West TN Medical News July 2014

By SUZANNE BOyD

After a series of events led Jimmy and Melanie Hoppers, both board-certified physicians to consider leaving their prac-tices, they came to the realization that there had to be a different approach to providing urgent care that was better than what they had been doing. After weighing their op-tions, the Hoppers went back to what they

knew best, providing acute care, only this time their basic philosophy is to follow the “Golden Rule.”

“Melanie and I had been working ur-gent care for years. However, at our pre-vious job, the only area that we had any control over was direct patient contact. We just weren’t happy with how things were going and felt like we needed a change. We

(CONTINUED ON PAGE 8)

HealthcareLeader

Jimmy Hoppers, MDFounder/Owner, Physicians Quality Care

July 2014 >> $5

PRSRT STDU.S.POSTAGE

PAIDFRANKLIN, TN

PERMIT NO.357

ON ROUNDS

PRINTED ON RECYCLED PAPER

Amelia Self, MD & David Self, MD

PAGE 2

PHYSICIAN SPOTLIGHT

ONLINE:WESTTNMEDICALNEWS.COM The Car. The City. One of a kind.

Exchange RateAn early analysis of the federal health exchange

After a very rough start, the federal health exchange managed a healthy rebound before the March 31 general signup deadline. Similarly, state exchanges have hit some glitches but are also now up and running ... 4

Grade: Needs ImprovementReport card highlights defi cits in children’s physical activity

Remember when P.E. was the ‘easy A’ in school? Evidently that’s no longer true.

The 2014 United States Report Card on Physical Activity for Children & Youth highlights just how far the country has fallen off the honor roll when it comes to getting our school-aged kids to move and play. “You wouldn’t want to bring this one home,” Russell Pate, PhD, said of the report card ... 10

FOCUS TOPICS PEDIATRICS HEALTH EXCHANGES

Prescription for Success State moves to curb Rx addiction

By CINDy SANDERS

Tennessee, like states across the nation, is facing a pervasive problem when it comes to the abuse of prescription drugs, particu-larly opioids and benzodiazepines.

It is estimated that of the 4.85 million adults in the state, nearly 5 percent … or about 221,000 … have used prescription opioids for non-medical purposes in the past year. Of that group, offi cials estimate more than 30 percent, approximately 69,100 adults, are addicted to the prescription drugs and require treat-ment for opioid abuse.

Although there is an increasing awareness of the issue by both prescribers and the public, Commissioner E. Douglas Varney of the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) said the problem is getting worse. As a result, TDMHSAS, in collaboration with other state agencies impacted by the issue, has created a strategic plan to turn the tide on the epidemic. Prescription for Success outlines a number of preven-tion, education and treatment strategies to meet seven stated goals:

• Decrease the number of Tennesseans who abuse controlled substances.

• Decrease the number of Tennesseans who overdose on con-trolled substances.

(CONTINUED ON PAGE 6)Governor Bill Haslam, joined by offi cials from key state agencies, outlines the plan to curb prescription drug abuse in Tennessee.

2 > JULY 2014 w e s t t n m e d i c a l n e w s . c o m

By SUZANNE BOyD

Talk about being all about kids. Between managing a busy pedi-atric practice in Jackson and having raised six chil-dren of their own, Amelia and David Self, live, eat, breath and sleep kids. Being so immersed in kids has a given these pe-diatricians, who are fi rst generation physicians in their families, a wealth of practical knowledge that they can share with pa-tients and parents in their practice as well as in their own home.

For Amelia, who was named for her grand-mother, growing up in Hartsville which is in the smallest county in the state of Tennessee where farming was king meant going to college was the exception not the norm. Her graduating class had 43 in it, with only ten of those going on to college or trade school. Amelia started college at the University of Alabama with plans to study criminal justice and eventually go to law school but instead transferred to Middle Tennessee State University. She also realized she enjoyed biology and chemistry so much that she changed her major to pre-med, which did not surprise her family at all.

“My mother had gone to nursing school but never fi nished so we had medi-cal books around our house while I was growing up and I always loved to look through them. Of course, going to medi-cal school was a dream where I grew up

but my family was very supportive of me pursuing it,” said Amelia. “After taking biology and chemistry as prerequisites at Alabama, I was hooked and realized med-icine was where my heart was and that was confi rmed even more as I pursued a pre-med degree at MTSU.”

For David, who grew up in Brent-wood, medicine was what he knew he wanted to pursue since he was a small child. After graduating from Lipscomb High School, David started college at Vanderbilt then transferred to Lipscomb University where he graduated with a pre-med degree.

The couple met while in medical school at East Tennessee State Univer-sity in Johnson City and married in their last year there. While the Selfs agreed to a lifetime together, they did not initially agree on pursuing the same specialty.

David was drawn to pedi-atrics all along but almost went the obstetrics route. Amelia originally thought psychiatry.

The couple matched for their respective in-ternships at the Medical College of Georgia in Au-gusta. “While we were in medical school, the pedi-atric program was really just getting started so I did not have a lot of expo-sure to working with chil-dren but I knew I wanted to go into child and ado-lescent psychiatry,” said Amelia. “During my year long internship I real-ized it wasn’t psychiatry I wanted, it was work-

ing with kids. So when I fi nished up my internship, I did one in pediatrics which put me a year behind David, who had already started his pediatric residency which meant when I started he could be my boss. After one rotation, that did not happen again because I wanted to chart my own course and did not want people to think I was getting any breaks.”

While the Selfs were busy with intern-ing and starting a residency, life at home was also busy with two kids, a daughter and a son and only got busier. Their third child, a son, arrived at the end of Amy’s psychiatry internship with the fourth, also a boy, coming in the fi rst year of her pe-diatric residency. “Funny thing about our residencies was that the kids always knew one parent was coming home, just they never knew which one would it be,” said David. “We would just sort of pass each

other. We might be home together one or two nights out of four. It was tough with no family there but we made it with the help of sitters. Only one had to spend any time in day care.”

While David waited for Amy to fi n-ish her residency, he went into private practice in Augusta. “When Amy came out of residency she was asked to stay on as a professor at the Medical College,” said David. “And she was contacted by the Children’s Clinic in Jackson about an opportunity to join their group. Although they were initially looking for one doctor, they were willing to take both of us. Mov-ing to Jackson meant we could be closer to our families, while we were growing our own.”

Within ten months of arriving in Jackson, their household grew to include one girl and four boys. Four years later, the last son arrived. Today, the family has four kids out of the house, one which has graduated college heading to graduate school, one who is married with three chil-dren and lives in Texas, one who works for Eco-Lab, a junior in college, one who will start college this Fall and the youngest who will enter high school this Fall.

One may ask how they managed six children and a busy pediatric practice. Amy says putting kids fi rst, whether that was in the offi ce or at home, was key. “David and I have always had different days off is that helped with the kids sched-ules. We were also fortunate to have great babysitters that could help with carpool or with the kids until they were old enough to go to school,” she said. “Things were hectic with running a practice and man-aging kids, but we always made sure to spend quality time with our own children. I honestly can say I miss all the kids being here everyday. I am so thankful we have four more years before the last one is out of the house.”

Raising six children has given the Selfs wisdom far beyond what a textbook can provide and they draw upon their own experiences when dealing with pa-tients. “I tell patients that about 50 per-cent of what I know is from a textbook and the rest is from life experience,” said Amelia. “I don’t know how you can do pediatrics without having kids. It all comes to life when you have a household. Each one is different and has their own unique personality. And with six, we have had quite a variety of an education with which we can share with patients.”

Amelia Self, MD & David Self, MD PhysicianSpotlight

Read Medical News Online:

WESTTNMEDICALNEWS.COM

O� er Expires in 30 days.Includes exam, cleaning and x-rays. New Patients Only.

A Proud Member of the Dental Practice Group of Tennessee.D0150, D0330, D0272, D0210, D1110, D0140, D0220, D0230, D9972

Contact us today!

Make an appointment instantly on our website!

(731) 256-0448 78 Lynoak Cove

Jackson, TN 38305

h� p://www.demandforce.com/b/JacksonFamilyDental

Affiliated with Dental PartnersAffiliated with Dental Partners

Jackson Family Dental CareAffiliated with Dental PartnersAffiliated with Dental Partners

Jackson Family Dental CareJackson Family Dental Care

$59 NEW PATIENTSPECIAL

We LOVE to see you SMILE!

w e s t t n m e d i c a l n e w s . c o m JULY 2014 > 3

“Partnering with a bank that understands more than just my banking needs was

a real TURNING POINT for me.”

Loans | Treasury Management | Can-Do Attitude

© 2014 Regions Bank. All loans and lines subject to credit approval.

When she opened her dental practice, Kids Healthy Teeth, in 1988, Dr. Sheryl Hunter-Griffi th had a vision of delivering

high-quality care to the most vulnerable of patients: children – especially children with special needs. But as her business

rapidly expanded, Sheryl had less time to focus on the details so she turned to Regions Banker Chris Peralta, who has

a special-needs child of his own. Chris has always proactively sought out opportunities to help Sheryl’s business move

forward. By performing a detailed analysis of every aspect of the business, and introducing the account management and

bill payment services available through Regions Online Banking, he has helped Kids Healthy Teeth to signifi cantly reduce its

costs. Sheryl is grateful she has a banker who not only understands the greater mission of her business, but also shares her

vision for moving forward. To see how we can help your business move forward when it’s at a turning point, turn to Regions.

Dr. Sheryl Hunter-Griffi th Kids Healthy Teeth Get the whole story at regions.com/kidshealthyteeth


By CINDy SANDERS

After a very rough start, the federal health exchange managed a healthy re-bound before the March 31 general signup deadline. Similarly, state exchanges have hit some glitches but are also now up and running.

Finishing the first half of the year, are the exchanges panning out to be as good as promised … as awful as predicted … or somewhere in the middle? Although much too early to make a definitive pronounce-ment, two of the nonpartisan experts on staff at The Advisory Board Company shared insights into what the first few months have revealed about the exchanges in terms of access, affordability, and expec-tations.

Rob Lazerow serves as practice man-ager and David Lumbert as a senior analyst in the Research & Insights divi-sion of the global health-care technology, research and consulting firm head-quartered in Washington, D.C. Despite the physi-cal location of The Ad-visory Board Company, Lazerow noted, “Our work is completely non-political. I stress this because every-thing with Obamacare is so politically charged.”

With that in mind, he and Lumbert broke down what they’ve seen so far.

Big Picture“We wound up with just over 8 mil-

lion, and that includes the special enroll-ment period which extended to April 19,” Lumbert said of the numbers for the public exchanges. He added the extra two-week period was only for those who had started the enrollment process before the March 31 deadline. “Originally, the Congressio-

nal Budget Office had projected 7 million so it did exceed that by just over 1 million,” he continued. Lumbert added nearly half of the enrollees selected a plan in March. “There was definitely a surge at the end due to technical problems being fixed and more education about the process and deadlines.”

Lazerow said the CBO provided ag-gregate coverage expansion figures that included exchange uptake, Medicaid expansion and potential changes in the employer market for a net/net effect on coverage in the wake of the Affordable Care Act. “From estimates in February 2013 from the Congressional Budget Of-fice, they expected ultimately around 27 million individuals to gain coverage by 2017,” he said. Lazerow added those pro-jections were adjusted downward in Febru-ary 2014 to project an increase in coverage for nonelderly individuals by about 13 mil-lion in 2014, 20 million in 2015, and 25 million in each of the subsequent years through 2024. The latest report from Health & Human Services shows coverage hitting the CBO projection with 8.019 mil-lion enrolled through marketplace plans and an uptick in Medicaid/CHIP enroll-ment of 4.824 million.

Even with expanded coverage, that still leaves about 31 million nonelderly U.S. residents uninsured. However, about 30 percent of that group, according to the CBO and Joint Committee on Taxa-tion (JCT), are unauthorized immigrants who would not qualify for most Medicaid benefits and exchange subsidies. As for the others, the CBO and JCT estimate 20 percent would qualify for Medicaid but choose not to enroll, 5 percent would not be able to get Medicaid coverage because they live in states that didn’t expand the program, and 45 percent would simply opt not to purchase coverage even though they have access to insurance through the

exchanges, an employer or directly from an insurer. Still, by 2016, more than 90 percent of legal nonelderly residents are anticipated to have health coverage in the United States.

In assessing the pros and cons of ACA, both analysts noted items in the ‘good’ col-umn might go south down the road just as those tallied as potential negatives might not turn out to be a problem over the long term.

So Far, So Good“One of the more baseline elements

is that we now have a reliable, working marketplace where people can go to see a range of plans and the prices for them,” said Lazerow. He added one of the policy objectives was to offer individuals more choice when it came to coverage options. Prior to ACA, most employers and indi-vidual carriers offered limited plan options. Lazerow noted that expansion is happen-ing not only in the public marketplaces but also in private exchanges now, as well. “Consumers shopping on exchanges often have a lot more choice in the types of health insurance plans available to them,” he said of the current climate.

Another goal was to create affordable options. “When you factor in all the sub-sidies — and there are subsidies for pre-mium support and cost-sharing subsidies — it appears affordable coverage is now within reach for many,” Lazerow contin-ued.

While most people know front-end subsidies are available to individuals be-tween 100 percent and 400 percent of the federal poverty level (FPL), Lazerow said not as many individuals are aware of the cost-sharing subsidies that also exist. “This is for individuals below 250 percent of the federal poverty level,” he explained, add-ing it helps reduce costs associated with co-payments, deductibles and co-insur-

ance. “That’s really important because in-dividuals may not fully understand they’re exposed to those deductibles when they ac-cess certain services,” he continued.

“The insurance companies have re-ported between 80 and 90 percent of en-rollees did pay their first month premium,” Lumbert said. Lazerow added this is on par with what has historically been seen with other individual commercial plans. “The question now,” Lumbert continued, “is whether people will continue to pay the second, third months … especially those who were uninsured before and are un-accustomed to paying a premium every month.”

Another positive for consumers and providers is the new plans include a more generous benefits package. Lumbert noted a 2012 analysis published in Health Af-fairs found 51 percent of pre-ACA policies didn’t offer the minimum standard for ‘es-sential benefits’ the law requires.

However, when policy termination notices were sent out last year for plans that didn’t meet the litmus test, some families found the new standards to be a negative, rather than a positive. In the wake of the outcry … and President Obama’s assertion people could keep plans they liked … car-riers have been allowed to extend coverage deemed out of compliance until 2015.

Red Flags & Open QuestionsThe nightmare rollout got the federal

exchange off to a bumpy beginning. “The turnaround seems to have done the job, but I don’t think it was the starting place the administration was hoping for,” Laz-erow said tongue-in-cheek. Although en-rollment rebounded, the question remains whether or not the rough start will have a lasting impact on public perception.

Long before the rollout however, the die was cast in what has become a serious issue for long-term hospital survival … particularly in rural areas. In negotiating the terms of ACA, hospitals made conces-sions based on certain coverage assump-tions. Lazerow noted the ‘gets’ outweighed the ‘gives’ in the original scope of the leg-islation. However, he continued, “The Medicaid expansion is a state-by-state issue now. One thing we see for hospitals and health systems is they face all of the downsides of the Affordable Care Act, but they don’t necessarily get all the upside.” Several states without Medicaid expansion have already witnessed the demise of some rural inpatient facilities, which could create access issues down the road.

Another issue now that the exchanges are active is how patients will operate under the new plans. Lazerow questioned how newly insured individuals would react to costs. “Is there going to be sticker shock … not at the point of coverage … but at the point of service, and how does that im-pact their utilization?”

Lazerow and Lumbert are also taking a wait-and-see stance when it comes to nar-

Exchange RateAn early analysis of the federal health exchange

Rob Lazerow

(CONTINUED ON PAGE 9)


Douglas C. Appleby, MD, DHAMedical School: Medical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South Carolina

Residency: University of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical CenterUniversity of Kentucky Medical Center

Thoracic and Cardiovascular Surgery Fellowship: University of Utah Medical CenterUniversity of Utah Medical CenterUniversity of Utah Medical CenterUniversity of Utah Medical CenterUniversity of Utah Medical CenterUniversity of Utah Medical CenterUniversity of Utah Medical CenterUniversity of Utah Medical Center

Doctorate of Health, Administration and Policy: Medical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South Carolina

Training in Clinical Advances: Johns Hopkins Hospital, The Cleveland ClinicJohns Hopkins Hospital, The Cleveland ClinicJohns Hopkins Hospital, The Cleveland ClinicJohns Hopkins Hospital, The Cleveland ClinicJohns Hopkins Hospital, The Cleveland ClinicJohns Hopkins Hospital, The Cleveland ClinicJohns Hopkins Hospital, The Cleveland ClinicJohns Hopkins Hospital, The Cleveland ClinicJohns Hopkins Hospital, The Cleveland ClinicJohns Hopkins Hospital, The Cleveland ClinicJohns Hopkins Hospital, The Cleveland Clinic

Certifications: National Board of Medical Examiners, National Board of Medical Examiners, National Board of Medical Examiners, National Board of Medical Examiners, National Board of Medical Examiners, National Board of Medical Examiners, National Board of Medical Examiners, National Board of Medical Examiners, National Board of Medical Examiners, National Board of Medical Examiners, American Board of Surgery, American Board of Surgery, American Board of Surgery, American Board of Surgery, American Board of Surgery, American Board of Surgery, American Board of Surgery, American Board of Surgery, American Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic Surgery

A Heart Felt WelcomeAs a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at As a new heart surgeon joins our team at West Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterWest Tennessee Heart & Vascular CenterAs a new heart surgeon joins our team at West Tennessee Heart & Vascular CenterAs a new heart surgeon joins our team at As a new heart surgeon joins our team at West Tennessee Heart & Vascular CenterAs a new heart surgeon joins our team at As a new heart surgeon joins our team at West Tennessee Heart & Vascular CenterAs a new heart surgeon joins our team at As a new heart surgeon joins our team at West Tennessee Heart & Vascular CenterAs a new heart surgeon joins our team at As a new heart surgeon joins our team at West Tennessee Heart & Vascular CenterAs a new heart surgeon joins our team at

Arthur Grimball, MDResidency: Vanderbilt University HospitalResidency: Vanderbilt University HospitalResidency: Vanderbilt University HospitalResidency: Vanderbilt University HospitalResidency: Vanderbilt University HospitalResidency: Vanderbilt University HospitalResidency: Vanderbilt University HospitalResidency: Vanderbilt University HospitalResidency: Vanderbilt University HospitalResidency: Vanderbilt University HospitalResidency: Vanderbilt University HospitalResidency: Vanderbilt University Hospital

Fellowship: University of Kentucky, Fellowship: University of Kentucky, Fellowship: University of Kentucky, Cardiothoracic Surgery

Certifications: American Board of Surgery, American Board of Surgery, American Board of Surgery, American Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic SurgeryAmerican Board of Thoracic Surgery

Eric M. Sievers, MDResidency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Residency: LAC-USC Medical Center, Los AngelesLos AngelesLos AngelesLos AngelesLos AngelesLos AngelesLos AngelesLos Angeles

Fellowships: University of Southern California, Fellowships: University of Southern California, Los Angeles Children’s HospitalsLos Angeles Children’s Hospitals

Certifications: American Board of Surgery, American Board of Thoracic Surgery

Cardiothoracic Surgery Center329 Coatsland Dr. Jackson, TN 38301731-424-5080 • cardiosurgery.wth.org

See Complete Bios & Learn More at WTHVC.orgSee Complete Bios & Learn More at WTHVC.orgSee Complete Bios & Learn More at WTHVC.orgSee Complete Bios & Learn More at WTHVC.org

Our Cardiothoracic Surgery Team

Since my last few columns have pretty much been to the point, I decided to provide some history and comedy this month. In previous columns, I talked about generational differences and their impact in the future. I enjoy reading about the different generations and their personal and professional thoughts on different things.

A few weeks ago I had a few of my high school friends over at my house to grill on the back deck (BYOB). We graduated from high school in 1972. So I grilled out with some fellow high school buddies who are also baby-boomers. I wish I had thought to film it – it would have gone viral.

In looking at our 1972 yearbook, we noticed how many people signed, “Don’t ever change. Stay just the way you are!”

What a strange valediction to give each other on the threshold of life. (Boomers, born between 1946-1964.) We are the generation that changed everything. Of all the eras and epochs of Americans, ours is the one that made the biggest impression on… ourselves.

We sat around and talked about where some of our other high school friends were, including some of the teachers and then reminisced about who went to detention hall after school. (I was reminded by these friends that I was one of those.)

Of course, we had to talk about the hardest and meanest teachers at our high school.

We started with Ms. Aste’s history class. I believe she advised me to drop her class after the first two weeks.

History is full of generations that had too many problems. We are the first generation to have too many answers. Well, back to Ms. Aste’s class…

I remember to this day one of her lectures. She said, “Consider the people who have faced up squarely to the deepest and most perplexing conundrums of existence. Leo Tolstoy, for example. He tackled every one of them. Why are we here? What kind of life should we lead? The nature of evil. The character of love. The essence of identity. Salvation, Suffering, Death.” I raised my hand. After all I was a boomer.

I asked Ms. Aste, “What did it get him? Dead, for one thing. And off his rocker for the last 30 years of his life. Plus, he was saddled with a thousand-page novel about war, peace, and everything else you can think of.”

Years later though, I reflected about that lecture. I thought what a life. If Leo Tolstoy had been one of us he could have entered a triathlon, invented a baby boom innovation of the middle 1970s. By then, it was starting to sink in that we couldn’t run away from our problems.

We now number more than 75 million, and we’re not only a diverse generation, but take thorny pride in our every deviation from the norm (even though we’re in therapy for it.) We are all alike in that each of us is unusual.

Then, in Mr. Garret’s class, he went on at length about the New Frontier. It was

full of Comanche’s, gunfighters, and cattle stampedes. Kirby, one of my friends in high school said, “I couldn’t picture myself dramatically wounded and bleeding to death while bravely urging Sargent Shriver to leave me behind and repair the village.” Well, he had just popped the top on his third beer.

One of my guests was the type we many times referred to as a hippie; long hair and always smelled of incense. I wouldn’t have remembered him from high school if someone hadn’t had told me. The word retire had barely been uttered when this classmate said, “We can’t retire. The mortgage is underwater. We’re in debt to the Rogaine for our son’s college education.” Funny stuff.

I have a confession. This article would never have been written if it weren’t for two books I have read. P.J. O’Rourke’s “The Baby Boom, How It Got That Way And It Wasn’t My Fault And I’ll Never Do It Again.” And “Millennial Momentum” by Morley Wingrad and Michael D. Hais.

In case you haven’t read any of his books, O’Rourke says in the very beginning, “Herein is a ballad of the Baby Boom, not a dissertation on it. A rhapsody, not a report.

A freehand sketch, not a faithful rendering. That is to say, I am – it is a writer’s vocation and the métier of his age cohort-full of crap.”

Think of the baby boomer presidents that we’ve had so far – Bill Clinton, George W. Bush, and Barack Obama. They are spread as far across the political map as you can get without going to Pyongyang.

According to Mr. O’Rourke, “Baby Boomers who are younger or female will vote for the Silly Party, Boomers who are older or male tend to vote for the Stupid Party. Then there are the Independents, product of the fact that they don’t know which is which.”

Remember folks, these are Mr. O’Rourke’s words not mine.

And yet we are the best generation in history. Which goes to show that history stinks. But at least we are fabulous by historical standards.

Our passionate belief in change hasn’t altered, going from “got spare change?” to “Hope and Change.”

We’re still opposed to prejudice, poverty, war and injustice. We’re a generation that doesn’t appreciate consequences. And we appreciated consequences even less after the Vietnam War, which had 47,415 of us killed in combat, not counting 153,303 wounded.

In conclusion: We bother and control our older children and interfere in every aspect of their lives because we don’t want them horning in on the fun of being a juvenile, which rightfully belongs in perpetuity to the baby boomers.

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

The Boomer Ballad: “Don’t Ever Change”

BY BILL APPLING

MedicalEconomics


For more information, contact J. Neal Rager at 731-661-6340 or [email protected].

Healthcare is Changing.ADMINISTRATORS

How can you stay on topof the issues?

Join MGMAin 2014!Monthly

luncheons withExecutive Level

Education!

WEST TN MGMA

• Decrease the amount of controlled substances dispensed in Tennessee.

• Increase access to drug disposal out-lets in Tennessee.

• Increase access and quality of early intervention, treatment and recov-ery services.

• Expand collaborations and coordi-nation among state agencies.

• Expand collaboration and coordi-nation with other states.

Gov. Bill Haslam joined Commis-sioner Varney to announce the plan on June 3 in Nashville and to launch a state-wide tour of events drawing awareness to the issue and the coordinated efforts aimed at prevention and treatment.

In unveiling the plan, Haslam said, “Prescription for Success is a comprehensive, multi-year strategic plan that will involve different agencies across state government to reduce the misuse and abuse of pre-scription drugs so Tennesseans can live happy, healthy and fulfi lling lives.”

Varney said it is often shocking when people learn who makes up this population of addicted Tennesseans. It’s a very dif-ferent demographic than typically comes to mind with the term ‘drug addict.’ Pre-scription addiction crosses all ethnic, social and economic lines and includes doctors, lawyers, law enforcement offi cials and suburban housewives. “It’s really a much broader spectrum of people, which in some ways makes it more diffi cult to deal with, but conversely, it opens up dialogue

about addiction in general and hopefully increases understanding,” he said.

The reasons for the rise in opioid abuse and addiction are multifactorial, but Varney said at least some of the cur-rent problem is probably an unintended consequence of the ‘pain as the fi fth vital sign’ initiative. Other reasons, he contin-ued, include better access to healthcare in general, not following recommended dos-ages, the low cost of many of the generic forms of addictive pain medications, and not recognizing the addiction.

“With illicit drugs, you know you are doing something wrong,” Varney added. However, he contin-ued, “Seventy percent of all of these drugs come from legitimate sources.”

Those sources in-clude ‘helpful’ family and friends with leftover pain medications in the cabinet, as well as phy-sicians and other pre-scribers. In some cases where patients are taking drugs that have been legitimately prescribed, Varney continued, “At the end of the treatment, they weren’t titrated off the medication.” He added, “They’re not placebos. They are serious medica-tions that need close medical supervi-sion. Just because it comes from a doctor doesn’t mean it can’t really hurt you.”

The state has already taken several

important steps to curb the issue, Varney noted. He said the Prescription Safety Act, which was signed into law in 2012, is already making a difference. The law requires medi-cal professionals to register with the Con-trolled Substance Monitoring Database and check a patient’s use of opioids and benzodi-azepine before prescribing. Updated weekly by pharmacists and dispensers, the database allows prescribers to see if a patient is doc-tor shopping. It also allows offi cials to see if there are prescribing patterns that raise a red fl ag and to reach out to those medical pro-fessionals to better educate them about the dangers of overprescribing.

“I think in our state, we’re going to see a sharp drop in the number of new people becoming addicted to these medi-cations and a sharp drop in the supply of these narcotics because physicians are being more vigilant and the standard of care has changed,” Varney predicted.

Prescription for Success has specifi c tar-gets for each of the goals such as reach-ing a 20 percent decrease in the number of people using prescription opioids and the number of people who die from pre-scription overdose by 2018. During that same timeframe, the goal is to decrease the amount of prescriptions dispensed in Tennessee by 15 percent. Although the fi rst benchmarks come in 2018, Varney was quick to point out the program has no endpoint as this will be an ongoing battle.

While prevention is a large part of the overall strategy, Varney said the col-laborative plan also focuses on helping those who already are … or will become … addicted have access to resources. He noted detox programs, inpatient and in-tensive outpatient programming, 12-step programs and medication management to wean individuals off of the drugs have been proven successful.

“Treatment does work if people will engage in therapy,” Varney stated. “We really want communities across our state to become more recovery-oriented.”

He continued, “There are so many

misperceptions about addiction. We need to reach out with more than just a stick. We need to also reach out with love and understanding.”

When people cross the line legally, Varney also hopes to see more recognition of alternatives for non-violent drug offend-ers. “I think we’re beginning to realize in this country that incarcerating people for addiction is not really the answer,” he said. Varney added an increasing number of judges across the state have become more vocal in moving people toward treatment and rehabilitation. “We added 10 new drug courts over the last year,” Varney said, adding there is also one statewide res-idential program in Morgan County that has diverted some of the most severely ad-dicted from state prison and into the nine-month intensive program. The program, which is unique in the nation, is for men, but Varney hopes to have such a program for women, as well.

While many of the strategies aren’t ‘new,’ Varney said what sets Prescription for Success apart is the intensity, focus, and collaboration behind it. Key state agencies that have come together to ad-dress this problem include the Tennessee Department of Health, Department of Children’s Services, TennCare, Tennes-see Bureau of Investigation, Tennessee Department of Safety and Homeland Security, Department of Correction, Tennessee National Guard, and the Ten-nessee branch of the U.S. Drug Enforce-ment Agency.

“We hope this document we’ve pub-lished will help keep us all focused and pointed in the same direction and have benchmarks to measure our success,” he concluded.

Prescription for Success, continued from page 1 How Big is the Problem in Tennessee?

There were 25 percent more controlled substances dispensed in Tennessee in 2012 than in 2010.

In March 2013, more than 2,000 people received prescriptions for opioids or benzodiazepines from four or more prescribers.

The number of emergency department visits for prescription drug poisoning has increased by approximately 40 percent from 2005 to 2010.

There has been a 220 percent increase in the number of drug overdose deaths from 1999 to 2012.

Young adults in Tennessee ages 18-25 are using prescription opioids at a 30 percent higher rate than the national average.

Drug-related crimes against property, people and society in Tennessee have increased by 33 percent from 2005 to 2012.

For more information, contact TDMHSAS at 615-532-6500 or go online to tn.gov/mental.

Commissioner E. Douglas

Varney

For additional details, go online to tn.gov/mental/prescriptionforsuccess.

Online Event Calendar

To submit or view local events visit the West TN Medical News website.

westtnmedicalnews.com

A user name and password are required to submit an event.

Under Member Options, go to “free sign up” to register.


By LyNNE JETER

When Jeff Holt begins talking to groups about healthcare embezzlement, he immediately gets everyone’s attention with these opening remarks:

“Look to your left and right. Chances are two of three people you see are being, have been, or will be embez-zled from,” said Holt, vice president of health-care business banking for PNC Financial Services Group, Orlando, Florida.

Then he hits home with statistics from the Association of Certifi ed Fraud Examin-ers: “The median loss for small businesses, defi ned as 100 employees or less, is about $150,000 through embezzlement alone. Medical and dental practices lose $25 billion annually from the combination of fraud and embezzlement.”

Holt emphasized the statistics only represent those incidents reported.

“In many cases, it goes unreported,” he said. “Practices don’t want to make it public because then the public may think ‘what else was stolen … my personal information?’

In some cases, more embezzlement simply isn’t discovered. Or perhaps the employee was fi red and never prosecuted, so it becomes an unreported statistic. I had a case recently where the healthcare attor-ney’s client didn’t want to look any further because he knew they weren’t going to re-cover any money anyway.”

Holt recently discussed “Protecting your Practice: What does embezzlement look like, and what are the best practices to secure your valuable business?”

“After my talk, almost every hand went up with questions,” said Holt.

After all, much of the pre-meeting buzz had centered on Christie B. Hunt, the 32-year-old offi ce manager from Mel-bourne, Florida, who had been arrested for embezzling nearly $700,000 from a medical group to fi nance a lavish lifestyle that included high-priced real estate and two 2014 Audi Q7s. While handling all fi -nancial management, and marketing and business development at the Titusville lo-cation, Hunt had allegedly diverted funds to shell corporations.

“There are more than 1,000 ways to embezzle money from a practice,” cau-tioned Holt. “Estimates are that each orga-nization loses 5 percent of their revenue to fraud each year. That’s signifi cant! Small organizations are disproportionally victim-ized by occupational fraud; they typically lack anti-fraud controls compared to hos-pitals and banks.”

Who’s Embezzling?Embezzlers are tricky to spot. Eighty-

fi ve percent have never been convicted previously of fraud-related offenses, noted

Holt. “In most cases, life events happen

that bring about a change – addictions, divorce, family problems, mid-life crises,” he explained.

Yet there are some typical character-istics to consider, Holt said, noting that 40 percent of embezzlers are circling the age of 40.

“The embezzler is typically a longtime employee with the full trust of the doctor and, on the surface, a devoted employee,” he said. “They typically don’t take vaca-tions. They’re very protective of their job and work many hours of overtime, often alone – that’s key because it’s typically when they commit the crime. Also, they never really train a substitute, so nobody else can interfere.”

Embezzlers despise operational changes; however, they can be very in-novative working different ways to funnel money to their pockets.

“It doesn’t necessarily have to be cash,” he said. “You can notice their at-titude change when you try to take the re-sponsibility away from them or change the processes.”

Investigative Hat Holt suggests that doctors take extra

time to understand their employees and changes going on in their lives, such as buying a bigger house or a boat, especially when nothing fi nancially has seemingly changed in their lives.

“Notice things going on in the prac-tice, too,” he said. “Indicators may show unusual adjustments on bank reconcilia-tions; audit controls in place on fi nances will help sniff out trouble.”

Some other red fl ags:• Issues with receivables, such as nu-

merous charge-offs;• Discrepancies between bank depos-

its and postings;• Abnormal numbers with personal

expense reimbursements (if so, re-quest backup documentation and proof of expenses);

• Increasing payroll costs, with no time clock for accountability; or

• Financial reports income/expense line items aren’t in line with prior time periods (benchmarking is key to recognizing issues here).

“Even $50 a week times 52 weeks, times the years of service … it can add up,” said Holt. “Over 20 years, that’s $52,000.”

Security MeasuresWhen hiring a new employee, pay

the fee for background checks on the front end, emphasized Holt.

“If not, you could pay for it on the back end. Also, look at possibly bonding and/or insurance for employees,” he said.

Holt advised doctors to have fi nancial statements mailed to their home, a post of-fi ce box, or a CPA, to bar the embezzler

from valuable information.Other suggestions:Do use invoices and statements online

instead of paper. “With paper, the em-ployee can give you copies where they’ve cut-and-pasted information the way they want you to see it,” explained Holt.

Don’t have employees jot down fi nan-cial information on patient credit cards, or worse yet, keep a log. “Because of potential problems with HIPAA compliance, credit card compliance (PCI, for example), and huge penalties for a practice – a severe fi ne is up to $100,000 per case – do have a management security code for patient refunds at the merchant terminal,” said Holt. “Have the credit card information digitally stored and encrypted. It also keeps the patient feeling secure about their other confi dential information at the practice.”

• Do engage your CPA or consul-tant to conduct random audits.

• Do make sure checks are stamped “for deposit only.” “An Orlando employee diverted $650,000 into a separate account because she had so much control,” lamented Holt.

• Don’t have signature stamps. “It’s very high risk,” he said.

• Do compare daily receipts to the bank deposits. “That’s a small daily audit you can do yourself,” he said.

• Do have in place inventory controls, IT security, cash controls.

• Do benchmark accounts month-to-month.

• Do keep seeking red fl ags. “The older the embezzler, the more money is typically taken,” he said. “Older employees usually feel they’re so slick; they won’t get caught. Personality remains the greatest indicator of a hint there’s something you should be concerned about.”

Minimizing EmbezzlementPNC’s Jeff Holt shares red fl ags, security measures to plug internal theft opportunities

Jeff Holt

If embezzlement is suspected, immediately contact your banker, CPA and attorney. Also, it’s critical not to share suspicions. Professional partners will convey the next steps, which may include contacting the police. For more information, contact [email protected].


wanted to try doing things differently,” said Hoppers. “After considering our op-tions, we realized medicine is what we knew best and since we had been doing acute care for years, we figured that is where we needed to stay.”

In developing their ‘new’ business, the Hoppers relied upon the book Good to Great by Jim Collins, which examined more than 500 companies and identified what it took to elevate a good company to greatness. The principles outlined in the book resonated with the Hoppers and they chose to incorporate them into Phy-sicians Quality Care. Their model of care was based on the principles of treating others as you would want to be treated, giving staff “ownership,” and taking re-sponsibility for the practice as a whole.

“Doctors are excellent at treating people as patients. Their focus is to make a diagnosis to get the patient better and they have to believe that their decisions are the right ones. But doctors are some-times not the best at treating people as consumers,” said Hoppers. “It is easy to get into the mindset that the only part of the visit that counts is when the doctor actually enters the exam room to see the patient.”

The Hoppers started their new en-deavor with a mobile Occupational Medicine program in early 2008. They purchased a medical RV and equipped it with a three-person audio room, exam room and lab. “We started going to in-dustrial parking lots for the eight months before our urgent care clinic, Physicians Quality Care, opened,” said Hoppers. “Our mobile unit has gone through 3 or 4 incarnations and now is primarily used for on-site audiograms. This allows us to be there when the client needs us any hour of the day. ”

In August 2008 Physicians Qual-ity Care opened. It included Boomers, a small, personal gym with state of the art equipment. In 2012 physical therapy was incorporated into the clinic. Over the past year PQC has begun seeing primary care patients for ongoing medical care. “Through the years, patients would ask us if we could be their primary doctor and a lot of patients considered us their ‘regular’ doctor anyway. We make ap-pointment times fit their schedule and are always looking for ways to make it easier on folks, like online check in. Whatever we can do to make life easier for patients is what we want to do.”

In July 2013, PQC opened a second location in Milan. “We learned a lot from Jackson and made some design changes. PQC Milan is a separate entity from Jack-son and we wanted to make it specifically fit the needs of Milan and Northwest Tennessee,” said Hoppers.

One of Hoppers’ heroes is Walt Dis-ney. “At Disney their business philosophy centers around customer service. Their product is customer service delivered through theme parks,” said Hoppers. “Our widget is customer service deliv-ered through healthcare. Every company has a foundational tenet that never gets violated. At Disney it is safety, for us at

Physician Quality Care, excellent medical care trumps everything else.”

Hoppers worked to create an atmo-sphere where patients felt more at home than in a doctor’s office. “Our concierges make our waiting rooms seem more like a living room. We never call patients by their last name. It is a rule in our clinic that we do not leave patients without some form of staff contact for more than 10-15 minutes,” said Hoppers. We rein-force the idea that that healthcare is more than doing a test and giving a shot. We may no longer be able to make a house call, but it is our hope to bring a house call back to our house.”

At PQC, Hoppers says there are some basic mantras: Do unto others as you would have them do unto you; if you see the problem, you own the problem; and the presumptive answer to every question is yes. “None of us ever says that something is not my job. We also are very aware that someone in a separate de-partment may be able to offer a different perspective on a problem and we invite everyone’s input no matter what their po-sition.” said Hoppers. “Our philosophy is that this is team sport. It is not a matter of who gets the credit but more ‘what I can do to serve the patient better.’ At the end of the day, if one of us wins, we all win.”

While PQC faces many of the same challenges as other clinics with healthcare reform, one of the biggest it has faced is rapid growth. When the clinic opened six years ago, it had a staff of around 25 employees; today that number has grown to 115. However, the biggest challenge, Hoppers sees, is ensuring the core philos-ophy permeates everything. “Everyone knows our core values and how seriously we take them,” he said. “Mistakes are going to happen and we will forgive a multitude of sins except not being nice to one another.”

Hoppers feels fortunate and blessed that patients have accepted the way care is provided at PQC but is always looking for ways to innovate and strives to con-tinue providing excellent medical care. “We know we can never get complacent,” he said. “Our staff are the ones making PQC successful and we have to be careful never to lose sight of that. It is they who deserve the credit.”

Having the ability to surround them-selves with really good people they can trust to excel at their jobs without mi-cromanagement is something Jimmy and Melanie are proud of. “In Good to Great, Collins says even if you don’t have a po-sition for a person, if they are excellent, hire them,” said Hoppers. “Look for the best people you can find then turn them loose. Most leaders in our organization started out low on the totem pole and have worked their way up. We have re-ally great people that have bought into the philosophy of treating people right. We continually try to put ourselves in the patient’s position. We treat your illness while striving to lift your spirits and make your total experience in our clinic a posi-tive one.”

Healthcare Leader, continued from page 1

If your marketing plans include impacting the medical doctors of

West TN, you should consider an advertising program in the

West TN Medical News.

We not only reach 1,150 West TN area physicians by mail each month, they spend quality time reading our monthly content. Our editorial content is infor-mative, educational, ethical, and created by professional healthcare editors with years of experience. Our content is a com-bination of clinical and business information needed by today’s physicians. Our news con-tent keeps physician readers aware of signifi cant changes in our region’s healthcare community.

The largest audience of medical doctors in the West TN area will read your advertising messages.

We Deliver Physician Readers.

CONTACT ME TODAY FOR INFORMATION ABOUT REACHING OUR PHYSICIAN READERS FOR PENNIES PER MONTH:

PAMELA HARRISWest TN Medical [email protected]


To learn more, visit healthcare.goarmy.com/y941 or call 1-888-550-ARMY.

Tim C. Nicholson is the President of Bigfi sh, LLC. His Memphis-based fi rm connects physicians, clinics and hospitals to patients and one another through healthcare social media solutions, branding initiatives and websites. His column, “Hey Doc”, appears here monthly. Find him on twitter @timbigfi sh or email tim@gobigfi shgo.com

By TIM NICHOLSON

We’ve been meeting together here for almost two years. I’ve shared a few thoughts with you and though the medium doesn’t allow you to share things with me, many of you have through phone calls, email and social media. Want to know what your peers are talking about? I thought you might. So, here are the Top 10 Things The Doctor Next Door Says to (Me) About Social Media (whew, that title):

I’m not sure how to say what needs to be said. Sure you are. You say it every day. Start there: the blinking cursor is simply a patient who has asked you an important question about her care. Patients like doctors with good bedside manner.

It’s too hard to keep up but I need to appear timely.

Well then, use social media to follow sources that you trust. Simply share or retweet their posts. You’ll appear helpful and connected. Patients like connected health care providers.

Just sharing data makes me sound robotic but I can’t share patient information.

Ah, the HIPAA excuse. You’re right. But you can provide insight on common problems through your per-sonal story. Patients like other humans.

There’s so much misinformation.

I don’t want to be part of that crowd.

Good for you but by not being there you’re part of the problem. Use social media to dispel common myths patients may have about treatment options by shar-ing truths. Patients like a trusted source. And to them, that’s always been you.

I just want to practice medicine.You can. Use social media to help pa-

tients cope with their conditions by provid-ing tips for managing common problems. There you go, practicing medicine. No pa-perwork to complete.

I want to be part of the community.

Then create one. You have built in neighbors. Use the “groups” feature in Facebook to build a wall around your neighborhood. Or, run it open allowing your patients to invite their friends and family to participate. Patients like to con-nect their friends to someone who knows and cares about them and people like them.

I’m focused on patient retention. I don’t have time for social media.

That Doc, is a direct contradiction to the power of social media. Not being present demonstrates indifference. Here’s a poem I wrote for a physician friend of mine:

Act like you give a damn.Show that you care.Lose the indifference.And you’re half-the-way-there.

Thanks for indulging my inner-poet.

I need to prove exponential return on investment for any investment we make in social media.

Me, too. Let’s make building a com-munity, also known as developing follow-ers, the fi rst factor in return on investment. And no, that’s not some sales guy talking. We both know we need to be in the market before we can do business development. People, yeah even patients, like to know that you’re investing in them and getting to know them before we start asking of them.

I want to make a viral video.Did you see the one featuring win-

dow-washers in super hero costumes? Look for moments that resonate with your inner child. Most viral videos work be-cause they make us smile. Hey Doc, you don’t have to be funny but you can laugh.

I don’t have time.I know. But we meet here once a

month and to me, I’d give up our time to-gether if you’d spend it with your patients via social media. Patients, okay doctors too, like people who make time for them.

Hey Doc, Because You Askedrowing networks. Lazerow noted a number of health systems and hospitals are increas-ingly willing to explore the tradeoff between price and volume … accepting lower reim-bursement rates in exchange for creating a deeper relationship with a payer. The same is being seen with private practices.

“It is not just an exchange issue by any means,” Lazerow noted. However, he continued, “It might be more visible on the exchange side.”

Lumbert said it would be interesting to see how patients respond to not having every hospital, every physician included in their plan. Another concern is whether or not there is enough transparency for consumers to fi gure out on the front end exactly who is included in a plan. “For some state-based plans, California comes to mind, there was a feature where you could search for plans based on providers, and there was a glitch where some provid-ers were coming up that weren’t actually in plan,” Lumbert said.

The Bottom Line“We’re fundamentally talking about

the restructuring and changing of the health insurance marketplace,” Lazerow stated.

He said while it is too early to deter-mine whether ACA is the major catalyst for the fundamental changes that are be-ginning to be seen in the employer-spon-sored market … changes that were already underway before the health reform legisla-tion … the law clearly impacted the indi-vidual side of the equation. “Certainly it was transformative for those who didn’t have coverage options before and the indi-vidual market as a whole,” Lazerow noted.

With the rise of private exchanges, employers are looking to employees to take more responsibility for their own health and make more decisions about their plans and coverage options … much like in the public exchanges.

“One of the questions we’re asking is if we are on the brink of a new retail health-care experience,” Lazerow said. “Are we headed into a retail insurance marketplace when the individual patient … the end consumer … is making a lot more deci-sions especially in three areas — point of coverage, point of service and again at the point of renewal?”

Only time will tell how it all plays out and what it will ultimately mean for pro-vider market share.

Exchange, continued from page 4

Get the current online edition of West TN Medical

News delivered to your desktop.


EMAIL NOTIFICATIONS


West TN Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2014 Medical News Communications. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.

PUBLISHED BY:SouthComm, Inc.

CHIEF EXECUTIVE OFFICERChris Ferrell

MARKET PUBLISHERPamela Harris

[email protected] Sales: 501.247.9189

LOCAL [email protected]

NATIONAL EDITORPepper Jeter

[email protected]

CREATIVE DIRECTOR Susan Graham

[email protected]

GRAPHIC DESIGNERSKaty Barrett-Alley

Amy GomoljakJames Osborne

Christie Passarello

CONTRIBUTING WRITERSSuzanne Boyd, Lynne Jeter,

Cindy Sanders

ACCOUNTANTKim Stangenberg

[email protected]

[email protected]

——

All editorial submissions and pressreleases should be emailed to:

[email protected]

——

Subscription requests or address changes should be mailed to:

Medical News, Inc.210 12th Ave S. • Suite 100

Nashville, TN 37203615.244.7989 • (FAX) 615.244.8578

or e-mailed to: [email protected]

Subscriptions: One year $48 • Two years $78

SOUTHCOMMChief Executive Offi cer Chris FerrellChief Financial Offi cer Patrick Min

Chief Marketing Offi cer Susan TorregrossaChief Technology Offi cer Matt Locke

Chief Operating Offi cer/Group Publisher Eric Norwood

Director of Digital Sales & Marketing David WalkerController Todd Patton

Creative Director Heather PierceDirector of Content /

Online Development Patrick Rains


By CINDy SANDERS

Remember when P.E. was the ‘easy A’ in school? Evidently that’s no longer true.

The 2014 United States Report Card on Physical Activity for Children & Youth high-lights just how far the country has fallen off the honor roll when it comes to getting our school-aged kids to move and play. “You wouldn’t want to bring this one home,” Russell Pate, PhD, said of the report card.

Chairman of the National Physical Activ-ity Plan (NPAP) Alliance and a member of the re-port card research advisory committee, Pate noted, “There certainly has been a concern for some time that American children are not as active as they used to be and not as active as they should be.”

That concern is not only for the toll inactivity takes on youth during their childhood but also the larger, and longer, impact of contributing to chronic condi-tions. “It’s very clear that low levels of physical activity are associated with disad-vantageous health profi les,” Pate stated. “Not only are they at risk of becoming overweight as children and adolescents, but they are signing up for health prob-lems that will manifest down the line.”

The alliance, a coalition of national organizations and experts committed to ensuring success of the NPAP, created the report card as a baseline measure to assess evidence-based improvement strategies. “The overall picture here … although not positive … does point the way forward and shows us how we can do better in the future,” continued Pate, a professor in the Department of Exercise Science and director of the Children’s Physical Activ-ity Research Group at the University of South Carolina.

In addition to assessing levels of physical activity and sedentary behaviors, the report card also sought to highlight barriers keeping American children from optimal levels of active living. The goal is to raise awareness among parents, pro-viders, educators, community leaders and policymakers and bring stakeholders to-gether to improve youth fi tness.

“We know we’re in bad shape, but we don’t exactly know what areas need attention. I think from a policy standpoint the report card helps move that forward,” said Scott Crouter, PhD, as-sistant professor in the Department of Ki-nesiology, Recreation & Sport Studies at the University of Tennessee – Knoxville.

Crouter, who also serves on the re-port card advisory committee, added not every plan plays out as expected. “There are policies in place that support physi-cal activity and require P.E. in school,” he pointed out. “Greater than 90 percent of schools are requiring P.E. to be taught, but only about 50 percent of children are attending P.E. classes once a week,” Crouter added of high school students.

The highest grade given was a B- in the category of the built environment and community resources. The worst score, an F, was given for active transportation.

Since 1969, the percentage of ele-mentary and middle school students walk-ing or biking to school has fallen 25 points from 47.7 percent in 1969 to 12.7 per-cent by 2009. Not surprisingly, proximity played a key role in active transportation. Although many children face long com-mutes to school that necessitate a car or bus, the low numbers for biking and walk-ing hold true when looking at children who lived two miles or less from school. “We see that once you get past about half a mile from the school, walking or biking decreases dramatically,” Crouter said.

Even when distance makes ac-tive transportation difficult, however, Crouter noted there are innovative ideas to increase movement. One example, he said, is to position parking lots or drop-off points a half-mile to mile away from the school building to encourage walk-ing. Other deterrents that need to be ad-dressed include safety concerns and a lack of sidewalks. “It’s really about changing the environment and how we do things,” Crouter said.

As for the built environment, Pate noted, “Most American kids do live prox-imal to a park or green space where they could engage in physical activity. The problem is we’re not taking advantage of that opportunity.”

Girls also tend to be even less active than boys. “In some cases, girls are so-cialized in a way that places less emphasis on physical activity and organized sports programs,” Pate said. He added Title IX certainly helped make sports more attain-able for girls. However, he continued, “Even with that progress, there’s still a pretty pronounced gender gap.”

When grading sedentary behaviors, the team used the primary indicator of two hours or less of screen time per day, which is in line with the American Acad-emy of Pediatrics recommendation. Al-though about half the children in America ages 6-11 do adhere to this recommenda-tion, signifi cant ethnic disparities exist, which resulted in the grade of D.

Sedentary behavior included both leisure time (watching television or play-ing a screen-based game) and produc-tive time (reading on a screen or using the computer for homework). It should

be noted that the negative effects associ-ated with leisure time sedentary behavior have not been observed with productive sedentary behavior. The research team noted future studies should examine the two types of screen time independently to determine health impact.

Pate stressed the research team was sensitive to screen requirements for homework, but he said that really isn’t the problem. “Kids are spending way too much time in front of screens that really have nothing to do with academic learn-ing,” he asserted. The average time per day American youth spent in sedentary pursuits was 7.1 hours.

Despite the poor grades, both Pate and Crouter found a silver lining in the report card. “The good news is now we have a document that pulls everything to-gether and gives us a starting point,” said Crouter. “It helps support where we need to go next, and it gives us the fuel to do that.” He continued, “It’s not about fail-ing grades and putting blame in any one place. It’s not about blame at this point. It’s where we are so let’s make it better.

Pate concurred, “The report card points out the severity and nature of the problem.” He added the information gathered would be used to review and revise the NPAP. “In late 2015, we ex-pect to release the second iteration of the plan,” he said.

In the meantime, Pate concluded, “There absolutely is no substitute for par-ents being attentive to this issue.”

Grade: Needs ImprovementReport card highlights defi cits in children’s physical activity

Dr. Russell Pate

Dr. Scott Crouter

The Grades

Overall Physical Activity D-

Sedentary Behaviors D

Active Transportation F

Organized Sport Participation C-

Active Play Inc.

Health-Related Fitness Inc.

Family & Peers Inc.

School C-

Community & The Built Environment B-

Government Strategies & Investments Inc.

An incomplete was given in areas where there is currently insuffi cient information available to establish a grade.


TODD D. SIROKY, ATTORNEY

316 South Shannon Street Jackson, TN 38301

731-300-3636 www.sirokylaw.com

Healthcare Law

Commercial Litigation

Business Law

Cardiothoracic Surgeon Joins West Tennessee Heart & Vascular Center

Douglas C. Appleby, Jr., MD, DHA, has joined the Cardiothoracic Surgery Center, the surgical arm of the West Ten-nessee Heart & Vascular Center at Jackson-Madi-son County General Hos-pital. He brings more than 20 years of experience as a cardiothoracic surgeon to JMCGH’s top ranked heart team.

Appleby is board certified by the Na-tional Board of Medical Examiners, the American Board of Surgery and the Amer-ican Board of Thoracic Surgery. He has received training in cardiac critical care, advanced cardiac and cardiothoracic sur-gery and robotic surgery at Johns Hopkins University and the Cleveland Clinic.

He joins Arthur Grimball, MD, and Eric M. Sievers,MD, at the Cardiothoracic Surgery Center.

Appleby earned his doctor of medi-cine degree from the Medical University of South Carolina. He completed his resi-dency at University of Kentucky Medical Center and his thoracic and cardiovas-cular surgery fellowship at the University of Utah Medical Center. He also holds a doctorate of health, administration and policy from the Medical University of South Carolina.

Before joining the Cardiothoracic Surgery Center, he most recently prac-ticed as a cardiothoracic and vascular surgeon at Baptist Health Lexington in Lexington, Ky. Dr. Appleby is a Fellow of the American College of Surgeons and a member of the International Society for Minimally Invasive Cardiothoracic Sur-gery.

In 2012, Dr. Appleby was named to the Best Doctors in America list. To be named to the list, physicians must be clin-ically and academically accomplished, re-viewed and elected by other physicians, affiliated with national and global centers of excellence and members of a presti-gious, peer-reviewed group.

Hospice of West Tennessee & West Tennessee Healthcare Foundation Sponsor Grief Camp for Children

Camp WINGS (Wisdom, Insight, Knowledge and Guidance through Sor-row) will soon welcome children ages 7-14 who are grieving the loss of a loved one. The camp takes place August 8, 9 and 10 at Mid-South Youth Camp in Hen-derson. This is the tenth year that Camp WINGS has been offered to children free of charge by Hospice of West Tennessee and West Tennessee Healthcare Founda-tion.

This special weekend begins Friday evening at 6 p.m. with fun recreational activities and ends Sunday morning with a memorial service and meaningful heal-ing moments. A talent show, a challenge course, arts and crafts, as well as music

are all part of the fun. Camp WINGS is staffed by trained counselors and volun-teers to ensure that children are offered a safe and supportive environment. Each child is paired with a trained adult buddy who spends the weekend with them hav-ing fun, laughing, and working through the bereavement process.

Camp WINGS operates entirely with volunteers and donations through the West Tennessee Healthcare Founda-tion. Checks can be payable to the West Tennessee Healthcare Foundation and mailed to:

Camp WINGS, 620 Skyline Drive, Jackson, TN 38301

If a special child in your life could benefit from Camp WINGS, please email Pat Bard at Hospice of West Tennessee at [email protected] The deadline for reg-istration is July 25.

Sports Plus Rehab Center Offers Dizziness And Balance ClinicSports Plus Rehab Centers are pleased to announce the opening of the Dizzi-ness and Balance Clinic in Jackson. The Dizziness and Balance Clinic will focus on vestibular and balance issues. Sports Plus therapists will treat disorders that are often associated with vertigo, dizziness, balance and visual disturbances. Patients who suffer with any of these symptoms can call the clinic at 731-984-7640 or ask their physician about vestibular therapy.

Medical Specialty Clinic Changes Name to West Tennessee Gastro

Medical Specialty Clinic has become West Tennessee Gastro. The name is be-ing changed to more clearly reflect its mission of providing specialized care for digestive disorders.

West Tennessee Gastro is staffed with four board certified physicians and two family nurse practitioners who treat all types of digestive disorders from ab-dominal pain, colon cancer, diarrhea and diverticulosis to inflammatory bowel dis-ease and ulcer disease. The staff is com-mitted to providing the highest quality of care and the latest technology with com-passion and respect. The staff includes: MDs Robert Hollis, Brittain Little and Joel Levien; DO Daniel Kayal; and ACNPs Me-lissa Bolton and Joanne Bledsoe.

MedEvolve EHR Software is Certified for Meaningful Use Stage 2

MedEvolve, a provider of practice management software, electronic health records (EHR), and physician revenue cycle management services, today announced that its EHR solution, MedEvolve EHR 6.0, has been tested and was certified for Meaningful Use Stage 2 on April 13, 2014 by Drummond Group’s Electronic Health Records Office of the National Coordina-tor Authorized Certification Body (ONC-ACB) program. MedEvolve EHR 6.0 met the requirements for ONC’s Complete

EHR 2014 criteria which were adopted by the Secretary of the US Department of Health and Human Services. MedE-volve’s EHR 6.0 supports both Meaningful Use Stage 1 and Stage 2 measures, and is certified for use by eligible providers to qualify for EHR incentives.

Drummond Group’s ONC-ACB certi-fication program certifies that EHRs meet the meaningful use criteria for either eli-gible provider or hospital technology. In turn, healthcare providers using the EHR systems of certified vendors are quali-fied to receive federal stimulus monies upon demonstrating meaningful use of the technology – a key component of the federal government’s push to improve clinical care delivery through the adop-tion and effective use of EHRs by U.S. healthcare providers.

This Complete EHR is 2014 Edition compliant and has been certified by an ONC-ACB in accordance with the ap-plicable certification criteria adopted by the Secretary of the U.S. Department of Health and Human Services. This certifica-tion does not represent an endorsement by the U.S. Department of Health and Hu-man Services or guarantee the receipt of incentive payments.

St. Jude Children’s Research Hospital renewed as NCI-designated Comprehensive Cancer Center

St. Jude Children’s Research Hos-pital’s designation as a Comprehensive Cancer Center has been renewed by the National Cancer Institute (NCI), earning the highest possible score of “excep-tional.” St. Jude remains the first and only NCI-designated Comprehensive Cancer Center that is devoted solely to children. St. Jude has been designated as an NCI cancer center since 1977. The hospital was named a comprehensive cancer cen-ter in 2008.

St. Jude Children’s Research Hospital officials also announced the appointment of three internationally recognized physi-cian-scientists to leadership positions.

Mitchell Weiss, M.D., Ph.D., has been named chair of the St. Jude Department of Hematology. He was recruited to the institution from the University of Pennsyl-vania (UPenn) Perelman School of Medi-cine and the Children’s Hospital of Phila-delphia (CHOP), where he is a professor of pediatrics and holds an endowed chair.

J. Paul Taylor, M.D., Ph.D., who joined the St. Jude Department of Developmental Neurobiology in 2008, has been appointed chair of the new St. Jude Department of Cell and Molecular Biology. He will also hold the Edward F. Barry Endowed Chair in Cell and Molecular Biology.

Kim Nichols, M.D., has been selected to launch the new Division of Hereditary Cancer Predisposition in the St. Jude De-partment of Oncology. She currently directs the CHOP Pediatric Hereditary Cancer Pre-disposition Program. She is also an associ-ate professor of pediatrics at the UPenn Perelman School of Medicine.

Saint Francis Fall Conference in Destin

Saint Francis Hospital-Memphis has announced dates for its 10th Annual Fall Update Continuing Medical Education (CME) Conference. It will be held at the Hilton Sandestin Beach and Golf Resort in Destin, Florida. The dates are Thursday, Friday and Saturday, October 9, 10, and 11. While Fall Update 2014 targets pri-mary care physicians, other physicians are welcome. Physicians attending all three days can earn up to 14 CME credits.

The 2014 conference will feature lectures on Heart Disease in Women, Mi-graines, Prescription Drug Abuse, Derma-tology, Gout, Genomics and the Future of Medicine, Rheumatoid Arthritis, and other topics. This year’s conference also features an optional 4-hour workshop entitled PDR: Psychologically Designed Resiliency. The conference faculty is composed of local, regional and national speakers with exceptional reputations in their respective fields. With lectures scheduled from 7:30 AM to 12:45 PM, the conference is structured to allow attend-ees to time to enjoy the many amenities offered in the Destin area.

The conference agenda is planned by the hospital’s CME physician commit-tee, with input from previous conference attendees regarding topic and speaker selections. The committee is chaired by Michael Threlkeld, MD, Infectious Dis-ease, with members representing various medical specialties.

Anyone interested in more information can email [email protected]

GrandRounds

Dr. Douglas C. Appleby, Jr.

Call 731- 424-1001 or 800-243-9220 for appointments.Satellite locations in Camden, Paris, and Savannah

Specialized Care for Digestive DisordersServing West Tennessee with over 30 years of experience, all of our physicians are board

certified in gastroenterology. Our staff is committed to providing the highest quality of care and the latest technology with compassion and respect.

27 Medical Center Drive, Jackson, TN 38301www.WTGastro.org

(formerly Medical Specialty Clinic)

• Abdominal Pain• Colon Cancer• Colon Polyps• Colonoscopy/Endoscopy• Constipation• Diarrhea

• Irritable Bowel Disease• Liver Disease• Nausea/Vomiting• Pancreatitis• Swallowing Disorders• Ulcer Disease

• Diverticulosis• Gastroesophageal Reflux Disease (GERD)• Gastrointestinal Bleeding• Heartburn/Indigestion• Inflammatory Bowel Disease

West TN Medical News July 2014

Documents

abuse of prescription

prescription opioids

prescription drug abuse

success state

state exchanges

federal health exchange

opioid abuse

n e w s