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FOCUS TOPICS PUBLIC HEALTH HEALTH LAW OPHTHALMOLOGY

BY JUDY OTTO

James Downing will never be in the pre-dicament faced by Alexander the Great, who is said to have wept because there were no more worlds to conquer. That’s because for Downing, owner of a tireless work ethic, in the world of hematopathological research you’re never “done.”

Despite the impressive record of honors

and achievements he has earned since joining St. Jude in 1986, Downing remains perpetu-ally excited by the prospect of what remains ahead, unknown and unachieved.

Thus far, his career at St. Jude has been capped by the launch of the Pediatric Cancer Genome Project (PCGP), one of TIME magazine’s top 10 medical breakthroughs for 2012, and his appointment

(CONTINUED ON PAGE 8)

HealthcareLeader

James Downing, MDPresident and CEO, St. Jude Children’s Research Hospital

Jerre M. Freeman, MD

PAGE 3

PHYSICIAN SPOTLIGHT At Five-Year Mark, ACA

Remains a ‘Mixed Bag’Fallout from 2010 law continues for doctors, hospitals, insurers

BY LINDSAY JONES

A patient experiences a medical emer-gency and is admitted to the local hospital. One of the fi rst questions he’s asked, be-sides his name and date of birth is . . . are you insured? If so, what is your health insurance plan and policy number?

So begins the time- and money-intensive dance between illness, treating that illness and paying for the privilege of treatment. It’s the bedrock of the American healthcare system – and con-tinues to be despite reforms introduced by the Affordable Care Act of 2010.

“I think what we’re seeing is it’s a period of adjustment for everyone,” said Craig Becker, president of the Tennessee Hospital Association.

From a physician’s perspective, the situation has only grown murkier, and more costly, with time as “wave after wave of regulations come down,” Becker said. This is especially true as re-quirements continue multiplying the costs associated with patient

care and the positive outcomes demanded by the law, many observers indicate.

“Some of the regulations are crazy,” Becker said, “but some are worthwhile.”

At the heart of the issue are insurance companies, which Becker acknowledged continue to be a dominant player in healthcare delivery: how long a patient is treated, what services can (and can-not) be rendered and what is (or is not) considered acceptable along the care continuum.

During a recent budget hearing, Julie Mix McPeak, commissioner of the

Tennessee Department of Commerce and Insurance, had this to say: “The Affordable

Care Act has had a profound impact, and contin-ues to impact, insurance providers in the state of Ten-

nessee. The 2010 statute has established parameters that control providers’ operations, from the underwriting process right on through the benefi t packages offered to consumers.”


The Man Behind UTHSC’s RenovationKennard Brown overseeing current $250 million project

By the time Kennard Brown was fi nishing his second year at Illinois State University in the mid-1970s, he realized college was just not for him ... 5

Memphis Physician Foresees Year of Challenges in Healthcare

Because the year 2015 promises to be one fi lled with important healthcare challenges, Memphis Medical News took the opportunity to talk with Keith Anderson, MD ... 6

[email protected]

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Jerre M. Freeman, MDMemphis native looks back on a long, distinguished career in ophthalmology

PhysicianSpotlight

BY RON COBB

Without trying to be clever, one might easily say that Memphis ophthalmologist Jerre M. Freeman is a man of vision. How else might you describe a doctor who is the founding chairman of the World Cataract Foundation, who was a founder of this city’s MECA Eye & Laser Center, who holds more than 20 patents for lens implants and surgical instruments, and who designed the Punctum Plug, a surgical device that helps correct dry eyes?

The former Navy pilot, who by the way also served as president of the Mem-phis Medical Society and of the American Board of Eye Surgery, is in the twilight of his career after 46 years in private practice. He performed 14 cataract and intraocular lens surgeries in the early part of the month last January before suffering two heart at-tacks, and he hasn’t operated since. But he isn’t ready to answer the rocking chair’s call. He plans to hold onto his medical li-cense and says his future may include some teaching of surgery.

“I’m interested in alternative medi-cine,” he said, “and have been involved recently in acquiring and helping package and ship an immune booster to a hospital in Sierra Leone to hopefully offer some protection from the Ebola virus.”

A desire to help other people has been a driving force from the time Freeman, at an early age, first began to think of a career in medicine.

“For some reason I was always inter-ested in medicine,” he said. “When TIME magazine would come in the mail at home, I would read the medical section first.”

He was born at Baptist Hospital and grew up in Whitehaven. In high school, he worked at his father’s grocery store on Madison Avenue.

“I even cut one of my fingers work-ing in the produce section,” he said, “but thanks to a good surgeon, my finger was sewn up well enough for me to later be-come a surgeon.”

An uncle was chair of the biology de-partment at Memphis Normal College, which became the University of Memphis. A brother-in-law was a physician. Medical careers have run in the family.

“In our immediate family of eight, there are five physicians and two Presby-terian ministers,” he said. “Also, two of my nephews and a niece have become physi-cians.”

Freeman attended Auburn University on a Navy scholarship, and it was during a 3½-year stint as a Navy pilot that he began working toward a medical degree at the University of Rhode Island, where his wife of 58 years, Anne, was a graduate student.

At the same time, the Navy helped him pursue his love of aviation.

“I opted for helicopters because I would rather have been involved in trans-

portation and rescue than in dropping bombs or fighting with enemy pilots,” he said.

“My active duty service was at the height of the Cold War, and my squadron flew off of the aircraft carrier USS Wasp and was tasked with chasing Russian sub-marines around the Mediterranean Sea and Atlantic Ocean.”

The time in the military proved valu-able later.

“It introduced me to a much wider in-ternational world, both geographically and culturally, not only with fellow servicemen but also in the places we visited,” he said. “Moreover, I learned about working as a team in the cockpit with clear, concise com-munication about possible dangers, regard-less of the rank of the person talking.

“This was later transferred directly to our eye surgery teams with everyone em-powered to be observant for and speak up about impending problems, regardless of their status. This was a new idea for some medical personnel, but is fairly well ac-cepted now.”

After the Navy, Freeman completed his medical degree at UT in Memphis, then interned at Baptist Memorial. After a course in ophthalmology at Colby College, he did his first NIH fellowship to Harvard, where he taught neuro-ophthalmology.

Following residency at UT, Freeman was awarded a Heed Fellowship to Har-vard, where he worked with Drs. David Donaldson and Claus Dohlman, research-ing, writing and editing two books on oph-thalmic signs of disease demonstrated by the then-new 3-D photography.

“During the Heed Fellowship,” he said, “my wife had to be in Memphis for the last few months of a difficult pregnancy. I was operating late on an emergency case when the word came that MLK had been shot in Memphis and there was rioting and burning there.

“There were no telephone lines open to Memphis, and I was concerned about my family’s safety until a Boston tower op-erator called the airport in Memphis and they called Anne and found out my family

was safe. The Boston tower operator said, ‘Doc, your wife says they are all OK. There is a National Guardsman standing at the corner about 30 yards away and a tank is circling the block every 20-30 minutes.’”

In the Netherlands, he worked with Cornelius Binkhorst, “the ophthalmolo-gist who worked long and hard to develop lenses and make the intraocular lens op-eration pioneered by Harold Ridley fairly routine,” he said. “I also worked with Sir Harold Ridley, the inventor of the intra-ocular lens, in England several times.

“Dr. Binkhorst had windows in his op-erating rooms, and we adopted the same plan for windows in the operating rooms at MECA. We stay in contact with the weather, and if there is a temporary power loss, we still have natural light until the gen-erator comes on in about six seconds.”

Freeman’s Punctum Plug had its ori-gin when Freeman was in Boston during a particularly cold winter.

“I saw many dry eyes, which causes pain and blurriness in eyes,” he said. “A so-lution did not come to mind immediately, but when back in Memphis, for some rea-son, the first dry-eye patient I saw caused the idea to come to mind.

“The plug preserves one’s natural tears, for which there is still no complete substitute, and helps lubricate the eye.”

When asked to explain his success with so many patents, Freeman said, “My mind just seems to work in such a way that I see connections that are not immediately evi-dent to some other people.”

Jerre and Anne have four children, one of whom is deceased. Two sons, James and John, are ophthalmologists at MECA, and their daughter is a missionary living with her family in Honduras.

Guided strongly by his faith, Freeman says it has “undergirded everything in my life and given me and my family a foun-dation to stand on. There is much I am grateful for. I am grateful to have grown up during the ‘golden era’ of a great nation where ordinary people could develop their potential.

“I have been blessed with good and encouraging friends and colleagues. I am very grateful for my wife. As a young man I was more interested in looks and personal-ity than character traits, so I have been very fortunate that Anne brought so much intel-ligence, humor, love and understanding to our family.”


Frocket. A Frat-Pocket. The very fratty pocket on the front of the shirt, typically worn by Fratdaddys or Sorositutes. According to the Urban Dictionary, a common misconception of the meaning of Frocket is the front-pocket.

I like using the misconception of words like Frocket as an analogous to terms like the Patient Protection and Affordable Care Act. (We’ve shortened it to the Affordable Care Act probably because we have been leaving out the Patient Protection part. Perhaps we should add to the name and call it the Patient Protection, Affordable and Patient Accountable Care Act.)

Between the Supreme Court verdict, the re-election of President Obama and even with the past mid-term election which gave the Republicans control of both houses, it seems clear that healthcare reform is here to stay. Tweaking and changes yes, but repeal, no.

Forward and faster with the ride. In a 2013 issue of the Memphis

Business Journal, I was one of three individuals interviewed for the article, “OVERHEARD…” in which I said, “So many things have yet to be defined. When you think of how much capital the providers have put into (reform efforts), for example, you have to ask how they can afford to put even more in without knowing what the federal government is expecting. If you thought the past year was bad, 2014 is going to be bloody.

If we had looked beyond 2014, what would have followed? One thing for sure, political and ideological affiliation continues to divide our country.

During 2014, I have been critical of:The Obama Administration was

obsessed with healthcare reform policy, but oblivious to the details of implementation. I can’t leave out both Democrats and Republicans in Congress regarding being oblivious to implementation. But does it really surprise us with 43 percent of Congress being lawyers? More on this later.

CMS has done more to add to the costs of healthcare with hurdles and regulations and both HHS and CMS rely too much on processes and not on outcomes. Again, I don’t want to leave out Congress when talking about processes and outcomes. This is obvious.

Process upon processes with a changing target, there can be no positive outcomes that patients and providers have and are facing. There are plenty of deviants in the political process to keep changing an undefined target. (Deviants are simply individuals who differ in many aspects from the larger flock of society...Urban Dictionary)

As I mentioned in my December column, in the book Systems Thinking Basics, Virginia Anderson and Lauren Johnson define systems thinking as a “holistic and big picture view of the whole. It is recognizing the interconnections between parts of a system and synthesizing them into a unified view.” Are we ready to accept unified/united to make the new paradigm work?

This is what I am thinking: HHS/CMS will come under more scrutiny concerning the way they do business. Ripping out and tearing down silos that add layers of processes with no definitive outcomes. Hopefully, with the change in leadership

in the Veteran Administration we may have a business model to emulate.

Hold HHS / CMS accountable. There is discussion now to give CMS more authority to fine providers without having to go through, as HHS/CMS says, “the expensive and time consuming due process audit.” I guess with the results of the different Medicare/RAC audits through both internal employees and contractors, which have been dismissed, thrown out, etc, I would be looking for a non-transparent way to have my cake and eat it too.

In a 2014 article, “CMS Hasn’t Got a Clue!” Medical Economics, Memphis Medical News, I quoted Melvin Kranzberg, who said, “This year is expected to be a watershed year in the area of information technology (HIT). Technology is neither good nor bad, nor is it neutral.”

Alongside challenging HIT reporting programs such as Meaningful Use II, ICD-10 implementation, are significant administrative simplification (for who?) opportunities with new standards and operating rules.”

I recently spoke to a friend and colleague, Robert Tennant, senior policy advisor for MGMA Government Affairs who had just returned from a panel discussion on interoperability. He said for all practical purposes it looked as though Meaningful Use II had ground to a halt. In Stage I Meaningful Use, 90 percent of hospitals and 75-80 percent of physicians were prepared for Stage I. Less than two percent of both hospitals and physicians were prepared for Meaningful Use II.”

Much of this is due to changes made in Stage II which impacted Stage I which

still has not been meaningfully defined. This most likely will cause another delay in Meaningful Use II and the implementation of ICD-10.

Tennant said, “Even if providers were prepared for Meaningful Use I and II, there would still be interoperability issues. The data required has more than 500 data points and would overwhelm us with all the information. He refers to a new concept, Targeted Interoperability, which means useful, actionable, reliable and standardized. In my simple mind, I compare that to all of the useless, time-consuming emails that I have to decide whether to read, save, or delete.

Members of the House Energy and Commerce Committee issued a report last year, saying health information technology would be “unable to truly transform our health system unless they can easily locate and exchange health information.” Spearheaded by Rep. Michael Burgess, R-Texas, House members said, “More must be done to bolster interoperability nationwide. Adopting these standards by 2018 is reasonable and should be the highest priority for the Office of the National Coordinator for Health Information Technology (ONC). The office of ONC seemed to agree, with its new chief, Karen DeSalvo, MD, calling interoperability the “Top priority for 2014” earlier this year.

HHS Secretary Sylvia Mathews Burwell, in October appointed DeSalvo to serve as acting Assistant of Health, effective immediately. She will serve as acting Assistant of Health, while maintaining her leadership of ONC and continuing to work on high-level issues at ONC and will follow the policy direction that she has set. She will continue leading the development of the interoperability road map and remain involved in meaningful use policy making.

I am not sure what type of medical degree she has, but I hope Dr. DeSalvo’s medicine bag is full of medicine. I think Dr. Joseph Schneider, chief medical information officer at Baylor Scott & White Health in Dallas, was more articulate with his concern. “DeSalvo is trying to handle two demanding jobs at the same time, which seldom has positive outcomes for anyone. If you give people too many things to do, they don’t get it done terribly well.”

Just like Ollie said to Stan: “Well, here’s another nice mess you’ve gotten us into.”

FROCKET and Other Common MisconceptionsBY BILL APPLING

MedicalEconomics

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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BY LAWRENCE BUSER

By the time Kennard Brown was

finishing his second year at Illinois State University in the mid-1970s, he realized college was just not for him.

He left school, joined the Marines and spent the next several years as an intelli-gence officer stationed in Rota, Spain. He left the service a new man – one who at-tacked college with a vengeance until he had more degrees and titles than can fit onto his business card.

Brown is now executive vice chan-cellor and chief operations officer for the University of Tennessee Health Science Center (UTHSC) and is overseeing a $250 million campus building, demolition and renovation project.

“This is a career trajectory that I would never have guessed, hoped for, or anticipated,” said Brown, who has a law degree, a master’s in public administration and a PhD in health science administration and is a Fellow of the American College of Health Care Executives. “I wish I could say I really, really loved school and that this was some thoughtful strategy that was laid out, but it just kind of evolved.”

The evolution, though, has been a steady one, much to the benefit of UTHSC and its 4,000 students in six colleges as

well as its 2,138 full-time employees in the Memphis area. In the past 15 years at UTHSC, Brown has worked in areas of law, equality and diversity, employee rela-tions and a number of other areas.

Now, as executive vice chancellor and chief operations officer, Brown focuses his efforts on the future design and appearance of the campus, which includes 40 buildings with 3 to 5 million square feet of space.

Projects include a $49 million Trans-

lational Science Research Building, which is nearing completion; some $70 million in renovations to buildings on the Historic Quadrangle to begin soon; $6 million in ongoing renovations to the Lamar Alex-ander Building and the UTHSC library; completion of the $60 million Pharmacy Building; construction of the Multi-Disci-plinary Simulation Building soon to begin; and construction of the Plough Center for Sterile Drug Delivery Systems set to begin this month.

Phase 2 will mark another $200 mil-lion to $300 million in construction, while Phase 3 will include a $180 million Wom-en’s and Infants Pavilion planned with Regional One Health to provide state-of-the-art maternity, fetal and women’s healthcare.

“Dr. Brown served as the primary architect of the UTHSC master plan,” said Steve Schwab, MD, chancellor of the health science center. “The plan was drafted by a third-party consultant (Perkins + Will) after extensive consultation with Dr. Brown and members of the Chancel-lor’s Cabinet and the deans. It was vetted with faculty, staff and students, as well as key outside stakeholders. Dr. Brown guided the entire process.”

The campus master plan unveiled in October calls for at least 15 new buildings

for expanding academics, research, clinical care and support. The plan also outlines improved pedestrian and bicycle routes, traffic flow, parking, green spaces, land-scaping, signage, housing options and 10 renovated buildings.

“I’m just a bit player,” said Brown, who’s off a good bit on that self-assessment. “I’m fortunate to work around a bunch of good guys. We basically extended invita-tions to virtually every member of the gen-eral assembly. When the UT trustees held their meeting here, they saw how dated the environment was. I was fortunate to come along at a time when our turn (for funding) came.”

Brown said the investment in the 103-year-old university’s infrastructure is crucial to attract and keep the best students and faculty in the nation. In competing with other schools, he added, the goal is for the campus to be closest to the top, not farthest from the bottom.

“The stakes are very high,” Brown said, “and we need to keep the people we train because that affects the health status of the people in Tennessee. So goes your health, so goes your jobs and so goes the economy of the state. The product we pro-duce is a very, very valuable contributor to the state. For a $110 million state appro-

The Man Behind UTHSC’s RenovationKennard Brown overseeing current $250 million project

Kennard Brown


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As reported previously in Memphis Medical News, this and other aspects of the law have led to a wave of consolidations between physicians’ groups and hospital systems, allowing them to insulate them-selves, at least to an extent. It also has helped them “gain more clout” when negotiating contracts with payers, Becker said.

However, the transition has been less than smooth, according to McPeak’s re-cent remarks.

“Unfortunately, ACA implementa-tion has also complicated the business of insurance for our carrier community,” she said in a statement. “The stepped rollout of the legislation, coupled with reliance on Department of Health and Human Ser-vices discretion, has often led to providers searching for answers and last-minute re-visions to business operations.”

This was particularly evident when physicians received notice from Blue Cross Blue Shield of Tennessee (BCBS-TN) in November 2013 that the insurance company would be amending its contract so doctors would receive a 48 percent re-

duction in the reimbursement cost, set by 2013 Medicare payments standards, for all services deemed “in-office physician lab services.”

The amendment went into effect on Jan. 1, 2014. At the time of the notice, doctors were given until Dec. 20, 2013, to decide whether they would accept the amendment. Ultimately, they did; it was either that or opt out altogether. And the situation is not unique.

Becker said it is something that, ulti-mately, could result in some kind of single payer, state-run system such as Medicare for all. In that case, healthcare would be fi-nanced by a public- or quasi-public entity, but care delivery would remain in private hands, according to Physicians for a Na-tional Health Program.

“We don’t know what it’s going to morph into,” Becker said. “I don’t know if this was intended (by the law) or (might be) a consequence of it.”

Unless or until such a thing occurs, larger physicians’ and hospital groups are here to stay, he said, and smaller, more rural providers aren’t likely to survive.

“I think we’re going to see a lot more of that.”

As it is, about 60 percent of physicians are being hired under some type of agree-ment with hospital systems, what Becker calls “an enormous jump” that likely will not slow.

Meanwhile, insurance premiums have increased for patients in Tennessee, while Medicaid coverage has not been ex-panded – yet.

“At least from a hospital standpoint, access to care might be getting worse,” Becker said.

However, the care itself might just have improved.

“Frankly, I think care’s gotten bet-ter because of what we’ve been able to do with safety and quality of care,” he said, meaning more attention for patients and fewer details missed as primary care doc-tors, specialists and hospital systems are forced to coordinate more closely.

That, he said, is where the ACA’s in-tent – and the reality of it, admittedly a “mixed bag” – are most marked. “In the end, it’s all about the patient,” he said.

BY LINDSAY JONES

Because the year 2015 promises to be one filled with important healthcare challenges, Memphis Medical News took the opportunity to talk with Keith Anderson, MD, a Memphis cardi-ologist and chairman of Board of Trustees of the 8,000-member Tennes-see Medical Association, about a number of issues, including the fallout from the Affordable Care Act and its impact on doctors, hospitals, insurers.

Here are his re-sponses to questions posed by the newspaper’s Lind-say Jones.

Memphis Medical News (MMN) – When the Affordable Care Act was passed, it was touted as being a ve-hicle to help average Americans ob-tain health insurance at better rates, even if they might have pre-existing conditions. Although coverage has expanded for many, it appears the health insurance industry has be-come even more influential in the ways services are delivered and billed (and how expensive premiums really are). What is right and wrong in the overall process as it exists now?

Anderson – It’s safe to say that physi-cians and other healthcare providers have strong personal opinions about the Afford-able Care Act. It’s a little more difficult at

this point to say on a wholesale level what is right versus what is wrong with the current process. We have seen more people access-ing health insurance coverage through the exchange, and that’s a good thing.

In terms of payment and delivery models, the biggest change continues to be the transition from the traditional fee-for-ser-vice model to new value-based reimbursement models. Payers and pro-viders are both trying to figure out how to operate in a system that includes rewards and penalties based on efficiency and quality measures. The epi-sodes of care in the State of Tennessee Health Care Innovation Initiative is one

example.

MMN – Recently, BlueCross BlueShield unilaterally changed its contract terms so doctors would be reimbursed much less for certain tests and services. Most practices complied because they really had no other choice, even though this hap-pened after they already had set their budgets. This is but one example among many of some marked strong-arming during contract talks. So, just how much power or leverage do in-surance carriers have when it comes to applying the Affordable Care Act’s mandates? Why does this situation seem to be accelerating unchecked?

Are some companies more known for this kind of tactic than others?

Anderson – This example is not really a byproduct of the ACA. It’s commonplace among health insurance companies, and has been for some time. Doctors contract to be in health plans’ networks to get predictable patient flow, but have little to no negotiating power, especially independent physicians and smaller groups. The insurance indus-try’s “take it or leave it” approach to network contracts and unreasonable reimbursement modifications in mid-contract is the reason TMA brought the Payer Accountability legislation before the General Assembly in 2014. We simply want health plans to honor the agreed upon contract provisions for the full contract term. This will be among our top legislative priorities again in 2015 and, if we are successful, will be the first law of its kind in the United States.

What it is attributable to the ACA is a narrowing of options or insurance providers for patients and employers. There are fewer plans, which in turn gives the industry more power to set the rules for providers – both in and out of their networks. Patient steerage will be an issue to watch in the coming year.

MMN – ACA is/was supposed to be about rewarding physicians not for the number of tests or inpatient procedures they perform, but for fa-vorable outcomes among patients. How is this possible, however, when it appears insurance companies can set care parameters by withhold-ing funds from providers? In other words, it seems that in the end, pa-tients are getting the short end of

the stick because of how hamstrung their healthcare providers are.

Anderson – It’s important to remem-ber that the ACA is just an umbrella regula-tory mechanism at the federal level. There are lots of different ways health plans, health systems and providers are trying to achieve the apex of quality, safety and efficiency. Some are proving to be more successful than others. All parties – payers, providers and even the patient – need to have skin in the game for this type of payment model to really be successful, and to truly get more value out of each episode of care.

We are in the very early stages of imple-mentation of only a few episodes in Tennes-see. What we already know is that there has to be better transparency of information and clinical data. There is also a longer view con-cern that this strategy for managing care will face a diminishing return and effectiveness in a short period of time.

MMN – What do you see as being the biggest issues in Tennessee right now, related to healthcare and insur-ance providers?

Anderson – Undoubtedly the biggest issue weighing on healthcare in Tennessee is the crushing weight of overregulation and mandates to perform work that has little or no value to patients.

MMN – What are some of the factors that determine whether a healthcare entity (physician practice, hospital-owned practice, etc.) can withstand or overcome the limita-tions imposed on it, mainly by insur-ance companies?

Anderson – Time is the biggest factor. Physicians have seen a dramatic increase in the administrative side of medicine. Some larger groups or employed physicians may have personnel resources to support admin-istrative burdens, but nearly all physicians have to deal with technology, federal and state regulations, payer requirements and a host of other demands that don’t have any-thing to do with patient care. Most physi-cians will agree that they want more face time with patients but have an increasingly difficult time finding it. We cannot deliver the highest quality care without preserving the doctor-patient relationship.

MMN – How do the spectrum of needs and problems in healthcare differ between urban and rural areas (for example, metro Memphis and rural West Tennessee)?

Anderson – Access to healthcare is among the most obvious and ongoing is-sues. People living in rural West Tennessee counties may have to commute to Jackson or Memphis to get the care they need, es-pecially for complex chronic conditions. By contrast, residents in Shelby County or other metropolitan areas typically have their choice of doctor, hospital, etc., and are prob-

At Five-Year Mark, continued from page 1

Memphis Physician Foresees Year of Challenges in Healthcare

Dr. Keith Anderson



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The historical transformation of the healthcare delivery system continues, and 2015 promises to bring to the forefront a number of key issues affecting providers. Chief among these issues are how will providers be reimbursed and how can they prepare for new models of care delivery and reimbursement while government scrutiny continues to increase. Naturally, integration will continue, and provider focuses in 2015 will be in areas that include:

Payor Contracting. Bundled payments and shared savings programs will materially expand in scope and scale with third party payors. Providers should be pre-pared for enhanced efforts by payors to increase cost efficiency. Providers should be aggressive in attempt-ing to reach contracts with payors that incorporate these inevitable concepts. On the ACO front, CMS is-sued a proposed rule on December 1, 2014 that would change the structure of the Medicare ACO program to make it more attractive to providers. Providers who have previously considered and rejected the idea of Medicare ACO participation should take a fresh look at the matter in light of the proposed changes.

Telemedicine. One of the fastest-growing trends among providers is the delivery of patient care through telemedicine. Both payors and providers view telemedicine as a meaningful way to reduce costs, increase efficiency in care delivery and improve patient access to care. As evidence of how payors are embracing telemedicine, starting on January 1, 2015, Medicare will cover wellness, behavioral health, and care for chronic disease management in certain expanded circumstances for visits that are not face-to-face visits.

Investments in Healthcare Information Technol-ogy. As more providers have invested in electronic health record systems and other emerging technolo-gies, the discussion about interoperability will be more pervasive. Coordinating care for patients with complex health conditions who see multiple physicians can be supported by better IT interoperability. There will also be more likelihood for data breaches, however, which can result in material liability for providers and troublesome audits by enforcement agencies.

Changes in Models of Care. Urgent care centers, retail medical clinics, federally qualified health centers (FQHCs) and rural health clinics (RHCs) will continue to proliferate in 2015. As emergency department costs increase, the Affordable Care Act begins to take effect and the primary care physician shortage wors-ens, urgent care centers are playing an increasingly important role. Urgent care provides cost-effective, convenient medical services for low- to mid-acuity illness or injury, is significantly less expensive than the cost of care at emergency departments, and urgent care centers may be owned by physicians, hospitals or private investors. Urgent care centers located in non-urban areas may also qualify for RHC status, which may dramatically increase Medicaid reimbursement. Similarly, FQHCs are qualified to receive enhanced reimbursement under Medicare and Medicaid.

Changing Strategies for Alignment. The eco-nomic feasibility of independent medical practices and smaller hospitals will face continuing challenges in 2015. In addition to the continued growth in the number of hospital-employed physicians and the number of smaller facilities being acquired by larger hospital systems, changing strategies for alignment will emerge. Not only will clinical integration continue, entities such as Shared Services Organiza-tions (SSOs) will continue to be an attractive option for providers seeking to form collaborations without losing independence or control while obtaining some of the benefits of consolidation, such as increased purchasing power, reduced costs of care and shared best practices.

Continued Enforcement. The $5.7 billion generated by False Claims Act litigation and settlements in 2014 is alarming and seemingly counter-productive to focusing on the above important initiatives, but relief for providers is not likely in 2015.

THE YEAR AHEAD FOR PROVIDERS

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last July as the hospital’s sixth president and CEO. He also has served the institution not only as pathology chair, scientific and deputy director and executive vice president, but as a guiding hand for the research efforts that have positioned St. Jude for a world leadership role in the field of cancer genomics.

The ripple effect of the PCGP has produced groundbreaking discoveries im-pacting future treatments for four types of brain tumors, four subtypes of childhood leukemia, a cancer of the peripheral ner-vous system, eye tumors and the degen-erative disorder known as Lou Gehrig’s disease. Several hundred participants and researchers at St. Jude are involved in the project, which continues to nurture new findings at more than 100 academic in-stitutions around the world that have al-ready accessed the PCGP’s data for use in their own research — contributing their findings back to the shared and growing body of knowledge.

“That’s one of its major strengths: that data lasts forever, and people use it and continue to make discoveries as new tools come out, as other cases get se-quenced,” Downing said.

A leader in launching the project, he describes it as a great team effort, with many areas of expertise coming together to generate, analyze, interpret and then follow up data with more direct experi-mentation. “It was just an amazing effort that pulled people together better than anything I’ve ever seen,” he said.

Like many super-achievers before him, Downing didn’t anticipate the direc-tion of his career path. As a kid growing up in Detroit during its glory days, he wanted to be a professional baseball player, and he recalls taking the bus to Tiger Stadium to watch the Tigers play — and riding his bike everywhere. “I thought it was the best place on Earth to grow up!”

He was studying engineering at the University of Michigan when he “stum-bled on” a biology course and really liked it, eventually gravitating into biomedical research. Medical school offered him the opportunity to pursue research while at-tending classes; he credits his research mentors at Washington University in St. Louis and the University of Florida for his advances into the field of pathology and hematopathology.

“I actually came to St. Jude primar-ily to work under Chuck Sherr,” he said, referring to Charles Sherr, MD, PhD, Chair-Tumor Cell Biology, “who is still one of St. Jude’s most decorated scientists; he taught me a lot.”

His initial impression of St. Jude wasn’t impressive, he admits. Accus-tomed to larger cities and larger medical complexes, he judged the place to be far too small during his interview visit; yet something about the place and its people prompted him to give it a try for five years — and he never left.

“I wake up every day excited about what I do,” he reflected, “and I still go to bed dreaming about what I do and what I have in front of me. It’s a job I’ve loved

since day one.”A dedicated and renowned re-

searcher, Downing acknowledges that taking on executive duties requires switching gears. “It’s a different kind of leadership opportunity with a different focus,” he said. “As part of the interview process, the board asked me to draft a vi-sion for St. Jude for the next five to 10 years — short, three to five pages, bullet points.”

After considerable thought, conversa-tion (and, of course, research), Downing delivered a nine-page manifesto describ-ing his vision for the hospital, which he is conscientiously implementing.

“St. Jude has an opportunity — al-most a responsibility – to step up and be the global leader of pediatric oncology, continuing to advance cures for pediatric catastrophic disease,” he said. “We would like to see significant expansion in our international outreach program. We’re in 15 countries right now with 22 differ-ent programs and a budget of about $11 million, which we would like to double or triple over the next four to six years, expanding our model across the globe.”

Recruiting a new leader for the pro-gram is a current priority.

Among other items on his list: • Increasing the number of cancer

patients brought to the St. Jude campus by more than 20 percent over the next four years.

• Developing new programs in bone marrow failure syndrome, he-reditary cancer predisposition and more.

• Adding new affiliates and doubling the number of children enrolled on St. Jude protocols at collaborating institutions.

Although he still leads the clinical aspect of the PCGP, he expects to down-size his research laboratory presence in order to fill his new role. The support he receives has smoothed the transition, however. “Every individual who works at St. Jude knows they’re part of this mis-sion and they take great pride in working here,” he said. “I feel fortunate and almost humbled to be a part of this incredible fac-ulty and staff.”

From a personal perspective, Down-ing stresses forward momentum rather than past laurels. “I never feel like I’ve done enough. There are papers I need to write, more cases we need to sequence, people we need to recruit. We have a responsibility to not look at what we’ve done, but to keep looking forward to what we can do.”

TIME magazine notwithstanding, however, Downing’s proudest accom-plishment is his family — three grown children and three grandchildren. He remains an avid biker, riding about 150 miles a week and striving to break the 40K best time he set when he was 35. Odds are he’ll do it.

Healthcare Leader: James Downing, MD continued from page 1

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BY CINDY SANDERS

The Advisory Board Company, Rob-ert Wood Johnson Foundation (RWJF), de Beaumont Foundation and The Kresge Foundation recently joined forces to launch a major public health initiative known as the BUILD Health Challenge, which will award up to $7.5 million in grants, low-interest loans and program-related investments over the next two years to improve health in low-income neighborhoods within cities that have a population of 150,000 or more.

Starting from a premise that good community health takes more than just healthcare, the four organizers seek to identify, accelerate and spotlight best practice models and innovative ap-proaches to addressing nonclinical factors that influence health through collabora-tive partnerships between hospitals and health systems, local health departments, and nonprofit community organizations. The goals of the funding program are to promote health equity, reduce per cap-ita health spending, shift resources from treating illness and chronic conditions to the upstream social conditions that impact population health, and to identify and promote scalable best practices.

“Tackling today’s biggest health

challenges is not the work of one orga-nization … it’s not the work of one sec-tor,” Abbey Cofsky, senior program officer with RWJF, pointed out. “The aim of the BUILD Health Challenge really is to increase the num-ber and the efficiency and effectiveness of the types of partnerships that we know it will take to improve health. And that means bring-ing together hospitals, community leaders and public health leaders to collaborate in efforts that are going to move the needle on health and ultimately really change the dynamic around cost.”

James Sprague, MD, chairman and CEO of the de Beaumont Foundation, noted, “There is much work that has to be done to improve population health, and this BUILD Health Challenge, we hope, will identify prom-ising models across the nation that will be repli-cable and sustainable in order to address health problems before they get started.”

Brian Castrucci, chief program and strategy officer with de Beaumont, said the United States pro-vides access to some of the best medical care in the world using some of the most advanced technologies and treat-ments available. How-ever, he continued, “Its (the healthcare system’s) impact is diminished when patients return to neighborhoods with limited access to fresh fruits and veg-

etables, no options for safe or affordable physical activity, or no options to fill phar-macy prescriptions.”

He noted individuals often pres-ent with chronic or complex conditions exacerbated by lifestyle choices that are impacted by the social determinants of health. “The simple truth is that our traditional model of healthcare delivery doesn’t really work anymore.” Castrucci added, “It was designed to respond to acute illnesses like polio and typhoid and not address causes of disease that occur far beyond the clinic walls.”

Chris Kabel, senior program officer with The Kresge Foundation, echoed those sentiments, noting there is a growing awareness that most of the nation’s health is determined outside of the healthcare

system. “Unfortunately, health-promot-ing resources are not equitably distributed and tend to be least prevalent in low-in-come neighborhoods and communities of color,” he said.

Kabel added, “One reason why most traditional health education campaigns have proven ineffective is they’ve done nothing to change the local opportunity infrastructure in which people live, learn, work and play.” With the BUILD Health Challenge, Kabel noted local community-based organizations are a critical compo-nent for success since their members truly understand the neighborhoods they serve including challenges, assets, obstacles and opportunities to maximize health.

Dennis Weaver, MD, chief medical

BUILD Health Challenge Issued …National collaborative awarding up to $7.5 million to improve community health

Applications & Key Dates

Information from web conferences held in December plus details about the challenge, partners, eligibility requirements and overall process are online at buildhealthchallenge.org.

To be eligible, BUILD Health applicants must include, at a minimum, a partnership between a hospital or health system, local health department, and nonprofit community organization or coalition of organizations. The nonprofit community organization must serve as the lead applicant in each proposal. Activity should be focused within a delineated ZIP code(s), census tract(s), or neighborhood(s) experiencing significant health disparities within a city of 150,000 or more residents. Also, participants must be willing to engage in a learning collaborative and openly share ideas, action plans, and results. Applications can be submitted online through the website.

Below are key dates going forward:• Jan. 16: Deadline for Round 1 applications.• Feb. 12: Invitations extended to select applicants for Round 2.• April 10: Deadline for Round 2 applications.• June 9: Winners announced.

Abbey Cofsky

Dr. James Sprague

Brian Castrucci

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ably not inconvenienced when referred to a specialist.

One trend that may exacerbate access issues is the merging and consolidation of practices with hospitals and health systems. When a practice becomes part of a larger group, they may not participate in the same insurance programs or networks, and pa-tients may be affected.

MMN – Aside from the negative aspects of this continuing issue, what are some positives happening in terms of the insurance industry and care providers?

Anderson – We are encouraged by the efforts being produced by our work between various medical professional organizations and groups. For example, TMA is working with the Tennessee Academy of Physician Assistants to advocate for more integrated, patient-centered healthcare delivery teams. The quality and value-driven healthcare cli-mate calls for a more team-based approach. If we in Tennessee can work more closely to-gether in a coordinated, integrated manner, then we will give patients better access to care without compromising quality, so they have the best possible patient experience, and we will lower costs in the process. We

have also seen a dramatic increase in our workings with the hospital industry related to payment bundles and episodes of care. We have always worked closely together, but new pay models are changing the inten-sity of our working relationships to align our vision and mutual performance for deliver-ing patient care together.

MMN – What do you foresee in the future for this issue? Will it be necessary to reform healthcare re-form, or is the landscape going to be made up of mainly hospital-system-owned practices and clinics to help

sustain the shortfalls in reimburse-ments? A lot of that has been hap-pening already ... but where, do you think, will it end? What will it ulti-mately look like?

Anderson – Wish we could say. Healthcare is traditionally slow to reveal and adapt to trends when compared to other sectors of our economy. I think it will be some time before we truly see whether the changes we are implementing now are the best solutions for the long term. I don’t believe we can ever consider ourselves done with healthcare reform. Medicine has to continually adapt to meet the needs of our patients, now and in the future. It is our na-ture to be cautious and challenging to new ideas and we will always start our evalu-ations with the question of good medicine and the relative value to the patient . . . the safety of our patients . . .

Memphis Physician Foresees Year of Challenges in Healthcare, continued from page 6

priation to have an economic impact of in excess of $2 billion, that’s a pretty signifi-cant return on investment for the state.”

How Brown came to be the chief landlord, so to speak, of such a sprawling operation is sometimes a puzzle even to him.

As he got into his new role, he found himself tending to piecemeal projects like power plants in one building, air condi-tioning upgrades in another. Soon he had a laundry list of individual repairs that needed to be done.

“Then it dawned on me that I’ll be chasing my tail like this forever, so I thought let’s stop the merry-go-round and systematically figure out a process, whether it’s building by building or college by col-lege,” he recalled. “I thought let’s break it up by mission components.”

He began with a plan to improve the academic environment by renovating classrooms and adding state-of-the-art flat-screen monitors. Then it was upgrades to research labs, the clinical environment and space for administration and faculty.

And so was born a five-year master plan that was not necessarily a new con-cept, but one that had been bouncing around for some time though never articu-lated or put to paper.

“Then it was going to the state, asking for money and staying with a really, really solid game plan,” Brown said. “We have old buildings that need to be torn down. We asked for demolition money for years and ultimately they gave it to us. We just finished about $5 million of demolition.”

Some of the projects and improve-ments in the plan are funded and under-way, while some are expected to evolve during the next five years or so.

“We want people to come to Mem-phis to get cured,” Brown said. “There’s no reason we shouldn’t be one of those des-tination places (for advanced health care). We don’t want to be a best-kept secret.”

The Man Behind,continued from page 5


is ensuring the state’s Certificate of Need program stays in tact. “There is no looming threat right now, but it’s always a concern,” Becker noted, adding the CON process lev-els the playing field for facilities across the state.

Russ Miller, CEO of the Tennessee Medi-cal Association, is also eager to see more Ten-nesseans be able to access the healthcare system through a commonsense Medicaid expansion plan. Additionally, the TMA has a full slate of activities pertaining to professional development, membership resources, and advocacy planned for 2015.

Among some of their key priorities for the year are preparing members for ICD-10, finishing the work on payer ac-countability, looking at issues pertaining to graduate medical education and physician sustainability, and helping TMA members, in partnership with other healthcare pro-fessionals, navigate new payment models and collaborative care arrangements.

A major push for the TMA over the next 18 months is becoming recertified as a CME provider. Miller said the orga-nization served as the state accreditor for continuing medical education until around 2005 but dropped that function for various reasons. “We thought it was time to bring it back,” he said.

The TMA already has a strong edu-cational component within the staff and offers online CME courses alongside lead-ership development and training on the latest issues. However, going through the recertification process will allow the state association to provide more clinical content to physicians and other providers. “It will give us the ability to create more original content to meet the needs of the market

BY CINDY SANDERS

For Craig Becker, president and CEO of the Tennessee Hospital Association, the top priority for 2015 is securing Medicaid expansion in Tennessee … now, it looks like that could happen this year.

On Dec. 15, 2014, Gov. Bill Haslam intro-duced his Insure Ten-nessee voucher plan to provide an alternative coverage option to low-income Tennesseans who don’t qualify for either TennCare or fed-eral subsidies. It’s estimated nearly 200,000 employed Tennesseans at or below 138 percent of the federal poverty level would be impacted by the pilot program designed to help them participate in employer-offered plans.

In responding to the plan’s announce-ment, Becker stated, “For the past two years, THA’s number one priority has been securing Medicaid expansion in our state, and today marks the beginning of this goal becoming a reality. I applaud the governor’s thoughtful approach to this vi-tally important issue and am grateful for his hard work with the Department of Health and Human Services in recent months.”

Becker added the Insure Tennessee plan is a meaningful alternative to tradi-tional expansion. He continued, “I also believe Insure Tennessee helps provide a solution to the financial challenges hospi-tals across Tennessee have faced for the last several years as a result of extreme cuts in healthcare reimbursement.”

However, he recognizes there is still more work to do on behalf of the THA membership. Getting the plan through the Tennessee Legislature is the next chal-lenge. “It’s most needed,” Becker said. “We’ve lost several hospitals in the last year. It’s going to be much tougher, es-pecially for our small and rural hospitals to survive … and for our urban safety net hospitals to provide the level of services they do … if we don’t get expansion.”

Still, having the Insure Tennessee plan approved by HHS is clearly an im-portant first step.

Other priorities for 2015 include pas-sage of the hospital assessment, which al-lows Tennessee hospitals to put up $452 million to help fund the TennCare pro-gram and draw down federal match dollars at a 2:1 rate. Although passage has been fairly routine the last few years, there was initially some skepticism when hospitals first broached the subject of funding the state’s portion so Tennessee wouldn’t ulti-mately lose out on $900 million in federal funding support. “Hospitals have taken that on for the last five years,” Becker said. “The dollars used to come from the gen-eral fund.” Becker added he is hopeful the general fund might again pick up some of state’s portion of Medicaid funding down the line as the economy continues to sta-bilize.

Another ongoing priority, Becker said,

THA, TMA Outline 2015 PrioritiesTHA’s New Leadership

During the annual meeting this past November, the Tennessee Hospital Association membership elected and installed the 2015 board of directors.

Mark Medley, senior vice president and president of hospital operations for Franklin-based Capella Healthcare, was installed as chairman. A Fellow of the American College of Healthcare Executives, Medley is responsible for the operations of 14 acute care and affiliated Capella entities throughout the United States. Previously, he served as a hospital CEO and division CFO for LifePoint Hospitals and began his career with

HCA. Prior to his current THA role, Medley served as chairman of the state association’s Council on Government Affairs and received the THA Small or Rural Hospital Leadership Award in 2013. He has also served on the boards of the THA Solutions Group and the Tennessee Rural Partnership.

Keith Goodwin, president and CEO of East Tennessee Children’s Hospital in Knoxville, was installed as chairman-elect and will step into the chairman’s role at the 2015 annual meeting in Nashville this coming November. Goodwin has served in his current position with ETCH since 2007. Prior to that, he spent more than 28 years at the Nationwide Children’s Hospital in Columbus, Ohio and also served as CEO at the

Children’s Hospital of Austin for three years. In addition to being a member of the boards of THA, Children’s Hospital Alliance of Tennessee and Hospital Alliance of Tennessee, Goodwin serves on the boards of the East Tennessee Foundation, Metropolitan Drug Commission and Knox County Imagination Library.

Reginald Coopwood, MD, president and CEO of Regional One Health in Memphis, handed the gavel over to Medley and stepped into his new role as immediate past chair. He also will serve as speaker of the THA House of Delegates in 2015. Coopwood received his medical degree from Meharry in Nashville and previously served as CMO for Nashville General Hospital and later as CEO of the Metropolitan Nashville Hospital

Authority before accepting his current position in March 2010. Coopwood serves on the boards of March of Dimes, QSource and Mid-South e-Health Alliance, among others.

Craig BeckerRuss Miller



BUILD Health Challenge, continued from page 9

and to get it to them faster without having to use a third party,” Miller explained.

Staying on an education theme, Miller said another issue is graduate medical edu-cation. “The Medicare program funds resi-dency programs in every state,” he pointed out. Looking at concerns over physician sustainability and shortages in a number of areas, Miller continued, “You can get more doctors through medical school, but if resi-dency positions don’t exist, you can’t finish training them.”

A cap of $50 million for GME has been in place in the TennCare waiver with-out any increase since the 1990s. “We’re asking the state to seek out more funding for graduate medical education,” he said of a hope the cap could be raised by $25 mil-lion. Miller was quick to add that doesn’t mean $75 million would be automatically funded, but at least there would be room for growth that doesn’t currently exist.

“Taking the long view, doctors often stay where they do residency. We want to keep doctors in Tennessee so we don’t have access issues for our citizenry.”

On the advocacy side, Miller said, “First and foremost is the continuation of the work we started last year on payer ac-countability.”

He expects legislation to be introduced in 2015 that addresses an issue he said has been an ongoing problem regarding com-mercial insurers making changes, often to fee schedules, mid-term in a contract cycle

rather than waiting until the end of the con-tract and re-negotiating with all parties at the table.

“What we heard from our doctors is they just needed more predictability,” Miller said. He added it’s difficult to plan for the year when contracts could be uni-laterally changed with little notice. “We spent almost every week with the insurers this (past) summer to tweak (the proposed legislation) it to make sure we don’t have unintended consequences,” Miller noted of working earnestly to get insurer’s input.

The TMA has also played a part in addressing some of the larger societal issues facing Tennesseans, including prescription drug abuse. Noting limited resources make it difficult for any one organization to make a big impact, Miller said this has led to more statewide collaboration. “It takes a lot of or-ganizations working together to move the needle a little bit,” he pointed out. In addi-tion to creating classes on the subject to help providers appropriately diagnose and treat patients with powerful opioids, TMA has also joined colleagues in educating the public and Tennessee Legislature about the issue.

Miller said much of the coming year’s work is an investment in the future to en-sure Tennessee continues to have realistic rules and regulations, a good practice en-vironment, fairness in reimbursement, and improved population health. “We want to make our state a great place to be a doc-tor,” he said of TMA’s ongoing mission.

THA, TMA Outline 2015 Prioritiescontinued from page 11

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BUILDing Better Health• The awards and low-interest loans

will support up to 14 community-driven efforts that take

• Bold,

• Upstream,

• Integrated,

• Local,

• Data-driven approaches to improving community health and promoting health equity.

officer and executive vice president with the Southwind Consulting and Manage-ment division of The Advisory Board Company, highlighted the emerging role hospitals and health systems are beginning to play in building healthier communities as providers move into a world of popula-tion health management.

“Most health systems are comfort-able with the clinical determinants of healthcare but often don’t focus as much on the social and economic determinants of healthcare which are so critically im-portant to population health because they feel that they can’t effect, essentially, a change in those areas,” Weaver said. He added the exciting part of the BUILD Health Challenge is that it brings the key stakeholders together to address those up-stream barriers going forward.

Awards include up to $3.5 million in grants and up to $4 million in low-interest loans. On the grant side, there will be up to five planning awards across a one-year period of up to $75,000 and as many as nine implementation awards of up to $250,000 each across a two-year period.

Cofsky said the planning awards are really designed for new partnerships look-ing to develop a well-defined community health improvement plan, whereas the implementation awards are geared toward collaborations that are already active or have gotten past the initial thought pro-cess but need an infusion of resources to accelerate their work. The partnering hos-

pital or health system must also agree to a 1:1 match of the implementation award with a mix of dollar and in-kind support.

Cofsky continued, “We are also ex-cited, as a part of this initiative, to have a low-interest loan pool of up to $4 mil-lion for community revitalization efforts aligned with those BUILD Health goals that could be advanced by this form of capital.” She added both forms of funding include a comprehensive menu of support services to help the partners succeed.

The competitive awards program, which has a first application deadline of Jan. 15, culminates with the announce-ment of up to 14 funded collaborations on June 9, 2015. For more information, go online to buildhealthchallenge.org.


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BY JULIE PARKER

Missed family gatherings and soccer games, frustration with bu-reaucracy, dwindling self-worth and utter exhaustion often over-shadow the initial call to heal others.

In the environment of protracted work days, countless rounds, scarce breaks, and pagers ringing incessantly have led many physicians to opt for early retirement, second-guess their chosen profession, and/or suffer professional burnout.

Alarmingly, more than 400 doctors commit suicide annually; the suicide rate is four times higher for women physicians than women in other professions.

According to a recent Medical Economics survey, more than one-third of physicians reported that if they could go back in time, they would choose a different specialty – or a different career altogether.

With an estimated 90,000 too few physicians practicing by 2020, America’s doctors will continue to work overtime to meet the demand.

“Most of us followed a calling to serve others through practicing medi-cine,” said Starla Fitch, MD, author of Remedy for Burnout: 7 Prescriptions Doc-tors Use to Find Meaning in Medicine (Langdon Street Press, 2014). “We’ve dedicated our time, talent and treasure to healing others, but as we (did), many of us forgot how to heal ourselves.”

Encountering burnout led to an ex-perience for Fitch, a board-certifi ed oph-thalmologist specializing in oculoplastic surgery, which renewed her spirit. One re-sult: she established the popular lovemedi-cineagain.com, an online community to help medical professionals reconnect with their passion for the practice after surviving life-altering burnout. A featured blogger for Huffi ngton Post, certifi ed life coach and CBS contributor, Fitch wrote Remedy for Burnout to benefi t colleagues and doctors-in-training.

“The level of burnout among physi-cians is at an all-time high,” said Fitch. “A great many of my burned-out colleagues are frustrated with the changes in the rela-

tionships within medicine.”One such

dysfunctional re-lationship: the tie

between doctors and insurance companies.

Case in point: a large managed-care network

recently removed Fitch’s practice from its list of

preferred providers.“Had we not taken

good care of our patients? Weren’t we available for

those patients 24/7? Did pa-tients complain that my part-

ners and I didn’t deliver quality c a r e ? No. No. And no. The managed-care network decided to provide the types of services we provide,” Fitch explained. “It opted to move the services in-house to save money, regardless of the consequences to its patients.”

The impact of that decision? One af-fected patient had been diagnosed with eyelid cancer. Surgery had been scheduled to remove the growth, followed by another surgery for reconstruction, Fitch said.

“The loss of continuity that has emerged in our healthcare system hasn’t only disrupted our patients’ health,” she said, “it’s disrupted physicians’ quality of

care.”Fitch’s personal prescriptions call for

doctors to:Develop resilience.Practice faith, which Fitch describes

as “front and center faith … the kind we doctors have when we make that fi rst inci-sion and trust we’ll be able to later close the wound.”

Cultivate self-worth. “Too often, we see ourselves incorrectly,” explained Fitch. “Instead of looking in the mirror and seeing the specialness we possess, we allow what we think other people think about us to enter the equation.”

Promote creativity. “Your staff has more creative tips up their sleeves than you can imagine,” said Fitch. “Brainstorm with them on ways to improve patient fl ow, ap-pointment time congestion, or any number of things that will allow for happier employ-ees and healthier patients.”

Fitch also included a section on inter-personal prescriptions, encouraging physi-cians to:

Foster support. “’Grinning and bear-ing it’ isn’t a successful coping mechanism,” said Fitch. “The stigma around doctors ask-ing for help lingers, unfortunately.”

Embrace compassion. When Fitch asked a colleague advice he would give his 29-year-old self, the doctor said: “Try to be

more empathetic. That’s more important than anything else. Having some idea of a patient’s situation really changes the way you treat people.”

Encourage connection, “the spark that ignites when you have a conversation in the doctors’ lounge and you laugh at the same jokes, commiserate over the same wins or losses of sports teams, or offer congratula-tions or condolences for the highs and lows we all experience,” she said. “These rela-tionships have a profound impact on doc-tors’ lives and are, therefore, the ones that need fostering.”

Going forward, Fitch hopes physicians fi nd their own personal remedy to over-come burnout. She uses “entrainment,” a word from the biomusicology world that means “the synchronization of organisms to an external rhythm, often produced by other organisms with which they interact socially.”

“Sometimes when I’m in the OR, I ask the anesthesiologist to slightly turn down the volume of the patient’s pulse oximeter,” she said, “as I can feel my own pulse trying to keep time with the patient’s rhythm.”

Fitch encourages physicians to “be brave and reach out to others in the com-munity.”

“Together,” she said, “we can all fi nd meaning in medicine.”

The Secret Suffering of DoctorsOphthalmologist pens book about the looming crisis in medicine, a remedy for burnout

Dr. Starla Fitch

Missed family gatherings and soccer games, frustration with bu-reaucracy, dwindling self-worth and utter exhaustion often over-shadow the initial call to heal

their chosen profession, and/or

tionships within medicine.”

between doctors and insurance companies.

Case in point: a large managed-care network

recently removed Fitch’s practice from its list of

preferred providers.“Had we not taken

good care of our patients? Weren’t we available for

those patients 24/7? Did pa-tients complain that my part-

ners and I didn’t deliver quality

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The West Clinic Helps Launch National Trial of Non-Surgical Breast Cancer Treatment

With its first recent successful proce-dure, The West Clinic is helping to launch a groundbreaking multi-center clinical trial of cryoablation to treat breast cancer without the trauma of surgery. Utilizing the innova-tive IceSense3 System to treat certain early stage tumors without scalpels, tissue remov-al or scarring, the ICE3 trial will significantly expand data on the technique. Potentially, it will usher in a new paradigm in the treat-ment of the disease.

According to Richard Fine, MD, who performed the procedure, it involves plac-ing a small IceSense3 nitrogen-cooled probe into the center of a tumor to freeze it from the inside out. The rapid temperature drop freezes diseased cells, causing them to crack open and die. The dead cells are then absorbed by the immune system over time.

The benefits of cryoablation over tradi-tional surgical tumor removal are significant, including fast recovery, improved cosmetic results, greater patient comfort, no need for general anesthesia or hospital operat-ing room and lower cost. Cryoablation es-sentially involves a nick in the skin and the destruction of a tumor in place with minimal discomfort. The procedure is typically per-formed in a physician’s office under ultra-

sound guidance in less than 20 minutes.Cryoablation is well-established for the

treatment of liver, lung, prostate and other cancers. Numerous, more limited studies have validated its success in the treatment of breast malignancies, including a recent ACOSOG trial and extensive long-term studies in Japan.

Vanessa Givens Joins Women’s Health Specialists

Vanessa M. Givens, MD, has joined Women’s Health Specialists as a partner. A graduate of Vanderbilt, she earned her MD at the University of Tennessee Health Sci-ence Center (UTHSC). Givens completed her internships and residency in Obstetrics and Gynecology at the UTHSC in the Col-lege of Medicine.

Givens continued there and received fellowship training in advanced abdominal and pelvic surgery. She has been named one of “America’s Top Obstetricians and Gynecologists” by Consumers’ Research Council of America.

Memphis Cardiology Practice Chooses Saint Francis

Cardiovascular Physicians of Memphis, where Drs. Joseph S. Weinstein, MD, FACC and Raj C. Dave’, MD, FACC have been pro-viding cardiovascular care in the Memphis

area for more than 20 years, has joined Saint Francis Medical Partners.

The practice will retain its current loca-tion at 4901 Raleigh Common Drive, Suite 100 and will serve patients where they cur-rently have hospital privileges as well as Saint Francis.

Weinstein graduated from Cornell University, then the University of Missouri, Columbia School of Medi-cine. He did his internship and residency in internal medicine at Johns Hopkins Hospital and completed a fellowship in both cardiol-ogy and interventional car-diology at Harvard Medical School. He formed Car-diovascular Physicians of Memphis in 1994 and has served as Chairman of Cardiology at both St. Joseph Hospital and Methodist North Hospital.

Dave’ graduated from University of Bombay in Bombay, India, and completed his training at Ravenswood Hospital in Chicago. He was clinical coordinator and chief resident of internal medicine at Raven-swood. He began his cardiology practice in Memphis in 1993.

Baptist’s Stephen Edge Elected to ASCO’s Board of Directors

Dr. Stephen Edge, director of Baptist Memorial Health Care’s Cancer Center, has been elected to the American Society of Clinical Oncology Board of Directors (ASCO).

Edge is one of four new board mem-bers elected by worldwide members of ASCO. The organization’s Board of Direc-tors is comprised of oncology leaders who are elected to positions reflecting various specialties within the oncology field.

Edge, a breast oncologic surgeon who came to Baptist in the summer of 2013 to head its Cancer Center, has been active in cancer care quality measurement and health services research and national policy devel-opment. He is the immediate past-chair of the Commission on Cancer of the American College of Surgeons and past-chair of the American Joint Committee on Cancer.

Memphis Mental Health Institute Selects Williams

Dr. S. Taylor Williams recently was ap-pointed Clinical Director at Memphis Men-tal Health Institute.

Williams has worked at the Veteran’s Administration Hospital in Memphis and served as assistant professor of psychiatry for the University of Tennessee Health Sci-ence Center (UTHSC), Chief of Psychiatry at The Regional Medical Center and as a con-tract Staff Psychiatrist at Memphis Mental Health Institute.

Board certified in psychiatry, Williams is a native of Tuscaloosa, Alabama, and gradu-ated magna cum laude from the University of Alabama. She received her MD from the University of Alabama School of Medicine and completed her Psychiatric Residency at UTHSC.

Memphis Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2015 Medical News Communications. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.

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Campbell Clinic physicians, volunteers provide free foot care and shoes

Dozens of home-less and underserved Memphians received free foot and ankle care from Campbell Clinic physi-cians and volunteers dur-ing its annual “Our Heart to Your Soles” event at the Memphis Union Mission’s Opportunity Center in No-vember. Each participant also received new shoes and socks courtesy of Red Wing Shoes.

The “Our Heart to Your Soles” program was founded in 2004 by then-high-school stu-dent, Matthew Conti, with the help of his father Dr. Stephen Conti, an orthopedic surgeon at Allegheny General Hospital near Pittsburgh.

Campbell Clinic volunteers (from left) fellow Dr. Kevin McCarthy; foot and ankle specialist Dr. David Richardson; Margaret Knack, RN; retired Campbell Clinic physician Dr. Greer Richardson and Rhodes student Will Murphy were all on hand to provide free foot care during the “Our Hearts to Your Soles” event at the Memphis Union Mission’s Opportunity Center in November.


Le Bonheur, St. Jude Select Co- Chief of Pediatric Cardiology

Jeffrey A. Towbin, MD, has been named co-director of the Heart Institute at Le Bonheur Children’s Hospital, chief of cardiology at St. Jude Children’s Research Hospital and chief of Pediatric Cardiology at the University of Tennessee Health Sci-ence Center (UTHSC). He will also be the vice chair for Strategic Advancement and will hold the St. Jude Chair of Pediatric Car-diology at Le Bonheur.

Dr. Towbin comes to Memphis from Cincinnati Children’s Hospital Medical Cen-ter, where he is the executive co-director of the Heart Institute, chief of pediatric cardi-ology and the Kindervelt-Samuel Kaplan Professor and Chair of Pediatric Cardiology and Cardiac Research. Clinically, Dr. Towbin specializes in diagnostic and therapeutic advances for cardiomyopathies, heart fail-ure, heart transplantation and cardiovascu-lar genetics.

At Cincinnati Children’s Hospital Medi-cal Center, Towbin successfully built one of the largest pediatric heart failure and car-diovascular genetics programs in the coun-try. His research work and clinical expertise in pediatric heart failure is internationally known, and he is widely thought of as a leader in pediatric cardiology.

Towbin’s plans include the recruitment of additional faculty, enhanced training of pediatric and congenital cardiologists, de-velopment of several novel clinical and re-search programs and facilitation of a new pediatric cardio-oncology specialty, in part-nership with St. Jude.

Assisi Foundation Awards Grant to MERI

The Assisi Foundation of Memphis, Inc. has provided a $40,000 grant to be used for community-wide disaster training to the Medical Education and Research Institute (MERI).

The goal of the training is to increase community resilience during a disaster with support from the Shelby County Health Department. The disaster preparedness training courses will provide education for medical personnel, caregivers and first re-sponders.

Physician Joins Wesley Neurology Clinic

Nada El Andary, MD, a board-certified neurologist, has joined Wesley Neurology Clinic.

El Andary earned her medical degree and com-pleted her internal medi-cine residency training at Beirut Arab University in Beirut, Lebanon. She completed her neurology residency and vascular neurology fellow-ship at the University of Connecticut, Hart-ford, Hospital. She is board-certified by the

American Board of Psychiatry and Neurol-ogy in Neurology and Vascular Neurology.

UTHSC Graduates 105 Healthcare Professionals

The University of Tennessee Health Sci-ence Center (UTHSC) last month graduated 105 healthcare professionals.

UTHSC Chancellor Steve J. Schwab, MD, presided over the ceremony.

The 105 graduates represented five of the six UT Health Science Center colleges and comprised 86 women and 19 men.

UT Medical Group Expands Plastic Surgery Team

Dr. Petros Konofaos, an assistant pro-fessor at the University of Tennessee Health Science Center, has joined the department of plas-tic surgery at UT Medical Group Inc.

A native of Greece, Ko-nofaos earned his medical degree at Aristotle Universi-ty of Thessaloniki School of Health Sciences. He completed residency in

general surgery at Laiko General Hospital in Athens and Prefectural Hospital of Nafplio in Argolida, followed by residency in plastic surgery at KAT Hospital in Athens.

Konofaos furthered his training with a residency in reconstructive microsurgery at Eastern Virginia Medical School in Norfolk, Virginia, and a fellowship in microsurgery at the University of Tennessee Health Science Center.

He cares for patients at 1068 Cresthav-en Road, Suite 500.

GrandRounds

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.

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For the second straight year we are honored to be named a Top Workplace. Among some of the nation’s best healthcare talent, our team is completely dedicated to making a difference. It’s not just a job, it’s our passion to restore, improve, heal, and care for the lives we see each and every

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