Fall magazine 2016 by Knoxville Academy of Medicine

Volum e L X X III, No . 3 â&#x20AC;¢ F a ll 2 0 1 6

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

TACOS AND TEQUILA RESIDENT MIXER A SUCCESS HIGHLIGHTS ON PAGE 12

KAM KNOXVILLE ACADEMY OF MEDICINE

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Southeastern Retina Associates Demonstrates Cost-Effectiveness and Quality Outcomes Citing multiple sources, SERA physicians continue to demonstrate cost-effectiveness and quality patient outcomes. In this article, we highlight several proactive efforts we have implemented to improve the outcomes and cost-effectiveness of the care we provide.

Outcomes Analysis

We always strive to provide excellent care, and we are beginning to directly measure our outcomes using multiple benchmarking platforms. These ongoing efforts include the American Academy of Ophthalmology’s (AAO) IRIS registry and Vestrum Health practice analytics. Currently, we’re pleased to note that we’re well above national averages for the services we provide.

IRIS RegIStRy The IRIS Registry was developed by the AAO, and includes clinical data from thousands of ophthalmologists and literally millions of patient encounters. SERA is pleased to report that in the most recent IRIS analysis, our practice exceeded the national benchmarks in all 14 measures reported!

VeStRum HealtH The Vestrum Health registry is a private registry focused on U.S. retina specialist data. This registry allows us to analyze our outcomes as compared to other retina specialists. In our most recent report, we compared favorably to other retina specialists both at the regional and national level.

R. Keith Shuler, Jr., M.D.

Stephen L. Perkins, M.D.

Cost-Effectiveness Analysis

While quality outcomes are critical for the health of our patients, we are also carefully considering and monitoring costs for the services we provide to ensure we provide not only superb quality but also excellent value. These tools included Medicare’s QRUR report, the American Society of Retina Specialists’ (ASRS) Retina PractiCare registry, and commercial payer utilization reports. These efforts have also been met with initial success, and demonstrate that SERA not only provides excellent care, but does so through costeffective measures.

QRuR RepoRt Every year the Centers for Medicare Services (CMS) publishes a Quality and Resource Use Report (QRUR) for all providers. In this report, SERA demonstrates high quality and low cost when compared to the entire Medicare eye provider population. This is noteworthy, as our practice specializes in complex surgical patients and patients with chronic conditions requiring intensive medical treatments.

James H. Miller, Jr., M.D. Joseph M. Googe, Jr., M.D.

Tod A. McMillan, M.D.

Nicholas G. Anderson, M.D.

Providing comprehensive Retina Care in East Tennessee for over 36 years. Nationally recognized as the Most Experienced Retina Team in East Tennessee. Specializing in: ◆◆ Macular Degeneration ◆◆ Intravitreal Injection for Macular Degeneration and Diabetic Eye Disease

◆◆ Diabetic Retinopathy ◆◆ Retinal Vein and Artery Occlusion ◆◆ Flashes and Floaters

865-588-0811

www.SoutheasternRetina.com Diseases and Surgery of the Retina and Vitreous

4 Knoxville Offices to Serve You

Experience Expertise Excellence

As well as offices in: Oak Ridge, Maryville, Harriman, Sevierville, Crossville, Morristown, Cleveland, Chattanooga, Dalton, GA, Rome, GA, Kingsport, Johnson City, Bristol, Abingdon, VA.

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Academy Officers

PRESIDENT’S MESSAGE By: Thomas Pollard, MD

Thomas Pollard, MD PRESIDENT

Neil Coleman, MD PRESIDENT ELECT

Ceeccy Yang, MD SECRETARY

Tim Wilson, MD TREASURER

Pat O’Brien, MD

IMMEDIATE PAST PRESIDENT

Kimberly Weaver, PhD CEO

Board of Trustees Clif Tennison, MD Jeff Ollis, MD David Harris, MD Michael Brunson, MD Daniel Bustamante, MD

Ex- Officio Board Members Randal Dabbs, MD Elise Denneny, MD Richard DePersio, MD Jerry Epps, MD Robert Page, MD Lorraine Johnson -KAMA

Publisher Kim Weaver, PhD

Editor Jonathan Weaver

Production Coordinator Margaret Maddox

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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It is hard to believe that the summer has already passed! The changing season is always associated with transition and is noted for weddings, graduations and new moves. This has been true for the Pollard family, as well, as I find myself writing this article on the way to Atlanta to drop off the youngest of the Pollard children at an institute of higher learning. An empty nester at last! This season is also a time of transition for our medical community. This July has seen the arrival of scores of new residents to the University of Tennessee Health System. The Knoxville Academy of Medicine had the opportunity to welcome these new physicians at our annual Resident Mixer. “Tacos and Tequila” was the theme, and our event was enjoyed by a very enthusiastic crowd. Our thanks to Capital Financial Group for their continued sponsorship of this festive event. The Academy looks forward to supporting these new physicians as they embark on their medical careers! This summer has also seen the arrival of several young physicians who have just completed their residencies and are eagerly starting new practices in our area. These physicians and their families were welcomed to our community at our Summer Picnic and Family Barbeque at Gettysvue Country Club. This event, hosted by the Academy, the Tennessee Medical Association, and Capital Financial, has been a valuable forum to introduce new physicians and their spouses not only to our society, but also to the Knoxville Academy of Medicine Alliance. This is an exciting time for these families and we certainly wish them all success. I hope that you will join me in encouraging all of these new potential members of our Academy. As the established physicians in our community know all too well, our profession today faces a unique set of challenges. We continue to wrestle with government and third-party payers regarding adequate and timely compensation for our services. Other professions are persistent in their efforts to take away those responsibilities and privileges normally reserved for medical doctors. And at the same time, we are asked to continue to provide excellent and consistent quality

KAM

KNOXVILLE ACADEMY OF MEDICINE of care in a climate of diminishing resources and support. Now more than ever, we need to work together if our voice is to be heard. I would like to thank each of you once again for your support of the Academy. It has been my honor and privilege to serve as your President for the past couple of years. Camy and I are a little apprehensive as we transition to a new phase in our lives, but many of you have cautioned us to be prepared. Your children have a tendency to wander back. We would be okay with that, too!

Tommy

KAM KNOXVILLE ACADEMY OF MEDICINE

Poker Night All KAM members and their guests are welcome to join us for a Poker Night! Monday, August 15, 2016 Casual Pint of Farragut 143 Brooklawn Street Farragut, TN 37934 Entry fee is $50.00 will benefit Knoxville Area Project Access (KAPA). Great Prizes for 1st, 2nd, and 3rd place! Dinner at 6:30 pm sponsored by Tournament starts at 7:00 pm Register at knoxvillemedicine.org or call Andrea Brown at (865) 531-2766

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CALENDAR OF EVENTS

KAM KNOXVILLE ACADEMY OF MEDICINE

KAM Poker Night

Monday, October 10, 2016 @ 6:30 pm Come join your colleagues for a night of poker with good food and fun! Great prizes! All proceeds benefit the KAM Foundation. Casual Pint – Farragut $50 per person includes dinner

TMA Insurance Workshop Wednesday, October 12th 2016 Holiday Inn World’s Fair Park

“Be the Drama” – FASHIONDRAMA 2016 Sunday, October 16, 2016 Knoxville Museum of Art

A Day at the Races - Trip to Keeneland

Saturday, October 22, 2016 Join the KAM as we travel via motorcoach to Lexington, Kentucky for a day at the races compliments of Capital Financial. Price includes transportation, dinner, and a reserved grand stand seat. Dinner will be provided on the trip home. $135 value but discounted thanks to our sponsors. Limited amount of tickets available. $50 Members and Member Guests $25 Resident and Resident Guests $100 Non-members

OSHA Workshops

Thursday, October 27, 2016 Two different times from which to choose, this seminar meets the annual OSHA requirement for office-based healthcare workers. Knoxville Marriott Morning Session: 8:30 am • Evening Session: 6:00 pm $89 per person includes meal

KAM/BCMS/RACMS Legislative Dinner

Wednesday, November 9, 2016 Meet your legislator and discuss issues that are important to medicine while enjoying a wonderful dinner. This event is sponsored by SouthEast Bank and is free to all KAM/BCMS/RACMS members and their spouses. SouthEast Bank - Farragut, TN Reception: 6:30 pm • Dinner: 7:00 pm Free for Members

CME Blitz

Saturday, December 3, 2016 Earn up to 5 hours of CME in one morning! Compliments of KAM and TMA. UT Hospital – Morrison’s Conference Center 7:30 am – 12:00 noon Free for Members/Guest Non-Members $25

Emeritus Christmas Party Wed, November 30, 2016 Calhoun’s Bearden 11:30 am

RACMS Holiday Party

Thursday, December 8, 2016 Calhoun’s Event Center Oak Ridge 6:30 pm

BCMS Holiday Party

Tuesday, December 13, 2016 Royal Oaks Country Club-Maryville 6:30 pm

President’s Bash

Friday, January 27, 2017 Join the KAM as we induct our 2017-18 president, Neil Coleman, MD. Reception, Dinner, and Live Music. Sponsored by SVMIC. The Foundry 6:30 pm $50 per person

PITCH

Tuesday, March 7, 2017 Join your colleagues as we travel via motorcoach to Nashville to meet with legislators and discuss issues important to medicine. Bus leaves at 8:30 am from Sears West Town

KAPA’s Boot Scootin’ Ball & Charlie Daniels’ Band Friday, April 7, 2017 Support KAPA while enjoying a wonderful evening with the Charlie Daniels’ Band. Tickets on sale soon. 6:30 pm

Pizza and Politics for Residents and Med Students Tuesday, November 29, 2016 Join Senator Richard Briggs, MD and Representative Bill Dunn at this informal gathering to learn how to effect important legislation and what bills are expected next session that will have an impact on medicine. Pizza buffet and complimentary beer or sodas. Barley’s Taproom in the Old City 6:00 - 8:00 pm Free for Residents/Medical Students and their guest

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For more information and registration on all events visit knoxvillemedicine.org or call (865) 531-2766

KNOXVILLE MED CINE | 5

Friday, April 7, 2017 6:30 pm Knoxville Marriott

KAPA’s Boot Scootin’ Ball is quickly becoming one of Knoxville’s most talked about charity events. The evening was packed with great country music by THE 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 souvenir glass. A large silent auction completed this special event with all of the proceeds to benefit Knoxville Area Project Access (KAPA). The Boot Scootin’ Ball is a high-end event that requires casual attire--what could be better than that? For more info & tickets visit kapabootscootin.com or call (865) 531-2766 4

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ACADEMY NEWS

KAM KNOXVILLE ACADEMY OF MEDICINE

Member Accolades Mancini Recieves Appointment

Dr. Matt Mancini, MD, assistant professor and chief of the division of general surgery at University of Tennessee Medical Center has been elected to the American Association of Endocrine Surgeons. Dr. Mancini is also the president of University Surgeons Associates, PC.

Robert Montgomery, MD Receives Healthcare Hero Award

KAM Past President, Dr. Robert Montgomery, received a 2016 Healthcare Hero Award from the Greater Knoxville Business Journal on September 8 at the Foundry. Dr. Montgomery was one of the original founders of the Knoxville Academy of Medicine in 1987, which has coordinated more than $180 million in donated healthcare and served more than 20,000 people. During his year as KAM president in 1989, the KAM board organized the formation of a Trauma Oversight Committee which was ultimately responsible for bringing together administrators from area hospitals to develop protocols that helped determine to which hospitals trauma patients would be delivered. Dr. Montgomery was also instrumental in the creation of Free Flu Shot Saturday, which continues to provide Knoxvillians with influenza vaccines each year.

KAM Member Graduates from Physician Leadership Immersion Program

Congratulations to Kristin Farr, MD, a pediatrician at East Tennessee Children’s Hospital, on recently completing the Physician Leadership Immersion Program through TMA. The program is a special getaway for physicians to gain leadership training in teamwork, collaboration, conflict resolution and media. Each year, TMA offers this program through the John Ingram Institute for Physician Leadership. The 2017 Physician Leadership Immersion Program will kick-off on Friday, July 28, 2017. For more information on participating, visit TMA’s website at tnmed.org.

“A Day at the Races!” Keeneland Racetrack Saturday, October 22

Members and Member Guest - $50 Residents and Resident Guest - $25 Non-Members - $100 •

KAM Welcomes Home Dr. Pat O’Brien!

KAM Past President, Pat O’Brien, MD has recently arrived home after serving our country in overseas military deployment. We are grateful for his safe return. Thank you for your service!

• • • • •

Keeneland Ticket price include:

Private dining in the Phoenix ad Room overlooking the Paddock Reserved Grandstand Seating Chartered Motorcoach Meal on the bus returning to Knoxville Complimentary alcoholic beverages and sodas served to and from the event on the bus Private Betting Windows

RSVP online at knoxvillemedicine.org KNOXVILLEMEDICINE.ORG

KNOXVILLE MED CINE | 7

ACADEMY NEWS New Members

KAM

KNOXVILLE ACADEMY OF MEDICINE

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

No Picture Available

JULIA ARANA, MD

CHARLES BARNETT, MD

________________________________________________

MATTHEW R. BESSOM, MD

PHILIPPE LEVEILLE, MD

________________________________________________

KRISTIN FARR, DO

STEVE J. THOMPSON, MD

________________________________________________

BRUCE RAMSHAW, MD

JULI WILLIAMS, MD

PEDIATRICS Children’s Pediatric Group at ETCH 2018 W. Clinch Ave Knoxville, TN 37916

FAMILY MEDICINE Summit Medical Group at Deane Hill 7211 Wellington Dr Ste 201 Knoxville, TN 37919

PEDIATRICS Children’s Pediatric Group 2018 W. Clinch Ave Knoxville, TN 37916

GENERAL SURGERY

________________________________________________

LANE COOK, MD

ABDELHAMID ALSHARIF, MD

Sutherland Associates 4428 Sutherland Ave Knoxville, TN 37919

INTERNAL MEDICINE Statcare Pulmonary Consultants 2240 Sutherland Ave Ste 103 Knoxville, TN 37919

________________________________________________

ERIC PENNIMAN, MD

ANTONIO BETANZOS, MD

________________________________________________

NIVA MISRA, MD

KENDRA BLACK, MD

________________________________________________

ERNEST WONG, DO

LARRY COOK, DO

INTERNAL MEDICINE Statcare Hospitalist 2240 Sutherland Ave Ste 104 Knoxville, TN 37919

Right Column Top to Bottom: Abdelhamid Alsharif, MD; Antonio Betanzos, MD; Kendra Black, MD; Larry Cook, DO

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INTERNAL MEDICINE Statcare Hospitalist 2240 Sutherland Ave Ste 104 Knoxville, TN 37919

INTERNAL MEDICINE University Internal Medicine 1932 Alcoa Hwy Ste C-570 Knoxville, TN 37920

FAMILY MEDICINE Summit Medical - Executive Med Director 1225 E. Weisgarber Rd. Knoxville, TN 37909

Center Column Top to Bottom: Niva Misra, MD; Ernest Wong, DO; Charlie Barnett, MD; Philippe Leveille, MD; Steve J. Thompson, MD; Juli Williams, MD

INTERNAL MEDICINE Statcare Hospitalist 2240 Sutherland Ave Ste 104 Knoxville, TN 37919

University Surgeons Associates PC 1934 Alcoa Hwy Ste D-285 Knoxville, TN 37920

PSYCHIATRY

Left Column Top to Bottom: Julia Arana, MD; Matthew R. Bessom, MD; Kristin Farr, DO; Bruce Ramshaw, MD; Lane Cook, MD; Eric Penniman, MD

INTERNAL MEDICINE

INTERNAL MEDICINE Statcare Hospitalist 2240 Sutherland Ave Ste 104 Knoxville, TN 37919

KAM KNOXVILLE ACADEMY OF MEDICINE

BME Update

By: Reeves Johnson, MD Since my last update, the 2016 Legislative Session has ended resulting in a number of new laws affecting medicine. Several have to do with the opioid crisis we have here in Tennessee. Below are excerpts of a summary provided at our May meeting: Public Chapter 912 requires nonresidential office-based facilities that prescribe products containing buprenorphine (Suboxone) to at least 50% of their patients and to at least 150 patients to be registered by January 1, 2017. Public Chapter 1033 requires Pain Clinics to be licensed by July 1, 2017. This is already having an effect as the number of pain clinics in Tennessee has decreased from well over 300 to the mid-200s. Here in Knox County, the number has dropped from almost 40 into the mid-20s. Public Chapter 1035 among other things allows the Board to issue a temporary license of limited duration to international medical school graduates if they demonstrate clinical competence to the Board. Also, a limited license can be issued to physicians who have been out of clinical

practice for an extended time or in administrative medicine. Public Chapter 956 addresses registering as a Medical Spa. Previously, any physician performing cosmetic surgery, which has a very broad definition, would have to register as a Medical Spa. Thanks to the efforts of Senator Joey Hensley, a family physician from Hohenwald, TN, his bill, now a law will only require registration of a physician owned practice if it advertises or holds itself out to be a Medical Spa or primarily performs cosmetics services. Public Chapter 1002 makes permanent the Prescription Safety Act. It also, among other things, requires a dispenser of controlled substances to periodically check the database which creates a professional duty to check the database before prescribing to someone exhibiting drug seeking behavior. Finally, I was elected to serve on the Board’s Development Committee which is tasked to research and discuss important topics relative to issues pertaining to the Board, present their findings and make recommendations to the full Board for possible action.

New Resident Members Matthew P. Abraham, MD Matthew Allison, MD Jonathan J. Allred, MD Andrew Antill, MD Brandon J. Birckhead, MD Tyler Black, MD Jonathan Dale, DO Sarah Dimino, MD Renee Do, MD Joshua A. Earl, MD Immaculate Fernandes, MD John Fisher, MD

Robert Ford, MD Justin Freeney, MD Christopher Gilsdorf, DO Jared Griffard, MD Christopher Hagenson, DO Daniel Halle, MD Raakesh S. Hassan, MD Christopher M. Hill, MD Andrew Hodge, DO Clayton Humphrey, DO Leland Husband, MD Kyle L. Kleppe, MD

Stephanie LeMaster, MD Rachel Lewis, MD William Lorson, DO Claudia Nieuwoudt, MD Katherine Patel, MD Joshua Ragan, MD Matthew Ramsey, MD Blair Reynolds, MD Bethany Sappington, MD Matthew Shachner, DO Tracy Shachner, DO Jordan Shealy, MD

Joanna Shechtel, MD Henry W Shiflett, DO Eric L. Sollenberg, MD Benjamin Spires, MD Justin Swengel, MD Rachel Taylor, MD Benjamin Verzi, MD Christopher Waggoner, DO William West, MD Adam Zalis, MD

The Knoxville Academy of Medicine mourns the recent loss of this physician member. James worden, MD 2/21/1923 – 7/18/2016 59 year member

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Joseph Acker, MD, FACC 10/19/1918 – 8/7/2016 67 year member

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WHEREVER YOU ARE IN OUR REGION, A GREAT PHYSICIAN IS ALWAYS NEARBY. JUST LIKE WE PROMISED. Claiborne

Scott

Fentress

Campbell

Union

Overton

Hancock

Grainger

Hawkins Hamblen

G Morgan

Anderson

Knox

Cumberland

Jefferson Cocke Sevier

Roane Loudon Rhea

Bledsoe

Meigs McMinn

Hamilton

Blount

Monroe

How do we keep a promise to care for an entire region? It takes elite physicians, specializing in all fields of medicine, who are backed by the Covenant Health network. And with nearly 1,500 affiliated physicians throughout the 23 counties we Bradley Polkis always nearby. serve, a top physician

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

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ACADEMY NEWS KAM Family Fun Night at the Smokies

KAM KNOXVILLE ACADEMY OF MEDICINE

On June 24th, KAM held its now annual KAM Night at the Smokies. More than 90 people attended this year’s event for KAM, BCMS, and RACMS members and their families. Attendees enjoyed a catered meal at Calhoun’s at the Yard, private deck seating, a souvenir hat, all for a reduced ticket price! Sponsorship for this family friendly members’ favorite event was SouthEast Bank, make sure that you plan to join us for it next year!

KNOXVILLEMEDICINE.ORG

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ACADEMY NEWS Resident Article

By: Patrick McFarland, MD PGY3 (Third Post-graduate Year) AN Resident UT Graduate School of Medicine, Dept. of Medicine Greetings! Thank you all for welcoming me as the new resident liaison to the Knoxville Academy of Medicine. My name is Patrick McFarland and I am a post-graduate year three resident in the Department of Anesthesiology at the University of Tennessee Medical Center Knoxville. To share some background, my family moved around a lot as I grew up, mostly due to my father’s career. We spent time in Chicago, Illinois; Cleveland, Ohio; South Burlington, Vermont; Franklin, Tennessee; and I attended college in Atlanta, Georgia. Despite living in all of these different places, Tennessee is the place I know best and the place I call home. I finished high school in Franklin, graduated medical school in Memphis at the University of Tennessee Health Science Center, and have passed the halfway point of residency training, this past month, here in Knoxville. There you have Middle Tennessee, West Tennessee, and East Tennessee, all together! With this in mind, I have grown to develop a sense of connection to something larger than a place of residence. In other words, a belief in what we do is not limited to where we work or where we live. Nowhere is this concept more apparent than in organized medicine. It is a concept I like to refer to as, “Beyond the Bedside.” Much of our medical training focuses on caring for patients at the bedside, and rightfully so. From histories and physicals, to differential

New Resident Mixer a Success

diagnoses and treatment plans, care at the bedside is first and foremost in medicine. However, we must realize our impact as providers extends beyond the bedside. Unfortunately, this aspect or ability is often underutilized, and sometimes even neglected. We as providers can positively affect patient care not only at the patient-level, but also at the hospitallevel, community-level, state-level, and beyond. Cue organized medicine. Whether it is developing hospital protocols, coordinating care in the community, or forming healthcare policy, organized medicine gives us a strong, collective voice that would otherwise be but a whisper. This collective voice is much needed, too, as we work with hospital administrators, insurance providers, and policymakers. Currently, almost as if behind the scenes, organized medicine continues to fight for us, and the patient, on a wide range of issues, such as preserving physician-led team based care, curbing the opiate epidemic, and increasing the number of spots for residency training. In the end, this column should act as a charge for residents, though it applies to all healthcare providers. Get involved. Learn how the process works. Residency is a busy, even trying time; however, we, as healthcare providers, must not neglect organized medicine and its greater impact on healthcare and the patient as a whole. Start in residency; learn the groundwork first-hand, so once in practice, those tools can be utilized to positively impact patient care on a greater level. Always remember, the patient is our first priority and their care extends to beyond the bedside. Thanks for reading. PDM

UTMCK residents gathered at Soccer Taco in Market Square to welcome the new residents to Knoxville and the KAM. This year’s KAM New Resident event called “Tacos and Tequila,” was sponsored by Capital Financial. Residents enjoyed appetizers, tacos and margaritas as well as the opportunity to win numerous prizes. Resident liaison to the KAM Board of Trustees, Dr. Patrick McFarland, along with his wife, Dr. Kristen McFarland, assisted in welcoming residents and ensured that all had a great evening.

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KAM KAPA Update

By: Jack Lacey, MD KAPA Medical Director On August 29th, Knoxville Area Project Access called a meeting to introduce a new community initiative: KAPA Connect. In attendance were leaders from KAM, all Knox area hospitals, the CMO of TennCare, State legislators, Knox County Health Department, Helen Ross McNabb Center, InterFaith Health Clinic, Cherokee Health Systems, University Physicians Association, Summit Medical Group, United Way of Greater Knoxville, and other community leaders. KAPA Connect will be a community-owned system of identifying and addressing barriers to good health care outcomes by connecting community resources facilitated by continuous two-way communication with the healthcare system. Some barriers are familiar and some are not. What are these barriers? • Lack of safe and healthy housing; • Lack of appropriate food; • Lack of transportation to healthcare appointments; • Lack of an effective level of health care literacy; • A challenge of mental health issues or drug dependency; • Lack of adequate financial resources; and • Lack of cell phone minutes. Using Community Navigators, making the right connections at the right time, supported with tools like etHIN, we can achieve the following: • Improve health outcomes

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KNOXVILLE ACADEMY OF MEDICINE

• Reduce inappropriate emergency room usage o In a current KAPA pilot program focused on frequent emergency department utilizers at UTMCK, a 40% reduction in nonemergent visits was achieved through case management addressing both medical needs and social barriers. • Reduce re-admission for chronic conditions • Increase access to preventative health screenings • Improvement inpatient adherence and experience • Achieve cost savings to healthcare providers and ultimately the community KAPA Connect will begin a pilot project on January 1, 2017. We will enroll existing KAPA, InterFaith, and Cherokee Health patients. We will recruit and train a group of volunteer community health navigators. A Community Advisory Council will be created to ensure the needs of the community are being addressed. We are going to create measures of success including outcome measures. Success will also mean that we are supporting physicians and hospitals in their value - based payment/ risk contracts. While we are doing the pilot we will construct a business model for sustainability and scalability. Once we have proof of concept from a pilot in hand, we want to approach all the payers in our area for their financial support and participation in this system of care. Because we see the payers benefitting significantly from this, we believe that they should be our principle funding source as we expand capabilities beyond the pilot.

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ACADEMY NEWS Employed Physician Dinner TMA and KAM recently hosted a focus group of physician members to hold an open dialogue regarding the needs of employed physicians. In a day when the number of physicians employed by a hospital are continuing to grow, it is important that medical societies evolve to meet the specific needs of all members. Issues discussed included: Trends in and drivers of physician employment • Student loan debt (avg. $250-$300k) is a huge driver in making decisions about how to practice – private practice, employed, etc., and more now are leaning toward employed • Complexity of modern healthcare is daunting for many physicians who just want to see patients and avoid business/administrative/regulatory burdens

• Costs of doing business are going up while reimbursements are going down – overhead costs remain the same – small physician offices are disappearing because they cannot keep up financially • Younger physicians want and even demand a better work/life balance than what has been customary in the medical profession Employed physician needs and wants • Doctors need help negotiating their contracts (with a focus on noncompete and exclusion clauses) and training on the mechanics of business and how healthcare is bought and sold (payer contracts, etc.) • Employers and physicians need be in sync about compensation, productivity, quality and efficiency expectations Many thanks to those in attendance for your valuable feedback, your comments and concerns were heard and noted.

Scripps Networks Tower opening soon. Learn more at www.etch.com/expansion

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ACADEMY NEWS

KAM

U.S. Surgeon General Dr. Vivek Murthy makes Grand Rounds at UTMCK In the fight against the growing opiod addiction epidemic U.S. Surgeon General Dr. Vivek Murthy held Grand Rounds at The University Medical Center in June. He acknowledged the issues with pain as the 5th vital sign and stated that prescribing and consumption has quadrupled since it began. Additionally he spoke of the SAMSA grant and his hopes that this will create an avenue to address things such as Naloxone, public education regarding how we think of addiction and the stigma associated with it. He mentioned that this a problem that needs to be solved as a joint effort by community and physicians. “Community still looks to its healers for help and hope”, said Murthy. The leadership we take on will have powerful effects. Together we must come together to fight this issue. It was also said that physicians should Google their name periodically to see where their prescribing practices rank with others in the state. In addition to giving them general knowledge of where they are it also provides a way to observe a red flag if a physician’s identity has been compromised by someone falsely writing scripts. “Start low and go slow” is the new message being sent to physicians when it comes to prescribing pain medication. A 3 day script is

U.S. Surgeon General Dr. Vivek Murthy

thought to be sufficient and physicians are encouraged to refer to a pain specialist if need be. Dr. Mitchell Mutter, Tennessee State Medical Director, added that Tennessee is #2 in opiod usage (behind Alabama- lifting the mood by acknowledging that it would be inappropriate to sing rolltide!) He also noted that physicians are required to query the database if they are writing a script for over 7 days. Dr. Mutter did state that we are making some headway in this issue. Tennessee is down 14% over the last 3 years in prescriptions and pain clinic guidelines have been tightened. In conjunction to the opiod problem, is the growing heroine issue. It was stated that 80% of all heroine addictions start with opiod prescriptions. Police officers are now carrying Naloxone to save lives from overdoses. Currently, there is increasing amounts of heroine that is being laced with fentanyl from S.E. Asia, which is not controlled by the FDA. This potent drug combination is lethal and responsible for an increasing number of fatalities. As people are searching for opiods they are turning to heroine to self-medicate. Murthy’s visit shined a light of hope on the issues that physicians are dealing with every day in regards to the growing addictions and opiod abuse. It is refreshing to hear that together we are making improvements and advances in the fight.

U.S. Surgeon General Dr. Vivek Murthy & CMO of UTMC Dr. Jerry Epps

Photo credits to University of Tennessee Graduate School of Medicine

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KNOXVILLE ACADEMY OF MEDICINE

TN State Medical Director Dr. Mitchell Mutter

Murthy demonstartes ease of Naloxone injector

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ACADEMY NEWS Covenant Health Announces Medical Student Program in Partnership with Lincoln Memorial University

Covenant Health in partnership with DeBusk College of Osteopathic Medicine at Lincoln Memorial University has launched a medical student program and welcomed the first group of 48 students at an inaugural event on July 19. The medical student program provides clinical experiences for aspiring physicians and mid-level providers at three Covenant Health hospitals: Cumberland Medical Center in Crossville, Methodist Medical Center in Oak Ridge, and Morristown-Hamblen Healthcare System in Morristown. Students may also be assigned to primary care clinics affiliated with Morristown-Hamblen and LeConte Medical Center in Sevierville. “This day marks a very important milestone when we celebrate a true partnership between two organizations – Covenant Health and LMU – that share a vision for excellence and a passion for quality,” said Jim VanderSteeg, Covenant Health president and CEO. “We share a culture of teaching and learning, and our organizations are built on a promise of service to the community.” DeBusk acknowledges the shortage of medical professionals in the area, and the medical student program will help address the need. “Through this innovative partnership between LMU and Covenant Health, we get a chance to be part of the future of education,” he added.

The Blount County Medical Society continues to grow. We are pleased to announce the following new physician members with the BCMS: Daniel Kim, MD Obeidurahman F. Rehmani, MD Bhavin Patel, MD Ryan Skinner, DO Aaron Smyth, DO 16

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Other Covenant Health presenters included Mark Browne, MD, senior vice president and chief medical officer, and Mandy Grubb Halford, MD, medical director of clinical documentation and informatics. Dr. Browne spoke to the students about Covenant Health’s commitment to quality and Dr. Halford discussed roles and responsibilities for students’ participation in the new program. After a celebratory luncheon the medical students participated in a white coat ceremony where they received physicians’ white coats to wear during their clinical experience. Each coat has the student’s name and a school patch embroidered on it. They will begin their hospital assignments on July 25. Working under the direct supervision of physicians, students will have opportunities to interview and examine patients, obtain and review clinical information, make hospital rounds, participate in interdisciplinary rounds and team meetings, practice appropriate documentation, and perform procedures. In addition to their core hospital rotations, students will have opportunities to participate in elective experiences at other Covenant facilities in specialty areas such as neurology, perinatology, radiology, and orthopedics. “No matter where you rotate throughout Covenant Health, you will have an excellent experience,” Dr. Halford told the students. For more information about the medical student program, contact Vickie Schulze, Covenant Health medical student coordinator, at 931-459-7037 or vschulze@covhlth.com.

Blount County Medical Society Quarterly Update Dr. Jerome Heiny

The physician practice has changed in recent years with the advent of hospitalists, many physicians now limit their practice to outpatient care. Our society strives to create an environment to bring physicians together as they now have less chance to interact with each other. On August 20, BCMS held its first Summer Backyard BBQ which provided a family-friendly event for our members to get to know each other. Please mark your calendars for Wednesday, November 9 as we will once again hold our annual Legislative Dinner in collaboration with KAM and Region 7. It’s a great opportunity to meet Blount County Legislators and discuss issues important to your practice and patients. The dinner will be held at 6:30 pm at the SouthEast Bank on Kingston Pike in Farragut. For more information, visit KAM’s website at knoxvillemedicine.org. Be sure and also mark your calendar for the KAM CME Blitz on December 3rd at UT Medical Center. BCMS members can earn CME’s without cost. Also, our BCMS Holiday Party will be on Tuesday, December 13 at the Royal Oaks Country Club at 6: 30 pm. Spouses are welcome to attend!

KAM Legislative Update By: Elise Denneny, MD

As we greet fall and football there are several legislative issues on TMA’s radar. Payor Accountability/Healthcare provider Stability Act This almost passed both the house and senate in 2016 and is expected, in some form, to be reintroduced in 2017. The push is to hold payors accountable to their contractual obligation for remuneration and eliminate the number of capricious payment schedule changes payors can make mid-contract. Email or have your office manager email your representative and senators examples where unfair insurance tract changes have negatively impacted your ability to care for patients and deliver quality care. Nurse Independent Practice The Nurse Independent Practice/Full Practice Authority initiative was sent to a special task force study at the end of 2016 followed by a summer study comprised of Drs. Jerry Thompson, Nita Shumaker and John Hale. They continue addressing pitfalls of nurse independent practice; the increased health care utilization dollars, increased control substance prescribing and decreased quality of care. TMA offers a better solution with patient-centered, physician-led, team-based health care in which nurses graduate to the ability of practicing to the full extent of their training under a team model. Let your legislator know how nurse practitioners are utilized in your practice, or even better, have your nurse practitioner share how this model works. The outcome is patients win by having access to quality care that does not waste health care dollars. The hope is that we can support the task force’s report. If not, TMA is prepared with a counterpoise. Balanced Billing Balanced billing will again be discussed in 2017 and deals with the problem that was created when payors narrowed provider networks. You all are familiar with instances when a patient has a procedure in a hospital where the physician is in network but the hospital or certain department services are out of network. A bill introduced in 2015 required all providers who are not in the patient network to inform them of anticipated charges. This would layer on another administrative hassle to the business of running a practice. TMA’s successful opposition resulted in the creation of a legislative task force that will address many insurance issues hopefully beyond balanced billing and narrow networks. TMA’s efforts easing insurance barriers in physician practices resulted in utilization review action which became public chapter 731 in 2014. Utilization review agents are to be board certified/board eligible, trained in a similar specialty, or be exempt by URAC or NCQA certification. Despite these efforts there are still instances of negative peer to “non” peer interactions. These can be cited to the Insurance Commissioner under PC 731. It’s time for insurance companies to stop dictating the practice of medicine. Maintenance of Certification Over the past decade, specialty boards have levied the experience and requirement of MOC for certification/re-certification, driven by the

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belief this would maintain a certain standard quality of care. MOC varies between specialties with some specialties egregiously expensive in time and monies. Kentucky and Oklahoma have passed legislation limiting MOC and Tennessee hopes to do the same. We invite your comments on MOC. Patients for Fair Compensation Addressed in the last issue and the point will not be belabored. Suffice it to say that any system striving to address adverse medical events by creating a new government agency such as workman’s compensation is fraught with excessive governmental cost, time delay and potential for fraud. Medicaid expansion Over 2016, the “three star healthy project taskforce” was established to recreate a system to expand Medicaid after “Insure Tennessee” failed. It met for public feedback and then met successfully with CMS. Through the successful efforts of several Tennessee Senators and representatives the expansion will most likely develop, first addressing behavioral health problems and then rolling out to include other diagnoses and enrollees. Opioid substance abuse The most recent data shows we are slowly decreasing the amount of opioids prescribed. You are making a difference! The National Safety Council shows Tennessee to be one of the top four states making headway in the fight against prescription drug abuse. http://www.nsc.org/RxDrugOverdoseDocuments/Prescription-Nation-2016-American-Drug-Epidemic.pdf However, the number of overdose deaths and NAS babies has not declined. In August, SAMSAS released proposed guidelines on the treatment of pregnant women on opioids and suggested MAT guidelines. They may hold little hope for reducing the incidence of NAS principally because babies born to women on buprenorphine or methadone still have NAS. PREVENTION is still our best hope. Women of childbearing age should practice birth control and be educated that opioids and prescription drugs will affect her unborn baby. We have yet to see the true cost of NAS to our society as they enter school and ultimately the work force. The simple daily care for just one NAS child is 24/7 as they have disrupted sleep cycles, and attention spans. It could be argued that their mental handicap is no less impactful than a child born with an “accutane” associated physical deformity. MACRA/MIPS By now many of us are wondering how MACRA/MIPS will all play out. We are still waiting to hear if CMS will delay the rollout of MIPS. Presently MIPS is based on four metrics applied to EPs (eligible provider). 50% quality (the old PQRS system), 25% advancing Care information (the old MU system), 15% clinical practice improvement activities, ad 10% resource use. Changes will be forwarded to the membership as they develop. Further questions can be queried to Dr. Doug Leahy dleahy@summitthill.com.

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KAMA CORNER By: Barbara J. Crist KAMA President, 2016-2017 Fashiondrama 2016, our 63rd annual fundraiser, will be held Sunday evening, October 16 from 6-9pm…..and will be a whole new exciting and innovative program! After years of holding our largest fundraiser as a lunchtime event primarily for women, we have changed to an elegant evening, couples’ black-tie optional event, with the theme “Be the Drama” at the Knoxville Museum of Art. Locally owned fashion vendors, live music by Kelle Jolly and The Will Boyd Project will be featured that evening. NEW this year – a Gentlemen’s Retreat with fashion and activities geared towards men. Tickets ($125 each) may be obtained by contacting Susan Brown, reservations chair, at (865) 691-0394 or swbknox@yahoo.com. Proceeds go to nursing and medical scholarships, in addition to health grants to community non-profit organizations. Mark your calendars and invite your friends for this inaugural event - you won’t want to miss it! The third annual KAMA/KAM Summer Welcome Picnic, held August 19th, was well attended and a successful event! The weather cleared for a beautiful evening. The picnic welcomes new and existing physician families, and familiarizes them with KAMA and KAM. It was held at the Gettysvue Country Club lower pool with barbecue from Sweet P’s being a hit. Sincere appreciation to KAM, to our energetic KAMA members on the committee (Robyn Doiron and Jennifer Ollis), and to TMA and the Capital Financial Group (Travis McCurry and Todd Williams) for their generous financial support.

AMAA 2016

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Six KAMA members (Jo Terry, Gail Brabson, Lorraine Johnson, Susan Brown, Jacque Prince, and myself) participated in the AMAA meeting held in Chicago on June 12-14. The theme was “Focus on the Future” and the inspiring keynote address was given by Sam Quinones, author of “Dreamland: the True Tale of America’s Opiate Epidemic”. He recommended the following to tackle the issue: no TV ads on pain medicines, forums designed to unite the medical community to fight the problem, changes in what alternative therapies insurance companies will pay for, and a tax on opiates. KAMA’s new project, KAMA Medication Task Force, led by Carolyn Cates is an extension of our Medication Safety committee to focus on the misuse of opiates. We are attending monthly MDC/ Community Drug Task Force meetings and have partnered with Knox County to assist bringing awareness for the Drug Take Back Day on October 26. TMAA Fall Update will be held November 6-7 at the Dubose Conference Center in Monteagle, TN. Milli Yium is TMAA president this year and is off to a strong, dynamic start. KAMA is an organization of local physician spouses committed to improving the health of our community and supporting the family of medicine through service, philanthropy and friendship. Meetings are held monthly on the first Thursday of each month and new members are welcome! There are many opportunities to get involved in KAMA. If you would like to learn more about KAMA, please visit our website www.kamalliance.org or our Facebook page Knoxville Academy of Medicine Alliance.

FINANCIAL NEWS Education Debt Refinance Programs Offer Choice to Borrowers by John Arnold Executive Chairman, SouthEast Bank

According to a study by the Association of American Medical Colleges, the average medical student in 2014 graduated with $176,000 of debt from medical school alone. When you tack on average undergraduate loan amounts estimated by the Project on Student Debt, total loan averages soar to over $200,000. Until recently, college graduates interested in consolidating education debt had limited options beyond bundling multiple federal loans into one payment. However, a new trend, driven largely by private lenders, extends borrower benefits beyond consolidation to offer more choices that fit borrowers’ needs, especially when compared to the traditional “one size fits all” approach of federal programs. Considering that PLUS loan interest rates for graduate and professional students have remained above 7% for the majority of time since 2006, some private lenders offer competitive rates and repayment options that could help graduates save money and get out of debt faster. For borrowers simply in need of a lower monthly payment, refinancing could extend the repayment period as long as 20 years, which may reduce the monthly payment amount significantly. While longer repayment terms may accrue more interest over the life of the loan, borrowers can make additional payments whenever possible, often with no prepayment penalties, to reduce the principal balance more quickly. Alternatively, borrowers who are comfortable with their current payment amount or could afford to contribute more may consider shortening the loan term. Shorter terms may generate lower interest rates,

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resulting in greater interest savings over the life of the loan. Some borrowers could achieve the best of both worlds, simultaneously lowering monthly payments with a longer term while still enjoying a lower total cost from decreased interest rates. Furthermore, unlike federal programs, many private student loan consolidation programs allow borrowers to combine both federal and private education debt, extending potential benefits to their entire loan profile. Private education debt refinancing isn’t for everyone. Ideal candidates include individuals with steady income proportionate to their debt balance. Since some protections offered under the federal student loan program are forfeited through private refinancing, borrowers should consider whether they may need hardship exceptions such as deferments or forbearances before applying; however, many of the private lending options also offer many of the deferment options offered under the federal program. Additionally, depending on factors such as creditworthiness and current interest rates, the new loan may have a higher monthly payment or interest rate. For some people, the convenience of having one loan payment is worth the process. Fortunately, if a borrower decides that refinancing all student loans is not ideal, refinancing only loans for which interest rates would decrease is another option — a benefit possible because student loan interest rates vary depending on the type of loan and when it was originated. The great news is that graduates have more options than ever before to find a repayment plan that best fits their individual needs. Many refinance companies, such as ELFI Education Loan Financing from Knoxville-based SouthEast Bank, offer online tools such as calculators to help estimate sample payments. Visit ELFI.com for more information about available programs.

This year’s event will feature cocktails and hors d’oeuvres, live music, an innovative runway show, and a special gentlemen’s retreat! Register at knoxvillemedicine.org For more information, please contact: fashiondrama.KAMAlliance @gmail.com

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GIVE YOUR FINANCES THE SAME CARE AS YOU DO YOUR PATIENTS. In today’s uncertain markets, having a bank that tends to your financial health is vital. First Tennessee Medical Private Banking can help with today’s needs and tomorrow’s goals. Our Relationship Managers offer guidance and solutions tailored to medical professionals. So you can focus on your priority: your patients. To make an appointment with a Relationship Manager, please contact: Robin Thomas Vice President Medical Private Banking ph: 865-971-2128 email: rlthomas@ftb.com

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LEGAL NEWS

KAM

Revisiting the Physician Payments Sunshine Act of 2010

By: Kelly Street, Esq., London Amburn, P.C. Earlier this year, the Centers for Medicare and Medicaid Services (CMS) revealed that physicians at a small hospital in West Tennessee received more compensation from the pharmaceutical and medical device industry than any other hospital in the country. As the data indicated, this hospital had the highest rate of such relationships out of more than 2,000 hospitals across the United States, with 95% of its physicians showing up on the report in 2014. The Physician Payments Sunshine Act of 2010 (the Act) makes this information available to the public via the CMS website, which publishes the data. Issues surrounding the pharmaceutical industry and its relationship with physicians have always received attention in the media. But now with three years of data generated by the Act available on the web - the issue will likely receive more scrutiny than ever before. In this environment, physicians should stay informed about the Act, how it works, and the various categories of information it makes available. As the CMS website states, the Act (passed in conjunction with the Affordable Care Act (ACA)), was designed to “increase transparency around the financial relationships between physicians, teaching hospitals and manufacturers of drugs, medical devices and biologics.” CMS carries out the purpose of the Act by making financial data available on its website through the Open Payments Program. Importantly, physicians are not required to register with the government or self-report on their relationships with manufacturers. Instead, registration is voluntary for physicians, but doing so allows them to gain access to information reported about them. Registration and reporting by manufacturers is mandatory and applies to drug companies, medical device manufacturers, medical supply manufacturers, biological device companies, and others. Such entities are required to report their financial relationships with physicians to CMS, including but not limited to consulting fees, speaking fees, gifts, entertainment, ownership interests, travel and lodging, and compensation for services given to physicians. Drug samples intended

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exclusively for distribution to patients are excluded from the reporting requirements. The law also provides physicians with an opportunity to amend or correct reports made about them. The data are published annually on the CMS website. In general, it is not illegal for a physician to maintain a financial relationship with a manufacturer. Such companies comprise much of the engine that brings about new and effective treatments for serious illnesses and conditions, and physicians are an important part of that process. But critics of the pharmaceutical industry have cited statistics suggesting negative effects, and many members of the public are likewise critical. A recent study in JAMA Internal Medicine, for example, found that doctors who received just one meal from pharmaceutical industry representatives prescribed a higher proportion of brand name medications to their patients; and it is argued that this may contribute to the high cost of prescription medicines. With this type of negative attention, it is imperative that physicians stay aware of the ever-changing legal environment that governs their relationships with manufacturers. Several states, mostly in the northeast, have now passed laws similar to the Act, which provide the public with even more information. And though Tennessee has not yet passed such a law, the national trend seems to suggest that lawmakers will increasingly target the physician/manufacturer relationship. Physicians should therefore think carefully about their relationships with manufacturers and closely monitor the information available to the public to assure its accuracy. More information about the Act can be found on the CMS website at www.cms.gov/openpayments. Kelly Street is an attorney 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 Mr. Street at (865) 637-0203 or visit www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

Pizza and Politics for Residents and Medical Students Tuesday, November 29, 2016 Barley’s Taproom in the Old City 6:00 - 8:00 pm Free for Residents/Medical Students and their guest. Join Senator Richard Briggs, MD and Representative Bill Dunn at this informal gathering to learn how to effect important legislation and what bills are expected next session that will have an impact on Medicine. Pizza buffet and complimentary beer or sodas.

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RACMS NEWS Managing Pain

by Edward Capparelli, MD In recent years we have all been increasingly frustrated by patients wanting narcotics for all sorts of problems. It is no longer terminal patients with cancer, but patients with a wide variety of maladies. In fact, the United States with 5% of the worldâ&#x20AC;&#x2122;s population now consumes 99.3% of the worldâ&#x20AC;&#x2122;s hydrocodone, an astounding 79,900 kg per year. This has been accompanied by a rise in deaths from drug overdose (now surpassing automobile accidents as the #1 cause of accidental deaths in the United States) and neonatal abstinence syndrome. At a recent Roane-Anderson Medical Society meeting, we heard from Tommy Farmer, Director of the Pharmaceutical Task Force for the Tennessee Bureau of Investigation. He gave an excellent talk about the drug problem but also talked about how to treat pain with narcotics, if needed, without risking investigation. First, he noted that of the top 50 prescribers, 38 were nurse practitioners. He stated that the supervising physician is also considered responsible for the mid-levels working underneath him or her. The importance of actually supervising, not just signing off, was stressed. Documentation in the chart, including a detailed history and physical examination, is the first step in pain management. This includes work-up such as MRIs, when indicated. Consultation of the Tennessee Controlled Substance Monitoring database (https://www.tncsmd.com) should be done

before prescribing narcotics. It is usually accurate to within 2 weeks and will show a patient that uses multiple prescribers or multiple pharmacies. In-house urine drug screens should be done before prescribing narcotics. I have seen many patients who claim they are not taking anything and have a clean database but tested positive for multiple legal and illegal controlled substances. If there is a question, the urine can be sent out for confirmatory testing. The use of non-narcotic options, such as NSAIDs and physical therapy, should be considered first when the pain is chronic in nature. Review of records from previous providers will often reveal issues that have led to dismissal and should be considered before chronic management is undertaken. For acute problems, it has been determined that a 3 day supply of narcotics should be sufficient. Be very careful using concomitant carisoprodol and benzodiazepines with narcotics. For chronic management, the use of a pain management agreement that incorporates long-term goals should be used. Many examples are available online. Ongoing regular consultation with the database and ongoing use of urine drug screening are also important. Mr. Farmer pointed out that a doctor has nothing to worry about as long as he or she is acting in the usual course of professional practice (federal Title 21 CFR Section 1306.04). Giving narcotics to everyone is irresponsible; denying narcotics to everyone that does not have cancer is cruel. Being cautious and following the above guidelines keeps us safe and appropriately manages our patients. Pain clinics should be the last resort, not the first choice.

Tommy Farmer, TBI

Edward Capparelli, MD & Tommy Farmer, TBI

Fall 2016 OSHA Annual Compliance Training for Healthcare & Dental Workers

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Two Seminars from Which to Choose: Thursday, October 27, 2016

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