memphis medical news april 2015

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BY JUDY OTTO

Perhaps it’s no accident that the acronym for Health Information Exchange is HIE, which literally means “to go quickly or hasten,” since the man spearheading the Mid-South eHealth Alliance seems driven by a contagious sense of excitement and urgency to spread the HIE gos-pel to Memphis-area medical professionals and

institutions.According to Executive Director Cameron

Brackett, that benefi ciary category includes all Memphis-area medical professionals because the ability to electronically and instantaneously access a patient’s vital medical information does unquestionably improve the speed, quality, safety and cost of patient care.

(CONTINUED ON PAGE 8)

HealthcareLeader

Cameron BrackettExecutive Director, Mid-South eHealth Alliance

PAGE 3

PHYSICIAN SPOTLIGHT Some Answers in Short Supply

During ‘Day on the Hill’ Event BY GINGER H. PORTER

Attendance was up approximately 20 percent for this year’s Day on the Hill, the annual one-on-one meeting in Nashville of legislators and physicians, nurses and healthcare administrators for the oppor-tunity to exchange opinions and concerns about issues affecting healthcare.

The two chief issues for the physi-cians and administrators involved during last month’s gathering, according to Keith G. Anderson, MD, were Governor Bill Haslam’s failed Insure Tennessee effort and the Payor Accountability Act.

Anderson, a cardiologist with Suther-land Clinic and the new president of the Tennessee Medical Association (TMA), observed, “One of our priorities as a medi-cal community has been to promote Insure Tennessee, but this year, since it’s already been voted down, we went with a ‘What happened? Can you give us the details of why Insure Tennessee did not pass?’ mindset.”

Anderson, a physician for 25 years, expressed his discontent that such an initiative is prohibited from coming up again for two

years, leaving 200,000 to 300,000 lives un-covered.

“These people cannot qualify for tradi-tional Medicaid or vouchers or buy insur-ance on the free market. Most are working part-time in service industries, are seasonal help, or are PRN in health care,” he said.

Anderson said they were not given a reason for the two-year window. He ex-plained it might just be a political cycle. The reason given for the failure of the measure, he said, was discontent with the Affordable Care Act which is what was perceived as the driver of this plan, and that this was a state-ment from the local legislature. He cited a heavy, organized coalition against Insure Tennessee that had protested on the hill be-fore the vote was taken.

“It was a very well-written plan and I commend Governor Haslam for his hard work on it. The time and effort put into cre-

ating it was tremendous. I’m just so sorry it failed so quickly in the legislature,” Anderson said.

The Payor Accountability bill, addressed in the 109th General (CONTINUED ON PAGE 10)

New Group Brings More Health Services to the UnderservedAfter years at Christ Community Health Services, doctors open Resurrection Health Fueled by faith and driven by compassion for the poor, Rick Donlon, MD, has spent the last two decades of his medical career aggressively reaching out to underserved populations in Memphis ... 6

Integrating for Improved Outcomes Community-Based Solutions Answer Some of Tennessee’s Toughest Behavioral Health Challenges Hillary Clinton famously said, “It takes a village.”

For behavioral health provid-ers, that con-cept – played out in communities all across Tennessee – has proven to be true ... 12

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Kenneth Ennis, MDPsychiatrist believes Memphis VA is meeting challenges of treating veterans

PhysicianSpotlight

BY RON COBB

Kenneth Ennis, MD, can’t speak for all of the Veterans Ad-ministration hospitals across the country, but he believes veterans are getting a fair shake at the facil-ity in Memphis.

After a wide-ranging career as a psychiatrist that included pri-vate practice and a stint as medical director of the psychiatric services at Methodist University Hospi-tal, Ennis joined the VA three years ago. He now is strictly at the Memphis VA Medical Center and sees only veterans.

“Speaking from my experience as a staff psychiatrist, I feel like the Mem-phis VA does a very good job in treating veterans,” he said. “I’m sure whether it’s in private practice, the VA or a hospi-tal practice there are going to be things that fall through the cracks. But I feel like we’re doing an excellent job here of try-ing to see that everyone is seen in a timely fashion.

“I think the care received at the VA is on par with healthcare in other organiza-tions or in private practice.”

One of the problems facing the VA, Ennis suggested, is the sheer number of vet-erans entering the system, with Afghanistan veterans coming in on the heels of Iraq vet-erans.

“The number of veterans taken care of at the VA has increased substantially, and we have a shortage of psychiatrists to meet that need, and a shortage of mental health-care workers in general,” he said. “We’re doing a lot of things to increase the number of providers that we have for mental health, but it’s a challenge.”

Although he came to the VA fairly late in his career, Ennis says he has always had an interest in veterans. His father, Wheaton Ennis, is a 94-year-old former Marine who served in the South Pacific during World War II.

As a youngster growing up in Mem-phis, Ennis enjoyed reading and went to Baylor University as an English major. He also liked science and took science courses. As he got close to earning his degree he began to wonder what he could do with an English degree.

He switched his focus to science and went to medical school at the University of Tennessee in Memphis, where he eventu-ally gravitated toward mental health.

“It wasn’t really a lifelong ambition of mine to be a physician,” he said. “But I sort of fell into it in a way. I always had a curios-ity about how the physical and emotional or mental interplayed, so it seemed like as a specialty it combined a lot of interests that I had.”

Aside from a year at the VA in Para-gould, Arkansas, Ennis has been based in or around Memphis for his entire career.

He has a faculty appointment in the de-partment of psychiatry at the University of Tennessee Health Science Center and has worked with the UT Medical Group.

“The VA has been a very interesting experience for me,” he said. “Prior to this I hadn’t treated veterans. I’ve learned a lot about treating people with PTSD, trau-matic brain injury, and people reintegrat-ing back into their civilian life after combat experiences.

“The most challenging thing is just helping veterans to reintegrate (as they re-turn) with physical problems, financial dif-ficulties and social and family changes and their having to contend with the constant news of conflict and violence.

“Here, much more than in other places where I’ve practiced, we use a multi-

disciplinary team approach toward patients, with psychologists, social workers and other support staff.”

Perhaps the most tragic issue Ennis has to deal with is the grow-ing number of veterans who con-template suicide.

“There’s been a lot of pub-licity about this, but we’ve had more and more patients with sui-cidal thoughts, suicide attempts and even completed suicides,” he said. “We’re addressing this in many ways. I’ve seen quite a few patients who feel hopeless and sui-cidal. But we see various diagnoses,

everything from the very serious such as schizophrenia to people with maybe social anxiety or what we might consider milder forms of mental illness.”

Ennis estimates that 15 percent of the veterans he sees are women, and the num-ber is growing.

“They’re being exposed to combat situations and explosives and generally just the trauma of war,” he said. “So we do see a lot of Post-traumatic Stress Disorder in female veterans as well as males.”

As one might expect, Ennis paid close attention to the recent “American Sniper” trial, in which Eddie Ray Routh was con-victed of capital murder in the death of former Navy SEAL Chris Kyle. But Ennis steers clear of passing any kind of judgment from afar.

“I’ll sort of leave the outcome to the jury and judges in that particular case,” he said. “I thought it was very sad for everyone involved and highlighted some of the issues with mental disorders and violence.”

Looking forward, Ennis is optimistic about changes that he foresees in health-care for mental patients, despite issues with trying to achieve parity in funding with more physical illnesses. Something fairly new is “telehealth,” whereby Ennis treats patients via computer at VA facilities out-side of Memphis.

“With technology,” he said, “we’re learning more and more about genet-ics and genomic testing and those sorts of things which will in the future guide our treatment in some more scientific basis than we’ve had in the past.”

While outright cures may be too much to ask, the goal continues to be to manage mental illness and improve the patient’s quality of life.

“You have some veterans who require only a minimal amount of treatment,” he said, “and most of our veterans return to a very productive life, or continue in a very productive life.”

Ennis and his wife, Gwen, a recently retired speech pathologist, have daugh-ters and grandchildren in New York and Texas. So although Ennis likes to travel when he has time off, these days “my trav-eling basically consists of going to see the grandchildren.”

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Letters to the Editor

Dear Editor of the Memphis Medical News,

The Page One article in the February issue (“Partners in Re-tail Clinics Tout Early Success”) appears to be an endorsement for this model of medicine. As a general pediatrician in the Mem-phis area, former President of the Memphis and Mid South Pedi-atric Society and former Chair-man of the Pediatric Department at Baptist Women’s Hospital, I have many concerns with these retail clinics.

This article seems to define success by total number of visits, but not the quality of the deci-sions made during these visits. I am unaware of any physician not affiliated with these clinics who actually believes this is an acceptable venue for healthcare.

The title of the article states, “Part-ners in Retail Clinics Tout Early Suc-cess.” Never in my career before, during or after medical school and training, did I imagine that primary care medicine would be described as a “Retail” indus-try. Medicine is not a retail industry and calling it this is a disservice to our patients and our profession.

As a physician I do not have clients,

customers or revenue units in my office – I simply have patients and families who I have the privilege of serving. At the core of this service is a relationship with patients and their families. It is within this environment that the medical home should be managed. Licensed providers who are more interested in patient care should be managing this care rather than bureaucrats managing the bottom line.

Patients are best served when getting a pre-participation sports physical or camp participation physical with their primary

care physician. Heart anomalies and screenings for other medical issues should be performed in a setting where more experienced healthcare providers are and not simply where expedience is adver-tised.

The pediatric cancers that I have detected in my patients have usually not been associated with the chief concern of the visit. Only after a thorough history and physi-cal exam was a pediatric cancer detected.

Retail clinics that not only advertise, but call themselves the “minute clinic” are a setup for less thorough exams and poten-tial malpractice. The convenience

that retail clinics advertise should not be replaced by the quality that more likely comes with a primary care physician.

The enclosed picture highlights a great concern with some of these clin-ics. Marketing a preventive health and wellness clinic over the cigarette and cigar display is unacceptable. Some of these clinics are profiting from the very items

I am educating people not to use. Imag-ine if I sold soft drinks, junk food, beer, wine and tobacco products in my waiting room – would the media endorse this rev-enue stream as a success for my practice? Imagine counseling a teenage girl on self-esteem issues, healthy eating, nutrition and on her walk out of the clinic was a magazine rack featuring publications with photo-shopped models on the covers. As absurd as this sounds, this is exactly what is happening at these retail clinics.

Most unfortunate is that the featured retail clinic in your article has aligned with a major hospital system in Memphis. This relationship lends credibility to a sub-standard level of care. While our current medical environment needs to address ac-cess to medicine, hospital-endorsed retail clinics are not the answer. Let’s hope that creative scheduling, extended office hours and increased access to primary care doc-tors may decrease the need for the public to resort to these retail clinics and preserve the dignity of our profession.

Thanks,Keith B. Owen, Sr., MD

Billing Department SupervisorRock solid dedication since 2001

JULIE MILLICAN

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To the Editor:Recently I spoke with Dr. James

Eason, Memphis’ own leading organ transplant surgeon. He has voiced ap-proval of and signed a letter issued this summer by about 20 members of the American Society of Transplant Sur-geons encouraging a pilot project to test the effects of remuneration for organ transplants. The 30-year-old Federal Organ Transplant Act would need to be amended to bring this about.

We hear much about life saving organ transplants from altruistic donors, but not enough about the many who die because of the organ shortages (about 10,000 per year in the US, or about 20 per day). The gap between supply and need of all organs is steadily growing and cries for solution are becoming louder.

The idea of having directly enticing or coercive payment for organs has been considered repugnant and is actually ille-gal (since 1984) because of the possibility of black market tourism trafficking. For illogical reasons payment for organs has been looked upon as ghoulish although we may accept many other disturbing entities such as autopsy, surgery and abortion. In all other aspects of healthcare, we espouse the policy of remuneration for service. We also sell our blood, bone marrow, sperm and eggs.

On this subject ethical and legal thought is complex and strenuous, de-

pending on such variables as whether there is live donation such as with kid-neys and part of the liver or brain-dead donation such as with heart. Ethicists are concerned about having thousands die be-cause of the idea that it is wrong to remu-nerate donors.

Many thoughtful activists believe that a strictly regulated, brokered marketplace, transparent and with controlled pricing would assure an adequate supply of or-gans. As Justice Brandeis said, “Sunlight is the best disinfectant.” Compensation would occur by removing the disincen-tives that hinder living donation. Remu-neration would be created by tax credits, tuition vouchers and payment for travel expenses and time of missing work.

To prevent black market exploita-tion of desperate patients, the laws against non-brokered direct payment and trans-plant tourism would be strengthened.

A living donor registry would be care-fully maintained and donors and their im-mediate families placed at the head of the waiting list in case the donors themselves would need a donation in the future.

The increase in donated live kidneys would save Medicare a huge amount of money because funding dialysis is much more expensive than supporting trans-plantation and is much better for the pa-tient.

Webster Riggs Jr., MD

Physician Expresses Concerns about Retail Clinics

Tobacco products and healthcare advice are both available.

New Thoughts on Organ Transplant Needs


Healthcare Industry Facts…

BY BILL APPLING

MedicalEconomics

Some low cost generic drugs that have “helped restrain” healthcare costs for decades are seeing unexpected price spikes of up to 8,000 percent. “If generic drug prices continue to rise, people all over this country who are sick and need medicine and will not be able to buy the medicines they need. (Senate sub-committee on Primary Health and Aging) An example: the antibiotic doxycycline hyclate rose more than 8,280 percent during a six- month period from $20 per bottle to $1,849 per bottle. (Associated Press, Nov. 21, 2014)

2,333,972 American military personnel had been deployed to Iraq, Afghanistan or both, as of Aug. 30, 2011. 711,986 have used VA healthcare between fiscal year 2002 and the third-quarter fiscal year 2011. 38 per 100,000 of these Veterans using the VA healthcare committed suicide during the latest data available. There is very little information about veterans who did not use VA healthcare. Compare that to 11.5 deaths per 100,000 for the general public. (VA’s Iraq and Afghanistan Veterans of America – Non-profit organization.)

$2,077 is the average balance in health savings and health savings reimbursement accounts in 2014, compared with $1,356 in 2008. (Modern Healthcare, Feb. 2015)

“While there is a reported trend of physician employment with hospitals and health centers, we have seen some of those medical groups going back to private practice during the past two years. This phenomenon not only plagues medical group and physicians, it affects groups that join and merge with other private practices to form larger single-specialty or multispecialty groups. Unfortunately, many hospitals and medical groups believe that performing financial due diligence of a practice and then focusing on compensation considerations is sufficient to successfully negotiate a deal.” (“20-20 hindsight: Choosing hospital employment and returning to Independence.” Nick Fabrzio, PhD, FACMPE, FACHE; MGMA Connection Magazine, March, 2015)

The adage that culture eats strategy every day of the week is certainly true with integration.

The primary reasons for returning to private practice were the desire to stay involved in decision-making and ensure physician satisfaction. In hindsight, physicians said they wished they had spent more time talking about how decisions were made at the hospital and learning more about what their level

of involvement would be before they sold their group. While compensation is often the primary motivation, it is a necessary but not a sufficient condition for successful relationships.

The prevalence and costs of Alzheimer’s disease are expected to grow substantially over the next few decades as the nation’s elderly population swells.

• 5.4 million; estimate number of Americans living with Alzheimer’s in 2012, a figure expected to triple by 2050. ( Alzheimer’s Association )

• 17.7 billion; Number of unpaid hours of care provided by relatives and friends in 2013 to those with Alzheimer’s valued at an estimated $220 billion (Journal of the American Geriatrics Society)

• $10,748; Average annual per-person payment for acute inpatient services for Medicare beneficiaries with dementia in 2013, compared with $4,321 for beneficiaries’ without dementia. (CMS)

• 75 percent; Percentage of people living in a nursing home by age 80 who are expected to have Alzheimer’s. (Alzheimer’s Disease and Associated Disorders.)

Dr. Karen DeSalvo heads up the Office of the National Coordinator for Health Information (ONC). ONC Tenure: January 13, 2014 to present. Observations about ONC So Far: There have been five coordinators, (former ONC chiefs over the last 10 years). Former ONC chiefs have differing views “about the role of government and the ONC in a national HIT strategy generally. Everyone is trying to solve the same three issues. They are capturing data, freeing it appropriately and then putting it to use. And everyone sort of sees a different way to do it.” Dr. DeSalvo has been impressed with the reach that the regional extension centers have in communities. (Apparently she has not been talking to the individuals and looking at the data that I have.)

ONC’s Future: A top priority by the end of this year is to update the national health IT strategic plan and include provisions for patient-generated data. “The technology in that area, because it is so consumer and market driven, is advancing fast,” says DeSalvo. (Not true – it’s because of all the roadblocks and various silos impeding its progress.)

Bill Appling, FACMPE, ACHE, is founder and president of J William Appling, LLC. He is a national speaker, presenter and a published author. He serves as an adjunct professor at the University of Memphis and is on the boards of Hope House and Life Blood. For more information contact Bill at [email protected].


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Fueled by faith and driven by com-passion for the poor, Rick Donlon, MD, has spent the last two decades of his medical career aggres-sively reaching out to un-derserved populations in Memphis. For 20 years, Donlon treated patients through Christ Com-munity Health Services, a faith-based health-care facility for lower-income patients that he founded with three other partners, including Dr. David Pepperman.

That operational structure expanded from a handful of physi-cians and support staff to nearly 50 medical providers and some 300 employees, working in seven primary care health centers and four dental clinics in some of the area’s poorest communities. And while Christ Community continues to branch out – including a new medical and dental facility scheduled to open later this year in Frayser – Donlon will not be part of it.

In mid-February, Donlon and Pep-perman opened Resurrection Health at 4095 American Way in Parkway Village. The opening followed the duo’s departure from CCHS in 2014, which resulted from differing views on how the faith-based medical organization should be run.

“The Christ Community board of directors wanted to go in one direction, and I felt we needed to go in a different one,” Donlon said. “But my commitment to the underserved has never wavered, and that’s why we worked to establish a new model.”

Resurrection Health is similar to CCHS in practice, if not yet in scope, and includes some familiar faces: About 20 medical personnel from CCHS have joined Donlon and Pepperman at the 7,100-square-foot facility on American Way that previously served as a Regional One Health Clinic. The center includes 18 exam rooms and offers a wide range of primary care services, such as prenatal care, pediatrics, adult care, HIV/AIDS care and geriatric medicine.

And while Resurrection Health is sol-idly based on evangelical Christian prin-ciples, its services are open to all.

“Our mission isn’t to turn anyone away because of what they believe in or don’t believe in,” Donlon said. “Our mis-sion is to care for the poor and under-

served, without regard to other factors. Our faith compels us along this path.”

In addition to providing care at the new clinic, Resurrection Health doctors also staff the Delta Medical ER at 3000 Getwell and perform general surgery at the Delta Medical Center at 3960 Knight Arnold. Plans include adding dental, op-tometry and pharmacy services.

“So few resources are available for the underserved, and while the majority of our patients are from the immediate areas around the communities we’re in, we get patients from as far away as Millington,” Donlon said. “There is just not a robust enough healthcare system in our area to provide proper care for all those in need. We’re trying to address that.”

In his role as CEO and practicing physician at Resurrection Health, Don-lon said his goal is to flood primary care “deserts” with exceptional medical ser-vices. Pepperman is on board as the chief medical officer. In July, the fully accred-ited residency training program at CCHS will permanently transfer to Resurrection, adding another two dozen medical profes-sionals to the operation.

Since opening its doors, Resurrection Health has been seeing about 150 patients a day, Donlon said. The nonprofit is sus-tained by reimbursements from Medicare and Medicaid, as well as from patients with insurance. Everyone pays something, Donlon said, and administrative and op-erational costs are kept as low as possible.

“We’ve done this long enough that we know how to run a lean operation,” Donlon said. “And because of our com-mitment to serving our patients, our doctors and staff work for lower salaries. We’re in this to provide the best health-care possible to the population that needs it the most.”

And that means reaching out to as many as possible of the estimated 225,000 low-income residents in southeast and west Shelby County, Donlon said.

Of course the new operation can’t reach anywhere near that number, Don-lon said, and that’s why it’s vital for orga-nizations such as CCHS and the Church Health Center to con-tinue treating the under-served and the working poor.

Ed Roberson, who assumed the CEO role at CCHS following Don-lon’s departure, agreed.

“The unfortunate re-ality is that there are many, many more patients who need care than we’re able to provide for, and because of that it’s

New Group Brings More Health Services to the UnderservedAfter years at Christ Community Health Services, doctors open Resurrection Health

Dr. Rick Donlon

Ed Roberson


Dr. David Pepperman


BY BETH SIMKANIN

In spite of tight budgets and other eco-

nomic challenges, the healthcare real estate market in the Memphis area remains on an upward trend, according to decision mak-ers involved in the business.

Development and building expansion continues to grow in all areas of the Mid-South with emphasis on providing patients with multi-specialty services, convenience and accessibility.

The trend is expected to continue the next two to three years, according to Kelly Truitt, executive vice president of CB Rich-ard Ellis Memphis, LLC.

“There are plenty of opportunities for continued future expansion in the Mid-South,” Truitt said. “Larger projects led by area hospitals that have been recently completed will lead to smaller projects such as medical office buildings. There are in-fill areas around major campuses where pri-mary care facilities could emerge. The loca-tions are convenient and easy accessible.”

An example is Regional One Health’s East Campus at 6555 Quince. The 110,000-square-foot building is under ren-ovation and will house 50,000 square feet of clinical space, which will include a com-prehensive imaging center, multi-specialty clinic, rehabilitation medicine center and reproductive clinic. The campus will open in phases throughout 2015, starting with the reproductive clinic, which will open later this month.

“Our goal for the facility is compre-hensive integrated care,” said Bret Perisho, vice president of finance and chief busi-ness development officer for Regional One Health. “The future in healthcare is to offer a one-stop-shop model that has the capabil-ity to provide multi-service specialties. We needed a centralized location that provided a full range of specialists. We don’t want patients to bounce around from place to place. We want them to have an efficient patient experience.”

Visibility and accessibility were factors in choosing the location for the East Cam-pus, according to Perisho. The hospital sys-tem performed a study on driving habits. According to the study’s findings, 900,000 people can drive to the 6555 Quince loca-tion in 20 minutes or less.

“The East Campus is an easy access point,” Perisho said. “It’s easily acces-sible from Bill Morris Parkway, and over 150,000 cars drive by our building every day. There are many routes a person can take to get here. Even Mississippi residents can drive here quickly by driving into Memphis on Riverdale Road.”

Regional One Health owns 40 acres of land west of the building. Space is there for over 1 million square feet of additional medical development. There are no imme-diate plans to develop the land, but Perisho can foresee a need for an outpatient surgery center or medical office group within the next five years.

Also in East Memphis is the Spence and Becky Wilson Children’s Hospi-tal at 6225 Humpreys Boulevard. The 19,000-square-foot pediatric emergency room and diagnostics area opened earlier this year. Additional pediatric services will be available over the next several years, in-cluding a 12-bed inpatient unit, outpatient pediatric surgery and a pediatric eye center.

“We will have multi-specialty services on the top floor where parents can consult

with various doctors for chronic issues,” said Anita Vaughn, the hospital’s CEO and administrator. “We want to make it convenient for parents and their children by having doctors with different specialties located there under one roof.”

This accessible, multi-specialty ex-pansion trend isn’t just happening in East Memphis. It’s occurring in all areas of the Mid-South from Olive Branch, Miss., to downtown Memphis.

Methodist Le Bonheur Healthcare will open an $11 million medical office build-ing downtown this fall. The 54,000-square-foot, three-story building at the northwest corner of Adams Avenue and Dunlap across from Le Bonheur Children’s Hos-pital will provide about 200 offices for physicians, freeing up clinical space in the hospital and nearby clinical buildings, said Dave Rosenbaum, vice president of facili-ties management for Methodist Le Bon-heur Healthcare.

“Our goal is to provide the most pa-tient-friendly care we can,” Rosenbaum said. “It’s better for our patients and for doctors if our medical services are located in one place. The patients can receive bet-ter care.”

Crosstown Concourse, formerly the vacant Sears Crosstown building at 495 North Watkins, is scheduled to open downtown in January 2017. The 1.1-mil-lion-square-foot, $200 million health and wellness development will house tenants from various healthcare-related entities such as Methodist Le Bonheur Healthcare, St. Jude Children’s Research Hospital, ALSAC/St. Jude and Southern College of Optometry. Additionally, the Church Health Center will be the building’s largest tenant, occupying 150,000 square feet.

“We have a good working relation-ship with hospital entities,” said Marvin Stockwell, communications director for the Church Health Center. “We can be the

Healthcare Real Estate Market SolidIn Spite of Economic Challenges

Leeyla Woods enjoys watching fish in large tank in the lobby of the newly completed Spence and Becky Wilson Baptist Children’s Hospital adjacent to the Baptist Memorial Hospital for Women. The hospital’s 17,000 square-foot emergency room features 10 bays for patient care, and a 2,000 square-foot diagnostics area.

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The idea of collecting patients’ data in one central repository that is readily ac-cessible to doctors, nurses, pharmacists, other healthcare providers and patients for secure sharing is not a new one, and few people dispute the logic behind develop-ing such a system. But Brackett pointed out that it was logistics, rather than logic, that was delaying the momentum of Mid-South

e-Health Alliance’s HIE project prior to his assuming the executive director’s chair seven months ago.

Since the Alliance’s creation in 2007, its growth has been limited by its low pro-file, Brackett said. “Those who used it got value out of it, but there was not a push to-ward getting the word out. Now, however, we’re comin’ at em!”

A Southerner at heart, Brackett spent his childhood in Jackson, Miss., and later married a native Memphian. Part of the life journey that brought him to Memphis was the longing to come home, which happened to be linked to an unexpected opportunity that meshed perfectly with his profession and made the choice irresistible.

A Baylor alumnus with a degree in computer science, Brackett always had an interest in technology, even as a kid tinker-ing with computers that his dad, an insur-ance executive, brought home from the office.

The catch was, he admits, he didn’t really know what you do with computer sci-ence. His search for purpose, and an oppor-tunity to innovate within the computer field in ways that were meaningful and beneficial to the medical community, took him from FedEx to engineering leadership positions at GE Healthcare in ultrasound and centricity, and to Cerner, where he led the reinvention of cardiology and patient monitoring R&D businesses and chaired the development of the standard for handling, storing, printing and transmitting information in medical imaging.

He then served Honeywell as director of research and development for its Milwau-kee-based Life Care Solutions, producing innovations in remote patient monitoring, population health management and patient engagement, before making the Memphis connection.

Along the way, he guided the explora-tion of global healthcare technology joint venture opportunities for several Asian-Pacific companies, helped launch Cerner operations in India and Australia, and ac-quired more than 30 patents worldwide in healthcare technology.

His career focus changed dramatically at a late 1990s Chicago trade show for ra-diologists, where he was introducing a new GE full-field digital mammography reading station that was totally voice-driven — a revolutionary concept for its time, Brackett noted.

“Although the radiologists loved it,

they weren’t interested in buying it,” he said. “What they really needed, they said, was information about the patient: lab re-ports, history, medications — everything else about the patient that the mammogra-phy station didn’t show. At that point I rec-ognized that I needed to be in an electronic health record company, after spending all this time in imaging.” Consequently he fo-cused his efforts in that direction.

Meanwhile, in Memphis, the 4-year-old Mid-South eHealth Alliance Board commissioned a consulting group to deliver an evaluation. Their report confirmed that MSeHA was a viable business opportunity, now able, due to the healthcare high-tech stimulus, to offer different and greater po-tential for facilitating providers’ efforts to meet the CMS meaningful use require-ments — specifically the requirement that physicians exchange health information with unaffiliated providers.

Memphis Bioworks Foundation won the bid to assume new management of MSeHA about a year ago, and a few months later began its search for an execu-tive director to lead the Alliance’s growth and expansion.

“It wasn’t just a job, for me,” Brack-ett said. “It was exactly what I was looking for: an opportunity to materially contribute to the community, leveraging my experi-ences and skill sets, which were really about healthcare, technology, entrepreneurship and innovation. I knew it was meant to be, to come to Memphis — which was just great for me.”

Meaningful use is driving some sub-stantial demands on the clinics and offices that need to provide continuity of care with patients who go to Baptist or Methodist or Regional One or such, but don’t have the technology connections with all these places, he explained.

“MSeHA is making it easier than ever for them,” he said. “We’re here to help them and provide for that service. We’re starting to launch the campaign and talk with independent clinics and offices about how we can make their lives better and what we can do to facilitate movement in this direction.”

Currently 16 hospitals and 16 ambula-tory clinics in the region share information through the service.

“A massive amount of data has been contributed to this service over the last five years,” Brackett said. He points to last year’s numbers – when more than 200,000 patients were viewed in the MSeHA health record system – as proof that the system is being used quite heavily.

“Our goal is to continue to grow that utilization by bringing in more healthcare providers,” he said, “including independent practices and clinics that want and need that technology connection, too.”

Brackett has strategies on the drawing board for additional expansion goals that he says will be revealed in due time.

In his leisure time, Brackett enjoys time with his family, which includes two sons, ages 9 and 11. He is a dedicated endurance runner who runs five miles every other day and five to 10 miles on weekends.

Healthcare Leader: Cameron Brackett, continued from page 1

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BY VALERIE ARNOLD, MD, FAPA, ACPSYCH

I am often asked, “Why should a physician refer patients to psychiatric clinical trials?” Simply put, we need more treatment alternatives for people with mental illness. Clinical trials allow for the evaluation and development of medications that can be more clinically efficacious with less side effects. I have had the pleasure of being part of the CNS Healthcare Memphis founding team, leading over 300 clinical research trials that brought some of today’s most prescribed and effective medicines to market including Abilify, Cymbalta, and Vyvanse. Still, more medications are needed to reduce the significant morbidity and mortality of mental disorders.

So when should you refer? When your treatment regimen is not going as planned, it is an excellent time to refer, as the problem may be because of comorbid psychiatric problems that warrant an innovative approach. Along the same lines, patients who have failed a trail of traditional psychotropics may also be good candidates for a psychiatric clinical trial.

It is not uncommon to have concerns about the risks associated with clinical research, but learning more about the CNS clinical trial process may help alleviate some of these concerns. As with all medications, clinical trials have risks and benefits. These are always explained to the patient. They are informed that not all patients will get better because some trials are placebo controlled and everyone responds differently to medications, that participation is voluntary, and that they can stop at any time. In research, we are held to the highest standards of safety and oversight to ensure patient safety. Some patients will not be able to enroll in a trial because they are not medically stable or the study drug is not safe due to an underlying condition. At times, a patient may have to discontinue some of their current medications to be included in a trial. This may be as simple as stopping aspirin or could potentially be more complex. Ultimately, you and your patient can work together to decide whether the clinical trial is right for them.

Typically, after the patient’s consent, we conduct diagnostic interviews, multiple labs, EKGs, and rating scales which are available to you with the patient’s signed release. Research trials are not intended to replace your current care or take patients from your practice, but rather offer us a chance to better understand and treat mental illnesses that will benefit our community in the future. Patients completing our trials are always offered free courtesy follow-up until they are connected back into the community and their PCP, and there is a waitlist option for those who may not qualify for a current trial. We are pleased to be able to offer opportunities for possible treatment with no cost to the patient and many times compensation for time and travel because we are supported to conduct trials.

Clinical trials represent an opportunity for increased access to healthcare and medications especially important today as Memphis continues to face economic challenges. For patients in the Memphis area with mental health issues who may not have responded to previous treatment, have financial limitations, or have difficulty accessing mental health providers, CNS Healthcare is here to offer the opportunity to learn and heal while at the same time paying it forward and helping others.

Valerie Arnold, MD, FAPA, ACPsych is board-certified in general adult psychiatry and child/adolescent psychiatry and a member of the CNS Healthcare Memphis founding team. She is a past President of the Memphis Medical Society.

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Assembly, was promoted by physicians to legislators during Day on the Hill as well. The legislation was filed, heard and passed in numerous committees in 2014. Bill sponsors felt continued discussions were warranted and TMA staff and members spent the last half of 2014 meeting with insurers to try to reach a compromise. The bill requires the insurers contracting with physicians honor their financial commit-ments to those physicians for at least one year, allowing one fee schedule change.

The TMA’s position on the issue behind the bill is that the constant rule-changing has made it impossible for phy-sician practices to run a sound business model.

“All providers have the right to be paid what they were promised when con-tracts were signed,” said Julie Griffin, di-rector of government affairs, TMA.

The TMA’s position is that staffing and other financial decisions are based on the fee schedule and changes not only af-fect the way they do business but also af-fect patients.

“If that is changed 10 times, then it interrupts our business and can sometimes end our contracts prematurely, making patients sit out,” said Anderson.

Another priority, according to An-derson, was the introduction of a bill for Physician-Led, Team-based Care. The bill is a response to an opposing bill by the Tennessee Nursing Association (TNA) to change the scope of practice such that ad-vanced practice nurses (APNs) could prac-tice without physician supervision. He said there is strong research to support that pa-tients like seeing nurse practitioners, but they want a physician available to head their care.

“We work very closely with mid-level practitioners and we feel they need to be part of a team with a physician at the head of it. In our bill, instead of calling it ‘su-pervisory,’ we are calling it physician-led,”

he said. One of the arguments for more inde-

pendent nurse practitioners has been ac-cess to physicians. Anderson does not see this as a problem in Tennessee.

“In Idaho, where you might not have a physician within 400 miles, there is a problem,” he said. “In Tennessee, we need more primary care docs like ev-erywhere else, and doctors are there and overworked, but they are there.”

A petition with approximately 200 supporters says the opposite. The petition asks Senator Ken Yager and State Rep-resentative Dennis Powers to vote yes on HB456 and SB680 to allow full practice authority for nurse practitioners and no to HB861/SB521, which is the Physician-Led Team Based Care Act. Elizabeth Chadwell of Sharps Chapel, Tennessee, signed and said “I’m an NP and believe it’s time for change. Patients deserve bet-ter access to care and this change will help assure such access.”

Another nurse practitioner, Lucille Vara, of Knoxville, asserted that “Re-search shows patient outcomes under NPs are as good as, even better than under physicians.”

Wendy Owen, from Murfreesboro, claimed her APN saved her life on more than one occasion, as she is uninsured and was sent home from the hospital.

Some Answers, continued from page 1

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connector and meeting ground so hospitals can provide shared services, which in turn provides better health. We will be able to provide shared efficiencies with this space and become better connected to the people we serve. ”

Methodist Le Bonheur Healthcare plans to relocate some of its non-clinical administration functions to Crosstown Concourse, but the locations haven’t been determined, Rosenbaum said.

Olive Branch will be a key area for medical expansion in the Mid-South for the next few years due to vast residential growth, according to Parrish Taylor, vice president of retail services for CB Richard Ellis, LLC.

Methodist Healthcare opened Meth-odist Desoto Hospital, a five-story, 100-bed building, in 2013. The area is underserved in medical development, according to Tru-itt.

“There isn’t as much mature growth in Olive Branch,” he said. “There is lots of surrounding land for development such as medical office buildings.”

There is also an emerging need for ur-gent care facilities in the area, according to Taylor.

“Compared to the rest of the coun-try, the Memphis area is underserved in the availability of urgent care facilities,” he said. “I see this area of the medical mar-ket expanding as residential growth occurs and as long as there is growth in the local economy and in the retail segment.”

Eastern Desoto County is a key sub-market where there has been fast residen-tial growth and medical has struggled to keep up, he said.

“It will, though. You will see more of these medical retail operations opening up in the next year,” Taylor said. “These ur-gent care facilities are convenient, cheaper, easily accessible and they are quick to get in and out of.”

This ties in with the trend that smaller medical projects may be on the rise.

“We will see continued growth in the Mid-South, just not on as grand of a scale, but the projects will not be any less signifi-cant,” Truitt said.

Healthcare Real Estate, continued from page 7


BY CINDY SANDERS

Hillary Clinton famously said, “It takes a village.”

For behavioral health providers, that concept – played out in communities all across Tennessee – has proven to be true. By taking an integrated, collaborative ap-proach between mental health clinicians, primary care physicians, and an array of social service providers, some of the most vulnerable Tennesseans are finding not only their voice but their sea legs, as well.

Leading the charge on a statewide level is the Tennessee Department of Mental Health and Substance Abuse Services (TD-MHSAS) and the Tennessee Association of Mental Health Organizations (TAMHO), but community-based mental health pro-viders from Johnson City to Jackson are on the healthcare delivery front lines.

One of the nation’s largest not-for-profit providers of community-based be-havioral health is Centerstone. Offering a range of mental health services, substance abuse treatment and intellectual and de-velopmental disability services in Ten-nessee, Illinois, Indiana and Kentucky, Centerstone cared for nearly 84,000 indi-viduals and families last year. Ben Middle-ton, COO for Centerstone Tennessee, said he remembers the not-too-distant past

when care was delivered in a much differ-ent manner in this state. Middleton noted that into the late 1980s and early 1990s, there was a heavy reliance on institutionalization in state hospitals and private residential facilities.

One example of how that is changing is a specialized program and training for foster parents. Centerstone handles fos-ter parent training across the state. In addition, the organization’s integrated therapeutic foster care program serves youth in more than 50 counties. “With the Foster Care Parenting Program, we have children who come to us through a DCS contract,” Middleton explained, adding the youth … mostly teens … typi-cally have needs that require a coordinated effort between community mental health providers, social services, DCS and the fos-ter parents.

“The intent is to provide a homelike environment,” Middleton said. “They don’t need to be in a facility where they are locked in.”

Yet, that’s what used to happen. “We used to be one of the top five states for hos-pitalization rates. Our hospital rates for children have gone down significantly,”

Middleton said. “Historically for the state of Tennessee, if this kind of service wasn’t in place, there’s no doubt in my mind that we’d be going back in time.”

Instead, Tennessee has flipped the script when it comes to reaching those in need of mental health services. “Prior to these community-based services, you had to go to the provider. It was always tied to you having to come to a facility, be assessed and go from there,” Middleton explained. Now, he continued, ‘community-based’ means providers come to those who need help in their own communities. “It is seeing people where they live, and it has opened the eyes of our clinicians to see that all the things we’re asking people to do may not be possible until we change their living en-vironment.”

Middleton described it as a more ho-listic, integrated approach where the client receives services – therapy, of course, but also the other social services necessary for success from food to clothing to transporta-tion.

Tom Doub, PhD, CEO of Center-stone Research Institute (CRI) said his af-filiated organization works hand-in-hand with Middleton. “Ben is responsible for programming. CRI writes grants,” Doub said of the funding mechanism to be able to put boots on the ground. In the last half

of 2014, CRI secured $19.8 million in grants and contracts from state and federal organizations to launch and expand com-munity-based behavioral health programs throughout Tennessee.

Two grants Doub is particularly ex-cited about focus on suicide prevention as a partnership between TDMHSAS, the Ten-nessee Suicide Prevention Network and Centerstone. “On a statewide basis, we’re educating a whole range of people who work with at-risk children,” Doub said. “People don’t know how to have conversa-tions about suicide, but those conversations are incredibly important,” he said.

The grant allows Centerstone to help police, teachers, healthcare providers, fos-ter parents, those working in the juvenile justice system and others working closely with Tennessee youth know how to respond when comments about suicidal thoughts or depression arise. “It equips them to have conversations with kids to understand what the risks really are and when to intervene,” Doub noted.

And, he added, the need is critical. Tennessee suicide rate is higher than the national average and now approaches the number of accidental deaths by motor ve-hicle each year.

Another grant specifically targets vet-

Integrating for Improved Outcomes Community-Based Solutions Answer Some of Tennessee’s Toughest Behavioral Health Challenges

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BY CINDY SANDERS

With three states plus the District of Columbia sanctioning recreational use of marijuana and virtually all other states ei-ther allowing for or considering decrimi-nalization and/or medical use of the drug, the great marijuana debate has become a legislative hot topic over the last three years. For Stuart Gitlow, MD, MPH, DFAPA, however, talk of medical benefits associated with inhaling the plant is just smoke and mirrors.

Gitlow, who con-cludes his term as presi-dent of the American Society of Addiction Medicine this month, said there are two major issues with the drug … addiction and toxicity. The double board-certified psychiatrist, who has a private practice in Rhode Island, is concerned by the possi-bility of adding marijuana to the mix of alcohol and tobacco as yet another sub-stance with the potential to do more harm than good.

The DrugMarijuana refers to the dried leaves,

flowers, stems and seeds from the hemp plant Cannabis sativa, which contains

the mind-altering chemical delta-9-tet-rahydrocannabinol (THC), along with other compounds. The National Institute on Drug Abuse (NIDA) has found mari-juana to be the most common illicit drug in America and one for which usage is on the rise. The national organization stated marijuana’s popularity, particularly since 2007, has coincided with a diminishing public perception of the drug’s risks.

However, at the same time risk per-ception has been declining, the drug’s potency has actually been on the rise. In looking at the amount of THC in mari-juana samples confiscated by the police, the THC concentration averaged close to 15 percent in 2012 as compared to around 4 percent in the 1980s, according to the NIDA fact sheet on marijuana.

Gitlow agreed, saying, “The mari-juana that is available today is much different, much more potent, than the marijuana that was available in the ‘60s. More research needs to be done to see if there are even more long-term issues with this more potent form.”

AddictionGitlow noted marijuana works like

any other addictive drug. “There’s not debate at all within the medical commu-nity that it’s addictive … that’s a given,” he said. “It’s like any other psychoactive

drug … it’s not addictive to the majority of those using it once or twice.” However, he continued, “There’s no way of knowing if a person is going to have a problem with the drug until they try it … and then they are playing Russian roulette.”

Gitlow explained, “Addictive disease is not about the drug, it’s about a brain ab-normality. It exists before somebody picks up the drug.” The three factors required for addiction, he said, are a genetic ab-normality, environmental trigger and the drug. “Addictive disease is in only, give or take, 15 percent of the population.”

He added popular consensus is that about 9 percent of adults and 17 percent of adolescents who use marijuana become addicted. In addition, NIDA’s marijuana fact sheet noted addiction rates jump in daily users, with as many as 25-50 percent becoming addicted.

Toxicity“There’s a second issue with mari-

juana, and it’s independent of addiction. Marijuana has toxic ramifications,” Git-low said. “Marijuana makes you stupid,” he stated bluntly. “It lowers IQ. It causes slowing of the processing speed. It causes abnormalities of attention and focus. It ba-sically dumbs you down, and it does that more or less universally.”

When marijuana is smoked, the

THC passes quickly from the lungs into the bloodstream and to the brain. THC targets cannabinoid receptors, which have a higher density in areas of the brain that influence pleasure, memory, concentra-tion, coordination, thinking and time per-ception. Additionally, THC’s chemical makeup is similar to a naturally occurring brain chemical called anandamide. That similar structure lets THC be ‘recognized’ by the brain, allowing the outside com-pound to alter normal brain communica-tion.

Of major concern is the affect mari-juana has on brain development when used heavily among adolescents. A recent study showed marijuana users who began in adolescence had fewer connections in the areas of the brain that control memory and learning. A large, long-term New Zea-land study found those who began heavily smoking marijuana in their teens lost an average of eight IQ points between ages 13 and 38. However, that impact on IQ wasn’t replicated in the study among those who didn’t begin smoking until adulthood.

NIDA also cited issues with cardiopul-monary and mental health. Gitlow said, “There’s a five-fold increase in psychotic disorders among those who use marijuana as compared to those who don’t.”

Dr. Stuart Gitlow


Marijuana, Medicine & AddictionA conversation with ASAM President Dr. Stuart Gitlow


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Alcohol vs. Tobacco, Marijuana

Last month, results of a new study stating marijuana is 114 times less lethal than alcohol made the media rounds and became fodder for late night comics. Git-low said comparing the two is like com-paring apples and oranges. “They affect different parts of the brain,” he said.

Gitlow also noted it is possible to in-gest enough alcohol in one sitting to kill you, which isn’t really true of marijuana or tobacco. “So I could make the argu-ment that cigarettes are safer than alco-hol,” he said. However, there aren’t many

physicians recommending a patient give up the occasional glass of wine and take up smoking tobacco instead.

“We’re not prohibitionists,” Gitlow continued. “No one at the American So-ciety of Addiction Medicine says alcohol should be banned, but all these drugs col-lectively are an enormous burden on the American public from an economic and health-related standpoint.”

Considering the dangers of tobacco and alcohol, Gitlow said he couldn’t fathom why, as a country, we would want to add marijuana to the mix. “Why would we want to make our burden worse?” he

questioned.

Possible BenefitsGitlow reiterated his frustration at

claims of marijuana being a medical mar-vel. “There is no medical purpose. No one has ever proven through a double-blinded trial a medical benefit of marijuana.” He continued, “That’s not to say there aren’t components within the plant that might not have medical application.”

However, Gitlow said breaking down the more than 100 components in mari-juana would require scientific investiga-tion just like any other drug in this country

seeking approval from the Food and Drug Administration. He added marijuana lob-byists bringing anecdotal evidence to legis-lators interested in the bottom line doesn’t constitute a thorough research endeavor.

NIDA’s viewpoint is similar, noting that so far clinical evidence does not show the therapeutic benefits of marijuana out-weigh the health risk. In it’s assessment of the drug, the national organization stated, “To be considered a legitimate medicine by the FDA, a substance must have well-defined and measurable ingredients that are consistent from one unit (such as a pill or injection) to the next. As the marijuana plant contains hundreds of chemical com-pounds that may have different effects and that vary from plant to plant, and because the plant is typically ingested via smoking, its use as a medicine is difficult to evaluate.

“However, THC-based drugs to treat pain and nausea are already FDA approved and prescribed, and scientists continue to investigate the medicinal properties of other chemicals found in the cannabis plant – such as cannabidiol, a non-psychoactive cannabinoid compound that is being studied for its effects at treat-ing pain, pediatric epilepsy, and other dis-orders.”

With the increased attention being given to marijuana around the country, it’s a safe assumption that opponents and proponents will continue the debate.

Marijuana, Medicine & Addiction, continued from page 12

vital for this area to have centers where quality care is available and affordable,” Roberson said. “We continue to expand and serve where we’re needed, but that means that there are growing numbers of the poor and underserved who need our services.”

CCHS logged more than 173,000 vis-its last year by nearly 60,000 patients, and the organization is looking to expand with a new clinic in Raleigh. Also in the works are plans for adding behavioral health ser-vices and expanding dental programs.

“The impact of dental health on overall health is profound, and we’ll be working to develop more resources in this area,” Roberson said. “We also want to increase our activities and our presence in the communities we serve and partner with other organizations and people to be able to treat more patients.”

Looking ahead, Roberson said CCHS will remain committed to its mission of providing care to the needy. And he hopes one day that those in government will sup-port that mission.

“There is a great need for our services and for centers like ours in this area and across the state, which is why it’s so det-rimental that so many of our legislators voted against Gov. Haslam’s health plan that would have helped so many,” Rober-son said. “So for now the struggle remains, and the underserved remain underserved. For us, they remain our primary focus, and caring for them is the reason we exist.”

New Group, continued from page 6


BY JULIE PARKER

UnitedHealth Group, the nation’s biggest player in the health insurance market, recently announced a policy change to narrow the rules on hysterec-tomy coverage.

Even though the insurer’s plan to impose tighter restrictions on the use of the morcellator has garnered the most attention – many hospitals ceased using the laparoscopic surgical device after the FDA reported in April 2014 the fast-spinning blade can actually spread uter-ine sarcoma in some women undergoing hysterectomies – the squeeze is also being felt on the performance of hysterectomies in general.

UnitedHealth (NYSE: UNH), the insurer of 40 million patients based in Minneapolis, Minn., now requires spe-cific authorization before most types of hysterectomies are performed. Only vaginal hysterectomies – the least inva-sive and inexpensive option – done on an outpatient basis are exempt. The policy doesn’t affect hysterectomies performed in cancer treatment. Approximately half a million hysterectomies are performed annually in the United States.

Before UnitedHealth announced its policy decision, Anthem was the only major commercial insurer requiring pre-authorization for hysterectomies. Cigna and Aetna haven’t indicated they will fol-low suit. An Aetna spokesperson said the decision is “best left up to the physician and patient based on clinical circum-stances,” a position also adopted by the American College of Obstetricians and Gynecologists (ACOG).

Days after UnitedHealth’s an-nouncement, ACOG members buzzed about the issue at an ACOG national leadership conference.

“It’s been good fodder for discussion, though we’re taking it very seriously,” said Ravi Johar, MD, an OB/GYN from St. Louis, Mo., past president of the St. Louis Metropolitan Medical Society. “For Unit-edHealth to reverse course, no one knows exactly what it means.”

Johar, council chair of the Missouri State Medical Association, said OB/GYNs are certainly accustomed to the pre-certifi-cation process.

“We’ll do what we’ve always done,” he said. “We’ll discuss with patients all of the options and go from there. The decision is between the patient and physician. My job is to provide the best medical care possible. How that affects them financially is a big impact, but it’s not my area of expertise.”

UnitedHealth is a good weathervane in the post Affordable Care Act era, with its combination of market power, community support, and access to exceptional data, said Jay Wolfson, DrPH, JD, Distinguished Professor of Public Health, Medicine and

Pharmacy at the University of South Flor-ida (USF) Morsani College of Medicine.

“In this case in particular, it’s impor-tant to recognize that UnitedHealth, over the past couple of years, has been the most aggressive of the health insurers in tighten-ing up their markets,” he said. “They began eliminating a lot of physicians and hospitals from their panels in many communities.”

For example, said Wolfson, cancer and children’s hospitals were removed from UnitedHealth’s list of risk providers, based on the argument of cost being signifi-cantly higher at those healthcare facilities than others.

“Procedures in hospitals like MD An-derson, Sloan Kettering and Moffitt may cost 50 percent more than non-specialty,

community facilities,” he said. “That’s to be expected because they’re teaching hos-pitals.”

Wolfson also pointed out that United-Health acquired Optum, a healthcare tech-nology firm established in 2010, which he considers one of the “best staffed analytic

What Does UnitedHealth’s Latest Move on Hysterectomies Mean?Nation’s largest health insurer stiffens rules on hysterectomy coverage



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division of third parties.”“Optum focuses on quality, outcome

and cost-effective analyses of United’s (and other available) databases” said Wolfson. “Their research translates into what, to whom and how much United will pay.”

That influence has infiltrated the healthcare industry in many ways. In Janu-ary 2013, while outsourcing work with Optum before bringing the fi rm in-house, UnitedHealth Group’s Center for Health Reform and Modernization proposed the use of predictive modeling software, par-

ticularly in Medicare and Medicaid pro-grams, as tools for care management and information security as a possible solution to both healthcare fraud and preventable hospitalizations.

“As part of the ACA, they’ll continue to drill down and drive down costs and utili-zation and attempt to be as directive as they can to their patients, physicians, hospitals … to optimize cost, utilization and safety while also reducing liability,” said Wolfson.

Some hospital systems are adopting a tough stance against UnitedHealth’s cull-ing process and policy changes they view as unfavorable.

“Three years ago, BayCare (Health System, Tampa Bay’s dominant non-profi t hospital chain), went up against United-Health over reimbursement issues,” noted Wolfson. “Unlike most standoffs, there was no last minute negotiation and 450,000 members in Tampa Bay had to change hospitals and physicians because BayCare stood its ground against this healthcare de-livery powerhouse.”

Wolfson also sees a trend of separate policy issues, in part led by UnitedHealth, that are shaking up the medical device manufacturing industry and the pharma-ceutical sector.

“Until recently, pharmaceutical com-panies have had a tremendous infl uence in medical schools and communities concern-

ing what medications physicians prescribe,” he said. “Now some medical schools across the country like ours have gone ‘drug-free’ and no longer allow pharmaceutical reps to teach in our classrooms or offer ‘educa-tional’ program lunches.”

The same cycle holds true for manu-facturers of medical devices, Wolfson said.

“The device manufacturing industry has also heavily affected medical practice,” he said. “Their signifi cant infl uence is wan-ing.”

In response to UnitedHealth’s policy change on hysterectomies, medical schools will place a stronger emphasis on technical skills to perform vaginal hysterectomies.

“We’ve developed a generation of sur-geons who don’t know how to do vaginal surgery, quite frankly,” said Neil Finkler, MD, an OB/GYN in Orlando and CMO at Florida Hospital Orlando.

“So many physicians stopped using vaginal hysterectomies and it’s not being taught very much,” Wolfson added. “Our younger medical students don’t have the skills. It’s easier to use a device, which gen-erates more revenue and becomes a stan-dard. Most clinicians interviewed say it’s safer, less complications, but it’s not done because it’s just not being done. That’ll change.”

What Does UnitedHealth’s Move Mean, continued from page 15

erans. “In Tennessee – the Volunteer State – we have a large veteran population,” Doub said. Middleton added Supportive Services for Veterans and Their Families (SSVF) is a three-year grant from Veteran’s Affairs to target vets who are homeless or at risk of being homeless.

Middleton noted that again, the focus is on integrated community-based services whether that means hiring an attorney to help with legal needs or providing addic-tion therapy services. “The grant allows us to make sure they have access to the basic things of life – a place to live, food to eat, and transportation. It makes sure they have all their behavioral, physical and social needs met,” he explained.

Technology, Doub added, plays a criti-cal role in meeting needs and curbing ex-penses. He said typically a small number of people have the most expensive healthcare is-sues. “Probably about two-thirds of that pop-ulation with high healthcare costs also have a mental health or substance abuse problem.”

Doub continued, “One of the things we’ve been working on is a new strategy on healthcare delivery – coactionHealth.”

The new initiative integrates mobile technology and data analytics as CRI, Ginger.io and Verizon have partnered to solve the ‘super-utilizer challenge.’ Doub said the program, which is being piloted in both Tennessee and Indiana, looks at “how we can begin to use mobile technol-ogy in smart ways so you can access your healthcare provider as easily as you can FaceTime your mother in California.”

He added that for someone having a panic attack on Friday night, getting in touch with a provider over the weekend has been problematic. On the other hand, he pointed out, “9-1-1 is a very easy way

to access care. The question is how can we become, as this community-based sys-tem, more convenient than 911? How do we become more accessible than pressing three digits?” he asked. Doub noted the early data from the project has been very promising. “It appears we’re going to cut hospitalizations and emergency room visits by approximately 50 percent.”

Centerstone is also looking at a num-ber of other innovative ways to incorporate technology into behavioral healthcare. Doub said perhaps it’s alerts from a smart-phone when the user signifi cantly deviates from their normal pattern of activity, such as remaining in bed for days … or maybe it’s a game that incorporates positive psy-chology. “By the time a child graduates from high school or at 18, they will spend over 10,000 hours on a screen or mobile device. That is a tremendous risk and op-portunity,” Doub said.

Although Centerstone isn’t going into the game development business, the orga-nization is helping to host some national gaming competitions to encourage devel-opers to build games for good. Doub said the response has been really positive from the game development community.

“We’ve been very involved in this in-tersection of technology and healthcare,” Doub said. Middleton added, “We’re able to interface without being face-to-face. The rest of the world is ahead of us outside healthcare in terms of technology because that’s how you do business.”

Having the additional funding pro-vided by grants, Middleton continued, helps close that gap between healthcare and other service industries by allowing Centerstone to launch innovative initiatives that wouldn’t otherwise be possible.

Integrating, continued from page 11

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GrandRounds

St. Jude Administrative Director Achieves Certification

Sanford Mann, administrative di-rector of the Division of Anesthesiol-ogy at St. Jude Children’s Research Hospital, has earned the professional designation of Certified Medical Practice Execu-tive (CMPE) by the Amer-ican College of Medi-cal Practice Executives, the certification entity of the Medical Group Management Association.

The designation of CMPE demon-strates that Mann has achieved board certification in medical practice man-agement.

Mann, who is a native of Long Beach, New York, has worked at St. Jude since 2008.

Sanford Mann

Wooddale Art Students’ Work Graces Delta Walls

Art students from Wooddale High School spent their spring break paint-ing a mural on a prominent wall at Del-ta Medical Center. The theme is “All About Memphis” and the wall just out-side the hospital cafeteria now depicts some of the city’s most notable scenes and people, including Elvis Presley,Isaac Hayes, AutoZone Park and Stax.

The Mural can be viewed at Delta Medical Center at 3000 Getwell Road.

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UTHSC Associate Professor Receives $26,818 Grant for Blood Transfusion Research

Mohamad Elabiad, MD, associate professor in the Department of Pedi-atrics at the University of Tennessee Health Science Center (UTHSC), has received a $26,818 grant from The Ger-ber Foundation to investigate whether extremely premature infants can safely handle the amounts of lead and mercu-ry acquired through blood transfusions. The award will support a project titled, “Pharmacokinetics of Lead, Mercury and Cadmium in Extremely Low Birth Weight Infants After Co-Transfusion with Packed Red Blood Cells.”

If successful, the research will show that blood transfusions are potentially a significant source of heavy metals in this vulnerable population. It is expected that this will lead to new regulations on how blood transfusions are evaluated and cleared, similar to the way donor blood is tested for infectious diseases.

The project began seven years ago with a theoretical study that looked at how much lead and mercury a prema-ture infant would receive when given blood from the average adult in the United States according to Elabiad. Each phase of the investigation raised enough concern for possible heavy metal toxicity for the premature infant for further research. The current investi-gation will look at proof of direct toxic-ity from these metals.


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GrandRounds

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Campbell Foundation Elects John C. Weinlein a New Trustee

The Campbell Foundation has elected John C. Weinlein, MD as a new member of its board of trustees.

Weinlein joined the Campbell Clin-ic staff as a orthopedic trauma surgeon in 2010. He completed his residency in Orthopedic Surgery from the Campbell Foundation in 2009, and an Orthopedic Trauma Fellowship at Hennepin County Medical Center in Minneapolis in 2010. Weinlein is conducting research in the field and has published several journal articles. He serves as a clinical instructor of orthopedic surgery in the University of Tennessee, Campbell Clinic Depart-ment of Orthopaedic Surgery & Bio-medical Engineering.

UTHSC Director of Endocrinology Named President Of Medicine & Science by Diabetes Association

As the 2015 president, Medicine & Science for the American Diabetes As-sociation (ADA), Samuel Dagogo-Jack, MD, director of the Division of Endocri-nology at the University of Tennessee Health Science Center (UTHSC), hopes to “shine a light on” the organization’s work in diabetes research and educa-tion around the world.

Dagogo-Jack is now the co-princi-pal spokesperson for the organization, along with the president, Health Care & Education, on matters of science, care and education concerning the disease, which currently affects more than 370 million.

During his one-year term, Dr. Da-gogo-Jack will also serve as a member of the board of directors of the ADA.

Saint Francis Honored by American Heart Association

Saint Francis Hospital has been named a Gold Fit-Friendly Worksite by the American Heart Association (AHA) for “demonstrating a strong commit-ment to providing a healthy workplace for employees.”

According to the AHA, Saint Fran-cis is in an elite group of awardees for this important initiative.

Saint Francis has put into play a number of healthy initiatives, including healthy menu options in the cafeteria, healthy choices vending machines, dis-counted membership at its on-campus YMCA, and the Healthy at Tenet pro-gram offered by Tenet Healthcare, the hospital’s corporate parent.

The AHA Gold Fit-Friendly Work-place recognition is valid for one year. Worksites must reapply annually.


Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

GrandRoundsMethodist Healthcare Foundation Receives $25,000 GrantTo Support Patients Living with Metastatic Breast Cancer

Methodist Healthcare Foundation has been chosen as one of 23 grant re-cipients for the Avon-Pfizer Metastatic Breast Cancer Grants Program: Identify-Amplify-Unify. The funds will be used by the West Cancer Center to develop and implement a program for women with metastatic breast cancer.

“The Avon Grant is going to allow us to reach patients who do not always receive all the information they need regarding what the diagnosis of meta-static breast cancer may mean for them. Women are given all of the scientific information, but sometimes they don’t receive information about what this might mean for them and their family,” said Kurt Tauer, M.D., chief of staff at the West Cancer Center.

The Avon-Pfizer Metastatic Breast Cancer Grants Program: Identify-Ampli-fy-Unify, run by Pfizer Inc. and the Avon Foundation for Women, granted a total of $1 million to 23 organizations nation-wide to support and educate more than 5,000 metastatic breast cancer patients, their caregivers, and their communities

Memphis Jewish Home Receives Highest Rating

Memphis Jewish Home & Rehab has received the highest rating from US News & World Report in the magazine’s seventh annual Best Nursing Homes survey.

An overall rating of five stars was awarded.

Created by the publisher of Best Hospitals and Best Children’s Hospitals, the Best Nursing Homes 2015 ratings highlight the top nursing homes in each city and state, out of nearly 16,000 fa-cilities nationwide. The goal is to help users find a home with a strong track re-cord of quality care.

To create Best Nursing Homes 2015, the magazine drew on data from Nursing Home Compare, a program run by the Centers for Medicare & Medic-aid Services, the federal agency that sets and enforces standards for nursing homes.

UTHSC Team from Department of Genetics, Genomics And Informatics Join Global ENIGMA Consortium Effort

Researchers from the University of Tennessee Health Science Center (UTHSC) are part of a global consortium of 190 institutions working to identify eight common genetic mutations that appear to age the brain an average of three years. The discovery could lead to targeted therapies and interventions for Alzheimer’s disease, autism and other neurological conditions.

It is believed to be the largest col-laborative study of the brain to date,

An international team of roughly 300 scientists known as the Enhancing Neuro Imaging Genetics through Meta Analysis (ENIGMA) Network pooled brain scans and genetic data worldwide to pinpoint genes that enhance or break down key brain regions in people from 33 countries.

“This is a great example of how in-ternational collaboration can jumpstart high impact science and genetics. We needed a pool of 30,000 willing subjects and their DNA to drill down to these five new genes,” said Robert W. Williams, PhD, a co-investigator of ENIGMA.

The study could help identify peo-ple who would most benefit from new drugs designed to save brain cells, but more research is necessary to deter-mine if the genetic mutations are impli-cated in disease.

Le Bonheur Organization Wins National Organization’s Support For Asthma-Related Projects Benefiting Low-Income Children

Le Bonheur Community Health and Well-Being, the community-based pro-grams nonprofit branch of Le Bonheur Children’s Hospital, is one of five orga-nizations to be selected by a Washing-ton DC-based national organization to receive support for projects benefitting low-income, asthmatic children.

Green & Healthy Homes Initiative (GHHI), a nonprofit dedicated to break-ing the link between unhealthy housing and unhealthy families, has selected five service recipients to receive support to explore promising Pay for Success (PFS) projects benefitting low-income, asth-matic children.

These funds will provide capac-ity building assistance to advance and evaluate new models of funding home-based interventions that produce mea-surable outcomes such as, reducing asthma-related hospitalizations, emer-gency department visits and missed school days. This program will be based on the asthma-focused PFS project that is being explored in Baltimore, Mary-land, by a partnership among GHHI, Calvert Foundation and Johns Hopkins Hospital and Healthcare System.

Additional partners in Le Bonheur’s effort include Le Bonheur’s CHAMP (Changing High-Risk Asthma in Mem-phis through Partnership) and Memphis CHiLD, a newly established medical legal partnership. Realizing the con-nection between substandard housing and the health of children, in 2013 Le Bonheur helped convene and co-found a multi-agency coalition called the Healthy Homes Partnership.

Carma C. Jude, CCIM901.747.0300

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memphis medical news april 2015

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