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Volume 20, Number 2

Inside: West Cancer Center’s Gynecologic Oncology Division Baptist Physician Blazes a Trail In Lung Cancer Treatment & Research

Summer 2017


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contents Volume 20, Number 21

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.

Summer Spring 2017

Features 8 West Cancer Center’s Gynecologic Oncology Division by: Katie McDermott 14 Baptist Physician Blazes a Trail in Lung Cancer Treatment and Research by: Karen Mayer

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

on the cover: Adam C. Elnaggar, M.D. Mark Reed, M.D. Linda Smiley, M.D. Todd Tillmanns, M.D.

Back Page 28 AMA Code of Medical Ethics – First of its Kind

Cover photo by Greg Campbell

Summer 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 Communications & Membership Director Victor J. Carrozza Finance Director Leah S. Lumm Business Services Division: Senior Staffing Coordinator Freda Reed Accounting Coordinator Paula Lipford Photography Credits Greg Campbell Victor J. Carrozza Editorial Thomas C. Gettelfinger, M.D. Graphic Design Liz Petzak 2

Editorial Thomas C. Gettelfinger, M.D.

Book Reports What Was That About Soren Kirkegaard? Doctors don’t have time to read books, or so it’s said. But I’ve known a good many doctors who are in fact bibliophiles, Dee Canale, collector of antique books; Jim Galyean, who reads almost a book a day, currently re-reading Faulkner; Jon Glass, medical school roommate, one of the best read people I know, despite being a science MIT graduate; Oakley Jordan, a novelist himself, any number of physician writers from Rabelais to Arthur Conan Doyle and forward. This brings me to two books that I’ve read recently, my choice, not selected for me. If you only read one fiction and one non-fiction book this year, you can’t go wrong with either. First, fiction, The Gentleman from Moscow by Amor Towles. Set in Moscow’s Hotel Metropole, it’s the story of Count Alexander Rostov, an aristocrat exiled to the hotel for a lifetime. It offers everything: beautiful historic setting, the sweep of postrevolutionary Russia, great plot and characters, unexpected twists, suspense, and clever sentence structure. The Gentleman will warm your cold nights and cool your hot days. Second, An American Sickness, How Healthcare Became Big Business and How You Can Take it Back by Elisabeth Rosenthal. She is one of our own, an Internist now turned writer. It also offers everything of its subject, but it’s more of a horror story. It’s organized like a case history, Chief Complaint, Present Illness, Review of Systems and so on. In good reportorial style she personalizes the issues, illustrating each point with real life people and events. My favorite anecdote: the patient whose doctor in Manhattan moved her practice 15 blocks north from Beth Israel Hospital to the NYU Langone Medical Center. The charge of the 6 weekly Remicade infusions went from $19,000 each visit to $132,791.04. Same medicine, same dosage same infusion. If they were the hospital donors, I wonder what the Langone family thinks of that, delivered in their name. And the bigger shock, the insurer “came up with almost all of the cash”. So doctors do read, and write, books. Kierkegaard wrote about depression, The Sickness unto Death. American Sickness may make you sick. Medical Society Quarterly


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

Time for Physicians to Act

Like the growing voter movements that impacted the recent U.S. presidential election, Great Britain’s Brexit, and the recent French presidential election, people worldwide are tiring of overblown regulations and regulators/executives that ignore public sentiment with impunity. There is a similar fatigue in medicine. As I said at the Memphis Medical Society (MMS) annual meeting and in my last Quarterly message, physicians are at the breaking point because of the stresses of practice, out of control regulatory demands, and diminished payment programs that are in many instances forcing doctors to work countless non-reimbursable hours in order to remain compliant. This has all happened because “practicing” physicians have largely not been appropriately included in legislative, administrative, or governmandated decisions. MMS doctors and the Tennessee Medical Association (TMA) are working with state legislators to improve unreasonable Maintenance of Certification (MOC) requirements, Payor Accountability trends, and many more issues.* Without physician input legislators might not get the full message; a message that is many times obscured by lobbying by the very opponents that brought on all the struggles in the first place. No other U.S. workers would tolerate the abuses physicians must sustain in order to care for a patient. Others join unions, pay their dues and show up to demonstrate their point of views. Attorneys exercise stealth maneuvering via a high percentage representation in legislative bodies. Does anyone actually think attorneys would allow a recurring Bar Exam? Nor would any business allow state-law to permit a contract to bind one party, while allowing the other party to change the terms at will.

The reason we have gotten into this helpless situation is simple. Most doctors are focused on their patients, are too tired and have little personal time remaining for political involvement. While we take care of our patients in the clinical setting, we are failing them on the legislative front, and the practice burdens are in fact impacting patient care. The regulations and delay tactics by insurance carriers are unfair and frustrating to patients. It many times delays care or interferes with a physician’s best judgment. Simple insurance approval processes can be catastrophic to patients; some dying patients are suffering because of delays in insurance company approval for pain treatment. As is typical of arrogant bureaucrats, rather than face their own misjudgment and negative results of excessive regulatory demands, they are pointing to a need for physician training to deal with the regulatory requirements/burdens and a 50% physician burnout rate. The absurdity of this would be comical if it were not so sad! To paraphrase two metaphorical idioms….the Elephant in the Room is that we have a serious problem. The Tail Wagging the Dog is that physicians have allowed people who know much less about patient care to control the destiny of the practice of medicine and the actual care of patients. We can no longer allow our voices to be drowned out by bureaucrats, administrators, CEOs and regulators. If you are not helping, you are part of the problem. What can an individual doctor do? Urge every doctor to join the MMS. (The number is 761-0200.) Sheer numbers will increase the volume of our voices.

“No other U.S. workers would tolerate the abuses physicians must sustain in order to care for a patient.”

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*Next Quarterly will deal with specific issues. Medical Society Quarterly


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UTHSC – College of Medicine – Memphis Holds Match Day The University of Tennessee Health Science Center – College of Medicine held its annual Match Day on Friday, March 17. Approximately 156 (out of 165 total) fourth year medical students and their families gathered at the Memphis Botanic Garden and waited for the letters that would tell them where they will go next for their residencies. The M4 students joined their peers from across the country in simultaneously opening the envelopes that revealed their respective match locations. Of the 156 students participating in the match, 44 percent went into primary care (Family Medicine, Internal Medicine, Pediatrics and OBGYN), 37 percent are staying in Tennessee, and 28 percent matched for residency and are remaining in the UT – Memphis / Jackson, TN program.

Summer 2017

(Above) Arian Nasab, M4 and Samantha Polly, M4 show off their matches in pediatrics and dermatology, respectively both to Case Western Reserve, along with Dr. and Mrs. Stuart Polly (Diane) (Left) Raj Budati, M4, with his parents and sister, matched in anesthesiology at the University of Texas – San Antonio. They are pictured with Edwin W. Gannon, III who matched in ophthalmology at the University of Tennessee – Memphis with his wife, Olivia and son, Asa.

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Application available for TennCare’s Patient-Centered Medical home (PCMH) Program In partnership with TennCare’s three health plans, the Tennessee Division of Health Care Finance and Administration (HCFA) launched a statewide aligned Patient-Centered Medical Homes (PCMH) program with twenty-nine organizations on January 1, 2017. PCMH is a comprehensive delivery care model designed to improve: 1. The quality of primary care services for TennCare members. 2. The capabilities and practice standards of primary care providers. 3. The overall value of health care delivered to the TennCare population. Participating organizations commit to member centered access, team based care, population health management, care management support, care coordination, performance measurement and quality improvement. Applications are now being accepted for additional PCMH organizations to join the program. Program participation for newly participating providers will begin January 1, 2018. The application may be found at http://www.tn.gov/hcfa/ article/patient-centered-medical-homesApplications. Applications are due by 5:00 pm CST on June 30, 2017. Please email questions or comments to payment.reform@tn.gov.

Kurt Tauer, M.D. to be honored during 2017 ACS Imagine Ball The American Cancer Society (ACS) will host its annual Imagine Ball presented by Horseshoe Tunica and Tunica Roadhouse on Saturday, August 26, at the FedEx Event Center at Shelby Farms Park. Each year during the Imagine Ball, the Society recognizes the work, service and commitment of a special member of the ACS family. This year’s honoree will be Kurt Tauer, M.D. Chief of Staff at West Cancer Center (WCC). “Dr. Tauer has dedicated the last thirty years to treating patients in the Mid-South with both compassionate care and the most innovative therapies available,” said Rola Obaji, Event Chair for the Imagine Ball. “He fights cancer on the front lines, right alongside his patients – every step of the way.” Dr. Tauer serves as a Medical Oncologist at West Cancer Center, an Associate Professor for the Department of Hematology/Oncology at the UTHSC and a board member of the National Comprehensive Cancer Network (NCCN). At WCC, Dr. Tauer leads the Community Outreach initiatives, which provide a cohesive and comprehensive approach to eliminating barriers to care. In 2013, he was awarded Best Healthcare Provider by Memphis Business Journal. In addition, he has also served on the local board of directors for the American Cancer Society and on the executive committee of the Baptist Cancer Institute. “Dr. Tauer not only advises his patients, but he guides the entire medical community,” said Obaji. “He empowers innovation, leads by example and gives colleagues a strong sense of purpose.”

Lindi H. Vanderwalde, M.D. selected as new MMS board member Lindi H. Vanderwalde, M.D., specializing in breast surgery, oncology and general surgery at Baptist Medical Group was recently selected to be a new board member of the Memphis Medical Society. Dr. Vanderwalde received her medical degree from the University of Pennsylvania School of Medicine in Philadelphia, PA. She completed her internship and residency at Kaiser Permanente Los Angeles Medical Center in Los Angeles, CA. She did a breast surgery fellowship at Cedars-Sinai Medical Center in Los Angeles, CA. Dr. Vanderwalde is board certified in breast ultrasound by the American Society of Breast Surgeons.

Medical Society Quarterly

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Continued in next column


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SPOTLIGHT

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West Cancer Center’s Gynecologic Oncology Division by: Katie McDermott For more than twenty years, West Cancer Center’s Gynecologic Oncology Division has provided rapid access to the most comprehensive treatment for women across the Mid-South. Beginning with the hiring of Linda Smiley, M.D., FACOG in 1995, West Cancer Center integrated a more refined and targeted approach to patient care, delivering customized – and multidisciplinary – treatment plans for women facing a gynecologic cancer diagnosis. Since then, the number of new gynecologic cancer diagnoses has grown to comprise one of the highest volumes for all cancer types treated at West Cancer Center. In 2016 alone, the Division saw more than 4,000 patients – including almost 800 new patients in the same timeframe. To accommodate this growing patient population, West now boasts the region’s largest team of multidisciplinary experts in the field. Todd Tillmanns, M.D., FACOG; Mark Reed, M.D., FACOG; Adam C. ElNaggar, M.D.; and Dr. Smiley form the Gynecologic Oncology Division – all playing the unique, dual role of oncologist and surgeon. “From evaluation to diagnosis, through surgery and treatment planning, this team cares for the entire patient – throughout their spectrum of care” said Dr. Tillmanns, Division Head and Program Director of the Gynecologic Oncology Division at the University of Tennessee Health Science Center. “This highly personalized and unique patient experience is coupled with unparalleled access to the most advanced technology and innovative resources available – ensuring each patient receives the care she needs. From radical debunking surgeries to the management of chemotherapy, our physicians are with our patients – every step of the way.” Comprehensive Care – on your home front In addition to the flagship location in Memphis, Tenn., the Division provides points of access to comprehensive services throughout the Mid-South. From satellite locations in West Tennessee and Eastern Arkansas, to two dedicated sites in North Mississippi, these experts provide multiple points of access to care for women across the region. This ensures not only the convenience of proximity, but also the benefit of more rapid access and appointment times across multiple sites.

“As the patient’s partner in their health care journey, we meet the patient – on her home front – to guide her comprehensively and efficiently through the stages of diagnosis, treatment planning and, ultimately, survivorship,” said Dr. Smiley. “This regional scope is foundational to our team, and essential to the patient experience. At the end of the day, that is what we are working to perfect.” Surgical Expertise Robotic-assisted surgery has quickly become one of the fastest growing technologic advances in the treatment of gynecologic cancers. Today, this commitment to innovative technology and resources continues as the team utilizes the most advanced robotic and minimally invasive systems for surgical intervention. The net result is ultimate benefit to the patients – ensuring decreased patient discomfort, quicker recovery and superior surgical outcomes. “In regards to cancer care, we were doing minimally invasive surgery here at West before anyone else in the city,” said Dr. Tillmanns. “That’s typically a robotic approach; however, there are other minimally invasive approaches that we are doing here as well that are very useful. We put our patients first, and that means finding the most successful methods that interrupt their lives as little as possible.” The Therapies of Tomorrow, Today West Cancer Center features the largest portfolio of clinical trial opportunities in the Mid-South. This, coupled with a commitment to targeted therapy empowered by a comprehensive Genetics Program, ensures patients benefit from the latest treatment opportunities and newest combination modalities. Dr. ElNaggar, the newest Gynecologic Oncologist to join West Cancer Center, believes this is essential to not only the patient, but also to elevating access to innovative care throughout the region. “At West Cancer Center, we are shaping the future of cancer care with an innovative, patient-centered approach to cancer treatment,” said Dr. ElNaggar. “For the Division, this includes providing patients access to the therapies of tomorrow – today – through our robust Clinical Research Program. This is reflective of West’s commitment to providing our patients with every tool, every resource available at our disposal to defeat this disease. ” Medical Society Quarterly


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“In regards to cancer care, we were doing minimally invasive surgery here at West before anyone else in the city.” – Dr. Tillmanns Patient and Caregiver Support In addition to regional access and innovative treatment opportunities, the Gynecologic Oncology Division reflects a commitment to the holistic patient experience – a component that has been a building block of West Cancer Center since the doors opened almost four decades ago. Realizing that the patient experience extends far beyond the physician and treatment visits, the WINGS Supportive Care Division picks up where the visit leaves off – providing patients access to the comprehensive, supportive services necessary for their cancer journey. “The cancer journey impacts not only the patient, but the entire network of family, friends and loved ones that surround her,” said Dr. Reed. “As their physician, we also become part of their network. And we realize that these additional supportive services are absolutely essential to the cancer journey.” From nutrition to rehabilitation, to psychological services and spiritual counseling, these services are available at no additional cost to the patient. The WINGS Supportive Care Division also houses the Genetic Counseling Program – a resource critical to the treatment planning process. “In partnership with the patient’s Gynecologic Oncologist, Genetic Counselors provide patients access to education and resources to better understand how genetics may play a role in developing cancer,” said Dr. Reed. “And, when evaluation and care planning deems necessary, they can also provide genetic testing services to determine how this information can empower both preventative health as well as the cancer treatment process.”

Summer 2017

Shaping the Future of Gynecologic Oncology In addition to excellence in comprehensive care, the Gynecologic Oncology Division is committed to providing access to education and training opportunities for specialists in the field. According to Dr. Tillmanns, integral to this commitment is the Division’s Fellowship Program. Featuring a dual focus on both clinical excellence as well as laboratory research, the Fellowship provides future experts with the necessary surgical experience, scientific knowledge and laboratory focus to build a foundation for a career in this field. The highly competitive program also distinguishes West Cancer Center as not only the region’s premier cancer care provider, but also as the educational epicenter for gynecologic experts in the Mid-South. And while the Gynecologic Oncology Division represents a comprehensive web of multidisciplinary services, education, programs and expertise, their mission is singular – and very clear: to provide each woman with the care she needs for her unique wellness journey. “We are very proud of the program that we’ve built here at West – one that is equal to some of the largest and most robust Gynecologic Programs in the country,” said Dr. Tillmanns. “But, at the end of the day, what truly makes us unique – what truly defines these expert physicians – is their commitment to each and every single patient that trusts us as their partner in their cancer journey. That is our focus. That is what gets us out of bed every day. We are with these patients, every step of the way.”

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Need Help with the New Quality Payment Program? Qsource Is Here to Serve You by: Alyssa Chase, MHA by: Tennessee Quality Program Director

The Quality Payment Program (QPP) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and is an enhanced approach to paying physicians and clinicians who care for Medicare beneficiaries. The QPP rewards the delivery of high quality patient care for eligible clinicians or groups through one of two paths: the Meritbased Incentive Payment System (MIPS) or Alternative Payment Model (APM). The Centers for Medicare & Medicaid Services (CMS) designed the QPP with the help of clinicians. The goal is to improve the quality of care patients can get, and specifically the two areas people want improved: • More time with their doctors • Better coordinated care Improving quality can help us all spend money more wisely and bring the costs down for everyone. CMS has selected Memphis-based Qsource to provide QPP support. We offer assistance to practices in understanding the new reporting requirements, meet performance goals and sustain or enhance reimbursement. We provide technical assistance, tools, and resources. Small, underserved and rural practices face unique challenges with QPP. Qsource can help practices with fifteen or fewer healthcare professionals in Tennessee and Alabama. Starting in 2019, MIPS will pay eligible physicians and clinicians for providing care based on four performance categories: advance care information, improvement activities, cost and quality. Larger practices with more than fifteen clinicians can receive customized technical assistance through our atom Alliance advisors offering support throughout Alabama, Indiana, Kentucky, Mississippi and Tennessee. Qsource leads atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIOs), which bring

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Medicare beneficiaries, providers, and communities together in data-driven initiatives that increase patient safety, make communities healthier, better coordinate post-hospital care, and improve clinical quality. By serving the five-state region, the QIN-QIO is able to help best practices for better care spread more quickly, while still accommodating local conditions and cultural factors. The work of the QIN-QIO is grounded in principles aligning with the goals of the CMS Quality Strategy: eliminating disparities; strengthening infrastructure and data systems; enabling local innovation; and fostering learning organizations. The QIN-QIO will build on this platform to accomplish four major goals: • Promoting effective prevention and treatment of chronic disease by promoting safe care that is patient and familycentered, reliable and accessible; • Making care safer and reducing harm caused in the delivery of care; • Promoting effective communication and coordination of care; and • Making care more affordable. Qsource is also a local resource for the Comprehensive Primary Care Plus (CPC+), a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. A helpdesk for QPP support requests is available at techassist@qsource.org. Please feel free to e-mail the helpdesk if you have any questions or we can provide you with assistance. You may also contact the QPP at QPP@cms.hhs.gov or 1-866-288-8292 (Monday-Friday 8 a.m.–8 p.m. ET). TTY users can call 1-877-715-6222. For questions about other QIN-QIO initiatives, please contact me at achase@qsource.org.

Medical Society Quarterly


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Dr. Fleming honored with TMA Outstanding Physician Award On Saturday, April 29 at their annual meeting, the Tennessee Medical Association (TMA) recognized James C. Fleming, M.D. with their Outstanding Physician Award. The award is given each year by the TMA House of Delegates to member physicians who through their illustrious medical career make an impression among their colleagues, peers and on the profession of medicine. Dr. Fleming, an ophthalmologist at Hamilton Eye Institute has been a leader in the Memphis medical community for over forty years. Dr. Fleming has held leadership positions in a number of local, state and national medical organizations during his career, including serving as past president of the Memphis Eye Society, The Memphis Medical Society, the Tennessee Medical Association and the American Society of Ophthalmic Plastic and Reconstructive Surgery. He has received numerous prestigious awards, including Best Doctors in America: Midwest Region award, American Academy of Ophthalmology’s Senior Achievement award, and the Outstanding Alumni award – University of Tennessee Health Science Center – Department of Ophthalmology.

Summer 2017

Dr. Fleming (center) with his wife, Mrs. Anne Fleming and their family.

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

Question:

I’m interested in making a series of sizeable charitable contributions during the next three years, but the majority of my money is invested in an individual retirement account (IRA) and a pension plan. I retired last year at age 71, and I started receiving pension plan and social security benefit payments. I plan on using these amounts to cover my standard of living expenses for at least the next 5 years. My IRA is the only other source of funds that I could use for charitable giving, but the tax liability on large IRA distributions is a major concern for me. Can you recommend a strategy to accomplish my charitable contribution goal?

Answer:

Based on the information you provided, I suggest that you make a Qualified Charitable Distribution (QCD) from your IRA. Current tax laws allow for distributions from your IRA directly to a qualified charity without paying income tax. The amount of the distribution is excluded from taxable income so deductions, credits, and phase-outs (adjusted gross income dependent items) are not impacted. The QCD would also satisfy all or part of your IRA Required Minimum Distribution (RMD) obligation for the year. Your charity of choice will need to meet the qualifications as defined by section 170(c) of the Internal Revenue Code. Be aware that the list does not include private foundations, donor-advised funds, or supporting organizations. Other requirements include the following: the donor must reach a minimum age of 70½ on the distribution date, the QCD is limited to the amount that would be taxed as ordinary income (nondeductible IRA contributions are excluded), the maximum annual

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amount for a QCD is $100,000 per taxpayer, employer-sponsored retirement accounts are disqualified (only IRAs, Inherited IRAs, and IRA rollover accounts are eligible), QCDs must meet a December 31 deadline, and a confirmation letter from the charity must be received for record keeping purposes. There is an important caveat if you decide to make a QCD from your IRA. Funds must be distributed from your IRA custodian directly to the qualified charity. This can be accomplished by an electronic transfer or a check made payable to the charity. Distributions paid to you would not qualify as a QCD and would be treated as taxable income. I would recommend that you seek the advice of a financial advisor or tax planning specialist in your area before taking any action. A detailed analysis of your financial situation might be helpful in the development of a strategy that maximizes your charitable gift giving.

Medical Society Quarterly


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Baptist Physician Blazes a Trail in Lung Cancer Treatment and Research by: Karen Mayer Under the direction of Dr. Raymond Osarogiagbon, the Baptist Multidisciplinary Thoracic Oncology program and the Thoracic Oncology Research Group have quietly garnered national and international recognition for innovation in lung cancer care, research models, and population-based improvement in lung cancer survival. These home-grown programs, developed right here in the Mid-South, include innovations in lung cancer care delivery models and critical insights into optimal treatment. The overall goal is to elevate lung cancer survival at the broad population level. Curious about the high cancer occurrence and death rates in the Mid-South, Dr. Osarogiagbon came to Memphis in 2005. His interest settled on lung cancer. Since then, he has been set on a course to change outcomes. His pivotal work revolves around improving the likelihood that patients survive lung cancer by increasing access to high-quality surgery and post- Raymond Osarogiagbon, M.D. surgical treatment. He invented a lymph node specimen collection kit which helps surgeons do a better operation and helps pathologists more thoroughly examine surgical specimens. With funding support from the National Cancer Institute, his research team has been disseminating use of this kit for lung cancer surgery across all the hospitals in the Mid-South. In early July this year, Dr. Osarogiagbon will present the two-day Druckenmiller Seminar at Memorial Sloane Kettering Cancer Center, where he will discuss the results of the regional project and how it can be applied even at the largest and most renowned comprehensive cancer centers in the US. “We are laying down infrastructure to support a systematic approach to high-quality care,” he said. Dr. Osarogiagbon has established that defects in the quality of lung cancer care are not exclusive to the Mid-South, but are a huge national and international problem. More importantly, his research team is showing ways to raise quality, enhance performance, and consequently, boost patient survival. Cancer centers across the nation and around the world are paying close attention to these lessons being taught from the MidSouth. “We are helping surgeons and pathologists to more 14

accurately examine the lymph nodes when doing lung cancer surgery. These lymph nodes contain a lot of useful information.” In fact, Dr. Osarogiagbon points out that in 90 percent of lung cancer cases, pathologists fail to extract vital information from the lymph nodes, and 30 percent of such cases have missed cancer spread, leading to underestimation of patients’ risk of death, and a missed opportunity for lifesaving additional treatment. This research was highlighted in two major papers his research team published in The Annals of Thoracic Surgery, August 2016, which were accompanied by a high-profile editorial. “We can transform things,” said Dr. Osarogiagbon. Dr. Osarogiagbon’s team with the Baptist Cancer Center holds three multi-million dollar research grants from the Patient-Centered Outcomes Research Institute (PCORI) and the National Institute of Health (R01 grant). The PCORI grant, which studies the impact of a multidisciplinary clinic environment on lung cancer patient outcomes, has generated interest from and collaboration with several high-level research and patient advocacy organizations across the country, including the Bonnie J. Addario Lung Cancer Foundation (BJALCF), the Association of Community Cancer Centers (ACCC), the American Society of Clinical Oncology (ASCO), the Southwest Oncology Group (SWOG), and the International Association for the Study of Lung Cancer (IASLC). In December 2016, Baptist’s Thoracic Oncology Research Group presented eleven abstracts at the 17th World Conference on Lung Cancer (WCLC) in Vienna, Austria. Dr. Osarogiagbon presented on the effect of the thoracic oncology program and the Center of Excellence model of care, participating in a worldwide press conference highlighting the impact of this community-based lung cancer quality improvement program. Through a regional symposium held in April 2017, Dr. Osarogiagbon is building regional collaboration across organizational lines, involving fourteen hospitals from seven health care systems, in Eastern Arkansas, Western Tennessee and Northern Mississippi, including five Baptist facilities, three Methodist facilities, St. Francis in Memphis, St. Bernard’s in Arkansas, and North Mississippi Medical Center in Tupelo. “This project is raising a lot of international interest because we have clearly identified the challenge of raising lung cancer survival at the broad Medical Society Quarterly


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population level as a worldwide opportunity,” said Dr. Osarogiagbon. “The idea is to trace the cancer from where it starts,” he said. Thanks to the Baptist Memorial Health Care Foundation’s $1 million grant, Dr. Osarogiagbon and his team including Todd Robbins, M.D.; Jeffrey Wright, M.D.; Keith Tonkin, M.D; Rob Optican, M.D.; David Spencer, M.D. and Ajay Wagh, M.D. are now moving into new territory. The team has established a comprehensive Multidisciplinary Lung Nodule Management program, led by Dr. Robbins, a thoracic surgeon, and Dr. Wright, a pulmonologist, to closely follow patients with potentially cancerous lung nodules found on CT scans done for other reasons. This program is expected to raise the odds of patients surviving lung cancer across our various communities. After twelve years of quiet, persistent labor in the Mid-South, Dr. Osarogiagbon’s research is now receiving widespread recognition. In late 2016, Dr. Osarogiagbon was named the Lead Research Consultant for a national project by the Association of Community Cancer Centers (ACCC) to improve access to highquality lung cancer care for patients enrolled into the Medicaid program. “We’re looking at how to optimize a cancer care delivery model and increase access to high-quality care. It’s all about how to standardize care or metaphorically, how to create a rising tide that will lift all boats. We’re looking to develop the next generation of care,” said Dr. Osarogiagbon. On another front, Dr. Osarogiagbon and his Baptist Cancer Center team are writing a chapter titled “Achieving Better Quality Lung Cancer Care” for a book, Lung Cancer: A Practical Approach to Evidence-Based Clinical Evaluation and Management to be published by Elsevier in 2017, and edited by Drs. Lynn Tanoue, Chief Section of Pulmonary Medicine and Frank Detterbeck, Chief of Thoracic Surgery, at Yale University. Dr. Osarogiagbon serves on the board of the Bonnie J. Addario Lung Cancer Foundation’s Center of Excellence program, as well as the External Advisory Board of the LUNGevity Foundation’s Patient-Focused Research Center (Patient FoRCe). LUNGevity is the largest national lung cancerfocused nonprofit. Working closely with the American Society of Clinical Oncology, Dr. Osarogiagbon also serves on the Workforce Advisory Group. In addition, he was recently appointed to lead the National Cancer Institute’s Community Oncology Research Program’s Cancer Screening/Prevention Research Interest Group. “We’re looking at the cancer care work force, physicians and allied work force, hoping to develop policies that will advance decisionmaking for all cancers.” Summer 2017

“We’re looking at how to optimize a cancer care delivery model and increase access to high-quality care. It’s all about how to standardize care or metaphorically, how to create a rising tide that will lift all boats.”

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Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for the Management of Peritoneal Carcinomatosis 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

Peritoneal Carcinomatosis (PC) from gastrointestinal and gynecologic malignancies is a difficult challenge for oncologists and surgeons to treat. The clinical course of PC is one of weight loss; progressive abdominal distention from the accumulation of ascites; uncontrolled tumor growth resulting in malignant bowel obstruction; and eventual death. Without treatment, the natural history is poor with a survival of approximately six months. As a result; these patients have historically been referred for palliative chemotherapy or simply given supportive care. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) offers the potential for cure for patients with PC. CRS/HIPEC is an accepted treatment modality for PC from intraperitoneal mesothelioma, appendiceal, colorectal, ovarian and sarcoma malignancies. CRS/HIPEC has also been referred to as “shake and bake”, “hot chemo,” or the “sugar baker” technique. Cytoreduction involves the surgical removal of all visible disease within the abdominal cavity. Tumor nodules, often numbering up to several hundred, are scattered throughout the abdominal cavity and may be present in all quadrants. The abdominal lining, the omentum and visceral organs of the pelvis (from drop metastases) are frequently involved with disease. At the completion of cytoreduction, HIPEC is performed (Figure 1). The rationale for performing HIPEC is that the chemotherapy kills any residual or microscopic disease left behind after cytoreduction. The chemotherapy is heated to a target temperature of 42 degrees Celsius to synergize the tumoricidal effects of the chemotherapy. Administering chemotherapy directly within the abdominal cavity allows a higher concentration of chemotherapy to be given with minimal to no systemic toxicity. HIPEC is performed using a “closed technique”. Inflow and outflow catheters are placed within the abdominal cavity, connected to a perfusion circuit and the abdomen is temporarily closed. The abdomen is filled with heated saline and the chemotherapy is administered. The abdomen is gently agitated during the HIPEC to improve the distribution and delivery of the heated chemotherapy.

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At the completion of HIPEC, anastomoses are performed, protective ostomies are created (if a low pelvic anastomosis is performed) and drains are placed. Patients are monitored in the intensive care unit overnight and remain in the hospital typically for seven to ten days. Patients are followed routinely for three to four months for the first two years then six months thereafter with physical examination, tumor markers and cross sectional imaging. Adjuvant chemotherapy may be required depending on the pathology of origin. The UTHSC Peritoneal Malignancy Program started in 2011 in collaboration with Methodist Healthcare and West Cancer Center. Patients are evaluated and managed in collaboration with a medical oncologist and presented in multidisciplinary gastrointestinal tumor board. Prior to CRS/HIPEC, all patients undergo comprehensive medical evaluation, nutritional and physical therapy assessment to optimize recovery. The UTHSC HIPEC coordinator helps to coordinate patient preoperative testing, arrange postoperative follow up and assists with long-term surveillance. For further inquiry, please call 901-609-3525 or email UTHSCHIPEC@westclinic.com.

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).

Medical Society Quarterly


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Is Long-Term Care Insurance Right for You? With the more than 70 million baby boomers getting closer to their 80s, we’ve been hearing a lot about long-term care in the insurance world. Before we get into whether long-term care insurance is right for you and your family, let’s define long-term care.

Purchasing long-term care insurance is an important decision to make, and the earlier you decide the better. While longterm care insurance can be worth it (it is called “insurance” for a reason), there are other alternatives we recommend for you to prepare for your future.

Long-term care is hands-on assistance for an extended period of time. It includes home care, adult day care and stays at assisted living and nursing home facilities.

• Save money for it. Many Americans choose to invest the money to save just in case the need for long-term care rises. And if they don’t use it, then their children receive a nice bonus in their inheritance. • Add on to life insurance or an annuity. “Linked-benefit” products are popular, as they add a long-term care rider to a life insurance policy. Annuities can also be combined with a long-term care rider. • Purchase an accelerated death benefit. A life insurance policy with an accelerated death benefit allows you to get an advance on your death benefit to pay for your extended care. However, the downside may be that an advance can interfere with your eligibility to receive Medicaid.

The primary users of long-term care benefits are senior citizens, but the service is available to people of any age. The service is typically for people who cannot take care of themselves, such as those with prolonged disabilities, illnesses and mental impairments such as Alzheimer’s. Unfortunately, the cost of long-term care can be high. Also, Medicare does not cover it because long-term care is not considered a medical expense. According to Genworth Financial’s long-term care calculator, a private room in a nursing home in the Memphis, Tennessee, area will cost about $74,000 per year out of pocket. Twenty hours a week of home health aid costs more than $35,000 per year. Because of the high costs of long-term care, we recommend the purchase of long-term care insurance. While insurance premiums can get costly, insurance can be worth the investment. In your 50s and 60s, it’s easy to believe that you’re invincible and you’ll be healthy and active forever. No one wants to admit that 20 years down the road they may end up immobile and frail in a nursing home.

Several health awareness causes are represented in June, including Men’s Health, Alzheimer’s and Brain Awareness and even Cataract Awareness, so now is a great time to consider options. Paying for long-term care comes with a lot of preparation and decision-making early in your life. The Barnett Group can help you consider the possibilities and alternatives to determine the path that best suits you and your family.

PAID ADVERTORIAL

Summer 2017

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LEGAL BRIEF Tennessee General Assembly adjourns session with significant increase in healthcare funding by: Senator Mark Norris Tennessee Senate Majority Leader and Special Counsel, Adams and Reese, LLP

The first session of the 110th Tennessee General Assembly has adjourned with passage of a $37 billion, balanced budget. Although the base budget was reduced by $127 million and taxes were cut by over $400 million more, we kept Tennessee safe and strong by resourcefully reallocating revenues and responsibly reinvesting in our future as a state and as a people. Nowhere was this more evident than our investment in healthcare and related causes. We increased funding by almost a quarter of a billion dollars including $181 million for TennCare provider rate restorations; $26 million for substance abuse, mental health crisis services and provider rate increases; $8 million to increase payments to providers for the developmentally and intellectually disabled; $1.4 million to combat physical abuse of the elderly and disabled; and more than $10 million to address adverse childhood experiences (ACEs). Of special note is Tennessee's support for the ACEs initiative of the Memphis Research Consortium, which I helped to establish in 2010. It received $10 million in 2011 and $2.5 million again this year. Partners include the University of Tennessee Health Science Center, the University of Memphis, St. Jude Children's Research

Hospital, Wright Medical, Smith & Nephew, Medtronic, Baptist Memorial Health Care, Methodist Healthcare, Memphis Coalition for Advanced Networking (MCAN), Memphis Bioworks, MicroPort Orthopedics, Medical Education & Research Institute (MERI) and FedEx. The mission of the consortium is "to promote the health and wellbeing of children and families through quality education, sustained practice, engaged research and service, and community partnership to promote health equity". Nowhere perhaps is this more critical than in Memphis and West Tennessee in general where poverty drives poor social and health outcomes for children. As reflected in the consortium's request for funding, "(multiple studies have shown that ACEs have a doseresponse relationship with health outcomes (including obesity, diabetes, depression, suicide..., sexually transmitted infections, heart disease, cancer, stroke, chronic obstructive pulmonary disease, and broken bones), risky behaviors (including smoking, alcoholism, and drug use), and life potential." This year's healthcare funding reflects the General Assembly's recognition that preventative intervention is paramount if we are to succeed.

Senator Norris practices in commercial litigation and business matters with Adams and Reese, LLP. He is Senate Majority Leader and represents West Tennessee in the state senate. For more information on the firm, visit www.adamsandreese.com.

Alabama | Florida | Georgia | Louisiana | Mississippi South Carolina | Tennessee | Texas | Washington, D.C.

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Robotic Surgery by: Alan Hammond, MD, FACS

In the summer of 1989, I witnessed the beginning of a revolution in surgery as a third year medical student in Birmingham, Alabama. As a group of surgeons, students and house staff gathered in an operating room to watch the first laparoscopic cholecystectomy performed at Baptist Medical Center, little did I realize the sea change that was occurring in what would become my chosen profession. In the ensuing 28 years, the range of operations that can, and should be, performed laparoscopically has broadened remarkably, as has the armamentarium of instruments and devices developed to make the performance of those operations safer and more easily accomplished. Perhaps most significant of these innovations is the da Vinci robotic surgical system. Initially adopted by gynecologists and urologists, most significantly in the performance of minimally invasive prostatectomies, the da Vinci robot has recently seen acceptance by general and thoracic surgeons for the performance of a wide array of procedures. Although many of these procedures can be performed with traditional laparoscopic techniques, advantages of the robot include: better visualization with a 3D high definition video system, surgeon control of all instruments and the camera, less surgeon fatigue, and wristed instruments that offer the full spectrum of motion found in the human hand and wrist. The illusion of actually being inside the abdomen while dissecting, sewing, stapling and dividing tissue is very strong, lending a sense of confidence and safety not experienced while standing and looking at a video screen four feet away in laparoscopy. Operations performed by general surgeons in the Memphis area using the da Vinci robot include, but are not limited to, colon and small bowel resection, fundoplication for GERD and gastric resection, adrenal and liver resection, inguinal and ventral hernia repair, and cholecystectomy. Notably, as cholecystectomy is one of the most frequentlyperformed operations by general surgeons, it provides an accessible entrĂŠe to gaining confidence before performing more complex procedures. Additionally, cholecystectomy may be performed in selected patients using a single site technique, utilizing a single, 2.5 cm incision at the umbilicus to insert the laparoscope and instruments to perform the operation, then removing the gallbladder through that 20

incision as the instruments are removed. This has proven to be popular in patients concerned with cosmesis, and early concerns about increased incidence of incisional hernia seem to be unfounded with careful attention to technique in fascial closure. It remains to be seen whether this single port technique can be expanded to other applications.

Despite being dismissed by some as an expensive fad in its early iterations, laparoscopic surgery has been established as an advance in surgery that is here to stay. Similarly, robotically-assisted laparoscopic surgery has been derided as too expensive and a technology in search of an application. It seems clear, however, that as thought leaders and innovators continue to expand the use of the surgical robot and demonstrate its safety and efficacy, robotic surgery is becoming another way to safely and effectively treat those entrusted to our care.

Alan Hammond, M.D., FACS received his undergraduate degree from University of Alabama. Dr. Hammond graduated from the University of Alabama at Birmingham Medical School. He did his surgery residency at Methodist University Hospital, University of Tennessee at Memphis. He has specialty certification as a Diplomate American Board of Surgery. Dr. Hammond is a Fellow of the American College of Surgeons. He is a member of Memphis Surgery Associates and an attending surgeon at Saint Francis Hospital – Memphis. Medical Society Quarterly


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UTHSC Leads New Study to Help African-Americans with Uncontrolled Diabetes Take Better Care of Their Health The University of Tennessee Health Science Center (UTHSC) is heading a coalition of primary care providers in the Mid-South in a program to help African-American adults diagnosed with diabetes better manage their disease.

uncontrolled diabetes will have a unique opportunity to benefit from some of the latest and most-proven approaches to controlling, or even curing, their diabetes through healthier habits. The study will last one year. Participants must have a cell phone with text messaging capability. They will receive up to $150 for follow-up visits. Participating clinics are Christ Community Health Services, Raleigh; Christ Community Health Services, Third Street; Tristate Medical Group; UT Methodist Physicians South; Hawkins Family Medicine, Holly Springs, Mississippi; UT Family Practice, Jackson, Tennessee; UT Family Practice, Tipton, Tennessee; and Methodist Medical Group Primary Care, 1325 Eastmoreland, Suite 245, and 1264 Wesley Drive, Suite 606.

Stanley Dowell, MD, who leads the MODEL providers group, talks with a patient about the benefits of motivational text messages in diabetes self-management.

Led by James Bailey, M.D., MPH, professor of Internal Medicine and Preventive Medicine and director of the Center for Health System Improvement at UTHSC, the MODEL (Management of Diabetes in Everyday Life) program is recruiting African-American men and women over age eighteen, who have diabetes with high blood sugar levels. Participants will be part of a research study to compare three approaches that primary care clinics can use to encourage better self-management of diabetes. The study will compare the benefits of health coaching, motivational text messages, or diabetes education material in helping people with diabetes take better care of themselves. “All of these approaches can be adapted to a primary care setting, and would support and enhance clinical care for patients with diabetes,� Dr. Bailey said. James Robinson, PsyD, CEO of Methodist South Hospital and co-principal investigator on the project, said this practical research will help show health systems across the country how they can improve care and decrease costs by empowering patients to take better care of their diabetes in partnership with their primary care doctor. Stanley Dowell, M.D., who leads the MODEL Provider Learning Collaborative, said patients in Memphis with

Summer 2017

Drs. Stanley Dowell, left, and James Bailey are leading area physicians in the MODEL program to test methods to help African-American patients better manage their diabetes in partnership with physicians.

In 2016, Dr. Bailey received a $5.2 million funding award from the Patient-Centered Outcomes Research Institute (PCORI). The funds, to be distributed over four years and four months, will be used for this study and others to determine the effectiveness of patient-driven resources to improve health care for African-Americans who live in underserved areas and have uncontrolled diabetes. For more information about the MODEL study, call (901) 448-1381.

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R E A L E S TAT E U P D AT E Time to Sell? by: Jon D. Albright, CCIM, SIOR, SRES

Many of you have either owned or have been part of partnerships that own your real estate. Key questions will always be when to own, where to own, and very importantly when to sell your real estate. Traditionally, many owners of medical real estate have included the sale of the practice to the next wave of physicians or younger associates and real estate is either included or a lease of your real estate is part of the equation. As I have stated in previous articles, do not wait until you retire to have this question answered. You may want to consider selling and leasing back while you and your partners are still making the important and relevant decisions regarding the practice and related real estate. I am still seeing quite a bit of interest in medical real estate ownership, despite the uncertain future of health insurance and the impact changes will have on the industry. I work with a number of smaller investors ($2,500,000.00 and under) and have seminars where questions and information about MOB (medical office buildings) are always of interest. Regional and national real estate investment trusts (REIT), as well as equity firms continue to seek viable options for larger properties. Understanding what investors will purchase, lease terms, length and guaranty provisions are very important to comprehend and need to be in place when discussing a sale with other entities. Memphis and West Tennessee continue to see growth with new facilities being constructed and financing is still readily available for many projects. However, interest rates (as previously predicted) have continued to rise and are expected to continue to do so this year. The cost of capital should be carefully considered and evaluated with your team of

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professionals. We continue to see newer facilities with varying designs and in many cases located closer to identified patient bases. As I always advocate, be sure to utilize your accountant, legal advisors and real estate professionals to provide key insights for your real estate strategy before making important decisions with your real estate.

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

Medical Society Quarterly


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CALENDAR MEMORIAM

JUNE 6 Board of Directors Meeting Medical Society, 6 pm

9-11 Bluff City Medical Society National Medical Assoc. Region III Conference Sheraton Hotel - Memphis

21 Bluff City Medical Society Meeting Location & speaker TBA, 6:30 pm

Jesse J. Cannon, Jr. March 22, 1951 – April 18, 2017

C. Robert Cooke June 12, 1929 – February 28, 2017

Robert Clayton Ford, Jr. March 2, 1935 – February 13, 2017

Julius Fernandez February 11, 1973 – February 22, 2017

Bruce W. Herndon, Jr. July 15, 1934 – May 6, 2017

JULY 4 Independence Day Holiday Medical Society Closed

Gumersindo R. Leal January 6, 1928 – March 11, 2017

H. Lynn Magill

AUGUST 1 Board of Directors Meeting Medical Society, 6 pm

8 M1 Reception Hughes Pavilion Dixon Gallery & Gardens, 5 pm

16 Bluff City Medical Society Meeting Location & speaker TBA, 6:30 pm

May 1, 1946 – April 5, 2017

Thomas B. McLemore April 16, 1926 – March 11, 2017

John Edward Outlan August 30, 1931 – April 11, 2017

Stanley L. Smith, Jr. October 18, 1949 – April 10, 2017

Stephen L. Winbery September 17, 1961 – May 6, 2017

The Memphis Medical Foundation acknowledges and appreciates the following memorial:

In memory of Howard W. Marker, 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.

New 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

Summer 2017

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NEW MEMBERS Violiza Inoa Acosta, M.D. Semmes-Murphey Clinic 6325 Humphreys Blvd Memphis, TN 38120 901-522-7700 Universidad Iberoamericana, 2006 University of Connecticut – Farmington (R-NS) Beth Israel Medical Center – Boston (F-VN) Harford Hospital – Hartford (F-IN)

Michael LaBagnara, M.D. Semmes-Murphey Clinic 6325 Humphreys Blvd Memphis, TN 38120 901-522-7700 New Jersey Medical School, 2009 New York Medical Center – Newark (R-NS) University of Virginia – Charlottesville (F-NSS)

Cassandra D. Howard, M.D. Germantown Emergency Physicians 7691 Poplar Avenue Germantown, TN 38138 901-516-6970 Medical College of Wisconsin, 1998 University of Tennessee – Memphis (R-IMPD)

Christina L. Nelson, M.D. Anesthesiology Medical Anesthesia Group, PA 6060 Primacy Pkwy, Ste. 241 Memphis, TN 38119 901-725-5846 University of Tennessee - Memphis, 2010 Carolinas Medical Center – Charlotte (R-GS) University of Tennessee – Knoxville (R-ANS)

Joan R. Johnson, M.D. Medicos Para La Familia 3030 Covington Pike, Ste. 100 Memphis, TN 38128 901-383-8889 Georgetown School of Medicine, 2008 Heritage Valley Health System – Beaver Falls, PA (R-FM) Esther E. Kim, M.D. Medicos Para La Familia 3030 Covington Pike, Ste. 100 Memphis, TN 38128 901-383-8889 Texas A&M College of Medicine, 2013 University of Tennessee – Memphis (R-FM)

Austin B. Plumlee, M.D. Medicos Para La Familia 3030 Covington Pike, Ste. 100 Memphis, TN 38128 901-383-8889 University of Arkansas School of Medicine, 2013 John Peter Smith Hospital – Fort Worth, TX (R-FM) Esther E. Kim, M.D. Medicos Para La Familia 3030 Covington Pike, Ste. 100 Memphis, TN 38128 901-383-8889 Texas A&M College of Medicine, 2013 University of Tennessee – Memphis (R-FM)

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Paula Lipford | Accounting Coordinator | plipford@mdmemphis.org

Medical Society Quarterly


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PRAC TICING MEDICINE Perception is Reality by: Alan Flippin

Over the past ten years, we have seen the trend toward increasing consolidation of physician practices and hospitals in the U.S. healthcare system and the negative effects of decreased competition on the quality of patient care and health care costs. In this period, there have been 561 hospital mergers, with nearly half being in concentrated markets. Sole practitioners have declined substantially. Since 2010, over 33% of 929,419 active physicians were employed by hospitals and many more are in affiliate partnerships.(1) Recent articles acknowledge that there is little evidence of the promised benefits of such consolidation to patients. Patient advocacy groups are calling on the presidential administration to "ensure that we have a dynamic health care marketplace". It almost seems a little late for that. However in the majority of cases, people (patients) still use a variety of methods to find the best physician for their family member's particular needs. In addition, regardless of the efforts for tort reform, a 2011 study(2) showed that sixty percent of all doctors over fifty-five years old have been sued at least once. One in fourteen doctors faces a medical malpractice suit every year according to an article in the New England Journal of Medicine. Moreover, every physician will face one or more lawsuits during his or her lifetime. Regardless of the trend and tendency to consolidate, physicians are competitive and extremely loyal to their patients. They too want the best care available at an affordable cost. The consensus of an 8,000+ patient satisfaction survey(3) illustrates that perception is the key factor in patient satisfaction, confidence and willingness to recommend a physician to an acquaintance, friend or family member. Physicians, offices and hospitals that are comfortable, visually attractive, clean and have polite and accommodating front desk personnel set the stage for a "high quality patient experience". Timeliness, clinical interaction and warm personal discussions with the provider (physician, nurse or NP) can assure a perception of quality care.

As simple as it seems, these positive experiences transfer into fewer lawsuits and a competitive advantage. Additionally, the strategies for information exchange helps immensely in the patient perception of high quality experiences. These include well prepared pre-visit packets, mobile access to websites, links to pertinent articles, pricing transparency, and results ratings. These things prepare patients for an informed, interactive and high quality encounter with the physician or office. Although many things seem – and are – out of one’s control, this important focus can result in an optimum patient experience. This translates into a higher competitive advantage, as well as reducing frivolous lawsuits.

(1) JAMA (2) New England Journal of Medicine (3) ADF Medical - Patient Satisfaction Surveys 1993-2016

TMA 2018 Legislative Session Planning Meeting

On Wednesday, May 17, members of the Tennessee Medical Association (TMA) legislative committee met to begin planning for the 2018 legislative session. Pictured are from left James K. Ensor, Jr., M.D.; Elise Denneny, M.D.; Ron Kirkland, M.D.; George R. Woodbury, Jr., M.D. and Clint F. Cummins, EVP of the MMS. 26

Medical Society Quarterly


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BACK PAGE

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AMA Code of Medical Ethics – First of Its Kind In 1847, physicians representing twenty-two states and the District of Columbia came together to establish America’s first national professional association for physicians, the American Medical Association (AMA). As one of its first acts, the AMA created the first national codification of ethics for any profession anywhere in the world. Authored by a committee chaired by Drs. John Bell and Issac Hays, the 1847 AMA Code of Medical Ethics was “unlike any ethics subscribed to by any earlier group of medical practitioners. No national assemblage had ever proposed to bind all of its members by a uniform code of ethics, and no previous code of ethics had ever been formulated as an explicit social contract between the profession, its patients, and the public.” (Baker et al., JAMA, 1997) As the first of its kind, the 1847 AMA Code was reprinted by medical societies in Berlin, London, Paris, Vienna, and around the world. Throughout the rest of the 19th century, it was the most commonly printed medical document in the English language. (Baker et al. eds. The American Medical Ethics Revolution, Johns Hopkins University Press, 1999) Today, the AMA Code remains the only codification of professional conduct for all US physicians regardless of their medical specialty, practice type or location. Ethics guidance is regularly added or amended in the AMA Code to reflect changes in medical science and societal expectations. As with any “living” document that is authored by different individuals over many decades, the AMA Code became fragmented and unwieldy. Ethics guidance on individual topics were “difficult to find; lacked a common narrative structure, which meant the underlying value motivating the guidance was not readily apparent; and were not always consistent in the guidance they offered or language they used.”(Brotherton et al., JAMA, 2016) To address these issues, the AMA embarked on a multi-year “modernization” project to comprehensively review and update the AMA Code. To make guidance easier to locate, Opinions were reorganized into eleven more intuitive topical chapters. Opinions that addressed overlapping topics were consolidated, reducing the number of Opinions from 220 to 161. In addition, a consistent format was “constructed to ensure that each Opinion succinctly articulates the core ethical values on which guidance is based, defines the broad context in which guidance is relevant, and sets out specific ethical responsibilities in the form of practical actions for individual physicians or the profession as a whole to take.”(Brotherton et al.) Over the course of the modernization project, input and feedback was solicited from physicians representing the diversity of medicine. After much deliberation and debate, the AMA House of Delegates adopted the modernized AMA Code last June. “The modernization project ensures that the Code of Medical Ethics will remain a useful and effective resource that physicians can continue to rely on, while remaining faithful to the virtues of fidelity, humanity, loyalty, tenderness, confidentiality and integrity enshrined in the original Code,” AMA Immediate Past President, Steven J. Stack, MD, said.

www.ama-assn.org

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The Memphis Medical Society 1067 Cresthaven Road Memphis, TN 38119-3833

MMS Quarterly Bulletin Summer17  

The Memphis Medical Society Quarterly Bulletin Summer17

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