East TN Medical News April 2014

Dr. Mariah Alexander

PAGE 3

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HEALTHCARE LEADER: Dawn D. Tipton, RN, BSNHer experiences have taken her all over the world, but for Dawn Tipton, Director of Nursing for three practices within State of Franklin Healthcare Associates (SoFHA), serving the patients of the Tri Cities and surrounding areas is where she wants to be ... 7

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By CINDy SANDERS

What is the best way to get … and keep … diabetic patients actively engaged in the lifelong self-management of their condition?

The individual or institution that comes up with a defi nitive answer to that question will surely be re-membered in the history books in the same manner as Jonas Salk. After all, diabetes is a pervasive condition of epidemic proportions in much of the world. Accord-ing to the latest statistics from the National Institutes of Health, 25.8 million Americans have diabetes … roughly 8.3 percent of the nation’s population. Additionally, it is estimated another 79 million American adults have prediabetes, putting them at high risk for developing the condition without active intervention to stop the progres-sion toward disease.

Keenly aware of the toll diabetes takes on the body, healthcare

providers routinely talk to patients about the threat of co-morbid conditions ranging from heart disease, stroke and kidney disease to blindness and amputation. Yet, there continues to be a disconnect from what a patient seem-ingly hears and understands in the offi ce and what actu-ally transpires on a daily basis.

“We talk about diabetes all day long with patients, but they have to go about their business of living with the disease,” noted Elizabeth S. Halprin, MD, associate direc-tor of Adult Diabetes at Joslin Diabetes Center, an affi liate of Harvard Medical School.

A recent study conducted by Joslin researchers looked at obstacles present among patients with poorly controlled diabetes. Halprin, a board certifi ed endocri-

nologist and instructor at Harvard Medical School, said the rea-sons for poor management vary hugely and are specifi c to individuals

Addressing Obstacles on the Road to Diabetes Control

(CONTINUED ON PAGE 10)

FOCUS TOPICS DIABETES/WOUND CARE ICD-10

With the Deadline Fast Approaching, AMA Continues to Campaign Against ICD-10 Implementation

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The fi rst rule of marketing is to make sure you have a clear message. For the American Medical Association leadership, their position on the impending ICD-10 conversion could not be more straightforward … they want to see it stopped.

AMA President Ardis Dee Hoven, MD, pointed to a number of issues that have members worried about the health of their practices … and ultimately their patients. Concerns range from cost of im-plementation and software availability to worries over disruption in pay and a siphoning of resources away from other transforma-tive changes that improve healthcare delivery.

In a Feb. 12 letter to Kathleen Sebelius, secretary for the U.S. Department of Health and Human Services (HHS), the AMA ac-knowledges the position they have taken is at odds with some of their industry colleagues. Yet, AMA offi cials believe the timing of such a massive undertaking is ill advised and could prove disastrous for physi-cians.

(CONTINUED ON PAGE 6

Dr. Elizabeth S. Halprin

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PhysicianSpotlight

By JOE MORRIS

Like most doctors, Mariah Alexander got into the field be-cause she wanted to help people. That said, she certainly didn’t head to college planning to be a surgeon.

“I just wanted to be in the healthcare field, and hadn’t thought much beyond that,” Al-exander said. “I liked the idea of being involved in other people’s lives, and doing something that would help them. I never really thought about medicine; I’m not from a family with doctors, or any-body working in medicine at all. I was thinking more along the lines of physical therapy. Then I started taking some pre-med classes, thinking I wouldn’t stick with it, and ended up staying.”

That was at the University of Ala-bama at Birmingham, where she received a Bachelor of Science in biology. The Ala-bama native then went on to the Univer-sity of Alabama School of Medicine and completed her residency in general sur-gery at the University of Tennessee Medi-cal Center in Knoxville.

Her professional associations include membership in the American College of Surgeons, the Society of American Gas-trointestinal and Endoscopic Surgery and the American Association of Endocrine Society. She is board certified in general surgery by the American Board of Sur-gery.

Following residency, Alexander made her way to the University of Texas Southwestern in Dallas for an advanced fellowship in minimally invasive surgery and bariatrics. That’s where she began to really hone her skills in the field of laparo-scopic surgery. While in Texas, she coau-thored two book chapters on laparoscopic hernia repair, and also taught courses in that facility’s simulation center.

She also began working with the Da-Vinci robotic-surgery system, a skill she is continuing to use in her current prac-tice at University Surgeons Associates in Knoxville.

Much like her career in medicine overall, Alexander didn’t just fall into min-imally invasive surgery. But like medicine, once she got there, she found she had a real aptitude for it.

“I never thought I’d do that kind of operating because I love working with my hands,” she said. “I never thought I’d find anything I loved as much as general sur-gery. But laparoscopy, which has a small incision, is much better for the patient from the standpoint of less pain, faster recovery time, and much more. So that aspect of it appealed to me, plus it’s really challenging and fun. I got interested in it

during my residency, and then later in my training started looking at bariatric work as well.”

Those surgeries are a higher calling for her, she says, given society’s obesity is-sues.

“It’s an epidemic, and it’s something that I’ve seen in my own family,” Alex-ander said. “There’s a real need, and I can really empathize with those patients. It’s very satisfying to see how we can help patients with those surgeries. I saw a lot of that in my fellowship, which was half bariatric, half minimally invasive proce-dures. I wasn’t sure at first that this was the area where I wanted to spend my practice, but by the time I was done with that training, I felt like it was what I’d been called to do.”

As with every other area of medicine, the changes are lightning fast and non-stop. Whether it’s advances in robotic tools or techniques, or new methodology behind laparoscopic procedures, there’s a lot to stay abreast of in addition to doing the day-to-day work. Alexander says she relies on the other physicians in her prac-tice, as well as at the University of Ten-nessee, where she returned in 2013 as an assistant professor.

“There’d definitely a learning curve as far as using the robot is concerned, and

I was fortunate to get the training I did,” she said. “We’re looking at the robot for many different types of surgery now, including bariatric, to see where it might be most use-ful. We really haven’t started with that yet, as there’s a lot to evaluate, but there are some strong possibili-ties.”

On the laparoscopic side, she says there is an ongoing peer re-view of new instruments and other tools that come out, and she and the other doctors take that infor-mation and use it in many ways.

“We are always being edu-cated by the manufacturers when they have new devices, but we also take what we learn and go out into the community and give programs on new surgical possibilities,” Al-exander said. “That’s fun, both in terms of having new tools to work

with, but also educating people on the op-tions they have when they are looking at a surgical procedure.”

Something else she’s keeping an eye on is the increasing intersection of the ro-botic and laparoscopic disciplines.

“We are seeing changes even in general surgery as robotics is becoming more commonplace as the costs begin to come down, and the equipment gets even smaller,” she said. “To me, that’s quite exciting. We are always advancing new techniques in laparoscopic surgery, but that equipment is already pretty small. With new options from the robotics side, there will be a lot more opportunities for us to look at new surgeries and different ways to perform the ones we now offer. That’s pretty exciting.”

Alexander also is looking at expand-ing her efforts when it comes to endocrine surgery, including thyroid and parathy-roid work as well as adrenalectomies. She plans to keep a hand in when it comes to general surgery, but says these new av-enues keep her challenged.

“I came back here because I did my training in Knoxville and really enjoy it here,” she said. “There’s a lot going on in many different types of surgery, and that’s the kind of environment I want to work in. Hopefully, I can also add some mission work to my schedule in the future and do some traveling, but I plan to be here for the long term.”

Honing in on excellenceAlexander finds her niche in smaller surgery techniques

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The question these days is, “How can we reform healthcare quickly and effi ciently?” There’s no one magic-bullet answer, but for some good working ideas, ask a nurse.

That’s what Mountain States Health Alliance does when it turns to Candace Jennings, Senior Vice President of Tennessee Operations for Mountain States Health Alliance (MSHA). Before assuming her current position, Jennings was Senior Vice President and CEO for Washington County operations, and holds a Bachelor’s degree in nursing and Master’s degree in health services administration from the University of Alabama-Birmingham.

Having watched MSHA continue to evolve and excel from vantage points at the bedside and the boardroom, Jennings lays out the future — and says all goals are attainable with smart decision making and hard work.

East Tennessee Medical News: Hospitals and healthcare providers are being told to innovate, or risk being left behind. Does that just mean signing onto an EMR system, or is it much more?

Candace Jennings: We think of two kinds of innovation in healthcare now; one is around technology, and the other is around totally new ways of healthcare delivery.

Retail pharmacies are becoming healthcare companies. They are changing the way that patients get primary care for things like immunizations or the sniffl es. That’s innovative. We haven’t thought of Walgreens as a competitor, but they and many others are getting into healthcare.

At MSHA, we launched our fi rst patient portal in April. Patients are taking an active role, and we are meeting them when it comes to delivering better care.

All this innovation is very disruptive to the current state, but it’s really important to getting us to a position where we are giving healthcare at a much reduced cost, but doing a better job on preventative medicine and maintenance care, not just sick care.

ETMN: With that in mind, how is MSHA sorting through its “to do” list when it comes to setting goals and operating within the reality of capital budgets?

CJ: We are working to become much more knowledgeable about telemedicine, for one. We have a telemedicine service at Johnson County Community Hospital, in consultation with ETSU. Now we can do consults at Johnson County using a robotic cart, and that is a very inexpensive technology compared to what we have spent on other information systems in healthcare. We also are working in conjunction with Vanderbilt University Medical Center to roll out a different way that our physicians can consult with a Vandy doctor via telemedicine. There, we’ll be using iPads in the emergency department to assess whether or not a patient is having a stroke, and what the next steps should be.

We can’t afford to have specialists at all four of our rural hospitals, but now those patients don’t have to be transferred to a bigger

Hospital Leadership 2014

Planning aheadJennings says MHSA’s multiyear focus on innovation is paying off

hospital because we’ll have access to those physicians by way of telemedicine. That’s going to be important in a few years because we already have a shortage of physicians in the specialties, and that’s going to worsen as current doctors retire and are not replenished. The Affordable Care Act is only going to increase demand for physicians, and so we see telemedicine as a very effective way to provide that care.

ETMN: Whether its innovation or effi ciency, it comes down to smart management of resources. How is MSHA going to leverage its strengths over the next few years?

CJ: We recently completed our strategic planning meetings in all our hospitals, as well as with our medical communities, to talk about exactly how we are going to do that. We have had a plan in place for a ten-year period, but now we’re getting to a much more granular level in terms of the next 12 to 24 months.

We have pillars, or areas of concentration, around things like fi nance, service excellence and quality, and we’ve now added innovation to that. We are focusing on innovation in all our operations, and trying to see how that can integrate technology and other tools to deliver healthcare in a different way.

We’ve also invested a lot of time and energy in developing patient-centered medical homes in our physician practices. They’ve been in place a year or more in some areas, and those along with the new patient portal really do provide a gateway to do a lot more in terms of population health management. We want to prevent our patients from getting diseases early on, and also help manage their chronic conditions much better.

We want to be the destination of choice. Sure, patients can go to the drug store for basic treatments now, but those facilities can’t do what we do. A physician in their medical home has a full knowledge of what that patients’ healthcare needs are — not just that episode. That physician can access a record and history, see meds and be able to do a faster and better job of thinking about the patient holistically rather than just treating a symptom and an episode.

Our board has charted the right course. We’re three years into that ten-year plan, and we are very well positioned to weather the storms that are occurring right now. A lot of things are taking business out of the hospital, and if the cost of healthcare is lower, then the reimbursement is, too. But we are convinced that lowering those costs is the right thing to do, and not every hospital has that vision, or is ready to do that.

Everything that’s happening now, we saw coming. We have crafted a vision for the next few years and have everything in place, including our own provider-sponsored health plan and insurance company, to let us be very creative and innovative for what’s coming up. We are ready, and so we won’t miss any opportunities. We are moving into this new era of healthcare in a very positive way.

Candace Jennings

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LegalMatters

Profit and Loss – The Top Ten Health Law Issues Medical Providers Need to Know

BY ERIN B. WILLIAMS, LONDON & AMBURN, P.C.

Health care providers are monitored for quality of healthcare, billing for services, documentation requirements, and professional and ethical behavior. The financial consequences resulting from an issue related to any one of these could result in a loss of profits, or worse, a major loss of revenue for a provider’s practice. To help the healthcare community be more prepared for what lies ahead, this article will be the first in a new series which further explores each of the topics below.

Office of Inspector General Work Plan for 2014

The U.S. Department of Health and Human Services Office of Inspector General’s mission is to protect the integrity of the HHS programs and the health and welfare of the beneficiaries of those programs. In Fiscal Year 2013, OIG reported expected recoveries of over $5.8 billion and exclusions of 3,214 individuals and entities from participation in Federal healthcare programs; 960 criminal actions against individuals or entities; 472 civil actions and administrative recoveries from self-disclosed matters. The OIG 2014 Work Plan outlines the current focus areas and this upcoming article will highlight the areas of concern related to a physician’s practice.

Private Insurance Audits and Recovery

Provider participation agreements with private insurance companies are governed by contractual terms and obligations. Appeal provisions may be limited based upon the disparity in bargaining power between the parties. This upcoming article will examine considerations for dealing with audits of claims.

Private Insurance Network Participation

Provider participation with private insurance company networks is also governed by federal and state law provisions related to reporting requirements and the National Practitioner Data Bank. Certain termination situations may result in reports to the National Practitioner Data Bank. Negotiations, corrective action, appeal and review provisions will be discussed in this upcoming article.

Health Insurance Portability and Accountability Act (HIPAA)

Privacy and security for individuals’ individually identifiable

protected health information (“PHI”) is more than an ethical responsibility. PHI is protected by a complex system of federal regulations which continue to evolve and the penalties can be severe. Enforcement activities and compliance programs will be addressed in this upcoming article.

60 Days to Report and Refund Identified Overpayments

As part of the federal government’s efforts to capture overpayments, the Accountable Care Act created the duty to report and refund identified overpayments. The time frame for making the refund is short, and the consequences for failing to report and refund are harsh. Retained overpayments may be classified as False Claims, triggering the civil monetary penalties in addition to the actual overpayment. Self-reporting and refunding overpayments will be discussed in this upcoming article.

Medicare Audits and Extrapolation of Error Rate Findings

In 2003, the Medicare Modernization Act was signed into law and included a provision for the Limitation on Use of Extrapolation in Medicare audits. Extrapolation allows Medicare to review a small sample of claims and then create a very large overpayment based upon the error rate. Permitting the Secretary of Health and Human Services to use extrapolation to calculate an overpayment when the provider has no history of billing problems may put unsuspecting providers out of business. In this upcoming article, we will review the Medicare audit and appeal process and how extrapolation can result in an overpayment in the millions.

Controlled Substance Prescribing and Pain Management Laws

Pain management and controlled substance prescribing laws have been a focus of the Tennessee legislature over the past few years. This upcoming article will discuss violations of the controlled substance prescribing and pain management laws, as well as monetary and other penalties for failure to comply.

Medical Board Investigations A multitude of issues can serve

as the impetus for investigation by the Health Related Boards: patient complaints, reports of settlements, criminal arrests, etc. The defense

of such investigations, which are sometimes but not always covered by insurance, can significantly impact the provider’s practice, as can the potential penalties, including licensure suspension or revocation. This upcoming article will focus on defense of board investigations potential penalties affecting a physician’s profits or, even worse, ability to continue the practice of medicine.

Stark Law Violations The “Stark” law prohibits referrals

for designated health services for Medicare and Medicaid patients if the physician (or an immediate family member) has a financial relationship with that entity (1). Stark law violations and penalties will be the focus of this upcoming article. While there are exceptions to the prohibition, there are also substantial penalties for violations. Repayment of all services provided during the period of noncompliance can make an innocent mistake extremely costly, depending upon the length of time the error went

undetected. This upcoming article will review CMS’s authority to settle these cases, as well as specific self-disclosure protocol for reporting and resolving these matters.

Medicare Audits and Appeals Medicare audit overpayments

are due to be repaid within 30 days of the Demand Letter sent to the provider. While the time table for action is expedited, there are ways to preclude collection which can protect the practice’s cash flow for several months. Protecting the practice during the appeal process will be further addressed in this upcoming article.

Notes1. 42 USC 1395nn.

Attorney Erin B. Williams focuses her practice on healthcare compliance and regulatory matters, including each of those topics mentioned in this article. For more information on any health law matters, you may contact Ms. Williams at (865) 637-0203 or visit www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.


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“The challenge here is disruption — it’s a disruptive process that delivers no direct benefit to patient care,” Hoven as-serted.

Many Codes Equals Much Room for Error

ICD-10 — the International Classi-fication of Diseases, 10th Edition — was endorsed by the World Health Organiza-tion (WHO) in May 1990 and put into use by member states beginning in 1994. It is the tool used to capture mortality and morbidity data, track disease outbreaks, highlight research needs, and provide a general snapshot of health among nations and populations.

There are two parts to the system in the United States. Clinical Modification (CM) is used for diagnosis coding in all healthcare settings. The Procedure Cod-ing System (PCS) is for inpatient settings only. According to the Centers for Medi-care and Medicaid Services (CMS), any-one covered by HIPAA… not just those who submit Medicare and Medicaid claims … must convert to ICD-10 by the Oct. 1, 2014 deadline.

“You’ve got to have an ICD-10 code for the disease signs and symptoms, ab-normal findings, complaints, circum-stances and external causes of injury or disease,” noted Hoven. “The problem is the granularity of the ICD-10 codes,” she continued.

Hoven said ICD-9-CM encompassed

between 13,000 to 14,000 codes compared to ICD-10’s 68,000 options. “It’s about a five-fold increase,” she pointed out.

She was quick to add the inflated num-ber of codes in ICD-10 wasn’t set by the WHO but instead is a product of U.S. modifica-tions to the system. In addition to the CM codes, the PCS portion has 72,000 codes. Other countries have significantly fewer options. Canada, Germany and Austra-lia all have less than 20,000 codes in their ICD-10 set, and Canada uses ICD-10 for inpatients only.

“There’s something like nine codes for parrot bites,” Hoven said of the U.S. system. The vast number of choices, she fears, makes the potential for error enor-mous.

Financial ConcernsSince ICD-10 accuracy is tied to

reimbursement, physicians across the country are worried about the financial stability of their practices if payments are denied, delayed or otherwise disrupted.

“If it’s not correct, Medicare won’t pay you … no one will pay you,” Hoven noted. She added patients might be the ones who ultimately pay the highest price in terms of access to care if some practices simply cannot weather the financial storm.

“This is why the American Medical Association has been so adamant in trying to get ICD-10 repealed.”

Not getting paid is a very real con-cern. Hoven pointed to the results of a pilot study released last year by the Healthcare Information & Management Systems Society (HIMSS) and the Work-group for Electronic Data Exchange (WEDI) that showed experienced coders had an average accuracy rate of about 63 percent when converting diagnoses to the ICD-10 coding system.

Conducted in 12 waves, each test series consisted of a number of different cases. While 63 percent accuracy was the overall result, individual figures varied widely within each wave. For example, in wave 6, ‘acute bronchiolitis due to RSV’ was accurately coded only 38 percent of the time. On the plus side, coding for “de-viated nasal septum” had a 100 percent accuracy rating in wave 7.

Another financial issue recently came to light when the AMA initiated an up-dated cost study, which found the price tag for ICD-10 implementation was dra-matically higher than previous estimates.

“We were basically operating on 2008 figures, and when we saw these new numbers, it was even worse,” Hoven said. In fact, the 2014 figures found that in some cases implementation costs would be nearly three times what had been pre-dicted six years earlier. Nachimson Ad-visors conducted both the original 2008 study and updated 2014 version.

In 2008, the average predicted cost to implement ICD-10 was:

• $83,290 for a small practice,

• $285,195 for a medium practice, and

• $2.7 million for a large practice.The new cost estimates feature a

range for each practice size based on variable factors including specialty, ven-dor and software. The updated study pre-dicted implementation costs would be:

• $56,639-$226,105 for a small prac-tice,

• $213,364-$824,735 for a medium practice, and

• $2 million to just over $8 million for a large practice.

Two-thirds of physician practices are projected to fall into the upper ranges of the current cost estimates, which include training, assessment and testing, produc-tivity loss, process remediation, payment disruption and vendor/software up-grades. Data also has shown vendors are lagging behind in software development, making it difficult for practices to install and conduct appropriate pre-launch test-ing and to institute workflow changes if needed.

“The markedly higher implementa-tion costs for ICD-10 place a crushing burden on physicians, straining vital re-sources needed to invest in new health-care delivery models and well-developed technology that promotes care coordina-tion with real value to patients,” Hoven said.

Balancing the Pluses and Minuses

ICD-10 certainly has many propo-nents who point to the benefit of hav-ing increased information through the detailed coding system to enhance data analysis, public health surveillance and research initiatives.

It isn’t an argument that sits particu-larly well with Hoven. “But at the end of the day is it going to improve patient care?” she questioned. “The answer is no.”

Those in favor of ICD-10 insist that’s exactly what the new system will do by providing greater opportunity for evidence-based practice and clinical de-cision support. The argument has even been made that the switch ultimately will lessen the burden on providers be-cause they won’t be required to provide as much detailed clinical documentation since the codes are already so specific.

Hoven stressed physicians are strongly supportive of changing the way healthcare is delivered in terms of imple-menting evidence-based protocols, work-ing collaboratively and adopting new models like the patient-centered medical home. However, according to Hoven, too many new administrative and regu-latory requirements that do little to im-prove outcomes have been thrust upon physicians to a point where it has become overwhelming.

“Over the last seven to eight years, the changes have been tumultuous in practices.” Hoven said.

On the way to implementing changes that improve patient care, she noted phy-sicians have been met time and again with

administrative and financial hurdles man-dated by CMS including new require-ments for the physician quality reporting system (PQRS), value-based payment modifier program, and meaningful use.

Despite a national call for adminis-trative simplification, Hoven pointed out, “Nothing seems to get simplified. It gets more complicated. The problem when you start dealing with rules at the federal level is it further complicates everything. It doesn’t improve healthcare, and it doesn’t improve health outcomes.”

What AMA Hopes to Achieve

In February, AMA launched a #StopICD-10 Twitter campaign in sup-port of the organization’s continuing ef-fort to urge HHS to make good on its commitment to improve the regulatory climate for physicians. However, after a number of delays, Hoven knows CMS officials have been adamant the ICD-10 implementation deadline will not move again. Oct. 1 is coming … ready or not.

Hoven said she was delighted by the announcement in mid-February that CMS would conduct end-to-end test-ing for select providers. AMA, along with other industry groups including the Medical Group Management Associa-tion, have pushed hard for such testing. Hoven said the AMA believes end-to-end testing is essential to ensuring there won’t be massive disruptions in claims and pay-ment processing. She noted it was critical that practices of different sizes and spe-cialties be included in the test and called upon CMS to start as soon as possible considering the short window between now and Oct. 1.

“If we see this end-to-end testing is a disaster, our hope is that they will, in fact, delay implementation until a) they can figure out how to fix it, or b) replace it with something else that is more work-able,” she said.

Hoven added if ICD-10 goes into ef-fect as planned, she would advocate for policy changes to protect physician prac-tices such as a two-year implementation period where there would not be payment denials around coding issues.

The Bottom Line“ICD-10 is an unfunded mandate,”

Hoven reiterated, adding it’s also one that comes with a high price tag at a time when physicians already are struggling to stay on top of other costly federal man-dates.

“Adopting ICD-10, while it may provide benefits to others in the health-care system, is unlikely to improve the care physicians provide their patients and takes valuable resources away from implementing delivery reforms and health information technology,” she concluded.

And One Final NoteWhile the debate rages on over ICD-

10, it should be noted work on develop-ing ICD-11 has already begun and is expected to be ready for WHO approval in 2017.

With the Deadline Fast Approaching, AMA Continues, continued from page 1

Dr. Ardis Dee Hoven


HealthcareLeader

Dawn D. Tipton, RN, BSNBy BRIDGET GARLAND

Her experiences have taken her all over the world, but for Dawn Tipton, Di-rector of Nursing for three practices within State of Franklin Healthcare Associates (SoFHA), serving the patients of the Tri Cities and surrounding areas is where she wants to be. In fact, Tipton’s travels, as she explained, opened her eyes and helped shape her perspective on how healthcare is delivered in the Appalachian region.

Originally from Knoxville, Tipton moved to Johnson City to attend East Ten-nessee State University (ETSU), where she received her Bachelor’s in Nursing. After graduation, she started working on the Med-Surg floor at Johnson City Medical Center, but at the time, didn’t have a spe-cific direction in mind for her career. While in the process of talking to a missions orga-nization about opportunities with them, a medical evacuation had Tipton bound for Ethiopia, where she worked for 14 months as a rural health nurse. Along with an Aus-tralian midwife, the two ran a clinic serving a remote tribe there.

“I fell in love with nursing all over again,” she said. “Although clinically, pe-diatrics was my passion, I really enjoyed rural health. We saw all ages, from birth to geriatrics.”

And for a nurse fairly new in her ca-reer, Tipton ended up getting a crash course in rural medicine when the midwife had to be flown out for a medical emer-gency. Tipton was left to run the clinic by herself for five months.

“It matured me,” she explained. “And the experience opened my eyes to the ac-cessibility of healthcare we have in the U.S., compared to Ethiopia.

“The people in the tribe were in a sense between a rock and a hard place,” she continued. “They have a government

system and a private system. The govern-ment system access wasn’t there for them, and the private care was too expensive. And insurance wasn’t available for the tribe.”

As Tipton explained, the tribe used a bartering system, so she would often hear offers such as asking to trade a cow for an-tibiotics, or a chicken for medicine, or even the offer to make something in exchange for medical supplies and equipment.

“I worked with a NGO (non-govern-ment organization), so we had a flat rate. Medical services were free, and we only charged for medicines or medical sup-plies,” she said. “When I finished serving there, I wanted to come back to work in a rural area.

“I really wanted to help patients and make sure they truly understood their dis-ease. I wanted to be somewhere that I could invest time in the patient,” she said. “They did more for me than I ever did for them.”

When she returned home, she took a position at East Tennessee Children’s Hos-pital in Pediatric Oncology. She loved it and decided to go back to school to earn her Master’s. For a while, she was driving back and forth from Johnson City to Knox-ville, working in one place and attending school at ETSU. She eventually met her husband, Jonathan, a Johnson City native,

and life veered in a slightly different direc-tion.

“I decided to take a break and let my husband focus on his career,” she said. “I also wanted to try working on the adminis-trative side of nursing. When this position opened up, I applied, and it has been a great fit.”

Tipton has been working at SoFHA for three years now, overseeing approxi-mately 54 nurses and phlebotomists for First Choice Family Practice, First Choice Internal Medicine, and Johnson City In-ternal Medicine. The couple also has a nineteen-month old daughter, Makenzie.

Tipton’s initial responsibilities at SoFHA included scheduling and oversight of day-to-day activities, but soon, she was challenged to develop a way to track how the clinics were serving and monitoring their patients, and, ultimately, ensure that patients did not fall through the cracks.

“The nurses and providers are great here,” she enthused. “The physicians are very forward thinking. When they see a need, they analyze it and try to meet that need. Dr. Moulton had the idea to moni-tor one of our largest populations, diabetes. About 11% of the population in this area is diabetic, and diabetes can lead to other diseases, such as eye problems, circulatory


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Enjoying East TennesseeKeeper Kids – Tennessee Aquarium

Leigh Anne W. Hoover is a native of South Carolina and a graduate of Clemson University. She has worked for over 25 years in the media with published articles encompassing personality and home profiles, arts and entertainment reviews, medical topics, and weekend escape pieces. Hoover currently serves as immediate president of the Literacy Council of Kingsport. Contact her at [email protected].

By LEIGH ANNE W. HOOVER

Did you know penguins are very picky eaters, and even a misshapen fish will cause them to turn up their beaks? Or, did you know a starfish is actually not a fish at all, and scientists call it a sea star?

These are just a few of the topics I enjoyed learning about during a backstage visit of the Ocean Journey at the Tennes-see Aquarium in Chattanooga. I love visiting aquariums and learning something new with every visit.

Spring break offers the per-fect time to take your family. In fact, the Tennessee Aquarium’s “Keeper Kids” program is some-thing very special for children ages six and up, and it will be offered through April 20, 2014, on a first come, first served basis with the price of admission.

Participants will be able to choose two of 16 different behind the scenes Keeper Kids activities happening daily at the Aquarium. Each program lasts 15 – 20 minutes, and whether it’s exploring the Ocean Journey with hands-on activities as I did, or going behind the scenes with River Journey experiences, your children will enjoy a fun, learning encounter.

In fact, one of the best things about visiting the Tennessee Aquarium is being able to glimpse animal behavior up close and personal—especially with the Keeper Kids experience.

“It’s [Keeper Kids] an opportunity for families to explore the aquarium in a different way,” explained Senior Market-ing & Communications Manager, Ten-

nessee Aquarium and IMAX Theater, Thom Benson. “It’s to have fun but keep that learning curve going during spring break.”

According to Benson, the Keeper Kids experience also allows inter-action with the many scientists, naturalists and veterinarians. For older teens, it is an opportunity to explore science as a pos-sible future career.

“To have the opportunity to go be-hind the scenes and see what it takes to care for the animals and maintain the ex-hibits and do a world-class job with the animal care is really something special,” said Benson. “It can strictly just be a lot

of fun, or it could be something that leads to something bigger and

longer term.”An advantage of Ten-

nessee Aquarium membership is visiting multiple days and doing

many of the Keeper Kids programs dur-ing the week while in Chattanooga.

Whether it’s observing and learning about the penguins from the overlook above their habitat, or viewing the new arrivals in the quarantine area, where animals are first introduced to the facility, participants will experience a whole new way of exploring and getting up close to the animals and fish on exhibit.

“Rivers of the World is a lot of fun

because you get to go behind the scenes and feed some of the fish,” explained Benson. “Up in the Delta Swamp, that feeding process is pretty cool because the aviculturist has trained the birds to come down on the posts and get mealworms… within a couple of feet of you. For people who are photographers and like native songbirds, that’s really a cool opportunity.”

To enjoy multiple Keeper Kids experiences tailored to children’s’ individual interests, Benson encourages parents to go one-on-one with children. Larger audiences will be also accommodated with additional special events in the auditorium.

“They’re [Keeper Kids] all a lot of fun, and we get a really big positive response from peo-ple who do the activities,” said Benson. “In fact, our staff really enjoys facilitating the programs

because it’s another way to directly engage our visitors.”

In addition to the Keepers Kids pro-grams, the Tennessee Aquarium will also be running the River Gorge Explorer on the Williams Island Family Adventure Cruise through April 17th with special Spring Break ticket pricing. Participants will hear about Civil War history and view wildlife and rookeries with onboard natu-ralists. It’s not unusual to spot an osprey nest, blue heron, and even a bald eagle from the observation deck. There’s also an onboard scavenger hunt!

The best way to get the most out of your Spring Break is to plan your expe-rience by consulting the website Keeper Kids: http://tnaqua.org/SpringBreak.aspx . Additionally, check the boat and the IMAX® 3D Theater schedules on the website: http://www.tnaqua.org/Home.aspx. Visitors can also use the new Ten-nessee Aquarium app, which contains conservation and keypad games to extend the experience, for event schedules.

Benson added that the great experts on staff at the Tennessee Aquarium truly love sharing their experience and knowl-edge.

“They’re very passionate about what they do,” explained Benson. “When kids get extra excited about learning about sea turtle or sharks, our biologists really love that!”

e a s t t n m e d i c a l n e w s . c o m APRIL 2014 > 9e a s t t n m e d i c a l n e w s . c o m

easttnmedicalnews.com

The third step from the bottom squeaks when you tread on it – which is something you tried to remember when you snuck in after curfew.

There’s a light switch near the door that does nothing, and never did. One of the kitchen drawers has a tendency to stick. And someone, sometime, put a strip of wallpaper on upside down.

Yes, the house you grew up in has its peccadilloes, but your mother loves it there and she wants to stay. In Living Safely, Aging Well by Dorothy A. Drago, MPH, you’ll learn how to ensure that she does.

You probably don’t need to be re-minded that, as we age, our bodies change. Bones get fragile, eyesight dims, hearing can fade, balance can go out of whack. These things are annoying when you’re younger but can lead to devastating injuries for an elder.

But mere awareness puts you on the advantage. Says Drago, “When you antic-ipate the possibility of an injury, you can attempt to prevent it.”

Take, for instance, falls.According to nearly all sources, falls

are “the primary injury mechanism for the aging population.” But merely knowing the risk for falls won’t prevent them; you need to know why people fall. Clothing mishaps, problems with furniture, slippery fl oors, and other environmental reasons can be dealt with individually or with pro-fessional help; poor balance, medications and other physical issues can be brought to the attention of a doctor. It can also be reassuring to teach someone how to get up if they tumble.

But though falls may be fi rst on your mind, there are other things to consider when making a home as safe as possible. Kitchens and bathrooms can be literal

hotspots, and there are ways to minimize the risk of burns and scalds. M e d i c a t i o n mix-ups can lead to poisoning, which can be easily monitored. The risk of choking – the “third leading cause of home injury death among those over the age of 76…” - can be minimized. And good health deci-sions can be made through health literacy and by asking your doctor to be an ally.

You want to keep Mom or Dad inde-pendent a little longer, whether it’s in their home or yours. Either way, Living Safely, Aging Well can give you the tools to do it.

We’ve all seen TV commercials about falling, and while author Dorothy A. Drago, MPH, has a huge chapter on that aspect of home safety, I was pleased to see

a bigger picture: Drago also digs deeper and of-

fers solutions to other is-sues that don’t normally

come to mind. Boomers will be relieved to know that that

includes the hard stuff, like giving up dangerous-but-be-

loved possessions and furniture, giving up a bit of autonomy, and giving up the driver’s license.

Specifi cally, because of those I-never-thought-of-that issues, I think anyone who’s over age 50 needs this book on their shelf. If you’re concerned about safety for a loved one or want to maintain indepen-dence yourself, Living Safely, Aging Well will give you the steps you need.

Terri Schlichenmeyer. Terri is a professional book reviewer who has been reading since she was 3 years old and she never goes anywhere without a book.

The Literary ExaminerBY TERRI SCHLICHENMEYER

hotspots, and there are ways to minimize the

lead to poisoning, which can be easily monitored. The risk of choking

a bigger picture: Drago also digs deeper and of-

fers solutions to other is-sues that don’t normally

come to mind. Boomers will be relieved to know that that

includes the hard stuff, like giving up dangerous-but-be-

loved possessions and furniture,

Living Safely, Aging Wellby Dorothy A. Drago, MPH; c.2013, Johns Hopkins University Press; $16.95 / higher in Canada, 204 pages

The UHS Board of Directors wish to congratulate the following physicians who completed

Physician Leadership AcademyThe University of Tennessee Medical Center

Supported by UT Graduate School of Medicine, The University of Tennessee Medical Center Medical Staff and UT College of Business.

The University of Tennessee Medical Center has established the advancement of the Physician Leadership Academy as one of our highest priorities. The Physician Leadership Academy is an intense year long formal education program provided by the Executive Education Program of the University of Tennessee College of Business Administration.

Mark E. Anderson, MDNeonatology

Larry Kilgore, MDGynecologicOncology

Amy Barger-Stevens, MDFamily Medicine

TreyLa Charité, MDHospitalist

J. KirkBass, MDNeonatology

J. RussellLangdon, MDAnesthesiology

RobertCraft, MDAnesthesiology

MelissaPhillips, MDGeneral Surgery

RaymondDieter, III, MDCardiothoracicSurgery

RamanujanSamavedy, MDGastroenterology

LisaDuncan, MDPathology

JamesShamiyeh, MDPulmonology

KeithGray, MDSurgical Oncology

MichaelWalsh, MDNeurosurgery

Jano Janoyan, DOHospitalist

WesleyWhite, MDUrology


and their own personal circumstances. Are there financial issues that make office visits cost prohibitive? What about transportation or geographic barriers that make it difficult to get to an appointment? Perhaps an indi-vidual is working multiple jobs or caring for everyone else in the family with little time left over to address their own needs.

Halprin said the study also revealed some interesting perceptions about the healthcare system and providers. “They find the whole healthcare system imper-sonal,” she said of the study participants. “They think we’re not listening and that we suggest things that aren’t practical.”

To a physician, telling a patient to ‘in-crease physical activity’ seems like a highly appropriate, straightforward step toward bet-ter diabetes management. To a patient who struggles financially, a gym membership is out of the question and strolling through an unsafe neighborhood could be more danger-ous to their health than the disease, itself.

“Diabetes is a very time consuming dis-ease to have, but it’s also a very time con-suming disease to treat,” Halprin pointed out. “The healthcare system doesn’t always permit the time for exploring and looking at each person’s individual needs.”

To address that, Joslin is investigating the addition of care coordinators to work with high-risk patients. The coordinator be-comes the point person who initiates a fol-low-up call after an appointment to see if the patient understood recommendations and to make sure prescriptions are being filled. The coordinator might also reach out to remind

the patient when it is time for their diabetic eye or foot exam. This is the individual who is more likely to know about medication assis-tance programs, area outlets for safe activity, and other resources to overcome obstacles.

Although the concept isn’t novel in healthcare, it is one that has been difficult to fund under the current payment system. Changes in reimbursement models, such as the patient-centered medical home, make it more feasible to add a care coordinator to the team approach that Halprin used at Joslin. In addition to the physician, the team includes a nurse practitioner, nutritionist, exercise physiologist, registered nurse, psy-chiatrist and diabetes educator. Through a joint project with Beth Israel Deaconess Medical Center, Joslin has launched the Diabetes Practice Liaison Program to share collaborative strategies with primary care providers and their office staff in the region.

Just as one provider doesn’t hold all the answers, it’s unlikely one approach will meet everyone’s needs.

Halprin pointed to another study among Joslin’s older patients that had en-couraging outcomes. “A highly structured education program with specific tasks and cognitive behavior strategies resulted in bet-ter A1c control, which was maintained for at least a year,” she noted of the interven-tion that worked well with older patients up to age 75. However, she continued, that program didn’t show the same promise among middle-aged patients.

Race and ethnicity are also important variables in how information is received,

perceived and acted upon. Joslin has ini-tiatives for Asian, African-American and Latino patients that take into account social and cultural traditions. Considering the risk of diagnosed diabetes in comparison to non-Hispanic whites is 18 percent higher among Asian Americans, 66 percent higher among Latinos, and 77 percent higher among non-Hispanic blacks, reaching these specific populations in a meaningful way is critical.

Halprin, a member of Joslin’s Latino Diabetes Initiative, noted there is a support group that meets regularly at the diabetes center to knit and chat. A staff psychologist joins the group to guide conversation and answer questions.

“They bring food so that’s an oppor-tunity to discuss what is a good choice or a not-so-good choice,” Halprin said. “Nu-trition is a huge part of diabetes care, but it’s also a huge part of the Latino culture,” she noted, adding nutritionists on staff try to make suggestions that are culturally ap-pealing or that revamp traditional meals to lighten the carbohydrate load.

Additionally, education classes are con-ducted in Spanish and materials have been translated. Providers with the Latino pro-gram also are piloting group medical visits with four-eight participants. All of these ef-forts combine to make the healthcare clinic less intimidating and more welcoming of natural conversation and questions about living with diabetes.

In fact, Joslin hosts a number of pro-grams in a group setting including DO IT, a four-day intensive outpatient program de-

signed for those who have gotten off track with their self-management; Why WAIT, a combined weight reduction and manage-ment program with a focus on nutrition, physical activity and behavioral support; and interactive games like CarbChallenge where participants test their knowledge of carbohydrate containing foods.

“Diabetes can be a very isolating con-dition,” Halprin said. “It’s good for people to be in a group and know other people are struggling with similar issues.”

What’s good for patients is also good for providers. Halprin’s colleague, Rob-ert Gabbay, MD, the chief medical officer for Joslin Diabetes Center, is slated to give the keynote speech at The American Journal of Managed Care annual meeting. “Patient-Centered Diabetic Care: Putting Theory into Practice” is the 2014 theme of the April 10-11 conference in Princeton, N.J.

“Our meeting will occur as the first waves of newly insured consumers are ac-cessing the healthcare system, including many who will learn for the first time they have diabetes or other cardiometabolic conditions,” said Brian Haug, president of AJMC. “This is an important time for healthcare professionals to be engaged with leaders in this field.”

By working collaboratively, utilizing diverse technologies and education offer-ings, and leveraging the theories embedded in new reimbursement models, the hope is patients and providers will work together to overcome the obstacles to effective diabetes self-management.

Addressing Obstacles on the Road to Diabetes Control, continued from page 1

Non-Alcoholic Steatohepatitis and Obesity

GI for Kids, PLLC

BY DIANA MOYA, MD

Obesity and Non-alcoholic steatohepatitis (NASH) are fascinating entities becoming more frequent in our practice. During the past two decades, there has been a dramatic increase in obesity in children and adolescents in the United States. Data from the CDC estimates that childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years, and approximates 17% (12.5 million). Parental obesity is one of the main risk factors for the development of pediatric obesity. Obese adolescents have a 50 to 77% risk of becoming obese adults with an increase to approximately 80% given 1 obese parent.

Obesity during childhood carries devastating consequences including hypertension, dyslipidemia, non-alcoholic fatty liver disease (NAFLD), insulin resistance, diabetes mellitus and metabolic syndrome. Children are at greater risk for bone and joint problems, sleep apnea, precocious puberty, polycystic ovary syndrome and social and psychological problems such as poor self-esteem and bullying.

Many families, surprisingly enough, report being unaware that their child is overweight or obese. This unawareness limits interventions in a timely fashion. As physicians and medical care providers, we must warn families for any concerns about overweight and obesity at any age. Body fat is measured by Body Mass Index (BMI) based on height and weight. BMI curves are calculated from the 5th to the 95th percentile and by consensus children and adolescents are overweight or obese if the BMI exceeds the 85th or 95th percentiles respectively.

Obesity can be multifactorial involving genetic and environmental factors. In overweight and obese children, excess fat accumulates when total energy intake exceeds total energy expenditure. Other factors include genetic syndromes, hormonal disorders, and medications.

NAFLD occurs more frequent in obese children. NAFLD is a spectrum of diseases ranging from simple steatosis to cirrhosis. Non-alcoholic steatohepatitis (NASH) is the severe form of NAFLD and is characterized by steatosis, hepatocyte injury and cell death, infl ammation and collagen deposition or fi brosis of the liver. The pathogenesis of NASH is not fully understood, although metabolic derangements related to obesity, insulin resistance and oxidative stress is well known factors involved. The development of NASH is likely a “two hit” process. Fat accumulation in the hepatocytes is the suggested “fi rst hit”. The “second hit” is related mainly to oxidative stress, and additionally mitochondrial dysfunction, pro-infl ammatory cytokines, and adipokines that leads to the production of reactive oxygen species.

Most obese children with NASH are asymptomatic. Few patients may complain about fatigue and upper abdominal discomfort. Although the only fi nding on physical exam may be a BMI above the 85th or 95th percentiles, other fi ndings may indicate organic etiologies

of obesity. Short stature may suggest hypothyroidism, hormonal abnormalities or genetic syndrome such as Prader-Willi syndrome. Constipation or intolerance to cold may indicate hypothyroidism. Polyuria and polydipsia may suggest diabetes. Acanthosis nigricans suggests insulin resistance. Symptoms of jaundice, ascites, edema or hepatosplenomegaly may be signs of advance liver disease related to cirrhosis due to progressive NASH.

Laboratory evaluation may be challenging as no single test is used to diagnose NASH. Helpful tests includes liver function tests, gamma-glutamyl transpeptidase, fasting insulin and glucose levels, fasting lipid panel, thyroid panel and iron studies. Occasionally more specialized tests are used to rule out other causes of elevated liver enzymes such as autoimmune or infectious hepatitis, Wilson’s disease or hemocromatosis.

Abdominal ultrasound is a helpful, simple and noninvasive way to diagnose hepatic steatosis and evaluate for portal hypertension or gallbladder disease. In patients with NASH, the liver is hyperechogenic or bright and steatosis is usually detected when more than 30% of liver has fatty changes. Other diagnostic studies also available are abdominal computed tomography and magnetic resonance. Invasive tests such as a liver biopsy should be considered in patients with suspected NASH to assess the extent of liver damage and fi brosis, defi ne the prognosis and exclude other unsuspected causes of liver disease.

No specifi c treatment is available for (NASH). Lifestyle modifi cation including weight loss, dietary changes, and exercise activity are the most important measures to slow the progression of the disease and reverse hepatic steatosis. According to the AASLD guidelines, 2-3% of weight loss generally reduces hepatic steatosis, but up to 10% weight loss may be needed to improve necroinfl ammation.

Recommendations for pharmacological therapies such as metformin, statins, ursodeoxycolic acid, thiazolidinediones, omega-3 fatty acids and vitamin E in children are limited and therefore not recommended for this population.

Some complications associated with NASH may include cirrhosis and its complications: variceal bleeding, ascites, encephalopathy, and liver failure. The prognosis in NASH depends on the histologic stage at presentation. The rate of progression worsens if more than one liver disease is present (alcoholic liver disease or chronic viral hepatitis).

At GI for Kids, we offer a weight management program, Bee Fit 4 Kids, for overweight and obese children and teenagers. Bee Fit comprises

group and individual counseling sessions with two Registered Dietitians to discuss healthy dietary habits, an Exercise Specialist to improve physical activity habits, and a Psychologist assessing

behavior modifi cation to ensure a successful weight loss journey. Our Gastroenterologists and Nurse Practitioners also participate in this program.www.giforkids.com (865) 546-3998

bleeding, ascites, encephalopathy, and liver failure. The prognosis in NASH depends on the histologic stage at presentation. The rate of progression worsens if more than one liver disease is present (alcoholic liver disease or chronic viral hepatitis).

At GI for Kids, we offer a weight management program, Bee Fit 4 Kids, for overweight and obese children and teenagers. Bee Fit comprises

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Although one in every 20 Americans over the age of 50 has peripheral arterial disease (PAD), less than a third of patients present with typical symptoms. Primary care providers may easily identify the common symptoms of lower extremity arterial diseases, primarily claudication (leg pain on walking or exertion), but patients with PAD also present with leg pain at rest, pain in the buttock or hip, unhealed ulcers and wounds, gangrenous feet or legs, discoloration of the feet or legs, cold or pale feet, burning, numbness, and leg fatigue . The American Heart Association and the American College of Cardiology recommend screening asymptomatic patients 50 years and older with a history of smoking or diabetes. Risk factors of PAD include smoking, diabetes, high cholesterol , hypertension, physical inactivity, and overweight/obesity.

An ABI (ankle-brachial index) is used in office to screen at-risk patients. The risk factors of patients who have an abnormal ABI should be aggressively controlled with medication and by changing their lifestyles. Smoking must stop, and diabetes, high cholesterol and high blood pressure need to be controlled.

Along with controlling risk factors of PAD and lifestyle modification, patients diagnosed with PAD should be on aspirin therapy for prevention of heart attack and stroke, and prescribed cilostazol for help in controlling symptoms (with the exception of patients with congestive heart failure). At the same time, all these patients should undergo a supervised exercise program. If after three months of medical treatment and supervised exercise, symptoms have not improved, patients should undergo an MRI, duplex ultrasound, or an abdominal aortogram with selective lower extremity angiogram to determine the exact location and percentage of blockage. Angioplasty and/or stenting or atherectomy is often indicated to open narrowed or blocked arteries.

A significant number of patients have uncontrolled blood pressure, even with optimal doses of multiple medication. Those patients and patients with accelerated or malignant hypertension; deteriorating kidney function; and flash pulmonary edema should undergo evaluation for renal artery stenosis as a cause. Renal duplex ultrasound is the initial screening method and renal angiogram is the gold standard for evaluation of renal artery stenosis. Renal artery stenting or angioplasty is indicated for resistant or malignant hypertension; deteriorating kidney function; and flash pulmonary edema.

Primary care providers can refer their patients for evaluation and management of lower extremity PAD and renal artery stenosis. Early identification and treatment of those patients significantly improve a patient’s quality of life , symptom relief, and prevent future adverse cardiovascular events.

Dr. Timir Paul practices with Quillen ETSU physicians and is skilled in the evaluation and treatment of peripheral vascular diseases. He performs angioplasty and stenting in renal, iliac, femoral, and popliteal arteries, as well as tibial and peroneal arteries.Dr. Paul earned his MD from the University of Dhaka, Dhaka Medical College, Dhaka, Bangladesh; MPH in Cardiovascular Epidemiology from the School of Public Health and Tropical Medicine, Tulane University, New Orleans, La; and a PhD in Cardiovascular Epidemiology, Tulane University, School of Public Health and Tropical Medicine, New Orleans, La.He completed his residency in internal medicine with the Department of Internal Medicine at the Quillen College of Medicine in Johnson City, Tenn. He completed his fellowship in cardiology at Oschner Clinic, New Orleans, La. He finished his interventional cardiology fellowship at University of North Carolina at Chapel Hill, Chapel Hill, N.C.

Quillen Heart

Talk Your Patients

and Peripheral Arterial Disease

By TIMIR K. PAUL, MD, PhD, MPH, FACC

329 North State of Franklin RoadJohnson City, TN 37604

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Nationally, healthcare providers list patient education as one of the most important

aspects of quality patient care, yet patient education is one of the most difficult quality initiatives to achieve. That’s why the Mountain States Health Alliance (MSHA) Health Resources Center (HRC) is such a valuable community resource. The HRC offers easily accessible health information, health classes, and health screenings for individuals throughout the Tri Cities. Open Monday through Saturday from 8 a.m. to 6 p.m., the Health Resources Center has two locations, at the Kingsport Town Center (formerly Fort Henry Mall) and the Mall at Johnson City. The Center also offers blood pressure checks and weight checks, with an RN on staff during all business hours. Individual nutritional counseling is available with a registered dietician who is certified in diabetes education (CDE).

In addition to health classes and screenings, the HRC hosts monthly support groups, offers cooking demonstrations, and exercise programs, such as yoga, Zumba Lite, dance fitness, and fitness training.

“We try to mix it up and have something for everyone,” said Laurel McKinney, RN, manager of the HRC. “The biggest advantage of the HRC to patients and the community is the help we offer for keeping people healthy, prevention of disease, and teaching optimal health. We want the community to understand, and stay healthy.”

Although the HRC offers a wide range of resources and education on many diseases and conditions, a big focus of the HRC is on diabetes, since a large percentage of the community population has been diagnosed with diabetes or is at risk for developing it. Currently, the Johnson City location offers on the spot Hemoglobin A1Cs, an important test for diabetics, which reveals a longer-term picture of blood sugar levels either for diabetics or for individuals who have had a fasting blood sugar that’s a little high. An RN goes over the results with the patient and instructs them on what the results can indicate. Lab work for diabetes as well as other disease screenings is typically cheaper than the co-pay on an individual’s insurance plan, and no doctor’s order is required.

Any person can use the HRC’s resources, no matter his or her healthcare provider or insurance carrier, and with most services offered free of charge or for a minimal cost, healthcare providers will find that the HRC can be a valuable resource to their patients.

“Our disease management classes are a great resource for physicians to use for patient education and disease management,” said McKinney. “We want to help keep patients healthy if they have been diagnosed with a disease, or who might be headed in that direction, to help keep them out of the hospital.

“Examples of our classes would be ‘Lowering Your Cholesterol’ or ‘Dash to Better Blood Pressure.’ We offer COPD classes, managing congestive heart failure, medication safety, smoking cessation, stress management, or even preparation for a joint replacement,” McKinney explained. “So when patients are diagnosed or discharged from the hospital, this is the perfect fit for them to come learn more about their disease and stay as healthy as they can be with their disease state. These are classes that we offer every single month. Our focus is on healthy living, preventative care, and disease management.”

A monthly calendar of events is available for both HRC locations and is sent out via email and postal mail, listing class and screening schedules. The HRC also makes the schedule available on the MSHA website, and highlighted events are posted on MSHA’s Facebook page, in the Johnson City Press, and in the Kingsport Times. The HRC also works with television stations WJHL and WKPT to announce screening and class schedules.

Physicians can call and register their patients if preferred or patients can sign up themselves. Although classes are typically free

or low cost, registration is required because of class size limitations and scheduling considerations. Classes often fill up.

Although the staff teaches disease management classes themselves, guest speakers are utilized—and needed—at both locations for Healthy Living

classes. Physicians can book classes to teach at the HRC, and both locations are very accommodating for a variety

of teaching methods. Most class sessions are scheduled for

an hour, with 40-45 minutes allowed for instruction, and 15 minutes for questions and answers.

“We would love to have physicians come speak. Classes can be as formal or as casual as the speaker desires,” said McKinney. “We have laptops, projectors, and other equipment for presentations or

speakers can pull up chairs and simply lead a discussion. We remind our speakers that most of the attendees are members of the general public, so a very simplified version of the topic is appreciated.”

For those who are interested in teaching a class, a call to the center is all that is required. Classes are planned at least a month in advanced, and the HRC checks credentials for those who have never presented before. Alternative therapy topics are welcomed, as long as the subject matter does not discourage MSHA protocols and practices.

The HRC also offers outreach programs to the community, making presentations for civic groups and schools, such as the Hope House Center for Women, the Johnson City Farmer’s Market, the Kingsport Funfest, or the No Boundaries Couch to 5K program.

Other services that can be scheduled are one-on-one education for diet and nutrition, weight management and reduction, or infant and child feeding, to name a few.

“We are here for the community, for help with understanding illness or disease, and a place for the community to come in and ask questions,” McKinney emphasized.

For more information, or to contact the Health Resources Center, call 423-915-5200, in Johnson City, or 423-857-7981 in Kingsport.

Presented in Partnership by East Tennessee Medical News and Mountain States Health Alliance

All source data for this article has been provided by

Health Resources Center Helps Community Understand and Stay Healthy

Patient Centered Practices

Laurel

McKinney, RN

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MEDICAL GROUP MANAGEMENT ASSOCIATION

UT Medical Center Names New Vice President and Chief Information Officer

KNOXVILLE—Eileen Clark recently joined The University of Tennessee Medical Center as vice president and chief informa-tion officer. In this role, Clark will oversee Information Systems and provide lead-ership in this rapidly chang-ing healthcare and technol-ogy environment.

Prior to joining the medical center, Clark served for two years as as-sociate chief information officer at Virginia Commonwealth University Health System. Other previous positions included Informa-tion Technology Services Senior Director and Information Technology Services Direc-tor at St. John Providence Health System, a member of Ascension Health, where she served for 18 years.

Clark received a Bachelor of Business Administration from Walsh College in Troy, Michigan and a Masters of Science in Ad-ministration at Central Michigan Univer-sity in Livonia, Michigan. She is a member in good standing with Health Information Management and Systems Society.

Clark and her husband, Michael, moved here from the Richmond, Virginia area. They have one adult child that current-ly resides in Virginia. In her free time, she enjoys traveling, hiking, and reading.

Neurohospitalist Loaiza Joins Parkwest Staff

KNOXVILLE—Parkwest Medical Cen-ter has announced the addition of neuro-hospitalist Sergio Loaiza, MD, to the hospital’s staff. Loaiza is a native of Colom-bia, South America, and began in family practice there in 1987. He is certi-fied through the American Board of Psychiatry and

Neurology with added qualifications in clini-cal neurophysiology, the American Board of Independent Medical Examiners, and the American Board of Pain Medicine. Loaiza is a member of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnotic Medi-cine, the American Medical Association, and the American Academy of Pain Medicine. Loaiza received a fellowship in neurophysi-

ology at St. Louis University Health Sciences Center in St. Louis, Missouri, after graduat-ing from Universidad Nacional de Colombia School of Medicine, and an internship at University of Southern California Medical Center in Los Angeles, CA. He was also a resident in child neurology at St. Louis Chil-dren’s Hospital. Dr. Loaiza has most recently served neurology patients at Parkway Neu-rology Associates in Knoxville.

problems, and stroke. I was asked to look at our clinical processes for these patients and explore ways to improve them.”

Tipton’s commission lead to the estab-lishment of the group’s diabetic clinic. A list of patients is generated quarterly who have been diagnosed with diabetes and have HgbA1C of 8 or greater. The list is used to develop a tracking mechanism for each individual patient, and it is one nurse’s sole responsibility to manage.

For each patient, standard treatment protocols are applied, such as determin-ing his or her HgbA1C, last microalbu-min, last eye exam, etc. If the labs are out of range or haven’t been recorded in the chart in the recommended timeframe, the clinic communicates with the patient and either schedules the patient to have the labs drawn or to see a provider. The nurse then follows up with the patient to report im-provements or to identify barriers that may be preventing improvements.

“Does the patient understand their disease? Do they have transportation to the clinic? Have they recently had changes in their insurance or a loss of a job? Is their medication affordable for them?” explained Tipton. “We ask these type of questions, and continue to follow the pa-tient indefinitely. We run the lists quarterly to capture patients with a new diagnosis or out of range hemoglobin A1C.”

“We have seen a drastic decrease in the hemoglobin A1C values since starting the clinic, and many were lowered by as little as one point, or even below eight. We found that following up with the patient, not hassling them, but expressing concern, really helps. Some are even depressed and just need a listening ear,” she said.

Although Tipton explained that the program aligns with their Patient Centered Medical Home, which focuses on track-ing chronic disease states, and their ACO, the providers in her clinics are quick to ask what they can do.

“They are invested in their patients, and they know their patients,” she ex-plained. “They ask us how to use this data to serve in the clinic itself, and not just as an administrative program.”

This dedication to patient care is one of the many reasons Tipton says she loves her job, “I work with a great team here,” she said. “The nurses and providers I work with are wonderful. We have a good time at work and are able to take each other seri-ous and take care of our patients.”

Tipton says she also enjoys having a bird’s eye view of the clinic, yet still hav-ing the ability to look closer at processes, develop them, and help the patients by facilitating improvements to the care they receive.

“I really enjoy developing programs that serve the patients. As part of our work on quality initiatives, we will soon start a hypertensive clinic, and we are looking at developing a lipid program as well,” she said. “We want to have processes and pro-grams in place that serve the patients in our area.”

Healthcare Leader, continued from page 7

GrandRounds

Eileen Clark

Erlanger Recognized for Leadership in Improving Infant Health CHATTANOOGA—Erlanger Health System has been recognized by the Tennessee Hos-

pital Association’s (THA) Tennessee Center for Patient Safety for its leadership in reducing the number of babies born electively between 37 to 39 weeks.

Erlanger successfully met its goal of decreasing the number of elective deliveries be-tween 37 to 39 weeks gestation to 5 percent or less and has maintained this goal for a mini-mum of six consecutive months. This dramatically increases the chances for good physical and developmental health of babies. It also allows for better health and safety of the mother. The Tennessee Center for Patient Safety awarded a congratulatory banner to Erlanger in rec-ognition of its team’s outstanding efforts.

Erlanger is part of a statewide Healthy Tennessee Babies Are Worth the Wait initiative launched less than two years ago to increase awareness of the benefits of full-term delivery. In May 2012, nearly 16 percent of all Tennessee deliveries that occurred prior to 39 weeks gesta-tion were considered elective. Today, that number has been reduced by almost 85 percent. Among other activities, Erlanger adopted a strict hard-stop policy that prohibits early elective deliveries before 39 weeks unless there is a clear medical risk to the mother or the baby.

The Healthy Tennessee Babies Are Worth the Wait program is a partnership of the local hospital, the Tennessee Department of Health, THA, Tennessee Initiative for Perinatal Qual-ity Care, March of Dimes and Tennessee Center for Patient Safety. The coalition has been recognized nationally as an example of successful collaboration in patient safety. For more information about the Healthy Tennessee Babies Are Worth the Wait program, go to www.healthytennesseebabies.com.

The Women’s Services Team from the Erlanger Baroness Campus displays the congratulatory banner from the Tennessee Center for Patient Safety in recognition of the team’s outstanding efforts.

Dr. Sergio Loaiza


Erlanger and Children’s Hospital Partner with the Tennessee Department of Health to Reduce Infant Deaths

CHATTANOOGA—As part of an effort to save lives and lower Tennessee’s infant mortality rate, Erlanger Health System and Children’s Hospital at Erlanger have part-nered with the Tennessee Department of Health in the effort to reduce infant mortal-ity by creating a hospital safe sleep policy. One of the top priorities of the Tennes-see Department of Health is to reduce the state’s infant mortality rate (a measure of how many babies die before reaching their first birthday). TDH has discovered that 20 percent of all infant deaths in Tennessee are due to unsafe sleep practices.

“Infants should sleep Alone, on their Back and in a Crib. As a hospital commit-ted to improving community health and lowering our infant mortality rate, we need to make sure parents know these simple rules and share this information with other people who may be putting infants down to sleep, including grandparents and other relatives,” said Cindy Rhodes, Administrator of Children’s Hospital at Erlanger.

Studies have shown that parents place their babies to sleep the same way they see their baby placed to sleep in the hospital. The new safe sleep policy at Erlanger and Children’s Hospital will require staff mem-bers to implement safe sleep practices in the hospital. In addition, the policy will re-

quire all staff members who care for infants to be trained on safe sleep on an annual basis.

Although SIDS numbers have de-creased in Tennessee, other preventable sleep-related deaths are on the rise.Causes of other sleep-related deaths include suffo-cation, such as when an adult rolls over on an infant or an infant is smothered by pil-lows or blankets. In 2011, 109 sleep-related deaths occurred in Tennessee. In 2012, the infant mortality rate in Tennessee was 7.2, meaning that 7.2 babies out of every 1,000 born did not reach their first birthday. Infant mortality rates in Tennessee and the United States lag far behind many other countries, including less-developed countries.

Erlanger and Children’s Hospital are committed to the health and safety of all patients and are excited to partner with the Tennessee Department of Health in this ef-fort to reduce infant deaths.

For more information on sleep-relat-ed deaths, visit the TDH website at http://safesleep.tn.gov. For more information about Erlanger Health System and Chil-dren’s Hospital at Erlanger, visit www.er-langer.org.

Siskin Hospital’s Young Earns Board Certification in Clinical Neuropsychology

CHATTANOOGA—Siskin Hospital is proud to announce that J. Christopher Young, PhD, is now Board Certified in

Clinical Neuropsychology by the American Board of Professional Psychology (ABPP).

Young is one of 14 individuals boarded in Clinical Neuropsychology by the ABPP in Tennessee and the only Clinical Neuropsy-chologist currently accepting patients in the Chattanooga region. Young sees patients who are in Siskin Hospital’s Inpatient and Outpatient Therapy Programs.

Young co-directs Siskin Hospital’s Stroke Recovery Aftercare Program with Dr. Matthew Rider. Young provides advanced expertise in the diagnosis and treatment of cognitive and neuropsychiatric disor-ders across the lifespan, including demen-tia, stroke, movement disorders, traumatic brain injury, and cognitive effects of chronic medical illness. Additionally, he provides evaluation and consultation services for a wide range of medicolegal issues pertain-ing to neurocognitive dysfunction.

Young is a native of Jackson, Missis-sippi and earned his undergraduate edu-cation at the University of Tennessee, with degrees in Economics and History, as well as Psychology. He obtained his Ph.D. in Clini-cal Psychology at University of Mississippi and completed his Neuropsychology Track Internship at Memphis VA Medical Center.

Young completed his Association of Post-doctoral Programs in Clinical Neuro-psychology (APPCN) member post-doctor-al fellowship in Clinical Neuropsychology at Memphis VA Medical Center, and also obtained post-doctoral training in Neuro-psychology at St. Jude Children’s Research Hospital and Semmes-Murphey Neurology and Spine Clinic in Memphis. He was instru-mental in establishing the Memory Disor-ders Clinic at Memphis VA Medical Center.

Through his continued involvement in dementia and test validity research, Young has earned valuable and extensive experi-ence in the Clinical Neuropsychology field. Additionally, he has eight peer-reviewed publications in journals such as The Clinical Neuropsychologist and Archives of Clinical Neuropsychology, as well as more than 40 presentations at state, national, and interna-tional conferences.

Furthermore, Young is a member of the International Neuropsychology Society, the American Academy of Clinical Neuro-psychology, and the American Psychology Association.

Young’s commitment to providing con-tinuity of care by seeing pediatric, adult, and geriatric patients is an asset to Siskin Hospital’s Psychology Department, which has the largest team of highly trained, li-censed rehabilitation Psychologists in the Chattanooga area who specialize in Neuro-psychology and behavioral medicine. Siskin Hospital Psychologists engage in treatment to further enhance a patient’s rehabilitation potential, while providing support for pa-tients, caregivers, and family members.

Please visit www.SiskinRehab.org to view Young’s profile, as well as the services provided by Siskin Hospital’s Department of Psychology.

Parkridge Medical Center Hosts Wine and Pearls Benefit on April 25

CHATTANOOGA–Parkridge Medical Center is proud to present Wine & Pearls 2014, a benefit for PearlPoint Cancer Sup-port, on April 25 from 6 p.m. to 9 p.m. at the Hunter Museum of American Art. Funds raised at this event will provide vital per-sonalized guidance, support, and informa-tion to Chattanooga-area adults navigating the journey through cancer diagnoses and treatments.

This event raises funds in support of Chattanooga-area men and women diag-nosed with cancer. Attendees will enjoy live music, wine tastings and a cocktail re-ception while taking the opportunity to bid on overnight stays, dining experiences, gift baskets, and other unique items at the eve-ning’s silent auction.

“We are honored to partner once again with Parkridge Medical Center for Wine and Pearls,” notes Susan Hosbach, President & CEO of PearlPoint Cancer Support. “This event is more than a special night out - it creates greater awareness about the per-sonalized guidance PearlPoint offers free of charge to adults impacted by cancer. Pro-ceeds from Wine and Pearls further our abil-ity to provide education and support from the moment of diagnosis to help survivors more confidently navigate their cancer jour-ney.”

Individual tickets for the event are $75. For more information about Wine & Pearls, visit www.pearlpoint.org/events or call (615)806-8299.

Parkridge Health System Appoints New Director of Physician Relations for Surgical Services

CHATTANOOGA–Parkridge Health System has appointed Tammy J. Brown as Director of Physician Rela-tions for Surgical Services.

In her new role, Brown will work closely with Chat-tanooga-area surgeons who practice at Parkridge Health System facilities. She has 20 years of experience in the Parkridge system, including nine years as Director of Physician Relations.

Brown holds a Bachelor of Science de-gree in organizational management from Covenant College. She and her husband Charlie reside in Chattanooga.

Parkridge Health System Offers Low-Dose CT Lung Cancer ScreeningPotentially life-saving screening can detect early lung cancer, especially helpful for older long-time smokers

CHATTANOOGA–Parkridge Medical Center and Parkridge East Hospital now of-fer a $50 low-dose computed tomography (CT) lung screening recommended by the American Cancer Society for older smokers, a population that is especially at risk for de-veloping lung cancer.

A low-dose CT scan of the chest pro-vides a high-resolution picture of the lungs, allowing detection of abnormal spots known

GrandRounds

UT College of Medicine Gold Humanism Honor Society (GHHS) Celebrates 4th Annual National Solidarity Day for Compassionate Patient Care

CHATTANOOGA—The UT College of Medicine Gold Humanism Honor Society (GHHS) celebrated the Fourth Annual National Solidarity Day for Compassionate Patient Care on Friday, February 15.

Solidarity Day is a celebration initiated by the national Gold Foundation and Honor Soci-ety after the tragic shoot-ings in Tuscon, Arizona, involving Congress-woman Gabriel Gifford in January 2011. Febru-ary 14 was the day se-lected to honor this day each year and the impor-tance of compassionate and humanistic patient care. The link for more information is about Soli-darity Day is http://bit.ly/1hjmHKV.

At Erlanger Health System, Solidarity Day 2014 is sponsored by the UT GHHS Chapter and the Chattanooga Tran-sitional Year Residency Program. Thank you cards and Solidarity Day buttons were distributed to each nursing station and messages elec-tronically emailed to all Erlanger nursing staff members, acknowledging them for all they do to provide quality compassionate care to their patients.

GHHS Chapter leader, Dr. Mukta Panda, also Chair, Department of Internal Medicine in Chattanooga and Program Director for the Transitional Year Residency in Chattanooga,” stated, “Solidarity Day gives us the opportunity to let our colleagues and healthcare provid-ers know how much we appreciate everything they do for patients and our medical students and residents throughout the UT System and Erlanger.”

Tennessee hospitals participating in Solidarity Day included Methodist University Hospi-tal, LeBonheur Children’s Hospital, and The Regional Medical Center in Memphis; St. Thomas Midtown Hospital in Nashville; University of Tennessee Medical Center in Knoxville; and Er-langer and Children’s Hospital in Chattanooga.

Pictured are Dr. Valerie Stine, Transitional Year (TY) Resident; Jill Cannon with Case Management; Dr. Patrick Aldred, TY Resident; Dr. Mukta Panda, Chair, Department of Medicine, & TY Program Director; Dr. Jennifer Dooley, TY Associate Program Director and Core Faculty, Department of Medicine; Dr. Carter Pelham, TY Resident; and Dr. Andrea Wood, TY Resident.

Tammy J. Brown


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as “nodules” within the lungs that are usual-ly too small to be seen on a traditional chest x-ray. The American Cancer Society recom-mends this low-dose CT lung screening for men and women who

• Are between 55 to 74 years of age• Regularly smoke or who have quit

smoking within the last 15 years• Are in fairly good healthThe screening, which requires a physi-

cian’s order, is brief and painless. Results are sent to the patient’s physician, who will discuss them with the patient. If needed, a nurse navigator will follow up to offer sup-port, explain next steps, and coordinate any necessary appointments.

Further treatment, if needed, is cus-tomized for each patient’s condition.

For more information about the low-dose CT lung screening, call MedLine at 800-242-5662.

New Ambulance Company Locates Corporate Headquarters in Knox County

KNOXVILLE—A new medical trans-port company, Priority Ambulance, has an-nounced the establishment of its corporate headquarters in Knox County, bringing more than 50 jobs to the area and several familiar faces among its leadership team.

Priority Ambulance President and CEO Bryan Gibson has more than 25 years of experience managing ambulance opera-tions. He is the former chief operating offi-cer of Rural/Metro Corporation and general manager of Rural/Metro of East Tennessee, as well as the owner of several other am-bulance companies. He said the choice to locate his new company’s headquarters in Knox County was an easy one.

Priority Ambulance’s national mission is to raise the bar of clinical excellence in emer-gency and nonemergency medical care. To accomplish this goal, Priority Ambulance has invested in cutting-edge technology and expert staff. The company currently op-erates more than 45 customized Mercedes-Benz ambulances outfitted with the latest medical technology and staffs more than 300 licensed paramedics and EMTs in Ten-nessee, operating as Priority Ambulance, and in Florence and Birmingham, Alabama, operating as Shoals Ambulance.

Knox County will serve as the corpo-rate headquarters for Priority Ambulance as it proceeds with plans to expand services.

At the corporate management level, Steve Blackburn joins Priority Ambulance as chief operating officer, and Kristi Ponczak will serve as chief financial officer. Both are former high-level managers at Rural/Metro Corporation.

Priority Ambulance’s corporate head-quarters is located on Callahan Drive in North Knoxville. Priority Ambulance recent-ly opened a regional branch in Scottsdale, Ariz., to manage its West Coast operations. Knoxville public relations company, Moxley Carmichael, now is representing Priority Ambulance in all markets.

In addition to its corporate headquar-ters, Priority Ambulance will also operate a local office providing ambulance service to Knox County and surrounding areas. Prior-

ity Ambulance has significantly invested in Knox County by purchasing 15 new Mer-cedes ambulances to offer basic life sup-port, advanced life support and critical care transport options to Knox County residents.

Supporting community causes and promoting awareness of public health is-sues and services are top priorities for the company, according to Gibson. In Decem-ber, Priority Ambulance donated $5,000 to “Wreaths Across America,” a charity cham-pioned by Knox County Mayor Tim Burchett to place a wreath on the grave of every vet-eran in East Tennessee. Gibson said that is just the start of his company’s community service.

“Knox County is Priority Ambulance’s new home, and we know we best serve our community when we are connected to the causes and organizations that matter to our patients and their families,” Gibson said.

Several other familiar faces join Priority Ambulance with a background in managing ambulance service in Knox County. Dennis Rowe, former Rural/Metro of East Tennes-see market general manager, will head the company’s Knox County ambulance opera-tions. Gary Morris will oversee Priority Am-bulance’s emergency and nonemergency communications. Former Knox County Commissioner John Mills has also joined the Priority Ambulance team as the director of government relations, and his wife, Char-lotte Mills, will serve as customer service manager.

To schedule a transport in Knox Coun-ty, call 865-688-4999.

Memorial Health Care System receives Chest Pain Center Reaccreditation

CHATTANOOGA–Memorial Health Care System has announced that Memo-rial Hospital and Memorial Hospital Hixson have received full chest pain center reac-creditation.

According to the Centers for Disease Control and Prevention, heart attacks are the leading cause of death in the United States, with approximately 600,000 people dying annually of the disease. More than five million Americans visit hospitals each year with chest pain. The hospital’s recent reaccreditation is an important achievement for people across the area. “By operat-ing accredited chest pain centers to serve patients in Chattanooga, Hixson and the surrounding areas, Memorial Health Care System has significantly raised the quality of care for chest pain patients and has demon-strated its commitment to higher standards of care,” said Memorial’s Chief Medical Of-ficer Kevin Lewis, MD.

As accredited chest pain centers, Me-morial Hospital and Memorial Hospital Hixson have demonstrated its expertise and commitment to quality patient care by meeting or exceeding a wide set of strin-gent criteria and undergoing an onsite re-view by a team of Society of Cardiovascular Patient Care (SCPC) accreditation review specialists.

GrandRounds


Knoxville MGMA Monthly MeetingDate: 3rd Thursday of each month

Time: 11:30 AM until 1:00 PMLocation: Bearden Banquet Hall, 5806 Kingston Pike,

Knoxville, TN 37919Lunch is $10 for regular members.

Come learn and network with peers at our monthly meetings. Topics are available on the website.

Registration is required. Visit www.kamgma.com.

Chattanooga MGMA Monthly MeetingDate: 2nd Wednesday of each month

Time: 11:30 AMLocation: The monthly meetings are held in Meeting Room A of the Diagnostic Center building, Parkridge Medical Center, 2205

McCallie Avenue, Chattanooga, TN 37404 Lunch is provided at no cost for members, and there is currently no cost to a visitor who is the guest of a current member. Each member is limited to one unpaid guest per meeting, additional guests will be $20 per guest. All guests must be confi rmed on

the Friday prior to the meeting.RSVP to Irene Gruter, e-mail: [email protected] or call

622.2872. For more information, visit www.cmgma.net.

3RD THURSDAY 2ND WEDNESDAY

Mark Your CalendarYour local Medical Group Managers Association is Connecting Members and

Building Partnerships. All area Healthcare Managers are invited to attend.

Pink! Nets $250,0001,000 attend signature event

CHATTANOOGA—Memorial Health Care System Foundation and Hamico Foun-dation presented the 9th Annual Pink! gala on Saturday, January 25, 2014, at the Chat-tanooga Convention Center. Net proceeds from the evening exceeded $250,000 to benefit the MaryEllen Locher Breast Center at Memorial. The crowd of more than 1,000 guests were addressed by chair couple, Scott and Donna Mattice, who said “Chat-tanooga is blessed to have this amazing facility right here in our hometown, dedicat-ed to not just fighting and preventing this dreaded disease but also to the care and well-being of its patients.”

Jennifer Nicely, Memorial Founda-tion President and Chief Development Of-ficer said “Pink! is a celebration of life for breast cancer patients and survivors raising more than $2 million since 2006 to ensure our community has access to the most ad-vanced breast cancer treatments available. The Pink! committee and staff of Memorial Foundation are grateful for the support by the community for this event.”

Next year’s Pink! gala will be held Sat-urday, January 31, 2015.

Visit www.memorial.org/pink for infor-mation or updates.

BlueCross Links Members with Pharmacists for Improved Medication ManagementFree program aims to improve quality of care for Medicare Advantage enrollees

CHATTANOOGA—Helping members with multiple health conditions effectively manage medications is the goal of a new Medication Therapy Management pro-gram (MTM) offered through BlueCross BlueShield of Tennessee’s Medicare Ad-vantage plans. The program links mem-bers with local pharmacists who provide a comprehensive program to ensure safe and effective use of medication in accordance with standards set forth by the Centers for

Medicare & Medicaid Services.BlueCross’ program, delivered through

OutcomesMTM, provides one-on-one medication management to high-risk mem-bers − those with three or more chronic health conditions requiring multiple medi-cations. Key to the program is an annual comprehensive medication review to detect and resolve any issues with the patient’s pre-scription and over-the-counter medications. As part of the review, the patient receives private consultation on existing regimen, a medication action plan and a personalized drug list.

The MTM program also provides time-ly alerts to specially trained pharmacists when the patient starts a medication with high risk of causing side effects. Addition-ally, patients who have difficulty with taking their medications on time receive special counseling to help them manage their drug treatments.

Adults ages 65 and older make more than 177,000 emergency department visits each year for adverse medication interac-tions. They are also seven times more likely to be hospitalized after the emergency visit than other age groups, according to the Centers for Disease Control and Prevention (CDC).

OutcomesMTM provides regular up-dates to pharmacists letting them know when a member starts a new medication and needs education and follow-up. Phar-macists confer with the member or his/her doctor to resolve issues found with the member’s medication. Additionally, phar-macists will also confer with the member on over-the-counter medicines for minor ailments.

Pharmacists who participate in the OutcomesMTM program complete spe-cial training to provide medication man-agement services to BlueCross’ members. The program is a free benefit covered in BlueCross’ Medicare Advantage plans.

Summit Welcomes New Members to Executive Leadership Team

KNOXVILLE—Summit Medical Group, the region’s largest primary care organiza-tion, welcomes two leaders to the senior ex-ecutive team, reporting to Chief Executive Officer Tim Young.

Ed Curtis, CMPE is the Chief Operat-ing Officer. He will lead all operational aspects of Summit Medical Group in-cluding Practice Support and Development and Diagnostic and Therapeu-tic Services. He will have directional responsibility for Statcare Hospitalist Ser-vices. Curtis is the former Chief Operating Officer for Hattiesburg Clinic in Mississippi and has experience in strategic planning, corporate financing, marketing positioning and systems administration. While serving as Chief Operating Officer at Hattiesburg Clinic - a 300 plus physician- owned multi-specialty provider practice with more than 40 locations in Southern Mississippi – Curtis developed a strategic plan and tactical ini-tiatives to open a Sleep and Spine Center, Infusion Clinic and Breast Center. He also served as the negotiator for physician con-tracts with several hospitals and oversaw the clinic’s conversion to new Electronic Medical Record software. In addition, he led clinical operations for the Departments of Surgery and Medicine as well as Ancillary Services and served as the Clinic’s Privacy Officer. He is a Certified Medical Practice Executive, with a Business Administration degree from West Virginia University, and completed the Graduate School of Credit and Financial Management at Dartmouth College.

Joseph L. Ortiz, MSCE, MBA is the Chief Informa-tion Officer, leading in-formation technology for Summit Medical Group.

Ortiz was most recently the President and Founder of 4D Imaging Systems, a health-care imaging systems provider. He also served as a Vice President with IPIX Corpo-ration and has held several leadership roles with national and international companies, including Motorola and Phillips Consumer Electronics. Ortiz was President of Con-cept2Market, Inc., a consulting firm advising clients on technology commercialization. He led the successful prototyping of the EPIgraph super high resolution visible light imager for total body photography. Ortiz holds a Master of Business Administration from Arizona State University a Master’s in Computer Engineering from the University of South Carolina, and a B.S. in Computer Science from Georgia Tech.

Erlanger announces national accreditations for both sleep disorders and cardiology services

CHATTANOOGA–Erlanger Health System President and CEO, Kevin M. Spie-gel, FACHE, is pleased to announce both Erlanger’s Sleep Disorders Center and Er-langer’s Cardiovascular Center of Excel-lence have received national accreditation.

The Erlanger North Sleep Disorders Center has been granted reaccreditation for the next five years by the American Acade-my of Sleep Medicine (AASM), the only pro-fessional society dedicated exclusively to the medical subspecialty of sleep medicine.

KDL Pathology Receives Accreditation from College of American Pathologists

KNOXVILLE—Knoxville Dermatopa-thology Laboratory (KDL Pathology), Paul B. Googe, MD, director, has been awarded ac-creditation to the College of the American Pathologists, based on a recent site study.

That means the laboratory has received recognition for very high standards of care and quality control. The U.S. federal gov-ernment recognizes the CAP accreditation program as being equal-to or more strin-gent than the government’s own inspection program.

Knoxville Dermatopathology Labora-tory of 315 Erin Drive is an independent, physician-owned and operated pathology laboratory. Founded in 1998 and directed continuously by Dr. Googe, KDL specializes in laboratory studies for skin and eye dis-ease, in addition to providing a wide spec-trum of surgical pathology services.

During the CAP accreditation process, designed to ensure the highest standard of care for all laboratory patients, inspec-tors examine the laboratory’s records and quality control for the preceding two years’ procedures. CAP inspectors also look at laboratory staff qualifications, equipment, facilities, safety programs and records, and the overall management of the laboratory.

Knoxville Dermatopathology Labora-tory is one of more than 7000 CAP-accred-ited facilities worldwide. CAP is the world’s largest association composed exclusively of board-certified pathologists, with more than 18,000 members. It is a world leader in labo-ratory quality assurance.

GrandRounds

Ed Curtis

Joseph L. Ortiz


By Andrew S. Rhinehart, MD, FACP, CDE, BC-ADM, CDTC

As we transition from our old fee-for-service model of healthcare to a more quality and value-based reimbursement system, diabetes is taking center stage. As the quintessential chronic disease state, we must put in place systems and processes to help our patients succeed in this new environment. I envision a 4-pronged approach to achieve the outcomes and quality care that our patients with diabetes deserve. It is essential that we:

• Develop an outpatient care model that helps make our primary care providers and patient centered medical homes successful.

• Strengthen our specialty care in the region for those individuals with difficult to manage disease states.

• Devise inpatient management strategies that achieve the glycemic control necessary to limit the excess morbidity and mortality related to poor glycemic control.

• Bolster our transitions of care between these different areas; primary care, specialty care, and hospital care.

However, with that being said, the best way to make this 4-pronged approach successful is to provide caregivers, providers, and people with diabetes the proper diabetes self-management education; thus, certified diabetes educators are the keystone of this care model.

Outpatient Diabetes CareAs we develop and grow our patient

centered medical homes across the region, we must provide these medical homes with the resources, both electronic and human, to successfully manage a large population of people with diabetes. Unfortunately, as providers, we have been historically poorly trained in managing a population of patients. However, population health management is the key to success as we move forward in this new healthcare system. We need to be able to identify, engage, and communicate successfully with our patients who are struggling with their diabetes care.

Without the proper technology in place, the identification of these patients, which is essential, will be almost impossible. We must

have electronic health records that allow us to mine the data and identify those patients who are missing appointments, not achieving A1c, blood pressure, or lipid targets, frequently visiting the emergency room, requiring recurrent hospitalizations, not refilling their medications, and who are missing their specialty appointments with the eye doctor, the podiatrist, and the like. Ergo, without a robust electronic health record with a population health management overlay in place, this endeavor will not be successful.

We must also have the human resources in place to engage these patients once they are identified. This includes care coordinators, clinical pharmacists, dietitians, nurse educators, and providers. Our struggling patients may require frequent communications, at times, possibly daily, as we work to keep these individuals out of the hospital and emergency rooms. But this requires manpower and technology. We need to meet patients where they are by discovering the best way to communicate with that individual. Is it through text message, e-mail, phone calls, telehealth visits, or the mail? We can use technology to our advantage as we move forward in population health management. Pay me now or pay me more later. We must invest in the electronic and human resources now to make this care model successful in the future.

Specialty Diabetes CareAs most of us are very well aware, the

paucity of specialty care in our region makes it challenging to get those difficult patients seen in a timely manner. Therefore, it’s essential that we work to recruit specialists to our area, discuss with our local residency programs to consider adding endocrinology and diabetology fellowships that may help with future staffing, and identify interested primary care providers to potentially train them in the specialty of diabetology.

Inpatient Glycemic ControlIt is vital that we work together with

the hospitalist teams and other admitting physicians to improve glycemic control of our patients to prevent readmissions, morbidity and mortality, postoperative surgical infections, and the need for post-hospital skilled nursing care. This is best accomplished though a

multidisciplinary team-based approach. This team will need to develop basal bolus insulin order sets, educate and engage the nursing staff, and energize the medical staff in regards to the importance and implementation of inpatient glycemic control.

Transitions of CareWe need to work together and develop

systems where patients are transitioned between all these different facets of care in a more timely, well informed, and seamless manner. Technology can help us here as well as care coordinators, diabetes educators, and better and more efficient communication between providers.

Diabetes EducationDiabetes self-management education is

essential for all patients with diabetes and is truly the cornerstone of diabetes management. People with diabetes have so much to manage on a daily basis, including the proper use of a glucose meter; medication adherence; proper use of injectables; decision-making in regards to food intake and exercise; the proper treatment of acute complications of diabetes, including hyper and hypoglycemia; and the daily struggle of balancing all of this along with work, school, family, and friends. It is critical that our patients receive proper education not only in specialty care, but also in primary care and hospital settings. Diabetes education has been proven to improve medication adherence and clinical outcomes and is vital when changes are made in medication regimens and during transitions of care. Therefore, certified diabetes educators are the most essential part of this chronic care model. Our patients with diabetes, as with all of our patients, deserve the best possible care and this new model of healthcare may provide us an opportunity to improve their care as we focus more on outcomes and quality.

Andrew S. Rhinehart, MD, FACP, CDE, BC-ADM, CDTC, is the program director for the Mountain States Medical Group Diabetes Wound Care Center in Abingdon, Va. A certified diabetologist, Rhinehart completed medical school at the University of Maryland School of Medicine. He finished his residency at East Tennessee State University’s Quillen College of Medicine. He is board certified by the American Board of Internal Medicine Specialities in Internal Medicine.

MSMG Diabetes Wound Care • 16000 Johnston Memorial Drive, Suite 313 • Abingdon, VA, 24211 • Phone: 276-258-3780 • Fax: 276-258-3776

Physician to Physician

Diabetes Care in our New Healthcare System

Proudly practicing at Johnston Memorial Hospital.

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Academic Urologists at Erlanger opens third location on Spring Creek Road

CHATTANOOGA–Erlanger Health Sys-tem is pleased to announce the opening of the third location of Academic Urologists at Erlanger on Spring Creek Road.

Drs. Anand Shridharani, Colin Goude-lock, Amar Singh and Argil Wheelock are now accepting patients at 961 Spring Creek Road Suite 202 to better serve patients in East Ridge, Tenn. and North Georgia with urological conditions.

Shridharani received a medical degree at the University of Massachusetts Medical School. He completed a preliminary intern-ship in urology and general surgery at the University of Louisville and a urology resi-dency program at the Medical College of Wisconsin in Milwaukee. He also received advanced fellowship training in Andrology and Erectile Dysfunction from the Medical College of Wisconsin. Shridharani special-izes in diagnosing and offering state-of-the-art treatments for disorders of male repro-duction, male hypogonadism, erectile dys-function, and Peyronie’s disease.

Goudelocke is board-certified and fel-lowship trained in urology and earned his medical degree from the Louisiana State University School of Medicine in New Or-leans, and completed both his internship and residency from Louisiana State Universi-ty Health Sciences Center in Shreveport. He continued his training, completing his fel-lowship in female urology from the Medical University of South Carolina in Charleston.

Singh received his medical degree from the SUNY Health Science Center in Syracuse, New York, after graduating cum laude from Cornell University in Ithaca, N.Y. with a B.S. in chemical engineering. He com-pleted his internship and residency training at University Hospital in Syracuse, N.Y., and his fellowship training at the National Can-cer Institute in Bethesda, Md. Singh spe-cializes in minimally invasive (laparoscopic) renal surgeries as well as robotic-assisted

laparoscopic prostatectomy and cystopros-tatectomy, with urinary diversion.

Wheelock earned his medical degree from the University of Tennessee College of Medicine after receiving a B.S. degree from East Tennessee State University. He served as captain and medical officer in the U.S. Army and completed general surgery and urology residencies at Mount Sinai Hospital in New York City.

Fresenius Medical Care Announces New Manufacturing Facility in Innovation ValleyMedical Supply Company to Invest $140M, Create 665 Jobs

KNOXVILLE—The Knoxville Chamber is excited to announce Fresenius Medical Care North America, the world’s largest provider of products and services for kidney dialysis, will bring its East Coast manufac-turing operations to Innovation Valley. The company will invest $140 million and create 665 jobs in Knox County.

The process to recruit Fresenius Medi-cal Care to the area began in May 2013, and was a collaborative effort by the Chamber, Knox County Industrial Development Board, the state of Tennessee, Tennessee Valley Authority, and Knoxville Utilities Board.

Fresenius Medical Care will occupy the former 277,000-square foot Panasonic Build-ing at Forks of the River Industrial Park. The company plans to begin retrofitting the facil-ity later this year. NAI Knoxville has represent-ed seller during the transfer of the building to the medical supply manufacturer.

The company is dedicated to raising life expectancy and improving quality-of-life for the one in 10 Americans that will be di-agnosed with kidney disease. The Knoxville facility will produce dialysis related prod-ucts, which will be distributed to Fresenius Medical Care’s clinics and distribution cen-ters in the eastern part of the United States. The company currently serves more than 266,000 patients in 3,220 clinics, 10 of those are located within a 30-mile radius of down-

town Knoxville.Fresenius Medical Care will begin mov-

ing one production line to the Knoxville fa-cility in September 2014. Actual production at the facility is not expected to begin until early 2016, pending a designation from the Food and Drug Administration that the facil-ity is a qualified plant for production. Once production reaches full capacity, the opera-tions will bring an estimated $37 million in annual wages into the region.

Fresenius Medical Care will begin hir-ing in different phases. Toward the middle of 2014, it will begin hiring for support jobs, such as engineering facilities management, and in the fourth quarter of 2015, it plans to begin hiring for other positions such as su-pervisors, technicians, production line work-ers and maintenance. Job opportunities will be posted on the Fresenius Medical Care website, http://jobs.fmcna.com.

TMA Annual Convention April 24-27 in Franklin

The Tennessee Medical Association will hold its Annual Convention on April 24-27 in Franklin. MedTenn 2014 features four days of exclusive medical education, professional networking and entertainment events. Physicians, practice managers, nurses and other healthcare professionals from all medical specialties in Tennessee are encouraged to attend and take up to 16.75 hours of CME or 10 hours of CEU courses at a fraction of the typical cost. You do not have to be a TMA member to at-tend.

Featured courses include:• ICD-10 Implementation Strategies• Prescribing Guidelines for Pain Man-

agement & Patient Safety• Health Reform, Government Initia-

tives & EHR Performance• Emerging Payment & Employment

ModelsRegister at www.tnmed.org/medtenn

2014.


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5 reasons to get the Niswonger Children’s Hospital mobile app:

The Niswonger Children’s Hospital app is available at Google Play Store or the iPhone App Store. Get yours today!

1. It’s FREE and interactive for both adults and kids!2. Learn about our physicians and services.3. Get up-to-date information and health tips for kids, teens, and parents.4. Enjoy daily devotionals and a photo gallery.5. Receive exclusive mobile alerts specific to children’s health care.

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Located in Johnson City, Tennessee • Serving children and families of Southern Appalachia

Home of the St. Jude Tri-Cities Affiliate Clinic • Affiliated with Cincinnati Children’s Hospital Medical Center

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