Memphis Medical News June 2015

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BY JUDY OTTO

Returning to his Southern roots has been more than merely a homecoming to Reed Hammond. Taking over as chief operating of-fi cer at St. Francis Hospital last fall also repre-sented a chance to serve an organization known

for its emphasis on caring patient service.“The South is just a different culture,” he

said. “It is a different mindset that I can relate to well from growing up here. There’s a sense of trust and honor that goes back into the pro-fession. When you’re able to work alongside

(CONTINUED ON PAGE 12)

HealthcareLeader

‘Different Culture’ Helped Lure New COO to Saint Francis Reed Hammond Relishes Trust and Honor

PAGE 3

PHYSICIANSPOTLIGHT Skyrocketing Cost of

Prescription Drugs Must Be Reversed, Says Dermatologist

BY JAMES DOWD

As baby boomers grow older and live longer – with the youngest members of that generation having already

passed the half-century mark – perhaps it isn’t surprising that prescription drug use continues to rise.But of increasing concern to a growing number of healthcare professionals is the

skyrocketing cost of prescription drugs, both name brand and generic. In fact, one Mid-South doctor – Dow Stough, MD, a practicing dermatologist for more than 20 years – has actively begun urging lawmakers and drug manufacturers to make medications more affordable.

Stough, who has private practices in Hot Springs, Ar-kansas, and Dallas, Texas, also is the founder and medical director of Hot Springs-based Burke Pharmaceutical Research. Founded in 2000, Burke Pharmaceutical has grown from a small clinical trials unit within a dermatology practice to what its website says is “a national leader in clinical trials of skin disease.”

“With the increase in price of generic and trade-name drugs, everyone is alarmed,” said Stough, who completed his internship


West Tennessee Physician Takes TMA HelmJohn Hale Displays Dedication to Practice of Medicine

Standing on the sideline and complaining is taking the easy way out, says John Hale, MD. Taking a leadership role means you have no one else to blame but yourself, so after 24 years’ involvement in the Tennessee Medical Association, Hale knew it was time for him to take the reins as president ... 5

Arrival of New ED Drugs Helps Ease Doctor-Patient ConversationConversations about sexual dysfunction between men and their doctors once were strained and diffi cult, if they took place at all. Now urologists fi nd they can hardly avoid requests from their patients for common erectile dysfunction (ED) drugs such as Cialis and Viagra ... 10

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To promote your business or practice in this high profi lespot, contact Pamela Harris at Memphis Medical News.

Paul Bierman, MD

FOCUS TOPICS MEN’S HEALTH PATIENT CARE MODELS GASTROENTEROLOGY

2 > JUNE 2015 m e m p h i s m e d i c a l n e w s . c o m

m e m p h i s m e d i c a l n e w s . c o m JUNE 2015 > 3

From Proud ‘Farm Hand’ to PhysicianDr. Paul Bierman’s Strong Work Ethic Paves the Way to a Lifetime Goal

PhysicianSpotlight

BY RON COBB

Paul Bierman, MD, can’t remember a time in his life when he didn’t want to be a doctor. His parents told him that as early as age 5 he said that’s what he planned to be.

So it served him well that early on he developed a strong work ethic. When his parents moved the family from New York City to upstate New York and bought a farm – because they didn’t think the big city was a good place to raise children – young Paul stayed busy feeding chickens, collecting eggs and selling them at a road-side stand.

When he was a teenager, the family moved to Miami and bought a restaurant, so Paul had jobs as a busboy, a short-order cook and a dishwasher.

“I always worked, even when I was a little kid,” Bierman said. “Either a paper route or working at the corner grocery . . . one thing my dad instilled in us was to work. That’s one of the gifts he gave me that I hope I can pass on to my children.”

Bierman, a gastroenterologist at Gas-trointestinal Specialists Foundation, has flourished for 19 years in Memphis, a city that he never would have thought he’d call home, given that he was strictly an East Coast guy until he was well into his 20s.

He earned his undergraduate degree at the University of Pennsylvania, then stayed in Philadelphia to attend medical school. Halfway finished, and now mar-ried to his wife, Kara, he returned to Miami to finish his medical degree so they could help care for his ailing father-in-law.

After his residency and fellowship at the University of Miami, Bierman was ap-plying for jobs, mostly in the East. Then came his last interview, a phone call from his future partner, Dr. Isaac Jalfon.

“He wouldn’t tell me where he was from,” Bierman said. “I kept pushing him and pushing him, ‘where are you?’ We re-ally hit it off and talked for an hour and a half. Finally he said ‘Memphis.’”

Neither he nor Kara knew much about Memphis, but he took the job be-cause Jalfon told him that if he came and worked hard, he’d be a partner in two years. Jalfon was true to his word.

“It worked out wonderfully,” Bier-man said. “I’m so lucky that I ended up in Memphis. What a great community, very family-centric, a lot of moral values and people who really appreciate what you do for them.”

It was also important to the Biermans that Memphis has a strong Jewish com-munity. Kara is president of Bornblum Jewish Community School and previously served as president of the Jewish Commu-nity Center.

Bierman hadn’t always set his sights on being a gastroenterologist. He origi-nally wanted to be a surgeon.

“But the more I got to understand the role of the surgeon,” he said, “I realized I’d have less patient contact, and I really enjoy communicating with patients and helping and caring. Not that surgeons don’t do that, but they tend to have more of a technical line of work.

“I realized I could have the best of both worlds because I do surgery and pro-cedures that are very, very technical, but I can still spend half my time in clinic, to be in a room with patients talking about their

bowel problem, indigestion, abdominal pain, bloating – all the human stuff – but I can still do the technical stuff.”

Back in school, when he started doing his rotations, he met a doctor who would be his mentor, Arvey Rogers, chairman of the GI department. Rogers gave him a valuable piece of advice: listen.

“There are a million things that have happened in my life that I don’t remem-ber,” Bierman said, “but I remember sit-ting there awed when he was talking about the average doctor interrupts their patient within 10 seconds of the conversation, and our real goal was to let the patient tell their story. Listening is 50 percent of the job. It’s something I do to this day, and I think it helps make me a good doctor.”

In his early days in Memphis, Bier-man and Jalfon comprised a two-physician practice downtown on Madison Avenue. Reluctantly, they eventually joined the healthcare migration to East Memphis. Over the years they expanded, adding four doctors, a surgery center and a his-tology lab, to the point where they could do virtually everything in-house. It was an efficient operation, but it wasn’t enough.

Insurance companies kept cutting re-imbursements. Medicare kept cutting fees. Modern-day healthcare realities began to sink in. After Jalfon tragically died in 2010, the practice was sold two years ago to Baptist Memorial Healthcare. Gastro-

intestinal Specialists Foundation is owned by Baptist Medical Group.

Selling the practice was “scary, scary, scary,” Bierman said. “But it turned out to be the best thing we could have done, in terms of healthcare, in terms of deliv-ery, in terms of insurance and economies of scale. Baptist has been an outstanding partner.

“Healthcare right now is very chal-lenging. We realized we could no longer sustain the services because the reimburse-ments didn’t cover the costs of all the em-ployees and equipment.

“What the government wants to do is form much larger units so there’s cost savings, where you’re part of a large or-ganization and you’re purchasing at such a volume that you get the most discount. We couldn’t do that as a six-man crew. I’m part of a 550-man group and we’re far more integrated now.”

For an East Coast guy, things could hardly have turned out better in Memphis. His three children are thriving – daughter Faryn, 25, lives in Jerusalem; son Logan, 21, just graduated from Indiana Univer-sity; and son Austin, 17, a junior at Lau-sanne Collegiate School, just went to the state lacrosse final.

“I have the best, most supportive wife in the entire world,” Bierman said, “and three amazing children. I couldn’t be me without them.”


Emphasis on InnovationA Look at the Tennessee Health Care Innovation Initiative

BY CINDY SANDERS

The move away from fee-for-service healthcare is sweeping across the coun-try as payers and providers come together to search for innovative ways to improve outcomes while lowering costs. With Tennessee’s robust resources, the state is well po-sitioned to take a lead role in transforming the delivery of healthcare.

“In 2013 Governor Haslam launched the Tennessee Health Care Innovation Initiative to move from volume to value,” said Brooks Daverman, director of Strategic Planning and Innovation for the Tennessee Division of Health Care Finance and Administra-tion (HCFA). “Our mission is to reward providers for the outcomes that we want – high quality and efficient treatment of medical conditions and better health over time.”

Key Stakeholders & BackgroundDuring a joint session of the Tennes-

see Legislature in the spring of 2013, Gov.

Haslam pledged Tennessee would be-come “a model for what true healthcare reform looks like.”

Central to achieving this goal is the involvement of key players representing payers, providers, patients and purchasers across the state. “We’re trying to create an aligned approach for all the stakeholders,” noted Daverman. He added that by late May 2015, he and his team had held more than 440 meetings with interested parties to share information and receive input. From consumer groups like the Common

Table Health Alliance to employer organizations including the Mem-phis Business Group on Health

and East Tennessee’s Health-Care 21 Business Coalition,

Daverman said payment reform could not occur in a vacuum.

Ongoing meetings with payers, providers

and workgroups are used to design strategies to be broadly implemented across the state. Routine meet-ings are held with major provider organizations in-

cluding the Tennessee Medical As-sociation (TMA), Tennessee Hospital

Association (THA), Hospital Alliance of Tennessee (HAT) and Tennessee Nurses Association (TNA), along with a host of specialty statewide organizations repre-senting family physicians, physician assis-tants, pediatricians, children’s hospitals, mental health organizations, primary care providers, and medical education. In ad-dition, Amerigroup, BlueCross BlueShield of Tennessee, Cigna, and UnitedHealth-care meet regularly with the team.

While the initiative took off in May 2013, Daverman said the roots of pay-ment reform go back even further to a vision task force, which included mem-bers of TMA, THA, Darin Gordon from HCFA, and others. “It was a group of likeminded, influential people in the state thinking about how we can move things forward in terms of healthcare payment and delivery,” Daverman noted. “I think the strategies we have chosen are all ones that were discussed in those meetings.”

As a result of stakeholder input, strat-egies in three key areas are being imple-mented: primary care transformation, episodes of care, and long-term services and supports. There is a Technical Advi-sory Group (TAG) for each strategic area to provide guidance on quality measures and program design.

Primary Care TransformationDaverman noted this component fo-

cuses on the “primary care provider – pre-venting illness, managing chronic illness and coordinating with other providers such as specialists.” He continued, “This is rewarding activities that are very impor-tant in primary care that aren’t necessarily paid for now.”

Daverman pointed out coordinating with a specialist takes time and effort for the primary care provider but isn’t nec-essarily reimbursable. Yet, the results of that coordination are often critical to a patient’s health.

“With all our strate-gies, we want to put the doctor in the driver’s seat,” he said. Daver-man added this focus on outcomes might require changes in communica-tion, clinic hours, phone staffing, and other pa-tient engagement ac-tivities in order to improve health and cut down on expensive emergency room visits. “If it results in better outcomes for quality and utilization, we want to reward that.”

Although he praised with work being done by ACOs, Daverman stressed the primary care transformation strategies are different and easily scalable. “All of our strategies are feasible for providers with-out making significant changes to business relationships,” he said.

The starting point is with patient centered medical Homes (PCMH), health homes for SMPI (serious and persistent mental illness) patients, and provider alerts for hospital and emergency depart-ment admissions, discharges and transfers. “We’ll start with about a dozen practices and want to go statewide within a couple of years,” Daverman said of program-ming, which is slated to launch in mid-2016.

Whether or not providers are in a

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BY SUZANNE BOYD

Standing on the sideline and com-plaining is taking the easy way out, says John Hale, MD. Taking a leadership role means you have no one else to blame but yourself, so after 24 years’ involvement in the Tennessee Medical Association, Hale knew it was time for him to take the reins as president. Leadership is nothing new to Hale, who started honing his leader-ship skills in high school when he was president of his class. In college he was ac-tive in student government. As president of the Tennessee Medical Association (TMA), Hale is working hard to make a difference while sharing his passion and belief in what the organization can do for physicians and patients across the volun-teer state.

Growing up in Halls, Hale’s first job at the age of 13 was picking tomatoes for $1.25 an hour. Since it was a typical sum-mer in the South, the temperature was scorching and the humidity was nearly 100 percent. “I would bring the tomatoes into the sorting shed where my great aunt Myrtle was,” said Hale. “She asked me one day what I wanted to be when I grew up. I told her I thought I wanted to be a lawyer to which she quickly replied that I would go to hell. Given the heat I was working in that was a pretty good indica-tor of what it may entail. She then said I was smart and encouraged me to be a doctor. I’m a firm believer in the good Lord, faith and callings. I can say God put medicine in my way and everyday has pointed me toward where I am today. Medicine is my calling.”

Hale opted for a cooler environment for medical school, graduating from Quil-len College of Medicine at East Tennes-see State University in Johnson City in 1988. He completed his residency in fam-ily medicine in Jackson at the UT Family Medicine Program in 1991. Hale began his medical career at the clinic where he still practices today, Doctor’s Clinic in Union City, a clinic with quite a legacy with TMA. Kelly Avery, MD, who had retired when Hale joined the clinic, had served as TMA president in 1970 and was instrumental in the development of the State Volunteer Medical Insurance Company. Many of the older physicians had served on the Board of Trustees and some had been chairman.

“I was by far the youngest physician at the clinic at the time and when it came to my joining the TMA, there was really not a choice. The older partners had all been active in it for most of their careers and they made sure my dues were always paid. I attended my first meeting three weeks after starting,” said Hale. “They engrained in me that this organization is the voice for doctors all across the state,

all that this organization has done for physicians and their patients as well as the importance of membership.”

When it comes to passing that philos-ophy on, Hale has done his part. “I try to do the same thing with any new physician we bring on staff, taking them to meetings and getting them involved. I think their eyes are opening up to what we are all about. I also encourage new members to attend our Leadership College, which is a great way to get an understanding of the TMA,” he said. “24 years ago, this orga-nization was pale and stale, but we have worked hard to overcome that. We don’t want to look to the past but rather build on it as we look to the future. We know as an organization it is important for us to connect with young physicians and fe-male physicians. In fact, the Chairman of our Trustees is a female as well as we have

our first female Speaker of the House.” Hale, who started attending an-

nual meetings in 1992, has followed in the footsteps of some of his mentors and has held various positions with TMA. “I started out being a judicial counselor, which hears complaints and governs the medical society on legal-type issues. I have served as Chair of the Young Physi-cians Delegates to the American Medical Association,” said Hale. “Additionally I have served on the Impact Board, both the Communications and Memberships committees as well as on the Board of Trustees. Before I ran for president, I was the vice speaker and then the Speaker of the House of Delegates.”

One has to wonder how a rural fam-ily medicine physician in a busy practice has time to not just be a member of TMA but to be president. Hale acknowledges that his level of involvement will take time from his busy practice and that not all his patients are thrilled at that. “Some of my patients are a little concerned about me taking this spot. They will congratulate me but ask if I am going to be out of the office,” he said. “I will be out one day a week except during our peak months. I have four wonderful partners who are willing to take up the slack and a very sup-portive wife and family. Without them, I could not do this.”

TMA was founded in 1831 by the state legislature and is committed to the health of Tennesseans. Hale says there are many things the TMA has champi-oned that have gone unpublished. “TMA works on a legislative basis on Capitol Hill. Often, it is due to our efforts that keep things we know are not good for

medicine from getting out of commit-tee. Legislators come to us seeking our opinions and asking our position on leg-islation. Sometimes they take our advice, sometimes they don’t. But if we don’t have someone speaking for us things would be a lot worse. Just think of the impact we could have if every physician belonged to organized medicine,” he said. “We’ve been a voice on tort reform, led a coali-tion to get caps on malpractice rates. We have a physician present at every meeting on the Health Initiative and are work-ing with the Governor on what quality medicine is that is not based on econom-ics. There are lots of issues we have been a catalyst in that many do not know our level of involvement on.”

One area Hale knows organized medicine could have had a bigger impact is the adoption of electronic medical re-cords. “We started using them about a year and a half ago. It puts up a barrier to the patient. When I walk in a room I have a laptop with me and apologize to the patient that I have to login before we start,” said Hale. “I try to make sure they understand the good aspects of it but the bad thing is it does take some of my at-tention away from the patient. Commu-nication is vital. Patients today are better educated and want to be informed. You have to embrace them in the decision making process so they understand their options.”

Many doctors are frustrated with how tough the practice of medicine has become; so much so that many are sell-ing their practices to large organizations to avoid having to deal with the business

West Tennessee Physician Takes TMA HelmJohn Hale Displays Dedication to Practice of Medicine



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PCMH, those who sign up can tap into the web-based statewide alert system. “We’re going to work to have real-time notices every time a patient goes to the emergency room of a hospital,” Daver-man said of the data being populated by participating payers. In addition, he said the system would be able to generate a ‘gaps in care’ report and alert providers to their patients’ drug fills. “It’s really, really important information to have if you want to manage your patients.”

Episodes of Care“This is the strategy that’s the furthest

along,” Daverman noted of aligning in-centives with desired outcomes. Episodes reward high quality care, promote the use of clinical pathways and evidence-based guidelines, and encourage coordination to reduced ineffective or inappropriate care. Under the initiative, episode-based payment is being rolled out in waves with the goal of implementing 75 episodes by the end of 2019.

Wave 1 launched in May 2014 with three episodes of care: acute asthma ex-acerbation, perinatal, and total joint re-placement. For six months, more than 500 providers received detailed preview reports from TennCare and commercial payers before the wave went live in 2015.

“Providers are getting new informa-tion they’ve never had before in quality reports,” Daverman explained. “They can see how they compare to their peers on cost, and we break down those costs into categories to make it actionable.”

He continued, “Providers who have the most expensive average episode cost for the year across the state are penalized by a portion of their excess cost.” How-

ever, Daverman noted, the threshold for a penalty is set pretty high and is considered only after adjusting for exclusions such as high-risk patients or extraordinary events. Ultimately, the projection is the most ex-pensive 10 percent of providers will face a penalty. On the other hand, he said, “It’s very important we reward providers who meet quality measures and provide efficient care with shared savings.” Daver-man predicted, “The majority of providers will have no change or will get rewarded.”

Preview reports for Wave 2 – acute COPD exacerbation, screening and sur-veillance colonoscopy, outpatient and non-acute inpatient cholecystectomy, and acute and non-acute PCI – began at the end of last month. The advisory group has just completed their process for Wave 3, which will roll out preview reports next year and go live at the beginning of 2017.

Long-Term Services & SupportsDaverman said the main premise of

this strategy is to tie payment to quality and acuity. “Some of the measures are around the patient experience, and some of the quality measures are around the caregivers,” he said.

Key points include implementing quality- and acuity-based payment for nursing facilities and home- and commu-nity-based services, value-based purchas-ing initiatives for enhanced respiratory care, and focusing on workforce develop-ment.

More InformationDetails on each of the strategies is

available online in the Strategic Planning and Innovation Group section of HCFA at tn.gov.

Emphasis on Innovation, continued from page 4

side of medicine. “I know there are doc-tors reading this that can identify with this,” said Hale. “We have lost a lot of independent doctors because of the pres-sures that providing efficient quality med-icine causes. The practice of medicine is so tough that you need group mentality to survive it seems. Our practice sold to Baptist. That arrangement has allowed us to have a new building and implement EMRs, which we could not have afforded otherwise. We have a great relationship with them and it has been a good thing.”

While preparing to take over as president, Hale participated in a transi-tion meeting where he was asked what he wanted to do over the course of his presi-dency. “At first I thought ‘oh my good-ness what have I gotten myself into,’ then realized the awesome responsibility I had placed upon me to serve as president of the voice for patients and doctors in this state,” said Hale. “Fortunately I have a lot of folks who will help me maintain this or-ganization and deal with the many issues we have ahead of us such as payment re-

form, scope of practice, the health initia-tive and telemedicine. I think my biggest goals are to be a voice for physicians and our patients, keep the organization mov-ing forward and to educate physicians on the value of membership in the TMA.”

In keeping with the changing land-scape of healthcare, Hale plans to speak to large groups that are buying up prac-tices and large practice groups across the state to see what they can achieve as a group. “Large groups are where a lot of medicine is heading and TMA needs to address the needs of these entities without sacrificing those of individual physicians and independent group practices,” he said. “The basis is quality medicine. With health initiatives we have to talk econom-ics and quality in the same sentence. We cannot continue to put as much in health-care as we do but we cannot afford to sac-rifice quality.”

TMA is also working to be more accessible to doctors, especially those in rural areas. “We are trying to go where the doctors are rather than have them come to us,” said Hale. “We are tak-ing our ICD-10 seminars as well as our prescribing lectures on the road so that rural areas have easier access to them. We are also trying to capitalize more on the eight regions across the state and go with a more regional model that include the metro areas and then combine the rural areas outside those to make them not only more effective for the TMA but physi-

cians as well.” With a goal a making TMA a value

based membership that is tangible to all, Hale wants doctors across the state to be proud of their organization and encour-ages members to wear their membership pins everyday. “So often patients believe the stereo typical idea that all doctors have fancy cars, a big house, belong to country clubs but when you ask them about their doctor, they will say he is car-ing, listens and is such a blessing to my family,” said Hale. “The same is true about the TMA, physicians may not re-ally think there is benefit to membership but when you wear your pin it can start a conversation about what the organiza-tion can do for not only doctors but pa-tients as well. Wearing your membership pin signifies that you are committed to quality healthcare and want the best for patients.”

To physicians who are not active and wonder why they should join, Hale says give him five minutes. “I can tell them what TMA has done for them in the past five years alone. What we have done in regard to tort reform alone saves them each year three times the cost of mem-

bership,” he said. “You may think that all it takes to practice medicine in Tennessee is to go to med school, get licensed and be board eligible but it actually only takes so many votes in the legislature. We fight ev-eryday to make sure that folks who have not gone to medical school cannot get in on the practice of medicine. Without the TMA there would be so many more bar-riers between the patient and the physi-cian than there already are. There is a lot more interference in medicine today, which frustrates many doctors but the only way we can move forward and con-tinue to advocate for patients is through membership in TMA.”

When asked why he is so active and involved, Hale says simply someone has to do it. “The TMA is so important to me and I am not being cliché when I say it is such an honor for me to serve and it is something I really wanted to do,” he said. “So often doctors believe they need to just keep their CME’s up, do good work and go home but there are a lot of outside influences affecting patient care. TMA helps control those outside influences. It is a calling and we have to advocate for our patients and fellow physicians.”

West Tennessee Physician Takes the Helm, continued from page 5

Bill Appling’s Medical Economics column doesn’t appear this month because he’s enjoying a vacation. Bill will return in July.


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Nine months after re-ceiving a federal grant to study how a current drug can be used to inhibit the growth of cancer cells in the prostate, a Mid-South re-searcher is one step closer to a possible breakthrough.

The Department of Defense awarded $562,500 last September to Subhash Chauhan, PhD, a profes-sor in the Department of Pharmaceutical Sciences in the College of Pharmacy at the University of Tennes-see Health Science Center, to research new therapies for advanced-stage prostate cancer.

The key to the study is to determine whether a drug called Ormeloxifene, a non-steroidal oral contraceptive, can be repurposed to inhibit the growth of ad-vanced-prostate cells and to treat meta-static prostate cancer.

“Our goal is to inhibit the wnt/beta-catenin signaling pathway so we can in-

hibit other downstream cancer-causing cellular pathways, block metastasis and stop the cancer from spreading,” Chau-han said. “Ormeloxifene is already in human use for a different purpose in 28 countries worldwide. If everything goes OK, then its translation to human use will be easy compared to a newly discovered treatment modality.”

According to Chauhan, Ormeloxi-fene, a birth control drug primarily used

in India, suppresses cell proliferation in the uterus for fertilization. He suspects that the drug will inhibit the growth of cancer cells in the prostate.

“Prostate cancer is the most commonly diagnosed cancer in men and the sec-ond-leading cause of cancer death in the United States,” Chauhan said. “Detection of the cancer is easy through existing diagnostic methods, but treatment is difficult.”

Current treatment for advanced-stage prostate cancer occurs either by sur-

gically removing the tumor or through chemotherapy.

According to Chauhan, surgery does not guarantee that all of the cancer can be removed if it has spread to other parts of the body. In addition, he said, chemother-apy, although the most common method used to treat cancer, has not proven to be very successful for metastatic prostate cancer.

The study, which Chauhan labeled

“A Novel Therapeutic Modality for Pros-tate Cancer,” focuses on the treatment of metastatic prostate cancer, which occurs when cells break away from the tumor in the prostate. The cancer cells can travel through the lymphatic system or the bloodstream to other areas of the body such as the bones, liver or lungs.

The American Cancer Society states that one in seven men are diagnosed with prostate cancer in their lifetimes. Prostate cancer is rarely found in men before age 40, while six in 10 cases are diagnosed in men 65 and older. The average age at the time of diagnosis is 66.

Also, the American Cancer Society estimated that roughly 233,000 men in the United States will be diagnosed with prostate cancer this year and 29,480 will die from it.

The grant, called the “Prostate Can-cer Idea Development Award,” supports new ideas that represent innovative ap-proaches to prostate cancer research and have the potential to make an important contribution to the field of prostate cancer research.

“The process is very competitive, and

Researcher Optimistic About Prostate Cancer StudyOral Contraceptive Ormeloxifene May Inhibit Growth of Cells

Dr. Subhash Chauhan



The changing health care landscape and the Affordable Care Act have made the term “medical home” part of the health care vernacular. Regional One Health has taken this concept to a new level as they near completion of a “medical neighborhood” on their east campus at 6555 Quince Road. Set to open in July, the health system is occupying 50,000 square feet of space to house outpatient rehabilitation, internal medicine, cardiology, endocrinology, rheumatology, reproductive medicine, urogynecology, imaging and a pharmacy.

“We are creating an innovative model, providing access to a modern and convenient health care campus where you not only go for your primary care but your specialty appointments too,” said Reginald W. Coopwood, MD, chief executive officer, Regional One Health. “To be able to take our world-class expertise and offer services in another geographical location I think will greatly benefit Memphis as we introduce a different model for delivery of outpatient services.” According to Bret Perisho, Regional One Health chief business development officer, accessibility was a large factor in choosing the location. A study performed by the hospital system indicated 900,000 people can drive to the 6555 Quince location in 20 minutes or less. Easily reachable on 385, it is also convenient for Mississippi residents driving to Memphis on Riverdale Road.

Area physicians will be able to refer patients to the multidisciplinary clinic, women’s services and rehabilitation services. Regional Medical Center, the flagship acute care hospital of Regional One Health, will remain in its current location. No inpatient beds are planned at the east campus.

The facility will have the first multidisciplinary rehabilitation center of its kind in Memphis, offering traditional orthopedic therapies and neurologic therapies, as well as pain management and a massage therapist working in step with physicians. The multimodal approach will also provide a platform for University of Tennessee faculty-appointed physicians to study the delivery model alignment and health outcomes. “It will create a continuum of rehab, servicing people discharged from inpatient facilities that need to have continuing outpatient care, those with ongoing pain management issues, or even someone who had a stroke two years ago who is trying to improve their balance,” said Perisho.

A newly constructed drop-off and canopy area will usher patients into the building at the main entrance. The lobby will be a bright, open space shared by services on the ground floor, creating a boutique hotel lobby experience when the patient enters. Cardiology, endocrinology, rheumatology, reproductive medicine, urogynecology, primary care, internal medicine, imaging, rehabilitation and pharmacy will cohabitate with the ability to work on the same technology platform. “This allows for sharing of patient records across practice sites for seamless transitions and information sharing. The design of the multispecialty clinic will facilitate consults with other physicians while the patient is visiting their original physician,” said Dr. Coopwood.

“In the changing health care market place, which is intensified by the Affordable Care Act, the care delivery models are changing and shifting, more rapidly, outside of the traditional hospital walls; people are looking

for non-traditional models for their health care services in an ambulatory setting,” Perisho said.

“The long range goal is to help individuals manage their health so that preventable hospitalizations are avoided. We believe this is the future of health care.”

Revenue gained from the new venture will go back into the health care system. “When we look at the reimbursement challenges hospitals are facing, it is imperative that we be able to create delivery models to manage the health care needs of individuals in a convenient, quality-focused and cost effective manner. It is the new norm in health care,” said Tish Towns, senior vice president, external relations. “We have to do something different if we are to maintain access for all of those in our community. The evolving health care paradigm dictates new models, strategies and quality outcomes if a health care system is going to be a sustainable and viable entity going forward. Our historic commitment remains strong and a vibrant part of the woven and intricate fabric of Regional One Health.” Long-term plans for the east campus include adding other specialties and services, and exploring the feasibility of building an outpatient surgery center or medical office building on the 35 acres of land Regional One Health owns west of the current structure. Repositioning the health system as an organization of choice, capable of expanding and serving a larger sector of the community, is the goal for Regional One Health. “Our mission is to help our community be healthier,” said Dr. Coopwood. “Historically, our community has been defined by our geographic location, but our real community is the whole Memphis area. This move aligns very well by expanding our reach further into the community we call the Mid-South.”

REGIONAL ONE HEALTH OPENS EAST CAMPUS

T H E M E D I C A L N E I G H B O R H O O D


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Explore your cognitive health.Contribute to scientifi c dicovery.

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Cognitive \käg-ne-tiv\ adjective:relating to conscious intellectual activity, such as thinking, reasoning, or remembering

Now recruiting healthy senior participants for an important clinical research study

WHAT IS MILD COGNITIVE IMPAIRMENT (MCI) DUE TO ALZHEIMER’S DISEASE (AD)?MCI due to AD refers to the early phase of AD in which an otherwise healthy-minded person experiences a gradual, progressive decline in thinking ability. This decline is signifi cant enough tobe noticed, but not severe enough to interfere with daily life or the ability to function independently.


WHAT IS THE TOMMORROW STUDY?The TOMMORROW study seeks to learn more about the genetic risk for developing MCI due to AD and whether an investigational medication might prove effetive in delaying the fi rt symptoms of this condition.With the chance of you or someone you know developing AD, why not participate in clinical research to help our understanding of this disease?


• 65 to 83 years of age • In good physical and mental health

Copyright ©2013 Takeda Development Center Americas, Inc. All rights reserved.

USA_ENG_E6005POSTER_10_3_2013

WANT TO learn more?CAll 901-848-7411 OR VISIT WWW.TOMMORROWStudy.COM

WHAT IS MILD COGNITIVE IMPAIRMENT (MCI)DUE TO ALZHEIMER’S DISEASE (AD)?MCI due to AD refers to the early phase of AD in which an otherwise healthy-minded person experiences a gradual, progressive decline in thinking ability. This decline is signifi cant enough tobe noticed, but not severe enough to interfere with daily life or the ability to function independently.


WHAT IS THE TOMMORROW STUDY?The TOMMORROW study seeks to learn more about the genetic risk for developing MCI due to AD and whether an investigational medication might prove effetive in delaying the fi rt symptoms of this condition.With the chance of you or someonevyou know developing AD, why not participate in clinical research to help our understanding of this disease?


• 65 to 83 years of age

• In good physical and mental health

BY PEGGY BURCH

Conversations about sexual dysfunc-tion between men and their doctors once were strained and diffi cult, if they took place at all. Now urologists fi nd they can hardly avoid requests from their patients for common erectile dysfunction (ED) drugs such as Cialis and Viagra.

“Men are much more open about talking about erectile dysfunction than they were 15 years ago, 10 years ago,” said Robert W. Wake, MD, professor and chairman of the Department of Urology at the University of Tennessee Health Sci-ence Center and residency program direc-tor. “It’s no longer a taboo subject at all.

“It’s very common, even when they bring in their wives. And sometimes if they don’t mention it, the wives will say, ‘Remember you wanted to talk about that other thing?’ . . . Often wives want to take control of the samples.”

Doctors say easy access to informa-tion about ED on medical sites such as WebMD, as well as the prevalence of tele-vision ads for Cialis and Viagra, make it easier for patients to bring up the subject. (Some of the TV ads are so provocative, critics say, they shouldn’t be watched by children. One contributor to Forbes mag-azine called on Viagra to withdraw one of its ads last year, writing that a message featuring a blonde on a bed had strayed too far from the “initially subtle” TV cam-paigns that employed spokesmen such as former U.S. Sen. Bob Dole, who had un-dergone a prostatectomy.)

Wake called the new dialogue a healthy one for men.

“We’re happy about that,” he said. “The majority of patients between the ages of 40 and 80 years old are interested in getting information about ED drugs. Their interest allows the physician to have a realistic discussion about which patients would benefi t from these medications ver-sus those patients who may just want it as a performance enhancer, which is not the intent for these ED drugs.”

David A. Gubin, MD, of The Urol-

ogy Group, with offi ces in Memphis and Southaven, called the request for samples “universal” among his patients.

“It doesn’t matter what the reason was they came in the offi ce to see you, the last thing they ask when they leave the of-fi ce is, ‘Hey, doc, you have any samples of some of those drugs?’” Gubin said. “They can come in for kidney stones, doesn’t matter what the issue is, univer-sally I would say, they’re always asking. People have heard so much about it now that they’re very curious, and they want to experiment or try it.”

The downside is that the drugs cost $20 to $30 a pill, he said.

Insurance companies commonly don’t cover the cost of pills for sexual dys-function issues, Wake said. But the U.S. Food and Drug Administration has ap-proved a low dose of Cialis for daily use to treat prostate enlargement -- or be-nign prostatic hyperplasia (BPH) – which can cause lower urinary tract symptoms including frequent or urgent urination, weak fl ow and straining to void. Insurance will pay for that treatment.

“People who have LUTS second-ary to BPH often have associated ED,” Wake said. “The exact relationship is not known, but both can be associated with aging due to hypertension, vascular dis-ease, diabetes and other co-morbidities often seen as we age.”

While the on-demand dose for ED drugs is 10 to 20 milligrams with Cia-lis and Levita and 50 to 100 milligrams for Viagra, when patients used a 2.5- or 5-milligram daily dose of Cialis, Wake said, “They saw that it did have some ef-fi cacy in the lower urinary tract symptoms (LUTS) and it also had the benefi t of help-

Arrival of New ED Drugs Helps Ease Doctor-Patient Conversation

Dr. Robert W. Wake



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First the good news … providers are generally excited about the idea of mov-ing to more holistic, integrated care with a focus on prevention, quality and out-comes. Now the not-so-good news … we have to figure out how to pay for it.

“Providers are on board for the po-tential benefits from changes to the way we provide care, which is different from the way we pay for care,” noted Dion P. Sheidy, a part-ner in KPMG’s Health Care Advisory Practice. “This is a little bit of the elephant in the room.”

Nashville-based Sheidy said the Cen-ters for Medicare and Medicaid Services have stated their plans to significantly increase value-based payments to provid-ers over the next few years. In a fact sheet released in late January, CMS noted im-proving quality and affordability of health-care was as much a pillar of the Affordable Care Act as expanding access. The goal, the memo continued, is to reward value (measured by quality of outcomes) and care coordination and efficiency rather than volume and duplication. To that end, the Department of Health and Human Services has adopted a framework of four categories of payment:

• category 1: fee-for-service with no link of payment to quality,

• category 2: fee-for-service with a link of payment to quality,

• category 3: alternative payment models built on fee-for-service ar-chitecture, and

• category 4: population-based pay-ment.

Value-based purchasing includes payments in categories two through four. The stated goal is to have 30 percent of Medicare payments in alternative pay-ment models (categories three and four) by the end of 2016 and 50 percent by the end of 2018. Additionally, HHS hopes to have 85 percent of Medicare fee-for-ser-vice payments in categories two through four by the end of 2016 and 90 percent by 2018.

“Although they have put that out there, they have yet to put out guidance about how they expect to achieve it,” noted Sheidy. “These are huge jumps. We’re going to go from less than 10 per-cent in fiscal year 2015 to 90 percent with some link to quality in fiscal year 2018.”

Sheidy added there is some ambigu-ity as to what CMS calls ‘alternative fee arrangements’ and that at this point there are a lot more questions than answers. While he doubts normal market forces would push payment reform fast enough to hit the HHS targets in the next three years, he said regulatory changes could be the driver to hasten the transition to value-based payment.

“There are elements of the Affordable Care Act that have some pretty significant unknowns attached such as the Cadillac tax,” he continued. The chief unknown, he continued, is “Does the Cadillac plan tax survive and get implemented as it stands today?” That question, he added, probably won’t be answered until after the presidential election.

The 40 percent excise tax, which is

currently scheduled to go into effect in 2018, is levied on healthcare benefits that exceed certain pre-set limits. Despite the name of the tax, Sheidy said its impact would be felt far beyond affluent circles. In fact, the thought is that a significant num-ber of employers could wind up incurring the tax. “This cuts across political parties when it comes to the impact of this,” he said, noting teachers, labor unions and

public officials often have strong health-care benefit packages. “You’re talking about having an excise tax that indirectly impacts a significant amount of the popu-lation through employer-provided ben-efits.”

He continued, “If this Cadillac tax survives, employers are going to be faced with having to change benefits, maintain

The Competing P’s: Provision & PaymentChanging reimbursement for new models of care

Dion Sheidy



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physicians who do their job to care for pa-tients rather than just to make money, it puts such a different perspective on what you do.”

The Saint Francis system’s adherence to Catholic values was also important to Hammond. “I’m not a Catholic, but my wife and I are very religious,” he said. “So praying before board meetings and medi-cal meetings and in staff meetings . . . that deeply ingrained culture here was very at-tractive to me.”

A native of Hattiesburg, Mississippi, Hammond started his career in Florida, where for several years he played golf competitively, “but never at Tiger Woods’ level,” he joked. After earning undergrad-uate and MBA degrees at the University of South Florida, he put them to work restor-ing profitability for a St. Petersburg auto-motive group and implementing a lean Sigma Six approach. (Six Sigma is a set of techniques and tools developed in 1986 and still widely used today for process im-provement.)

Hammond grew up in a medical en-vironment; his father served as physician and healthcare executive for more than 25

years. So when Florida’s economy suffered in 2008, the younger Hammond saw an opportunity.

“I knew there was, and probably always will be, a strong future in health-care,” he said, “even with the uncertain-ties of which way healthcare is heading. So I called my father and said I was ready to get into healthcare, if he would help me.”

The doors the elder Hammond opened led to growth positions with Health Management Associates, Inc., serving Mississippi hospitals in Brandon and Amory (as associate administrator and chief operating officer), and, most recently, to the COO role at Centen-nial Medical Center in Frisco, Texas — a Tenet Healthcare Corporation facility in the Dallas-Fort Worth metroplex.

One of the top challenges he faced when he joined the Saint Francis family last November was a need to differenti-ate the hospital from competitors such as Methodist and Baptist, which boast a sig-nificantly larger share of the market.

“We set out on a mission to change the culture in the operating room,” Ham-

mond said. “We want to be the easiest place to operate, the easiest place for a surgeon to come do his cases in the city.”

In conjunction with that mission, he’s striving to enhance a reputation: “We don’t provide services to our patients, we create experiences.” The goal is to make those experiences so noteworthy that pa-tients will serve as ambassadors, sharing those experiences with others.

Another continuing challenge is staffing, especially regarding nurses, he explained. “Nurses can dictate where they want to go nowadays — they are a rare commodity. There aren’t enough nurses coming out of school to keep up with the demand. In an ever-changing paradigm, it gets more and more difficult to compete with the agencies who are of-fering nurses to be travelers to take 12- to 16-week assignments — at astronomical rates” sometimes between two and three times the hospital’s normal base rate of pay.

His solution to addressing the nurs-ing shortage involves consistent creativity regarding staffing strategies and helping nurses feel like a vital part of the organi-zation. The plusses that Saint Francis of-fers them include those family-style values that impressed Hammond himself and at-tracted him to the job.

“Once nurses are on the floor and shoulder to shoulder with their co-work-ers, those nurses definitely stay,” he said. “Those numbers are reflected in our re-tention and turnover rates. We measure our turnover annually, and we’ve gone from about 18 percent total facility turn-over to less than 10 percent annually in the last 14 to 16 months. So that culture is certainly embedded here.”

When the hospital celebrated its 40th anniversary in December, “I was blown away by the number of current active em-ployees that turned 40 with us!” he said. “They have a long tenure here — more than I’ve ever seen anywhere else.”

Hammond described an initiative

that would create a more horizontal infra-structure regarding frontline staff, allow-ing them to be part of the solutions to their day-to-day issues, and consequently allow the organization overall to work leaner and smarter.

Other initiatives are still in develop-ment, pending new and rapidly changing regulations. Indeed, much of his job seems to focus on keeping up with multiple and changing aspects of planning and manage-ment — plus being visible, accessible, at-tentive and responsive to the concerns and needs of surgeons and staff.

“My greatest accomplishment,” he said, “is setting an example for those that I work with — showing that you can truly bring the faith you demonstrate to your family into the workplace and still have your family values there. You don’t have to be two different people at home versus at work.

“Physicians who come here will in-stantly find credibility and comfort, know-ing that your patients are in good hands — because the providers and nursing staff taking care of patients here do it because they care about what they do. It’s not just a job.”

‘Different Culture’ Helped Lure New COO to Saint Francis, continued from page 1

only 10 to 15 grants are awarded,” Chau-han said.

Chauhan and his team of four re-searchers must submit a progress report to the DOD at the end of every year over the three-year period as part of the grant’s funding requirements.

Testing for the study takes place on the University of Tennessee Health Sci-ence Center campus. Mice are injected with Ormeloxifene in a vivarium and monitored to see how the drug affects the cancer. If this proves to be successful, Chauhan and his team will try to procure funding to do additional testing once the initial study is complete

Chauhan is hopeful that Ormeloxi-fene will be the breakthrough needed in the treatment of metastatic prostate can-cer.

“I suspect the drug will stop the can-cer from growing and the results will be that the cancer will die easily,” Chauhan said. “If our findings prove to be success-ful, this drug could be in human hands in the next five to seven years.”

Chauhan received his doctorate in reproductive endocrinology from the Central Drug Research Institute in India. He has been an independent faculty pro-fessor for nine years at various medical institutions in the United States. He re-located to Memphis and began a stint at UTHSC two years ago.

“We have been very pleased with the results so far in our research,” Chauhan said. “There has been positive data and it shows promising results. We are very excited.”

Researcher Optimistic,continued from page 8


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Most medium to large-scale health care projects require a combination of various monetary resources to fill a variety of financial gaps. Today’s traditional capital sources are not sufficient for project costs without a tremendous source of public funding and/or private equity. Obtaining certain subsidies, credits or grants in connection with these economic development projects can often be the financial difference-maker for an otherwise viable project.

Upon learning that New Markets Tax Credit (“NMTC”) financing can create as much as a twenty-five percent subsidy for their project costs, many of our health care clients initially ask, “What’s the catch?” While NMTC transactions involve a competitive marketplace for allocation and are more complicated than more conventional financings, borrowers that reach financial closing are greatly rewarded.

New Markets Tax Credit ProgramThe New Markets Tax Credit program was enacted as part of the Community

Renewal and Tax Relief Act of 2000 (P.L. 106-554, 113 Stat. 2763) and is designed to encourage new private sector investments in low-income communities. NMTCs are allocated by the Community Development Financial Institutions Fund, a bureau within the United States Department of the Treasury that runs the NMTC program, under a competitive application process.

Corporate taxpayers may participate in the NMTC Program by receiving a credit against federal income taxes for making qualified equity investments in designated community development entities. The credit received is equivalent to thirty-nine percent of the investment and is utilized over a seven-year period (five percent for the first three years and six percent for the four remaining years). These investments are typically leveraged with various types of secured debt (e.g., conventional lending or bond financing) or affiliate debt, which allows the tax credit investor to receive the NMTCs on the equity/debt combination. The resulting subsidy to a project generated from the monetized NMTCs can amount to as much as twenty to twenty-five percent (of the total cost of the project.

Geographic Qualification Through Census In most cases, the NMTC program utilizes geographic qualification based

on the census tract location of the project. In other words, the first step to determine whether your project qualifies for NMTCs is to identify the location of the project and whether it is located in a “qualified census tract.” Qualifying census tracts have either a poverty rate of at least 20 percent or a median family income below 80 percent of statewide median income or area median income, whichever is greater. While a census tract will qualify if it meets one of the above criteria, most projects that receive NMTC allocation are located in census tracts with characteristics evidencing a higher level of distress such as a median family income less than 60 percent, a poverty rate greater than 30 percent and an unemployment rate at least 1.5 times the national average. In fact, more than 70 percent of NMTC investments have been made in highly distressed areas.

The NMTC program has proven to be an effective means of rebuilding economically distressed communities, and new and rehabilitated projects are being developed throughout the country as a result of the program, including health care facilities and hospitals. NMTC financing can be used for real estate acquisitions, site prep, substantial rehab, new construction, equipment and soft costs and working capital. Typically, projects should have costs of at least $5 million in order to attract adequate interest from investors.

Benefits Public & Private Health Care CompaniesBoth public and private health care companies can utilize the NMTC program.

For public hospitals and health care facilities, the governmental authority may utilize NMTCs by creating a non-profit public benefit corporation to lease and develop the real estate and construction. NMTC financing has been utilized for numerous public and private health care companies across the country.

In summary, the NMTC is a non-refundable tax credit designed to encourage private investments in eligible low-income communities. As a general rule of thumb, the resulting subsidy to a project generated from the use of NMTCs can amount to as much as 20-25 percent of the total cost of the project. In other words, every dollar generated in equity from the NMTCs is a dollar saved for the project borrower. Because NMTCs provide a substantial current and long-term subsidy to the construction and operation of a project, every medium to large-scale health care project in a qualified census tract should consider NMTCs as an alternative source of financing.

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ing their erectile dysfunction.” He emphasized that low-dose Cialis is

not the common treatment for LUTS. “It does have some efficacy, but it’s certainly not as good as the first line treatment, which is the Alpha blockers that every-body’s familiar with -- Flomax, Uroxatral.” In his practice, 90 percent of BPH patients are treated with the standard Alpha blocker therapy. “And then they’re treating their erectile dysfunction on demand. So they’re not using the daily dose.”

Men may put up with a headache, facial flushing and nasal congestion when they use ED drugs on demand, Wake said,

but it’s a different lifestyle choice if they take the daily low dose of Cialis. They might have continuous side effects while not treating their urinary tract symptoms as well as they could with Flomax.

Doctors have to oversee the ED pre-scription process carefully, Wake said. “If they think they’re functioning pretty good, then they see how good they can function on (ED drugs), they think they need it all the time, so you’ve got to be very careful,” he said. “In that 50-to-70 age group, al-most any of them will say, ‘Yeah, I’m not like I was – could I be?’ And the medica-tion can do that.”

The Mayo Clinic’s website points out, “In most cases, erectile dys-function is caused by something physical.” Among the common causes the clinic lists are heart disease, atheroscle-rosis, high cholesterol, high blood pressure, dia-betes and obesity, as well as treatments for prostate cancer and enlarged prostate. Psychological causes of ED include de-pression, anxiety and stress.

“Usually erectile dysfunction is a

sign of underlying issues,” said Gubin, of The Urology Group. “Penile arteries are smaller than the heart arteries, so where are you going to have issues initially show up? People who are diabetics, or have hy-pertension, et cetera, will show up with is-sues of erectile dysfunction, and that may be an underlying sign.

“So patients who come in complain-ing of that, one thing the doctor should do is see that they have a routine physi-cal and see their primary-care physician and make sure that nothing underlying is being missed. Psychological issues also do play a role, obviously. I don’t think we understand everything associated with sexual dysfunction.”

Arrival of New ED Drugs Helps Ease Conversation, continued from page 10

Dr. David A. Gubin

benefit levels under a different cost struc-ture, or pay the tax.” Sheidy added that since there doesn’t seem to be much en-thusiasm for paying the tax, employers are going to look at how to bend plan design or the cost curve and will be more willing to consider value-based network designs.

“The government … through state-ments around the move to the 80 percent (value-based purchasing) along with the continuing lingering effects of the Afford-able Care Act … has really set the industry up for the opportunity for some significant impact on payment reform over a fairly short time frame,” he noted. “On the payer side, CMS is looking to change the payment mechanism. On the commercial side, we’re looking at the Cadillac tax and how to get costs under control. And all of those things share the potential to come into play over the next several years. It’s almost like the perfect storm.”

It’s not that the industry hasn’t taken any steps to prepare for a move to a differ-ent type of payment mechanism. Sheidy said the industry is already involved in demonstration projects, quality reporting and capturing data points. However, he pointed out, the true impact on payment of all that collection and monitoring is still pretty narrow.

“People confuse population health with risk and payment,” he said. Now, we’re at the intersection of how to more effectively, efficiently manage the health of a population while simultaneously figur-ing out how to link payment to these new practice models.

While the industry has floated along with a foot in both the fee-for-service and value-based worlds for quite a while, Sheidy said the drivers are now in place, barring any changes, to force the movement to a more outcomes-based payment methodol-ogy in a very short window of time.

The Competing P’s, continued from page 11

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BY JULIE PARKER

The most influential demographic group – millennials, ages 21-32, em-powered by advances in technology – is turning America’s healthcare landscape upside down.

In a recently released survey com-missioned by PNC Healthcare, more than 5,000 participants nationwide ex-plored the impact of patient-centered care among various age groups, including millennials, Generation X or Gen-Xers (ages 33-49), baby boomers (ages 50-71) and seniors (72+). The most significant finding: online shopping for doctors, web-based diagnostic tools and research about treatment options have a role in health-care decisions for millennials, replacing the single-source, primary care physi-cian (PCP) favored by older generations. “As millennials overtake boomers as the nation’s biggest consumer buying group, they will expect more efficient ways to make healthcare payments via digital channels that are consistent with their ex-periences in other industries,” said Shane Print, vice president of PNC Healthcare for Florida, Alabama and Georgia. “It’ll be important for payers and providers to work together to meet these payment expectations by progressing further along the technology continuum, especially con-sidering that much of the growth in the healthcare payments industry has been driven by a rise in patient responsibility. Those insurers and healthcare providers that thrive will be those that adapt sooner than later to the preferences of this fast-paced, technology-driven generation.” Growing trends among the millennials that are driving change in healthcare in-clude:

Speedy deliveryWhen it comes to the drive-thru gen-

eration, millennials prefer retail (34 per-cent) and acute care clinics (25 percent) double that of boomers (17 and 14 per-cent, respectively) and seniors (15 and 11 percent, respectively). On the flip side, seniors (85 percent) and boomers (80 per-cent) visited their PCP significantly more than millennials at 61 percent.

For example in Florida, Print noted that urgent, specialty and retail clin-ics over the last four years have grown dramatically. “Quick Care” availabil-ity has been recognized as a top priority by many healthcare organizations, and even large retailers and several phar-macy chains. Millennials expressed con-cern about this method of care and the quality of the patient’s care, based on who’s consulting with the patient (level of education), possible lack of patient’s accurate healthcare background, and pressure of being a “quick appointment.”

Word-of-mouth marketingNearly 50 percent of millennials and

Gen-Xers use online reviews, such as Yelp and Healthgrades, when shopping for a healthcare provider, compared to 40 per-cent of baby boomers and 28 percent for seniors.

“The timely management of so-cial media is critically important to the growth and success of healthcare,” said Print. “Bad patient reviews can come too easy, so making sure positive reviews

greatly outnumber the negative ones is a constant challenge for all practices. Get-ting happy patients engaged with sharing their positive experience will continue to be important for a practice’s success.”

Kick the tires online before buying

Half of millennials and 52 percent of Gen X-ers checked online informa-

tion about their insurance options during their last enrollment period, compared to 25 percent of seniors, who prefer printed materials (48 percent) or a company rep-resentative (38 percent) before selecting their plan.

Good faith, upfront estimatesOne of five people surveyed by PNC

Five Ways Millennials Have Shaken Up Healthcare



at Baptist Memorial Hospital-Memphis. “Doctors, patients, politicians, the media – everyone is looking into this situation to see what’s going on.”

What’s going on is that patients are spending more – much more – on pre-scriptions.

According to Truveris, a firm that an-alyzes prescription drug pricing, last year patients spent nearly 11 percent more for name brand and generic drugs than they did in 2013. More recently, a study by the IMS Institute for Health-care Informatics showed an even higher increase, indicating that spending on medicine in 2014 jumped 13.1 percent over 2013 levels, the highest rate since 2001 when spending growth jumped to 17 percent.

Key findings of the IMS report show:• Spending on new brands in-

creased by $20.2 billion in 2014, triple the previous level.

• Over 161,000 patients started treat-ment for hepatitis C in 2014, more than four times the previous peak, and nearly 10 times more than in the previous year.

• Specialty medicines now account for one-third of spending, driven by a wave of recent innovations in treatment for auto-immune diseases, hepatitis C and cancer.

• Specialty medicine spending in-creased by 26.5 percent to $124.1 bil-

lion in 2014.• Increasing numbers of launches and

growth in spending on specialty prod-ucts in 2014 were driven by the growing research and development focus on spe-cialty medicines over the past decade

The result was nearly $375 billion spent on prescription drugs in 2014. And with more brand-name drugs retaining their patents, fewer generic treatments were available.

In an interview with the Wall Street Journal, Murray Aitken, executive direc-tor of the IMS Institute, acknowledged, “It was a truly remarkable year. We had an unusual confluence of events.”

With fewer generics available in 2014, those on the market cost 5 percent more than a year earlier. And with a complex system from development to FDA ap-proval to distribution, drug makers are seeing thinner profit margins, explained Stough, who also founded Burke Pharma-ceutical research facility.

“The Unites States government has put in regulations that make competition very difficult, and now companies aren’t in it to bring low-cost medicine to patients,” Stough said. “The moment a trade name goes on field, within four months generic trials are going on. The patent life is too short, and the FDA development cost is too high.

“The government allows generics to come on the field before patents run out, and the result is that during the last 20 years, generic drugs in the United States have increased from under 20 percent to 80 percent of all prescriptions.”

Stough maintains that the decreased barriers to generic drug development have allowed generic companies to flood the market with no-name drugs, which, in turn, has resulted in shrinking profit mar-gins for drug developers.

“Normal market forces are not in play, and that’s the problem,” he said. “There’s not enough competition, and filing fees are too high for patents. For the pharmaceutical industry, as prices in-crease, market share drops, but revenue remains the same.”

As drug prices continue to rise, con-sumers are the ones paying the cost, Stough said. And while the pricing situa-tion is complex, he does not believe a con-spiracy exists between drug developers, lawmakers and medical personnel.

“This is a complicated system, created over years by a series of actions that were intended to drive down drug costs, but had an alternate effect,” Stough said. “Am I an expert? No, but I understand more than I did before I started researching this, and while 99 percent of doctors may throw up their hands and think there’s a smoking gun, that’s simply not true. There are not five guys in a back room somewhere ma-nipulating the price of drugs.”

Stough, who is in discussions with local medical organizations to present a seminar in Memphis later this year on drug costs, acknowledges that there is no quick fix to the problem. But he does believe that by working together, drug developers, in-surers and government officials can effect

change.For starters, Stough thinks fees for

FDA approval should be decreased. And patients should be allowed to purchase drugs outside their insurance network if the prescriptions are cheaper elsewhere. And that includes outside the United States.

“We should open up the distribution channels to make Canadian drugs read-ily available and easily obtainable in the United States,” Stough said. “There are plenty of good foreign drugs, many of the same ones we have here, but under dif-ferent names, that are incredibly cheaper than what’s on the market in the United States. Patients should absolutely have access to those more-affordable prescrip-tions.”

Looking ahead, it’s possible that spending may dip in the next few years as more trade-name drugs lose patent pro-tection and generics arrive on the field, Stough said. But parties involved in all facets of drug development, regulation and distribution must work together to gener-ate benefits for consumers.

“America has the highest prices for prescriptions in the world, and that’s ri-diculous,” Stough said. “We created this mess, and the question before us now is are we going to do what it takes to fix it?”

Skyrocketing Cost of Prescription Drugs, continued from page 1

Dr. Dow Stough

listed unexpected/surprise bills as the No. 1 billing-related issue. With out-of-pocket costs on the rise, millennials are more in-clined (41 percent) to request and receive estimates before undergoing treatment. Only 18 percent of seniors and 21 percent of boomers reported asking for or receiv-ing information on costs upfront. Unfortu-nately, 34 percent noted the final bill was higher than the estimate; only 8 percent reported a bill lower than estimate.

“What we’ve found with our clients in the southeast is that healthcare practices are now more motivated than before to improve the patient’s experience around billing, payment plans, and care and insur-ance coverage education due to the need to comply with healthcare reform require-ments and for the sake of improving the profitability of the practice,” added Print.

Kicking care down the road.All age groups agreed that medical

care is too expensive (79 percent) and healthcare costs are unpredictable (77 percent). But more than half of millenni-als (54 percent) and Gen-Xers (53 percent) reported delaying or avoiding treatment because of cost, compared to seniors (18 percent) and boomers (37 percent).

“What we’ve found locally,” added Print, “is that with many patients neglect-ing their care due to costs, practices are ad-dressing this issues by offering free/low cost healthcare clinics, healthcare education, and automated patient payment programs.”

PNC Healthcare is a member of The PNC Financial Services Group Inc. The survey was conducted by Shapiro+Raj in January.

Five Ways, continued from page 15

GrandRounds

UTHSC’s Valerie K. Arnold Inducted into American College of Psychiatrists

Valerie K. Arnold MD, FAPA, chief of Child and Adolescent Psychiatry in the College of Medicine at the University of Tennessee Health Science Center, has been inducted into the American Col-lege of Psychiatrists.

The organization comprises more than 750 psychiatrists who have demon-strated excellence in the field of psychia-try, and achieved national recognition in clinical practice, research, academic leadership, or teaching.

The University of Tennessee Health Science Center Graduates 698

The University of Tennessee Health Science Center (UTHSC) last month graduated 698 health care professionals during six different graduation ceremo-nies.

This year’s graduating class includes 68 African-Americans, 12 Latino-Ameri-cans, and 145 graduates who came from out of state to study at UTHSC. In ad-dition, this graduating class comprises 410 women and 288 men. Additionally, 26 of the out-of-state dentistry graduates are Arkansans. A number of Arkansas students come to Tennessee to train as dentists because their state has no den-tal college

Memphian Named President Elect of the American Association of Neurological Surgeons

Memphis neurosurgeon Frederick A. Boop, MD, FAANS, is President-Elect of the American Association of Neuro-logical Surgeons (AANS). His appoint-ment was announced during the 83rd AANS Annual Scientific Meeting, held last month in Washington, D.C.

Named one of America’s top doc-tors by the US News and World Report in 2012, Boop is the professor and chair-man of the department of neurosurgery at the University of Tennessee Health Sci-ence Center. Additionally, he is chief of the division of pediatric neurosurgery at Le Bonheur Children’s Hospital.

Aside from his leadership role within the AANS, Boop’s professional mem-berships include the American Board of Neurological Surgery, the American Board of Pediatric Neurological Surgery, the International Society of Pediatric Neurosurgeons and NeurosurgeryPAC, for which he is a past-president. In 2010, he received the Endowed Chair of Pedi-atric Neurosurgery at St. Jude Children’s Research Hospital.


Le Bonheur’s Barry Gilmore Honored During TNEMSC Conference

Dr. Barry Gilmore, Medical Director of Emergency Services at Le Bonheur Children’s Hospital was presented the Advocate for Children award during the 14th Annual meeting of the Tennessee Emergency Medical Services for Children (TNEMSC) Update on Acute and Emer-gency Care Pediatrics Conference.

The award recognizes an individual who has made an outstanding contribu-tion of major significance to the TNEMSC program. Candidates are from all areas of the continuum of pediatric emergency care in Tennessee. The honoree has pro-vided an indispensable service which is above and beyond all expectations and their efforts demonstrate exemplary ded-ication to the well-being of children.

TMA to Offer Workshops Concerning Transition to ICD-10; Memphis Date Set August 11

The Tennessee Medical Association (TMA) will offer workshops at different locations in the state to help providers transition to ICD-10 before the October 1 deadline. The hands-on billing and cod-ing immersion will allow participants to practice the actual ICD-10 exercises that will be required for their specialties.

The workshop in Memphis will be held on August 11 at the Fogelman Center on the campus of the University of Memphis.

The OB/GYN class will run from 8:00 am until noon. The cardiology class will run from 1:00 pm until 5:00 pm.

The member cost of the classes will be $189 for the four-hour course and $329 for the eight hour session. Non-member costs will be $289 and $429. Free parking will available in the parking garage next to Fogelman Center.

Camps will be led by certified ICD-10 trainers from the American Academy of Professional Coders, the nation’s larg-est training and credentialing organiza-tion of medical coding, billing, auditing and compliance.

To register, visit http://www.tnmed.org/TMA/Professional_Development/ICD_10.aspx

Those wanting more information about the classes should contact Angie Madden, director of practice solutions at the TMA, either by email at [email protected] or by phone at 615-460-1662.

SVMIC Completes Board Leadership Transition with Memphis Physician Assuming Role as Chair

Brentwood, Tennessee-based State Volunteer Mutual Insurance Company (SVMIC) has completed a planned lead-ership transition within its Board of Direc-tors with Dr. Hugh Francis of Memphis succeeding Dr. Paul McNabb of Nashville as Chair of the Board.

Francis has previously served as vice

chair since 2006.Dr. John O. Lytle of Pine Bluff, Arkan-

sas, is the new of vice chair.

Methodist North Hospital Names Community Development Director

Ashante Hodges has been named program director of community develop-ment for Methodist North Hospital.

She will be respon-sible for advancing the growth pillar at Method-ist North by assisting in the expansion of North’s service area and the co-ordination of community outreach activities.

Hodges has served in marketing and communications at Bap-tist Memorial Hospital, FedEx, Time War-ner/Comcast Cable andbeen involved in production work at WREG and WMC TV stations.

She has a bachelor’s degree in com-munications from The University of Mem-phis.

Three Sutherland Cardiologists Begin New Treatment for Peripheral Arterial Disease

Three interventional cardiologists with Sutherland Cardiology – Dwight Dishmon, MD; Shadwan Alsafwah, MD; and Rami Khouzam, MD – have begun offering a new minimally-invasive pro-cedure to treat peripheral artery disease (PAD) in the upper leg, a condition as-sociated with an increased risk for heart attack and stroke.

Recently approved by the U. S. Food and Drug Administration (FDA), the IN.PACT Admiral drug-coated balloons (DCB) is a new type of medical device used to treat PAD in the upper legs once medical management has failed.

Drug-coated balloons are designed to help restore blood flow by reopen-ing blocked arteries and delivering a medication to the artery wall that clini-cal studies have shown helps keep the artery open longer than other available therapies. During the procedure, an in-flated balloon pushes the plaque away to create a channel for blood flow and the medication on the balloon surface is ab-sorbed into the artery wall. The balloon is then removed with only the medication left behind.

“What many people don’t realize is that PAD in the legs is often connected to health conditions in other parts of the body, especially in the heart,” said Dr. Dishmon. “With drug-coated balloons, we now have a way to more effectively treat PAD.”

Affecting an estimated eight to 12 million people in the U.S., PAD is a debili-tating disease that occurs when arteries become narrowed or blocked by plaque build-up, restricting blood flow.

UTHSC Alumna Margaret Rhea Seddon Inducted Into Astronaut Hall of Fame

Margaret Rhea Seddon, MD, alumna of the College of Medicine (’73) at the University of Tennessee Health Science Center (UTHSC), last month was inducted into the Astro-naut Hall of Fame during a ceremony at the Kennedy Space Center Visitor Com-plex in Cape Canaveral, Florida.

One of NASA’s first female astro-nauts, Seddon will join the ranks of well-known space explorers including Alan Shepard, Neil Armstrong and Buzz Aldrin.

Seddon is a three-time space shuttle astronaut. She was selected by NASA in 1978 as one of the first six women to enter the astronaut program. On her fi-nal flight, STS-58/Columbia, Seddon was payload commander in charge of all sci-ence activities. This life science research flight is recognized by NASA as the most successful and efficient Spacelab mission ever flown. In all, Dr. Seddon has spent a total of 30 days in space.

From 1996 until 2007, Seddon served as assistant chief medical officer at Vanderbilt University Medical Center in Nashville. Since 2007, she has been a co-owner of LifeWings Partners, LLC, providing health care institutions across the country with support and guidance on leadership and patient safety.

GrandRounds

Ashante Hodges

Dr. Margaret Rhea Seddon

Methodist Le Bonheur Recognizes Its 2015 Nurses of the Year Methodist Le Bonheur Healthcare recognized ten outstanding nurses during its

Nursing Stars Celebration, held annually during National Nurses’ Week. Hospital offi-cials said the annual event recognizes the exceptional men and women who define the patient- and family-centered care MLH is committed to providing.

Nursing Stars are selected from each MLH facility. From the Nursing Stars, one Nurse of the Year is chosen from each facility. Candidates are nominated by their peers based on professionalism, interpersonal relations, community involvement, innovation, patient- and family-centered care and the science of nursing.

Back row, l-r: Donna Fountain, Methodist Affiliated Services; Tina Bringle, Le Bonheur; Renee Holley, West Cancer Center; Methodist Le Bonheur Healthcare Chief Nursing Executive Nikki Polis; Jeri Lawson Pennel, Methodist North Hospital; Tammy Lancaster, Physician Alignment and Michelle Hathaway, Methodist University Hospital. Front row, l-r: MLH President and COO Michael Ugwueke; Dana Hope, Methodist South Hospital; Kristen Guttierrez, Olive Branch Hospital; Pat Bahadosing, Methodist Extended Care Hospital; Debbie Thompson, Methodist Le Bonheur Germantown Hospital and MLH CEO Gary Shorb.

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Johns Hopkins Official Discusses Nation’s Changing Population at the Common Table Health Alliance’s Annual Meeting

Thomas LaVeist, director of Johns Hopkins Center for Health Disparities Solutions, discussed the impact and growing diversity of the nation’s population as part of his keynote address during Common Table Health Alliance’s Sixth Annual Meeting on May 12 at the Racquet Club of Memphis.

LaVeist, who also serves as a Johns Hopkins professor in health policy and is a member of the Institute of Medicine of the National Academy of Sciences, said according to the U.S. Bureau of the Census, 90 percent of the U.S. population was non-Hispanic white in 1950. By the end of the century, that number had declined to 70 percent.

“The Census Bureau reports this pattern will continue throughout the 21st century, and at some point in the middle of the century, this nation will be a majority of what we currently refer to as racial and ethnic minorities,” LaVeist said. “This will be transformative of the nation.”

While this shift is taking place, LaVeist noted there has been an 80 percent growth in the propor-tion of Americans with Limited English Proficiencies (LEP), meaning they speak English as a second language or have limited command of the English language.

LaVeist said there are seven states that have more than 10 percent of the total pop-ulation that are LEP. However, between 1990 and 2010, the 10 states experiencing the greatest growth in their LEP populations had not traditionally seen that form of diversity. Tennessee is among the fastest growing states.

Thomas LaVeist

Delta Medical Center Announces 60-Bed Behavioral Health Hospital Being Built in Germantown

A 60-bed behavioral health hos-pital currently under construction on Winchester Road in Germantown is scheduled to open in the spring of 2016, according to officials at Delta Medical Center.

The facility, being built by Acadia

Healthcare in partnership with Delta Medical Center, Baptist Memorial Health Care, and Saint Francis Hospital, will of-fer inpatient care for those suffering with mental health conditions and addiction issues, and will include programs de-signed for adolescents, adults, and se-niors.

“There is a shortage of beds in this area for those struggling with mental health and addiction issues.’ said Bill Pat-

terson of Delta Medical Center. “A new provider means more choices for those who need behavioral health treatment.”

The facility will consist of four core units dedicated to the spectrum of be-havioral health needs from adolescent care to geriatric psychiatry and will also include units dedicated to adult psychia-try and addictions. The 61,592-square-foot hospital will be named Crestwyn and located on a 34-acre site.

Methodist South Hospital Names Community Development Director

Vickye Ford has been named com-munity development director at Method-ist South Hospital.

Her responsibilities will include enhancing and extending the hospital’s growth strategies through coordinated community outreach efforts.

Ford most recently served as a communica-tions specialist in MLH’s Marketing & Communication department. Prior to Methodist, she was the public relations director at Drake State Community & Technical College in Alabama where she managed a nationally-recognized com-munity relations program.

She has a bachelor’s degree in Eng-lish from Alabama Agricultural & Me-chanical University in Huntsville and a master’s degree in journalism from The University of Memphis.

Vickye Ford


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