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FOCUS TOPICS HEALTH LAW • ACOS• TELEMEDICINE • TMA

September/October 2020 >> $5

ACO Pays Off for Patients and Physicians in West Tennessee

ON ROUNDS

Revised Regulations Make Some Employees of Healthcare Entities Newly Eligible for Paid Leave

Everyone wins the benefits of an Accountable Care Organization By SUZANNE BOyD

Since their inception, accountable care organizations (ACO)s have blazed a path of innovation in the healthcare industry, from delivery to quality of care. Originally established in 2012 as a Medicare payment model, an ACO is a group of healthcare providers who voluntarily come together to coordinate healthcare services and engage in valuebased payment models. These providerbased networks utilize data analytics and population health management strategies to increase efficiency, improve patient outcomes, and reduce healthcare costs. West Tennessee Clinical Partners, an ACO centered in Jackson with clinics and providers spread across the region and throughout Kentucky serving over 30,000 Medicare

Many healthcare entities have been issuing “blanket denials” of employee requests for coronavirus related family leave under the (correct) belief that their healthcare entity qualified for an exemption to the new laws. Recent revisions to the regulations will require more individualized determinations.

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Four Ways COVID-19 is Changing Health Care – Now and in the Future

beneficiaries is reaping the benefits of this program. What makes this group unique for this area is that it was formed without the assistance of a major healthcare system or hospital. Dustin Summers, CEO of West Tennessee Clinical Partners, began laying the groundwork for the organization in 2014. “I knew that ACOs and the Medicare Shared Savings Program would come to the forefront with the passing of the Affordable Care Act,” said Summers. “I started laying the groundwork for this group through an Independent Physician Alliance I was working with, which allowed me to get the wheels in motion very quickly. I figured Vanderbilt, the Jackson Clinic and West Tennessee Healthcare would be forming their own ACOs, so we needed to have a similar program. It (CONTINUED ON PAGE 6)

HealthcareLeader

Dr. Ronald Kirkland Steps Up as President-Elect for the TMA

As Tennessee and the nation continue to navigate the deep impacts of COVID-19, one thing seems certain — the pandemic has changed the way many of us have traditionally viewed and engaged with the health care system.

Jackson physician tackles healthcare issues statewide By LAWRENCE BUSER

As President-Elect of the Tennessee Medical Association (TMA), Dr. Ron Kirkland of Jackson will be taking over an organization that has some significant momentum in its favor. The physician’s group, which last year was named most influential advocacy organization on Capitol Hill, recently saw passage of special-session legislation related to two key areas of concern: telemedicine and COVID liability. “The insurance companies would not pay for telemedicine which allows patients the ease of remotely talking with their physician,” said Kirkland, an otolaryngologist/head and neck surgeon who retired from The Jackson Clinic in 2015 after 31 years in practice. “Now the legislation requires them to pay for the service at the same rate as they would for a similar service in the office.

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Dr. Ronald Kirkland Steps Up as President-Elect, continued from page 1 “It was on our plate before COVID, but we couldn’t get anywhere. Then it was made necessary by COVID when we didn’t want to have interpersonal contacts. Telemedicine is of great benefit to patients who don’t have to drive to an office, sit in the waiting room, where they might get sick, and then drive back home. That’s all eliminated with telemedicine. Of course, there are some things that require a faceto-face visit, but routine issues can be taken care of with telemedicine.� The second piece of legislation involved limiting liability for physicians, clinics, and hospitals that saw patients who later acquired COVID. “They could bring suit and say you exposed them to COVID and you’re liable for these damages,� said Kirkland. “Now the law insists that there is grossly negligent behavior on the part of the physician, clinic, or hospital before they can be sued. That’s a reasonable standard. Otherwise we’d be flooded with lawsuits.� But the new legislation says the grossly negligent standard only applies to suits that are filed after August 3, 2020. “So, there’s still significant exposure,� he said.  Kirkland is scheduled to succeed Dr. Kevin Smith of Nashville as TMA president in April of 2021, but there will still be plenty of issues to address on behalf of TMA.  “Another ongoing issue is the scope of practice regarding nurse practitioners, physician’s assistants and others who, in our view, want to practice medicine without a medical license,� Kirkland said. “They are essential to providing high-quality care to our patient population, but it’s the position of the TMA that those professionals should work in collaboration with physicians who are available to help them in more difficult situations. “It seems to me that it’s not in the best interests of patients to have nurse practitioners and physicians assistants, who only have a small fraction of the training of physicians, making important decisions without the support of physicians. Before I retired, we had a wonderful nurse practitioner in our office who was very knowledgeable and she could do 99 percent of the office work I did, but she knew that I was there if she needed me and I knew she would call on me if she was in a situation where she was not comfortable.� Kirkland also would like to boost membership in TMA, whose 9,500 members represent about 60 percent of the state’s licensed physicians. He has been a member since his medical school days and has been quite active the past 10 years. 

His path into medicine was a circuitous one, though one marked by dogged persistence. Kirkland entered the University of Tennessee at Knoxville as an engineering student, posting good grades before switching to pre-med. Then, while dealing with family issues, his study habits dissolved, he began skipping classes and by his junior year he was gone. He was then “taken in� by UT-Martin, did well there for two years, spent a brief time in law school and then, with no more college deferment, enlisted in the Army.

“The recruiter suggested I go into military intelligence and said I would get to wear civilian clothes and I wouldn’t have to go to Vietnam, so I said, ‘Where do I sign?’� Kirkland recalled. “As it turned out, I went to Vietnam as a counterintelligence agent, but I did get to wear civilian clothes, so the recruiter was half right.� He was stationed in Nha Trang near Cam Ranh Bay, living in, and working out of two houses surrounded by concertina wire. His duties included making sure military units were handling classified documents properly, conducting background investigations on certain Army personnel,

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and conducting clandestine weekly debriefings of local confidential informants. “My duties involved flying around the Central Highlands in helicopters and small airplanes,� he said. “It could be risky, but I never had an incident that I knew about. It was kind of fun, as long as you didn’t get shot.� Kirkland was discharged in 1971, worked a short time in a family-owned Ben Franklin Store, and then began to pursue medical school in earnest. He bulked up on upper division biology, chemistry and physical chemistry at UT Martin and graduate (CONTINUED ON PAGE 6)

Dr. Tatevik “Tev� Minasyan Family Practice

Residency: University of Tennessee Family Medicine Jackson, TN Medical School: University of Tennessee Health Science Center Memphis, TN Undergraduate: University of Memphis Memphis, TN

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Legal & Practical Considerations for Telemedicine   AHLA Panel Looks at Current, Post-Pandemic Landscape  By CINDY SANDERS 

 In the face of a global health crisis that called for limiting close, in-person contact, it’s not surprising telemedicine has enjoyed skyrocketing popularity in 2020. In addition to the practicality of such medical appointments, emergency orders loosening tight regulatory mandates around the field has made it possible for more providers to offer services to a larger patient population.  Nothing, however, lasts forever.   Turning an eye to a post-pandemic landscape, the Physician Organizations Practice Group of the American Health Law Association recently hosted a webinar looking at both legal and practical considerations of telemedicine now and moving forward. The regulatory changes currently in place are in effect throughout the public health emergency. When that designation is removed, rules and regulations revert to pre-pandemic status unless there is further action at the federal level.   

Public Health Emergency

On March 13 of this year, President Donald Trump made an emergency declaration in regard to the COVID-19 pandemic under the Stafford Act and the National Emergencies Act. That declaration of a public health emergency (PHE) set into motion authority for various federal agencies to issue waivers providing flexibility to meet the unique challenges of COVID-19.   Within days, changes went into effect across Health and Human Services. The Office for Civil Rights (OCR) issued new HIPAA guidance allowing covered providers, “in good faith, (to) provide telehealth services to patients using remote communication technologies, such as commonly used apps – including FaceTime, Facebook Messenger, Google Hangouts, Zoom, or Skype – for telehealth services, even if the application does not fully comply with HIPAA rules.”   CMS issued a number of waivers making it easier for those enrolled in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) to access care through telehealth platforms during the crisis. Changes have allowed providers to conduct telehealth visits with patients inside their homes and outside of designated rural areas. In many cases, providers could practice even across state lines. Telemedicine could be used for both established and new patients, and the appointments have been billable as if the visit was in person. Additional waivers specifically addressed Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), including easing some physician supervision requirements for nurse practitioners to the extent permitted by state law.    

Transformation of Telemedicine

Ronnen Isakov serves as managing director of healthcare advisory services 4

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for Medic Management Group, which provides operational, management, financial and revenue services for practices. He noted CMS added 135 allowable services and CPT codes under the emergency orders, immediately doubling what had been available at the beginning of the year.   The healthcare industry, said Isakov, is notoriously slow-moving when it comes to transformation. “For our rules to change takes a long process,” he pointed out. “The pandemic kick-started the digitalization of healthcare.” Isakov added telehealth saw a decade of regulatory changes in a matter of a days and weeks.  Similarly, the medium saw an explosion in usage. Isakov said the normal number of telemedicine visits in March had been about 13,000 Medicare beneficiaries per week. “During the last week of April, in a six-week period, that number jumped to 1.7 million beneficiaries,” he noted. For those keeping score, that’s a 15,354 percent increase.  Isakov added that pre-pandemic, McKinsey estimated the total annual revenue of all American telehealth companies to be $3 billion. The company now estimates $250 billion of the nation’s health spend could ultimately be digitized. Similarly, Frost & Sullivan now predicts a seven-fold growth in telehealth by 2025.  From the operational viewpoint, Isakov said telehealth has focused on ease of access. “For our rural practices and facilities, it was an immediate way to solve some patient transportation issues,” he added of the relaxed RHC regulations.   On the flip side, Isakov noted, “There’s still a lot of perceived quality of care concerns.” He also said smaller practices continue to worry about the financial investment required long-term, coupled with reimbursement uncertainty once temporary waivers expire. While it remains to be seen if payers continue to reimburse adequately, Isakov said there is a lot of pushback for expanded services to continue.   “We really believe it’s unlikely to see telehealth volumes go back to the preMarch numbers but that some form of telehealth is here to stay,” he concluded.   

Practical Application

Kyle Sharp, interim associate vice president and executive director of OSU Physicians at Ohio State University, said the huge system utilized telemedicine for about 100 visits per month for a total of 0.04 percent of overall patient visits prior to COVID-19.   Looking at telehealth vs. in-person visits, Sharp said telehealth didn’t even register in the numbers pre-pandemic. By March, a little more than 13,000 visits were conducted remotely. In April and May, telehealth visits outnumbered inperson visits with 44,591 telehealth visits in April and 40,898 in May. “During the peak of the pandemic, 90 percent of our providers were using telehealth,” he said. At this point, Sharp added, they have had telehealth visits from 49 states, although the

majority of remote visits have been in a four-state region. As clinics slowly reopened and expanded services throughout the summer, Sharp said in-person visits began to rebound with total number of patient visits nearing pre-COVID projections. While telehealth visits have decreased, they have remained a significant percentage of overall visits. In August 2020, in-person visits accounted for 82,866 patient encounters, but telehealth added another 26,429 visits – a far cry from the 100 per month before the pandemic.   Coming out of COVID, Sharp said their ongoing telehealth targets are for about 30 percent of primary care, 20 percent of medical specialty and 10 percent of surgical visits to be conducted via telehealth. Sustaining momentum, he added, will require some additional patient education. “Our Medicare population did not resonate with our telehealth platforms as did our other populations,” he noted.    

Evolving Telehealth Law

Kate Hickner, a partner in the Cleveland office of  Brennan Manna & Diamond and chair of AHLA’s Physician Organizations Practice Group, noted telemedicine first came on the scene in 1997 as part of the Balanced Budget Act.  There have been multiple tweaks to the law, some quite significant, over the ensuing two decades.  Hickner said the Medicare Telehealth Benefit is outlined in section 1834(m) of the Social Security Act, which includes specific geographic, location, service, technology and provider requirements, albeit with some exceptions. “Even though Medicare has implemented waivers, 1834(m) of the Social Security Act is still the law,” she pointed out.   Hickner said Congress will have to address the changes that have been put in place when the public health emergency declaration expires. She added there does seem to be a will to expand telehealth access. “There is a White House directive to CMS to look at telehealth efforts in rural health areas,” Hickner noted. She added the proposed 2021 physician fee schedule adds nine telehealth codes permanently, removes 74 at the end of the year in which the public health emergency declaration expires, and includes 13 codes to add to the list of telehealth services. However, she pointed out, any changes at this point are still in the proposed stage.  During the PHE, Hickner noted the HHS Office of the Inspector General (OIG) has created increased flexibility to allow providers to waive copays and deductibles for telehealth. Under normal circumstances, such a move to reduce or waive costs owed by federal healthcare program beneficiaries  could  be seen as inducement under the anti-kickback statute. However, OIG has said they will not enforce the statutes if providers choose to reduce or waive cost-sharing for telehealth during the COVID-19 emergency.  Other flexibilities around supervision,

signature requirements, licensure, credentialling, prescribing and data privacy and security have all been temporarily implemented, as well. Medical documentation for a telehealth visit, she continued, is generally the same as for an in-person visit with two key distinctions: 1) consent to receive telehealth services and 2) notation of the state where the patient is located for the visit and specific location of the rendering provider.   “Regardless of the flexibility offered by CMS, we do need to consider state law,” Hickner reminded the audience. “The practice of medicine occurs where the patient is located at the time of service,” she continued. If a physician is in Tennessee but caring for a patient in Arkansas, then Arkansas’ rules and regulations govern the encounter.   

Plan Now for Post-Pandemic 

For those who didn’t previously have a robust telehealth program in place, Greg Stein, IT and IP counsel for Cleveland Clinic, said now is the time to be thinking about how to move forward post-pandemic.   Currently, the type of technology that can be used has been greatly expanded to include any non-public facing remote communications product including Zoom, FaceTime, Microsoft Teams and other popular platforms. Similarly, private texting applications including Facebook Messenger, Jabber and iMessage are acceptable. However, cautioned Stein, using public-facing technologies like TikTok, Facebook Live or Twitch are prohibited for telehealth.  While penalties aren’t being enforced right now for a hack related to the “good faith provision of a telehealth service,” Stein said a “bad faith provision” is still in play including an intentional invasion of privacy, use of personal health information (PHI) prohibited by the HIPAA Privacy Rule such as selling data or using PHI for marketing purposes without authorization, telehealth violations of state licensing laws or professional ethical standards, and for using public-facing remote communication products.  “At some point, this moratorium is not going to apply, so practices need to be thinking how telehealth will work within the framework of HIPAA,” he said of reverting back to more stringent rules. “With this enforcement discretion in place, it’s a really good opportunity to dig into details right now,” he continued.   Stein, who served as vice chair of the Data Privacy and Information Security Group as a partner at Ulmer & Berne LLP prior to joining Cleveland Clinic, suggested teaming up with someone who understands the technology in play and the requirements to adequately protect privacy and security to meet stringent HIPAA requirements once the PHE expires. He recommended asking lots of questions or finding an advisor who knows what questions to consider when it comes to negotiating a telehealth agreement and analyzing risk.   westtnmedicalnews

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Four Ways COVID-19 is Revised Regulations Changing Health Care – Make Some Employees of Now and in the Future HEALTH LAW UPDATE

Healthcare Entities Newly Eligible for Paid Leave By DENISE BURKE and MARK PETERS

Many healthcare entities have been issuing “blanket denials” of employee requests for coronavirus related family leave under the (correct) belief that their healthcare entity qualified for an exemption to the new laws. Recent revisions to the regulations will require more individualized determinations. The Families First Coronavirus Response Act (FFCRA) enacted on March 18, 2020 created additional leave rights for employees in response to the COVID19 pandemic through two provisions: the Emergency Family and Medical Leave Expansion Act (EFMLA) and the Emergency Paid Sick Leave Act (EPSLA). Since then, the exact contours of employee rights and employer obligations under the FFCRA have been the subject of considerable debate and disagreement. On August 3, 2020, a federal district court judge for the Southern District of New York struck down several portions of the DOL temporary EFMLA regulations it determined exceeded the scope of the agency’s authority, leaving employers without a clear understanding of what portion of the temporary regulations remained in effect through the end of 2020 when the FFCRA terminates by its terms (unless otherwise renewed). On September 16, 2020, new revised temporary regulations became effective in response to the New York case that significantly narrows the healthcare provider exemption. Under the FFCRA, employers are not required to provide any type of FFCRA paid leave to “health care providers.” That term, however, was left undefined by Congress. Originally, DOL interpreted it expansively to include almost anyone employed by a healthcare employer. The New York federal court ruled that interpretation was too broad. The new DOL regulation more narrowly defines who is a healthcare provider, providing concrete guidance on who is and is not covered by the exemption. First, the DOL clarified that “it is not enough that an employee works for an entity that provides health care services.” The worksite of the employee is also not conclusive, so not all employees of a healthcare entity are covered and conversely, employees need not work at a healthcare entity to be covered. The definition of “healthcare provider” under FFCRA is broader than the one used for that term under the FMLA. Unlike FMLA regulations, an employee is not required to carry a specific license or certification to meet the definition of “health care provider.” Instead, the new westtnmedicalnews

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test focuses on the work performed by the employee. The employee must be “employed to provide diagnostic services, preventive services, treatment services, or other services that are integrated with and necessary to the provision of patient care and, if not provided, would adversely impact patient care.” Each of these terms (diagnostic services, preventative services, treatment services, and other integrated services) is specifically defined and include not only traditional healthcare services like patient visits and procedures but also taking and processing samples, performing x-rays or other tests, administering medication, physical therapy, bathing, dressing, feeding, and setting up for procedures. Under this definition, the DOL recognizes four categories of healthcare workers who are covered by the exemption and not eligible for FFCRA leave: The first group are those who are included in the definition of “health care provider” under FMLA regulations. This covers “physicians and others who make medical diagnoses,” such as dentists, psychologists, optometrists, chiropractors, nurse practitioners, physician assistants and clinical social workers.  The second group are those who directly provide patient services, such as nurses, nurse assistants, and medical technicians. The third group are workers who work under the supervision, order, or direction of or provide direct assistance to employees who are in the first or second group. The fourth group are those workers who do not work directly with patients but who are integral to patient care and treatment, such as laboratory technicians who process test results. Employees who are employed by a healthcare provider but who do not fit into one of these four categories are presumed not to fall within the exemption and are eligible for FFCRA leave. Under the revised regulation, examples of such employees who are eligible might include “IT professionals, building maintenance staff, human resources personnel, cooks, food services workers, records managers, consultants, and billers.”  The revised regulations also include other changes regarding notice requirements and leave related to school closures. Denise Burke and Mark Peters are partners at Waller Lansden Dortch & Davis, LLP, in Memphis and can be reached at denise.burke@wallerlaw. com or mark.peters@ wallerlaw.com

By STEVE WILSON

As Tennessee and the nation continue to navigate the deep impacts of COVID-19, one thing seems certain — the pandemic has changed the way many of us have traditionally viewed and engaged with the health care system. Many times, crises create an urgency to speed up innovations in order to meet consumers’ demands and provide convenience. COVID-19 has led to a few emerging trends that may usher in permanent changes to the ways we access health care.

1. Telehealth is here to stay

Telehealth wasn’t new prior to COVID-19, but fewer people were using it before the pandemic. Now many health insurance plans have encouraged the use of virtual visits as an alternative to visiting health care facilities in person, and we’re seeing adoption accelerate. Through June, we’ve seen 10 times as many telehealth visits as we did all of last year. Even specialty care is leveraging telehealth through prenatal visits, and more recently UnitedHealthcare has made physical, occupational and speech therapies available. The push toward contactless care is likely to continue through virtual appointments in primary care, urgent care, disease management and behavioral health.

2. More people will receive care at home.

Similar to how telehealth enables efficient and accessible care at home, the response to the pandemic has created momentum around the concept of a patient’s home as a site for medical services. This idea relies heavily on the adoption of technology and advanced digital tools. Some areas where home-health is advancing are chronic disease management and infusion services. For example, diabetes and congestive heart failure are two chronic conditions that can currently be monitored with the help of digital remote-monitoring tools like continuous glucose monitors (CGM) and activity trackers. Members are able to sync their devices to track progress, check their health data in real time, send and receive messages from a nurse care coach and share progress with their doctor. This helps address long periods of ongoing care. And for patients who need certain medications, home infusion services may be a dependable way to reduce public exposure risk, especially during COVID-19. Typically, a nurse will come to the home and train the patient or caregiver on how to administer the drug. When infusion services are performed in the home, it may help patients receive the critical therapies they need without having to manage the travel and logistical concerns associated with leaving home to visit a clinic or hospital. Moving the site of care to the home may also be an opportunity to save money

by avoiding the overhead costs of an inpatient hospital setting. By improving continuity of care, patients may be able to avoid adverse events that may lead to readmissions to the hospital. We could also see more oncology care being moved to the comfort of the home. This would be especially important for patients who are immunocompromised and still need treatment.

3. The role of a pharmacist is changing.

Pharmacists play an important role beyond medication management in a care team. When doctor’s offices were closed or not available, some pharmacists could fill a gap in care. Even before the crisis, some states had expanded the scope of practice for pharmacists. A few states have given pharmacists limited prescribing authority, and more than 800 pharmacists in the United States are board-certified in infectious diseases. Pharmacists are also integrating more with behavioral health. We’re starting to look at a few things, including how we can help individuals with medication adherence and screening for depression through some of our pharmacies. But similar to the momentum around telehealth and homebased care, there’s an evolving definition of what being a pharmacist can mean.

4. Americans may live healthier lifestyles.

COVID-19 represents a convergence of current and long-term threats to the health of individuals and their families. A number of chronic conditions — many of which are preventable and can be treated — are risk factors for falling severely ill to COVID-19. In addition, maintaining a strong immune system is seemingly more important than ever to avoid contracting or overcoming the coronavirus. In addition, there’s a heightened awareness that cleanliness and hygiene practices can keep people healthier and avoid the spread of disease — expanding the notion of good health to include cleanliness of the things people interact with each day. If the momentum continues to shift toward greater health ownership, the pandemic has brought forth advances that could support this renewed focus on health and well-being.

Looking ahead

COVID-19 has changed several aspects of health care, some for the better. These trends can help increase flexibility, convenience and access and may help more people get the care they need to live healthier lives. Steve Wilson is the CEO of UnitedHealthcare of Tennessee

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ACO Pays Off for Patients and Physicians, continued from page 1 was important to me to empower independent, primary care providers as they struggle to stay afloat in this era of healthcare where bloated systems swallow up more and more practices.”  In January of 2015, six clinics formed an ACO named West Tennessee Clinical Partners and was officially recognized by Medicare. Imperium Health Management out of Louisville played an integral role in the group’s formation. “We started with just primary care doctors in West Tennessee that we knew were pretty engaged and that could work in conjunction with each other. We also knew we wanted it to be a doctor driven group with no hospital involvement. Not Dustin Summers every doctor we approached wanted to be involved. We started small, covering about 7000 Medicare lives for the first few years. You have to have at least 5000 to even be recognized as an ACO,” said Summers. “Initially, we were hesitant to take on anyone outside of West Tennessee but after the first few years we added several clinics in Central and Eastern Kentucky who were made up of doctors very similar to the ones in our group.”  The ACO did not hit a shared saving distribution bonus in its first few years of operation but it did reveal a lot of data and insight into these practices that oth-

erwise might not have been seen making participation in the program worthwhile especially since it cost nothing. In 2018, Medicare changed the formulation to include physician counterparts in the region. “It was already a high bar to clear when they were on their own but then when you compared our physicians to their counterparts, it made things more interesting,” said Summers. “We knew what our doctors historically cost Medicare and as the system was built on being able to save money, we were already pretty streamlined. But our group fared very well, and they were rewarded for work they had been doing.”   One of the first hurdles Summers faced was making sure physicians and patients knew what an ACO was and how it could benefit them.  More than simply a network of providers, the ACO is focused on streamlining and optimizing the quality of care.  This is done by using data and best practices to reduce duplication of medical services, close gaps in care, deliver effective preventive care, and coordinate services across the care continuum, thus producing better outcomes for healthcare dollars spent. The goal of an ACO is to help the healthcare system reduce its overall spending by rewarding value instead of volume. ACOs reward providers for balancing spending and quality by giving successful participants a portion of the savings, compared to typical fee-for-service rates, they achieve for their payers.    “An ACO provides the doctor far more insight into the care their patients

Physicians Surgery Center of Jackson celebrates 25th anniversary With advancements of anesthesia, pain management, surgical techniques and equipment, surgeries once done in hospitals are now done safely in an ambulatory surgery center (ASC). Physicians Surgery Center is recognized with a 5-Star Medicare rating and Certificate from the Accreditation Association for Ambulatory Health Care in recognition of its commitment to high quality and substantial compliance standards. Physicians Surgery Center is the only ASC in Tennessee that has robotic-assisted device for total joint arthroplasties. Founded by ophthalmologists of The Eye Clinic, P.C., in 1995, the center became synonymous with convenient, boutique and cost-conscious procedures. In 2008, orthopedic surgeons and physicians of West Tennessee Bone & Joint Clinic, P.C., joined the Center. Today, the Physicians Surgery Center completes about 8,000 surgeries annually with medical specialties of ophthalmology, orthopedics, interventional pain management, plastics and urology. It has partnerships with many insurance companies, such as Blue Cross/Blue Shield of Tennessee, Cigna, Aetna and United Healthcare, providing excellent value through high quality outcomes with lower costs. Physicians ns Surgery Center is a member of the national Ambulatory Surgery Center Association, on, which makes up 5,700 ambulatory surgery centers across the United States. S

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receive beyond the clinic, which makes for better continuum of care from primary to specialist to hospital and beyond. The practice gets specific data on where patients are receiving care and the outcomes,” said Summers. “It allows the physician to have empirical data on what is happening outside of the clinic, where there are inefficiencies in care, what the outcomes are and where the best care is being provided for their patients.”   Growing the ACO is always something Summers is looking to do but in a very intentional localized manner. “We have to be sure that a physician or group is a good fit before we consider adding them to our organization. Medicare also can provide some insight on a doctor for us so we can see if there are any outliers in their practice  that may be red flags,” he said. “The great part of it is that not being tied to a bigger health organization our members can remain independent and autonomous while not drowning financially. We are one of only three groups in our region and are the only one not tied to a larger health organization, beyond that clinics participate in national ACOs that are spread across the country.”   The ACO model continues to evolve, but it seems to be here to stay. Although they started as a public option under Medicare, ACOs have grown into a force in the commercial payer market and West Tennessee Clinical Partners is following suit. With more than 20,000 patients in 2019, the group is pursuing multiple contracts with private insurance companies.    

Dr. Ronald Kirkland Steps Up, continued from page 3 studies in molecular biology at Vanderbilt. He was turned down twice for medical school before finally getting accepted on the third try to the University of Tennessee Health Science Center in Memphis. Kirkland, his wife of 52 years Carol, and their four children have some 10 academic degrees from the UT system from one side of the state to the other. “I remember thinking when I got that medical degree in my hand, I’m going to be so smart,” said Kirkland, who is a former president of the University of Tennessee National Alumni Association. “Then as I walked across the stage at the Mid-South Coliseum on graduation day, I was handed my degree and looked out at the audience and thought, ‘Oh, no. I don’t know anything.’ “I think every physician goes through that time period where they feel inadequate, but ultimately you build enough confidence and have enough training and experience that you feel you can handle just about anything. The most satisfying part of my career is having patients coming up to me years later and saying you did this operation or that operation and thanking me for doing good work. I think it’s the relationships with the patients and the staff that I worked with that’s been the most satisfying.” 

GrandRounds Physicians Surgery Center in Jackson Obtains Second Robot for Orthopedic Surgery

The Physicians Surgery Center, a nationally accredited ambulatory surgery center in Jackson, now has a second robot that is used for total and partial knee replacement surgery. Orthopedic Surgeons at West Tennessee Bone & Joint Clinic are using the CORI® robot, the latest technology for total and partial knee replacement surgeries. The Physicians Surgery Center became the first freestanding, ambulatory surgery center in Tennessee to offer robotic-assisted orthopedic surgery when Bone and Joint surgeons began using the NAVIO® robot in July 2018. Since that time, Bone & Joint surgeons have performed over 1,200 robotic-assisted arthroplasties at their continued on page 7

PUBLISHER Pamela Z. Haskins pamela@memphismedicalnews.com EDITOR PL Jeter editor@westtnmedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com GRAPHIC DESIGNERS Susan Graham Katy Barrett-Alley CONTRIBUTING WRITERS Suzanne Boyd, Denise Burke, Lawrence Buser, Mark Peters, Cindy Sanders, Steve Wilson 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 164831 Little Rock, AR 72206

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GrandRounds combined locations in Jackson and Paris. Both the CORI and NAVIO robots were developed by Smith & Nephew. CORI, introduced in July at the Physicians Surgery Center, continues to allow the surgeons to create individualized plans for knee replacement procedures and precisely align implants. Meanwhile, orthopedic surgeons at West Tennessee Bone & Joint Clinic Paris use the Stryker Mako robotic system.

West Tennessee Healthcare Announces Organizational Changes

JACKSON - West Tennessee Healthcare is pleased to announce several organizational changes on the Executive Leadership Team. Earlier this year, Vanessa Patrick was promoted and named Vice-President of Business Development for the system. Vanessa joined the organization in 1999.  Her areas of responsibility include provider recruiting, the physician liaison program, corporate health and wellness, Vanessa Patrick and strategic development including acquisitions.  Mrs. Patrick attended the University of Tennessee at Martin where she obtained her Bachelor of Science degree and her Master’s degree in Business Administration. Mrs. Patrick currently lives with her family in Medina, TN. Scott Krodel was named Chief Information Officer for West Tennessee Healthcare earlier this year.  Scott has over 30 years of experience, with 20 years being at the executive leadership level.   He brings extensive experience and expertise in InScott Krodel formation Technology and has a Bachelor’s Degree in Business Management from Indiana State University and a Master’s Degree in Health Administration from the University of Southern Indiana.  Scott and his family will be relocating to Jackson from Trafalgar, Indiana.   Dr. Vinay Pallekonda joined the team, effective September 14, as the Chief Medical Officer for Jackson-Madison County General Hospital. In this role, Dr. Pallekonda will work closely with the medical staff, officers and clinical department chairs to coordinate clinical Vinay Pallekonda staff administrative activities. He will also be responsible for oversight of hospital quality initiatives. Dr. Pallekonda has more than 20 years of clinical, operational and clinical healthcare experience, and is Board westtnmedicalnews

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Certified in Anesthesiology, Internal Medicine and Critical Care Medicine. He and his family are relocating to Jackson following his service as Chief Medical Officer for DMC Sinai Grace Hospital in Detroit, Michigan.

The Jackson Clinic Announces New Family Practice Physician

JACKSON - The Jackson Clinic recently added Dr. Tatevik “Tev” Minasyan to their Family Practice Department. Dr. Minasyan joins Dr. Anna “Liz” Burgess, Dr. Phillip A. Coy, Dr. David L. Garey,

Dr. Ashada F. Knight, Dr. Eric W. Muir, Dr. Jason A. Myatt, Dr. Rebecca A. Nass and Dr. Kellie L. Wilding. The Family Practice Department is located at 2863 Hwy 45 Bypass. Tev Minasyan Dr. Minasyan received Doctor of Medicine degree from the University of Tennessee Health Science Center, Memphis, TN. She received her undergraduate degree at the University of Memphis,

Memphis, TN. Dr. Minasyan completed her residency at the University of Tennessee Family Medicine, Jackson, TN. Dr. Minasyan is Board Eligible, American Board of Family Practice. A family practitioner’s primary focus is his or her patient and their family’s health care needs. They provide general medical care, such as check-ups and treatment for illnesses and injuries, for an individual and/or their entire family. Family practitioners have received a wide range of medical training including pediatrics, geriatrics, internal medicine, and gynecology.

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