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October 2019 >> $5

Driving Change in West Tennessee


Patient First From Cleveland Clinic to Jackson Clinic, Dr. Shuang Fu develops deep doctor/patient relationships

Long-term care providers are taking charge of the clinical and economic outcomes of patients

Patient First is more than just a slogan for Jackson Clinic hematologist/ oncologist, Shuang Fu, MD. Putting the needs of her patients at the Kirkland Cancer Center above all else is an essential element of her medical practice.


Putting long-term care providers in the driver’s seat of the clinical and economic outcomes of patients has meant an increase in the level of care provided in long-term care facilities. With more proactive care on the front lines in nursing homes, hospitalization rates have decreased and the quality of life for residents has been positively impacted. For more than 30 years, American Health Partners has been operating long term care facilities across the Southeast. In an effort to increase the level of care that could be provided in the nursing home, the company has evolved from its traditional role as a post-acute care provider to a national Medicare Advantage com-

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pany and partner to post-acute care providers across the country. “When we saw a clinical need for our long-term care residents that was not being met by traditional insurance, we knew that with the right resources we could provide a higher level of care. We recognized that those on the front lines were in the best position to help determine what resources were needed to provide that care while the ones paying for those resources were dictating what those resources could be and how they could be utilized,” said Hank Watson, Chief Development Officer for American Health Plans. “American Health Partners was in a unique position as we had divisions that were on both


New Hope, More Options For Breast Cancer Patients

Minimizing Risk New SVMIC Tool Helps Assess, Avoid Missteps In the highly regulated healthcare industry, it’s far too easy for a medical practice to accidentally overlook a necessary posting or updated compliance mandate among the long list of requirements that stem from multiple government agencies ranging from CMS to OSHA. Unfortunately, even small missteps can result in hefty fines.

Advancements in Technology, Medicine Are Improving Outcomes By BETH SIMKANIN

A number of medical and surgical oncologists in the Memphis area who specialize in breast cancer say they believe local healthcare systems and cancer centers have moved a step closer to improving cure rates because of the recent addition of new technologies, surgical techniques, partnerships and market-approved medications. The introduction of new surgical technology at Baptist Memorial Health Care and a newly formed partnership between the University of Tennessee Health Science Center (UTHSC) and Methodist Healthcare bring new technological advancements and expertise to the area. Recent medications, approved

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Patient First

From Cleveland Clinic to Jackson Clinic, Dr. Shuang Fu develops deep doctor/patient relationships By SUZANNE BOYD

Patient First is more than just a slogan for Jackson Clinic hematologist/oncologist, Shuang Fu, MD. Putting the needs of her patients at the Kirkland Cancer Center above all else is an essential element of her medical practice. Medicine is truly Fu’s lifeblood. Her great grandfather, grandfather and mother were all doctors, and it was well understood in her family that the tradition was to continue with her. “My grandfather sent me a child-size stethoscope and blood pressure cuff when I was five,” said Fu. “I knew he wanted me to be a doctor, but I think it was his way of planting the seed early.” Fu holds a medical degree, master’s degree and a PhD from Beijing Medical University. During her training, she had the opportunity to participate in the first peripheral blood stem cell transplant in China at the Institute of Hematology at Beijing Medical University. When she came to the United States, she spent eight years doing medical research at Mount Sinai Hospital and Columbia University in New York. She completed a three-year fellowship in hematology and medical oncology at the Cleveland Clinic in Ohio in 2016. Relationships have always been important to Fu, but she developed a deeper appreciation of the doctor/patient relationship during her fellowship. “At the Cleveland Clinic, the patient comes first, period,” she said. “Each attending spent a lot of time with their patients, getting to know them and the stories behind them. Seeing how that level of interaction could positively impact the doctor/patient rela-

Is the missing

tionship left quite an impression on me.” As her fellowship was ending, Fu was considering several offers when a recruiter for the Jackson Clinic contacted her. Initially, she did not think much about it because she was in the middle of a rotation. But the recruiter was persistent, and Fu decided to take a look. “I was very impressed with the people, the Jackson Clinic and the Kirkland Cancer Center. It was a very similar setting to the Cleveland Clinic,” said Fu. “I was also married with two children which were big factors in this decision. Jackson seemed to hold much of what we were looking for.” Working in a smaller cancer center, Fu sees all types of cancers but regardless of the type, her initial approach is the same. “I try to see the patient within three to five days of diagnosis and review their chart before I see them so that I know as much about them as I can, and have a treatment plan to present them,” she

said. “When a patient is first diagnosed, they are anxious. Having a plan of action can help alleviate some of that anxiousness as well as build up their trust in me from our initial meeting.” While many treatments can be done at the Kirkland Cancer Center, there are cases that require a higher level of care and are referred to larger medical centers such as Vanderbilt or MD Anderson. “We have a cancer conference weekly here to discuss challenging cases to make sure we are providing the best care and options,” said Fu. “Often times when we do have to refer a patient for a clinical trial or care at another facility, their followup care can be done here.” Each October, West Tennessee Healthcare’s Kirkland Cancer Center and the West Tennessee Imaging Center offer free breast cancer screenings to uninsured women ages 40 and up. For

the past two years, Fu has headed this initiative. “I have been a part of this program since I came to Jackson – initially, as one of the physician volunteers who helped with the screenings,” she said. “Last year, I took over as head of the program when Dr. Lewis retired, and review all patient reports from the screenings.” After three years, Fu says her initial fear of how a female Asian physician would be received in West Tennessee has passed. “I have worked hard to make sure my patients know they are my priority. As they get to know me, they see I have a good heart and am going to do the best I can to take care of them as I would a family member,” she said. “Patient trust is much greater here, and there are closer relationships formed which makes my heart feel warm. I feel so much responsibility to them because they are putting their lives in my hands.” Fu’s family life is one filled with music. Her husband sings in the Chinese Association choir in Memphis. Her son is a senior in high school and plays violin in Memphis orchestras and Union University. Her daughter, a seventh grader, is an accomplished pianist who also plays the flute.

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Minimizing Risk

New SVMIC Tool Helps Assess, Avoid Missteps By CINDY SANDERS

In the highly regulated healthcare industry, it’s far too easy for a medical practice to accidentally overlook a necessary posting or updated compliance mandate among the long list of requirements that stem from multiple government agencies ranging from CMS to OSHA. Unfortunately, even small missteps can result in hefty fines. Enter RiskView by SVMIC, a new virtual reality tool that walks practice managers through a traditional physician office with audio scripts and downloadable resources referencing regulatory mandates and best practices. Meghan Clark, learning systems manager for SVMIC, noted the new interactive, self-guided tool is based on the same technology real estate agents use for virtual home tours and was created using a 360-degree Matterport camera. As users naviMeghan Clark gate through the different spaces typically found in an office or clinic, Clark explained purple dots on the screen link to audio scripts describing requirements for specific areas – from public spaces like the front desk, waiting room and exam rooms

RiskView’s 360-degree virtual tour walks users through regulatory mandates and best practices by utilizing audio scripts and links to downloadable resources to help practices stay compliant.

to behind-the-scenes spaces including administrative offices and onsite lab space. Blue dots, she continued, link to downloadable resources on the SVMIC website for additional detail and guidance. “The idea stemmed from an internal employee,” Clark said of the impetus to make years of risk mitigation expertise more readily available to stakeholders. While RiskView wasn’t developed as a replacement for a personal consultation – a service SVMIC has offered for many years to help reduce risk in medical offices – the technology provides valuable information

and updates to reinforce onsite observations and to provide guidance between visits. Clark said the tool will also serve to extend risk assessment and patient safety expertise to more practices. “Consultations cover a lot of ground,” Clark pointed out. “You don’t remember everything,” she added of the need to fill in gaps in notes. Can’t remember what the consultant said about the refrigerator or which posting had to be put in the break room? RiskView can provide a quick reminder by logging in and hovering over the areas of concern.

Driving Change in West Tennessee, continued from page 1 sides of that equation. This enabled us to design our own plan to address the needs of our residents.” Watson and his team had very few examples to look to for guidance as they developed the program. “To start one of these plans is daunting. It requires significant infrastructure and capital investment. Most nursing homes do not have either of those. And most traditional Hank Watson insurers have no interest in or idea of what it takes to run a nursing home,” he said. “We had nursing homes, were licensed through the Department of Insurance and had a contract with the Centers for Medicare and Medicaid Services. So, we were well poised to develop a special needs plan for Medicare, based on the needs we had identified in our facilities.” In 2017, Watson helped American Health Partners expand beyond its provider businesses into Medicare Advantage through a new company – American Health Plans. He has been on the front lines of developing not only the program 4



but also in forming partnerships with long-term care providers to offer the program to their residents across multiple states. American Health Communities, a division of American Health Partners, has 28 facilities in Tennessee, 26 in the program as well as partnerships with ten incremental facilities across the area that offer American Health Advantage of Tennessee to residents and in conversation to bring other nursing home facilities into the program as partners.” “American Health Advantage of Tennessee which launched January 1, 2019, has allowed our facilities and partner facilities to provide a higher level of care that is customized to our residents. Members get access to nurse practitioners and RN case managers who provide incremental care in the nursing home environment,” said Watson. “For the majority of our membership there is no additional cost because most patients are dual eligible for Medicare and Medicaid, which means they receive financial assistance with Medicare advantage premiums and cost sharing.” Through the program, care is provided to members 24/7 in the facility by either a nurse practitioner or RN case manager. “Each provider’s sole purpose is to provide high quality proactive care

for their group. Their practice consists of regular weekly rounds to check on members as well as providing on-call coverage for their panel,” said Watson. “Each panel consists of about 60–80 members, so our providers get to know their members very well and can be responsive to their needs.” Through customized care programs and provider-owned Medicare Advantage plans, American Health Plans have reduced unnecessary hospitalizations for patients by transforming the role provider partners play in the overall health of patients. “Under a traditional Medicare plan, if a nursing home resident needs elevated care for something such as a urinary tract infection, they are required to be hospitalized for three days. This process can cause undue stress to a patient who is already frail,” said Watson. “In our model, since on the plan and having a nurse practitioner and case manager on site, that threeday hospital stay can be waived because the resources needed to provide the elevated level of care is in the facility.” Strong engagement with facility staff and families in addition to clinical resources have had positive impacts as well. “Nurse practitioner and case managers work with the director of nursing, medical director, pharmacist, therapist as well as member advocates to make sure they

Updated as regulations and requirements change, it also serves as an ongoing resource for all users, regardless of participation in an on-site consultation. Clark said RiskView’s goal is to reach a wide audience and to serve varying purposes to match needs. She noted the virtual practice navigation platform has allowed SVMIC to take a large body of professional resources developed over time and to organize a large portion of that information in one, easy-t0access place. Another benefit of RiskView is that it’s available at policyholders’ and their practice administrator’s convenience and can be referenced whenever needed. “The whole purpose is risk mitigation,” said Clark. “Our policyholders don’t have to pay for it . . . it’s just an added benefit.” While access to the full platform requires logging into the SVMIC member portal, anyone interested in seeing how RiskView works can sample the program by going online to home.svmic. com/#riskview. “RiskView is intended to assist policyholders with improving patient care and reducing liability exposure in an online format that is easily accessible,” concluded Clark. “We are excited to release this new tool and look forward to continuing our search for new and creative ways to share our professional resources and make risk mitigation an easier part of our policyholders’ day.”

are on top of all aspects of a members care,” said Watson. “Member advocates are a part of the care team in each facility. Besides checking on members, they make sure members are having good social interactions, especially if a member does not have regular visits from family members. From bringing them balloons on special occasions to just interacting with them on a social level, advocates play an important role in ensuring our residents have as high of a quality of life as possible. These qualitative non-clinical discussions can often identify changes in things such as behavior or demeanor that be an indicator of an underlying health related issue.” Watson says that when the nursing home becomes the payer for its patients, it eliminates the need to depend on other resources to provide the level of care needed for their residents. “Our plans are designed specifically to help nursing home operators enhance patient care and manage financial risk. Sponsoring a health plan through the nursing home can increase patient services, improve health outcomes and generate a reliable, shared revenue stream,” he said. “Through shared ownership in Medicare Advantage plans, we help nursing homes control their financial future in a challenging healthcare environment.” westtnmedicalnews


New Hope, More Options For Breast Cancer Patients, continued from page 1 by the Food and Drug Administration, as a result of clinical trials conducted at West Cancer Center, give breast cancer patients additional treatment options. One new technological procedure that Baptist began offering in March to patients who are ideal candidates is intraoperative radiation therapy (IORT). According to Lindi VanderWalde, MD, surgical oncologist with Baptist Medical Group, IORT occurs in the operating room after a surgeon performs a lumpectomy. The surgeon prepares the breast for radiation and a radiation oncologist Lindi VanderWalde administers radiation to the cavity where the tumor was present with a balloon device. She says there are fewer side effects with the new technology and the long-term cosmetic results are better for the patient. Previously, a patient underwent radiation therapy five times a week for three to four weeks after a lumpectomy. Now, says Dr. VanderWalde, the radiation is administered only one time during surgery. “It’s exciting and revolutionary,” Dr. VanderWalde said. “We can combine procedures in the operating room in a multidisciplinary setting, which may add 20 to 30 minutes in the operating room but save the patient time in the long run, so they can get back to their daily lives.” Dr. VanderWalde says IORT is most effective for patients who are in the early stages of breast cancer and are postmenopausal. The technology builds on the investment Baptist made last year on another device called the SPY Elite Fluorescence Imaging System, which enables surgeons performing breast reconstruction to visualize microvascular blood flow and perfusion in tissue in real time during surgery. Dr. VanderWalde says Baptist is the first healthcare system to be equipped with the machine, which uses color to distinguish healthy tissue from dying tissue during breast reconstruction surgery. It reduces the likelihood of post-operative complications, such as infection, which can inflate medical costs. Additionally, she says the system removes the guesswork, and surgeons know immediately which tissue can be used during breast reconstruction. In many cases, the patient can receive a breast implant minutes after a mastectomy. UTHSC plans to introduce new technology and improve diagnosis and treatment options for breast care patients in the Memphis area with its newly formed breast surgery section in its department of surgery, which formed a partnership with Methodist Healthcare in August. Five surgeons, specializing in breast cancer, have joined the team and will be embedded at two Methodist Comprehensive Breast Centers providing multidisciplinary care in the next six months,



according to Martin Fleming, MD, associate professor and chief of the division of surgical oncology in the College of Medicine at UTHSC. Dr. Fleming will be leading the new Martin Fleming section. Dr. Fleming says the team will be able to collaborate with plastic surgeons and perform localized techniques and procedures at the

same time, such as a lumpectomy and breast reduction in a multidisciplinary setting. “This will provide a next level of care for cancer patients,” Dr. Fleming said. “A breast surgeon will be able to map out a patient’s care at the same location where the patient receives a mammogram and a biopsy.” As a result of the new formation, UTHSC will be involved in national collaborative trials through two research organizations, the SWOG Cancer Research Network and the Alliance for Clinical Trials in Oncology.

According to Dr. Fleming, the team has planned a series of lectures through the Congressional Health Network, a collaborative partnership between Methodist Healthcare and 400 Mid-South congregations, during October, which is Breast Cancer Awareness Month. The team will hold sessions to the public on Thursday nights focusing on the importance of screenings, self-examination, surgical treatment, radiation, chemotherapy and breast health. Both Dr. Fleming and Dr. VanderWalde stress the importance of com(CONTINUED ON PAGE 6)

The Jackson Clinic Welcomes Our Newest Physician

David M. Hall, M.D.

GENERAL SURGERY 700 WEST FOREST AVE Board Eligible: American Board of Surgery Residency: The University of Tennessee Health Science Center, Memphis, TN Medical School: Northeast Ohio Medical University, Rootstown, OH

731.422.0213 | 800.372.8221 |




GrandRounds Christ Community Health Services Expands to Jackson

JACKSON - Christ Community Health Services has been awarded a New Access Point grant from the Bureau of Primary Health Care to extend healthcare to East Jackson, TN.  Providing $650,000 annually, the grant affords community health centers the opportunity to expand needed primary care services to medically underserved and rural communities. Christ Community will expand its services to Jackson, operating out of a center currently owned by the Faith Health Center.  Christ Community plans to open the Center by the end of 2019 as the Christ Community Health Services, East Jackson Health Center. The East Jackson location will be the ninth

Christ Community location within its network and the first expansion outside of Memphis and Shelby County, TN. Christ Community will be partnering with West Tennessee Health Care to address the unmet needs in East Jackson. The need for quality and affordable healthcare is paramount as the area lacks a federally qualified health center in the targeted service area according to Christ Community Health Services, Chief Executive Officer, Shantelle Leatherwood. She said Christ Community was approached by Dr. David Larsen, founder of the Faith Health Center, regarding a desire to partner approximately 12 months ago. Working alongside Dr. Larsen, the organization plans to replicate the same model of care in the Jackson community. 

To open the clinic, Christ Community is collaborating with West Tennessee Health Care in Jackson. With financial support from both HRSA and West Tennessee Health Center, Christ Community will be able to serve the medical needs of residents in East Jackson. The targeted population surrounding the existing Faith Health Center

has a concentration of low income and minority residents, with approximately 32% living 200% below the federal poverty guidelines.  The Faith Health Center plans to cease operations on November 26, 2019. Christ Community will reopen the Center and begin serving the community in late December 2019.

New Hope, More Options For Breast Cancer Patients, continued from page 5 munity outreach to eliminate fear and encourage early detection. “As a physician, you see patients who have delayed getting treatment either out of fear or for financial reasons,” Dr. VanderWalde said. “It’s important to get out the message about the importance of mammograms because there are so many options now and the success rate is the highest it’s ever been.” Medications recently approved by the FDA provide more treatment options for breast cancer patients, especially when the breast cancer is metastatic, according to Gregory Vidal, MD, PhD, medical oncologist and hematologist at West Cancer Center and associate professor of medicine at UTHSC. Gregory Vidal An immunebased therapy drug called atezolizumab was approved in March to treat patients with advanced or metastatic triple negative breast cancer after successful results were reported in clinical trials. Triple negative breast cancer is diagnosed when breast cancer cells test negative for the three most common types of protein receptors – estrogen, progesterone and hormone epidermal growth factor receptor 2 (HER-2), which are known to fuel breast cancer growth. Because the tumor isn’t supported by

these receptors, triple negative breast cancer doesn’t respond to traditional hormone therapy and specific targeted therapies. Usually a patient is given chemotherapy to shrink the tumor, followed by surgery to remove it. As a result, the cancer has a higher reoccurrence rate. Only 10 to 20 percent of breast cancer patients are diagnosed with it, according to the Johns Hopkins Breast Center, but it’s known to be a more aggressive type of breast cancer. The progression-free survival was 7.4 months for patients in clinical trials who received a combination of atezolizumab and chemotherapy, and 4.8 months for patients who received placebo and chemotherapy. Dr. Vidal, who has conducted several clinical trials at West Cancer Center dealing with triple negative breast cancer, said West Cancer Center recruited the highest number of patients to participate in clinical trials with triple negative breast cancer. “This is the first time we’ve had a drug approved for metastatic triple negative breast cancer,” he said. “The survival rate of patients with triple negative breast cancer is less because only traditional chemotherapy was used to treat the cancer cells. Last year, there weren’t any successful options, besides chemotherapy, available for this type of cancer.” Another drug approved by the FDA earlier this year is the anti-estrogen therapy alpelisib. It’s designated to be used in combination with chemotherapy in postmenopausal men and women with HR-2 positive and HER-2 negative advanced or metastatic breast cancer.


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West Tennessee Healthcare Announces Plan to Consolidate Emergency Services in Gibson County

JACKSON - On Tuesday evening, September 24, West Tennessee Healthcare’s Board of Trustees approved a resolution for $5,576,425 for renovation and expansion of the emergency department located at Milan General Hospital. The emergency department renovation will expand the department from 6 beds to 10 beds, improve patient flow, renovate trauma space, and add additional square footage to the existing facility. Completion of the project is expected in the first quarter of 2021. Milan General Hospital also offers inpatient and outpatient services, such as surgical services, lab and radiology services, and an Intensive Care Unit. Expanding the emergency department in Milan is necessary for providing access to much needed quality healthcare for the citizens of Gibson County and the surrounding area. In order to increase efficiency in providing emergency services for the county, the organization will be closing the emergency room, outpatient lab, and radiology services currently located at Humboldt Medical Center, and consolidating these services with the existing services provided at Milan and North Hospital in Jackson. Milan General Hospital’s emergency department is located 12 miles from the Humboldt Medical Center, and North Hospital’s emergency department is located only 8 miles from the Humboldt Medical Center. West Tennessee Healthcare also operates emergency departments in Bolivar, Camden, Dyersburg, Martin, and JacksonMadison County General Hospital. North Hospital, formerly known as Regional Hospital of Jackson, was acquired by West Tennessee Healthcare in 2018, and currently operates a 16-bed emergency department, as well as outpatient services, such as lab and radiology, and advanced services such as interventional radiology services. There are also plans to further expand the services at North Hospital to provide for high quality orthopedic services. The emergency department in Humboldt has been operating as a department of Jackson-Madison County General Hospital since the closure of the Humboldt General Hospital in 2014. Emergency department visits in Humboldt have dropped significantly over the past 5 years and the majority of emergencies are transferred to Jackson-Madison County General Hospital or other larger facilities in the region. According to West Tennessee Healthcare President and CEO, James Ross said the decision was made after many months of review of the utilization of services at Humboldt Medical Center, and they believe it is the best decision for financial sustainability for the future and to improve healthcare services offered in Gibson County. The Humboldt Medical Center will continue to be home to the Thomas D. Dunlap conference center, Sports + Rehab Center, which offers outpatient physical therapy and aquatic therapy, and A Mother’s Love, a program for pregnant women battling opioid addiction. The existing facility is being evaluated in order to determine which additional services are needed in the community and are appropriate for the Humboldt Medical Center campus. Ross said the goal is for no employee to become unemployed. They want to retain all employees who wish to stay with WTH and will support them as they seek other jobs in the health care system. They are restructuring and expanding emergency services in Gibson County in order to better utilize existing facilities, Humboldt Medical Center and Milan General Hospital, in the most efficient and effective way. westtnmedicalnews


GrandRounds BlueCross Names Director of Corporate Communications

BlueCross BlueShield of Tennessee has named Dalya Qualls as director of corporate communications. Qualls will serve as a spokesperson for the company and direct a team responsible the company’s internal and external Dalya Qualls communication strategies. Prior to joining BlueCross, Qualls served as communications manager with HCA Healthcare, where she di-

rected the company’s media strategy and oversaw the team that developed content for digital platforms. Previously, Qualls served as deputy communications director for the Tennessee Department of Safety and Homeland Security, where she held primary spokesperson duties and handled media strategy for related agencies. Qualls earned a master’s degree in mass communications from Southern Illinois University and received her bachelor’s degree in English from the University of Illinois at Urbana-Champaign.

AMA Intensifies Campaign to End Burnout

The American Medical Association (AMA) has launched its Practice Transformation Initiative to fight physician burnout. Jesse M. Ehrenfeld, MD, MPH AMA board chair, said “While AMA efforts to date have increased awareness of the physician burnout crisis at all levels and driven positive change, there is an immediate need for transformational solutions.” The AMA said although symptoms

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of burnout have been well researched, actionable solutions have not been analyzed rigorously. As a result, information on effective interventions remains limited. The goal of the initiative is to fill those knowledge gaps. To make physician burnout a thing of the past, the initiative will support research and advance evidence-based solutions by collaborating with organizations who are committed to the practice transformation journey, according to the AMA.

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