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FOCUS TOPICS ORTHOPEDIC SURGERY • IMMUNOLOGY • COVID-19 PREPAREDNESS

April 2020 >> $5 ON ROUNDS

Orthopedic Surgeon Replicates Nashville Practice in Rural West Tennessee Michael Calfee, MD, turned closed doors into thriving Advanced Orthopedics and Sports Medicine Watching rural healthcare decline around him, orthopedic surgeon Michael Calfee, MD, found himself with an opportunity to not only provide the best care possible to the residents of Obion and surrounding counties, but to also provide them with access to care that they may have otherwise had to look to bigger cities to find.

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West Tennessee Healthcare Prepped Early for Covid-19

Coordination, preparation and commitment is key to WTH Covid-19 plan BY SUZANNE BOYD

Benjamin Franklin once said, ‘By failing to prepare you are preparing to fail,’ and in the throes of the Covid-19 pandemic our nation is facing, those words ring very true. While West Tennessee is just starting to see the number of Covid-19 cases rise, West Tennessee Healthcare has a game plan in place and the prep work has been done to aid the area’s largest healthcare provider in meeting the demands of this pandemic. Key to the plan is coordination, preparation and commitment. While the world was just starting to hear of the Covid-19 virus early in 2020, West Tennessee Healthcare’s emergency management team said that experiences from the past have had them prepping and planning for something like this for a long time. Drawing on lessons learned from 9/11, tornados and H1N1, as well as those learned from other areas, have helped formulate an ever evolving and fluid plan. “We have been planning for a long time for really any disaster or pandemic that may come our way. While each (CONTINUED ON PAGE 4)

AARDA: Addressing Autoimmune Disorders through Awareness, Advocacy & Action BY CINDY SANDERS

When it works efficiently, the immune system is an elegant masterpiece of defense mechanisms warding off foreign invaders, including bacteria, cancers and the current novel coronavirus. For as many as 50 million Americans, however, a glitch in the system leads to chronic disease that can be difficult to identify and harder to manage. “The body literally turns on its own tissues with a disproportionate overreaction,” noted Randall Rutta, president and CEO of the American Autoimmune Related Diseases Association (AARDA). That internal attack manifests in scores of ways with targeted assaults on organs, tissues, joints, glands or the entire body. “We now believe there are at least 130 separately identifiable autoimmune diseases,” said Rutta. (CONTINUED ON PAGE 5)

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PhysicianSpotlight

Orthopedic Surgeon Replicates Nashville Practice in Rural West Tennessee

Michael Calfee, MD, turned closed doors into thriving Advanced Orthopedics and Sports Medicine BY SUZANNE BOYD

Watching rural healthcare decline around him, orthopedic surgeon Michael Calfee, MD, found himself with an opportunity to not only provide the best care possible to the residents of Obion and surrounding counties, but to also provide them with access to care that they may have otherwise had to look to bigger cities to find. In 2009, Calfee, who was practicing in Huntingdon at the time, had an opportunity to purchase a medical office building in Union City and took it, relocating his family to Union City as well. By 2012, he was practicing full time in Union City. “Before I came to Union City, there had been four orthopedists here, but that number was rapidly dwindling down,” said Calfee. “I was pretty much the only one in town and my practice has evolved tremendously over the years.” When he made the move to Union City, Calfee envisioned hiring a partner and he added physical therapy to his practice. The growth he expected did not pan out which meant he did not need a partner. In 2016, he also closed the physical therapy side of his practice and discontinued the athletic trainer component. All of this was done to allow him to focus more on his strengths and his practice. Just as doors were closing around his practice, one other closing in town resulted in a huge opportunity for Calfee. “In 2016, as I was closing down some of the elements of my practice, the Union City Surgery Center was also closing and I owned the building,” he said. “I needed something in there to generate revenue, but it would require a partner. I started calling everyone to help me restart it. And it was going to be a heroic effort since I would also have to convince Baptist to let me re-open it.” Calfee’s search led him to David DeBoer, MD, in Nashville. “His was a name I had heard forever because lots of people from the area were going to him, I approached him about helping me re-open the surgery center and he said ‘yes,’” said Calfee. “It took a heroic effort to jump through all the hoops and to get Baptist Memorial Healthcare to let us re-open it, but we did.” Partnering with DeBoer, says Calfee, has been a blessing. “He is in practice with six orthopedic surgeons who were well experienced in total joint replacement surgeries,” said Calfee. “We were able to draw upon their experience and evidence-based practices from Centennial Hospital in Nashville and replicating it in Union City. Since doing our first WESTTNMEDICALNEWS

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case in 2017, we have zero infection rate and our results have been really good. We have been tracking outcomes since day one. We typically have total knee or hip patients walking within an hour of their procedure and out the door in two, which is outstanding. People are happy and we are providing a really good service to our patients.” The center has done about 150 total joint replacement surgeries in the past

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three years. Calfee anticipates additional growth in 2020 since Medicare has approved outpatient total knee replacements in an ambulatory setting. “This has really helped these types of surgeries in an ambulatory setting take off,” he said. “Literature such as Becker’s Hospital Review indicates that in five years 50 percent of all total joint procedures would be performed in an outpatient setting such as an ambulatory surgery center.” In addition to podiatrists, Thomas Hodgekiss, MD, a pain management and regenerative medicine specialist is also a part of the team at the center. “He is an interventional radiologist that deals with pain management that does not involve narcotics. He also provides epidural pain treatments,” said Calfee. “He does a lot of spinal cord stimulation for chronic pain and is having really good results. If he was not here, patients would be having to go to Nashville for this type of treatment.” Calfee grew up in Cleveland Ten-

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nessee and earned a bachelor’s degree in Biology and Religious Studies from The University of Tennessee at Knoxville in 1991. He was accepted to medical school in his junior year and attended the University of Tennessee at Memphis for Medical School. He completed his residency at Campbell Clinic in Memphis. The following year, he completed a fellowship in foot and ankle medicine. “There was really nothing I cared about but orthopedics. In fact I was not really sure I was meant to be a doctor as I was to be an orthopedic surgeon. I really like to be able to help people, and it is pretty amazing what modern medicine orthopedics can do when we get it right,” said Calfee. “I feel like rural healthcare is on the decline. Having the Surgery Center and bringing the experts we have been able to bring in, means we can still provide a high level of care in the rural setting. I truly want to take care of the people of Obion County and surrounding areas as best I can.”

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West Tennessee Healthcare Prepped Early for Covid-19, continued from page 1 situation and its associated challenges are unique, they help us for the next time.” said Lyn Tisdale, Director of Respiratory Care for West Tennessee Healthcare. “We have stockpiled supplies Lyn Tisdale and have identified where additional beds can be pulled from as well as additional staffing in the event they are needed.” Director of Emergency Management Services, Kevin Deaton, says training in the past and multiple annual drills have also gone a long way in helping with the system’s emergency preparedness. “We have learned a lot, and communication is key,” he said. “We have to change things on the fly as new Kevin Deaton guidelines and updates come out which can be on a daily, if not hourly basis. We then have to push that out to all the points in the system and community that need to have it.” Amy Garner, Vice President/Chief Compliance and Communication Officer for West Tennessee Healthcare says relationships forged in the past on the local, state and national level have really come into play. “Knowing who to call, who to vet information through has Amy Garner been so beneficial as we ramp up efforts to meet the demands placed on the system,” she said. “All the players are at the table sharing information, ideas and best practices. It is really a ‘we are all in this together mentality’ across all lines.” Besides being the Executive Director of Emergency Services at West Tennessee Healthcare, James Fountain also serves as the Executive Director of the Watch Coalition for West Tennessee. Coalitions in Tennessee are aligned with the eight Emergency Medical Services (EMS) Regions. These coalitions work on planning, orJames Fountain ganizing, equipping, training, exercising and evaluation of healthcare system preparedness in their respective regions. Representatives from all healthcare related entities from assisted living facilities to hospitals to EMS and public health agencies meet monthly to discuss issues, plan, coordinate and prepare for issues such as this pandemic or natural disaster. The Watch Coalition serves 17 counites in West Tennessee. “Being in emergency management gives you a worst-case scenario mindset that makes you always think what if. When this first emerged in China, discus4

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sions started. When the first case was reported outside of China, our radar kicked in. When it showed up in Washington state, we realized the impact it could have on the elderly,” he said. “We started firming up our action plans because we knew it would make its way here.” The Watch coalition has played an integral part of WTH’s plans. “Coalition members have been working at various stages for some time updating plans, resources and numbers. We are all working together because when disaster takes place, we are all stronger together,” said Fountain. “Every day at 4pm, we hold a phone conference where we discuss everything from supply chain issues, resources to anything we need to send up to the state level. I also sit on the state advisory board and we have conference calls on Mondays and Fridays to discuss things we are experiencing in our hospitals so that we can work collectively to address issues across the state.” “Every disaster is a scalable event that requires that we plan at every level. Our plans have been adapted based on what we see happening in other places, but each area could be affected a little differently,” said Tisdale. “Our initial response is isolation rooms. As the case load increases, we will cohort patients until the need arises to designate floors or areas in a patient tower. Ultimately, we could designate an affiliate hospital for these patients. Having multiple hospitals and affiliates in our system means we also have plans to support them as well as move critically ill patients as needed.” Communication is key says Garner, who has seen her role as Public Information Officer for the system take on an entirely new role with daily, if not hourly, demands. “We have daily huddles with all hospital and clinic administrators to report challenges, bed capacity, equipment needs as well as solutions and best practices,” she said. “We are constantly in touch with other facilities and healthcare associations across the state and country sharing information.” “Tina Prescott, our Chief Operating Officer, runs daily conference calls with all administrators across the system in addition to other key personnel to maintain a system wide approach to things,” said Fountain. “I hold a daily conference call with the Emergency Department personnel and chief of nursing in addition to

after-hours calls as needed. It is imperative that we have a coordinated response so when we roll out information or a best practice at one place, it is done system wide. We are running 24/7 to stay in front of this and head things off as we can.” As larger areas in the nation are facing ventilator shortages due to the high volume of patients, the availability of those in West Tennessee is something Tisdale feels comfortable about. “Over there years we have allocated funds to purchase ventilators and maintain a stockpile of them. Other non-traditional ventilators have been ordered that we can use in the event they are needed,” he said. “Over my career, at our highest point we had 38 ventilators running concurrently.” In addition to equipment needs, adequate manpower is also an important part of the WTH plan. “We have one director tasked with maintaining and scheduling a list of providers to work. It is volume driven and we have a plan for pulling staff in when needed,” said Garner. “We have taken steps such as canceling non-essential surgeries to increase this pool of caregivers and providers.” “Protocols have been implemented for when a patient presents at a clinic or the emergency department. While we do not want someone to hesitate to seek medical attention, we are encouraging them to call ahead if they think they have the virus. If we suspect it could be a case, nursing staff meeting them outside and direct them to the appropriate entrance to be screened. We also screen visitors,” said Fountain. “While it may be an inconvenience, it is prudent that this process takes place so that we protect patients and staff.” One of the hardest decisions that has had to be made in this process has been limiting visitors. “We realize that if you have a loved one in the hospital you want to be with them. There is a human and an emotional element,” said Tisdale. “But it is what is best for the patient, the visitor and the general public. We want people to understand if they cannot be with their loved one, we are going to give them the best care.” Though the focus may seem to be on Covid-19, the reality is there are other patients that have to be cared for. “We still have the day to day illnesses, chest pains, traumas and such to take care of,” said Deaton. “One decision we made early on was the route we would take once we had

our first Covid-19 case. There is a flow chart we follow for every transport outlining communication with the ER, proper entrance to use, isolation rooms, etc. There are questions asked with every call we get so the process starts well before the ambulance arrives. We follow national standards for screening calls for potential patients who have symptoms so that we can alert medical staff to take proper precautions.” The level of anxiety in the community as a whole as well as the rapid spread of the virus throughout the nation are things that have surprised the team but what has not surprised them is that the greatest strength to fight this is people. “We have had things before, just nothing that has generated this much anxiety or concern,” said Tisdale. “But what I am most proud of is our people, as that is who is going to fix this problem. The level of commitment and teamwork being displayed daily has been amazing.” “The response from the community has been overwhelming. People are coming to the hospital and writing messages on sidewalks or on signs for our healthcare workers. There is a gentleman who stands out at shift change to pray for our staff,” said Garner. “Businesses are donating food and supplies. Churches are providing childcare. We are so thankful for all they are doing.” Despite the stress, Garner says morale is good. “We are staying in touch with those on the front lines, making sure they have what they need and that they are informed. Employees seem happy that we have taken that actions that we have. The hospital is not as chaotic and there is a sense of calm throughout the halls,” she said. “The staff and leaders that are emerging throughout all this is what I am so proud of. We have some phenomenal young leaders stepping up to the task.” While the WTH team has huddled up to address the ever-changing horizon, what this pandemic has also brought to the forefront is a heightened sense of teamwork, both from other players in the healthcare arena as well as from staff members and the community. “One thing people need to realize is that while healthcare workers are on the front lines, the average citizen has just as much of an impact as they have,” said Garner. “We have to rely on them to help stop the spread of this virus by following the protocols that have been implemented.”

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AARDA: Addressing Autoimmune Disorders, continued from page 1 Raising Awareness

AARDA was founded in 1991 by Virginia Ladd, who herself has autoimmune disease and was a leader in the lupus movement. Although support organizations and research efforts existed for a number of the more well-known autoimmune diseases including lupus, type 1 diabetes and rheuRandall Rutta matoid arthritis, Ladd began to wonder why there wasn’t an umbrella organization to advocate for all the diseases that fall into the autoimmune category. “We needed to understand the common denominator of those diseases,â€? Rutta said of the impetus to form AARDA. “Sadly, to this day, we still don’t fully understand the underlying causes of autoimmune disease.â€? While there are still many mysteries, Rutta said a lot has been discovered over the ensuing decades. Autoimmune disease primarily impacts women, often in their late teens, 20s, 30s and 40s as they are building careers and families. There is a familial component to developing autoimmune disease and having one disorder increases the risk of developing others over a lifetime. “Thirty percent of people who have a single autoimmune disease will actually have two or more,â€? explained Rutta, adding support for those with multiple conditions is exactly why AARDA is so unique and important. Even with an increasing body of scientific evidence, pinpointing a specific autoimmune disease is often a difficult endeavor for both patients and providers. Although some conditions like type 1 diabetes have definitive markers, most diseases in the autoimmune spectrum are much more difficult to identify. “The journey to diagnosis can take three to five to seven ‌ or even 10 ‌ years,â€? said Rutta. “It’s the rare person who on first referral gets to the specialist who will ultimately treat them.â€? Rutta noted getting the right combination of referral, diagnosis and treatment remains tough for many Americans. “One of AARDA’s key objectives is shortening that time to diagnosis,â€? he added. While providers are more aware of autoimmune disorders now, diagnosing still relies heavily on a process of elimination. “Fatigue is a shared condition across almost all autoimmune disease,â€? said Rutta. However, AARDA found the way fatigue is interpreted varies significantly by gender. Rutta said the organization funded a study several years ago focused on fatigue. Men who told providers they felt constantly fatigued were taken seriously. The women were often told everyone gets tired and were labeled chronic complainers. “There’s definitely a gender bias there,â€? Rutta stated. One of the problems, he continued, is accurately measuring levels of fatigue. While everyone does get tired at times, those with autoimmune disease typically face overwhelming fatigue that can make it difficult to even get out of bed at times. Rutta westtnmedicalnews

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said AARDA is proposing a collaboration with the Patient-Centered Outcomes Research Institute (PCORI) to better understand how fatigue is being identified as a first step toward improving measurement and benchmarking of the common symptom.

Advances

Despite ongoing diagnostic difficulties in autoimmune disease, Rutta said, “It’s still an area, from a medical science perspective, that’s advanced leaps and bounds.� After years without targeted medication options, there have been significant

advances more recently. “Increasingly, physicians can choose from multiple treatment options,� said Rutta. “Previously, the only option was to manage symptoms with steroids – often with severe side effects and lasting damage.� He continued, “What we have seen that has been life-changing advancements in biologics. These are breakthrough medicines produced by living organisms.� Rutta added the field has advanced to a point where biosimilars are beginning to become available, making treatments more widely accessible and affordable than the original branded biologics.

“Gene therapies hold a lot of promise that are just coming on the horizon,� continued Rutta. He noted with excitement that these newer developments could potentially lead to cure rather than symptom management. Newer rules and regulations for orphan and rare drugs have also helped. Through the FDA fast track program for breakthrough drugs, teprotumumab-trbw has just been approved to treat thyroid eye disease (TED), most commonly associated with Graves’ disease. The rare condition causes the muscles and fatty tissue behind

(CONTINUED ON PAGE 6)

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AARDA, continued from page 5 the eyes to become inflamed, causing the eyes to push forward and bulge outwards. Previously, the only hope to slow the disease was steroid injection or to surgically scrape sockets to try to make more room for the eye. “If this new drug is administered to someone during the five-year active phase of the disease, the result for many patients is to stop progression and even reverse harmful effects,” said Rutta. He continued, “This also speaks to why the journey to diagnosis needs to be faster.” To that end, Rutta also is encouraged by the discovery of more biomarkers and advancing diagnostic tools to improve time to treatment.

COVID-19

“We knew right away when the CDC started talking about underlying conditions, those with autoimmune disease would be included,” said Rutta. However, he added, much of the public messaging has focused on diabetes, heart disease and respiratory illnesses. Part of AARDA’s task has been getting the word out that everyone with any form of autoimmune disease is at higher risk for more severe disease with the current coronavirus. AARDA established a dedicated COVID-19 resource on the website to ensure accurate information is available. On the treatment front, he said, “COVID-19 has been very disruptive. For most people sheltering in place, they couldn’t just ask for an extra 30-day supply of medicine.” Drugs and biologics to treat autoimmune disorders are often expensive with high co-pays that could make it cost prohibitive to prepay for extra months, even if a patient could get it approved. Additionally, a lot of patients receive infusions or injections at hospital-based clinics. Between overwhelmed hospitals and patients trying to steer clear of potential coronavirus hot spots, it has made it difficult to receive treatment. Rutta said AARDA applauds emerging actions by the government and insurers to help patients stick with their treatment regimens during the pandemic, through extra refills, options for home treatment, and telemedicine. “Then, along comes the idea that hydroxychloroquine might treat the coronavi-

rus, and all of a sudden lupus patients and Sjogren’s patients, who also rely on it to survive, call their pharmacies and can’t get it,” said Rutta. “Those are real challenges for people with autoimmune disease. It’s causing fear and stress. If there’s one thing we know about autoimmune disease, it’s that stress exacerbates their condition.” AARDA, on behalf of the National Coalition of Autoimmune Patient Groups, is co-hosting a virtual national briefing with the CDC in early April to discuss aspects of the pandemic that are of particular relevance to their constituency. Additionally, Rutta said AARDA is actively talking to legislators about ensuring access to medications and approving additional sites of care, potentially even in a patient’s home, during the pandemic.

Ongoing Challenges

Ensuring patients have access to needed treatments isn’t uniquely a COVID- challenge. Instead, it is an ongoing battle for many. “Too often insurance plans and PBMs (pharmacy benefit managers) use step therapy – utilization management practices and policies designed to control costs that are medically appropriate for the general population,” explained Rutta. He added these policies often “cause unwarranted suffering and lasting damages for patients forced to take medicines they know will not help them or delay effective and prescribed treatments.” AARDA also looks to physicians to craft the coordinated, integrated care needed to manage autoimmune disease, and Rutta said treatment decisions should always be made by physicians in consultation with patients. “Providers must take a patient-centered view … trust the patient in their description of their condition,” he noted, adding it’s also critical to engage patients as active partners and advocates in their own health and wellness. Rutta urged employers, payers, legislators, providers and other decision-makers to keep those with autoimmune diseases in mind when crafting policies, treatment regimens and regulations. “If we can all understand autoimmune disease is a natural part of the human condition, we should make sure we aren’t putting any barriers in place to inhibit people from living their best lives as we look for cures or therapies to manage

Supporting the Science With so many unknowns about the underlying cause or causes of autoimmune disease, AARDA President and CEO Randall Rutta said the best way to find answers is to support the researchers asking questions. AARDA promotes innovation and discovery through a number of grants and programs. Direct research investment includes the Virginia T. Ladd Young Investigators Program, Noel R. Rose Scientific Colloquia, and Johns Hopkins Autoimmunity Awareness and Intern Diversity. The Autoimmune Research Network – ARNet – is a registry of more than 22,000 patients that serves as a common databank for researchers and clinical trials. Created in conjunction with other autoimmune disease groups, the goal is to improve representation in clinical trials, which often have exclusion criteria preventing those with chronic or multiple conditions from participating. Additionally, the goal is to increase equity by encouraging greater participation along gender, race, age and ethnicity. AARDA also supports science through education by hosting physician conferences to share information and foster greater collaboration, as well as seminars to educate and empower patients and families.

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GrandRounds Free Online Mental Health Resource for TN Healthcare Providers

Situations like the current COVID crisis illustrate the need for more resources to help Tennessee’s medical workforce cope with the intensity of the times. A new free online mental health resource is now available to address increased incidence of suicide, depression, burnout, and other mental health problems among Tennessee’s licensed health professionals. The Tennessee Professional Screening Questionnaire, or TN PSQ, launched in February and is available to health professions served by the Tennessee Medical Foundation’s Physician’s Health Program (TMF-PHP). Those include physicians (MDs and DOs), residents, interns, and students, as well as physician assistants, optometrists, podiatrists, chiropractors, x-ray technicians, clinical perfusionists, and veterinarians, both licensed and in training. The tool is accessible at tn.providerwellness.org and e-tmf.org/tnpsq. Physicians and other health professionals are on the front lines of this crisis and are stressed out, and that may not reach a peak for several months according to TMF Medical Director Michael Baron, MD. Interactive Tool This new statewide resource utilizes the Interactive Screening Program (ISP), an online tool created by the American Foundation for Suicide Prevention (AFSP). Initiated by the TMF with support from the Tennessee Board of Medical Examiners, Tennessee Medical Association, Tennessee Hospital Association, and State Volunteer Mutual Insurance Company, the TN PSQ is intended to help connect struggling health professionals with available mental health resources in their area. There are known barriers to getting help for mental health problems among doctors and other licensed health professionals. Confidentiality and existing stigma over seeking help, fears of career implications, and the perceived time and cost involved are all factors that can stop them from reaching out when they probably need it the most added new TMF Administrator Jennifer Rainwater. .  Key Principles The TN PSQ will be used strictly as a NON-crisis service, offering an anonymous, confidential online mental health screening that will result in referrals to

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appropriate mental health resources and optional interaction with a program mental health professional. This tool will be totally anonymous, voluntary, and the outcome completely driven by the user. The tool went live on February 3 and is being shared in a phased rollout by the TMF, state health professional licensing boards, TMA, THA, SVMIC, health professional organizations, regional and specialty societies, medical schools, and other partnering entities. Questions? For more information, contact the TMF at 615-467-6411 or online at e-tmf. org.

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GrandRounds Coronavirus Updates from West Tennessee Bone & Joint Clinic

JACKSON/PARIS – In these uncertain times and as the situation of the novel Coronavirus (COVID-19) continues to evolve, WTBJC is asking for your support in social distancing but still wanting you to know that we are available for your orthopedic and interventional pain procedures. We are constantly monitoring guidelines given from the CDC, World Health Organization and TN Department of Health. Our number one goal, as it has always been, is to keep our patients, employees and providers safe and healthy. We take great pride in our response to the coronavirus with additional cleaning and sanitary measures developed in consultation with our public health authorities and janitorial services. • Please call to reschedule your appointment if you are experiencing any flu like symptoms. • Unless the child is the patient, we ask that children under the age of 13 do not come to WTBJ Clinics. • We ask that no more than one person come with the patient at the time of the appointment. • We are asking that all sales, vendors and pharmaceutical representatives refrain from visiting our practices at this time. We are closely monitoring this ever-changing situation and will make changes as needed for the safety of our patients, staff and providers. If you have any questions or concerns, give us a call at our Jackson office 731-661-9825 or at our Paris location at 731-644-0474. Telemedicine We are constantly working to give our patients the best care we possibly can, so we are now offering telemedicine appointments. Visits most appropriate for a telemedicine visit could include post-operative follow-up visits, visits to review MRI and CT results, and visits to check progress or response to a treatment. Telemedicine involves the use of electronic communications such as a computer or phone. If a telemedicine visit is appropriate, our staff is happy to help get you setup for your telemedicine visit. Through the online app “OrthoLive©,” patients are able to have a faceto-face encounter with any of our providers offering this service in order to continue their care. While we are currently still seeing patients in our offices, telemedicine allows us to ‘see’ patients without requiring patients to travel to the doctor’s office. We offer new evaluations, check in with patients after surgery, order therapy or additional tests, and review results from MRIs all through our smartphones. Technology certainly has limitations though this is the one way it increases convenience for patients, provides continuity of care, and helps keep our community safer. OrthoLive is available for free on both Apple and Android devices. Appointments are available immediately and can be scheduled using the Orthowesttnmedicalnews

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Live app. You can also visit https://www. ortholive.com/patients. Call us at 888661-9825 if you have any questions. Patient Screening In order to ensure we are providing the safest environment for our patients, staff and providers we will be screening all of our patients. That will include: • Screening for ANY flu like symptoms • Temperature checks • Once you have been screened and check in we are asking you to return to your vehicle until your provider is ready for you Temporary West Tennessee Bone & Joint Physical Therapy Policy The care and safety of our patients and staff at West Tennessee Bone & Joint Rehab is our top priority. In accordance with the recommendations from the CDC, West Tennessee Bone & Joint is implementing the following temporary policies: • We ask that you cancel your appointment if you are experiencing any flu-like symptoms. • We will be screening each patient that arrives for treatment. If you are experiencing any flu-like symptom, you will be rescheduled. We have implemented enhanced cleaning procedures and will be spacing patient throughout the rehab department top honor CDC-recommended social distancing. During the COVID-19 crisis, our physical therapy hours are Monday through Friday, from 8 a.m. to 5 p.m.

Health System Restricts Visitors Further to Protect Patients and Staff

JACKSON - In our continued efforts to prevent the spread of illness of the novel coronavirus (COVID-19) and to protect our patients and healthcare workers, effective immediately, we are prohibiting visitors in our inpatient facilities with limited exceptions. NO visitors will be permitted to our inpatient facilities. The only exceptions will be: One parent or legal guardian of the patient who is a minor. Obstetric patients may have one support person to accompany them. Neonatal Intensive Care Unit (NICU) patients may have two parents who must remain in the room the duration of the visit. Patients at end-of-life may have a very limited number of visitors who must remain in the room for the duration of the visit. Patients undergoing surgery or procedures may have one visitor before and immediately after the procedure/surgery. If a single, approved designated visitor meets an exception, this individual must be determined at the time of hospitalization and may not be changed during hospital stay. To limit the spread of infectious disease, approved visitors will still be asked questions, to understand if they are ex-

periencing any symptoms such as fever, cough or shortness of breath. Visitors exhibiting flu-like symptoms will be prohibited from visiting patients. We understand that this may be difficult for visitors and patients, but these changes have been implemented to protect the wellbeing of all of our patients, providers and staff, which is our top priority. We reserve the right to further restrict visitation to our facilities as the situation changes. We are also coordinating our activities with our local health department directors and will follow guidance from them if they direct us to take additional actions that they deem necessary to protect the health of the public. We will continue to provide updates as we receive them.

Tennessee Doctors Unite in Opposition to Bill that Would Allow Nurses to Practice Without Physician Oversight A dozen healthcare advocacy groups are banding together as a coalition to ask the Tennessee General Assembly to reject legislation that would sever critical relationships between physicians and advance practice registered nurses and threaten patient safety and quality of care. The bill, SB 2110 / HB 2203, is sponsored by Sen. Jon Lundberg and Rep. Bob Ramsey. The sponsors and proponents, including the Tennessee Nurses Association, propose to change state law to remove requirements for nurses to maintain a collaborative relationship with a physician. Tennessee doctors say that while the current regulatory environment may be improved to create more efficiency for healthcare teams, existing laws provide a necessary framework for physicians, nurses and other healthcare providers to work together in delivering patient care. Each member of the healthcare team plays a vital role and should be able to work to the fullest extent of his or her education and training, but team members are not equivalent or interchangeable. Doctors have much more education, training and experience than any other team members and should remain responsible for determining safe, appropriate levels of autonomy according to Dr. Elise Denneny, a Knoxville otolaryngologist and current President of the Tennessee Medical Association. SB 2110 / HB 2203 is the linchpin of a renewed push by the Tennessee Nurses Association that seeks complete independent (unsupervised) practice for advance practice nurses in Tennessee. TNA has been unsuccessful in its repeated attempts for independent practice since 2014. TMA and other physician advocacy groups, meanwhile, are calling for more integrated and coordinated healthcare delivery, not more silos. Allowing nurses to diagnose and treat patients and prescribe medications

without any collaborative relationship with a physician would create more fragmentation in healthcare when the entire industry is moving in the opposite direction. Teamwork helps prevent misdiagnoses and missed diagnoses. It increases the capacity of our limited healthcare manpower in Tennessee. It makes us more efficient and effective in delivering quality care at the lowest possible cost added Dr. Denneny. Scope of practice is one of TMA’s top legislative priorities in 2020. The state’s largest physician advocacy organization has assembled a coalition of medical specialty associations to identify and promote best practices for physicianled, team-based healthcare delivery in Tennessee. The Coalition for Collaborative Care spent the past several months meeting with representatives of the nursing profession in good faith efforts to modernize collaboration rules but was unable to reach an agreement, as APRNs made clear they are unsatisfied with anything less than independent practice. The Coalition now has turned its efforts to educating lawmakers and the general public about the unnecessary risks associated with nurse independent practice, and alternative solutions for more efficient healthcare, particularly in rural, underserved areas of the state. The emergence of telemedicine, for instance, allows for more frequent and effective collaboration between physicians and the rest of the healthcare team despite geographic challenges. TMA is part of another coalition supporting a bill (SB 1892/HB 1669) that would define certain regulations and reimbursement protocols for telehealth in Tennessee. In 2019, TMA also led advocacy efforts that added $8.7 million in graduate medical education funding to the state budget. The additional funding will allow Tennessee to train and retain more doctors in Tennessee instead of exporting them to other states, and improve primary care access in underserved areas. The Coalition is also working on ways to address specific complaints by nurses about the availability and cost of collaborating physicians in rural areas. The vast majority of nurse practitioners in Tennessee practice in hospitals or group medical practice environments where team-based structures are the norm. The faction of APRNs who choose to establish their own clinics, however, are required by law to have a formal, collaborative working agreement with a physician and claim that they have difficulty finding doctors in rural areas to review charts and oversee patient care, or that the negotiated fees are unreasonable. The Coalition is advocating for the state medical boards to maintain a registry of physicians who are willing to collaborate with nurses in rural areas, and for the boards to set some parameters for appropriate fees.

APRIL 2020

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For over 100 years, Semmes Murphey Clinic has been a leader in neurological and spinal care. Our dedicated team of doctors provides cutting edge treatment options with compassionate, personal care.

SEMMES-MURPHEY.COM CALL (901) 522-7700

Profile for Medical News

West TN Medical News April 2020  

your primary source for professional healthcare news

West TN Medical News April 2020  

your primary source for professional healthcare news