MMS Quarterly Volume 3, 2021

Volume 25, Number 3

2021

David Weber, M.D. es D.

Bringing Healthcare Home Again

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Volume Volume25, 25,Number Number33 Volume 25, Number 3

2021 2021 2021

The mission physicians of ofMemphis Memphisand andShelby ShelbyCounty Countyinto into organization to promote The missionofofthe theMemphis MemphisMedical MedicalSociety Society isis to to unite unite the physicians anan organization to promote The mission of the Memphis Medical Societyquality is to unite the physicians Memphis andofShelby County thehighest highest quality practice the the of medical practiceofand and thehealth health ofour ourcitizens. citizens.into an organization to promote the highest quality of medical practice and the health of our citizens.

ManagingEditor Editor Managing Managing Editor AllisonCook Cook Allison Allison Cook 2021Board BoardofofDirectors Directors 2021 2021 Board of Directors President President President AndrewWatson, Watson,M.D. M.D. Andrew Andrew Watson, M.D. ImmediatePast PastPresident President Immediate Immediate Past M.D. President Danielle Hassel, Danielle Hassel, M.D. Danielle Hassel, M.D. President-Elect President-Elect President-Elect Christopher M. Pokabla, M.D. Christopher M. Christopher M.Pokabla, Pokabla,M.D. M.D. Vice President Vice President Vice President Lisa Usdan, M.D. Lisa LisaUsdan, Usdan,M.D. M.D. Secretary Secretary Secretary Dale Criner, M.D. Dale Criner, Dale Criner,M.D. M.D. Treasurer Treasurer Treasurer David L. Cannon, M.D. David L. David L.Cannon, Cannon,M.D. M.D. Members-at-Large Members-at-Large Members-at-Large James Beaty, M.D. James JamesBeaty, Beaty,M.D. M.D. M.D. Christopher Jackson, Christopher Jackson, Christopher Jackson, M.D. Walter Rayford, PhD,M.D. M.D., MBA Walter PhD, Raymond R. Walker, M.D. WalterRayford, Rayford, PhD,M.D., M.D.,MBA MBA Raymond R. Walker, M.D. James Wang, M.D. M.D. Raymond R. Walker, James Wang, M.D. Paul Tackett, M.D. James Wang, Paul M.D. Perisco Wofford, M.D. PaulTackett, Tackett, M.D. Perisco M.D. Catherine Womack, M.D. PeriscoWofford, Wofford, M.D. Melanie Woodall, M.D Catherine Womack, M.D. Catherine Womack, M.D. Melanie MelanieWoodall, Woodall,M.D M.D Ex-Officio Board Members LaTonya Washington, M.D., Ex-Officio Board Ex-Officio BoardMembers Members President, Bluff City Medical LaTonya M.D., LaTonyaWashington, Washington, M.D., Society President, President,Bluff BluffCity CityMedical Medical Andreana Smith, President MidSociety Society South MGMA AndreanaSmith, Smith,President PresidentMidMidAndreana SouthMGMA MGMA South

In this issue this issue issue In this

Editorial Editorial Editorial President’s Letter President’s Letter President’s Letter Hospital Updates Hospital Updates Hospital Updates Member Spotlight Member Spotlight Member Spotlight Feature Feature Feature In Practice In In Practice Practice Finance Q&A Finance Q&A Finance Q&A Legislative Update Legislative Update Legislative Update

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The Memphis Medical Society 1067 Cresthaven Road Memphis, TN 38119 The Memphis Memphis Medical Society The Medical Society 901-761-0200 1067 Cresthaven CresthavenRoad RoadMemphis, Memphis,TN TN38119 38119 mdmemphis.org 901-761-0200 901-761-0200

mdmemphis.org mdmemphis.org CEO/Executive Vice President, Clint Cummins, MHA CEO/Executive Vice CEO/Executive VicePresident, President,Clint ClintCummins, Cummins,MHA MHA

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Editorial

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Call For Editor

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Editorial

Hello friends, As you may recall from our last edition, we bid farewell to Dr. Thomas Gettelfinger as Editor of this magazine. Dr. Gettelfinger (aka Tom or Dr. G) has been the consistent voice of our flagship publication for twenty years. He worked with two CEOs of the Society, numerous staff editors, and a couple of generations of physicians in his career as Editor.

I want to take a few sentences and give my personal thanks to Dr. G. He was one of the first physicians to inspire me in this role five years ago. He did it twice within my first year.

The first was when I was barely into my tenure at the medical society. Combing through his articles and just being generally astonished at the dedication of anyone to a volunteer role was inspiring to me as a new CEO. It gave me hope that we could package the collective talent and resources of our physician community to make Memphis a better place to live and practice medicine (project ongoing).

The second occasion of inspiration came primarily from his advocating voice for the lowering of prescription drug prices. Dr. G was on this mission way before it was the cool thing to do in healthcare advocacy. A couple of phone calls and emails, along with some meetings with our federal delegation, and I was mesmerized. It culminated at a meeting of healthcare law attorneys at University of Memphis a few years ago. All of these attorneys and me in the room. Then came a time for commentary and off he went. One of the few physicians in the room educating attorneys on the importance of lowering prescription drug prices. Much progress has been made, but we obviously are not finished.

I’ll leave my goodbye in a simple one-liner, ala Dr. G – Thank you, sir. You’re the best.

And now we turn the chapter and call on our membership to recruit a new Editor. Send me an email at ccummins@mdmemphis.org and let me know if you are interested in serving, or feel free to recommend someone whose voice you would love to hear in our publication. We consistently hear that our editorial page is the number one reason people read our publication. We will put out a call via email to the membership as well.

And don’t worry…we don’t expect you to top Dr. G. That’s impossible!

Clint Cummins, MHA, CEO 3

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President’s Letter

In each of this year’s previous publications, I’ve briefly mentioned a new program launched in 2021 on our side of Tennessee, Project Access West Tennessee (“PAWT”).

It’s time to pick up the pace so that West Tennessee can share in the same benefits this program has produced in other areas of the state.

Why PAWT works is because it runs differently and with proven impact, but it absolutely only works if you are involved. Please read that last sentence again.

PAWT program information is readily available through the Memphis Medical Society, PAWT Executive Director Nicole Scroggins, and Clint Cummins, MHA, CEO of the Memphis Medical Foundation and the Memphis Medical Society. They can tell you how to refer patients in need, give you information about the patient screening process, offer suggestions on how to determine how many patients you or your group might consider seeing, explain the after-care documentation needed, etc. They will take you through every step of the process.

The first question you are likely asking yourself is: Why does this program deserve my attention and participation?

Many of our colleagues already help in providing medical care to low-income and uninsured patients at safety-net clinics, hospitals, health departments, and federally-qualified health centers. As always, demand is high, resources limited, volunteer hours are frequently stretched past elasticity, patients fall through the gaps or still cannot reach a care provider most suited to their needs despite best intentions. Basic principles of economics apply: when demand is not met by supply, then seek ways to increase and/or vary the supply.

That’s how Project Access works. By increasing the supply of us physicians (primary care, specialists, subspecialists, surgeons, anesthesia groups, pathology groups, diagnostics – every aspect of medical care) willing to expand our practices by seeing even one additional low-income, uninsured PAWT patient per month at no charge, West Tennessee will begin to see its overall community health start to improve in coordination with the various sites already seeing similar patients. This is a level of expanded and coordinated health care for the low-income, uninsured patient population never before seen in our area.

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When seeing a PAWT patient, you’ll know that your contributed time and expertise is being given to the truly needful because PAWT staff has already screened the patients and made the referral to you. We physicians get to focus on the medicine and let the PAWT staff at the Memphis Medical Society handle the paperchase. Medical societies in more than 50 locations are successfully running similar urban and rural programs. In Tennessee, based on each program’s material, we know: • The Chattanooga/Hamilton County program started in 2004 has over 900 physicians/providers with over $200 million in donated medical care and has generated over 500 jobs. In Nashville since 2005, over $40 million in care equates to 32,000 patient encounters by 1400-1500 physicians.

• Knoxville’s program, launched in 2006, has enrolled 30,000+ patients receiving upwards of $350 million in donated care assisted by 1800 physicians and health care providers.

• Since 2007, Appalachian Mountain’s program has over 500 participating physicians and health care providers donating $75 million worth of care with an average of 200 referrals per month.

Our immediate goal here is to recruit 50 specialty and primary care physician volunteers by January 1, 2022. For primary care volunteers, PAWT asks that you become the primary care home for one new PAWT patient per month in 2022. Please also refer to PAWT’s staff any low-income primary care adult patients you think will meet PAWT criteria and will require specialty care. PAWT staff will review their program eligibility, educate about insurance offerings and, if they are enrolled, schedule specialist appointments for the individual with one of the specialist volunteers at no cost to the patient. For specialist and other advanced care providers, PAWT asks for an annual commitment of seeing one new patient per month at no charge to the patient.

PAWT’s commitment to you: PAWT will only refer the number of patients you have agreed to take through the program and PAWT staff will help to ensure the patients navigate the system effectively and accurately.

Note also that PAWT physician volunteers are covered by Title 63, Chapter 6, Part 7 of the Tennessee Code Annotated. This states that health care providers are released from civil liability while providing charitable health care services.

So please reach out to Nicole, Clint, and the MMS to learn more program details. Speak with your partners, liaise with your practice managers, and carve out space in your practice to participate in this important program. Make joining the PAWT program one of your New Year’s resolutions and get involved before January 1. By the way, program participation is not limited to MMS membership. We welcome and encourage all practicing physicians in West Tennessee to partner with us for a healthier, more active community and a brighter future for us all.

Andrew Watson, M.D.

President, Memphis Medical Society 2021 5

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Hospitals

Methodist Le Bonheur Healthcare receives a million-dollar grant for COVID-19 education The U.S. Department of Health and Human Services awarded Methodist Le Bonheur Healthcare a milliondollar grant to increase COVID-19 education and vaccine access in underserved communities throughout Memphis, Shelby County and West Tennessee.

Jonathan Lewis, director of Community Partnerships at Methodist Le Bonheur Healthcare (MLH), shared that this grant will allow trained MLH navigators to collaborate with community members to heighten vaccine awareness and encourage vaccinations. “Our Mission Integration Division and our Congregational Health Network will collaborate with two community partners, Center for Transforming Communities and Legacy of Legends Community Development Corporation, to expand and diversify our outreach efforts,” Lewis said.

The grant will build on Methodist’s previously launched community-wide vaccination awareness campaign to increase vaccine adoption, address vaccine safety and debunk vaccine myths. The campaign included social media influencers, billboard and bus shelter placements and radio PSAs. Another key component was collaborating with local churches and faith-based organizations to meet people where they are most comfortable to hear from trusted medical experts. “We know increasing vaccination rates is the only way to turn the corner on this pandemic,” said MLH President and CEO Michael Ugwueke. “As COVID-19 continues to have a devastating effect on our community, we must do all we can to encourage vaccination by sharing the latest evidence about vaccine safety and efficacy.”

Regional One Health’s Cyrilyn Walters, MD, named to Tennessee Hospital Association’s Council on Inclusion and Health Equity Regional One Health Medical Director of Ambulatory Services Cyrilyn Walters, MD, has been appointed to the Tennessee Hospital Association’s Council of Inclusion and Health Equity. She is excited to tackle the challenge of working to help find solutions to ensure high-quality care is inclusive. She looks forward to the opportunity as a chance to help hospitals, health care systems and other organizations develop strategies to improve care for all patients in the State of Tennessee.

“I am looking forward to working with the Council to identify areas in which we can improve and create processes that hospitals and health care systems across Tennessee can implement to reduce and eventually eliminate disparities,” Dr. Cyrilyn Walters says.

“Hospitals and health care organizations will only truly move towards reducing and eliminating disparities by enacting change at the hospital level,” said Dr. Walters. “We are fortunate to have a hospital association that is intentional about having a Council on Inclusion and Health Equity.”

“I am looking forward to working with the Council to identify areas in which we can improve and create processes that hospitals and health care systems across Tennessee can implement to reduce and eventually eliminate disparities,” said Dr. Walters. “The end result will help us provide exceptional care for every patient we serve.”

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Hospitals

Saint Francis Healthcare Names Chris Cosby Market CEO for Tenet Healthcare’s Memphis Market and CEO of Saint Francis Hospital-Memphis Saint Francis Healthcare names Christopher “Chris” Cosby to the Market Chief Executive Officer position for Tenet Healthcare’s Memphis market and as CEO of Saint Francis Hospital-Memphis.

Tenet’s Memphis market includes Saint Francis Hospital-Memphis and Saint Francis Hospital-Bartlett.

With more than 20 years of healthcare leadership experience, Cosby has spent the last decade as a CEO with HCA Healthcare. Most recently, he served as the CEO of Poinciana Medical Center in Orlando, Florida—a position he held for the past five years. While there, he developed and enhanced several of the hospital’s key service lines including orthopedic surgery, neurology, gastroenterology, urology and gynecology and added new programs for colorectal surgery and bariatrics. Cosby also oversaw a more than $22 million ER expansion project inclusive of a free standing emergency department, and created programs aimed at enhancing healthcare delivery to the senior population. Other accolades include being recognized by the Orlando Business Journal as both a Top 40 under 40 Business Leader in 2018 and as a CEO of the Year honoree in 2019.

“Chris is a perfect choice for the Market CEO position,” said Group CEO of Tenet Health’s Mid-South Market, Jeffrey M. Welch. “He brings the perfect blend of leadership skills, experience and strategic thinking to immediately become an asset in helping the Memphis market move forward.”

Dr. Saui Joy was appointed as senior VP, chief medical officer, and chief physician executive for Baptist Healthcare Dr. Saui Joy follows Dr. Henry Sullivant, who retired in May 2021. Joy comes to Baptist from Charlotte, where he was the chief medical officer for the central division of Atrium Health. In his previous role, he also led the hospital’s COVID-19 response.

“Dr. Joy has an impressive background, and he will be an outstanding addition to Baptist’s leadership team,” said Dr. Paul DePriest, the health system’s executive VP and COO, in a press release. “His extensive experience will help guide our medical and administrative teams through the challenges of the COVID-19 pandemic and into the future of health care at Baptist.”

“In my role as chief medical officer, I will be working with our teams in quality and patient safety across our system,” Joy said, in the release. “As the chief physician executive, I will support our medical group physicians and advanced practice providers to deliver the best care across the continuum from acute care to our ambulatory settings.”

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Society Updates Society Updates Society Updates

Project Access West Tennessee Welcome to charity care that benefits and physicians.

Project Access Tennessee Project Access Westpatients Tennessee

Welcome tocharity charity care that that to benefits patients and We are expanding healthcare uninsured, low-income people Welcome to care benefits patients andphysicians. physicians.

Weare areexpanding expanding healthcare to uninsured, people throughout western Tennessee.

Join us in low-income providing speciality We healthcare to uninsured, low-income people throughout western Tennessee. Join care to those in need.Tennessee. throughout western Join us us in in providing providingspeciality speciality caretotothose thosein inneed. need. care

Flexible Commitments FlexibleCommitments Commitments Customize your level of Flexible Customizeyour your level of commitment and choose Customize level of commitment and choose from teleheath, phone commitment and choose from teleheath, phone consults or in-office visits. from teleheath, phone consults or in-office visits. consults or in-office visits.

Simple Billing Simple Billing Our collects Simple Billing Ourteam team collectsall all billing and reimbursement Our team collects all billing and reimbursement paperwork, and billing and reimbursement paperwork, andvolunteers volunteers can receive CME paperwork, and volunteers can receive CMEfor for participating. can receive CME for participating. participating.

Liability Coverage Liability Coverage The Volunteer Health Services Liability Coverage The protects Volunteer Health Services Act physicians The Volunteer Health Services Act protects physicians providing charity care.

Act protects physicians providing charity providing charitycare. care.

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

Donate Your Your Time Time and Donate Donate Your Time and YourTalents Talents Today Your Today Your Talents Today 901-761-0200 901-761-0200 901-761-0200 projectaccess@mdmemphis.org projectaccess@mdmemphis.org 8 8projectaccess@mdmemphis.org 8

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Dr. David Weber

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Member Spotlight

Bringing back house calls in a pandemic Over the last year and a half, we have found ourselves surrounded by the persistent existence of a virus that has changed lives around the globe. We have also found ourselves surrounded by a lighter reality, a spotlight on the healthcare heroes who work tirelessly to care for our families and communities. While every individual in the healthcare industry (and beyond) can be classified as a hero, some stick out.

Some heroes literally go the extra mile to care for their patients, and one of them is Dr. Weber.

He has always gone the extra mile. In 2003, he made waves and headlines by opening a new clinical practice in Memphis called Housecall Family Medicine. The mission of the practice was to meet patients where they are – in their healthcare journey and their homes. He began traveling to patients’ homes, focusing on those who were home-bound, straddling the fence of needing permanent assistance in an assisted living facility, but still had family/caretakers available to care for them at home. Many of Dr. Weber’s patients cannot easily, or at all, travel for medical care, so Dr. Weber makes the trip. He cares for them the same way he would in a clinic.

When the COVID-19 pandemic hit, Dr. Weber was one of the first physicians to reach out to the Memphis Medical Society (MMS) seeking trustworthy personal protective equipment (PPE) to protect himself and his patients. He was not hesitant to go the extra mile with protection, even before it was recommended and required.

In January 2021, when COVID-19 vaccines became available, Dr. Weber was on top of getting his patients inoculated. His patients were eligible for the vaccine but couldn’t travel to a vaccine site or sit in line. Shortly after vaccines came to Memphis, Dr. Weber was working to track down a way to get vaccines in his car and to his patients. He quickly reached out to MMS and CEO Clint Cummins connected him with the state health department. A few weeks later, Dr. Weber was traveling more than 100 miles a day around Memphis to inoculate his mostly home-bound patients.

Recently, Dr. Weber has been working to bring the COVID-19 antibodies to his patients at home to avoid sending them to a hospital or clinic. He continues to evolve his practice to meet his patients’ needs, and we know he isn’t finished yet.

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Scan with your smart phone’s camera to join

Join us at a new member discount!

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

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

WE ARE STRONGER TOGETHER 10

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OUR FOCUS IS YOU

• Wellness programs to reduce burnout and more YOUR PRACTICE

• Staffing and recruiting services YOUR COMMUNITY

• Networking for direct referrals

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Physician Wellness

President’s Gala

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

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

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

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Feature

Project Access West Tennessee

PAWT launches to fill gaps in healthcare for uninsured Project Access West Tennessee, an integrated health improvement organization now serving West Tennessee, is the latest Project Access model program with a focus on coordinated efforts to increase healthcare access for low-income, uninsured people, aiming to reduce health disparity and inequity.

PAWT is committed to ensuring everyone in its service area can access the healthcare that they and their families need. PAWT is designed to bridge care gaps, improve health, and reduce avoidable healthcare cost and utilization. The program coordinates care between area hospitals, outpatient services and physician practices, along with a regional network of care providers and primary care services offered through safety-net clinics, health departments and federally-qualified health centers.

“Individual health departments, safety-net clinics and healthcare providers do the best they can to care for uninsured, resource-limited people,” said Project Access West Tennessee Executive Director, Nicole Scroggins. “But to truly improve the health of our communities and reach those who need our help the most, we all have to come together and work cooperatively and collaboratively.” With funding from the state of Tennessee Department of Health and support from Memphis Medical Foundation, this initiative has a regional focus, including rural and urban areas.

This new healthcare network was adapted from the national model of Project Access, and similar programs exist throughout the state in Hamilton County, Knoxville, Nashville, and the Appalachian Mountain area. All programs are currently in the process of expanding with the goal of total state coverage.

Through Project Access West Tennessee, uninsured patients who need specialty or diagnostic care are referred to the program from providers, hospitals, health departments, community clinics and faithbased centers. The network enrolls members based on a financial assessment, conducts social needs assessments and schedules necessary medical appointments, procedures, and testing. The regional program is building networks in Shelby County initially and will soon expand to cover their full region.

The goal is to increase the number of individuals served month over month.

“Ultimately, this model of care delivery for Western Tennessee will show what is possible when we all work together to solve a community-wide problem,” said Scroggins. “We are very pleased with the level of support from the essential partnerships we have already made with so many providers. Our goal is to grow the network to completely fill the care gaps that exist.”

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Q

PAWT’s first steps have been care coordination and meeting care gaps for essential services. It will focus on connecting people with diagnostic and Feature specialty care, with an emphasis on those in need of treatment for urgent and complex medical conditions. The care coordination team, which currently includes four care coordinators, will aid people with complex conditions, chronic disease or behavioral health issues and social needs. It will identify patients through referral sources, and it will provide disease and medication management education and counseling to prevent harm and unnecessary hospital visits. Throughout the process, the care team will also work with patients on prevention, health literacy and promoting healthy behaviors.

“This is a tremendous leap forward for our region, as we will be able to provide patients with the level of services that increase their access to the healthcare system and the quality of care they receive,” said Clint Cummins, MHA, CEO of Memphis Medical Foundation and Memphis Medical Society.

Patients who qualify for Project Access West Tennessee include those who do not have access to health insurance and whose income is at or below 200% of the Federal Poverty Level. When these patients are referred to the program through a safety net clinic or primary care, they take part in an enrollment process that further evaluates their eligibility and medical needs, as well as their potential need for social services and other assistance.

Why do Doctors Participate in Project Access?

• Project Access allows you and your group to efficiently manage and track the charity care that you have always provided.

• Project Access allows you to define the amount of charity care that you are able and willing to provide.

• Project Access creates a whole network of providers and healthcare services that are automatically available to you and your Project Access charity patients.

• Project Access screens potential charity care patients before they are referred to you, verifying that they meet financial, residential, and healthcare need criteria.

• Project Access charity care patients are eligible for services for a specific period of time and only as long as they continue to meet program criteria.

• Project Access tracks both the nature and dollar value of the charity care so your efforts can be recognized and to ensure that the care is documented so physicians can receive protection under the Volunteer Health Services Act (see below). This information is also a powerful tool to advance issues of importance to providers.

• Project Access allows for an equitable distribution of services by physicians, hospitals, and other providers when attending to the needs of the underserved in our community.

• Project Access prevents any single physician, physician group, hospital or other provider from being asked to provide more than a fair share of charity care.

• Project Access creates an infrastructure that helps our entire community, including business, governments, media, and educational institutions, to support the provision of charity healthcare services.

• The Tennessee General Assembly recognized the value of charity care by passing legislation that provides liability protection for physicians for charity care provided through a coordinated program such as Project Access.

• It’s the right thing to do!

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In Practice

Incentives are Powerful Motivators

By Kathy Hunt, Executive Director, Hunt & Associates When I think of incentives, I think of one saying I heard …"It’s hard to get a person to do something unless they are paid to do it." At face value, this saying might seem harsh or cynical. But let’s explore it a bit.

If I had to synthesize this into a single thought, it could be this: Incentives are very important in the business side of medicine (as well as other industries). As we know, where there is no margin there is no mission. Business entities as a general principle seek to operate to the best of their ability. A well-run healthcare operation delivering lower cost and higher quality generally correlates with solid financial performance. Take profit and not for profit status out of consideration. This remains true of all healthcare entities to ensure long term viability and success. No entity with a strong service mission consciously chooses to perform less than optimally. Yet many US health care businesses shutter every day because they cannot adapt to changes in the environment of industry.

We are all paid based on some formula or model. In the case of healthcare, the waning days of pure fee for service may lead some to think it will always be a business of more volume than profit.

There are signs that is not true anymore. The language of value (higher quality and lower cost) and changing incentives are working their way through the healthcare system and the most progressive players appear to be positioning away from volume alone and toward value. There are several great local examples of that concept. Even so, I’ve heard local administrators wrestle with why they should fully adapt at this time when they are not always paid by commercial payers based on value. They have a point. If you are not incentivized based on value concepts, you may not prioritize these new (sometimes more costly) structures until required to or before it’s too late.

Could it be that we must rise above our current payment model and proactively drive a value equation where we are paid based on performance? Not a new concept but what does that look like today? Well, imagine an organization embracing value-based strategy and negotiating the incentives necessary to further improve quality while replacing more expensive services with less expensive ones. Unless they have a value-based arrangement, that organization would just cut their own margins and the reality is that in large part they won’t be prone to do that. Yet when incentivized and equipped to do so, most will embrace value and in doing so take patient care and improved outcomes to the next level. There is our catch 22. Many are frozen in a model that doesn’t reward or incentivize cost or quality innovations. If your payment model dances around the edges of accountability and value, and doesn’t really embrace those concepts, it is easier to dismiss the impact or explain away the need and timeline to adapt.

If your time horizon in the business is three more years then retirement, perhaps it is not your current priority. But if you plan to be engaged and providing services in this industry in ten years, 14

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being proactive now could save and even transform your business model.

Strongly negotiate a value-based arrangement now if ready for an accountable relationship with a payer.

Well executed, it should be a win-win for everyone, most importantly the patient. A well-constructed value-based contracting arrangement will reward providers for the significant work and effort put in, more often so than fee for services medicine and ultimately drive better outcomes. The proof of that is all over the US in more progressive markets.

Begin the discussion on your terms. Don’t wait until your name shows up on a list or it is finally your turn in re-contracting for a payer network. The sooner you turn the corner and align your incentives, the sooner you will be prepared and better place yourself in the health care system of the future. It may be additionally beneficial to explore various partnerships and collaborations with physician-driven networks, health systems, and/or payers to accelerate readiness and allow you to remain focused on an environment that allows you to better take care of your existing patient populations.

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SUPPORTING SUPPORTING ORGANIZED ORGANIZED MEDICINE MEDICINE

EVERY DONATION HELPS

The Memphis Medical Foundation provides leadership The Memphis Medical Foundation provides leadership and educational opportunities for physicians as well as and educational opportunities for physicians as well as wellness and pu~lic health support. We need your help wellness and pu~lic health support. We need your help to continue our mission of supportin physicians in all to continue our mission of supportin physicians in all sta es of their career.. sta es of their career..

Charity Care Charity Care Planned Giving Planned Giving Fund Physician Fund Physician Mental Health Mental Health Visits Visits In - kind Medical In - kind Medical Supplies Supplies CONTACT AMANDA HARRIS CONTACT AMANDA HARRIS AHARRIS @ MDMEMPHIS ORG AHARRIS @ MDMEMPHIS ORG 901 - 761 - 0200 901 - 761 - 0200

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Financial Q&A Protecting your investment portfolio

Q - I am concerned about the possible changes to our current tax laws. What are the major changes the current administration is considering? Are there any actions I can take this year that will to soften the blow if taxes increase?

A - The current administration has been working to develop legislation which they believe will boost the domestic economy. The American Jobs Plan (infrastructure) and the American Families Plan (family benefits, college, healthcare) are two proposals that will have wide-ranging implications. Funding these initiatives will require major changes to the current system which will significantly increase the tax burden for many Americans.

To start, the top individual income tax rate would likely increase from 37% to 39.6%.

Action to take: (for high earners) accelerate income into this tax year as much as you can. Long-term capital gains and qualified dividend tax would increase from 23.8% to as high as 43.4% (ordinary income rate of 39.6% plus the Net Investment Income Tax of 3.8%). Action to take: review your taxable investment portfolio and realize gains in this calendar year.

The step-up in basis for

inherited property could vanish for gains larger than $1,000,000 for an individual and $2,000,000 for a married couple. Under current law, if the decedent invested $500,000 in stocks and at their death the stocks are worth $2,000,000, their heirs would not pay any tax on the gain. The gain is considered a step-up in basis to the date of death value. In other words, the $500,000 stock portfolio now has a cost basis of $2,000,000.

The proposed change would tax the gains over the new limit as capital gains with the top ordinary income tax rate of 43.4%. In addition, the change could cause a serious headache for inherited property where the cost basis is unknown or lost. The stepup in basis has been eliminated two times during the past five decades (1976 & 2010). Both times it was relatively shortlived. Action to take: Develop a plan before you die by donating appreciating assets to charity, harvest tax losses to offset potential gains, adjust asset ownership, and consider trust protection options.

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Financial Q&A

would be a significant change that would force many Americans to deal with estate taxes at death. Action to take: (for anyone with a large estate over $3.5 million) consider giving away appreciating assets to reduce the size of the estate and a possible tax bill. The annual gift exclusion could also be changing from the unlimited $15,000 per individual, per donee basis to an aggregate individual annual limit and a per donee annual limit. Gifts over the limit would still be possible, but they would reduce the lifetime exemption amount. Action to take: consider gifts this year to take full advantage of the exclusion amounts.

It is possible that some of these changes might become retroactive to an earlier date this year, so planning opportunities could be limited.

Nonetheless, we suggest a financial health review with your team of advisors to evaluate how the proposed changes might impact your financial plan. Even if passed, tax changes are not always permanent and could potentially be reversed during a future administration.

The federal lifetime estate and gift tax exemption could be reduced from $11.7 million per person to $3.5 million per William B. Howard, Jr., ChFC, CFP 6410 Poplar Ave., Suite 330 person, and rates are also Memphis, TN 38119 likely to increase from the Telephone: 901-761-5068 current 40% rate to a tiered Fax: 901-761-2217 structure that has a top rate of 65%. The exemption reduction whoward@whcfa.com 17

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Legislative Dinner We celebrated this annual event back in person

A huge thank you to everyone who joined us at our 2021 Legislative Dinner! It was a wonderful opportunity for legislators and physicians to discuss upcoming healthcare bills and how we can shape Tennessee healthcare for the betterment of patients and physicians. Held at the Crescent Club, physicians enjoyed casually mingling with the legislators as well as a question and answer time on specific issues.

Save the date for our Day on the Hill, March 23, 2022, and join us in Nashville for a day of sit-down meetings with legislators where they learn from you, and you can share your viewpoint and experiences.

Rep. Jesse Chism, MMS President- Elect Dr. Christopher Pokabla, Rep. Joe Towns

Bluff City Medical Society President, Dr. LaTonya Washington

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Rep. Larry Miller, Rep. Dwayne Thompson, Board Members Dr. Lisa Usdan, Dr. Catherine Womack, Dr. David Cannon and Dr. James Wang

Rep. Tom Leatherwood with Board Members Dr. Dale Criner and Dr. David Cannon

TMA Lobbyist Julie Griffin with Dr. Cathy Chapman

Dr. James Ensor, Rep. Dwayne Thompson, Rep. John Gilespie, and Dr. George Woodbury, Jr.

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SEEING ALL THE DETAILS doesn’t always require a microscope.

As a mutual malpractice insurance company, SVMIC has developed a fast and easy alternative for accessing policy information online. This new web-based tool was designed to match the responsive service that our policyholders already experience with us over the phone.

See our new policy management platform

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at svmic.com/vantage

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 Horizon 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, please contact: Margaret Yancey Senior Vice President Medical Private Banking ph: 901-681-2526 myancey@firsthorizon.com Jeff McIlvain Vice President Medical Private Banking ph: 901-681-2555 jmcilvain@firsthorizon.com

©2021 First Horizon Bank. Member FDIC.

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“I am forever grateful and thankful for your part in my life.”

VANCE STACKS, JR. Three-time cancer survivor

Some days, you need a warm blanket and a shoulder to cry on. On much harder days, you need a nurse that tells you, “You’re going to make it,” and a team of skilled oncologists with an evidence-based approach to back it up. Our individually-focused expertise detected and removed Vance’s breast cancer, but it was our caring team that truly saved him.

At Methodist Le Bonheur Healthcare, we don’t just provide exceptional healthcare, we give every patient the comfort, support and care they deserve.

Read Vance’s story of thanks at methodisthealth.org/thankyou.