Knoxville Medicine

Volum e L X X I, N o. 2 • S u mme r 2 0 1 4

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

CELEBRATING KAPA’S EVENT: THE BOOT SCOOTIN’ BALL

KAM KNOXVILLE ACADEMY OF MEDICINE

Wherever you are in East Tennessee, there’s a great hospital nearby.

Just like we promised.

CovenantHealth.com

Claiborne county hospital | CUMBERLAND MEDICAL CENTER | Fort Loudoun Medical Center | Fort Sanders Regional Medical Center LeConte Medical Center | Methodist Medical Center | Morristown-Hamblen Healthcare System Parkwest Medical Center | Peninsula, a division of Parkwest Medical Center | Roane Medical Center

8300-1223

How do you keep a promise to care for an entire region? It takes a lot of great hospitals – nine so far, and counting. Each one home to top physicians, and all part of one of the nation’s highest-performing health networks. So no matter where you call home, a great hospital is never far away. We promise.

KNOXVILLE ACADEMY OF MEDICINE KNOXDOCS.ORG

PRESIDENT’S MESSAGE

Academy Officers

KAM 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

Design Jonathan Weaver ADVERTISING:

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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

Have you ever had a gun pulled on you and you don’t know what to do? Unfortunately, I have had that experience and that analogy reminds me of an issue we are facing in our region. My personal story you can ask me about when you see me! We in the House of Medicine in Knoxville, TN have the gun of prescription drug abuse pointing at us right now. We have to act fast, we have to think straight, we have to DO SOMETHING or more damage will be done.

We as physicians have for right or wrong allowed the use of prescription narcotics to become ubiquitous and plentiful in our society. We, I think, were sold a bill of goods that these medications were safe and effective, no big deal to prescribe. We have gone down the path of patient satisfaction for better or worse, writing what we perceive people need and in some cases what people want to keep the peace. We have thought nothing of writing a few Lortab here, Percocet there, and throwing in a few Xanax to calm folks down.

But I know the vast majority of us know better and practice better than that. I know many colleagues in our community that are steadfast in their commitment to provide measured care that looks for the best treatment for the individual seated on the exam table in front of them. The problem is some, a few, a very small number of us, do not do that and it is giving all of us a black eye in the larger community. We have had the largest number of pain clinics in one county in the state recently, more than Shelby and Davidson. We have the highest percentage of prescribers out of the top 50 here. Do we have patients with so much pain that only narcotics will do? Is there something different here than most places in the country that people flock here for their pain care?

We at the Knoxville Academy of Medicine are active participants in the Prescription

Drug Task Force that meets monthly at the Academy. We sit with the TBI, DA’s office, Sheriff, KPD police chief, medical examiner, state Department of Health, and the Metropolitan Drug Commission among others to find solutions to this overwhelming problem.

This is the gun in our gut. We are the purveyors of these drugs initially. We have got to get a handle on this now before more harm is done to members of our community and to us as physicians.

I ask that you personally look at your prescribing habits and think does this patient really need this narcotic and/or benzo? Can I make a difference one patient at a time in the fight to bring sanity to the table? Do I know colleagues that need help realizing that they may be a part of the problem and will I sit down and talk candidly about their prescribing practices?

As your president, I have committed along with Karen Pershing, executive director of the Metropolitan Drug Commission, to meet individually with the medical directors of area pain management clinics. I hope to get their help in this fight.

I challenge those of you that prescribe scheduled drugs to review the CSMD website each time you contemplate a scheduled prescription and see if a problem is present. If you provide chronic pain care, will you abide by the new state guidelines that are being put in place? And if we are unsuccessful in reining in the rampant prescription of these medicines, our legal colleagues will be visiting the outliers who skirt the law and raising awareness to a whole other level. We do not want to see physicians, nurse practitioners, and PAs being taken away in handcuffs! So please be part of the solution. Think clearly and move that gun away from us and deescalate the situation. Have a great summer and please know that we are here for you to represent your needs in our local and state communities.

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

In the State Legislative session 2014, KAM achieved several successes, partnering with the TMA and other groups this past year.

Before I detail the accomplishments please allow a brief “legislative primer” for the uninitiated.

Each year the State General Assembly, comprising of 99 representatives in the House and 33 senators in the Senate, meet from midJanuary to about late April to deliberate issues. These members serve us at the State level and are not to be confused with the individuals who serve us at the Federal level (including Senators Lamar Alexander (up for reelection in 2014), and Bob Corker (up for reelection in 2018)).

In Tennessee’s General Assembly much of the work on a bill is done in committee and many bills concerning the “House of Medicine” need to pass through committee prior to getting on the floor for vote. Much of the work ushering, keeping our bills alive and nurturing physician concerns are done by two TMA legislative liaisons. They are Ms. Julie Griffin and Ms. Katie Hitt. They work by testifying for physician’s interests on the hill, and lobbying behind the scene, driving our bills forward. Undoubtedly, many of our bills are stronger if we can partner with other groups such as TNA, TAFP, TACS, THA, TAPA, etc. and their legislative lobbyists. Conversely, our bills may also meet with resistance from lobbyists representing other interest groups. Not infrequently it may take one year to lay the groundwork for a bill, and with perseverance, finally reap its passage after three or more years of “hammering” away for support while neutralizing the bill’s opponents. This takes time and capital. Do not be fooled into thinking “the other doc can take care of these issues while I practice and I do not need to get involved or contribute”.

Legislation

Nothing could be further from the truth. Your money speaks whether given at the IMPACT level or given towards individual contributions and handshakes with your representative and senator from your district. Yes, giving money to your medical subspecialty is no less worthy but these usually serve some interest at the federal level and often interests narrowed to your field of interest. TMA serves to support all physicians in the great state of Tennessee. And in response to those naysayers, there are many issues that unite ALL physicians. Additionally, you would be astonished to find how much influence you actually have as an INDIVIDUAL voice on medical expertise. Remember the average legislator has little more than a high school understanding of medicine and they listen to you!!!!! Kim Weaver or I can help you contact your legislator state representative or senator and develop a relationship. Most will value your input.

TMA has intentionally designed their 2015 stated agenda with the purposed driven goal of decreasing the onerous “Business” of medicine and concentrating on how we can effect change which improves the practice of medicine. The challenges facing medicine today are couched in rising technology and staffing costs, increased downward regulatory pressure from the government, continued litigation pressure and premiums, and declining reimbursement from the insurance industry “bully”. It is no wonder that many physicians are moving toward hospital employment only to find a new set of pressures from employers placing them in clinical conflicts of interest, and pressures to see more for less with hidden contractual points of negotiation.

With these pressures in mind TMA represents physicians.

Prior to outlining our work for 2015 a review of what happened in the 2014 legislative session is in order.

Below is a quick reference for recent legislation, our position, and the outcomes:

Position Outcome

Payer Accountability – SB2427/HB2303 by Senator Bo Watson (R – Hixson) and Representative Jon Lundberg (R – Bristol) – This bill would hold responsible insurers to honor contractual term and amounts of reimbursement and allow only one change per calendar year.

Passed four Committees before being taken off notice in Finance. The bill received support from the house and senate and its potential impact to the insurance industry prompted summer meetings to “tweak” the language for consideration in the 2015 session. This bill is a top priority for TMA 2015.

Peer Review – SB2052/HB1955 by Senator Doug Overbey (R –Maryville) and Representative Vance Dennis (R – Savannah) Brought jointly by TMA and THA. Clarifies that documents as well as discussions in a peer review setting are non-discoverable and participants are immune from liability for good faith efforts.

Also allows Quality Improvement Committees to share information.

Enacted as Public Chapter 0651 effective April 8, 2014.

Healthcare Consumer Right-to-Know Profile – SB1853/HB2171

by Senator Rusty Crowe (R – Johnson City) and Representative Barrett Rich (R – Somerville) This allows physicians to have his or her name removed as “supervising physician” from the DOH profile of any midlevel.

Enacted as Public Chapter 0898 effective January 1, 2015.

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KAM KNOXVILLE ACADEMY OF MEDICINE

Pain Management – SB2000/HB1939 by Senator Ken Yager (R – Kingston) and Representative Bill Dunn (R – Knoxville) As it was originally written physicians writing or dispensing unauthorized prescriptions would possibly have their license suspended and pay a $10,000 fine (guilty or not as in the case of patient fraud and abuse).

Enacted as Public Chapter 0700 effective July 1, 2014. Working with the our legislators we were able to get this civil penalty deleted, and were able to remove the requirement of reporting dispensing to the DOH on line profile except for employees, and streamlined the limits of benzos and opiates to be in line with the Prescription Safety Act of 2013.

Infant CPR – SB1886/HB1788 by Senator Dolores Gresham (R-Somerville) and Representative Jeremy Faison (R-Cosby) – Clarifies when healthcare providers are required to provide a prenatal patient or caregiver of a newborn information on infant CPR in an effort to improve the timing and effectiveness of the education.

Enacted as Public Chapter 0594 effective July 1, 2014.

Reports from CSMD to be part of the Medical Record – SB1630/ HB1426 by Senator Mark Norris (R –Collierville) and Representative Gerald McCormick (R – Chattanooga)

Enacted as Public Chapter 0622 effective July 1, 2014.

Limits on Pseudoephedrine Products – SB1751/HB1574 by Senator Mark Norris (R-Collierville) and Representative Gerald McCormick (R-Chattanooga) Bills were introduced to address the methamphetamine epidemic in our state. TMA’s main concern was helping restrict abuse without restricting access to the average citizen.

Worked W/ Administration Opposed as Filed

Enacted as Public Chapter 0906 effective July 1, 2014. The present version was amended in conference committee to limit the purchase of the drug to 5.76 grams per month and a total of 28.8 grams per year before a prescription would be required.

Utilization Review/Prior Authorization – SB1142/HB0926 by Senator Mark Green M.D. (R-Clarksville) and Representative Glen Casada (R-College Grove) – Requires utilization review of prior authorizations to be compliant in giving the providers access to all guidelines used in PA determinations and if the evidence based standards used for PA on any treatment, test, imaging are unavailable then only a licensed physician can deny coverage.

Enacted as Public Chapter 0731 effective January 15, 2015.

Motorcycle Helmet Repeal – SB0548/HB0044 by Senator Mike Bell (R-Riceville) and Representative Cameron Sexton (R-Crossville) – Permits motorcycle operators to ride without a helmet if certain requirements are met.

Failed in Senate Finance, Ways & Means Committee on a 5-6 vote

Optometry Bill – SB0220/HB0555 by Senator Doug Overbey (RMaryville) and Representative Vance Dennis (R-Savannah) – this bill that would allow broadly defined surgical procedures to be performed by optometrists. The optometry lobby has long petitioned for surgical privileges.

Enacted as Public Chapter 0638 effective April 8, 2014. We successfully amended the bill to limit them to the six procedures they currently perform.

LET’S HEAR IT FOR TEAMWORK! The ID Bill was drafted by a joint prescription drug task force with the Knoxville Academy of Medicine and the Metropolitan Drug Commission with help from Rep. Bill Dunn, local law enforcement, Tennessee Bureau of Investigation, and the Tennessee Department of Health.

The law establishes identification requirements for picking up certain prescription medications to reduce prescription fraud and abuse.

KNOXDOCS.ORG

In Attendance: Governor Haslam, Mitchell Mutter, MD, Phil LaFoy, Kimberly Weaver, PhD, Karen Pershing, Sharon Davis, Elise Denneny, MD, Chief David Rausch, Senator Randy McNally, and two representatives from the Knox County Sheriff’s office.

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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.

THUY L. VU, M.D.

DIAGNOSTIC RADIOLOGY Vista Radiology 2001 Laurel Ave Ste. 304 Knoxville, TN 37916 (865) 595-4100 Transferred from Nashville Academy of Medicine ________________________________________________

MELISSA CHILES, MD PATHOLOGY Parkside Pathology, PLLC 139 Fox Road Knoxville, TN 37922 (865) 474-8866

WALTER CHILES, MD

UROLOGY University Neurosurgery 1932 Alcoa Highway, Suite 580 Knoxville, TN 37920 ________________________________________________

KEITH DEMOND GRAY, MD GENERAL SURGERY University Surgical Oncology 1926 Alcoa Hwy., Ste. 330 Knoxville, TN 37920

________________________________________________

LEONARD W. BROWN, MD OTOLARYNGOLOGY Farragut ENT 1201 W Point Drive Ste. 103 Knoxville, TN 37934

FROM TOP LEFT TO RIGHT: Thuy L. Vu, MD, Melissa Chiles, MD, Walter Chiles, MD, Keith Demond Gray, MD, Leonard W. Brown, MD.

New Resident Members Victor Henry-Loch Gordon, MD Patrick David McFarland, MD Reem Adel Hussein, MD Daniel Harmon Snyder, DO Brady Cole Seaton, MD Timothy Day Williams, DO Hillary Ann Haley, MD Jaime Claudette Morris, DO Kelly Michelle Schwirian, MD Loman Collin Trover, MD Amar Parikh, MD Cody Gene Stroupe, MD David Earle Smith, MD Kyle Robert Christopherson, MD Daniel Thomas Sandlin, MD David Matthew Marvin, MD Tamer M. Hadi, MD Xi Zhang, MD Diane Marissa Gaydos, DO Shelly Marie Compton, MD Aimee Allison Wehber, MD Roy Adam Ferraiuolo, MD Katoura Rose Williams, DO Tara Renae Samples Shields, MD Marcum Wesley Collins, MD

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David Scott Parks, MD Kathleen Hamrick, MD Jeffrey N. Mahony, MD Rafael Alba Yunen, MD Mike Phillip Bramati, MD John Busigin, MD Miles Landry, MD Emily Anne Pospiech, MD John Mark McLain, MD Alexander Carl Cavalea, MD Oladapo Oshikoya, MD Branson William Hyatt, MD Stephen Parker, MD Michael O. Jennings, MD Jonathan Travis Williams, DMD, MD Michael Ryan Buckley, MD Roy Franklin Roberts, Jr., MD Mohamed Osman, MD Megan Rebecca Wilson, MD Suneeta Acharya, MD Peter Coulson, MD Steven James Massaro, MD Kristen A. Stancher, MD Fred Brandon Sammons, MD

Strength in Numbers IF any of your colleagues are not

members of KAM, please stress the importane 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.

KAM ETQA - Conversation Ready

Can I Just Have a Few Words With You? By: Gregory Phelps, MD Three surveys- First, a survey by the Center for the Advancement of Palliative Care (2011) surveyed 800 seriously ill people.

They found out one of their top complaints was that they didn’t know what to do when they got home from the doctor’s office 51% of the time. Given that Docere, the Latin root for doctor, means teacher, that means we fail more than we succeed. A second survey, by the California Healthcare Foundation (2012), says 95 percent of patients would like to talk to their doctor about their advance care desires but only 8 % have ever had a doctor ask them about that. Finally, a study (2013) on cancer care, done by the Institute of Medicine, said that patient’s first two desires were: 1. “Listen to me.”

2. “Tell me the truth about diagnosis and prognosis even if it is unpleasant and uncomfortable.”

After the death of her mother, Ellen Goodman, Pulitzer Prize winning columnist of the Boston Globe, realized how much stress she went through wondering what her mother would have wanted.

“We talked about everything except one thing: how she wanted to live at the end of her life.”

Out of that experience in 2010 was born the Conversation Project, an effort to promote conversations about living into the end of life. In 2014, the Institute of Healthcare Improvement adopted the Conversation Project as a quality initiative to change our death denying culture to be “Conversation Ready” about “What Matters.”

In this context come three actions: Engage Patients, Steward their Plans and Respect their wishes at end of life. As one wag com-

KNOXVILLE ACADEMY OF MEDICINE

mented: “At present, we are perfectly prepared for something totally predictable.”

The Knoxville Academy of Medicine Foundation has enrolled as a pilot site in one of 23 sites across the US where the Institute for Healthcare Improvement is engaging in Conversation Ready. The collaborative project involves area hospitals, providers and other institutions.

The IHI is very data driven, so the project includes, frequent evaluations of current state and interventions for improvement.

The physicians and staff involved are also heavily involved in education oriented towards the providers, the community and patients.

The goal is to make advance care plans as much a part of the medical record as allergies.

Conversation Ready is also collaborating with etHIN to work towards ensuring advance directives show up in community medical records. In Lacrosse, Wisconsin, where a very similar project has been running for 25+ years, the effort shows results that include close to 90% of the community having advance directives.

Nationally, a patient averages over 30 days in the hospital in their final two years of life, in Lacrosse, the number is 13 days. Spearheaded by the Gundersen Clinic, the protocol there calls for three “asks.” Once when the patient is young and healthy, again with age > 55 or onset of chronic illness and a third time when a potentially life ending illness is encountered.

The Knoxville Academy of Medicine is very pleased to be part of this national pilot program.

For additional information please check with the Knoxville Academy of Medicine or see the following sites: IHI.org, conversationproject.org, endoflifecaretn.org.

One final question: Have you documented your own care wishes?

Members of the Conversation Ready project

Back row left to right: Leigh Sterling, Marty Prince, MD, Annette Mendola, PhD, Lynn Osterlund, MD, Jack Lacey, MD, David Wooten, MD Front row left to right: Becky Dodson, Greg Phelps, MD, Jacque Prince

KNOXDOCS.ORG

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ACADEMY NEWS KAPA’s Bootin’ Ball April 4, 2014

KAPA’s Boot Scootin’ Ball THANK YOU! Diamond Sponsors • Covenant Health • Tennova Healthcare • UT Medical Center • Bandit Lights Media Sponsors • WBIR • MerleFM Gold Sponsors • Priority Ambulance Silver Sponsors • Abercrombie Radiology • Home Federal Bank • Hanna Cancer Associates

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KAPA’s Boot Scootin’ Ball brought Montgomery Gentry to Knoxville for one of East Tennessee’s premier fundraisers. Country Music, Western dancing with plenty of good food and drink made Knoxville Area Project Access’ Third Annual Boot Scootin’ Ball a great party for a great cause. Montgomery Gentry, the country duo from up the road in Kentucky brought the crowd to its feet and on the dance floor.

“I think everybody was excited about seeing Montgomery Gentry.” said Kim Weaver, CEO of the Knoxville Academy of Medicine.

“We were thrilled that they were here with us and that they did their full show.

We had lights, smog-- the whole works! It was a real premier event for Knoxville.

It was a great party. More than 300 revelers had the opportunity to enjoy the concert, dinner, their bottomless beer mugs and bid on dozens of donated items in a silent auction to help Knoxville Area Project Access (KAPA) provide health care to low income and uninsured residents of Knox County.

We could not do this event without the sponsorships, in-kind gifts, teamwork and overall support of so many of you in the medical community.

Already planning for and looking forward to next year-- Yee-haw!

KAM KNOXVILLE ACADEMY OF MEDICINE

KNOXDOCS.ORG

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Proudly serving Tennessee physicians for over 35 years.

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Today SVMIC insures over 14,000 physicians in seven states and exists to serve you, the physician, with a mission that recognizes the importance of the participation of physician policyholders in keeping our company strong.

Mutual Interests. Mutually Insured.

Contact Deborah Hudson at deborah.hudson@svmic.com or call 1-800-342-2239.

Follow us on Twitter @SVMIC

www.svmic.com

ACADEMY NEWS

KAM KNOXVILLE ACADEMY OF MEDICINE

Summer Welcome Picnic

We had some ugly weather on our original date, but we won't let it rain us out completely! You are invited to join us for the RESCHEDULED “Summer Welcome Picnic,” the inaugural picnic for young physicians and their families, cohosted by the Knoxville Academy of Medicine and the Knoxville Academy of Medicine Alliance and sponsored by the Tennessee Medical Association. The event will be held at the lower pool area of Gettysvue Country Club, located at the corner of Westland Drive and Gettysvue Way. Enjoy an opportunity to meet fellow physician families in a casual setting including food from Backyard Burgers, live music and a playground for kids. We look forward to seeing you there!

August 22nd - 6-9 pm Gettysvue, Lower Pool Area If you are able to attend, please RSVP by Monday, August 18th, 2014.

RSVP to Andrea Southard with full names asouthard@knoxdocs.org (865) 531-2766

East TN Women’s Medical Society

The July Women in Medicine meeting was hosted at the home of Rosanne Barker, MD. Richard Briggs, MD, Past KAM President who is running for State Senate, was the special guest speaker. The evening consisted of delicious summer appetizers and wine as well as lively discussion on education.

Stan Brock - Community Service Award

KAM staff was in attendance as TMA honored the tireless work of Remote Area Medical (RAM) with the Community Service Award during the TMA Convention. The award was presented to Stan Brock, the founder and president of RAM. Brock founded RAM in 1985 to help provide free healthcare, dental care and eye care to underserved people in remote areas of the US through two-day "pop-up" clinics. Because of their efforts, the State of Tennessee changed laws to allow medical volunteers to perform services at RAM clinics with their home state licensure. This has opened the door for other qualified medical professionals to serve in areas of need away from home.

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OUR COMMUNITY. OUR PRIORITY.

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OUR MISSION. At Priority Ambulance, we provide the highest standard of excellence for emergency and nonemergency medical transport to Knox, Blount and Loudon counties.

OUR TECHNOLOGY. Our Mercedes-Benz ambulances are the most advanced emergency vehicles on the road and are stocked with the latest technology, such as LIFEPAK cardiac monitoring devices.

OUR EXPERIENCE. Our management team has more than 400 years of combined experience in East Tennessee medical transport operations. Our EMTs and paramedics are trained in the latest medical protocols.

OUR COMMITMENT. We showed our commitment to East Tennessee by locating our national headquarters in Knox County. We are the only national ambulance provider based in East Tennessee.

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LEGAL NEWS

KAM KNOXVILLE ACADEMY OF MEDICINE

Medicare Math Statistical Sampling and Extrapolation = Million Dollar Debts By: Diana L. Gustin, London & Amburn, P.C. While a malpractice verdict may be covered by an insurance policy, a multimillion dollar Medicare overpayment could sink your practice before you have your day in court. The reason is the use of statistical sampling and extrapolation, which allows Medicare to review a sample of claims and estimate an overpayment that could result in a million dollar overpayment.

Statistically Valid Random Sampling (“SVRS”) is used to permit HHS to audit a relatively small sample of claims and project the findings from the review to a specific time period. For example, 60 claims which total $6,000 in reimbursement might be selected for review. The “universe” of claims being reviewed might be a three year time period during which Medicare paid a provider $1 million per year. If half of the claims in the sample are denied (considered to have been paid in error) the “error rate” of 50% would be established. Medicare would then project that error rate to the total amount paid for the three year time period and estimate an overpayment of approximately $1.5 million.

Although it was challenged in the federal court system in the 1990’s, the D.C. District Court upheld the Secretary of Health and Human Services’ right to use statistical sampling instead of a claim by claim review. Passed in 2003, Section 935 of Medicare Modernization Act states that there is a limitation on the use of extrapolation: a Medicare contractor may not use extrapolation to determine an overpayment unless the Secretary determines that there is a sustained or high level of payment error or there is documented educational intervention which has failed to correct the payment error. However, as the statute is currently written, there is no review – judicial, administrative, or otherwise – of the Secretary’s determination of a high or sustained payment error. To date, plaintiffs who sought judicial review of this issue have been turned away by the Courts.

The potential for devastating financial impact on your medical

Stay Connected

practice cannot be emphasized enough.

Extrapolated overpayment calculations can result in million dollar overpayments which must be repaid to Medicare within thirty days of the demand letter (unless a valid and timely appeal is filed or an extended repayment plan approved). Moreover, a physician or medical practice has the burden of demonstrating that the denial of claims is wrong, or that the overpayment calculation is incorrect. The first level of appeal is a Redetermination by Medicare, the second level of appeal is a Reconsideration by a Qualified Independent Contractor, and the third level appeal is the Administrative Law Judge Hearing. Federal Court level judicial review does not occur until there is a final administrative determination.

The repayment is due (with interest) while the appeal is pending.

If a Medicare request for medical records is received, practice management must be involved along with the physician leadership. Careful consideration must be given to the content of the request and the deadlines for response. Any type of Medicare audit or review should be addressed promptly by management and, if necessary, legal counsel should be retained. Requests for records may be based upon patient complaints, data analysis or areas of concern within a given specialty. In certain cases, suspension of Medicare payment may be threatened, while other letters may indicate a routine review for compliance. Keep in mind that any medical record review may ultimately lead to extrapolation of the error rate which could result in a devastating debt that must be repaid or appealed.

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

Diana L. Gustin is an attorney at London & Amburn, P.C. in Knoxville, Tennessee. Ms. Gustin has over 30 years’ experience in healthcare reimbursement and compliance matters. She has extensive experience with Medicare cost report appeals at the Provider Reimbursement Review Board; Medicare claims disputes and the administrative appeal process including Hearings before numerous Administrative Law Judges from the Office of Medicare Hearings and Appeals; private payor reimbursement disputes involving Arbitration; as well as consultation with health care clients concerning HIPAA, Stark, False Claim Act, and Credentialing issues. She chairs the firm’s Government Private Payor Reimbursement Claims Defense practice group and co-chairs the Healthcare Compliance, Regulatory Matters, HIPAA, Peer Review, and Managed Care practice group.

We have been busy at KAM this summer sprucing up our look!

The new logo is clean, modern and easily recognizable. We have started integrating it into social and printed materials and have received positive feedback from many of you.

We want to stay connected and keep you current on important news and events . . .

And we hope you’ll share your news and events with us too!

So be sure to like us on Facebook and follow us on Twitter!

We hope that you enjoy the new Knoxville Medicine magazine —We surveyed you several months ago, and we listened. We have re-imagined this publication from the ground up. More color, more images and more info that matters to you.

Keep your eyes out for the new modern KAM website as well. You will be able to pay your dues on-line and easily navigate to areas of interest.

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TECHNOLOGY NEWS etHIN Launches Image Exchange Technology Immediate Access to Diagnostic Quality Medical Images from across the etHIN Community By: Leigh Sterling Community-wide image sharing is coming to East Tennessee! East Tennessee Health Information Network (etHIN) recently selected eHealth Technologies (www.ehealthtechnologies.com) as its technology partner for the exchange of images across the 19-county etHIN region. etHIN chose Image Exchange as its newest service offering based on community need. Image exchange has the capability to save time for providers by allowing immediate access to recent and prior imaging studies from external sources. It can also help reduce healthcare costs by eliminating unnecessary duplicate imaging procedures, which ultimately improves patient safety by eliminating unnecessary radiation exposure.

Common problems of lost or non-viewable CDs and large file transfers are eliminated with this solution. Images in the HIE are available when and where they’re needed, potentially saving significant healthcare dollars.

Images that traditionally take hours to days to obtain from off-site locations will be available to participating providers within seconds through the HIE. With a single click from a connected EHR or etHIN’s Virtual Health Record, partici-

Calendar of Events AUGUST 18 Drug Task Force Meeting, 6:00 pm 20 TMA Clinical Documentation Workshop,

pating providers can view images on eHealth Technologies’ zero-foot print Health Viewer® ZF diagnostic quality image viewer.

In addition to viewing images, a real-time collaboration feature allows multiple clinicians to collaborate on the same imaging exam from wherever they are.

Authorized users within the HIE can quickly access images from different PACS located at any imaging provider that participates in etHIN. Images from participants anywhere in the HIE region, including EKG waveforms, x-rays, MRIs, CT scans, ultrasounds, and any other DICOM images, will be available in full diagnostic quality at any time, from any computer that has a secure internet connection.

Participating providers will be able to view images as part of their patients’ records through the community-wide Virtual Health Record (VHR), etHIN’s Clinical Inbox, and even from their own EHR system when it is connected to etHIN by an interface.

The image sources for the HIE will include Covenant Health, UT Medical Center, East Tennessee Children’s Hospital, and others as providers are added to the exchange. The initial images are expected to be available for viewing by etHIN’s participating providers beginning mid-summer. The implementation timelines are still being determined. After these image sources are available in the HIE, more real-time information and even greater value for HIE participants can be realized.

Register today for Fall OSHA! Two Options:

ETCH, Schmidt Room, Managers/Staff 12:00 - 3:00 pm, Physicians 5:00 - 8:00 pm

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Summer Welcome Picnic, Gettysvue Country Club, Lower Pool, 6:00 - 9:00 pm

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Tennessee End of Life PartnershipConference UTMC, 8:30 am - 2:00 pm

SEPTEMBER Labor Day - KAM closed 1 2 KAM Board Meeting, 6:00 - 8:00 pm OCTOBER 9 OSHA, Knoxville Marriott, 8:00 - 10:30 am or 6:00 - 8:30 pm

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| KNOXVILLE MED CINE

Thursday October 9, 2014 8:00 am - 10:30 am Breakfast will be served

 New Location 

OR

Thursday October 9, 2014 6:00 pm - 8:30 pm Dinner will be served

Only $89 per person

Knoxville Marriott 501 Hill Avenue SE Knoxville, TN 37915

To register call or email Andrea Southard at (865) 531-2766 or asouthard@knoxdocs.org

ONE ACADEMIC MEDICAL CENTER. SIX CENTERS OF EXCELLENCE. ADvANCED ORThOpAEDIC CENTER Dedicated to providing comprehensive orthopaedic care, our multidisciplinary team of orthopaedic specialists has earned the Joint Commission’s Gold Seal of Approval for knee and hip replacement. ®

BRAIN & SpINE INSTITuTE An expert team of neuroscience specialists provides the most advanced healthcare in East Tennessee. Certified as a Comprehensive Stroke Center, the institute has the experience to care for the most complex strokes.

CANCER INSTITuTE Hope is here, with an integrated approach to cancer diagnosis, treatment, support and patient assistance provided by board-certified cancer specialists, dedicated nurses and skilled health professionals—all in one location.

EMERgENCy & TRAuMA CENTER As the only Level I Trauma Center featuring a team of trauma surgeons and clinical staff on-site 24/7/365, we are equipped to handle any level of severity of trauma or accident for residents throughout Knox County and the surrounding 21-county region.

hEART LuNg vASCuLAR INSTITuTE With its focus on comprehensive chest and vascular care, the Institute provides the latest in technology and treatment from multidisciplinary teams of cardiologists, pulmonologists, cardiac and vascular surgeons, and researchers.

WOMEN & ChILDREN’S hEALTh This Center offers comprehensive services for women and newborn infants. With a designated Level III private room Neonatal Intensive Care Unit (NICU), it’s the only state-designated perinatal center for high-risk pregnancies in the region.

As the only academic medical center in the region, we had a choice to make. And we choose excellence, creating six Centers of Excellence, each focused on a critical area of medicine. As a result, you and your family can enjoy the best in healthcare. Because we know each patient has different healthcare needs.

And it takes an academic medical center with six Centers of Excellence to care for all of them.

1-877- u t c a r e s utmedicalcenter.org

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5/9/14 | 9:55 AM 13 KNOXVILLE MED CINE

The best grill in town has something new on the menu.

AN UNLIMITED MILEAGE WARRANTY When you choose a Certified Pre-Owned (CPO) Mercedes-Benz, you get much more than an extraordinary automobile. You get industry-leading coverage -- which now includes unlimited mileage with all CPO warranties.

Membership has its rewards.

Ask us about Fleet Incentives from Mercedes-Benz of Knoxville.

See Mercedes-Benz of Knoxville for details.

mercedesofknoxville.com | (865) 777-2222 Conveniently located on Parkside Drive