Knoxville Medicine Magazine - Spring 2015

Vol um e L X X II , No . 1 • S p r in g 2 0 1 5

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

KAPA’S BOOT SCOOTIN’ BALL FEATURING THE CHARLIE DANIELS BAND KNOXVILLE MARRIOTT, APRIL 24, 6:30 PM

FEATURED NEWS: Page 5 • PITCH 2015 • KAM Celebrates New President with Inaugural Party • Leonard Brabson, MD receives McCain Fellowship Award

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There’s no such thing as a HIPAA-compliant app Secure all modes of clinical communication

HIPAA compliance is not just simply buying and installing a specific technology – it is about assessing the risks to your organization and then developing and implementing a strategy to monitor those risks.

PHYSICIANS AND CLINICIANS USE MANY MODES OF COMMUNICATION: real-time calls

paging email

text messaging voice messaging

SMS messaging fax

Protected health information (PHI) moves along ALL of these pathways.

PerfectServe can help secure your clinical communications and reduce your HIPAA compliance risk.

Visit perfectserve.com to find out how PerfectServe turns mobile apps, pagers, texting, websites, answering services, switchboards and call centers into one powerful, secure, streamlined communications network. perfectserve.com 866.844.5484

KNOXVILLE ACADEMY OF MEDICINE

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Academy Officers Thomas Pollard, MD PRESIDENT

Neil Coleman, MD PRESIDENT ELECT

Ceeccy Yang, MD SECRETARY

Jack Benhayon, MD TREASURER

Pat O’Brien, MD

IMMEDIATE PAST PRESIDENT

Kimberly Weaver, PhD CEO

Board of Trustees David Harris, MD Ed McBride, MD Clifton Tennison, MD Tim Wilson, MD

Ex- Officio Board Members Randal Dabbs, MD Richard Briggs, MD Richard DePersio, MD John W. Lacey, III, MD Robert Page, MD Cynthia Gash - KAMA Rep.

Publisher Kim Weaver, PhD

Editor Julie Morris

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

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PRESIDENT’S MESSAGE By: Thomas Pollard, MD I consider it an honor to have been chosen as your President for the coming year, actually, two years! During my tenure as a trustee for Knoxville Academy of Medicine Board of Trustees, I have had the privilege of serving with a tremendous group of physician leaders.

Not the least of these is our outgoing President, Dr. Pat O’Brien. Pat’s efforts to insure the quality and ethical functioning of regional pain clinics has protected the reputation of our physician community and enhanced care for our patients. Pat accomplished all of this while continuing his service in the military reserve, and, starting a new business. If you get a chance, drop in to the Casual Pint in Farragut to thank him for his service!

Another physician with whom I have had the privilege of working is Dr. Richard Briggs. Rick has been a mentor to me both as a surgeon and a physician leader. I’d have to admit that as a group, cardiac surgeons tend to be “nocturnal” and don’t get out much. Rick, on the contrary, has been the poster child for medical leadership at both the local and state levels.

He has shown to me how important it is to be aware of the political decisions that impact the way in which we practice medicine everyday.

Now as a senator in the Tennessee State Legislature, Dr. Briggs continues to advocate for the issues important to East Tennessee physicians.

A number of bills of importance to East Tennessee physicians will be voted upon in the upcoming legislative session. Perhaps the most concerning of these is SB680 which dramatically changes the way in which advanced practice nurses (APNs) will be allowed to practice. This bill would allow APNs to “diagnose and treat”, a privilege normally subject to the oversight of physicians. It also liberalizes prescribing abilities. Ultimately, the bill allows for APNs to practice independent of physician supervision following a short period of collaborative practice.

Other bills of concern include SB925 which would allow motorcycle drivers and passengers

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KNOXVILLE ACADEMY OF MEDICINE over age 21 with proper insurance to ride without a helmet. This proposal has been put forth despite a multitude of evidence showing increased numbers of head injuries and death among unhelmeted riders. Bill SB764 extends the statute of limitations from one year to three years for personal injury causes of action including medical malpractice and would certainly undermine much of the progress that has been achieved by the TMA in tort reform.

It is clear that now, more than ever, physician involvement is needed in the legislative process. On March 3rd, Tennessee physicians were invited to meet directly with lawmakers to discuss these and other medical concerns. If you were unable to take advantage of this opportunity, I encourage you to take the time to call your representative and express your opinion.

I thank you once again for the opportunity to serve you over the next two years!

Tommy

Calendar of Events MARCH Doctor’s Day Luncheon, 30 Lakeside Tavern, 11:30

APRIL 9-12 MedTenn15, Gaylord Opryland Resort & Conference Center

24 MAY 7

KAPA’s Boot Scootin’ Ball Knoxville Marriott, 6:30 pm The Charlie Daniels Band

Spring OSHA, Knoxville Marriott 8:00 am - 10:30 am, 6:00 pm - 8:30 pm

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ACADEMY NEWS Congratulations Dr. Leonard Brabson

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At the 2/22/2015 Interim District VII Meeting for the American Congress of Obstetrics & Gynecology (ACOG) in New Orleans it was announced that Dr. Leonard A. Brabson was awarded a John McCain Memorial Fellowship for 2015. Out of 50,000 OBGYNS in the US, only two are selected for this honor. Dr. Brabson will spend 2-4 weeks this year at the national headquarters of ACOG in Washington, DC. The Fellowship affords the recipient insight into the programs, policies, and interrelations of the executive and legislative branches of the federal and state governments.

Highlights include: • Meetings with lawmakers and staff • Attendance at legislative hearings on issues of interest to the specialty • Interaction with officials of regulatory agencies • Meetings with representatives of medical groups and other allied organizations The John McCain Memorial Fellowship provides selected ACOG Fellows with firsthand exposure to policy development and the legislative process in the federal and state governments. The award was founded in 1981 in memory of Dr. John McCain, a strong advocate for ACOG’s Government Affairs program.

KAM Celebrates New President with Inaugural Party On January 23rd, Dr. Pat O’Brien passed the reigns of KAM to the new president, Thomas Pollard, MD at the Inaugural Party held at The Foundry. The party continued with lively music

by Remedy, dancing and fun!

Dr. Pollard specializes in Cardiovascular Surgery and is a physician at East Tennessee Cardiovascular Surgery Group. Dr. Pollard has been a member of the Knoxville Academy of Medicine and the Tennessee Medical Association for almost 20 years. He will be serving as KAM president for a 2 year term.

A Big Thank You to SVMIC for sponsoring the party and additionally everyone who attended and made this a successful event!

For more information about upcoming events, check out our online events calendar on our website at knoxvillemedicine.org.

PITCH 2015 We had a great turnout for PITCH (Physicians Involved in Tennessee’s Capitol Hill) this year! On March 3rd, physicians and spouses from Knoxville and across the state traveled to Nashville to discuss important issues regarding health with legislators. This year’s hot topics involved payer accountability, addiction treatment, physician-led team-based care, and nurse independent practice. Our physicians were able to have meaningful discussions with area legislators as well as, other legislators from around the state.

If you were unable to participate this year, please plan to join your colleagues for PITCH 2016 and let your voice be heard! This is a great time for Knoxville Academy of Medicine members to speak with a unified voice to our elected officials.

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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.

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JASON BUEHLER, MD

CHRISTINE ORMSBY, MD

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CAROLEE CUTLER PECK, MD

BRADLEY PEARMAN, MD

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ASHLEY HAMBRIGHT, MD

JACE PERKERSON, MD

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CHRISTOPHER KLUGEWICZ, MD

QUYN S. RAHMAN, MD

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JEFFREY W. MARTIN, MD

STEPHANIE S. SHULTS, MD

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KABEL MORGAN, MD

BRANDON SMITHEY, MD

ANESTHESIOLOGY University Anesthesiologists 1924 Alcoa Hwy U-109 Knoxville, TN 37920

RADIOLOGY Association of University Radiologists 5401 Kingston Pike Ste 540 Knoxville, TN 37919

OPHTHALMOLOGY Southeast Eye Specialists 1400 Dowell Springs Blvd Ste 310 Knoxville, TN 37909

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OPHTHALMOLOGY University Eye Surgeons PC 1928 Alcoa Hwy Ste 324 Knoxville, TN 37920

ANESTHESIOLOGY University Anesthesiologists 1924 Alcoa Hwy U-109 Knoxville, TN 37920

ANESTHESIOLOGY University Anesthesiologists 1924 Alcoa Hwy #U-109 Knoxville, TN 37920

CARDIOVASCULAR DISEASE Statcare Hospitalist Group 2240 Sutherland Ave Ste 103 Knoxville, TN 37919

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DERMATOLOGY Anderson and Rahman Dermatology 6311 Kingston Pike Ste 21E Knoxville, TN 37919

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Left Column Top to Bottom: Jason Buehler, MD, Carolee Cuter Peck, MD, Ashley Hambright, MD, Christopher Klugewicz, MD Center Column Top to Bottom: Jeffrey W. Martin, MD, Kabel Morgan, MD, Christine Ormsby, MD, Bradley Pearman, MD Right Column Top to Bottom: Jace Perkerson, MD, Quyn S. Rahman, MD, Stephanie S. Shults, MD, Brandon Smithey, MD

PEDIATRIC EMERGENCY MEDICINE Align MD 14 Market Square Ste 201 Knoxville, TN 37902

PEDIATRICS Shults Pediatrics PC 9142 S Northshore Drive Knoxville, TN 37922

ANESTHESIOLOGY University Anesthesiologists 1924 Alcoa Hwy U-109 Knoxville, TN 37920

PATHOLOGY Pathology Laboratories West 9303 Park West Blvd Ste 200 Knoxville, TN 37923

Strength in Numbers Reminder!

2015 Membership Dues are due by March 31, 2015.

Pay dues online at knoxvillemedicine.org 6

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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 • Current information via e-mail, Legistats,

and quarterly magazine

• • • •

CME Programs Outreach Programs like KAPA Special Events Annual Pictorial Membership Directory

For information on how to join, please contact Danielle Sims at ddufur@knoxdocs.org or (865) 531-2766.

KAM TAG You’re It!

By Matt Mancini, MD I was asked by the TMA leadership to participate recently in one of the TAG meetings at the Bureau of Tenncare on Laproscopic Cholecystectomy. Believe me, taking off three Thursdays and driving to Nashville to meet TennCare officials was not my idea of a good time.

But the opportunity to shape how general surgeons will soon be graded was too important to pass on. The first meeting engaged 15 surgeons from around the state as well as representatives from the major insurers. The first meeting everyone was on edge. We were not sure how

Resident’s Message

By: Niva Misra-Sammons, MD PGY2 (2nd Post-graduate Year) Internal Medicine Resident UT Graduate School of Medicine, Dept. of Medicine When it comes to medical education, there are many evolving factors. These include the ability to practice procedures on a simulation laboratory patient and the use of new medications to benefit patients.

While we are fortunate to be practicing medicine in an era with so much change, there are certain factors that will never change. Throughout medical school and into residency, the one factor that helps us to become successful and competent physicians is mentorship. Each of us is impacted by other physicians that teach us, treat us with respect, and act as role models for what we want to strive to be like. The role of mentorship may start early on, such as what I have experienced in my family, with my older sister and my late father as physician role models.

I was also fortunate enough to develop relationships in high school and college from participating in the Medical Explorations program at UT Medical Center. Many of those physicians that I met were willing to write recommendation letters for me in order to help me reach my goal.

Two of them that I have known since that time, one a currently practic-

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the process would work and definitely opinionated about how it will be difficult to implement. We began by explaining how different acute cholecystitis diagnosed in the hospital was from symptomatic cholelithiasis seen in the office setting. It was reassuring to see each week our ideas shape the score card. After three meetings we had definitely impacted what metrics would be used in this episode of care. Although I have concerns that the data collection will still have flaws, I hope this will not be as penalizing as many first thought. I would encourage all physicians to be involved in this process. If we are to be graded, we need to help shape the report card.

ing cardiologist and one who is a now retired pulmonologist, would often simply tell me throughout the years, “I’m proud of you”. It’s amazing how much that helps a young physician move forward. Many of the professors and physicians at my medical school spent their time and energy to help enrich the learning of myself and my peers in order to help us move forward. Their positive feedback and beliefs in me had a definite influence on my decision to go into an Internal Medicine Residency. Now, as I am halfway through my residency, I continually depend on mentorship and the kindness of attending physicians around me. Many of the attendings on the General Medicine and Ambulatory Clinic services, the Critical care service, Specialty electives, and the Residency program director and Chairman have made a positive impact on the kind of physician I will become. Those that have taken extra time to teach, those that have stayed late at night to help manage sick patients, and those that come to our presentations and help us to prepare, all make an impact on us. On our worst days, it is those attendings that consistently believe in us and help us see past the small things and look to the larger picture that help us get through. Every attending physician that works with us makes an impression in some way. It is those physicians that believe in you and help you learn from your mistakes in a kind and caring way that breeds success.

KAM’s fabulous 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 events and opportunities for networking, and important deadline dates.

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.

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

KNOXVILLEMEDICINE.ORG

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ACADEMY NEWS Legislative Report

By: Elise Denneny, MD

The TMA Legislative Committee continues to work on three main issues. The first is payor accountability which strives to hold third party payer to contractual agreement and limits arbitrary changes in reimbursement for services rendered.

For the past two years legislation has passed bills to tighten regulation on pain pill treatment centers in effort to close the “pain pill mills” while not increasing undue regulation on legitimate pain clinics. As you are aware pain addiction is a multifaceted problem. This year the committee is focusing on eliminating barriers for those who need pain addition help.

Remember that a significant percentage of pain medications find their way on the street via a “friend’s” medicine cabinet ...leftover from treating another condition.The recent State practice guidelines for pain management address the scope of chronic nonmalignant pain. http://agencymeddirectors.wa.gov/mobile.html. A helpful site to have on your desktop is the http://agencymeddirectors.wa.gov/mobile.html which will convert pre-

From the TMA web site: 2015 TMA Legislative Package Payer Accountability Atop the TMA’s list of priorities is the return of Payer Accountability.

The purpose of the bill is to reduce insurance companies’ ability to arbitrarily change reimbursement terms in the middle of a contract. In 2014, Payer Accountability legislation was filed, heard and passed in numerous committees. The bill sponsors ultimately felt that continued discussions were warranted. TMA staff and members spent countless hours through the summer and fall meeting with insurers to discuss options for legislation and try to reach a compromise. While various ideas were discussed, the ultimate goal for Tennessee’s physicians remains the same: predictability and stability.

Addiction Treatment For a number of years the legislature has tried to address Tennessee’s prescription drug problem by placing regulations on those writing the prescriptions, without properly addressing issues related to the identification and availability of appropriate treatment. The Addiction Treatment Act of 2015 seeks to address several issues that are barriers to identifying those

Don’t Miss the Boot Scootin’ Ball!

Friday, April 24, 2015 6:30 pm Knoxville Marriott With The Charlie Daniels Band!

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scribed opioids to morphine equivalents.

The third issue involves what part we will play as physicians in the delivery of medical health care in the future. Patient-centered, team-based as the concept of “patient centered team based health care delivery” evolves, our role as primary point of care provider is changing. Do we as physicians, who are well equipped to understand the multiple facets of a particular illness want to lead team based health care? The Tennessee Nurses Association has filed a bill entitled “Full Practice Authority” for the 2015 legislative session. We already have a variety of provider team models and which provides the best quality and access? I would submit that one size does not fit all. I encourage to voice your opinions and share experiences.

These three issues are not exclusive and other thoughts or concerns you may have are welcome. It is easy to stay involved with your state senator or representative. Simply open your respective representative/senator website and subscribe to the mailing list. Every representative and senator emails a weekly report while they are in session. Hitting reply to their report will send your concerns directly to their staff.

who need treatment and ensure that some of the most important treatment options are prescribed appropriately. The bill has a three-pronged approach: 1. Provide Good Samaritan protections for an individual who is having a drug overdose or in good faith seeks medical assistance for another person who is experiencing or believed to be experiencing a drug overdose.

2. Limit the prescribing of buprenorphine/naloxone to healthcare providers with a DEAx license and only in circumstances in which the FDA has approved the use of the drug.

3. Repeal a section of the code that discourages providers from identifying individuals who may be under the influence of alcohol or illegal drugs when seeking treatment.

Physician-Led Team-Based Care Rumors circulated for years that Tennessee’s nurses would bring an independent practice bill, and it has happened in 2015. While the nurses seek what they have termed “full practice authority,” it is nothing more than the severing of the required relationship between a physician and nurse.

TMA plans to propose a bill with a coordinated care approach, the Tennessee Healthcare Improvement Act of 2015, to allow healthcare in our state to evolve toward a more efficient and effective physician-led team-based delivery model.

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Board of Medical Examiners

reinstatement without a penalty. However, if it has been more than 30 days, but less than 6 months, you must pay a penalty of $100 per month practiced in excess of 30 days from the expiration date and this is reportable to the National Practitioners Data Bank. The Board is considering increasing this penalty to $1000 per month.

CME for Residents and Fellows Residents and fellows in an ACGME accredited graduate medical education program will be credited with 20 hours of CME each year they remain in good standing in the program. Those who hold a “full” Tennessee medical license (not a training license) will still need to complete the required 2 hours related to controlled substance prescribing in the 2 years before renewal. Those with a training license do not have to complete these 2 hours.

Chronic Pain Because of the recent adoption of the Tennessee Chronic Pain Guidelines, the BME repealed its Management of Prescribing with Emphasis on Addictive or Dependence-Producing Drugs policy.

Respiratory Therapists Placing and Inserting PICC Lines The State Respiratory Care Board (SRCB) is considering allowing its licensees to place and inset PICC lines. The BME emphatically opposes this interpretation of the applicable rules and has urged the SRCB to refrain from allowing its therapists to do this.

Licensure Fee Increase It has been several years since the last fee increase for new and renewal licenses. Much of the BME’s revenue comes from these fees, due to increased costs associated with the Controlled Substance Database along with the generalized increase in cost of personnel and services, the BME will be considering increasing these fees.

By Reeves Johnson, MD, BME Board Member BME Article Spring 2015 - Also includes excerpts from the TMA article at: http://tnmed.org/prod/TMA/News_and_Media/News/Updates_from_BME_Meeting.aspx Telemedicine Rules: At our meeting this past January, the Board was able to agree on revisions to the proposed rule amendment regarding Telemedicine Licensure that was originally proposed in May of last year. Because of significant changes, another rulemaking hearing has been set for Monday, March 16 at 9 AM in Nashville. Some of the key changes approved since the original draft rule include removal of the requirement for a prior direct face-to-face examination, prohibiting the prescribing of controlled substances except by certain Board Certified specialists in the treatment of ADHD in children under 18 years old and no longer requiring a facilitator except when prescribing controlled substances as mentioned above. The Notice of Rulemaking Hearing and the revised proposed rule may be found at: http://www.state.tn.us/sos/rules_filings/01-09-15.pdf Collaborative Practice Between Pharmacists and Providers (Public Chapter 832) Last year, Tennessee passed a law relating to practice agreements between pharmacists and providers. A multidisciplinary committee made up from members of the BME, Board of Pharmacy and the Board of Osteopath Examination has been created to develop the rules required by this law. More to come.

Lapsed Licenses Currently, if you practice on an expired license less than 30 days, you must stop practicing immediately and will be allowed to apply for

Spring 2015 OSHA Annual Compliance Training for Healthcare & Dental Workers

To Register:

Two Seminars from Which to Choose: Thursday, May 7, 2015

Visit knoxvillemedicine.org Call Andrea Southard at (865) 531-2766 Email at asouthard@knoxdocs.org Only $89 per person

KNOXVILLEMEDICINE.ORG

8:00 am - 10:30 am Breakfast will be served or

Convenient Location

Knoxville Marriott 501 Hill Avenue SE Knoxville, TN 37915

6:00 pm - 8:30 pm Dinner will be served KNOXVILLE MED CINE | 9

TECHNOLOGY NEWS Improve Your Reimbursements By: Leigh Sterling etHIN Executive Director

In the upcoming year, healthcare providers will face increased scrutiny of their coding practices as well as the continued reduction of reimbursement from Medicare and other third-party payers. Many practices are already experiencing problems in these areas, including management of reimbursement denials due to inaccurate filing and/or duplication of services, and increased expense relating to supporting medical necessity and correct medical coding. etHIN provides participating physicians and their support staff access to information that is needed to help reduce or prevent payment denials. etHIN’s clinical portal, the Virtual Health Record (VHR), frequently includes patient insurance information, which can make determining the proper plan with which to file a claim much easier. Providers can quickly determine if a patient has Medicare or a Medicare replacement plan, which allows for billing within the approved timeframe, making reimbursement much more likely.

Medicare guidelines are becoming more rigid with regard to how often imaging studies may be performed and how many times a procedure may be updated due to a certain indication. etHIN provides authorized users access to image reports and their associated studies from

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numerous hospital systems. From this information, authorized users can determine if, and when, studies for a specific problem were performed elsewhere.

This additional information can help the provider make decisions about whether another or perhaps more complex study is needed, and whether or not it would be reimbursable.

The need to substantiate medical necessity continues to be a major determination of payment for those services rendered to the patient.

Within the etHIN VHR, authorized users have access to the patient’s previous ICD-9 codes (both acute and chronic) as well as studies that have been performed, medications previously prescribed, and a long-term picture of the patient’s health status. This information provides the documentation to support the medical necessity of the physician’s decisions, thus affecting your bottom line.

There are numerous ways that the information accessible through etHIN can be beneficial to your reimbursement.

While your use cases may be specific to your practice, some other examples include determining the appropriate modifier for your patient’s health status or locating the presence of patient or family history to which you otherwise might not have had access.

Contact etHIN at 865-691-8433 to find out how participating in the Health Information Exchange could have a positive impact on your bottom line.

tnmed.org

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Friday, April 24, 2015 6:30 pm Knoxville Marriott

KAPA's Boot Scootin' Ball is quickly becoming one of Knoxville's most talked about charity events. The evening will be packed with great country music provided by CHARLIE DANIELS BAND, line dancing, signature drinks, a stick to your bones mouth-watering western-themed dinner, and a variety of beers in your own bottomless mason jar. A large silent auction will complete this special event with all of the proceeds to benefit Knoxville Area Project Access (KAPA). The Boot Scootin' Ball is a highend event that requires casual attire--what could be better than that?

For more info & tickets visit kapabootscootin.com or call (865) 531-2766

LEGAL NEWS

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Medicare Settlements in the News

By: Diana L. Gustin, London & Amburn. P.C. Medicare has been making headlines for the arduous and everlengthening appeals process for denied claims. While unrelated in subject matter, summarized below are two recent developments that perhaps signal a new willingness by CMS to settle disputes and end the protracted appeals process. The requirement to exhaust administrative appeals may finally be as exhausting for the government as it for the providers.

Claim Appeal Settlements Medicare Part B Appeals arrive at the Office of Medicare Hearings and Appeals as the third level of review. In January 2014, the Office for Medicare Hearings and Appeals (OMHA) announced the unprecedented growth in claim appeals, which continue to exceed the Medicare Administrative Law Judges’ ability to adjudicate in a timely manner. The delay in docketing new requests for an Administrative Law Judge Hearing is estimated at between 20 to 24 weeks. Requests submitted after April 1, 2013, operate under the new “Deferred Assignment & Filing Alert” instructions.

While this is bad news for Medicare providers waiting for their appeal to be heard, it might be good news for certain hospitals. In August 2014, CMS announced it would offer an “administrative agreement” to any acute care hospital or critical care hospital that agrees to resolve its pending appeals (or waive its right to request an appeal) in exchange for a partial payment of 68% of the net payable amount. The offer of settlement was made to reduce the volume of claims currently pending. The deadline for participation in the settlement offer was October 31, 2014.

To participate in the settlement, an eligible hospital must complete and submit a spreadsheet of eligible claims that will be verified by CMS. If discrepancies are identified, discussions will address the issues.

Stay Connected

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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!

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Disproportionate Share Hospital Reimbursement Hospitals are reimbursed from Medicare Part A and their cost report appeals are filed at the Provider Reimbursement Review Board (PRRB).

In January 2015, the U.S. District Court for the District of Columbia received a status report from the Secretary of Health and Human Services as the Defendant in a class action suit concerning disproportionate share hospital reimbursement. Hospitals with disproportionate share of low income patients are entitled to receive adjustments to increase their reimbursement. The plaintiffs in the case are seeking review of PRRB decisions and requesting the Secretary retract CMS Ruling 1498-R to ensure payment is calculated in accordance with the law. Settlement discussions for the majority of claims at issue in the case might encompass more than 40 cases, more than 1,000 hospitals and more than 2,800 different cost reporting periods. On February 19, 2015, the Court appointed two Special Masters to oversee settlement.

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.

Congratulations to Dr. Bob Proffitt on being elected to the Maryville School Board!

He was quoted as saying…

“All students deserve to learn to the best of their abilities. I’ve seen poor achievers who have prospered in society and the work force due to encouragement. In fact, it’s been one of the pleasures of my profession, seeing people grow.

It’d be meaningful to see this transformation from a board member’s perspective.”

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KAMA UPDATE KAMA Retreat 2015 The 3rd Annual KAMA Retreat was held on March 1 - 2 at the Buckhorn Inn in Gatlinburg, Tennessee. Twenty-four KAMA members attended the retreat designed to review current projects and facilitate planning for the upcoming year. Topics discussed included member recruitment, website updates, use of social media, fundraising and health promotions.

Let’s Move KAMA has been invited to participate at the 4th Annual “Let’s Move Knoxville” event on May 2 at Victor Ashe Park. Health Promotions Chair, Juliann Chavez, will be coordinating volunteers for a KAMA booth with the theme “I Can Be Healthy” and will focus on activities to keep families active. KAMA received an AMAA HPPG grant to help produce silicone bracelets with the “I Can Be Healthy” slogan to use at this event. KAMA will also be using “I Can Be Healthy” activity booklets from the AMAA SAVE program as well.

Past President’s Luncheon and Installation of Officers On Thursday, May 7, 2015, KAMA will host a Past President’s Luncheon along with the Installation of Officers at Cherokee Country Club. In addition to welcoming in the new leadership for 2015-2016, KAMA will recognize those members who have dedicated their time and talents to serve in the capacity of president for the organization in preceding years, bringing together past, present and future leaders.

Doctor’s Day 2015 On Monday, March 30, KAMA will host a Doctor’s Day Luncheon at Lakeside Tavern to honor the KAM Emeritus Club members for their many years of valuable service to our community. Robin Hutchins and Roma Misra are co-chairs of the committee. Invitations will be mailed in early March.

TMAA Annual Meeting and Convention The TMAA 87th Annual Meeting and Convention will be held in Nashville on April 10-11, where KAMA member and Past President Gail Brabson will be installed as TMAA President for 2015-2016. More details, including registration information, can be found at www.tmaalliance.org.

Interested in KAMA? If you would like to learn more about KAMA: visit us on Facebook (Knoxville Academy of Medicine Alliance); follow us on Twitter (KAM_Alliance) and Pinterest (Knoxville Academy of Medicine Alliance); and watch for our updated website (www.kamalliance.org.) coming soon!

Cynthia Gash KAMA President 2014-2015 Supporting Physician Families :: Past, Present, Future

Doc Rock for Health 2015 The Knoxville Academy of Medicine Alliance hosted the 10th Annual Doc Rock for Health on Friday, February 27 at NV and The Bowery. The event was co-chaired by Jacque Prince and Sheila Barnett. Proceeds from the event were divided among six health-related charities represented by six bands as follows: “Spinal Tappin’ Doctors” for St Mary’s Legacy Mobile Medical Clinic; “Remedy” for Interfaith Health Clinic; “South River Trail” for Hope Resource Center; “Patriot Rising” for KAPPI; “Second Opinion” for Hospitality House; “Funk and Awesome” for Vine School Health Center. That same evening, KAMA hosted a “Pre-Doc Rock Gathering” at Barley’s for resident physician/ spouse couples as well as practicing physician/ spouse couples new to Knoxville.

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