Tool Helps Assess, Avoid Missteps By CINDY SANDERS
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In the highly regulated healthcare industry, it’s far too easy for a medical practice to accidentally overlook a necessary posting or updated compliance mandate among the long list of requirements that stem from multiple government agencies ranging from CMS to OSHA. Unfortunately, even small missteps can result in hefty fines. Enter RiskView by SVMIC, a new virtual reality tool that walks practice managers through a traditional physician office with audio scripts and downloadable resources referencing regulatory mandates and best practices. Meghan Clark, learning systems manager for SVMIC, noted the new interactive, self-guided tool is based on the same technology real estate agents use for virtual home tours and Meghan Clark was created using a 360-degree Matterport camera. As users navigate through the different spaces typically found in an office or clinic, Clark explained purple dots on the screen link to audio scripts describing requirements for specific areas – from public spaces like the front desk, waiting room and exam rooms to behind-thescenes spaces including administrative offices and onsite lab space. Blue dots, she continued, link to downloadable resources on the SVMIC website for additional detail and guidance. “The idea stemmed from an internal employee,” Clark said of the impetus to make years of risk mitigation expertise more readily available to stakeholders. While RiskView wasn’t developed as a replacement for a personal consultation – a service SVMIC has offered for many years to help reduce risk in medical offices
– the technology provides valuable information and updates to reinforce onsite observations and to provide guidance between visits. Clark said the tool will also serve to extend risk assessment and patient safety expertise to more practices. “Consultations cover a lot of ground,” Clark pointed out. “You don’t remember everything,” she added of the need to fill in gaps in notes. Can’t remember what the consultant said about the refrigerator or which posting had to be put in the break room? RiskView can provide a quick reminder by logging in and hovering over the areas of concern. Updated as regulations and requirements change, it also serves as an ongoing resource for all users, regardless of participation in an on-site consultation. Clark said RiskView’s goal is to reach a wide audience and to serve varying purposes to match needs. She noted the virtual practice navigation platform has allowed SVMIC to take a large body of professional resources developed over time and to organize a large portion of that information in one, easyt0-access place. Another benefit of RiskView is that it’s available at policyholders’ and their practice administrator’s convenience and can be referenced whenever needed. “The whole purpose is risk mitigation,” said Clark. “Our policyholders don’t have to pay for it . . . it’s just an added benefit.” While access to the full platform requires logging into the SVMIC member portal, anyone interested in seeing how RiskView works can sample the program by going online to home.svmic. com/#riskview. “RiskView is intended to assist policyholders with improving patient care and reducing liability exposure in an online format that is easily accessible,” concluded Clark. “We are excited to release this new tool and look forward to continuing our search for new and creative ways to share our professional resources and make risk mitigation an easier part of our policyholders’ day.” memphismedicalnews
Remodeled Waiting Rooms Now Are Patient-Friendly Lighter Colors, More Space, Amenities Equal More Comfort, Less Stress By LELA GARLINGTON
No one likes to wait, especially in today’s fast-paced world. That’s one reason many Memphis doctors and medical practices are at least making the wait easier and less stressful. Waiting rooms that have been remodeled now feature lighter colors that offer a welcome reprieve with such amenities as digital registration, Wi-Fi, coffee bars, charging stations and work areas. Gone, hopefully, will be the days of sitting in waiting areas elbow-to-elbow with other patients as the television blares and at least one person, invariably, is coughing. “We want to ensure our patients spend very little time in the waiting rooms,” explained Jenny Turner Koltnow, Jenny Turner Koltnow Communications and Development Director for Church Health.
An artist’s rendering of the lobby of Campbell Clinic’s new Wolf River outpatient building scheduled to open this month.
The changes Church Health made to its waiting rooms are the result of a massive transformation when it moved its 13-building operations to its new 150,000-square-foot home in Crosstown Concourse in 2017. Koltnow called the new digs magnificent, an upgrade that spans to all of their clinics, operations and services as well as their waiting
rooms. “Our patients literally cannot afford to sit here all day – each minute they are waiting is a minute they’re not working or not taking care of their families,” Koltnow said. “That said, our waiting rooms are bright, clean, spacious and comfortable.” Because of the number of people it
sees on a daily basis, Church Health has separate waiting rooms designated WalkIn, Dental, Behavioral Health, Physical Rehabilitation, Medical Specialty, Family Medicine and Eye Care. Each year, Church Health treats almost 18,500 individual patients, accounting for more than 62,500 appointments. More than 85 percent of the patients live below the federal poverty line. With the new renovated space at Crosstown, Church Health added digital screens throughout its waiting areas. It’s another way to promote its support services such as the next date for family cooking classes or what physical rehab services provide. Before McDonald Murrmann moved to its current office space several years ago at the corner of Riverdale and Wolf River Boulevard, Dr. Susan Murrmann described the typical doctor’s office. “Like our previous waiting area, most offices had very tight seating arrangements, no amenities for the patients, a large front desk with multiple operations going, phone calls, appointment making, call backs and check in/ (CONTINUED ON PAGE 9)
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BMG’s Vest Hopes to Help, continued from page 1
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recalls–but his new family’s move to Memphis “reminded me that this isn’t necessarily what I wanted to do.” When the position with Baptist opened in 2008, Vest shifted gears and took on the job of helping hospital administrators and corporate leaders negotiate and execute physician services agreements for the BMG. His experience as a transactional attorney was helpful, but his inexperience and fresh perspective also proved to be an advantage. He took on the new role of executive director of physician acquisitions and development in 2010, building on an original population of about 40 employed providers which grew to over 500 within four years. As the Baptist representative who met with doctors and negotiated both independent and group practice acquisition agreements, he developed trusting relationships with many of the physicians—and a personal obligation to fulfill promises made. The new hands-on role and additional responsibilities of executive director of transition operations enabled Vest to help newly acquired clinics transition smoothly and correctly into the BMG culture— sometimes by operating those clinics for a year or more. He takes pride in having developed an infrastructure that has allowed BMG to create a group culture that empowers physicians to do more together to improve patient care than had been possible separately. “We’re the first generation of Baptist Medical Group; it’s very rare that one has the opportunity to be an architect of something new—particularly in an organization like Baptist, where you’re well-funded and you have the resources to do wonderful and great things…I want to make sure that this Group outlives us.” He points to BMG’s Diabetes Care Coordination Implementation Team (DCCIT), conceived and implemented through the brainstorming efforts of concerned physicians seeking an affordable way to better treat diabetic patients. “If we can get these patients to come back every 90 days for their appointment, we could make sure they understood their medications, that they could afford them and were taking them…and we could get them into diabetes education to help them better understand their disease and be more proactive in their own care.” Vest said that in mid-September, after making its 47,000th phone call to a group of 5,000 patients, the DCCIT has outperformed well-known national programs, demonstrably reducing patients’ A1C by about 1.86 points, extending their lives by more than seven years, extending their vision, saving them an estimated $7,000 in medical expenses, and making their lives better. They plan to use the same affordable model to provide lung cancer screenings for BMG’s smoking patients and address other chronic care conditions. Although BMG currently has more than 800 physicians, and the group’s turnover is significantly below national averages, burnout is nonetheless a concern. “Physicians are under a lot of strain
in this community because the need is so great, and they’re so few,” he points out, noting that most of BMG’s physicians work 14 to 16-hour days. “-- because they care about their patients,” he stresses. Electronic health records and evolving technology also add stress and steal physicians’ time. Vest has addressed the burnout problem at national conferences where it is a growing concern. “I see my role—and my team’s role—as eliminating obstacles in the way of physicians being able to deliver patient-centered care.” Although the trend toward practice acquisitions has slowed, Vest observes that there are still more than 100 open recruiting positions for new doctors across the Baptist system, especially in the rural markets which have long been underserved. As BMG moves toward a patient-centered medical home model, primary care physicians, who are in increasingly short supply, are especially needed. That many providers are over 60, and currently caring for “a not insignificant number of patients” is also worrisome, he notes. Patient expectations are also evolving, prompting BMG to innovate and implement more convenient ways to see a physician, e.g. hybrid clinics that combine a walk-in clinic with traditional primary care, evisits, and televisits—which are a challenge “because payors haven’t…developed a methodology for paying for those yet, in traditional plans.” Today, Vest’s legal roots still impact BMG’s success by influencing his management style. “My legal training at UT was very Socratic; you answer questions by asking questions. I apply that concept to every decision I make, and I’ve tried to pass it on to my team. We question why things are occurring—even positive things…to make sure we see both sides of an issue and we’re making the best decisions.” When both his parents faced lifethreatening diseases, he realized how helpless even a strong-willed problem-solver is. “It really gave me a perspective – and I hope I bring that leadership perspective to my team – of putting yourself in the patient’s shoes, recognizing that every person a patient touches in our organization contributes to that patient’s quality of care.” It appears to be working: On that date in 2010, he notes, “our patient satisfaction was at the 27th percentile; and last quarter, it was at the 81st percentile.” His pride in his team is clear; but Vest believes his greatest life accomplishment may have been convincing his wife, Courtney, to marry him—and make possible two other great accomplishments – his sons Anderson, 8; and George, 4. “Jesus told us that the second greatest commandment is to love your neighbor as yourself. In healthcare, maybe more than any other industry, we have the ability to actually communicate that love and caring to the people of our community who really need it . . . regardless of shade, age, sexual orientation – it doesn’t matter. We’re a community in healthcare. “That’s a little unique; and if my sons choose to go into that field, I’ll be very proud.” memphismedicalnews
New Hope, More Options For Breast Cancer Patients, continued from page 1 performs a lumpectomy. The surgeon prepares the breast for radiation and a radiation oncologist administers radiation to the cavity where the tumor was present with a balloon device. She says there are fewer side effects with the new technology and the long-term cosmetic results are better for the patient. Previously, a patient underwent radiation therapy five times a week for three to four weeks after a lumpectomy. Now, says Dr. VanderWalde, the radiation is administered only one time during surgery. “It’s exciting and revolutionary,” Dr. VanderWalde said. “We can combine procedures in the operating Lindi VanderWalde room in a multidisciplinary setting, which may add 20 to 30 minutes in the operating room but save the patient time in the long run, so they can get back to their daily lives.” Dr. VanderWalde says IORT is most effective for patients who are in the early stages of breast cancer and are postmenopausal. The technology builds on the investment Baptist made last year on another device called the SPY Elite Fluorescence Imaging System, which enables surgeons
performing breast reconstruction to visualize microvascular blood flow and perfusion in tissue in real time during surgery. Dr. VanderWalde says Baptist is the first healthcare system to be equipped with the machine, which uses color to distinguish healthy tissue from dying tissue during breast reconstruction surgery. It reduces the likelihood of post-operative complications, such as infection, which can inflate medical costs. Additionally, she says the system removes the guesswork, and surgeons know immediately which tissue can be used during breast reconstruction. In many cases, the patient can receive a breast implant minutes after a mastectomy. UTHSC plans to introduce new technology and improve diagnosis and treatment options for breast care patients in the Memphis area with its newly formed breast surgery section in its department of surgery, which formed a partnership with Methodist Healthcare in August. Five surgeons, specializing in breast cancer, have joined the team and will be embedded at two Methodist Comprehensive Breast Centers providing multidisciplinary care in the next six months, according to Martin Fleming, MD, associate proMartin Fleming fessor and chief of
the division of surgical oncology in the College of Medicine at UTHSC. Dr. Fleming will be leading the new section. Dr. Fleming says the team will be able to collaborate with plastic surgeons and perform localized techniques and procedures at the same time, such as a lumpectomy and breast reduction in a multidisciplinary setting. “This will provide a next level of care for cancer patients,” Dr. Fleming said. “A breast surgeon will be able to map out a patient’s care at the same location where the patient receives a mammogram and a biopsy.” As a result of the new formation, UTHSC will be involved in national collaborative trials through two research organizations, the SWOG Cancer Research Network and the Alliance for Clinical Trials in Oncology. According to Dr. Fleming, the team has planned a series of lectures through the Congressional Health Network, a collaborative partnership between Methodist Healthcare and 400 Mid-South congregations, during October, which is Breast Cancer Awareness Month. The team will hold sessions for the public on Thursday nights focusing on the importance of screenings, self-examination, surgical treatment, radiation, chemotherapy and breast health. Both Dr. Fleming and Dr. VanderWalde stress the importance of community outreach to eliminate fear and encourage early detection.
“As a physician, you see patients who have delayed getting treatment either out of fear or for financial reasons,” Dr. VanderWalde said. “It’s important to get out the message about the importance of mammograms because there are so many options now and the success rate is the highest it’s ever been.” Medications recently approved by the FDA provide more treatment options for breast cancer patients, especially when the breast cancer is metastatic, according to Gregory Vidal, MD, PhD, medical oncologist and hematologist at West Cancer Center and associate professor of medicine at UTHSC. An immunebased therapy drug called atezolizumab was Gregory Vidal approved in March to treat patients with advanced or metastatic triple negative breast cancer after successful results were reported in clinical trials. Triple negative breast cancer is diagnosed when breast cancer cells test negative for the three most common types of protein receptors – estrogen, progesterone and hormone epidermal growth factor receptor 2 (HER-2), which are known to fuel breast (CONTINUED ON PAGE 8)
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been asked to participate in a Harvard medical school study on aging. Dr. Beaver is making arrangements so her patient will not have to leave Shelby County to participate. Another patient, also a woman, is 103 and several others are between 95 and 100. “One of the goals is to keep an elderly patient out of the emergency room or the hospital because a really frail elderly person in the hospital is really at risk — at risk of falls, at risk of confusion in being away from their normal environment, at risk of polypharmacy and drug interaction, and at risk of loss of their normal social support,” Dr. Beaver says. “In the future, if you have the manpower, home-based medical care would be really beneficial. This might be a role for physician extenders, assistants, and nurse practitioners. For physician home visits, you’d have to be very selective because you don’t want to use precious time traveling to one patient that you could use seeing a number of patients.” She said living in Memphis has both risks and rewards for the elderly not found
in other parts of the country. “We live in the stroke and heart attack belt, so no matter what issue an elderly patient has we’ll also see hypertension, cardiac disease, and diabetes more so than in people who live in other geographic regions,” says Dr. Beaver. “This just adds to the complexity of care. More people, more frail, more problems. “One good thing we have in Memphis, though, is that the faith-based communities have done a really good job of taking on the role of trying to serve the elderly, especially in the low-income neighborhoods, and trying to see that their basic needs are met.” Dr. Beaver, who has an 89-year-old mother and a 27-year-old daughter, says she tries to practice what she preaches. She and her husband, Robert Tisdale, try to stay well-rounded, regularly playing golf and, more recently, pickleball. “Pickleball is so much fun, and it’s like being a kid because you just show up and play with whoever’s there,” she says with a laugh. “We’re preparing for old age. We’re getting a social network and getting some exercise.”
New Hope, More Options, continued from page 7 cancer growth. Because the tumor isn’t supported by these receptors, triple negative breast cancer doesn’t respond to traditional hormone therapy and specific targeted therapies. Usually a patient is given chemotherapy to shrink the tumor, followed by surgery to remove it. As a result, the cancer has a higher reoccurrence rate. Only 10 to 20 percent of breast cancer patients are diagnosed with it, according to the Johns Hopkins Breast Center, but it’s known to be a more aggressive type of breast cancer. The progression-free survival was 7.4 months for patients in clinical trials who received a combination of atezolizumab and chemotherapy, and 4.8 months for patients who received placebo and chemotherapy. Dr. Vidal, who has conducted several clinical trials at West Cancer Center dealing with triple negative breast cancer, said West Cancer Center recruited the highest number of patients to participate in clinical
trials with triple negative breast cancer. “This is the first time we’ve had a drug approved for metastatic triple negative breast cancer,” he said. “The survival rate of patients with triple negative breast cancer is less because only traditional chemotherapy was used to treat the cancer cells. Last year, there weren’t any successful options, besides chemotherapy, available for this type of cancer.” Another drug approved by the FDA earlier this year is the anti-estrogen therapy alpelisib. It’s designated to be used in combination with chemotherapy in postmenopausal men and women with HR-2 positive and HER-2 negative advanced or metastatic breast cancer. Despite recent medication approvals for patients with advanced types of breast cancer, Dr. Vidal says more work needs to be done. “We now have more medications in our arsenal to improve cure rates, but there still is a lack of options for more aggressive types of cancers,” Dr. Vidal said.
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Remodeled, continued from page 5 out. The offices appeared very busy, and that probably created a lot of anxiety for some patients,” she said. Now, Dr. Murrmann added, “I feel that our office has a clean, more contemporary look. It’s more peaceful, open and inviting. And, of course, the coffee Susan Murrmann bar is a big hit.” During a recent visit to the McDonald Murrmann Center for Wellness & Health, two women worked at a charging station/ communal work table with bar stools. Eventually, the center plans to add iPads so that patients can browse through the services offered. Other patients sat in spacious seating areas. Just a six-minute drive from the McDonald Murrmann offices, Campbell Clinic’s Spine Center in Cordova is serving as a pilot for a relatively new “on stage/off stage” concept. “Under this design,” said Valerie Toole, Director of Operations at Campbell Clinic, “patients are moved to smaller, more private waiting areas sooner in the process and aren’t exposed to the busier parts of our exam areas – the nursing work stations, the charting areas, company phones and X-ray reviews.” Because the patients like the new look, Toole said they’ll be adopting the same model once the new, $45 million Campbell Clinic outpatient facility in Germantown opens. “The Spine Center, as well as the new building on our Germantown campus, added public USB ports for patient convenience while charging laptops, tablets and cell phones,” Toole added. Standing stations also are a hit. “We found that standing-height work stations are more comfortable for patients in pain, as well as sometimes more convenient when using a laptop or tablet while working or browsing the Internet during their wait,” she said. Even as new concepts are added, Campbell Clinic officials are not afraid to tweak their ideas. Originally, they
Is the missing
located the standing stations in the center of the waiting room. “We moved them to the interior walls to provide a more open waiting room,” Toole said. While making the waiting rooms more open, Toole said they have added layers of privacy and security for their patients through the “on stage/off stage model.” “This concept allows the patient to enter the exam room through a patient corridor and allows the staff to enter/exit the exam room through a separate door to the ‘staff work area,’ ” Toole said. Patients see less of the off stage or back-of-the-house workings which now allows the staff to collaborate in a more HIPAA-secure manner. Whether a patient chooses to wait in a quiet area or in a communal one with other patients, Toole said, “We want it to be a seamless experience for them. We realize patients are on the go at all times and work and life don’t stop just because you have to see the doctor.” When the doors open to the new Germantown outpatient clinic on Wolf River Boulevard, Toole promised even more patient-friendly amenities: “We’re going to offer a grab-and-go style café in the grand lobby that will feature healthy food and beverage options for purchase.” Michael Taylor, with Michael Taylor Interiors, sees the trends in waiting rooms and medical offices as a move toward a simpler look. By having more streamlined features with chrome, light colors and an array of electronic amenities, Taylor said designers are creating happier, less stressful and more cheerful surroundings in waiting rooms and patient areas. “Color changes your mood. Think how much we have on our minds,” Taylor said. “Previously, waiting rooms were more a traditional style with warmer reds, golds and greens and dark woods. Now, many offices are using pops of color like lime green or baby blue on lighter fabrics that are bleachable and cleanable that we didn’t have 10 years ago.” Sometimes the hardest part of a doctor’s visit is the waiting. With the more patient-friendly changes being made, the wait just got a little easier.
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Attorney Ashley Cleek has been representing individual providers and hospitals in medical malpractice cases throughout Tennessee for the past 15 years. He also assists physicians, nurses, and midlevel providers who are under investigation or facing disciplinary action by the medical/nursing board. Mr. Cleek has significant appellate experience, handling numerous cases before the Tennessee Court of Appeals, Tennessee Supreme Court, and the United States Court of Appeals for the Sixth Circuit. He is an AVPreeminent® rated lawyer, which is the highest rating available in the Martindale-Hubbell® evaluation system.
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The CHORDS Study is testing an investigational medication for people diagnosed with idiopathic hypersomnia (IH). There are currently no medications specifically approved for IH, and medications that are used do not work for everyone. Therefore, there Want to knowis more? a need to find additional treatment options for this unmet need. The CHORDS Study is a clinical research Want to know more? study that will help us learn more about how safe an Want to know more? investigational medication is and whether it works for excessive daytime sleepiness (EDS) in people who have IH. If you are interested in learning more about the CHORDS Study, please contact: If you are interested in learning more about the CHORDS Study, please contact: If you are interested in learning more about the CHORDS Study, please contact:
We are looking for people 18–75 years of age who:
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There are also some other requirements for taking part. The study will last for 44 to 46 weeks and will include up to18 study center visits and up to 7 phone calls. All study-related medication and care will be provided at no cost.
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GrandRounds West Cancer Center Celebrates New Lab, New Partnership West Clinic Cancer Center celebrated its recent advancement in lab technology and its partnership with Roche Tissue Diagnostics. A news release from the hospital stated last month its pathology laboratory enhanced patient care by adding the Ventana Benchmark Ultra Automated Advanced Staining System to perform immunohistochemical/in situhybridization testing. This technology, from Roche Diagnostics, will provide advanced assay testing to pathologists resulting in faster diagnoses for the patients of West Cancer Center, according to the hospital. Roche Tissue Diagnostics is the largest company in the anatomic pathology industry offering an FDAcleared testing package of seven key breast biomarkers for cancer patients. Roche recently announced US Food and Drug Administration’s approval of the VENTANA PD-L1 (SP142) Assay as the first companion diagnostic to aid in identifying triple-negative breast cancer (TNBC) patients eligible for treatment with the Roche cancer immunotherapy Tecentriq®(atezolizumab) plus chemotherapy (Abraxane® [paclitaxel protein-bound particles for injectable suspension (albumin-bound); nabpaclitaxel]). Assessment of PD-L1 biomarker status on tumor-infiltrating immune cells with the assay is essential for identifying those patients most likely to benefit from this treatment. A diagnosis of triple-negative breast cancer means that the three most common proteins associated with breast cancer growth – estrogen receptor, progesterone receptor and HER2/neu – are not expressed on the tumor cells.
BlueCross Names Director of Corporate Communications BlueCross BlueShield of Tennessee has named Dalya Qualls as director of corporate communications. Qualls will serve as a spokesperson for the company and direct a team responsible the company’s internal and external communication strategies. Dalya Qualls Prior to joining BlueCross, Qualls served as communications manager with HCA Healthcare, where she directed the company’s media strategy and oversaw the team that developed content for digital platforms. Previously, Qualls served as deputy communica-
tions director for the Tennessee Department of Safety and Homeland Security, where she held primary spokesperson duties and handled media strategy for related agencies. Qualls earned a master’s degree in mass communications from Southern Illinois University and received her bachelor’s degree in English from the University of Illinois at Urbana-Champaign.
Dr. J.T. Tran Joins Mid-South Internal Medicine Dr. J. T. Tran has joined Mid-South Internal Medicine and will specialize in Internal Medicine, with an emphasis on (continued on page 11)
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GrandRounds wellness and preventive medicine. He is a graduate of the University of Memphis and Lincoln Memorial University DeBusk College of OsteoJ. T. Tran pathic Medicine. He completed his medical residency at the University of Tennessee Health Science Center where he saw patients at Baptist Hospital, Methodist University Hospital, Regional One Health, and VA Memphis.
Assistant Professor Awarded Grant to Improve Outcomes Satya Surbhi, PhD, assistant professor of Medicine in the Center for Health System Improvement at the University of Tennessee Health Science Center (UTHSC), received a $100,000 grant from the Pharmaceutical Satya Surbhi Research and Manu-
facturers of America Foundation to pursue research in improving medication adherence for low-income Tennessee Medicaid users. Surbhi’s study showed that only 20 percent of Medicaid super-utilizers (patients with numerous hospital visits causing high health care costs) properly used their chronic disease medication as prescribed in a six-month period following a hospital discharge. Beneficiaries suffered from persistent ailments, such as diabetes, hypertension, con-
gestive heart failure, coronary artery disease, and chronic lung diseases. Study participants noted that transportation barriers and financial burdens were the major factors making it difficult to get medicine in a timely manner. Surbhi contends that hospitals and payers can take steps to make medicine more accessible, which would then provide better health treatments for lowincome patients.
AMA Intensifies Campaign to End Burnout The American Medical Association (AMA) has announced an escalation in its efforts to fight the root causes of physician burnout and dissatisfaction by launching the Practice Transformation Initiative. An AMA announcement says “The new course of action strengthens the AMA’s resolve to advance evidence-based solutions tha,t increase joy in medicine.” Jesse M. Ehrenfeld, MD, MPH AMA board chair, said “Since 2013, the AMA has been leading the national conversation on physician burnout with innovative research and bold advocacy aimed at removing obstacles and burdens that contribute to symptoms of burnout in 44 percent of physicians. “While AMA efforts to date have increased awareness of the physician burnout crisis at all levels and driven positive change, there is an immediate need for transformational solutions.” An AMA news release stated, “While the frequency, causes and impact of professional fatigue and burnout among physicians have been well researched, actionable solutions have had much less rigorous analysis. As a result, information on effective interventions remains limited. The mission of the Practice Transformation Initiative is to fill the knowledge gaps regarding effective interventions to reduce burnout. “To make physician burnout a thing of the past, the initiative will support research and advance evidence-based solutions by collaborating with organizations who are committed to the practice transformation journey. Participating health systems and practices will take on improving joy in medicine by using validated assessment tools to measure burnout; field-testing interventions that are designed to improve workflows, applying practice science research methodology to evaluate impact and sharing best practices within an AMA facilitated learning community.”
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