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Volume 20, Number 1

Spring 2017

Inside: Regulatory Burdens vs Patient Care 140th Annual Meeting and Installation of Officers


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contents Volume 20, Number 1

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 2017

Features 8 Regulatory Burdens vs Patient Care by: Phillip R. Langsdon, M.D. 14 140th Annual Meeting and Installation of Officers

In Every Issue 2 Editorial 23 Calendar 24 New Members

Back Page 28 Recognition of Annual Meeting Sponsors on the cover: Phillip R. Langsdon, M.D. Cover photo by Greg Campbell

Spring 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 Sri I. Naidu, M.D. Treasurer Lanetta Anderson, M.D. David L. Cannon, 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. 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.

I Give Up I’ve often wondered what she meant… I thought I had stumbled on something good and juicy, grist for a general conclusion based on the particular. The occasion presented itself through a patient recently operated for cataract surgery, first at an outpatient facility, ASC, and, a few weeks later, for the second eye, at one of our largest for profit hospitals. The switch was necessitated by significant general health issues, not insurance problems. Enrolled in a Medicare Advantage plan, that served him well at both facilities. Ah, the perfect opportunity to compare charges, long knowing that hospitals charge more, and are reimbursed more, for the same procedure done in a free-standing ambulatory facility (ASC), though both are outpatient procedures. The patient is a good friend, retired attorney, and if the truth were known, an inveterate malcontent, political activist and curmudgeon, characteristics that have their own charm, for he is indeed a charming and cooperative fellow. The hospital charge: $16,390.48 Paid provider: $1,308.58 The ASC charge: $12,300.00 Paid provider: $1,595.54 Ah ha! So why does the hospital get more for the same identical service? Why the outrageous charge at the hospital? As my friend said (remember he is a curmudgeon): “I can’t imagine whoever prepared this (hospital) bill did so with a straight face. The fact they had to reduce it because insurance isn’t stupid enough to pay the full amount doesn’t detract from the outrageousness of the bill. $4,000 for “pharmacy” and $750 for an EKG? Who do they think they’re kidding?” Well, this is the infamous Chargemaster, inflated charges. All hospitals do it. The ASC did it. A call to the hospital billing office, though a local 901 number, took me to Anaheim, California. No help there and a number of hoops to jump to get an itemized bill. A second call to the local hospital administration was pleasant, helpful, but there was no explanation for such a high Chargemaster bill. Further the bills were not exactly comparable, the hospital bill included an EKG even though our patient had just been cleared by his cardiologist and his EKGs were up-to-date, and other items as well. And neither the hospital nor ASC bill included codes that I could search. Well, that’s enough. To investigate the differences, to question the whole Chargemaster farce, to get comprehensible bills to enable consumer driven health care, it’s all just too much. Reform? I remember the girl back in college: “Forget it Tom, it ain’t gonna happen”, she said. At last I think I know what she meant. Medical Society Quarterly


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Upper Airway Stimulation (UAS) for Obstructive Sleep Apnea by: M. Boyd Gillespie, MD, MSc Chair, Department of Otolaryngology – Head and Neck Surgery University of Tennessee Health Science Center (UTHSC) UT Methodist Physicians, Head and Neck Surgery Obstructive sleep apnea (OSA) is a common disorder that causes loud snoring, daytime sleepiness, sleep disturbance, impaired quality of life, and an increased risk of heart disease and car accidents. Many patients with OSA have upper airway muscles that become too relaxed during sleep, and therefore fail to keep the airway open. Repeated closure of the airway during sleep causes a decrease in blood oxygen that can lead to high blood pressure, heart arrhythmia, and daytime sleepiness and memory problems. Currently, the first line therapy for OSA is continuous positive airway pressure (CPAP) which forces pressurized air into the nose and throat in order to open the collapsing tissues. However, the effectiveness of CPAP is limited by poor patient acceptance with only 50% of patients continuing the therapy over the long-term. The idea of stimulating the upper airway muscles to stay open during sleep has been around for more than twenty years. However, only recently has the technology been developed to allow this to be successfully performed. The Inspire Upper Airway Stimulation (UAS) System (Inspire Medical Systems, Minneapolis, MN, USA) is a small pacemaker like device inserted under the skin of the chest that has an electrode that connects to the hypoglossal nerve which stimulates the major dilating muscles of the upper airway. The patient uses a hand held remote control to activate the device prior to sleep. The effectiveness of the UAS device was shown in a study published in the New England Journal of Medicine in 2014 which observed a 68% reduction in sleep apnea 4

severity with a mean decrease in the apnea-hypopnea index (AHI) from 29 to 9; an 85% reduction in bothersome snoring; and an excellent safety profile. Long-term follow-up studies of the original cohort of implanted patients demonstrates ongoing control of OSA with a mean AHI of 6 at 3 years. At 48-months of follow-up, implanted patients show ongoing significant improvement in daytime sleepiness, sleep-related quality of life, and snoring reduction with 81% of patients using the device nightly as their primary form of OSA therapy. The study results led to FDA approval of the Inspire UAS device for commercial implantation in 2014. The ideal candidate for UAS are patients with moderate to severe sleep apnea (AHI 20-65) who have tried and failed CPAP and who are not overly obese (BMI < 32 kg/m2). In general, Medicare has covered the device, and a growing number of private insurers have approved the device after a case by case review. Patients who do not fit these criteria may benefit from treatment with other advanced surgical techniques including transoral robotic surgery (TORS). In addition to the commercially available Inspire system, a separate UAS system (ImThera Medical, Inc.; San Diego, CA) is under study as part of a multi-center phase III trial which will be enrolling eligible patients at Methodist University Hospital in 2017. OSA continues to be a significant quality-of-life and public health burden, and patients struggling with CPAP need to be informed that they may be eligible for alternative therapy. Medical Society Quarterly


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Support the Medical Foundation by using your Kroger Plus Card

Alex Woods, M.D. serves as TMA Doctor of the Day

The Memphis Medical Foundation is now signed up for Kroger Community Rewards. This is an easy way to earn money for the foundation through everyday shopping at your local Kroger. Just register your Kroger Plus Card by using the steps below. The foundation will begin earning money each time you shop and use your Kroger Plus Card. 1. Go to www.kroger.com 2. Click on sign-in or create an account 3. Sign up for a Kroger Rewards account (if you do not have one) 4. Click on the “Community” tab and select “Community Rewards”. 5. Scroll to the bottom and click the “enroll” button. 6. Enter 73246. 7. Select Memphis Medical Foundation from the list and click “enroll”.

Spring 2017

On Monday, February 6, Alex Woods, M.D. served as the TMA legislative Doctor of the Day. Dr. Woods is currently a resident in internal medicine at the University of Tennessee Health Science Center – Memphis where he is Chief Resident. He is pictured with State Senator Lee Harris (D-29).

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Baptist Opens New Epilepsy Monitoring Unit (EMU) by: Karen Ott Mayer

“Before, people had to travel to Vanderbilt in Nashville because there was no unit in this area.” Those diagnosed with epilepsy live a life of uncertainty, never knowing when the next seizure may occur. Until now, those Memphians suffering from the disease were forced to drive several hours to seek advanced care. Baptist has now changed that reality through a $1.5 million Baptist Foundation grant. With the August 2016 opening of the new Epilepsy Monitoring Unit (EMU), patients not only have a local treatment option, they have access to specialized care aimed at discovering what’s behind a seizure. Opened under the leadership of Dr. Pawan Rawal, the four-bed unit is located on the Pawan Rawal, M.D. first floor at Baptist Memphis. “There are so few epilepsy centers, and epilepsy is fairly common. One in 26 people have seizures, which include shaking, confusion and passing out. Before, people had to travel to Vanderbilt in Nashville because there was no unit in this area,” said Dr. Rawal. The unit team consists of a fellowship-trained epileptologist; trained nurses; technologists; pharmacists; and specialists in neurosurgery, neuropsychology, neuroradiology and psychiatry. This same team monitors patients 24/7 through video and EEG. Patients follow a specific protocol upon arrival and stay in private rooms with beds designed to protect patients. Ironically, the team hopes a patient experiences a seizure while on site so the data can help diagnose the type. “We evaluate them while being monitored to determine which part of the brain is causing the seizure. One third of patients don’t have substantial benefit from any medicine,” said Dr. Rawal. In only certain cases can epilepsy be cured with surgery. “But not everyone is a candidate,” said Dr. Rawal. Patients must be 18 or older and be referred by a

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physician. The average length of stay is five days. “Most of the time, we do get some type of information while they are here. We also confirm their diagnosis, as sometimes people are incorrectly diagnosed with epilepsy.” For Connie Prudhomme, a Baptist team member who works in the EMU, the opening holds special significance. Her son Michael Anderson is an adult epileptic and the pair previously traveled to Jackson, Tenn., for treatment. “It’s a burden to take off work and then incur additional travel expenses,” said Connie. “This has been wonderful on a personal level. A child with epilepsy who grows into adulthood has challenges with a social life, learning and work. One seizure per year can result in no driving for six months.” Michael likes the new unit, as well. “It’s better here, he said.” For more information or to make a referral, please call 901-226-1490.

On Friday, February 17, members of the Memphis Medical Society (MMS) and Bluff City Medical Society (BCMS) met with Congressman David Kustoff of the 8th Congressional District of Tennessee. Pictured from left are Clint F. Cummins, EVP of the MMS; Perisco Wofford, M.D., president of the BCMS; Congressman Kustoff; George R. Woodbury, Jr., M.D. and David Cannon, M.D.

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SPOTLIGHT

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Regulatory Burdens vs Patient Care by: Phillip R. Langsdon, M.D. The TMA, with the support of county medical societies like the MMS, continues to do an exemplary job with many legislative challenges. Physicians and patients owe the TMA a debt of gratitude for years of good work toward quality patient care. However, there are basic challenges that need more individual and local physician involvement in order to create a communitywide grassroots awareness of the pervasive erosion of time available for our patients. Over the last few decades, physicians have faced numerous regulatory burdens that have become a mounting obstacle to patient care. Around 1966, as a young boy in the old delta farming community of Osceola, Arkansas, I remember sitting in the waiting room of my family doctors’ office. Whether I was there for a sore throat, an ear infection, the flu, or perhaps a sports physical, the clinic was always packed. What struck me, even as a young child, was that everyone in town went to see these doctors; black, white, Hispanic, rich, poor, banker, barber, police officer, the entire community. These doctors were in clinic all day and could be seen returning to the hospital at night to check on patients. And, they turned down no one. If you had insurance, they accepted it. If you did not, they would give you a bill. If you could not pay it, you would be welcomed with a smile the next time you needed care. Charity was part of their practice. The doctors treated when they could cure and gave comfort when they could not. They were missionaries, ministers, and healers, selflessly working to help others. They were truly dedicated to taking care of their patients and that is what they spent most of their time doing. I thought being like those physicians was an honorable mission for one’s life! Their dedication to patient care that inspired me to go into medicine is likely not much different than what inspired most doctors in the U.S. or around the world. Around 40 years ago in 1977, as a first year medical student home on break, I was invited to go to the county medical society meeting with two of our Osceola doctors. As we rode the 14 miles from

Osceola to Blytheville, I sat in the backseat of the car and hung on to every word between these two physicians. They talked about the impact of the relatively new (10-year-old) government program, Medicare. They were telling me that Medicare was changing medicine. They related that it had changed the doctor patient relationship. They explained that before Medicare, the doctor and the patient would discuss the best course for diagnosis and treatment and talk about the costs. After Medicare, the patients began to feel that all the tests and possible treatments should be available to them, even if not relevant, because the government was now paying the bill. The other change was new regulations, compliance, and oversight issues. You had to make sure that not only the doctor, but also office employees knew all the rules and regulations in order to file Medicare because a filing error could have serious ramifications with the government. The doctors were telling this young medical student that government intervention in patient care would one day become a problem. The prescience of these two country doctors is astounding! While all of us recognize that the advent of Medicare/Medicaid has certainly expanded access to care, especially for complex diagnosis, treatment, and hospitalization, the subsequent explosion of government intervention as well as the evolution of “managed care” has complicated practices, increased the cost of running them, added to the staff workload, and takes more of a doctor’s time away from actual patient care. Today, we have a non-stop flow of requirements from hospitals, state and federal government, CMS, licensing boards, certifying boards, insurance companies, managed care companies, as well as from self-perpetuating entities such as ACCME, ACGME, ABMS, Joint Commission and non-medical agencies such as OSHA. Aside from the normal rigors of practice we now have terms like “meaningful use”, “value based care”, as well as new demands resulting from EMR, ICD-10 codes, HIPPA, ACA. Each new program, law, or requirement erodes time available for treating patients. One seemingly simple new Medical Society Quarterly


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Incoming President Phillip R. Langsdon, M.D. addressed the members and guests of The Memphis Medical Society on Saturday, January 28 at the 140th Annual Meeting and Installation of Officers. requirement, however justified, such as Tennessee’s prescribing practices law may by itself seem like a benign step in a day’s work, but add this to multiple other requirements and the load is soon unsustainable. Regulators have failed to comprehend the aggregate negative impact upon patients and practices. Worse, regulators have taken a punitive approach toward doctors. Many programs such as HIPPA, Health Care Fraud Prevention & Enforcement Initiative, and the Affordable Care Act’s Medicare Incentive Payment initiative are designed to have punitive consequences, rather than a constructive approach. The recent ACA “claw back” upon primary care doctors is one example. The “claw back” is also an example of regulators’ grossly unfair and arbitrary abuse of power against doctors who have little recourse against an arrogant and dysfunctional government system. A study conducted by the AMA and DartmouthHitchcock Health Care System and published in the Annals of Internal Medicine in September 2016 found that almost one-half of the physician work day is now spent on electronic health record (EHR) data entry and other administrative desk work while only 27% is spent on direct clinical face time with patients. The conundrum is not limited to a doctor’s time. Considering just one requirement, third party authorizations for diagnosis/treatment can cause a delay in care; scheduling hassles; increased office costs, distraction of staff efforts, and patient inconvenience/frustration/confusion. Only then does the game begin with post-authorization denials, delays, underpayment, and sometimes questionable maneuvering by the carrier. If any non-physician is interested in understanding how burdened a day is, ask him/her to compare it to calling your internet service provider/cable company to repair service/correct a bill…and do that at least twenty times/day. Add to this other responsibilities such as, multiple doctor reappointment processes, licensure, hospital mandated programs, the time and expense of fulfilling CME requirements or preparation for MOC (that has no proof of benefit) and there is little time for patient care Spring 2017

or resources remaining to run a practice. In fact, I know doctors who are frequently up until midnight fulfilling “compliance” issues. Becoming an institutional employee does not solve this problem. Employed physicians must still deal with most regulations and are not immune to clerical claims errors. “Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative” was designed to penalize physicians and they are actively trying to find doctors to use as examples. They actually use the term “strike force” when targeting doctors. Are we the enemy? Something is not quite right with “our” government’s attitude toward us citizens. The emotional impact on the physician of all the pressure cannot be ignored as it has been in the past. The time demands from practice/compliance complexities and stress/fear of malpractice, punitive government action, and the enormous responsibility for our patients’ health have a staggering personal impact upon physicians. The quality of patient care, physician’s personal lives and families can suffer. The Physicians Foundation study (AMA 2016) found that the physician burnout rate was at least 49%, some specialties as high as 60% [#1]. “A frequently cited suicide rate in male physicians is 40 percent higher than in the general male population and 130 percent higher among female physicians than in the general female population” (AMA Wire, November 15, 2016). I think a burnout rate of 49% says that it is time something is done! Today, the practice of medicine is exceedingly more complex than in 1966. The MMS carried out a recent survey that determined many practices need help; 47% with group benefits, 34.4% with staffing assistance, 51.4% with coding and reimbursement. We do not need a survey to tell us that an individual doctor has no influence in managed care negotiations, little ability to understand the legal ramifications of new laws/rules (some that we are not even aware of until we violate them), or that it is a financial burden to be forced to purchase and maintain EMR or spend time on esoteric coding. 9


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The reality is that doctors cannot sustain everincreasing practice burdens. Administrative burdens and practice complexities must be addressed. So, what can we do? We must help our partners in care begin to recognize the human limits of mandates, time, stresses, and distraction from patient care. 1. Educate Healthcare Regulators/Administrators – We need to develop a Patient Distraction Meter, much like the U.S. debt meter and help the public, government, hospitals, insurers, legislators and the plethora of overseeing bodies understand the impact that growing administrative burdens are having on patient care. With the support of the MMS board of directors, we can begin to diplomatically educate through our normal channels, as well as by becoming a real time information source through the web and social media. Done in the right way with careful oversight, we can get our message out. 2. Support Practices – We need to provide advanced practice support. The challenges to practices are simply staggering for the single or small group and costly to small and large practices alike. We will establish a consensus group that will help MMS determine how we can better assist our membership meet many of the regulatory challenges and mandates. Perhaps we need to create an Alternative Practice Vehicle to help physicians. While this might seem like a lofty goal, there is a precedent for meeting big challenges. The best example is the creation of SVMIC. I think all of us want to preserve that doctorpatient relationship that inspired many of us and is required for good care. So, today we have a choice – to keep medicine a meaningful and fulfilling mission or to allow well-meaning, but sometimes not so well meaning regulators, who know little about caring for

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patients to suck the life out of good doctors, complicate practices, and destroy good quality patient care. Only physicians can respond to this. As former Utah governor and Health and Human Services Secretary Mike Leavitt said to the AMA State Legislative Strategy Conference recently, we can be “overcome by events” or we “can lead it...” Many of our partners in health care claim to understand what it takes to deliver good care. They want to tell us how to do our job, to accomplish the impossible in less time, under extreme pressure, but then want us to take responsibility when problems occur and costs skyrocket. I’m reminded of the television commercials for drug advertisements that we see every day urging patients to tell their doctors about the great new drug. The ads designed to indirectly tell doctors what to prescribe, are careful to always add the caveat, “If you have these side effects, call your doctor”. The advertisements don’t say to call your pharmaceutical manufacturer, the hospital medical staff office, state licensing board, CMS, insurance executives or the Joint Commission…they say “call your doctor”. The unstated message is that the doctor is responsible if something goes wrong. If we are going to be responsible, then we need to stop allowing events to overcome us. We need every doctor to work with the Memphis Medical Society to communicate our message so that our patients, the regulators, insurance companies, hospitals, legislators all understand the staggering negative cumulative impact of their mandates upon the time and resources available to patient care. It is time to address regulatory burdens from government, administrative mandates from hospitals/insurance carriers/overseeing entities, etc., and we must streamline authorizations to treat patients. All most physicians’ want is the time to properly care for their patients.

#1 Santry, HP, Surgeons Are Burnt Out and the Numbers are Staggering, Physician, October 23, 2015

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

Question: My retirement assets have performed well over the past couple of years, but I am worried that troubling times are ahead despite the rally in stocks since the election. Do you think financial conditions will remain favorable under the new administration or should I rebalance to a more conservative allocation? One of my goals is to retire in the next 10 years depending on the growth of my portfolio. Answer:

The best political party for financial market success is a common debate. It is often believed that a Republican administration will produce greater periods of market performance versus a Democratic administration due to their pro-business policies. While both parties have enjoyed many years of financial success during their respective presidential terms, historical market returns for the S&P 500 Index actually favor Democratic over Republican presidents. From an investment point of view, it is important to remember the economy and financial markets are impacted by more than the political party in charge. Stock valuations, corporate profits, employment, inflation, interest rates, and monetary policy are also powerful influences. Predicting the financial outcome for the next four years is impossible, but it appears the current administration’s policies will support the domestic economic expansion. Regardless of the current political climate, I recommend that you implement a diversified asset allocation strategy for your

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retirement assets. This strategy should include offensive assets (stocks), as well as, defensive assets (cash and bonds). Your selection of assets is crucial to the overall success of your portfolio, so I would also suggest you choose investments from multiple asset classes. Using asset classes that behave differently during changing economic or market conditions will help insulate your retirement assets from major downswings. Consider the following asset classes for your portfolio: U.S. Bonds, U.S. Large Company Stocks, U.S. Small Company Stocks, International Stocks, and Real Estate or REITs. Broad exposure to these asset classes can be accomplished easily by investing in indexed mutual funds or exchanged traded funds. Finally, I would recommend that you seek the advice of a financial advisor in your area. They can answer questions and provide you with guidance on goals and objectives, asset selection, and specific allocation. In my experience, I have learned that it is time - not timing - that matters most. History shows the successful long-term investor is patient, weathers market swings, and adheres to a disciplined investment process.

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140th Annual Meeting & Installation of Officers The 140th Annual Meeting and Installation of officers was held at the Holiday Inn – University of Memphis on Saturday, January 28. The event, attended by approximately 200 physicians and their spouses, sponsors and special guests began with hors d’oeuvres and cocktails just outside the Grand Ballroom. The dinner preceded the program which included keynote speaker, TMA president, Keith G. Anderson, M.D.; acknowledgment of retiring Board members; and installation of the 2017 Board of Directors.

Tommy J. Campbell, M.D., (right) immediate past president receives an award for his year of service to the Society from incoming president Phillip R. Langsdon, M.D.

2017 Board of Directors Officers: President: President Elect: Vice President: Secretary: Treasurer:

Phillip R. Langsdon, M.D. Autry J. Parker, M.D. Andrew T. Watson, M.D. Danielle H. Hassel, M.D. Sri I. Naidu, M.D.

L-R: Cathy M. Chapman, M.D.; George R. Woodbury, Jr., M.D.; Clint F. Cummins and Phillip R. Langsdon, M.D.

Board Members: David L. Cannon, M.D. Frederick A. Fiedler, M.D. Jame E. Klemis, M.D. Jimmie Mancell, M.D. Justin Monroe, M.D. Christopher M. Pokabla, M.D. Lisa S. Usdan, M.D.

Immediate Past President: Tommy J. Campbell, M.D.

New Board Members: Lanetta Anderson, M.D. Raymond R. Walker, M.D.

50-Year Honorees The Class of 1966 was honored with certif icates of achievement. Rex A. Amonette, M.D. John J. Angel, M.D. Reed C. Baskin, M.D. C. Hal Brunt, M.D. Nancy Duckworth, M.D. Thomas G. Gettelfinger, M.D. H. David Hickey, Jr., M.D. Laila I. Kassees, M.D. Albert E. Laughlin, Jr., M.D. Joe S. Levy, M.D.

Zachary Rosenberg, M.D. Charles F. Safley, Jr., M.D. Alan D. Samuels, M.D. William V. Shappley, Jr., M.D. Vincent L. Solomito, M.D. Alagiri P. Swamy, M.D. Indurani Tejwani, M.D. David A. Usdan, M.D. Claude R. Varner, Jr., M.D. Lee L. Wardlaw, M.D.

Ex-Officio Board Members: Perisco Wofford, M.D. - Bluff City Medical Society President Jessica Harrison - Mid-South MGMA President

American Medical Association Delegation: O. Lee Berkenstock, M.D. Lee R. Morisy, M.D. Wiley T. Robinson, M.D.

Tennessee Medical Association Board of Trustees: Keith G. Anderson, M.D. – President James K. Ensor, Jr., M.D. 14

L-R Class of 1966 50-year award recipients Rex A. Amonette, M.D.; David A. Usdan, M.D.; Lee L. Wardlaw, M.D. and Indurani Tejwani, M.D.

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Meet Your 2017 Board of Directors Officers: Phillip R. Langsdon, M.D. – President Dr. Langsdon received his medical degree from the University of Arkansas – Little Rock in 1980. He completed an otolaryngology – head and neck surgery residency at Indiana University. He is a fellow with the American Academy of Facial Plastic and Reconstructive Surgery. Dr. Langsdon is a facial plastic surgeon in private practice at The Langsdon Clinic. Dr. Langsdon has been a delegate to the TMA since 2007. He has also served on the Legislative Committee and Communications/ Public Relations Committee and currently chairs the CME Committee. Autry J. Parker, M.D. – President-elect Dr. Parker was born in Memphis, Tennessee. He received his medical degree from Yale University School of Medicine. He also received a Master of Public Health from Yale University. He completed his residency in anesthesiology at Johns Hopkins Hospital. Dr. Parker is board certified by the American Board of Anesthesiology. He is a diplomat to the American Board of Pain Management. Dr. Parker specializes in pain management at Semmes-Murphey Clinic. He is a past board member of the Bluff City Medical Society, where he served as treasurer. Andrew T. Watson, M.D. – Vice-President Dr. Watson received his medical degree from the American University of the Caribbean School of Medicine. He completed his internship and residency in cardiology through the University of Tennessee – Memphis. Dr. Watson did a fellowship in cardiology at Marshall University, Joan C. Edwards School of Medicine. He is board certified by the American Board of Internal Medicine. He is in private practice with Sutherland Cardiology Clinic. Dr. Watson has served as the TMA Young Physician Delegate. Danielle Hinton Hassel, M.D. – Secretary Dr. Hassel received her medical degree from the University of South Alabama – School of Medicine. She completed her residency in physical medicine and rehabilitation at the University of Arkansas for Medical Sciences in Little Rock. Dr. Hassel specializes in physical medicine and rehabilitation. She is in practice at the Memphis Veteran’s Administration Medical Center. Dr. Hassel is a graduate of the TMA Physician Leadership College. She has also served as the TMA Young Physician delegate. Dr. Hassel is currently serving as the parliamentarian on the Board of the Bluff City Medical Society. Spring 2017

2017 Board Members take the Oath of Office

Sri I. Naidu, M.D. – Treasurer Dr. Naidu received his medical degree from the University of Alabama Birmingham. He completed his residency in Otolaryngology, Head and Neck Surgery at the University of Tennessee – Memphis. Dr. Naidu is board certified by the American Academy of Otolaryngology. He is an otolaryngologist at the Mid-South Ear, Nose and Throat, P.C. Tommy J. Campbell, M.D. – Immediate Past President Dr. Campbell received his medical degree from the University of Mississippi – Jackson. He did his residency in internal medicine at Baptist Memorial Hospital – Memphis. He is board certified in internal medicine. Dr. Campbell is an internist in private practice with Consolidated Medical Practices of Memphis. He served as a TMA Delegate in 2010.

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Returning Board Members: David L. Cannon, M.D. Dr. Cannon received his medical degree from Cornell University Medical College. He completed his residency in orthopedic surgery at Duke University. He did a fellowship in hand surgery at University of California – San Diego. Dr. Cannon is Board certified by the American Board of Orthopaedic Surgery. He is a hand surgeon at Campbell Clinic Orthopaedics. Frederick A. Fiedler, M.D. Dr. Fiedler received his medical degree from the University of Tennessee - Memphis. He completed his residency in internal medicine through Baptist Memorial Hospital Memphis. Dr. Fiedler is board certified by the American Board of Internal Medicine. He is in private practice with Inpatient Physicians of the MidSouth. Dr. Fiedler is a 2013 graduate of the Physician Leadership College. He also serves on the TMA Constitution and Bylaws Committee. James E. Klemis, M.D. Dr. Klemis received his medical degree from the Medical College of Georgia. He completed his residency in internal medicine at the University of Tennessee – Memphis. He did a fellowship in cardiovascular disease at the University of Tennessee – Memphis and a fellowship in interventional cardiology at Lenox Hill Heart and Vascular Institute in New York, New York. Dr. Klemis is Board certified by the American Board of Internal Medicine, sub-specialty cardiovascular disease. He specializes in interventional cardiology with a special interest in vascular medicine at The Stern Cardiovascular Foundation. Jimmie Mancell, M.D Dr. Mancell received his medical degree from the University of Tennessee College of Medicine - Memphis. He completed his residency in internal medicine at the University of Tennessee – Memphis. Dr. Mancell is Board certified by the American Board of Internal Medicine. He specializes in emergency medicine at Methodist Le Bonheur Healthcare. Justin Monroe, M.D. Dr. Monroe is a native Memphian. He received his medical degree from the University of Tennessee – Memphis. He completed his internship and residency in general surgery through the University of Tennessee – Memphis. Dr. Monroe specializes in colon and rectal surgery. He is in private practice with Memphis Surgery Associates. 16

Christopher M. Pokabla, M.D. Dr. Pokabla received his medical degree from Northeastern Ohio Universities – Rootstown, Ohio. He completed his residency in orthopedic surgery at The Ohio State University in Columbus. He did a fellowship in shoulder surgery / sports medicine at Mississippi Sports Medicine in Jackson, Mississippi. Dr. Pokabla is board certified by the American board of Orthopaedic Surgery. He is an orthopedic surgeon at the Memphis Orthopaedic Group, a division of MSK Group, PC. Lisa S. Usdan, M.D. Dr. Usdan received her medical degree from the University of Tennessee College of Medicine - Memphis. She completed her residency in internal medicine at Thomas Jefferson University – Philadelphia, Pennsylvania. She did a fellowship in endocrinology at Boston Medical Center. Dr. Usdan is board certified by the American Board of Internal Medicine. She is an endocrinologist with UT Methodist Physicians, LLC s

New Board Members: Lanetta Anderson, M.D. Dr. Anderson received her medical degree from Johns Hopkins University. She completed her residency in obstetrics and gynecology at Northwestern University – Chicago. She is board certified by the American College of OB/GYN. Dr. Anderson is the immediate past president of the Bluff City Medical Society. She is in private practice with The Women’s Physician Group. Raymond R. Walker, M.D. Dr. Walker received his medical degree from the University of Tennessee College of Medicine - Memphis. He completed his residency in family medicine at the University of Tennessee – Memphis. Dr. Walker is board certified by the American Board of Family Medicine. He is in practice with Saint Francis Inpatient Physicians.

Medical Society Quarterly


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Mr. Cates Expresses his Gratitude for Thirty-One Year Journey Health and many others To the Board of The showed the community Memphis Medical Society: that Memphis physicians It is amazing how 1985 were willing to step turned into 2016. Thirtyforward into the future. one presidents, from Dee Thank you for the Canale, M.D. to Tommy wonderful send off. My Campbell, M.D. Thirtyfamily was so honored one Board of Directors and overwhelmed by the with ever changing generosity of the parting members. But, one thing gifts. Carolyn and I will remained the same, the Mr. Cates is pictured with fourteen past MMS presidents display them proudly in physician commitment to our home. We will plan improving the health of the an exciting trip, in the near future with the travel vouchers citizens of Shelby County and the willingness to move forward. and will forever appreciate the journey we took together. Whatever success I may have been credited, I owe it all But, nothing can compare to the thirty-one year journey to the leadership of The Memphis Medical Society who took we were privileged to take with The Memphis Medical bold steps and were not satisfied with the status quo. Society. What an incredible ride. We feel truly blessed. Exploring the formation of an IPA, starting MedTemps, Very sincerely â&#x20AC;&#x201C; entering into partnerships with Healthy Memphis Common Mike Table, The Robert Wood Johnson Foundation, Church

Spring 2017

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LEGAL BRIEF Don’t Get Caught in Uncharted Territory – Prevent FCA Claims with Better Medical Documentation by: Rocky King

The medical chart has always been one of the primary tools that doctors and other health care providers use to document a patient’s health condition, treatments received, and responses to that treatment. Because they contain such insights, health insurance companies, Medicare, and state Medicaid organizations are auditing patient charts with increasing frequency to ensure that its contents support medical reimbursement claims. If medical conditions and treatments are not properly documented, these entities may deem the prior medical claim improperly paid and demand repayment by either seeking immediate repayment or using recoupment to offset the payment of future claims. As such, poor charting can result in the loss of operating income. In more extreme circumstances, poor charting can result in allegations of fraudulent or abusive billing practices. Such a conclusion can convert a traditional audit into a federal or state investigation under the Federal False Claim Act or a state’s corresponding statute. Healthcare fraud and abuse claims under the FCA are on the rise, with the United States Department of Justice

boasting that it recovered $2.5 billion in settlements and judgments in healthcare fraud investigations, prosecutions, and civil litigations in 2016. Further, the DOJ has amplified its focus to scrutinize individual health care providers and pursue these providers, personally, in health care fraud and abusive billing matters. Fraud investigations and prosecutions related to poor charting, however, can be avoided. Focusing on good charting practices, such as identifying the care provided and the justification for that care coupled with good communications with practice billing coordinators can reduce billing mistakes. Further, internal audits of billing practices by in-house or outside counsel can help determine if billing practices need to be adjusted. Advances in technology have and will continue to enhance the practice of medical data extrapolation. If President Trump makes good on his campaign promise to focus on “waste, fraud, and abuse” in government spending, the healthcare industry can expect continued scrutiny of its medical record-keeping.

“In more extreme circumstances, poor charting can result in allegations of fraudulent or abusive billing practices.”

Rocklan “Rocky” William King III practices with Adams and Reese in litigation and health care. He can be reached at 615.259.1041 or rocky.king@arlaw.com.

Alabama | Florida | Louisiana | Mississippi | South Carolina Tennessee | Texas | Washington, D.C. 18

Medical Society Quarterly


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Anorectal Physiology Center and Ostomy Center and Saint Francis Hospital by: Joshua A. Katz, MD FACS, FASCRS

Memphis Surgery Associates and St. Francis Hospital Memphis proudly introduce the Anorectal Physiology Center and Ostomy Center. This center provides diagnostic evaluation of chronic constipation, fecal incontinence and rectal prolapse, and provides for care of patients with colostomies, ileostomies, and urostomies. Fecal incontinence is the inability to defer the passage of stool to a proper time and place. This condition can dramatically compromise quality of life. Causes include vaginal childbirth. Anorectal surgery, trauma, radiation, chemotherapy, and a variety of medical conditions. The problem can be related to sphincter function, pelvic floor function or intestinal motility. Constipation may be variably defined as passing infrequent bowel movements, passing hard stools, straining to pass stools, being unable to pass stools, or requiring multiples attempts or maneuvers to complete a bowel movement. Constipation has multiple causes including poor diet and bowel habits, medication, childbirth, menopause, surgery, or radiation. The problem can be with the colon, the pelvic floor, or the anal sphincter muscle. Rectal prolapse refers to passage of the rectum through the anus. It may be sudden or gradual, reducible or not, painful, and associate with bleeding, straining, incontinence and discharge. Unlike prolapsing hemorrhoids, rectal prolapse almost always requires surgical repair. There are a variety of procedures that can be performed; these are chosen based on patient needs and risks, and the surgeon’s experience. Evaluation of functional bowel disorders always starts with a medical history and careful physical examination. Patients are asked to keep a diet and bowel journal to assess frequency, severity and impact on function of their symptoms. The journal can also assess the impact of medical or surgical intervention. Testing includes anorectal manometry, sensation and compliance testing, electromyography, and defecography. These tests enable physicians to determine who will benefit from medical management, pelvic floor retraining, and surgical intervention. Testing can also help surgeons to determine the best procedure patients for inflammatory bowel disease, diverticulitis, and cancer, such as a two stage procedure with sphincter preservation, or a one stage procedure with a permanent ostomy. Contraindications 20

to testing include the presence of acute inflammatory gastrointestinal disorders, infection, dementia, substance abuse, terminal illness, or morbid obesity. For patients requiring temporary or permanent fecal or urinary diversion, the Ostomy Center provides preoperative counseling and marking services, and postoperative ostomy care. Patients do better with ostomies when they receive preoperative counseling and when they participate in determining where the ostomy will be located on their abdomen. After creation of an ostomy, a person’s anatomy and bowel function may change and the equipment used to pouch an ostomy may need to be modified. Staff manage ostomy related complications such as pain, leakage, skin breakdown and difficulties keeping a pouch attached to the skin. Patients are asked to bring their current ostomy equipment to their appointments. Patients must be referred by a physician, and have had a colonoscopy within one year of referral. Patients also must have a recent history and physical examination and have no other outstanding active medical issues requiring ongoing intervention. Patients must have decisional capacity and be able to actively participate in their care. Prompt communication with the referring physician is a high priority for the center. Results and clinic notes are available to physicians through the St. Francis Cerner Health Information System and by fax or regular mail. Appointments are by referral and appointment. Please call 901.765.1347 or visit www.memphissurgery.com for further information. Joshua Katz,MD, FACS, FASCRS is certified by the American Board of Colon and Rectal Surgery and the American Board of Surgery. He graduated from Yale University and obtained his medical degree from Cornell University Medical College. He completed a residency in General Surgery at New York University Medical Center and Bellevue Hospital Center. He underwent fellowship training in Colon and Rectal Surgery at Cleveland Clinic Florida and served an additional year as Clinical Associate for the Department of Colorectal Surgery. He practiced colorectal surgery in Rockville, Maryland for ten years. During this time, he directed the Ostomy Clinic and Anorectal Physiology Clinic at Shady Grove Adventist Hospital. Dr. Katz moved to Memphis, Tennessee in 2013. He is a member of Memphis Surgery Associates and an attending surgeon at Saint Francis Hospital – Memphis. He currently serves as the Medical Director for the Anorectal Physiology Center and Wound Ostomy Center at Saint Francis Hospital – Memphis. Medical Society Quarterly


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BMH-Memphis Medical Staff Honors Dr. Wruble with Lifetime Achievement Award BMH-Memphis Medical Staff recently honored Lawrence D. Wruble, M.D. with the 2016 Lifetime Achievement Award. The award was given to express their sincere thanks and with humble appreciation for his years of

(L-R): Stephen C. Threlkeld, M.D., BMH- Memphis Medical Staff President; Lawrence D. Wruble, M.D. and Guy R. Voeller, M.D.

from the University of Tennessee College of Medicine – Memphis. He did his internship at Philadelphia General Hospital and his residency at Jackson Memorial Hospital, University of Miami Medical Center. Dr. Wruble completed his fellowship in gastroenterology at the University of Miami and a year as a National Institutes of Health research fellow at the same institution. After completing his training, he joined the faculty of the University of Tennessee Health Science Center – Memphis as an instructor in medicine. He served as acting Chairman of the Division of Gastroenterology for several years in the early 1970s. He is presently Clinical Professor of Medicine. He has published numerous articles and book chapters. He has served as governor for the American College of Gastroenterology in the State of Tennessee and as its Regional Director for the Southeastern United States. Dr. Wruble remains active in clinical research and medical education for which he has won numerous teaching awards. He is married to the former Diane Leach of Memphis. They have three children, all in medical fields. Lisa is a registered nurse, Steve and Gary are physicians. They have twelve grandchildren.

dedicated service and contribution to countless lives saved. According to BMH-Memphis, “Dr. Wruble has been a shining example for so many of the medical staff, and it is with great pleasure that we give him this award for lifetime achievement.” Dr. Wruble was born in Wilkes-Barre, Pennsylvania. He graduated medical school with honors

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 Spring 2017

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R E A L E S TAT E U P D AT E Expect Changes in 2017 by: Jon D. Albright, CCIM, SIOR, SRES A new president has been elected. It is said that the first hundred days of the new administration are important regarding defining of a legacy. Early indicators are to expect changes. What can this mean for medical real estate? All indications are that medical real estate is still valued by national and local investors alike. Interest rates have slowly started to rise. Buyers should expect that to continue in some capacity this year. What that means is that capital will cost more. Investors, medical groups or individuals buying will be paying more for property. Keep this in mind as you plan or negotiate your next location. The composition of our population continues to change. Millennials (ages 18-35) have overtaken Baby Boomers (age 51-69) and the Boomers are retiring at over 10,000 per day. Additionally, individuals who are 90 or older have tripled since 1980. This information is important when you consider and evaluate whom your patient base is and how

best to reach them. It is equally important when considering how best for them to get to you and the medical services you provide. As I have stated in previous articles, medical groups are considering non-traditional offices and retail spaces to be closer to their patient bases and to help reduce occupancy costs in some cases. There is a trend nationally for development of high density mixed-use centers and growing pressure on suburbs to become more urban. The Cross Town project is an example of revitalization and a very large high density center here in Memphis. It will be very interesting to see how it progresses in the years ahead. As always, allocating the necessary time to plan your next real estate decision is important, as well as including your team of professionals to assist with information and expertise. 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

Did you ever hire the WRONG person?

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Thoroughly screened potential applicants In-depth analysis of the applicants’ skills and qualifications “Pay rolling” service for your practice to try out a potential employee prior to hiring her 1067 Cresthaven Road | Memphis, TN 38119 | 901-761-0200 | www.mdmemphis.org Freda Reed | Senior Staffing Coordinator | freed@mdmemphis.org

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Paula Lipford | Accounting Coordinator | plipford@mdmemphis.org

Medical Society Quarterly


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CALENDAR MARCH 7 TMA Day on the Hill Bus departs Medical Society, 6:30 am

MEMORIAM George L. Barker March 5, 1931 – January 19, 2017

Robert Buchalter February 7, 1940 – January 28, 2017

14 Board of Directors Meeting Medical Society, 6 pm

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

APRIL 4 Board of Directors Meeting Medical Society, 6 pm

Lynn W. Conrad July 27, 1943 – December 30, 2016

John B. Kirkley September 10, 1921 – February 17, 2017

Howard William Marker November 16, 1932 – January 19, 2017

Robert Edward Murray October 25, 1943 – December 4, 2016

Suzanne Satterfield October 28, 1955 – January 15, 2017

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

29 TMA House of Delegates 2017

Joseph M. Scott May 9, 1925 – November 29, 2016

Janice Garrison White February 28, 1953 – December 20, 2016

Nashville Airport Marriott

MAY 2 Board of Directors Meeting Medical Society, 6 pm

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

29 Memorial Day Holiday Medical Society Closed

Spring 2017

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NEW MEMBERS Ramakrishna Battini, M.D. Hematology West Cancer Center 7945 Wolf River Blvd. Germantown, TN 38138 901-683-0055 Medical School at Gunter Medical College, 2003 Montefiore Medical Center – Bronx, NY (R-IM) Montefiore Medical Center – Bronx (F-HON)

Marion B. Gillespie, M.D. Otolaryngology UT Methodist Physicians, LLC 1211 Union Avenue, Ste. 300 Memphis, TN 38104 901-448-5885 Johns Hopkins - Baltimore, 1994 Johns Hopkins – Baltimore, (I-GS) Johns Hopkins – Baltimore (R-OTO)

Vikram P. Patel, M.D. Pediatric Anesthesiology Pediatric Anesthesiologists, PA 50 North Dunlap Street, 1st Floor Memphis, TN 38103 901-287-6060 BJ Medical College, 1993 Pennsylvania Hospital – Philadelphia (R-ANS) Thomas Jefferson Univ. Hospital (F-PAN)

Michael Beebe, M.D. Orthopedic Surgery Campbell Clinic Orthopaedics 1400 South Germantown Road Germantown, TN 38138 901-759-3214 University of Tennessee - Memphis, 2010 University of Utah – Salt Lake City (R-OS) Florida Othopaedic Institute – Temple Terrace (F-TO)

Joel F. Gradowski, M.D. Anatomic/Clinical Pathology Memphis Pathology Group 1265 Union Avenue, 6th Flr. Sherard Wing Memphis, TN 38104 901-516-7182 Jefferson Medical College, 2004 University of Pennsylvania – Pittsburgh (R-PTH) University of Pennsylvania – Pittsburgh (F-HPTH)

Joseph Pietrangelo, M.D. Dermatology Memphis Dermatology Group 1455 Union Avenue Memphis, TN 38104 901-726-6655 University of Tennessee - Memphis, 2012 University of Tennessee - Memphis (R-DER)

Clayton C. Bettin, M.D. Orthopedic Surgery Campbell Clinic Orthopaedics 1400 South Germantown Road Germantown, TN 38138 901-759-3214 Ohio State University, 2010 University of Tennessee – Memphis (R-OS) University of Utah – Salt Lake City (F-FAS)

Mark David Harris, M.D. Family Medicine Care More 1169 Jefferson Avenue Memphis, TN 38104 901-425-1880 Loma Linda University, 1991 Madigan Army Medical Center – Tacoma, WA (R-FM)

Stephen G. Portera, M.D. Obstetrics and Gynecology Center for Urinary and Pelvic Disorders 6215 Humphreys Blvd, Ste. 110 Memphis, TN 38120 901-227-9610 Tulane University – New Orleans, 1992 University of Tennessee – Memphis (R-OB/GYN) University of Tennessee – Memphis (F-UGYN)

Shari Brown, M.D. Anatomic/Clinical Pathology Memphis Pathology Group 1265 Union Avenue, 6th Flr. Sherard Wing Memphis, TN 38104 901-516-7182 University of North Carolina, 2008 University of Hawaii – Honolulu (R-PTH) Oregon Health & Science Univ. – Portland (F-MGP) Lucy L. Bruijn, M.D. Family Medicine Peabody Family Care 1325 Eastmoreland Avenue, Ste. 150 Memphis, TN 38104 901-516-9830 Bengurion University, 2002 University of Rochester – Rochester, NY (R-FM) Kayla G. Bryan, M.D. Pediatric Anesthesiology Pediatric Anesthesiologists, PA 50 North Dunlap Street, 1st Floor Memphis, TN 38103 901-287-6060 University of Tennessee - Memphis, 2008 Duke University – Durham, NC (R-ANS) Children’s Hospital of Wisconsin (F-PAN)

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Xi Lin Jing, M.D. Plastic Surgery University Clinical Health 1068 Cresthaven Road Ste. 500 Memphis, TN 38119 901-866-8525 St. George’s University, 2006 University of Tennessee – Memphis (R-PS) Temple University – Philadelphia (F-CFS) Matthew Kangas, M.D. Interventional Pain Medicine Tabor Orthopedics 1244 Primacy Parkway Memphis, TN 38119 901-767-8662 Michigan State University, 2011 University of Michigan – Ann Arbor (R-ANS) University of Michigan – Ann Arbor (F-PM) Khawaj M. Muddassir, M.D. Pulmonary / Critical Care UT Methodist Physicians 1325 Eastmoreland Avenue Ste. 370 Memphis, TN 38104 901-758-7888 King Edward Medical College, 2002 Queens Hospital Center – Jamaica, NY (R-IM) University of Tennessee – Memphis (F-PCC)

Michael Fred Bugg, M.D. Pathology American Esoteric Laboratories 1701 Century Center Cove Memphis, TN 38134 901-432-8545 Louisiana State University, 1988 University of Tennessee – Memphis (R-PTH)

Sarra M. Musa, M.D. Rheumatology The Arthritis Group, PC 1211 Union Avenue, Ste. 200 Memphis, TN 38104 901-525-0278 University of Texas Medical School - Galveston, 2011 University of Texas – Houston (R-IM) University of Texas – Houston (F-RHU)

Meghan V. Burkley, M.D. Pediatric Anesthesiology Pediatric Anesthesiologists, PA 50 North Dunlap Street, 1st Floor Memphis, TN 38103 901-287-6060 Indiana University - Indianapolis, 2011 Emory University – Atlanta (R-ANS) Cincinnati Children’s Hospital (F-PAN)

Sangeetha Pabolu, M.D. Rheumatology The Arthritis Group, PC 1211 Union Avenue, Ste. 200 Memphis, TN 38104 901-525-0278 Kurnool Medical College, 2003 Texas Tech University – Odessa (R-IM) Indiana University School of Medicine (F-RHU)

James N. Robinson, M.D. Sports Medicine Campbell Clinic Orthopaedics 1400 South Germantown Parkway Germantown, TN 38138 901-759-3100 University of Alabama, 2008 St. Joseph RMC – Mishawaka, IN (R-FM) American Sports Medicine Inst. – Birmingham, AL (F-SM) Manavjot S. Sidhu, M.D. Cardiovascular Disease Sutherland Cardiology Clinic 3950 New Covington Pike, Ste. 220 Memphis, TN 38128 901-763-0200 Dayanand Medical College, 2006 University of Missouri – Columbia (R-IM) University of Missouri – Columbia (F-CD) Robert Cherry Stephenson, M.D. Emergency Medicine Methodist Emergency Physicians 1265 Union Avenue Memphis, TN 38104 901-516-7653 University of Tennessee - Memphis, 1975 University of Tennessee – Memphis (R-EM) Joseph C. Sullivan, III, M.D. Neuroradiology Mid-South Imaging & Therapeutics 7600 Wolf River Blvd, Ste. 200 Germantown, TN 38138 901-747-1000 St. George’s University, 1998 Wake Forest University – Winston-Salem (I-GS) University of South Alabama – Mobile (R-DR) John C. Winton, M.D. Internal Medicine / Pediatrics Methodist Le Bonheur – Germantown 7691 Poplar Avenue Germantown, TN 38138 901-516-1238 University of Mississippi, 2004 University of Tennessee – Memphis (R-IMP) Medical Society Quarterly


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PRAC TICING MEDICINE The patient experience era is upon us… by: Alan Flippin

For the past twenty-five years, the practice of medicine has been in constant change. It appears that will continue as politicians scramble to fulfill campaign promises. When the ACA was making its way through legislation, there were dozens and dozens of predictions about how the law would affect physicians. Most will agree that the new regulations for patients and physicians have been cumbersome and consistent of government involvement in to what should be focused on relationships between patients and physicians. We will not know for some time how the proposed changes will actually affect physician practices. Most offices are actually in a better position knowing how to handle the regulations, documentation and higher deductibles for patients. While we wait to see what actually happens, there are things that can be done to position ourselves for the newest undeclared model. Focusing on the patient experience and quality will almost certainly put practices in a better position to compete again and have higher profits. The trend has been migrating to reimbursements tied to best outcomes. This is very likely to continue to be the trend with reimbursements tied closely to measurement and comparative data –

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all part of the value of exceptional patient experience. PXJ (Patient Experience Journal) states that an average of 6,000 individual articles were downloaded each month during the last half of 2016. The patient experience (PX) era is upon us. There has been talk of a more competitive system where offices post standard pricing and self-paying patients would actually "shop" for the best offering based on statistical data of good outcomes. This seems to make more sense than a government controlled reimbursement system with a multitude of regulations and hurdles just to get paid. Patients are looking for speed, affordability and convenience of health care services as they take on more of the burden to pay for health care with self-pay or rising copays and high-deductible insurance plans. Regardless of the final model, practices that are patient friendly and provide exceptional care will certainly be more profitable and also desired by companies that are self-insured, individuals, and insurance companies. This is all just part of the evolution of practicing medicine. Perhaps this latest evolution will put more of the decisions back in the hands of capable providers.

“Focusing on the patient experience and quality will almost certainly put practices in a better position to compete again and have higher prof its.”

Medical Society Quarterly


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BACK PAGE

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140th Annual Meeting Sponsors Presenting Sponsor

Platinum Sponsor

Bo Allen and Phillip R. Langsdon, M.D.

Gold Sponsor

Silver Sponsors Erica Evans and Phillip R. Langsdon, M.D.

Bronze Sponsors Answering Advantage, LLC Bank 3 BlueCross BlueShield of Tennessee

Campbell Clinic Mid-South Medical Group Management Assoc. Pinnacle Financial Partners

Iron Sponsors Dr. and Mrs. O. Lee Berkenstock Commercial Bank & Trust Inpatient Physicians of the Mid-South

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Memphis Business Group on Health Memphis Eye & Cataract Associates (MECA) Watkins Uiberall, PLLC

Autry J. Parker, M.D. and Phillip R. Langsdon, M.D.

Medical Society Quarterly


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

MMS Quarterly Bulletin Spring17  

The Memphis Medical Society Quarterly Bulletin Spring 2017

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