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FOCUS TOPICS HEALTH LAW • ONCOLOGY • PEDIATRICS •TMA

September/October 2020 >> $5 ON ROUNDS They are Not Little Adults Dr. Leon Livingston of Pediatric Consultants focuses on parental education as much as treating children

Legal & Practical Considerations for Telemedicine AHLA Panel Looks at Current, Post-Pandemic Landscape

By CINDY SANDERS

In the face of a global health crisis that called for limiting close, in-person contact, it’s not surprising telemedicine has enjoyed skyrocketing popularity in 2020. In addition to the practicality of such medical appointments, emergency orders loosening tight regulatory mandates around the field has made it possible for more providers to offer services to a larger patient population. Nothing, however, lasts forever. Turning an eye to a post-pandemic landscape, the Physician Organizations Practice Group of the American Health Law Association recently hosted a webinar looking at both legal and practical considerations of telemedicine now and moving forward. The regulatory changes currently in place are in effect

Dr. Leon Livingston of Pediatric Consultants decided early in life that he not only wanted to be a physician, but also that he wanted to be a pediatrician.

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Loving What He Does

West Cancer Center’s Dr. Gregory Vidal is “getting to do everything” He estimates that 60 percent of his practice involves seeing patients, 30 percent involves research, and 10 percent involves teaching as an associate professor in the Department of Hematology/ Oncology at the University of Tennessee Health Science Center.

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Dr. Ronald Kirkland Steps Up as President-Elect for the TMA West Tennessee physician tackles healthcare issues By LAWRENCE BUSER

As President-Elect of the Tennessee Medical Association (TMA), Dr. Ron Kirkland of Jackson will be taking over an organization that has some significant momentum in its favor. The physician’s group, which last year was named most influential advocacy organization on Capitol Hill, recently saw passage of special-session legislation related to two key areas of concern: telemedicine and COVID liability. “The insurance companies would not pay for telemedicine which allows patients the ease of remotely talking with their physician,” said Kirkland, an otolaryngologist/head and neck surgeon who retired from The Jackson Clinic in 2015 after 31 years in practice. “Now the legislation requires them to pay for the service at the same rate as they would for a similar service (CONTINUED ON PAGE 8)

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Physician

They are Not Little Adults

Dr. Leon Livingston of Pediatric Consultants focuses on parental education as much as treating children By LAWRENCE BUSER

Dr. Leon Livingston of Pediatric Consultants decided early in life that he not only wanted to be a physician, but also that he wanted to be a pediatrician. His exposure to health care began at home. His mother was a registered nurse for more than 30 years in the Duke University hospital system, and his father, an Army veteran, was a radiologic technologist at the Veterans Hospital in Durham. “When I was growing up, my general pediatrician gave me the opportunity to shadow him during the summers of my junior high school years and I think that’s where my interest in pediatrics came from,” said Livingston. “I felt that as a general pediatrician you can have an impact on children’s overall health through preventive medicine and teaching parents how to better take care of their children.” And, as the well-worn medical phrase goes, treating children is not treating small adults. The issues are different, and they change as children age. “When you’re treating an adult, you’re educating the adult on how to take better care of themselves and what to do to get blood pressure or diabetes under control,” Livingston said. “With children, you’re taking care of the child, but you’re also educating the parent on how to better take care of their child. “Adults deal with issues that sometimes can be related to years-of-life decisions about what you ate from age 12 or 15, or your decision to start smoking at 15 and you’re now up to several packs a day at age 60 or 70. As a pediatrician, you’re trying to teach people to make better decisions so that when they’re an adult they don’t have to deal with those issues. A 16-year old’s

decision-making process might be sort of rash and not well thought out. It isn’t the same as a 25-year old’s. Those are some of the issues a pediatrician deals with.” In these days of dealing with the COVID-19 pandemic, physicians’ offices like Pediatric Consultants have been trying to limit the number of patients in the office at any one time. “We’ve been doing telehealth visits and we’ve also had to do more phone triage to decide if a patient should come in and be seen or if they should be tested first,” said Livingston, adding that there also are screening processes for everyone who comes to the office. “Children are still at risk for COVID, but they don’t tend to get as sick. There’s some thought that smaller children don’t spread it as easily, but we’ve certainly had older kids who had it – high school kids who probably spread it as much as adults. “How that’s going to play out is something we’re going to see later on because

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Shelby County Schools, for the most part, is doing virtual, some schools are doing hybrid, and some schools like those in Mississippi are doing in-person. We’ll get a better idea of how that spreads going forward.” The importance of wellness checkups and vaccines poses an extra problem for pediatricians. “At the start of the pandemic, we were seeing well children only in the morning and then seeing sicker patients in the afternoon to try to keep them separate, but there were still some parents not interested in coming in because they were worried about exposures in getting out,” said Livingston. “So, we did have some delay in vaccinations, but we’ve started to catch up. That was an issue early on, and it still might be an issue when we get to the flu season because people may not come in for their flu shots like they may routinely have done.” On the positive side, he said that since many children are staying home and not mingling with other children at school or day care, there are fewer incidences of routine ear infections and cases of strep throat. “We’re primarily an outpatient clinic so we don’t see the severe things they see in the hospitals where kids get admitted for things like respiratory issues,” said Livingston. “Our office, more so than others, also sees kids with special needs, such as traumatic brain injury or extreme prematurity, because of (practice founder) Dr. Noel Frizzell’s interest in that. “We’re still offering telehealth visits, but at some point, before the end of the year, we’ll need an office visit. A tele-visit isn’t a replacement for actually seeing a patient and laying hands on them. I can’t examine a child’s throat or look in a child’s ear like I would do in the office. Also, in a

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perfect world I would have perfect reception and the patient would have great internet access, but that’s not always the case.” Livingston graduated from Johns Hopkins University School of Medicine in Baltimore and earned a Master of Public Health before coming to Memphis for his residency training. He notes that the biggest change in his two decades of practice has been in technology. “When I was starting out, we would write things on paper charts and being able to review what happened with a patient would sort of depend on how well you could read someone’s handwriting,” Livingston said. “Everyone is pretty much using electronic medical records now and, although it’s a pain and all of us complain about too many clicks, I do think it’s made taking care of patients a whole lot easier. “Charts are more legible, and they’re recorded in a more orderly fashion. The ability to send a prescription electronically, and not handwritten, has cut down on pharmacists having to call back asking what this medicine is. I think that has helped cut down on medication errors tremendously. Also, being able to review a patient’s chart electronically is sort of ingrained in what we do now. It’s something we’re used to, whereas before, we just had to rely on what the patient told us.” Away from the office, Livingston is an avid sports fan. He’s had season tickets for the NBA Grizzlies since they arrived in Memphis in 2001 and closely follows his alma mater, the University of North Carolina Tar Heels. He also regularly attends the annual pop-culture event known as ComicCon in San Diego, an event that regularly attracts more than 100,000 people. Because of COVID, however, this year Livingston and other fans had to settle for watching the event from home via digital streaming.

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Spotlights

Loving What He Does

West Cancer Center’s Dr. Gregory Vidal is “getting to do everything” By LAWRENCE BUSER

He estimates that 60 percent of his practice involves seeing patients, 30 percent involves research, and 10 percent involves teaching as an associate professor in the Department of Hematology/ Oncology at the University of Tennessee Health Science Center. Just don’t ask which he enjoys most. Dr. Gregory Vidal is a medical oncologist at the West Cancer Center and Research Institute where he specializes in breast cancer. “Don’t ask me to choose between my children,” Vidal replies with a laugh. “I like it all. I love what I do. Being here at West makes me a happy person because I get to do everything that I want to do. I love research and got into it because of personal experience and wanting to find a better understanding of cancer. I also love teaching and lecturing, and I love clinic and interacting with my patients. I wouldn’t do anything differently.” His personal experience was the loss of his mother to leukemia in 1997. That motivated him to pursue a Master of Science degree with research in hemoglobin genetics to get a better understanding of the disease that took his mother. Coincidentally, he was mentored by the late Steven D’Surney, PhD, who later succumbed to pancreatic cancer and was treated at the West Cancer Center.   “Instead of medical school, I wanted to do research, but then I decided on a dual MD/PhD program at Tulane,” Vidal said. “My intention was to become a hematologist and study blood cancers, but the same year I got to New Orleans, Tulane hired this new guy, associate professor Frank Jones, who did breast cancer research. After rotating in his lab, we sat down and he put forth a plan for me and my career that I could not say no to, so I became a breast cancer researcher.”  After Tulane, he did residency and fellowship programs at Stanford, where his mentors included some of the world’s leading experts in the field of breast cancer research, including Dr. Mark Pegram who played a major role in development of the drug Herceptin/Trastuzumab which revolutionized the treatment of HER2-positive breast cancer. “It is probably the cancer with the most exposure and funding for research mainly because breast cancer has very dedicated advocates,” Vidal said. “So, we have moved the bar toward a cure at a much faster rate than other types of tumors. Today, the 10-year survival rate for patients with early breast cancer is upwards of 80 percent, although all breast cancers are not created equal.  “There are some breast cancers with a lower 10-year survival rate, such as the triple negative where we have a memphismedicalnews

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lot of work to do, particularly in the metastatic setting. It’s just a more aggressive and, as one of my old mentors used to say, a smarter cancer. By this I mean it’s more likely to develop resistance to our standard therapies without an obvious driver mutation. It therefore makes it more difficult to develop targeted therapies. It’s an area of focus in breast cancer research and it is my hope that in the next five years or so we will have made significant inroads toward increasing the cure rate.” There are basically three types of breast cancer: hormone-driven tumors, HER2-driven tumors, and triple-negative tumors, lacking expression of hormone or HER2. There are also some gray areas in between. He said the breast is vulnerable to cancers because the cells in the breast are constantly changing due to variations in hormonal cycles. The constant changes make the cell more vulnerable to errors, resulting in cancers. “The redeeming feature is that the breast is not a vital organ and it is external, so women are more likely to notice when there is a change, and also it could be removed and not be life threatening,” said Vidal. “Additionally, we have an excellent screening tool, mammograms. This allows us to find breast cancers early. The earlier we can detect cancer the higher the cure rate.” He advises that women become familiar with their breasts. If there’s a change, bring it to the attention of a health care practitioner as soon as possible.  “Once there is a diagnosis, don’t delay treatment,” he added. “Family history is also important. Female relatives in the family are at higher risk if their close relatives have had breast cancer, so sharing your history with family members allows others to be more prudent about their breast health.” Post-menopausal women are the most vulnerable to breast cancer, and

while locally the incidence for breast cancer is slightly higher for Caucasian women, the death rate is higher for women of color, he said. “The reasons for that include socioeconomic factors, access to care, access to quality care, disparity and biases in care, but there also is a biological perspective there because folks of color are more likely to have triple-negative breast cancer,” he said, referring to the aggressive cancer type in which three receptors are absent and there are no targeted treatments. “So, it varies a lot as far as who’s at risk, but certainly older women and, in terms of mortality, it’s folks of color.”  Vidal, who grew up on the small island of Dominica in the West Indies, was the first in his family to go to college.  “I knew very early on in elementary school that I wanted to go into medicine because biology and studying about the body was just so intriguing to me,” he said. “Cardiology was my first thought since that’s the first organ we were taught. In high school, I fell in love with the science of medicine, not just the idea of medicine.”

From 1995, when he enrolled at the University of Mississippi, to 2014, when he left Stanford for Memphis, Vidal was going to college after college earning a bachelors in biology, a masters in genetics, an MD/PhD, and then residency and fellowship in oncology. “My first real job not in training was in 2014 when I came to the West Cancer Center,” he noted. “It’s a long, long journey and I enjoy it all. It was a difficult decision coming to Memphis, having had offers at some really top-notch institutions, but I will tell you if I had to make that decision again, I would do it again. I have not one regret.” Leaving Dominica for the United States was a big leap, but one that was made easier since he was among approximately 30 fellow islanders recruited between 1994-98 to Ole Miss by Dr. Donald Peters, the school’s first vice chancellor of color, who himself is from Dominica. He said most of the group have settled down and become successful in various fields, including his friend Roosevelt Skerrit who, for the past 16 years, has been the Prime Minister of Dominica.

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Legal & Practical Considerations for Telemedicine, continued from page 1   throughout the public health emergency. When that designation is removed, rules and regulations revert to pre-pandemic status unless there is further action at the federal level.   

Public Health Emergency

On March 13 of this year, President Donald Trump made an emergency declaration in regard to the COVID-19 pandemic under the Stafford Act and the National Emergencies Act. That declaration of a public health emergency (PHE) set into motion authority for various federal agencies to issue waivers providing flexibility to meet the unique challenges of COVID-19.   Within days, changes went into effect across Health and Human Services. The Office for Civil Rights (OCR) issued new HIPAA guidance allowing covered providers, “in good faith, (to) provide telehealth services to patients using remote communication technologies, such as commonly used apps – including FaceTime, Facebook Messenger, Google Hangouts, Zoom, or Skype – for telehealth services, even if the application does not fully comply with HIPAA rules.”   CMS issued a number of waivers making it easier for those enrolled in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) to access care through telehealth platforms during the crisis. Changes have allowed providers to conduct telehealth visits with patients inside their homes and outside of designated rural areas. In many cases, providers could practice even across state lines. Telemedicine could be used for both established and new patients, and the appointments have been billable as if the visit was in person. Additional waivers specifically addressed Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), including easing some physician supervision requirements for nurse practitioners to the extent permitted by state law.    

Transformation of Telemedicine

Ronnen Isakov serves as managing director of healthcare advisory services for Medic Management Group, which provides operational, management, financial and revenue services for practices. He noted CMS added 135 allowable services and CPT codes under the emergency orders, immediately doubling what had been available at the beginning of the year.   The healthcare industry, said Isa-

kov, is notoriously slow-moving when it comes to transformation. “For our rules to change takes a long process,” he pointed out. “The pandemic kick-started the digitalization of healthcare.” Isakov added telehealth saw a decade of regulatory changes in a matter of a days and weeks.  Similarly, the medium saw an explosion in usage. Isakov said the normal number of telemedicine visits in March had been about 13,000 Medicare beneficiaries per week. “During the last week of April, in a six-week period, that number jumped to 1.7 million beneficiaries,” he noted. For those keeping score, that’s a 15,354 percent increase.  Isakov added that pre-pandemic, McKinsey estimated the total annual revenue of all American telehealth companies to be $3 billion. The company now estimates $250 billion of the nation’s health spend could ultimately be digitized. Similarly, Frost & Sullivan now predicts a seven-fold growth in telehealth by 2025.  From the operational viewpoint, Isakov said telehealth has focused on ease of access. “For our rural practices and facilities, it was an immediate way to solve some patient transportation issues,” he added of the relaxed RHC regulations.   On the flip side, Isakov noted, “There’s still a lot of perceived quality of care concerns.” He also said smaller practices continue to worry about the financial investment required long-term, coupled with reimbursement uncertainty once temporary waivers expire. While it remains to be seen if payers continue to reimburse adequately, Isakov said there is a lot of pushback for expanded services to continue.   “We really believe it’s unlikely to see telehealth volumes go back to the preMarch numbers but that some form of telehealth is here to stay,” he concluded.   

Practical Application

Kyle Sharp, interim associate vice president and executive director of OSU Physicians at Ohio State University, said the huge system utilized telemedicine for about 100 visits per month for a total of 0.04 percent of overall patient visits prior to COVID-19.   Looking at telehealth vs. in-person visits, Sharp said telehealth didn’t even register in the numbers pre-pandemic. By March, a little more than 13,000 visits were conducted remotely. In April and May, telehealth visits outnumbered in-person visits with 44,591 telehealth visits in April and 40,898 in May. “During the peak of the pandemic, 90 percent

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of our providers were using telehealth,” he said. At this point, Sharp added, they have had telehealth visits from 49 states, although the majority of remote visits have been in a four-state region.  As clinics slowly reopened and expanded services throughout the summer, Sharp said in-person visits began to rebound with total number of patient visits nearing pre-COVID projections. While telehealth visits have decreased, they have remained a significant percentage of overall visits. In August 2020, in-person visits accounted for 82,866 patient encounters, but telehealth added another 26,429 visits – a far cry from the 100 per month before the pandemic.   Coming out of COVID, Sharp said their ongoing telehealth targets are for about 30 percent of primary care, 20 percent of medical specialty and 10 percent of surgical visits to be conducted via telehealth. Sustaining momentum, he added, will require some additional patient education. “Our Medicare population did not resonate with our telehealth platforms as did our other populations,” he noted.    

Evolving Telehealth Law

Kate Hickner, a partner in the Cleveland office of  Brennan Manna & Diamond and chair of AHLA’s Physician Organizations Practice Group, noted telemedicine first came on the scene in 1997 as part of the Balanced Budget Act.  There have been multiple tweaks to the law, some quite significant, over the ensuing two decades.  Hickner said the Medicare Telehealth Benefit is outlined in section 1834(m) of the Social Security Act, which includes specific geographic, location, service, technology and provider requirements, albeit with some exceptions. “Even though Medicare has implemented waivers, 1834(m) of the Social Security Act is still the law,” she pointed out.   Hickner said Congress will have to address the changes that have been put in place when the public health emergency declaration expires. She added there does seem to be a will to expand telehealth access. “There is a White House directive to CMS to look at telehealth efforts in rural health areas,” Hickner noted. She added the proposed 2021 physician fee schedule adds nine telehealth codes permanently, removes 74 at the end of the year in which the public health emergency declaration expires, and includes 13 codes to add to the list of telehealth services. However, she pointed out, any changes at this point are still in the proposed stage.  During the PHE, Hickner noted the HHS Office of the Inspector General (OIG) has created increased flexibility to allow providers to waive copays and deductibles for telehealth. Under normal circumstances, such a move to reduce or waive costs owed by federal healthcare program beneficiaries  could  be seen as inducement under the anti-kickback statute. However, OIG has said they will not enforce the statutes if providers choose to reduce or waive cost-sharing for telehealth during the COVID-19 emergency. 

Other flexibilities around supervision, signature requirements, licensure, credentialling, prescribing and data privacy and security have all been temporarily implemented, as well. Medical documentation for a telehealth visit, she continued, is generally the same as for an in-person visit with two key distinctions: 1) consent to receive telehealth services and 2) notation of the state where the patient is located for the visit and specific location of the rendering provider.   “Regardless of the flexibility offered by CMS, we do need to consider state law,” Hickner reminded the audience. “The practice of medicine occurs where the patient is located at the time of service,” she continued. If a physician is in Tennessee but caring for a patient in Arkansas, then Arkansas’ rules and regulations govern the encounter.   

Plan Now for Post-Pandemic 

For those who didn’t previously have a robust telehealth program in place, Greg Stein, IT and IP counsel for Cleveland Clinic, said now is the time to be thinking about how to move forward post-pandemic.   Currently, the type of technology that can be used has been greatly expanded to include any non-public facing remote communications product including Zoom, FaceTime, Microsoft Teams and other popular platforms. Similarly, private texting applications including Facebook Messenger, Jabber and iMessage are acceptable. However, cautioned Stein, using public-facing technologies like TikTok, Facebook Live or Twitch are prohibited for telehealth.  While penalties aren’t being enforced right now for a hack related to the “good faith provision of a telehealth service,” Stein said a “bad faith provision” is still in play including an intentional invasion of privacy, use of personal health information (PHI) prohibited by the HIPAA Privacy Rule such as selling data or using PHI for marketing purposes without authorization, telehealth violations of state licensing laws or professional ethical standards, and for using publicfacing remote communication products.  “At some point, this moratorium is not going to apply, so practices need to be thinking how telehealth will work within the framework of HIPAA,” he said of reverting back to more stringent rules. “With this enforcement discretion in place, it’s a really good opportunity to dig into details right now,” he continued.   Stein, who served as vice chair of the Data Privacy and Information Security Group as a partner at Ulmer & Berne LLP prior to joining Cleveland Clinic, suggested teaming up with someone who understands the technology in play and the requirements to adequately protect privacy and security to meet stringent HIPAA requirements once the PHE expires. He recommended asking lots of questions or finding an advisor who knows what questions to consider when it comes to negotiating a telehealth agreement and analyzing risk.   memphismedicalnews

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AACR Releases Landmark Cancer Disparities Progress Report By CINDY SANDERS

On Sept. 16, the American Association for Cancer Research released a first-of-its-kind report outlining disparities in outcomes and clinical trial participation for ethnic and racial minorities, along with other medically underserved populations. The inaugural Cancer Disparities Progress Report provides a comprehensive overview of the latest research and serves as a clarion call for action to achieve health equity. “Over the years, the AACR and it’s more than 47,000 members from the United States and 126 other countries around the world have been at the forefront of every major breakthrough against cancer,” said AACR CEO Margaret Foti, PhD, MD (hc), during a virtual Congressional briefing to introduce the progress report. Margaret Foti Foti said the idea of undertaking this historic initiative began about two years ago. AACR leadership, along with member scientists and physicians, recognized achieving a vision of health equity would require a comprehensive plan to identify the parameters of this major public health issue, inform and educate policymakers, regulators and the public, and outline the effective steps to address the problem. Originally slated to be released in March, COVID-19 upended those plans. Foti said the pandemic has served as yet another reminder of disparate outcomes and underscores the need to address healthcare inequities. Although this landmark report is new, Foti added AACR has long recognized disparities – from inclusiveness in clinical trials to fielding a diverse workforce – and has taken concrete steps to improve representation. MICR, Minorities in Cancer Research, celebrates its 20th anniversary

this year and has led the way in increasing participation by minority researchers in the field of cancer. “Diversity and inclusion in our field are extremely important for accelerating the pace of progress against cancer, and a lack of racial and ethnic diversity in both the cancer research and healthcare workforce is one of the major factors contributing to cancer health disparities,” Foti stated. MICR Council Chair John Carpten, PhD, also chaired the Cancer Disparities Progress Report steering committee and said there is both reasons to be excited and much more work to do. “This inaugural and historic progress report will provide the world with a comprehensive baseline John Carpten understanding of our progress toward recognizing and eliminating cancer health disparities from the standpoint of biological factors, clinical management, population science, public policy and workforce diversity,” he said. “What I’m excited about now is that we have amazing tools and technologies and methodologies that are really allowing us to hone in on biological factors that might be influencing these disparities.” There have been several areas of progress including the differences in the overall cancer death rate among racial and ethnic groups being less pronounced today than ever before. The AACR cited an overall cancer death rate for African Americans being 33 percent higher than the cancer death rate for whites in 1990. While an unacceptable disparity still exists, the difference dropped to 14 percent higher by 2016. Recent studies have shown outcome disparities could be eliminated for some types of cancer if all patients had equal access to standard treatment, and other initiatives have shown the effectiveness of tailored outreach and patient navigation efforts. Additionally,

Concrete Steps to Move Forward In addition to providing a baseline picture of where cancer disparities stand in the United States, the Cancer Disparities Progress Report also issued a call to action to all stakeholders to eradicate barriers to health equity. A few of those action items include:  • Provide robust, sustained, and predictable funding increases for the federal agencies and programs that are tasked with reducing cancer health disparities.  • Implement steps to ensure clinical trials include a diverse population of participants.  • Support programs to make sure the healthcare workforce reflects and appreciates the diverse communities it serves.  • Prioritize cancer control initiatives.  • Work with members of the Congressional Tri-Caucus — comprised of the Congressional Asian Pacific American Caucus, Congressional Black Caucus, and Congressional Hispanic Caucus — to pass the provisions included in the Health Equity and Accountability Act. 

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multiple studies and initiatives focused on gaps in knowledge about cancer biology in diverse populations is already underway. Two such efforts are the AACR

Disparities Persist According to the AACR Cancer Disparities Progress Report 2020: Achieving the Bold Vision of Health Equity for Racial and Ethnic Minorities and Other Underserved Populations:  African Americans have had the highest overall cancer death rate of any racial or ethnic group in the United States for more than four decades.  African American men and women have a 111 percent and 39 percent higher risk of dying from prostate cancer and breast cancer, respectively, than their white counterparts.  Hispanics have the lowest colorectal cancer screening rate of any racial or ethnic group in the United States.  Hispanic children and adolescents are 20 percent and 38 percent more likely to develop leukemia than their non-Hispanic white counterparts, respectively.  American Indians/Alaska Natives have the lowest breast cancer screening rate of any racial or ethnic group in the United States.  Asian/Pacific Islander adults are twice as likely to die from stomach cancer as white adults.  Complex and interrelated factors contribute to cancer health disparities in the United States. Adverse differences in many, if not all, of these factors are directly influenced by structural and systemic racism.  Racial and ethnic minorities are severely underrepresented in clinical trials and understanding of how cancer develops in racial and ethnic minorities is significantly lacking.  Many of the U.S. population groups that experience cancer health disparities, in particular, racial and ethnic minorities, are also experiencing disparities related to coronavirus disease 2019 (COVID-19). Many of the factors driving COVID-19 disparities overlap with the factors that contribute to cancer health disparities.  Experts predict that the COVID-19 pandemic will exacerbate existing cancer health disparities as a result of the disproportionate impact of COVID-19 on racial and ethnic minorities and other underserved populations. 

Project Genomics Evidence Neoplasia Information Exchange (GENIE) and the National Cancer Institute-funded African American Breast Cancer Epidemiology and Risk (AMBER) Consortium. Carpten, who is chair of the Department of Translational Genomics and co-leader of the Norris Comprehensive Cancer Center at the University of Southern California, said additional research is a critical component to building on current efforts. “We need to diversify clinical trials, increasing the numbers of minority individuals participating,” he stated. Carpten also keyed in on the importance of integrating societal issues and how they impact biology and outcomes into the bigger picture of addressing disparities. As referenced in the report, Carpten noted 21 percent of African Americans, 18 percent of Hispanics and 8 percent of non-Hispanic whites lived below the federal poverty level in 2018. “Without a doubt, socioeconomics and inequities in access to quality care represent major factors influencing cancer health disparities, and these disparities will persist until we address these issues,” he said. “We’ve made progress in a number of areas, again particularly on the biology side, but I still think we have a long way to go,” Carpten said. Having this landmark report to help all stakeholders better understand where we currently stand is a critical step in that continued journey. To view the full report and additional resource materials, go online to cancerrprogressreport.aacr.org/ disparities.

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Many healthcare entities have been issuing “blanket denials” of employee requests for coronavirus related family leave under the (correct) belief that their healthcare entity qualified for an exemption to the new laws. Recent revisions to the regulations will require more individualized determinations. The Families First Coronavirus Response Act (FFCRA) enacted on March 18, 2020 created additional leave rights for employees in response to the COVID-19 pandemic through two provisions: the Emergency Family and Medical Leave Expansion Act (EFMLA) and the Emergency Paid Sick Leave Act (EPSLA). Since then, the exact contours of employee rights and employer obligations under the FFCRA have been the subject of considerable debate and disagreement. On August 3, 2020, a federal district court judge for the Southern District of New York struck down several portions of the DOL temporary EFMLA regulations it determined exceeded the scope of the agency’s authority, leaving employers without a clear understanding of what portion of the temporary regulations remained in effect through the end of 2020 when the FFCRA terminates by its terms (unless otherwise renewed). On September 16, 2020, new revised temporary regulations became effective in response to the New York case that significantly narrows the healthcare provider exemption. Under the FFCRA, employers are not required to provide any type of FFCRA paid leave to “health care providers.” That term, however, was left undefined by Congress. Originally, DOL interpreted it expansively to include almost anyone employed by a healthcare employer. The New York federal court ruled that interpretation was too broad. The new DOL regulation more narrowly defines who is a healthcare provider, providing concrete guidance on who is and is not covered by the exemption. First, the DOL clarified that “it is not enough that an employee works for an entity that provides health care services.” The worksite of the employee is also not conclusive, so not all employees of a healthcare entity are covered and conversely, employees need not work at a healthcare entity to be covered. The definition of “healthcare provider” under FFCRA is broader than the one used for that term under the FMLA. Unlike FMLA regulations, an employee is not required to carry a specific license or certification to meet the definition of “health care provider.” Instead, the new

test focuses on the work performed by the employee. The employee must be “employed to provide diagnostic services, preventive services, treatment services, or other services that are integrated with and necessary to the provision of patient care and, if not provided, would adversely impact patient care.” Each of these terms (diagnostic services, preventative services, treatment services, and other integrated services) is specifically defined and include not only traditional healthcare services like patient visits and procedures but also taking and processing samples, performing x-rays or other tests, administering medication, physical therapy, bathing, dressing, feeding, and setting up for procedures. Under this definition, the DOL recognizes four categories of healthcare workers who are covered by the exemption and not eligible for FFCRA leave: The first group are those who are included in the definition of “health care provider” under FMLA regulations. This covers “physicians and others who make medical diagnoses,” such as dentists, psychologists, optometrists, chiropractors, nurse practitioners, physician assistants and clinical social workers.  The second group are those who directly provide patient services, such as nurses, nurse assistants, and medical technicians. The third group are workers who work under the supervision, order, or direction of or provide direct assistance to employees who are in the first or second group. The fourth group are those workers who do not work directly with patients but who are integral to patient care and treatment, such as laboratory technicians who process test results. Employees who are employed by a healthcare provider but who do not fit into one of these four categories are presumed not to fall within the exemption and  are  eligible for FFCRA leave. Under the revised regulation, examples of such employees who are eligible might include “IT professionals, building maintenance staff, human resources personnel, cooks, food services workers, records managers, consultants, and billers.”  The revised regulations also include other changes regarding notice requirements and leave related to school closures. Denise Burke and Mark Peters are partners at Waller Lansden Dortch & Davis, LLP, in Memphis and can be reached at denise. burke@wallerlaw. com or mark. peters@wallerlaw. com

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Dr. Ronald Kirkland Steps Up as President-Elect for the TMA, continued from page 1 in the office. “It was on our plate before COVID, but we couldn’t get anywhere. Then it was made necessary by COVID when we didn’t want to have interpersonal contacts. Telemedicine is of great benefit to patients who don’t have to drive to an office, sit in the waiting room, where they might get sick, and then drive back home. That’s all eliminated with telemedicine. Of course, there are some things that require a faceto-face visit, but routine issues can be taken care of with telemedicine.” The second piece of legislation involved limiting liability for physicians, clinics, and hospitals that saw patients who later acquired COVID. “They could bring suit and say you exposed them to COVID and you’re liable for these damages,” said Kirkland. “Now the law insists that there is grossly negligent behavior on the part of the physician, clinic, or hospital before they can be sued. That’s a reasonable standard. Otherwise we’d be flooded with lawsuits.” But the new legislation says the grossly negligent standard only applies to suits that are filed after August 3, 2020. “So, there’s still significant exposure,” he said.  Kirkland is scheduled to succeed Dr. Kevin Smith of Nashville as TMA president in April of 2021, but there will still be plenty of issues to address on behalf of TMA.  “Another ongoing issue is the scope

of practice regarding nurse practitioners, physician’s assistants and others who, in our view, want to practice medicine without a medical license,” Kirkland said. “They are essential to providing highquality care to our patient population, but it’s the position of the TMA that those professionals should work in collaboration with physicians who are available to help them in more difficult situations. “It seems to me that it’s not in the best interests of patients to have nurse practitioners and physicians assistants, who only have a small fraction of the training of physicians, making important decisions without the support of physicians. Before I retired, we had a wonderful nurse practitioner in our office who was very knowledgeable and she could do 99 percent of the office work I did, but she knew that I was there if she needed me and I knew she would call on me if she was in a situation where she was not comfortable.” Kirkland also would like to boost membership in TMA, whose 9,500 members represent about 60 percent of the state’s licensed physicians. He has been a member since his medical school days and has been quite active the past 10 years. His path into medicine was a circuitous one, though one marked by dogged persistence.  Kirkland entered the University of Tennessee at Knoxville as an engineering student, posting good grades before switching to pre-med. Then, while deal-

ing with family issues, his study habits dissolved, he began skipping classes and by his junior year he was gone. He was then “taken in” by UT-Martin, did well there for two years, spent a brief time in law school and then, with no more college deferment, enlisted in the Army. “The recruiter suggested I go into military intelligence and said I would get to wear civilian clothes and I wouldn’t have to go to Vietnam, so I said, ‘Where do I sign?’” Kirkland recalled. “As it turned out, I went to Vietnam as a counterintelligence agent, but I did get to wear civilian clothes, so the recruiter was half right.” He was stationed in Nha Trang near Cam Ranh Bay, living in, and working out of two houses surrounded by concertina wire. His duties included making sure military units were handling classified documents properly, conducting background investigations on certain Army personnel, and conducting clandestine weekly debriefings of local confidential informants. “My duties involved flying around the Central Highlands in helicopters and small airplanes,” he said. “It could be risky, but I never had an incident that I knew about. It was kind of fun, as long as you didn’t get shot.” Kirkland was discharged in 1971, worked a short time in a family-owned Ben Franklin Store, and then began to

pursue medical school in earnest. He bulked up on upper division biology, chemistry and physical chemistry at UT Martin and graduate studies in molecular biology at Vanderbilt. He was turned down twice for medical school before finally getting accepted on the third try to the University of Tennessee Health Science Center in Memphis. Kirkland, his wife of 52 years Carol, and their four children have some 10 academic degrees from the UT system from one side of the state to the other. “I remember thinking when I got that medical degree in my hand, I’m going to be so smart,” said Kirkland, who is a former president of the University of Tennessee National Alumni Association. “Then as I walked across the stage at the MidSouth Coliseum on graduation day, I was handed my degree and looked out at the audience and thought, ‘Oh, no. I don’t know anything.’ “I think every physician goes through that time period where they feel inadequate, but ultimately you build enough confidence and have enough training and experience that you feel you can handle just about anything. The most satisfying part of my career is having patients coming up to me years later and saying you did this operation or that operation and thanking me for doing good work. I think it’s the relationships with the patients and the staff that I worked with that’s been the most satisfying.” 

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Four Ways COVID-19 is Changing Health Care – Now and in the Future By STEVE WILSON

As Tennessee and the nation continue to navigate the deep impacts of COVID-19, one thing seems certain — the pandemic has changed the way many of us have traditionally viewed and engaged with the health care system. Many times, crises create an urgency to speed up innovations in order to meet consumers’ demands and provide convenience. COVID-19 has led to a few emerging trends that may usher in permanent changes to the ways we access health care.

1. Telehealth is here to stay

Telehealth wasn’t new prior to COVID-19, but fewer people were using it before the pandemic. Now many health insurance plans have encouraged the use of virtual visits as an alternative to visiting health care facilities in person, and we’re seeing adoption accelerate. Through June, we’ve seen 10 times as many telehealth visits as we did all of last year. Even specialty care is leveraging telehealth through prenatal visits, and more recently UnitedHealthcare has made physical, occupational and speech therapies available. The push toward contactless care is likely to continue through virtual appointments in primary care, urgent care, disease management and behavioral health.

2. More people will receive care at home.

Similar to how telehealth enables efficient and accessible care at home, the response to the pandemic has created momentum around the concept of a patient’s home as a site for medical services. This idea relies heavily on the adoption of technology and advanced digital tools. Some areas where home-health is advancing are chronic disease management and infusion services. For example, diabetes and congestive heart failure are two chronic conditions that can currently be monitored with the help of digital remote-monitoring tools like continuous glucose monitors (CGM) and activity trackers. Members are able to sync their devices to track progress, check their health data in real time, send and receive messages from a nurse care coach and share progress with their doctor. This helps address long periods of ongoing care. And for patients who need certain medications, home infusion services may be a dependable way to reduce public exposure risk, especially during COVID-19. Typically, a nurse will come to the home and train the patient or caregiver on how to administer the drug. When infusion services are performed in the home, it may help patients receive the critical therapies they need without having to manage the travel and logistical concerns associated with leaving home to visit a clinic or hospital. Moving the site of care to the home may also be an opportunity to save money memphismedicalnews

.com

by avoiding the overhead costs of an inpatient hospital setting. By improving continuity of care, patients may be able to avoid adverse events that may lead to readmissions to the hospital. We could also see more oncology care being moved to the comfort of the home. This would be especially important for patients who are immunocompromised and still need treatment.

3. The role of a pharmacist is changing.

Pharmacists play an important role beyond medication management in a care team. When doctor’s offices were closed or not available, some pharmacists could fill a gap in care. Even before the crisis, some states had expanded the scope of practice for pharmacists. A few states have given pharmacists limited prescribing authority, and more than 800 pharmacists in the United States are board-certified in infectious diseases. Pharmacists are also integrating more with behavioral health. We’re starting to look at a few things, including how we can help individuals with medication adherence and screening for depression through some of our pharmacies. But similar to the momentum around telehealth and homebased care, there’s an evolving definition of what being a pharmacist can mean.

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4. Americans may live healthier lifestyles.

COVID-19 represents a convergence of current and long-term threats to the health of individuals and their families. A number of chronic conditions — many of which are preventable and can be treated — are risk factors for falling severely ill to COVID-19. In addition, maintaining a strong immune system is seemingly more important than ever to avoid contracting or overcoming the coronavirus. In addition, there’s a heightened awareness that cleanliness and hygiene practices can keep people healthier and avoid the spread of disease — expanding the notion of good health to include cleanliness of the things people interact with each day. If the momentum continues to shift toward greater health ownership, the pandemic has brought forth advances that could support this renewed focus on health and well-being.

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Looking ahead

COVID-19 has changed several aspects of health care, some for the better. These trends can help increase flexibility, convenience and access and may help more people get the care they need to live healthier lives. Steve Wilson is the CEO of UnitedHealthcare of Tennessee

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ACO Pays Off for Patients and Physicians in Western Tennessee  

Everyone wins the benefits of an Accountable Care Organization By SUZANNE BOYD

Since their inception, accountable care organizations (ACO)s have blazed a path of innovation in the healthcare industry, from delivery to quality of care. Originally established in 2012 as a Medicare payment model, an ACO is a group of healthcare providers who voluntarily come together to coordinate healthcare services and engage in valuebased payment models. These providerbased networks utilize data analytics and population health management strategies to increase efficiency, improve patient outcomes, and reduce healthcare costs. West Tennessee Clinical Partners, an ACO with clinics and providers spread across the region and throughout Kentucky serving over 30,000 Medicare beneficiaries is reaping the benefits of this program. What makes this group unique for this area is that it was formed without the assistance of a major healthcare system or hospital. Dustin Summers, CEO, began laying the groundwork for the organization in 2014. “I knew that ACOs and the Medicare Shared Savings Program would come to the forefront with the passing

of the Affordable Care Act,” said Summers. “I started laying the groundwork for this group through an Independent Physician Alliance I was working with, which allowed me to get the Dustin Summers wheels in motion very quickly. I figured Vanderbilt, the Jackson Clinic and West Tennessee Healthcare would be forming their own ACOs, so we needed to have a similar program. It was important to me to empower independent, primary care providers as they struggle to stay afloat in this era of healthcare where bloated systems swallow up more and more practices.” In January of 2015, six clinics formed an ACO named West Tennessee Clinical Partners and was officially recognized by Medicare. Imperium Health Management out of Louisville played an integral role in the group’s formation. “We started with just primary care doctors in West Tennessee that we knew were pretty engaged and that could work in conjunction with each other. We also

knew we wanted it to be a doctor driven group with no hospital involvement. Not every doctor we approached wanted to be involved. We started small, covering about 7000 Medicare lives for the first few years. You have to have at least 5000 to even be recognized as an ACO,” said Summers. “Initially, we were hesitant to take on anyone outside of West Tennessee but after the first few years we added several clinics in Central and Eastern Kentucky who were made up of doctors very similar to the ones in our group.” The ACO did not hit a shared saving distribution bonus in its first few years of operation but it did reveal a lot of data and insight into these practices that otherwise might not have been seen making participation in the program worthwhile especially since it cost nothing. In 2018, Medicare changed the formulation to include physician counterparts in the region. “It was already a high bar to clear when they were on their own but then when you compared our physicians to their counterparts, it made things more interesting,” said Summers. “We knew what our doctors historically cost Medicare and as the system was built on being able to save money, we were already

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who is ‘in charge’ is important to fostering relationships and partnerships to keep this vital industry moving forward. Each January, Memphis Medical News provides a definitive list of leaders in the annual InCharge Healthcare issue, which is formatted as a glossy, four-color magazine. InCharge showcases a wide range of differencemakers, including:

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Neal Beckford, MD Board Member Tennessee State Board of Medical Examiners

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Michael Wiggins President Le Bonheur Children’s Hospital

Inside: A Snapshot of Who’s Leading Memphis Healthcare Into the Next Decade

Want to nominate a Memphis healthcare leader for a listing? Interested in advertising in the next InCharge? Talk to the publisher: Pamela Haskins 501.247.9189 or pamela@memphismedicalnews.com.

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pretty streamlined. But our group fared very well, and they were rewarded for work they had been doing.” One of the first hurdles Summers faced was making sure physicians and patients knew what an ACO was and how it could benefit them. More than simply a network of providers, the ACO is focused on streamlining and optimizing the quality of care. This is done by using data and best practices to reduce duplication of medical services, close gaps in care, deliver effective preventive care, and coordinate services across the care continuum, thus producing better outcomes for healthcare dollars spent. The goal of an ACO is to help the healthcare system reduce its overall spending by rewarding value instead of volume. ACOs reward providers for balancing spending and quality by giving successful participants a portion of the savings, compared to typical fee-for-service rates, they achieve for their payers. “An ACO provides the doctor far more insight into the care their patients receive beyond the clinic, which makes for better continuum of care from primary to specialist to hospital and beyond. The practice gets specific data on where patients are receiving care and the outcomes,” said Summers. “It allows the physician to have empirical data on what is happening outside of the clinic, where there are inefficiencies in care, what the outcomes are and where the best care is being provided for their patients.” Growing the ACO is always something Summers is looking to do but in a very intentional localized manner. “We have to be sure that a physician or group is a good fit before we consider adding them to our organization. Medicare also can provide some insight on a doctor for us so we can see if there are any outliers in their practice that may be red flags,” he said. “The great part of it is that not being tied to a bigger health organization our members can remain independent and autonomous while not drowning financially. We are one of only three groups in our region and are the only one not tied to a larger health organization, beyond that clinics participate in national ACOs that are spread across the country.” The ACO model continues to evolve, but it seems to be here to stay. Although they started as a public option under Medicare, ACOs have grown into a force in the commercial payer market and West Tennessee Clinical Partners is following suit. With more than 20,000 patients in 2019, the group is pursuing multiple contracts with private insurance companies.

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GrandRounds Campbell Clinic Announces Retirement of CEO George Hernandez For the past 25 years, George Hernandez has led Campbell Clinic, initially as CFO and, since 2010, as the organization’s CEO. A planned executive leadership succession was announced today and will become effective January 1, 2021. Daniel Shumate, George who has served as Hernandez Campbell Clinic’s CFO since 2010, has been named as CEO, effective following Hernandez’s retirement.Recruitment for Shumate’s successor as CFO will commence immediately. Daniel Shumate When Hernandez began his career with Campbell Clinic in 1995, revenues were $30 million and, through organic growth and a broadened scope of facilities and services, revenues in 2019 exceeded $300 million. Employee count has shown a similar trend, now approaching the 600 mark. The Memphis Business Journal lists Campbell Clinic as the largest independent physician practice and recently named Campbell Clinic as one of the 50 Fastest Growing

Companies in Memphis. Late last year, Campbell Clinic completed construction and occupancy of its flagship medical office building, located at 7887 Wolf River Boulevard in Germantown, complementing its other offices on the campus on Germantown Road. The new facility is four stories, 120,000 square feet, and contains clini-

cal office space, an 8-operating room ambulatory surgery center, expanded physical therapy, and a new-to-themarket sports performance and wellness center called ACCEL Performance and Wellness Center, named in honor of former Campbell Clinic physician and Chief of Staff S.Terry Canale and his family.

Outside of his duties at Campbell Clinic, Hernandez, a 34-year resident of Germantown, serves on the City of Germantown’s Planning Commission and has completed his 10 th year as a Reserve Officer with the Germantown Police Department.

Campbell Clinic First in Memphis to Use ROSA® Robot Knee System on Outpatient Surgeries Campbell Clinic has recently procured the Zimmer-Biomet’s ROSA® Robot Knee System. ROSA®, which stands for Robotic Surgical Assistant, will assist Campbell Clinic surgeons in performing accurate and individualized knee replacements. Campbell Clinic is among the first in the region and the very first in the MidSouth to use this robot-assisted technology on outpatient total knee replacement. The Zimmer-Biomet’s ROSA® Robot Knee System supports surgeons in performing total knee arthroplasty (TKA) with features to assist with bone resections, as well as assessing the state of the patient’s soft tissue to facilitate implant positioning intraoperatively. The ROSA® robot incorporates dynamic tracking and real-time data of each patient’s anatomy to help surgeons achieve personalized care and optimal patient outcomes. ROSA® is designed to help surgeons tailor the placement of each patient’s unique knee implant. A precise fit is critical to the comfort and overall recovery of patients following knee replacements. ROSA® uses real time data about each individuals knee during surgery to let the surgeon know details related to each patient’s anatomy that may affect his/her implant. By using this data to make more informed decisions, Campbell Clinic surgeons are able to plan for and carry out personalized surgeries based on individual needs.

I CHOOSE beter collaboration I choose to work with a team of experts who are as dedicated to my patient’s fight as I am. Baptist Cancer Center’s multidisciplinary team of doctors ensures my patients receive customized treatment plans that include the latest technology, therapies, surgery options and access to groundbreaking national research and clinical trials. From diagnosis to survivor care, the best way to fight cancer is together.

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GrandRounds UTHSC and Regional One Health Collaborate on COVID-19 Treatment Clinical

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The University of Tennessee Health Science Center and Regional One Health have announced they are partnering on a clinical trial program including two late-stage clinical trials evaluating Regeneron’s REGN-COV2, the company’s investigational two-antibody cocktail for the treatment and prevention of COVID-19. Leading the efforts are John Jefferies, MD, MPH, FAAP, FACC, FAHA, FHFSA, Jay Michael Sullivan Distinguished Chair in Cardiology, and professor and chief of the Division of Adult Cardiovascular Diseases at UTHSC, and Amber Thacker, MD, an assistant professor of Medicine and Pediatrics John Jefferies at UTHSC and medical director of the Hospital Medicine Service at Regional One Health. They will work with patients at Regional One Health’s downtown campus to conduct the clinical trial. Amber Thacker By enrolling in one of the clinical studies, individuals suffering with COVID-19 symptoms or living with someone with COVID-19 will have the opportunity to gain early access to a potentially life-saving treatment or preventive option and be part of an effort that may be far-reaching according to Martin Croce, MD, chief medical officer at Regional One Health and a professor of surgery and chief of the Division of Trauma and Critical Care at UTHSC. A Phase 2/3 trial is testing the cocktail’s ability to treat patients who are COVID-19 positive and symptomatic, but not sick enough to be hospitalized. A Phase 3 trial is evaluating REGN-COV2’s ability to prevent infection among individuals who have been exposed to COVID-19 through a family member or other close contact. Regeneron developed the REGNCOV2 antibodies to bind to the SARSCoV2 “spike” protein and prevent it from attaching to cells in the human body, which is expected to neutralize SARS-CoV-2. Participants will receive a one-time IV infusion of the investigational drug. The infusion takes about an hour and patients are monitored onsite for several hours. Patients can then go home, where they will have follow-up visits from a home health provider for lab work and assessment. At Regional One Health, patients with COVID-19 symptoms, who test positive and meet study criteria, can be referred to Dr. Thacker or another member of her hospitalist team within 96 hours of their positive test. Individuals who think they may qualify are encouraged to contact (901) 448-2499 for more information. Individuals may also learn more about the criteria and enroll at www.ClinLife.

com/COVID. To participate in the treatment trial, individuals must be at least 18 years old, have a laboratory confirmed COVID-positive diagnosis or experience COVID symptoms, and not have been hospitalized due to COVID-19. To participate in the prevention trial, participants must be at least 18 years old, test negative for COVID-19, and live and remain in the same household with someone who recently tested positive.

Memphis Pain Management Practice Expands to Mississippi Mays & Schnapp Neurospine and Pain is bringing its unique approach to pain management to Mississippi. The medical office, located in East Memphis, has added a second location in Southaven and is open and treating patients. Mays & Schnapp has been successfully helping patients with chronic pain for over 25 years. With the clinic’s growth and the addition of a second location, this is the perfect time to update the practice’s look and name. Mays & Schnapp’s multidisciplinary treatment philosophy involves treating chronic pain with several therapies that work together to provide the most effective pain relief. Each patient is different, so each treatment plan is individualized with the therapy or therapies that will work best for that patient. A medical plan can include a combination of advanced interventional treatments, physical therapy, and other therapies. Ryan McGaughey, MD, an interventional pain specialist with Mays & Schnapp, is looking forward to bringing the practice’s patient-focused, specialized care closer to Southaven and north Mississippi patients. Nurse practitioner Gerrie Walters will also be working at Mays & Schnapp’s Southaven office. For decades, Mays & Schnapp has been the premier pain management group in the greater Memphis area. Its experienced medical team focuses on the whole person and offers interventional treatments including: • Nerve Blocks • Radiofrequency Ablation • Spinal Cord Stimulation • Physical Therapy • Medication Management The medical team at Mays & Schnapp treats a variety of pain conditions such as back, neck, leg and arm pain, arthritis, bursitis, sciatica, shingles, fibromyalgia, peripheral neuropathy pain from diabetes, multiple sclerosis, complex regional pain syndrome, and post-stroke pain. The new Southaven office consists of approximately 3,500 square feet. The space is divided into a front office, waiting room, nine exam rooms, and one procedure room with fluoroscopy. Plans also include offering physical therapy. Office hours are Monday – Friday 8 a.m. – 4:30 p.m.

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GrandRounds Campbell Clinic Announces Appointment of New Spine Surgeon Campbell Clinic Orthopaedics has announced the appointment of Kirk Thompson, MD as the new spine surgeon at its Wolf River location. As a board eligible orthopaedic spine surgeon, Thompson has expertise in performing minimally invasive spine Kirk Thompson surgery, cervical disk replacement and lateral interbody fusion, as well as treating adult degenerative scoliosis, degenerative disk disease, bone health and a range of other patient problems. Thompson finished his residency at Campbell Clinic and completed his fellowship in spine surgery at OrthoCarolina in Charlotte, North Carolina. During his residency, he served both as chief resident and orthopaedic surgery resident at the University of Tennessee – Campbell Clinic Department of Orthopaedic Surgery. Thompson received his Doctor of Medicine from Southern Illinois University. He is experienced in sports orthopaedics, covering the Memphis Redbirds AAA Minor League Baseball team and the Memphis Academy of Health Sciences high school football team. Thompson is currently accepting patients. Visit www.campbellclinic.com for more information

Li Appointed UTHSC Distinguished Professor Wei Li, PhD, professor in the Department of Pharmaceutical Sciences in the University of Tennessee Health Science Center’s College of Pharmacy, has been appointed a UTHSC Distinguished Professor. The title is reserved for those who have contributed in a superlative way to UTHSC and brought distinction and respect to the university. The appointment comes from College of Pharmacy Dean Marie Wei Li Chisholm-Burns, PharmD, MPH, MBA, FCCP FASHP, FAST, and UTHSC Chancellor Steve Schwab, MD. Dr. Li has emerged as one of UTHSC’s most innovative and successful investigators according to Chancellor Steve Schwab, MD. Dr. Li also serves as director of the College of Pharmacy’s Drug Discovery Center and as the faculty director of the college’s Shared Instrument Facility. He has been working in the UTHSC College of Pharmacy since 1999. He has published more than 160 peer-reviewed papers, four book chapters, and is an inventor of 10 issued U.S. patents, with additional related patents issued in other countries. His current research is supported by six federal grants,

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two industry sponsored research grants, one foundation grant, and various internal supports from UTHSC.

UTHSC’s Yousefi Awarded $600,000 in Grants to Develop Artificial Intelligence for Glaucoma Research, Diagnosis Siamak Yousefi, PhD, an assistant professor in the Department of Ophthalmology and the Department of Genetics, Genomics, and Informatics at the University of Tennessee Health Science Center, has received two grants worth more than $600,000 combined to Siamak Yousefi further develop artificial intelligence (AI) to help diagnose and monitor glaucoma. Dr. Yousefi is the recipient of $451,139 from the National Eye Institute of the National Institutes of Health for a two-year study aimed at improving glaucoma monitoring using an artificial-intelligence-enabled dashboard. He was also awarded $180,000 from the Bright Focus Foundation to study the impact of glaucoma on certain retinal ganglion cells, as a path to uncover more information on glaucoma progression. The foundation is a nonprofit organization supporting research on brain and eye diseases. With the NIH grant, Dr. Yousefi proposes to develop state-of-the-art machine learning and advanced visualization dashboards using a large clinical dataset with about 1 million samples to provide a fuller and more-informative quantitative glaucoma assessment that is accessible to clinicians. With the Bright Focus grant, Dr. Yousefi will seek to identify the impact of glaucoma on certain retinal ganglion cells. Glaucoma-induced vision loss and blindness result from the slow degeneration and death of retinal ganglion cells, which can be subdivided into more than 30 subtypes. Certain of these cells are more vulnerable to glaucoma-induced damage than others. Yousefi says they will develop and refine novel artificial intelligence approaches to study single-cell RNA-sequencing data, and to identify retinal ganglion cell subtypes that are more impacted by glaucoma. They hypothesize that stateof-the-art AI algorithms can improve identification of the subtypes that are affected in early stages of glaucoma. Such analyses can advance our understanding of the genetic basis for glaucomainduced retinal ganglion cell death and may lead to possible therapeutic interventions. Dr. Yousefi is the director of the Data Mining and Machine Learning laboratory at UTHSC. He and his team develop state-of-the-art models to identify eye conditions from ocular imaging data. His laboratory is among a few in the nation working on data mining techniques applied on a range of eye conditions includ-

ing glaucoma, macular degeneration, keratoconus, keratoplasty, and uveitis.

Saint Francis Hospital-Bartlett Names Jacquelyn Whobrey, MSN, RN, as Chief Nursing Officer Saint Francis Hospital-Bartlett appoints Jacquelyn Whobrey, MSN, RN, CMSRN, NEA-BC, as its new Chief Nursing Officer (CNO). Whobrey brings extensive healthcare leadership experience, and a sharp focus on patient-centered care and performance imJacquelyn Whobrey provement. Whobrey is an innovative and strategic leader with a reputation for relationship building and nursing practice excellence. She comes to SFH-Bartlett from Community Health Network in Kokomo, IN, where she was the Vice President of Patient Services and Chief Nursing Executive. She has demonstrated success in reducing hospital acquired infections, improving other quality metrics and employee engagement scores. Known for her focus on a strong culture of safety, she has led the charge for successful Joint Commission surveys, and implemented effective programs centering on fall and readmission reduction. She has worked in leadership roles in both critical care and medical/surgical units. Whobrey holds an MS in Nursing Administration and a BS in Nursing from Indiana Purdue University. In addition to her RN, she is a Certified Medical Surgical Registered Nurse (CMSRN), and holds a Lean Six Sigma Green Belt Certification and Nurse Executive Advanced Certification (NEA-BC). She is a member of the American Organization for Nursing Leadership, Indiana Organization of Nursing Leadership, American College of Healthcare Executives, American Medical Surgical Academy and American Nurses Association.

Methodist Le Bonheur Healthcare Names Michael V. Paul as Chief Strategy Officer Methodist Le Bonheur Healthcare announced the appointment of Michael V. Paul as senior vice president and chief strategy officer. Paul joins the healthcare system from WellCare Health Plans in Tampa, Fla., where he served most recently as chief operating officer Michael V. Paul and chief of staff for the South and Midwest division. Paul will lead strategic planning initiatives that guide decision making along with growth and operational objectives. He will also be responsible for identifying and developing new business opportunities and innovative approaches aligned with MLH’s vision and mission to provide high quality, cost effective care to anyone who walks through its doors. Paul will

oversee Strategy, Planning and Research; Marketing, Communications and Web Strategy; and Process Improvement and Innovation. As COO and chief of staff of WellCare’s South and Midwest division, Paul led the division’s financial, strategic and operational priorities that drove clinical outcomes, growth, operational efficiency and financial performance of more than $15 billion in revenue. Paul holds a bachelor’s degree in business, cum laude, from Indiana University and an MBA from the University of Chicago Booth School of Business. Paul, his wife Lindsay and daughter Olivia will relocate to Memphis this fall.

St. Jude Children’s Research Hospital to Begin Constructing New Patient Housing Facility St. Jude Children’s Research Hospital will begin constructing The Domino’s Village, a new housing facility for patients and their families, this fall at 361 N. Third Street. The new facility, which will cost $110 million, will open for St. Jude patient families in the spring of 2023. Domino’s announced today that it will contribute $100 million to St. Jude during the next 10 years to fund The Domino’s Village and support the mission of St. Jude. A diagnosis of pediatric cancer or other life-threatening diseases affects the entire family, and treatments can take months or even years said James R. Downing, M.D., St. Jude president and chief executive officer. They asked patients and their families to indicate what would make their experience the best possible while staying at St. Jude so their thoughts and ideas are reflected in the planning and design of the new residence. The design for the new six-story, 288,998-square-foot facility includes an underground parking garage, an outside courtyard/play area and a planned pedestrian bridge across North Third Street to the St. Jude campus. The new facility will feature 140 units for both short-term and long-term stays, including one-bedroom suites and two- and three-bedroom apartments. In addition, amenities and activity spaces customized for families and children of various ages will make the residence more like home. If a family must travel 35 miles or greater for their child’s treatment, St. Jude provides housing at no cost to the patient and caregiver. Families may stay in Tri Delta Place, Ronald McDonald House, Target House or The Parcels at Crosstown Concourse. Each of these facilities offers families comfortable lodging with recreational opportunities and other amenities. Since the start of its 2016–2021 strategic plan, St. Jude has treated 2,820 new cancer patients. The Domino’s Village will help meet this increased need. The Renaissance Group designed the building, and Linkois Construction is the contractor.

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GrandRounds Hamilton Eye Institute at UTHSC Announces Joshua R. Ford, MD as their Newest Physician

New Name & Second Location > Same Great Team > Same Exceptional Care Our ambulatory surgery center, alongside our physician practice and physical therapy team, provide compassionate, comprehensive, and state-of-the art care for patients suffering from chronic pain. We pinpoint the source of pain and treat the whole patient in order to relieve pain, restore function, and improve quality of life.

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Mays & Schnapp Pain Clinic and Rehabilitation Center

UTHSC Hamilton Eye Institute at The University of Tennessee Health Science Center dedicated to improving vision and empowering lives, welcomes Joshua R. Ford, MD as a staff member. Dr. Ford joins the practice following his Ophthalmic Plastic and Joshua R. Ford Reconstructive Surgery (ASOPRS) Fellowship at MD Anderson Cancer Center in Houston, Texas. After graduating from Yale University, he went on to earn his medical degree from Dartmouth Medical School in Hanover, New Hampshire. Later, he did an Ophthalmic Pathology and Research Fellowship at the University of Utah in Salt Lake City, Utah, followed by an Ophthalmology residency at Tulane University in New Orleans, Louisiana. Dr. Penny Asbell, Director of UTHSC Hamilton Eye Institute said Dr. Ford has phenomenal training in Ophthalmic Plastic and Reconstructive Surgery and Orbital Oncology. Dr. Ford specializes in Ophthalmic Plastic and Reconstructive Surgery, Eyelid and Orbital Oncology, and Aesthetic Surgery. He is a native of Sylvester, Georgia and enjoys college football, hiking, kayaking, camping, participating in international mission trips, and spending time with his family. Memphis Pain Management Practice Expands to Mississippi

The Hamilton Eye Institute Welcomes Claire L. Kiernan, MD The Hamilton Eye Institute at The University of Tennessee Health Science Center, improving vision and empowering lives, is pleased to welcome Claire L. Kiernan, MD as a staff member. Dr. Kiernan joins the practice following Claire L. Kiernan her Glaucoma fellowship at Tufts Medical Center where she practiced with the New England Eye Center, Ophthalmic Consultants of Boston and Massachusetts Eye and Ear Infirmary in Boston,

Massachusetts. She earned her medical degree from Rush University, Rush Medical College in Chicago, Illinois. Next, she completed an internal medicine internship at Advocate Illinois Masonic Hospital in Chicago, Illinois followed by an Ophthalmology residency at the UTHSC Hamilton Eye Institute in Memphis, TN. Dr. Kiernan specializes in the diagnosis and treatment of Glaucoma and Cataracts.   Dr. Kiernan is a native of Chicago, Illinois and enjoys baking, cooking, running and spending time with her husband and family.

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GrandRounds 2020 Methodist Healthcare Luncheon is December 11th This year, the 2020 Memphis Healthcare Luncheon is going virtual, streaming live on Friday, December 11. We are very excited to announce that our 2020 celebrity speaker/entertainer/author will be Tony and Grammy Award-winner and star of the Broadway smash hit musical, “Hamilton,” Leslie Odom, Jr.! Leslie Odom, Jr., is a multifaceted performer-spanning Broadway, television, film and music. He is perhaps best known for his breakout role as Aaron Burr in “Hamilton,” for which he won the Tony Award for Best Actor in a Musical and a Grammy Award as a principal soloist on the original cast recording. He most recently released his third full-length album and first of original material, entitled “Mr” and also starred alongside Cynthia Erivo in the Harriet Tubman biopic, “Harriet.” His book, Failing Up: How to Take Risks, Aim Higher and Never Stop Learning, brings together what Odom has learned in life thus far, tapping into universal themes of starting something new, following your passions, discovering your own potential and surrounding yourself with the right people and making your own dreams come true. Odom will also be singing several songs from “Hamilton” as well as his Christmas album! For more information, please call 901-478-0697.

OrthoSouth Surgeon Completes First ImageGuided Total Shoulder Replacement in Greater Memphis OrthoSouth is proud to announce the completion of the first CT-navigated total shoulder replacement in the Greater Memphis Area, performed by Dr. Christopher Pokabla at Methodist LeBonheur Hospital in Germantown, TN. Utilizing the ExactechGPS® Shoulder Application with 3-D Computed To-

mography scans (CT scans), Dr. Pokabla received live visual feedback confirming the precise placement of tools and implants during the surgery. For his practice, Dr. Pokabla believes image-guided navigation will help with implant placement during surgery, and especially with patients who have unusual shoulder anatomy. Dr. Pokabla proactively seeks innovative solutions for his patients with unique shoulder problems. The successful completion of the region’s first image-guided shoulder

replacement is yet another case of his dedication to cutting edge care. Just last year, for example he had a completely customized, 3D-printed implant crafted for another shoulder replacement recipient. Dr. Pokabla is a board-certified, fellowship-trained orthopaedic surgeon specializing in sports medicine, arthroscopic shoulder surgery and shoulder replacement. He practices at OrthoSouth’s Poplar Ave., Germantown, and Bartlett locations.

Kosten Foundation’s 10th Annual Kick It 5K Going Virtual The Kosten Foundation has announced their 10th annual Kick It 5K will now be a virtual event hosted November 5-19 during Pancreatic Cancer Awareness Month. The walk/run fundraiser has been rescheduled from April due to COVID-19 and rescheduled again from October to the final dates of November 5-19 to align with Pancreatic Cancer Awareness Month. Out of an abundance of caution, the Kosten Foundation is making the 5K a virtual event in November. Participants can now sign up to run or walk the virtual Kick It 5K and/or donate to help fight Pancreatic Cancer and support those fighting the disease at this link https:// kickit5k.raceroster.com/page/home12. Those interested can also visit kostenfoundation.com for more information. Participants can now social distance and either run or walk their 5K wherever they want over a two-week period. Runners, walkers, and supporters that signed up during the earlier registration periods will have their registrations carried over to the new date. Over the last 17 years, the Kosten Foundation has raised more than $2 million for research, awareness, and support against pancreatic cancer. The Kick It 5K is the organization’s largest fundraiser for the cause.

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