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Volume 20, Number 3

Inside: Dr. Alan Levy, Levy Dermatology Baptist Lung Screening Program

Fall 2017


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contents Volume 20, Number 31

The mission of the Society is to unite the physicians of Memphis & Shelby County into an organization to promote the highest quality of medical practice and the health of our citizens.

Spring Fall 2017

Features 8 Dr. Alan Levy, Levy Dermatology 10 Baptist Lung Screening Program by: Karen Mayer

In Every Issue 2 Editorial 4 From the President 23 Calendar 24 New Members

Back Page on the cover: Alan Levy, M.D.

28 Unused drugs? New state law will allow you to donate them

Cover photo by Greg Campbell

Fall 2017

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2017 Board of Directors Phillip R. Langsdon, M.D. President Autry J. Parker, M.D. President-elect Andrew T. Watson, M.D.. Vice-President Danielle Hinton Hassel, M.D. Secretary David L. Cannon, M.D. Treasurer Lanetta Anderson, M.D. Frederick A. Fielder, M.D. James E. Klemis, M.D. Jimmie Mancell, M.D. Justin Monroe, M.D. Christopher M. Pokabla, M.D. Lisa S. Usdan, M.D. Lindi Vanderwalde, M.D. Raymond R. Walker, M.D. Immediate Past President: Tommy J. Campbell, M.D. Ex-Officio Board Members: Perisco Wofford, M.D. President - Bluff City Medical Society Jessica Harrison President - Mid-South MGMA

The Memphis Medical Society 1067 Cresthaven Road, Memphis, TN 38119-3833 (901) 761-0200 • FAX (901) 761-2944 www.mdmemphis.org Executive Vice President Clint Cummins Executive Assistant Janice Cooper Manager, Business Development, MedTemps Personnel Service Cailyn Bautista Finance Director Leah S. Lumm Business Services Division: Senior Staffing Coordinator Freda Reed Accounting Coordinator Paula Lipford Photography Credits Greg Campbell Janice Cooper Victor J. Carrozza Editorial Thomas C. Gettelfinger, M.D. Graphic Design Liz Petzak 2

Editorial Thomas C. Gettelfinger, M.D.

Yes Donald, There Is An Answer And there is already a consensus Look my friend…it’s over. You called the Republican Senate’s bluff on health care reform and they didn’t deliver. They cried havoc for years but they didn’t have an acceptable plan. And I say, Good God Almighty, thank them for that. You live and die on your brand. Believe me, you didn’t want that bill as your brand. TrumpCare would always have had a bad odor about it. Declare that you tried, call it a day and move on. Now insist on a bipartisan, centrist committee and work for a year, more if it takes, and come up with something you, and all of America, can be proud of. But there is already a consensus, one that you promised, and one you can move NOW: control drug costs. That consensus is among doctors, patients, pundits, opinion leaders, everyone except the drug industry, that prices are too high. Drug costs have traditionally been 10% of the health care dollar. Now they are probably 17% and rising. In at least one plan, they account for 33% of total costs. You will never control health care spending until drug costs are controlled. Medicare Part D was passed by your Party, Republicans. You have never been given enough credit for that. It did however have a fatal flaw: drug prices were not negotiable. That must change. An evil empire has arisen in our midst: pharmacy benefit managers. Hold them accountable for their responsibility in rising costs and make their transactions transparent. In fact make the whole price structure transparent. Call out Senator Cory Booker, who took big donations from the drug industry. Call out Representative Steve Cohen who says reform is hopeless, that Congress is bought by the drug interests. And make sure Elizabeth Rosenthal and Marcia Angell help write the necessary reform legislation. Or just make it easy for Amazon to get in the Pharmacy business. That threat should get people to the table. This is your issue. Own it. You promised. Medical Society Quarterly


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President’s Message Phillip R. Langsdon, M.D.

MOC “We Must Come Together”

It has been said in jest many times that getting physicians to a consensus is like herding cats. Candidly though, physicians do generally agree on the big issues like health care policy, MOC, EMR, etc. Our failure....is in allowing events to overcome us by failing to come together as a unified voice to lead the changes. We can no longer continue to allow the tail to wag the dog…so to speak. Practicing medicine has become too costly, too high stress and over-regulated with extraneous pressures (outside of our patient responsibility) responsible for the well-documented physician burn out rate of 50% (Liselotte N. Dyrbye, et al, Physician Satisfaction and Burnout at Different Career Stages, Mayo Clinic Proceedings, Dec. 2013 & Medscape, Lifestyle Report, 2017 ) and the loss of physician-patient face time. One of the most unnecessary burdens is Maintenance of Certification (MOC). It has become overwhelmingly time consuming, stressful and costly. Physicians already comply with state requirements for continuing medical education (CME). CME alone requires a lot of course time, expense, loss of revenue, and time away from home and family. However, most physicians enjoy CME education, a process that often includes the opportunity to talk to peers about treatment experiences while at the symposiums; an educational benefit you cannot gain from a written exam. I don’t know a single doctor who does not believe in continuing education. By our nature we love to learn. Unfortunately a few years ago some of the national boards began to mandate that physicians re-take written board exams. (As I have said before, “Do you think attorneys would tolerate being forced to re-take the bar exam?”) MOC can cost thousands of dollars in exam fees, thousands of dollars to review pre-test materials, hundreds of hours of study, time away from practice (while the overhead of running an office, paying employees, patient’s needs continue), travel, hotel expense, and loss of personal/family time…in addition to our state mandated CME. The expended cost for MOC can run $10,000, but the loss of time and revenue can amount to much more; Not to mention the loss of personal time with family, rest, etc. [Physicians require rest

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and mental recovery just as every human does, but this fact is ignored by regulating bodies who have no remorse in forcing overworked physicians to complying with continually increasing regulations.] Proponents of MOC are “mostly” from the non-clinical, non-profit, academic, public policy world and many are grandfathered out of MOC. Most of these boards are selfcontrolled and internally appointed entities that keep their likeminded friends in power without any significant oversight from those they govern…the practicing doctors. They argue that “they” need to force physicians to keep up. The unstated aspersion though is that physicians are careless individuals who need more policing and that the board members are protecting the public from lazy or bad doctors. I’ve even heard of one MOC proponent quoted who said (and I paraphrase), “It is unethical not to participate in MOC”. He was implying that if you were not in favor of MOC you are a bad doctor because you don’t think you need to keep up. A statement like that is a disingenuous presumption and a deflection from the truth. I don’t know anyone who is saying we don’t need to continue our education. The opponents of this costly, time consuming and dictatorial MOC system are mostly the silent majority of overburdened clinical physicians, overwhelmed with patient care, that work in an unreasonably over-regulated environment. Opponents of MOC are not saying doctors should not continue to educate themselves and comply with CME requirements. What they are saying is that the current MOC process is unsustainable, unfair, costly, extremely burdensome and without any proven merit. We already have an educational process in place…CME. In reality many clinicians feel the boards are coercing practicing physicians to pay fees to support their policies, organizational and personal agendas. Another thing many physicians disagree with is the impunity of these self-perpetuating boards. Academics push the idea of Evidence Based Medicine, but in this case they fail to produce evidence that supports MOC. How absurdly disingenuous! In fact there are no good prospective studies

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that demonstrate any benefit in patient outcomes. What little has been written was mostly produced by those closely related to regulatory boards and has been challenged. Writing in Anesthesia & Analgesia Paul Kempen, MD calls recertification and MOC “untested, unnecessary, ethically questionable, and lucrative to academic-based physicians, board corporations, and national medical specialty societies.” The current MOC process is being challenged not only by the AMA and our TMA. Paul Teirstein, MD, a cardiologist in La Jolla, California, started an online petition regarding the lack of scientific data that shows the benefits of MOC alleging that the process detracts from patient care and other educational opportunities. The petition had more than 17,000 signatures as of this past July (From Medical Economics). Even more damning are the growing questions by practicing physicians of these boards and policy making entities regarding the use of the millions of dollars generated by the MOC process. At the risk of ruffling some feathers, I’ll mention Dr. Wes Fisher’s 2015 investigation of the American Board of Internal Medicine [itself a501(c)(3)]. Dr. Fisher uncovered some stinging revelations regarding the creation of a secondary 501(c)(3) Foundation by that board, the purchase of a luxury condominium, and the 2007 payment to the ABIM president and CEO $484,883 from the ABIM and $161,627 from the second Foundation, the same year the condo was purchased. Other ABIM executives with a history of working for these boards and policy-making entities received $370,000 or more serving these two 501(c)(3)s. By comparison the median general internal medicine physician salary in the U.S. was $205,441 in 2009. That condo, by the way, accumulated expenses of $850,340 from December 2007 through June 30, 2013. Most of the expenses were reported as “program service expenses”. After revelations of the luxury condominium were at a December 2, 2014 Pennsylvania Medical Society town hall meeting, Dr. Baron mentioned in passing that the ABIM was putting the condominium up for sale (A physician investigates the American Board of Internal Medicine | | January 7, 2015 ). Lets also not forget that these boards charge newly graduating residents large fees for initial board examinations, subspecialty exams (in many cases of sub-specialization), plus yearly board maintenance fees. They do this at a time when a young doctor just begins practice and is faced with huge educational debt. (Medical Boards Ring Up Big Margins Fall 2017

By Charging Doctors High Exam Fees, Max Blau, STAT, Aug. 1, 2017). A new article published in JAMA exposed that boards making up the ABMS accumulated a $24,000,000 surplus....just in 2013, and they exposed “the boards net balance more than tripled between 2003 and 2013”. Fees for Certification and Finances of Medical Specialty Boards, Drolet & Tandon, JAMA. 2017;318(5):477-479. This all smacks of board efforts to enlarge their expense accounts, especially when we see ludicrous exam fees, high board/executive salaries, the purchase of expensive condos, expensive dinners for examiners, etc. These revelations don’t bode well for any specialty board imposed MOC agenda. Boards seem to be creating a rigorous dictate with a payoff from hard working doctors that reminds me of mafia tactics. If the point of MOC is to maintain education, why not simply incorporate CME into the process to reduce individual physician stress, expense, and personal time loss. The solution is simple. There is no reason our CME credits should not count for MOC and that assurances of a maintenance of education cannot rest with state medical boards. We should ask our state legislature to allow the Tennessee Board of Medical Examiners to continue to set the number of CME hours required for licensure, with the additional requirement of obtaining CME relevant to a doctor’s main area of practice. This would ensure that we are keeping up with our education. To protect clinical physicians from regulatory abuse we should ask the legislature to make it unlawful for any insurance carrier, hospital or certifying agency to limit membership based on any national board MOC re-testing program. If that happens… boards will have no choice but to change their dictatorial and expensive process. We can no longer allow events to overcome us. Clinical physicians must lead….and convince all interested parties that an alternative process is workable, fair to doctors, equivalent to anything a specialty board can create and will provide hospitals & patients the proof that their doctors keep up with their fields. Remember the words from John Dickinson’s “Liberty Song” published in 1786; “By uniting we stand, by dividing we fall”. If we want to survive, we must come together. We need you at the state Capitol for Doctor’s Day on the Hill on March 6, 2018. If you know doctors who are not members of the Memphis Medical Society…remind them that we can help each other IF we bind together. The MMS office number is 901-761-0200. 5


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Medical Society Hires Bautista to Lead Business Development Cailyn Bautista has been hired to lead the business development efforts of the Society, including leading sales for MedTemps, increasing membership, and creating unique partnerships for The Society.

(Save the Date)

The Memphis Medical Society

2018 Annual Meeting and Installation of Officers Saturday, January 27, 2018

Social Media Pages Announcing our new Twitter, LinkedIn and Facebook pages! Please like, share, follow, re-tweet and suggest information for sharing on our new social media pages. We need Shelby County physicians and their spheres of influence attached to these pages. Facebook: https://www.facebook.com/mdmemphis/ Twitter: https://twitter.com/memphisdocs @MemphisDocs LinkedIn: https://www.linkedin.com/company/memphismedical-society

Holiday Inn – University of Memphis

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SPOTLIGHT

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Dr. Alan Levy, Founder and Medical Director at Levy Dermatology

With a father as a doctor and a mother as a teacher, becoming a physician who teaches other doctors may not seem like a stretch. However, that wasn’t how it all started for Dr. Alan Levy. He worked in Silicon Valley at Cisco Systems for three years before going to medical school. “At Cisco, my role was to help the business succeed – and while that was fulfilling, I wanted to help on a more individual level,” he said. “Medicine offered that opportunity.” Levy’s father, allergist Dr. Joe Levy, was “uncharacteristically unopinionated” about his son following in his footsteps. “He didn’t want to influence me,” Levy said. “He did say it was the noblest of professions but left the decision up to me. He has since reminded me that being a good doctor requires competence and compassion – and to be prepared to work harder than you ever have,” Levy added. Dermatology began to interest Levy when he was a medical student. “I had excellent teachers who loved what they did,” he said. “It was evident in how they spoke with patients and each other. They were happy with what they did. It was infectious. Seeing their level of satisfaction influenced me a lot.” That influence led Levy to build a team that shares his passion for helping patients. The practice includes two other physicians – Dr. Danielle Levine and Dr. John Huber; nurse practitioner Lauren Plyler; and physician assistant Jodi Burgess. Three licensed aestheticians – Marcy Blen, Kimberley Schratz and Rebekah Marrow – also work there, along with support staff including nurses, medical assistants and technicians. Levy also serves as an Allergan physician trainer, teaching doctors nationwide about the proper methods of injecting Botox, Juvederm and Voluma. “I enjoy being an advisor. If I’ve improved their skill set and knowledge of anatomy, then I’ve

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contributed to making them better providers,” he said. “It’s like helping those who help others.” He noted that proper training is critical. “It minimizes the risk of complications and improves outcomes,” he explained. “The more training and experience you have with cosmetic products and procedures, the better the end result and the happier the patient, which is most important.” Levy also emphasized the importance of using the correct provider for such procedures, as outlined by the Tennessee Patient Safety Cosmetic Medical Procedures Act which notes that services like laser procedures or chemical peels must be supervised by a physician licensed by the State of Tennessee. “This is your face. This is your health,” he noted. “Find a board-certified dermatologist or plastic surgeon to ensure you get the best outcome and minimize complications.” In terms of rewards from his job, Levy says there are too many to count. “I am fulfilled when we remove skin cancers and have excellent outcomes,” he said. “When you open a bandage and see a surgical site that is going to fade and leave minimal visible scarring – and the patient is smiling, it’s an awesome feeling.” Levy’s previous 3 ½ years in practice at his East Memphis office (6254 Poplar Avenue) have been so successful that he is adding a new location in Schilling Farms in Collierville this year. “We have a lot of patients in that area and are at capacity in Memphis,” he noted. “We wanted to create greater access to dermatology services.” Levy’s wife Shira handles the practice’s operations including payroll, inventory, research, and vendors and will manage the new Collierville office. “She does all the things I can’t or don’t love to do,” he laughed. The couple has two 8-year-old twin boys, Rex and Max, and a 3-year-old daughter, Gia.

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Baptist Cancer Center Lung Screening Programs Pioneering New Treatment Hopes by: Karen Mayer BMHCC Corporate Communications Every day, patients like Marthanne Maroney face decisions about their health, largely based on symptoms and the results of tests done to evaluate them. But what if a seemingly innocuous, unrelated finding from a test performed for other reasons became as important as the initial reason for the test? In Maroney’s case, the radiologic test, which produced an accidental finding, may just have saved her life. Lung cancer is the number 1 cancer killer in the US and worldwide. Survival depends on catching it early when it might still be curable. Yet, screening for early lung cancer has largely lagged behind screening for other diseases like breast, cervical, colon, and prostate cancer due to lack of technology. Although low-dose CT screening for lung cancer has recently become possible, adoption still lags behind significantly. Currently only three to four percent of eligible patients participate in screening. “Our challenge has been how to find an early stage 1 lung cancer,” said Dr. Todd Robbins, lung cancer surgeon and co-director with Dr. Jeffrey Wright of the Incidental Lung Nodule Program, which is part of the Multidisciplinary Thoracic Oncology Program at Baptist Cancer Center. As a parallel, but closely related step to developing a world-class lung cancer screening program, the team decided to attack the problem of proper management of incidentally detected lung nodules- spots detected in the lungs of patients who had X-rays or CT scans performed for completely unrelated reasons- some of which turn out to be lung cancer. In 2012, Dr. Robbins and members of his team visited providers in Kentucky’s highest lung cancer incidence area to examine how they were implementing their lung cancer screening program. “We found they had the same challenges we did, despite the evidence of benefit, there was no mechanism for insurance coverage at the time,” said Robbins. We decided to build the program by initially focusing on patients with existing scans that identified lung spots that could be cancer. “I went to Dana Dye, CEO of Baptist Memphis, and explained what we were doing and she liked the idea. The Baptist Foundation, led by Scott Fountain, Jenny Nevels and Dr. Rodney Wolf gave us a grant to get started. This couldn’t have happened otherwise,” said Robbins.

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(L to R) Raymond Osarogiagbon, M.D., Marthanne Maroney, Todd Robbins, M.D.

Understanding the logic behind this approach requires looking at the bigger technical picture at Baptist. Any patient in the Baptist system who undergoes a diagnostic scan that includes a part of the chest, regardless of the actual reason for the test, has the potential to be screened for lung cancer. When a doctor uses a diagnostic scan like an MRI or CT to investigate an injury from a car wreck or, in the case of a patient like Maroney who arrived at the ER with unexplained abdominal pain and had a CT scan of her abdomen, the team has tweaked Epic, Baptist’s electronic health record system, to capture results that use certain specific language. The team worked with Drs. Robert Optican and Keith Tonkin, radiologists at Mid-South Imaging and Therapeutics (MSIT), to develop a list of key words that trigger real-time tracking of potential lung cancer lesions. “If a radiologist uses certain words like “tumor”, “nodule”, “mass” or “lesion”, Epic sweeps those records to our group,” said Dr. Raymond Osarogiagbon, an oncologist/hematologist and director of Thoracic Oncology Research Group and co-director of the Multidisciplinary Thoracic Oncology Program.

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Maroney, 73, smoked for 25 years during her younger days. Her case clearly proves the power of Baptist’s Incidental Lung Nodule Program. In October 2016, she developed severe abdominal pain, went to an emergency room in a different health care system and, after doctors took scans of her abdomen, she had an emergency appendectomy. Those scans also revealed spots on her kidney. She saw a urologist about the kidney spots which turned out to be nothing. The scan, however, also picked up on a nodule in her lung. She discovered the finding by reviewing her paperwork and talking to her Baptist Medical Group primary care doctor. In February 2017, her doctor connected her with the Baptist Multidisciplinary Thoracic Oncology Program. Even if humans fail, the Epic technology catches cases like hers. “We’re a safety-net system to provide backup for busy clinicians who can easily be distracted by the primary problem for which the scan was done in the first place,” said Robbins. In the clinic, a group of specialists, surgeons, radiologists, and pulmonologists gather to review patient

Fall 2017

cases like Maroney’s. In one month, the program may receive about 250 scans. “We then review those scans to take a closer look. Of those 250, about 50 may need no follow up, 150 we may follow closely with no action and anywhere from 30 to 50 may require immediate follow up,” said Robbins. The thoracic team provides the critical review and support work for the programs, specifically Pulmonary Nodule Navigators, Amanda Epperson, RN and Diane Richards, RN. Together, they review thousands of records which contain specific coded language. The program requires doctors contact patients out of the blue to inform them of a possible finding. “At the start, we thought we might experience resistance or even anger about reviewing scans for patients with whom we had no pre-existing relationship, but we found the opposite. Almost 100 percent of the patients agreed to come in for further review,” said Robbins. Continued on page 20

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Keeping Fiscally Fit William B. Howard, Jr., ChFC®, CFP®

Question: I have been offered a part-time job at a new hospital as an Emergency Room Physician. The hospital would classify me as an independent contractor, and I heard that a solo 401(k) might be a good option for my situation. Can you please explain this option to me in further detail? Answer:

An individual or solo 401(k) plan is a qualified retirement plan for the self-employed that allows tax-deferred contributions. It is cost effective, does not require a plan administrator, and no annual filings are required until you exceed $250,000 in assets. As an independent contractor, this type of plan is a great alternative if you are restricted from participation in a group retirement plan and if you receive self-employment income. The initial setup for the account requires the adoption of a plan agreement, but most of the major brokerage institutions have IRS approved documents that streamline the account opening process. The solo 401(k) plan is very similar to a standard employersponsored plan due to the employee contribution (elective deferral) and the employer contribution (discretionary contribution). The maximum employee contribution is $18,000 for 2017 with a $6,000 catch up contribution for those ages 50 and older. While the elective deferral maximum stays constant, the discretionary contribution can change depending on your classification as sole proprietor or a corporation. If you formed a corporation, the employer contribution is subject to a rules limit of 25% of the

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salary you receive. If you are a sole proprietor, the employer contribution is based on 20% of your net income. Both are subject to the 2017 combined (employee plus employer) annual maximum limit across all plans of $54,000 ($60,000 for ages 50 and older). Therefore, an elective deferral of $18,000 limits the discretionary contribution to $36,000. Another feature to point out is the ability to designate your employee contributions as Roth 401(k) contributions. This means that you would forgo the upfront taxdeduction, but the employee contribution amount grows tax-free, and withdrawals taken during retirement aren't subject to income tax, provided you're at least 59 1/2 and you've held the account for five years or more. The downside is employer contributions remain pre-tax, so keeping pre-tax and after-tax funds separate might be tricky. The investment options for the plan will be dictated by the custodian of choice, but you should have a wide variety of options available. Remember that the solo 401(k) is an IRS qualified retirement plan and is subject to the same tax responsibilities as other qualified plans. I would recommend that you seek the advice and assistance of a financial advisor in your area before opening this type of account.

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Bianca Sweeten, M.D. with several young participants.

Medical Societies participate in Community Health Fair On Saturday, July 15th The Memphis Medical Society and the Bluff City Medical Society participated in the Omega Ministries/Omega Health Practices & The Helthcare Organizations of Greater Memphis Coalition annual community health fair. This was the twenty-ninth year that the health fair has been held. Over 550 individuals attended this year’s event. It is organized by Mrs. Joyce Shaw and sponsored by Omega Ministries. This year’s fair was held from 8:00 am to 12:00 pm at University of Tennessee Health Science Center (UTHSC) in the Student Alumni Center (SAC). Together with the nurse practitioners from UTHSC School of Nursing, 61 preschool physicals were performed. Bianca Sweeten, M.D. served as the supervising physician at this year’s fair. She assisted the nurse practitioners and shared her expertise when evaluating pathological situations. In addition to the preschool physicals, health fair participants had their BP measured, BMI measurements performed and were provided health education. Other areas of UTHSC were represented. James C. Fleming, M.D. and Thomas J. O’Donnell, M.D., along with several residents from Hamilton Eye Institute conducted vision exams. Tim Self, Ph.D. and his students with the College of Pharmacy provided asthma education. The UT School of Dentistry performed dental checkups. The event provided free immunizations from the Memphis and Shelby County Health Department. A free lunch and backpack filled with school supplies were given to all participating students.

J. Chris Fleming, M.D. and Tom O’Donnell reviewing a vison chart with a young patient.

Resident doing eye exams.

Dr. Sweeten going over exam results with participants.

UTHSC Resident Recruitment Yields Strong Membership Numbers New UTHSC residents during orientation.

Kharole Compere, M.D. and Sara Nelson-Owens, M.D. 14

Sarah Thompson, M.D.; Edwin Gannon, M.D. and Elizabeth Hall, M.D. (R)

The University of Tennessee Health Science Center (UTHSC) – Memphis, Department of Graduate Medical Education (GME) held its annual PGY1 orientation on Thursday, June 22, 2017. Approximately 160 first year interns and residents were in attendance in the UTHSC Student Alumni Center (SAC) auditorium. George R. Woodbury, Jr., M.D., chair of the Memphis Medical Society (MMS) Legislative Committee spoke to the group about the importance of becoming involved with organized medicine. The Tennessee Medical Association (TMA) and MMS recruited 231 new members from the incoming intern, resident and fellows beginning the UTHSC – Memphis GME program on July 1, 2017. Medical Society Quarterly


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M1 Reception Each year, the Memphis Medical Society (MMS) participates in the orientation of and sponsors a welcome reception for incoming M1 students at the University of Tennessee Health Science Center (UTHSC) College of Medicine. UTHSC – Memphis has 170 M1 students in the class of 2021. These new incoming students were recruited for membership in the American Medical Association (AMA), Tennessee Medical Association (TMA) and MMS. This year, the welcome reception was held on Tuesday, August 8 at the Dixon Gallery and Gardens. Representatives from the MMS and UTHSC were on hand to greet the medical students. Approximately one hundred and seventy-five students and their guests attended the reception. Traditional Memphis barbeque was served. Physicians who were in attendance included: Patricia Adams-Graves, M.D.; Lanetta Anderson, M.D.; Gregory Anderson, M.D.; Susan Brewer, M.D.; Dr. Kennard Brown, Executive Vice Chancellor; Brenda Hardy, M.D.; Danielle Hassel, M.D.; Phillip Langsdon, M.D.; Justin Monroe, M.D.; Gerald Presbury, M.D.; Wiley Robinson, M.D.; Lisa Usdan, M.D. and George Woodbury, Jr., M.D.

Fall 2017

L-R: Dr. Kennard Brown, Executive Vice Chancellor, UTHSC and Phillip Langsdon., M.D., President of the Memphis Medical Society.

L-R: Lanetta Anderson, M.D.; Susan Brewer, M.D.; and Kiyah L. Anderson, M1. Kiyah is Dr. Anderson’s niece.

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Isolated Limb Infusion for the Management of Cutaneous and Soft Tissue Malignancies by: Jeremiah Deneve, DO FACS, Assistant Professor of Surgery, Surgical Oncology, Department of by: Surgery, University of Tennessee Health Science Center (UTHSC), West Cancer Center There has been a growing trend over the last decade with the development of several new locoregional and systemic treatment options for metastatic melanoma. For patients who develop in-transit melanoma metastases, however, treatment options have remained limited. In-transit metastases are tumor deposits within the dermal lymphatics that develop between the primary tumor and the regional nodal basin. Often, the tumors are too numerous to resect and do not respond well to systemic chemotherapy or radiation. In certain instances, these tumors may grow, ulcerate or are associated with significant pain and swelling (lymphedema). Often, many patients develop in-transit metastases in the setting of distant disease. They are a challenge to treat and can negatively impact patient quality of life.

Maximal treatment response to ILI is generally observed around 3 months. Overall response rates (ORR) for intransit melanoma range between 60-75% depending on the burden of disease. ILI can be repeated with similar response rates observed as the initial ILI procedure. For those with low volume disease or who have regional lymphadenopathy, resection and/or lymphadenectomy can be performed at the time of ILI.

Isolated limb infusion (ILI) offers one potential treatment option for these patients. ILI is a surgical procedure which allows the regional delivery of chemotherapy to the affected extremity. ILI allows the delivery of drug concentrations 15-25 times higher than systemic dosages without the systemic side effects. ILI is safe, well tolerated and can be used as part of the multimodality treatment for patients with advanced melanoma. Briefly, ILI is performed under general anesthesia. Percutaneous catheters are placed and advanced into the affected extremity. The catheters are connected to a perfusion circuit consisting of a heater element and a bubble excluder. The extremity is heated to synergize the tumoricidal effects of the chemotherapy agents and systemic anticoagulation is given. Subcutaneous temperature probes are placed and a pneumatic tourniquet is placed proximally within the extremity to isolate the limb from the systemic circulation. Chemoperfusion is then performed manually using a syringe and a three-way stopcock (Figure 1). Melphalan and Actinomycin D are both administered within the isolated extremity and circulated for 30 minutes. Upon completion of chemoperfusion, the extremity is flushed with saline solution, heparanization is reversed and the catheters are removed. Patients are monitored in the intensive care unit overnight and typically remain in the hospital 3-4 days. Regional toxicity (Weiberdink toxicity) is generally mild with erythema, blistering and swelling observed (Grade I-III). 16

ILI has also been safely used for the management of other rare malignancies such as recurrent soft tissue sarcoma, squamous cell carcinoma, Merkel cell carcinoma, osteosarcoma and desmoid tumors. ILI can also be used to treat bulky, ulcerated primary tumors in the setting of distant disease. In these situations, ILI is safe, repeatable and offers a limb-salvage treatment option to provide locoregional control, maintain extremity function and preserve patient quality of life. Jeremiah Deneve, DO, FACS is a Surgical Oncologist with the UTHSC Department of Surgery. He joined UTHSC faculty in 2012 as an Assistant Professor of Surgery. He completed medical school at Midwestern University (Chicago College of Osteopathic Medicine). He underwent general surgery residency at Emory University, Atlanta, GA. During residency, he completed a two-year basic research fellowship with the Carlyle Fraser Research Institute. Upon completing general surgery residency, Dr. Deneve completed surgical oncology fellowship at Moffitt Cancer Center, Tampa, FL. He is involved in multiple national organizations and has many publications and book chapters on a variety of malignancy-related topics. He has clinical interest in complex gastrointestinal malignancies, melanoma and soft tissue sarcoma as well as the regional delivery of chemotherapy (HIPEC and Isolated Limb Infusion).

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Overcoming the Anxiety of Open Enrollment By Hal Stansbury

Fall is underway and it’s easy to get wrapped up in the fun seasonal activities like tailgating, pumpkin picking and holiday festivals. In many ways, fall is also the time to plan ahead for your health coverage. For companies who begin their fiscal year on January 1, which accounts for about 40 to 50 percent of employers, most renew their employee benefits in the fall. This means open enrollment is fast approaching for many. Open enrollment is the period of time each year when employers work with staff members to prepare their health insurance plans for the upcoming fiscal year. This includes renewing employees’ existing plans, signing up for a new plan or making changes to their existing coverage. While open enrollment happens in the fall for many companies, it’s important to remember the following tips for a successful enrollment process, no matter what time of year your company’s fiscal year begins. • Communicate the 5 C’s. To ease the process for everyone and quell any confusion or speculation, remember to communicate the following with your employees: Cost, Coverage, Changes to plans, Comparisons to last year’s plans and Current options. • Maintain transparency. Be transparent and direct when discussing health benefits, especially if employees are facing cost increases in their coverage. Also, communicate with them the importance of taking advantage of wellness benefits and preventative care screenings that are in included in their plan. Keeping your employees informed will help them prepare better for the coming year and maintain their health and wellness. • Consider going digital. There are many online services popping up each day to

ease and expedite the enrollment process. Electronic enrollment offers paperless and e-signature capabilities that will actually save you and your employees from the precious hours it previously took you to fill out overwhelming piles of paperwork. If you are not part of a group plan, for instance through an employer, and you’re filing for health insurance as an individual, keep in mind that open enrollment for individual health care plans for 2018 is from November 1 to December 15, 2017, which is half the length of previous years. Open enrollment for both employers and individuals does not have to be as stressful as it sounds. With online services, such as Maxwell Health, a company can seamlessly integrate its health care benefits package, from dental and vision to short-term and long-term disability. They offer an easy-to-use benefits administration system that simplifies the open enrollment process and allows employees to pick and choose what benefits best fit with their unique lifestyle. And since people only have six weeks to complete open enrollment this year, the ability to save time by managing all the paperwork digitally is a win-win! Additionally, amid the ongoing uncertainty and complications of the nation’s health care legislation, digital HR platforms will oversee that your company is compliant with the most current requirements and regulations, no matter how complex. With built-in communication tools and alerts, employers and HR managers can easily send their team the latest updates on health care and employee rights. By using an integrated online system to manage your company’s benefits, open enrollment this year will be a breeze. Hal Stansbury is the director of business development at The Barnett Group. You can reach him at 901-365-3447 or hal@gobarnett.com. For more information on The Barnett Group, please visit gobarnett.com.

PAID ADVERTORIAL

Fall 2017

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2017 Legislative Report Card TMA made big strides forward during the first session of the 110th General Assembly. Laws passed, amended and defeated in 2017 will have a positive effect on healthcare in Tennessee for years to come:

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• • • •

Passed three TMA-generated bills into law TMA’s government affairs team reviewed 1,466 bills Tracked more than 300 bills Amended more than 40 pieces of legislation

Medical Society Quarterly


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Methodist Le Bonheur Healthcare Named 2017 Most Wired by: Mary Alice Taylor Summary: Most Wired hospitals use technology to partner with patients on health. Technology is making it easier for patients and providers to interact, thus improving communication, safety and patient-provider relationships. New tools are helping patients become more actively involved in their care and maintaining their health, according to results of the 19th Annual Health Care’s Most Wired® survey, released today by the American Hospital Association’s (AHA) Health Forum. “Technology is a powerful tool which enables us to elevate patient care, improve the patient experience, and enhance patient-and family-centered care,” said Mark McMath, Senior Vice President, Chief Information Officer for Methodist Le Bonheur Healthcare. “We’re honored to receive this recognition, but the real value is for our patients because Most Wired is an indicator of a safe organization. According to the survey, Most Wired hospitals are using smart phones, telehealth and remote monitoring to create more ways for patients to access health care services and capture health information. This year’s results show: • 76 percent offer secure messaging with clinicians on mobile devices. • When patients need ongoing monitoring at home, 74 percent use secure e-mails for patients and families to keep in touch with the care team. • 68 percent simplify prescription renewals by letting patients make requests on mobile devices. • 62 percent add data reported by patients to the electronic health record to get a better picture of what is going on with the patient. • Nearly half of the hospitals are using telehealth to provide behavioral health services to more patients. • 40 percent offer virtual physician visits. • More than 40 percent provide real-time care management services to patients at home for diabetes and congestive heart failure. “The Most Wired hospitals are using every available technology option to create more ways to reach their patients in order to provide access to care,” said AHA President and CEO Rick Pollack. “They are transforming care delivery, investing in new delivery models in order to improve quality, provide access and control costs.”Innovation in patient care embraces emerging technologies and underscores the need for secure patient information exchange. Hospitals have increased their use of sophisticated IT monitoring systems to Fall 2017

protect patient privacy and produce real-time analysis of security alerts. Most Wired hospitals are transforming care delivery with knowledge gained from data and analytics. They are investing in analytics to support new delivery models and effective decision-making and training clinicians on how to use analytics to improve quality, provide access and control costs. • 82 percent analyze retrospective clinical and administrative data to identify areas for improving quality and reducing the cost of care. • Three-quarters use sophisticated analytics such as predictive modeling and data to improve decisionmaking. • Nearly 70 percent interface electronic health record data with population health tools for care management. • More than 70 percent are providing data analytic tools training to physicians and nurses. • 45 percent initiate a patient pathway using health IT to follow a care plan. • Nearly 40 percent deliver quality metrics to physicians at the point-of-care. • 32 percent have tools for real-time patient identification and tracking for value-based care conditions, such as chronic obstructive pulmonary disease. HealthCare’s Most Wired® survey, conducted between Jan. 15 and March 15, 2017, is published annually by Health & Hospitals Networks (H&HN). The 2017 Most Wired® survey and benchmarking study is a leading industry barometer measuring information technology (IT) use and adoption among hospitals nationwide. The survey of 698 participants, representing an estimated 2,158 hospitals — more than 39 percent of all hospitals in the U.S. — examines how organizations are leveraging IT to improve performance for value-based health care in the areas of infrastructure, business and administrative management; quality and safety; and clinical integration. Detailed results of the survey and study can be found in the July issue of H&HN. For a full list of winners, visit www.hhnmag.com. About the Most Wired Survey The 2017 Most Wired Survey is conducted in cooperation with the American Hospital Association and Clearwater Compliance, LLC. Mary Alice Taylor, Senior Commuications Specialist Methodist Le Bonheur Healthcare 901-516-0617 maryalice.taylor@mlh.org 19


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Continued from page 11

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TMA Disability Insurance Program

Open enrollment September 1 through October 31 In 2016, the program detected 44 patients with lung cancer. Already in the first half of 2017, 32 lung cancer cases have been found through the program. For these lung doctors, this is real progress. Usually only one in 10 lung cancer patients will be diagnosed in stage 1, the earliest stage. So far about 70 percent of the lung cancer patients found through the Lung Nodule Program have been detected in stage 1, meaning their lung cancer is most likely to be cured with treatment. By the time a patient presents with symptoms of lung cancer, it is usually highly advanced and survival is unlikely. “Efforts like this are moving the needle for lung cancer survival for the first time in more than 30 years,” said Robbins. “If we can catch 100 patients at Stage 1, survival rates are as high as 80 or 90 percent. At stage IV, only four out of 100 patients will survive,” said Osarogiagbon. Because the majority of the spots in a lung are benign, a complex set of decisions must be made to correctly separate patients who need intervention from the vast majority who can either be watched closely or discharged without further testing. Osarogiagbon’s first goal was to focus on building and maintaining the complex infrastructure needed to support this decision-making. “Neither could happen without infrastructure that we had to build first,” he said. The Baptist program launched with a $900,000 grant from the Baptist Memorial Health Care Foundation and now, the program supports itself. When she had surgery for her appendicitis, little did Maroney know her early scans would prove even more important down the road. Now understanding how the Epic technology plays a critical role in connecting all the parties, she feels even stronger about Baptist and the network. “It became clear to me how important it is to stay within the same system.” The Baptist Cancer Center lung programs, driven by intense physician dedication, represent the critical intersection of technology and innovative research. With both, patients like Maroney have greater hope for survival. “Our goal is to standardize these programs across the entire system with the ability to review 200,000 to 300,000 records annually,” said Robbins.

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If you miss that window, members must wait a year for the next opportunity

· Letters are in the mail from TMA describing the program · Phone calls have begun from a local rep to follow up · Email reminders will continue through October · Look for a www.tnmed.org reminder button going up soon

Medical Society Quarterly


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R E A L E S TAT E U P D AT E Types of Real Estate Ownership by: Jon D. Albright, CCIM, SIOR, SRES After thorough evaluation, comparison, discussion and planning, it is determined that ownership is the best option for your medical real estate. There are a variety of options that could be available for your consideration. The most recognizable, is where the group, individuals or a combination of people owns the land and the property entirely. Many are familiar with this type of ownership. Can be managed and sold in the future rather easily depending upon market conditions at the time of a sale. Fractional ownership can occur when multiple entities own portions of a particular property. Most likely ownership percentages will vary . This can be more complicated to manage and sell, but can also offer smaller groups an opportunity to own a portion of a significant location and larger property. In some cases, groups can sign long-term leases and as an inducement from a developer or Landlord obtain an ownership stake without financial contributions aside from the lease commitment made on behalf of the leasing entity.

Usually larger square footages and longer terms are required. In most cases, the tenant is not the majority owner and if the property is sold the remaining lease commitment is still required to be honored by the subsequent owner. Profit distributions should help to offset lease balances. Land lease can help lower overall capital costs by leasing land for long period of time without having to purchase. However, the owner of the land lease will assume ownership of the improved property when the lease expires (building and improvements). Long-term leases with renewal options are recommended in these instances. Once the decision has been made to own your property remember there may be more than form of ownership you want or need to consider. This is also where the advice and input from your “experts” is so important to consider. Discuss carefully with your real estate professional, CPA, lawyer and other trusted advisors before making a commitment. Jon D. Albright, CCIM, SIOR, SRES Investec Realty Services, LLC 51 Germantown Court, Ste 215 Memphis, TN 38018 901-758-2424 phone albright@svn.com

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Paula Lipford | Accounting Coordinator | plipford@mdmemphis.org

Medical Society Quarterly


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CALENDAR SEPTEMER 5 Board of Directors Meeting 8-9 17 20

Medical Society, 6 pm TriMed Healthcare Education Summit Music City Center Nashville RSVP to trimedtn.com Women in Medicine, 4-6 p.m., RSVP to jcooper@mdmemphis.org Bluff City Medical Society Meeting Char Restaurant & Phillip Northcrest, M.D., 6:30 pm

OCTOBER 3 Board of Directors Meeting Medical Society, 6 pm

18 Bluff City Medical Society 24

Location & speaker TBA, 6:30 pm TMA 37th Annual Insurance Workshop Holiday Inn – University of Memphis

NOVEMBER 7 Board of Directors Meeting Medical Society, 6 pm

MEMORIAM Francis F. Fountain, Jr. November 22, 1936 – July 28, 2017

Charles E. Frankum May 17, 1932 – May 27, 2017

Ralph S. Hamilton November 25, 1929 – August 14, 2017

Edward Steven Kaplan November 16, 1933 – July 18, 2017

Charles N. Larkin September 18, 1946 – June 9, 2017

William F. Mackey, Sr. August 24, 1917 – June 21, 2017

Claude D. Oglesby October 29, 1926 – July 5, 2017

13 Legislative Reception, Buckley’s Lunch Box, 6 p.m.

15 Bluff City Medical Society Folk’s Folly & Frank McGrew, M.D., 6:30 pm

24-25 Thanksgiving Holiday Medical Society closed The Memphis Medical Foundation acknowledges and appreciates the following memorials: In Memory of Charles (Tucker) Larkin, M.D. by Herbert B. Taylor, M.D. and the late Mrs. Diane B. Taylor James C. Fleming, M.D. Jesse C. Woodall, Jr., M.D. Mack Land, M.D. Gary W. Kimzey, M.D. Phillip Langsdon, M.D. In Memory of Lynn Conrad, M.D. by Wiley T. Robinson, M.D. Please consider making a tax deductible contribution to the Foundation in memory of colleagues who have died.

Fall 2017

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NEW MEMBERS John William Allen, M.D. Internal Medicine Methodist Olive Branch Hospitalist Group 7163 Goodman Road Olive Branch, TN 38654 662-893-7878 University of Mississippi, 1998 University of Tennessee – Memphis (R-IM) Ahmad H. Altabbaa, M.D. Cardiovascular Diseases Methodist North Hospitalist Group 3950 New Covington Pike Ste. 290 Memphis, TN 38128 901-516-5389 Damascus University, 1988 Wright State University – Dayton (R-IM) Wright State University – Dayton (F-CD) Jacyln B. Bergeron, M.D. Internal Medicine/Pediatrics Methodist University Hospitalist Group 1265 Union Avenue Memphis, TN 38104 901-516-2362 University of Tennessee – Memphis, 2009 University of Tennessee – Memphis (R-IM/PED) Robert W. Bradsher, III, M.D. Internal Medicine Methodist University Hospitalist Group 251 S Claybrook St Fl 2 Memphis, TN 38104 901-516-7448 University of Arkansas – Little Rock, 2011 Johns Hopkins University – Baltimore (R-IM) Diana J. Childers, M.D. Internal Medicine Methodist North Hospitalist Group 3960 New Covington Pike Memphis, TN 38128 901-516-5389 Loyola University – Stritch School of Medicine, 2002 University of California – Irvine (R-IM) Roger D. Criner, Jr., M.D. ApolloMD 5959 Park Avenue Memphis, TN 38119 731-676-8868 American University of the Caribbean, 2003 University of Tennessee – Jackson (R-FM) Buckley Kin Dempsey, Jr., M.D. Internal Medicine / Pediatrics Methodist Germantown Hospitalist Group 7691 Poplar Ave Ste. 350 Germantown, TN 38138 901-516-1290 University of Tennessee – Memphis, 2006 University of Tennessee – Memphis (R-IM/PED) Amara F. Elochukwu, M.D. Internal Medicine Methodist North Hospitalist Group 3960 New Covington Pike Memphis, TN 38128 901-516-5389 St. Geroge’s University, 2009 University of Florida – Gainesville (R-IM) Michel K. Faircloth, M.D. Internal Medicine Methodist Germantown Hospitalist Group 7691 Poplar Ave Ste. 350 Germantown, TN 38138 901-516-1290 University of Tennessee – Memphis, 2009 University of Tennessee – Memphis (R-IM) 24

Adolph W. Flowers, M.D. Internal Medicine Methodist North Hospitalist Group 3960 New Covington Pike Memphis, TN 38128 901-516-5389 Duke University, 2010 Tulane University – New Orleans (R-IM) Albert C. Flowers, M.D. Internal Medicine Methodist North Hospitalist Group 3960 New Covington Pike Memphis, TN 38128 901-516-5389 Howard University, 2011 University of Tennessee – Memphis (R-IM) Lauren M. Fulmer, M.D. Internal Medicine/Pediatrics Methodist Germantown Hospitalist Group 7691 Poplar Ave Ste. 350 Germantown, TN 38138 901-516-1290 University of Kentucky – Lexington, 2010 University of Tennessee – Memphis (R- IM/PED) Jerry P. Gilless, M.D. Internal Medicine Methodist University Hospitalist Group 251 S Claybrook St Fl 2 Memphis, TN 38104 901-516-7448 University of Tennessee – Memphis, 2006 University of Tennessee – Memphis (R-IM) Elizabeth John, M.D. Internal Medicine Methodist University Hospitalist Group 251 S Calybrook St Fl 2 Memphis, TN 38104 901-516-7448 Kerala University – India, 2011 University of Tennessee – Memphis (R-IM) Yasser A. Khaled, M.D. Hematology/Oncology Methodist University Hospitalist Group 251 S Claybrook St Fl 2 Memphis, TN 38104 901-516-7448 Cairo University School of Medicine, 1989 SUNY – Brooklyn, NY (R-IM) New York Medical College (F-HEM/ONC) Virginia Commonwealth University (F-HEM/ONC) Maram Mallisho, M.D. Internal Medicine Methodist Germantown Hospitalist Group 7691 Poplar Ave Ste. 350 Germantown, TN 38138 901-516-1290 University of Damascus, 2002 University of Tennessee – Memphis (R-IM) Amy E. Maruitson, M.D. Internal Medicine Methodist Germantown Hospitalist Group 7691 Poplar Ave Ste. 3500 Germantown, TN 38138 901-516-1290 University of Tennessee – Memphis, 2010 University of Tennessee – Memphis (R-IM)

Yared M. Medhane, M.D. Internal Medicine Methodist North Hospitalist Group 3960 New Covington Pike Memphis, TN 38128 901-516-5389 Gondar College of Medicine, 1999 St. Louis University – Chesterfield, MO (R-IM) Shayla T. Merry, M.D. Internal Medicine Methodist North Hospitalist Group 3960 New Covington Pike Memphis, TN 38128 901-516-5389 University of Tennessee – Memphis, 2011 University of Tennessee – Memphis (R-IM) Michael K. Muhlert, M.D. Diagnostic Radiology Memphis Physicians Radiological Group, PC P.O. Box 171206 Memphis, TN 38187 901-765-3213 University of Texas – San Antonio, 2004 University of Tennessee – Memphis (R-DR) Irene N. Okafor, M.D. Internal Medicine Methodist North Hospitalist Group 3960 New Covington Pike Memphis, TN 38128 901-516-5389 East VA College of Osteopathic Medicine, 2011 Danville Regional Medical Center (R-IM) Andrew S. Olinger, M.D. Internal Medicine Methodist University Hospitalist Group 251 S Claybrook St Fl 2 Memphis, TN 38104 901-516-7448 University of Tennessee – Memphis, 2013 University of Tennessee – Memphis (R-IM) Shailesh M. Patel, M.D. Internal Medicine Methodist Olive Branch Hospitalist Group 7163 Goodman Rd Olive Branch, MS 38654 662-932-9000 Kansas City University, 2005 Drexel University – Philadelphia (R-IM) Tejesh Patel, M.D. UTHSC – Dept. of Dermatology 930 Madison Avenue, Ste. 890 Memphis, TN 38103 901-866-8834 Guys, Kings & St. Thomas Medical School, 2004 University of Tennessee – Memphis (R-DERM) Gregoy L. Phelps, Jr., M.D. Internal Medicine Methodist University Hospitalist Group 251 S Claybrook St Fl 2 Memphis, TN 38104 901-516-7448 University of Tennessee – Memphis, 2008 University of Tennessee – Memphis (R-IM) Kelinda P. Ramsay, M.D. Internal Medicine Methodist North Hospitalist Group 3960 New Covington Pike Memphis, TN 38128 901-516-5389 University of Tennessee – Memphis, 2005 University of Tennessee – Memphis (R-IM) Medical Society Quarterly


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Christopher W. Sands, M.D. Internal Medicine Methodist University Hospitalist Group 251 S Claybrook St Fl 2 Memphis, TN 38104 901-516-7448 University of Tennessee – Memphis, 1992 University of Tennessee – Memphis (R-IM)

Ari M. VanderWalde, M.D. Hematology / Oncology West Cancer Center 7945 Wolf River Blvd Germantown, TN 38138 901-683-0055 University of Pennsylvania – Philadelphia, 2005 University of California – Los Angeles (R-IM) University of California – Duarte, CA (F-HEM/ONC)

Rachael E. Smith-Klingbeil, M.D. Pediatric Emergency Medicine Methodist Germantown Hospitalist Group 7691 Poplar Ave Ste 350 Germantown, TN 38138 901-516-1290 University of Tennessee – Memphis, 2004 University of Tennessee – Memphis (R-IM)

Brian J. Wheeler, M.D. Internal Medicine Methodist University Hospitalist Group 251 S Claybrook St Fl 2 Memphis, TN 38104 901-516-7448 University of Tennessee – Memphis, 2010 University of Tennessee – Memphis (R-IM)

Heather R. Swanson, M.D. Internal Medicine Methodist University Hospitalist Group 251 S Claybrook St Fl 2 Memphis, TN 38104 901-516-7448 University of Tennessee – Memphis, 2001 University of Tennessee – Memphis (R-IM)

Perisco A. Wofford, M.D. Nephrology Perisco A. Wofford, M.D. 4567 Millbranch Road Memphis, TN 38116 901-345-1454 University of Mississippi, 2000 University of Tennessee – Memphis (R – IM) University of Tennessee – Memphis (F-NEPH)

Nia N. Zalamea, M.D. General Surgery UT Methodist Physicians, LLC 1325 Eastmoreland Ave Ste. 310 Memphis, TN 38104 901-758-7970 East Tennessee State University, 2004 Santa Barbara Cottage Hospital (R-GS) Daniel D. Zobell, M.D. General Surgery Methodist North Hospitalist Group 3960 New Covington Pike Memphis, TN 38128 901-516-5389 University of Tennessee – Memphis, 2009 University of Tennessee – Memphis (R-GS)

Residents / Fellows Erik A. Adair, M.D. Prabhat Adhikari, M.D. Nathaniel B. Alexander, M.D. Bilal Ali, M.D. Nureddin Almaddah, M.D. Casey L. Anderson, M.D. Alyssa R. Andring, M.D. Anita V. Arias Prado, M.D. Addis A. Asfaw, M.D. Faisal Ashfaq, M.D. Farhan Ashraf, M.D. Sameh F. Askander, M.D. Akram F. Assadi, M.D. Michael M. Aziz, M.D. Joshua R. Bakke, M.D. Morgan M. Bankston, M.D. Rachel P. Barker, M.D. Melissa A. Barnhart, M.D. Jennifer M. Bassett, M.D. Mahmoud Bayoumi, M.D. Sarah K. Bell, M.D. Manan R. Bhatt, M.D. Kavita Bomb, M.D. Vandana Botta, M.D. Michael I. Bright, M.D. Kenneth M. Busby, III, M.D. Ryan Buse, M.D. Jennifer M. Butryn, M.D. Asra K. Butt, M.D. Blaise A. Carney, M.D. Leslie N. Chanasue, M.D. Amina R. Chaudhry, M.D. Rishi R. Chauohuri, M.D. Stephanie Chen, M.D. Anthony R. Chuang, M.D. William B. Clinkscales, M.D. Scott J. Collier, M.D. Kharole C. Compere, M.D. Spencer H. Conner, M.D. David A. Cooper, M.D. Edward M. Cordero, M.D. Clifford J. Costello, M.D. Kevin C. Coughlin, M.D. Domenic R. Craner, M.D. Faith V. Creekmore, M.D. Tracey D. Dabal, M.D.

Fall 2017

Laura R. Daily, M.D. Dijoia Darden, M.D. Aravind Dasari, M.D. Peter M. DeLeeuw, M.D. Kristine D. DeMaio, M.D. Gonzalo R. DeVilla, M.D. Samuel R. Dudley, M.D. Dwayne J. Dunbar, M.D. Jose R. Duncan, M.D. Jonathan D. Dvorak, M.D. Travis B. Eason, M.D. Prasanna V. Eswaradass, M.D. Sarah E. Fahnhorst, M.D. Malik Fakhar, M.D. Sandra m. Farach, M.D. Michael T. Fitzgerald, M.D. Timothy T. Flerlage, M.D. Joseph A. Freeman, M.D. Louis G. Gamble, III, M.D. Jatin S. Gandhi, M.D. Edwin W. Gannon, III, M.D. Robert R. Geier, M.D. Timothy C. Gooldy, M.D. Juan J. Goyanes, M.D. Amit J. Grover, M.D. Sandeepkuma J. Gupta, M.D. Clayton J. Habiger, M.D. Alireza Hamidian, M.D. Bailey A. Hansen, M.D. Ravikumar Hanumaiah, M.D. Fatima Hassan, M.D. Mahmoud Hassouba, M.D. Vernisha N. Hearn, M.D. Jane E. Henkel, M.D. Kristen G. Hesterberg, M.D. Richard A. Hillesheim, M.D. Jared C. Hogan, M.D. Mary K. Hood, M.D. Bradley C. Houston, M.D. Samantha L. Howard, M.D. Collin G. Howser, M.D. Charles H. Hubbert, M.D. Nazih Isseh, M.D. Sathish K. Itikyala, M.D. Lauren P. Jacobs, M.D. Pooja S. Jagadish, M.D.

Amit L. Jain, M.D. Ankita Jain, M.D. John M. Jansen, M.D. Awais Javed, M.D. Jason D. Jensen, M.D. Nathan R. Johnson, M.D. Iris Jo-Shi, M.D. Stephen J. Juel, M.D. Joshua M. Justice, M.D. Sean M. Kearns, M.D. Muhammad B. Khalid, M.D. Muhammad F. Khalid, M.D. Abdulhalim Khan, M.D. Muhammad W. Khan, M.D. Lindsay M. Kokoska, M.D. Christopher W. Koo, M.D. Colton T. Kordsmeier, M.D. Balaji Krishnaiah, M.D. Stacey A. Kubovec, M.D. Oladimeji F. Lanade, M.D. Douglas R. Layman, M.D. Elizabeth F. Lee, M.D. Stephen G. Legg, M.D. Justin B. Lendermon, M.D. Yongchao Li, M.D. Jenny E. Liles, M.D. Lucas C. Littleton, D.O. Ana h. Maleki, M.D. Pouran Malekzadeh, M.D. Faizan Malik, M.D. Alpin D. Malkan, M.D. Hemnishil K. Marella, M.D. Kristen N. Marley, M.D. Stephanie C. Martinez, M.D. Charles D. McGuffey, M.D. Eric J. Merkle, M.D. Madeline M. Michalopulos, M.D. Michael G. Michalopulos, M.D. Kathryn G. Michels, M.D. Luke A. Miller, M.D. Chakradhar Mishra, M.D. Jared A. Mitchell, M.D. Mallory A. Mitchell, M.D. Matthew B. Mitchell, M.D. Rachel H. Mitchell, M.D. Evgeniya Mohammed, M.D.

Mubeen K. Mohammed, M.D. Paul A. Molloy, M.D. David J. Moquin, M.D. Rajesh Mourya, M.D. Muntazim Mukit, M.D. Kayln C. Mulhern, M.D. Ann E. Murphy, M.D. Austin B. Murphy, M.D. Khalid Najib, M.D. Amit S. Nanda, M.D. Sara M. Nelson-Owens, M.D. Ngan T. Nguyen, M.D. Chioma C. Nwagbara, M.D. Anthony R. Oddo, M.D. Atinuke A. Osinusi, M.D. Eunbit G. Owen, M.D. Wesley M. Owen, M.D. Jeffrey T. Owsley, M.D. David L. Parker, M.D. Chase C. Parsons, M.D. Abhishek J. Patel, M.D. Naveen Pattisapu, M.D. James H. Pelham, M.D. Jordan D. Perchik, M.D. Rebecca Pollack, M.D. Abduljaleel M. Poovathumkadavil, M.D. Issa Pour-Ghaz, M.D. Jordi Puente Espel, M.D. Anna E. Quantrille, M.D. Danny A. Rader, M.D. Salar Rafieetary, M.D. Yala K. Reddy, M.D. Michael S. Reich, M.D. Mona Rezaei Mirghaed, M.D. Claire E. Rikard, M.D. Shannon K. Riley, M.D. Mallory L. Roberts, M.D. Cody S. Rogers, M.D. Jordan D. Ross, M.D. Elizabeth D. Ruedrich, M.D. Brianna N. Saadat, M.D. Divya Salhan, M.D. Fernand D. Samson, M.D. Cesar A. Sanchez Padron, M.D. Marina Santa Cruz Terrazas, M.D. Aaron L. Schaffner, M.D.

Claudio V. Schenone, M.D. Jenny R. Schmidt, M.D. Noah E. Schusslor, M.D. Katherine A. Senter, M.D. Pralhad Sharma, M.D. Aaron J. Shaw, M.D. Melissa A. Shenep, M.D. Steven T. Shinn, M.D. Elena R. Siani, M.D. Jason T. Silberman, M.D. Marisha A. Sirdar, M.D. Anita Sivam, M.D. Alyssa M. Smith, M.D. Jeslon T. Smith, M.D. Eric L. Sollenberger, M.D. Christine K. Son, M.D. Lauren E. Spradley, M.D. Melanie J. Stall, M.D. Kent T. Starkweather, M.D. Lea E. Stokes, M.D. Madison Sweet, M.D. Elizabeth J. Tarsi, M.D. Meron K. Teshome, M.D. Aby Thomas, M.D. Sarah M. Thompson, M.D. Nicholas C. Thomson, M.D. Devon R. Tobey, M.D. Miriam W. Tsao, M.D. James M. Turner, M.D. Rohan N. Vaidya, D.O. Poojitha Valasareddy, M.D. Casey S. Van Allen, M.D. Katrina J. Van Pelt, D.O. Maggie M. Vickers, M.D. Andrew B. Vizcarra, M.D. Tara L. Vizcarra, M.D. Aaron T. Walsh, M.D. Manuel S. Weekley, M.D. William G. Woodruff, M.D. Susie B. Wright, M.D. Charles L. Xie, M.D. Owais Yahya, M.D. Thomas B. Young, M.D. Benjamin R. Zambetti, M.D. Blake R. Zelickson, M.D. William P. Zickler, M.D. Sarah M. Zorko, M.D.

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PRAC TICING MEDICINE Profits Equate to Speaking the Same Language by: Alan Flippin

Communication with patients has always been in the forefront of successful, effective practices. Effectively communicating with patients, regardless of their origin and language is very important in our multi cultural society. In addition to patient to patient dialogue, there are other equally important issues regarding effective communications for physicians and medical practices. Are you effectively communicating with your referral sources? Are you speaking their language? There exists a new problem within the age of Healthcare Technology directly affecting your practice; the Intra-Practice System Language Barrier.

(MIPS) “The Quality Payment Program.” qpp.cms.gov/mips/overview. Andy Slavitt, director of CMS, heralded this as ”the end of the Meaningful Use Program;” and essentially the beginning of a new acronym riddled payment program consisting of the usual arbitrary metrics - only to be explained in language vaguely decipherable by the combined skills of an attorney, accountant and linguists. This accentuates the incompatibilities from individual practice to practice. Some of the more advanced EHR companies have established peer to peer (P2P) interfaces for individual physicians to include the guidelines for MIPS, making it easier, faster and more efficient to refer patients and to communicate back effectively. This results in increased compensation, preservers patient “ownership” and referral sources.

It is imperative to speak the language A number of years ago, EMRs were of your referral sources. introduced to our world with the promise of better and easier communication, That may be by fax, efax improved quality patient care and email, telephone, increased reimbursements. While electronically capturing data on patients, along or EHR with documenting care and follow up are referral. certainly necessary actions for a better experi-

ence and outcome, incompatibility within competing EMR systems has proven to make efficient electronic records very difficult. Physicians and practices knowing that Electronic Medical Records was necessary to move forward endured many trainings, retrainings, and incompatibility with systems that were different from their own. There have been additional stresses and tremendous costs associated with implementing EMRs. It has been quite frustrating. EMRs have evolved to EHRs and many are taking a critical role in referrals. The Centers for Medicare and Medicaid Services (CMS) has instituted Merit Based Incentive Programs

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It is imperative to speak the language of your referral sources. That may be by fax, efax, email, telephone, or EHR referral. Careful attention must be paid to this critical phase of your business. There are always other groups, institutions or organizations looking for ways to increase their referrals at your expense. Understanding your referral percentages, sources and communication methods will keep you competitive and profitable. It is more complex than ever before. For additional information of developing referral sources, please feel free to call us for a consultation. (901.490.2330) There is no charge for this phone consultation rather, provided as a professional courtesy for members of the Memphis Medical Society. Understand and speak the language of your valued referral sources.

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Unused drugs? New state law will allow you to donate them Elle Perry, Digital Producer, Memphis Business Journal Tennessee's new prescription drug donation repository program mirrors a 10-year-old Iowa program. Since Good Shepherd Health opened its Hickory Ridge mall location in 2015, founder Dr. Philip Baker said people call at least once a week asking where they can donate their grandparents' unused medication. Located in a former Bath & Body Works, the non-profit pharmacy distributes medication via mail order and in person to its members. To help redistribute unused — but still potent — medicine, Tennessee Rep. Cameron Sexon of Crossville sponsored legislation that authorizes the state Department of Health to establish a prescription drug donation repository. The legislation, which has been signed by the governor, will allow unused, donated medication to be re-distributed by pharmacies. "It mirrored what Iowa had been doing," Sexton said of Tennessee's program. Iowa created its drug donation program in 2007. In that state, long-term care dispensing pharmacies, retail pharmacies, health providers and individuals all donate unused medications and medical supplies. Those resources are then inspected by a pharmacist, distributed to medical providers or pharmacies, and re-dispensed. Since its inception, the program reports serving 70,000 people in need of medication and distributing $15 million in donated medication and supplies. "I want to be a state where anyone can donate," Good Shepherd's Baker said. Sexton said the program would allow people to donate certain medications — excluding controlled substances — under certain circumstances. The donated medication would only be able to be used by people at or below 200 percent of poverty or are uninsured. Current federal poverty guidelines put families of four earning $49,200 at 200 percent of poverty. Currently, the Tennessee Board of Pharmacy has until January 15, 2018, to make rules about the quantity and kinds of prescription drugs that will fall under the drug disposal program. The board will also include the number and geographic distribution of pharmacies to participate in the program — and could allow pharmacies such as Baker's to contract with larger health care organizations. "State law would not permit longterm care facilities to contract with a nonprofit pharmacy for unused meds," Sexton said. "The pharmacy needed changes in statute to make it possible for [Baker]."

About 90 percent of Good Shepherd members are in Memphis, but the nonprofit has members from across the state. Members pay $40 a month for medications "at cost," giving them 60 to 90 percent savings, Baker said. Church Health patients already use Good Shepherd Health. The pharmacy also works with the Morning Center, which provides prenatal and postpartum care; local churches; and patients from Resurrection Health, which provides health care to the underserved. However, people with higher incomes and insurance could see also benefits of membership, Baker said. "Anyone who takes a lot of medicine," he said. "Four or more drugs." The average Good Shepherd patient takes eight. Typical ailments include diabetes and hypertension. "If [the depository donation program] goes as expected, it will be very beneficial as it continues to grow year after year," Sexton said.

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MMS Bulletin Fall17  

The Memphis Medical Society Fall 2017 Quarterly Bulletin

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