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August 2019 >> $5 ON ROUNDS

Non-Surgical Healing for Sports Injuries Sports Medicine Specialist, Scott Johnson, MD, provides alternatives for those avoiding surgery Approximately 90 percent of all sports related injuries will not require surgery to heal, but they will require Sports Medicine specialists like Scott Johnson, MD, of Sports Orthopedic and Spine to provide the latest advancements in orthopedic care.

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Josse’s Travels Take Her To Key Role at Medtronic Helps Launch Important New Orthopedic Device Sharrolyn Josse admits she was fascinated with the field of medicine as well as travel at a young age. She was exposed to both through her father, a physician, while growing up in South Africa, Canada and the United States.

Story on page 4.

Considerable Surprises May Lurk in ‘No Surprises’ Legislation By DENISE BURKE, JD

The term “surprise billing” is used to describe the situation when a patient receives a bill for the difference between the outof-network provider’s fee and the amount covered by the patient’s health insurance, after co-pays and deductible. Patients often assume that providers such as radiologists, pathologists, physician anesthesiologists, emergency physicians and trauma surgeons are in-network because the treating hospital is innetwork, thus they are “surprised” that the charges are not covered by their insurance. The issue of surprise billing has been hotly debated by the 116th Congress as an estimated 40 percent of patients received a surprise bill in 2018. Multiple pieces of legislation have been proposed and it seems likely that legislation will be passed, although the exact substance is yet to be determined. There is considerable agreement between the proposals on protecting patients in emergency situations, but there are notable and important differences beyond that agreement. For example, the Cassidy Senate Bill (“Protecting People from Surprise Medical Bills Act”) prohibits surprise billing when a patient is seeking (CONTINUED ON PAGE 6)


Leading Through the Team Balancing clinical with administrative duties causes this director to really appreciate his team By SUZANNE BOyD

It would seem change is not something Andrew Jackson readily embraces. Outside of college, he has always lived in the same hometown. He has only worked for one company his entire career. And he even plans to drive the same car until it hits 500,000 miles, a goal he is well over halfway to achieving.

Even taking on the role of Director of Rehabilitation at Baptist Memorial Hospital in Union City only meant a slight change for the physical therapist because he now balances his administrative duties along with clinical ones. Jackson has always called Dyersburg home. His grandparents had a pediatric and (CONTINUED ON PAGE 5)











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Non-Surgical Healing for Sports Injuries Sports Medicine Specialist, Scott Johnson, MD, provides alternatives for those avoiding surgery By SUZANNE BOyD

Approximately 90 percent of all sports related injuries will not require surgery to heal, but they will require Sports Medicine specialists like Scott Johnson, MD, of Sports Orthopedic and Spine to provide the latest advancements in orthopedic care. As a sports medicine physician, Johnson is a valuable member of the clinic’s team, both in the office and on the sidelines. Johnson, a Wyoming native, earned his undergraduate degree in natural science and math from the University of Wyoming. After two years of medical school out of the States, he transferred to the Medical College of Georgia in Augusta to complete his degree. He remained at the Medical College of Georgia to complete a one-year internal medicine internship, train in emergency medicine and complete a residency in family medicine. Johnson knew that he wanted to combine his interest in sports with medicine but was not drawn to the surgical side of medicine. A sports medicine certification was the answer to his dilemma. Sports medicine physicians specialize solely in non-surgical sports medicine and are Board Certified in Emergency Medicine, Family Medicine, Internal Medicine, Pediatrics or Physical Medicine/Rehabilitation. They have completed one to two years of additional fellowship training in Sports Medicine, which includes significant specialized training in both the treatment and prevention of illness and injury. To earn a Certificate of Added Qualification in Sports Medicine, the physician must pass a national Sports Medicine certification examination, which must be renewed every 10 years. “The operating room is not some-

thing that appeals to everyone. I felt that I could make as much of a difference by bringing my family practice background into play and viewing the patient from that perspective,” said Johnson. “There are many sports injuries that do not require surgery, such as sprains and strains, that I can help the athlete recover from and get back to playing. For non-surgical patients, I can diagnose the issue and develop an appropriate treatment plan. For patients who require surgery, I can order tests necessary for the surgeon to do what needs to be done.” While in the first year of his family practice residency, 9/11 occurred and reignited Johnson’s interest in serving in the military. His father had served in the Air Force and Johnson had always thought he would serve his country in some capacity, but there never seemed to be a good time. “With my plan to go into sports medicine, which would require a fellowship, I knew that now was probably the

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best, if not the only, time to serve my country,” said Johnson. “So, I joined the Air Force in my first year of residency and earned a monthly stipend until I completed it. I then served on active duty for three years, one year for each year I had received the stipend plus one additional year.” Johnson was stationed at Columbus Air Force Base in Mississippi where he completed a primary course in aerospace medicine and served as a flight surgeon. He also became involved in aircraft mishap investigation. He was selected to serve on investigation boards for mishaps in Arizona and Oklahoma. Johnson served on an initial investigation team for his primary base in Columbus gathering information in the first three days after an accident that was then turned over to the investigation board. After leaving the Air Force in June 2009, Johnson completed a one-year fellowship in primary care sports medicine at Beacon Orthopedics in Cincinnati, Ohio. Part of his training included working with the team physician for the Cincinnati Reds baseball team, as well as with athletic programs at Xavier University and Wittenberg College. In 2010, Johnson completed his fellowship and joined the staff of Sports Orthopedic and Spine as their first full-time sports medicine physician. “Sports medicine physicians were becoming the norm in orthopedic practices. The practice had a part-time sports medicine physician prior to my arrival and saw the benefit of having one on staff,” said Johnson. “I can see, evaluate and diagnose most problems, whether they are sports related or not and I specialize in concussion management as well as ultrasound guided injections. Since I am in the Jackson office five days a week and the orthopedists

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tend to rotate to satellite offices, patients can usually get in to see me within 24-48 hours. I also help provide sideline coverage for area teams.” One of Johnson’s favorite duties at Sports Orthopedic is his work educating students and family practice residents. “We have several groups of residents each year who do a monthly rotation through the clinic. We also host athletic training students for six weeks,” he said. “Getting to work with and help teach these students is something I find to be very rewarding.” Another team that ranks high for Johnson is his family. He married his wife Christy while in college and today their family includes two elementary aged boys, Brooks and Braxton. “Family is first for me and we spend a lot of time traveling and going to sports events together,” he said. “Our faith and church are also a high priority for us. We try to serve and help others when we can. I am a Sunday school teacher and we have all done work for the Church of Jesus Christ of LatterDay Saints with organizations such as RIFA and through mission work in California.”

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Josse’s Travels Take Her To Key Role at Medtronic Helps Launch Important New Orthopedic Device




Sharrolyn Josse with the Mazor X Stealth Edition.

damage, and improves surgical outcomes. “It’s rare that robotics and navigation merge into a sole platform like this,” Josse said. “Competitors piece together parts of this technology, but Medtronic is the first to integrate the platform in the industry. The goal is to increase accuracy and safety in the operating room while driving down cost for the surgeon and patient. This means less time in the operating room, which saves money.” The product allows the surgeon to preplan surgery using a combination of three-dimensional imaging and navigation software so the surgeon can visualize the precise angle for the implant place-

curve for orthopedic surgeons who want to use the new technology. They must undergo product training at one of Medtronic’s three U.S. training facilities. “Work flow is extremely critical, so it’s important for the surgeon to use the same steps every time,” Josse said. “We want to reduce any variables. We train surgeons and their staff so there is a team approach and everyone knows their roles.” Josse says she has met patients whose lives were transformed as a result of the robotic-assisted surgery, including children. It’s given her tremendous joy and satisfaction to know she is helping to make a difference in patients’ lives. “If I had to have spine surgery, I would want to have this robotic-assisted surgery,” she said. Josse says her work to transform outcomes for both surgeons and patients is never ending. The key to her work ethic is to view all challenges as opportunities. In addition to product development, her team works on solutions to drive innovation to the U.S. and global markets, while meeting market price demands at the same time. Josse says the future of roboticassisted spine surgery with navigation will involve soft tissues in the spine. For instance, surgeons will be able to replace collapsed discs in the spine with roboticassisted surgery in the future. Josse moved to West Tennessee in 2016. She enjoys traveling to see her siblings, who live in different locations across the globe. She spends her spare time with her two children, ages 6 and 11, playing board games and attending art shows and school plays.

Medtronic’s Device Unites Robotics and Navigation Medtronic launched the Mazor X Stealth Edition in January earlier this year after acquiring Israeli-based Mazor Robotics last September for $1.64 billion. The acquisition combined Medtronic’s spine implants, navigation and intra-operative imaging technology with Mazor’s roboticassisted surgery systems. The Mazor X Stealth Edition combines robotic-assisted surgical technology from Mazor Robotics with Medtronic’s spinal navigation. “The marriage of robotics and navigation represents the future of computerized planning and execution in spine surgery,” commented Christopher R. Good, MD, spine surgeon at Reston Hospital Center in Reston, Va., director of Scoliosis and Spinal Deformity and president of The Virginia Spine Institute. “Robotics and navigation have both been shown to improve accuracy and precision in spine surgery,” Dr. Good continued. “The Mazor X Stealth Edition is a revolutionary new technology that uses The Mazor X Stealth Edition. cutting-edge software to plan the surgical procedure and then uses the robotic arm to guide implants and instruments through the steps of the surgical procedure with precision, while simultaneously using real-time imaging feedback to ensure the plan is being carried out as desired.” The U.S. Food and Drug Administration cleared the product for use last November. Medtronic reports the product has been used in 1,000 procedures in more than 50 hospitals in the U.S. since its introduction to the market in January.



Sharrolyn Josse admits she was fascinated with the field of medicine as well as travel at a young age. She was exposed to both through her father, a physician, while growing up in South Africa, Canada and the United States. She always thought she would become a doctor, but discovered in college she wanted to have a career that allowed her the opportunity to travel. It turns out, her favorite pastime led her back to the same field that fascinated her as a young girl. Upon graduation from college more than 20 years ago, a move to France unexpectedly led her to a career in business and product development for spinal implants and technologies – a profession she’s committed to two decades later. She is vice president and general manager of core spine for Medtronic. “I’ve always been drawn to the medical industry because of my father,” she said recently in her office at the firm’s expansive campus. “I discovered later that I was interested in the business side of things. I love coming up with ideas and innovations that make a difference in people’s lives. It gives me great joy to meet people whose lives have been directly impacted by a product. We are constantly working to extend lives and relieve pain.” Josse manages Medtronic’s core spine initiatives, which assist neurosurgeons and orthopedic surgeons with surgical solutions for patients with various spinal conditions. According to Josse, the company’s recent launch of the Mazor X Stealth Edition combines robotic technology, navigation and instrumentation to give surgeons precise trajectory guidance for spinal procedures, something that’s never been done before under one platform in robotic-assisted surgery. Robotic-assisted surgery isn’t a new concept to physicians in healthcare -- it’s been around for almost two decades -- but Josse says that combining a robotics platform with navigation software ensures that the surgeon can plan for more precision in the operating room while using threedimensional CT imaging to visualize how the implant interacts with spinal anatomy so there are no surprises during surgery. As a result, Josse says, it reduces the potential for complications, like nerve

ment. The surgeon determines the size and length of the screws and the location where the screws need to be placed. Then, the software guides the roboticsurgical arm into position during surgery based on the instructions given during the preplanning process. The surgeon can visualize, in real time, the exact area where the surgical instrument places the implant on the patient’s spine. “This ensures less room for error, so the surgeon can execute exact precision during surgery,” Josse said. The Mazor X Stealth Edition was launched in January after Medtronic acquired Israeli-based Mazor Robotics last September. Medtronic combined its navigation technology with Mazor’s robotic surgery systems to create the product, which was approved by the U.S. Food and Drug administration in November last year. Since January, Medtronic says the Mazor X Stealth Edition has been used in 1,000 procedures in more than 50 hospitals in the U.S. The product is so new that Josse says surgeons in the Memphis area have not yet to used it in spinal surgeries. She points out that there is a learning MEMPHIS MEDICAL NEWS PHOTO BY GREG CAMPBELL



Leading Through the Team, continued from page 1 family medicine office in their home in Dyersburg. His grandfather was the doctor, his grandmother the nurse. His uncle is a surgeon and his aunt is a pediatric nurse practitioner. With so much medical influence on his life, Jackson headed to Freed Hardeman University in the Fall of 1991, with a goal of doing something in the medical field. “I wasn’t sure medicine was what I wanted to do. While in college I felt like physical therapy (PT) may be a better fit for me,” said Jackson. “I started volunteering in a PT setting, and the more I was around it, the more I knew it suited me better than medical school. After graduating college in 1994, I went to PT school at UT-Memphis and earned my Physical Therapy degree.” It was during his last clinical rotation in the Fall of 1996, that Jackson’s career with the Baptist Health System began. He was assigned to the Baptist Hospital in Union City and was hired to work there after graduation. Initially he worked in the hospital setting but space was limited and as the outpatient population continued to grow, a new outpatient clinic was opened. Jackson moved to the larger 5000 square foot space when it opened in August of 1998. “Initially, there were just two physical therapists; one was the director and I was the other one. Since then, we have grown to four PT’s and five physical therapy assistants,” said Jackson. “In 2016, speech therapy was added to our service line when we hired a speech and language therapists. Today, due to growing demand, we have two full-time SLP’s on staff.” Shortly after the outpatient physical therapy clinic opened, Jackson was approached to take on the role of manager for the clinic. “The director of rehabilitation had been with the hospital for over 15 years. She was a practicing PT in the hospital and oversaw things there as well as at the clinic,” said Jackson. “My role as manager only took up about 25 percent of my time. The rest of the time was still focused on patient care. I handled the budget for the clinic, staffing, equipment purchases and expansion of services.” Two years ago, when the opportunity to take over as director of rehabilitation came his way, Jackson said it was more of a flip than a change. “When the director retired, it was an easy transition for me to step into the role. With the majority of my clinical practice being on the outpatient side, I stay at the clinic but still oversee the rehabilitation services at the acute care department,” he said. “I split my time

between the hospital and the clinic with one day devoted to just director responsibilities. The other days are clinical days with one afternoon being in the hospital department seeing patients and the rest of the time I am in the outpatient clinic seeing patients.” When asked how it is to be in the clinic but also overseeing the hospital department, Jackson gives all the credit to the staff for making the situation work. “They are phenomenal, professional, caring people. When you have good people working with you and supporting you,

it makes the director role easy,” he said. “We really are all a team and I feel like I am a team member, who just happens to be a director. I am pretty laid back and a good listener who loves to serve. Being available to patients and employees is very important to me and I feel like it’s an area I excel in.” Although it is considered a rural healthcare area, Jackson says they have therapists trained in specialty services such as lymphedema therapy, mechanical diagnosis and therapy (McKenzie method) and two that are trained in the

LSVT (Lee Silverman Voice Treatment) used with Parkinson patients dealing with voice impairment. While the majority of their patient population is surgical orthopedic patients, they are also set-up to see any other type of patients that need their services. “We keep our ears to the ground for opportunities to expand and grow our service lines to meet the needs of Obion County. Based on communication within the community and other providers in area, we gauge what direction we (CONTINUED ON PAGE 6)

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Considerable Surprises May Lurk, continued from page 1 non-emergency care by an out-of-network provider at an in-network facility. The version from the Energy and Commerce committee, (the “No Surprises Act”) would allow such billing if the patient is provided with written and oral notice and consent. The “Protecting People from Surprise Medical Bills Act” (HR 3502), would prohibit surprise billing for out-of-network after-emergency care when a patient cannot travel without medical transport, as well as for outof-network imaging or lab services when ordered by an in-network provider. The Senate HELP Bill would require that patients receiving out-of-network ancillary services only pay the in-network cost-sharing amount and unstable patients who receive services emergency services would be responsible only for the amount they would have paid in-network. The Senate HELP Bill would also require that patients be given advance notice of any out-of-network care, an estimate of the costs, and referrals for alternative options for in-network care. If a patient is not provided the required notice, the patient would not be responsible for the outof-network cost.

About the Writer Denise Burke is an accomplished healthcare attorney providing special regulatory counsel to private equity companies, hospitals, physicians, medical device companies and other healthcare clients on a wide range of complex regulatory/compliance, operations and transactional issues.  She is a prior Chair of the Tennessee Bar Association Health Law Section and was named a Fellow of the Nashville Health Care Council in 2016.  Burke has been consistently recognized by Best Lawyers for the past decade, including 2012’s “Lawyer of the Year” in healthcare law for the Memphis and West Tennessee area and as a “Woman of Influence” in 2017.  She is also ranked in Healthcare by Mid-South Super Lawyers ®. She serves as a member of the Advisory Board of the Institute for Health Law & Policy at the University of Memphis Cecil C. Humphreys School of Law and the Common Table Health Alliance.

The Senate HELP Bill proposes to set rates for practitioner or facility based on the median in-network contracted rate for services in that geographic area and does not include arbitration style provisions. The No Surprise Act and the Cassidy Senate Bill incorporate a dispute resolution process (that does not involve the patient) to resolve issues between providers

Leading Through the Team, continued from page 5 need to head,” said Jackson. “We added speech therapy based on requests from local physicians. We also knew no one in the area was providing lymphedema or LSVT therapies so we had some therapists trained so patients would not have to travel out of town for those therapies.” The limitations insurance places on the number of visits for patients has been a challenge but has also caused the staff to be more focused on patient education and involvement. “We don’t have an unlimited amount of time to see a patient, so every interaction with them has to give them tools to get them involved in their treatment at home,” said Jackson. “We also have to make a bigger difference in a shorter amount of time.” Being a part of a large healthcare organization has its benefits – one being a tremendous support network. “There are

a number of rural facilities in the Baptist family which means a network of folks facing the same challenges we do. I correspond daily with many of them by email and we meet monthly to share information. Most of the rural directors are still hands on clinically, so our roles are very much the same,” said Jackson, “I am also very fortunate to work for an administrator who is very supportive of our department and attentive to any issue we take to him.” Working in Union City and living in Dyersburg with his wife and two kids, Jackson says it’s as though he has two homes. “I grew up in Dyersburg and love that our children will too. I am also very blessed to have worked for 20 years with people who have become like family to me,” he said. “Family and faith come before anything else.”

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and health insurers when no agreement can be reached between the parties. The American Medical Association is supportive of alternative dispute resolution models, noting successful implementation in several states. While all stakeholders agree that patients need to be protected from surprise bills, it remains to be seen whether con-

GrandRounds St. Jude Included on U.S. News’ Most Distinguished List St. Jude Children’s Research Hospital has been ranked as the No. 2 pediatric cancer hospital on U.S. News & World Report’s 13th Annual “Best Children’s Hospitals” list. The publication ranks the 50 highest-scoring pediatric hospitals across the U.S. in 10 comprehensive specialties. The U.S. News Best Children’s Hospitals rankings rely on clinical data and on an annual survey of pediatric specialists. The rankings, which were announced at the end of July, methodology factors in patient outcomes, such as mortality and infection rates, as well as available clinical resources and compliance with best practices. St. Jude  is the only National Cancer Institute-designated Comprehensive Care Center devoted solely to children, having recently received the NCI’s highest ranking of “exceptional.” The hospital has top survival rates for some of the most common and aggressive childhood cancers, including acute lymphoblastic leukemia and medulloblastoma.  St. Jude  creates more cancer clinical trials than any other children’s hospital in the U.S., and unlike most hospitals, no family receives a bill from  St. Jude  for anything, including treatment, travel, housing and food. St. Jude  has maintained designated Magnet status by the American Nurses Credentialing Center. Magnet status is the highest honor granted to nursing services. Only 7 percent of all U.S. hospitals have achieved this recognition.

sensus can be reached or what unintended consequences may arise. For example, adoption of a fixed payment standard might incentivize insurers to rely on default payments rather than contract with providers to join networks. The legislation might also lead to broader rate setting for physicians. Myriad practical considerations will also need to be addressed. For instance, the logistics of implementing some of the proposed notice requirements in an Emergency Department seem daunting. Right now there appears to be general consensus among Democrats, Republicans and the president that the issue needs to be addressed but with the political climate as unpredictable as ever there are probably more than a few “surprises” in store.

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GrandRounds UTHSC Researcher Investigating Early Glaucoma Detection

Siamak Yousefi, PhD, assistant professor in the Department of Ophthalmology and the Department of Genetics, Genomics, and Informatics at the University of Tennessee Health Science Center, was awarded an exploratory grant of $499,229 from the National Institutes of Siamak Yousefi Health (NIH) to use artificial intelligence as a tool to detect glaucoma early or in the beginning of its progression. Glaucoma is a group of disorders that damages the optic nerve and can result in vision loss and complete blindness. It is the second-leading cause of irreversible blindness worldwide and more than 3 million Americans are living with the disease. Routine eye exams are necessary for an accurate diagnosis and to prevent eye nerve damage. However, Yousefi believes there is one important factor keeping many from seeking proper treatment. “Half of the people who suffer from glaucoma don’t even know they have the disease because it’s very hard to detect. There are no symptoms and the brain will adapt to some part of the vision loss,” Yousefi said. “This can happen all the way to early, and in some patients, the moderate stages of the disease.” To address this problem, Yousefi has partnered with Tobias Elze, PhD, assistant professor of Ophthalmology at Harvard Medical School to develop a joint artificial intelligence algorithm. The algorithm is a non-invasive procedure that will process retinal images to determine if a patient is at risk for glaucoma or in the early stages of the disease. The project is being funded for two years.

UTHSC’s Kim Wins Grant to Research Psychiatric Disorders

Il Hwan Kim, PhD, assistant professor in the Department of Anatomy and Neurobiology in the College of Medicine at the University of Tennessee Health Science Center, has been awarded more than $1.53 million to identify neural circuit dysfunction that may cause behavioral difIl Hwan Kim ficulties in several mental disorders. Difficulties with social interactions, as well as struggles with mental focus, are common symptoms in mental ailments such as schizophrenia, depression, and autism-spectrum disorder. Dr. Kim used basic medical knowledge like this from psychology, his first undergraduate college major, to establish his main research idea. “Schizophrenia, autism, and de-



pression patients share social symptoms, so that’s very helpful for doctors to know… But for scientists, that connection could be a variant for our approach,” Dr. Kim said. “So, I decided to forget about the name of the disorders and focused on the individual behavioral symptoms, then find the underlying mechanisms as my starting point.” According to the National Institute of Mental Health (NIMH), one in every five children and adults experience mental illness. In addition, nearly 60 percent of those with a mental illness did not receive mental health services in the past

year. Research shows approximately 90 percent of people who die by suicide show symptoms of mental illnesses, a rate that has not changed since it was tracked beginning in 1965. Dr. Kim’s hopes his innovative approach may provide a new framework for treating these psychiatric disorders in the future.

Physicians Quality Care OCCMed to expand

The bulldozers are in place and site work has begun on expanding Physicians Quality Care OCCMed facilities in Jackson. OCCMed is adding about 4,000

square feet to the north side of its current building at 2075 Pleasant Plains Ext. in Jackson. This expansion will not only benefit the clinic’s OCCMed patients, it will also create needed space for other Physicians Quality Care services, such as primary care, said Dr. Jimmy Hoppers, the company’s CEO. He expects work crews to be done in early 2020. Physicians Quality Care OCCMed provides occupational medicine services to West Tennessee’s industrial base. For more information, visit

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