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FOCUS TOPICS DENTISTRY • UROLOGY • MIPS

June 2018 >> $5

Strengthening the Connection Between Teeth and Heart

ON ROUNDS

Medicine & Music, the Perfect Duet Zapping kidney stones by day, rocking the town at night keeps Jackson Urological physician busy

Study: Periodontal Disease Connected to Risk of Heart Attack, Stroke By MADELINE PATTERSON SMITH

Those who argue that dentists could save their patients from a heart attack or stroke now can point to research that supports the claim. A new study is strengthening the link between periodontal disease and increased risk of heart attack and stroke. David R. Cagna, DDS, MS, is Associate Dean at the University of Tennessee College of Dentistry. “A lot of diseases that are in the mouth,” he said, “can have a global effect on the body.” He sees a future where “dentists and physicians will have to interact more frequently than they used to” as we continue to learn more about the links between diseases in the mouth and the rest of the body. The University of South Carolina School of Medicine’s Souvik Sen, MD, conducted one of the largest U.S.-based studies of periodontal disease, dental care and ischemic stroke. The results were published in the January issue of the journal Stroke, showing that patients with regular dental care had half the stroke risk of those who fail

Zapping kidney stones by day and rocking the town at night composes the perfect duet for urologist Don McKnight, MD. Whether seeing patients at Jackson Urological Associates, playing one of his five guitars with his band the Double Wides or writing and performing original music, McKnight is finding the perfect mix of healing arts and musical arts.

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Back from the Brink

USPSTF Issues Final Recommendation on PSA-Based Screening

Impeli Health’s investment breathes life back into Decatur County’s Hospital

U.S. Preventive Services Task Force last month published its final recommendation for screening men for prostate cancer. After reviewing the evidence, the task force issued a ‘C’ recommendation for men ages 55-69 with an emphasis on “informed, individual decision-making...

By SUZANNE BOyD

Building on its motto of keeping quality healthcare close to home, Impeli Health is putting its money where its motto is and saving one fledgling rural West Tennessee Hospital from closing its doors. The company that says it is dedicated to a high quality of management and preserving rural hospitals has purchased Decatur County Hospital for $1 million and will match that amount in improvements to the facility that will be renamed Riverside Community Hospital. With a focus on community health initiatives, revitalizing the facility and the staff, Impeli Health is focused on making this facility the role model for rural healthcare facilities. The plight of Decatur County Hospital started well before the County

Read the story on page 5.

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The new front elevation for Riverside Community Hospital is designed to have a river esthetic and improve patient access.

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The Region’s Most Trusted Care is Now in More Places Than Ever.

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We’re proud to welcome Dyersburg Regional, Regional Jackson and Volunteer Martin to our growing West Tennessee Healthcare family. Dyersburg Regional is now West Tennessee Healthcare Dyersburg Hospital. Regional Jackson is now West Tennessee Healthcare North Hospital. And Volunteer Martin is now West Tennessee Healthcare Volunteer Hospital. With these exciting additions, we can better serve more people in more places. In total, we now offer the region’s most trusted healthcare to over a million people across 22 counties. As the need grows, so too will our commitment. Looks like we’re going to need more pins.

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PhysicianSpotlight

Medicine & Music, the Perfect Duet

Zapping kidney stones by day, rocking the town at night keeps Jackson Urological physician busy By SUZANNE BOyD

Zapping kidney stones by day and rocking the town at night composes the perfect duet for urologist Don McKnight, MD. Whether seeing patients at Jackson Urological Associates, playing one of his five guitars with his band the Double Wides or writing and performing original music, McKnight is finding the perfect mix of healing arts and musical arts. The musical side of McKnight started developing in grade school when, as is the case for many kids, his mother made him take piano lessons. In high school, he thought the guitar would be a cool instrument to play so he saved up his allowance from working on his father’s farm to buy a guitar and taught himself to play. Though he grew up working on his family’s farm in Parkin, Arkansas, McKnight never had an interest in making it his career. “Science really appealed to me as did the thought of working with people,” he said. “I had an uncle who was an ophthalmologist in Little Rock, he practiced until he was 77 and very dedicated to his patients. He was a character and I enjoyed being around him. I thought that if this the kind of people in medicine, this is for me.” While in college at the University of Arkansas, McKnight worked as an orderly in a hospital in Winn, Arkansas which galvanized his resolve to be a doctor. McKnight earned his degree in zoology in just three years and entered medical school as one of the youngest in his class at UT Health Science Center in Memphis, Tennessee. Although McKnight initially thought he would join his uncle in his ophthalmology practice, his rotations in med school changed his mind. “I found I liked internal medicine, gastroenterology and surgery,” said McKnight. “Part of surgical rotation had me spending two weeks in urology. The residents had so much fun while working hard and it made me think there was really something to this. And thus, the decision was made.” After medical school, McKnight

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headed to Augusta, Georgia to complete his residency training in internal medicine and urology at the Medical College of Georgia. While in residency, McKnight and his first wife had their first two children. Following his residency, he and the family moved to Jackson, Tennessee where he joined Jackson Urological Associates and the McKnight family grew by one more.

“I never thought we would come to Jackson,” said McKnight. “I really thought I would be in Oak Ridge but then I found this practice that Drs. Yarbrough and Burleson had started. They needed someone and the more we talked, the more I realized this was the exact situation I wanted to be in. A good practice in a smaller town that would be a great place to raise my three kids.” After almost 26 years of practicing urology, McKnight still finds the combination of surgery and medicine the specialty offers to be really interesting. “I liked it at first because it offered the opportunity to do surgery without the busy night schedule a surgeon typically has,” he said. “And after all these years that holds true, just that we have gotten so much busier. With the patient population growth this practice has experienced, we are all working as hard as we can these days.” Robotics has played a part in the growth of the practice since 2009. “Dr. Lawrence and I really got behind the technology and realized it was something we needed here in Jackson,” said McKnight. “At the time it was pretty cuttingedge technology for our specialty and we

were the first two to be trained in it in this area. It has many applications for urology patients and is what we use in about 99% of prostate cancer cases.” The musical side of McKnight has also grown since coming to Jackson. “I’ve taken guitar lessons, learned to play bass, was part of a band made up of all doctors and now have five guitars, an electric bass and an upright bass which looks sort of like a cello just twice as big and produces lower notes,” he said. “I wish I had stayed with the piano when I was younger since it seems to be a lot more popular when you are 50 than 18. I understand music but still have to practice quite a bit.” “Besides playing for my church twice a week, I helped form a band called the Double Wides. We thought it was funny and it was either that or Three Cow Garage. We play mostly rockabilly and Americana style music as well as some covers, plus we have written and recorded several songs. Our EP is available for streaming on reverbnation.com. We play around town a couple times a month and hope to expand that to out of town as well.” McKnight remarried three and a half years ago. His wife Tracey is from Tullahoma and runs the pre-admission testing department at an area hospital. Four of their children have graduated college. The youngest attends UT-Knoxville.

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2018 MIPS Update: 10 Changes You Should Know About                                  By JAYNE COLLARD

In the new 2018 Quality Payment Program (QPP) Final Rule, the Centers for Medicare and Medicaid Services (CMS) has outlined a wide range of changes to its value-based care programs. Are you and your EHR vendor prepared? 2018 marks the second year of the Merit-Based Incentive Payment System (MIPS), and the requirements are definitely ramping up and posing more of a challenge. However, CMS’ MIPS is nothing to be too scared of—as long as your practice has the right technology to streamline your MIPS data collection and submission. So what’s specifically changing? In case you don’t have time to read all 1,653 pages of the 2018 Quality Payment Program Final Rule yourself, here’s an overview:

1. Payment adjustment increases to +/-5 percent.

CMS is raising the stakes for 2018—if only by 1 percent. This past year, providers could earn up to a 4 percent positive or negative adjustment on their Medicare reimbursements (applied in 2019) depending on their MIPS performance, but that percentage increases to +/-5 percent for 2018 (applied in 2020). This means that if your practice bills $1,000,000 in Medicare per year, then your MIPS performance could earn you a $50,000 bonus or penalty in 2020. And since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS’ MIPS program to be budget-neutral, that bonus could increase by an additional adjustment factor if more providers earn a negative adjustment than anticipated.

specialty or location. CMS simply requires that they report as a group across all performance categories and meet the same MIPS requirements as non-virtual groups. Once MIPS reporting is complete, all group members will receive the same score and Medicare payment adjustment percentage. The idea is that by sharing the reporting burden and combining their strengths, providers may be able to earn higher MIPS scores together than individually. To learn more, download CMS’ MIPS Virtual Groups Toolkit.

7. Extreme and uncontrollable circumstances exemption added ability (PI; formerly Advancing Care Information) base measures. For the 2018 performance period, you’ll need 15 points or more to avoid the negative adjustment in 2020. While this is a 400% increase, it could still be as simple as completing 2-3 Quality measures, four IAs or all PI base measures. For practices that are already strong MIPS performers, this minimum threshold change will have little impact. The exceptional performance threshold required for positive adjustments will remain at 70 points.

4. Cost category takes effect

In its first year, MIPS scored providers on three categories: Quality, PI and IA, with the Cost category weighted at 0%. Starting in 2018, MIPS adds a 10 percent weight for the Cost category, which is based on Medicare Part B claim

ophthalmologists, rheumatologists and oncologists. We’ll take a closer look at the Cost category in an upcoming blog post, so stay tuned!

5. Category weights change

The Quality category was originally proposed to remain at 60 percent of the MIPS CPS in 2018, with Cost not factoring in until 2019. However, the 2018 QPP Final Rule introduced Cost this year at 10 percent, so CMS is decreasing Quality’s weight to 50% to compensate. The PI and IA categories will remain at 25 and 15 percent, respectively.

6. Virtual group participation option introduced

With many small practices concerned about their ability to succeed independently under MACRA and MIPS, CMS

3. Performance threshold increases to 15

For the 2017 performance period, providers could avoid the negative Medicare payment adjustment in 2019 with a MIPS Composite Performance Score (CPS) of just three points. This could be easily achieved by submitting either one Quality measure, one Improvement Activity (IA) or all Promoting Interoper4

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8. Small practice bonus instituted

In an effort to further reduce the MIPS reporting burden for small practices, CMS will automatically award qualifying practices a bonus of up to 5 points. Practices must have 15 or fewer ECs and submit data on at least one performance category to be eligible.

2. Low-volume threshold goes up

In 2018, providers with ≤$90,000 in Part B allowed charges or ≤200 Part B beneficiaries will not be subject to MIPS. Compared to the 2017 MIPS threshold of ≤$30,000 in charges or ≤100 beneficiaries, this is a significant increase. The 2017 threshold already exempted a large proportion of Medicare Part B providers, and this 2018 change will exempt even more.

In the wake of Hurricanes Harvey, Irma and Maria, CMS has added new hardship exemptions for physicians who cannot meet MIPS reporting requirements due to hurricanes, natural disasters or public health emergencies. These will apply to the 2017 Quality Payment Program performance year as well as 2018, and the application deadline for hardship exceptions will be December 31 each year. How does it work? If affected clinicians don’t submit any data, they will be exempt from penalties. Meanwhile, those who do submit data will be scored on the data they submit, but the categories will be reweighted. If you were impacted in 2017, you may submit an application for reweighting of the PI category. Even if you don’t submit a PI application, CMS will automatically exempt you from Quality, Cost and IA for 2017.

9. 2014 CEHRT permitted and 2015 CEHRT bonus created

submissions. Because eligible clinicians (ECs) already submit this claims data to CMS, they will not need to send any additional data to report the Cost category. More specifically, Cost scoring is based on the Medicare spending per beneficiary (MSPB) and the total per capita costs for all attributed beneficiaries measure. This could have an enormous impact on the scores of clinicians who frequently prescribe expensive Part B drugs, such as

has introduced a virtual groups option that can allow ECs to benefit from group reporting without actually joining a group or selling their practice. To form a MIPS virtual group in the Quality Payment Program, a solo practitioner or group of 10 or fewer ECs must come together virtually with at least one other solo practitioner or group to participate in MIPS for a year. Group members do not need to be in the same

Originally, CMS planned to allow 2018 MIPS data submission only from 2015 Certified Electronic Health Record Technology (CEHRT). Instead, it has now decided to continue allowing ECs to use 2014 CEHRT—a relief for both vendors and providers. However, CMS is offering a 10 percent bonus in the PI category to providers who report with 2015 CEHRT.

10. New ePrescribing and HIE exclusions established starting 2017

To allay concerns about the difficulty

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USPSTF Issues Final Recommendation on PSA-Based Screening By CINDY SANDERS

U.S. Preventive Services Task Force last month published its final recommendation for screening men for prostate cancer. After reviewing the evidence, the task force issued a ‘C’ recommendation for men ages 55-69 with an emphasis on “informed, individual decision-making based on a man’s values and specific clinical circumstances.” For men aged 70 and older, the task force issued a ‘D’ recommendation, noting such screening would not routinely be advised as potential benefits do not outweigh harms. The recommendation applies to all adult men who have no signs or symptoms of prostate cancer and who have not previously been diagnosed with the disease – including men at increased risk for the cancer. However, the recommendation statement incorporates specific sections to address higher risk populations with additional information for these men and their clinicians to consider during the decisionmaking process. While the final recommendation letter grades didn’t change from the draft report issued last year, USPSTF Vice Chair Alex Krist, MD, MPH, said some of the wording was refined after reviewing the feedback submitted from various stakeholders during the public comment period. “It’s a little bit clearer that we’re trying to cue patients and clinicians in the factors that might lead a man to be screened or not be screened,” he said, adding there is an increased focus on this being an individual decision. “Prostate cancer is one of the most common cancers to affect men, and the decision whether to be screened is complex,” Krist noted. “Men should discuss the benefits and harms of screening with their doctor so they can make the best choice for themselves based on their values and individual circumstances.” While the routine use of prostatespecific antigen (PSA) screening elicits strong opinions both for and against, Krist pointed out the evidence-based USPSTF recommendation aligns with a number of other organizations, including the American Urological Association (AUA). While specific screening recommendations from the AUA, American Cancer Society, National Comprehensive Cancer Network, and USPSTF are somewhat varied in the details, all stress a shared decision-making component between patient and clinician. Krist – who is a professor of Family Medicine and Population Health at Virginia Commonwealth University, an active clinician, and director of community-engaged research at the Center for Clinical and Translational Research – said it is important for a physician and patient to talk about the clinical implications of screening in the context of that patient’s particular circumstances. “For some men, it may not even need a discussion,” he noted of patients facing competing health concerns that would westtnmedicalnews

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significantly reduce or eliminate the need to worry about prostate cancer, which is typically slow growing. For others, who are at higher risk for the disease and expected to live more than 10 years, the decision should be weighed in terms of benefits versus harms. There are three major concerns tied to PSA screening, said Krist. The first is the number of false positives as a result of test-

ing. Krist noted, “240 men out of 1,000 will have a high PSA . . . and approximately 140 of those are false positives.” There are a number of reasons why a man’s PSA level might be elevated from cancer to an enlarged prostate or inflammation of the prostate. Krist said many of those with elevated PSA levels will go on to have a biopsy for a definitive diagnosis. In addition to stress, there are other potential side ef-

fects with biopsy including pain, bleeding and infection. The second concern, he continued, is over-diagnosis. “Of those screened, 100 out of 1,000 men will be diagnosed at some point in their lifetime (with prostate cancer), but 20 to 50 percent of them will be over-diagnosed,” Krist said. “That’s a really hard concept for people to grasp be(CONTINUED ON PAGE 7)

DR. KELSEY DEXTER Endocrinologist

Board Certified: American Board of Internal Medicine; American Board of Endocrinology Fellowship: Endocrinology, Diabetes & Metabolism, University of Colorado, Anschutz Medical Center, Aurora, CO Memberships: American Association of Clinical Endocrinologists; American Diabetes Association Internship: University of Tennessee at St. Thomas Midtown Hospital, Nashville, TN Residency: University of Tennessee at St. Thomas Midtown Hospital, Nashville, TN Medical School: University of Tennessee Health Science Center, Memphis, TN Undergraduate: Vanderbilt University, Nashville, TN

North Campus

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Back from the Brink, continued from page 1 Commission voted to close the facility back in January 2018. The 45-bed facility in Parsons, Tennessee had been relying on county funds to barely stay afloat to the tune of $200,000 a month for some time. If the county had not voted to close the hospital, it would have been closed by the state. Had the facility closed, it would have been the ninth such rural hospital in the state since 2012. Impeli executives expressed an interest in purchasing the facility the day after the initial vote to close. “I had been talking to County Mayor Mike Creasy and others, so we were aware of the situation. I knew I could make a difference here,” said Kelly Codega, Impeli’s Chief Operating Officer and CEO of Riverside Community Hospital. “There were signs around town in people’s yards that said Kelly Codega save our hospital and we wanted to. It took a couple of votes but in February the commission voted unanimously to sell us the hospital and the closing process was stopped. We took over the management contract March 1.” Under the terms of the sale, the hospital will revert from being a public nonprofit entity to a private for-profit one and will be known as Riverside Community

Hospital. While final approval from the Attorney General is expected in the next few weeks, Impeli has taken over management of the hospital and the arduous overhaul process has begun with signs of improvement already evident. The hospital has been repainted, equipment added and updated as well as plans to change the front elevation to make the hospital entrance more accessible and convenient for patients. Census is up from one patient on the day Impeli took over to an average of 35. Staffing which was at a bare minimum has been increased, which actually decreased overtime costs saving the hospital money. “In the first few weeks everyone was nervous about us being here, then they realized we are here to stay and are serious about making this a better hospital. There was more progress made in 30 days than had been in the past five years and that generated a lot of excitement,” said Codega. “We even had some key former employees return that have brought a wealth of knowledge with them.” On April 16, the facility underwent a recertification audit which Codega says was one of the best things that could have happened. “It was a comprehensive inspection and we had very little time to prepare,” she said. “Our whole team rallied together, worked long hours without complaining. To accomplish something of this magnitude was very exciting and really made the staff feel like they are part of a team that has our support.”

While the facility is moving toward Joint Commission accreditation in the next 18 months, all policies, procedures, instruments and equipment are up to date. “We are a full functioning facility and a lot goes on here. We want to make sure the community knows all we have to offer, patients get good care and that we have a good referral network,” said Codega. “So that the patient goes to a place that is best for their diagnosis.” Though she is excited about the direction things are heading, Codega says she still gets overwhelmed at times because there is long way still to go to get there. “We want to make sure we are paying attention to quality health initiatives in the community. To that end, starting in July we will be offering free blood pressure checks on Tuesday afternoons and are hoping to have some health fairs,” she said. “We are also trying to recruit primary care doctors, update managed care networks, establish an allergy clinic and have more women’s health options. Eventually we want to have satellite specialty clinics in surrounding areas, so folks do not have to drive so far for care.” Codega, who has previously worked in marketing and physician relations for Baptist Memorial Healthcare Corporation and Baptist Medical Group, says that going through the West Star Leadership program in 2016 had a big impact on her. “We saw counties that were thriving, those that were struggling and ones that had lost their healthcare facility. It made me so aware of the need to have access to healthcare,” she said. “I had felt a

tremendous calling and this opportunity was an answer to my prayers. My entire career prepared me for this, so in December I resigned from Baptist and started the management group here in March with my Impeli partner Blake Gowder.” Gowder and Codega head the administrative team at Riverside Community Hospital. Both have tremendous passion for small hospitals and bring a plethora of knowledge and experience that will greatly benefit Riverside Community Hospital and the community. Codega said that the outpouring of support they have received from the community has been amazing. “It will take an army to keep hospitals in rural areas and this one is going to be a challenge. But I believe in keeping healthcare at home and I believe in this hospital,” said Codega, who many in the community have come to refer to as mighty mouse. “We want to make sure we do this right and do this well. We don’t plan on managing the hospital, we plan on becoming part of the community and living here.”

Impeli Health Care Group

Impeli Health Care Group, which is licensed in the states of Tennessee and Georgia was established in March 2016. It has four divisions: hospital acquisitions, management and consulting, imaging centers and healthcare technology. Decatur County Hospital is the first hospital to be acquired by the group as part of its plan to preserve healthcare in rural areas by building healthy communities.

2018 MIPS Update: 10 Changes You Should Know About, continued from page 4                               substantially improve health outcomes or reduce costs. However, for many physicians and industry associations, this relative leniency comes as a major relief. To learn more and view the full list of calendar year (CY) 2018 MIPS changes, check out CMS’ 2018 Quality Payment Program Final Rule fact sheet.

The Bottom Line

of meeting certain measures involving ePrescribing and health information exchange (HIE), CMS has introduced new exclusions that would allow ECs to claim the exclusion from one or both of those measures and still earn a base score. It’s important to note that these exclusions are being applied to the 2017 performance year as well as 2018. Who’s eligible? To claim the eRx exclusion, a provider or group must write fewer than 100 permissible prescriptions during the reporting period. For the HIE exclusion, they must refer or transition fewer than 100 times during the reporting period.

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Analysis

With these new rules, CMS is continuing to ramp up the reporting requirements as planned, building up to full MIPS implementation in 2019. In response to concerns from the healthcare community about the burden of Quality Payment Program reporting, CMS is also focusing heavily on easing the transition and accommodating real clinical workflows. Especially for small practices, the new Quality Payment Program rules provide additional flexibility and incentives in a wide variety of areas. As a result, some organizations have actually criticized CMS for not challenging providers enough to

Value-based care is here to stay, but it’s reassuring to see that CMS continues to listen to feedback from the healthcare community. And ultimately, meeting these new MIPS requirements doesn’t require an enormous amount of time and resources – it just comes down to whether you have the right tools. With the performance periods for Quality and Cost beginning on January 1 for all MIPS-eligible clinicians, now is a good time to evaluate whether your current EHR system will be able to support your MIPS success in 2018. A robust MIPS solution should be able to

collect reportable MIPS data during the exam, track and benchmark your CPS in real time and submit your data directly to CMS. Plus, consider augmenting your technology with personal guidance from certified MIPS coaches  who are also experts in your EHR system. When you’re equipped with comprehensive MIPS support tools from a proven MIPS performer, you can gain peace of mind while helping increase your Medicare income. Reprinted with permission from Modernizing Medicine. Modernizing Medicine and its affiliated companies empower physicians with suites of mobile, specialty-specific solutions that transform how healthcare information is created, consumed and utilized to increase practice efficiency and improve patient outcomes. Built for valuebased healthcare, Modernizing Medicine’s data-driven, touch- and cloud-based products and services are programmed by a team that includes practicing physicians to meet the unique needs of dermatology, gastroenterology, ophthalmology, orthopedics, otolaryngology, pain management, plastic surgery and urology practices, as well as ambulatory surgery centers. For more information, please visit www.modmed.com. 

About the Writer Jayne Collard is the Manager of Advisory Services at Modernizing Medicine and is a Certified MIPS Health Professional (CMHP). She leads an EMAzing team of MIPS Advisors for both EMA and gMed while living and working out of Colorado.

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Strengthening the Connection, continued from page 1                                  to see their dentist regularly. However, researchers hesitate to draw a causal link because periodontal disease, strokes and heart disease are complex health conditions with multiple Dr. David R. Cagna causes and are all exacerbated by smoking. The European Journal of Preventive Cardiology published a study early this year showing a connection between periodontal disease and heart disease, especially in men who smoke. “In men, tooth loss was associated with an elevated risk of coronary heart disease,” the report stated. “The magnitude of these relationships was, however, modest such that the greatest increased risk associated with tooth loss was around 10 percent.” When studying the female subgroup, the researchers found “the general pattern of an increased risk of coronary heart disease with a greater degree of tooth loss re-

PUBLISHER Pamela Z. Harris pamela@memphismedicalnews.com EDITOR Pepper Jeter editor@westtnmedicalnews.com SALES Kristen Owensby 219-781-1744 kristen@westtnmedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com GRAPHIC DESIGNERS Susan Graham, Katy Barrett-Alley CONTRIBUTING WRITERS Suzanne Boyd, Jayne Collard Cindy Sanders, Madeline Patterson Smith All editorial submissions and press releases should be sent to pamela@memphismedicalnews.com Subscription requests can be mailed to the address below or emailed to pamela@memphismedicalnews.com. West TN Medical News is now privately and locally owned by Ziggy Productions, LLC. P O Box 1842 Memphis, TN 38101- 1842 President: Pamela Harris Vice President: Patrick Rains Reproduction in whole or in part without written permission is prohibited. West TN Medical News will assume no responsibility for unsolicited materials. All letters sent to West TN Medical News will be considered the newspaper’s property and unconditionally assigned to West TN Medical News for publication and copyright purposes.

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mained, even in ‘never-smokers.’” In summary, although the study was large in scope, including a sizable number of “never-smokers,” researchers proved a “modest” tooth loss-coronary heart disease link in men that was explained by the presence of cigarette smoking in patient history but not in other subgroups. Memphis private practitioner Gregg Kemp, DDS, said he was “shocked” by the strong correlation between periodontal disease and heart blockage. He has observed that some patients often put off going to see a doctor, so dentists must help catch warning signs of more serious conditions during routine teeth cleanings. “We take your blood pressure when you get your teeth cleaned and refer patients to their doctor if it’s high. It’s comprehensive care. . . . We’re the first ones to catch a lot of things,” Kemp said. Other things are changing in dental care. For example, implants. According to the American Academy of Implant Dentistry’s latest figures, 3 million people in the U.S. have implants, and that number is growing by 500,000 per year. Implants have become big business. Researchers at Million Insights said the dental implants market was valued at more than $3.56 billion in 2015. Dr. Cagna noted the change in general dentistry curriculum at schools such as the University of Tennessee Health Science Center now include implant restoration for all students. Previously, implants and implant restoration were only part of specialty dental programs.  Dr. Kemp notes that physicians, dentists and dental specialists have collaborated for years, especially regarding patients with recent surgery, or those undergoing cancer treatment, and patients with heart condi-

tions. Sleep apnea recently has been added to that list, as UTHSC opened the Center for Dental Sleep Medicine and Orofacial Pain in the College of Dentistry. Treatment options for those with sleep apnea include the CPAP (continuous positive airway pressure) machine, surgery on the palate or base of the tongue and oral appliance therapy. Alan O. Blanton, DDS, MS, Diplomate, American Board of Dental Sleep Medicine, believes oral appliance therapy is the least invasive treatment option for patients, and is personally invested in continuing research. Dr. Blanton was diagnosed with sleep apnea and decided to join the UTHSC faculty in January. The oral appliance is fitted to the patient and is similar to a mouth guard worn during sports. It holds the lower jaw forward, adds stability and lifts tissue to prevent the airway from collapsing during sleep. The treatment is generally only for those without severe sleep apnea. The Center hopes to develop a graduate program for residents to learn about sleep disorders and orofacial pain. “I want Tennessee to be positioned to be a major player in that inter-professional education initiative,” Dr. Blanton said. “Patients are less likely to see their primary care physician for regular check-ups and physicals. However, many patients will see their dentists regularly, once or twice a year. “That puts us in the position of being able to screen for many conditions like hypertension, skin disorders, oral cancers, sleep-disordered breathing problems, just to name a few,” Dr. Blanton said. “We will continue to see more research on mouth and body links, and dentists and physicians collaborating in the future.”

USPSTF Issues Final, continued from page 5 cause there is fear with cancer, but it won’t cause any signs or even symptoms ever in their lifetime,” he explained of those in the over-diagnosed group who have prostate cancer that never grows, spreads or harms them. The third issue is that the majority of men, once they’ve received a prostate cancer diagnosis, will go on to have surgery or radiation treatment. Data cited by the USPSTF shows 80 of the 100 diagnosed undergo one of the two treatments initially or after a period of active surveillance. Yet, Krist said, there are harms that could result from either treatment option. Estimates based on observed benefits in the ERSPC trial for men 55 to 69 years of age and on harms derived from pooled absolute rates from three treatment trials found 50 of the 80 who choose surgery or radiation treatment will experience erectile dysfunction and 15 will have urinary incontinence. Further, the USPSTF estimates three men will avoid cancer spreading to other organs, 1.3 will avoid death from prostate cancer, and five will die from the cancer even after surgery or treatment. Krist said the Task Force didn’t make any recommendation for men younger

than 55 due to a lack of clinical data. “I certainly think we need more research on men under 55 at higher risk – AfricanAmerican men and those with a family history,” he said. Krist added this call for additional research was part of the group’s report to Congress. On the other end of the age spectrum, he said there were quite a few comments about extending screening. “In the draft, many folks criticized us and said men are living longer so we should be screening longer,” Krist noted. However, he continued, “There is good data that there are more false positives, more over-diagnosed prostate cancers, and more harms for biopsies and treatments. We had good confidence that men over 70 are more likely to be harmed than would benefit from screening.” Krist pointed out these recommendations pertain to routine screenings across the broad population and reiterated individual circumstances at any age could influence screening decisions. At the heart of the recommendations, Krist concluded, “We want men and their doctors to talk about the benefits and the harms. We want men to make informed decisions about what’s right for them.”

GrandRounds Dr. Scott Castle Earns Board Certification From the American Board of Urology

JACKSON — Dr. Scott Castle, a urologist at The Jackson Clinic, is now Board Certified, American Board of Urology. Dr. Castle completed his undergraduate degree at the University of Tennessee in Knoxville. He received his Doctor of Medicine from the University of Dr. Scott Castle Tennessee Health Science Center in Memphis. Dr. Castle completed his residency, as well as his internship at the University of Miami/Jackson Memorial Hospital in Miami, Fla. Castle is a urologist trained in treating all areas of urologic conditions. He has published over 20 peer reviewed articles in the Journal of Urology® and other esteemed urology journals in the areas of kidney cancer treatments and infertility in men with spinal cord injuries. He also received extensive training in state- of-the-art techniques in robotic surgery for all areas of urology, including Robotic Kidney removal (Nephrectomy), Robotic Partial Kidney removal (Partial Nephrectomy), Robotic Prostate Removal (Prostatectomy), and Robotic Reconstructive Surgery. Dr. Castle is working in conjunction with his partners at The Jackson Clinic to advance Jackson to a stateof-the-art prostate cancer diagnosis and treatment center by offering prostate cancer biomarkers, and MRI fusion prostate biopsy to aid in accurate diagnosis of prostate cancer.

WTH Completes Acquisition of Three Hospitals and Multiple Physician Practices

As West Tennessee’s leading healthcare provider, this purchase is an essential step to addressing health issues affecting our region by becoming a more integrated consumer-focused health system designed to be among the best in the nation. Dyersburg Regional is now West Tennessee Healthcare Dyersburg Hospital Regional Jackson is now West Tennessee Healthcare North Hospital Volunteer Martin is now West Tennessee Healthcare Volunteer Hospital The plans call for Dyersburg Hospital and Volunteer Hospital to continue as general acute care hospitals. North Hospital will operate as a satellite of JacksonMadison County General Hospital and will also provide general acute care services. West Tennessee Healthcare will oversee these hospitals’ continued commitment to high quality and low-cost care. West Tennessee Healthcare will provide specialists and services that people in our region have to currently drive hours to find. At each of its new locations, we remain committed to keeping care affordable, improving quality of care, and enhancing access. With elimination of unnecessary duplication in operations we will create new health benefits for the communities we serve. The effective date of the transaction is June 1, 2018. JUNE 2018

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June 2018 West TN Medical News  

West TN Medical News June 2018

June 2018 West TN Medical News  

West TN Medical News June 2018