Knoxville Medicine Magazine- Fall 2015 by Knoxville Academy of Medicine

Volum e L X X II, N o . 3 • F a ll 2 0 1 5

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

KAM/KAMA SUMMER WELCOME PICNIC HIGHLIGHTS PAGE 10

KAM KNOXVILLE ACADEMY OF MEDICINE

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There’s a fundamental problem standing in the way of improving population health—doctors and nurses still struggle to get in touch with each other to coordinate care of their patients

of physicians indicate they have wasted time trying to communicate with the broader care team

of clinicians admit they don’t always know the correct care team member to contact in a given situation

of primary care physicians agree HIPAA regulations pose an obstacle to efﬁcient communications and collaboration within the care team

of clinicians and administrators utilize mobile and remote technologies to facilitate timely care

Nearly 3 in 10 are not satisﬁed with the technology their organization uses for secure communications Of those who are dissatisﬁed, dissatisfaction largely arises because

members of the community use different technologies

not all team members have access to secure communication technology

of physicians report being contacted erroneously when they’re not caring for the patient in question, contributing to wasted time and unnecessary delays

The majority of nurses and case managers do not believe the electronic health record is adequate for effectively communicating with physicians [1] “Clinicians” includes all physician categories surveyed, nurses and case managers, and excludes hospital administrators and office managers. [2] “Physicians” includes all Hospitalists, primary care physicians, and in-hospital and office-based specialists.

Visit perfectserve.com/survey to download the full report.

PerfectServe Synchrony™ solves this breakdown in communication so you can reach the right care team member the first time, every time. Whether you are looking for secure messaging or an enterprise-wide solution, PerfectServe Synchrony helps you improve care transitions and speed time to treatment. Call 866.844.5484 to request a demo.

About the Survey: The PerfectServe survey was conducted online by Harris Poll on behalf of PerfectServe between February 12 and March 6, 2015. The research was conducted among 955 hospitalists, primary care physicians in offices, specialist physicians in hospitals, specialist physicians in offices, hospital administrators, office managers/practice administrators, nurses in hospitals, and case managers. For complete survey methodology, including weighting variables, please contact Michelle McCleerey, vice president product marketing at mmccleerey@perfectserve.com.

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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 Jonathan Weaver

Production Coordinator Margaret Dillingham

Advertising David Caudill

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

KAM

By: Thomas Pollard, MD Throughout my years of service with the Knoxville Academy of Medicine, I have been impressed with the organization’s ability to unite physicians for the common good of the community. Initiatives such as Conversation Ready, ventilator-associated pneumonia project, and MRSA/ hand washing education have all shown the Academy and Foundation to be true to their mission to improve the overall health and well-being of Knox County and area residents. Knoxville Area Project Access is another example of physicians coming together from across different hospital systems and medical specialties to assist the underserved and medically disenfranchised of our community. In the coming year, I will be calling on this same spirit to assist in a project that has come very close to my heart (so to speak!). This past month, I was troubled by a young, drugaddicted patient who will likely lose his life to prosthetic valve endocarditis. No matter what your specialty may be, I am sure that you too are seeing more and more patients who struggle with drug addiction and its complications. Our hospitals are becoming overburdened with this group of patients who often manifest the perfect storm of young age/immaturity, noncompliance, and poor funding. In the case of our cardiac surgery patients, a new heart valve does not make much of a difference if the root problem of addiction is not addressed and they are discharged into the same environment that fostered their behaviors, lacking the necessary tools to cope. I am happy to report that the East Tennessee Quality Alliance (ETQA) has agreed to address this growing problem of bacterial endocarditis associated with drug abuse. The ETQA is a partnership of all the major local health systems including The University of Tennessee Medical Center, Covenant Health System, Tennova Healthcare, Children’s Hospital, Blount Medical Center, and the Knox County Health Department. We envision a program that would not only provide the medical and surgical care

KNOXVILLE ACADEMY OF MEDICINE

these patients need, but would also require participation in a structured drug rehabilitation program with accountability testing. With the support of all of our local hospital systems, we hope to attract grants and other third party funding to make the program financially viable and of benefit to our entire community. Having witnessed the powerful hold that drug addiction has on these patients, I am not so naive to think that this problem will ever go away, but I am confident that working together we can make a difference in a significant number of lives. Once again, I have you, the members of the Knoxville Academy of Medicine, to thank for making projects like this possible. Please give me your ideas regarding this initiative or any other project that you feel would enhance the health of our community.

Tommy

Calendar of Events OCTOBER Young Physicians Tailgate Party for UT 10 vs. Georgia, Circle Park

TMA Insurance Workshop, Bridgewater Place, 8:00 am - 4:30 pm

“KAM Day at the Races” Keeneland Kentucky *time to be determined

Fall OSHA Seminars, Knoxville Marriott 8:00 am – 10:30 am, 6:00 pm -8:30 pm

NOVEMBER Legislative Dinner, SouthEast Bank 12 6:30 pm

APRIL 28-1 MedTenn16 - Save the Date!

Embassy Suites in Murfreesboro, TN

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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. ABDUL ALMATARI, MD

KAYLEIGH MCDANIEL LITTON, DO

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BASHAR BARGOTY, MD

JOSE LUIS MEJIA, MD, FACS

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ANDREW R. BEJARANO, DO

LENETTE H. PERRA, MD

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MARK BROWNE, MD

FAMILY MEDICINE Summit Medical Group Healthcare Services 7211 Wellington Dr. Ste 201 Knoxville, TN 37919

INTERNAL MEDICINE Summit Medical Group Healthcare Services 2240 Sutherland Ave Ste 103 Knoxville, TN 37919

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PULMONARY DISEASE Summit Medical Group Healthcare Services 2240 Sutherland Ave Ste 103 Knoxville, TN 37919

FAMILY MEDICINE Summit Medical Group Healthcare Services 2125 W Emory Rd Powell, TN 37849-3704

EXECUTIVE MEDICINE CMO Covenant Health 280 Fort Sanders West Blvd Knoxville, TN 37922

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KAM

WILLIAM S. COX, MD

KNOXVILLE ACADEMY OF MEDICINE

ANESTHESIOLOGY, PEDIATRICS

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Children’s Anesthesiologists, PC 2018 Clinch Ave Knoxville TN 37916 ________________________________________________

PRIYANKA GAIKWAD, MD

KAM

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INTERNAL MEDICINE Summit Medical Group Healthcare Services 2240 Sutherland Ave Ste 103 Knoxville, TN 37919 ________________________________________________

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Left Column Top to Bottom: Bashar Bargoty, MD; Andrew R. Bejarano, DO; Mark Browne, MD; Willaim S. Cox, MD; Priyanka Gaikwad, MD Center Column Top to Bottom: Michael S. Howard, MD; Donald Lakatosh, MD: James Landon, DO; Kayleigh McDaniel Litton, DO; Jose Luis Mejia, MD, FACS; LENETTE H. PERRA, MD Right Column Top to Bottom: Jonathan Smeltzer, DO; Julia Richards Van Zyl, MD; David Wasserman, DO; Michael Watterson, MD; Michael Wolff, DO

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GENERAL SURGERY Premier Surgical Associates 7557A Dannaher Drive, Suite 110 Powell TN 37849

INTERNAL MEDICINE Summit Medical Group Healthcare Services 501 20th St Ste 404 Knoxville, TN 37916

JONATHAN SMELTZER, DO

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JULIA RICHARDS VAN ZYL, MD INTERNAL MEDICINE UT Hospitalists 1924 Alcoa Hwy #56 Knoxville, TN 37920

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DAVID WASSERMAN, DO

INTERNAL MEDICINE Summit Medical Group Healthcare Services 324 Park 40 North Blvd Knoxville, TN 37923 ________________________________________________

MICHAEL S. HOWARD, MD

MICHAEL WATTERSON, MD

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DONALD LAKATOSH, MD

MICHAEL WOLFF, DO

ORTHOPEDIC SURGERY OrthoKnox, PLLC 10810 Parkside Dr. Suite 209 Knoxville, TN 37934-1985

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INTERNAL MEDICINE Statcare Hospitalist Group 2240 Sutherland Ave Ste 103 Knoxville, TN 37919-2333

PHYSICAL MEDICINE AND REHAB Donald A. Lakatosh MD PA 220 Fort Sanders West Blvd MOB II Ste 100 Knoxville, TN 37922 ________________________________________________

JAMES LANDON, DO

INTERNAL MEDICINE Summit Medical Group Healthcare Services 2240 Sutherland Ave Ste 103 Knoxville, TN 37919

INTERNAL MEDICINE Summit Medical Group Healthcare Services 324 Park 40 North Blvd Knoxville, TN 37923

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New Resident Members Jonathan Dewald, MD - Internal Medicine Lesley Jackson, MD - Internal Medicine Katherine Warner, DO - Vascular Surgery Bryon Cook, MD - Cardiology Trevor Rosenlof, MD - Ophthalmology Rebecca Kemmet, MD - Sports Medicine Sean Jenkins, DO - Family Medicine Matthew Boulos, DO - Internal Medicine James Hart II, DO - Family Medicine Christina Yang, DO - Family Medicine Vimal Patel, DO - Internal Medicine Amber Shell, DO - Internal Medicine Sylvia Clarkson, MD - Family Medicine Sung Lee, MD - General Surgery William Robinson, DO - Pathology Nicholas Sutton, MD - Radiology Elizabeth Richardson, MD - OB/GYN Keith S. Porter, MD - Anesthesiology

Cain Green, MD - General Surgery Charles Gaston, Jr., MD - Radiology Patrick Jennings, MD - Radiology Robert Eberly, MD - Radiology Lauren Grimsley, MD - General Surgery Spencer Pugh, MD - Internal Medicine Parthavkumar Patel, MD - Pathology Dennis Lester, MD - Internal Medicine Corey Lake, MD - Anesthesiology Jarred Tanksley, MD - Transitional Year Spencer Wolken, MD - Family Medicine Bradley Woodman, MD - General Surgery Marcia Mains, MD - OB/GYN Matthew Sorensen, MD - Urology Azaria Ehlers, MD - Internal Medicine Adam Price, MD - Internal Medicine Bryan Lamb, MD - General Surgery Andrew Walker, MD - Anesthesiology

Travis S. Davis, MD - Anesthesiology Jonathan Angotti, MD - Internal Medicine Nathaniel Slater, MD - Dermatology Tipton Sholes, MD - General Surgery Laura Pruitt, MD - Transitional Year Avi Das, MD - Internal Medicine Emily Gregory, MD - OB/GYN Vamsee Lakkakula, MD- Internal Medicine Callie Reeder, MD - OB/GYN Lauren Thoma, MD - Family Medicine Sandy Henin, MD - Family Medicine Madelyn Weil, MD - Anesthesiology Hannah Byland, MD - Anesthesiology Meagan Dodd, MD - Anesthesiology Allison Magnusson, MD - Anesthesiology Lynellen Gregory, MD - General Surgery Vijay Patel, MD - Pathology

United Way Campaign Kicks Off Do you know there is now a KAM Physicians Campaign for United Way? The UNITED WAY OF GREATER KNOXVILLE (UWGK) has served this community for 93 years! This year’s Co-Chairs, Robin Wilhoit and Dr. John Lacey, III, have officially kicked off this year’s campaign. United Way partners with more than 50 different agencies and 102 different programs. In fact, in 2007, our own Knoxville Area Project Access (KAPA) was awarded the largest single grant that United Way had ever presented prior to that time. Now, it’s our opportunity to give back by supporting the United Way through our own KAM Physicians’ Campaign. To-kick off our physicians’ campaign, renowned Knoxville cartoonist, Charlie Daniel, has drawn a special cartoon just for physicians. For each KAM member who donates at least $500, we will send you a copy of this print suitable for framing. The 2015 campaign (dubbed Not Your Father’s United Way campaign) is about bringing all demographics of our community together to give back by giving forward …and having fun while we do it! This year’s goal is $13,150,000.00 and will be used locally to assist the needs in our community. Please visit the KAM website at knoxvillemedicine.org and use our donation link to make your United Way Donation.

KNOXVILLEMEDICINE.ORG

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ACADEMY NEWS

KAM KNOXVILLE ACADEMY OF MEDICINE

Legislative Report By: Elise Denneny, MD

Over the summer the TMA legislative committee met to discuss and refine the legislative agenda for the upcoming 2016 Tennessee legislative session. Several issues were discussed to help focus efforts on specific issues. The prioritization of issues takes into account several factors including representation of the membership, public welfare, and professional impact. Bear in mind that the TMA can choose to watch, support, oppose or caption bills that are filed by others and have an impact on medicine. TMA responds to the feedback and problems from physicians across the state. The primary insurance issue is Payor Accountability/Healthcare Provider Stability Act. After this act was introduced in 2014 it had significant impact potential to payors and was placed into summer study. If you recall this act held payors accountable to honor their contractual agreement with physicians and the agreed upon level of reimbursements. It also placed limits on when and how frequently insurance companies could change the agreed reimbursements. Insurance companies have responded with a report from AON Hewitt to support the argument that this act would be cost prohibitive to insurers. ( Aon Hewitt; is a provider of human capital and management consulting services headquartered in Lincolnshire, United States. provides consulting, outsourcing, and reinsurance brokerage services.) The report’s conclusions are flawed; we will respond with a report that reflects the impact to insurance companies and continue to push for payor accountability. The TMA is leading this charge for physicians. If you remember in 2012 we were able to pass tort reform. This will require a constitutional amendment be placed on ballot for vote. The TMA plans to begin the process of adopting a constitutional amendment that allows the General Assembly to set caps on Non-economic damages. Timing is important here and we need to implement this in 2016. If we do not start this process in 2016 our next opportunity to secure caps for non-economic damages will be in 2022. Last year the Tennessee Nursing Association introduced the Full Practice Authority Bill which gives Advance Practice Nurses full prac-

tice authority. The TMA responded with the Patient Centered, physician-led teambased health care model bill. Over the upcoming year, the TMA will roll out the concept of patient-centered physician-led team-based health care as being the best model for delivery of health care. It is the best health care model for value based, quality health care. The model provides flexibility for adoption into the varied ACO models and shared savings plan. A greater political voice in Nashville is heard when other specialties' lobbyists join and support the bill. These efforts are not specialty specific. They affect all physicians. They need the support from the lobbyists of other specialties. I encourage you to reach out to your specialty lobbyist at the state level with a request that they lend their support on these issues. TMA staffer, Rebecca Lofty continues to coordinate to help you, the grassroots energy, to communicate and educate your legislators on health care issues. NO doubt there will be other bills introduced in the 2016 sessions that will affect health care and the TMA will be poised to respond. The TMA continues to be the voice of physicians on several other issues including accurate provider directories, Network standards and adequacy, MOC, interstate Medical Licensure Compact, cannabis, workers compensation, and clinical practice guidelines vs. standard of care. Keep on your radar an initiative called Patients for Fair Compensation bill that was introduced last year. It takes medical malpractice out of the court which has several implications. Marketing rhetoric has already been sent to physicians. But is it accurate? "Following the money" behind this bill reveals that it is promoted by a company that will financially benefit from managing each claim, and the claims will be paid out of a pool of money collected from an assessment on every physician. The Knoxville Academy of Medicine dinner with the legislators will be held at SouthEast Bank on November 12th at 6:30 pm. You will be able to share your opinions and expertise on issues that are important to you with the legislators over dinner. It is a good opportunity and not to be missed.

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:

Reminder!

2016 Membership Dues are due by December 31, 2015. Pay dues online at knoxvillemedicine.org

Strength in Numbers

• • • • • • •

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 Margaret Dillingham at (865) 531-2766 or mdillingham@knoxvillemedicine.org.

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ONE REASON WHY COVENANT HEALTH IS THE REGIONâ&#x20AC;&#x2122;S TOP PERFORMING HEALTHCARE NETWORK? OUR PHYSICIANS.

How do we keep a promise to care for an entire region? It takes elite physicians, are backed by the Covenant Health network. And with nearly 1,500 physicians throughout our area, a top doc is always nearby.

For a referral to a Covenant Health physician: covenanthealth.com/findaphysician 1-877-334-4500

8302-0078

specializing in all fields of medicine, who

KAM KAM Family Fun Day at the Smokies

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KAM members, along with their families, enjoyed an evening watching the Tennessee Smokies play the Chattanooga Lookouts at the Smokies Stadium in Sevierville. Calhouns barbecue was included in the discounted ticket price that was made available by SouthEast Bank, who partnered with KAM for this event. Many of our members have requested more events, including those that are family friendly, which would allow them to get to know other area physicians. KAM is pleased to announce that we have heard you and our calendar is filling up with more opportunities for our members. Keep watching the Calendar of Events that is available online at http://www.knoxvillemedicine.org/events/.

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KAMA CORNER By: Lorraine Johnson, KAMA President The Second Annual Summer Welcome Picnic held on Friday, August 14th was a big success. A huge THANK YOU to KAM for designing and sending the invitations, to the hard working KAMA members on the committee (Jennifer Ollis, Robyn Dorion and Ashley Sandlin) and to the TMA and Capital Financial Group for their financial support! The evening wouldn’t have been so enjoyable without the support of all of us working together for the common goal of welcoming new physicians and their families. Knoxville will host the TMAA Fall Update again this year. It will be held at the Courtyard Marriott on Papermill Drive on September 13-14, 2015. This meeting is a wonderful opportunity to hear from other alliances

in our state regarding their involvement in their community and to share ideas. Fashiondrama will be held on Tuesday, September 29th at Cherokee Country Club and the theme this year is “Destination Fashion”. The show will highlight various cities that are well known for being leaders in the fashion industry. The cost of the ticket is $75.00. Reservations can be made by mailing a check to Susan Brown, 9733 Franklin Hill Blvd, 37922 or call 384-8274 for Credit Card Purchase. Kimball’s has provided a beautiful David Yurman Sterling Silver Crossover Cuff for the raffle item. It’s a beautiful piece of jewelry, so buy lots of tickets -$10.00 each or 3 for $25.00. You must be present to win! I will be happy to hold your tickets for you if you can’t be there! Looking forward to “FOOTBALL TIME IN TENNESSEE”!! Go Vols!

KAM/KAMA Summer Welcome Picnic

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KAPA

KAM KNOXVILLE ACADEMY OF MEDICINE

KAPA - What’s It All About? Well what is KAPA, you ask? It is the best kept secret in Knox County! Knoxville Area Project Access (KAPA) is one of the most successful programs of the Knoxville Academy of Medicine. For almost ten years KAPA has been serving the low income and uninsured in Knox County. KAPA has coordinated over $150 million dollars in donated medical care and has enrolled over 18,000 Knox County residents. Our physician network consists of over 1,200 providers and all Knox area hospitals. Where it all started: In 2005, over 190,000 Tennessee residents were disenrolled from TennCare. An estimated 17% of East Tennessee residents were without access to healthcare; 66,000 in Knox County alone. In an effort to address this growing problem of the uninsured in the Knox County community, the physicians of the Knoxville Academy of Medicine Foundation (KAMF) began exploring the possibilities of starting a program being adapted in other communities across the country known as Project Access, which coordinates charity healthcare for the low-income, uninsured. The KAMF physicians collaborated with area hospitals and primary care clinics to begin KAPA. In March 2006, after the creation of a physician network, KAPA began enrolling patients. In order to qualify for KAPA, a patient must be a Knox County resident, have no access to employment-sponsored or government-sponsored healthcare, and have an income at or below 200% of the Federal Poverty Level. Qualified applicants receive services such as primary care, specialty care, hospital inpatient and outpatient care, ancillary and lab services, psychiatric care and pharmacy support at little or no charge. How KAPA assists those in need: Patients come to the KAPA program in a variety of ways. The most

prominent is the referral from our partnerships with physicians, area hospitals, and other healthcare organizations including the Health Department. KAPA believes that all patients enrolled in the program need to be good healthcare citizens. Patients are required to sign the Patient Responsibilities form. This form outlines the expectations of going to all appointments coordinated through KAPA, following their physician’s treatment plan, being respectful of the KAPA staff, the provider and the provider’s staff and finally not improperly using Emergency Departments. If the patient does not abide by criteria outlined, the patient is subject to program dismissal. When enrolled, patients are assigned a Care Manager to help navigate the healthcare system and provide education for healthy lifestyles. The Care Manager coordinates all of the patients’ services for primary and specialty care, including establishing a primary care home. If the primary care provider feels that the patient needs to see a specialist or have any procedures done, the provider will send KAPA a referral and KAPA will coordinate the referral within our volunteer provider network. KAPA’s main objective is to aid in solving the problem of the uninsured in Knox County. In doing so, over 1,200 local providers and all area hospitals are part of the KAPA network and donate their time and services, so that KAPA patients can receive medical treatment at little or no charge. Physician leadership and involvement are the keys to the success of KAPA. If you have not volunteered to join KAPA yet, your help is very much needed. Join your colleagues and support this worthy program by volunteering to treat 10-20 patients annually. If you would like more information or would like to become a KAPA provider, please contact the KAPA office at 865-531-2766 or email Danielle Sims at ddufur@knoxvillemedicine.org.

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STAY CONNECTED Report From the Knox County Prescription Drug Task Force By: Elise Denneny, MD

The fight against controlled substance abuse continues in 2016. The collaborative efforts of the TMA and the East Tennessee Controlled Substance Task Force have made inroads in the fight against pain pill abuse. The Prescription Drug Task Force is a coalition of physicians, nurses, pharmacists, Knoxville Academy of Medicine, Tennessee Department of Health, Knoxville Police Department, Knox County Sheriff’s Office, DEA, Healthcare 21 Business Coalition, Tennessee State legislators, and the Metropolitan Drug Commission. It is an amazing opportunity for individuals with common concerns to share ideas, have honest disagreements and look at all facets involving the epidemic the State of Tennessee fights against the abuse/misuse of opioid and other controlled substances. As medical providers we are a point of access to prescription drugs. Written prescriptions are only one source of the drugs. Diversion of prescription drugs comes from many different sources, and one source is written prescriptions. Consecutive legislative regulations such as the CSMD, (Controlled Substance Monitoring Database) and the Prescription Safety Act have impacted physicians’ practices and their patients for whom they advocate and treat. Aggregate data show that physician support in the fight against pain prescription abuse is making a difference. • There is a 21 % drop in doctor shopping for prescription drugs. • There is an 11% drop in Morphine milligram equivalents (MME) for the first quarter of 2015. • There is a very encouraging downward trend, especially in Knox County, in MME per capita • There is promising data on the cumulative cases of NAS (Neonatal Abstinence Syndrome) reported with NO increase in cases when compared to 2014. Physicians.....we ARE making a difference...pat yourselves on the back, BUT lest we succumb to self-aggrandizement let me hasten to add much work lies ahead. Specifically, support and more training in addiction and resources to help break addiction. PREVENTION of addiction starts with educating our patients that opioids and benzodiazepams have the potential to be addictive

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as well as the potential for clinical benefit with judicious use. We need to support and develop non pharmacological treatment for pain. The United States consumes greater than 95% of the world’s opioid supply. We are a society addicted to pills and society has been led by many outside organizations to believe that life can be pain free. We can help our patients understand that life is not pain free, but we can strive for pain attenuation. It is hard to break the vicious cycle. Many patients testify that their weight makes their pain worse but that they just don’t feel like exercising and the medication makes them hungry.....and on it goes. Once addiction sets in they fight for pills “just to feel normal”. The use of heroin is on the rise. Is it because we are making access to opioids more difficult? Heroin and its attendant deep space infections, and endocarditis, will be a burden on society’s health resources, crime prevention and education. Finally each time we write a pain medication prescription for a women of childbearing age, it opens the possibility of bringing a child into the world addicted through no action of their own. We can educate for the prevention of Neonatal Abstinence Syndrome. We can implement SBIRT (Screening, Brief Intervention, Referral to Treatment) in our evaluation and management. We can inform our colleagues about the chronic pain guidelines. https://health.state.tn.us/Downloads/ChronicPainGuidelines.pdf Finally, how do we manage and treat addiction? The Tennessee BME (Board of Medical Examiners) has a policy Statement on office based treatment of opioid addiction and is developing guidelines similar to the chronic pain guidelines. What about Suboxone, Subutex and why do we not talk about Naloxone rescue more often with families? What about synthetic drugs used to augment the “high” from opioids and heroin, like fentanyl, and gabapentin? We can warn our patients about the additive effects of pain and mood altering drugs. We can work with our pharmaceutical colleagues in identification of at risk patients. What about the emergence of heroin and its attendant deep space infections and endocarditis? Although there is work ahead.... your efforts have made a difference. YOU have made a difference. Thank you. Chronic Pain Guidelines for physicians. link...https://health.state.tn.us/Downloads/ChronicPainGuidelines.pdf

KAM Young Physicians Tailgate Party Circle Park Saturday, October 10 3 hours before Kickoff Complimentary Food & Beverages RSVP online at knoxvillemedicine.org

LEGAL NEWS

KAM KNOXVILLE ACADEMY OF MEDICINE

A HIPAA BREACH CAN LEAD TO LITIGATION

In November 2014, for example, the Connecticut Supreme Court held that HIPAA can establish a healthcare provider’s duty in a state-court negligence case. And similarly, though not outright endorsing HIPAA-based suits, the United States District Court for the Middle District of Tennessee has held that HIPAA does not entirely preempt Tennessee state law. Although it’s becoming easier to bring this type of lawsuit, plaintiffs still face some challenges. Specifically, plaintiffs have a hard time proving that they were damaged by the breach. Unless the patient in a case like that can prove that the breach actually caused damages – for example, that someone actually saw or used the data - the defendant may be entitled to dismissal of the lawsuit or judgment in its favor. While there is no perfect solution to prevent a HIPAA breach and subsequent litigation, medical practices can and should take steps to carefully construct a HIPAA compliance program that evaluates potential cybersecurity risks for the practice. Adequately and routinely training staff can also help reduce careless errors which may result in a catastrophic breach. * * * Kelly Street and Erin Williams are attorneys with London Amburn, a law firm based in Knoxville, Tennessee, which represents providers in the area of healthcare law, including regulatory, compliance, HIPAA, malpractice and nursing home defense, employment, mergers and acquisitions, corporate and business matters. For more information, you may contact (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.

By: Kelly Street and Erin Williams, London Amburn, P.C.

Recent years have seen a push toward technological advances in patient care, including real-time digital consultation through telehealth services and the widespread adoption of electronic health records. However, with these advancements have also come new threats to patient privacy. A single careless staff member can now place large amounts of patient information at risk with the stroke of a single key. So, if your organization has a cybersecurity incident causing a HIPAA breach, can you be at risk for more than just HIPAA penalties? Unfortunately, yes. While private citizens cannot file lawsuits under HIPAA, an increasing number of patients have found ways around this general prohibition through other, related theories of liability. As data breaches and unauthorized disclosures continue to rise so too are the number of lawsuits related to these breaches. The most common cause of action related to a HIPAA breach is a claim for negligence or negligence per se. Under this theory, a patient must prove that the defendant breached a duty which caused the patient’s damages. So, a patient would argue that the provider had a duty to follow HIPAA and breached that duty, and because of the breach the patient’s protected health information was compromised. As evidence of the breach, some patients have attempted to use the HIPAA breach notification letter that federal law requires the practice send to the patient. Despite the strong argument that HIPAA preempts (or prohibits) this type of lawsuit, ten states have allowed, or at least noted, the practice.

Fall 2015 OSHA Annual Compliance Training for Healthcare & Dental Workers

To Register:

Two Seminars from Which to Choose: Thursday, October 22, 2015

Visit knoxvillemedicine.org Call Andrea Southard at (865) 531-2766 Email at asouthard@knoxvillemedicine.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 | 13

ACADEMY NEWS Resident Article

By: Niva Misra-Sammons, MD PGY2 (2nd Post-graduate Year) IM Resident UT Graduate School of Medicine, Dept. of Medicine A physicianâ&#x20AC;&#x2122;s early education is primarily from books and lectures. Clinical experiences then start to become integrated in the latter part of medical school and into the intern year of residency. I have personally felt it is only in the latter part of residency that we begin to truly understand patients as people. The doctor-patient relationship can be complicated, especially as a young resident who is learning to integrate communication with all that medical knowledge. Good communication seems to be one of the key factors in good patient care. The further I progress in my residency, the more I realize that every interaction with a patient will somehow shape the kind of physician I will be. Communicating with the sickest patients and their families has often been a challenge I have faced in residency. I was recently involved in the care of a very ill young woman who had metastatic cancer. Originally I was unable to talk much with her, but rather she became open and easily communicated with me. We talked about her pet rabbit, who unfortunately

also experienced the ravages of cancer and had become her inspiration. These small conversations, and others, including my telling her about my own pet cat named Cole, seemed to take away some of the pain she was facing and focused her attention elsewhere, for a little while. It taught me that although not every patient may be as open or as communicative, someone may be helped with just a bit of conversation. Physician mentors are a great example of how to learn from and interact with patients and their families. Each physician has their own way of communicating. However, it seems the most successful have the constant factor of empathy and compassion present. These same physicians also have the presence of patience as a key factor. It is evident that those best at communication remain calm in all aspects. As I am going through my training and am interacting with more patients, I am slowly picking up a few main points. Patients and families want to be heard and want some type of information. I know that we can never please everyone, no matter how much we strive. I realize that it helps to be compassionate in all scenarios. Fatigue and frustration seem to interfere at times, but the best interactions depend upon compassion and patience. I am also learning not to be afraid to reach out to patients and truly attempt to connect to them. It is becoming more evident to me that the most unlikely patients are the ones that will appreciate you the most.

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