FOCUS TOPICS BEHAVIORAL HEALTH • PULMONARY/SLEEP STUDIES • PRACTICE MANAGEMENT • FINANCIAL PLANNING
November 2018 >> $5
Psychiatry Gave Shubi Mukatira The Best Answer A section on a medical school application provided Shubi Razdan Mukatira the answer she was looking for as far as her future was concerned. “I believed then, and I believe now,” she says of that decision.
Profile on page 3
After a 4-Year Wait, Crittenden County Has a Hospital Again The new $44-million Baptist Memorial HospitalCrittenden County will open in West Memphis early next month. The new facility puts to an end the entire county’s lack of a hospital for four years.
Who’s Getting Healthcare Right? Healthgrades Releases 2019 Hospital Quality Rankings By CINDY SANDERS
For 20 years, Healthgrades has reviewed hospital quality and released an annual analysis of performance across a number of common conditions and procedures, assigning a rating of one to five stars for each. Last month, the online healthcare information resource released its 2019 Report to the Nation.
Why Ratings Matter
As the nation continues the move to value-based care, consumers have become more engaged in their health and healthcare. With higher deductibles and co-pays, more consumers have begun to think of healthcare in a similar fashion to other major purchases, looking online for information on cost and quality. When it comes to healthcare, however, the stakes are considerably higher than selecting a new car or refrigerator. In looking at the variation in clinical quality and outcomes across the nation, the 2019 HealthObservations About grades analysis found patients treated Memphis: Page 8 at a hospital with a five-star rating, as compared to a hospital with a one-star rating, in a specific condition or procedure have a significantly lower risk of death and of experiencing complications during the inpatient stay.
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(CONTINUED ON PAGE 8)
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VA Memphis CEO: Progress Indicates A Bright Future
Eric Gibson Helps Practices Take Good Care of Business
When it comes to gauging the future of VA Memphis, David Dunning, the hospital’s director and CEO, invites observers to take a look at the hospital’s progress rather than a government annual report.
By JUDY OTTO
“Physician, heal thyself” might not be such great advice when it comes to addressing the ailments of medical practices, it seems. Eric Gibson, Principal/CFO of ClearlyMD, LLC, a Memphis practice management company, points out that medical professionals are often so deeply (and understandably) immersed in their mission of patient care that business management may be frequently over-
Story on page 13.
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looked or neglected. “We want doctors to practice medicine and see patients and provide quality care, and someone has to make sure that the back office and the financials are being done properly,” he said. “You’d be surprised how often financials are an afterthought.” This is where ClearlyMD steps in to help practices fill in the gaps with billing, accounting, financial services and more, (CONTINUED ON PAGE 10)
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Doctor Followed Her Passion to a Psychiatry Career For Dr. Shubi Mukatira, ‘It’s a Privilege to Work as a Healer’ By LAWRENCE BUSER
When Shubi Razdan Mukatira was a computer science major at Purdue University and applying to medical school, she came to the personal statement section of her admission paperwork. The one where prospective medical students are asked to explain why they should be admitted. “I said my passion was to become a psychiatrist,” she said. “I believed then, and I believe now, that psychiatry is an arena of medicine which addresses neurobiological illnesses and pharmacological options to address these. Psychiatry is also unique in that there is such a significant component to treatment of mental illness that involves sociology, behavioral changes, spirituality. It truly embodies a holistic, mind-bodyspirit specialty of medicine. This is why it felt like my calling in medicine.” Dr. Mukatira was accepted to the Indiana University School of Medicine in her hometown of Indianapolis and did her internship in internal medicine and residency in psychiatry at the University of Tennessee Center for the Health Sciences. Today she is medical director at Crestwyn Behavioral Health Hospital and also practices at Blues City Psychiatry. In addition she runs an outpatient clinic called the Transformation Center for Women which she likens to an “immersive training in the language of therapy, like a boot-camp for therapeutic skills” and where her husband, Raj, is a psychiatric nurse practitioner. Transformations Center is an outpatient facility for men and women who are struggling with severe depression, anxiety and post-traumatic stress disorder and need more comprehensive treatment. “These patients may not need to go to a hospital, but they’ve suffered an existential crisis such as the loss of a loved one or a job or a profession. They’re kind of at a crossroads. It’s our labor of love.” She initially majored in engineering and then switched to computer science at Purdue – which first-man-on-the-moon Neil Armstrong and many other astronauts attended – because it allowed her to take many electives and pursue pre-med and philosophy classes and still graduate with a marketable degree. “I was surprised at how much I enjoyed learning the rules and language of coding and creating programs in computer science,” Dr. Mukatira said. “The creative process really resonated with me.” She also volunteered at a crisis hotline, which introduced her to people with mental illnesses, even if just by phone. The training and experience were compelling. “Part of what I did was answer phone calls, and if they were having a mental health crisis I learned to de-escalate indimemphismedicalnews
viduals when they called.” Dr. Mukatira said. “It gave me some idea of what behavioral health might look like. “There’s such a pervasiveness of mental illness. It’s not just somewhere out there. Just about everyone has someone in their family or in their circle of friends who struggles with some form of mental illness. It is here – within our circle and within our own journey.” Today she sees patients with major depressive disorders, bipolar disorders, post traumatic distress disorders, opioid and alcohol dependency, schizophrenia, generalized anxiety and obsessive-compulsive disorders.
Suicide also is a major issue, especially around holidays when keeping a balance between body, mind and spirit can be a challenge. Exercise, sleep, proper eating, limiting alcohol consumption and even getting healthy amounts of sunlight are important. “The shift in daylight hours impacts a lot of patients,” Dr. Mukatira said. “Also, there’s the personal nuances of the holidays and the expectation of a joyful, family-oriented time. For those who have experienced the loss of family, friends or have significant family dysfunction, this can be very triggering at that time.” Some other factors about suicide hit closer to home, such as the recent study published in MedScape that said the physician rate of suicide is higher than for any other profession, including the military. The suicide rate among physicians is more than double the rate of that found in the general population, according to the study. Psychiatrists are near the top. “I don’t really know why that is, but stress and burnout are certainly factors as well as a lack of self-care by physicians,” she said. “Physicians and other healthcare professionals are less likely to take time out for their own care.” As for the general population, Dr. Mukatira noted that every generation has its struggles, whether it be depressions, wars or national political discord. “I am uncertain if we are living in more stressful times today as compared to the past, but in our outpatient office it’s interesting to note the increased anxi-
ety and increased depression surrounding events that come up in the news and social media,” the doctor said. “In some cases, there’s increased avoidance. ‘I don’t want to talk about it. I don’t want to hear about it.’ It can cause heightened anxiety in some patients. “Mental illness is so impacted by psycho-social variables and behavioral variables like diet, sleep and exercise which have a tremendous impact on your moods and your anxiety level. It seems that every generation has its struggles, and it is important for us, as a society, to find ways to learn from these experiences and to continue to evolve as a nation and as a community.” Dr. Mukatira said there’s always new data and new research on medication and procedural options, but that electroconvulsive therapy continues to have very beneficial results for patients with major depressive episodes, “unlike how it’s portrayed in Hollywood movies.” She added that in recent years there have been encouraging results with transcranial magnetic stimulation, which produces small electric currents to targeted regions of the brain to treat major depressive disorders and neuropathic pain. And a form of psychotherapy called eye movement desensitization and reprocessing is being used to treat problems such as PTSD and trauma. “A lot of what we know about is cognitive behavioral therapy which has been the gold standard when it comes to treat-
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Pillar Procedure Helping Treat Sleep Apnea Dr. M. Boyd Gillespie Finds Success in Reducing Snoring By MADELINE PATTERSON SMITH
A Memphis physician is using a snoring procedure that he has found to be successful in treating patients with sleep apnea. M. Boyd Gillespie, MD, an otolaryngologist and head and neck surgeon for UT Methodist Physicians and Professor and Chair of the Department of Otolaryngology- Head and Neck Surgery at UTHSC has treated patients with chronic snoring for 10-years with the Pillar Procedure, an in-office treatment under local anesthesia which implants threads that stiffen the palate to reduce the vibrations that create the snoring M. Boyd Gillespie sound. Since snoring can originate from the nose, palate and/ or tongue, the first step is evaluating the patient to identify the snoring site. Snoring from the tongue can be treated with a bite guard whereas palate snoring can be treated with the Pillar with some patients benefiting from both methods. Snoring is often a symptom of sleep apnea. According to FAIR health, sleep apnea claims have increased 850 percent nationwide from 2014 to 2017. For many patients, sleep apnea is caused by obesity and from aging. As the body ages, tissues
An implant used in the Pillar Procedure.
soften and can cause the airway to be blocked. The pillar procedure helps stiffen the collapsed tissue to prevent the flutter and snore. As our population ages, we may continue to see more cases of sleep apnea. After evaluating the patient and determining the snoring site and severity of sleep apnea if present, Gillespie numbs the throat with a topical spray andlidocaine injection. The threads are implanted, with an average of four to five implants for men and three to four for women, depending on the palate size. “Over 90 days the implants stiffen the palate and reduce the vibrations that create the snoring sound. Typically we see a
50 percent reduction in snoring intensity which gradually improves over a 90 day period. Usually the snoring is reduced enough that is no longer bothersome and is less frequent during the night,” says Gillespie. “Pillar has been around for 10-years, but we have more research now that describe how the optimize results,” said Gillespie. Previous treatments for snoring included nasal surgery and tonsil removal, which are costly procedures performed in the operating room. Pillar “has an excellent safety profile, the major risk is occasionally one of these threads can work their way out,” says Gillespie but this is very rare and not painful for patients. The
Pillar Procedure is nondestructive to tissues and works by reinforcing collapsible tissues instead of painful tissue removal. “Patients are able to resume a soft diet immediately [after the procedure] and a regular diet within a few days,” says Gillespie. Patients who experience discomfort following the procedure can treat pain with over-the-counter painkillers instead of opioids, which Gillespie says make sleeping and breathing worse. Patients with mild to moderate sleep apnea are also finding success with the Pillar Procedure, which can reduce sleep apnea by an average of 10-blockages per hour. Sleep apnea is divided into three levels of severity – mild is 5-15 blockages per hour, moderate is 16-30 blockages per hour and severe is 30 or more blockages per hour. For those with mild to moderate sleep apnea, Pillar can improve symptoms by reducing the number of blockages per hour. “Even patients on CPAP can benefit from Pillar if they have a tendency to wear the CPAP only part of the night. The ideal patient, however, has socially disruptive snoring without daytime sleepiness and is at low risk for sleep apnea,” says Gillespie. Patients with sleep apnea with associated heart disease or stroke are not strong candidates for the Pillar Procedure.
SOURCES FAIR Health https://www.ajmc.com/contributor/robin-gelburd-jd/2018/03/sleepapnea-a-growing-public-health-issue
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West Memphis Prepares To Open New Hospital Facility May Lessen Pressure on Memphis ERs For the first time in four years, Crittenden County, Arkansas, and its population of about 51,000, will have a hospital when its new $44-million facility opens in West Memphis next month. After a ribbon cutting this month, Baptist Memorial Hospital-Crittenden County is scheduled to officially open Monday, December 3, at 108 West Tyler Ave. The county has been without a hospital since bankruptcy forced Crittenden Regional Hospital to close in 2014. The new 65,000-square-foot facility, which had an original price tag of $25 million, will include: • Emergency Services • Inpatient/Outpatient diagnostic imaging including CT, MRI, X-Ray, Fluoroscopy, Nuclear Medicine, Mammography • Two operating rooms for general and orthopedic surgery • Inpatient Medical/Surgical • Inpatient/outpatient lab services • Endoscopy suite • Eight-chair cancer and chemotherapy infusion center. There are 11 licensed beds and 10 in-patient rooms (one semi-private room) as well as 10 ER rooms, including two trauma rooms, five triage rooms, and a five-chair results waiting area. The new hospital, located at a different site than old one, will somewhat lessen the pressure on the emergency services of Memphis hospitals which during the last four years handled a number of cases from the West Memphis area. It will also improve the delivery of emergency care for West Memphis-area patients. Brian Welton the CEO and adminis-
trator of the new facility, the wait sometimes was said the hospital “will longer because the ERs not likely provide any usually were much busMemphis ERs a huge ier than in West Memreprieve since patients phis. are being dispersed to “It’s been a major all Memphis-area ERs, burden not having a as well as Forrest City, hospital. It has taxed and Jonesboro in Arkanour ambulance services sas, but it will prevent to death,” Crittenden patients in the West County Judge Woody Memphis community Wheeless, told Talk BusiBrian Welton from having to drive ness & Politics, a monthly very far for emergency services.” Arkansas print publication. When Crittenden Regional HospiBaptist has a 10-year lease on the new tal was serving the area, the average time hospital and a 10-year renewal option. for an ambulance to deliver a patient was Baptist officials named Welton as the about 30 minutes. Delivering a patient new hospital CEO in May, 2016. from Crittenden County to a Memphis He came to Baptist six years ago as hospital could sometimes take as much as a Frank S. Groner Administrative Fellow. 70 minutes because of the added distance After completing his fellowship, he served and heavy Memphis traffic. When the as an assistant administrator at Baptist patient did arrive at a Memphis hospital, Golden Triangle for 18 months. From
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there, he became an operations director for Baptist Medical Group, managing physician offices in Columbus, Mississippi, and Memphis. He has continued in his current role with Baptist Medical Group as he transitions to his role at the new Crittenden hospital. Welton received master’s degrees in health administration and business administration from the University of Alabama, Birmingham. He earned a Bachelor of Science degree in business administration from the University of Tennessee, Knoxville.
Doctor Followed Her Passion, continued from page 3
ing anxiety and mood disorders, but there is recently increased emphasis on dialectical behavioral therapy as well that incorporates Eastern ideologies of mindfulness and distress tolerance,” she said. “It is a privilege to work as a healer, and it is work that involves regularly confronting illness, death and mortality. It also involves our own limitations as providers. We often don’t have cures for many complex illnesses.” Dr. Mukarita and husband Raj, who works with her at Blues City Psychiatry, have three boys and a girl, ages 3 to 11, which means regularly attending soccer and golf matches. Her little spare time includes running and reading books such as social researcher Brene Brown’s “Dare to Lead: Brave Work. Tough Conversations. Whole Hearts.” and Pema Chodron’s “The Places That Scare You,” which explores living with less fear and anxiety. “I love what I do, and I’m always interested in what’s going on out there,” she said. “As an attending physician, I am surprised by how often the best tool I have is literally to be present with my patient for whom I do not have a cure, despite every advance in medicine and science.”
Income Protection Vital for Medical Professionals By ROB LACKEY
Wages for those in the medical field, particularly physicians, are among the highest of all occupations, according to the Bureau of Labor Statistics. So, whatever reason you chose to work in the medical profession, it is undeniable that the money you make will impact your lifestyle over the long term. There are a variety of things to consider when entering the healthcare profession. There is the extended, often costly, education required to pursue a job in the medical field, which means that throughout your career, management of debt will be a consideration. With the ability to earn a higher income comes the obligation to pay higher taxes, so navigating the tax landscape and learning how to be more tax efficient is a factor – an important factor that makes income protection a key issue and one to consider here. Let’s start from the beginning. For the sake of example, let’s assume you want to become a doctor in internal medicine. To do that you must graduate with a bachelor’s degree, graduate from medical school, pass three U.S. Medical Licensing Exams, complete a three-year residency program, and pass an internal medicine board exam. The estimated total classroom, training, and study time to complete that process is 33,760 hours. That equates to just over 16 years of full-time working hours. The Association of American Medical Colleges reported that the average total student loan balance for a doctor is $207,000 and for many it is much higher. It is not a stretch to say the average total loan cost, over the course of repayment, will be north of half a million dollars for the average doctor. If you lose the ability to make the income you’ve worked so hard for, would it impact your ability to repay that debt? Now, let’s assume you are a physician in the prime of your earning potential. Perhaps you’ve gotten your student loan debt taken care of but replaced it with new debt. You’ve bought your family home, maybe a vacation home or a boat. You’ve created a lifestyle that is dependent on a certain level of income. Perhaps you have ownership in a practice that would be adversely affected if you were unable to work. You’ve also started planning for the day you no longer want to work. Are you willing to risk your home if you were no longer able to pay the mortgage? Do you want you or your family to change their entire lifestyle because it could no longer be financially supported? Do you want to surrender control of the ability to retire in the future? According to the Social Security Administration, there is about a 25 percent chance of an individual becoming disabled and being unable to work for 3 month or more during their working career. With the amount of time and effort you’ve put in to achieving your current level of success, does it not make sense to protect your income and your ability to earn it? Given that the memphismedicalnews
Time moves on; memories should not
Rob Lackey has been working as a financial planner and wealth advisor for six years. He has passed the series 7 and series 66 securities exams and holds state life, health, and variable insurance licenses. He is licensed and appointed in Arkansas, Florida, Mississippi, Georgia, Oklahoma, Tennessee, and Texas.
income you make, and your ability to make it, drives ever other financial decision you’ll have to make, would you not agree that is Take part in this journey with us to learn more one of the most important conversations you need to have in regard to your financial about Alzheimer’s planning? Now that we agree on the importance of the conversation, let’s look at how to The TAURIEL Study will look at an investigational medication for people with mild Alzheimer’s disease address income protection. or people who have problems with memory. The study will help determine how safe the investigational When financial professionals bring up medication is and whether or not it works in affecting Alzheimer’s disease. income protection, we’re referring to disabilWe are looking for approximately 360 people who The study could last up to 3.5 years, depending ity income coverage. There are a variety of may be able to join this study. on how long you choose to participate. All studyways that this coverage can be achieved, and related care will be providedmedication at no cost. The TAURIEL Study will look at an investigational The TAURIEL Study might be right for you if you: reasons to consider each option. There are with or people who We are enrolling people nowhave — ¢for are people 50 to 80 years of agemild Alzheimer’s disease a variety factors to consider, the key compowant to know more? ¢ have mild Alzheimer’s disease or problems problems with memory. The study will help determine how safe nents are the amount of the benefit, the length with memory If you are interested, please contact: of the benefit, and the type of coverage. is and whether or not it works in ¢the haveinvestigational somebody who can be amedication reliable study First, let’s discuss the amount of the partner or caregiver and who can come to some affecting Alzheimer’s disease. benefit. Generally, disability income covstudy visits with you and answer questions about your health. erage provides 60-70/ percent income We are looking for approximately 360 people who may be able to replacement, but it ultimately depends on the plan guidelines and your earned income. join this study. The TAURIEL Study might be right for you if you: You should review, annually, how much of • are 50 to 80 years of age your monthly expenses would be covered in the event you become disabled. At a mini• have mild Alzheimer’s disease or problems with memory mum you want to cover your fixed and basic monthly expenses such as your mortgage, • have somebody who can be a reliable study partner or utilities, and groceries. caregiver and who can come to some study visits with you Next, make sure you understand the and answer questions about your health. length of your coverage. This can range from six months up to your retirement age. They definition of disability that is used can The study could last up to 3.5 years, depending on how also change during the benefit period. Some long you choose to participate. All study related care will be policies will pay the benefit for a period of The TAURIEL will look at an investigational medication for people with mild provided at Study no cost. time on an ‘own occupation’ basis, or the or people who have problems with memory. The study will help determine how s ability to do the job you had prior to becommedication is and whether or not it works in affecting Alzheimer’s disease. ing disabled. After that pre-set period, they revert to the definition of permanent disability which changes to the ability to do ANY We are looking for approximately 360 people who The study could last up job. For medical professionals, due to the may be able to join this study. on how long you choo specialized training, you want to make sure The TAURIEL Study will look at an investigational medication for people with mild Alzheimer’s disease related care will be pro you’re covered for own occupation for the or people who have problems with memory. Themight study will help determine how safe the investigational The TAURIEL Study be right for you if you: If you are interested, please contact: duration of the coverage. medication is and whether or not it works in affecting Alzheimer’s disease. Finally, it’s important to understand We are enrolling ¢ are 50 to 80 years of age there are three types of disability Neurology Clinic, Wecoverage: are looking for approximately 360 people who The study could last upP.C. to 3.5 years, depending have mild Alzheimer’s disease employer provided group plan,may individual be able to join this¢study. on how or longproblems you choose to participate.want All study-to know m Dr. Lee Stein, Dr. Kendrick Henderson, with memory disability income policy, and business conrelated care will be provided at no cost. If you are interested, p Thewho TAURIEL Dr. Thomas Arnold, tinuation coverage. Depending on pays Study might be right for you if you: ¢ have somebody who can be a reliable study We areDr. enrolling people the premium or how the premium is paid, ¢ are 50 to 80 years of age Dr. David Pritchard, Barbra O’Brien,now — partneror or caregiver and want who can come to some there may also be tax consequences on mild the Alzheimer’s disease to know more? ¢ have problems Cara Pendley benefit. In some cases, it may be important study visits Dr. withJoshua you andLennon, answer Dr. questions with memory If you are interested, please contact: to have all three policies to be¢adequately about your health. have somebody who can be a reliable study 901-507-3535 covered and offset any tax consequence. partner or caregiver and who can come to some These three items are by no means a firstname.lastname@example.org study visits with you and answer questions comprehensive list of things to know aboutand your health. understand about your income protection plan. These are the three basic pieces that you need to make sure you know and help start the conversation. The next step is working with your trusted financial advisor to gRED Confidential – do not copy, distribute, or use without prior written consent ensure the coverage you have in place will Patient Aprwritten 2018consent [V01 USA] gRED Confidential – do not copy, distribute, or useFlyer, without10prior provide the protection you need to continue Patient Flyer, 10 Apr 2018 [V01 USA] meeting your goals.
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Whoâ€™s Getting Healthcare Right? continued from page 1 To create the latest report, Healthgrades analysts looked at Medicare Provider Analysis and Review (MedPAR) data from 2015 through 2017, which provides information on Medicare beneficiaries who access inpatient services. From the data dive, the report found: â€œFrom 2015 through 2017, if all hospitals as a group performed similarly to hospitals receiving 5-stars as a group, on average 222,210 lives could potentially have been saved and 157,210 complications could potentially have been avoided.â€? Healthgrades Chief Medical Officer Brad Bowman, MD, noted, â€œConsum-
ers have many choices for healthcare, but most important is understanding that there is a significant variation in care from hospital to hospital and doctor to doctor. In fact, hospitals within close proximity to each other can have significant differences in complication and mortality rates for the same condition or procedure. The analysis of hospital quality is intended to spotlight the importance of doing your homework before selecting your care. It could be a matter of life or death.â€?
National Health Index
At the same time Healthgrades
released the 2019 Report to the Nation, the organization also released its second annual National Health Index. Archelle Georgiou, MD, a senior advisor to Healthgrades, said the index looks at â€œwho is getting healthcare right.â€? A former CMO of UnitedHealthcare and author of the book â€œHealthcare Choices,â€? Dr. Georgiou noted, â€œWe recognize that healthcare is broader than just Archelle Georgiou, MD
WHO HEALS HIM? Admired. Respected. Relied upon. While being a medical professional is among the PRVWVDWLVI\LQJFDUHHUVIHZLIDQ\ MREVDUHĂ€OOHG with more pressure. The commitment it takes to be a doctor, nurse, WHFKQLFLDQRUĂ€UVWUHVSRQGHULVQRWRQO\SK\VLFDOO\ demanding but also mentally taxing and emotionally draining. As a result, mental health and substance abuse LVVXHVDIĂ LFWSURIHVVLRQDOVLQWKHPHGLFDOĂ€HOGDW higher rates than the general population. 7KH /DQGLQJ ZDV FUHDWHG VSHFLĂ€FDOO\ IRU SURfessionals like you in need of treatment, support and recovery. Our approach is informed by years of clinical expeULHQFH DQG FRQĂ€UPV WKDW high-functioning patients can be connected to the outside world and still realize treatment success.
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(CONTINUED ON PAGE 9)
Observations of Memphis
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the quality of the hospitals.â€? She continued, â€œHealth and healthcare is comprised of many different factors. To understand whether a city is getting healthcare right is complex, which is why Healthgrades compiled numerous industry data sets to help paint a more complete picture of healthcare at the local level in cities across the country.â€? Healthgrades analysts turned to four key sources to evaluate health and healthcare in 130 metropolitan areas across the country. Data was pulled from the Behavioral Risk Factor Surveillance System (BRFSS) 2016 survey at the MSA level, provider specialty information and patient experience survey scores from Healthgrades.com, 2017 population estimates from the U.S. Census Bureau, and the 2019 hospital quality rankings from Healthgrades. Dr. Georgiou said the team looked at 14 factors spread across four major categories. The big categories, she said,
Of 130 metropolitan areas reviewed, Memphis came in at 112. Archelle Georgiou, MD, a senior advisor to Healthgrades, said the city ranked significantly below average in the percentage of insured and in overall access. There were also low numbers of individuals visiting a dentist in the past 12 months and a higher-thanaverage body mass index (BMI). The city does have a good number of specialists and ranks well in terms of satisfaction with those specialists. While hospital quality rankings were below average, Dr. Georgiou noted that this doesnâ€™t mean good care isnâ€™t happening in Memphis. In fact, most of the cityâ€™s major hospitals had one or more five-star ratings in specific conditions or procedures but not as many across the 32 conditions considered as other cities. â€œWhen you compare it to the population and how other citiesâ€™ hospitals are performing, they will have more hospitals performing above average in more conditions . . . so itâ€™s like grading on a curve,â€? Dr. Georgiou explained. â€œThis is a wonderful start to looking at where your biggest opportunities are and where to invest,â€? she continued, suggesting using the data as a jumping off point for improvement.
Who’s, continued from page 8 were: “Do people have access to care? Is the population healthy? Do they have high quality hospitals? And do they have high quality specialists?” She said in addition to having some form of insurance coverage, analysts also considered the percentage of population that didn’t feel restricted from seeking care due to cost, including high deductibles and co-pays. The group also looked at preventive and behavioral measures including the percentage of people ages 50-75 who had a colonoscopy in the past 10 years, percentage of women 40 and older who had a mammogram within the last two years, percentage who had visited a dentist in the past 12 months, had a normal body mass index (BMI), reported physical activity within the past month, and the percentage of residents who reported having at least one person they identified as their personal healthcare provider. Hospital quality measures came from the latest Healthgrades rankings; and the team looked at the number of specialists per capita across multiple disciplines, as well as patient satisfaction with those specialists. “In order to have a healthy community, it’s all these different factors,” Dr. Georgiou said of the ingredients required to enable healthiness. Rochester, Minnesota, Burlington, Vermont, and Charleston, South Carolina, led the way this year. San Francisco, which came in at 17th on the list, was identified as having the healthiest residents. Worchester, Massachusetts, with an overall rank of 55, had the highest access to healthcare. Berlin, New Hampshire, which ranked last at 130, struggles with population health and availability of high quality hospitals and specialists. Yet, Dr. Georgiou noted, the area does have a high percentage of the population insured and an above average rate of those who can access care affordably. She pointed out every metropolitan area has different strengths and challenges to address. Some cities might need to focus on community programming or public works to create more opportunities for physical activity. Others might have to look at creative ways to entice more specialists to the area. The index, she noted, provides a starting point for those discussions and a snapshot for patients making decisions about their care. “I think the index is a step forward in our whole mentality around being consumer-focused. It looks at the full continuum from access and insurance all the way through to your personal behaviors,” Dr. Georgiou concluded. “The National Health Index is designed to help consumers understand the health of their community, to empower them to navigate their care journey with confidence and to help them access the right care in their market.”
Healthgrades’ Top and Bottom Twenty This is Healthgrades’ top and bottom according to its 2019 report. The entire Healthgrades Hospital Quality list can be found on its website.
The Top Twenty 1
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Eric Gibson Helps Practices Take Good Care of Business, continued from page 1 effectively becoming partners who share a strong interest in their mutual success. The rapidly evolving nature of the medical arena presents a challenge even to those whose business it is to keep abreast of changes, Gibson points out. “When I first started, technology was a little bit of an afterthought,” he said. “We didn’t have a lot of servers; we barely had email. Remote access was slow. Things have changed a lot. “The business itself has always been challenging from a standpoint of the money, billing, dealing with the insurance companies, trying to get paid, the rules ... but over the past 10 years, healthcare has gotten so much more complicated and complex with meaningful use, more compliance requirements, HIPAA, electronic medical records. … If you take a practice that didn’t have the basics already going well, then you add these further complications, it’s a quick disaster if you’re not careful.” A dual major in accounting and psychology from Union University gives Gibson a unique combination of strengths that provides an advantage in dealing with the two most frequently cited client complaints: billing and staffing issues. His first job was in Nashville with the national accounting firm of Arthur Andersen. The work honed Gibson’s natural tendency to focus on details — and question everything. Another position, in
which he served as controller and internal auditor with West Tennessee Healthcare in Jackson, gave him exposure to a healthcare climate that led to an interest in the physician practice side. He started in 1999 as controller and CFO with Uniphy Healthcare, where he met and worked with his current partner, Robert Burns. Together, they established ClearlyMD, LLC, in 2013. To go in and fix years of client mistakes, where things had not been done the right way, can be challenging and costly, he said. “So my advice is to get the right people doing the right job from day one. It’s worth the money to pay a professional to do an assessment every couple of years — like we pay a doctor for an annual physical exam — to make sure things are happening as they should — and there’s a heartbeat.” Even though it may not always be profitable, Gibson allocates about 20 percent of his time to troubleshooting for practices that need urgent care to stop the bleeding, and even assisting dying practices with palliative care to help them transition with dignity. If he can’t help, ClearlyMD will at least provide enough advice, consultation or references to help practices address the problems they face. “But I definitely prefer helping successful practices stay successful,” he added. As doctors and their businesses age,
he explained, they must have a long-term strategy to survive the next generation. “If you’re not bringing in new doctors or finding ways to create a 10-year future, then it’s just a matter of time,” he said. A common failing he sees in practices is a lack of attention to details, especially the billing and accounting for the money, exemplified by something as simple as the doctor taking cash for lunch one day. “It’s his money, he can do that, but he still needs to account for it, otherwise there’s no balancing out how much revenue he really generated: ‘You’re saying that you had money, but if it’s not in the bank, where is it?’” This attention to detail is what Gibson identifies as his strong suit. “I’m naturally a confrontational person who tries to verify; I have a healthy skepticism when it comes to the truth. If it’s true, you should be able to prove it and not take things at face value. I keep asking questions; I keep digging. I have to verify things.” Confrontation, as Gibson describes it, can be a good thing. “Especially in a complex business, you’ve got to ask great questions, which means you have to confront the answers.” Where others may not have the time to invest in critical thinking of this type, or the natural ability to size up root cause analysis, Gibson does, and he knows how to use it to their advantage.
So rather than expecting physicians to heal themselves and their practice management ills, such healing might best be undertaken with the guidance of professionals such as the ClearlyMD team — and, Gibson suggests, through supportive collegial relationships like those fostered within the Mid-South Medical Group Management Association (MGMA), where he is reportedly on track to become the 2020 president. “It’s probably more important now than ever,” he said, “to be plugged in. Being engaged with the local MGMA, with peers that are fighting the same fight, dealing with the same issues and challenges, and working together to find best practices and solutions for those problems, is critical to long-term success for both the small practice and individual doctors within large practices.” Gibson takes pride in the strong relationships his business has built and maintained with doctors for the past 20-plus years — and in his six children. “Having children has been a blessing,” he said. “I’m still learning how to be a good father.” His leisure pursuits range from reading to playing piano and writing music; and since the arrival of a new son, he has given up motorcycles to enjoy golf.
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Addy is a little cowgirl. Horses are her favorite animal, and she won't go anywhere without her boots. At St. Jude Children's Research Hospital®, her treatment for a type of brain cancer called anaplastic astrocytoma includes chemotherapy and proton radiation therapy. Families never receive a bill from St. Jude for treatment, travel, housing or food – because all a family should worry about is helping their child live.
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"I've never gone into a medical facility and felt as good as I do about St. Jude," said Addy's mom. "We've left here feeling like it was family. They've made everything that we've gone through, even cancer, as easy as possible."
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This year, B&G Foods will donate $350,000 to St. Jude Children’s Research Hospital® to support its mission: Finding cures. Saving children®.
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Packaging Recognizes Childhood Cancer Awareness Month The artwork of Shadyac Jr., president two young patients and CEO of ALSAC, from St. Jude Chilthe fundraising and dren’s Hospital will awareness organibe featured on one zation for St. Jude million bags of limited Children’s Research edition Green Giant Hospital. “We’re Veggie Tots during thrilled to partner the next few months. with this iconic brand As part of a partas Green Giant uses nership with St. Jude, its platform and popuGreen Giant worked larity to showcase our with patients to create patients’ stories and colorful drawings of the critical work of vegetables. Artwork by St. Jude Children’s Addy, age 4, and BaiResearch Hospital.” ley, age 13, is featured “We’re proud to on the new packagbring our partnership Addy ing that will be availwith St. Jude to the able in grocery stores freezer aisle in such a nationwide this fall. big way by featuring In addition to patient artwork and prominent promotion compelling stories on of St. Jude on Green our new limited ediGiant product packtion Green Giant Veggie aging, B&G Foods, Tots packaging,” said Inc., the owner of the Jordan Greenberg, Green Giant brand, Vice President and has donated $350,000 General Manager, to the organization to Green Giant. help St. Jude further “It was important its efforts in leading for us to release this the way the world timed to September understands, treats and Childhood Canand defeats childhood cer Awareness Month cancer and other lifeto bring awareness of Bailey threatening diseases. the important work To round out the donation, B&G Foods being done by St. Jude to help children employees have committed an additional and families.” $250,000 of their own dollars to the cause. Those wanting more information “Green Giant is incredibly generabout the limited edition tots or the ous in its support of St. Jude, our patients brand’s partnership with St. Jude, should and lifesaving mission,” said Richard visit stjude.org. memphismedicalnews
CONSOLIDATED MEDICAL PRACTICES OF MEMPHIS SALUTES HENRY STAMPS, MD
Dr. Stamps is an internal medicine physician who has practiced medicine for 17 years, in Collierville for the last 12 years. He graduated from the University of Arkansas for Medical Sciences, Little Rock in 1991. He did his internship and residency in internal medicine at the Naval Medical Center in Portsmouth, Virginia. Dr. Stamps is a primary care physician dedicated to treating patients from 18 years of age and older. He is affiliated with Baptist Collierville and Methodist Germantown Hospitals. Dr. Stamps is always working in the community to help people live healthier. He gives talks at the local YMCA and has participated on a radio show called “Ask the Doctor.” To refer a patient to Dr. Stamps, please call 901-854-1877.
We address the health care needs of those in the Shelby County region and surrounding areas by providing outstanding and compassionate care. Derene E Akins, MD Derene Reuben EW.Akins, Avila, MD MD Reuben W. Avila, Robert Burns, MDMD
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For more information visit our website: MedicalOfMemphis.com or call 901.751.0405 NOVEMBER 2018
Responding to Payer Audits By Kathy Doelling Health care payer audits are pervasive. We receive requests on a continual basis for assistance in addressing these and in assessing potential risks and liabilities associated with an audit. Audits can be time consuming and stressful, especially for the small group practice. There are several things for a Kathy Doelling healthcare provider Senior Compliance and Coding Advisor to consider when (901) 680-7215 responding to an kathy.doelling@ audit request from butlersnow.com Medicare, Medicaid or a commercial carrier. How an organization responds to an audit can have long lasting financial and/ or personal penalties for the entity and its personnel, therefore payer audits should be taken very seriously. We have put together the following steps that should be considered when responding to a payerâ€™s request for medical records or medical record audit. This list is not exhaustive, but does represent a sampling of items that we routinely discuss with providers facing an audit.
care, (v) equipment list, (vi) exercise and modality records, (vii) therapy evaluation, (viii) legend of abbreviations, (ix) name and credentials of all individuals rendering care to patients, (x) signature log, and (xi) proof of delivery forms. Note that this list is not a comprehensive list of documentation that an auditor could request. Also note that this information should be readily available and should be assembled by an individual familiar with the medical record system and the types of information the auditor is requesting.
8. Send the audit package to the payer via certified mail or return receipt requested. Keep a copy of the proof of delivery form. When appealing an audit, we recommend getting a signature from the appellate organization receiving your appeal and documentation to ensure evidence of timely submission. 9. In order to preserve your appeal rights, ensure your response is sent within the stated timeline. Commercial payer auditors are usually flexible to extend deadlines if you get that approved in writing, in advance. Note that Medicare will not extend a deadline, so filings must be timley.
SOME TAKE CREDIT. WE TAKE INITIATIVE. 3. Engage a certified coder to review all records prior to submission confirming (i) documentation supports the service billed, (ii) documentation was appropriately authenticated by the author, (iii) documentation was dated appropriately, (iv) all information reported on the claim is accurate. Although this is an up-front added expense, an independent review by a certified coder may raise concerns in a proactive sense and help the organization strategize in its response with the auditor to appropriately address identified issues.
10. Include a cover letter in response to all issues identified in the audit. 11. Consider contacting a health care attorney to assist you in responding to an audit if you have concerns that the audit may raise issues based on regulatory or policy interpretations.
The items listed above should be viewed as a starting point in responding to an audit not a comprehensive list of instructions. As a best practice and to avoid audit penalties, it is a good idea to affirmatively review payer 4. Do not alter medical records bulletins, manuals, program memoranda, 1. Ensure all payer correspondence is without appropriate and transparent medlearn articles, local coverage received by someone in the organization amendments, attestations, etc. determinations, local coverage articles, local who knows how to recognize and medical review policies, national coverage 5. Ensure that each page of the record is address an audit request. Make at least determinations, and society coding guidance copied completely and text is legible. one copy of the correspondence and on a regular basis to ensure that your save it electronically for reference in a 6. Number each individual page of the organization is in compliance with payer secure file. documents you are sending to the payer billing and record keeping policies. Finally, in consecutive order. If the auditor loses having an effective compliance program in 2. Carefully read the audit request letter Some legal teams are more concerned with pages, the numbering system will help a highly regulated industry like healthcare and provide all information requested, retain integrity of the submission. This Snow, is essential. The compliance program taking credit than initiative. At Butler but no more. A few examples of will also help both the provider and must include internal billing auditing and information payers may request are our teamwork approach allows with us to anticipate the auditor discuss concerns clear monitoring. This is a smart business practice (i) complete medical record for date reference to the medical record. and demonstrates that your organization GLEPPIRKIWERHXSÄŒRHGVIEXMZIWSPYXMSRW of service requested, (ii) results of is committed to act in accordance with diagnostic imaging tests orders, (iii) Keep copy of all documents you send After7. all, wea measure our success by yours.healthcare rules and regulations. treatment flow sheets, (iv) plan of to the payer.
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VA Memphis Chief Suggests Looking at the Improvements By BOB PHILLIPS
“VA Memphis is among the fastest improving medical centers in all of VHA,” David K. Dunning drew bell curves Dunning said. “Some of our biggest strides on a legal pad as he patiently tried to were in the areas of mental health, includexplain the Hospital Star ratings released ing suicide prevention, hospital complicaby the Department of Veterans Affairs. tions and sepsis recognition. Our hospital However, the ratings still were difficult for is far safer in every aspect than we were a visitor to understand. one, two or three years To start with, the ratago.” ings are not actually ratThe reason for the ings. impressive improvement is “Really, it’s a rankDunning himself, according system, not a rating ing to Thomas C. Fergusystem,” said Dunning, son, MD, the chief of staff the director and CEO of at VA Memphis. VA Memphis. “While he has only The VA says it issues been here since May, its Star System annually 2017, much has been “to evaluate and benchaccomplished since his mark quality of care delivarrival,” said Dr. Ferguery at VA medical centers. son, who has been at VA It is designed to help VA Memphis for 10 years. identify best practices of its He pointed to the top performing hospitals addition of major new David K. Dunning and share them across its equipment that was badly healthcare system to achieve system-wide needed. improvements.” “We are in the middle of installing the Although the one-star rating VA third of three new-generation CT scanMemphis received in October did not ners,” he began. “We have 244 beds and seem like an event to celebrate, Dunning every one of them is new. We have a new insists there is plenty to cheer about. And cardiac cath lab. And a new PET scanner if a visitor to VA Memphis takes a closer is coming. look, there is indeed plenty of evidence to “Plus, we’re getting a lot of help – persupport Dunning’s optimism. sonnel.” Even starting with the Star System He said the hospital’s culture has draitself there is progress – especially considermatically improved since Dunning’s arrival ing the improvement that has been made about 17 months ago. New employees have in the last three years. The report indicates been added as staff has increased and oththat VA Memphis made positive improveers, whose attitude was lacking, are no lonments in overall quality, with the largest ger there. gains coming in the key benchmarks: mor“Our staff now is happier, more tality, length of stay and avoidable hospital engaged and glad to be here,” Dr. Fergucomplications. son said. “Things are completely different “Three years ago, of 130 VA hospitals, now.” we were the worst,” Dunning said. “Much Dunning, an Army veteran who has changed.” reached the rank of colonel before retirIn 2016, of the 130 hospitals surveyed, ing after serving 30 years and 16 days, is VA Memphis was ranked 93 in Best Places the first veteran in more than 30 years to to Work by its own employees; in 2017 take charge of VA Memphis. Dr. FerguMemphis ranked 47, and this year VA son believes having a veteran in charge has Memphis is fourth. made a difference. Dunning, he says, has
an empathy with the patients – there is a special relationship. The patients respond to him, as do the employees. Dunning walks the hospital every day and makes it a point to talk with patients and employees. He makes it a point to find out what they need. “It’s the best way to find out how we can improve,” he says. “Morale has turned around; people are more engaged and happier. The culture has changed,” Dr. Ferguson said. “Employees now believe that when we say something will be done, it actually is done. For example, before, when we were promised we’d get new equipment, it never happened. We never got the funding. Staff lost confidence that things would get better. Now, when we’re told we’re going to get something – we do.” Again, the reason for that is Dunning. During his Army career, he was involved in finance and purchasing. He learned the art of getting what you ask for – a talent that is acquired over time when working for the government. Putting that talent to work has had a lot to do with VA Memphis getting $34-millon of badly needed new equipment since Dunning’s arrival. Plus, it was announced last month that the facility is going to get a new three-deck parking garage. “Believe it or not, the number one complaint when I got here was parking,” Dunning said. So he quickly took spaces reserved for employees and designated them for patients and visitors. At the same time he provided more parking for employees, but a bit further away from the front door. He also established free valet parking for visitors. Dunning, whose Army service includes service in Operation Desert Storm and a tour in Baghdad, also served at two military hospitals – Fort Polk Louisiana and in Hawaii. “This is my home now,” said Dunning, who for a time lived in Tennessee while growing up. “Memphis is similar to places I’ve worked in the past and I believe it has true potential to be a national leader among VA Centers.” Dunning knows there have been prob-
lems and VA Memphis has had its share of criticism. But he is quick to point out the improvements, such as new equipment, increased staff and better morale, improved mortality rates, shorter hospital stays, and, of course, vastly improved parking. He has seen the negative media reports such as a recent editorial that was highly critical. “They never came to see us,” he says. “Most of the negativity is now perception.” Those people, perhaps, are looking at the stars and not at the hospital.
Memphis VA Breaks Ground on New Parking Garage VA Medical Center Memphis broke ground this month for a three-deck parking garage on the west side of its campus at Jefferson Avenue and Pauline Street. The facility will provide 315 parking spaces, replacing the current 131 parking spaces in the present surface lot. The project is scheduled to be completed in September 2019. Foundation work is scheduled to begin late this month. “Parking at this Medical Center has been a concern for veterans for quite some time,” said David K. Dunning, VA Memphis CEO. “We are very pleased to get this project underway to increase parking availability on our main campus.” The hospital is located at 1030 Jefferson Avenue.
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GrandRounds Dr. Edward Scott to Participate in New Clinical Trial Edward P. Scott, MD will participate in a new clinical trial by Dendreon, maker of Provenge, the first FDA-approved (2010) autologous cell immunotherapy for tumors. According to a news release, the breakthrough sipuleucel-T treatment targets metastatic, hormone-refractory prostate cancer to improve survivability – and has encouraged other solid-tumor immuno-oncology researchers. The new ‘ProVent’ study will evaluate the drug’s efficacy in reducing or halting disease progression and/or delaying definitive therapies in 300 subjects against the disease progression and quality-oflife in 150 Active Surveillance subjects. Johns Hopkins’ research shows 30-40 percent of early-stage prostrate patients opt to delay or forego treatment to avoid often life-altering effects of radiation and surgery1. The study will begin enrolling inclusive, early-stage and late-stage patients for the 18 month investigative course later this fall.
A research affiliate since Dendreon’s original 2005 sipuleucil-T trial, Scott continues working with 70 patients annually referred by Mid-South oncologists for nonstudy Provenge cell-based therapy.
Urologist Paul R. Eber, MD of The Conrad Pearson Clinic, also a long-experienced
Provenge therapy facilitator will serve as a clinical trial investigative site clinician for the ProVent study. Scott and his Key Biologics medical team will conduct critical leukaphareses and proprietary cell processing of study patients enrolled in the targeted treatment group. Specialized WBC collections provide the antigen-presenting dendritic cells and T cells to Dendreon that are lab-incubated with a fusion protein to target prostate cancer cells, stimulated to mature, and returned to the patient by infusion. Each patient will undergo three tailored aphereses under the hematologist’s care.
Solaster Health Ofﬁcially Partners with Good Shepherd Pharmacy
Good Shepherd, Solaster Health Form Partnership Nashville-based Solaster Health has begun a partnership with Good Shepherd Pharmacy, which is based in Memphis and has served the underinsured marketplace since its inception in 2013. Good Shepherd will bring its pricing transparency and monthly membership platform to blockchain. Good Shepherd has more than 1,000 active members. In exchange for a fixed monthly membership fee, Good Shepherd members have access to medications at little to no cost with no markup.
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As a nonprofit entity, Good Shepherd Pharmacy does not accept insurance and is completely transparent about the true price of prescription medication—saving its members a significant amount of money per month. To bring this approach to a broader market, Good Shepherd will join Solaster’s decentralized health marketplace and build an updated solution on GoChain.
Smith & Nephew, HealthyHere Offer Mobile Medical Clinic Smith & Nephew has partnered with HealthyHere, a mobile medical clinic, to provide annual physicals, primary care, and follow-up care to employees. The HealthyHere mobile clinics offer portable ultrasound machines and other equipment necessary to perform exams in the vehicles’ private area. Lab work and biometric measurements also can be done on board.
Saint Francis’ Keith McClure Inducted into Tenet Heroes Hall of Fame Keith McClure, an assistant nurse manager of surgery at Saint Francis Hospital-Memphis, has been inducted into the Tenet Heroes 2018 Hall of Fame, Tenet’s highest honor for its employees. The Tenet Heroes program celebrates those individuals who make a meaningful impact within their respective communities that goes above and beyond their daily job responsibilities. Nominated by fellow colleagues, Tenet Heroes exemplify the company’s core values of quality, integrity, service, innovation, and transparency. McClure was selected for his leadership in the community, which centers around a faith-based 501c3 program that he and his wife, Sherry, a home healthcare nurse, founded in 2014. The program, which is named Merge Memphis, provides free meals in underserved neighborhoods. In addition, Merge Memphis delivers food boxes to supplement the food supply for those in need in Shelby and Desoto Counties. Merge Memphis operates 10 freestanding small food pantries. Stocked weekly by volunteers, the pantries have a note that says, “Take what you need and leave what you can.” Through a series of fundraising events, the non-profit is able to provide gloves, hats and scarves during the winter, and as its newest endeavor, Merge Memphis is working to open a shelter to serve homeless women in Memphis.
Rhodes Builds Impressive Med School Acceptance Record
John Pantall, Microsoft Certified 901.466.6358
Rhodes College has one of the top medical school acceptance rates in the nation. Eighty-six percent of Rhodes graduates with a GPA greater than 3.4 and an MCAT score greater than 57 percent have been accepted to medical
school over the last five years. Harvard, Vanderbilt, and Emory were among the medical schools where Rhodes graduates were admitted in 2018. Two graduates were awarded spots in the National Institutes for Health Medical Scientist Training Program, which provides a fully funded path to a PhD and MD. J. Carey Thompson, vice president of enrollment and communications, said, “Our pre-health advising program has a top-notch reputation, as proven by this year’s list of acceptances.” Rhodes offers pre-health advising to all students pursuing medical school or a career in the health professions. Mentorship begins as soon as students are admitted to the college and continues beyond graduation.
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Memphis Medical News November 2018