Reaching More Patients With More Services is Key

The Memphis-area healthcare market continues to experience steady growth - both physically with new facilities and technologically with advancements, most of which focused on providing patients with outpatient services, convenience and accessibility. However, the challenges remain, as most Memphis healthcare leaders are quick to tell you.

The lack of Medicaid expansion in Tennessee under the Affordable Care Act and the competitive job market continue to pose challenges for some healthcare employers. All the experts agree that meeting patient demands for better outcomes at a lower cost is a tough order, but leaders remain optimistic.

Leaders from various hospital systems and medical clinics including, Campbell Clinic, Regional One Health, Stern Cardiovascular, Saint Francis Healthcare and VA Memphis recently shared their thoughts on the current state of healthcare in the Memphis area and what may ahead in 2019.

Growth and Expansion

During the past several years, Campbell Clinic, Regional One Health and Stern Cardiovascular have placed a major emphasis on expanding their footprint and services in order to meet patient demand. Following the trend, the Memphis VA Medical Center continues to undergo much-needed renovations to its current facility in the Memphis Medical District.

Regional One Health's east campus expansion which began several years ago now makes outpatient and primary care services more accessible and convenient for patients in eastern Shelby County. Dr. Martin Croce, MD, chief medical officer of Regional One Health, says the hospital system continues to work toward changing perception that it only offers trauma care.

"We aren't just a trauma or burn center in the region anymore," Dr. Croce said. "We have increased our primary care presence in the Mid-South. We have five freestanding primary care offices in Shelby County. We continue to work to increase access to potential patients."

Campbell Clinic, a national leader in orthopedics, broke ground in October on a 120,000-square-foot expansion project adjacent to its current location in Germantown. The new building, which will include outpatient orthopedic space, an expanded physical therapy area, imaging suites and an ambulatory surgery center with eight operating rooms, is a $30 million project, which the City of Germantown forecasts will add 185 new jobs to the area in three years.

George Hernandez, CEO of Campbell Clinic, says there is strong demand for orthopedic services due to the growing number of people who are remaining active later in life He believes the new expansion - in addition to the clinic's other four locations in Shelby County and north Mississippi - is located strategically to be closer to potential patients.

"We have doubled in size over the past two decades in the number of patients we serve and physicians on staff," Hernandez said. "When I joined Campbell Clinic 23 years ago, we employed 26 physicians. Now we have 50 on staff and are expected to hire three additional physicians over the next three years. The number of people projected to have joint replacement will increase 700 percent in the next two decades. We want to be able to accommodate that growth."

With eight primary locations in Arkansas, Tennessee and Mississippi, Stern Cardiovascular has focused on offering medical care not only to patients in urban areas, but also rural areas where medical care isn't as accessible.

"We live in an area where heart disease, hypertension and diabetes is high," said Dr. Steven Gubin, MD, president of Stern Cardiovascular. "Accessing patients is important. We have 12 outreach centers in smaller, rural areas in Tennessee and Mississippi, so those patients can have access to adequate medical care."

The Memphis VA Medical Center has undergone renovation over the past year. In addition to the renovated lobby, emergency department and first floor, the facility broke ground on a three-story parking garage recently, which will provide 315 parking spaces for patients. VA Memphis is expected to renovate its spinal cord injury rehabilitation pool and gym and construct a new clinical laboratory area next year in addition to other smaller projects. David Dunning, CEO of VA Memphis, points out that all buildings at the VA Medical Center are either under renovation or planned to be renovated.

New Technology

In addition to physical growth, the Memphis healthcare market continues to be on the forefront of medical technology. According to Dr. Gubin, Stern Cardiovascular is unique compared to many other cardiology clinics because it performs clinical research at its facilities.

"We are fortunate that we have access to cutting edge technology and medicine two to three years ahead of the market due to the clinical research that's done on site," Dr. Gubin said. "Right now, we are participating in 36 clinical research studies."

Saint Francis Healthcare has made strides robotic-assisted and spine technology. According to Dr. Audrey Gregory, Ph.D., CEO of Saint Francis Healthcare, the hospital system was the first in the Memphis area to offer the Mako robotic-assisted arm technology for total knee replacement.

"Patients drive outside of Memphis to receive this service, which we began to offer in April," Gregory said.

Likewise, Saint Francis updated its spine technology and now uses a surgical robotic guidance system for spinal procedures.

"This technology allows surgeons a customized approach by providing 3D images of a patient's anatomy," Gregory said.

Additionally, Dunning says that the VA Medical Center will spend $24 million for new medical equipment in the upcoming year. The medical center has one new positron emission tomography (PET) scanner and three new computed tomography (CT) scanners. He said the hospital plans to replace all hospital beds, infusion pumps and computer carts in 2019.

"In the next six months, we will jump ahead 10 years in technology," Dunning said.

Access and Convenience

Memphis-area healthcare leaders are in agreement that being accessible to patients and offering convenient services, sometimes during the same appointment, has become expected. According to Hernandez, this is monetarily advantageous for both the facility and the patient.

"Now, we are able to provide surgical procedures, such as total knee, hip or shoulder replacement, on an outpatient basis," Hernandez said. "These procedures were done in a hospital not long ago. Patients are awake and feel relief immediately within an hour of surgery. They start walking right away. This brings a distinct economic advantage. The cost of outpatient surgery is much lower. There is a cost savings to the insurance company, government and patient."

Both Campbell Clinic and Stern Cardiovascular strive to offer multiple medical services to the patient during the same visit. According to Hernandez, who says Campbell Clinic can draw patients from up to 200 miles away, this saves time for both the patient and staff.

"We want patients to get the most out of their visit," Hernandez said. "We can perform a MRI and then start physical therapy the same day patients are diagnosed, so they don't have to come back for an additional visit."

Dr. Gubin said it's obviously more convenient for patients when Stern's clinical offices offer a variety of services for patients on site.

"It's important to be a one-stop shop for our patients," he said. "They can get vascular screenings, be coached on an adequate protein and low carb diet and have their prescriptions filled at our dispensary, which is located in the lobby of our office in Germantown."

Additionally, Hernandez says that patients demand flexible options for medical care more than ever before. Campbell Clinic offers a variety of times for patients to be seen by a physician.

"Access and convenience are extremely important for patients," Hernandez said. "We offer a Saturday clinic, a weekday after-hours clinic and walk-in clinic for patients. Our physicians work at least one night a week."

Medicaid Expansion

Tennessee is one of 14 states that hasn't adopted Medicaid expansion under the Affordable Care Act, and according to Regional One Health and Saint Francis Healthcare, this poses challenges for them to provide adequate care for lower-income patients. Despite the lack of expansion, Gregory is hopeful that lower-cost insurance providers may enter the Memphis market in 2019.

"The ACA has led to the most significant expansion of access to healthcare since Medicare and Medicaid," Gregory said. "Without expansion in Tennessee, it has created challenges related to access to care for patients in the Memphis area. We're encouraged that lower cost alternatives such as Oscar and Bright Health may become available in the Mid-South."

Challenging Hiring Market

With a nationwide physician shortage, Memphis-area hospitals and medical clinics face a fierce challenge to recruit quality physicians, especially in primary care. According to Dunning, VA Memphis struggles to recruit for medical positions in the Memphis area. He has received funding to hire 130 full-time equivalence positions next year, which according to Dunning, will contribute $13 million to the Shelby County economy.

"Memphis is a medically rich community," Dunning said. "It's a very competitive, high-quality job market. Many hospitals in the area are competing for the same people. We need additional primary care providers, which is a struggle for all medical employers. We've had some success recruiting outside the Memphis market."

Constant Change

Healthcare executives say that they are prepared to meet the upcoming healthcare challenges in the upcoming year. Dr. Gubin says change is the only constant and the medical community must be one step ahead.

"The healthcare market is always changing and the medical community has to be willing to change with it and offer better and more cost efficient solutions for patients," he said. "It's important to turn challenges into opportunities and provide high-quality healthcare at a lower cost."