Memphis Medical News June 2016

Emergency Care Streamlined in Baptist SystemPatient Placement Center Improves Workfl ow, Saves TimeForty-six minutes was just enough time to save the life of a new mother ... 5

Seeking Treatment for ED Leads Many to Improved Overall HealthNearly two decades after its introduction as a viable treatment for erectile dysfunction, Viagra has achieved mainstream status. The little blue pill accounts for nearly half the annual revenue of all ED drugs, and Grand View Research predicts the global market for ED drugs will reach $3.2 billion within six years ... 6

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BY JUDY OTTO

Although Susan Cooper, RN, MSN, FANN, has worn a number of hats during a distinguished career dotted with titles and commendations, the chief integration offi cer and senior vice president for ambulatory care at Regional One Health claims to have re-ceived most of her accolades simply by being a good listener.

“You hear a lot about patient-centered care, but here we talk about person-centered care,” she said, “because every person who comes to see you doesn’t necessarily have just a healthcare issue, they may have other needs to be addressed.”

Only about 10 percent of an individual’s health status is attributable to the care he or she receives as a patient, Cooper said.

(CONTINUED ON PAGE 4)

Susan Cooper Helps PolishRegional One’s New Look

Proposed Bill Could Benefi tMany of the State’s HospitalsReimbursements Have Been Disproportionately Low in Tennessee

BY MADELINE PATTERSON

A bill co-authored by a Tennessean and co-spon-

sored by another could – if passed by Congress – bring help to many Tennessee hospitals.

The bill was co-authored and introduced in the House by U.S. Representative (R-TN) Diane Black, a nurse of more than 40 years and a member of the Ways and Means Health Subcommittee. It was introduced in the Senate by Lamar Alexander (R-TN) along with sena-tors from Ohio, Virginia and Alabama.

The bipartisan bill, the Fair Medicare Hospital Payments Act of 2016, proposes establishing a national minimum Area Wage Index (AWI) of 0.874 for Medicare reimbursement of both inpatient and outpatient services. According to a news release from Black’s offi ce, the bill would correct “a fl awed formula that results in dispropor-tionately low reimbursement payments to rural hospitals (such as) those in Tennessee.”

Currently, the factor used for determining Medicare reimbursements for hospitals is based on the cost to pro-vide patient care in each particular geographical area.


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PAGE 3

PHYSICIANSPOTLIGHT

Larry Kun, MD

ON ROUNDS

FOCUS TOPICS MEN’S HEALTH • PEDIATRIC ONCOLOGY • WORKFORCE IMPROVEMENT • MEDICARE/MEDICAID

HealthcareLeader

2 > JUNE 2016 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 2016 > 3

St. Jude’s Clinical Director Says FarewellOver 32 Years, Larry Kun Made His Mark in Radiation Therapy, Brain Tumors

BY RON COBB

The final day at St. Jude for Larry Kun, MD, will be June 30, but in reality the es-teemed radiation oncologist and the hospital’s clinical di-rector has had one foot out the door since December. That’s when he and Donna, his wife of 45 years, moved to Dallas to be close to daughter Amy Pass, a pediatrician who has three young children.

So there will be no turning back for Kun, who has been commuting to Memphis during the week. By his reckoning, he is already late in embarking on his retirement.

“It was my promise to my wife and expectation that I would do that when I turned 65,” he said. “I turned 70 in March, so it’s five years later.”

A key factor in extending his stay at St. Jude Children’s Research Hospital was his appointment in April 2013 to clinical director and executive vice president.

“It’s extremely difficult to step away from St. Jude,” he said. “It’s been a phe-nomenal ride and opportunity – both in contributions and realizations that I could never have imagined when I came to St. Jude in 1984.”

A Philadelphia native and son of a mechanical engineer and homemaker, Kun entered medical school at age 18, thanks to a five-year program offered by Penn State and Jefferson Medical College. He was at Penn State for only one year before he started med school.

“I wrote annually to the dean and pleaded with him to make it at least six years,” Kun said. “Five years was just too soon. It was by far the shortest program in the U.S.”

While he was at Jefferson, Kun was sent to Colorado Springs for an elective with Juan del Regato, a Cuba native who was one of the people who introduced ra-diation oncology into the United States. After residency training with del Regato, Kun spent two years at the National Can-cer Institute in Bethesda, Maryland, and did a six-month fellowship in Rotterdam.

After a brief stay on the faculty at the University of Vermont, Kun joined a group for a new radiation oncology pro-gram with several other trainees of del Re-gato at the Medical College of Wisconsin.

He was recruited as well by Don Pinkel, who had been the first medical director at St. Jude and had gone on to establish the Midwest Children’s Cancer Center. Dur-ing his time in Milwaukee, Kun was urged by Pinkel to take a look at St. Jude. He did so in 1979 but didn’t make the commit-ment until five years later.

When he arrived in Memphis he did not expect he would still be here 32 years later.

Ideally, Kun would depart June 30 with a sense that all the things he wanted to see happen during his tenure had hap-pened. But, as he noted, “I’m struggling to tie up a number of loose ends. The institu-tion is a very dynamic one and continues to move along. As I step away, there will be some things that are finished and other

things that are still on the horizon.”

Not that the doctor will be lacking in career achieve-ments. His footprints will be especially large in two areas – radiation therapy and pe-diatric brain tumors, in par-ticular his leadership role in establishing the Brain Tumor Program in Mem-phis, the national Pediatric Brain Tumor Consortium and, having opened this past December, the world’s first proton therapy center for children.

When he came to St. Jude, “the greatest emphasis on radiation oncology was how it could be diminished or removed from certain as-

pects of treating pediatric cancer because of side effects that are particularly appar-ent in children who are more vulnerable to the effects of radiation,” he said.

But in part because of “dramatic leaps in technology,” he said, “quite the opposite has happened. Instead of seeing the role of radiation therapy diminished, with the exception of leukemia, its role has been enhanced and has been ever more safe in treating kids, and this is something one would never have expected in the 1980s.”

Of the proton therapy center, Kun said “with the support of the board and the CEO at the time, Bill Evans, we were able to develop what is now the most technically sophisticated proton center anywhere.”

Kun recalls that when he started at

St. Jude, pediatric brain tumors, which account for about 20 percent of all pe-diatric cancers, were low on the priority list. That’s because, he said, “St. Jude just didn’t have the full spectrum of medical subspecialties necessary in neurosurgery, neuroimaging, neuropathology, neuropsy-chology and neuro everything.”

“One of the aspects in my recruit-ment was my interest in brain tumors and the commitment that St. Jude gave me to develop a small pediatric brain tumor program. And that was done literally with a handshake among the leadership of Le Bonheur and St. Jude and myself and the recruitment of a neurosurgeon, Alex San-ford, to help with that program.

“That developed from a commit-ment that we’d never see more than 12 to 18 kids a year to a program where we see about 180 a year, as one of the larg-est pediatric brain tumor programs in the world.”

Besides their daughter in Dallas, the Kuns have another daughter,Julie Alpert, in Columbus, Ohio. She is married to Seth Alpert, a pediatric urologist who trained in Memphis. They have two children, so the Kuns’ travel itinerary will include stops in Ohio.

“I’ve really committed to not commit-ting myself for the next sixth months so I could do some traveling with my wife, which is long overdue,” Kun said.

Because of what he calls his “abbrevi-ated time in college,” he would like to take some college courses “and at that point decide whether I want to get back into an administrative position in medicine in Dallas or continue to do some non-med-ical things.”

PhysicianSpotlight

Dr. Larry Kun

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Socioeconomic status, genetics, behavior and environmental issues also dramatically impact one’s health. And while Regional One had always provided ambulatory care within what was previously four primary-care clinics and campus clinics, “that model was really not sufficient to meet the needs of the community,” she concluded. “We had a very different view of what care should be.”

When Cooper retired in 2012 from her role as the state commissioner of health – the first registered nurse to be appointed to the position in Tennessee — she went to work as a consultant to Dr. Reginald Coopwood, president and CEO of Regional One Health, and quickly rec-ognized and embraced the power of his vision of healthcare for Memphians. Her temporary commitment to assist him with creating an ambulatory strategy became

something greater: “I just changed hats one day and never left,” she said.

Steps toward realizing that shared vi-sion led to the development of Regional One’s new East Campus at 6555 Quince Road, at Kirby Parkway and the Bill Mor-ris Parkway (State Route 385). Cooper describes it as an effort to pilot out the new model of care.

The campus houses services that in-clude a new reproductive medicine pro-gram, urogynecology, outpatient physical rehabilitation, a multispecialty care site, and an outpatient pharmacy. A diagnos-tic/imaging center opening in June will offer DXA (dual-energy X-ray absorpti-ometry) scan, mammography and MRI capabilities within the same building.

“We wanted to design care from the patient’s point of view,” said Cooper, who notes that more than 50 percent of adults

have one or more chronic diseases; more than 25 percent of adults have two or more chronic diseases, so oftentimes pa-tients have multiple concerns.

Patients referred by one physician for specialized care can often receive that care from a physician just across the hall — or, better yet, referral doctors might come to the patient.

“We believe that we should bring care to people — we should not make people go to care,” Cooper said. “We feel very proud not only of what we’ve built out there, we’re trying to apply what we’ve learned to improve other clinical opera-tions across the system.”

She points also to a new infusion cen-ter in the Regional One Outpatient Cen-ter that can best be described as “state surpassing the art,” designed with help from a patient advisory council of indi-

viduals who live with chronic diseases and need regular infusions. Custom-designed chairs with special foam, heat, massage and drop-down sides convert to recliners or beds; high-tech “sound domes” allow patients in shared space to hear only their own TV.

But trying to shift the popular view from emergency and trauma care at Re-gional One to also the system of choice takes time.

“Oftentimes when people think of us,” Cooper said, “they don’t think of us for those outpatient ambulatory services, but for the Elvis Presley Trauma Center, the Sheldon Korones Neonatal Intensive Care Unit or the Firefighters Burn Center. But our extraordinary group of physicians who provide care for other populations of patients is really second to none.”

Looking back, Cooper points with pride to her state commissioner’s role in promoting passage of the non-smoker protection act. “During that period from 2007 to 2012, we had the largest improve-ments in health status of any state in the nation,” she said. “As I traveled across the state during those years and listened to folks, the conversations were crucial to trying to help us make healthier options available to people.”

Cooper also served as assistant dean and assistant professor at Vanderbilt Uni-versity School of Nursing, where she re-ceived her own degrees. Encouraged by her father, a physician, and her mother, a nurse, she began her own career as a nurse specializing in emergency and in-tensive care.

As a student, still filled with doubts about her career choice, Cooper took a summer job as a nursing assistant and ex-perienced a life-changing moment she still recalls with clarity: An elderly man with a neurosurgical condition talked to her at length about his life and the knowledge that he was not going to live.

“He arrested and died that night,” Cooper said. “I remember sitting on the floor and sobbing, not only because he lost his life but because of the gift of the con-versation that he gave to me, and the doc-tor’s words about the importance of that connection — and that time spent.”

It left her profoundly shaken but cer-tain of her calling – and the nurse’s heart that guides her still.

“I never wanted to do anything else from that point on,” she said. “I always asked, ‘How can I improve the experience for someone who is in a difficult situa-tion?’”

Her words to remember: “I think as a healthcare system we can always do better. Inasmuch as the world now re-quires us to focus on the financial health of healthcare systems, we cannot lose sight of the patient or the person who comes to us for care. Our job is to listen— and to deliver upon their need in the most effi-cient way possible.”

Cooper is an avid reader who grew up in West Tennessee; she enjoys travel and spending time with her three grown children and four grandchildren.

Susan Cooper Helps Polish Regional One’s New Look, continued from page 1


BY BETH SIMKANIN

Forty-six minutes was just enough time to save the life of a new mother.

That’s the amount of time it took for her to be transported from a Baptist Me-morial Health Care regional hospital emer-gency department to the intensive care unit at Baptist Memorial Hospital, Memphis, after she suffered a cardiac arrest following an emergency Cesarean section due to fetal distress.

Upon her arrival, specialists were able to save her life. A physician at the re-gional facility made one phone call to the Baptist Patient Placement Center (BPPC) and the nurses there arranged transporta-tion for the patient, had a bed secured and contacted on-call specialists in a matter of minutes.

“The nurse who took the call stayed on the phone the entire time with the para-medic while the patient was transported,” said Deborah Hall, director of the BPPC. “This was not just about getting a patient a bed, it was about this mother living to see her new baby.”

In just a little over a year, Baptist has made the lives of patients, physicians and

hospital staff easier by implementing the BPPC, which creates efficiencies, stream-lines workflow throughout the hospital system and ultimately makes it easier for medical professionals to save lives.

The BPPC, which is staffed with reg-istered nurses ranging in acute and emer-gency experience from seven to 39 years, tracks the status and manages all 2,700 hos-

pital beds in the Baptist system and helps transfer and admit patients all from one lo-cation. In addition, nurses can dispatch air travel for a critical case, monitor calls, track calls, transfer volume and find capacity for a patient all from one location. This is ac-complished via a series of monitors using a software system called TeleTracking.

“It’s a fully automated process,” Hall

said. “All it takes is one phone call to get the patient’s information, determine what facility can service the patient best, see what beds are available and contact the on-call physician. It’s done in real time and in a matter of minutes.”

Katie Morrissette, administrator of TeleHealth at Baptist, said that prior to the creation of the BPPC, each hospital managed its own transfer and admissions process and nurses were not part of the procedure.

“It was a manual process, and it could take multiple calls to admit or transfer a patient,” Morrissette said. “There were pa-tient delays, and it could be difficult to get in touch with an on-call physician. Now the nurses in the center can manage it all for every hospital in the system.”

Additionally, Morrissette said physi-cians from other area hospitals and phy-sician offices may not know each Baptist hospital specialty. Now physicians have one number to call, and the nurse in the BPPC knows exactly where to send the patient, depending on the patient’s need.

The BPPC has made it easier for a physician when calling to admit or transfer

Baptist Streamlines Emergency Care SystemPatient Placement Center Improves Workflow, Saves Time

PHO

TO B

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Staff members follow the activity at Baptist’s Patient Placement Center.


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Nearly two decades after its introduc-

tion as a viable treatment for erectile dys-function, Viagra has achieved mainstream status. The little blue pill accounts for nearly half the annual revenue of all ED drugs, and Grand View Research predicts the global market for ED drugs will reach $3.2 billion within six years.

And as more men become comfortable seeking treatment for ED, some Memphis-area medical professionals see opportunities to address other health concerns.

“Erectile dysfunction becomes more common after age 40, but there are often underlying causes that need to be treated such as cardiac disease or diabetes or obe-sity,” said Robert Wake, MD, chairman of the Department of Urology at the Univer-sity of Tennessee Health Science Center. “Men will come see us because of ED, but not as many make appointments for pre-ventative care like cholesterol or prostate screenings. We want to change that.”

Those seemingly ubiquitous ads for ED treatments that appear across broadcast, online and traditional print media platforms just might help, Wake said. The very prolif-eration of treatment options that lead men to explore ways to increase their libidos can help improve their health at the same time.

Richard Pearson, MD, a board-certi-fied urologist with Exceed Hormone Spe-cialists, agreed.

“Endothelial dysfunction is usually the underlying cause for ED, and it may be due to high blood pressure or high cholesterol or smoking or being overweight,” Pearson said. “Treatment that includes smoking

cessation, getting more exercise and losing weight, adopting a healthy diet and getting blood sugar levels where they need to be will often correct this condition over time in many patients. But that involves making lifestyle changes, and it can be difficult to convince men to make those changes on a permanent basis.”

And adopting healthier habits to ad-dress ED is not just a challenge for older men, doctors acknowledge.

In fact, a 2013 study published by The Journal of Sexual Medicine revealed that of men seeking treatment for new onset erec-tile dysfunction, 26 percent were under age 40. And of those under 40 diagnosed with ED, nearly 50 percent were diagnosed with severe rates of erectile dysfunction.

That doesn’t surprise Rob Booth, a physician assistant at Atlas Men’s Health.

“Many times ED issues, particularly for younger men, are psychological because they may have a bad episode and then be-come anxious that this will happen again and it becomes a self-fulfilling prophecy because of diminished confidence,” Booth said. “One thing we’re noticing today is that increasing numbers of men are exhibiting lower testosterone levels, and that can affect their libido and energy level.”

A 2012 study published by the Journal of Clinical Endocrinology and Metabolism found that testosterone levels in men have been on the decline for the last two decades. The re-search was conducted during three periods from 1987 to 2004 on 1,500 men.

“Male serum testosterone levels appear to vary by generation, even after age is taken into account,” said Thomas G. Travison, PhD, of the New England Research Insti-tutes in Watertown, Massachusetts, and lead

Seeking Treatment for ED Leads Many to Improved Overall Health

“Endothelial dysfunction is usually the underlying cause for ED, and it may be due to high blood pressure or high cholesterol or smoking or being overweight.”

– Dr. Richard Pearson

“Erectile dysfunction becomes more common after age 40, but there are often underlying causes that need to be treated...”

– Dr. Robert Wake


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Why Can’t Everyone Just Get Along?The Quest for Healthcare Interoperability

BY CINDY SANDERS

You can get money out of an ATM in Istanbul and watch a movie 35,000 feet in the air on the flight back, but you cannot electronically access your patient’s x-ray taken at the urgent care center two blocks down the street.

What would be totally unacceptable in any other industry has somehow become widely tolerated as ‘business as usual’ in healthcare … but one group is determined that’s about to change. The Center for Medical Interoperability is on a quest to bring healthcare in line with other vertical markets to improve safety, outcomes and cost efficiency.

Ed Cantwell, executive director for the Center for Medical Interoperability, said the 501(c)(3) organization came about as a result of the philanthropic work and strategic vision of the Gary and Mary West Foundation and West Health Institute. Look-ing at what drives costs in healthcare and contrib-utes to less-than-stellar outcomes within the industry, Cantwell and colleagues were given the task of identifying the elephant in the room.

Zeroing in on the technological dis-connect from medical devices to electronic health records, Cantwell noted the team was asked to bring a fresh perspective from outside of healthcare to the problem at hand “instead of conceding defeat from a legacy attitude.”

Guiding MotivationFrom the start, Cantwell said the Cen-

ter has had five guiding motivators to ad-dress and resolve:

High cost: “Technology is in the way instead of in the background,” he said of a lack of efficiency driving costs.

Preventable deaths: “We lose nearly two 747s a day with about 400 people each,” Cantwell pointed out. “If an airline lost two planes, or 800 people a day, would the public tolerate it?”

Caregiver burnout: A former pilot, Cantwell said the difference between when he flew regularly 15 years ago and today is unbelievable. Technological advancements guide decision-making and have vastly im-proved safety. “The systems are intercon-nected; they wrap the pilot in knowledge,” he pointed out. However, the same cannot be said in healthcare where there has been little effective change in the underlying technology infrastructure over the same time period. Cantwell noted in the absence of data interoperability, providers make calls without all the available information at hand. The current process of attempt-ing to integrate data is cumbersome and exhausting.

Precision medicine: “If you don’t have true data interoperability, how can you realize the benefits of personalized medi-cine?” he questioned of applying data to individuals and the broader population health mission.

Innovation in an application-based economy: “Between Apple and Google, the app-driven economy is fundamentally changing the way you live and is starting to penetrate your wellness,” Cantwell noted. “In general, healthcare has had very little IT innovation, and it’s because access to data is so proprietary and so hard to hook into that it doesn’t attract investors. There’s not an underlying uniform infrastructure so innovators are shunning healthcare be-cause it’s just so hard.”

Creating a Structure for Success

Cantwell said in every other vertical market – including the highly competitive cable, phone, financial, and airline indus-tries – data has been made available to drive advancement. “That interoperabil-ity and data exchange allows for a level of wisdom that drives productivity and out-comes,” he pointed out.

Not only is communication difficult among healthcare entities across the con-tinuum of care, but it is often hard to share data even within a single practice or health system. With so much of the equipment being proprietary, one device or piece of technology can’t ‘talk’ to another with-out the purchase of middleware. “Why

do I need to pay for an interpreter? Why can’t you just speak the same language?” Cantwell questioned. “In many ways, the hospitals and health systems are just being held hostage.”

To change that, the core staff of the Center has spent the last few years study-ing other vertical markets. “There was one common denominator,” Cantwell said. “Each has the benefit of what we call a centralized lab.”

He noted these successful industries have created a non-profit made up of lead-ing companies within their sector and have challenged the CEOs to support the non-profit by serving on the board and bringing in their technical staff to come together and agree on a fundamental architecture that is both vendor and member neutral.

Taking a page from these industries, Cantwell noted, “In mid-2012 we started building a lab for healthcare with a focus being on the seamless exchange of informa-tion.” Incubated in California, the Center is in the process of moving to its permanent home in ONEC1TY in Nashville.

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“Like many, Tennessee hospitals are getting less and less from Medicare, while hospitals in other areas of the country get more and more for the same services, be-cause of a flawed for-mula,” Alexander said in a statement. “This bill will protect Tennes-see hospitals, and oth-ers around the country, from shrinking Medicare reimbursements that make it harder for them to recruit skilled doctors and nurses, make pay-roll, pay bills and care for patients.”

According to the Centers for Medicare and Medicaid Ser-vices (CMS), the AWI was created “for area differences in hospital wage levels by a factor reflecting the relative hospital wage level in the geographic area of the hospital compared to the national average hospital wage level.”

The wage is reviewed annually through surveys and uses information such as hospital payroll records to create an hourly wage for each labor market, and a national average hourly wage.

In West Tennessee, multiple rural hospitals have closed, including Gibson General Hospital in Trenton, Haywood Park Community Hospital in Brownsville,

McNairy Regional Hospital in Selmer and Humboldt General Hospital. The AWI disproportionately hurts rural hospitals such as these by its low reimbursement rates.

Smaller hospitals lack the negotiating power of larger hospital systems to push back on Medicare for higher reimburse-ments.

“Small hospitals are faced with a take-it-or-leave-it (scenario),” said Tennes-see Hospital Association President Craig Becker.

Becker explained that not only does the AWI impact rural hospitals and their communities, but the ripple effect also hurts urban hospitals. As the rural hos-pitals close, patients from surrounding areas travel to a city for care, increasing the number of Medicare patients at urban hospitals.

“Tennessee hospitals have seen the rate go down,” he said. “We’ve been good stewards.”

California, a more densely populated state, is receiving much higher reimburse-ment rates than Tennessee for performing the same level of care. For example, Con-gressman Black’s release states the AWI in Watsonville, California, is 1.72, while Clarksville, Tennessee, is .7439. The na-tional average AWI should be 1.0, but no hospital in Tennessee is reimbursed at 1.0 AWI or greater.

The bill was introduced to the House in February and referred to the Subcom-

mittee on Health. In the Senate, the bill was introduced in late April and is being evaluated by Senate Finance before it moves to the Committee on Health, Edu-cation, Labor and Pensions, which Alex-ander chairs.

In addition to the disadvantage hos-pitals in Tennessee face with the low AWI rates, the failure to expand Medicare coverage through TennCare is also hurt-ing smaller health systems. Patients are in need of care, there are shortages in emer-gency rooms, but medical costs are rising and hospitals are struggling to make ends meet with low Medicare reimbursement rates.

Becker cites New Mexico, a state that recently expanded Medicare and is now seeing “historic lows” in the rate of uninsured citizens, as an example of

the positive change expanding coverage generates. He says New Mexico’s rural hospitals are experiencing better finan-cial health, and the U.S. Department of Health and Human Services reports that now only 10.2 percent of the state popu-lation has no insurance coverage, down from 15 percent last year.

The CMS estimates that expansion of Medicare and Marketplace coverage helped save $7.4 billion in uncompensated care costs nationwide in 2014.

Becker said Medicare expansion “would go a long way to ensuring health in the future.”

The CMS was contacted for this story, but declined to comment on the Fair Medicare Hospital Payments Act or reimbursement rates for Tennessee hos-pitals.

Proposed Bill Could Help State’s Hospitals, continued from page 1

Diane Black

Lamar Alexander

Health Systems, Ascension Health, Scripps Health, and Vanderbilt University, Univer-sity of North Carolina and Johns Hopkins Schools of Medicine, among others.

“We’re using the industry leaders and their procurement power and technical ad-visors and a dedicated R&D organization that will work within the ecosystem to de-velop a data interoperability platform and make it available free to the ecosystem and then become the test and certification body for it,” Cantwell said of the Center.

Moving ForwardThe Center is focused on five core

platform requirements to achieve interop-erability:

Plug-and-play so that when two in-dependent pieces are connected, they self-configure how to talk to each other with minimal or no human intervention.

One-to-many communication where once a device or system is certified as being conformant with reference specifications or set of standards, it can be used with simi-larly certified devices without additional testing.

Two-way data exchange enabling data to flow in both directions for feedback loops and automation.

Standards-based options that use

open, as opposed to proprietary, solutions in reference architectures, interface specifi-cations and testing.

Trust so that users have the confidence that interoperable systems will be safe, se-cure and reliable.

Calling the work to be done both “a moonshot and a marathon,” Cantwell said the Center has a very aggressive goal to have the basic components in place within two years. After that, he said the function of the Center would be to build strong governance that encourages continuing innovation. “You’re not going to be able to keep healthcare out of an app-based economy forever,” he said. “Once it tips, you’re not going to be able to stop it.”

Improving interoperability holds great promise both in terms of patient outcomes and increased cost efficiency. However, Cantwell noted, success has even broader implications for the over-all health and wellbeing of the country. “With healthcare (spending) at nearly 25 percent of the GDP, if you take even 10 points out of that, you could almost fund all the other social issues that are threat-ened,” he pointed out.

Cantwell concluded, “I think as a na-tion, it’s time. It’s time as consumers, we demand more from our healthcare system.”

Why Can’t Everyone, continued from page 7


BY CINDY SANDERS

Recently, Rep. Cameron Sexton (R-Crossville), who serves as chair of both the Tennessee House Health Committee and Speaker Beth Harwell’s 3-Star Healthy Project task force, and Michele Johnson, executive di-rector of the Tennessee Justice Center, spoke to Medical News about ex-panding access to care in the state.

After the U.S. Su-preme Court struck down the Affordable Care Act’s Medicaid expansion mandate in 2012, it was left to individual states to decide whether or not to expand their eligibility criteria and take advantage of additional federal dollars. The ruling left millions of low-income Americans in the ‘coverage gap’ where they didn’t qualify for either Medicaid programs or financial subsidies on the insurance exchange.

As of January 2016, 19 states had not expanded Medicaid, including Tennessee where Gov. Bill Haslam’s Insure Tennes-

see pilot has twice been shot down. It is es-timated 280,000 to 300,000 Tennesseans are caught in the coverage gap.

While ‘Obamacare’ remains unpop-ular with many Tennesseans, attitudes have significantly softened when it comes to expanding access and coverage. On May 18, icitizen released results from a survey of 562 registered Tennessee voters with data crossing age, gender and geo-graphic regions to reflect the composition of registered voters in the state. Specific to improving healthcare access, 55 per-cent said they were satisfied with the steps legislators are taking to try to improve the problem, and 45 percent were dissatisfied. However, in a follow-up question, a full 83 percent supported the reintroduction of Insure Tennessee with only 17 percent opposing such a step.

Johnson would like to see Insure Ten-nessee fully implemented. Sexton and the 3-Star Healthy Project committee are ex-ploring a range of other options.

The Task Force ViewChairman Sexton heads the six-mem-

ber task force, which was created on April 12 to find viable alternatives to Insure Tennessee and now includes one Demo-crat. The group has been charged with presenting a plan to the Centers for Medi-

care and Medicaid Services by June that will be palatable to the federal agency, state lawmakers, and constituents. “It will be an initial proposal,” Sexton said, add-ing he expects there will be several months of negotiations and ‘back and forth’ with the federal agency to hammer out details.

The task force has held a series of meetings across the state to hear from stakeholders, including hospitals, physi-cians, charity clinics, employers and un-insured Tennesseans. Sexton said they are evaluating at a number of approaches ranging from medication therapy man-agement (MTM) programs, telemedicine, and home visits to creating public-private partnerships and a behavioral health pilot project. He also stressed the committee is looking at ‘cost’ from various angles and with a recognition that short-term outlays might be required for longer term savings.

“We’re looking at it more from pro-viding healthcare than from a strictly monetary position,” he said.

A chief concern is how emergency de-partments are being utilized by the unin-sured at hospitals around the state. “When we’ve talked to hospitals about their data on the 300,000, there are a lot of services they provide for that population in acute care that could be better served in other settings,” he said of trying to free up ERs

for their intended use.The task force is looking at a pilot

project to address about 100,000 to 125,000 Tennesseans in the coverage gap who have a behavioral health component to their medical needs. If that plan moves forward, Sexton said it would most likely be administered through TennCare. He noted the goal would be to assess specific pieces of the pilot and then roll out suc-cessful elements to the broader TennCare population to achieve better outcomes and efficiencies.

“The task force is looking at a phase-in approach,” he said. “But in that first phase, if we just do the behavioral health pilot, then we’ll look at the remaining number of uninsureds and ask: How can they have healthcare that might not be government-run healthcare but still have some access?”

For that part of the equation, Sexton said the task force has had discussions with faith-based and charity clinics regarding their care model and how they control cost and measure performance. He also said mechanisms for supplemental fund-ing for specialty care were being studied.

Sexton pointed out that simply hav-ing coverage doesn’t necessarily mean a person has real access to the system. “An

A Question of AccessTwo Stakeholders in the Debate over TennCare Expansion Share Their Views

Rep. Cameron Sexton

Michele Johnson


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a patient to a Baptist facility, according to Jerry Gooch, MD, medical director of the BPPC and a thoracic and cardiovascular surgeon.

He knows from experience. He called the BPPC from a Baptist regional facility to transfer a patient for critical surgery. Gooch said that one call to the BPPC had the patient transferred for surgery and the referring physician notified in only 90 min-utes.

“The admissions and transfer process has been streamlined significantly,” Gooch said. “One call gets the ball rolling for the patient to be transferred. I have called other hospitals across the country to transfer or admit a patient and have had to make mul-tiple calls. This cuts down on time, which means less delay for the patient.”

In addition to getting in touch with an on-call physician to accept a patient, the nurses in the BPPC can facilitate calls to multiple specialists for critical cases. Hall said this can save time when a patient must be transferred quickly to another hospital location.

Another advantage to the BPPC is that nurses can see what beds are available in each hospital at all times and can assign patients to available rooms at a click of a button. Nurses on the floor in each hospital can see when a patient is assigned a room, and they can begin the transfer process im-mediately. Additionally, after each patient is discharged, the environmental services team is notified that a room needs to be cleaned for a patient.

“Once a patient enters our system, we can track their transport in the system until they are discharged,” Morrissette said. “That way a bed can be turned over quickly. This helps especially when there is a high demand for a specific area. For in-stance, intensive care unit beds are usually the most needed.”

The TeleTracking system tracks ev-erything from how long a patient waits in the emergency department for a room to how long it takes for a room to be cleaned when a patient is discharged. Morrissette said Baptist leadership reviews a monthly dashboard to drill down the metrics and find out what has improved and needs to be addressed.

“It’s an effective tool for managing ef-ficiencies and changing up strategies,” Hall said. “We drill down the metrics system wide. We can predict our patient flow and bottlenecks and make adjustments.”

There have been many improvements over the past year, according to Morris-sette. The average wait time for a patient to be assigned a bed from the emergency department is 17 minutes.

“Before it could take hours for a pa-tient to be assigned a bed from the ED,” Gooch said. “Now the patient is assigned in minutes, which frees up the ED, so there is less waiting time.”

Additionally, hospital staff can identify when a room needs to be attended. Mor-rissette said this allows the environmental services department to redirect staff so a bed can be made available.

Also, more phone calls are coming through the BPPC from outside the Baptist system. Morrissette said 40 to 45 percent of calls are admissions from outside Baptist. This number has steadily gone up over the past year as more hospitals and physician offices have learned about the BPPC.

Although there have been many im-provements to the system’s workflow, Hall said in the end it’s all about the patient.

“Even though the nurses in the center don’t see the patient face-to-face, they take each patient seriously. They are totally fo-cused on seeing the patient is taken care of immediately, so they can get the care they need.”

Emergency Care, continued from page 5

author of the study. “In 1988, men who were 50 years old had higher serum testosterone concentrations than did comparable 50-year-old men in 1996. This suggests that some fac-tor other than age may be contributing to the observed declines in testosterone over time.”

In addition to an increasingly sedentary lifestyle for men in the U.S., Booth believes stress and a constant plugged-in lifestyle are also to blame.

“Everyone is always ‘on’ and connected to some device,” Booth said. “We sleep with our mobile phones by our beds, we’ve got all kinds of electric devices in our bedrooms that emit light and this interrupts REM sleep, which decreases testosterone produc-tion. Our culture is affecting our virility.”

The American Urological Association advises men to discuss testosterone therapy with their doctors before seeking such treat-ments for erectile dysfunction. The orga-nization recommends that patients discuss medical histories with their doctors and un-dergo physical evaluations before exploring treatment options.

And that’s a message Wake is deter-mined to promote.

He is working with other medical pro-

fessionals and the Regional One Health Foundation to develop a comprehensive clinic dedicated to men’s health. Wake be-lieves that such a facility, the first in the re-gion, will soon be operational.

“My vision is to get men into preven-tative medicine to prolong life and improve the quality of their life,” Wake said. “I’d like to see us be able to offer medical services and health screenings all in one place and even include psychiatric and counseling services and smoking cessation and weight loss ser-vices.”

Wake is optimistic about the compre-hensive clinic at the Regional One campus at 6555 Quince. He said the group is pursu-ing additional funding to bring the concept to fruition within five years.

“Men may initially come in to talk about ED but address other health concerns while they’re there. The idea is that there would be no issue too small or condition too big for patients to come to this clinic about,” Wake said. “Men could come and get their medical workups done, have tests run and access whatever health services they need. We’re setting our dreams high, and we’re dedicated to making this happen.”

Seeking Treatment, continued from page 6


Jack O. Bovender, Jr. Stanley Cohen, Ph.D. Henry W. Foster, Jr., M.D., FACOG

Frank S. Groner, LL.D. Paul E. Stanton, M.D. Colleen Conway Welch, Ph.D.,CNM, FAAN, FACNM

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Be a Part of the 2016 Induction Ceremony!With a mission to honor men and women who have made significant and lasting contributions to the health care industry, The Tennessee Health Care

Hall of Fame seeks to recognize and honor the pioneers and current leaders that have formed Tennessee’s health and health care community and encourage future generations of health care professionals. Don’t miss the second annual induction, featuring these health care legends:

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BY CINDY SANDERS

The 2016 Tennessee Health Care Hall of Fame inductees were unveiled in Nashville during the McWhorter Soci-ety Luncheon at Belmont University last month. With a mission to honor men and women with strong ties to Tennessee who have made significant and lasting contribu-tions to the health and healthcare industry, the Hall of Fame was created by Belmont University and the McWhorter Society and is supported by the Nashville Health Care Council, a Hall of Fame Founding Partner.

The nomination process began in Feb-ruary and was open to practitioners, exec-utives, entrepreneurs, mentors, teachers, scientists, researchers, innovators or others who have a strong connection to healthcare field. Nominees must have:

• Been born, lived or have worked in Tennessee

• Made a significant impact and last-ing contribution to healthcare at the local, state, national or international level

• Exhibit the highest ethical and pro-fessional character

• Serve as an outstanding role model in their community

From the highly qualified candidates nominated for 2016, the selection commit-tee chose six for the prestigious honor. A recipient of the Nobel Prize, a senior ad-

visor to the Clinton Administration, and a ‘Best CEO in America’ are among the group being inducted at a formal ceremony on Oct. 10 at Belmont.

Jack Bovender, Jr.: A 40-year healthcare veteran and the retired chair-man and CEO of Hospital Corporation of America, Bovender is credited with the heroic rescue of patients in an HCA hospi-tal in New Orleans during Hurricane Ka-trina. A champion of implementing patient safety measures and of fostering diversity in leadership, Bovender was named an Insti-tutional Investor’s “Best CEO in America” for healthcare facilities three times. In 2015, he was inducted into the national Health Care Hall of Fame.

Stanley Cohen, PhD: Recipient of the Nobel Peace Prize in medicine in physi-ology, Cohen served as a faculty member at Washington University and is a distin-guished professor emeritus of Biochemistry at Vanderbilt. Born in 1922, the renowned biochemist has dedicated his lifetime re-search to cell growth, benefitting both burn victims and cancer patients. His work on epidermal growth factors has led to discov-eries for individual cancer therapies and served as the basis for drugs that target can-cers and immune system dysfunctions.

Henry W. Foster, Jr., MD, FACOG: The former dean of Me-harry College’s School of Medicine and professor emeritus and former chair

of the Department of Obstetrics and Gy-necology, Foster has been a lifelong cham-pion of helping young people realize their full potential. He served as President Bill Clinton’s senior advisor on Teen Preg-nancy Reduction and Youth Issues, be-came the senior program consultant for the Robert Wood Johnson Foundation and directed “Consolidate Health Services for High-Risk Young People,” and pioneered a national model for regionalized perinatal healthcare systems.

Frank Groner, LLD: The for-mer CEO and president emeritus of Memphis’s Baptist Memorial Hospital, Groner brought national prominence to the Baptist system during his 34 years of lead-ership and served as both Commissioner of the Joint Commission on Accreditation of Hospitals and as a health consultant to the federal government. During his tenure, he led Baptist Memorial Hospital to become the largest non-government hospital in the nation and was responsible for many inno-vations in quality and patient satisfaction.

Paul Stanton, MD: The for-mer dean of the James H. Quillen College of Medicine and vice president for Health Affairs was named the eighth president of East Tennessee State University in 1997. Now president emeritus, the vascular sur-geon continues to teach medical students. He also served as a member of Governor Phil Bredesen’s TennCare Roundtable and

assisted in conducting the first review and recommendation of changes for Tennes-see’s Medicaid program.

Colleen Conway Welch, PhD, CNM, FAAN, FACNM: The former dean of the Vanderbilt University School of Nursing has served on many national com-mittees including President Reagan’s Com-mission on HIV Epidemic and the National Bipartisan Commissions of the Future of Medicare. Still teaching and mentoring the next generation of nurse leaders, Welch is also the founder of Friends of the National Institutes of Health, National Institute of Nursing Research.

The HallIn addition to recognizing Tennessee’s

most influential health and healthcare lead-ers, the Health Care Hall of Fame serves as an ongoing educational resource to docu-ment the rich history that has contributed to Tennessee’s position as a leader for na-tional healthcare initiatives.

Debuting last year, members of the inaugural class of the Hall of Fame were: Thomas F. Frist, Jr., MD; Thomas F. Frist, Sr., MD; Ernest William Goodpasture, MD; Jack C. Massey; Clayton McWhorter; David Satcher, MD, PhD; Mildred T. Stahlman, MD; and Danny Thomas.

For more information on the Health Care Hall of Fame, go to TNHealthCareHall.com.

2016 Health Care Hall of Fame Inductees


insurance policy doesn’t mean you have healthcare,” he said, noting many people have policies with such high copays and deductibles that individuals can’t afford to see a provider. “We want to make sure we are providing access to care,” he stressed of any plans proposed.

Sexton also noted it’s important to make sure providers are able to care for any new additions to the TennCare rolls. “I know the task force is well aware of the cuts to providers over the years from the TennCare program so we’re looking at ways to have some type of better reim-bursement or better incentives so that pro-viders are more comfortable and able to see this potential TennCare population.”

Whatever plan is put into place, Sex-ton envisions sign-off by the full legislature. He said there were various reasons Insure Tennessee didn’t pass and noted legisla-tive members have asked the task force to look at having triggers or circuit break-ers in place so the state could pull back if costs spiral out of control. While the fed-eral government has pledged much higher reimbursement for this added population, Sexton said Tennessee has to have a plan in case that changes in the future. “We have to be prepared to pay those costs ourselves if we need to and be comfortable with those costs.” He added no one wants a repeat of 2005 when more than 300,000 were dropped from TennCare rolls.

While he seeks to be fi scally respon-sible, Sexton said he doesn’t want to be fi -nancially shortsighted. “One of the things that drives me crazy about government is we’re always focused on today’s dollars,” he said. With the task force, he concluded, “We want to put in innovative approaches to see if it saves money down the road and monitor that.”

The TJC PerspectiveMichele Johnson, executive director

of the Tennessee Justice Center, hopes the state doesn’t have to wait for months of ‘back-and-forth’ with CMS and then another legislative session. She said the stories and immediate needs of those fac-ing dire medical decisions are too critical to put off any longer.

“In Memphis, they (the task force) heard from a variety of witnesses who all made a compelling case for why they need to close the coverage gap,” Johnson said.

The TJC has created a video – “Dear State Legislators: A Message from the Coverage Gap” – featuring Tennesseans asking their elected offi cials to provide a real plan and to act quickly to implement it. At press time, the three-minute video was approaching 20,000 views.

Johnson said it is a huge mispercep-tion that many of those in the coverage gap don’t work. “The vast majority of these folks are working at least one job, many of them are working more, and many of them are really sick.” She added, “These are our friends, neighbors, the people who clean our hotel room and wait on our tables.”

Johnson said it is also a misperception that charity care could somehow take care of those lacking coverage. “It isn’t because the healthcare industry isn’t charitable enough, it’s because the system is too com-plex.” She added there are too many mov-ing parts for those with chronic illnesses or a diagnosis of heart disease or cancer to be able to piece together the kind of cohesive care required.

Noting that CMS has been “very consistent” with what they will and won’t approve, she said, “If the task force sub-mits a plan that is in the range of what has been approved before, I think CMS will act quickly.”

If that happens, Johnson said the state should move forward without waiting for the legislature to come back in session in January. “I understand why they might want to for political reasons, but there is no valid policy reason to wait when these people have been living in pain as long as they have and when it will be the seventh hospital closing this week,” she said, refer-ring to the recent closure of rural McNairy Regional Hospital.

From a fi nancial standpoint, Johnson said expedient approval of Insure Tennes-see or a similar plan would draw down more federal dollars to the state. “We have one more year of 100 percent funding,” she said of the federal match program. “Next year, it goes down slightly until 2020 when it goes down to 90 percent.” However, she continued, “Hospitals have said they will pick up what the federal government doesn’t.” She stressed, “It’s budget neutral to Tennessee taxpayers. It’s budget neutral to Tennessee, period.”

Johnson concluded, “The testimony has been really clear that a real plan would make sense economically for our state, for our healthcare infrastructure, and will take care of citizens that need health cov-erage.” Now, she said, the question re-mains, “Can legislators set aside their own political interest and stand up for their constituents?”

A Question of Access, continued from page 9

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In the little more than 15 months be-tween Peak 10’s first and second rounds of research into healthcare information tech-nology trends, a lot has changed. From evolving CIO roles and added emphasis on data analytics to increased cloud adoption and growing concerns over interoperability and security, HIT departments are being asked to rapidly adapt to the industry’s shift-ing landscape.

Peak 10 – a national information tech-nology infrastructure solutions provider with data centers and sales offices in 14 major metropolitan areas including Nash-ville – surveyed HIT decision makers from across the United States in March 2016 for the Second National IT Trends in Health-care Study, which was released last month. After receiving online surveys from 157 re-spondents in more than 40 states, a series of in-depth, one-on-one qualitative phone in-terviews was conducted with a subset of the participants. Peak 10’s latest report follows the company’s research into current mar-ket conditions and HIT trends conducted in late 2014 that resulted in the inaugural study being published in the first quarter of 2015.

“We saw some big differences versus the last time,” noted Christina Kyriazi, product marketing and analytics manager for Peak 10 and lead author and researcher for the report. “One of the biggest was the cloud adoption trend,” she continued.

Kyriazi said there was signficant change from fourth quarter 2014 to first quarter 2016 in attitudes and adoption of colocated and Infrastructure as a Service (IaaS) environments. While most respon-dents still heavily rely on in-house technol-ogy infrastructure delivery models, there was a marked increase in IaaS reliance. Across three categories – production, devel-opment and testing, and disaster recovery – each saw a decrease for in-house utiliza-tion and an increase in IaaS. Kyriazi said the shift resulted in a 50 percent increase in IaaS adoption and an average increase of 33 percent in Software as a Service (SaaS) adoption.

“There’s been quite a few strides in public clouds, as well as hosted private clouds, in making them more secure so I think people have gained confidence,” she said. Kyriazi added that many healthcare providers have incrementally tested cloud-based services and evaluated outcomes. With positive results, organizations have become more willing to take advantage of cloud-based efficiencies, although some level of unease still lingers.

No matter where it’s stored, Kyriazi noted, “When you talk to healthcare pro-fessionals, the number one concern that comes up with data is security.” In fact, she added, there were numerous comments from survey respondents that security and compliance worries have been responsible for more than a few sleepless nights with

ransomware emerging as a particular con-cern. When asked to evaluate their own or-ganization’s security program, the average grade was a B-, with only 11 percent of re-spondents giving themselves an A. Not sur-prisingly, encryption services (28 percent), security assessments (25 percent), and ad-vanced malware protection (25 percent) led the way in additional investments planned in the next 12-24 months.

“The number two issue, which kept coming up, was the interoperability of sys-tems,” she continued. “Fifty-three percent of the IT decision makers told us they use two or more EHR providers.” And a full 25 percent of respondents are dealing with three or more providers. Kyriazi added the picture only gets more complicated when factoring in all the different devices and programs used by clinical providers and ad-ministrative personnel. “With all these dis-parate systems, they are having a hard time integrating them.”

Kyriazi said another striking change is the evolution of the chief information officer within a hospital or health system. “The role of the healthcare CIO has changed drasti-cally even in the last couple of years,” she said. “All of a sudden, the CIO’s role has shifted to a very strategic one.”

Kyriazi pointed out helping an orga-nization meet the triple aim of improved efficiencies, quality of care, and patient experience calls for a very different skill set from what was previously required of CIOs. That shift, she added, could be one of the drivers behind the growing trend in outsourcing some day-to-day functions to managed services providers. By turning to an outside company for IaaS and monitor-ing, Kyriazi said CIOs can “focus their IT teams to become more strategic to gain that competitive edge in the marketplace.”

Part of that competitive advantage is effectively utilizing big data. The survey revealed 66 percent of respondents created new IT roles in the last 24 months. “The number one role that came up was analyt-ics, followed closely by number two, secu-rity. I was expecting to see that be first,” Kyriazi noted.

Considering increased complexity and demands, 67 percent of the organizations represented in the study anticipate increas-ing IT budgets from 2016 to 2018. Another 24 percent anticipated staying the same, 6 percent expected to decrease budgets, and 3 percent were unsure.

Other interesting points included 77 percent of respondents saying they currently have, or plan to implement, a telemedicine program, and 85 percent said they have a patient portal to help improve the patient experience and act as a competitive differ-entiator to drive business.

“The big picture is the healthcare in-dustry is rapidly changing, and these IT leaders have to adapt to it,” Kyriazi con-cluded.

Second National IT Trends in Healthcare Study Released


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Audrey Gregory Returns to Saint Francis Healthcare as CEO

Audrey Gregory, Ph.D., RN, has returned to Memphis as chief execu-tive officer at Saint Fran-cis Healthcare. She suc-ceeds David Archer, who recently announced his retirement.

Gregory will be re-sponsible for overseeing all areas of operations at Saint Francis Hospital-Memphis and Saint Francis Hospital-Bartlett. Chris Locke, CEO at Saint Francis Hospital-Bartlett will remain in his position. Greg-ory will report to Garry Gause, CEO of Tenet Healthcare’s Southern Region.

Gregory, who has more than 20 years of nursing experience, began her Tenet career in 2004 at Delray Medical Center in Delray Beach, Florida, as di-rector of emergency services before be-ing named director of nursing and then chief nursing officer in 2008.

In 2011, she was promoted to chief operating officer (COO) at St. Francis, where she was responsible for all as-pects of day-to-day operations includ-ing key medical, surgical, quality and ancillary services at the 519-bed facility. She was promoted to chief executive officer (CEO) at Placentia-Linda Hospi-tal in Placentia, California in 2014.

Gregory earned a Ph.D. in global leadership concentrating in corporate and organizational management from Lynn University in Boca Raton as well as both a master’s degree and a bachelor’s degree in nursing and a master’s de-gree in healthcare administration from Armstrong Atlantic State University in Savannah, Georgia.

Antony Sheehan Joins Methodist Le Bonheur Leadership Team

Antony Sheehan, who has served as president of the Church Health Cen-ter since 2013, has joined Methodist Le Bonheur Healthcare (MLH) as a senior advisor.

Michael Ugwueke, current presi-dent and COO of MLH, said the addi-tion of Sheehan would “better position our system to craft innovative solutions for the changing healthcare landscape in Memphis.” Plans are that Sheehan would work with MLH and Mid-South community leaders to “coordinate the development of a primary care safety net program for the underserved in our community.”

Originally from England, Sheehan began his healthcare career in nursing and has more than 25 years of strategic, operational and clinical leadership ex-perience. Prior to his appointment as president of the Church Health Center,

Sheehan served as fellow and faculty member for the Institute for Healthcare Improvement (IHI) in Cambridge, Mas-sachusetts.

He has also held leadership roles in the United Kingdom, including serv-ing as a CEO of Leicester Partnership Teaching Trust and Director General of the UK Department of Health, London where he lead civil service healthcare efforts ranging from mental health, dis-ability, elder care and social care policy.

Sheehan holds a postgraduate diploma in Health Services Manage-ment from Keele University, Master of Philosophy from Nottingham University, Bachelor of Education from Manchester Metropolitan University and Registered Nurse licensure from Saint George’s Hospital (UK).

Inaugural CORNET Awards Presented for Nine Research Initiatives

Nine research grants have been announced as the 2016 awardees for the inaugural University of Tennessee Health Science Center (UTHSC) Col-laborative Research Network (CORNET) Awards.

Based on the ideals of cross-dis-ciplinary team science, the CORNET Awards were created to stimulate inno-vative, interdisciplinary, team research that crosses not only UTHSC’s Memphis colleges, but also encourages collabo-ration across all UT campuses and be-yond.

Thia year’s winners are:Isaac Donkor, PhD; Michio Kurosu,

PhD; Ying Kong, PhDBob Moore, PhD; Byron Jones,

PhD; Megan Mulligan, PhDDetlef Heck, PhD; Francesca-Fang

Liao, PhD; Anton Reiner, PhD; Bob Moore, PhD

Kui Li, PhD; Tao Lowe, PhDCatherine Kaczorowski, PhD; Wei

Li, PhD; Kristen O’Connell, PhDAnsley Stanfill, PhD; RN; Lucas Eli-

jovich, MD; Brandon Baughman, PhD; Claire Simpson, PhD

Liang Hong, DDS, PhD; Franklin Garcia-Godoy, DDS, PhD, PhD; Wei Li, PhD; David Tipton, DDS, PhD; Yanhui Zhang, PhD

Charisse Madlock-Brown, PhD, MLS; Robert Davis, MD, MPH; Panduka Nagahawatte, MS

Francesco Giorgianni, PhD; Marko Radic, PhD

To be eligible for a UTHSC COR-NET Award, each proposal must in-clude, at minimum, one faculty member from at least two of the UTHSC colleges and promote new lines of research. Re-sources are available for up to $50,000 per award for one year, and became accessible to each winning research team on May 1. A symposium will be hosted at the end of the year in which the awardees will present their findings.

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GrandRoundsFasten Your Seatbelts: CMS Racing to Launch New Initiatives During Obama’s Last Months in OfficeBy Denise Burke

On its way out the door, the Obama administration is racing to secure the Presi-dent’s legacy by implementing major new initiatives under the authority of the Affordable Care Act to reshape how healthcare is delivered in the United States. According to Kathleen Sebelius, former U.S. Health and Human Services secre-tary, “The time clock is very much in everybody’s mind. What will happen over the next eight months is as much as these projects can be accelerated, they will be.” Two key elements on the agenda are reducing drug prices and redesigning how primary care is delivered.

Taking Part B ApartIn March, the Centers for Medicare & Medicaid Services (CMS) proposed a new plan for overhauling Medicare Part B drug payments with the goal of encourag-ing physicians to prescribe less expensive drugs without sacrificing the quality of care. Currently under Medicare Part B, CMS reimburses the average sales price plus 6 percent. Under the new proposal, physicians would be paid the average sales price of a medicine, plus another 2.5 percent and a flat fee of $16.80. Obvi-ously, the change will have a financial impact for physicians who administer high dollar drugs. Not surprisingly, the pharmaceutical industry is lobbying against it, and some patient advocacy groups and physicians are also expressing concern.

Comprehensive Primary Care Plus In April, CMS announced that it is launching a new initiative that “represents the future of health care.” The Comprehensive Primary Care Plus (CPC+) model is aimed at strengthening primary care by “enabling primary care doctors and clini-cians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists,” according to the press release issued by CMS. The five-year CPC+ model goes into effect on Jan. 1, 2017 and could involve up to 5,000 physician practices in up to 20 regions. CMS projects it could ultimately encompass more than 20,000 physicians and 25 million patients.

CPC+ continues the transition away from fee-for-service reimbursement that began when CMS launched the Comprehensive Primary Care initiative in 2012. CMS estimates it has met the goal of tying 30% of Medicare payments to quality metrics through alternative payment models.

Two tracks will be available for physician participation in CPC+. In Track 1, physicians will receive a monthly care management fee ranging from $6 to $30 per beneficiary in addition to fee-for-service payments for covered services under the Medicare Physician Fee Schedule. In Track 2, physicians will receive a monthly care management fee ranging from $9 to $33 per beneficiary, and “instead of full Medicare fee-for-ser-vice payments for Evaluation and Management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care pay-ments for those services.”

Incentive payments will be provided in advance to prac-tices in both tracks, but whether participating practices are permitted to retain or are required to return those incentives will be based on health outcomes determined by quality and utilization metrics. Practices cannot partici-pate in CPC+ if they participate in other Medicare shared savings programs and demonstrations.

It remains to be seen how much legacy building the Obama administration can accomplish with respect to healthcare between now and January 20, 2017 when the next president is inaugurated, but it’s clear there’s going to be a lot of activity. Healthcare providers will likely face unexpected changes and new challenges. And depending on the results of November’s presidential and congressio-nal elections, another new wave of change could be just around the corner.

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About the Author:

Denise Burke is a partner with Waller and focuses exclusively on healthcare investigations, regulatory and operational issues. Denise is the current chair of the Tennessee Bar Association Health Law Section, ranked by Best Lawyers and featured in Memphis Medical New’s InCharge magazine.

UTHSC Graduates 779 New Healthcare Professionals

The University of Tennessee Health Science Center graduated 779 new healthcare professionals during sepa-rate ceremonies for each of its six col-leges last month.

The 779 graduates include:• 123 from the College of Dentistry.• 77 from the College of Graduate

Health Sciences.• 188 from the College of Health

Professions.• 158 from the College of Medi-

cine.• 81 from the College of Nursing.• 152 from the College of Pharma-

cy.The class is comprised of 462 wom-

en and 317 men. Reflective of the di-versity in Tennessee, 20 percent of the graduates are from underrepresented groups. The class includes 197 gradu-ates who came from out of state.

Lori Gonzalez, PhD, vice chancel-lor for Academic, Faculty and Student Affairs, said this year’s class of 779 is a significant increase in number over last year’s class of 698 graduates.

Ovarian Cancer Fundraiser to Be Part of ‘West Fight On’ Event

The Ovarian Cancer Awareness Foundation’s Teal Run/Walk fundraiser will become part of the West Cancer Center’s Fight On Cycle, Run, Walk event which will be held September 17 at Shelby Farms Park.

Fight On Cycle, Run, Walk will in-

clude a 5K run and a tribute walk in conjunction with the Ovarian Cancer Awareness Foundation and will include cycling events , an 18-mile ride, a 32-mile ride, a 62-mile metric century ride, a Cyclocross event; and a health and wellness expo complete with entertain-ment, food, and beverages.

Those wanting more information should visit http://www.ocafoundation.org/ or http://www.westcancercenter.org/, or http://westfighton.com/

Saint Francis Healthcare Hospitals Honored for Patient Safety

Saint Francis Hospital-Bartlett and Saint Francis Hospital-Memphis have been honored with “A” Hospital Safety Scores by The Leapfrog Group, an in-dependent hospital industry watchdog.

The two hospitals were the only ones in the Memphis area to receive an “A” grade. A total of 24 hospitals in Tennessee received an “A” grade.

Saint Francis Hospital-Memphis was recognized as a “Straight A” hospi-tal for being one of 98 hospitals nation-wide to have achieved an “A” grade in every grading period since 2012. Saint Francis Hospital-Bartlett received its fifth consecutive “A” grade.

The Hospital Safety Score was cal-culated under the guidance of the na-tion’s leading experts on patient safety and is administered by The Leapfrog Group. The Hospital Safety Score is designed to provide consumers with in-formation they need when making deci-sions about a hospital stay.

Methodist Healthcare Wins CON Approval for $280 Million Project

The Tennessee Health Services and Development Agency approved the Certifi-cate of Need (CON) filed by Methodist Healthcare to modernize Methodist Univer-sity Hospital (MUH).

The hospi-tal’s news release stated, “The mod-ernization project will restructure the campus and centralize clinical services, creating a patient-and-fam-ily-centered care environment that will be easily ac-cessible and easy to navigate.”

Transplant services currently spread across the hospital will be consolidated on two floors in the tower.

West Cancer Center’s Union Avenue clinic will be consolidated in the tower with hospital-based inpatient and surgical services creating one comprehensive cancer center.

Outpatient care will be consolidated in the new tower, making these services easily accessible from the parking plaza that will connect directly to the tower.

The $280 million plan will add 440,000 square feet to the hospital’s campus and remove 240,000 square feet with the demolition of the Crews Building. A new nine-story tower will be constructed above the emergency department extending above and over Eastmoreland. Methodist will also invest in state-of-the-art equipment, el-evating health care with the most advanced technology available.

Construction is expected to begin in January 2017 and be completed in the spring of 2019.

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Memphis Medical News June 2016

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