MMS Quarterly Summer 2022

Page 1

MMS board members influence updating clinical guidelines

Volume 26, Number 2 2022
Christopher Jackson, MD, FACP, FSSCI, and Desiree Burroughs-Ray, MD, MPH

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Managing Editor

Allison Cook

2022 Board of Directors


Christopher Pokabla, M.D. Immediate Past President Andrew Watson, M.D. President-Elect

Lisa Usdan, M.D. Vice President

Dale Criner, M.D. Secretary Catherine Womack, M.D. Treasurer David L. Cannon, M.D.


James Beaty, M.D. Christopher Jackson, M.D. Desiree Burroughs-Ray, M.D. Walter Rayford, M.D.

Kyle Smith, M.D. James Wang, M.D. Paul Tackett, M.D. Perisco Wofford, M.D. Melanie Woodall, M.D.

Ex-Officio Board Members

LaTonya Washington, M.D., President, Bluff City Medical Society Andreana Smith, President, Mid-South MGMA

In this issue

Medical Society

1067 Cresthaven Road Memphis, TN 38119 901-761-0200

CEO/Executive Vice President, Clint Cummins, MHA

The Memphis
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.
Volume 26, Number 2 2022 President’s Letter 2 Hospital Updates 4 Society Updates 6 Member Spotlights 10 Feature Story 12 Research 14 Finance Q&A 17 Legislative Update 19

From Our President

We Need You: Tell Your Prior Authorization Stories

Almost all of us have practiced medicine with the onerous process of prior authorization. In my own practice, it is routine to call an insurance company and have a member of my staff sit on hold for up to 45 minutes, only for me to end up on the phone with a nurse or physician who is not board-certified in orthopaedics determining the fate of my patients’ care.

Let’s assume for a moment that the decision to implement this process years ago was one made in good faith with financial responsibility in mind. Even then, I know none of you or your staff have time to sit on hold during a busy clinic day while patients wait for the approvals to come through. I know of one of the larger practices in our community that has 5-6 FTE’s exclusively dedicated to handling prior authorization requests. How is this good for the healthcare system and for our patient care?

In most cases for me, and I’m told by many others, the case goes on to be approved anyway. And when they’re denied, we often appeal, which delays the process even more. This often leads to worsening of our patients’ medical condition.

I applaud the TMA for deciding to take on this important issue in medicine. This effort represents what we should be doing to support our physicians who are constantly striving to promote the best outcomes for their patients

And now, we need you and your practice to act. We need you to scan the QR code below with your phone’s camera and tell your prior authorization story.

It is a short form and easy to fill out. You can be as brief or descriptive as you want in your narrative. You can also have TMA staff reach out to you for more detailed information. I encourage you to check that box. If we flood the legislature with these important patient stories, it will encourage them to take action on behalf of the constituents they serve.

President’s Letter
Visit this link, or scan the code with your phone:

As a reminder, the Memphis Medical Society offers Thrive, a physician wellbeing program which has a wellness hotline. The hotline connects you to a psychologist CONFIDENTIALLY, and our 501c3 partner Memphis Medical Foundation covers your costs. The program is generously funded 100% by private physicians.

In addition, be on the lookout for our fall events, a member happy hour, and our annual legislative reception. I hope to see you there.


Christopher Pokabla, M.D. President, Memphis Medical Society 2022



Methodist Le Bonheur Healthcare names Kate Dowd senior vice president and chief legal officer.

In this role she will direct the Memphis-based integrated healthcare system’s legal department and risk management goals. “After a comprehensive nationwide search, it became clear the right candidate was already within our organization,” said Monica Wharton, MLH executive vice president and chief administrative officer. “Kate’s experience navigating complex healthcare-related legal matters gives me great confidence she will successfully lead our multifaceted legal affairs efforts and serve as a trusted member of our system leadership team.”

Dowd has a decade of experience specializing in health and regulatory law, most recently serving as MLH’s regulatory counsel. Prior to joining MLH in 2019, she served as an attorney in the Healthcare Regulatory and Transactions Practice Group at Butler Snow LLP.

“Our policies, best practices and unshakeable commitment to our patients enable us to deliver outstanding care,” added Wharton. “Kate’s core values align perfectly with our mission to improve the health and wellbeing of our community.”

Originally from Charlotte, North Carolina, Dowd has called Memphis home for 17 years. She received her undergraduate degree from Rhodes College and graduated cum laude from the Cecil C. Humphreys School of Law at the University of Memphis.

Baptist Cancer Center awarded prestifious international award at lung cancer conference.

The International Association for the Study of Lung Cancer (IASLC) recently named Baptist Can cer Center the 2022 North America Regional Winner for one of the association’s most prestigious awards—the IASLC Cancer Care Team Award during the IASLC 2022 World Conference on Lung Cancer.

The International Association for the Study of Lung Cancer (IASLC) recently named Baptist Cancer Center the 2022 North America Regional Winner for one of the association’s most prestigious awareds-the IASLC Cancer Care Team Aware--during the IASLC 2022 World Conference on lung cancer. The Cancer Care Team Award recognizes a single institution in North America, Europe, Latin America and Asia/Rest of the World for extraordinary patient care in the field of lung cancer and thoracic malignancies. Patients and their loved ones nominate teams for the award.

“We are honored to be one of only three cancer teams across the globe to receive this award, but it is most meaningful because we were nominated by one of our patients,” said Dr. Raymond Osarogiagbon, chief scientist for Baptist Memorial Health Care and director of the multidisciplinary thoracic oncology program and the thoracic oncology research group for Baptist Cancer Center. “Our team is dedicated to caring for our patients and furthering research in the field of lung cancer. This award demonstrates our exceptional teamwork and how it benefits our patients.”


Regional One Health’s Center for Innovation is partnering with Welwaze to test its Celbrea technology.

Celbrea is a quick, non-invasive and painless way to alert patients to seek further evaluation for breast cancer. It detects biothermal activity, which is a marker for breast disease, in just 15 minutes. Catching cancer early is crucial to successful treatment and reducing the number of patients who die from breast cancer. It is used along with routine physical exams, breast palpation, mammography and other established procedures.

“We want to encourage women to seek medical attention as early as possible so they have the best chance to survive,” said Alex Ness, founder and CEO of Welwaze. “Our innovative technology helps women easily learn if there is any sign of breast disease so if the results show breast disease, they know how important it is to make an appointment with their physician.”

Celbrea can help women who face challenges with access to doctors and screening centers, as well as patients who need to monitor themselves more often because of their breast density or genetic profile. Ness added the technology can increase women’s compliance when it comes to keeping up their recommended mammogram schedule and can serve as a means of encouraging women to be more diligent about screening and seeing their doctor.

Saint Francis Hospital-Memphis recently named radiation oncologist Dr. Matthew Ballo as Medical Director of the hospital’s radiation oncology program.

Dr. Ballo also serves as Medical Director of Radiation Oncology at West Cancer Center and Research Institute. In June 2021, West Cancer Center and Saint Francis announced a partnership that would include the area’s first ever urgent care clinic for oncology patients, to be housed at Saint FrancisMemphis, a dedicated oncology floor within the hospital and a joint commitment to providing patients with access to advanced technology.

Most recently, Dr. Ballo and physicians from Semmes-Murphey completed the area’s first GammaTile® procedure at Saint Francis. Only one other hospital in the state of Tennessee boasts the GammaTile® Technology. Designed to help prevent the reoccurrence of brain tumors, GammaTile is a collagen tile implant that delivers radiation to the area where the patient’s brain tumor was removed— with the goal of leaving healthy tissue unaffected. It is a one-time treatment intended to eliminate the need for ongoing radiation treatments.

“Having Dr. Ballo as Director of Radiation Oncology will help propel us forward in our mission of providing a broad spectrum of oncology services to the community, staffed by the area’s finest providers, and featuring leading-edge technology,” said Chris Cosby, Market Chief Executive Officer for Saint Francis Healthcare and CEO of Saint Francis Hospital-Memphis.

5 Q HospitalsI

From Our CEO

Let me begin with this disclaimer: this is not intended to open a political debate about guns, although that debate certainly informs the conversation we need to have.

No matter your political stance, I think we can ALL agree on this: Every patient, caregiver, vendor, and medical provider that enters a healthcare facility in our community should feel SAFE.

Assuming you agree with that, and assuming you are a leader in the healthcare community, let us also agree on this: we need to have a community conversation (and subsequent actions) about how we improve safety in healthcare. We need to establish minimum standards for what our employees, members, patients, friends and all can expect when they walk through the doors of our world-class care organizations in this city.

Yes, we need more active shooter trainings and crisis management education. But we need something deeper. You have likely read about the hospital shooting in Tulsa where we lost two doctors, a receptionist and mother of two boys, and a devoted husband and veteran. Upon hearing that, I sought information from some of the leaders of our healthcare community about their feelings of safety in Greater Memphis. What I learned shocked me.

In one story, an ER employee told me that a wounded patient arose from a gurney and attacked a nurse and two physicians. There was a security officer on duty who stated they could not intervene in a physical way. The result was the two physicians taking the patient down to the ground to restrain the individual and await law enforcement arrival.

In a second story, a female hospital employee told me that she always carries a concealed weapon on her. Think about that for a second: you’re a healthcare provider, and you don’t feel safe doing your job. So much so that you bring a weapon with you to work.

And, finally, I was told a story from a suburban private practice administrator who stated that a patient’s family member waited until the end of the day when security was looser to get through several locked doors in order to make a threat on the administrator’s life.

QSociety UpdatesI
It’s Time for a Conversation about Safety in our Healthcare Community

What shocked me the most about these stories was the normalcy that was conveyed by the storytellers and the diversity in victims and their locations throughout the metro area.

There are more stories out there that are even more shocking, and likely one of these conjured up a personal story from you. That is just plain sad.

I know, I know: the crazy people will always find a way to be crazy. And there is no need to remind me of the metro area that we live in and its crime problems. I don’t know about you, but as someone who cares about my community and is in a position to improve safety, I feel an obligation to assess and strive for meaningful improvement in the safety of our healthcare community.

We have local organizations that represent physicians, nurses, and administrators from all healthcare entities. It is time to band together and improve this issue before Memphis is the next city in the headlines.

Finally, let’s agree on one last thing: healthcare is notoriously slow to adapt, innovate, and collaborate across competitive lines. Let this be one issue that serves as the exception to that rule.

I welcome your comments and suggestions at


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MMS Welcomes Residents

Guests networked with new collegues and practicing physicians

MMS CEO, Clint Cummins, MHA, spoke at Resident Orientation this year, welcoming and congratulating them on the beginning of their residency program.

He also assured them that the best is yet to come. Specifically the resident welcoming party that MMS was hosting in their honor that evening.

New residents, as well as practicing physicians and the MMS board of directors, gathered at Grind City Brewing in downtown Memphis. With views overlooking the pyramid, river and downtown skyline, it was the perfect Memphis setting. Along with brews from Grind City Brewing, the food truck Authentic Toast provided delicious fare for everyone.

“While we have hosted these welcoming events for several years now, it is always exciting to see new faces to Memphis and to be a part of their excitement for this next stage in their careers,” says Cummins. “A special thanks to SVMIC and MedTemps, who each sponsored this event. Without sponsors like these two, we wouldn’t be able to host such wonderful events for our members.”

QMember SpotlightI

Annual M1 Dinner a Continued Success

MMS hosts incoming medical students with dinner

Each August brings a new medical school class to Memphis. While some are from Memphis, many are new to town. Knowing this, MMS hosts a dinner each year to welcome the incoming class in partnership with UTHSC, which gave students their first stethoscope as part of the celebration.

This year’s event was held at 409 South Main with catering from Pete & Sam’s. Sponsored by MedTemps, the event drew the full incoming class.

UTHSC administration and MMS board members were on hand to greet students, answer questions and provide perspectives on practicing medicine in Memphis.

“We thank Memphis Medical Society for hosting this event for our students each year,” said Catherine Womack, M.D., Associate Dean of Student Affairs and Admissions at UTHSC and MMS board member. “The students always enjoy it, and it’s such a fun addition to their orientation week.”

QMember SpotlightI

UTHSC Physicians, MMS Board Members Set Standard for Treatment of Thromboembolisms

MMS members give direct input on new clinical guidelines

Desiree Burroughs-Ray, MD, MPH, and Christopher Jackson, MD, FACP, FSSCI, were invited to join other experts in a review of the guidelines written by the American College of Chest Physicians. After analyzing years of new data collected in the form of clinical trials, randomized controlled trials, and systematic reviews, the Journal of American Medical Association published the panel’s new recommendations as a clinical guidelines synopsis.

Venous Thromboembolism refers to a medical condition in which blood clots form in the lower veins of the leg (deep vein thrombosis) or in the lungs (pulmonary embolism). The condition is usually diagnosed after a clot is already established, since early symptoms often go unnoticed. Treatment typically involves administering strong anticoagulants intravenously while under close observation in an inpatient setting.

The analysis and review led the panel to make new recommendations for treatment, which include a more prominent role for a class of drugs previously used for less-severe cases. While intravenous clot busters have been often prescribed for thromboembolisms, they bring risks including bruising, excessive bleeding, shortness of breath, fever, and elevated potassium levels in the blood. This treatment must be done over the course of a few days under supervision in a hospital.

The new recommendations advise using direct-acting oral anticoagulants (DOACs) in more-severe cases than previously thought possible. DOACs have less serious risks than other treatment options and can be self-administered at home by the patient. “In the mid-2000s, there was a lot of data being published about the efficacy of DOACs; five or six studies came out saying patient populations with clots had results just as good or better than other treatments,” said Dr. Jackson, who serves as an assistant professor of Medicine and associate program director for the Internal Medicine Residency at UTHSC.

12 Q FeatureI

A big challenge in treating the condition comes from the fact that early symptoms are hard for patients to notice. “When patients come in, they are usually coming in for some reason other than a suspected blood clot. When the thrombosis is found, it is usually already causing strain on the heart,” said Dr. Burroughs-Ray, who practices general internal medicine and pediatrics at Le Bonheur Children’s Hospital. “There is no way to simply make the clots disappear. The treatments available at this stage, like manually removing the clot or using clot-busting drugs, have risks associated with them,” Dr. Burroughs-Ray said.

The doctors are excited to put the changes into practice themselves, and to see the results. “As a hospitalist, I have the benefit of putting these guidelines into action on a daily basis and I get to have an impact on the next group of trainees and help them internalize these practices,” Dr. Burroughs-Ray said. Dr. Jackson added that the efficacy of the new treatment recommendations should be observable in just a few years.

13 Q FeatureI

UTHSC, International Colorectal Cancer Study

UTHSC Part of International Colorectal Cancer Study Renewed for Five Years $10 Million in New Funding to Continue Innovative Research

A major international study of colorectal cancer called the ColoCare Study, which includes the University of Tennessee Health Science Center, has received a five-year renewal with $10 million from the National Institutes of Health to fuel new innovations in colorectal cancer treatment.

This next phase of the project will focus on developing new medical interventions based on earlier research findings from the ColoCare Study. It will also engage more patients in the research designed to yield insights into new tailored treatment approaches to critical unmet medical needs facing individuals with colorectal cancer.

Originally founded in 2009, the ColoCare Study brings together scientists and a diverse group of patients from several research institutions and geographic areas across the United States in addition to UTHSC: Huntsman Cancer Institute, Salt Lake City; Cedars Sinai Medical Center, Los Angeles; Fred Hutchinson Cancer Research Center, Seattle; Moffitt Cancer Center, Tampa; and Washington University, St. Louis; and a site in Europe: University of Heidelberg in Germany. The goal is to better understand the unique factors that impact survival and quality of life outcomes among people with colorectal cancer.

The principal investigator at UTHSC is David Shibata, MD, professor and chair of the UTHSC Department of Surgery, executive director of the UTHSC Cancer Program and newly named executive director of UTHSC Oncology at Regional One Health. “This is truly a unique research study that combines contributions of experts around the U. S. and the world, with the sole objective of conquering colorectal cancer,” Dr. Shibata said.

Colorectal cancers start in the colon or rectum. According to the American Cancer Society, colorectal cancers account for 10% of the approximately 19 million new cancer cases diagnosed worldwide last year. In recent decades there have been major improvements in colorectal cancer survival. But alarmingly, trends in recent years show colorectal cancer incidence and mortality is on the rise in people under age 50 (early onset colorectal cancers.) Racial and socioeconomic disparities are prevalent among those most likely to die of the disease.

The ColoCare Study seeks to make a major impact in understanding how to reduce suffering caused by colorectal cancers.

In its first five years, the study sites engaged more than 3,300 people diagnosed with colorectal cancers to participate in the research. The international network is a key feature of ColoCare, providing


insights from diverse patients across a variety of geographic areas. The ColoCare Study has been the basis of innovative research in nutrition, exercise, medication use, diet, quality of life, blood and tumor markers, and the gut microbiome, among many others. “It is becoming increasingly apparent that not all colorectal cancers are the same and the ColoCare Study will help advance knowledge to further personalize treatments for patients,” Dr. Shibata said.

Other insights from the first phase of the study include new clues about the relationship between inflammation and patients most likely to experience significant quality-of-life side effects, like cancer-related fatigue. Another avenue explored how high levels of physical activity among colorectal cancer patients improved outcomes. Researchers also learned that while obesity and colorectal cancer are closely related, the particular location of the fatty tissues in the body— rather than a measure like body mass index—was far more useful in terms of predicting potential negative outcomes.

Recruiting more early-onset cancer patients is a principal focus area of the next five years of funding. The team will also work to better understand the unique needs of patients who live in rural areas and have limited access to health care, and patients who are part of diverse racial and ethnic groups, including those who are Hispanic or Black. The team will also continue to deliver insights using sophisticated techniques to understand how tumor biomarkers, meaning substances in the blood or tissue that can indicate characteristics of a tumor, can be used to inform outcomes. Patients provide key insights about risk factors for colorectal cancer outcomes, including health behaviors, dietary patterns, and more.

The ColoCare Study was initially launched at UTHSC in 2016 and currently is primarily recruiting patients at Regional One Health. “I am extremely grateful to the hundreds of patients in the Memphis community who have already participated, as well as to those future patients who will help us to make a significant difference in improving outcomes for individuals affected by this disease,” Dr. Shibata said.

15 Q ResearchI

Scan me for more information.


Financial Q&A

Protecting your investment portfolio

I inherited an individual retirement account (IRA) from my father in 2020. I was told the SECURE act that passed in 2019 would allow me to take distributions anytime within 10 years of his death as long as the entire balance was distributed at the end of that period. As a result, I have not taken any distributions since the account was opened in 2020. I recently heard there was a rule change for inherited IRAs. Will this affect how I should take distributions from this account?

Your distribution plans might be affected by a recent IRS interpretation of the 10-year rule. Based on the guidance provided, if a non-spouse beneficiary inherited an IRA from someone who already started taking their required minimum distributions (RMD), then the beneficiary must continue taking annual distributions from the inherited IRA account in years 1 through 9 and then take the balance in year 10. If the original IRA account owner had not reached the required beginning date for distributions, then the non-spouse beneficiary does not have to take annual distributions or RMDs and they can wait until year 10 to take a distribution of the entire account balance. The calculation for the beneficiary’s RMD is based on the ending account balance for the previous year and an IRS life expectancy factor for the beneficiary’s age. For subsequent years, the calculation process is repeated using the year-end account balance and a reduction of one to the IRS life expectancy factor.

Find out if your father was taking RMDs prior to his death. If the answer is yes, you should start annual distributions from the inherited IRA. If not, you can continue to wait until year 10 before the balance needs to come out. The IRS has not provided guidance on 2021 distributions that should have been taken and were not based on this new interpretation. They may retroactively require those inherited IRA account owners to take the 2021 distribution this calendar year on top of the 2022 distribution. Then again, they may just decide to move forward and not penalize anyone for a missing distribution. A 2022 distribution from your inherited IRA might be a prudent plan of action regardless of the situation. At a minimum, it will satisfy the annual requirement for 2022 and help you avoid the IRS penalty. While the IRS may require a minimum inherited IRA distribution, you always have the option to withdrawal any amount over the minimum if you choose. I suggest you revisit the situation later this year to see if the IRS has provided further guidance and consult your financial advisor if you have additional questions about account distributions and the IRS rules for inherited IRAs.

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

QFinancial Q&AI

2022 Legislative Summary

The 112th Tennessee General Assembly adjourned on April 28, capping an eventful two-year term that saw legislators convene a total of five times due to three special sessions. Below is a summary of TMA legislative activity and how its top priorities fared during session.


SB1846 Sen. Bo Watson (R-Hixson)

HB1843 Rep. Bryan Terry, MD (R-Murfreesboro)

Expands Telemedicine Coverage

Expands the definition of provider-based telemedicine to include coverage for HIPAA-compliant audio-only encounters when access to audio-video is unavailable. Specifies that “unavailable” means a patient does not own the technology to conduct an audio-video encounter; the encounter cannot take place due to lack of service; or the patient has a physical disability which inhibits the use of video technology.


SB2453 Sen. Ken Yager (R-Kingston)

HB2655 Rep. David Hawk (R-Greeneville)

Removes Payment Parity Repeal Date

Removes the sunset date of April 1, 2022 to enable payment parity for telehealth services to continue beyond the pandemic. Clarifies that the 16-month requirement for telemedicine encounters does not apply during a declared state of emergency.


SB1310 Sen. Joey Hensley, MD (R-Hohenwald)

HB677 Rep. Mark Hall (R-Cleveland)

Reforms Step Therapy Protocols

Requires health plans and utilization review organizations to provide a clear, readily accessible, and convenient process for a patient or prescribing practitioner to request a step therapy exception. Specifies conditions in which an exception must be granted including when the drug is contraindicated or may cause an adverse reaction; the drug is expected to be ineffective; the patient has already gone through step therapy under a different health plan; or the patient is stable on a drug covered by a previous health plan. TMA provided an amendment to clarify that only one, not all, requirements must be met in order to obtain an exemption from step therapy. The bill will not apply to TennCare or state-funded plans but will apply to all commercial plans.


SB2219 Sen. Richard Briggs, MD (R-Knoxville)

HB2705 Rep. Michele Carringer (R-Knoxville)

Bills Reviewed: 1,467Bills Tracked: 248 Bills Amended: 13 Bills Defeated: 11Bills Passed: 7


SB2511 Sen. Becky Massey (R-Knoxville)

HB2537 Rep. Ron Gant (R-Rossville)

Allows for Site Visits by HIPAA-Compliant Means

Allows 10 of the required 12 annual site visits by collaborating physicians with APRNs and PAs to be conducted by HIPAA-compliant electronic means instead of in person. TMA’s amendment extends the authorization for federally-qualified health centers to arrange for 100 percent of chart review to be remote, joining free clinics, community mental health centers, and volunteer healthcare providers.


SB176 Sen. Jon Lundberg (R-Bristol)

HB184 Rep. Bob Ramsey (R-Maryville)

Eliminates Collaborative Practice Agreements

Would have eliminated the requirement for APRNs to maintain formal collaborative relationships with physicians except for those in their first three (3) years of practice, and expanded their scope to allow diagnosis and treatment without physician delegation. The bill would also have allowed APRNs to perform invasive procedures like spinal blocks, determine cause of death, and sign death certificates. Additionally, it would have eliminated the certificate of fitness requirement under current law, meaning an APRN license from the Board of Nursing would have equaled prescriptive authority for all legend and controlled drugs. The Senate Commerce and Labor committee will convene a summer work group to try to facilitate

requirements set forth in law and created a disciplinary record that would unnecessarily follow a physician the rest of his or her career, even if he or she was completely compliant with treatment and recovery. Although TMA offered an amendment, it was not accepted by the sponsor. The legislation failed on a voice vote following testimony by TMA and the Tennessee Medical Foundation (TMF).


SB2775 Sen. Mike Bell (R-Riceville)

HB2629 Rep. Mark Cochran (R-Englewood)

Eliminates Collaborative Practice Agreements

Would have authorized PAs with more than 6,000 hours of clinical practice to practice under a written collaboration statement signed by either the employer or a physician. Employer was defined as: 1)an entity that is organized to deliver healthcare services in this state (including PCs and PLLCs), 2) a group or medical practice that is part of a health system, or 3) a physician who employs a PA. PAs with less than 6,000 hours of clinical practice would practice in collaboration under a specific physician or a PA with more than 10,000 clinical hours. TMA will work toward resolution with both PAs and APRNs in the summer study called by the Senate Commerce and Labor committee.


SB2465 Sen. Shane Reeves (R-Murfreesboro)

Physician Wellness




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