Tri Cities Medical News June 2013

By CINDy SANDERS

Preventing America’s seniors from falling is a national health priority both in terms of injury and cost. Yet, fall preven-tion programs have only proven to be marginally successful over the long term.

Cathleen S. Colón-Emeric, MD, MHS, and colleagues fo-cused on the gap between quality improvement (QI) protocols and sustained bedside implementation in the nursing home set-ting. An associate professor of Medicine in the Division of Ge-riatrics at Duke University School of Medicine, Colón-Emeric said previous studies found the desired improvements occurred when outside trainers and researchers stepped in to create in-terventions. The external staff addressed multiple risk factors to help lower fall rates, recurrent falls and injurious falls. How-ever, she continued, “When you try to train the existing nursing home staff to do those things, it doesn’t seem to work.”

Based on social constructivist theory, complexity science, and prior studies, the research team believed there was a di-

Mark Williams, MD

PAGE 3

PHYSICIAN SPOTLIGHT

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Healthcare Leader: James W. Hansen, MD

Meshing a medical practice with healthcare administration may not be a responsibility most physicians would relish, but for James W. Hansen, MD, his position as Chief Manager at State of Franklin Healthcare Associates (SoFHA) in Johnson City has been a rewarding experience. Hansen, an internist with SoFHA’s Johnson City Internal Medicine Associates, joined the group in 1999 and within fi ve years, he had been offered and accepted his administrative position. He heads the SoFHA board and oversees its administration ... 4

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FOCUS TOPICS SENIOR HEALTH RETIREMENT SUCCESSION PLANNING

(CONTINUED ON PAGE 8)

Selling Your Practice? Considerations for Ensuring Your Succession Plans Are Successful

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By IAN P. HENNESSEy

Succession planning in physician practices can take many forms, includ-ing options not traditionally thought of when planning to retire. While it is still common for practices to recruit younger physicians to pur-chase an ownership interest in the practice and, after some transi-tion period, eventually buy out the retiring physician, trends over the past few years show a marked decline in the number of indepen-dently practicing physicians. In fact, a recent survey conducted by Accenture

found that today only 39 percent of doctors nation-wide are on their own, which is down from 57

percent in 2000. Perhaps, consequently, there appears to be increased willingness by phy-sicians to consider selling their practice to hospitals and other healthcare organiza-tions. While there are many advantages

to selling your practice in anticipation of retirement, there are several potential

issues to consider before you sign on the dotted line.

Purchase price…but with strings attached.One perceived advantage of selling a

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Health eShare Direct Project Delivers Promise of Secure Exchange of Patient Information to State’s Healthcare Workers, and Then Some

As the structure of Tennessee’s healthcare system takes

shape around healthcare reform legislation, providers

and patients have new opportunities to improve the

way services are coordinated, funded and delivered to

patients. Through a program called Tennessee Health

eShare Direct Project, healthcare providers and their

staffs are using a newly available, secure messaging

protocol being piloted in Memphis, Chattanooga and

Hickman County, with each community testing and

developing use cases of the platform.

The technology, known as Direct Messaging, was

developed by the federal government and is being

implemented nationwide. Direct is a protocol for secure

exchange of health information from point to point.

Direct improves workflow and increases efficiency for

healthcare providers, administrative staff and healthcare

organizations.

For those who have taken the simple step of enrolling in

the program, the advantages to their daily practices have

included workflow and efficiency improvement – and

then some. Tommy Preston is one of those individuals.

As the assistant director of the Southeast Tennessee

Area Agency on Aging and Disability, Preston knows

the inefficiency of the healthcare system better than

many of the healthcare providers he works with every

day. As a participant in the Community-based Care

Transitions Program (CCTP) in Chattanooga, Preston’s

agency is responsible for connecting its high-risk clients

discharged from hospital inpatient care settings with the

community care, rehabilitation and ancillary services they

need to recuperate, recover, and avoid costly hospital

readmissions.

Yet before enrolling in the Direct pilot, Preston’s staff,

like the overwhelming majority of healthcare providers

in Tennessee, had no means of securely sending or

receiving patient discharge information or exchanging

patient information electronically with its multiple

hospital system and healthcare provider partners.

The solution? Frequent road trips to retrieve patient

charts and discharge summaries from hospitals were

the only option. Staff hours that should have been spent

arranging home health visits, securing transportation

to dialysis centers or scheduling visits to specialty care

physicians were spent…in traffic.

But once enrolled in the project and using Direct, the

impact on Preston’s staff and the patients they serve was

immediate. Preston says his staff began receiving patient

discharge notifications and relevant information from

patients’ clinical charts almost instantaneously. As a result,

Tommy’s staff can immediately engage health coaches to

reach out to patients, usually within hours of their discharge.

Today Southeast Tennessee Area Agency on Aging and

Disability staff login to Direct from wherever they are,

identify information sent from one provider and send

referral information on to an orthopedist, confirm ICD-9

codes, transmit patient clinical information, or confirm an

address for the referral.

Direct is gaining traction in the state thanks to the increased visibility it’s receiving through Tennessee Health eShare. Access to the Direct technology is available now, and the cost of using Direct technology is more than covered by an incentive program offered by the state of Tennessee Office of eHealth Initiatives.

That’s why a growing number of healthcare providers

and eligible individuals across the state are signing up

and using Direct through Tennessee Health eShare.

Several healthcare organizations, including Erlanger

Health Systems, have also signed up. If you work in

healthcare and routinely handle patient information,

chances are you can too.

Direct secure messaging technology is being implemented and supported by Qsource, a Tennessee-based nonprofit healthcare quality improvement and information technology company, working in cooperation with the Tennessee Office of eHealth Initiatives. To learn more about how you can get started using Direct, visit the Tennessee Health eShare Direct website at http://www.healthesharetn.com/.

About the Office of eHealth: The mission of the Tennessee Office of eHealth Initiatives (OeHI) is to facilitate improvements in Tennessee’s healthcare quality, safety, transparency, efficiency, and cost effectiveness through statewide adoption and use of electronic health records (EHR) and health information exchange (HIE). OeHI received grant funding from the American Recovery and Reinvestment Act of 2009 (ARRA) to support this Direct Project and other projects to implement secure health information exchange. Through these stimulus funds, ARRA enables Tennessee the opportunity to advance the secure exchange of health information and to expand the adoption and Meaningful Use of EHRs and HIE. For more information, please visit http://www.tn.gov/ehealth/.

Client: QsourceJob No: QSO-40993Title: Chattanooga Success Story

Pub: East TN Medical NewsInsert: June 2013Size: 10"x13"

e a s t t n m e d i c a l n e w s . c o m JUNE 2013 > 3

PhysicianSpotlight

By JENNIFER CULP

Mark Williams, MD, usually begins

his mornings at the hospital, where he

sees several patients (often his own long-

term patients who have been hospitalized),

before going to work at Johnson City In-

ternal Medicine, where he continues to

see and treat patients until the end of the

workday at 5:00. Fortunately, given the

volume of ailing people he interacts with,

talking to patients is the part of his job

Williams enjoys most. In fact, the lure of

spending time with older patients, hear-

ing their stories, and helping them with

chronic illnesses strongly infl uenced Wil-

liams’ decision to enter medical school and

become a physician.

Born in Southwest Virginia, Williams

grew up mainly in East Tennessee, where

he attended Washington College Acad-

emy in Limestone. He remained in the

area throughout his undergraduate studies

at East Tennessee State University, where

he earned a degree in microbiology, then

decamped to the southwestern end of the

state where he lived and worked in Mem-

phis for a total of twelve years.

“I always liked healthcare, but it was

later in life when I decided to become a

doctor. I worked in the toxicology lab at

Baptist Memorial Hospital in Memphis

for four years, then decided I wanted to

further my education,” he said. After

considering different options, he realized

that he wanted to attend medical school.

“I worked in a hospital setting, so I was

familiar with all the laboratory tests, the

diagnosis and treatment of chronic medi-

cal illnesses and diseases,” he explained.

He went on to earn a doctorate of

medicine from the University of Ten-

nessee College of Medicine in Memphis,

Tennessee, and went on to complete his

residency at the University of Tennessee-

affi liated hospitals in Memphis. Internal

medicine proved to be a particularly at-

tractive choice for Williams. “I enjoyed

dealing with geriatric patients and older

folks, and I just enjoyed the personal in-

teraction with patients—diagnosis, treat-

ment, the long-term continuity of care you

have with patients in internal medicine,”

he said.

Once fi nished with his training, Wil-

liams knew he was on the right path in

life, but wasn’t yet in the right location.

“After I fi nished my training, I knew

I wanted to move back to this area [of

East Tennessee],” he explained. After in-

terviewing at several different places, he

discovered the perfect fi t at Johnson City

Internal Medicine, which he described

as “a great, quality group of physicians.”

Williams enjoys spending time with pa-

tients each day, as well as his coworkers.

“It is a lot of variety. We have a prepon-

derance of geriatric patients, but I do

treat all ages,” he said. Or rather, “I treat

all patients from age 16 to, you know,

100!” he clarifi ed. It’s plain after convers-

ing with him that Williams is happy to

see centenarians in his offi ce. “For a lot

of older people, coming to the doctor is

a social event to them, it’s one of the few

times they get out of the house and are

around other people, so they enjoy com-

ing to the doctor and interacting with the

physicians, the nurses, and the staff. We

try to make it a pleasant experience for

them as much as we can,” he said.

A less pleasant part of the job? Insur-

ance paperwork, if you ask Williams, who

prefers to spend time interacting with pa-

tients and colleagues. Filling out compli-

cated forms just isn’t much fun. “That’s

probably true of any business,” he said,

“but,” he continued, “it’s a necessary

evil.” Time spent talking to patients and

working to improve their lives makes up

for the unpleasantry of dealing with con-

voluted paperwork. “My favorite part of

the job is sitting and chatting with people,

talking with them about day-to-day things

and their interests. A lot of the older pa-

tients like to reminisce a little bit about

their early lives, or what they’ve enjoyed

throughout life, so just sitting and talking

with patients is probably my greatest joy,”

he said.

Along with his wife, Nancy, Wil-

liams teaches Sunday school classes and

is involved with the youth at Westmin-

ster Presbyterian Church. His daughter,

Elizabeth, just fi nished her third year at

the University of Tennessee in Knoxville,

and son, Alex, attends Providence Acad-

emy in Johnson City. Along with Alex,

who recently became an Eagle Scout,

Williams traveled to New Mexico last

year to participate in a 10-day hiking and

camping trip at Philmont Scout Ranch.

Along with a group from East Tennes-

see, they backpacked for a total of 85

miles over the course of the trip, climbing

through pine forests to the top of “Mount

Baldy” at an elevation of nearly 12,500

feet. “I got one shower in 10 days,” he

admitted when asked, “but it was all guys,

so it didn’t really matter. It was really a

neat experience.” Though the scenery of

New Mexico was very different from that

of East Tennessee, Williams admires the

beautiful area he chooses to call home

and the interesting people who live there.

“I really enjoy where I am,” he said. “I

plan to stay here; I’m committed to my

patients and hope to be here for a good

long time.”

Mark Williams, MDFOCUS ON SENIOR HEALTH

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HealthcareLeader

James W. Hansen, MDBy BRIDGET GARLAND

Meshing a medical practice with healthcare administration may not be a responsibility most physicians would relish, but for James W. Han-sen, MD, his position as Chief Manager at State of Franklin Healthcare Associates (SoFHA) in Johnson City has been a rewarding experience. Hansen, an internist with SoFHA’s Johnson City Internal Medicine Associates, joined the group in 1999 and within fi ve years, he had been offered and accepted his administrative position. He heads the SoFHA board and oversees its administration.

“I enjoy decision making, even though it’s nothing I ever trained to do,” he explained. “We have a strong admin-istration at SoFHA, which is necessary when diffi cult fi nancial decisions have to be made.”

Continued Hansen, “And as a mul-tispecialty group, our board is comprised of many different viewpoints and every-

body has an equal say.” Specialties represented include Internal Medi-cine, OB/GYN, Family Practice, Pediatrics, Hos-pitalist Medicine, and Sleep Medicine

Physician owned and board managed, SoFHA, PLLC, was formed in July 1998 and currently has 90 primary care pro-viders, of which 71 are physicians. Hansen works closely with his colleague Ronald Blackmore, MD, who serves as chairman

of the board. Although Hansen never received for-

mal training in healthcare administration, he brought with him a wealth of adminis-trative experience. He grew up in Boone, Iowa, and attended the University of Iowa as an undergraduate, where he earned a Bachelor of Science degree in Chemistry. Board certifi ed by the American Board of Internal Medicine, Hansen received his medical degree from Creighton Uni-versity in Omaha, Nebraska in 1986, and continued on at Creighton for his Intern-ship and Residency in Internal Medicine.

Although his current practice is primarily general internal medicine, Hansen com-pleted a pulmonary/sleep fellowship while at Creighton and is an American College of Chest Physicians Fellow.

After fi nishing at Creighton, Hansen served in the Navy in Charleston, SC, for eight years, where he gained much of his experience in administration, as well as in-ternal medicine and critical care.

After fi nishing his service with the Navy, Hansen and his wife started con-sidering places to relocate. After talking with his friend Richard Rolen, MD, who served in the Navy with him, Hansen was “prompted to take a look” at East Tennessee, and made the move to John-son City to join Rolen in practice with Johnson City Internal Medicine Asso-ciates. His wife, Shoko Hansen, MD, also practices in Johnson City. Origi-nally from Tokyo, Japan, she met her future husband while they were interns at Creighton. “She rescues greyhounds now,” shared Hansen. “Outside of medi-cine, that’s her passion.”

As for passions, Hansen’s life-long pursuit has been medicine. “In the 6th grade, we went on a school fi eld trip to the University of Iowa Hospital. We were able to see all of the equipment, and I was

fascinated,” he recalled. “That stuck with me.”

Even before starting his residency, Hansen knew he wanted to do primary care, and while at Creighton, he decided to complete the pulmonary fellowship be-cause of the strong, high quality program there.

Throughout his career, Hansen has witnessed many technological advances in medicine, which makes him excited about the future of his profession. “We have made great advances in Alzheimer’s, dia-betes, cancers, genetic testing, hyperten-sion,” he said. “It’s so great that we can offer better treatments and quality of life, and people are living longer.”

Of course, even with the great strides healthcare has made, it is not without its challenges. “The biggest challenge is the cost,” Hansen said. “Finding a solution is a diffi cult decision, but it needs to be ad-dressed.”



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By LEIGH ANNE W. HOOVER

For the ninth year, the city voted “best town ever” by Outdoor magazine will play host to the Southeastern Wilderness Medicine (SEWM) Conference June 21 – 26, 2013. Whether you are an outdoor enthusiast or a weekend warrior, earning continuing educational units is the most fun in Chattanooga.

“Chattanooga is one of the few metropolitan areas in the country where you have such im-mediate access to the outdoors,” explained Chris Moore, MD, Founder & Program Director, Southeastern Wilderness Medi-cine. “This is a great location to be able to produce this conference.”

In a world where continuing medical education (CME) credits can be obtained online, this conference offers education mixed with adventure. According to Moore, even if a physician is not particu-larly an outdoor enthusiast, the SEWM conference touts world renowned leading speakers on wilderness medicine and of-fers an opportunity to experience learning from the very best.

“This conference will open avenues

to medical topics many doctors have never even thought about,” said Moore. “It’s probably one of the most interesting and enjoyable ways to earn lots of CME credits in an interactive setting among some of the most adventurous, creative doctors out there.”

Unlike most wilderness medicine

conferences, sessions can also be selected to accommodate personal schedules and taken individually without committing to the entire event, and pricing is refl ective of per day and even half-day sessions.

“People are blown away by all of the outdoor amenities this conference pro-vides, and with the summer event date, they can also bring their families. Many events and classes are available for them, too,” said Moore. “It’s one of the most en-joyable ways to earn continuing medical education that I know of!”

For additional information visit www.sewm.net

Southeastern Wilderness Medicine ConferenceCome Outdoors!


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By JENNIFER CULP

The importance of patient-centered care is widely recognized. Treating a sick person in a holistic fashion and recogniz-ing the import of his or her individual cir-cumstances is known to improve patient outcomes and benefit healing. At Erlanger Health System and the University of Tennessee College of Medicine in Chat-tanooga, healthcare providers have coor-dinated their efforts in order to provide the best possible experience for patients in all aspects of care.

“The goal was to incorporate a system that really promotes integrated, account-able, patient-centered care,” explained Mukta Panda, MD. “We wanted to really look at patient care from a different model, rather than hav-ing a hierarchical model where the doctor’s on the top, and then the nurse, and so on. We wanted to put the patient in the center, with all the healthcare team around the patient working toward a common goal so that all patient care needs are met. So, not just looking at the physical healing of the pa-tient, but also social, emotional, spiritual healing, and all the ways we could allocate resources to make sure that patient care is seamless and continuity is maintained,” she continued.

The multidisciplinary rounding team, which meets weekly to discuss each pa-tient and holds daily huddles on the floor to ensure that all issues are addressed in a timely fashion, consists of physicians, medicine trainees, a nurse practitioner, the floor nurse manager, nurses who care for each individual patient under care, a dietician, a pharmacist, therapists (physi-cal, occupational, speech, and respiratory, as needed), a case management team (in-cluding case manager and documentation specialist), legal aid, and a chaplain. Each Wednesday morning, the physician team presents the patient from a medical stand-point and addresses any issues needing as-sistance from other disciplines, and then, in turn, the other disciplines represented in the team discuss each patient from their standpoints and address any issues they have uncovered. Following input from each member, the team collaborates to solve any outstanding problems.

This interdisciplinary team is unique not only in coordinating efforts between members of different healthcare disci-plines in order to strategize and maintain continuity of care both in and out of the hospital, but also in its inclusion of Legal Aid and pastoral care services. Legal Aid provides assistance for low-income patients who fall below the poverty line, allowing them to receive care without undue worry over financial or other legal concerns. Two chaplains offer pastoral

care, visiting patients in the hospital and their homes. “We know that spiritual healing is paramount to physical heal-ing,” Panda said, continuing, “We have a unique opportunity here, where, in the Department of Medicine, we have two chaplains on the faculty.” The availability of legal aid and pastoral care benefits pa-tients, patients’ families, and patients who have no family to rely on. The inclusion of these team members, as well as case man-agers, demonstrates a great commitment to whole-person, patient-centered care, respecting the needs of the patient, who, for example, might not have insurance or be able to afford out-of-pocket care but nonetheless finds herself in the hospital, or the family members of a patient who needs to be placed under conservatorship, or the patient who has no living family but needs counseling and comfort throughout the process of struggling with disease and treatment. The multidisciplinary team is equipped to provide for patients in ways that a single physician or provider simply could not accomplish alone.

This multidisciplinary approach to care has also proved satisfying to team members. “Our communication has im-proved; we learn from each other,” said Panda. Since the project’s inception, team members have reported increased communication, better understanding of patients’ plans of care, better subjec-tive “insight” into patients’ issues, better follow-up plans, easier navigation of so-cial, ethical, and end-of-life issues, and in-creased education on documentation and its role in reimbursement.

“There are times when we get caught in our focused tunnels of thinking, and it’s important to hear each other’s per-spectives, because we are all trying to achieve the same shared covenant, which is to make sure that we provide the best evidence-based, coordinated care for our patients,” Panda explained.

Improved communication between team members allows providers to better serve patients, and also seems to alleviate stressors on the part of team members. “As you know, healthcare providers and physi-cians probably are the worst at taking care of themselves, and I think this approach brings a mindfulness to medicine,” Panda said. “Everybody has different pressures on them, and we know that one person cannot always spend the time needed for each individual patient. What can we do to make sure that all of the patient’s needs are met? With the team, we con-tinue care once the patient is discharged from the hospital, and we see them in our

offices. We have all these resources avail-able to them; they see that the chaplains are available to meet with them, the legal aid is available to them, the case managers are available, and, of course, the physician and other team members are there, also.” Within this framework, the patient truly occupies the center of team members’ ef-forts, which not only benefits the patient but spreads the burden of care among the team members.

Panda, her colleagues in the Depart-ment of Medicine, the trainees, program director, and hospital hope to expand the multidisciplinary rounds program in the future. “We’ve had a lot of support from my own department, faculty, and residents, Erlanger, and the dean of the University of Tennessee,” Panda said. “The hospital leadership is really want-ing to make this a part of every patient care unit now. We are looking toward that, and it is moving pretty quickly. We are really excited!” Even beyond Erlanger and the University of Tennessee’s efforts, Panda envisions this type of interdisciplin-ary care spreading in the future: “We’re training our future doctors in this system, so this type of care will be carried beyond the walls of Erlanger and the University of Tennessee Chattanooga.”

Multidisciplinary Rounds put emphasis on Holistic Care

Dr. Mukta Panda

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By Kevin Gormley

Financial planning and investment management are not the same thing. The former creates a plan and the lat-ter may be a piece of that plan. Finan-cial planning involves the coordination of all or most of your financial issues—retirement planning, tax planning with tax professionals, college planning, es-tate and trust planning with attorneys, an evaluation of insurance needs, debt management, and investments.

Investment management is about – simply put – investments. Unfortunately, the financial industry has added to the confusion by describing people who work with financial products with many similar names. They may be known as financial advisors, financial consultants, wealth managers, and other various names. There are some in the industry who say they do “financial planning” –but all they are really doing is putting numbers into a software program that spits out the reasons why one should in-vest, purchase insurance, buy annuities and other products –usually from their company. Your sound future is not their priority.

My focus as a financial planner is the financial plan and how it can help establish and clarify a family’s goals and take action with the use of ideas and well-considered, structured strategies to reach and protect those goals. Financial planning can help reinforce confidence in how one feels about their plans. It can inspire others towards action. Husbands and wives can become more comfort-able discussing financial issues with a professional third-party planner and look to the future with a greater sense of control and calm. The financial plan document may ultimately be the tan-gible product that is produced, but the intangible benefits are the key to a good financial-planning engagement.

What benefits can a financial plan produce for clients?

• Compile data into an easy-to-re-view format, taken from various sources, including 401ks, IRAs, 529 plans, loans, personal assets, insurance policies, trusts, restricted stock, stock options, and Social Security expectations.

• Motivate clients to save more, in-vest with purpose, get estate documents in order, have appropriate insurance

coverage, and manage their credit cards and other debt.

• Ensure that the fees being paid for all financial products are fair and reason-able

• Improve the decision-making pro-cess around money.

• Help minimize taxes on invest-ments based on asset allocation, asset choices, and asset location (investments should be in appropriate account types).

• Aid with decisions about the need or possibility of changing companies or careers where compensation plans are different or other major life events where financial decisions are part of the equa-tion.

• Possibly offer advice on invest-ments.

Despite all of these advantages, the real benefits of ongoing financial plan-ning include the discussion during the planning phase, evaluating and break-ing down and making sense of the num-bers in relation to the desires and needs of the family, the presentation of initial ideas and alternatives, updates on tax laws, what the investment horizon looks like, and clarifying the family’s personal goals and needs.

The most difficult financial plan to work on – the one that motivates me the most – is the one where the individual or couple is near the end of their work-ing lives. They are extremely motivated to have a plan. Their needs, wants, and wishes may not match their assets and other income streams, creating a major problem. There is an obvious shortfall. The data is rechecked and the shortfall still exists. In the follow-up meeting, the concern is shared and it can be dis-couraging. There are obvious solutions – keep working, spend less, or take more risks with investments. None of these are greeted with excitement. The worst words to hear in the financial planning process: “Are you sure that is right?”

What can be done to improve your outcomes?

• Investment assets. Save and in-vest more. Maximize returns with low-cost investments. Minimize taxes. Persist through down markets. Simple advice but hard to follow.

• Social Security. Social Security (SS) is not an entitlement. U.S. citizens pay for it and possibly pay more into it than one will ever receive. By working longer at higher income levels, one can increase benefits and if income is lower, there is no penalty. Surprisingly, many (76%) people apply for SS as soon as it is available (now age 62) and do no plan-ning around Social Security income at all. There are at least six choices from which a married couple can choose and five (5) involve one of the spouses not

taking SS at age 62. Currently, if one waits until age 70 rather than taking it at age 66 there is an annual 8% growth in the amount of the benefit. Where can anyone get 4 years of guaranteed 8% growth in the marketplace today? Of course, the health of each individual must be discussed and wealth strate-gies reviewed. Software can show the amount of money that one will get at age 62-70 and every age in between. If the spouse is eligible, they can receive their own benefits or may receive spou-sal benefits at full retirement age (rules apply). One spouse may be able to con-tinue to work and “file and suspend” –which allows the spouse to get spousal benefits. This area of financial planning is much more complex than most people believe. Get help.

• Pension. The most frequently asked question for people who are con-sidering leaving “Corporate America” is: “Should I take the pension money as an annuity payout or should I take the lump sum?” This is where a profes-sional advisor needs to be an important participant in the discussion. Review the benefits and drawbacks of either choice with the advisor. The actuarial assump-tions should be reviewed on the annuity pension. One should ask if the planner/advisor has a conflict of interest, as the lump sum may create great income for the advisor and the annuity may not. With actuarial assumptions, there can be differences between what a different company’s actuaries believe will happen in the future concerning interest rates or mortality tables. Three other key issues are health, flexibility, and the diligence and discipline of an individual to invest the money rather than spend it.

A million dollars is a lot of money when one is still working. But when one is living off of a million dollars, most data suggests that only $40,000 (known as the 4% rule) is the maximum that can be removed and keep the million dollars stable. With today’s interest- rate envi-ronment it may be even lower.

Don’t let the phrase “Can’t get there from here” happen to you. There are lim-ited options when one retires. You must know and understand those options. There are decisions that can be irrevers-ible and time is no longer on the retiree’s side to make tangible adjustments. Plan, protect, save, invest –and keep repeat-ing this. Otherwise, you may be caught in a situation of looking for directions on how to retire …. and not finding an easy path.

theBottomLine

Can’t Get There from HereThe Worst Financial Planning Scenario

Kevin Gormley, CPA, PFS, CFP(R), is a certified financial planner with Patriot Investment Management and lives in Knoxville, Tenn. He may be contacted at [email protected].

e a s t t n m e d i c a l n e w s . c o m JANUARY 2013 > 7

Stacy Schuettler Katie GrahamGreg Gilbert Brooke ThurmanShatita Daniels

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Andrew works with a team of experienced healthcare professionals that possess diverse backgrounds in valuation, accounting, coding/compliance, information technology consulting, revenue cycle management and general healthcare management. During a 27-year career as either full-time administrator or consultant to a broad range of healthcare organizations, he is experienced in providing fair market value compensation opinions, practice valuation, EMR assessment, billing/coding/collection, strategic planning, human resource management, financial analysis, practice development, and general practice management services to organizations preparing to meet the challenges presented by an ever-changing healthcare environment.

Meet Andrew McDonald, FACHE 615.309.2474 (direct) / [email protected] Partner - Healthcare Consulting

Where Great Companies Come to Grow.

By LEIGH ANNE W. HOOVER

Each year, a single rhododendron blooms outside my kitchen window in a backyard flowerbed. It’s planted beside a statue of an angel that was given to me by my sister-in-law nearly 10 years ago following my mother’s passing and stands as a reminder of her life’s work and passion for gardening.

Growing up in South Carolina, we would take family outings to the nearby mountains of North Carolina to see our azaleas’ flowering cousins, the rhododen-drons and mountain laurel. Although cer-tain varieties of rhododendrons can endure the hot, humid summers of the upstate, they tend to thrive in higher, cooler, lush environments with nutrient rich soil free of clay.

Nearly 30 years ago, when I moved to my husband’s home state of Tennessee, I was captivated by the gorgeous beauty of

the rhododendrons in flowerbeds and fas-cinated by their size. From June 15th -16th, the rhododendron is showcased in all of its glory during the annual Roan Mountain Rhododendron Festival.

Originating in 1947, the Roan Moun-tain Citizen’s Club has been conducting this festival that celebrates God’s beauty in nature and beckons visitors to Roan Moun-tain State Park. Located near the Tennes-see/ North Carolina state line, beauty

abounds, and the altitude offers a cooler calling for a summer outing on either side of the Mountain.

In fact, the festival originally included both states. Today, the North Carolina side of the Roan celebrates with the North Carolina Rhododendron Festival in Bakersville, N.C., on the same week-end, June 14th and 15th. This way, visitors can ex-perience both festivals and come to the Tennessee side on Sunday, June 16th.

Years ago, the Ten-nessee festival was actu-ally in the gardens, but it has since moved down the

mountain in the state park. In addition to a variety of vendors with specified “person-ally handcrafted” items, visitors can also enjoy onstage musical entertainment.

“This is the 66th annual Rhododen-dron Festival,” said Citizens Club Vice President Brian Tipton. “The festival is the largest event that the club puts on, and they usually try to always have it when the rho-dodendrons will be in full bloom.”

Just seven miles up the mountain,

spectators can glimpse the “world’s larg-est,” natural rhododendron gardens, atop Roan Mountain. Spanning over 600 acres, the rhododendron catawbiense (Catawba rhododendron) blankets the top of Roan Mountain in all of its glory in natural gar-dens that attract visitors from all over the world.

Sitting atop Roan Mountain, over 6,000 feet above sea level, the luxury Cloudland Hotel once attracted wealthy guests with breathtaking views to enjoy the higher altitude and offered a respite from hay fever. Although the famous hotel no longer exists, the spectacular views still pre-vail for current and future generations to experience and enjoy.

“One of the things that is amazing to me is how the rhododendron have expanded to fill the space where the old Cloudland Hotel stood back in the late 1800s and how accessible the paths are for wheelchairs and walkers,” explained Emma Ruth Shomaker, secretary of the Roan Mountain Citizens Club.

Festival activities are always the third weekend in June. However, with the higher altitude and the later blooming cycle, the colorful views usually are available through-out the remainder of the month.

“If there is a time other than during

Enjoying East TennesseeRhododendron Festival – Roan Mountain



rect link between the failure to successfully deploy fall interventions and the hierarchi-cal culture present in most skilled nursing facilities. Colón-Emeric, who also serves as associate director – clinical program for the Durham VA Geriatric Research, Edu-cation & Clinical Center (GRECC), noted the vertical command structure doesn’t foster broad-based, interdisciplinary staff interaction.

“They lack the connections with their coworkers that they need to share informa-tion and problem solve,” she said. “Nursing home staff tend to work in silos.”

Colón-Emeric continued, “Coordi-nation of a multi-factorial risk reduction program requires a great deal of commu-nication. Older adults don’t fall because of one risk factor … they fall because of five or six factors. To reduce risks, you have to intervene on all of those things.”

She added reasons for a fall might in-clude any number of factors from a long, diverse list ranging from poor vision and tripping hazards to a drop in blood pres-sure upon standing or suboptimal choice of an assistive device.

“In order to improve fall rates,” Colón-Emeric said, “the team needs to know what the resident’s behavior is like.”

However, the person with the most hands-on knowledge often isn’t the one creating that resident’s specific care plan. Colón-Emeric pointed out aides deliver the majority of care in the nursing home setting. Yet, nurse aides aren’t typically part of the decision-making process and are often expected to communicate only within the chain of command. “They are less likely to implement the care plan if they haven’t been involved in making it in the first place,” she noted.

In an article published in Implemen-tation Science last year, the research team said QI programs could not reach optimal levels of staff behavioral changes unless the context of social learning was present. The team developed the CONNECT educa-tional intervention to foster improved con-nections within and between disciplines, heighten communication flow and encour-age cognitive diversity in solving problems on behalf of residents.

The next step was to see if the ‘all hands on deck’ approach made a difference in fall rates in comparison to traditional QI initiatives that focus on an individual’s mas-tery of content and process change.

Colón-Emeric said eight nursing homes in North Carolina and Virginia

were selected with half randomized to re-ceive three months of CONNECT training followed by three months of a traditional falls QI program and the other half receiv-ing only the QI program training. The eight participants included a mix of com-munity nursing homes and VA facilities.

The CONNECT intervention in-cluded interactive in-class learning sessions, unit-based mentoring and relationship mapping. All activities were focused on helping the staff build networks and rela-tionships for problem-solving activities. “We designed the CONNECT interven-tion to show staff where their communi-cations weren’t working … where gaps existed … and to teach them some practi-cal tools to better communicate,” she ex-plained.

Post-intervention, three areas were reviewed for both the CONNECT and control groups — staff communications measures, charting, and fall rates. Colón-Emeric said to measure communication, the team used surveys before, during and after the intervention. The team also re-viewed documentation of the types of prevention interventions in the medical re-cord. Fall rates, she added, were viewed as an exploratory outcome in light of the small number of study sites.

“What we found was that the staff communication levels improved a little bit in the CONNECT group but decreased in the control facilities,” she said, adding the net result was significant. Among the CONNECT group, increased communica-tion was more pronounced in the commu-nity settings, as Colón-Emeric said the VA facilities already had high levels of commu-nication.

Charting turned out to be a non-fac-

tor. “Both groups improved a little bit and neither was significant,” she said, adding improved documentation did not correlate with decreased falls. “We don’t think the chart measures are really a good measure of what is happening at the bedside … at the site of patient care.”

As for the most important outcome — preventing falls — Colón-Emeric said the team saw the desired trajectory. “There was no change in fall rates in the control group, but the fall rate in the CONNECT facilities improved … they went down about 12 percent,” she said.

Colón-Emeric was quick to temper the significance of the outcome in light of the small number of participating study sites. However, she said the group is now in the second year of a larger trial of 24 nursing homes with 12 each in the CONNECT and control groups.

“If we see the same magnitude of ben-efit, that would be statistically significant.” She continued, “We should be finished with our last nursing homes in 2014 and have the results out shortly thereafter.”

Colón-Emeric added that if the im-proved collaboration is proven to positively impact falls QI initiatives, then it would be reasonable to apply the same tactics to other multi-factorial issues facing Ameri-ca’s growing senior population.

CONNECTing Caregivers to Prevent Patient Falls, continued from page 1

Falls Hurt Physically & Financially

According to the Centers for Disease Control & Prevention, one in every three adults age 65 and older falls each year. In this age group, falls are the leading cause of injury death and are the most common cause of nonfatal injuries and hospital admissions for trauma.

In 2010, 2.3 million nonfatal fall injuries among older adults were treated in the emergency room with more than 662,000 requiring hospitalization. The direct medical cost of these falls, adjusted for inflation, was estimated to be $30 billion.

festival weekend when someone can go to the top of the mountain to see the rhodo-dendron, traffic will be less, and travel will be faster,” explained Shomaker.

With hiking trails, fields, private camp sites and unrivaled views, Roan Mountain State Park is definitely a “must see.”

According to Tipton, on a clear Fourth of July evening, fireworks can often be seen in Johnson City, Tenn., which is 45 min-utes away in drive time.

“The Roan Mountain State Park is also one of Tennessee’s best parks,” added Tipton. “Actually, a sign we have here on the mountain says, ‘Roan Mountain State Park is the crown jewel of all Tennessee state parks.’”

The annual Rhododendron Festival serves as a fundraiser for the Roan Moun-tain Citizens Club, and all proceeds go back into the community for a college scholar-ship and beautification efforts to enhance the community and maintain its beauty.

“Once you go up on top of the moun-tain, there’s fresh, cool air where you can enjoy the weather and not burn up doing it,” explained Tipton. “There’s also usu-ally a 10 to 15 degree drop in temperature making Roan Mountain the place to go!”

For additional information, visit www.RoanMountain.com

Enjoying,continued from page 7

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].


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By AMANDA SHELL

How much will it cost to transport my mother from the nursing home to her dialysis appointment by ambulance? Dad’s home from the hospital, but they want him back for a CAT scan. What do I do if I can’t fi t his electric wheelchair into my car?

Good questions.An ambulance is more than just an

emergency vehicle. Patients often re-quire ambulance transportation in non-emergency situations as well. And those requiring specialized transportation ser-vices are most often disabled or elderly.

There are several non-emergency transport providers available in East Tennessee, and cost and coverage varies widely depending on the provider and level of care required. Before scheduling transportation, it is important to get the facts and be an informed consumer.

Does my insurance or Medicare cover non-emergency transportation?

The short answer is sometimes – if it meets a medical necessity. Typically, insurance will cover all or part of non-emergency transportation for medical treatments, outpatient procedures, or post-operative check-ups if that trans-portation assistance is determined to be a medical necessity.

According to Darlene Kitts, division marketing manager at Rural/Metro, the most important thing to know about get-ting a transport covered is to make sure the medical need for an ambulance is documented by a physician.

“It’s important that a patient has a document from their doctor proving med-ical necessity,” said Kitts. “Medicare has forms specifi cally for this. This is such an important step for qualifying for payment that we will sometimes to into physicians’ offi ces to update them on proper docu-mentation and provide information on how to code medical necessity on forms.”

Additionally, some carriers require that the ambulance service provider be in the insurance carrier preferred network. Several require pre-certifi cation, meaning the insurance carrier must be notifi ed in advance about the ambulance transport. There may also be a deductible or co-pay involved.

All or part of non-emergency trans-ports are more likely to be covered if a patient is moving from one hospital or care facility to another, particularly if the patient is moving for specialized care or long-term rehabilitation. Some carriers, excluding Medicare, will cover transport for a doctor’s visit. Medicare and others also cover wound care at an approved hospital-based clinic.

“Most reputable ambulance service providers, like Rural/Metro, will have a consumer advocate on staff that will

help customers determine eligibility re-quirements and what documentation is needed,” said Kitts. “Once we get all the information, we can usually let people know right then an estimate of costs.”

To be certain, patients and caregiv-ers are encouraged to check with their individual insurance providers for specifi c requirements and coverage, and Medicare provides information on their website, www.medicare.gov.

What type of service is best?There are a number of reasons a

patient may need professional assistance with transportation. If the patient has a wheelchair that will not fi t in a standard vehicle, has complex medical equipment

such as a ventilator or needs continual medical monitoring during transportation, an ambulance may be needed.

There are several types of ambu-lances, and it is important to get the right one – for health and safety as well as cost savings. Patients do not want to pay for more than they need.

For example, Rural/Metro has fi ve different types of ambulance transporta-tion available. The differences are based on the medical equipment on board and the qualifi cations of the personnel.

·• Wheelchair van service is ideal for patients who need an escort, assistance walking or have a wheelchair that will not fi t in a standard car. No medical care is provided.

• A Basic Life Support (BLS) ambu-lance is required when a patient requires a little more assistance, such as medi-cal monitoring, oxygen administration or oral suctioning. This ambulance has a minimum of two state-licensed emer-gency medical technicians (EMTs) and an automatic external defi brillator (AED) on board.

• An Advanced Life Support (ALS) ambulance is needed for a patient with more intensive medical needs such as EKG monitoring, advanced airway man-agement or medical administration. The ALS ambulance has and EMT as well as a paramedic and more advanced medical equipment available.

• The Critical Care ambulance is for a patient needing medication adminis-tered via pump or ventilator, and is staffed with a paramedic trained in critical care.

• A bariatric ambulance is equipped with a wider bariatric cot rated to carry patients weighing more than 300 pounds and require a wider stretcher.

Specifying the level of assistance needed when scheduling non-emergency medical transport service ensures the pa-tient will have the appropriate personnel and equipment for a safe transport. It also helps keep costs down, since most plans cover only the level of service medically necessary. It is best to check with a phy-sician to specify clearly what services are required.

What You Need to Know About Non-emergency Medical Transportation

Rural/Metro emergency medical technicians Lauren Luttrell (left) and Lindsay Wheeler transport patient Roosevelt Davis from NHC Healthcare to his dialysis treatment. In addition to being the offi cial emergency services provider for Knox County, Rural/Metro also has a staff dedicated to non-emergency transport.





A medical home is where the primary care physician leads a professional health care team that will be responsible

for the ongoing care of the patient. Patients are encouraged to self-manage their con-ditions through shared goals, education on disease states, and health coaches. The goal is to create partnerships between patients and their primary care physician. There is no additional cost to pa-tients, just a signed agreement between the prima-ry care physician/ physician extender and patient to participate.

This program is being conducted at SoFHA for patients with certain chronic disease states such as diabetes. If you are someone with a chronic dis-ease state, you may qualify for participation in this program.

Patients participating in the PCMH have available and will be provided with the following: educational tools on their specifi c disease states; receive one-on-one assistance with their care coordinator on their specifi c disease state; assistance in schedul-ing appointments and referrals; receive proactive

healthcare services; assistance in making same day “urgent” appointments with their personal physician or a member of his/her healthcare team.

Patients enrolled and participating in PCMH will have access to their personal care coordinator via e-mail and phone Monday -Friday 8:00am-5:00pm during operational business hours. The care coor-dinator will assist patients by triaging (determining medical priority) for same-day appointments with physician/physician extender. The care coordina-tor will follow-up with patients on a monthly ba-sis for any needs or assistance in areas that may help in maintaining compliance with their on-going health care plan.

Our medical team will assist patients in man-aging chronic disease states by providing educa-tion and ensuring any tests relevant to a particular disease state is performed as needed. In addition, patients will be provided with education related to preventive health screenings and any assistance with scheduling these screenings.

www.sofha.net

Vision, Experience,Understanding.

Blue Ridge Family Medicine301 Med Tech Parkway - Suite 120Johnson City, TN 37604Phone: 423-794-1800Fax: 423-794-1801

Family Physicians of Johnson City303 Med Tech Parkway - Suite 100Johnson City, TN 37604Phone: 423-282-5611Fax: 423-282-5712

FirstChoice Family Practice301 Med Tech Parkway - Suite 140Johnson City, TN 37604Phone: 423-794-5530Fax: 423-794-1824

FirstChoice Internal Medicine301 Med Tech Parkway - Suite 280Johnson City, TN 37604Phone: 423-794-5550Fax: 423-794-1829

FirstChoice Pediatrics301 Med Tech Parkway - Suite 160Johnson City, TN 37604Phone: 423-794-5560Fax: 423-794-5873

First Medical Ob/Gyn1505 W Elk Ave.Elizabethton, TN 37643Phone: 423-543-7919Fax: 423-543-5323

Johnson City Internal Medicine Associates301 Med Tech Parkway - Suite 240Johnson City, TN 37604Phone: 423-794-5520Fax: 423-282-6940

Johnson City Pediatrics301 Med Tech Parkway - Suite 180Johnson City, TN 37604Phone: 423-794-5540Fax: 423-926-3187

Pinnacle Family Medicine303 Med Tech Parkway - Suite 150Johnson City, TN 37604Phone: 423-282-8070Fax: 423-282-8550

Riverside Pediatrics1503 W Elk Ave.Elizabethton, TN 37643Phone: 423-547-9400

State of Franklin OB/GYN Specialists301 Med Tech Parkway - Suite 200Johnson City, TN 37604Phone: 423-794-1300Fax: 423-794-1398

Our Clinics

We at SoFHA want to provide you with the highest level of care possible and we feel this program will allow us to enhance your care by involving “you”, the patient, in all areas of your health care.

MORE ABOUT our services

JUST WALK IN AND WE’LL TAKE IT FROM THERE.

A consistent leader in ambulatory care in East Tennes-see, State of Franklin Walk-In Clinic in Johnson City is dedicated to providing accessible, high-quality healthcare to the community we serve. Above all else, we strive for the highest standard of excellence in compassionate patient care. We love what we do and consider it a privilege to o� er warm and welcoming care to you when you need it most – from our family to yours.

Designed with your busy lifestyle in mind, no appointment is necessary in the unfortunate event you should sustain an injury or become ill. Whether it’s a routine sports physical, an itchy case of poison ivy, or just cold or � u symptoms, our experienced providers will treat you with excellent and e� cient care so that you may be on your way and on the mend in no time.

Visit us for ambulatory injuries and illnesses seven days a week – adults and children alike. Our

family of staff is here for you Monday thru Friday from 8:00 AM to 8:00 PM and on Saturdays and Sundays

from 9:00 AM to 5:00 PM.

Unsure or just have a question? Email us at [email protected].

REST ASSURED WE ARE HERE FOR YOU.

� e SoFHA Sleep Center, which is accredited by the American Academy of Sleep Medicine, o� ers comprehen-sive testing for an array of sleep disorders. � e studies are performed in a comfortable, homelike setting using state-of-the-art equipment. Our goal is to increase awareness of the importance and potential serious consequences of untreated sleep apnea and other sleep related disorders. We can improve the lives of our patients by educating, diagnos-ing, and managing these disorders. Above all else, our primary goal is to provide quality patient care.

Tests are conducted by highly skilled, licensed sleep technologists and reviewed by sleep physicians certi� ed by the American Board of Sleep Medicine (ABSM). � e sleep technologists work with each patient to explain the procedures used in completing a sleep study. � e recording techniques are noninvasive and all electrodes are applied to the surface of the skin. During the study, the electrodes will record the amount and quality of sleep. � e data displayed will include measurements such as brain waves, heart rate, oxygen level, muscle activity, breathing pattern and various other activities throughout the study.

We take referrals from SoFHA and non-SoFHA physicians as well as self-referrals. We also accommodate vendors and DME (medical equipment companies).

Our services include: • Standard Polysomnogram (95810) • PAP Titration (95811) • Multiple Sleep Latency Test (95805) • Maintenance of Wakefulness Test (95805) • Consultation with Sleep Specialist • Follow-up with Sleep Specialist (w/o initial consultation)

Treatment options available are: • CPAP • Dental Appliance (Mild OSA) • Positional Th erapy • Behavioral Modifi cation • Medications

Some treatment options may require a referral to a specialist. � ese specialists may include a Dentist, Psychiatrist, Psychologist, Cardiologist, or an ENT (ear, nose, and throat).

Our offi ce hours are 8:00 AM – 5:00 PM with clinical hours being from 9:00 PM – 6:30 AM.

DEDICATED TO IMPROVING YOUR QUALITY OF LIFE.

Th e Physical Th erapy Department of State of Franklin Healthcare is dedicated to making a positive di� erence in the quality of life of our patients. Our mission is to provide every patient with the best possible physical therapy ser-vices in a supportive and educational atmosphere to enable him or her to achieve goals. We strive to ensure the highest quality healthcare in a positive and forward thinking environment.

Our goal is to achieve measurable results, which are proven, in an environment that permits comfort and change. We also aim for the highest level of integrity, professionalism, honesty, and delivery of individualized care to improve the quality of life in all of our patients.

We have been o� ering compassionate and highly skilled care to our patients in pursuit of their individual needs and goals since our doors opened in 2003. We welcome oppor-tunities for professional development and advanced clinical training in order to ensure that our clinical practice aligns with the changing needs of our patient population.

We treat and educate patients with medical problems and health-related conditions that interfere and/or limit their ability to move and perform functional activities in their daily lives. Proper movement and function are promoted through exercise and functional training in a “hands-on” care approach.

Common conditions we treat include: all orthopedic injuries and dysfunctions (including spine, shoulder, hip, knee, etc.), muscular strains and sprains, sports injuries, post-operative conditions, and work-related injuries and repetitive conditions.

By o� ering a variety of specialized treatment options for various populations, SoFHA Physical Th erapy Department has the ability to successfully treat all physical therapy related conditions. Most of our therapists are certi� ed in McKenzie Spine evaluation and treatment.

Visit us Monday thru Fridays from 8:00 AM to 5:00 PM.

At State of Franklin Healthcare (SOFHA), we are continually searching for ways to improve services to our patients. We are pleased to share with you our program that has been designed to provide more advanced personalized health care services. The“Patient Centered Medical Home” was developed to enhance care by enabling our patients personalized medical access provided by a care coordinator under the direction of their primary care physician.

Proud members of Qualuable Medical Professionalswww.qualuable.com

Sleep Center Walk-In ClinicPhysical Therapy


A medical home is where the primary care physician leads a professional health care team that will be responsible

for the ongoing care of the patient. Patients are encouraged to self-manage their con-ditions through shared goals, education on disease states, and health coaches. The goal is to create partnerships between patients and their primary care physician. There is no additional cost to pa-tients, just a signed agreement between the prima-ry care physician/ physician extender and patient to participate.

This program is being conducted at SoFHA for patients with certain chronic disease states such as diabetes. If you are someone with a chronic dis-ease state, you may qualify for participation in this program.

Patients participating in the PCMH have available and will be provided with the following: educational tools on their specifi c disease states; receive one-on-one assistance with their care coordinator on their specifi c disease state; assistance in schedul-ing appointments and referrals; receive proactive

healthcare services; assistance in making same day “urgent” appointments with their personal physician or a member of his/her healthcare team.

Patients enrolled and participating in PCMH will have access to their personal care coordinator via e-mail and phone Monday -Friday 8:00am-5:00pm during operational business hours. The care coor-dinator will assist patients by triaging (determining medical priority) for same-day appointments with physician/physician extender. The care coordina-tor will follow-up with patients on a monthly ba-sis for any needs or assistance in areas that may help in maintaining compliance with their on-going health care plan.

Our medical team will assist patients in man-aging chronic disease states by providing educa-tion and ensuring any tests relevant to a particular disease state is performed as needed. In addition, patients will be provided with education related to preventive health screenings and any assistance with scheduling these screenings.

www.sofha.net

Vision, Experience,Understanding.

Blue Ridge Family Medicine301 Med Tech Parkway - Suite 120Johnson City, TN 37604Phone: 423-794-1800Fax: 423-794-1801

Family Physicians of Johnson City303 Med Tech Parkway - Suite 100Johnson City, TN 37604Phone: 423-282-5611Fax: 423-282-5712

FirstChoice Family Practice301 Med Tech Parkway - Suite 140Johnson City, TN 37604Phone: 423-794-5530Fax: 423-794-1824

FirstChoice Internal Medicine301 Med Tech Parkway - Suite 280Johnson City, TN 37604Phone: 423-794-5550Fax: 423-794-1829

FirstChoice Pediatrics301 Med Tech Parkway - Suite 160Johnson City, TN 37604Phone: 423-794-5560Fax: 423-794-5873

First Medical Ob/Gyn1505 W Elk Ave.Elizabethton, TN 37643Phone: 423-543-7919Fax: 423-543-5323

Johnson City Internal Medicine Associates301 Med Tech Parkway - Suite 240Johnson City, TN 37604Phone: 423-794-5520Fax: 423-282-6940

Johnson City Pediatrics301 Med Tech Parkway - Suite 180Johnson City, TN 37604Phone: 423-794-5540Fax: 423-926-3187

Pinnacle Family Medicine303 Med Tech Parkway - Suite 150Johnson City, TN 37604Phone: 423-282-8070Fax: 423-282-8550

Riverside Pediatrics1503 W Elk Ave.Elizabethton, TN 37643Phone: 423-547-9400

State of Franklin OB/GYN Specialists301 Med Tech Parkway - Suite 200Johnson City, TN 37604Phone: 423-794-1300Fax: 423-794-1398

Our Clinics

We at SoFHA want to provide you with the highest level of care possible and we feel this program will allow us to enhance your care by involving “you”, the patient, in all areas of your health care.

MORE ABOUT our services

JUST WALK IN AND WE’LL TAKE IT FROM THERE.

A consistent leader in ambulatory care in East Tennes-see, State of Franklin Walk-In Clinic in Johnson City is dedicated to providing accessible, high-quality healthcare to the community we serve. Above all else, we strive for the highest standard of excellence in compassionate patient care. We love what we do and consider it a privilege to o� er warm and welcoming care to you when you need it most – from our family to yours.

Designed with your busy lifestyle in mind, no appointment is necessary in the unfortunate event you should sustain an injury or become ill. Whether it’s a routine sports physical, an itchy case of poison ivy, or just cold or � u symptoms, our experienced providers will treat you with excellent and e� cient care so that you may be on your way and on the mend in no time.

Visit us for ambulatory injuries and illnesses seven days a week – adults and children alike. Our

family of staff is here for you Monday thru Friday from 8:00 AM to 8:00 PM and on Saturdays and Sundays

from 9:00 AM to 5:00 PM.

Unsure or just have a question? Email us at [email protected].

REST ASSURED WE ARE HERE FOR YOU.

� e SoFHA Sleep Center, which is accredited by the American Academy of Sleep Medicine, o� ers comprehen-sive testing for an array of sleep disorders. � e studies are performed in a comfortable, homelike setting using state-of-the-art equipment. Our goal is to increase awareness of the importance and potential serious consequences of untreated sleep apnea and other sleep related disorders. We can improve the lives of our patients by educating, diagnos-ing, and managing these disorders. Above all else, our primary goal is to provide quality patient care.

Tests are conducted by highly skilled, licensed sleep technologists and reviewed by sleep physicians certi� ed by the American Board of Sleep Medicine (ABSM). � e sleep technologists work with each patient to explain the procedures used in completing a sleep study. � e recording techniques are noninvasive and all electrodes are applied to the surface of the skin. During the study, the electrodes will record the amount and quality of sleep. � e data displayed will include measurements such as brain waves, heart rate, oxygen level, muscle activity, breathing pattern and various other activities throughout the study.

We take referrals from SoFHA and non-SoFHA physicians as well as self-referrals. We also accommodate vendors and DME (medical equipment companies).

Our services include: • Standard Polysomnogram (95810) • PAP Titration (95811) • Multiple Sleep Latency Test (95805) • Maintenance of Wakefulness Test (95805) • Consultation with Sleep Specialist • Follow-up with Sleep Specialist (w/o initial consultation)

Treatment options available are: • CPAP • Dental Appliance (Mild OSA) • Positional Th erapy • Behavioral Modifi cation • Medications

Some treatment options may require a referral to a specialist. � ese specialists may include a Dentist, Psychiatrist, Psychologist, Cardiologist, or an ENT (ear, nose, and throat).

Our offi ce hours are 8:00 AM – 5:00 PM with clinical hours being from 9:00 PM – 6:30 AM.

DEDICATED TO IMPROVING YOUR QUALITY OF LIFE.

Th e Physical Th erapy Department of State of Franklin Healthcare is dedicated to making a positive di� erence in the quality of life of our patients. Our mission is to provide every patient with the best possible physical therapy ser-vices in a supportive and educational atmosphere to enable him or her to achieve goals. We strive to ensure the highest quality healthcare in a positive and forward thinking environment.

Our goal is to achieve measurable results, which are proven, in an environment that permits comfort and change. We also aim for the highest level of integrity, professionalism, honesty, and delivery of individualized care to improve the quality of life in all of our patients.

We have been o� ering compassionate and highly skilled care to our patients in pursuit of their individual needs and goals since our doors opened in 2003. We welcome oppor-tunities for professional development and advanced clinical training in order to ensure that our clinical practice aligns with the changing needs of our patient population.

We treat and educate patients with medical problems and health-related conditions that interfere and/or limit their ability to move and perform functional activities in their daily lives. Proper movement and function are promoted through exercise and functional training in a “hands-on” care approach.

Common conditions we treat include: all orthopedic injuries and dysfunctions (including spine, shoulder, hip, knee, etc.), muscular strains and sprains, sports injuries, post-operative conditions, and work-related injuries and repetitive conditions.

By o� ering a variety of specialized treatment options for various populations, SoFHA Physical Th erapy Department has the ability to successfully treat all physical therapy related conditions. Most of our therapists are certi� ed in McKenzie Spine evaluation and treatment.

Visit us Monday thru Fridays from 8:00 AM to 5:00 PM.

At State of Franklin Healthcare (SOFHA), we are continually searching for ways to improve services to our patients. We are pleased to share with you our program that has been designed to provide more advanced personalized health care services. The“Patient Centered Medical Home” was developed to enhance care by enabling our patients personalized medical access provided by a care coordinator under the direction of their primary care physician.

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Sleep Center Walk-In ClinicPhysical Therapy


physician practice to a hospital or other healthcare organization is that the pur-chase price is paid at the time of the closing rather than in installments over time. In some transactions, however, only a portion of the purchase price is paid at closing, with the remaining amount paid over time and often with some strings attached. For in-stance, a purchase agreement may require you to continue your employment for a certain period of time after the closing to ensure a smooth transition. If you decide to retire before the end of the period, you may be required to forfeit some or all of the remaining payments of the purchase price. In addition, you may be required to indemnify the buyer against liabilities of the practice that arose prior to the transac-tion closing date. Accordingly, if you are considering selling your practice to another entity, it is important that you not only

become comfortable with the overall pur-chase price, but also with all of the terms and conditions associated with obtaining the full purchase price for the sale.

Becoming an employee.In many cases, a physician who sells

his or her practice to a hospital or other healthcare organization will be required to continue practicing as a hospital em-ployee. If you are considering such a sale as your succession plan, it is very impor-tant that you carefully review the terms of the proposed employment agreement in light of your personal retirement plans. In most cases, physicians directly employed by a hospital are likely to have fewer re-sponsibilities and less time devoted to ad-ministrative, non-medical duties that come along with running a practice. On the other hand, this transition usually comes

with a marked decrease in your indepen-dence. Decisions regarding the call sched-ule, staffing, the location of your practice, vacation, and a host of other matters will now be in the hands of hospital manage-ment. Keep in mind that these issues and others are likely to have a significant im-pact on your lifestyle in the time between the sale and your retirement.

Restrictive covenants.Not all succession planning involves

total retirement from the practice of medicine. Accordingly, before choos-ing a practice sale as a form of succes-sion planning, you should be aware of the potentially broad restrictions that can be associated with the sale of your practice. If you continue as an employee after the closing, you may be subject to a covenant not to compete as part of your employ-

ment agreement. Under Tennessee law, noncompete provisions in physician em-ployment agreements are enforceable if the restriction is for two years or less (1) and the geographical area of the restric-tion is the greater of a ten-mile radius from the physician’s primary practice site or the county in which the primary practice is lo-cated. Depending on the circumstances, a physician may be restricted from practic-ing at any facility at which the physician provided services during the term of the employment agreement. If the buyer is a hospital, however, the noncompete pro-vision must also include a clause permit-ting the physician to buy back his or her medical practice. If the medical practice is repurchased from the hospital, the non-compete provision is void.

Tennessee also permits physician noncompete agreements in conjunction with the sale of a medical practice, which are merely required to be “reasonable under the circumstances.” Moreover, there is a rebuttable presumption that such “deal noncompete” provisions are enforceable. While a healthcare orga-nization (such as a large medical group, for example) may utilize deal noncom-pete provisions, there is currently some question regarding whether a hospital is permitted to utilize deal noncompete pro-visions in conjunction with the purchase of a physician’s practice. In any event, it is possible that a hospital or other health-care organization acquiring your practice will seek to restrict your ability to provide patient care over a longer period and/or in a much wider area in which a hospital and its affiliates conduct business. In ad-dition, it could also restrict your ability to perform other activities, such as provid-ing consulting services, investing in other healthcare companies, or participating in other management activities that may “compete” with the company that pur-chases your practice. Therefore, if you are considering selling your practice as your succession plan, it is important that you evaluate any proposed restrictive cov-enants in light of your future plans.

Selling your practice to a hospital or other healthcare organization may be a simpler, more attractive alternative to re-cruiting a younger physician to purchase your practice. As you move forward with your succession plan, however, be aware of the strings attached to a practice sale and what effect they may have on your future plans.

Note: if the employing entity is a hos-pital, the duration of the restriction can be longer (though not to exceed five years) if it is determined by written mutual agree-ment that the extended period is necessary to comply with federal statutes, rules, reg-ulations or IRS revenue rulings or private letters. See T.C.A. §63-6-204.

Selling Your Practice? continued from page 1

Ian P. Hennessey is with London & Amburn, P.C. His practice focuses primarily on health law. He may be contacted at [email protected]. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

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Our behavior clinicians are experienced in helping a variety of disorders.

Allergy 4 Food is a resource that allows you to shop for nutritional supplements without the frustration of driving all over town. www.allergy4food.com

Support group helping the Knoxville region with celiac disease & gluten intolerance. www.celi-act.com

East Tennessee Children’s Hospital Gastroenterology and Nutrition Services

is East Tennessee’s premier pediatric gastroenterology group. We are staffed with four of the area’s fi nest board certifi ed pediatric gastroenterologists, in addition to three nurse practitioners, two behavior health clinicians, three registered dieticians, one physicians assistant, and a research coordinator. We serve all of east Tennessee and the surrounding areas.

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ACCEPTING NEW PATIENTS

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What do you look for in non-emergency transport service?

Whether scheduling transport from home or from a medical care facility, the patient has options. In order to make the best, most efficient and cost-effective deci-sion, there are several things to look for when choosing a service provider.

The first thing to consider is the level of service required. Some companies have only one type of ambulance, which may or may not meet the patient’s needs. When choosing a non-emergency medical transport service, patients should also consider the qualifica-tions of both the service and the personnel.

“It is important that patients use only licensed service providers. All non-emer-gency medical transportation providers are required to be licensed by the state of Tennessee,” said Kitts. “As the only CAAS-accredited service in East Tennes-see, Rural/Metro goes above and beyond

the state requirements for licensure.” The Commission on the Accredita-

tion of Ambulance Services (CAAS) is an independent commission that established a comprehensive series of standards for the ambulance industry determined to designate excellence in modern emer-gency medical services providers for clini-cal quality and operational efficiency.

Licensed and trained EMTs and paramedics are another important con-sideration. These professionals are trained to move patients to avoid injury and can address medical emergencies if necessary during the transport. The state of Tennes-see does not require an EMT on board for a wheelchair van transport, so patients should inquire whether the service they are scheduling has a medically trained person on board.

“Rural/Metro strives to go above and beyond minimum state requirements,”

said Kitts. “We always staff wheelchair vans with a licensed EMT. Not every provider does, but we feel it’s always im-portant to be prepared in case an emer-gency situation arises.”If a patient requires specialty equipment such as oxygen, it is important to know whether the carrier will have it on board or if the patient is expected to provide what is needed.

With so many services to choose from and details that affect cost and coverage, selecting the right non-emergency medi-cal transportation can become a compli-cated decision. The first and best decision is to consult with a doctor and insurance provider and choose an excellent and re-liable service provider, like Rural/Metro, who can provide a patient with an advo-cate. Knowing what questions to ask can help prevent delays and perhaps cancel-lations if the right level of service is not dispatched.

What You Need to Know About Non-emergency Medical Transportation, continued from page 9


By BRAD LIFFORD

When Donald L. Wells began his career at Johnson City Eye Clinic, a vi-sion problem that now affects untold millions of people was virtually unheard of.

And one thing is sure: computer vision syndrome, commonly referred to as CVS, is hardly on the decline.

“CVS is widespread,” Wells said, “and definitely growing.”

Computer vision syndrome is a problem that encompasses a set of vision symptoms that – while not caus-ing permanent damage – can cause serious discomfort and strain the eyes. The pervasiveness of high technology has enriched our productivity and work capabilities and opened up wondrous realms of entertainment, but staring at screens big and small has taken a toll.

The American Optometric Association estimates that as little as 50 per-cent and as much as 90 percent of the U.S. adult population experiences CVS.

Wells is well-versed in conditions related to the eye. A Master Optician, he began his career at Johnson City Eye in June of 1980. Johnson City Eye Clinic, located in Med Tech Park, has a tradition of eye excellence that dates to 1942.

Interestingly enough, the first digital computers were being used in the same era when Johnson City Eye got its start, but just one of those computers was the size of a room. Today, 90 percent of Americans own a personal electronic device, according to the Pew Internet and American Life Project: computer, MP3 player, videogame console, cell phone, e-book reader, or tablet computer. And that’s not to mention the video monitors that capture our gaze at work.

“Our doctors at Johnson City Eye don’t have a specific diagnosis for CVS,” Wells said, “but it’s a condition that is generally associated with sec-ondary complaints of dry eyes, eye strain, blurred vision, and headaches. Those are some of the major complaints related to the eye, and those are often associated with musculoskeletal symptoms as well, such as shoulder and neck pain.”

Wells said that our electronic devices literally hold our attention too long and often for uninterrupted duration.

“One of the main contributors to CVS is probably dry eyes,” Wells said. “When people work on their computers, they don’t blink enough, and therefore they don’t spread their tears over the cornea, the clear front part of the eye. The cornea dries out, and it causes problems that can include blurred vision and burning eyes.”

That fixation on video monitors large and small and, with computers, the related typing on a keyboard, differs from the typists of yesteryear, Wells said.

“I have wondered why the typists of pre-computer years didn’t suffer the same symptoms,” Wells said. “But their habits were different. I’ve been told that typists then moved around more – both their eyes and body. In general, they took breaks from typing; they would get up and move around and deliver a typed letter to someone or get envelopes and stuff them.

“People who work on computers have different habits. With no breaks

and no movement, they can do ev-erything electronically – receive and send e-mail, play games, buy things, read the news. You don’t have to move.”

So moving around, blinking to keep the eyes moist and limiting those rapt gazes are advisable, Wells said. Another tip: Ensure your moni-tor or device is used in the right lighting.

“Lighting can be another very important variable,” Wells said. “You should generally avoid working near windows or have too much lighting; you probably need to vary it in order to have the right lighting for you. Lighting can cause a lot of glare on monitors, too. Sometimes just tilting your screen a little can reduce glare, and you can use a non-glare screen

and also have non-glare put on your glasses if you wear them.”Wells said the simplest solution for those experiencing symptoms that

could be related to CVS is one that will benefit them regardless of whether they are actually experiencing CVS – and it that solution could offer a big return where their vision is concerned.

“The problem area,” Wells said, “is that not enough people get their eyes examined.”

Ample research backs that contention. Regular eye exams detect more serious and treatable conditions than CVS; the U.S. Centers for Disease Control estimates that 11 million Americans ages 12 and older could see better through measures that include reading glasses, contact lenses or eye surgery.

“Anyone having any eye problems should start with a good eye exam,” Wells said. “They need to make sure their vision is corrected. As we age, it becomes more likely that we’ll need to have our vision corrected. For exam-ple, people who are approaching 40 may need correction for near vision.”

Johnson City Eye Clinic provides a full spectrum of eye care and surgi-cal services for adult and pediatric patients. In addition to comprehensive eye care, Johnson City Eye physicians specialize in cataract surgeries, the treatment of glaucoma, macular degeneration, reconstructive surgeries, pediatric ophthalmology and retinal disease. The medical staff at Johnson City Eye includes Drs. Alan N. McCartt, John C. Johnson Jr.; Dr. Jeffrey O. Carlsen; Amy B. Young; James W. Battle; Randal J. Rabon; Calvin L. Miller; Michael F. Shahbazi; and Peter Lemkin, a doctor of optometry.

InSights

Johnson City Eye Clinic & Johnson City Eye Surgery Center110 Med Tech Park • Johnson City, TN 37604

225 Medical Park Drive, BristolPhone: (423) 929-2111 • Fax: (423) 929-0497

Email: [email protected]

Computer vision syndrome a widespread, growing problem


Wine 201Wines with Barbecue

Rick Jelovsek is a retired physician, a Certified Specialist of Wine, and a member of the Society of Wine Educators. He is also author of a book available from Amazon on Wine Service for Wait Staff and Wine Lovers. You may contact him with wine questions at [email protected] or visit his website at www.winetasteathome.com.

Barbecue, barbeque, or BBQ? Each means slightly different cooking to differ-ent people. We have some friends from the UK who talk about grilling meat over charcoal or a gas grill and call it barbecue. In East Tennessee, however, we just call that ‘grillin.’ Barbecue to us refers to sea-soned meat very slowly cooked over wood or wood charcoal and often finished with a glazing sauce containing vinegar and spices and varying degrees of sweetness from sugar, honey, or molasses. We admit that dry rub (spices only) barbecue exists, but for the most part, East Tennesseans favor slow cooked meats with added tangy sweet, tomato-based sauces.

I must admit that beer is often just right with barbecue, but I usually prefer wine. The only time I switch to beer is if the meat or sauce contains a fair amount of red pepper hotness. In that case, the higher amount of alcohol in wine, com-pared to beer, further dissolves the capsa-icin oil and makes the dish even “hotter”; I confess that I do not care for super hot BBQ. In Arkansas or Texas, I will grab a beer with BBQ, but in East Tennessee, the lower capsaicin hotness and dominant smoke-flavored meat with vinegary sweet and spicy sauces go extremely well with acidic wines with a touch of sweetness. Let me explain why.

Basic food, sauce, and wine pair-ing rules include acidic wines with acidic foods; low acid wines with savory foods; slight sweetness with spicy (hot) foods, fat, and salt to cut tannins; and oaky wines with roasted meats. What these pairing rules do, if you choose to follow them, is to bring the wines into balance with the foods. You may not care for acidic wines, but following acidic foods, they taste much more balanced. If you don’t like astringent tannins in wine, have that tannic wine with some fatty, salted pulled pork, and you will be amazed at the difference. If you are just grilling, oaked red wines or an oaked Chardonnay bring that smoke taste into a delicious perspective.

Over the years, I have found that some of the best wine combinations with barbecue or even just plain grilled foods include the following:

Meat: Pulled Pork Sauce: East Tennessee/Western

North Carolina, tomato/vinegary, slightly sweet sauce

Wines: Fruity, California Cabernet Sauvignon (Bogle, Don Sebastiani, Robert Hall, Black Box); Apothic Red; eastern US Chambourcin or Chancellor

Meat: Pulled Pork Sauce: East Carolina vinegary, pep-

pery sauceWines: Rosé, White Zinfandel,

Chenin Blanc, Rieslings, Pinot Gris/Gri-gio

Meat: Pulled Pork Sauce: South Carolina, mustardy

BBQ sauceWines: New Zealand Sauvignon

Blancs (Oyster Bay, Cloudy Bay, Kim Crawford)

Meat: ChickenSauce: Alabama white sauceWines: Austrian Grüner Veltliner

(GruVee)

Meat: St Louis/Kansas City style ribs

Sauce: Allspice in the sweet sauce Wines: Off dry reds (Apothic Red,

Ménage à Trois Red)

Meat: Texas Barbecue brisket Sauce: Mild hot sauce Wine: Zinfandel (Steele, Ridge,

Rosenblum) or Spanish Tempranillo wines

Meat: Grilled steaks or roasts Sauce: Salt, pepper, and butter onlyWine: Petit Sirah (Bogle, Greg Nor-

man, Foppiano); Carmenére (Concho y Toro); Bordeaux

Meat: Cedar board grilled salmon or grilled smoked salmon

Sauce: AnyWines: Oaked Chardonnays (Chal-

one, Chateau St Jean, Toasted Head,)

Meat: Barbecued chicken Sauce: Red BBQ sauceWines: Russian River Pinot Noir

(Martin Ray, Merry Edwards, Martinelli, Rodney A Strong, Siduri)

Meat: Grilled Italian or smoked sau-sages, bratwurst

Wines: Alexander Valley or Napa Valley Cabernet Sauvignon, Italian San-giovese or Chianti

Meat: Grilled hamburgers and hot dogs

Wines: Depends upon what con-diments you like: California Sauvignon Blanc (St Supery, Ledford, Bogle ) with mustard, pickles, onions; Unoaked Char-donnay (Joel Gott, Sebastiani, Simply Naked, Toad Hollow) with tomato, may-onnaise, and lettuce; California Pinot Noir (Bogle, Mark West, Mondavi Coastal, Castle Rock) with catsup; Italian Pinot Grigio (Cavit, Ecco Domani, Cupcake) with chili and slaw

I am getting hungry just writing this article. If you have not tried wines very often with barbecue, now is the time. Try it, you might like it!

What Makes a Baby

by Cory Silverberg, illustrated by Fiona Smyth; c.2013, Seven Stories Press; $16.95 U.S. & Canada, 36 pages

So your wee one knows that some-body’s going to have a baby… but you haven’t had The Talk yet. The new book What Makes a Baby by Cory Silverberg, illustrated by Fiona Smyth makes the con-versation a little bit easier.

Using ideas that are easy for smaller kids to understand, author Cory Silverberg tastefully explains how babies are con-ceived and born.

Eggs and sperm are pretty special. Inside each egg, there’s a story about the person that the egg came from. The sperm is the same way: it contains a story, too.

Not all bodies have sperm. Not all bodies have eggs. So when grown-ups want to make a baby, they use an egg from one person and a sperm from another person and they put them in a warm, safe place. That place is called a uterus, and even though it has the words “YOU” and “US” in it, not every body has one of those, either.

When an egg and a sperm get togeth-er in the uterus, they do a sort of dance, and they talk to each other and share those stories about the bodies they came from. By the time the dance is done, they’re not an egg and sperm anymore – they’re a brand-new, tiny thing that might or might not grow. If it does, it becomes a baby just like you were a long time ago.

Inside, a baby grows… and grows… and grows for about forty weeks until it’s ready to be born. Sometimes, the baby comes out on its own and sometimes a doctor decides when it’s time – but no mat-ter how it arrives, it’s a pretty big deal for the baby and for the people who were hap-py for it to arrive. And one of those people who are happy to meet the baby is you!

While the story itself is quick to read, the brightly colored illustrations by Fiona Smyth will make kids want to linger on each page. Those illustrations are, in fact, my fa-vorite part of the book because they oh-so-subtly touch upon kids and families of all kinds. That inclusion means a fresh take on an age-old story.

If your child is full of questions, make sure you’ve got this cute book around for easy answers. For curious 3-to-6-year-olds, not having What Makes a Baby is incon-ceivable.

Is Work Killing You? A Doctor’s Prescription for Treating Workplace Stress

by David Posen, MD; c.2013, House of Anansi, $18.95 US and Canada, 358 pages

Your employees have had to push a little harder than they ever had to before, and they’ve endured some layoffs, but ev-erybody seems to have adjusted. Still, you know that morale is low, and you’re think-

ing a fun group event might help.According to David Posen, MD, you’re

on the right track, but there are lots more things you can do for your employees. In his book Is Work Killing You? you’ll see how helping them will help you.

In his medical practice, David Posen sees “first-hand and up close the psycho-logical and physical damage” caused by workplace woes. Employees are stretched too thin, they’re doing more work for less money - some businesses even expect em-ployees to work through lunches, week-ends, holidays, and vacations – which often leads to headaches, forgetfulness, irritabil-ity, agitation, and depression that Posen di-rectly attributes to work-related stress.

“Workplaces are making people sick,” he says, and no one seems willing to discuss it.

As he sees it, the biggest contributors to workplace stress are volume (an increase in workload, to the point of overload), velocity (accelerated speed at which em-ployees are expected to work), and abuse (office bullies who “wreak havoc”). Other issues come into play, but these are the top three.

Though it’s a “hard sell,” Posen says studies indicate that productivity, mental clarity, and energy actually improve when work hours are reduced, face-time and meetings become optional, vacation-taking is mandatory, and employees are encour-aged to disconnect from work on a regular basis.

As an employer, you’ll also get more out of your employees if you encourage healthy habits. If it’s feasible, let them go home early when work is finished. Share the wealth – or at least make salaries more equitable. Help employees deal with of-fice politics. Know the difference between “excellent service and excessive service.” Prioritize projects wisely and discourage multitasking.

Lastly, ease up. Your employees’ health and your bottom line both depend on it.

As I was reading Is Work Killing You? there was one question that kept popping into mind: why isn’t this book taught in school?

You’ll ask yourself that, too, as you devour this common-sense, how-to, rant-slash-advice book because author and physician David Posen makes many good points for employees and business owners alike. In making those arguments, he under-scores his research by sharing dozens of an-ecdotes from his patients and others, and some of them are jaw-droppingly uncom-fortable to read. Posen doesn’t leave us hanging on those squirmy details for long, though; he offers pages and pages of ideas meant to make the business world better, do-able from dual sides of the paycheck.

This is one of those books that could potentially benefit anyone who works for a living, and I’m excited to finally see this topic tackled. I think that if a stress-free workday is what your business needs, then reading Is Work Killing You? should be your goal.

theLiteraryExaminerBY TERRI SCHLICHENMEYER

Terri Schlichenmeyer has been reading since she was 3 years old, and she never goes anywhere without a book. She lives on a hill in Wisconsin with two dogs and 11,000 books.


CME Events in the Greater Knoxville Area

Name of activity: Medicine Grand Rounds: Ethics and Allocation of ResourcesName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of MedicineDate: June 11, 2013Times: 8-9 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Pulmonary Tumor Board SeriesName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer InstituteDate: June 13, 2013Times: 7-8 a.m.Place: University of Tennessee Medical Center Cancer Institute, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Surgery Grand RoundsName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of SurgeryDate: June 13, 2013Times: 7-8 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: John Sullivan, DDS, Memorial Endowed LectureName of CE provider/sponsor: University of Tennessee Graduate School of Medicine and Department of General DentistryDate: June 14, 2013Time: 7:30 a.m.-5:00 p.m.Place: Heart Hospital Auditorium, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AGD credits and CEUsContact: Department of General Dentistry: 865-305-9191, [email protected]

Name of activity: Pulmonary Tumor Board SeriesName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer InstituteDate: June 20, 2013Times: 7-8 a.m.Place: University of Tennessee Medical Center Cancer Institute, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Surgery Grand RoundsName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery

Date: June 20, 2013Times: 7-8 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Medicine Grand Rounds: Celiac DiseaseName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of MedicineDate: June 25, 2013Times: 8-9 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Pulmonary Tumor Board SeriesName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer InstituteDate: June 27, 2013Times: 7-8 a.m.Place: University of Tennessee

Medical Center Cancer Institute, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Surgery Grand RoundsName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of SurgeryDate: June 27, 2013Times: 7-8 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

East Tennessee CME Events Editor’s Note: In an effort to provide our readership with the latest professional healthcare news, East Tennessee Medical News is working with area institutions to provide this monthly listing of CME events throughout the East Tennessee region. For more information about each activity, please see the contact information provided for each event.

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

All area Healthcare Managers (including non-members) are invited to attend.

Speakers Vary Each Month, Covering Topics Such As Meaningful Use, Compliance, Coding, Legal Considerations, and More. To assist with appropriate catering preparation, please RSVP by the Monday prior to the meeting:

Johnson City: Michael Manning @ [email protected].

Kingsport: Frances Sizemore @ [email protected] or fax to (423)224-3901.

JOHNSON CITY MGMA MONTHLY MEETING

Date: The 2nd Thursday of Each Month

Time: 11:30 AM – 1:00 PM

Location: Quillen ETSU Physicians Clinical Education Building,

325 N. State of Franklin Rd., Johnson City

Save the Date: Don’t miss the September meeting, comedian Matt Fore will be performing.

KINGSPORT MGMA MONTHLY MEETING

Date: The 3rd Thursday of Each Month

Time: 11:30 AM – 1:00 PM

Location: Indian Path Medical Center Conference Room, Building 2002,

Second Floor, Kingsport

2ND THURSDAY 3RD THURSDAY

East TN Medical News

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GrandRoundsHMG welcomes Heather Archer, PharmD

KINGSPORT, Tenn. – Holston Medi-cal Group (HMG) welcomes Heather Ar-cher, PharmD, to HMG Primary Care at the HMG Medical Plaza (105 W. Stone Drive, Suite 3A) in Kingsport, Tenn. Ar-cher will be working along-side HMG providers in the area of patient medication counseling and manage-ment.

Archer received her doctor of pharmacy degree from Ohio Northern University in Ada, Ohio, and completed her residency in primary care specialty at the William Jennings Bryan Dorn VA Medical Center in Columbia, S.C.

She holds a diabetic certification for pharmacists and is also certified in CPR and smoking cessation. Archer brings hospital pharmacy work experience to HMG.

Takoma Named ‘Safety Superstar’ By AARP Magazine

GREENEVILLE – Takoma Regional Hospital has been named a “safety su-perstar” by the international AARP The Magazine.

The publication’s April/May edition highlights 66 of America’s safest hospitals in an investigative report that discusses how hospitals fight errors and how pa-tients can protect themselves.

Takoma was listed, along with sev-eral other top hospitals, including the Mayo Clinic Hospital in Phoenix, Beth Israel Deaconess Medical Center in Bos-ton and Vanderbilt University Hospital in Nashville. For the full list of organizations featured as “hospital safety standouts,” please go to www.aarp.org/safehospitals.

With nearly 33 million readers, AARP The Magazine is the world’s largest circu-lation magazine and the definitive lifestyle publication for Americans 50 and older.

Daniel Wolcott, Takoma’s president and CEO, said he is excited about the recognition. “Takoma has an advantage of having two large parent organizations – Wellmont Health System and Adventist Health System,” Wolcott said. “The rec-ognition of Takoma as a ‘Top Hospital’ is the result of two things: the technology and innovation provided by Adventist Health System; and the great work of our physicians and clinical staff who have caught the vision for being world class in patient safety.”

According to the magazine article, more than 180,000 people die each year in U.S. hospitals from preventable accidents and errors. What’s more, an estimated one-third of hospital admis-sions result in harm to a patient. AARP explained that they wrote the article to draw attention to these tragic realities. AARP magazine teamed up with the non-profit organization, The Leapfrog Group, to highlight the innovative steps some hospitals are taking to protect the health of their patients.

The April/May issue, offered both in-home and online, showcases these “safe-ty superstars” in the magazine’s first ever “Health” issue. From creating patient alerts to implementing electronic medi-cal recordkeeping, the magazine reveals

what these groundbreaking hospitals are doing to prevent mistakes and how patients can properly arm themselves against preventable errors. The article is available at: http://www.aarp.org/health/healthy-living/info-04-2013/safe-health-care.html?intcmp=ATMBB1

Leapfrog rates hospitals on 26 mea-sures of safety – including infection rates from IV and catheter lines, secondary in-fections and hospital-acquired conditions like pressure ulcers. The data is compiled from the Centers for Medicare & Medic-aid Services, the American Hospital Asso-ciation and the Leapfrog Hospital Survey.

Takoma has received an “A” grade for the past two years. To view area Hos-pital Safety Scores, please go to: http://www.hospitalsafetyscore.org.

Other hospitals featured in the mag-azine article include:

• Allegheny General Hospital (Pitts-burgh, Pa.)

• Geisinger Medical Center (Danville, Pa.)

• Kaiser Permanente (Multiple Loca-tions)

• The Methodist Hospital (Houston, Texas)

• Rush University Medical Center (Chicago, Ill.)

• St. David's Georgetown Hospital (Georgetown, Texas)

• Stanford Hospital and Clinics (Stan-ford, Calif.)

• Wake Forest Baptist Medical Cen-ter (Winston-Salem, N.C.)

Holston Valley Picked As One of Top 100 Hospitals in Country in Five Categories for Medical Excellence

KINGSPORT – Holston Valley Medi-cal Center, which has a long-standing reputation of delivering superior cardio-vascular care to patients in the region, has been recognized as one of the top 100 hospitals in the nation by a leading rat-ings agency.

Holston Valley earned this designa-tion in five medical excellence catego-ries – cardiac care, major cardiac surgery, coronary bypass surgery, heart attack treatment and vascular surgery – from CareChex, a division of Comparion that evaluates hospitals on multiple compo-nents of quality.

In addition, Holston Valley was named among the top 10 percent in the nation in these five areas as well as in neu-rological care.

CareChex ratings are based on a comprehensive review of nearly all gen-eral, acute, nonfederal hospitals in the United States. The company sifts through a collection of publicly available data-bases, such as the Centers for Medicare & Medicaid Services and the Hospital Quality Alliance, for its analysis. CareChex considers factors such as process of care, outcomes of care and patient satisfaction.

The company’s reason for compil-ing the rankings is to help providers and healthcare consumers evaluate the qual-ity of inpatient care.

While CareChex focuses on evaluat-ing the quality of hospitals, companies recognize the value of relying on this national ratings agency. For example, The Wall Street Journal said the National Business Coalition on Health planned to

use clinical and financial information from CareChex to assess the value of hospital services for employer contracting.

Attaining successful results for pa-tients is a relentless pursuit for the Well-mont CVA Heart Institute, a team of 46 physicians that oversees the cardiovascu-lar program at Holston Valley and other Wellmont Health System hospitals.

The heart institute has worked con-tinuously to develop and refine its Level One Heart Attack Network to ensure blockages in patients’ arteries are cleared as soon as possible. The network is a part-nership between physicians at the hospi-tal and medical providers who respond to patients in the community.

This process saves time because it gives personnel in the cardiac catheter-ization lab more time to mobilize prior to the patient’s arrival at the hospital. It has empowered Holston Valley cardiologists to restore blood flow in a clogged artery in less than 15 minutes after the patient comes through the hospital doors.

Meanwhile, Holston Valley’s perfor-mance with coronary bypass surgery led to the hospital twice being recognized among the best in the country by the na-tion’s leading consumer magazine.

The hospital is also one of only a lim-ited number of facilities across the coun-try – and the only one in the region – ap-proved to perform transcatheter aortic valve replacements.

Data from CareChex are publicly available at www.carechex.com.

4th consecutive year HMG Pediatrics receives award for 100% vaccine compliance

KINGSPORT – The Vaccine for Chil-dren Program (VFC) has awarded Holston Medical Group (HMG) Pediatrics, King-sport, Tenn., the “Hot Shot” award in rec-ognition of the pediatrician’s demonstra-tion of 100-percent compliance with all vaccine protocols.

“It’s great recognition for our com-mitment to the children of our region,” says HMG Pediatrician and Pediatric De-partment Chair Donald Lewis, MD.

The “Hot Shot” award is presented annually to VFC providers exemplifying outstanding dedication and commitment to the VFC program and to the children of Tennessee by demonstrating 100 percent compliance with all the protocols involv-ing vaccine storage and handling, the screening of patients for program eligibil-ity, documentation of immunizations and vaccine accountability.

HMG Pediatrics has proven to be an immunization leader for the state of Ten-nessee and has been awarded the “Hot Shot” Award for four consecutive years.

Hawkins County Memorial Chosen Among Top 10 Percent in Nation for Patient Satisfaction

ROGERSVILLE – Hawkins County Memorial Hospital, a shining example of healthcare excellence for more than 50 years, was recently recognized by a na-tional ratings agency for being among the top 10 percent of hospitals in the na-tion in patient satisfaction.

The hospital received the honor from CareChex, a division of Comparion that independently evaluates hospitals on multiple components of hospital quality.

Hawkins County Memorial is part of an elite group in the nation for patient sat-isfaction in overall hospital care, medical care and surgical care.

Hawkins County Memorial also achieved Stage 1 in the meaningful use of certified electronic medical records. This further reduced the potential for medical errors and increased secured sharing of patient data among providers.

Hawkins County Memorial, which is accredited by The Joint Commission, has a team of 100 percent board-certified physicians and nearly 200 nurses, techni-cians and support staff.

Southwest Virginia Cancer Center Oncologist Earns Board Certification in Palliative, Hospice Care

NORTON, Va. – Dr. Daryl Pierce, a medical oncologist with the Southwest Virginia Cancer Center, passionately believes palli-ative care isn’t about treat-ing illnesses – it’s about taking care of patients.

This strong conviction motivated him to expand his knowledge base and attain board certification in hospice and palliative medicine through the American Board of Internal Medicine. He was already board-certified in medical oncology but viewed this latest credential as an opportunity to enhance his delivery of compassionate care.

“Palliative and hospice medicine is re-ally fascinating,” Dr. Pierce said. “I pursued the certification because I wanted to know more. The longer a physician practices medicine, he or she is entrusted to handle more complicated cases. It’s important for me to keep learning so I can continue pro-viding patients with the best care.”

Many people are familiar with hos-pice as a service to make the last segment of life more fulfilling and comfortable. Hospice care provides support at home for people in the end stages of progres-sive, incurable illnesses. Inpatient hospice care is an option for patients who have symptoms that can no longer be con-trolled at home.

Hospice provides effective man-agement of pain and other symptoms and supportive services for patients and families. Caregivers address the physical, emotional, social and spiritual needs of patients and families to offer hope, com-fort and support.

The concept of palliative care is not as well understood as hospice. Pallia-tive care focuses on improving the lives of people of all ages who have serious, chronic and life-threatening conditions – including cancer, congestive heart failure, kidney failure, Alzheimer’s disease and chronic obstructive pulmonary disease.

Part of coordinating palliative care means a team of doctors and nurses – and potentially social workers, counsel-ors, chaplains and others who can assist – communicates clearly with one another, with other physicians and specialists and with patients to ensure patient comfort.

Heather Archer

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

Dr. Daryl Pierce


Wellmont Receives Seven Honors from Tri-Cities Chapter of Public Relations Society of America

KINGSPORT – Wellmont Health Sys-tem recently earned seven honors during the annual awards banquet for the Tri-Cities chapter of Public Relations Society of America.

Wellmont collected four Awards of Merit and three Awards of Quality for pro-viding valuable health information to the communities it serves in Northeast Ten-nessee and Southwest Virginia.

Two of the Awards of Merit recog-nized news releases. One concerned the expansion and renovation of the emergency department at Lee Regional Medical Center. The other pertained to an innovative program at Holston Valley Medical Center in which volunteers stay with dying patients who have no family.

Another Award of Merit revolved around public service announcements promoting awareness of stroke symp-toms and urging people to call 911 if they

show signs of this brain-impairing condi-tion. The final Award of Merit was a direct mailer that promoted Holston Valley’s convenience and quality.

Wellmont garnered an Award of Quality for a news release about Bristol Regional Medical Center’s Primary Stroke Center being honored with a national award from the American Heart Associa-tion and American Stroke Association.

The remaining Awards of Quality were for a direct mail piece that promoted Spa Day at the Wellmont Breast Center in Johnson City and Wellmont Defined, the health system’s annual report for fiscal 2011.

“We appreciate the external valida-tion of these important materials, which were designed to inform and empower our patients and their loved ones about the services available at Wellmont,” said Nick Adams, the health system’s execu-tive director of marketing communica-tions. “The more information we can provide our communities, the better equipped those individuals are to make

healthy choices for themselves and their families.”

Chair of ETSU Department of Health Sciences co-authors new book

JOHNSON CITY – An East Tennes-see State University professor who is a leading expert on the struggle by micro-organisms to obtain iron – one of life’s es-sential building blocks – is the co-author and editor of a new book on the subject.

Dr. Ranjan Chakraborty, professor and chair of the ETSU Department of Health Sciences in the College of Public Health, contributed the introduction and a chapter and served as editor of “Iron Uptake in Bacteria with Emphasis on E. Coli and Pseudomonas.”

“Iron is actually the fourth-most abun-dant metal in Earth’s crust,” Chakraborty said, “but it’s a struggle for microorgan-isms – both inside and outside the body – to acquire iron in its soluble form. All living organisms, including us, need iron. Because iron is a vital component for liv-ing cells, microorganisms employ a vari-ety of strategies to obtain it.”

Chakraborty has focused his research on one method in particular that microor-ganisms use to acquire iron: compounds called siderophores. Microorganisms use these organic molecules, which can bind to iron, to latch onto the metal and return it to the cell to aid in respiration and re-production.

Chakraborty created the book as not only a means to publish current re-

search in the field but also as an ode to his mentor, the late Dr. Dick van der Helm. Chakraborty referred to him as the “iron-man” of siderophore biology, and his work with van der Helm at the University of Oklahoma and Dr. Johann Deisen-hofer, a Nobel Laureate at the University of Texas Southwestern Medical School, shaped his research career. Chakraborty has co-authored papers on the subject in several publications, including the aca-demic journals Science and Nature.

The siderophore’s role in human health looms large, as many patho-gens rely on the compounds for iron. In Chakraborty’s lab, he and his group study in particular that transport mechanism in Escherichia coli, a bacterium commonly known as E. coli. By reaching a better understanding of that transport mecha-nism, Chakraborty said, scientists could design drugs that are more targeted and more effective in treating infections, as these transport systems are prevalent in bacteria, including many pathogens. Chakraborty said solving that siderophore transport model could also lead to better treatments for infections caused by bac-teria, like Methicillin-resistant Staphylo-coccus aureus, which is potentially deadly and hard to treat.

“Iron Uptake in Bacteria with Empha-sis on E. coli and Pseudomonas” includes chapters from Drs. Volkmar Braun and Klaus Hantke of Tübingen, Germany, and Dr. Pierre Cornelis of Brussels, Belgium. It is published by Springer Briefs in Molecu-lar Science.

GrandRounds

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Through special funding, tnREC is Through special funding, tnREC is offering free or low-cost health information technology services if an EP meets the Medicaid patient volume thresholds.

We help healthcare providers take We help healthcare providers take the right steps to implement new technologies that enhance and improve the quality of care available.

Apply onlinewww.tnrec.org

This presentation and related material was prepared by tnREC, the HIT Regional Extension Center for Tennessee, under a contract with the Office of the National Coordinator for Health Information Technology (ONC), a federal agency of The Department of Health and Human Services (HHS). Contents do not necessarily reflect ONC policy. 90RC0026/01 13.TREC.04.049

We can help guide your path.Incentive funding up to $63,750 is available for Eligible Professionals (EPs) within the Medicaid program seeking to achieve Meaningful Use of an EHR.




















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Name: Thomas Myers

Position: Emergency Response Vehicle driver, American Red Cross

At a Glance: During his more than 20 years of service as a Red Cross volunteer, Thomas Meyers has seen more human suffering than most of us, as he has looked into the eyes of literally thousands of people facing the worst day of their lives. As a result, he understands that each of the 70,000+ people the Red Cross helps every year carries a personal story.

Whenever horrific disaster scenes play out on TV and the Red Cross vans, also known as ERVs, appear delivering food to people who just lost everything, there’s someone like Thomas either behind the wheel or handing out meals. Although he delivers the basic human need of food into disaster situations, Myers gives something intangible but equally as healing. His assuring smile and calming demeanor brings comfort and hope that although the situation is bad now, it’s going to get better. For Myers, it’s about more than just driving through neighborhoods to deliver food. He knows the importance of the human touch.

This great-grandfather and Vietnam-era veteran, along with other loyal Red Cross volunteers, hit the road with the ERV: Ready, Set, Rock & Roll Tour during the month of May. It was an opportunity for the Red Cross to recruit and train new disaster volunteers to deliver emergency services and help local communities be better prepared whenever the need arises.


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MEDICAL MOVER MOMENTDerby Day

A fundraiser for the Spine Health Foundation, Derby Day, was held on May 4, 2013 at The Olde Farm.

Attendees came to-gether to celebrate and support the mission of The Spine Health Foun-dation, the only non-profit organization in the nation directly impacting lives by providing disadvantaged individuals access to spe-cialized spine care.

Guests walked the red carpet to have their picture taken as they en-tered the Party Barn to join the pre-derby party festivities.

A few highlights of the evening were traditional southern derby cuisine and mint juleps; a Best Derby Hats Contest; and a silent and live auction.

Annually, the Spine Health Foundation honors one individual who has gone above and beyond to help those suffering with spinal disorders or injuries. Dr. Mor-gan Lorio presented the 2013 Hope Award to Dr. David Wiles of East Tennessee Brain and Spine Center, P.C. Dr. Wiles was not present, and Dr. Timothy Fullagar accepted on his behalf.

Major sponsors included Alpha Natural Resources, Eastman Credit Union, Re-gions Bank, Depuy Synthes, Victory Orthotics & Prosthetics, Medtronic, Alphatec Spine, Integra Foundation, Bill Gatton Automotive.

Kim Nicewonder, Carol Conduff, Krista Wharton

JCMC seeks to increase breastfeeding rates through OB/GYN collaboration

JOHNSON CITY, Tenn. -- The John-son City Medical Center Family Birth Center recently received a grant to help put two lactation specialists in local OB/GYN practices so they can talk to expect-ant moms about breast feeding. The goal is to provide early education to women about the benefits of breast feeding and to increase the rate of breastfeeding mothers.

“We’re looking more and more at preventative health care, and we’ve learned over the years that breast feed-ing is huge part of that,” said Chasta Hite, RNC, IBCLC and MSHA’s lactation servic-es manager. “To increase the breastfeed-ing rate, we need to capture expectant mothers before they come into the hos-pital to have their baby and have already chosen their feeding method.

“If we contact them in the doctors’ offices, hopefully we can influence their decision and prepare them for what to ex-pect and what can help them have a bet-ter experience when they get to JCMC to have their baby.”

Since exclusive breast milk feeding is a Perinatal Care Core Measure of The Joint Commission and the Center for Medicare and Medicaid Services, health care systems must seek out innovative ways to encourage this positive health choice for their patients.

The JCMC Family Birth Center was the recipient of the Breastfeeding Sup-port Funding opportunity through the U.S. Department of Health and Human Services, Office on Women’s Health. It will allow a lactation consultant to be present at the Johnson City OB/GYN and ETSU OB/GYN practices twice a week for a to-

tal of six hours. The trial program began in March

and will continue through mid-Septem-ber. If the results are good, it could be expanded within MSHA.

Having a lactation consultant avail-able in obstetric offices prenatally will in-crease the opportunity for clients to ask questions, learn more about infant feed-ing options and talk with a professional regarding the best choice for feeding their infant.

Allergies, asthma problems, obesity, heart disease, juvenile diabetes – breast-

feeding can help lower the chance of all these. It’s just a matter of letting more expectant mothers know all the benefits.

“We have so many moms come in who’ve decided to bottle feed and we find out they may have misconceptions about breastfeeding,” Hite said. “This program puts information in the patients’ hands so they can make an informed de-cision.”

For more on The Joint Commission’s efforts toward perinatal care, visit www.jointcommission.org/perinatal_care/.


East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Commu-nications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore uncondition-ally assigned to Medical News for publication and copyright purposes.

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GrandRounds

Mountain States Health Alliance, Vanderbilt announce strategic affiliation

JOHNSON CITY – The leaders of Mountain States Health Alliance (MSHA) and Vanderbilt University Medical Center (VUMC) announced that the two organi-zations have signed an affiliation agree-ment that will benefit MSHA, VUMC and the residents of Northeast Tennessee and Southwest Virginia.

“We are pleased to announce this mutual affiliation between Vanderbilt and MSHA,” said Dennis Vonderfecht, president and CEO of MSHA. “This an-nouncement represents the culmination of a three-year search process that MSHA leadership has undertaken, driven by the rapid changes taking place in our health care industry today. As part of our 10-year strategic plan, we have been diligently seeking a partner outside of our region who shares our vision for the future as well as our culture of quality and cost ef-fectiveness. We believe we have found that partner in Vanderbilt University Medi-cal Center.”

As part of the affiliation agreement, VUMC will assist with recruitment of hard-to-find specialists and subspecialists to serve the Northeast Tennessee/South-west Virginia area. VUMC also brings to the table a number of evidence-based care models that will help MSHA to en-hance the care of patients with certain di-agnoses like diabetes, heart disease and asthma.

“Evidence-based care models allow us to consistently provide the highest-quality care across the entire continuum,” said Dr. Morris Seligman, MSHA senior vice president and chief medical officer. “These care models apply not just in the hospital, but in outpatient and home care settings as well. This allows us to ensure that we’re giving each patient the care they need not just to recover from an epi-sode of illness, but to effectively manage their conditions so that they stay well all the time.”

An internationally-renowned re-search institution, VUMC will also bring to MSHA’s service area a number of clinical trials that have the potential to benefit pa-tients while making significant advances in medical research.

The collaborative relationship be-tween MSHA and VUMC is expected to grow and strengthen in future years as each organization finds new ways to pro-vide better care through cooperation. At the outset, however, the two organiza-tions are prepared to:

• Share best practices in the areas of evidence-based care models;

• Collaborate in the areas of medical research and clinical trials;

• Develop consultative relationships among specialists and subspecialists;

• Work together in the area of physi-cian recruitment to facilitate access, espe-cially to specialty services;

• Collaborate clinically, with particu-lar emphasis on cardiovascular and oncol-ogy services; and

• Work together to develop a state-wide clinically-integrated network to con-tract with payers for high-quality, efficient-ly-provided health care services.

(noun) the right or opportunity to use or benefit from something

Important Information for People with BlueCross BlueShield of Tennessee Insurance Coverage

8At t e n t i o n

What does the word “access” mean to you?

www.msha.com/bcbsT

We will do everything we can to stay in-network for all plans, but we want to be sure you know your options if MSHA is dropped from the BlueCross BlueShield of Tennessee network on July 1, 2013. You may want to

consider other insurance options that would guarantee your aCCeSS to your local MSHA providers. A list of other health plans that include MSHA facilities and physicians in their networks is below.

• Aetna• BeechStreetNetwork• Stratoseformerly

CoalitionAmerica/NPPN• CoventryNational

HealthcareNetwork/ First Health

• CrestPointHealth• FortifiedProvider

Network• GatewayHealth• HumANA

• IntegratedHealthPlan(IHP)

• IntegratedSolutions HealthNetworkLLC

• magellanHealthServices• medicare• mountainStates

PreferredNetwork• multiPlanNetwork• NovaNetInc.• OneCallmedical

(Norton,VA)

• OptimaHealth• OptumHealth

Behavioral Solutions/ United Behavioral Health

• PHCSNetwork• unitedHealthcare• VirginiaHealthNetwork• VirginiamedicaidPlans• VirginiaPremier

HealthPlanInc.

access

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Tri Cities Medical News June 2013

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