August-September 2022 Memphis Medical News

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FOCUS TOPICS PEDIATRICS • ORTHO/SPORTS MEDICINE • HEALTH LAW

August/September 2022 >> $5 ON ROUNDS

Coronaphobia, a Perplexing Social Anxiety Disorder

Slow pandemic reintegration posing a problem for healthcare professionals By LYNNE JETER

This Sports Medicine Surgeon is a Man for All Seasons Treatments at OrthoSouth evolving through the years

As an orthopedic surgeon specializing in sports medicine, Marcus Biggers, MD, doesn’t need to see leaves changing colors or azaleas coming into full bloom to mark the change of seasons.

Coronaphobia, a newly minted term, perhaps best describes patients suffering from social anxiety spurred by the pandemic – and it’s a problem for doctors. Some patients have become so accustomed to sequestering in their homes during the early stages of the pandemic – while also transitioning to zoom meetings and phone calls with medical providers – that they’re reluctant to return to inperson visits, especially when restrictions are placed on companions in the waiting room. The problem has led to morethan-usual cancellations and no-shows. (CONTINUED ON PAGE 4)

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The Waiting is the Hardest Part

Growing Trend of Younger Patients Seeking Ortho Treatment

Consider this common scenario: A new physician joins your practice – whether from out-of-state, residency, or another practice. Your practice is contracted with a multitude of payors including Medicare, Medicaid, TRICARE, managed care organizations (MCOs) that administer some of these programs, and various commercial payors.

More effort being directed toward prevention By JAMES DOWD Growing up the son of two physicians, Drew Murphy, MD, decided early on that his future lay in medicine. Now looking back over more than a quarter century of practicing at Campbell Clinic, the foot and ankle specialist is convinced he followed the right path. “I grew up immersed in medicine, so it wasn’t a great surprise to my family that I chose a career in it,” Murphy said. “But I never felt pressure from either parent to choose their

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PHYSICIAN SPOTLIGHT

This Sports Medicine Surgeon is a Man for All Seasons Treatments at OrthoSouth evolving through the years By LAWRENCE BUSER As an orthopedic surgeon specializing in sports medicine, Marcus Biggers, MD, doesn’t need to see leaves changing colors or azaleas coming into full bloom to mark the change of seasons. He can pretty much tell by the types of injuries he sees at OrthoSouth. “It seems like now each sport has its own subset of injuries that we’ll see depending on whatever sport is in season at the time,” said Biggers, who treats shoulders, elbows, hips, and knees, and has expertise in shoulder and knee replacements. “With football revving up now, we’re starting to see those athletes circle in with their injuries with anything from an ankle sprain to ligament injuries around the knee which we see in a lot of football linemen. Many times, it’s an MCL injury which most of the time can be managed with braces and does not require surgery. “Once basketball season gets up and going, we’ll see a very different subset of injuries. You tend to seed more patellar tendonitis issues with basketball players and more ACL injuries with soccer and football players. You see more shoulder and elbow injuries with baseball players, especially with pitchers.” Despite his expertise as an orthopedic surgeon, Biggers said his goal first consideration is to treat his patients’ injuries without surgery. “Our initial goal is, if non-operative management can be an option, that’s always my preferred strategy,” he said. “We’re able to diagnose and confirm what we’re dealing with, so we know when it’s safe to let the body heal on its own. We also know when that simply is not an option. A ligament is not going to repair itself, so we have to go in and do surgery to stabilize the joint. “When I was growing up there were certain situations where if a player tore an ACL on the football field, the doctors probably would have put them in a brace and told them they could play to the end of the season and then have surgery. We now know that’s probably not a good option to allow recurring instability. When we see an ACL tear, that’s an immediate indication to stop playing, to have an operation, and to stabilize the knee. Whether you’re a running back for Alabama or on second-string for a memphismedicalnews

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small high school, the treatment for an more commonly known as the Tommy newer implants that are available and ACL tear is going to be the same.” John ligament that helps maintain get the athlete back to pitching in about Less serious injuries to the ACL, the function of the elbow and allows half the time we were able to when we such as a sprain, can be managed with overhead-throwing athletes maintain were doing the full-out reconstruction a few weeks of rest, a brace and some velocity and control. surgery.” physical therapy, he added. Doctors helped former major league Biggers has always been a sports Just as the pitcher Tommy fan and played high school football and understanding of John extend his soccer while growing up in Greenwood, injuries, treatments career by replacing Miss., where his father is an attorney and healing is everhis worn-out UCL and his mother a pharmacist. He evolving, so too is the with a tendon from majored in microbiology at Mississippi development of new elsewhere in his State University and soon after entermedical devices and body. For younger ing the University of Mississippi Medical surgical techniques. pitchers with less Center School of Medicine, he spent “Arthroscopy is mileage on their a month with a group of orthopedic kind of the center of arms, a UCL probsurgeons. what my practice is lem is more likely “After about a week with them, I with minimally invato be an acute tear knew that’s exactly what I have to do sive surgery using a caused by throwing and that this was where my passion was camera inside the too hard and playreally going to be,” said Biggers, who for joints,” said Biggers. ing all year round. some 10 years spent Friday nights on the “That was some“The ligament sidelines covering high school football thing that came to will just tear off the games as a team physician. “It always Marcus Biggers be just a generation bone, but the ligaseems a lot less like work when I enjoy ago. It developed in ment is still pretty what I’m doing.” the 1980s and added a lot of evolvehealthy. It’s just not attached anyHe and wife Anna have a 10-yearments in the 1990s and 2000s, and now more,” said Biggers, who underwent old daughter and an 8-year-old son, it’s something that many of us are very, specialty training at the prestigious both of whom are involved in a variety very comfortable with. American Sports Medicine Institute in of activities ranging from horseback “I see (older) patients now who had Birmingham, whose patients include riding to football. injuries when they were in high school, many of the biggest names in sports. “In the past year, with my children and they’ve developed arthritis and “For a high school kid with a nice now playing sports, most of my free have had knee replacements and I’ll healthy ligament, we’ve found that if time involves their extracurriculars,” he look at the incisions along their knee. I we just go in and sew that ligament said. “I wasn’t working last Friday, but would treat a similar problem they had back down and reinforce it with some I still was at a football game.” in the past in a very different way. In their defense, doctors did a good job and a lot of those older surgeries worked, but they were just different than what we do now, which is a smaller incision resulting in less pain, a little faster rehabilitation and recovery, and return to the sport. “I hear people say they had ACL surgery and were put in a cast for six weeks and I just cringe at the thought www.memphismedicalnews.com because patients would get a really stiff knee and have a really bad outcome. Leaderboard: $500 When I do an ACL reconstruction, I’ll have them in physical therapy the Scoreboard: $300 next day and working on that range of motion. At times it can be crazy to think Billboard: $400 of what was done in the past, but at the end of my career I’m sure I’ll be doing For more info call or email things differently that I’m doing now.” The age of a patient is always an Pamela Haskins, 501.247.9189 important factor, particularly with pamela@memphismedicalnews.com the elbow’s ulnar collateral ligament

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Coronaphobia, a Perplexing Social Anxiety Disorder, continued from page 1 “Coronaphobia describes the excessive fear of contracting the virus and the stress and avoidance of public places and situations that result from fear,” said MaryCatherine Segota, PsyD, co-founder of Counseling Resource Services. “An increase in anxiety during the pandemic led to fears of leaving the house for some, and eventually symptoms of agoraphobia and panic disorder. What does this mean for healthcare providers, and how does it influence how we screen and probe for psychiatric issues?” Individual reactions to the pandemic have differed in many ways, Segota explained. “The initial adjustment to the shock of sudden and necessary lockdown and dealing with such issues as virus contagion, contamination fears, distance from loved ones, changes in patterns and routines, and isolation was difficult for almost everyone,” she said. “Adding to this was the unanticipated extension of the pandemic spanning two-plus years, which led to additional difficulties adjusting and more distress. Now that we are beginning to return to integrated social interactions and

a ‘new normal,’ we see that some individuals have not adjusted as well as anticipated nor resumed their prior level of functioning.” Preliminary anxiety related to the pandemic was initially associated with obsessive compulsive disorder and health-related anxieties, said Segota. “An increase in anxiety during the pandemic led to fears of leaving the house for some and eventually symptoms of agoraphobia and panic disorders,” she said. “Agoraphobia typically last six months or longer and is accompanied by symptoms characteristic of panic disorder.” Dr. Brian Thoma, an interventional pain physician for Cahaba Pain and Spine Care in Hoover, Ala., said the nearly six-week surgical shutdown in early 2020 greatly impacted patients who rely on pain-relieving procedures to stay functional. That includes the new SGB block for patients with PTSD that many military veterans call a game-changing reset. “Early in the pandemic, I recall a young woman being referred to us for an epidural blood patch, a

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Brian Thoma

Jacqueline Hobbs

for activities outside the home. Ask procedure we’re asked to do for about attempts to increase activities patients with a terrible headache outside the house or avoidance of after a lumbar puncture,” said those activities.” Thoma. “The patient was relucSome health systems have introtant to come in, but ultimately the duced new programs to address headache was bad enough that she these problems. For example, Kaiser wanted the procedure. Fortunately, Permanente this month is unveiling it worked well for her.” to its members on-demand emoAs society transitions to a new tional support through the Ginger phase of the pandemic, it’s essential app. Ginger’s emotional support to ask critical questions to help assess coaches are available 24/7 to help the presence of clinical anxiety and with stress, low mood, sleep troubles to help differentiate disorders, said and more. The first 90 days are free. Segota, who suggests implementing a Jacqueline Hobbs, MD, PhD., questionnaire that assesses COVIDan associate related stressors professor in the and socialization University of reintegration Florida College difficulties. As society of Medicine’s “Ask about the transitions to a department following stressors: of psychiatry, financial probnew phase of emphasized the lems (difficulty the pandemic, importance of paying bills, debt), it’s essential the pandemic not work problems being over. (unemployment, to ask critical “It’s a pandecreased hours/ questions to demic seemingly roles, conflicts without end. with colleagues), help assess the It’s a recipe for educational probpresence of a mental health lems (difficulty crisis,” she said. completing course clinical anxiety “The latest corowork), housing and to help navirus variant problems (instais fueling a surge bility, moves), differentiate in cases while relationship probdisorders. Americans worry lems (isolation, about ever-more separation or infectious versions divorce, conflict to come.” with family or friends, intimacy The pandemic is so prolonged problems), personal or loved one’s that it has become a chronic stressor, health problems (new or worsening said Hobbs. illness, medication issues, disability) “People don’t feel like there’s an and caregiving problems (emotional end in sight,” she said. “We get little stress, time demands). Ask about glimpses of the finish line, but then mood and adjustment to changes, we’re right back at it.” sleep, energy, appetite, and desires MEMPHISMEDICALNEWS

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Growing Trend, continued from page 1 specialties. They allowed me to pursue my own interests and supported me when the time came to choose a specialty.” Unlike his plastic surgeon father or his radiation oncologist mother, Murphy opted for what he said had traditionally been characterized as a more mechanical discipline. He was attracted by the chance to help patients improve their quality of life. “Generally speaking, orthopedics isn’t about life-or-death conditions, it’s about improving or restoring mobility,” Murphy said. “I find it rewarding to help patients lead better lives.” Born in Jackson, Mississippi, Murphy grew up in Memphis and graduated from Briarcrest. He earned his bachelor’s degree from the University of Mississippi and went to medical school at the University of Tennessee-Memphis. He completed his residency at Campbell Clinic and has been on staff there for more than 25 years. “Memphis is home for us and there never really was any question of our moving elsewhere after I finished my medical training,” Murphy said. “Campbell Clinic is a fantastic place to practice and combines the feel of a private practice with a strong academic/research/ teaching side. It is truly a unique place and there’s nothing like it across the country.” Founded in 1909, Campbell Clinic has expanded from one location to five clinics and two surgery centers across the Memphis metropolitan area. The practice also offers extended hours through Campbell Clinic After Hours. The clinic has grown to respond to increasing – and evolving – patient needs, Murphy said. And the clinic’s evolution reflects a field that has changed dramatically in the last three decades, Murphy explained, transitioning from a strength-dominated discipline to one that showcases greater finesse. Along the way, more women entered orthopedics and treatments evolved to include preventive measures. One growing trend is the prevalence of younger patients seeking treatment, Murphy said. With so many adolescents and preteens involved in year-round athletics, sports-related injuries are increasingly common. In addition, overtraining is taking a toll on young bodies in ways that weren’t common a couple generations ago. “For example, elite cheerleading and some year-round sports require these young athletes to practice for hours a day to achieve a high level of performance,” Murphy said. “As a result, we’re seeing more stress fractures and more overuse injuries than we ever have before.” Gymnastics is another area where Murphy has witnessed increased numbers of injuries. While the sport itself offers a great community that promotes family involvement, young people whose bodies are rapidly changing can be at greater risk for getting hurt.

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“Young athletes who can perform extraordinary exercises at 70 pounds may find their bodies responding quite differently when performing difficult exercises when they grow taller and gain weight,” Murphy said. “We’re seeing more feet, ankle and back injuries and working with these patients to address these concerns before they result in catastrophic injuries.” One treatment that has emerged over the last 10-15 years is therapy for Vitamin D deficiency in athletes. Young people involved in heavy training for winter sports such as basketball are at risk for stress fractures in their legs and feet because so much practice takes place on indoor courts and there is a lack of sunlight exposure. “We check their Vitamin D levels and prescribe Vitamin D if they’re deficient. We also educate them about proactive muscle training and core strengthening to help them avoid injuries,” Murphy said. “There has been a cultural change in our field and we’re no longer treating a patient who comes in with a sprain or a broken bone. Now we’re working to reduce injuries before they occur.” Along with an increase in sportsrelated injuries among adolescents, Murphy has seen an uptick in the number of young people whose injuries are complicated by obesity or diabetes. Those conditions can slow wound and bone healing, so the practice offers medical management for patients and their families. “We work with them to gain better control of their risk factors to ensure a better outcome following their treatment,” Murphy said. “This is something you didn’t see 15 years ago, but now it’s part of our regular routine.” Although Murphy is quick to point out that while not every ankle sprain requires attention by an orthopedic surgeon, cases such as pediatric elbow injuries that seem minor may need a specialist’s care. And there is one area that is always cause for concern among young patients. “Back pain in young people is never normal,” Murphy said. “In children or adolescents, if it lasts more than a couple weeks, then it needs to be addressed. At that point you need to come see us.” Spending his professional time promoting healing in others has made Murphy aware of his own physical condition and the older he gets the more aware he becomes of focusing on his quality of life. A long-time member of an adult soccer team, he’s now comfortable trading his cleats in favor of more time in the garden or in the kitchen. “At my age, the risk of injury keeps rising, so I don’t mind leaving soccer to the younger players,” Murphy said. “My wife and I grow vegetables and cook and entertain and that’s our focus these days. Everything has a season this is the one we’re in now. And we’re loving it.”

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Hospitals Cut Jobs and Services as Rising Costs Strain Budgets By KATHERYN HOUGHTON, Kaiser Health News

Bozeman Health had a problem, one that officials at the health system with hospitals and clinics in southwestern Montana said had been building for months. It had made it through the covid-19 pandemic’s most difficult trials but lost employees and paid a premium for traveling workers to fill the void. Inflation had also driven up operating costs. The system, which serves one of the state’s richest and fastest-growing areas, was losing money. It spent nearly $15 million more than it brought in from January to June of this year, President and CEO John Hill said. On Aug. 2, Hill announced that Bozeman Health had laid off 28 people in leadership positions and wouldn’t fill 25 open leadership jobs. The system has a workforce of about 2,400 and an approximately $450 million budget for the year. The pandemic has intensified a longrunning health care worker shortage that has hit especially hard in large, rural states like Montana, which have few candidates to replace workers who depart. Expensive stopgaps — including traveling nurses — caused hospitals’ costs to rise. Staffing shortages have also left patients with longer waits for treatment or fewer providers to care for them. In addition to Montana, hospitals in California, Mississippi, New York, Oregon, and elsewhere laid off workers and scaled back services this summer. Health systems have pointed toward low surgery volumes, high equipment prices, sicker patients, and struggling investments. Parallel to those problems, hospitals’ largest expense — payroll — skyrocketed. “If you talk with just about any hospital leader across the country, they would put workforce as their top one, two, and three priorities,” said Akin Demehin, senior director of quality and patient safety policy for the American Hospital Association. Workers left the health care industry in droves during the pandemic, citing low pay and burnout. Nationwide, hospitals competed for contract workers to fill the void, which drove up prices. That left hospitals with an awkward balancing act: keep existing employees and fill essential roles while cutting costs. Bozeman Health Chief Financial Officer Brad Ludford said the system went from spending less than $100,000 a month on short-term workers before the pandemic to $1.2 million a week last fall. That number is now closer to $1.4 million a month. Overall, the system’s labor costs are roughly $20 million a month, an increase of about 12% compared with this time last year. Hill said the health system took other measures before cutting jobs: It stopped all out-of-state business travel, cut executive compensation, and readjusted workloads. Simultaneously, it tried to convert contract 6

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workers into full-time employees and to retain existing staffers though a minimum wage increase. Hill said the hospital system has had some success but it’s slow. As of mid-August, it had 487 vacancies for essential workers. “It still has not been enough,” Hill said. Vicky Byrd, a registered nurse and the CEO of the Montana Nurses Association, said nationwide shortages mean nurses are asked to do more with less help. She wants to see more hospitals offer longtime employees the kind of incentives they’ve used for recruitment, such as giving nurses premium pay for picking up additional shifts or bonuses for longevity. “It’s not just about recruiting — you can get anybody in the door for $20,000 bonuses,” Byrd said. “But how are you going to keep them there for 10 or 20 years?” Hospitals’ financial challenges have evolved since early in the pandemic, when concerns focused on covid response costs and revenue that didn’t come in because people delayed other care. In 2020, because of federal aid and a return to more normal service levels, many of the nation’s wealthy hospitals made money. But hospital officials have said the financial picture shifted early in 2022. Some hospitals were hit hard by the omicron surge, as well as rising inflation and staffing challenges. Hospitals received millions of dollars in pandemic relief from the government, but industry officials said that has dwindled. Bozeman Health, for example, received roughly $20 million in federal aid in 2020. It received $2.5 million last year and about $100,000 in 2022. John Romley, a health economist and a senior fellow at the University of Southern California’s Schaeffer Center for Health Policy and Economics, said that with federal aid drying up and inflation taking off, some hospitals may now be losing money. But he cautioned that more data is needed to determine how hospitals overall have fared compared with previous years. Providence, a health system with 52 hospitals across the West, reported a net operating loss of $510 million for the first three months of the year. In July, Providence announced it was putting in place a “leaner executive team.” The system operates one of Montana’s largest providers, Providence St. Patrick Hospital in Missoula. Kirk Bodlovic, chief operating officer of Providence Montana, said the new structure hasn’t affected local positions yet, although he said hospital leaders are scrutinizing open jobs that aren’t essential to patient care. He said the hospital is trying to reduce its reliance on contract workers. “Recruitment efforts are not keeping up with the demand,” Bodlovic said.

Providence, a health system with hospitals and clinics across the West, including Providence St. Patrick Hospital in Missoula, Montana, reported a net operating loss of $510 million for the first three months of 2022. (Katheryn Houghton / KHN)

Hospital job cuts across the nation have pushed out some health care professionals who had stuck with their jobs during the stress of the pandemic. And the cuts have meant some patients have needed to travel further for treatment. In Coos Bay, Oregon, the Bay Area Hospital faced community backlash after it announced it would cut the contracts of 56 travel workers and end its inpatient behavioral health services. Hospital officials cited the high cost of filling open positions quickly. St. Charles Health System, headquartered in Bend, Oregon, laid off 105 workers and eliminated 76 vacant positions in May. The system’s CEO at the time, Joe Sluka, said in a news release that labor costs had “skyrocketed” largely because of the need to bring in contract clinical workers. He said the hospital ended April with a $21.8 million loss. “It has taken us two pandemic years to get us into this situation, and it will take at least two years for us to recover,” Sluka said in the release. In Montana, Bozeman Health hasn’t been able to offer inpatient dialysis at its largest hospital for months, so patients who need that service have been sent elsewhere. Hill said he expects some delays for services outside of critical care, such as lab testing. Ludford said the hope is that the system will begin breaking even in the second half of this year. About 100 miles away, Shodair Children’s Hospital in Helena halved the number of patients it accepted because of staffing shortages. It’s the only inpatient psychiatric hospital for kids in Montana and is constructing a $66 million facility to expand bed capacity. CEO Craig Aasved said the 74-bed hospital downsized roughly two years ago

instead of adding contract workers so it could leave space for patients to quarantine in case of covid outbreaks. Aasved said he’s scrambling to get another unit open. Shodair, which historically hasn’t relied on travel workers, hired four traveling workers in recent months, he said. “It’s a double whammy: We lost revenue because we’ve closed beds, and then you’ve got the additional expense for travelers on top of that,” Aasved said. “The goal is no layoffs, no furloughs, but we can’t stay in what we’ve been doing forever.” He said the hospital increased pay for some employees and opened a nurse residency program roughly six months ago to bring in new people. But those steps haven’t delivered immediate help. Nearby, the CEO of St. Peter’s Health, Wade Johnson, said the hospital closed part of its inpatient unit and scaled back hours for some services because of staffing shortages. Some beds remain out of use. Administrators are exploring automation of more services — such as having patients order food by iPad instead of through a hospital employee. They also are allowing more flexible schedules to retain existing staffers. “Now that we’ve adapted to life with covid in many regards in the clinical setting, we are dealing with the repercussions of how the pandemic impacted our staff and our communities as a whole,” Johnson said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. memphismedicalnews

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The Waiting is the Hardest Part By JD THOMAS AND ANDREW SOLINGER

Consider this common scenario: A new physician joins your practice – whether from out-of-state, residency, or another practice. Your practice is contracted with a multitude of payors including Medicare, Medicaid, TRICARE, managed care organizations (MCOs) that administer some of these programs, and various commercial payors. You’re busy, and you want your new physician to start seeing patients immediately. But before you can bill any of these payors, the physician needs to be credentialed and enrolled with each of them. It’s a time-consuming and convoluted process, different for each payor and full of many hurry-up-and-wait moments. Our example describes a medical practice, but it’s not just physicians who require credentialing. Dentists, counselors and many other healthcare providers must also be credentialed by their respective payors in order to bill for the services that they provide. Some providers are waiting 30 days to as much as a year for MCOs and other payors to verify documentation, review applications, and make approval decisions. Unfortunately, this growing backlog for government and private payors can lead to the temptation to cut corners when submitting claims during the gap between application submission and approval, but by doing so they may ultimately create significant civil, and possibly criminal, liability. So, how can a practice bill for a new provider’s services after a credentialing application is submitted but before it has been approved? Claims submitted for new and as-yet uncredentialed providers must be carefully considered in order to avoid compliance issues. A significant area of concern during the credentialing/ enrollment process is the potential for a practice to bill for services rendered by new practitioners using the credentials of an already-credentialed provider in the same practice. Staff may see this as an easy way to avoid holding claims, but it comes with tremendous risk. Depending on how the claim is billed, it likely results in inaccurate claims being submitted, and any claims submitted by the still-un-credentialed provider may either be denied or, if already paid, may lead to overpayments. Medicaid and other government payors typically view such claims as fraudulent under the False Claims Act and other civil – and even criminal – laws. Most payors – including federal healthcare programs, MCOs, and commercial payors –retroactively approve providers’ credentials back to the date of application. This presumes, however, that the application is ultimately approved, and that the provider complies with all other MEMPHISMEDICALNEWS

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Some providers are waiting 30 days to as much as a year for MCOs and other payors to verify documentation, review applications, and make approval decisions. requirements set forth by the payors. If a credentialing application is denied for any reason, whether it’s incomplete data, failure to meet the payor’s standards, or on any other basis, a new application must be submitted, and the retroactive approval date will typically be the new application date. This means that the period between the first application and the application denial is lost for purposes of submitting claims, and any claims submitted by that provider during that period run the risk of either being denied or resulting in potential overpayments. Regardless of how a practice decides to handle new providers’ claims, it is imperative to understand each payor’s rules and regulations. Medicaid payors have increased their focus in this area. If a practice participates in government healthcare programs, additional attention must be paid to ensure that all claims are accurate and submitted for properly credentialed providers. Buyers considering the purchase of a medical or dental practice or practice management company would be wise to verify that no claims have been billed for non-enrolled/non-credentialed providers under another provider’s number. Failure to exercise due care in this area can lead to significant liability.

Inflation Markets rarely give us clear skies, and there are always threats to watch for on the horizon, but the right preparation, context, and support can help us navigate anything that may lie ahead. So far, this year hasn’t seen a full-blown crisis like 2008–2009 or 2020, but the ride has been very bumpy. We may not be flying into a storm, but there’s been plenty of turbulence the first of 2022. How businesses, households, and central banks steer through the rough air will set the tone for markets over the second half of 2022. The sources of turbulence are clear. A global economy that was already vulnerable to inflation from supply chain disruptions, tight labor markets, excess stimulus, and loose monetary policy came under more pressure when Russian aggression in Ukraine added sharply rising commodity prices and pushed Europe into what may be the brink of a recession. The effects have included renewed pressure on interest rates, which hurt bond investors and contributed to tightening financial conditions, and a much more aggressive stance by the Federal Reserve (Fed) and other global central banks. Add in the typical market challenges of a midterm election year and the third year of a bull market, and it’s not surprising it’s been a bumpy ride. Understandably, rising prices, slowing economic growth, and a challenging first half for both stocks and bonds have many investors on edge, and fatigue from more than two years of COVID-19 measures doesn’t make it any easier. But markets are always forward looking, so it’s important to remain focused on what lies ahead. There will most certainly be challenges, but there are also some tailwinds from a strong job market, still resilient businesses, and the likelihood that inflation will soon start to slow. Markets historically can even get a little lift from lower uncertainty around elections as midterms approach. Turbulence cannot be avoided, but it also need not deter us from making progress toward our financial goals. When times are turbulent, the surest path toward progress remains sound financial advice from dedicated professionals who have logged many hours in similar conditions.

How Applicable Is the CPI? While it's the commonly used indicator of inflation, the CPI has come under scrutiny. For example, the CPI rose 7.9 percent for the 12-months ending in February 2022. However, a closer look at the report shows movement in prices on a more detailed level. Energy prices, for example, rose 25.6 percent during those 12 months.1

Are Investments Affected by Inflation? They sure are. As inflation rises and falls, three notable effects are observed.

First, inflation reduces the real rate of return on investments. So, if an investment earned 6 percent for a 12-month period and inflation averaged 1.5 percent over that time, the investment's real rate of return would have been 4.5 percent. If taxes are considered, the real rate of return may be reduced even further.3 Second, inflation puts purchasing power at risk. When prices rise, a fixed amount of money has the power to purchase fewer and fewer goods. Third, inflation can influence the actions of the Federal Reserve. If the Fed wants to control inflation, it has various methods for reducing the amount of money in circulation. Hypothetically, a smaller supply of money would lead to less spending, which may lead to lower prices and lower inflation.

Empower Yourself with a Trusted Professional

When inflation is low, it's easy to overlook how rising prices are affecting a household budget. "If the current annual inflation rate is 7.9 On the other hand, when inflation is high, it may percent, why do my bills seem like they're 10 be tempting to make more sweeping changes in percent higher than last year?"1 response to increasing prices. The best approach may be to reach out to your financial Many of us ask ourselves that question, and it professional to help you develop a sound illustrates the importance of understanding investment strategy that takes both possible how inflation is reported and how it can affect scenarios into account. investments.

Inflation & Your Money

What Is Inflation?

JD Thomas is a partner at Waller and a former federal prosecutor. He advises healthcare clients in government investigations and prosecutions, qui tam and False Claims Act defense and other enforcement actions.

the average level of prices. Each month, the Bureau of Labor Statistics releases a report called the Consumer Price Index Chirag Chauhan, (CPI) to track these AIF®, CFP® fluctuations. It was developed from detailed expenditure information provided by families and individuals on purchases made in the following categories: food and beverages, housing, apparel, transportation, medical care, recreation, education and communication, and other groups and services.2

Inflation is defined as an upward movement in

1. USInflationCalculator.com, 2022 2. BLS.gov, 2022 3. This is a hypothetical example used for illustrative purposes only. It is not representative of any specific investment or combination of investments. Past performance does not guarantee future results.

Chirag Chauhan, MBA, AIF®, CFP® is the managing partner of Bluff City Advisory Group in Memphis, Tennessee. For more info, please visit bluffcityadvisory.com.

Andrew Solinger is an associate at Waller where he assists clients in responding to investigations, audits and other inquiries brought by federal and state government agencies and regulators. AUGUST/SEPTEMBER 2022

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What We Owe Long COVID Patients

The complexity of delivering an accurate diagnosis Compassionate and quality care for patients of all faiths.

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By DR. ZIJIAN CHEN When Gov. Andrew Cuomo shut down New York City in March 2020, we knew little about treating COVID-19. While treatment has improved considerably, and those with milder symptoms. Yet there is a third category of patients: those suffering from long COVID, whose symptoms linger for an extended period or mysteriously reappear months after their original infection. Clinicians recognized the existence of these long COVID patients early in the pandemic. May 13, 2022, marked the two-year anniversary of the opening of the Mount Sinai Center for Post-COVID Care in New York City, a first-of-its-kind unit in the U.S. Since then, long COVID has emerged as one of the biggest but least-addressed medical concerns. Anywhere from 10% to 30% of those who contracted COVID-19 suffer chronic aftereffects, some lasting many months after the initial diagnosis. These patients face increased risk of thromboembolic disease, cardiovascular complications, hepatic and renal impairment, and systemic inflammatory response syndrome. While most of the U.S. has returned to “normal” (or at least a new version of it), these long COVID sufferers, through no fault of their own, have been left behind. They may have avoided the most serious outcomes of COVID-19 initially but are missing out on the return to life as they knew it. And while these patients struggle, so do their healthcare providers—many of whom suffer from long COVID themselves after fighting on the front line as intensive care units and morgues exceeded capacity. Long COVID presents varying and unpredictable symptoms and has no known cure, so with very little information, healthcare providers are facing an uphill battle when it comes to providing adequate care to these patients. The absence of a standard set of interventions leaves caregivers vulnerable to liability risks stemming from misdiagnoses— either by not recognizing that the patient has long COVID or by diagnosing long COVID when, in fact, the patient has another serious disease. Medical errors do happen; in fact, diagnostic error is the No. 1 cause of serious harm, making it the top concern for preventing patient injury. In light of these findings, patients need to present clinicians with the full range of symptoms and ask for comprehensive diagnostic tests to be run in order to identify if it’s long COVID or another ailment. In return, health-care providers need to bring experts from varying fields together. Forming a strong multidisciplinary care team, communicating clearly and often with patients, keeping detailed chart notes, conducting exploratory testing, following up frequently with the patient and proactively referring to specialists are all essential elements of effective long COVID care.

If a patient suspects they suffer from long COVID or presents a variety of symptoms after having COVID-19, their assembled care team—which often starts at the office of their primary care provider—should first rule out a separate underlying illness. Health-care professionals need to find a balance whereby they maintain, when appropriate, a high index of suspicion for long COVID, without letting long COVID become a catchall diagnosis. Knowing that long COVID can present as more than 200 symptoms affecting 10 organ systems, health-care providers find it challenging to pinpoint which ailments, if any, were a direct result of COVID-19. With so many individual symptoms, patients may see a range of specialists, calling for a high degree of collaboration between providers. That there are other ailments masquerading as long COVID emphasizes the importance of seeing patients quickly and providing a thorough evaluation. Common long COVID symptoms like chest pain and heart palpitations could also be the presentation of some other, more emergent condition. As frustrating and debilitating as long COVID can be, it can mask worse diseases that might lead to costlier medical bills and a more rapid decline in a patient’s health—as well as a higher chance for litigation against physicians if these diagnoses are missed. When signs of long COVID emerged in the summer of 2020, many doctors were skeptical. Even now—two years later—skeptics remain. Consequently, many patients feel that medical professionals are failing them. In the early 1990s, given limited research, some health-care providers did not yet believe that chronic Lyme was a real disease. Similar doubts have been expressed about long COVID. When health-care providers struggle with doubts about long COVID, they should remember that COVID-19 can result in something other than short-term symptoms or death. There’s another scenario—a third category of COVID-19 patients—and we need to accept that reality. This work first appeared in The New York Daily News and online at www.nydailynews.com. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Dr. Zijian Chen is the Assistant Professor of Medicine at the Icahn School of Medicine at Mount Sinai, and Peter A. Kolbert, Senior Vice President of Claim and Litigation services for Healthcare Risk Advisors, part of TDC Group. MEMPHISMEDICALNEWS

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An Interventionalist’s Perspective on Neuromodulation for Chronic Pain Chronic pain, defined as pain of at least 3-6 months, affects more than 20 percent of Americans. Managing this pain can be frustrating for providers and patients, particularly when pain becomes refractory and options may be limited by failed treatments, side effects, or medical co-morbidities. For By WINFRED B. neuropathic pain ABRAMS, JR., MD and nociceptive pain, the area of neuromodulation has increasingly led to greater options for many patients. Neuromodulation involves the attenuation of painful signals via neural pathways. An available option to help patients with refractory neuropathic pain is spinal cord stimulation (SCS). Conditions that can benefit from this technology are peripheral diabetic neuropathy (PDN) and radicular pain (RP). Other indicated conditions are post spinal surgery syndrome (PSSS) (i.e., failed back surgery syndrome/ post-laminectomy pain syndrome), CRPS, post-herpetic neuralgia, ischemic limb pain, and non-surgical axial back pain. Targets of neuromodulation have varied over the years but include stimulation alone or in combination of the spinal cord dorsal horn or dorsal

column. Melzack and Wall’s Gate Theory, as well as glial cell activation, had been proposed mechanisms of pain relief. Whether PSSS, RP, or PDN, all have the same process of evaluation. After failed conservative or surgical management, patients can be evaluated by an Interventionalist. There is a 3-step process: (1) referral to a psychological specialist for psychoanalytic clearance to rule out conditions with poor outcomes such as unstable sociodynamic situations, significant depression or anxiety, history of active substance abuse or psychosis; (2) prognostication of satisfactory pain relief with a percutaneous SCS trial; and (3) final implantation in select patients. The goal of this device is to eliminate or appreciably reduce medication burdens, particularly opiates. For diabetic patients, there is a fair latitude regarding diabetic control (RCT up to HA1C 10 %), but tight control with HA1C < 7.5% - 8% is ideal to reduce the risk of post-operative infections, which can occur up to 90 days later. In addition, PDN patients should have been previously evaluated by the referring physician and found to have a diagnosis of PDN either on EMG/NCS, monofilament testing with HA1C testing, and have failed at least two medications over at least 6 months of treatment (note: patients who are unwilling to quit smoking more than 60 days are less ideal candidates). Success of these modalities has had varied scrutiny over the greater than 30 years

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of utilization, but overwhelmingly evidence supports its use. PDN presents in 50 percent of diabetic patients, and up to 45 percent of those have inadequate pain relief. SCS can be 84 percent effective in reducing pain from severe pain to mild. Most who experience relief with a trial desire conversion to an implant. For radicular pain, conversion rates are equally as high and patients often have improvements in pain of 50-70 percent, with a roughly 60-70 percent success rate. Currently, approval for SCS for PDN can be challenging, but success is being seen with Medicare, United Health, and select BCBS insurance. Wider coverage is seen for SCS for non-diabetic indications with variations based on upon local coverage determinations. Another area of neuromodulation also commonly used is that of radiofrequency ablation (RF). There are three forms: conventional thermal, cooled, and pulsed. Pulsed and cooled RF can have very good outcomes, but often are only covered by hospital-based or hospitalassociated practices or require self-pay. RF can be used to modulate pain of neuropathic origin, but most commonly is used to reduce deep somatic pain from facet joints in the axial spine; it also is indicated for pain from the shoulder, knee, hip, and SI joint. The Interventionalist takes the patient through another 3-step process: (1) diagnostic block, (2) prognostic block, and the ablation (treatment). The patient requires, depending on the insurer, usually

50-80 percent or greater pain relief for a few hours after the anesthetic block of the nerves of a joint combined with improved function and reduced pain. After successful work-up, the patient moves on with RF. Outcomes, depending on body region, consistently provide relief from 6 to 24 months. Cervical and lumbar regions can see average pain relief 8-15 months. The procedures mentioned above are safe and effective options to help your patients. With all these conditions, conservative management with an NSAID and/or neuropathic agent AND physical therapy (PT) are standard of care. PT can be performed before referral to a specialist and can expedite outcomes. Collaboration with your community Interventionalist can facilitate all phases of care for your patients. OrthoSouth Interventionalists practice at 8 convenient clinic locations across Western Tennessee and Northern Mississippi. For patients who may be candidates for interventional procedures, our in-house physical therapy services – located at all 8 clinics – can facilitate a smooth and collaborative transition from conservative care to advanced interventions. Winfred B. Abrams, Jr., MD is a fellowship trained interventional spine specialist practicing at the OrthoSouth Germantown, Memphis-Briarcrest, and Southaven clinics. He can be reached at 901641-3000. Learn more about Dr. Abrams and other OrthoSouth providers.

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GrandRounds Surging Growth Creates Need for Guardian MidSouth Memphis Relocation Guardian Mid-South Pharmacy, a leading Tennessee long-term care (LTC) pharmacy based in Memphis, announced its move into a brand new 20,000-square-foot headquarters after expanding its customer base by over 33 percent in the past 18 months. Double the size of the former location, the larger facility will allow Guardian Mid-South Pharmacy to increase its workforce and operations to meet surging business growth and better support LTC communities. The relocation comes as the pharmacy celebrates a decade serving residents in assisted living, skilled nursing and behavioral health communities as well as individuals with intellectual and developmental disabilities across Tennessee, eastern Arkansas and northern Mississippi. With the expansion, Guardian Mid-South Pharmacy anticipates increasing its number of employees by 25 percent over the next two years. The headquarters alleviates the capacity limitation of the prior Memphis facility and allows for future growth. “For 10 years, the Guardian MidSouth team has been dedicated to providing superior expertise and customer service to our clients, and we’ve succeeded as evidenced by our rapidly expanding customer base,” said Curt Bicknell, PharmD and president of Guardian Mid-South Pharmacy. “The new facility’s additional space will house our growing workforce and enhance operational efficiency, so that we can continue to provide innovative programs and medication management services to help our clients improve the lives of their residents.” Guardian Mid-South Pharmacy, which opened in 2012, is part of Guardian Pharmacy Services, one of the nation’s largest LTC pharmacy companies with 41 locations serving 30 states. Guardian’s pharmacies provide outstanding client service and resident care to long-term care communities, including assisted living and skilled nursing, group home, behavioral health and to organizations that serve individuals with intellectual and developmental disabilities. www.guardianpharmacy.com.

University Clinical Health Welcomes Dr. Joseph Fong and Dr. Priscilla April Lao to Hamilton Eye Institute Hamilton Eye Institute (HEI), a specialty of University Clinical Health, welcomes Dr. Joseph Fong and Dr. Priscilla April Lao. They joined the HEI physician team on September 1. Fong recently completed a NeuroOphthalmology and Adult Strabismus fellowship at the University of Oklahoma Health Science Center’s

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Dean McGee Eye Institute. Prior to his fellowship, Fong was a resident at University of Arkansas’s Jones Eye Institute. He is a graduate of University of Tennessee Health Science Center, and a member of the American Academy of Ophthalmology. Fong will be serving patients at HEI’s Madison and Cresthaven locations, St. Jude Children’s Research Hospital and the Memphis VA Medical Center. Dr. Priscilla April Lao is a graduate of Louisiana State University Health Sciences Center, and recently completed her fellowship in NeuroOphthalmology and Oculoplastics at Jefferson Medical College’s Wills Eye Hospital in Philadelphia. She is a member of the American Academy of Ophthalmology and the North American Neuro-Ophthalmology Society. Lao will be serving patients at HEI’s Madison and Cresthaven locations.

Methodist Le Bonheur Healthcare Names Kate Dowd SVP/Chief Legal Officer Methodist Le Bonheur Healthcare has named Kate Dowd senior vice president and chief legal officer. In this role she will direct the Memphis-based integrated healthcare system’s legal Kate Dowd department and risk management goals. “After a comprehensive nationwide search, it became clear the right candidate was already within our organization,” said Monica Wharton, MLH executive vice president and chief administrative officer. “Kate’s experience navigating complex healthcare-related legal matters gives me great confidence she will successfully lead our multifaceted legal affairs efforts and serve as a trusted member of our system leadership team.” Dowd has a decade of experience specializing in health and regulatory law, most recently serving as MLH’s regulatory counsel. Prior to joining MLH in 2019, she served as an attorney in the Healthcare Regulatory and Transactions Practice Group at Butler Snow LLP. “Our policies, best practices and unshakeable commitment to our patients enable us to deliver outstanding care,” added Wharton. “Kate’s core values align perfectly with our mission to improve the health and wellbeing of our community.” Originally from Charlotte, North Carolina, Dowd has called Memphis home for 17 years. She received her undergraduate degree from Rhodes College and graduated cum laude from the Cecil C. Humphreys School of Law at the University of Memphis. She is a member of the American

Health Law Association, the Tennessee Bar Association and the Memphis Bar Association, and recently served as chair and president emeritus of the local Memphis Bar Association’s health law section.

Campbell Clinic Orthopaedics Announces Growth in East Tennessee Campbell Clinic Orthopaedics, the largest and oldest multi-specialty orthopaedic practice in West Tennessee, has announced a partnership with Tier 1 Orthopedic and Neurosurgical Institute headquartered in Cookeville, Tennessee. As part of the alliance, Tier 1’s orthopaedic physicians will have access to Campbell Clinic’s clinical research as well as its care team’s best practices, standard approaches and clinical processes, all of which are designed to improve patient outcomes. Tier 1 is comprised of 11 physicians. The practice offers a full range of multi-specialty orthopaedic and neurological services and has locations in Cookeville and Crossville and serves residents in the Upper Cumberland region of Tennessee. “When looking for a partner, we focused on finding an institution that shares our commitment to providing the highest quality care and leadingedge orthopaedic expertise,” said Dr. Greg Roberts of Tier 1. “Most importantly, we aimed to align with a group whose dedication to patients has been unwavering during the challenging healthcare climate. There is no one better than Campbell Clinic that checks all those boxes.” Campbell Clinic is equally as enthusiastic about the new alliance. “Tier 1 is a natural fit for our organization as their values and commitment match our own,” said Daniel Shumate, CEO of Campbell Clinic. “They are the ideal candidate as we grow our practice area to embrace our partners in east Tennessee and beyond. We’re excited to welcome their more than 100 new employees to the Campbell Clinic family.” Campbell Clinic is already the largest multi-specialty orthopaedic clinic in West Tennessee, North Mississippi, and West Arkansas. The partnership of Tier 1 brings the total physician count of Campbell Clinic to 62, further bolstering the clinic’s position as the industry leader in the Mid-South. “This is all about improving patient care,” says Dr. Frederick Azar, Campbell Clinic’s Chief of Staff. “When you come to one of our clinics, you’re receiving more than just orthopaedic expertise. You are receiving the best possible care from our world-class experts. On behalf of the physicians at Campbell Clinic and the patients we are privileged to serve, we feel very blessed to have the team at Tier 1 join ours.”

Founded by the late Willis C. Campbell, M.D. in 1909, Campbell Clinic is world-renowned for its clinical excellence. Campbell Clinic is an industry leader in orthopaedic medicine, surgery, teaching and research. For more information, call 901-759-3100 or visit www.campbellclinic.com.

Baptist Memorial’s Lansky selected as Emerging Leader for “Exercise is Medicine” Program Lia Lansky, system director of wellbeing for Baptist Memorial Health Care, is one of only six national experts

Lia Lansky

PUBLISHER Pamela Z. Haskins pamela@memphismedicalnews.com EDITOR P L Jeter editor@memphismedicalnews.com PHOTOGRAPHER Greg Campbell ADVERTISING INFORMATION 501.247.9189 Pamela Z. Haskins GRAPHIC DESIGNER Sarah Reimer sarah@memphismedicalnews.com CONTRIBUTING WRITERS Lawrence Buser Dr. Zijian Chen James Dowd Katheryn Houghton Lynne Jeter Shelley Rizzo Andrew Solinger JD Thomas All editorial submissions and press releases should be sent to editor@ memphismedicalnews.com Subscription requests can be mailed to the address below or emailed to pamela@memphismedicalnews.com. Memphis Medical News© is now privately and locally owned by Ziggy Productions, LLC. P O Box 164831 Little Rock, AR 72206 President: Pamela Z. Haskins Vice President: Patrick Rains Reproduction in whole or in part without written permission is prohibited. Memphis Medical News will assume no responsibility for unsolicited materials. All letters sent to Memphis Medical News will be considered the newspaper’s property and unconditionally assigned to Memphis Medical News for publication and copyright purposes.

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GrandRounds chosen for the American College of Sports Medicine’s 2022-2024 Exercise is Medicine Emerging Leaders Program. The vision of EIM, a global health initiative managed by the ACSM, is to make the assessment and promotion of physical activity a standard in clinical care by connecting health care with evidence-based physical activity resources for people everywhere and of all abilities. “We are pleased that the American College of Sports Medicine recognizes Lia’s talents and potential contributions to the Exercise is Medicine Program,” said Nancy Averwater, senior vice president and chief human resources officer for Baptist Memorial Health Care. “She truly is a leader in wellness and physical health, as evidenced by her success with Baptist’s BestHealth wellbeing program. She’s significantly helped improve the health of Baptist’s employee population, and I can only imagine what she will accomplish during her two-year term with the Exercise is Medicine program.” At Baptist, Lansky oversees BestHealth by Baptist, an employerbased program launched five years ago, aimed at giving large and small self-insured employers an effective, cost-saving way to sustainably improve

OrthoSouth Workers’ Compensation Conference We’d be honored for your attendance at the 2022 OrthoSouth “re-booted” Workers’ Compensation Conference on October 27th. Featuring Dr. Riley Jones as MC, and Jeff Francis, Assistant Administrator, Tennessee Bureau of Workers’ Compensation as keynote speaker in the morning hour. The event will also showcase a panel of experts including physician, physical therapist, attorneys, and nurse case manager for a full 360 discussion of a workers’ compensation case profile.

Date: Thursday, October 27, 2022 Venue: The Great Hall & Conference Center Venue address: 1900 South Germantown Road, Germantown, TN Price range: $35.00 attendees | $500.00 vendors Attendees and vendors please register via the attached link and select your profile. We hope to see you there!

Click to Register

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GrandRounds their employees’ overall health and reduce the cost of health insurance claims. Those selected to serve as EIM Emerging Leaders by the EIM governance board and EIM advisory panel will participate in a series of webinars on the Exercise is Medicine initiative; gather at the ACSM Annual Meeting/ EIM World Congress; and learn about EIM strategic initiatives related to education, research, clinical integration, resource development, EIM On Campus and the EIM Global Network. EIM Emerging Leaders serve as spokespeople, provide presentations, disseminate information and assist in EIM projects and activities to expand the reach of the initiative nationally and globally. They will have the opportunity to be mentored by experienced clinicians and/or faculty leaders.

Regional One Health Executive Leader Joins Essential Hospitals Institute Board Susan Cooper, BSN, MSN, chief integration officer and senior vice president of Regional One Health, has been selected to serve as chair-elect and secretary for the Essential Hospitals Institute Board of Directors. Essential Hospitals Susan Cooper Institute is the research, education, dissemination, and leadership development arm of America’s Essential Hospitals. The Institute supports the nation’s essential hospitals as they provide high-quality, equitable, and affordable care to their communities. Cooper was the first nurse to serve as the Commissioner of Health for the state of Tennessee and one of the few nurses to serve in the role nationally. She’s spearheaded powerful initiatives to foster prevention for people at risk for diabetes and obesity. She also leads the ONE Health complex care program

at Regional One Health. The program identifies vulnerable patients who frequently visit the ER or have numerous inpatient stays and addresses their medical needs as well as their social needs such as housing, food, and transportation to uplift their lives. .

UTHSC College of Nursing Receives $3.9 Million Grant for Mobile Health Unit, Outreach to Lake, Lauderdale Counties

The University of Tennessee Health Science Center’s College of Nursing has received a $3.9 million, four-year grant that will enable the college to provide health care to two rural counties using a mobile health unit. The grant will also allow the college to integrate rural health education into its undergraduate and graduate programs. The Health Resources and Services Administration (HRSA) grant is called Student Training and Education through Partnerships with Underserved Populations for Health Equity and Lifestyle Promotion (STEP UP and HELP). It focuses on outreach to Lake and Lauderdale counties in West Tennessee, which are designated by HRSA as underserved. “There is a population in Lake and Lauderdale counties who have poorer health care outcomes due to difficulty accessing care,” said Assistant Professor Diana Dedmon, DNP, FNP-BC, who is the principal investigator for the grant. “It’s excit- Diana Dedmon ing to know that these two communities will benefit from this grant.” Lake and Lauderdale counties have the second and thirteenth highest poverty rates among the 95 Tennessee counties, respectively, according to the University of Wisconsin Population Health Institute Report on Tennessee for 2021. Lake County has the highest incidence of low birth weight and

smoking. Lauderdale County has the second highest rates of diabetes and adult obesity and the fourth highest adult smoking rate. Life expectancy in both counties is below state and national averages. “This is such an exciting grant that can create real-world changes to improve the health and quality of life in these communities,” said College of Nursing Dean Wendy Likes, PhD, DNSc, APRN-BC, FAANP. “The work through this grant will also expose students to the unique needs of rural communities with the goal of sparking a desire to work in rural communities.” The first six months of the grant will be focused on developing partnerships and meeting with community advisory boards in the counties to determine the needs and creating a plan to meet those needs, Dr. Dedmon said. During the first year, the grant team will also work to purchase and retrofit a vehicle to serve as a mobile health unit. A primary goal of the grant is to establish the mobile health unit to provide care to vulnerable populations that do not have health care access. “There are rural health care providers who have dedicated their careers to making a difference in these counties. This project does not intend to compete with those providers, but rather to work with them to offer greater access to care,” Dr. Dedmon said. Some of the care will be offered directly on the mobile health unit, and some can be offered through telehealth. The mobile health unit will be staffed with an advanced practice nurse and a medical assistant. Another major goal of the grant is to expand the nursing workforce and to increase the cultural competency of nurses serving patients in rural areas. Students in the college’s Bachelor of Science in Nursing (BSN) program will have the opportunity to earn microcredentials in selected concepts that prepare nurse graduates to improve health equity, access, and outcomes for vulnerable populations. A Rural Scholars Program will be implemented

in the Doctor of Nursing Practice (DNP) program for the following concentrations: family nurse practitioner, psychiatric mental health nurse practitioner, and nurse-midwifery. Students in this program will complete 50 percent of their clinical hours on the mobile health unit and will focus their DNP scholarly project on a health care challenge in the rural community. Assistant Professor Christie Manasco, PhD, RN, who is a co-investigator for the grant, will lead the rural education segment for the BSN program. “As a first of its kind in West Tennessee, the mobile health unit will Christie Manasco help address specific needs of the populations in Lake and Lauderdale counties, while developing a nursing workforce prepared to improve health outcomes in underserved populations,” she said. Assistant Professor Lisa Beasley, DNP, APRN, NP-C, RN, is also a co-investigator for the grant and will lead the DNP Rural Scholars Program. “The opportunity to have nurses lead a community-based, Lisa Beasley mobile health unit to serve the socioeconomic needs related to health care access of those citizens in Lake and Lauderdale Counties will not only benefit these vulnerable populations, but will help strengthen the rural health workforce. Both undergraduate and graduate students will be able to enhance their critical-thinking skills to become more culturally aware and understand how the social determinants of health affect patient and population health outcomes.” Dr. Dedmon, who grew up in Lauderdale County and worked there as a nurse practitioner, said she hopes the education portion of the grant will continued on page 14

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Your patients deserve nothing less than a 5-star experience from OrthoSouth.

What does that look like? URGENT CARE

Patients with urgent injuries or in acute pain may be sent directly to our Urgent Orthopedic Care office at 6286 Briarcrest Ave. in Memphis.

WALK-IN READY

Patients in acute pain needing to see a provider the same day may be seen by walking in or making a same-day appointment at one of our 8 convenient locations.

CONVENIENT HOURS

Early, weekend, lunchtime, and after hours, your patient’s time is our time.

ONLINE BOOKING

SCAN TO LEARN MORE

Use our convenient Book Online portal to book your patient’s visit before they leave your office.

VIP TREATMENT

From streamlined processes to comfortable waiting spaces and personable team members, the OrthoSouth experience is designed to provide fast, friendly, and convenient care to the most important person in the room - your patient.

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GrandRounds expose nursing students to the intrinsic benefits of serving rural communities. “It is so rewarding to serve in rural communities where you are able to connect with patients and their families on such a personal level,” she said.

Regional One Health Executive Leader Joins THA Board of Directors Tish Towns, executive vice president and chief administrative officer for Regional One Health, has been appointed to the Tennessee Hospital Association (THA) Board of Directors and named Chair of the THA Council on Inclusion and Health Equity. Tish Towns THA is a membership association serving as an advocate for hospitals, health systems and other health care organizations and the patients they serve. The organization also provides education and information to the public about health care issues at the state and national levels. The THA Council on Inclusion and Health Equity addresses inequality in the healthcare system in Tennessee. As chair of this group, Towns will work with the Council to promote equity of care and eliminate health care disparities. The Council advocates strategies to help members develop culturally competent leaders and staff to improve health outcomes in the communities they serve. Towns began her career in State Government with the Tennessee Departments of Human Services and Health. Since the early 1990s, she has served in senior executive roles in community not-for-profit, rural and urban academic delivery settings. She joined Regional One Health in 2009. In her current role, Towns has direct responsibility for ambulatory services, post-acute care services, marketing and communications, market development and growth, community engagement, pastoral care, volunteers and guest services.

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

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The Cancer Care Team Award recognizes a single institution in North America, Europe, Latin America and Asia/Rest of the World for extraordinary patient care in the field of lung cancer and thoracic malignancies. Patients and their loved ones nominate teams for the award. “We are honored to be one of only three cancer teams across the globe to receive this award, but it is most meaningful because we were nominated by one of our patients,” said Dr. Raymond Osarogiagbon, chief scientist for Baptist Memorial Health Care and director of the multidisciplinary thoracic oncology program and the thoracic oncology research group for Baptist Cancer Center. “Our team is dedicated to caring for our patients and furthering research in the field of lung cancer. This award demonstrates our exceptional teamwork and how it benefits our patients.” The Asia/ROW Regional Winner of the Cancer Care Team Award is Shanghai Pulmonary Hospital, affiliated with Tongji University in Shanghai, China, and the Latin America Regional Winner is Instituto Nacional del Tórax in Providencia, Chile. “Lung cancer care requires contributions from strong multidisciplinary teams to offer the best therapy for today’s patients,” said Dr. Heather Wakelee, president of IASLC. “This year’s Cancer Care Team Award winners all demonstrate tremendous commitment to patient care and communication.” The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated solely to the study of lung cancer and other thoracic malignancies. Founded

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in 1974, the association’s membership includes nearly 7,500 lung cancer specialists across all disciplines in over 100 countries, forming a global network working together to conquer lung and thoracic cancers worldwide. The association also publishes the Journal of Thoracic Oncology, the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis,and treatment of all thoracic malignancies. Visit www. iaslc.org for more information.

UTHSC Team Receives $2.19 Million To Study Neurotoxicity of CommonlyUsed Chemical Solvent A team of University of Tennessee Health Science Center researchers has been awarded $2.19 million from the National Institute of Environmental Health Sciences for their investigation of the neurotoxic effects of toluene, a common chemical found in many household products. Alex M. Dopico, MD, Van Vleet Chair of Excellence and professor in the Department of Pharmacology, Addiction Science, and Toxicology (PHAST) in the UTHSC College of Medicine, and Anna N. Bukiya, PhD, professor in the same department, are

principal investigators on the award. Jeff Steketee, PhD, also professor in the PHAST Department and chair of the Institutional Animal Care and Use Committee, is a co-investigator. Toluene reaches the brain through inhalation. Intoxication with toluene, whether accidental or following recreational use (e.g., “glue sniffing”), leads to dizziness, blurred vision and even neurological deficits with catastrophic outcomes, including death. A reduction in blood flow to the brain is thought to contribute to these toxic effects, but how and why toluene exposure affects the brain circulation is not known. The team hypothesizes that toluene reduces the activity of a protein (the BK channel) located in the cerebral artery muscle cells, causing the brain arteries to constrict upon exposure. Performing tests at the molecular level using computational methods, and in vitro and in vivo evaluation of BK channel function in animal models, the team aims to identify the specific mechanism and site of action in BK channels that makes cerebral arteries constrict in the presence of toluene. Their tests will include delivering new selective drug therapies for early intervention in toluene-induced brain ischemia.

Save the Date for the Memphis Healthcare Foundation’s Luncheon with George Lopez: The 2022 Methodist H e a l t h c a re Luncheon scheduled for December 16th at the Peabody Hotel will feature an intimate conversation with criticallyacclaimed actor and comedian, George Lopez, who will share his connection to the mission of Methodist Le Bonheur Healthcare through his personal kidney transplant experience.

Tickets, tables and sponsorship opportunities are available now. Proceeds from the Methodist Healthcare Luncheon will benefit the faith-based mission of Methodist Le Bonheur Healthcare by helping address critical community health and patient support needs.

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Welcome Our Newest Providers Thomas Kleisli, MD

Cardiothoracic Surgery

Ashley Fratello, MD Cardiothoracic Surgery

Saint Francis Medical Partners is happy to welcome Ashley Fratello, MD and Thomas Kleisli, MD to our Thoracic and Cardiovascular Surgery Associates team. Ashley Fratello, MD received her Bachelor’s degree in Business Administration and attended medical school at SUNY, Stony Brook University, NY. She completed her Integrated Cardiothoracic Residency in Los Angeles, CA. Thomas Kleisli, MD received his Bachelor of Science degree in Chemistry/Biology and obtained his doctorate at the University of California, Irvine. He completed his residency in General Surgery at Maricopa Medical Center in Phoenix, AZ. Dr. Kleisli has earned fellowships for Congenital Cardiac Surgery, Cardiothoracic Surgery and a Postdoctoral Research fellowship in Vascular Surgery. Conditions Treated Coronary artery disease Valvular disease processes (including aortic, mitral and tricuspid) Congenital heart defects Carotid artery blockages Peripheral arterial blockages Aneurysms of the chest, abdomen and peripherally Lung cancer or other abnormalities Venous disease

Procedures Performed Coronary artery bypass grafting (including without bypass machine) Aortic or mitral valve replacements (including TAVR) Lung resections Leg bypass procedures

6005 Park Ave., Ste. 802 Memphis, TN 38119

To refer a patient, call 901-236-0508. Scan the QR code or visit SFMP.com to learn more about the entire team.

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When you’re hurt, we’re there.

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The region’s top orthopaedic specialists are available near you when you need them most.

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Campbell Clinic has kept the Mid-South healthy for more than 100 years. Wherever you are, we’ve got a convenient clinic nearby. Midtown | East Memphis | Germantown | Wolf River Arlington | Collierville | Southaven | Olive Branch

Find walk-in and after-hours availability at campbellclinic.com.

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