Quarterly Winter 2018-2019

Volume 22, Number 4

The Medicine of Books

Winter 18-19

Internal Mediciine and Multispecialty Clinic • Cardiology • Endocrinology • Infectious Disease

• Internal Medicine • Neurology • Nephrology

EASTT CAMPUS S

• Pain Medicine • Rhheumatology • Wound o Care

Gynecology and Menopause Care Physical Therapy and Rehabilitation Fertility and IVFF Urology and Urrogynecology On-site Pharmacy and Imaging Cennter Online schedulling and same-day apppointments

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Editorial Thomas C. Gettelfinger, M.D. Managing Editor Allison Cook 2018 Board of Directors President Autry J. Parker, M.D.

contents Volume 22, Number 4

President-Elect Andrew Watson, M.D.

Features

Vice President Danielle Hinton Hassel, M.D.

12 14

Winter 2018-2019

Member Spotlight The Medicine of Books

Secretary Justin Monroe, M.D. Treasurer David L. Cannon, M.D. Immediate Past President Phillip R. Langsdon, 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. Ex-Officio Board Members Perisco Wofford, M.D., President of Bluff City Medical Society Karen Adams, President of Mid-South MGMA

Every Issue 3 5 8 19 22 24 28

Editorial Your President’s Lettter Your Society At Work Your Legislative Update Your Community Current Research Your Bulletin

Cover: Jason Yaun, M.D., photo courtesy Methodist LeBonhuer Healthcare

2

The Memphis Medical Society Quarterly

your editor Thomas C. Gettelfinger, M.D. Is Memphis Sick?

Or Am I the Victim Of An Unscientific Anecdotal Fallacy?

Nothing gets your attention more than the personal.

I live downtown.

On September 27 Phillip Trenary, the President and CEO of the Greater Memphis Chamber of Commerce was murdered, shot in the head on South Front Street.

A double cab white truck pulled slowly past him and pulled to the curb. The person in the passenger side of the truck got out and killed him. Shot him. In the head.

Downtown.

LeBonheur trauma surgeon Dr.Regan Williams is personal witness to the doubling of childhood gunshot victims since 1996. LeBonheur has to pay special attention to the social need of their patients…it’s not just a matter of health care. It’s the whole social milieu. Some of my patients in poorer parts of town don’t shop in their neighborhoods because of harassment in the parking lots, even at Walmart in Southaven. Some tell me they don’t go out at night for fear of their own safety.

By almost any criterion, Memphis is sick.

On November 7, 2017, Susan Grissom 56 year old medical representative was shot and killed in her home on Mud Island. She tried to defend herself with a kitchen knife. As a medical rep, at one time she had visited our office. Shot her. In her home. Downtown.

“Memphis was…Murder USA, the most dangerous place in the country…the highest murder rate in the country.” That was in 1916.

So it’s not a recent phenomenon.

On August 12, 2013, David Santucci, 27 year old nurse at Le Bonheur was killed at 275 South Main, somewhere between Pearl’s Oyster House and the Orpheum. Shot in the chest, bystanders held his hand as he died. Shot him. On the street. Downtown.

On February 27, 1995 my friend Emily Fisher was murdered in her home, 1649 Central. Midtown.

In 2013 our colleague Plastic Surgeon Charlie White died, partly as a result of injuries sustained during an early morning robbery near an East Memphis Surgery Center. East Memphis.

“7 killed, 6 injured in weekend shootings” Commercial Appeal headline, November 13, 2018.

All over the city.

Internet rankings of our city place Memphis as the third most dangerous in the country. National chain stores close because of high theft rates. Statistics on rape, robbery, gangs, carjacking, murder, sexually transmitted diseases, obesity, you name the pejorative, we own it.

Winter 2018-2019

I said it was personal. I was stalked, I feel certain, by the same white double cab truck that stalked Phillip Trenery, the same modus operandi, pulling past me to stop at the curb where I was walking home from dinner downtown, two nights before he was murdered.

Something seemed wrong. Instead of walking the sidewalk as Phil Trenary did, I was out in the middle of the street, passing the white truck on the drivers’s side. Yes, that was two days before Trenary was murdered. The Memphis precinct officer I called complimented me on my reptilian brain, “you sensed something wrong, you took action.”

So by walking one way rather than the other, I had no problem. But I don’t want to rely on a reptilian brain. I like Memphis. I have friends, colleagues, patients here. I will stay here. I will walk my downtown neighborhood.

I will respect my neighbors, near and far.

What else can I do? What else can we do?

3

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your president Autry J. Parker, M.D.

Throwing Out the Baby With the Bathwater As the president of Memphis Medical Society, I have the privilege to speak through our magazine about issues that directly affect the society and our members. As my last opportunity to express this privilege, I want to discuss the specialty of Pain Management. As the first Blaustein Pain Fellow at Johns Hopkins University Hospital, I was trained at a time when it was apparent to the medical community that significant numbers of people suffered with chronic severe, often debilitating pain despite our medical advances or as a consequence of them. The treatment promoted was a multidisciplinary model to manage the whole person through medical, interventional and rehabilitative means, encompassing both physical and psychological concerns.

For more than two decades, I would like to think that we provided care and comfort through disciplined medical management to countless of patients who would go on to live more functional lives and contribute to their families and society. However, about 10 years ago the specialty became inundated from several sides.

Opportunist patients often manipulated medical providers in order to abuse drugs, and opportunist medical providers created business models on prescribing of addictive medication to addicts and other vulnerable patients. As a result, the specialty inadvertently ignited the opiate epidemic that has ruined so many lives in this country. Though the crisis, as it stands, is fueled more by illicit fentanyl, the specialty must accept its responsibility for igniting the crisis.

As the deaths from overdose reached epidemic levels, state governments felt compelled to act. Rightfully, legislators focused their efforts on reversing the overprescribing of opiates. Pain management has become the focus of scrutiny by the state and Federal legislatures as well as the insurance industry. Strict formulaic prescribing limits are now being enforced by either insurance fiat or coerced by state oversight. Though well intentioned, I fear these overreaching efforts will result in the destruction of the specialty, and with it, the hope for those patients in need of expert treatment for severe debilitating pain.

In nearly three decades of practice, I have watched the pendulum swing from irrational fear of opiates leaving patients to suffer with chronic pain to irrational exuberance for the benefits of opiates in the treatment of chronic pain. Clearly neither extreme is appropriate so in the words of neo soul artist Indie Arie “let’s get back to the middle.” Let’s allow fellowship trained and board certified physicians the latitude to make medical decisions based on individual needs of the patients.

Let’s not throw out the baby with the bathwater.

Sincerely Autry J. Parker, MD, MPH, President Memphis Medical Society Interventional Pain Management Physician Winter 2018-2019

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YOUR

BENEFITS Online Appointments Now Available!

The Memphis Medical Society unveils capacity for patients to schedule doctor’s visits online through the Society’s web site, a mere six months after a complete web site redesign.

“We want our web site to be a tool not only for our physician members but for the community as well,” says Chief Executive Officer, Clint Cummins. “Our web site provides extensive information on each of our physicians, and now patients have the ability to easily schedule an appointment with a physician of his or her choosing without leaving our web site.”

This new functionality is HIPPA compliant so patients do not have to worry about personal information submitted through the site being breached. “It was of utmost importance to us that we offer a user-friendly and highly secure portal to the community,” Cummins says. “We are excited to be able to bring this convenience to the Memphis community, and our physicians are thrilled to be able to extend their services to patients in need.”

The web site is located at www.mdmemphis.org

Listen Up! We have launched a podcast series In an effort to continually support our members through timely communications, we are launching our own podcast!

Memphis MedCast highlights current and ongoing issues in organized medicine.We want to offer unique and enriching topics for our members and supporters. A variety of the podcasts will offer CME simply by listening to them.

Our inital CME-accredited episodes offer a broad rand of topics. First, Ben Simpson, Associate Director of Government Affairs at Tennessee Medical Association covers 2018 healthcare advocacy issues and what's on the horizon for 2019. And, Society CEO, Clint Cummins, interviews Dr. Clay Jackson from West Cancer Center on the topic of physician burnout. This episode also introduces Thrive, a new well-being program for Society members Memphis MedCast can be found through any podcast application, including Apple’s itunes Store, or by visiting: https://www.mdmemphis.org/10954-2/

If you have a topic to suggest for an upcoming podcast, please email Allison Cook, acook@mdmemphis.org.

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The Memphis Medical Society Quarterly

We were STEM before STEM was cool.

Science, technology, engineering, and math excellence is a tradition at Memphis University School – and so is teaching boys in grades 7-12 to think, to reason, to write, to create, and to serve.

No pre-packaged programs here.

Our expert instructors tailor courses to meet the needs of our boys and the demands of college curricula.

Check us out at musowls.org.

2019 ACPH call for abstracts now through March 29 Showcase your work at the American Conference on Physician Health (ACPH)! The conference, which is being hosted by the American Medical Association, Mayo Clinic and Stanford University School of Medicine, is being held September 19-21, 2019 at the Sheraton Charlotte Hotel/Le Meridien in Charlotte, NC. Authors are invited to submit abstracts for consideration as part of the 2019 ACPH. Submissions will be accepted from December 10, 2018 to March 29, 2019.

Submit your abstract in one of two categories: • Research: submitted as either a poster or oral presentation • Workshop: submitted as an interactive session *research and non-research workshops considered Be sure to visit the conference website physician-wellbeing-conference.org to review important details in our “Call for Abstracts” section, as well as the instructions for submitting abstracts. Submissions for all abstracts must be made electronically via the abstract submission form, information available at the ACPH 2019 Call for Abstracts website.

Deadline: All abstracts must be submitted online by March 29, 2019 (11:59 pm Central Standard Time) for consideration!

Please contact us at physicianhealth@ama-assn.org with any questions or requests for further information.

Winter 2018-2019

7

Welcome our newest members!

Mark S. Edwards, MD Inpatient Physicians of the Mid-South

Spencer William Hauser, MD Tabor Orthopedics

Lauren Cooper King, MD Memphis Pathology Group

working for you

Rodolfo Laucirica, MD Memphis Pathology Group

Jonathan Michael Stuart, DO Memphis Orthopaedic Group Inc

James Bret Winblad, MD Mid-South Imaging and Therapeutics PA

Catherine Ann Alexander, MD East Memphis Neonatology Associates

Carey Faber Campbell, MD Plastic Surgery Group of Memphis PC

your

SOCIETY

Student members meet with TMA President

8

Student members were given the chance to have dinner with Dr. Matt Mancini, the president of the Tennessee Medical Association. The event was part of a multi-day trip Dr. Mancini made to Memphis.

The Memphis Medical Society Quarterly

Residency Exploration :: Speciality Speed Dating

The annual Speciality Speed Dating event for students to speak with practicing physicians regarding their speciality of choice transformed a bit this year. Instead of one evening, the students were offered three evenings. Each night’s slate of guest physicians and residents was carefully scheduled by Debbie Hester, Program Coordinator with UTHSC, to allow students to visit with not only more physicians, but with physicians grouped by educational and speciality paths. Students enjoyed asking questions in each session, and the physicians were excited by their enthusiasm.

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Winter 2018-2019

9

your hospitals

This year marks Methodist Le Bonheur Healthcare’s (MLH) Centennial. As the healthcare system is celebrating serving the greater Memphis area for 100 years, construction is underway on Shorb Tower which is expected to open in the spring of 2019.

The Tower will bring some of the latest advancements in caring for patients, including leading-edge technology in the operating room, enabling images to be captured and recorded with consent for diagnostic and teaching purposes in multiple settings. This capability will elevate Methodist University Hospital’s status as an academic medical center.

Also housed in the Tower will be a 512 slice CT (256 channel detector). With its 160 mm wide detector, the Revolution CT is able to capture the entire heart in one heartbeat, freezing the motion of the heart and making the most complex exams, routine.

As MLH celebrates a century of innovations, from living donor liver transplants to offering the latest cancer fighting treatments such as CAR-T for treating patients with acute lymphoblastic leukemia and non-Hodgkin’s lymphoma, Methodist is dedicated to the future of medicine and is looking towards another century of providing advanced medical care and emphasizing patient-and family-centered care.

Crittenden County and Baptist Memorial Health Care officials cut the ribbon on Baptist Memorial HospitalCrittenden on Nov. 5. The 65,000-square-foot facility, which will open in December, will offer emergency services, inpatient medical-surgical services, inpatient and outpatient diagnostic imaging, two operating rooms, a cancer and chemotherapy infusion center and other services.

During the ribbon-cutting ceremony, Baptist Crittenden Administrator and CEO Brian Welton thanked Crittenden County residents for their enthusiasm and support of the hospital throughout construction. In 2016, residents voted to direct proceeds from an existing one-cent, five-year sales tax to fund construction of the new hospital, and Crittenden County officials chose Baptist to manage the hospital. Construction began in early 2017.

Most of Baptist Crittenden’s staff has been hired, and 83 percent of the hospital’s employees live in and around Crittenden County. A significant number worked for the former Crittenden Regional Hospital, which closed in September 2014.

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The Memphis Medical Society Quarterly

your hospitals

Regional One Health Celebrates the NICU 50th In the Sheldon B. Korones Newborn Center, Regional One Health’s NICU, the life of every baby saved is celebrated. Over the past 50 years, there has been much to celebrate. Since opening in 1968 under the direction of Dr. Korones, the NICU has treated more than 45,000 premature babies.

Current NICU medical director, Ramasubbareddy Dhanireddy, MD, credits the NICU’s success to a multidisciplinary team approach to caring for patients and their families. The team’s work begins before the baby is born, culminates at delivery, and does not stop until the tiny patient is ready to go home. According to Dr. Dhanireddy: “What we do in the delivery room – in the first few minutes, the first few hours – makes a big difference if the baby is going to survive. It’s very gratifying to me to see these moms and dads coming back with their babies. It makes us believers in what we do.”

Multiple events were held throughout the year where patients, families, staff and physicians had an opportunity to celebrate. To learn more about the NICU and read patient stories celebrating 50 years of NICU moments, visit regionalonehealth.org.

In 2018, Saint Francis Hospital-Memphis received a three-year accreditation from CARF International (Commission of Accreditation for Rehabilitation Facilities) for its adult Inpatient Rehabilitation Unit. In receiving this distinction, Saint Francis has undergone a detailed peer review process and has shown its commitment to providing programs and services of the highest quality. Achieving this accreditation demonstrates Saint Francis's commitment to exceptional, personalized patient care.

For cardiac services, Saint Francis Hospital was the first hospital in Memphis to establish a Chest Pain Emergency Center, where a heart team is dedicated to the intervention and treatment of heart emergencies. Saint Francis’s newest cardiac offering, the Myocardial Perfusion Nuclear Cardiac Imaging camera, allows the hospital the flexibility to image the most technically challenging cardiac patient either upright or lying flat and supports patients up to 1,000 pounds, providing the ability to image morbidly obese patients. The open design eliminates claustrophobia and reduces the chance of movement during imaging and with shorter imaging times, dose reduction and ability to quantify coronary blood flow the benefits to patients are evident. This new offering coupled with an upgraded EP mapping system to capture more complex cases and chest pain accreditation continues to bring Saint Francis to the forefront in providing high quality cardiac care to patients in our community.

Winter 2018-2019

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FDA Approves CAR T Theraphy in Memphis Yasser Khaled, M.D.

MEMBER SPOTLIGHT

Methodist Healthcare Blood and Marrow Transplant Center Certified to Offer FDA-Approved CAR T Therapy

12

Methodist Healthcare Blood and Marrow Transplant Center has been selected to join an elite list of authorized treatment centers in the United States approved to administer the first FDAapproved chimeric antigen receptor T-cell (CAR T) therapy for treatment of patients with acute lymphoblastic leukemia and non-Hodgkin’s lymphoma. Methodist Healthcare Blood and Marrow Transplant Center, located at Methodist University Hospital, is the only treatment center to offer this therapy to patients in the Greater Memphis area, Mississippi and Arkansas.

“We are excited to now offer this novel therapy to patients in Memphis and the surrounding areas who have acute lymphoblastic leukemia and non-Hodgkin’s lymphoma,” said Yasser Khaled, M.D., program director of the Methodist Healthcare Blood and Marrow Transplant Center. “This advanced therapy offers not just hope to patients but possible cures.”

CAR T-cell therapy is a type of immunotherapy called adoptive cell therapy. T-cells – a type of white blood cell – are extracted from the patient’s blood and an artificial receptor called a “chimeric antigen receptor” is added to their surface. The receptor enables the modified cells to produce chemicals that kill cancer. Once infused back into a patient’s body through an IV, they begin multiplying and attacking tumor cells. Methodist Healthcare Blood and Marrow Transplant program inpatients will be housed on the 9th floor of Shorb Tower, which is expected to open in 2019.

The Memphis Medical Society Quarterly

Legislative Reception The annual event is an optimum time for members to meet legislators in a very unique setting. Held at Buckley’s Lunchbox, physicians and legislators are able to sit together and eat, while discussing upcoming issues facing the practice of medicine. By getting these two groups of professionals together, Memphis Medical Society is addressing its mission of uniting and advocating for its members in a direct way.

Rep. Tom Leatherwood with TMA President candidate, Ron Kirkland.

Winter 2018-2019

Memphis Medical Society board members, Lindi VanderWalde, M.D., and Lisa Usdan, M.D.

Memphis Medical Society members George Flinn, M.D.,and Mack Land, M.D., with Rep. Dwayne Thompason.

Memphis Medical Society Board President, Autry Parker, M.D., with Rep. Kevin Vaughan and Tennessee Medical Association Director of Government Affairs, Julie M. Griffin.

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The Medicine of Books After his parents put him to bed as a child, Dr. Jason Yaun would lie there, reading by flashlight or the light in the hallway.

Now, Yaun, a pediatrician hopes to instill that same love of reading in the patients he sees. He is committed to caring for the bodies and the minds of his patients.

Yaun, 36, works as an assistant professor of pediatrics at the UT Health Science Center (UTHSC) and a physician in the general pediatrics department at Le Bonheur Children’s Hospital in Memphis. Born and raised in Memphis, he says he feels a calling to take care of the children in his hometown.

“It was during my pediatrics residency training at UTHSC, when I was trying to decide what to do from there and what to do with the rest of my life, that I really just felt I had a heart to take care of the children of Memphis,” he says. “So that led me to a passion of not just general pediatrics, but advocacy and being involved in the community.”

Always an avid reader, he has transformed his personal passion into a community mission as a champion of early childhood literacy.

“My love for reading is something that was instilled in me at a very early age,” says the father of a daughter, 7, and a son, 11. “I think there are all these great literacy programs out there, but most of them focus on school-age kids, and that’s generally too late.”

He heard about Reach Out and Read, a nonprofit organization founded in 1989—at what is now Boston Medical Center—to give free books to children from infancy to school age through physician offices. “I was looking at all the literature, all the evidence behind it, and just got really passionate about it,” he says. “So, while I was still actually a resident, knowing that I was going to stay on as faculty here, I worked to get funding to start a Reach Out and Read program here in our clinic.”

Evidence from literacy programs, including Reach Out and Read, suggests benefits that last a lifetime, Yaun says. “Not only does reading give children communication skills and literacy skills, but it also serves as a buffer against adverse childhood experiences and toxic stress by promoting nurturing relationships.”

Now, through Reach Out and Read at UT Le Bonheur Pediatric Specialists, the outpatient resident teaching practice at Le Bonheur Children’s Hospital, all children from 6 months old to age 5 get free books chosen for them by their physicians during every well-patient visit.

14

The Memphis Medical Society Quarterly

Plastic tubs filled with books, sorted for appropriate age, language and content, line the walls of his office and are in the physician workroom. “The idea is the physician actually gives the book,” Yaun says. “It’s not like a sticker at the end of the visit. It is supposed to be brought in by the doctor. That way, the doctor is a trusted messenger and can give the message of early literacy.”

Parents receive instruction about the importance of reading aloud every day to their children and learn that, as their children’s first teachers, they are not only building literacy skills but also social and emotional skills.

“Really, we’re talking about building brains from the critical time from birth to 3 years old,” Yaun says.

Jon McCullers, chair of UTHSC pediatrics and pediatrician-in-chief at Le Bonheur, says Yaun, with his quiet and analytical personality, has excelled at growing into his role as a leader, progressing from student, to resident, to chief resident, to faculty member and director of the resident clinic.

“At each stage, it has consideration prior to followed by performance beyond McCullers says.

All pediatric faculty have an interest in beyond their clinical his early career clinic, he developed childhood literacy,” Yaun.

been this careful commitment, exceptional expectations,” are expected to academic pursuits duties. “Through experiences in the an interest in early McCullers says of

“Again, after a period of analysis and contemplation, he dove in. He is now becoming recognized as a leader in this field across the state and will eventually have a national profile—truly, a rapid success story in an important area and one of our most promising young faculty.”

Yaun also is working with community partners to expand Reach Out and Read in Memphis and has officially launched at three Christ Community locations. This has been done in partnership with Books from Birth-Porter Leath. “We have plans and funding to continue to expand,” he says.

Since 2015, Yaun has served on the board of Books from Birth, the Shelby County organization to promote kindergarten readiness and strengthen family bonds by providing age-appropriate books for all children from birth to age 5. That program and the national Reach Out and Read program offer assistance in getting the books to distribute to Yaun’s young patients.

“Reach Out and Read has a partnership with Scholastic (a company known for publishing and selling books) on a national level, so we get books at a very deep discount,” he says. Funding also comes from the Urban Child Institute in Memphis.

“We also have books in the waiting room that kids can read or that parents can read to their children,” he says.

Those books come from book drives or from Books from Birth.

Yaun’s program accepts books donated for the waiting room. Those can be dropped off at the clinic at 51 North Dunlap, Suite 350, Memphis. Volunteers to read books aloud to patients, siblings and family members prior to clinic appointments also are welcome. For more information, visit lebonheur.org/ror.

Winter 2018-2019

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Women in Medicine Explore Creative Side Thanks to our sponsor, First Tennessee Medical Private Banking Division, we were able to host a Women in Medicine event at Pinot’s Palette. The female residents and physicians were able to come and relax, and enjoy the guided painting class. With drinks and snacks provided, the women chatted and caught up with colleagues during the class.

Women in Medicine events are provided throughout the year to encourage fun, social settings, and to allow female physicians an opportunity to share unique ideas from their home or profressional lives.

To see more photos from the event, visit mdmemphis.org

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The Memphis Medical Society Quarterly

Winter 2018-2019

17

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CMS has released its Final Rule regarding the 2019 fee schedule.

Below are some of the key points in the Final Rule for 2019: Delayed Until 2021

Not Adopted

Blended reimbursement rate for E & M levels of service

Modifier 25 change (reduction of lesser procedure 50%)

New G codes for Primary Care Services, Specialty Services and Extended Care (prolonged services)

Proposed G codes for podiatric services

Reduction in documentation requirements Providers will only be required to document to a level 99202/99212 and include use of ancillary staff within the creation of outpatient office based E & M services

Pizza & Politics with Dr. George Woodbury, Jr. Dr. George Woodbury, Jr., visited with UTHSC students over a pizza lunch. He provided a legislative update, highlighting issues that directly affect the students, such as GME funding. He also reviewed strides that The Memphis Medical Society and the Tennessee Medical Association have made with legislators to create physician-friendly laws.

Dr. Woodbury encouraged the students to get involved with politics, especially local and state, as soon as they could.

“Our current legislators are making decisions that will affect how you practice medicine when you are out of school,” he said. “It may seem far off, but now is when we can make an impact for your future.”

Finally, he invited them to Doctors Day on the Hill on Tuesday, March 26, 2019. “This is a unique opportunity to meet directly with legislators and inform them on how laws are affecting practicing medicine,” he said, “The Memphis Medical Society provides a free bus ride up and back with food, and it is a really enjoyable day.”

Winter 2018-2019

19

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keeping yourself fiscally fit William B. Howard, Jr., ChFC, CFP I want to open a 529 Plan for my newborn grandchild, but I heard from a colleague that it is better for the parent to own the plan instead of the grandparent. Are there other advantages and disadvantages I need to be aware of?

529 plans are a great tool to help pay for education expenses, and the list of advantages far outweighs potential disadvantages. As the owner of the plan, you retain control of the contributions, investment decisions, and withdrawals. You are eligible to participate in the 529 plan of your choice, and some plans even allow a state income tax deduction on contributions. The deduction usually requires residents to use their home state’s plan, but there are several states that allow the tax deduction regardless of the plan you use. Plan contributions qualify for the annual gift tax exclusion up to $15,000 for the current year, and if you treat the contribution as being made over a five-year period, you can accelerate your gift and make a one-time deposit of $75,000.

Maximum contribution limits vary by plan; anyone can contribute to the plan; there are no income restrictions on those wanting to contribute, and contributions are not considered part of your estate for federal estate tax purposes. Earnings grow tax free if withdrawals from the plan are made for qualified education expenses, and as of 2018, up to $10,000 in annual tuition expenses at elementary or secondary public, private or parochial schools are considered qualified educational expenses. 529 plans are easy to manage, portable (transfer from one state plan to another), the beneficiary can be changed as needed, and multiple plans can be set up for the same beneficiary. You can also name a contingent owner upon your death or transfer ownership of the plan during your lifetime.

There are several disadvantages you should be aware of. First, financial aid eligibility can be limited based on plan ownership. A grandparent owned 529 plan is not counted as an asset on the Free Application for Federal Student Aid (FAFSA), but a distribution would be treated as untaxed income to the beneficiary in the following year. Student income reduces aid eligibility by 50%, so a $1,000 payment of college expenses from a grandparent owned 529 plan would reduce the beneficiary’s aid eligibility by $500. Additionally, distributions used for purposes other than qualified education expenses can have negative consequences. These non-qualified distributions are generally subject to taxable income and a 10% federal penalty tax on the earnings portion of the distribution. Finally, 529 plans are not created equally. Plan providers fluctuate by state, investment options are often limited, and administrative costs and fees can be high.

Setting up a 529 plan allows you to play an essential part in the educational success of your grandchild, so seek the advice of a trusted financial professional with questions or for plan recommendations.

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

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Winter 2018-2019

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your community The Alliance Relaunch!

Supporting the families and partners of our physicians The

A ance

The Memphis Medical Society Alliance, an organization created to support the families of physicians, hosted a re-launch party in November at the home of Board President, Dr. Autry and Denise Parker.

The hope for this group is to create events and programs that will support our physician community, while also offering networking opportunities for their partners and families.

The rich history of the Alliance goes back to the founding of the Society, and its members have supported the Society through fundraising, special events, networking opportunities, and hoiday parties. As we bring back this group, we would love to hear from our members on how and what their partners and families would benefit from whether it is social, educational or service focused.

If you are interested in taking an active role in the future direction of this group, please send an email to Allison Cook at acook@mdmemphis.org, or call us at 901.761.0200. And thank you to our sponsor!

Member Meet Up: Ghost River Brewery

Members were given the chance to network and spend time together through a Member Meet Up at Ghost River Brewery, Sponsored by Triumph Bank, UTHSC and Henry Turley Company, members enjoyed a delicious spread catered by Draper’s Catering and a wide selection of Ghost River Brewery beer. Attendees were entered into a raffle for several gifts, including a variety of gift cards and cases of beer.

Thank you to our sponsors! Be sure to check your emails and our website for upcoming member meet ups.

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The Memphis Medical Society Quarterly

current research Key Biologics Memphians’ experiences and critical blood cells advancing biotherapeutics progress around the world A new blood product collection study targeting hematologic malignancies to facilitate advancement of autologous immuno-oncologic (IMO) therapeutics is helping Memphis cancer patients ‘fight back’ and accelerating innovative treatment and cures research around the globe.

Principal Investigator and hematologist Edward P. Scott, M.D., Key Biologics, is conducting a study of adult patients to I. Qualitatively evaluate, via phenomenological and case Edward Scott, M.D. study methods, apheresis experiences to inform holistic pathway improvements for the patient population-at-large that increasingly will participate in clinical IMO protocols, and II. Facilitate preclinical IMO research and development efficacy and safety investigations predicated on critical cells availability.

Targeted diagnoses are Chronic Lymphocytic Leukemia, Hematologic malignancy patient subject Bruce Clifford with Director Non-Hodgkin Lymphoma, Multiple Myeloma, and Acute of Aphaeresis & Clinical Care Denise Jones, RN Lymphocytic Leukemia in males and females ages 18-65 years. Inclusion of Acute Myeloid Leukemia will begin in first quarter 2019. A coordinated protocol of targeted solid tumor diagnoses, whose salient patient-care process improvement features will be collated with the current study’s results and reported to clinical and clinical trial readerships, is slated for mid-2019.

Director of Operations and Med Lab Director Scott Carter, patient Bruce Clifford, patient's spouse Pamela Clifford

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The Memphis Medical Society Quarterly

Patients meeting inclusion/exclusion criteria are eligible to enroll in the open-ended study already working with subjects. A 3-4 visit process and patient-tailored low-volume peripheral blood mononuclear cells collection by leukapheresis is implemented in consultation with the patient’s primary physician to ensure timing appropriateness. Strong interest from potential enrollees across a breadth of professions and cancer history timelines demonstrates patients’ strong desire for legacy-building contribution.

Study prioritization of patient-centered care, however, makes physician referrals an important mechanism to help identify candidates and minimize disappointing the many purpose-driven patients whose status makes them deferrals.

Dr. Scott’s long history of collection and autologous patient care partnership with IMO pioneer Dendreon, from its prelicensure clinical trial in 2005 to its newly enrolling clinical trial for treatment-naïve patients, and other Key Biologics IMO research efforts with (e.g.) glioblastoma Directors of research process, laboratory science, and multiforme and Multiple Sclerosis patients, prepares study clinical care staff with experience sensitively supporting cancer fighters.

Hiring in Healthcare?

We staff

Coder, RN, CRNA and many others

Need a Healthcare Job? We offer Direct hire, Temp-to-hire, Permanent positions and Part time jobs

901-761-0200 MedTemps is a division of The Memphis Medical Society

Learn more at www.mdmemphis.org Winter 2018-2019

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your practice Alan Flippin Senior Partner ADF Medical Practice Development

The Patient Experience Challenge For the past 30 years, the practice of medicine has been in constant change. Change is accepted as normal now.

It appears that will continue as provider systems acquire, merge, and compete more aggressively than in recent years. The ACA mystery and declining reimbursements are also accepted as normal, for today. Most will agree that new "corporate" administration from larger owner or hospital systems, increasing regulations for patient AND physicians have been cumbersome and consistent of corporate and government involvement in to what should be focused on relationships between patients and physicians. It will continue to be a challenge and competitive in 2019.

Most offices are actually in a better position knowing how to handle the regulations, documentation and higher deductibles and lower reimbursements for patients. While we anticipate the expected changes that are destined to be coming, there are things that can be done to continue to position ourselves for success and higher patient satisfaction.

Focusing on the patient experience and quality will almost certainly put practices in a better position to compete and have higher profits. The trend continues to be tied to reimbursements based on best outcomes. This is an accepted fact and very likely to continue to be the trend with reimbursements tied closely to measurement and comparative data - all part of the value of exceptional patient experience. PXJ (Patient Experience Journal) states that an average of 6,000 individual articles were downloaded each month since the last half of 2016. The patient experience (PX) continues to be the front where improvements, and therefore, better reimbursements can be accomplished.

Many walk-in clinics use a competitive advantage posting standard pricing. Self-paying, and high-deductable patients actually "shop" for the best offering based on statistical data of good outcomes. This seems to be working when the patient experience is favourable.

Patients continue to look for promptness, affordability and convenience of health care services as they take on more of the burden to pay for health care with self-pay or rising co-pays and high-deductable insurance plans.

Regardless of the final model, practices that are patient-friendly and provide exceptional care will be more profitable and also desired by companies that are self-insured, individuals, and insurance companies. This is all just part of the evolution of practicing medicine. Perhaps this evolution will put more of the decisions back in the hands of capable providers. The challenge continues. Those with higher PX will continue to be more successful, and therefore, receive higher profitability.

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The Memphis Medical Society Quarterly

PRESIDENT’S

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A reimagined Annual Meeting SATURDAY, JANUARY 26 FedEx Event Center, Shelby Farms Park 415 Great View Drive East, Cordova 38018

6:00 p.m.

Complimentary valet Music from Copacetic 901 Debut of 2019 Board of Heavy hors d’oeuvres Directors Silent auction RSVP by scanning this code with your smart phone’s camera, or visit http://bit.ly/MMS2019

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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 Memoriam Robert J. Smith, M.D.

November 21, 1929—February 12, 2018

Robert Julian Howse, M.D. June 30, 1934—October 15, 2018 Grady Lee Saxton, Sr., M.D. December 2, 1949—October 13, 2018

The Memphis Medical Society 1067 Cresthaven Road Memphis, TN 38119 901-761-0200 Fax: 901-374-9574

UPCOMING EVENTS December 22-January 2—Memphis Medical Society office closed January 26—President’s Gala

CEO/Executive Vice President Clint Cummins

February 5—Memphis Medical Society board meeting

Executive Assistant Janice Cooper

May 18—House of Delegates, Cool Springs, Marriott Hotel

Director, Communications & Marketing Allison Cook Business Development Cailyn Bautista Finance Director Leah Lumm MedTemps Director, Healthcare Staffing Freda Reed MedTemps Administrative Coordinator Katie Yaun

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March 26—Doctors’ Day on the Hill, Nashville

HAPPY NEW YEAR! What will 2019 bring?

More podcasts!

A more active MEMPAC THRIVE—our wellbeing platform Resources for financial managment And SO much more!

The Memphis Medical Society Quarterly

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