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November 2017 >> $5 ON ROUNDS
Meet the Medical Director at Pathways Dr. Kevin Turner retires from state and takes medical director position with West Tennessee Healthcare As a social butterﬂy who enjoyed biology, medicine seemed to be a perfect match for Kevin Turner, MD. In his third year of medical school, he discovered psychiatry was where he felt he could do the most good. After 20 years working in a state institution, Turner is now turning to administration as medical director for Pathways Behavioral Health Services...
Clinical Trials Improve Options For Behavioral Health Patients New Trends Create Better, More Accurate Results By BETH SIMKANIN
New trends are emerging to help physicians who traditionally have faced several challenges when conducting clinical trials. These trends can help researchers avoid bias and obtain more accurate results in clinical trials, according to Valerie Arnold, MD, a psychiatrist and principal investigator for CNS Healthcare, a clinical trials center that explores treatment and medication options. Being consistent and maintaining neutrality in a controlled environment is highly important when conducting a successful clinical trial. Patients must be chosen who fit specific criteria for each trial and maintain a neutral environment to avoid bias. Some patients The use of technology, improved processes and advancements in genomics are improving have several diagnoses the quality of studies, according to several and you have to make Mid-South experts. One of the leading principal investigasure they will benefit tors on clinical trials in the Mid-South, Dr. from the study. Arnold has more than 15 years of experience and has conducted 200 trials. She has led trials – Dr. Valerie Arnold, that have led to approval of well-known medicaprincipal investigator, CNS Healthcare tions such as Ambien, Wellbutrin and Lyrica.
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A Plan to Address COPD
After Dedicated Service, Gee Finds New Direction
Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death and fourth leading cause of disability in America, according to the National Institutes of Health.
Retirement for Gee means it’s time to race By SUZANNE BOyD
There’s an adage that says when one retires it’s like riding off into the sunset. For one long time West Tennessee healthcare executive, retirement will include literally riding off into the sunset. After 25 years, Henry County Medical Center Chief Executive Officer, Tom Gee, hung up his coat
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and tie at the end of October but will replace it with a bike helmet and racing attire to pursue his dream of competitive cycling. While he may be running a different kind of race, he plans to also continue to make an impact in the fight for rural healthcare. At the age of 66, Gee felt it was time to pass (CONTINUED ON PAGE 4)
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Meet the Medical Director at Pathways
Dr. Kevin Turner retires from state and takes medical director position with West Tennessee Healthcare By SUZANNE BOYD
As a social butterfly who enjoyed biology, medicine seemed to be a perfect match for Kevin Turner, MD. In his third year of medical school, he discovered psychiatry was where he felt he could do the most good. After 20 years working in a state institution, Turner is now turning to administration as medical director for Pathways Behavioral Health Services in Jackson, Tennessee. Growing up in Chicago, Turner knew he enjoyed working with people and it was while he was pursuing a degree in biology at Illinois Benedictine University that he decided medicine may be the route he wanted to take. “I enjoy talking with people and am a very social person,” said Turner. “Several of my friends were pre-med students and in talking to them, it peaked my interest. I did some graduate work in biology at Southern Illinois University before I began medical school there.” As Turner entered medical school, he envisioned himself having a Marcus Welby family physician type of life. That picture changed in his third-year rotations when he was exposed to psychiatry. “When I was doing my rotation, psychiatry was entering a very exciting time as new medications were being introduced that were very effective in treatment,” said Turner. “There were some big advances in medications at that time, such as Prozac. It really amazed me how well people responded to treatment and the difference medications could make in people with psychiatric disorders. I was very impressed.” After completing his first year of psychiatric residency at Rush Presbyterian Hospital in Chicago, Turner transferred to the University of Southern California for the remaining three years of his residency. “I really wanted to focus on psycho pharmacology and the program at Southern Cal was one of the top in the country for that,” he said. “It was what had really attracted me to psychiatry and I wanted to have the best training possible. At the time, they were ahead of the curve from other programs for using medicines to treat various psychiatric conditions.” To pay for his medical education, Turner utilized a public health scholarship which meant he would be obligated to practice in an area that was determined to have a medical shortage once he completed his training. After residency, he moved to Middle Tennessee to practice in McMinnville, a town of around 14,000. When the state made changes to westtnmedicalnews
its TennCare program that were unfavorable to private practice, Turner went to work for the state of Tennessee at Western Mental Health Institute in Bolivar. Initially, the facility had 500 beds but when the state changed the focus of the mental health system to long-term care, patients and the facility became a 150bed institution. “The state reorganized the mental health system about ten years ago, and state hospitals started only treating severe cases, such as forensic or court committed patients, that could not be managed in other facilities such as Pathways,” said Turner. “I was the attending psychiatrist for patients on the two longterm units which had about 25 patients each and was responsible for managing their medications as well as making reports to the courts on patients’ status when needed.” In June 2017, Turner retired from the state after 20 years of service. In July, he was named medical director for Pathways Behavioral Health Services in Jackson. “My wife and I had lived in Jackson for about 13 years so our kids could go to school here,” said Turner. “I had also been moonlighting at Pathways for the past couple of years. I mainly provided off-hours coverage for them when they needed to admit a patient or if a problem arose on the inpatient unit that needed to be addressed by a physician. That experience allowed me to not only meet a lot of people that work there but it also gave me a sense of what was going on there. It was a good opportunity for me once I retired from the state. While I prefer the clinical side, I was at a point in my career that I was interested in the administrative side and wanted to develop that.” Pathways has a 28-bed inpatient unit in addition to outpatient clinics. Turner’s
President Trump Turns to Executive Orders to Reform Healthcare and Stocks Plummet By Denise Burke After repeated failures to repeal and replace the Affordable Care Act (ACA), President Trump took matters into his own hands and started issuing Executive Orders. On October 12, 2017, President Trump released his “Executive Order Promoting Healthcare Choice and Competition Across the United States.” The Order directed agencies to take action to: • allow small businesses to pool together to purchase health insurance, • permit short-term, limited-duration insurance policies to cover 12 months (currently limited to three months), and • expand access to employer-funded Health Saving Accounts. Later the same day, the President announced that the Administration would stop funding cost-sharing reductions available on the ACA Health Insurance Marketplaces until Congress appropriates the funding to cover the subsidies. The ACA, as enacted, requires insurers to offer plans with reduced co-pays and deductibles for persons with very low-incomes, but the ACA does not appropriate the cost-sharing subsidies to pay for the subsidies. Without Congressional authority, and thus, the legal authority to do so, President Obama agreed to pay costsharing subsidies, an action he believed necessary to entice insurers to enter the Marketplace. Ironically, President Obama’s prior actions that exceeded executive authority allowed President Trump to “undo” the action critical to the ACA without Congressional approval. Proponents of the Executive Orders claim that they are aimed at increasing competition in the healthcare marketplace, while critics claim their sole purpose is to undermine “ObamaCare.” Regardless of the intent, the President’s actions had immediate impact on the healthcare and healthcare insurance markets. While provider stock prices fell slightly, healthcare insurers were battered by the news. Centene, which provides services to government-sponsored healthcare programs, lost nearly 6%, managed care company Molina Healthcare lost more than 4% and Anthem was down nearly 3%. The day after signing the Order, the President tweeted “Health Insurance stocks, which have gone through the roof during the ObamaCare years, plunged yesterday after I ended their Dems windfall!” This is a classic case where two wrongs (and a tweet), don’t make a right. Healthcare is too important to individual well-being and the national economy, to be rewritten by each new President without Congressional approval. Healthcare providers and the healthcare insurance markets are complex industries that require significant lead time to adjust to change. Chaotic change unnecessarily stresses the nation’s healthcare system. Bipartisan efforts to stabilize the ACA in a less chaotic manner have been quietly under way since the last failed Republican attempt at full-scale repeal and replace (prior to the executive actions). Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) are sponsoring the Bipartisan Health Care The Author: Stabilization Act of 2017 that would: • make cost-sharing reductions available in the healthcare marketplace to individuals with incomes within 100-250% of the federal poverty level through 2019, • make catastrophic health plans available to everyone (currently only available to persons less than age 30 or individuals with financial hardships), • fund ACA assistance and enrollment programs, which have been faced with budgets cuts, andincentivize states to create innovative ways to improve healthcare. Denise Burke The bill language and a section-by-section summary can be found at www.help.senate.gov/download/bipar-stabilization-section-by-section. A possible second bill has been announced by Sen. Orrin Hatch (R-UT) and Rep. Kevin Brady (R-TX and Chair of the HouseWays and Means Committee). This bill would: • continue funding for cost-sharing reductions for until 2019 (limited to policies that don’t cover abortion), • provide limited relief from the individual mandate (through 2021) and employer shared responsibility mandate (retroactive to 2015), and • increase the contribution limits on health savings accounts. While the outlook for the healthcare industry is shrouded in uncertainty right now, the weeks and months ahead will almost assuredly be filled with new legislative proposals to modify the ACA in meaningful ways. There could even be some level of bipartisan cooperation moving forward but maybe it’s too early for Christmas wishes.
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This Doctor Threw His Best Punch, But Tuberculosis Is Still Standing With pulmonary disease as a focus topic in this issue, publisher Pamela Harris suggested that editor Bob Phillips write an historical account of his father’s journey in medicine. By BOB PHILLIPS
Doctors were still making house calls when my dad was practicing medicine in Memphis. However, when the phone rang at our house the calls were seldom related to healthcare. My dad was Samuel Phillips, MD, and despite having an “MD” after his name in the phone book (remember those?) most of the calls were from people in the entertainment industry. The callers were looking for the Sam Phillips who owned Sun Records, which had a list of entertainers that included Roy Orbison, Jerry Lee Lewis, Johnny Cash and our neighbor at the time, Elvis Presley. The other Sam Phillips evidently had an unlisted number. Because my dad was a doctor, he believed we shouldn’t have one, something that was a constant irritant to my mother. But I thought it was totally cool. I was given the job of answering the phone. It was the best household chore my parents ever gave me. After learning that the callers were looking for the un-
listed Sam, I would explain they had the wrong one. Between conversing with all the wrong numbers and having Elvis down the street, I thought I was witnessing what stardom was really like. Perhaps I was. But years later I realized I had a real star living right in my own house: my dad, a man who dedicated his life to medicine, and believed, as the Hippocratic Oath states, “into whatsoever houses I enter, I will enter to help the sick.” Samuel Phillips was born in New York and graduated from the Royal College of Physicians, King’s College Medical
School, London, England. I doubt years ago he or anyone else had ever heard of a pulmonologist. He simply said he specialized in pulmonary disease while he spent a good part of five decades trying to eradicate tuberculosis (TB). Also called “consumption,” I am told at one time tuberculosis was feared more than cancer. After interning at Grasslands Hospital in White Plains, New York, he took a position at South Dakota Tuberculosis Sanitorium in Sanator near the Black Hills National Forest. It was a huge facility – a city within itself. And it was remote. The nearest town was Custer (population of 1,987 according to the 2010 census) which is believed to be the oldest town established by European Americans in the Black Hills of South Dakota and Wyoming. Gold was found there in 1874. I’m pretty sure there was no gold when my parents arrived in 1941, but there was plenty of cold weather. The high temperature there between November and April is about 23. The average annual snowfall is 56 inches. My dad said there was so much snow that tunnels were built to connect the buildings. But the weather was perfect for treating TB patients. Research indicated that breathing cold air could be excellent therapy. Each patient’s room had a balcony and every day each occupant was bundled in warm clothing and blankets and placed on their balcony to breathe in the brisk air.
Gee Rides Off Into The Sunset, continued from page 1
the torch while he was still in good physical shape to pursue his passion of competitive cycling. “I have been a competitive cyclist since high school and still in good shape so it was time to really focus on competing before I can’t,” said Gee. “One of my biggest goals is to go back to the world championship race in Italy next year. I competed in it this year and really learned so much so I want to go back and see if I can improve. I also have the distinction of being the only American to have completed the Paris-Bret-Paris, a long-distance cycling event, eight times and I want to add a ninth.” Much like training for competitive cycling, Gee prepared for his retirement well in advance. “I have always been a planner and succession planning in our industry is very important. I have watched hospitals struggle with transition of power so several years ago I developed a succession plan with the board chair,” said Gee. “About a year ago I told them a date I would retire. It did get announced sooner than I would have liked so it has been a bit confusing as to when I was actually going to step down.” As a part of the succession plan and the early announcement of his retirement, the Board had time to evaluate what kind of person they would want to take the reins. “While we did initially consider looking outside of the organization, as we began to determine the type of person and what 4
type of knowledge base we wanted them to have, we realized we may very well have the candidate in-house,” said Gee. “As we interviewed and evaluated our chief financial officer, Lisa Casteel, we saw that she had everything we were looking for. The Board has been very comfortable with their decision and the transition.” Gee has been preparing Casteel for the transition for several years. “The issues facing rural hospitals are not new to Lisa,” he said. “Making ends meet, the financial stresses and the need to be more efficient, she is aware of them all. My best advice to her has been to hang in there, things are cyclical and they will get better. She has a solid background in the basics, and it’s just a matter of keep on keeping on. She will think of goals she wants to achieve and she will get there. I have told her and the Board that I am happy to help in any way I can.” While he initially thought he would only stay five years at Henry County Medical Center (HCMC), after 25, Gee is proud of what he has achieved. “When I came here this hospital was about to be sold. They hired me to come in and try to save it and I saw great potential here. We needed more doctors and to be more strategic in our thinking. It has been such a gratifying process to take a hospital and make it a real asset in this community and this state,” he said. “We have one of the best run facilities
and are one of the best rural hospitals in the state. We have so many things here that lots of small communities would love to have.” During his time at HCMC, Gee has managed to not only double the size of the physical plant but has also seen the medical staff double in size as well. “We have also expanded our behavioral health program to include geriatric psych and adult psych programs,” he said. “We have upgraded our robotic program and were one of the first in Tennessee to use the type of orthopedic robot we have.” Gee says he has seen some challenges over his career. One of the greatest has been dealing with the financial frustrations of the TennCare program. “There has been an apathy in legislators and government to recognize the importance of the healthcare system,” he said. “There are simple things that they could do to support the system. I have just gotten so frustrated with all the politics, and now we are in danger of losing jobs and resources in our rural communities that we need and that should be here. The real frustration is elected officials’ lack of understanding of healthcare and how it works. There seems to be an erosion of what we have built and I am afraid we will have to take several steps back before we figure it out.” As a private citizen, Gee still wants to support healthcare in any way he can. “I
When the U.S. entered World War II, my dad wanted to join the Army. However, he was told his job was considered “essential” and he was exempt from service. So he resigned and took a position at City of Hope Hospital in Duarte, California, which was a treatment center for TB. The TB treatment, called pneumothorax, involved surgery. As best I understand it, a portion of the lower rib was removed and the lung was collapsed and treated. The lung became healthy and the rib grew. The healing process took about one year. Then the procedure was repeated on the other side. My dad was there only until he was able to enter the Army. As a member of the medical corps, he was stationed at several military bases, including one in Como, Mississippi, which was a German prisoner of war facility. The job of caring for German POWs was especially distasteful because my mother lost relatives in the Holocaust. Dad was soon transferred to Memphis and Kennedy General Hospital. Named for James M. Kennedy, the hospital opened in 1943 and became the largest Army hospital in the U.S. It was described as a “state-of-the-art medical facility and one of the best equipped hospitals in the nation.” It was located at Park and Getwell, which earlier was named “Shotwell.” During the next three years, 44,000 patients were treated there and an (CONTINUED ON PAGE 5)
want to be a real voice for rural healthcare,” he said. “There is a real need for it and I hope to use the knowledge I have to help be that voice. I have been extensively involved in organizations such as the Tennessee Hospital Association and was even awarded the THA President’s Award in recognition of my years of service. I still plan on being involved with them in some capacity, since I still have a few years left on the state licensure board. I will also be around to help with long-range planning and such at Henry County Medical Center.” After 25 years in the community, he and his wife plan to stay in Paris. Gee says it is also a great place to train for his bike races and it will be nice to train in the daylight. Retirement will mean more time to travel and enjoy his grandchildren in Colorado. He also plans to stay active in the community, the Rotary Club and his church. Gee says it will be hard to go from being a decision maker and leader for 40 years to a private citizen. “I hear the first couple of weeks can be tough but then you get used to it,” he said. “I know I won’t miss the stress of worrying about the hospital each day but I will definitely miss the people. Going up on the floors and being greeted by the staff each day as I made rounds made me always feel so appreciated and I am going to miss that. I do hope to keep the many great friendships that I have developed.” westtnmedicalnews
A Plan to Address COPD By CINDy SANDERS
Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death and fourth leading cause of disability in America, according to the National Institutes of Health. The umbrella term encompasses a number of progressive lung diseases including emphysema, chronic bronchitis and refractory asthma. While the National Heart, Lung, and Blood Institute (NHLBI) identifies 16 million Americans as being diagnosed with COPD, that figure only tells part of the story. The American Lung Association and COPD Foundation both estimate closer to 25-30 million Americans are impacted by COPD . . . but millions are unaware they have the disease. The Diagnosis Issue Jamie Sullivan, MPH, vice president of Public Policy and Advocacy for the COPD Foundation, said one reason people go undiagnosed is because symptoms often aren’t noticeable in the earliest stages. Even when individuals begin to experience increased breathlessness and Jamie Sullivan coughing, it’s easy to pass it off as a cold, allergies or simply part of the aging process and to change behaviors, like avoiding stairs, to mask the problem. Another issue, she added, is that physicians aren’t necessarily asking the right questions during routine visits when the disease
Meet the Medical, continued from page 3
direct clinical duties include management of patients on the inpatient unit as well as overseeing a satellite clinic in Camden that treats elderly psychiatric patients. On the administrative side, Turner supervises the clinical work of the six nurse practitioners on staff as well as serves on various committees throughout the organization. While improving the lives of his patients is what Turner finds most satisfying about his career, he is impressed by the impact technology has had on the field. “Technology has impacted so much,” he said. “We used to scribble notes on a pad now everything is on computer. Telehealth has been able to positively impact rural health because we are able to reach more people by seeing thing over the computer if we cannot get to where they are. Improving the lives of my patients is what gives me the most satisfaction.” With all three kids in college, Turner and his wife have a bit more time to travel and visit family. He also likes to spend his off hours enjoying his radiocontrolled model airplanes with two local clubs that he belongs to. While he has more of them than he cares to admit, he will say his favorite ones to fly are the aerobatic models. WESTTNMEDICALNEWS
might be caught in the early stages. Sullivan noted most diagnoses occur when symptoms have become so severe patients can no longer ignore them. The CAPTURE Study, she added, found most people aren’t diagnosed with COPD until they have already lost half their lung function. Primarily seen as a smoker’s disease, Sullivan said there is also a “shame and blame” element surrounding COPD. However, she noted, there is an increasing understanding that other factors including environment, prematurity, and genetics also add to the burden of the disease. “Our founder John Walsh, who unfortunately passed away earlier this year, saw there was this huge hole in support for COPD patients,” said Sullivan. “He really put out a call to action to the patient and scientific community to come together and find solutions to support the community.” Mounting a Response It has only been since 2013 that COPD rates across all 50 states have been available with the data put forth from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance Survey (BRFSS). Further complicating the issue, there haven’t been national screening parameters, a coordinated action plan, or funding for COPD research at the level of other diseases. However, the hope is all of that might be about to change with the release of the COPD National Action Plan earlier this year. “Prior to the release of the federal action plan in May, there hadn’t been a coordinated federal response,” said Sullivan. Now, she continued, “Here’s a blueprint of how we, as a country, can tackle COPD.” Sullivan said the COPD community had advocated for this type of coordinated response for years. She noted many stake-
holders, including the COPD Foundation, had a voice in creating the collaborative plan. Following interagency work groups at the federal level in 2014 and 2015 and a letter from Congress urging next steps in late 2015, Sullivan said NHLBI hosted a town hall meeting in February 2016 open to physicians, patients, researchers and COPD organizations. “That was a great chance for the community to come together to talk about what are the major issues the plan should address and to prioritize goals,” Sullivan noted. Following the town hall meeting and period for public comment, the finalized COPD National Action Plan outlines five key goals: • Empower people with COPD, their families, and caregivers to recognize and reduce the burden of COPD. • Improve the diagnosis, prevention, treatment and management of COPD by improving the quality of care delivered across the healthcare continuum. • Collect, analyze, report and disseminate COPD-related public health data that drive change and track progress. • Increase and sustain research to better understand the prevention, pathogenesis, diagnosis, treatment and management of COPD. • Translate national policy, educational, and program recommendations into research and public health actions. The next steps, Sullivan said, are to move forward with implementation of the plan. What’s Happening Now In the meantime, Sullivan said there are a number of immediate steps to improve care including an emphasis on ensuring everyone is diagnosed properly and on time, enhancing patient education efforts, insti-
tuting a personalized treatment regimen to meet a patient’s specific needs, and where appropriate, utilizing pulmonary rehab. “These are all things we don’t need new treatments to do,” she said of deploying an evidence-based approach. Sullivan added the COPD Foundation and others have long advocated for broader use of primary pulmonary rehab, a non-pharmacologic management option. “Think of it as physical therapy for your lungs with the added benefit of education and support,” she said. Reimbursable at low levels that Sullivan said aren’t sustainable, pulmonary rehab therapy is typically offered only though hospital-based programs. Without enough programs, Sullivan said it’s been hard to gain traction among patients and physicians. Another issue is the time commitment, which entails two hours of education and exercise plus travel time. “To get adherence and compliance with someone, that takes a major commitment,” she noted. “But for the people who do, nearly everyone you talk to will say it changes their life.” While the therapy is evidence-based, Sullivan said more research is needed to grow awareness and improve reimbursement rates. However, she noted, research funding has been another ongoing issue. “It goes back to the federal response to COPD, which is around $100 million per year gets spent on federal research … which is pennies compared to the impact of the disease,” she said. Sullivan added that while a great deal of progress has been made in understanding COPD and its genetic basis, additional research funding could really accelerate that work. “This coordinated action plan could be the tipping point,” she said. “It has the potential to be if the community rallies around it,” she concluded.
This Doctor Threw His Best Punch, continued from page 4 estimated average of 30 surgeries a day were performed. While a large number of the wounded soldiers were paraplegics and quadriplegics many others required treatment for all types of casualties and illnesses, including the chest. My dad became chief of pulmonary diseases. According to author Paul Dudenefer, who wrote a brief, but excellent piece about Kennedy, when the war ended “a census that reached 6,000 patients and the hospital had evolved into a center for research, evaluation, and specialization for psychiatric and penicillin medical care, as well as surgical procedures for neurological, thoracic, and orthopedic cases.” When Kennedy was given to the Veterans Administration in 1946, my dad stayed. He had become chief, pulmonary diseases, and part of the hospital’s research included TB. At Kennedy the clinical trials involved three drugs, usually used in combination. Kennedy proved to be an excellent facility for the trials because patients would be there a lengthy time. They could be monitored closely and it was easy
to ensure they took their drugs on schedule. During this time research also began on lung cancer and the team zeroed in on cigarette smoking. As the evidence began to grow, my dad asked that the cigarette machines that were actually on the TB ward be removed. The administration resisted, but eventually the machines were taken out, much to the displeasure of the patients. This was also about the time my dad talked to me about the evils of smoking. When I asked why there wasn’t more attention given to problems tobacco created, he explained before going public the doctors had to build a stronger case to fight the lawyers in the courtroom. At the same time, successes began to grow involving the drugs and TB. In fact, the effort became so successful that tuberculosis sanitoriums began to close. I remember my dad was excited about going to the closure of one in Memphis. He would be disappointed today. He thought they had greatly reduced the threat of TB. However, it now is the second-most common cause of death from infectious disease (after those
due to HIV/AIDS). But I still consider my dad a star. He spent his life fighting a deadly disease, running the risk of contracting it himself. He worked in locations many others would pass on. He never lost his passion or his dedication. That’s a star in my book.
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Clinical Trials Improve Options For Behavioral Health Patients, continued from page 1 “Multi-site, double-blind, placebocontrolled clinical trials are the gold standard,” Dr. Arnold said. “They are considered less influential. It’s considered a high-quality study when the patients and the principal investigator don’t know which patient is getting the drug and which patient is getting the placebo.” Typically, Dr. Arnold conducts clinical trials that are sponsored by pharmaceutical companies. She specializes in behavioral health and studies dealing with patients with attention deficient hyperactivity disorder. “Safety is extremely important,” she said, “We want to make sure the medication works and is safe for a patient to use. That is why we do trials in a controlled environment.” In addition to safety, clinical trials result in patients being offered better medication options. “Clinical trials are important, especially in mental health, because we can improve efficacy and side effects in newer medications,” said Dr. Anita Varma, MD, a psychiatrist and principal investigator for Research Strategies of Memphis. “Often
times patients who are on older medications are not able to function as well because the side effects could add to other health issues. Newer medications may make a patient feel better and more able to function. We are able to inform the patient there are other medication options. “It’s important to understand that mental illness is treatable,” Dr. Varma continued. “We want patients to feel better. Medication compliance in clinical trials is highly important in mental health. It’s through clinical trials that we can offer more treatment options and improve side-effect profiles so patients can function better. We’ve been seeing some newer medications have less side effects.” Dr. Arnold said a double-blind study helps create a neutral environment because neither the patients nor the medical staff knows which patients are taking a certain drug and which patients are receiving a placebo. Medical staff must be trained on how to talk with a patient so they don’t influence or change a patient’s perception during a trial. “You have to be careful because the
GrandRounds Tennova Healthcare – Regional Jackson Names New CEO
JACKSON - Lance Beus has been named Chief Executive Officer of Tennova Healthcare – Regional Jackson effective October 30th. He comes to Jackson from CHRISTUS Jasper Memorial Hospital in Jasper, Texas. Since 2014, Beus has served as President of Lance Beus CHRISTUS Jasper Memorial Hospital, overseeing an acute care hospital and four rural clinics. He began his healthcare career as administrator of a 17-provider cardiology practice in Johnson City, Tennessee and has since applied his leadership skills as Assistant CEO at CHS-affiliated Woodland Heights Medical Center in Lufkin, Texas and CEO at hospitals in Saudi Arabia and Egypt. Beus earned a master’s degree in public health – healthcare administration from East Tennessee State University and his bachelor’s degree in sociology from Brigham Young University.
Dr. Lisa Piercey Receives Rural Healthcare Award
JACKSON - Dr. Lisa Piercey, Executive Vice President, received the American College of Healthcare Executives (ACHE) Rural Healthcare Executive Award in October at the Tennessee Hospital Association’s annual meeting in Nashville. The award recognizes Lisa Piercey ACHE members who have made significant contributions to the advancement of the healthcare profession and the achievement of ACHE’s goals.
Piercey has served as Executive Vice President since 2015. Her current areas of responsibility include administrative oversight of three rural hospitals, Spire Rehabilitation Hospital, Pathways inpatient and outpatient mental health services, LIFT Wellness Center, Population Health and Disease Management, Medical Center Medical Products, Employer Services, Community Education, and Senior Services.
West Tennessee Healthcare Welcomes New Cardiothoracic Surgeon
JACKSON - West Tennessee Healthcare welcomes Dr. Hetal D. Patel to the leading cardiothoracic surgery team in the region. Dr. Patel joins the Cardiothoracic Surgery Center, located at 27A Medical Center Drive. Dr. Patel was most recently with University of Hetal D. Petal Kentucky while completing his Cardiothoracic Fellowship. He is a graduate of the University of Alabama at Birmingham, went to medical school at the University of South Alabama College of Medicine in Mobile, and completed his residency at Baptist Health Systems. As the only clinic in the area with surgeons who provide open heart surgery procedures, the physicians and the staff at the Cardiothoracic Surgery Center work daily with patients to provide the best outcomes and return them to a healthy life. West Tennessee Healthcare is proud to have cardiovascular surgeons from some of the top heart programs in the country providing state-of-the-art service and expertise. Dr. Patel is currently accepting new patients.
smallest influence can damage a trial,” Dr. Arnold said. “I just got out of a meeting which discussed how pre-programmed after-hours phone messages can influence a patient. These are small things people don’t even think about, yet how we word something makes a big difference.” Dr. Arnold said she is seeing new trends that aid medical staff in creating a consistent, controlled environment. “We are utilizing more technology,” she said. “Over the last couple of years, companies have required us to video our interactions with patients. We are given feedback from medical experts to make sure that our treatment and wording is consistent.” Dr. Arnold said she will have experts who deal with certain illnesses such as post traumatic stress disorder or obsessive compulsive disorder assist in monitoring patients and give feedback. Additionally, she said she is conducting more genetically influenced studies where companies are looking for specific genetic markers in patients to find out how certain medications respond to them. According to Dr. Arnold, one of the most important processes, and the most challenging for physicians, is choosing the right patient for each trial. “There is not one simple diagnosis,” she said. “Some patients many have several diagnoses and you have to make sure they will benefit from the study.” Dr. Arnold said it’s ideal to have patients from various sources and different geographic locations, as it increases the chances to get the best sample of patients. “It’s important to have different sites because you typically get a better sample this way,” she said. “If you don’t have multiple sites, it could adversely affect a study.” She added that it’s not uncommon for some trials to be conducted at 25 different locations. Multi-site selection in a clinical trial is so important that the University of Tennessee Health Science Center has announced a plan for a new initiative that could bring more clinical trials to Tennessee and result in more research grant money for the state and UTHSC. According to Dr. Steven Goodman, Ph.D., vice chancellor for research at UTHSC, university clinical faculty conduct many clinical trials at various hospitals throughout Tennessee, yet the university doesn’t receive credit for the trials because they are conducted at hospitals the instituSteven Goodman tion doesn’t own. As a result, UTHSC doesn’t receive additional research grant money. “We estimate that we aren’t getting $30 million of grant money for research that we would otherwise if the university was receiving credit for these trials,” Dr. Goodman said. “Our faculty is doing the work, but the university isn’t getting credit for it.” Goodman presented an idea to Dr.
Steve Schwab, MD, chancellor of UTHSC, to create a 501 (c) (3) organization through the University of Tennessee Research Foundation. Identified as the Clinical Trials Network (CTN2), it would provide that any clinical trial that is conducted by a UTHSC faculty member will go through the subsidiary of the foundation and give UTHSC credit for the clinical trial. CTN2 will provide personnel for the trials at the hospitals. Dr. Schwab announced UTHSC’s commitment to the endeavor last month at his State of the University address. State hospitals and health centers affiliated with UTHSC are Methodist University Hospital, Le Bonheur Children’s Hospital, Regional One Health, West Cancer Center, Saint Thomas Health in Nashville, the University of Tennessee Medical Center in Knoxville and Erlanger Health System in Chattanooga. “You can’t get enough subjects from one health center for a clinical trial,” Dr. Goodman said. “You need to have multiple sites to get a good sample.” He is in the process of having memorandums of understandings signed at each location and anticipates CTN2 will be up and running by January 2018.
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SIX RECENT TENNESSEE HEALTHRELATED LAWS YOU SHOULD KNOW By Arthur S. Richey This article highlights six recent changes and developments in Tennessee state laws that could potentially impact hospitals, physicians, and other providers.
1. Licensure of Pain Management Clinics. Before July 1, 2017, the Tennessee Department of Health (“DOH”) maintained a certification system for pain management clinics. Effective July 1, 2017, however, this prior certification system has been replaced by a licensing requirement. Under the new law, generally, no one may operate one of the following Arthur S. Richey without a license: (1) a privately owned clinic where any Tennessee-licensed healthcare provider prescribes or dispenses opioids (noncancer related), benzodiazepines, barbiturates or carisoprodol to a majority of its patients for 90 days or more in a 12-month period; or (2) a privately owned clinic advertising pain management services. Certain clinics providing interventional pain management are exempt from the license requirement. The most burdensome of the new requirements are: (1) the pain management clinic medical director must qualify as a “pain management specialist” providing a large array of specific clinical and administrative services; and (2) if DOH has reasonable suspicion that a clinic is operating as an unlicensed pain management clinic, DOH may conduct an unannounced inspection at any time. The inspected clinic will be deemed to be operating as an unlicensed pain management clinic unless the clinic can provide documentation demonstrating that it does not meet the definition of a “pain management clinic.
2. Identification of High-Risk Opioid Prescribers. As of July 1, 2017, DOH will investigate and identify high-risk opioid prescribers based on clinical outcomes (e.g., patient overdoses) and will convey that information to the prescribers’ licensing boards. The licensing boards will notify the prescribers of their high-risk status and the remedial actions they must take over a period of time. Prescribers
failing to complete the required remedial actions may face licensure disciplinary action.
3. Waiver of Liability Clauses May Be More Enforceable Than You Think in the Healthcare Setting. In a recent Court of Appeals of Tennessee case, a transport company providing non-emergent transportation services was not held liable for a patient’s fall because the patient signed a waiver expressly releasing the transport company from all claims of ordinary negligence. This case illustrates that waiver of liability clauses may be more enforceable than previously thought in situations where services provided to patients are not considered to be professional services. Thus, hospitals, physicians, and other providers should consider including these clauses (or modifying existing clauses) to clarify that patients are expressly waiving all claims of ordinary negligence in the event an employee, agent, or independent contractor the clinic or facility furnishes non-professional medical services.
their respective fee schedules once every 12 months. Arthur S. Richey is a member of the Healthcare Regulatory and Transactions Group at Butler Snow LLP. He focuses his practice on healthcare law, commercial contracting, regulatory compliance counsel and advice, and mergers and acquisitions. Learn more about Butler Snow’s healthcare practice at butlersnow.com.
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4. Treatment of Minors for Sexually Transmitted Diseases. Effective July 1, 2017, certain healthcare providers, such as physicians and advanced practice nurses, may examine, diagnose, and treat minors infected with sexually transmitted diseases without the knowledge or consent of the minor’s parents.
5. Continuing Medical Education Credit (“CME”) for Volunteer Healthcare Services. Effective May 11, 2017, certain healthcare providers may obtain one hour of CME for each one hour of volunteer healthcare services, subject to a maximum annual amount of the lesser of eight hours or 20% of the total annual amount required for the applicable license.
Some legal teams are more concerned with taking credit than initiative. At Butler Snow, our teamwork approach allows us to anticipate GLEPPIRKIWERHXSČRHGVIEXMZIWSPYXMSRW After all, we measure our success by yours.
6. Required Notice Before Changes to Reimbursement Policies. Effective January 1, 2019, a commercial payor must provide 60 days’ prior notice to providers of any material changes made by the payor to its provider manual or reimbursement rules and coverage policies. Such payors must provide at least 90 days’ prior written notice to a provider before implementing any change to a provider’s fee schedule. Health insurance entities can only change
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