Volume 22, Number 2
Healthcare in a Pandemic
Edito Thom Mana Alliso
Presi Danie Presi Andre Vice P Chris Secre Lisa U Treas David Imme Jimm
For over 100 years, Semmes Murphey Clinic has been a leader in neurological and spinal care. Our dedicated team of doctors provides cutting edge treatment options with compassionate, personal care.
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SEMMES-MURPHEY.COM CALL (901) 522-7700
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Volume 24, Number 2
The mission of the Memphis Medical Society is to unite the physicians of Memphis and Shelby County into an organization to promote the highest quality of medical practice and the health of our citizens.
Editorial Thomas C. Gettelfinger, M.D. Managing Editor Allison Cook
2020 Board of Directors President Danielle Hassel, M.D. President-Elect Andrew Watson, M.D. Vice President Christopher M. Pokabla, M.D. Secretary Lisa Usdan, M.D. Treasurer David L. Cannon, M.D. Immediate Past President Jimmie Mancell, M.D. Board Members W. Clay Jackson, M.D., DipTh Walter Rayford, PhD, M.D., MBA Paul Tackett, M.D. Lindi Vanderwalde, M.D. Raymond R. Walker, M.D. Catherine Womack, M.D. Ex-Officio Board Members LaTonya Washington, M.D., President of Bluff City Medical Society Eric Gibson, President of Mid-South MGMA
In this issue Editorial
Member Spotlight: Mays & Schnapp
Feature: Behind the Mask
The Memphis Medical Society, 1067 Cresthaven Road Memphis, TN 38119 901-761-0200 CEO/Executive Vice President, Clint Cummins Executive Assistant, Janice Cooper Director, Communications & Marketing, Allison Cook Finance Director, Leah Lumm Marketing and Membership Coordinator, Cara Azhar Director, Healthcare Staffing, Cailyn Bautista Lillard MedTemps Administrative Coordinator, Katie Yaun
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How Can You Talk About Anything Else Quantum Change In The Year Of COVID-19
In the last three months I have had three good friends die, two of COVID-19, one in Memphis, the other in Seattle; the third friend, also in Memphis, admitted in congestive heart failure, died not of COVID-19, but of hospital acquired sepsis. Three good friends. That’s natural, friends dying as they grow older, but it is sobering. And that’s not to mention the COVID-19 deaths that our hospital colleagues have seen, nor fellow physician colleagues who have contracted and died of it. To say this is the year of epidemic, then pandemic, then endemic; the year of torn social fabric; the year of sobering recognition of the fragility of humankind; the year of reckoning; each would state the obvious. I am brought to the idea of Quantum Change, not as in Quantum physics, but as in the term coined in 1994 by Psychologist William Miller, the idea of “long-lasting…profound realizations that can happen quickly…that fundamentally alter a person’s sense of values, perspective on life, how they view themselves in the world.” The idea applies to an individual, but surely applies collectively to us all. No doubt there will be profound changes in the marketplace, in how business is conducted, changes that may have happened anyway, but are now accelerated. No doubt there will be profound change in how physicians diagnose, treat, control infections. Advances in surgery and medicine were often born of necessity, out of crisis, and the same is happening now, particularly in re-thinking the damage caused by our own immune systems, now targeting a different pathway of treating infection. Early in sepsis the treatment target is the inciting organism, but now focus has shifted to our dysfunctional immune system. Paul Thomas, immunologist at St. Jude Children’s Research Hospital, is looking at the role of interferons and interleukin-10. Monoclonal antibodies, all the rage in oncology, are now investigated for their potential role treating infection, including hospital acquired. It is too late for my friends, but we will get through this, new treatment, new understanding, new prevention. But will we come to that Quantum Change, all of us, that we really need? Thomas C. Gettelfinger, M.D. 3
COVID-19 VACCINE RESEARCH STUDY
VOLUNTEER & MAKE A DIFFERENCE
Every modern vaccine and medicine we have today was studied in hundreds to thousands of people before becoming available to the public. This study will enroll up to 30,000 people. By volunteering, you will represent people like you – in age, gender, race, ethnicity, and the communities where you live. Involving people from all backgrounds will improve the development of this vaccine for everyone. Joining a clinical trial is an important and personal decision. We hope it is one you will consider.
WHAT TO EXPECT PARTICIPANTS WILL BE
RANDOMLY ASSIGNED (BY CHANCE) TO RECEIVE THE STUDY VACCINE OR PLACEBO (INACTIVE SUBSTANCE)
CONTACT A STUDY TEAM MEMBER TO LEARN MORE 4
THE STUDY DOCTOR WILL EXPLAIN TO PARTICIPANTS WHEN THEY WILL RECEIVE THEIR
PARTICIPANT TIME AND VISIT COMMITMENT
2 YEARS 6 VISITS STUDY DURATION
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STUDY CLINIC CNS Healthcare CONTACT PERSON 6401 Poplar Avenue, Suite 420, Memphis, TN 38119 PHONE NUMBER Sign Up at www.covid19research.us EMAIL ADDRESS Pfizer-COViD-19_C4591001_flyer-WhattOexPeCt_V1.2_23Jul2020
The world has been hit with the unexpected. COVID-19 swarmed in and now we are in battle with a pandemic to save lives. You’ve seen how world leaders are responding. And on a local level, the MMS is responding too. The organization worked with Memphis and Shelby County mayors and fought for “shelter in place” orders to mitigate the COVID-19 impact. We joined with TMA to task the governor to take the same action statewide. We saw these changes affect our society like never before in this generation. The MMS administrative team immediately jumped to the rescue by securing PPE and supplies for delivery to our members. They’ve kept our website updated with the latest advisories and statutes. Members have been provided with ongoing virtual education and clinical resources. If you haven’t recently visited mdmemphis.org, then I encourage you to check it out, and find if it can be of help to you. Also at this crucial time, our country is experiencing a revolution against racial injustice and biases. The MMS Board overwhelmingly agreed to support “White Coats for Black Lives,” a peaceful protest initiated by students at UTHSC. As an organization, MMS urges and adheres to diversity and inclusion, yet recognizes there continues to be much more to our society’s racial and cultural challenges. For example, health care disparities/ inequities are real, and there are volumes of data to confirm it. MMS has a long history of collaboration with organizations whose missions focus on minorities and the underserved. No matter how big or small, the entire medical community can have a role in effective change. I implore all of us to take a long, hard look at what roles we play, to educate ourselves, and to find a means to actively make our world a better place for all. Ultimately, MMS and its members remain on the front lines serving our community. The organization is dedicated to supporting you and will continue to work with government officials to ensure appropriate actions are taken on behalf of patients and physicians. Now, more than ever, we stand together in unity as physicians leading Memphis through this crisis and seeking the best outcomes for our patients. Be well and stay safe. “In the end, we will remember not the words of our enemies, but the silence of our friends.” —Dr. Martin Luther King, Jr. 1965 Your President, Danielle Hassel, M.D.
The Nationwide Search for Effective COVID-19 Treatments: Methodist joins Mayo in searching for successful therapies for COVID-19 patients. Methodist Le Bonheur Healthcare is now participating in Mayo Clinic’s Expanded Access Protocol for Convalescent Plasma Program for treatment of patients with COVID-19. The antibodies in plasma from recovered patients may have the ability to help those infected with coronavirus recover more quickly. Fully recovered COVID-19 patient makes first plasma donation. On April 21, Dr. Daniel Wakefield, a 30-year-old radiation oncology resident in Memphis, became the first fully recovered COVID-19 patient to donate plasma to the program. Wakefield got tested when he developed a cough after working at a COVID-19 testing site in Memphis. Wakefield is now fully recovered and hopes his story will inspire others to donate plasma. You can be a hero too. Plasma from fully recovered COVID-19 patients is incredibly important in the search to find a treatment for COVID-19 patients. To donate, you must be symptom free, be fully recovered for at least 14 days, and have a negative nasal swab test.
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For more information or to find out how you can donate plasma, visit www.methodisthealth.org/plasma.
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Baptist starts Right Care podcast to keep providers informed about COVID-19
On June 9, Baptist Memorial Health Care aired its Right Care at Baptist podcast to cover timely clinical information on COVID-19 for the medical staff. This weekly conversational update on COVID-19 topics, such as convalescent plasma therapy, ICU management, remdesivir, lab testing and current treatments, has proven to be a convenient way to get pertinent information to providers when the time is right for them to listen.
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“The idea of receiving hits of needed COVID-19 information in a 15-minute format on your drive to the hospital or drive home is vital,” said Dr. Henry Sullivant, vice president and chief medical officer for Baptist Memorial Health Care. “It’s easier for our audience to receive the information on their time-table.”
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These days, providers have travel constraints and distancing rules that prohibit normal meetings and seminars, but they still want the latest information on health care system findings and plans. To accommodate their needs, Dr. Jake Lancaster, vice president and chief medical information officer, suggested the podcast. Dr. Sullivant and Dr. Lancaster co-host the podcast, which attracts guests from across the region to share their knowledge and internal resources.
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Right Care at Baptist is sent to a network of 3,768 physicians and 1,100 advanced practice providers through e-mail and can be found on Spotify and in Apple Podcasts. This has led to the broadening of the podcast’s listening audience, which includes Tennessee and Mississippi, Georgia listeners who rank third, and listeners from Europe and the Philippines have been captured. This method of using a podcast to reach providers has been so successful that the application may eventually address other important issues in the future.
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Regional One Health Offering New Incisionless Focused Ultrasound Treatment Regional One Health is now offering a new, incisionless treatment for medication-refractory essential tremor and tremor-dominant Parkinson’s patients. The treatment uses focused ultrasound technology developed to treat deep within the brain with no surgical incision, implants, anesthesia, or ionizing radiation. The incisionless treatment is performed by Aaron Bond, MD, neurosurgeon at Semmes Murphey, exclusively at Regional One Health’s East Campus Imaging Center.
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“Focused ultrasound guided by magnetic resonance imaging provides patients suffering from debilitating tremor with an incisionless treatment option, which can be performed on an outpatient basis with short recovery time,” said Tony Edwards, director of imaging and radiology services at Regional One Health. “This noninvasive technology gives our patients more treatment options as they decide with their physicians the best course to get back to a more independent and active lifestyle.”
The treatment uses sound energy to target and precisely treat a small spot in the thalamus, considered to be responsible for causing tremor. The result for many patients is immediate improvement in their hand tremor with minimal complications reported.
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“Patients often assume their tremor is a sign of old age, and they don’t realize there are treatments out there, which can potentially eliminate their tremors,” said Dr. Bond. “I have been involved with focused ultrasound since the early days of the first research cases. Medical technology has advanced greatly, and we now have several years of data that shows this treatment to be a safe and effective option for many patients.”
Saint Francis Hospital - Bartlett has added new offerings to its robust robotic program In August surgeons performed the hospital’s first spinal procedures with the Globus ExcelsiusGPS. Designed to use robotics and navigation for a personalized plan of care for spinal implant patients, based on their anatomy, Saint Francis Bartlett is proud to be the first in the community to bring the ExcelsiusGPS to the area. Saint Francis Hospital - Memphis has expanded its structural heart program to include Transcatheter aortic valve replacements (TAVR). Offered as an alternative procedure for patients at risk for open heart surgery, the TAVR program at Saint Francis Memphis offers patients in the community more options to receive continuity of cardiology care in one location.
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The USPI Surgery Center at Saint Francis Memphis is the first in the Memphis area to offer a new solution to the millions of people who suffer from incontinence. The first Interstim™ Micro System - a rechargeable neurostimulator for bladder and bowel control, was implanted in the Memphis area by Dr. Rusty Shappley. The Interstim Micro System by MedTronic is FDA approved and can offer relief for urinary frequency, urge incontinence, incomplete bladder emptying, and fecal incontinence.
The presence of a family member can have a positive impact in the healing process of patients. Saint Francis now has limited visitation for patients. One visitor may accompany patients for outpatient visits and surgery and each inpatient may have one visitor per day during visiting hours.
Serving on frontlines of COVID-19 Staffing medical practices has taken on a new meaning as the COVID-19 pandemic has brought new challenges to the medical community. As of the writing of this article, COVID-19 case counts were at an all-time high, as was positivity rate of testing and hospital bed capacity. MedTemps has been called to staff many new opportunities through the pandemic, including daily testing at worksites and at community testing locations. It is those employees we want to recognize. They have braved a challenging environment that includes wearing of full PPE in high temperatures and executed challenging testing protocols. Remember, an assignment with MedTemps does not guarantee full employment, therefore financial stress also endures during this time. MedTemps is very grateful for these team members who have done tremendous work at various testing centers. Do you need quality staff like this at your practice? Call us at 901-761-0200, or email firstname.lastname@example.org.
Retirement News Janice Cooper retires after more than 22 years
We know many of you share our appreciation for Janice’s efforts over the years. She served The Society in a variety of roles, most recently as our Executive Administrative Assistant. “Janice has been a rock for me, even before I became an employee,” says Clint Cummins, CEO. “She was the warm voice greeting me on the other end of the phone as I anxiously called to check in on the status of my application. That continued once I officially joined the team. She was introduced to me as ‘the person who knows where the bodies are buried.’ Not quite, but pretty darn close to the truth!” She stepped in and stepped up at every opportunity presented before her. She accepted job responsibilities that weren’t necessarily ideal for her in order to advance the organization. This decision was difficult for Janice. She is stepping up again, this time for her family, in order to lead the education of her grandchildren from home. I can’t imagine a better role model to learn from in their early years! 8
Welcome our latest members
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Taslim A. Khattak, MD Kyle Anthony Smith, MD Mary E. Killian, MD Benjamin T. Emery, MD STUDENTS Garrett Jeffrey Allen Sarah E. Baxley Victoria Nicole Beard Shalanda R. Berkley Mary K. Beuter Jon-Austin James Brannon Nalan Ross Callonas Michelle Chintanaphol Ezra Jonathan Chow Joseph Mitchell Clayton Cole Baird Dain Jakub Antoni Denkiewicz Sessen R. Dudek Paden Samuel Duke Jason Davis Eakes Vania Chinwe Ejiofor Christopher Robin Forsyth Logan Cade Fortenberry Katherine Anne Garrett Whitney Carol Gulledge Bradley Pearce Hambly Jessica L. Hanks Christopher James Harper Christina Warren Harvey Dilovan A. Hawrami Gabrielle Mary Hochu Ashton Christopher Hunter Jessica M. Kariuki Kinza Khan Sonal Vinay Khedkar Marquinta Mona King Sarah Virginia Kromer Taylor Katherine Lewelling James Parker Lewis
Isaac H. Lies Tiffany Taylor Loo Daniel Ma Rachel K. McCann Grace Elizabeth McCarthy Christopher E. Montes-Sabino Jocelyn Kelly Newman Timothy Storm Owens Laura M. Oxford Andrew J. Paladino Grace L. Par Zara Michele Parkinson Prisha Shashikant Patel Kaes Edward Pepke Rahul Peravali Alisa L. Phillips Erin Nicole Prester Jacqueline Alexandra Pulliam Bawan Faraedoon Qaladize Anjali Ravee Andrew Duncan Renshaw Victoria Alexandria Roberson Avery L. Roland Daniel Isaiah Robert Rose Alexandra Rogers Russell Kylie Dâ&#x20AC;&#x2122;Andra Schall Matthew Thomas Scott Edward D. Sickle Nausheen Aara Siddiqui London M. Spears Robert W. Stout, Jr. Trell Freeman Stroud Samhita D. Swamy Aaron M. Tetreault Chase William Toth Amber M. Tran Dagny M. Vaughn Charles Devon Waldroff James Heath Wilder Christopher Dequan Williams Woodi H. Woodland
Yenny Y. Yang Colin R. Yarid Erin Nicole Young Henna M. Zaver Milton Alexander Addington
Has your membership lapsed? Do you know of a colleague who needs to join? Your membership is the key to organized medicine in Memphis and in the state. We are here to support you in practice and at home, through every stage of your career. Join us by calling 901-761-0200, or by visiting mdmemphis.org.
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For more than 40 years, the West name has been synonymous with compassionate cancer care and innovative research. West Cancer Foundation is taking the next step in ﬁghting cancer by investing in research and education, patient support, and promoting the overall health of our community. West Cancer Foundation is committed to keeping cancer patients at the center of everything that we do. We are investing in the most promising research to ﬁnd the treatments of tomorrow and educating the best and brightest students to ensure the future of oncology. We are providing comprehensive patient support by offering transportation, lymphedema and form-ﬁtting assistance to cancer patients free of charge. We are committed to addressing the health inequities in our community by providing free cancer screenings to those who cannot afford them. Together we give hope in the face of cancer. 10
Pain Specialists: Chronic Pain Experts
The majority of patients suffering from pain rely on their primary care physician for treatment. Pain is indeed the most common complaint in a doctorâ&#x20AC;&#x2122;s office, and it frequently directs the physician to a proper diagnosis and treatment. From fractures to appendicitis, from heart attacks to ingrown toenails, pain is often the guiding light. Chronic unrelenting pain is a different matter. When pain extends beyond its usefulness, or when it recurs without diagnostic or therapeutic value, it causes unnecessary suffering. Loss of function, depression, and work and family difficulties are just some of its side effects. Among the most common ailments in a pain practice include spinal problems such as low back pain and sciatica, neuralgias relating to diabetes and shingles, and osteoporosis and rheumatoid arthritis, but the most severe and disabling pains usually involve nerve damage. Complex regional pain syndrome is a good example of a combination of severe limb neuralgia and associated dystrophic changes of the musculoskeletal system that may benefit from pain management. The main role of the pain specialist is to aid the primary care or other physician in elucidating the diagnosis, which is not always easy, and designing a treatment plan for difficult to treat patients. Most individuals suffering from pain that has lasted at least a few months may benefit from multi-modality treatments ranging from medication and physical therapy to nerve blocks and radio frequency ablation of selected nerves, or even the addition of more sophisticated procedures such as peripheral or central nerve stimulators. More important than any modality, however, is the support and reassurance that leads to a productive patient-physician alliance.
Behind the Mask
Dispatches from our members face-to-face with COVID-19 every day Dale Criner, MD, MBA, FAAFP MMS Board Member Chairman, Department of Emergency Medicine Emergency Department Medical Director, St. Francis Hospital-Bartlett Affiliate Asst. Professor of Medicine, UTHSC, Department Of Medicine, Memphis, TN In his own words One would think a global pandemic would mean a near unmanageable increase in Emergency Department patient volume. Certainly, that is exactly what many of us expected as we prepared for the worst. Fortunately, that has not happened in our facilities. Hopefully, it never will. What did occur was an extreme drop in patients seeking Emergency Medical Care. This has been one of the most impactful aspects of COVID-19 in our practice. We strive to improve our time of recognition and treatment of time-sensitive medical emergencies, such as heart attacks, strokes, and sepsis. As the weeks of the pandemic unfolded, we realized many of these patients, who previously presented “within the window” for the time-sensitive treatments were simply staying at home until it was too late. It is heartbreaking to know that if your patient had simply called 911 at the onset of their symptoms, it is very possible they would have been successfully treated with a full recovery. However, EMS professionals relayed to us an increase in calls at patient’s homes where it was too late. The patient had already died. Fortunately, this trend has improved. However, there are still many barriers to overcome to reach as many patients as possible in time to make a meaningful difference. One of the greatest challenges for both patients and healthcare providers has been the necessary restrictions on hospital visitation. Imagine not being able to see your nursing home bound mother for months and then receiving a call from an unknown Emergency Physician telling you that she is doing very poorly, and likely will not survive her current medical condition. Then add to that the fact you will not be able to hold her hand as she passes. This is heartbreaking for the patient, the family, and the healthcare providers. This scenario plays out every day. In my opinion, this is the most impactful and under reported aspect of practicing medicine during the COVID-19 pandemic.
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When we speak of physician wellness, I know some of the “right” answers are more exercise, ensure proper rest, meditation/relaxation, unplug and recharge. I wish I could say I’ve been able to accomplish those goals. That would simply not be true. Oh…I’ve tried at times. However, there always seems to be another aspect of this uncharted healthcare territory that keeps the stress level much higher than healthy. As a leader, I try to ensure my team is taking care of themselves. I give great advice on wellness. However, I am not quite as vigilant at taking care of myself. I apologize for written honesty that does not set the best example, but it’s an area I know needs a lot of improvement. Specific to Memphis, it has been concerning to see how politically polarizing COVID-19 has been even within the medical community. A lot of physicians think they know all the right answers and are quick to criticize other physicians who may not share their same viewpoint. The bottom line…we are all figuring this out as we go. It is quite disheartening when one physician criticizes another for admitting a patient with COVID-19 that “isn’t sick enough to be in the hospital” and another physician criticizes the same physician for sending a patient home who got worse and then needed hospitalization. I personally do not believe a single physician wakes up in the morning with the goal of providing poor care. Certainly, we can all learn and improve our practice. Collegial support and teamwork will accomplish that goal. We need to support each other…not tear each other down. I so greatly appreciate when physicians with different perspectives and experience can work together with a common goal of better Medicine. Lastly, and most importantly, I have seen great examples of compassion throughout Memphis and Shelby County. The love poured upon the healthcare workers from the public and business community has been uplifting. Cards and posters crafted with love showing support for of healthcare workers and meals delivered to fatigued hospital staff are wonderful examples of the best of the Mid-South. We are truly blessed to practice Medicine in Memphis!
Elizabeth Gilless, M.D. Hospitalist, Methodist Le Bonheur Healthcare-Germantown a Q&A What has been the biggest change in your practice that COVID-19 has brought? I trained and have always practiced in the era of evidence-based medicine. The practice of medicine is not a cookbook, it is nuanced and individualized for patients, but I have always practiced under the guiding principles of evidence-based medicine. COVID-19 did not come with an instruction manual. For the first few months, we really had no qualityevidence guiding treatment. For instance, in March steroids were specifically recommended against, then in May, we learned that they provided mortality
benefit. It is a whole new challenge to practice without the confidence that the therapies you are using are proven to help. What do you think are the largest impacts on your patients that COVID-19 has brought? Definitely the most difficult part of being a patient in the time of COVID-19 is the isolation. For the safety of the patients and the staff at Methodist, visitors are not currently allowed, unless the patient qualifies for a handful of exceptions. It takes a whole new level of trust on the part of the patients and their families to drop off their loved ones and trust our team to care for them without an advocate present. We don’t take that responsibility lightly. What experience are you having, or have you had, that we are not seeing in the news every day? It’s hard to appreciate the fight that patients with severe COVID-19 have to endure. For most infections in the hospital, like bacterial infections, patients usually come in very sick, are treated aggressively with fluids and antibiotics, and if they survive the first few days, tend to improve from there. COVID-19 works differently. When patients began to feel badly, it is often days or longer until the peak of their illness. We watch them decompensate slowly and are limited in our tools to stop the decline. At Methodist Germantown, we recently celebrated when a young mother who survived the virus was discharged after 70+ days in the hospital. She was pregnant with and delivered her baby while on the ventilator being treated for COVID-19. She will have lifelong health issues as a result of her infection but what a celebration it was when she was able to leave the hospital. These lengthy hospital stays are common for patients who survive severe COVID-19, and we definitely get to know those patients well. Everyone at our hospital was rooting for her. What have you noticed, or possibly changed, in your own self-care/wellness habits and routines during the pandemic? There were times, especially early on during the pandemic, when COVID-19 was all I could think about. If I wasn’t working, I was reading about COVID-19, and if I wasn’t reading about it, I was talking about it. I had to learn to turn it off some. Our CEO sends a daily email with information about our bed capacity, PPE availability, and COVID-19 numbers, and I found myself obsessively checking my email every afternoon looking for it. It wasn’t good for my mental health, and I’ve had to discipline myself not to read and to think about COVID-19 all the time. My kids deserve my undivided attention occasionally. What have you seen personally or professionally unique to Memphis that you would like to highlight? What other city had a drive-thru testing site in the tailgaiting area of their college football stadium? Staffed, initially, by medical students!
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New program offers free burnout appointments Research upon research cites physician burnout as a serious health concern. In some studies, as many as 63% of physicians say they have felt a sense of burnout. And this was before the COVID-19 pandemic, which is increasing physician stress immensely. Burnout not only can harm the physician, but also his or her patients. The residual effects on our healthcare system are immeasurable. We also know that threats to a physician’s professional and social lives can be impacted due to hesitation in seeking care. In response to this growing concern, Memphis Medical Society and Memphis Medical Foundation are launching Thrive, a physician wellness initiative. Through Thrive, a doctor can call or text a confidential hotline (901-286-3110) to request an appointment, and he or she will be connected to a licensed psychologist. The Memphis Medical Foundation will cover the costs of up to six sessions with this psychologist. Physicians may also access the program through the Memphis Medical Society website. www.mdmemphis.org. “The lack of availability for in-person psychology appointments presented us with some challenges, but the pandemic has caused a rapid development in telehealth capabilities that are ideal for this program. We have partnered with CareClix to deliver a seamless, telehealth experience. We would be excited to launch this program at any time but being able to do so during a pandemic has extra relevance to it,” says Clint Cummins, CEO of Memphis Medical Society. “A physician simply needs to call or text 901-286-3110 requesting an appointment. He or she can also fill out the form at https://hipaa.jotform.com/ACOOK24/thrive-request. A psychologist will be in touch immediately. Memphis Medical Foundation works with the psychologist to pay the costs of the first six appointments. After that, the physician can continue the relationship with the psychologist at their own cost. All initial information collected for the appointment is confidential.” The mission of Thrive is to provide independent resources for the physician community to confidentially seek counseling in a safe, convenient environment without judgement before they experience serious burnout. Physicians have a calling to take care of patients, and it is our turn to take care of them.
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Money & Medicine MMS expands financial assistance for loans
Memphis Medical Society has partnered with Splash Financial, a leading student loan refinancing company. Splash’s student loan rates are some of the most competitive in the nation. MMS members will have access to reduced rates in order to refinance their current student loan(s). “The MMS CEO and Board of Directors have carefully reviewed the proposal from Splash and believe it provides tremendous value to our members,” says MMS 2020 President, Danielle Hassel, M.D. “We consistently hear that finance and student loan payback are a top concern for our members, and we decided that we must act to provide a solution.” Many medical professionals pay rates as high as a 6.5% on student loans. Splash offers rates as low as 1.99% How does it work? If you have student loans and are not pursuing a loan forgiveness program, you may be able to save money by refinancing with Splash Financial. Splash was founded to help physicians refinance their student loans, and has expanded to any degree or profession. Memphis Medical Society members, members’ employees and members’ families can qualify for a $500 cash bonus if they refinance at least $30,000 with Splash. There are no origination fees or prepayment penalties with Splash. Check your rates in 3 minutes without impacting your credit score. Rates start at 1.99% for those that qualify. The process is simple. Visit https://splashfinancial.com/partner/mdmemphis
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Q. I have a small medical practice that has been severely impacted by the COVID-19 pandemic. I tried to keep my practice open during the initial stages of the virus outbreak, but eventually decided to temporarily close until conditions improve. Iâ&#x20AC;&#x2122;ve heard about financial relief the Small Business Administration is providing to businesses suffering because of the economic disruption and social distancing requirements. Is it too late to apply for financial assistance? A. The Small Business Administration (SBA) has several programs that might provide some financial assistance for your practice. The Paycheck Protection Program has received a lot of attention. The program offers small businesses a loan, and an option to have loans fully forgiven if employees stay on the payroll over an eight-week period, and the money is used for payroll costs, rent, mortgage interest, or utilities. Loan forgiveness is not automatic and requires a submitted request to the lender servicing the loan. Lenders then have 60 days to respond to the forgiveness request. The amount of forgiveness will be based on the employer maintaining or quickly rehiring employees and maintaining salary levels. Additional loan terms include: no collateral or personal guarantee, no prepayment penalties, six-month deferral on payments, 2-year loan period, and a 1% fixed interest rate. Eligibility requirements apply and applications must be made through an approved lender by June 30, 2020. The Economic Injury Disaster Loan program is another way the SBA is providing vital economic support to small businesses. An advance on a loan up to $10,000 is available to eligible applicants experiencing a temporary loss of revenue due to the economic crisis. Funds are available following a successful application and the loan advance does not have to be repaid. Applications will be restricted based on fund appropriations. Full loans are long-term with low interest rates. The SBA is also providing quick access to funds (up to $25,000) via the Express Bridge Loan program and automatic debt relief assistance (six-month hiatus for loan payments) for current 7(a), 504, and Microloans in regular servicing status. It is in your best interest to act quickly. These programs are funded through the creation of the CARES Act and the amounts are limited based on participation. In addition, consider contacting a local lender. An existing relationship with a local lender might help you leverage an alternate source of funding until your practice can reopen. William B. Howard, Jr., ChFC, CFP International Place II 6410 Poplar Ave., Suite 330 Memphis, TN 38119 Telephone: (901) 761-5068 Fax: (901) 761-2217 email@example.com 17
2020 LEGISLATIVE SUMMARY JULY 2020
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Quick reprioritization distinguished life for all engaged in the second half of Tennessee’s 112th General Assembly, and Tennessee Medical Association was no exception. As the antagonistic COVID-19 epidemic advanced across our state, TMA’s steady legislative experience was clearly influential. From quick, one-off issues to a multitude of large, encompassing bills that threatened both the practice of medicine and the health of patients statewide, our lobbying and legal guidance helped shape the outputs of the 112th General Assembly in ways we’re proud. All told, TMA’s legislative team: •
reviewed just under 1,700 bills that impacted or had the potential to impact our members;
actively tracked and actioned on 253 bills affected our members most;
took action, ranging from mild to major, on 119 bills by session’s end;
amended 34 bills, and actively worked to defeat 16 more;
added muscle to 12 bills requiring late-minute support to become law;
all while advising, lobbying or otherwise supporting 20 of Governor Bill Lee’s 29 Executive Orders dealing with the rapidly advancing virus.
As we exit the 112th General Assembly’s bifurcated session with significant wins, two major issues, yet unresolved, are expected to resurface in an August Special Session: COVID-related liability protections and parity payment for telehealth visits. These important matters will potentially need member engagement through phone calls, emails and other action once we understand the legislation coming forth. Please be watching for upcoming alerts on how you can get involved for the benefit of organized medicine next month and beyond.
SCOPE OF PRACTICE With the help of the House Subcommittee on Health Licensure and Regulation, TMA achieved our top legislative priority: Defeat a major push by the Tennessee Nursing Association and nurses across the state for independent practice for advanced practice nurse practitioners. This was TNA’s first renewed attempt at the issue after a three-year moratorium expired in 2019. For years, TMA has led advocacy efforts to keep Tennessee physicians supervising patient care and prevent inappropriate scope of practice expansion by mid-level healthcare providers. Advance practice nurses and a subset of doctoral physician assistant students have failed previous attempts to change state laws to achieve independent practice in Tennessee (DMS bill in 2018 and 2019, and APRN prescriber bill regarding buprenorphine in 2019). We continue to educate new legislators about legacy Scope of Practice issues, and advocate for policies that strengthen inter-professional relationships, not weaken them. We have formed and continue to work with a coalition of the state’s largest medical specialty societies and other healthcare organizations to advance the practice of physician-led, team-based healthcare delivery as the best model for patient safety and quality of care. The group is examining collaboration rules to identify how the state might improve the regulatory environment to support more efficient primary care as an alternative to nurse independent practice. See more next page...
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Anticipated August Special Session Our dedication to telehealth legislation continues as we believe technology-based services should be reimbursed at parity with in-office visits. TMA was unable to pass telehealth parity during the regular session, but we remain confident of success during the upcoming special session. Two versions of telehealth legislation made more progress than ever in previous years. Unfortunately, neither passed, and a final bill was defeated in the Senate after the House demanded both chambers pass telehealth and limited liability legislation. This supports our belief that the right players understand the significance of both issues. We believe this session advanced the conversation about appropriate rules and reimbursement for technology, which is crucial for improving healthcare access, particularly in rural, underserved areas. TMA expects to work closely with Rep. Robin Smith (Hixson) and Sen. Art Swann (Maryville) on future versions of telehealth parity legislation.
COVID-RELATED LIABILITY PROTECTIONS
Anticipated August Special Session
The Tennessee Safe Harbor and Recovery Act, sponsored by Rep. Michael Curcio (Dickson) and Sen. Mike Bell (Riceville), sought to protect businesses from frivolous COVID-related lawsuits when they have done everything required to protect them-selves and their customers. After considerable debate, most differences were resolved, leaving one significant divide: whether the Act should be retroactive to the day of the first confirmed positive COVID-19 test in Tennessee (March 5, 2020). The Senate sought the retroactive provision; the House did not. The bill fell four votes short of passing when legislators contended the final version violated the Stateâ&#x20AC;&#x2122;s constitutional prohibition on backward-leaning legislation. Failure of this bill had residual impacts as the Senate refused to further address telehealth.
We anticipate liability protections to be one of two primary issues Gov. Lee wishes to resolve (along with telehealth payment parity) in the anticipated special session in August.
Anticipated 112th General Assembly A majority of American patients have been surprised by a medical bill they thought was covered by insurance. Most of those surprises involve out-of-network medical bills the patient mistakenly thought were in-network at the time of service. Often, the confusion can be debilitating for patients. TMA offered a solution, championed by Sen. Bo Watson and Rep. Timothy Hill, to hold patients harmless from a balance bill when they do everything correctly. The proposed legislation maintained support until the final days of session, when advocates of payors all but threatened an amendment detrimental to providers. Sponsors pulled the bill to regroup for the 112th General Assembly. We anticipate meetings among all the parties will begin as soon as this month (July 2020) and continue until legislation is filed. TMA remains opposed to any effort that gives health insurance companies undue leverage and forces unfair contractual terms onto providers. We believe a reasonable solution shares the burden between providers, payers and hospitals â&#x20AC;&#x201D; and frees patients from the liability of billing inconsistencies. Balance billing has been an issue in Tennessee since the ACA allowed payors to narrow their networks, excluding providers from performing services.
For even more,See visit mdmemphis.org more next page...
SAVE THESE DATES NOV. 10, 11, 12
Learn best practices from speakers on a variety of topics from TennCare to telemedicine, to coding and documentation.
Engage with payers in virtual chat rooms for help with claims issues, disputes and appeals, prior authorization and more.
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TNMED.ORG/SYMPOSIUM Join us online in November for the 2nd annual Tennessee Healthcare Symposium, designed to help practice managers, coders, billers, auditors and other medical office staff improve office productivity and financial performance. A collaborative event between Tennessee Medical Association and major insurance carriers, our 2020 Symposium features Commissioner Hodgen Mainda from the Tennessee Department of Commerce and Insurance as our keynote speaker among 31 industry experts, across 12 unique educational seminars and eight insurance plan updates specially designed to help practices succeed. Up to 17.5 CME and CEU credits are available over the 3-day Webex event! Participating Payors include: BCBST, Cigna, United Healthcare, Palmetto, Humana, Ambetter, TennCare MCOs (Amerigroup BlueCare, United Healthcare Community Plan), and TennCare. Special thanks to our private sector partners for sharing their expertise: LBMC, AllHealth Choice, Strategic Financial Partners, Centene, Burr & Forman, Jeter IT, Ackermann Marketing & PR, NAMAS, and Doctors Management.
REGISTER TODAY tnmed.org/symposium 3-Day Admission Members $149 Nonmembers $199 Available Specialty Tracks Include:
Nov. 10: 2021 payor plan updates Nov. 11: Practice Management Nov. 12: Coding and Billing
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We salute the masked heroes of Memphis. Memphis is a city of heroes. A place where tenacious healthcare workers unfailingly answer the call. Where caregivers and first responders bravely face adversity day after day. Where compassionate business owners and service industry workers keep our city moving. And where our selfless citizens have rallied to the cause of flattening the curve. And though the rules of engagement in this fight continue to change, each day is an opportunity for all of us to improve the lives of others. Together, we will make a difference. This will be our cityâ&#x20AC;&#x2122;s finest moment.