FOCUS TOPICS WORKFORCE IMPROVEMENT MENTAL HEALTH SLEEP STUDIES
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PHYSICIAN SPOTLIGHT PAGE 3
Jeff McCartney, MD
ON ROUNDS TAMHO The Voice for Behavioral Healthcare in Tennessee For 55 years, the Tennessee Association of Mental Health Organizations has served as the voice for community mental health centers and nonproﬁt organizations that provide behavioral health services to some of the state’s most vulnerable residents ... 5
Success in the Trenches
Sometimes it takes all hands on deck to achieve optimal outcomes or counselor. Approximately only half of those are admitted; others are referred to a professional, as needed, Out of tragedy emerges progress – and potenfor appropriate follow-up care. tial respite for those suffering from mental illness. Golden is familiar with the challenges of destigThat’s the belief of Joy Golden, CEO of Lakeside matizing mental health treatment. She joined Lakeside Behavioral Health System. in 1997 as a part-time nurse on the weekends while Many sufferers and their families have been still filling an executive position as human resources reluctant to seek help because of the stigma and director at Methodist Healthcare-Memphis. She conmisconceptions commonly associated with mental tinued to juggle a Monday-through-Friday executive illness. Now, however, Lakeside is seeing an increase job and her weekend staff nurse job at Lakeside for in its patient population, reflecting a heightened senmore than 10 years until 2007, when she was invited sitivity to mental health issues that Golden attributes to join Lakeside full-time as chief nursing officer. to high-profile national disasters where in some cases Although it’s an unusual career choice to “backunderlying mental illness was an issue with the pertrack” from an administrative position to become a petrators. staff nurse, Golden’s original objective was to gain the “We have worked desperately hard to reduce credentials of registered nurse (RN) and use that in the stigma of mental illness and have stressed seeking her executive role. Joy Golden help early enough so that we can help the patient “To my surprise, I fell in love with nursing,” she and the family have a normal life – long before you get to a high-risk said. “I started here, picking up part-time hours just to keep my nurssituation where there’s a tragedy,” Golden said. ing license current. But then I started working every weekend because There is no stigma associated with getting a broken leg fixed, she I loved it. It has absolutely been a joy in the journey!” points out; yet seeking mental health assistance is a different story. From nurse to chief nurse to COO, and ultimately to CEO for “We’re trying to reduce that stigma. We’d love to eliminate it entirely.” Lakeside, Golden acknowledges with pride the added insight and caOne popular misconception is that those who seek help will be pability her unusual career path has given her. “I think being able to be admitted; in fact, Lakeside sees hundreds of people each month who a clinician and have that clinician foundation is incredibly important to (CONTINUED ON PAGE 10) receive no-cost assessments completed by a masters-prepared therapist By JUDy OTTO
Research Uncovers New Clues to the Causes of Schizophrenia
Executive Director, Pathways of Tennessee
Genome-wide study discovers new variants, pathways
By SUZANNE BOyD
Pam Henson, a licensed professional counselor, first dipped her toes in the world of psychology as a high school student and found herself hooked. After interning in graduate school where she spent time testing and counseling patients, she knew counseling was for her. Today Henson, executive director for Pathways of Tennessee, a division of West Tennessee
An insidious condition, schizophrenia is estimated to occur in about 1 percent of the population worldwide. Characterized by a breakdown in thought processes, the mental illness ... 6
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Healthcare, oversees a wide range of behavioral medicine treatment options for patients in West Tennessee. Henson was born in California but moved to Bradford while in Junior High School. In high school she worked for the school system’s Special Education Department superintendent organizing information collected from student psychological evaluations. This experience led
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With Winter Comes Illness... by Michelle Puzdrakiewicz, M.D.
& It’s Almost Here.
Winter is quickly approaching and we will see an increase in seasonal illnesses as we do every year. Causes of illness range from respiratory viruses such as Influenza A and B, RSV, Parainfluenza, Coronavirus, Rhinovirus and of course last year’s dreaded gastroenteritis caused by Norovirus. These illnesses typically require only supportive care and will self-resolve but that can be frustrating and disconcerting to parents. Three to ten days after the initial illness children occasionally develop secondary infections such as ear infections, sinus infections or lung infections and providers need to counsel families regarding signs and symptoms to look for to prompt a return visit. Tireless education from providers regarding the avoidance of overuse of antibiotics to treat viral infections is imperative for the general health of our community. The time put towards educating families is well worth the benefit. Office posters and handouts from the CDC are useful reminders to staff and parents that antibiotics are only indicated for bacterial infections, not viral illnesses. Efforts to reduce the impact of a bad flu season begin now. Through vaccination and education regarding hygiene practices we can help to prevent the spread of influenza and other viruses. The Influenza vaccine has arrived in clinics and is already being administered. Since 2010, the CDC has recommended Influenza vaccination for all patients over six months who do not have a contraindication to the vaccine. We are no longer only vaccinating high risk patients. By vaccinating our healthy population we reduce influenza infection in the general population, reduce absenteeism from school and work, and most importantly reduce the spread of the flu virus to compromised patients who may not mount an adequate response to their vaccine or are too young to be vaccinated.
Helpful Reminders for Clinic Staff:
Michelle Puzdrakiewicz, M.D.
Influenza vaccination: (multiple formulations available this year - trivalent and quadrivalent, live attenuated and inactivated with preservative and without – follow package insert guidelines regarding age recommendation six months to thirty-five months, >3 years, >9 years, >18 years - 64 years, >65 years for various injectable formulations and two years to forty-nine years for intranasal administration). • Recommended for all persons over six months • Two doses for children six months to eight years old who have not received two doses separated by four weeks in one season since 2010 • Contraindicated in persons with history of severe reaction to previous flu vaccine • Additional recommendations for egg allergic patients – may receive RIV (Recombinant Influenza Vaccine) if mild egg allergy in physician’s office if observed within 30 minutes
Indications for use of antiviral agents in treatment of Influenza A or B: CONSIDER the use of antiviral agent in the following patients: (antiviral must be started within 48 hours of onset of symptoms). • Children <2 years • Adults >65 years • Persons with chronic pulmonary, cardiovascular, renal, hepatic, hematological, metabolic, neurologic or neurodevelopmental conditions • Persons with immunosuppression caused by medications or by HIV • Women who are pregnant or postpartum two weeks after delivery • Persons age <19 who are on long term aspirin therapy • American Indians/Alaska Natives • Persons who are morbidly obese (BMI >40) • Residents of nursing homes and other chronic care facilities.
Chemoprophylaxis for exposure to Influenza A or B: The CDC does NOT recommend widespread or routine use of chemoprophylaxis due to concerns of the emergence of antiviral resistance. • Control of outbreaks in institutional settings such as nursing homes • Prevention of influenza in high risk person during the first two weeks post vaccination who was exposed to influenza • Prevention in patient with severe immune deficiency • Prevention in patient at high risk for complications of influenza who have been exposed and have contraindications to influenza vaccination Clinics may need to adjust hours, scheduling, or function during the winter months to allow easy access to flu vaccines and appointments as patients become ill in an attempt to keep emergency departments from being overwhelmed with non-emergent illnesses.
2863 Highway 45 Bypass Jackson, TN 38305 Hours: M-F 8am - 5pm 731-664-1375 | 800-372-8221
Jeff McCartney, MD By SUZANNE BOYD
Trenton native, Jeff McCartney, MD, always knew he wanted to be a doctor. As a resident, he found he enjoyed handling the critical care patients and thought a life in the ICU was the place for him, but after a mentor advised him otherwise, he chose to pursue critical care and pulmonology. After many years of taking call nearly every other night, he decided a change in pace was in order. Today, McCartney makes sure his patients, as well as himself, get the rest they need in his practice which specializes in treating patients with not only lung problems but sleep disorders as well. Knowing he wanted to pursue medicine, McCartney, who played football throughout high school, studied to achieve good grades and ended up graduating in the top ten in his class at Trenton Peabody High School. For college, McCartney says he was in that stage in life where you do what your friends do and followed the crowd to the University of Tennessee at Martin, where he majored in chemistry. He applied to medical school in his junior year and was accepted to the University of Tennessee Health Sciences Center in Memphis. “I really did not know what I wanted to do at first, but mid-way through medical school I thought about thoracic surgery. That changed while I was completing my internal medicine internship and residency at the old Baptist Hospital that used to be in downtown Memphis,” said McCartney. “I was sort of an aggressive resident in that I always took all the critical care work I could. I really liked doing procedures and thought that I wanted to do just ICU work as a physician. Fortunately, I had a great mentor who convinced me that what I really wanted to do was pulmonary and critical care. Back in the mid-1990’s the two were separate programs, today you can’t do one without doing the other.” McCartney went to Louisiana State University’s Shreveport campus to complete fellowships in pulmonology followed by one in critical care. In 1996, as he started to look at practice options, having a wife and two children factored into his decision. “I had met my wife, Candie, who was a critical care nurse from Memphis, while in residency. The first time I met her, she was performing CPR on a patient as I walked in the room and I knew she was the one for me,” said McCartney. “We knew we did not want to be too far from our families. Trenton was too small for what I wanted to do but Memphis was not where we wanted to raise our family. Jackson was the logical place for us to land.” McCartney started with the Medical Specialty Clinic, where he practiced until 2001, when he opened his own clinic, Jackson Pulmonary Care PA. In 2005, he relocated his practice from near the Regional Hospital campus to the building to its current location. McCartney covered call at both Regional and Jackson General Hospitals until 2006, when he decided to take a westtnmedicalnews
leave of absence from Jackson General. “At that time there were only two lung doctors outside the Jackson Clinic; Dr. Jim Carruth and myself. We shared call for both hospitals, which meant I had been on call every other night for the past ten years. That is hard on an individual to maintain. The hours and being up all night was just not desirable,” said McCartney. “I had started doing mission work in Africa near the Botswana border. One night I was looking up at the stars and started doing a bit of soul searching. When I returned, I talked with Dr. Carruth and we both decided to take a step back and just work at one hospital, which was Regional. It took my call schedule back to every third night.” When McCartney opened his own clinic, he opened his own sleep study lab, the first physician owned one in West Tennessee to be located outside of a hospital setting. “My lab was in a hotel since it a conducive environment for sleep so all I did was move in my equipment,” said McCartney. “Vanderbilt had already started the model for this type of setting, so I based mine on theirs. In 2005, when I moved into
my current building, I had space built out in it that met the requirements for an accredited sleep lab. Within a year we had our accreditation, which was no small process. I sort of went crazy for a while with the sleep study program because I had a four-bed lab in our office as well as owned two other out of town labs.” In 2010, McCartney sold his practice and sleep study lab to Regional Hospital only to buy his practice back a year later. McCartney continues to treat sleep disorders, which comprise about a third of his practice. Some patients can now have a home study rather than having to utilize a lab setting. “When the ability to use a home study first came out, I was a bit skeptical since I was big on in lab studies. In 2009, when Medicare started to reimburse for the home studies, the technology really took off,” said McCartney, who has been using the technology for the past year. “Home studies are about a tenth of the cost of an in lab study. One other huge benefit to the patient is they can go about their normal nightly routine in their home. The device is user friendly and all that is diagnostically required is one night but you can go longer if needed.” For more in depth studies for issues such as seizures or unusual behavior in sleep that a home study will not cover, McCartney sends patients to an accredited sleep lab. “Most sleep issues are not like those though, and can be diagnosed with a home study. Often times the issue is obstructive sleep apnea, which is caused by an airway closure that occurs during sleep and this leads to an oxygen deficit,” said McCartney. “Although sleep apnea can lead to various medical conditions, the five primary medical problems it can cause, if it goes untreated, are hypertension or cardiomyopathy, that can eventually lead to congestive heart failure, atrial fibrillation, diabetes and
stroke.” Patients often come to see McCartney because a spouse or family member has recommend they come in. “They can have a variety of symptoms such as snoring, which is more prominent in males, restless sleep, tiredness, cognitive memory problems, wanting to nap or feeling draggy. For teens obesity can lead to sleep apnea,” said McCartney. “Symptoms of sleep apnea may bring a patient in and can tip us off to there being something wrong. Sleep is important and there is no substitute, which is why God designed it for a third of our life.” Treatment for sleep apnea involves the use of a C-PAP mask that is placed over the nose and/or mouth while the patient is sleeping. The mask provides a continuous stream of air that keeps the airway open so that air flow is not obstructed. “Each patient’s pressure to the mask is titrated to give them the right pressure needed to solve their issues,” said McCartney. “In some circumstances patients can have the titration set on their masks at home due to auto-titration. On the second night of treatment we have the pressure set where it needs to be for them. If a patient has a lot of issues we need to address we may have to send them to a lab. The biggest hurdle is making sure the patient understands the treatment and complies with it.” Outside of the office, McCartney’s free time is full of activities associated with being a father of four sons. His oldest is in the Army, another plays soccer at Union and hopes to be a nurse anesthetist, one is a junior in high school and also plays soccer and the youngest is home schooled. McCartney also enjoys woodworking, primarily making clocks. To date he has made 18 and is proud to say he still has all his fingers. He is also an avid War World II buff, and has a vast collection of memorabilia.
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Nearly half the health insurance exchange plans in 13 states (Tennessee included) with early filings will be of the narrow-network type according to an unpublished McKinsey & Company analysis of 955 plan offerings. Enrollees in such plans will have limited or no coverage if they seek care outside their plan network. In exchanges, subscribers will see lower premiums than they would pay for plans with broader networks, insurers say. These narrow panels will also reduce provider reimbursement because it will reduce completion and set prices. In the large-employer market, Aetna’s narrow panels are 15 percent to 35 percent smaller than its standard preferred provider panels. Blue Cross Blue Shield of Illinois says its exchange plans using narrow networks will cost 20 percent to 30 percent less than its exchange plans with bigger networks. Is this the definition that payers have been waiting on when they discuss quality of care? Some physician groups, hospitals, and patient advocates are concerned that many of the insurers’ networks have not yet publicly announced. (At least by the time you read this article.) Open enrollment begins October 1, 2013. They fear that patients, particularly those who need specialized providers, may not have adequate access to care. Last year the Obama administration issued a rule that insurers “must maintain a network of a sufficient number and type of providers…to assure that all services will be available without unreasonable delay.” It also requires that “essential community providers” be included in all plans. Please allow me to express my opinion as to why this will fail. Although enrollment begins October 1, many of the insurers’ networks have not yet publically announced their networks. This major flaw in apparent design, or no design, in the Affordable Care Act failed to fully realize the lack of state acceptance and/or lack of information coming out of Washington, caused a rush to throw out something and did not consider present obstacles to achieve transformational change which must be considered when designing a “new program.” In Greg Butler and Chip Caldwell’s book, Top-Performing Health Organizations, they discuss seven proven steps for accelerating and achieving change. I want to discuss one barrier that always seems to be ignored, yet by not realizing it and paying attention to it, we doom the program before it even gets started. “Human Nature and the Barriers to Change”: • Acceptance of the need to change is an admission of guilt. Before change can occur, mangers must acknowledge
that change is needed (and not to increase the bottom line of the insurers) and their current performance and work processes are not optimal. Thus the perception of failure. • Fear of failure and rejection trumps the desire for change. For many individuals, the personal risk involved in change outweighs its potential rewards. Healthcare is a risk-averse culture. It fosters an environment that demands error-free performance and does not reward risk taking. Fear of failure appears to be a part of healthcare’s DNA. • Comfort with the familiar leads to avoidance of change. Human nature’s first response to changes is to evaluate the risk and run though endless scenarios of possible negative outcomes. • Complicated projects create the Mt. Everest syndrome. When considering a complex task in totality, people become overwhelmed. The reference to Mt. Everest analogy is; “Imagine yourself as a mountain climber facing a difficult slope. If you sit at the base of the mountain and contemplate the climb, trying to envision every step of the journey to the summit, you will become overwhelmed with the magnitude of what you must accomplish. (Sounds similar to our own personal lives, doesn’t it?) Breaking the climb into achievable phases, it becomes a series of small climbs rather than an insurmountable challenge. (Sounds like it might be a good plan for our personal lives, doesn’t it?) • Discomfort with ambiguity leads to avoidance. Most human beings are uncomfortable with even small amounts of ambiguity and uncertainty. They seek a proven map before they take the first step of a journey. Ambiguity is the root cause of many anxieties. This desire for certainty can prevent progress. Fear and protection of the status quo can masquerade as due diligence. Ambiguity can invoke a perpetual call for more data, more analysis, and examination of more alternative solutions.” This is one of the problems I have with academia with their “publish or perish.” Many times these publications turn out to be a blueprint for perish or failure. A guiding vision is important, but seldom does one have the luxury of knowing all the answers and details before starting a transformational initiative. Bill Appling, FACMPE, ACHE is founder and president of J William Appling and Associates. He serves on the Medical Group Management board of directors. He is a national speaker, presenter and a published author. He serves as an adjunct professor at the University of Memphis and Chair of Harrah’s Hope Lodge board, and serves on the board of Life Blood. For more information contact Bill at firstname.lastname@example.org.
The Voice for Behavioral Healthcare in Tennessee By CINDy SANDERS
For 55 years, the Tennessee Association of Mental Health Organizations has served as the voice for community mental health centers and nonprofit organizations that provide behavioral health services to some of the state’s most vulnerable residents. Founded in 1958 as the Tennessee Association of Mental Health Centers, the statewide trade association changed its name in 1995 to better represent the changing organizational structure of its members. “The purpose of the organization is to advocate for people who need services,” said Ellyn Wilbur, executive director for TAMHO. To achieve that goal, the association promotes the advancement of effective behavioral health services, advocates for access to care, and works to serve its 21 member organizations, which include com- Ellyn Wilbur munity mental health centers, specialty providers, and substance abuse experts. To carry the behavioral health agenda forward, working committees, task forces, and professional membership sections bring together more than 400
staff from TAMHO member organizations on a regular basis to identify problems and issues from a provider perspective and to develop recommendations to effectively address them. As the primary provider network for the state’s Medicaid waiver program, Wilbur noted, “The majority of the people our centers serve are TennCare-eligible, although that number has decreased slightly, and there are more uninsured people now than in years past.” She added some centers also serve those with private insurance and Medicare. “We see, on average, about 90,000 people a month,” Wilbur said of the provider network, noting many people access the system multiple times a year. “The community mental health centers see, by and large, those with severe mental illness or substance abuse disorders, which means repeat visits. We typically see more adults than children … roughly two-thirds adults to one-third children.” Every county has at least one provider and some have multiple providers, she said of the network’s reach. In addition, there are 13 crisis providers across the state available around the clock, seven days a week, 365 days a year; and eight crisis stabilization units (CSUs) spread across Tennessee. Wilbur explained a CSU is a short-term
unit staffed by a range of professionals and paraprofessionals where an individual typically stays two to four days to get past the point of crisis. “When you have this type of system in place, you can often stave off the need for hospitalization,” Wilbur said. “The sooner you can return someone to their community with the supports they need, the better the outcome often is.” Wilbur, who has worked in community behavioral health and social services for more than 30 years, said she has seen the science behind behavioral health markedly evolve. “From my perspective, we’ve seen a tremendous increase in the knowledge base of what actually works for people with severe illness,” she said. “There’s been a pretty dramatic increase in the number of effective medicines that are now available,” she added. “At the same time, we’ve seen a pretty dramatic increase in demand over the last four or five years.” Wilbur said there are multifactorial reasons for the increased demand including stress brought on by economic concerns, mental health parity laws making services more accessible, and a lessening of the social stigma of seeking help. “We have worked hard as an industry to decrease the stigma and impress upon people that mental illness (CONTINUED ON PAGE 8)
Annual Conference Dec. 3-4 Embassy Suites Hotel & Conference Center • Murfreesboro Ellyn Wilbur, executive director of TAMHO, said integrated care is a main theme for the 2013 meeting, which includes a full slate of keynote, public policy and educational sessions, plus an awards and recognition celebration, annual business meeting and installation of the new board. On Dec. 4, Charles Good, CEO of Frontier Health, will pass the presidential gavel to Bob Vero, EdD, CEO of Centerstone Tennessee, as the 2014 board of directors is seated. Wilbur is particularly excited about the broad appeal of this year’s keynote speakers. TAMHO has partnered with the Tennessee Department of Health to bring Nadine Burke Harris, MD, MPH, to attendees. Harris is CEO of the Center for Youth Wellness in California. “Her expertise is in adverse child experiences as a risk factor for adult disease,” said Wilbur. “I think we’ve not always made the connection between those two things.” Wilbur added, “She understands when children have been exposed to trauma or (CONTINUED ON PAGE 8)
Healthcare is Changing.
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Research Uncovers New Clues to the Causes of Schizophrenia Genome-wide study discovers new variants, pathways By CINDY SANDERS
An insidious condition, schizophrenia is estimated to occur in about 1 percent of the population worldwide. Characterized by a breakdown in thought processes, the mental illness has been described for centuries through accounts of individuals suffering from delusions, paranoia and hallucinations. The chronic, debilitating disorder takes a heavy toll not only on affected individuals but also on their families and society as a whole. An early onset disorder, many patients are first diagnosed during the late teens or early adult years and struggle throughout their lifetime Dr. Patrick to manage symptoms. Sullivan “It’s a horrible disorder,” stated Patrick Sullivan, MD, director of the Center for Psychiatric Genomics at the University of North Carolina School of Medicine. “It’s a huge, huge public health problem, and it’s one where the scientific discussion has been dominated on partial information.” He added, “Peo-
ple have done the best they can with what information they have. We’ve been debating the cause of schizophrenia for the better part of a century now.” On Aug. 25, Sullivan and colleagues helped move that conversation forward with the online publication of a new
genome-wide association study (GWAS) in the journal Nature Genetics. “This is the largest published study we’ve done in the field,” noted the lead author who also serves as a professor in the departments of Genetics and Psychiatry and UNC. Collaborators in the study include co-authors from the Karolinska Institutet in Sweden, the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard, and the Mount Sinai School of Medicine in New York. “We discovered there were 22 places in the genome, 13 of which to our knowledge had never been described before, and each is a clue about the cause of schizophrenia,” Sullivan said of identifying nearly two dozen locations in the human genome that are involved in the disorder, including one that has previously been implicated in bipolar disorder. “If finding the causes of schizophrenia is like solving a jigsaw puzzle, then these new results give us the corners and some of the pieces on the edges,” he stated, adding the number of genetic vari-
ants probably numbers in the thousands. “These 22 are the tip of the iceberg.” The study was based on a multistage analysis that began with a Swedish national sample of 5,000 schizophrenia cases and 6,200 controls followed by a meta analysis of previous GWAS studies and then a replication of single nucleotide polymorphisms (SNPs) in 168 genomic regions in independent samples for a total of more than 59,000 people included in the research. The results underscored two takeaways for Sullivan. The first, “We need to do more studies urgently. We’re actually quite encouraged and believe larger studies of this type will lead to more knowledge,” he said. The second, “The early results we have here certainly indicate two different biological processes are involved.” The research uncovered two distinct pathways that might be associated with the disorder — a calcium channel and microRNA 137. Calling the calcium channel, which includes the genes CACNA1C and CACNB2, the ‘queen of the channels,’ Sullivan explained there are a number of FDA-approved calcium channel blockers (CONTINUED ON PAGE 8)
Hey Doc, The Writing is on the Wall
There IS Something You Can Do…..
By TIM NICHOLSON
On the wall leading to the poetry room at City Lights Bookstore in San Francisco, there is a corkboard covered with hundreds of colorful post-it notes. Each note includes a personal response to the question, “What book scared you the most as a kid?” The post-it note, although anonymous, gives the community a look into the hearts and minds of its customers, their friends and themselves. Each note is part of a conversation. One that is carried on between those who stop to read the responses. One that takes place between the employee who posted the questions and those who gather them. Heck, even one between those who decide which books to stock! And these are the kinds of conversations that you could be having with your patients if you only had your own wall. But you do. Today’s corkboard wall is social media. There are several platforms. And there are lots of opportunities to ask good questions, gather responses and better understand those who rely on you to reach their healthcare objectives. Okay, so the responses aren’t anonymous. But they are voluntary. The right question doesn’t ask someone to give away personal health information but could give them an opportunity to share information on the periphery that might help you develop a strategy for meeting their needs. It’s this simple. You’re a cardiologist. The post on your practice’s Facebook page asks this, “What’s your favorite cardio exercise?” Or, maybe it’s broader like, “Who inspires you to get off the couch and take a walk?” By asking, “What’s your favorite?” you’re learning what most find doable and can share that with others. They’ll even share ideas with one another. And you may even find some new exercises that your particular audience is comfortable performing. By asking, “Who inspires you?” you’re learning about motivations. Is it family? Is it sports heroes? Is it that hot new contestant on “Dancing with the Stars”? And with this information you’re learning more about what moves your patient to, well, move. It’s better than a lecture like, “Exercise now or die soon.” Oops. I’m sorry for the dramatic lecture title. I get a little excited about the topic of connecting you with your patient. Dr. Bubba Edwards is a pediatrician
By: Vanessa smith, CmDs aDF meDiCal
in Memphis, Tennessee. On a wall at his office are the handprints of kids who have successfully (and heroically) received all of their shots. It’s just a handprint and a first name. But it’s a great encouragement for the anxious child being walked to the exam room in nervous anticipation of his school shots. And well, it’s just plain fun. Okay, maybe your patients are too grown up for that. But they’re not too grown up to have fears of their own. They are not so grown up that we can’t encourage them to pursue the treatments that can improve and perhaps even save their life. So you don’t have a wall for the handprints of your grown up patients? Sure you do. It’s called Instagram. The free picture and, dare I say, inspiration sharing smartphone app has nearly one billion users. Each user is posting pictures of everything from what they’re eating to where they’re spending the day with friends. Imagine your challenge, or encouragement, to a patient is that he posts pictures of his meals as a sort of accountability to eat well. There’s no mention of a condition that demands it. It’s merely a celebration of “I can do this.” Heck, with the plug-ins for your website that sort or encouragement can be shared with everyone who interacts with you there. It’s sort of like a handprint on Dr. Bubba’s wall. And so, maybe there are things beyond prescriptions that can improve the quality of life for your patients. Maybe there are things beyond office visits that can help us stay connected. And maybe, just maybe, we can have some fun doing it. By the way, what book scares you now? Tim C. Nicholson is the President of Bigfish, LLC. His Memphis-based firm connects physicians, clinics and hospitals to patients and one another through healthcare social media solutions, branding initiatives and websites. His column, “Hey Doc”, appears here monthly. Find him on twitter @timbigfish or email firstname.lastname@example.org
We are all weary of hearing about it and thinking about it, but not knowing the bottom line of it is the worst of it! (The Affordable Care Act. aka, Obamacare) The constant rollercoaster of issues ranging from decreasing reimbursements to the increase of physicians retiring early due to negative payment certainties with Obamacare can depress even the most optimistic individual. One thing not to ignore is your ability to develop a successful referral generation program in the midst of these many changes. Regardless of whether or not you are now aligned with a large health system, referrals from other providers are essential, perhaps even critical to your practice’s viability and profitability. Many clinics are utilizing the growing number of hospital-based physicians to care for their hospital patients instead of leaving the clinic. While that decision may be necessary and a very good one, the lack of interaction in the hospital halls and doctor’s lounge makes building physician-to-physician relationships next to impossible. Many practices have come to the realization that more direct effort is needed and have turned to specialists in referral generation. Is this something you or your practice have done? Having Practice Representatives or Physician Relations experts actively seeking referrals for you and your practice is a tremendous advantage. Not only can the representative inform referring practices of your services but can develop relationships with the people who influence a patient referral, whether they are schedulers, nurses or MDs. Having this vital interaction and face time with referring practices can open lines of
communication and result in correcting unknown issues that may have hindered the practice from referring to you in the past. It also shows the referring entity of your interest in them, appreciation, and keeps them up to date on all advantages of your practice. Educating clinics of your offerings and developing relationships are an extremely important service a Practice Representative or Physician Relations expert can offer. The knowledge gained and relayed will result in positive revenues due to more cases that reimburse well being referred to you and your practice. Make sure you have control of the referral flow from ALL referring and influencing entities. Do not rely on the Yellow Pages or hospital based referral lines to grow your referrals. Only when you possess your practice’s accurate referral data in conjunction with a list that identifies the providers, by specialty, in your target market can you conclude which referring and potential referring providers are top priority to target to generate more revenue. If you do not already have a process implemented to capture referral data - now is the time to do so. Insist that your office staff capture referring provider information at every touch point possible: when an appointment is made, when paper work is being completed, and when the patient is being interviewed by administration or your nurse/care provider. Developing a referral generation program in your practice will pay for itself exponentially and produce a constant flow of revenue producing activities – needed for the difficult days to come. Take a proactive approach to the coming changes and not only survive but prosper.
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Research Uncovers Clues,
continued from page 6
is an illness. It’s a brain disease just like diabetes or another chronic disease.” With the health insurance exchanges launching this month, Wilbur said her member organizations anticipate the marketplace plans will enable even more people to come through the doors to seek services. “I think we’re concerned that if the state of Tennessee does not agree to expand Medicaid, there will be a significant group of people with no payer source for services at all,” she said, referring to the group of people caught in the gap between TennCare eligibility and qualifying for health exchange subsidies. Wilbur added the hope would be for an increase in state funding from the Department of Mental Health. “Right now about 33,000 people are served through that fund every year.” TAMHO members are also dealing with more medically complex cases as patients present with co-occurring disorders … either a physical/behavioral health combination or a mental health diagnosis plus substance abuse. “Many of our providers are doing more integrated care,” Wilbur said, adding the new reality means providers have begun to meet a range of physical and behavioral health needs and to collaborate and connect with each other to better coordinate care and improve outcomes.
on the market today that are used for a variety of conditions ranging from hypertension and angina to migraines. Stressing that it was much too early to draw conclusions, Sullivan said the findings at least indicate the calcium channel might be an area that deserves further attention from those studying schizophrenia. Hypothetically, he continued, calcium channel blockers might be found to have unexpected efficacy in schizophrenics. “That’s something that needs to be evaluated in a careful, rigorous way,” he said, again cautioning against jumping too far ahead. The second pathway includes its namesake gene MIR137, which is a known regulator of neuronal development. Sullivan noted more than a dozen other genes are also known to be regulated by MIR137, as well. Schizophrenia has long been known to have a strong genetic component. While it occurs in about 1 percent of the general population, the disorder is found in about 10 percent of people with a firstdegree relative diagnosed with schizophrenia. The National Institute of Mental Health notes the highest risk for developing the illness — 40 to 65 percent — occurs in an identical twin of an individual with schizophrenia. Yet, most scientists believe genetics is only one component in developing the disorder, which probably has environmental triggers, as well. While Sullivan said each different approach to solving the enigma of schizophrenia is important, he noted the genetic approach offers a strong foundation for discovery. “We can measure the DNA part of people particularly well these days,” he said. “Our study is a step forward in understanding the genetic basis of the disorder. This is really, truly nice progress.” He added the new findings provide “a couple of good strides forward” even though an endpoint isn’t yet in sight. “But for researchers and scientists, it shows us a bunch of things we’ve never seen before … and that’s pretty cool.” And Sullivan expects more information to be forthcoming. “What’s really exciting about this is that now we can use standard, off-the-shelf genomic technologies to help us fill in the missing pieces,” he said. “We now have a clear and obvious path to get a fairly complete understanding of the genetic part of schizophrenia. That wouldn’t have been possible five years ago.”
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Annual Conference, continued from page 5 violence, that exposure changes the way their brains develop and leads to more physical issues later.” Kathleen Reynolds, a consultant with the National Council for Behavioral Health, is an expert on bidirectional integration between behavioral health and primary care. Kenneth Minkoff, MD, a clinical assistant professor at Harvard, is another nationally renowned speaker and consultant. “He is considered one of the nation’s leading experts on integrated treatments for individuals with co-occurring psychiatric and substance abuse disorders,” Wilbur noted. A fourth expert on integration speaking at this year’s conference was found a little closer to home, she continued. Jeff Howard with Cherokee Health Systems, which is headquartered in Knoxville, will discuss his organization’s more than 30 years experience blending primary care and behavioral health services. Cherokee staff members have provided technical assistance on integrated care to more than 100 organizations nationwide. Although always open to those outside the TAMHO membership, Wilbur said this year’s meeting with its focus on integrated care should be especially appealing to a range of providers and encouraged anyone interested to attend. For more detailed program information and to register, go online to www. tamho.org.
A New Gold Standard?
Washington University team performs ﬁrst incisionless procedure for treating esophageal achalasia in St. Louis By LyNNE JETER
An incisionless procedure first performed in St. Louis at Washington University’s 7th Annual GI Live Conference in July may very well represent a new gold standard for treating esophageal achalasia. “This is the closest we’ve gotten to the Holy Grail dream of incisionless surgery, where the patient goes to sleep, wakes up, feels no pain and has no side effects or complications,” said surgeon Michael Awad, MD, PhD, FACS, associate dean of medical student education, program director of general surgery, and director of the Washington University Institute for Surgical Education. “We’re not Dr. Michael totally there yet, but we’re Awad very, very close.” Awad and interventional gastroenterologist Faris Murad, MD, assistant professor of medicine, and director of endoscopic ultrasound at Washington University, Dr. Faris performed the area’s first Murad
POEM (Per Oral Endoscopic Myotomy) procedure on July 19, on a 54-year-old female who awoke early the next morning ready to go for a run. “We said, ‘no, you can’t do that yet,’” recalled Murad, with a laugh. Immediately after completing the procedure, Murad and Awad could see how well the patient’s esophagus opened. “Other than minor bleeding and some CO2 that leaked into her abdomen, the case went great,” said Murad. “We’d practiced it and really understood the game plan.” When checking on the patient postoperatively that evening and the next morning, Awad was pleased to learn the patient had zero pain from the procedure. She only expressed slight discomfort from the postoperative barium swallow study and the IV in her arm. “We wrote her (a script for) IV pain medication,” he said. “She didn’t use it once. We’d also written (a script) for Tylenol, but she didn’t take even one Tylenol. That’s almost unheard of after a procedure like this.” Within a couple of days, the patient returned to her daily routine. “She’s noticed a huge difference,” said Murad. “We’re thrilled with her outcome so far.”
The Long Preparation
Murad and Awad began preparing for the introduction of the incisionless procedure to St. Louis two years ago, when they first heard about POEM being introduced in the United States. Worldwide since 2010, some 1,400 POEM procedures have been performed. Nationally, there have been only 200 POEM cases, mostly at two locations. The largest POEM center in Portland, Ore., accounts for roughly half of them. Awad trained with Lee Swanstrom, MD, FACS, of The Oregon Clinic in Portland, who was the first doctor to perform natural orifice surgery in the United States. The second largest center is Chicago; roughly 35 POEM procedures have been performed at NorthShore Hospital, and perhaps 25 cases at Northwestern Memorial Hospital. “One of the first times POEM came up in the U.S. was two years ago at a Society of American Gastrointestinal and Endoscopic Surgery (SAGES) conference in San Diego,” said Murad. “I was presenting at the conference and had heard discussion about POEM, but it was the first time I’d seen video and learned more about it. A consensus meeting discussing the best
Current Gold Standard for Treating Esophageal Achalasia The Heller myotomy is most commonly used to treat achalasia, a dysfunction of the lower esophageal sphincter (LES), which fails to relax properly, making passage to the stomach difficult for food and liquids. Initially performed by Ernest Heller in 1913, the procedure, now performed laparoscopically, involves cutting the LES muscles. The myotomy only cuts through the exterior esophagus muscle layers that are squeezing the muscle, leaving the inner mucosal layer intact.
approach to POEM with preliminary data and other details was very enlightening. POEM has been slow to take hold in the U.S. because so much goes into it, and the procedure takes highly skilled people.” In St. Louis, a collaborative approach was taken with minimally invasive surgery (CONTINUED ON PAGE 10)
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Success in the Trenches, continued from page 1 managing a hospital,” she said. It has guided her in developing a management philosophy that her executive staff shares, and which contributes to her success in minimizing staff turnover: “Our managers have ‘boots on the ground,’” she said. “We are not office people. I model that, and they follow that model. I am on a unit every single day, and the perception of the staff is that we are doing this together. I think it’s helpful to employees to understand that leadership doesn’t come from some administrative staff sitting in a different building who don’t have a clue what’s going on. If they’re having a difficult day on the unit, we show up – literally. And we’re qualified to pitch in and help.” Lakeside has been through a number of changes since its opening in 1969, many of which Golden has witnessed and/or implemented. Universal Health Services bought the hospital more than 10 years ago, and it is the largest of the 200 behavioral health facilities that Universal owns nationwide, including Puerto Rico. Lakeside’s patient census also includes overflow from the Veterans Administration hospital, many of whose patients are suffering from post traumatic stress disorder (PTSD), Golden said. “We have a trauma resolution group led by a masters-prepared therapist who includes eye movement desensitization and reprocessing (EMDR) therapy, which has been very successful in helping to release internal trauma.” An acknowledged trailblazer, Lakeside
has adopted other treatment methodologies that represent the state of the science. “If there’s a new treatment, we want to do it first and best,” Golden said. “We are the only hospital in the area that has the equipment to administer trans-cranial magnetic stimulation (TMS), an FDA- approved therapy for major depressive disorder. It is a non-invasive outpatient treatment that has been successful in our experience.” The prefrontal cortex of the brain – the mood center – is essentially jump-started by magnetic pulses released into that portion of the brain. No medication or sedation is given and no pain is involved; patients can drive themselves home after a 37-minute treatment. Treatments are usually administered five days a week for four to six weeks. “Those we have treated have experienced improvement in their mood,” Golden said. Another effective treatment option – electroconvulsive therapy (ECT) – is administered by experienced physicians and also produces impressive results. The most prevalent conditions that Lakeside treats are major depressive disorder, bipolar disease and schizophrenia, although the range of care covers many other conditions, such as Asperger’s syndrome, autism and Alzheimer’s disease. “Sometimes all patients need is somebody to listen to them and to instill confidence and hope that with treatment options and medications they can have a better life,” Golden said. “Unfortunately, there’s a lot of non-compliance in mental health pa-
tients, who stop taking necessary medicines because they feel better. Education is a continuing challenge for us.” Golden spends her leisure time enjoying her two granddaughters – competitive cheerleaders – and participating with her
husband in shows sponsored by the Memphis Chevy Classic Club, for which he is the events director. The shows raise funds that benefit the Tennessee Baptist Children’s Home or the Burn Center at The MED.
A New Gold Standard? continued from page 9 and interventional endoscopy. This collaboration paired surgical experts in performing laparoscopic Heller myotomy, with interventional endoscopy and an esophagologist. Awad and Murad co-directed the start of the POEM program at Washington University. Because the POEM procedure pairs specialists in surgery and GI, Murad and Awad began concentrated efforts to expedite bringing the POEM procedure to St. Louis. “POEM is a convergence of disciplines, with both specialties focusing on the GI tract,” said Awad. “Traditionally, the approach to those disorders has come from different angles. GI approached it through use of medications and limited therapeutic maneuvers (injection of Botox and balloon dilation). On my end, we usually approach disease of the GI tract with keyhole surgery. We’ve been trying for years on a national level to make our procedures less invasive, and a huge jump was made 20 years ago with the advent of laparoscopic and minimally invasive surgery. It was a huge advance toward less pain, faster recovery, and fewer complications for patients.”
During the preparation phase, Awad and Murad connected with Haruhiro Inoue, MD, a professor at Showa University Northern Yokohama Hospital and Digestive Disease Center in Japan, who has performed 423 POEM procedures. The timing worked well for Inoue (pronounced “in-you-way”) to keynote the July 19 St. Louis Live Endoscopy Conference and also proctor the first POEM case at Washington University. “It’s too early for us to know long-term outcomes, but right now they’re matching laparoscopic outcomes,” said Murad. “As our understanding of the procedure improves, it might lead to better long-term outcomes.” Is the POEM procedure the new gold standard for esophagus achalasia? “That’s the hope,” said Murad. “We don’t have quite enough evidence yet to say that, but it’s emerging, and very promising. However, this particular procedure requires a great deal of technical expertise and a lot of specialized training. It won’t be done in all corners yet.”
“As the stigma of mental health decreases and it is regarded as a disease and a
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Heathcare Leader: Pam Henson, continued from page 1 Henson to training as a psychological examiner. She received her Bachelor of Science in Psychology from the University of Tennessee at Martin. Her Master of Clinical Psychology degree is from Murray State University in Murray, Kentucky. “During graduate school I was married and living in Trenton, TN, so I commuted to school,” said Henson. “My internship in graduate school was with Northwest Counseling Center in Martin where I did both psychological testing and counseling. That experience led me to get my license as a professional counselor. After graduating in 1987, I remained with Northwest Counseling Center.” While at Northwest Counseling Center, Henson’s responsibilities included all the children’s programs, the outpatient programs and ultimately she was named the center’s clinical director. In 1994, the center merged with West Tennessee Behavioral Center to become Pathways, where she served as a director. In 1999, Henson went to work with Quinco Mental Health Centers, where she opened an outpatient office in Lexington, TN. She returned to Pathways in 2001 and was named executive director in 2006. Today, Henson oversees ten outpatient offices, an inpatient psych unit, a crisis stabilization unit, a mobile crisis team, an adolescent alcohol and drug residential program in Trenton, a walk-in crisis center in Jackson and several grants with the state. “We serve around 10,000 patients
each year,” said Henson. “There is one other director who manages all our 24hour programs. There are four managers, who report directly to me with 20 additional managers who are responsible for an office or major program. In total we have 270 part-time and registry employees with another 30 contract employees.” For Henson, getting into management just sort of happened as part of her career. Her management style is one that has evolved as well and reflects adapting to the demands of her position. “I try to put the best people I know in the best position for them. Being so spread out, we have offices from Bolivar to Tiptonville. It is important that they can manage the day-to-day operations,” said Henson. “I try not to micro manage unless I have to. When financially things are not going well, it is my responsibility to ascertain what needs to be fixed, be it productivity, a program or whatever.” Coming from a counseling background, impacts Henson’s perspective as a manager. “Being a counselor, my door is always open. People seem to tell me what is going on whether it is something terrible that has happened or their computer has broken,” said Henson. “The downside is that I probably have more empathy for them when they have things going on more so than others may who do not have a counseling background. It can get in the way, but more often it brings me a perspective on what staff members are doing
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since I have done much of the same things they are.” One recent challenge for Henson was the implementation of electronic medical records at Pathways. For many behavioral health providers, cost is a deterrent to implementation but making the move to EMRs, Henson saw as a necessary step with great benefits. “We used to spend a lot of time getting paper charts from one office to another so that it was where it needed to be for an appointment. Now it is available to everyone just by checking the computer,” said Henson. “Being a part of a health system helped on several issues, cost being one.We also qualified for some governmental assistance.” Implementation, Henson noted, was tough. “No one at West Tennessee Healthcare really had enough experience with the behavioral health side of things so we had to do a lot of things on our own,” she said. “Once we selected our vendor, we had to move forward on our own to develop our forms and then to train the staff on how to use the system. Having access to the WTH’s IT department was a plus as they helped set up the computers and we have access to their help desk when we need it. They have given us a lot of support that has helped us ease into this. Being such an integral part of the development process has really helped me to understand what the staff has had issues with.” Pathways went live with their EMRs in November of 2012. “There is a learning curve to it. Some have adjusted well and others are struggling a bit,” said Henson. “We have had complaints that go from one extreme to the next. Initially they complained about not having a paper chart, but now they complain if the internet goes out and they have to use paper.” Now that Pathways has implemented their system and completed the first round of attestation, Henson is focused on the reaching the second stage of attestation by the first of 2014. “Much of the data is basic information that can be shared among various types of providers and is standard across all types of healthcare providers,” said Henson. “I am sure that as
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we progress through the stages, our criteria for data to collect may be more behavioral medicine related.” In addition to meeting the attestation goal, Henson is also looking at the changes coming on the healthcare horizon. “With the reform changes, we do not know what is going to happen with Medicaid and will mental health benefits be included?” said Henson. “Most insurance will cover mental health and substance abuse but not at the same level as medical care. Mental health parity, making benefits equal, is something that is supposed to happen but with the exchanges going into effect due to reforms, I think it may be a bit longer before we see that parity taking effect.” Being able to continue to treat the indigent population is something Henson is proud of. “Many centers can no longer accept indigent patients and the fact that Pathways provides over $1 million a year in outpatient services alone to the indigent speaks volumes as to our commitment to providing services to those who need them,” said Henson. “We have applied and received grants from the Department of Mental Health and the Division of Alcohol and Drug Abuse Services – one of which covered patients who had lost Tenncare coverage. We also received a Behavioral Health Safety Net Grant for those people who made more than to qualify for Tenncare yet had no other way to get coverage or pay for their services. We also have a staff person who can help patients sign-up for a prescription plan that helps them pay for prescription medications needed.” Pathways is one of only a few programs in the state with a crisis stabilization unit. “This is a 15-bed unit that allows a patient to stay for 72-96 hours to stabilize whatever crisis they are experiencing. Often times these are patients dealing with depression, who may be suicidal or have stopped their medications and are experiencing symptoms of their disorder,” said Henson. Her nearly 20-year career with West Tennessee Healthcare is a source of pride for Henson, who says she certainly never saw herself as executive director in 1987. “Having this position is such an accomplishment for me personally,” said Henson. “I was clinical director before this. When my predecessor took another position at the hospital, I took this position not really knowing if I could do it all from the financial aspects to the people and program requirements. But I am proud of the job I do and enjoy it so much.” With a husband who is a former softball and basketball coach, Henson has learned to love sports, as have her twin 25-year old daughters who both live in West Tennessee. “We are huge St. Louis Cardinal fans and have made it to a game each year for the past 30 years. We also love to watch the Redbirds and the Grizzlies. Plus, there is no telling how many high school games I have seen over the years,” said Henson. “I have sort of turned into a sports fan but with a coach for a husband you sort of have to get into it or be miserable.” westtnmedicalnews
GrandRounds Jackson-Madison County General Hospital Receives Healthgrades 2013 Patient Safety Excellence Award™
Jackson- Madison County General Hospital has been recognized with the Healthgrades 2013 Patient Safety Excellence Award™, according to Healthgrades®, the leading online resource that helps consumers search, evaluate, compare and connect with physicians and hospitals. The distinction places JacksonMadison County General Hospital within the top 10 percent of all hospitals for its excellent performance in safeguarding patients from serious, potentially preventable complications during their hospital stays. The hospital was one of only 5 in the state of Tennessee and 379 nationwide to receive this recognition. When compared to hospitals performing in the bottom 5 percent for patient safety, Healthgrades Patient Safety Excellence Award™ recipients had three patient safety indicators showing the largest difference in observed to expected ratios. On average, patients treated in Patient Safety Excellence Award hospitals were also: · 81 percent less likely to experience hip fracture following surgery compared to hospitals ranked in the bottom 5 percent in the nation 80 percent less likely to experience pressure sores or bed sores acquired in the hospital compared to hospitals ranked in the bottom 5 percent in the nation During the 2013 study period (20092011), Patient Safety Excellence Award hospitals showed better than expected performance in providing safety for patients in the Medicare population, as measured by objective outcomes (riskadjusted patient safety indicator rates) across 13 of the 14 most common patient safety indicators, as defined by the Agency for Healthcare Research and Quality (AHRQ). Hospital staff works closely with the Tennessee Center for Patient Safety to identify and implement best practices in patient safety and quality care. Teams have worked to improve clinical outcomes for many conditions, including heart attack, heart failure, and stroke. Teams are also working to reduce preventable complications, such as central line infections, ventilator associated pneumonia, surgical site infections and urinary tract infections.
West Tennessee Healthcare Foundation Announces New Endowment
The West Tennessee Healthcare Foundation announces a new endowment to honor a long-time employee. Since its beginning in 1984, the West Tennessee Healthcare Foundation has worked to improve the health and well being of those living in Jackson and West Tennessee by raising funds for efforts that enhance the quality of life, educational opportunities, and promote the arts. Earlier this year, West Tennessee Healthcare lost a long-term and dedi-
cated employee, Eric Wollam. Eric’s work in the Radiology Department of JacksonMadison County General Hospital endeared him to physicians, employees and patients. His untimely death has lead to the creation of the Eric Wollam Radiology Scholarship Endowment. The Eric Wollam Radiology Scholarship Endowment has been established by donations from the Jackson Radiology physicians who wanted to remember Eric’s life and provide a scholarship program in his memory. Donations to the Eric Wollam Radiology Scholarship Endowment will provide scholarships for his children as well as radiology students at Jackson State Community College. Gifts to this endowment in Eric’s memory will be applied to the endowment principal. Eric’s wife, Catherine Wollam, will receive a card acknowledging the gift in his memory. Endowments are a permanent way to provide an income stream for a specific cause such as scholarships in Eric’s memory. To find out more about establishing a fund or an endowment or a fund at the Foundation, email Frank McMeen at Frank.McMeen@wth.org or call 731-9842140.
Methodist Le Bonheur Healthcare, UTHSC and UT Medical Group Create UT Methodist Physicians
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Methodist Le Bonheur Healthcare (MLH) has partnered with UT Medical Group, Inc. (UTMG) and the University of Tennessee Health Science Center (UTHSC) to create a new academic physician practice group that will enhance the delivery of specialty care and hospital-based medical services in the Memphis area. The new group, called UT Methodist Physicians (UTMP), launched in September and includes UTMG physicians who have a strong history of affiliation with Methodist. UTMP specialties include urology, surgical oncology, and most adult medicine specialties, such as internal medicine, pulmonology and endocrinology. As of Aug. 30, 53 UTMG physicians in those areas and 80 supporting staff members joined UTMP and became MLH associates. Most physicians joining UTMP will continue to care for patients at their current UTMG locations. UTMP will also include other physicians from the Memphis area. Initially, seven doctors from other practices will join the group, with more to be added in the coming months. The UTMP collaboration is similar to the successful formation in 2011 of UT Le Bonheur Pediatric Specialists (ULPS) by UTMG, MLH, and UTHSC. The creation of that group strengthened the pediatric practices at Le Bonheur Children’s Hospital, supported recruitment of additional outstanding sub-specialists, and helped it achieve national recognition. Chris Jenkins will serve as administrative director for UT Methodist Physicians. He was previously an administrator at Methodist University Hospital. Jessica Harrison, formerly clinic administrator at UT Medical Group, will be UTMP’s director of operations. OCTOBER 2013
GrandRounds West Tennessee Healthcare Welcomes Dr. Brittain Little The Medical Specialty Clinic is pleased to announce the addition of Gastroenterologist Dr. Brittain Little to the West Tennessee Healthcare family of physicians. Dr. Little earned his medical degree from the University of Tennessee Dr. Brittain Little College of Medicine in Memphis. He received a Bachelor of Science and graduated Magna cum Laude from Lipscomb University in Nashville. Dr. Little’s training included a Fellowship in Gastroenterology and Hepatology at the University of Tennessee. Dr. Little treasures his volunteer and medical missions work including several trips to Honduras. He is married with three children.
Baptist Union County breaks ground on new ER
And It’s Not Just How Many We Treat, It’s How Well
Among the lowest occurrence of complications after surgery or a hospital stay. 30 day readmission rates for heart attack or heart failure lower than national rates.
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Baptist Memorial Hospital-Union County has broken ground on a new $12 million emergency department. The new ER will be located behind the hospital and will connect to the radiology department. It will have 22 exam rooms, two trauma rooms and two triage rooms. The number of ER visits to the hospital has increased by more than 20 percent during the past three years according to Walter Grace, Baptist Union County administrator and CEO. He says that by expanding the facility, they expect to meet the community’s growing demand for emergency services and help patients achieve optimal health and wellness. The ER project is scheduled for completion in August 2014. The existing ER has seven exam rooms and will remain open and continue to treat patients during construction. Baptist Union County recently initiated a number of projects to enhance care and services, including purchasing a 64-slice CT scanner in April. The new ER is Baptist Union County’s largest construction project in years. The Women’s Center, renovated in August 2008, features 10 private labor/delivery/ recovery rooms and two suites equipped for Cesarean sections. The 28-bed postpartum unit features private baths and couches for family. In addition to the wellbaby nursery, the center has a Level I nursery equipped for newborns with special needs that was renovated in 2010. In 2008, the Mississippi Nurses’ Association named Baptist Union County “Hospital of the Year” (less than 100 beds). Since leasing the hospital 26 years ago, Baptist has invested more than $47 million to enhance the facility and services.
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HEALTH CARE REFORM DECLINING TOP LINE REVENUE
DELIVERY MODEL CHANGES S SK RI ON TI SA EN MP CO N IA IC YS PH EVERY DAY IS A CHALLENGE
IN THE WORLD OF HEALTH CARE
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Published on Oct 7, 2013