Memphis Medical Society Summer Quarterly 2018

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Volume 21, Number 2

Summer 2018

Member Spotlight: Marion Boyd Gillespie, M.D., MSc, FACS

Feature: A House of Doctors

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In our world,

STAYING SHARP has nothing to do with your instruments.

We strive to bring the latest theories and practices right to our physicians through online and in-person education and consultation.

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svmic.com | 800.342.2239

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Editorial Thomas C. Gettelfinger, M.D. Graphic Design Allison Cook 2018 Board of Directors President Autry J. Parker, M.D. President-Elect Andrew Watson, M.D.

contents Volume 21, Number 2

Features

Vice President Danielle Hinton Hassel, M.D.

12 14

Treasure David L. Cannon, M.D.

Every Issue

Secretary Justin Monroe, M.D.

Immediate Past President Phillip R. Langsdon, M.D.

Frederick A. Fielder, M.D. W. Clay Jackson, M.D., DipTh Jimmie Mancell, M.D. Christopher M. Pokabla, M.D. Walter Rayford, PhD, M.D., MBA Lisa S. Usdan, M.D. Lindi Vanderwalde, M.D. Raymond R. Walker, M.D. JoAnn Phillips Wood, M.D.

Summer 2018

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Member Spotlight A House of Doctors

Editorial Your President’s Lettter Your Society At Work Your Legislative Update Your Community New Members Students at House of Delegates Your Bulletin

Ex-Officio Board Members Perisco Wofford, M.D., President of Bluff City Medical Society Karen Adams, President of Mid-South MGMA

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The Memphis Medical Society Quarterly

your editor

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Thomas C. Gettelfinger, M.D.

THE THINGS YOU LEARN It’s more than basketball….

I recently attended the annual Great Conversations event hosted by Tom Menon, Dean of the College of Arts and Sciences at the University of Memphis, and Carolyn Dickens, Director of Development for the College. The purpose of the meeting was to introduce U of M faculty to the community, particularly to members of the Advisory Committee of the College. Faculty members conduct an informal conversation, over dinner, and at a series of tables, with topics ranging from Terrorism by Verena Erlenbusch, Assistant Professor of Philosophy; to The Metabolism of Rome: How to Provision a City of One Million People in Antiquity by Benjamin Graham, Assistant Professor, History; to What Makes Kin: Contemporary Philosophical Reflections on Kinship by Mary Beth Mader, Professor and Chair, Philosophy. And, topics from a number of other faculty members. They are somewhat like Ted talks and judging from the interest and noise from the different tables, each was well received.

I chose the table of Duane McKenna, Associate Professor Biological Sciences: An Inordinate, Fondness for Beetles. At first thought you might think: Say, What? I can assure you the topic was fascinating, ranging from ecology to symbiosis to genetics to new ideas of how beetles fit within The Tree of Life (a term new to me, re-organizing life forms into related groups). With a PhD from Harvard and a continuing appointment there, I can assure you Dr. McKenna is a complete master of the subject, engaging, and I suspect, a great mentor to his students. In fact, he feels that his students, as they reach junior and senior years are prepared for graduate work at any University, no matter how daunting the reputation.

That naturally led me to the College of Medicine, University of Tennessee, alma mater of many of you in the Memphis Medical Society. Over the past four years an average of 10 students matriculated at UTHSC from the U of M; an average of 34 applied. Rhodes, Christian Brothers, UT Knoxville are also well represented. For the medical class entering in 2017 there were 56 different colleges represented, 1947 applications, 268 acceptances, 170 enrollees, 107 men, 63 women. Tuition and fees for residents $35,063, non-residents $68,155. Most new medical students came from a science major background, with a few nonscience majors.

I don’t know what you might make of this, but I conclude that one can get a good education at the University of Memphis and at our other local colleges as well. So support your college alma mater.

If it happens to be the University of Memphis, you might even want to join the College of Arts and Sciences Advisory Board.

It is more than basketball.

Summer 2018

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Get back into the swing of things with minimally invasive spine surgery.

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your president

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Autry J. Parker, M.D.

The Law of Unintended Consequences?

The opioid crisis is real and there is plenty of blame to go around. But not all of us are at fault. I witnessed the epidemic first hand as a pain physician for 25 years. We look back and blame the drug companies who marketed the “pain relief ladder,” the pain societies and the Fifth Vital sign.

In our zeal to address an unmet need to relieve pain, we liberalized the use of medications that historically had been shown to be dangerous. Unintended consequences.

Now in our zeal to eliminate an overdose crisis, we may be eliminating a valuable tool that millions have used to control their pain and lead functional lives. Unintended consequences.

Your Tennessee Assembly passed SB2257/HB1831 (aka Governor Haslam’s opioid bill or the TN Together Plan), which is being touted as the country’s most comprehensive and restrictive opioid legislation.

The mandates of strict limits on prescribing and erecting checks on legitimate patients and prescribers I fear will result in many physicians foregoing opioid prescriptions altogether. Many more patients will be sent to the very clinics that have been deemed to be a big part of the problem or to our already-crowded emergency rooms. Unintended consequences.

While it’s not the most physician-friendly bill in the world, we still need physician leadership on this and other issues in our state. TMA and MMS are currently taking suggestions for its 2019 Legislative Agenda.

I encourage you to email info@mdmemphis.org with your suggestions on addressing our next challenges.

We have a long way to go to address the greater problem of addiction in our country. We need a comprehensive community plan to address addiction. Continuing to stomp out individual fires (today it was opioids, yesterday it was methamphetamine and bath salts, tomorrow it may be a drug we haven’t heard of yet) won’t solve the greater problem.

I am encouraged and eager to see the fruit from the Shelby County Opioid Task Force, in which our EVP Clint Cummins participated. It was led by outgoing Shelby County Commissioner Heidi Shafer. May it be a step in the right direction for our community and beyond.

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YOUR

BENEFITS

new website a bonus to members

As President, I have the honor of annoucing that our new web site is officially launched. A big thank you to Dr. Phillip Langsdon for spearheading this effort and to the MMS staff led by Allison Cook for getting us to this point.

We have three objectives on the site:

1) Find a Doctor

2) Find Staffing for your Practice 3) Find a Job

We need you to review your profile on the site, offer changes and submit information that will make you easy to find, such as procedures, specialties and other information related to you and your practice. We are investing a lot of time, energy and funds to make this site support you in living a better personal and professional life. Stay tuned as we are adding information to the site daily. —Autry J. Parker, M.D.

www.mdmemphis.org

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The Memphis Medical Society Quarterly

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Hiring g in H lth Healthcare?

da Need are Job? Healthca

We staff We offfer Director of Operations, CEO, Direct hire, Teemp-to-hire, ositions and Medical Coder, RN, CRNA Permanent po and many others Part timee jobs

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MedTemps is accredited by The Joint Commissiion, and is a division of The Memphis Medical Socieety y

Summer 2018

Learn more at www.mdmemph his.org

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working for you

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Members headed to Nashville to lobby on behalf of patient- and physician-friendly laws.

This year’s issues included: •

your

SOCIETY

•

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Above, from left to right: Clint Cummins, Keith Anderson, M.D., David Cannon, M.D., Senator Brian Kelsey, O. Lee Berkenstock, M.D., Kay Anderson, Dale Criner, M.D.

• • • • •

Supporting Prohibition of Mandatory Maintenance of Certification

Supporting Halting Episodes of Care Supporting Balance Billing Transparency Supporting Prohibition on Minors’ Use of Tanning Facilities

Amending Opioid Legislation

Above, from left to right: Catherine Womack, M.D., Lisa USdan, M.D., Alex Galloway, M.D., Senator Sarah Kyle, Keith Anderson, M.D., Kay Anderson, Nate Henry, M.D., Surabhi Rao, M.D.

Left: The entire bus load gathers at the drop off point outside the capital before heading to their respective meetings. Members had appointments throughout the day with a break for lunch, and an evening reception, hosted by TMA.

The Memphis Medical Society Quarterly

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Above, from left to right: Jimmie Mancell, M.D., Representative Antonio Parkinson, Gerald Presbury, M.D.

February

Board Meeting Summaries

•

Judge David Rudolph and his wife, Elizabeth Rudolph, visited the Board. He is running for a four-year term in Circuit Court Division 9.

•

Dr. Susan Nelson reported on the Family Medicine Training cutbacks at UTHSC. Starting in 2018, clerkships will be shortened from eight to six weeks.

•

Dr. O. Lee Berkenstock reported that physicians won a judgement against the TennCare’s audit and recoupment demands.

Summer 2018

Above, from left to right:Catherine Womack, M.D., Lisa Usdan, M.D., Senator Lee Harris, Keith Anderson, M.D., Kay Anderson, James Ensor, Jr., M.D.

•

•

April

Mr. Russ Miller, CEO of TMA, visited the Board. He reported that the House of Delegates meeting will focus on future policy, while the Legislative session is coming to a close.

Board voted to continue to fund student travel to the AMA conference. Each Board member made a personal donation.

May

•

Several members of Cox Health Marketing sponsored the meeting and presented about physicians marketing their practices to gain patients.

•

Twenty one new members were accepted by the Board through a group Methodist Healthcare agreement.

•

Communications Committee reported the new web site was launched successfully.

•

Volunteers to serve on TMA Insurance Issues Committee were requested.

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your hospitals

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Methodist University Hospital Earns Two Awards from the American Heart Association

Methodist University Hospital has received the American Heart Association/American Stroke Association’s Get With The Guidelines® Stroke Gold Plus Quality Achievement Award. This award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines. MUH has the only Comprehensive Stroke Center in the Mid-South.

MUH earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients.

Additionally, MUH received the American Heart Association’s Target: Stroke℠ Elite Honor Roll Quality Achievement Award. To qualify for this recognition, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA.

Advancing Lung Cancer Treatment at Baptist Cancer Center: Systematic Process Leads to Earlier Detection of Malignant Lung Disease

The Incidental Pulmonary Nodule Program at Baptist Cancer Center is now in its third year. Through this program, doctors have seen more than 400 patients and diagnosed more than 120 cases of lung cancer. Three out of four of these patients were in stage 1—when the cancer can most likely be cured. This is significant because most lung cancers are found when the cancer is too advanced to cure. But through Baptist Cancer Center’s program, patients who have indications of early lung cancer on radiographic chest scans, such as Xrays, CT scans and other types of imaging, taken for other reasons are tracked and monitored.

For example, a patient who might need a scan for heart attack, heart failure, abdominal pain or trauma, could have a potentially malignant lung disease that has not been found. The Incidental Pulmonary Nodule Program allows BCC doctors to track such patients with their permission and that of their doctors. This tracking system helps reduce the risk that such patients’ cancer will not be treated until it is widespread and too late for a cure.

The program was initially funded by a grant from the Baptist Memorial Health Care Foundation.

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The Memphis Medical Society Quarterly

your hospitals

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Regional One Health has continued to expand services at their East Campus, located at the Kirby exit of 385

The East Campus houses specialty physician offices including a multispecialty care site that offers a one-stop shop for patients to see multiple providers in one space, including internal medicine, cardiology, endocrinology, nephrology and rheumatology. The East Campus houses other outpatient services including imaging, rehabilitative medicine and a pharmacy.

The East Campus Imaging Center has the capacity to get patients in quickly for diagnostic imaging services and offers the most current diagnostic tools physicians rely on for their patients. The Imaging Center’s alldigital capabilities and on-site, board-certified radiologists provide patients with quality diagnostic testing, leading to more rapid diagnosis and treatment. The center offers unique imaging services including elastography and diagnostic mammography and ultrasound. Diagnostic services include MRI, CT, 3D mammography, ultrasound, x-ray, fluoroscopy and bone density.

To make an appointment at the East Campus Imaging Center, call (901) 515-3600. Regional One Health East Campus is located at 6555 Quince Road, where 385 crosses Kirby Parkway.

Free joint pain seminars can help conquer daily pain

June 28, 2018- Saint Francis Hospital-Bartlett, Magnolia Room Tyler Cannon, M.D.- Aches, Breaks, and Scrapes-Common Orthopedic Injuries and Treatment Approximately one of every four Americans has an orthopedic impairment. This seminar will provide information regarding some of the most common conditions and treatments.

July 26, 2018- Saint Francis Hospital-Memphis, Oak Room Peter Lindy, M.D.- Minimally Invasive Knee Surgery and MAKOplasty Minimally invasive knee surgery involves the use of smaller incisions that can result in less pain and a faster recovery. Find out more about this and other options to conquer your knee pain.

August 30, 2018- Saint Francis Hospital-Bartlett, Magnolia Room Marcus Biggers, M.D.- Shoulder Pain Shoulder pain can affect a variety of activities from throwing a ball to scratching your back. This seminar will provide information about what may be causing your shoulderpain and the various treatment options available.

Summer 2018

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MEMBER SPOTLIGHT

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The HPV Throat Cancer Epidemic: A Brief Update

M. Boyd Gillespie, MD, MSc, FACS

Otolaryngologist, Head and Neck Surgeon, Methodist University Hospital Professor and Chair, UTHSC Department of Otolaryngology-Head & Neck Surgery

Noticing a recent lump in his neck, a 52-year old man makes an appointment to see his doctor. The lump is not painful, and he doesn’t have any symptoms of sore throat, sinusitis, or a skin or ear infection. On examination, he has a three-centemeter, right upper neck mass that isn’t tender. The man doesn’t have a fever and other than the lump in his neck has a normal physical examination. He does not have a history of tobacco exposure and only moderately drinks alcohol. His doctor prescribes an antibiotic in case it is an infection, and he tells his patient to follow-up if it does not improve.

Two months pass and the man develops an unusual earache and calls his doctor. The doctor finds that the ear appears normal, but his right tonsil is enlarged, and the right neck node is now larger. His doctor refers him for an ultrasound-guided fine needle aspiration, which shows squamous cell carcinoma. The man is confused about having throat cancer since only smokers are supposed to get throat cancer.

Oropharyngeal squamous cell carcinoma (OPSCC) is throat cancer that involves the tongue base, tonsil, soft palate, and posterior pharyngeal wall. Human Papillomavirus (HPV) is currently implicated in 70% of cases of OPSCC. The incidence of OPSCC is increasing and predicted to overtake HPV-associated cervical cancer by 2020. HPV(+) and HPV(-) OPSCC are two distinct diseases, with different demographics, survival, symptoms radiosensitivities, and molecular pathogenesis. The virus has greatly changed our paradigm of mouth and throat cancer.

The Memphis Medical Society Quarterly

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HPV(+) OPSCC begins with oral HPV infection which is present in 15 million Americans (7%) at any given time and is significantly higher in men than women. High-risk HPV 16 infection, the strain associated with over 90% of HPV+ OPSCC, is found in 1% of all Americans. The natural infection is not completely understood, but most infections clear in a year for immunocompetent individuals. The tetravalent vaccine (Gardasil™, Merck, Sharp and Dohme) covers strains HPV 6 and 11, responsible for genital warts, and 16, and 18, responsible for cancers. The vaccine is effective in preventing premalignant genital lesions in both sexes and is predicted to protect against oral HPV infection.

Vaccines do not treat established infections, and only 53% and 7% of adolescent American girls and boys, respectively, have received at least one dose of the series of three that are required. With HPV causing cancers of the cervix, anus, penis, vagina, vulva, oropharynx, and other head and neck sites, continued educational and vaccination efforts are critical to reduce these preventable cancers and promote herd immunity.

It is critical that cancer is considered in certain circumstances involving patients who have a sore throat, and that these patients get referred to a specialist. Early detection depends upon direct visual examination.

Oropharyngeal examination is challenging, especially for base of tongue tumors and lesions that begin in deep tonsillar crypts. Often, a specialist will be able to view these areas with flexible transnasal endoscopy which is easily performed in the office setting. Diagnosis of OPSCC requires pathological analysis of biopsies from visualized lesions or fine-needle aspiration biopsy of neck masses. Routine p16 immunohistochemical staining can quickly and accurately suggest HPV involvement.

Summer 2018

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Left: Lisa Usdan, M.D. with husband David Portnoy, M.D., and their two children.

The daily workload of a physician can be overwhelming, but what if your spouse was also a physician?

@

Hous_

of

Do]tors

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Right, from left to right: Thomas Arnold, M.D., with his wife, Valerie Arnold, M.D., and another double doctor couple, Cathy Chapman, M.D., with her husband, George Woodbury, M.D.

We reached out to members who are married to physicians to see how they wrangle schedules, house work and even kids!

The Memphis Medical Society Quarterly

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Thomas W Arnold (Neurology) President, Neurology Clinic PC & Valerie K Arnold (Psychiatry) Chief, Child and Adolescent.

Psychiatry UTHSC and CNS Healthcare What is the best aspect of being married to another physician?

They understand why you might be running late and why it was a really hard day.

What is the most difficult aspect of being married to another physician?

Dual schedules and not having someone who can easily wait at home for repairmen.

Do you “talk shop” at home?

Yes, but never with patient names. It is usually when it has something to do with the other person’s speciality, and they might be able to help.

Are most meals eaten together or separately?

Weekends together, weekdays not so much. We made more of an effort when we had kids at home.

Takeout or home cooked?

Both, home during the week and takeout on the weekend.

What’s the most common phrase said at your house? Do you want coffee before you go?

What’s something you’ll never hear said at your house?

I am caught up.

If you have older children:Are they interested in practicing medicine?

One daughter is a pediatric intern, one is graduating law school and one is getting a PhD in educational policy.

Is there something you two do to stay connect through your busy schedules?

Thomas is great about making breakfast on Sunday, and we usually stay in bed and read the paper and catch up.

We are both pretty independent, and we trust that everything is okay because we know that if it wasn’t, we would know.

Do you have tips or tricks of advice for other double-physician households?

Divide and conquer. Do the stuff you don’t mind doing, leave the other stuff to them. If there is something you both don’t like, find someone to do it. Talk to them before taking on big projects.

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Lisa Usdan, MD, FACE (Endocrinology) CNS Healthcare and UT Methodist Physicians & David Portnoy, MD, FACP (Hematology and Oncology) The West Clinic

What is the best aspect of being married to another physician?

The best part of being married to another physician is that we speak the same language.

We are both patient with each other’s professional responsibilities and work schedules. We understand the emotional and mental challenges that the other person goes through when they are at work, and we can support each other when times are rough.

What is the most difficult aspect of being married to another physician?

Our greatest challenges revolve around finding the time to do everything we want to do for our families, our careers and ourselves. We both wish we could find a way to have a few more hours in each day!

Do you “talk shop” at home?

It definitely happens! As spouses we are best friends and as professionals we value each other as colleagues. It is always nice to have an expert at home you can turn to when you need to bounce an idea off someone.

Are most meals eaten together or separately?

Breakfast is shared on the weekends, and we try and eat dinner together as often as possible as a family at the table without screens. We know it can’t happen every night, but we do the best we can!

Takeout or home cooked?

We typically eat a home cooked meal most nights. Lisa loves to cook, and we both love taking advantage of local foods. We try to incorporate lots of “colors” in our meals. Lisa loves seeing a “rainbow” of foods on our plates at night. Eating at home is a challenge with our jobs and our kids’ activities. Our crockpot is in use every week!

Who is better at the laundry?

We marvel at the quantity of laundry our family of four makes. It is never ending. Laundry has fallen almost exclusively into Lisa’s domain. This is something that seems to work well for us. As our girls get older, they are helping out more with this as well.

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The Memphis Medical Society Quarterly

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What’s the most common phrase said at your house?

Our youngest daughter is often skeptical of things we tell her, and she frequently asks us, “for real?” We now are perpetually asking each other “for real?” as we share details of our days!

What’s something you’ll never hear said at your house?

“Take your time, we are NOT running late!”

If you have young kids: Who does daycare/school drop off and pick up?

Lisa drops off our kids at school each day, and Dave picks up one or both kids one day a week while Lisa is in clinic. We do have to be flexible for early meetings and will occasionally have to call in the “village” (grandparents) to help with this as well.

How do your kids describe each of your jobs?

Dave is known as a “blood doctor” and Lisa is a “sugar doctor.” Our girls think of us as working in an office just like their pediatrician.

If you have older children, are they interested in practicing medicine?

Our kindergartener has expressed interest in being a ladybug doctor, ballerina, and ice skating teacher--all at the same time--when she grows up. Our third grader wants to be a pop star or an astronaut.

How do you juggle school obligations, i.e., programs, recitals?

We try to put everything on our master calendar, and make sure we communicate as early as possible about things, but we also recognize that we can’t both be at everything Do you have tips or tricks of advice for other double-physician households?

The key to our family is communication and organization. We met during our intern year while working at different hospitals in Philadelphia. Balancing out our call schedules has always been a part of our relationship. As our family has grown, we have evolved our schedules to match our priorities and maximize our time together.

Summer 2018

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Your 2018 Legislative Recap

It’s another year of legislative success and progress for the Society and TMA. What you may not know is that much of the progress made on healthcare legislation begins or runs through Memphis on its way to Nashville.

Our local Legislative Committee is chaired by George Woodbury, M.D., and co-chaired by Catherine Womack, M.D. Throughout the year, our committee is focused on meeting candidates locally and making sure they know what issues impact our local physicians. You can get active in our Legislative Committee by calling the Memphis Medical Society office at 901.761.0200, or emailing ccummins@mdmemphis.org and asking to be added to our meetings list.

Don’t forget to join us for Meet the Candidates sessions in June and our Legislative Reception at Buckley’s Lunchbox on Monday, November 12th.

TMA is the largest advocacy organization for physicians in the state, and in 2018 had one of its most active and successful legislative sessions in recent history. TMA lobbyists reviewed hundreds of bills and amended, supported or defeated more than 50 pieces of legislation impacting Tennessee physicians and/or patients.

Opioids: While TMA did not proactively support any opioid-related bills, it was no surprise that the state’s number one public health crisis became the legislature’s number one debate. From the moment Governor Haslam announced his “TN Together” plan in January, TMA was actively involved in communicating doctors’ concerns to lawmakers to ensure that any related laws did not interfere with physicians’ appropriate medical discretion or obstruct patients in legitimate pain from getting the care they need. TMA was able to negotiate important amendments to improve the governor’s proposal but the new laws, effective July 1, 2018, represent the most comprehensive and restrictive opioid laws of any state. TMA has developed proprietary information to help educate members on the new Summer 2018

prescribing restrictions, along with a number of other opioid-related resources, at tnmed.org/opioids.

Maintenance of Certification: Thanks to TMA, Tennessee now has one of the most physicianfriendly MOC laws in the U.S. In 2017, TMA responded to members’ requests to ease the burdensome and costly MOC requirements by passing a law prohibiting MOC as a condition of medical licensure in Tennessee. Laws passed in 2018 prohibit health insurance companies from requiring MOC as a condition for network participation and allows individual hospital medical staffs to determine whether MOC is a requirement for hospital privileges.

Midlevel Scope of Practice: TMA in 2016 negotiated a three-year moratorium with the Tennessee Nurses Association on any scope of practice legislation, so there were no bills in 2018 related to APRN independent practice. There was a contentious debate in the legislature, however, surrounding a proposal for a new scope of licensure for physician assistants Lincoln Memorial University sought legislation that would allow graduates of LMU’s Doctor of Medical Science degree program to practice in primary care as “doctors of medical science.” TMA was opposed to the bill in 2017 and 2018 and changed its position to neutral only after the proponents addressed all of physicians’ concerns, including changing the licensure name from “doctor of medical science” to “Essential Access Practitioner.” EAPs would have also been regulated by the Board of Medical Examiners in a physician-led, team-based care healthcare delivery model. The bill was withdrawn late in the session and LMU has said it does not intend to revisit. Read more about what happened with this bill in the Q2 issue of Tennessee Medicine magazine, or watch a brief video highlighting myths vs. facts about what the bill did and where TMA stood.

Indoor Tanning Prohibition for Minors: TMA led a coalition of healthcare organizations that helped reduce the risk of children contracting melanoma and 19

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other forms of cancer by persuading lawmakers to prohibit anyone in Tennessee younger than 16 from using indoor tanning devices. The new law requires parental consent for 16 and 17-year-olds to use tanning beds.

Balance Billing: Legislators continue to look for ways to address their constituents’ complaints about “surprise medical bills,” including considering proposals to ban the practice altogether or lift the ban on corporate practice of medicine. TMA defeated numerous proposals again in 2018 that would have eliminated hospital-based physicians’ ability to balance bill patients for services provided out of a health plan network. TMA continues advocating for a reasonable solution for all stakeholders, especially physicians and patients, and opposes any effort that gives health insurance companies even more undue leverage to force providers to accept unfair contractual terms.

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Episodes of Care: No bills were passed in 2018 related to TennCare’s episodes of care payment model but TMA continued its longstanding efforts to educate lawmakers on physicians’ concerns about fundamental flaws in the program design and implementation.

Discussions are ongoing with key officials in the TennCare Bureau and legislative committees, and TMA has redoubled its advocacy efforts to ask the state to pause any new episodes so it can fix the issues.

Tort Reform: TMA claimed an early legislative win in November 2017 when it announced that a Georgiabased group ended its three-year push to dismantle Tennessee’s medical malpractice system and replace it with a government-run administrative system. TMA constantly monitors threats to the malpractice climate and routinely fends off special interest groups that challenge caps on noneconomic damages, which keeps premiums low and have reduced the overall number of malpractice cases by nearly 40% in the past several years. See at tnmed.org/tortreformROI.

The Memphis Medical Society Quarterly

keeping yourself fiscally fit

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William B. Howard, Jr., ChFC, CFP

Question: I’m a 50-year old physician with an investment portfolio worth approximately $5 million. My investment portfolio has performed well over the last couple of years, but the recent increase in market volatility concerns me. What can I do to protect my investments from significant losses?

Answer: History shows us that stock market corrections are inevitable and a natural part of the market cycle. The recent decline in domestic equities (S&P 500) was modest, but not necessarily a bad thing for the long-term health of the current nine-year bull market. In fact, market corrections provide great opportunities to purchase quality companies at attractive valuations. While no investment strategy can guarantee positive returns, investors can mitigate the negative effects of market volatility by following these tips: • • • • • • •

DO

Be patient Remain invested Maintain a diversified portfolio Monitor your investments Understand your risk tolerance Set realistic expectations Consult your financial advisor periodically to ensure that you are on track

• • • •

DON’T

Panic Make emotional investment decisions Attempt to time the market Lose focus of your long-term financial goals

William Howard & Co. Financial Advisors, Inc. Fee only Financial Planning and Investment Advisory Services

William B. Howard, Jr., ChFC, CFP

International Place II 6410 Poplar Ave., Suite 330 Memphis, TN 38119 Telephone: (901) 761-5068 Facsimile: (901) 761-2217 E-mail:whoward@whcfa.com Summer 2018

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your community

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Memphis gets smart about 911 usage Thanks to an IBM Smarter Cities Challenge Grant The 911 emergency call service is vital to a city, and Memphis is no exception. Calling 911 connects citizens to emergency responders in record time, with the fire department usually the first on the scene. Over the past six years, the call volume to 911 has steadily been rising up to 12% each year. With no additional ambulances in service, the drain on the system was taking a toll.

“On average, 25% of 911 calls are actually non-emergency, low acuity calls,” says Dr. Joe Holley, Medical Director of Memphis Division of Fire Services. “This population of high users is calling 911 more than three times a week, and some even more than three times a day, with non-emergency issues.”

He continues, “They may call regarding chronic medical problems, transportation issues and physiological needs. When our ambulances have to respond to these calls, they are not available when true emergency calls come through.”

In an effort to investigate, understand and find solutions to this issue, the city applied for and was granted a Smarter Cities Challenge grant through IBM. The grant provided a team of IBM’s top engineers to work with the city of Memphis, Memphis Fire Department and other healthcare shareholders to create a smarter plan on dealing with the misuse of the 911 system.

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One idea to come out of the team’s findings and suggestions was a six-month pilot program of a RADAR car. This non-ambulance vehicle carried a paramedic and a physician. “One in five calls to 911 are non-emergency at the onset,” says Kevin Spratlin, MS, NRP, Lieutenant, Healthcare Navigator Program, Memphis Fire Department.

“Then many are nonemergency once on scene.”

With the RADAR car, when a non-emergency call came into the 911 system, the dispatcher alerts the RADAR car instead of an ambulance. The paramedic ensures there is no real emergency, and the physician makes sure an emergency room visit is not needed.

Then the team set about to match the caller with his or her actual needs.

“Many in this high-user population really just needed to be referred to a primary care doctor,” says Dr. Holley. “Some do not have transportation to medical appointments and were using the ambulances for transport, while others presented with mental health issues.”

“These are social safety net issues that need addressing, but not with a 911 call and an ambulance,” he says.

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Spratlin continued, “These people are seeking healthcare, but they have a difficult time navigating the healthcare system,” he says. “The RADAR car was very successful because the fire department is a trusted resource in our community. Citizens know that we always show up. They let us in their homes, and we don’t ask about insurance before caring for them. We are able to get to know them, and help get them the help they need.”

This help reached from scheduling a primary care physician visit and explaining how to take medications to finding medical transport shuttles and getting social workers and mental health professional on board. “Paramedics are trained to deal with emergent issues,” says Spratlin. “We are now learning about long-term health issues, training on insurance guidelines and more.”

“We are facilitating connections with social workers, case managers, mental health professional and others for the broader good of our community and the healthcare pieces that affect it,” he says.

AFTER THE 6 MONTH PILOT PROGRAM

• More than 800 patients were helped

• 70% were successfully redirected to appropriate form of care

• 62% of patients were redirected away from emergency room

• 80% did not call 911 again within a week • 90% kept their primary care physician appointments

THE FUTURE

Although the pilot program is finished, the collaborators on this program are looking into ways and methods of further funding to make this a permanent piece of Memphis healthcare.

TennCare Pausing Episodes of Care Rollout

Memphis Medical Society along with Tennessee Medical Association, have been asking the state for a pause-and-fix since fall 2017. MMS and TMA last year increased their efforts to persuade TennCare to improve the transparency, accuracy and fairness of the program.

Tennessee physicians can now celebrate the announcement from TennCare that the state will temporarily stop expanding its episodes of care payment model. TennCare reports that it will not design future episodes to concentrate on improving and maintaining episodes already in place.

“After months of discussions and years of meeting about episodes, I am ecstatic to get this news that TennCare has agreed to pause expansion and work on what is in place to hopefully avoid more problems and frustrations in the future,” said Matthew L. Mancini, MD, a Knoxville surgeon and President of the Tennessee Medical Association.

TennCare now says it will continue to work on improving provider engagement and analysis of episode performance data. There will not be any Technical Advisory Groups (TAGs) held this fall and the following episodes will be paused:The 20 episodes in waves 10 and 11 that have not been designedThe five episodes with incomplete design due to data issues – Neonatal 31 weeks or less, Neonatal 32 to 36 weeks, Neonatal 36 weeks or more, Mastectomy, and Breast Cancer Medical OncologyAnxiety and Non-Emergent Depression episodes have been removed from the episodes program. For more information, visit www.mdmemphis.org.

Summer 2018

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current research

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help your patients stop smoking

Are you looking for a smoking cessation referral resource for your patients? The Fit & Quit program is a National Institutes of Health-funded research study at the University of Tennessee Health Science Center to help people quit smoking and maintain their weight.

People gain 10 pounds, on average, when quitting smoking. Ideally, there would be treatment “packages” that would not require people to choose between quitting smoking and substantial weight gain—the Fit & Quit program is working to create such a treatment package.

Participants in the study receive all treatment at no cost. The smoking cessation treatment includes six months of Chantix™ and phone-based sessions, which provides the medication to reduce cravings and the skills to quit smoking. Participants are also randomized to one of three promising approaches to weight management.

We are recruiting both men and women who live within 45 minutes of Memphis and have access to email and a phone. Participants will receive financial compensation for in-person follow-up assessments.

This program will be available for the next three years. Health care providers or interested individuals can call 901-448-2000, visiting www.fitandquit.org, or emailing fitquit@uthsc.edu.

new members

Joined in May

Rowena A. DeSouza, MD Urology The Urology Group 6029 Walnut Grove Rd Ste 300 Memphis, TN 38120-2112

Ravpreet Singh Gill, MD Anesthesiology American Anesthesiology of TN 1900 Exeter Rs Ste 210 Germantown, TN 38138-2954

Oluwatoyi J. Agbaosi, MD Internal Medicine Inpatient Physicians of the Mid-South 6263 Poplar Ave Ste 1052 Memphis, TN 38119-4736

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Emmanuel M Agapos, MD Internal Medicine Inpatient Physicians of the MidSouth 6263 Poplar Ave Ste 1052 Memphis, TN 38119-4736 New members from Methodist Healthcare: Vasanthi Balaraman, MD Nephrology UT Methodist Physicians 1265 Union Ave Ste 184 Memphis, TN 38104-3415

Laura Battle, MD Hospice & Palliative Medicine West Cancer Center 7945 Wolf River Blvd Germatown, TN 38138-1762

Amber J Evans, MD Internal Medicine Methodist Teaching Practice 1325 Eastmoreland Ave Ste 101 Memphis, TN 38104-3507

Arijit Chakravarty, MD Nephrology UT Methodist Physicians 1265 Union Ave Ste 184 Memphis, TN 38104-3415

John P. Gleysteen, MD Otolaryngology Methodist Healthcare 1325 Eastmoreland Ave Ste 260 Memphis, TN 38104-7549

Thomas B Beasley, MD General Surgery SPG II LLC 1264 Wesley Dr., Ste 302 Memphis, TN 38116-6445

Denis A Foretia, MD General Surgery UT Methodist Physicians LLC 1325 Eastmoreland Ave Ste 370 Memphis, TN 38104-7542

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Dabney J Hamner, Jr, MD Obstetrics & Gynecology Southcrest Women's Healthcare 1265 Union Ave. Memphis, TN 38104-3415

D. Neil Hayes, MD Hematology/Medical Oncology West Cancer Center 7945 Wolf River Blvd Germatown, TN 38138-1762

Ehud R Kamin, MD Internal Medicine Methodist Inpatient Physicians LLC 1265 Union Ave Memphis, TN 38104-3415

Lakshmi Krishnamurthi, MD Endocrinology, Diabetes & Metabolism Methodist Inpatient Physicians LLC 1265 Union Ave Memphis, TN 38104-3415

Jennifer J Lee, MD Internal Medicine/Pediatrics Methodist Inpatient Physicians LLC 1265 Union Ave Memphis, TN 38104-3415

Corbi D Milligan, MD Internal Medicine/Pediatrics Methodist Inpatient Physicians LLC 1265 Union Ave Memphis, TN 38104-3415

Micah Monaghan, MD Radiation Oncology West Cancer Center 7945 Wolf River Blvd Germatown, TN 38138-1762

Mary Brinson Owens, MD General Surgery Methodist Inpatient Physicians 1265 Union Ave Memphis, TN 38104-3415

Mehul B Patel, MD Interventional Cardiology Sutherland Cardiology-Specialty Physicians Group 7460 Wolf River Blvd Germatown, TN 38138-1760

Eric H. Reiner, DO Vascular and Interventional Radiology West Cancer Center 7945 Wolf River Blvd Germatown, TN 38138-1762

Summer 2018

Michelle G Sands, MD Internal Medicine Methodist Teaching Practice 1325 Eastmoreland Ave Ste 101 Memphis, TN 38104-3507

Douglas D Thaggard, MD Internal Medicine Methodist Inpatient Physicians 1265 Union Ave Memphis, TN 38104-3415

Aimee J Wing, MD Internal Medicine Methodist Inpatient Physicians 1265 Union Ave Memphis, TN 38104-3415

Kazi A Zaman, MD Internal Medicine Methodist Inpatient Physicians LLC 1265 Union Ave Memphis, TN 38104-3415 Interns/Residents/Fellows: William P. Adkins, MD Emergency Medicine

Cailin McKenna Frank, DO Pediatrics

Joined in June Jennifer Haaga Berger, MD Pediatrics Memphis Pediatrics PLLC 1255 S Germantown Rd Germantown, TN 38138

Christian Blake Bergeron, MD Pediatrics Pediatric Associates PC 3876 New Covington Pike Memphis, TN 38128

Jara Lavonda Best-Jones, MD Pediatrics Pediatric Consultants PC 1458 W Poplar Ave Ste 201 Collierville, TN 38017

Aimee M. Christian, MD Pediatrics Memphis Pediatrics PLLC 1255 S Germantown Rd Germantown, TN 38138

Janet W. Dellinger, MD Pediatrics Memphis Pediatrics PLLC 1255 S Germantown Rd Germantown, TN 38138

Charlotte J. Dick, MD Pediatrics Memphis Pediatrics PLLC 1255 S Germantown Rd Germantown, TN 38138

Robert M. Eiseman, MD Pediatrics Segal Parker Kronenberg Tsiu and Eiseman 920 Estate Dr Ste 3` Memphis, TN 38119

John W. Ellis, III, MD Pediatrics Pediatric Consultants PC 1458 W Poplar Ave Ste 201 Collierville, TN 38017

Nkiruka Chikaodili Ezenwa, MD Pediatrics LeBonheur Pediatrics 850 Poplar Ave Memphis, TN 38105

Noel K. Frizzell, MD Pediatrics Pediatric Consultants PC 777 Washingotn Ave Ste 410 Memphis, TN 38105

Amy Elizabeth Hubbard, MD Pediatrics Pediatric Associates PC 3876 New Covington Pike Memphis, TN 38128

Joel I. Kronenberg, MD Pediatrics Segal Parker Kronenberg Tsiu and Eiseman 920 Estate Dr Ste 3` Memphis, TN 38119

Leon O. Livingston, MD Pediatrics Pediatric Consultants PC 777 Washingotn Ave Ste 410 Memphis, TN 38105

Christopher L. Mathis, MD Pediatrics Pediatric Consultants PC 6215 Humphreys Blvd Ste 200 Memphis, TN 38120

Jane Elizabeth McAdory, MD OB/GYN Memphis OB/GYN Associates 7900 Airways Blvd Ste 2 Bldg C Southaven, MS 38671

Johnita K. Norman, MD Pediatrics Pediatric Associates PC 3876 New Covington Pike Memphis, TN 38128

Ruth Cheney Patton, MD Pediatrics Pediatric Consultants PC 777 Washingotn Ave Ste 410 Memphis, TN 38105

Landon B. Pendergrass, MD Pediatrics Pediatric Consultants PC 6215 Humphreys Blvd Ste 200 Memphis, TN 38120

Patrice Reed, MD Pediatrics Memphis Pediatrics PLLC 1255 S Germantown Rd Germantown, TN 38138

Dawn H. Scott, MD Pediatrics Pediatric Consultants PC 777 Washingotn Ave Ste 410 Memphis, TN 38105

Fatima Shahbaz, MD Pediatrics Segal Parker Kronenberg Tsiu and Eiseman 920 Estate Dr Ste 3` Memphis, TN 38119

Elizabeth Claire Simmons, MD Pediatrics Pediatric Associates PC 3876 New Covington Pike Memphis, TN 38128

Willie Tsiu, MD Pediatrics Segal Parker Kronenberg Tsiu and Eiseman 920 Estate Dr Ste 3` Memphis, TN 38119

Susan W. Warner, MD Anatomic.Clinical Pathology Pathology Group of the Midsouth 7550 Wolf River Blvd Ste 200 Germantown, TN 38138

Margaret Heath West-Hodges, MD Pediatrics Pediatric Consultants PC 6215 Humphreys Blvd Ste 200 Memphis, TN 38120

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Alan Flippin

Empowering Healthcare Consumers Digital Journey to Wellness

The ongoing and ever changing healthcare industry transformation creates challenges and opportunities for practitioners. The evolution from a fee for service payment system to a healthcare delivery model based on outcomes, patient satisfaction and quality is now the trend - fast becoming the norm.

This effects doctor "employees" and independents alike.

One of the most prominent trends we see is digital marketing overtaking traditional marketing channels.

Of course - that will never supersede the doctor to doctor and doctor to patient relationship being the most important factor.

Studies show that the greatest growth for diagnostic, medical device and pharmaceutical budgets are in digital marketing. Social Media is major factor (including MD ratings online) for choices on physician and services selection. Hospital providers are also shifting to digital channels to market to healthcare consumers.

These statistics* show why; • 77% of patients use search engines prior to booking appointments.

• Search drives nearly three times as many visitors to hospital sites, compared to visitors from other referral sites.

• 44% of patients who research hospitals on a mobile device schedule an appointment.

• Patients search symptoms online before and after appointments are made.

For specialty services and physicians, referring physicians still determine a majority of where patients are scheduled, but for non specialty, ambulatory and hospital services, digital sources are often a deciding factor; • 77% of patients searched using a mobile device or computer • 83% used hospital sites • 54% used health insurance sites • 50% used health information sites • 26% used consumer-generated reviews

As we have written about many times before, reputation management and the patient experience often converts in to digital information for others to view and decide. This is the single most important factor for Physicians and Healthcare providers to remember and focus on. Medicine is still a people business. *statistical source - Healthcare Trends 2016 26

The Memphis Medical Society Quarterly

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of

House

Delegates

Back row, L to R: Max Keeling (student at LMU), Russ Miller (CEO of the TMA), Troy Nold (student at ETSU), John Russell (student at UTHSC), Anderson Webb (student at UTHSC), Nate Henry (student at UTHSC) Front row, L to R: Matt Scott (student at UTHSC), Jennings Hardee (student at UTHSC), Glenn Harris (student at Vanderbilt)

Student leaders traveled to Nashville to take part in this year’s Tennessee Medical Association House of Delegates’ annual business meeting. They joined more than 150 doctors, representing a wide range of medical specialties, practice environments and geographic areas of the state. The group debated and set policies of the Association, transitioned leadership positions and honored individuals and organizations with awards.

L to R: Anderson Webb (student at UTHSC), Nate Henry (student at UTHSC), Jennings Hardee (student at UTHSC), Dr. Nita Shumaker (TMA past president), Matt Scott (student at UTHSC), John Russell (student at UTHSC), Troy Nold (student at ETSU)

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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.

your quarterly bulletin UPCOMING EVENTS

June 20—Meet the Candidates, Medical Society Office

June 20—Bluff City Medical Society meeting, Buckley’s Lunch Box June 27—Meet the Candidates, Methodist University Hospital July 4—Memphis Medical Society office closed

July 12—Resident Happy Hour, High Cotton Brewery

July 14—30th Annual Community Health Fair, UTHSC

July 18—Bluff City Medical Society meeting, TBD July 31—Memphis Medical Society board meeting

The Memphis Medical Society 1067 Cresthaven Road Memphis, TN 38119 901-761-0200 Fax: 901-761-2944

Executive Vice President Clint Cummins

Executive Assistant Janice Cooper

August 7—M1 Reception, Dixon Gallery and Gardens

September 15-16—TriMed Education Conference, Nashville

Memoriam

John M. Barron, M.D. William L. Bourland, M.D. Panduranga Jallepalli, M.D. William Michael Leppert, M.D. Jeffrey Alan Scrugham, M.D.

September 17, 1925—June 3, 2018 January 18, 1947—April 10, 2018 July 9, 1945—March 12, 2018 February 18, 1955—April 8, 2018 July 28, 1977—February 27, 2018

Communications, Membership Manager Allison Cook

Manager, Business Development Cailyn Bautista Finance Director Leah Lumm

MedTemps Director, Healthcare Staffing Freda Reed

MedTemps Administrative Coordinator Katie Yaun

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The Memphis Medical Society Quarterly

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GIVE YOUR FINANCES THE SAME CARE AS YOU DO YOUR PATIENTS.

In today’s uncertain markets, having a bank that tends to your financial health is vital. First Tennessee Medical Private Banking can help with today’s needs and tomorrow’s goals. Our Relationship Managers offer guidance and solutions tailored to medical professionals. So you can focus on your priority: your patients.

To make an appointment with a Relationship Manager, please contact: Margaret Yancey Senior Vice President Medical Private Banking ph: 901-681-2526 email: myancey@ftb.com

Thomas Carlisle Relationship Manager Medical Private Banking ph: 901-681-2522 email: tcarlisle@ftb.com

Jeff McIlvain Vice President Medical Private Banking ph: 901-681-2555 email: jmcilvain@ftb.com

Chris Webb Vice President Medical Private Banking ph: 901-681-2523 email: cawebb@ftb.com

MMS SUMMER COVERS FINISHED_Layout 1 6/15/2018 12:49 PM Page 4

1067 Cresthaven Road Memphis, TN 38119