MMS Quarterly Summer 2021

Volume 25, Number 2

President, Andrew Watson, M.D., and the 2021 Board of Directors

Member Spotlight: Claudette Jones The Art of Practicing Shephard, Medicine M.D.

2021

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Volume 25, Number 2

2021

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 2021 Board of Directors President Andrew Watson, M.D. Immediate Past President Danielle Hassel, M.D. President-Elect Christopher M. Pokabla, M.D. Vice President Lisa Usdan Secretary Dale Criner, M.D. Treasurer David L. Cannon, M.D. Members-at-Large James Beaty, M.D. Christopher Jackson, M.D. Walter Rayford, PhD, M.D., MBA Raymond R. Walker, M.D. James Wang, M.D. Paul Tackett, M.D. Perisco Wofford, M.D. Catherine Womack, M.D. Melanie Woodall, M.D Ex-Officio Board Members LaTonya Washington, M.D., President, Bluff City Medical Society Andreana Smith, President MidSouth MGMA

In this issue

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The Memphis Medical Society 1067 Cresthaven Road Memphis, TN 38119 901-761-0200 mdmemphis.org CEO/Executive Vice President, Clint Cummins, MHA Director, Communications & Marketing, Allison Cook Finance Director, Leah Lumm Physician Liaison, Cara Azhar Administrative Assistant, Olivia Jones Director, MedTemps, Cailyn Bautista Lillard MedTemps Administrative Coordinator, Katie Yaun MedTemps HR Coordinator, Tripp Knight Director, Project Access, Nicole Scroggins Business Development, Amanda Harris Cover photo: Dr. Tom Gettelfinger. Credit: Lizy Heard, Church Health

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Editorial

Searching the Files

By Thomas C. Gettelfinger, M.D.

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Editorial

All good things must come to an end.

Bad things too.

It’s been a long time since I have been writing these brief editorials for the Memphis Medical Society.

I can hardly believe how long.

Now it’s time to hang it up.

I can say I have enjoyed the chance to share thoughts with our membership. There has been no end to topics related to medicine, healthcare, politics, lifestyle that deserve discussion.

I’ve looked over my files, digital and paper, finding some editorials that still resonate with me. Cost of drugs, lack of transparency in medical charges, failing of the social contact where the rich have an obligation to the poor, unconscionably high charges to the uninsured, the high murder rate in our city, all these have been favorite subjects.

As I read some of those past editorials, I am drawn to that of winter 2018 ‘Is Memphis Sick?’.

It was about murder in our city. We rank third as the most murderous in the country. That sorry record dates back a hundred years; we had the highest rate all the way back in 1916. Not much progress I would say.

And of course, that is a public health issue.

Dr. Ted Pincus, a medical school classmate of mine, has written extensively on models of disease, contrasting the Biomedical Model, the scientific, disease-specific model we are all taught, to a Biopsychosocial Model, one that embraces social conditions influencing patient behavior. He points out that education is the most important predictor of outcomes in chronic disease. For example, in rheumatoid arthritis, non-completion of high school is the most significant risk factor, even more than that of race.

Is it too much of a leap to say that our chronic disease of public health, murder, is more a function of education, not of race?

But allow me an abrupt change of subject. I had occasion to speak recently with Dr. Perry Rothrock, solo practitioner in Cordova. He had written me about the issue of transparency in medical costs. It was obvious from our conversation that he has a deep commitment to his patients, aware of their differing backgrounds.

So may I end, almost end that is, with an exhortation for awareness of the social construct in chronic disease, combined with the empathy and concern for the individual patient that Dr. Rothrock shared with me.

So now I end, playing in the background, Guy Lombardo, ‘Enjoy yourself, it’s later than you think’.

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President’s Letter

As physicians and healthcare professionals, we often find ourselves surrounded by individuals, groups, and contrived constituencies that claim to know our reality, profession, and responsibilities better than we do. It would be comedic, a comedy of errors though, if such groups and their misinformation didn’t so regularly take up time, which is far better used doing what we do best – taking care of our patients. I hope in these times you have found ways to continue to enjoy your practice and being physicians and identified additional ways of being active in our greater community.

I appreciate time is always tight, so I’ll only ask for a little more to mention a few on-going topics: COVID-19 Continues Society is largely well past the point of saturation on any information regarding the COVID-19 pandemic, its variants, treatment efficacies, related mandates, lifestyle restrictions, etc…. the list is naturally, but burdensomely long. Equally long, if not longer, are the vast and everchanging opinions and media coverage on how to proceed in this new reality. It seems everyone believes everyone else is not only entitled to know his/her personal opinion, but also frequently asserts theirs is the only correct opinion. As healthcare professionals, we know the true situation better than anyone so let’s keep our message clear and concise: The Memphis Medical Society continues to strongly encourage vaccination.

The opportunity to dispel misinformation and assist our patients in making informed decisions regarding their healthcare, including vaccination, is fundamental to our role as healthcare providers and is a unique position we as physicians are both privileged to be in and duty bound to serve. While I am confident you each are already doing so, I encourage every Tennessee doctor to take whatever extra time is needed with his/her patients to discuss what is best and right for that patient and subsequently our communities in this matter. There was no vaccine in 2020 to help combat the spread and lessen the effects of COVID-19. Now we have several to use and in ready supply. Please do your part to help protect Tennessee, and all of us, by educating about this virus and offering, giving and getting the vaccine.

Membership Update As we enter the 2022 membership recruitment season, I am pleased to report we are closer to our goal of 1,100 dues-paying members. We have achieved this through a combination of efforts including a newly-introduced graduated discount plan in partnership with TMA and a commitment from the MMS board of directors. To date, our total membership tallies at 2,452 members. That number comprises:

Dues-Paying Physicians: 957 Residents: 939

Retired Members: 201 Medical Students: 355

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My sincere thanks to those who have supported and continue to support membership growth. I believe the MMS and the TMA offers physicians a real value through their active efforts to safeguard what is important and necessary for our profession and to substantially influence its positive future. As members, you agree with the value of this work so please share your experience with other physicians and encourage them to join us.

When you next speak with Cara Azhar, MMS’s staff Physician Liaison, please join me in thanking her for her leadership with every aspect of our membership support and growth.

Speaking of Future MMS Members On August 10, the Memphis Medical Society and The University of Tennessee School of Medicine jointly welcomed incoming 2021-2022 medical students. Held on the grounds of the Dixon Gallery and Gardens, more than 200 students attended the evening event along with an array of local physicians, MMS board members and UT faculty. In the picturesque setting while enjoying a catered dinner, students got to know their classmates and faculty better and were able to speak at length with local physicians about the realities of practicing medicine now and the future possibilities that the field holds for us all.

A Call to Care for the Uninsured Many of you have been made aware of the recent partnership between Memphis Medical Foundation, our 501c3 sister foundation, and the State of Tennessee to launch Project Access West Tennessee. As mentioned in our last publication, Project Access is a program that exists in other parts of the state that is designed to expand access to specialty and subspecialty care for those without insurance. Many of you are already contributing to that effort in various ways and our appreciation for your help is immense. The goal of Project Access is to increase the involvement of our provider community in these efforts. Basically, it is asked that each of you volunteer one appointment per month and/or minimal time to consult with primary care providers, be it on behalf of you or a team of providers that you oversee. Stay tuned for communication from Clint Cummins, our CEO, or Nicole Scroggins, our newly hired Director of Project Access. Thank you to those of you who have given verbal commitments thus far. We anticipate “seeing” our first patients in this program before the end of the year.

Congratulations 200 years in the Making Also, the MMS would like to extend its congratulations to Robin Williams, MD (Chair), Nicole Schlechter, MD (President), Rebecca Leslie, MBA (CEO) and the entire membership of the Nashville Academy of Medicine, which is celebrating its Bicentennial Anniversary this year (1821-2021).

Thank you to each of you and your staff for all you’ve done to care for our community and all you will no doubt continue to do.

Andrew Watson, M.D.

President, Memphis Medical Society 2021

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Hospitals

Successful daughter-to-father liver transplant performed at Methodist University Hospital Father’s Day 2021 will be one Robert Cartwright will never forget. It’s the day he and his daughter, Denisea Cartwright, celebrated a successful daughter-to-father liver transplant.

After a routine checkup, Robert’s gastroenterologist discovered a tumor on his liver. When he was placed on a donor list, amazingly, Denisea insisted she gift the lifesaving donation.

The 12-hour procedure was performed at Methodist University Hospital by a medical team led by Dr. James D. Eason. The transplant institute performs more than 120 liver transplants and more than 140 kidney transplants each year. Dr. Eason, who has performed some 2,000 liver transplants in his career, said the procedure offers miraculous results. And Robert’s case was no exception.

The female-to-male liver transplant surgery can prove challenging--a female liver is smaller than a male’s and the recipient receives about 60 percent of a donor’s liver. The operation was successful and, as Dr. Eason explains, “The liver in both the donor and the recipient will regenerate and reach full size in about three months.” For those suffering from liver cancer, Dr. Eason considers a transplant to be the cure, stating “This state-of-the-art facility, which is unrivaled across the nation…offers the only program in the Southeast to do this procedure to any degree.”

Saint Francis Healthcare’s Saint Francis Hospital-Bartlett and Saint Francis HospitalMemphis recognized as a High Performing Hospital for 2021-22 by U.S. News & World Report “Saint Francis Hospital-Bartlett earned “High Performing” ratings for stroke and chronic obstructive pulmonary disease (COPD), “ said Dr. Syed Shirazee, pulmonologist and Intensive Care Unit Medical Director at Saint Francis Hospital-Bartlett. “In cases of stroke and pulmonary concerns, time is of the essence and our teams work very hard to assist each patient on their journey to wellness.”

“Saint Francis Hospital-Memphis earned “High Performing” ratings for knee replacement, heart failure, stroke and COPD,” said Dr. Mark Shermer, nephrologist and Chief of Staff at Saint Francis Hospital-Memphis.

“Providing safe, high-quality care for local Memphians and visitors is a top priority for our team. We are honored to be recognized for our effort to care for our community.” “High Performing” is the highest rating U.S. News awards for these types of care and signifies that the care provided was significantly better than the national average, as measured by factors such as patient outcomes.

“Congratulations to our deserving staff on receiving these significant accolades from U.S. News and World Report for their diligence and dedication to the health and well-being of our community,” said Jay Krishnaswamy, Interim Market CEO of Saint Francis Healthcare. “This recognition is a great honor and it is my hope that local residents and visitors continue to confidently choose Saint Francis Healthcare for their medical needs.”

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Hospitals

Regional One Health Receives Labor and Delivery Honors Regional One Health has earned both national and statewide recognition recently in the areas of women’s services and labor and delivery.

Regional One Health was named a “Best Maternity Hospital” by Newsweek. Newsweek partners with The Leapfrog Group, a national organization that reports on the safety and quality performance of health care facilities.

Best Maternity Hospitals are hospitals that meet the tough standards for excellence in maternity care: hospitals that have low rates of C-section, episiotomy, and early elective deliveries, and also follow important protocols to protect moms and babies. Though these are standards aligned with medical research and best practices, not all hospitals achieve them. Newsweek’s Best Maternity Hospitals are an elite group of hospitals demonstrating the highest performance in the United States.

Regional One Health actively participates with the Tennessee Initiative for Perinatal Quality Care (TIPQC), which includes working on projects to improve health outcomes for mothers and infants. At a recent TIPQC conference, the Regional One Health team was given the Gold Quality Award for their work in the Opioid Use Disorder in Pregnancy Project. The aim of the project was to decrease complications of opioid use disorder in pregnancy by optimizing the care for women though education, resource mapping, screening and access to treatment service.

Baptist is First in Region to Offer Treatment for Debilitating Condition The Baptist Advanced Heart Failure Program at Baptist Memphis recently became the first in the region to use a new medication called Onpattro to treat amyloidosis, when the body produces an abnormal protein called amyloid that can affect all tissues and organs, including the heart. Often, the first signs of amyloidosis are orthopedic conditions such as spinal stenosis or carpal tunnel syndrome. Eventually the patient can end up in a cardiologist’s office with a heart in extreme distress.“By the time we’re diagnosing patients with amyloidosis in our offices, they also have advanced heart disease,” said Dr. Dmitry Yaranov, a cardiologist and program director for advanced heart failure, heart transplant and mechanical circulatory support for the Advanced Heart Failure Program.

Onpattro halts amyloid production in the liver. That allows Dr. Yaranov and his team to stabilize the heart and other disease-affected organs. The first patient treated with Onpattro is doing well, and several more patients have since started to receive the infusion treatment. Baptist is the only hospital in the Mid-South to offer this medication; the closest alternative is in Nashville.

“If patients present with heart disease, we can treat them for that chief complaint once the amyloid production is under control,” said Dr. Yaranov. “We can even list the patient for a heart transplant if that is what is needed.”

Nationally, almost four percent of African Americans are carriers for the genetic mutation that causes amyloidosis. Because the Memphis area’s African American population is six and a half times greater than the national average, the presence of amyloidosis could be more than six times greater in Memphis.

Because the disease is mostly hereditary, genetic testing could help detect it early.

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Society Updates

Project Access West Tennessee

Welcome to charity care that benefits patients and physicians.

We are expanding healthcare to uninsured, low-income people throughout western Tennessee. Join us in providing speciality care to those in need.

Flexible Commitments Choose from teleheath, phone consults or in-person visits.

Liability Coverage Physicians providing charity care are exempt from civil lawsuits.

Simple Billing We take care of all your billing and reimbursement paperwork.

Easy Referrals Our team coordinates referrals and guides the patient through each appointment.

MAKE A DIFFERENCE Call today 901-761-0200 8

projectaccess@mdmemphis.org

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Member Updates

West Cancer Center Welcome New Providers Three new physicians join its oncology network

West Cancer Center & Research Institute has recently welcomed three new physicians to its oncology network: Dr. Richard Gilmore, Dr. Steven Nokes, and Dr. Saradasri Karri Wellikoff.

Richard Gilmore, MD, Oncology Breast Surgeon Dr. Richard Gilmore joined West’s Margaret West Comprehensive Breast Center located in Germantown, TN. He received his medical degree from Emory University School of Medicine in Atlanta, GA, then completed an internship and residency in General Surgery at Johns Hopkins University School of Medicine. After completing a Breast Surgical Oncology Fellowship at Margaret West Comprehensive Breast Center, he is now on staff as one of breast surgeons.

Steven Nokes, MD, Breast Radiologist Dr. Steven Nokes brings more than 30 years of breast specific radiology experience to Margaret West Comprehensive Breast Center. The breast center relies exclusively radiologists on who specialize in breast to ensure accuracy and early detection. Dr. Nokes earned his medical degree from the University of Tennessee followed by a Radiology Residency at the University of South Florida, with a Fellowship from Duke University Medical Center. He comes to the network from Radiology Consultants in Little Rock, AR. While serving Radiology Consultants, he served as the Section Chief of CT/MRI from 1989-2004, President from 2003-2009, and Chief of Workflow from 2009-2017. Dr. Nokes was also the Editor of Radiology Case of the Month for Arkansas Medical Journal from 1990-2008.

Saradasri Karri Wellikoff, MD, Medical Oncologist Dr. Saradasri Karri Wellikoff earned her Medical Degree and Residency in Internal Medicine from the University of Tennessee Health Science Center. She completed her Hematology/Oncology Fellowship at West Cancer Center. Dr. Wellikoff specializes in endocrine, neuroendocrine, and central nervous system tumors. She will treat patients at the Midtown-Memphis / Regional One Health Cancer Center Campus and the Germantown location.

The West network is extremely proud to have these three talented oncology specialists join their team, sharing a mission to offer the best cancer care to patients in the Midsouth.

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Member Benefits

Scan with your smart phone’s camera to join

Join us at a new member discount!

Join your physician colleagues in Shelby County in this professional organization dedicated to supporting, advocating and enriching the lives of physicians at home and in practice.

Join today, and you’ll soon learn the benefits of organized medicine.

WE ARE STRONGER TOGETHER 10

OUR FOCUS IS YOU

• Wellness programs to reduce burnout and more YOUR PRACTICE

• Staffing and recruiting services YOUR COMMUNITY

• Networking for direct referrals

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Physician Wellness

President’s Gala

Three easy ways for you to receive up to six, free and confidential visits with a licensed psychologist Call, text or fill out a short form.

Burnout is normal, and we can help you get back on track.

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FILL OUT A FORM

This hotline is answered 24 hours a day, 7 days a week.

Our confidential hotline also accepts text messages.

901-286-3110

901-286-3110

mdmemphis.org

Our form is HIPPAcompliant. Use your smartphone's camera to scan this code.

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Feature

The Art of Practicing Medicine

Physician’s artistic talents shine with patients and behind the camera

As our reigning Editor, Dr. Tom Gettelfinger, retires his duties, we take a look at his history with the magazine as well as love of photography, including his recent art exhibit at Church Health Center.

“Initially, I was on the MMS board, and I began writing something for the magazine each issue. Back then it was monthly, but that was really too much. We moved it to quarterly, and that worked much better,” says Dr. Gettelfinger. “I’ve always thought print was important, and I was the editor of both my high school and college yearbooks.”

As yearbook editor, Dr. Gettelfinger scoured photographs to find the most impactful ones that told a story. He became fascinated by the power of photography, and soon took up photography as a hobby.

“My uncle had a 15mm Minox camera that I began using. I didn’t know enough to buy fancy equipment,” he says. “I evolved to an Olympus, which was a smaller camera that I used when I traveled for medical conferences.”

Today, Dr. Gettelfinger relies on his iPhone for his photography. “I find the technology revolution incredible,” he says. “Shooting with three lens at the same time is phenomenal. All of the photographs in the Church Health exhibit were taken with my iPhone.”

Ken Hall, Special Events Manager, with Church Health had worked with Dr. Gettelfinger on several art shows since 2011. “His work is always insightfully composed and captures the imagination,” he says. “This inaugural show in the Lois Estes Ruleman Gallery is very important to Church Health. The late wife of retired ENT Dr. Allan Ruleman, Lois was our longest serving volunteer with 27 years of service. I thought Tom would be the ideal artist to show in the space given his versatility as an artist and his understanding of the need for beauty and distraction in a patient waiting room.”

“The secret to a good photograph,” says Dr. Gettelfinger, “is being able to tell who took it. That’s a real style.

My style has grown around close ups of flowers over the years, and that’s what the Church Health exhibit focuses on. I’ve always been very intrigued by the visual world and visual information. In the brain, the area processing vision is close to the area for smell. Visual memory is much more powerful than other memories. It’s what drew me to ophthalmology in the first place. Reading Dr. Zhivago, I remember him saying that ophthalmology was the most artistic of the medical fields.”

Practicing medicine has many overlaps with being an artist to Dr. Gettelfinger. “You are always learning and growing your skills, finding the right balance of things to heal and similarly to inspire.”

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Feature

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In Practice

Scan the Horizon, See the Future!

By Kathy Hunt, Executive Director, Hunt & Associates Business alliances are changing, so be prepared.

These days in health care there seems to be a common theme. Choosing, developing and maintaining strong business alliances is an important part of strategic management. Perhaps the most newsworthy events in Mid-South healthcare industry recently have been the number of changing business alliances making news. It seems like what is old is new again. What we thought was very likely was turned on its head and now we have another new normal. For what it is worth, many markets have seen similar shakeups. But with each new buckle in the road, somebody’s strategic plan becomes outdated and simultaneously a new business opportunity is created.

A common reason for such alliances involves the desire to create value for both parties. In analyzing the success of an alliance one test is to ask if the alliance is based on creating higher quality or lower cost. If so, it is likely more sustainable. Likewise, a change in alliance can be judged the same way. For the physician practice devoted to the patient, changes in business alliances can range from uneventful to frustrating or even life changing. If someone perceives a changed alliance affects quality, the result might even be anger. What does a physician do about it?

First recognize the change. Face it honestly, knowing that in the short run, things may be outside your control.

The change may be like gravity. That reaction should not be confused with complacency. In the medium and longer term, however, physicians can still have a significant impact on their own situation. For some, choosing new or additional business alliances can be an important part of creating your new, more successful reality.

Predicting the future exactly is impossible. The last year in this region’s healthcare has taught many observers that fact. But several important currents are at work. First is the quest for higher quality and lower cost.

Related but separate is the quest for innovation that delivers these results. Recent innovations and investment in health care products to improve value are staggering. This development will likely bring disruption to those not chasing value. Recognize that changes can happen rapidly when there is strong motivation. The best attribute to prepare for disruption is to be nimble and adaptive, knowing that disruptive forces are at work. Business alliances and changes in them will reflect this reality as well.

The further move to ambulatory care, the consolidation of health systems and new products that improve patient engagement in their own care are influencing and creating new business alliances every day. According to a 2019 study by NRC Health of consumer attitudes, consumer centric demands are upending business strategies and business alliances alike. These changes are also pushing us to unfamiliar territory. This change will likely accelerate. And if it does, just remember that it’s often better to make the journey with an ally than to travel alone. Successful partnerships require honesty and open communication. Respectful negotiation. Clear purpose and agreed expectations. A welcoming and supportive space so all parties can contribute to shared goals respectfully. At the heart of most is passion for our profession and the genuine desire to put patients first, last, and at the core of business.

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In Practice

MedTemps Continues to Grow Record staffing hours week over week

We staff all opportunities in healthcare • Medical Office Manager

• Medical Office Assistant

• Certified Medical Assistant

• Medical Assistant (Non-Certified) • Licensed Practical Nurse

• Registered Nurse

• Phlebotomist

• Radiology Technician

• X-Ray Technician

• Nurse Practitioner

• Physician Assistant

Why you should use MedTemps?

You want to hire for a position, but you don’t want all of the headaches of onboarding, training, pay-rolling, etc. Maybe you prefer to give employees a trial period before hiring. You may not have the capacity to perform recruiting, employee relations and other critical human resources functions.

Don’t be confused by the name; we’re not just a temp service. We stay connected to the city’s best healthcare talent in order to recruit and retain for our city and our members. And don’t forget that we are owned and operated by Memphis Medical Society! That means our pricing stays low. We exist to support MMS and help fund initiatives and events that supports the entire medical community.

Call 901-264-0031or visit medtempsmemphis.com for more information.

MedTemps strictly prohibits discriminatory practices, including all sorts of workplace harassment, including sexual harassment.

MedTemps prohibits harassment on the basis of race, color, religion, sex, national origin, age or disability.

For any concerns regarding the quality and safety of patient care provided by MedTemps employees, please contact us at medtemps@mdmemphis.org. Concerns about patient care that are not adequately resolved by MedTemps management can be addressed by contacting the Joint Commission at www.jointcommission. org. For general questions, please contact the Joint Commission Customer Service at 630-792-5800 or customerservice@jointcommission.org.

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Your Benefits 1067 Cresthaven Rd Memphis, TN 38119 901-761-0200 aharris@mdmemphis.org www.mdmemphis.org

We Help Organized Medicine

Support You Wellbeing Burnout is a serious issues for physicians, and we have created Thrive as a direct response. We provide confidential, free counseling with a psychologist.

Public Health Increasing access to healthcare in our community benefits everyone. Project Access West Tennessee is here to help by expanding charity care networks and benefits.

Memphis Medical Foundation Memphis Medical Foundation is the charitable nonprofit organization supporting Memphis Medical Society.

Our funding initiatives include Thrive, promoting physician wellness, Project Access West Tennessee, growing charity care networks in west Tennessee and a wide variety of leadership training and educational opportunities to empower physicians in each stage of their career. We are also able to offer our members exclusive purchasing discounts on PPE, regardless of quantity needed.

Donating is Easy Online, tax-deductible donations are easy at http://bit.ly/MMFdonate

Empowering Positioning the next generation of physician leaders is key to the sustainability and growth of organized medicine.

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Planned giving is simple through our 1876 Trust.

Volunteer a consult, screening, etc., through Project Access West Tennesse Call us today, and we can customize a giving program just right for you.

Financial Q&A

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Financial Q&A

Protecting your investment portfolio Q: One of my partners was telling me about a trust he and his wife established to protect their assets. He said it was a Tenants by the Entirety trust. What is it, and how does it work?

Tenants by the Entirety (TBE) is a way property is owned by married couples, and it allows both spouses to mutually own the entire property as an undivided whole. One advantage of owning property as tenants by the entirety is asset protection from creditors. Creditor claims of an individual spouse cannot be attached to assets titled as TBE because the “marital unit” owns the property. Only claims by joint creditors would apply to assets owned this way. In addition, TBE property avoids the probate process by allowing the property to pass at death to the surviving spouse. During the marriage, both parties must consent to a disposition of the property or agree to make any changes in the ownership structure. In case of a divorce, the tenancy by entirety would be eliminated as the property would be divided between the couple.

In Tennessee, a Tenancy by the Entirety Joint Revocable Trust allows a married couple to transfer property to a joint trust and receive the asset protection that is not available to revocable living trusts.

A revocable living trust is an estate planning tool to manage your property during lifetime and at death the assets you titled to the trust avoid probate. The trust terms and provisions are private. This differs from property transferred under a last will and testament. Property distributed under a will is subject to probate. At death, a will is filed with the court and all details become a matter of public record. You can serve as trustee of the revocable living trust, the trust terms can be changed or dissolved during your lifetime, but the trust does not provide asset protection from creditors. Enter the Tenancy by the Entirety Trust (TBET). The TBET became available on July 1, 2014 in Tennessee, and it works like a revocable living trust. However, the TBET has the creditor protection shield from claims of an individual spouse and upon death, the creditors of the deceased spouse cannot reach the property. To receive protection from creditors, any property transferred to the trust should first be owned as tenants by the entirety and later conveyed to the trust. This type of trust can be a very effective estate planning tool and provide stellar asset protection.

While it has solid benefits, it should only be considered for married couples who have stable, happy, long-term marriages and are very unlikely to get a divorce. I suggest you discuss this with an estate-planning attorney and decide if a TBET is a viable estate planning tool for you.

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 whoward@whcfa.com

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Legislative Report Card 2021

During the 112th Tennessee General Assembly, TMA spent much of the 2021 legislative session dealing with pandemic-related bills, matched against our lobbying team’s limited abilities to attend hearings and meet 3 in person with legislators due to protocols and precautions.

Our annual pilgrimage to Capitol Hill in Nashville was once again held as a DOCTORS’ VIRTUAL ON THE HILL virtual event, drawing more than 250 physicians, medicalDAY support staff and annual policy briefing and lobby day other advocates to lobby for better healthcare policies.TMA’s engaged inMembers Nashville connects physicians directly with lawmakers so they can advocate for with over 100 state lawmakers on our key issues. their patients and discuss major issues affecting the medical profession in Tennessee.

2021 by the numbers

1,654

bills reviewed 18

351

bills tracked

18

bills amended

This year the General Assembly declined large, in-person group lobbying events due to the COVID-19 pandemic. So TMA visited lawmakers virtually via Zoom video conferencing with small group breakout discussions. Our typical all-day event shrunk to a dynamic 60 minutes. This event was held on March 3, 2021.

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While the online format was new, the overall concept and inner workings remained the same. Invitations were extended to all 133 legislators, and over 300 physicians attended online to address healthcare-related issues.

bills defeated

4

bills passed

tnmed.org/legislative

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1 GRADUATE MEDICAL EDUCATION FUNDING 2021 Legislative Priority PC587 (TMA Member Sen. Richard Briggs, R. - Knoxville | Rep. Kevin Vaughan, R. - Collierville) Approximately $5.5 million was placed in the state budget to fund 130 new residency spots for family practice, general pediatrics, med-peds and psychiatry in medically underserved areas and distressed rural counties of Tennessee. Funding was included in the appropriations bill, which passed both the House and Senate and was signed by the Governor.

Background: The Centers for Medicare and Medicaid Services (CMS) ruled in 2020 that Tennessee must scratch its longstanding funding formula for graduate medical education slots through TennCare. It places millions of dollars and all of Tennessee’s residency programs at risk. TMA’s priorities will be to obtain a seat at the table for further discussions on resident funding and advocate for a sensible funding mechanism for preserving the existing slots.

2 SCOPE OF PRACTICE 2021 Legislative Priority SB0671 | HB1080 (Sen. Mike Bell, R. - Riceville | Rep. Jerry Sexton, R. - Bean Station) This new law preserves PA-physician collaboration and will create a semi-autonomous licensing board for physician assistants. All rules regarding physician collaboration remain in effect and will continue to be overseen by the medical board. The bill as amended was signed by the governor.

Background: TMA opposed this bill as originally drafted because it would have eliminated the requirement for physician assistants to formally collaborate with physicians. TMA is a leader in efforts to preserve Tennessee physicians’ ability to supervise patient care and oppose unsafe scope of practice expansion by midlevel healthcare providers. Because of our leadership, advanced practice nurses and physician assistants have failed to change state laws to achieve collaborative practice in Tennessee. We joined a coalition of medical specialty societies and other healthcare organizations promoting physician-led, team-based healthcare delivery teams as the best model for patient safety and quality of care.

3 BALANCE BILLING 2021 Legislative Priority SB0001 | HB0002 (Sen. Bo Watson, R. - Hixson | Rep. Robin Smith, R. - Hixson) The House planned a summer study of this issue to determine the effects of the federal balance billing law. The Senate postponed the bill until 2022.

Background: This bill would have ensured a balance billing solution for the state-regulated health insurance market in state law. TMA leads a coalition of hospital-based physician specialty organizations working to protect patients from narrow networks created by health insurance companies. Sen. Bo Watson and Rep. Robin Smith offered a physician-friendly balance billing solution which would require patients to only pay according to their in-network responsibility if they receive a surprise medical bill. It would also allow out-of-network physicians to pursue fair payment from health insurance companies through an independent arbitration process if the initial payment was unsatisfactory. Their bill would incentivize health insurance companies to offer fair initial payments to out-ofnetwork hospital-based physicians.

4 PROFESSIONAL PRIVILEGE TAX REPEAL SB884 | HB519 (Sen. John Stevens, R. - Huntingdon | Rep. Ron Gant, R - Rossville) TMA continues to advocate for the reduction or removal of the Tennessee professional privilege tax. The General Assembly exempted some professions in 2019, but doctors are still required to pay the $400 annual tax. It is unfair to impose the tax on physicians when other health professionals are exempt. We will continue to fight to repeal the tax for physicians.

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