Knoxville Medicine Fall Issue

Volum e L X X I, No . 3 • F a ll 2 0 1 4

Se r ving the Gr e ate r M e tr opolitan Knoxvi l l e Area

KAM PAST PRESIDENT, DR. RICHARD BRIGGS: WINS REPUBLICAN PRIMARY FOR SENATE DISTRICT 7

KAM KNOXVILLE ACADEMY OF MEDICINE

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KNOXVILLE ACADEMY OF MEDICINE KNOXDOCS.ORG

PRESIDENT’S MESSAGE

KAM

By: Pat O’Brien, MD

Academy Officers

KNOXVILLE ACADEMY OF MEDICINE

Pat O’Brien, MD PRESIDENT

Elise Denneny, MD

IMMEDIATE PAST PRESIDENT

Thomas Pollard, MD PRESIDENT ELECT

Jeff Broussard, MD SECRETARY

Neil Coleman, MD TREASURER

Roy King, MD

KAMF PRESIDENT

Kimberly Weaver, PhD CEO

Board of Trustees Thomas Haskins, MD David Harris, MD Jack Benhayon, MD Ceeccy Yang, MD Clifton Tennison, MD Ed McBride, MD

Ex- Officio Board Members Randal Dabbs, MD Richard Briggs, MD Richard DePersio, MD Roy King, MD John W. Lacey, III, MD Robert Page, MD Jacque Prince - KAMA Rep.

Publisher Kim Weaver, PhD

Editor Julie Morris

Production Coordinator Danielle DuFur-Sims

Design Jonathan Weaver ADVERTISING:

For

advertising

information,

call the Academy offices at (865) 531-2766. The magazine is published four times per year by the Knoxville Academy of Medicine (KAM). All rights reserved. This publication or any part thereof may not be reproduced without the expressed written consent of the KAM. The appearance of advertising in KAM publications is not a KAM guarantee/ endorsement of the product or the claims made for the product by the manufacturer. The fact that an advertisement for a product, service, or company has appeared in a KAM publication shall not be

Recently, your KAM leadership was invited along with the leaders of the other metro medical societies in Tennessee (Memphis, Nashville, and Chattanooga) to a meeting in Nashville by the leadership of the Tennessee Medical Association to brainstorm on where we should plan to put our collective efforts in the future. Tommy Pollard, MD (president elect), myself and Kim Weaver, PhD, our CEO, spent a day in meeting rooms in Nashville trying to work through what is important to you our members and how to bring more physicians to the table in organized medicine.

What we ended up with after much collegial discussion is a blueprint for action in the coming months and years that will be discussed at the state level to bring us a more cohesive voice and advocacy. The bottom-line is that we have had a shrinking pool of active physicians in organized medicine whether at the county, state, national and specialty levels. We have the labor of the few benefiting the many who have decided for one reason or another to “let somebody else do it.” Maybe its apathy, dealing with the many new and expanding mandates that affect our practices daily, feeling it’s our employers’ job to advocate for us as physicians, or just being plain tired of it all; we have great numbers of our colleagues who stand on the sidelines. What are we, the active members of organized medicine in Knox County, going to do?

Well, I have a few words for each of you.

The first is—Thank You! You are part of the solution for physicians and the patients we advocate for. You are in the boat, not treading out in the storm. You have elected to join and remain a part of our august organization. You are the reason we even have a Knoxville Academy of Medicine for lo these many years. We are stronger together, there is no doubt about it!

Next words to you is please speak up with your partners, colleagues, and friends who are not members of the KAM. We want everyone in the boat! Throw a life preserver to one and all to join and be heard. Get the word out we want them to join us. We offer collegiality, benefits, and advocacy. Tell them to look at our new website, www. knoxvillemedicine.org. They can see our new look and easy to navigate website. They can join easily online now, something that has not been available until recently. And if they are employed, have them ask their practice management group to contact the KAM on their behalf for group membership offerings.

With fall here and winter following close behind, we need to give physicians in Knoxville the life preserver of membership and having their voice heard. Throw them that line and let’s save the practice of medicine with a stronger and more vibrant membership!

Calendar of Events NOVEMBER Election Day 4 KAM BOT/BOG Meeting, KAM, 6:00 5 pm

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KAMA/KAM A Little More Conversation 60’s event, NV

8-11 20

AMA Interim Meeting, Dallas, TX

27-28

Thanksgiving Holiday - KAM Closed

KAM Legislative Dinner, Flemings, 6:30 pm

referred to in collateral advertising. The KAM reserves the right to accept or reject any advertising in the publication.

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ACADEMY NEWS Legislative Report

By: Elise Denneny, MD

Dear colleagues.

I hope this edition finds all of you well as fall and football season begins!

TMA along with the Knoxville Academy of Medicine has been working hard and a legislative report card was recently released. The link to this easily digested succinct report follows. I encourage you to scan it and reply with any questions you may have. http://www.tnmed.org/wp-content/uploads/2014/06/TMA-LegislativeScorecard-webSINGLE.pdf It has become apparent that many are interested in the problem of pain medication abuse and neonatal abstinence syndrome. The Knoxville Academy of Medicine along with Dr. Mitch Mutter of the TN Department of Health, and Karen Pershing of the Metropolitan Drug Commission, have been working tirelessly with the KAM Prescription Drug Task Force this past year and much has been accomplished.

First, the group is tasked with addressing the problem of pain pill abuse, of which we are second in the nation, in all aspects. To effectively tackle this issue, we have brought all stake holders to the table including representatives from local and state law enforcement, healthcare providers of varied levels and disciplines, pharmacists, nursing, mental health, the Knox County Health Department, Tennessee Board of Health representatives, legislators and elected officials to discuss solutions and problems. Not all solutions require new legislation and frequently more ground is gained outside the legislative arena.

The recent pain management guidelines have been released and can be found at http://health.state.tn.us/Downloads/ChronicPainGuidelines.pdf Since the committee’s inception, KAM President Pat O’Brien, MD and Past-President, Tara Sturdivant, MD have visited or contacted many of the pain clinics in our area to stress the importance of proper prescribing. We have seen a reduction of the number of pain clinics in Knox County from 36 to 34.

On the legislative front, the task force was successful in passing the “ID Bill” sponsored by Representative Ken Yager (R-Kingston) and Representative Bob Ramsey (R-Maryville). It seems like requiring proof of ID should have been required many years ago as ID is required when you purchase alcohol, nevertheless better late than never and this requirement of showing ID when purchasing narcotics should create a paper trail to help law enforcement. Unfortunately, the laws in place seem to protect the guilty and prosecution is extremely difficult and expensive. Getting bad laws off the books is just as hard, so the process is slow and tedious BUT WE ARE GAINING GROUND! Since implementation of the Controlled Substance Monitoring Database (CSMD) we have seen a reduction in scripts written and ongoing “tweaks” to the CSMD, such as push notifications of high utilization, should help providers and continue to curb abuse.

Effective October 6, 2014, the DEA has published in the Federal Register the rule to transfer hydrocodone combination products from

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schedule III to schedule II. As you know, hydrocodone combination products are the most prescribed opioids, which may lead to increased abuse, especially considering the United States consumes 95% of the worlds’ hydrocodone. Additionally, HCP’s are responsible for 75% of drug-related deaths. Even though many hydrocodone products are already a C-II drug, this rule should capture other HCP and make record keeping in “pill mill” clinics more difficult. Also, all HCP now will need a written prescription, thus reducing phone prescription fraud.

In preventing and treating abuse, all physicians know compliance is an issue and newer delivery systems such as Probuphrine, which can deliver 6 month medication subdermal, may find good utility.

One note to keep in mind, as we gain tighter control over pain pill mills, we try to avoid unintended harmful consequences. I have learned much from my excellent colleagues who are on the front line fighting this epidemic. Not all pain is the same. Cancer pain is very different from back pain,etc. We must be cognizant of those who need medication. Also, as we gain tighter control, many patients may unintentionally find themselves acutely without their opioids and/or we may see an increase in heroin use.

Two more issues I would like to bring to your attention.

First, many of you already know the wonderful results of the recent primary election. Dr. Richard Briggs (Knoxville) won the republican primary for State Senator, beating incumbent Stacy Campfield; Dr. Sabi Kumar (Springfield) won the republican primary for House District 66 and Dr. Brian Terry (Murfreesboro) won the primary for House District 48. This took a lot of work and I encourage you to congratulate them on a well-run campaign. ALL three will be in the general election in November. VOTE THIS NOVEMBER! We now have three more physicians in the state legislature!!!! I recall a time when a physician commented that if medicine were ever to change, doctors would have to unionize... whether or not we need to unionize, it is good for the house of medicine to now have three more docs fighting for us and our patients.

Secondly, recently Drs. Randal Dabbs, Charlie Barnett, and Pat O’Brien, along with Karen Pershing and Representative Bill Dunn met with representatives from Senator Lamar Alexander’s office to discuss the emerging problem of physician performance being tied to patient satisfaction surveys. It is ridiculous to think that patient satisfaction surveys as presently constructed can reflect quality of care.

Physicians, like parents, often have to render advice and opinions that patients do not like to hear. No amount of statistical adjustments and psychometrics can fix bad metrics and bad data. Medicine is unique art, and to be measured as a business, although desirable for efficiencies in health care delivery models, will ultimately erode quality of care for patients!!!! We do not argue against “long waiting times” but patients need to be cognizant that more often than not, many office clerical dissatisfactions are out of the physician’s control. Senator Lamar’s staff received our comments in a favorable light and will work to help address the growing problem.

As always your comments and thoughts are welcome.

Be well and smile, for all of you work to make life better for our patients!

KAM KNOXVILLE ACADEMY OF MEDICINE

Hot Topic: Pregnancy and Addition

By Karen Pershing Executive Director - Metropolitan Drug Commission Are you confused about Tennessee’s new law regarding pregnancy and substance use? You are not alone! On July 1, 2014, a new law went into effect stating that a woman who gives birth to a baby, who is harmed by her illegal use of a narcotic drug while pregnant, can result in assaultive offense charges. If a pregnant woman enters into a treatment program and gets prenatal care, these positive actions can be used as an affirmative defense.

Sounds pretty simple, right? If you have a legal background, maybe! First of all, in the State of Tennessee, a baby is not considered a baby until the day of the birth; therefore, women who are pregnant and using drugs cannot be charged with a crime. Once the baby is born and the baby has symptoms of Neonatal Abstinence Syndrome or other harm as a result of the Mother’s drug use, the mother could be charged with misdemeanor assault.

In recent conversations with service providers, I was informed that both service providers as well as pregnant women with addiction issues are confused and think that if they are not “clean” at the time they access prenatal care that they will be arrested. This is NOT true and should be corrected as soon as possible. Medical professionals who are providing care are NOT required to report the drug use of a pregnant woman. Again, that baby is not defined as a baby until the day the child is born.

Once the baby is born and the hospital confirms drug use of the mother and that harm to the baby has occurred as a result, the birthing facility is required to file a report with the Department of Children’s Services, who then opens a case and notifies local law enforcement. If the birth mother can document that she is actively engaged in a treatment program AND received prenatal care, charges will NOT be filed. If she cannot produce verification that she is in a treatment program, misdemeanor charges will then be filed and the Mother arrested.

It is critical for both the health of the mother and the baby to receive prenatal care as early in the pregnancy as possible.

For a woman struggling with the disease of addiction, this is even more paramount.

There have already been some women who have reported buying Methadone off the street and trying to detoxify themselves prior to seeking medical care. This can be very dangerous for both the mother and the baby. Detoxification of pregnant women should be medically managed and the tapering process should be gradual.

It is up to all of us to spread the word and make sure we are not making an already difficult situation worse for fear of criminal charges. This law was put in place to encourage women to access treatment for their addiction and deliver the healthiest baby possible.

Note: This law has a sunset provision and will expire on June 30, 2016.

Legislative Dinner at Flemings Come and Join Us at Fleming’s Prime Steakhouse and Wine Bar for Dinner with your Legislators from Knox, Blount, Roane, and Anderson Counties to discuss issues important to all physicians.

Thursday, November 20, 2014 Flemings 6:30 pm $60 per person To Register please call Andrea Southard at (865) 531-2766 or visit knoxvillemedicine.org

KNOXVILLEMEDICINE.ORG

Strength in Numbers IF any of your colleagues are not

members of KAM, please stress the importance of joining. Here are a few of the benefits each physician receives once becoming a member • Legislative Activities • Physician Referrals • CME Programs • Current information via e-mail, Legistats, and quarterly magazine • Outreach Programs like KAPA • Special Events • Annual Pictorial Membership Directory For information on how to join, please contact Danielle DuFur at ddufur@ knoxdocs.org or (865) 531-2766.

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ACADEMY NEWS New Members A big welcome to our newest members! We are excited that you have decided to join the Knoxville Academy of Medicine.

MARCUS A. BARBER, MD

PAUL B. PRUETT, MD

________________________________________________

________________________________________________

JOEL F. BRADLEY, III, MD

JESSICA L. VINSANT, MD

________________________________________________

________________________________________________

WALTER W. CHILES III, MD

KRISTOPHER B. WILLIAMS, MD

________________________________________________

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VASCULAR SURGERY Premier Surgical Associates PLLC 930 Emerald Ave., Ste. 110 Knoxville, TN 37917

GENERAL SURGERY Premier Surgical Associates PLLC 1819 W Clinch Ave., Ste. 200 Knoxville, TN 37916

UROLOGY Knoxville Urology Clinic PC 9245 Park West Blvd Knoxville, TN 37923

JAMES CUDZILO, MD

PULMONARY DISEASES Summit Medical Group 2240 Sutherland Ave., Ste. 103 Knoxville, TN 37919 ________________________________________________

TROY F. KIMSEY, MD

GENERAL SURGERY Premier Surgical Associates PLLC 1819 W Clinch Ave., Ste. 200 Knoxville, TN 37916 ________________________________________________

ADAM LETT, MD

FAMILY PRACTICE Summit Medical Group 7211 Wellington Dr., Ste. 201 Knoxville, TN 37919

OPHTHALMOLOGY Baptist Eye Surgeons PLLC 2020 Kay Street Knoxville, TN 37920

GENERAL SURGERY Premier Surgical Associates PLLC 7557A Dannaher Dr., Ste. 110 Knoxville, TN 37849

GENERAL SURGERY Premier Surgical Associates PLLC 9430 Park West Blvd., Ste. 310 Knoxville, TN 37923 Transfers:

DAVID DEVOID, MD

PEDIATRIC GASTROENTEROLOGY Children’s Hospital Pediatric Gastroenterology 2100 W Clinch Ave., Ste. 510 Knoxville, TN 37916 Transfer from Chattanooga Hamilton County Medical Society ________________________________________________

BRANDON LANCASTER, MD FAMILY PRACTICE UT Graduate School of Medicine 1924 Alcoa Hwy. Knoxville, TN 37920 Transfer from Washington County

________________________________________________

________________________________________________

DAVID NEWMAN, MD

ANESTHESIOLOGY Genesis Analgesia Center PLLC 1408 Currier Lane Knoxville, TN 37919

JAMES MCELMURRAY, MD

RADIOLOGY Association of University Radiologists 5401 Kingston Pike Ste. 540 Knoxville, TN 37919 Transfer from Nashville Academy of Medicine

Left Column Top to Bottom: Marcus A. Barber, MD., Joel F. Bradley, III, MD., Walter W. Chiles, III, MD., James Cudzilo, MD., Troy F. Kimsy, MD., Adam Lett, MD., David Newman, MD. Rigth Column Top to Bottom: Paul B. Pruett, MD., Jessica L. Vinsant, MD., Kristopher B. Williams, MD., David Devoid, MD., Brandon Lancaster, MD.(no photo available), James McElmurray, MD.

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KAM KNOXVILLE ACADEMY OF MEDICINE

KAM PAST PRESIDENT WINS SENATE PRIMARY It is always great to have physician representation in government.

Richard Briggs, MD, a KAM past president, recently handily defeated incumbent Senator Stacey Campfield in the republican primary for Senate district 7.

Dr. Richard Briggs was elected to the Knox County Commission in 2008 and represents District 5 in Knox County.

He was re-elected to a six year term in 2010.

Dr. Briggs earned his B.S. degree from Transylvania University in Lexington, KY. Upon graduation from the University of Kentucky College of Medicine in 1978, Dr. Briggs entered active military service and rose through the ranks to full Colonel. He served in combat during Operation Desert Storm and was awarded the Bronze Star. With over 30 years of military service in command and leadership positions, Colonel Briggs recently completed combat tours in Afghanistan and Iraq as a combat trauma surgeon.

Dr. Briggs has practiced heart and lung surgery for over 22 years at the St Marys-Tennova Medical Center in Knoxville. He has held academic appointments at the University of Texas-San An-

KNOXVILLEMEDCINE.ORG

tonio, the University of Louisville, and the University of TennesseeKnoxville. Dr. Briggs is a past president of the Knoxville Academy of Medicine and serves on the Board of Trustees of the Tennessee Medical Association.

Congratulations Dr. Briggs and good luck in the general election!

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ACADEMY NEWS Healthcare Heroes Award On September 9th, 2014, Dr. Leonard Brabson and Dr. John Bell accepted their Healthcare Heroes Awards at the Knoxville Business Journal Healthcare Heroes Luncheon.

Dr. Leonard Brabson, has delivered more than 14,000 babies since starting medical school more than 40 years ago. He is touted for his commitment to giving mothers more choices for childbirth. “He has a long standing history of being a pioneer for health care for women,” says Libbi Martino, a certified nurse midwife and women’s health nurse practitioner who practices with Brabson at the St. Mary’s Birth and Midwifery Center in the Women’s Pavilion at Tennova-owned Physicians Regional Medical Center. “He genuinely cares about women, their experience when they leave our office and accommodating the needs of each individual woman.” He is a past Knoxville Academy of Medicine President and the Medical Director at St. Mary’s Birth and Midwifery.

Dr. John Bell founded the oncology department 34 years ago at the University of Tennessee Medical Center, and it has grown into one of the award-winning hospital’s Centers of Excellence. He is also credited with preventing many women from ever having to walk through those doors. Dr. John Lacey, senior vice president and chief medical officer at UT Medical Center said “Dr. Bell’s vision and passion has provided opportunities for many in our community to receive the message of early detection and have access to lifesaving screening mammograms” He is the Director of the Cancer Institute and a KAM Member. Kudos to them and their accomplishments!

Celebrating our new look, the Knoxville Academy of Medicine Alliance has adopted a new logo!

Left: Leonard Brabson, MD

The Knoxville Academy of Medicine Alliance (KAMA or KAM Alliance) is an organization of local physician spouses committed to improving the health of our community and supporting the family of medicine through service, philanthropy and friendship. Meetings are held monthly on the first Thursday of each month and new members are always welcome!

There are many opportunities to get involved in KAMA and the commitment can range from leadership positions to one-time, short-term spots. KAMA offers many such “micro-volunteer” areas for women who want to be a part of the organization but have limited time to offer - and there is no required attendance.

Some of our current activities include:

Right: John Bell, MD

Community Health Relations – KAMA members organize, participate and/or volunteer in a variety of health related projects/events being conducted at the county, state and national level.

DOC ROCK – A concert where bands including local physicians perform and compete to raise money for local health-related non-profits.

DOCTORS DAY - Committee plans and coordinates a project each year to honor area physicians for their valuable service to the community.

FASHIONDRAMA – KAMA members organize and produce the annual fashion show benefitting the KAMA Philanthropic Fund for nursing scholarships and grants to local health-related non-profits.

Just for Fun - Purely social gatherings organized to enjoy each other’s company while strengthening our friendships.

For more information contact: Cynthia Gash- KAMA President 2014-2015 cynthiagash@gmail.com

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Summer Welcome Picnic

KAM KNOXVILLE ACADEMY OF MEDICINE

KAM/KAMA

On Friday, August 22, the Knoxville Academy of Medicine joined the Knoxville Academy of Medicine Alliance to host a Summer Welcome Picnic for young physicians and their families and physicians who were new to Knoxville. The picnic was held at the Gettysvue Country Club lower pool area. The evening included food from Backyard Burgers and live music compliments of Chuck French of The French Connection.

Over 140 people attended the picnic sponsored by the Tennessee Medical Association (TMA.) TMA representative Brett Boyd traveled to Knoxville to attend. He expressed his enthusiastic support for the event:

TMA representative Brett Boyd and family; Andrea Southard and Danielle DuFur of KAM; Gordon Family; David Gallegos, Rick Briggs, Reeves Johnson, Elise Denneny; Bradley Family; Bill and Jo Terry; Robyn Doiron, Jennifer Ollis, Cynthia Gash, Lorraine Johnson.

“The TMA was pleased to sponsor the KAMA Summer Welcome Picnic last Friday evening. My wife, my daughter and I personally enjoyed attending. They had a super turnout, and I especially enjoyed an opportunity to have meaningful dialogue with our physician members and their spouses. I was pleased to see there were also a number of non-member physicians in attendance and I was grateful to make their acquaintance.

The TMA exists in order to support all Tennessee physicians and to protect the health interests of their patients. We hope to have more opportunities like this one to show our support of Knoxville area physicians and their families.”

–Brett Boyd, TMA

Legislator Visit New State Representative, Martin Daniel (R-House District 18), and Representative Bill Dunn, (R-House District 16), visited the Knoxville Academy of Medicine to discuss issues important to Knox County physicians. KAM Past President, Leonard Brabson, MD (pictured) gave each Representative an overview of the TMA/KAM Legislative agenda for 2015. Also present: KAMA Member Gail Brabson, KAM CEO Kimberly Weaver, and TMA Lobbyists Julie Griffin and Katie Hitt.

TeamHealth founder named top entrepreneur in Southeast Dr. Lynn Massingale, co-founder and executive chairman of Knoxville-based TeamHealth has won the EY Entrepreneur of the Year award for the Southeast region in services category.

Tennessee End of Life Partnership Conference The KAM Foundation’s East TN Quality Alliance Program (ETQA) recently sponsored a conference with the Tennessee End of Life Partnership (TELP) to over 50 healthcare professionals. Speakers included Stephanie Anderson from the Gundersen Health System, Melody Cunningham, MD from Le Bonheur Children’s Hospital, as well our own: Greg Phelps, MD and Annette Mendola, PhD. The topics covered were how does the AD/Living Will relate to the POST, Pediatric POST, Ethics, Goals of Care, CPR and Aggressive Treatment, and Limits of Patient Autonomy.

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ACADEMY NEWS Inherited IRAs and Bankruptcy

Provided by Todd Williams and Travis McCurry of Capital Financial Group Retirement assets like IRA accounts, pensions and 401(k) plans have generally been protected from creditors in the event of bankruptcy. When an IRA account owner dies, his or her designated beneficiary can choose to withdraw the account or maintain the IRA as an “Inherited IRA.” In the case of Clark v. Rameker, 134 S. Ct. 2242 (U.S. 2014), the U.S. Supreme Court unanimously held that IRA accounts passed along to non-spousal beneficiaries are to be treated like any other asset when it comes to distribution to creditors in cases of personal bankruptcy. The Court’s rationale was that the purpose of the bankruptcy exemption for retirement funds is to protect the money for the person who earned the money. Heirs of the person who earned the money were not meant to be protected.

Despite the Supreme Court’s ruling, creditor protection can still be achieved for the portion of the IRA that is passed on to beneficiaries. However, the process to obtain the creditor protection has become more complicated.

Most notably the decision has important ramifications for spouses. The surviving spouse can roll the assets into their own

KAM KNOXVILLE ACADEMY OF MEDICINE

IRA and postpone distributions from a traditional IRA until they turn 70½, unlike other inheritors. Unfortunately, the surviving spouse may have to pay a 10% early-withdrawal penalty, like others, if they take withdrawals before age 59½ from their own IRA. Spouses have much more incentive to do a rollover following the Supreme Court’s recent ruling. Unless the surviving spouse does the rollover, however, the account is considered an Inherited IRA. The surviving spouse would not have to take any money out until the deceased spouse would have turned 70½. But under the recent decision those assets would not seem to be protected in bankruptcy. Spouses now have one more reason, in addition to income tax benefits, to do a rollover.

Another option is to designate an approved IRA trust as the beneficiary of the IRA. Using a trust as beneficiary of an IRA or retirement plan account will let you use the oldest beneficiary’s life expectancy to stretch out the tax-deferred growth. Article written

by Sarah Johnson. Todd Williams and Travis McCurry of Capital Financial Group are Preferred vendors offering discounts to KAM members. They can be reached at (865) 246-1697 or email: tmccurry@financialguide.com / toddwilliams@financialguide.com

In Memorium Henry Abbott Callaway, Jr., MD Blount County Member He received his Medical Docotor degree from Vanderbilt University in 1954 and completed his residency in general and thoracic surgery at Duke University in 1960. Dr. Callaway then returned to Maryville and joined Callaway and Callaway, M.D. He practiced general, thoracic and vascular surgery for thirty-four years. Dr. Callaway helped start the Vascular Lab at Blount Memorial Hospital.

Robert Bruce Whittle, MD KAM member Dr. Whittle received his Medical Doctor degree from the University of Tennessee in Memphis. He served two years in the United States Navy and entered into practice in 1960 in Knoxville until semi-retirement in 1988. He was Chief of Staff at Baptist Hospital in 1975.

He worked since 1991 at InterFaith Health Clinic and also the last several years at the Volunteers In Medicine Clinic in Hilton Head, South Carolina.

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“I wouldn’t be here today if it were not for Dr. Hanna,” says Sandra Gupton. She has been in remission for a number of years and enjoys an active life that includes biking, riding horses and aerobic walking.

Sandra Gupton, R.N.

UTMC Office: 1926 Alcoa Highway Building F, Ste 380 Knoxville, TN 37920 p: 865-544-9171 f: 865-305-6886

West Office: Physicians Plaza 11440 Parkside Dr., Ste 202 Knoxville, TN 37934 p: 865-544-9171 f: 865-305-6886

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LEGAL NEWS

KAM

Quality Review Audits: A Survival Guide

By: Erin B. Williams and Diana L. Gustin, London Amburn, P.C. While most providers are familiar with a private health plan’s audit of paid claims to ensure billing accuracy, fewer are familiar with a quality review audit. Although it might not result in a financial overpayment, a quality review audit can cause a significant impact in reimbursement if a large percentage of the provider’s patients are members of the reviewing health plan.

A quality review audit is a review of the health care provider’s medical record documentation and treatment. An audit may focus on medical records as the provider’s documentation/evidence for meeting the standard of care, compliance with the health plan’s policies and procedures for documentation, and quality of care for the patient. Often, private health plans engage a provider in the same specialty to review the requested medical records and determine whether the patient’s treatment and the documentation meet the standard of care.

Like most audits, a quality review audit typically begins with a request for medical records. When the provider receives such a request, it is absolutely critical to understand the potential consequences that may result. The letter should immediately be brought to the attention of management, who should begin a thorough review and work on coordinating the effort to respond. If the individual under review is a midlevel provider, his or her supervising physician may also receive a similar letter. If medical records are requested, providers should take care to provide the information requested to support the care at issue.

In most situations, a provider will be offered the opportunity to improve upon identified deficiencies and allowed a period of time to initiate corrective action. Then, the payer will conduct a second

KNOXVILLE ACADEMY OF MEDICINE

audit to determine if the provider addressed the deficiencies and made improvement. Providers should make every effort to become educated on how to properly address all of the audit concerns and should consider obtaining their own experts to review the payer’s concerns, the medical records, and to offer advice on how to address the concerns and improve documentation. If a provider shows no improvement after the second audit, the health plan (insurance company) may elect to terminate the provider’s participation contract.

Once a provider’s participation contract is terminated, the provider must quickly determine if there is an appeal process available. Providers may have a limited timeframe to request an appeal. If termination results after a due process review, the action is reportable to the National Practitioner Data Bank. If the provider elects not to use the due process (appeal) mechanism offered, that is immaterial to the mandatory reporting process. So long as such a process is available to the provider before the decision is made final, it is, by law, a reportable event.

The key to surviving a quality review audit is to act quickly and devote the time and attention to the audit response in the beginning stages to avoid termination. If the health plan terminates a provider’s participation agreement, it is extremely difficult to reverse the decision.

The consequences of termination can be disastrous and should be avoided, at all costs.

Attorneys Erin B. Williams and Diana L. Gustin focus their practice on healthcare compliance and regulatory matters. For more information on any health law or compliance matters, you may contact Ms. Williams or Ms. Gustin at (865) 637-0203 or visit www.londonamburn.com.

Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

KAM’s fabulous new Event Calendar!

Explore all the exciting events that the Knoxville Academy of Medicine and our partners have planned for the coming months at KnoxvilleMedicine.org/events. Every month we promote a variety of events of interest to our membership. These range from continuing medical education, KAM, KAMF and community meetings. don’t miss parties and opportunities for networking, important dates for filings and even holidays.

View the events by the month, a list or even by day. Each event has details, links for registration and event maps to the locations.

Take a tour of KnoxvilleMedicine.org today--our new website has so many great features!

If you have an event that you would like included on the KAM Calendar, please email the info to Jonathan Weaver at jweaver@knoxdocs.org

KNOXVILLE MED CINE | 13

TECHNOLOGY NEWS Meeting the Transitions of Care Measure for Meaningful Use By: Leigh Sterling etHIN Executive Director

One of the most important purposes of electronic health information exchange is to facilitate the seamless, secure handoff of patient summary care records between healthcare providers during care transitions. Unfortunately, these important Meaningful Use Transitions of Care objectives may also cause many issues for providers when working to demonstrate the ability to electronically transmit and receive patient information to and from external locations.

Measures 12 and 15 of Meaningful Use state that Eligible Hospitals and Eligible Providers who transition their patients to another setting or provider of care, or who refer their patients to another provider of care, should provide a summary care record for targeted percentages of their patients.

Many of you are involved in transitions of care on a daily basis. Let’s create a scenario for the purpose of this discussion: A patient visits her primary care provider (PCP) for a routine visit. The patient is referred by the PCP to a specialist for a consultation, and a condition is then diagnosed requiring surgery. The patient is subsequently admitted to the hospital for surgery, performed by the specialist. During the post-surgical follow up with the specialist, the patient is instructed to return

to her PCP for follow up care. It is critical to understand that a care transition occurs each step along the way, and each transition requires the exchange of patient information. etHIN’s DirectSX product enables the secure sending and receiving of the patient’s PHI, simply and efficiently, even by clinicians who are not using an integrated EMR solution.

DirectSX is a secure e-mail system designed specifically for the exchange of personal health information and communication between healthcare providers. A low-cost solution, DirectSX also mitigates the risks found in historical methods of exchange, such as faxing, by providing a simple, secure way for participating health care providers to share information directly with one another. Providers using EHR technology and having the ability to create Patient Summary of Care(CCDA) records may be working toward either Measure 12 or 15 of Meaningful Use. DirectSX, whether integrated or portal based, may be used to securely send Patient Summary of Care documents for care transitions and referrals, allowing you to meet those Measures.

If you are looking for a secure method to communicate electronically with your peers regarding common patient care, or if implementing the steps needed to meet Meaningful Use seems challenging, etHIN may be able to help. For more information, contact etHIN at 865-691-8433.

A Little More Conversation Friday, November 7 NV Nightclub 7:00 - 10:00 pm Tickets are $15 or $20 at the door VIP Tickets available for $50 Get your tickets now at knoxvillemedicine.org or call Andrea Southard at (865) 531-2766

14

| KNOXVILLE MED CINE

Conversation ready

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9/23/14 10:45 AM

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See Mercedes-Benz of Knoxville for details. mercedesofknoxville.com | (865) 777-2222 Conveniently located on Parkside Drive * Excludes all options, taxes, title, registration, $925 transportation charge, and dealer prep fee.