Volum e L X X III, No . 2 • S u mme r 2 0 1 6
Se r ving the Gr e ate r M e tr opolitan Knoxvi l l e Area
KAPA’S BOOT SCOOTIN’ BALL FEATURING RODNEY ATKINS
KAM KNOXVILLE ACADEMY OF MEDICINE
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KNOXVILLE ACADEMY OF MEDICINE
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Academy Officers
PRESIDENT’S MESSAGE
KAM
By: Thomas Pollard, MD
KNOXVILLE ACADEMY OF MEDICINE
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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“Doctor”. For as long as we can remember, this word has been associated with feelings of trust, professionalism, and respect. Your doctor always took care of you and your family. Your doctor could be reached at any time to allay your fears and to address your healthcare needs. Your doctor was the primary decision-maker regarding the medical needs of the community. Over the years, the term “doctor” has lost some of its mystique. The term applies to any individual who has an advanced degree in his or her given field, not just medicine. In the healthcare community, doctors of pharmacy, nursing, and administration, just to name a few, all play a vital role in our medical community. It is not the dilution of the term “doctor” that should garner our attention, but rather, the attack on our role as the primary supervisor of the health care needs of our patients. Government, third-party payors, and ancillary institutions have all issued challenges to our role, disguised as improvements in access to care and cost-cutting. At the Tennessee Medical Association delegates meeting this past month, maintaining our professional integrity was a theme of several resolutions. These actions encouraged our lawmakers to forbid the continued use of the term “medical” in advertisement particularly as it relates to “medical“ spas and salons unless a licensed physician is directly involved in the supervision of these businesses. In order to protect our patients further, the delegates asked that the State support legislation to forbid the sale of tanning services to minors at these establishments. All of us have also been effected by the efforts of our respective medical specialty societies to impose maintenance of certification (MOC) on our practice. Although the intent of these mandates is to improve quality of patient care, there is no good evidence that MOC is any better at achieving this goal over the quality initiatives of individual practices and hospitals. As the cost of MOC has become burdensome to the physician, the TMA has asked the State to no longer use MOC as a qualifier for state licensure and hospital privileging.
These are just a few examples of how the Knoxville Academy of Medicine and TMA are working on your behalf to maintain our professional integrity as doctors. I cannot thank you enough as members for your continued support of our legislative efforts!
Tommy
Calendar of Events JUNE 20 24 JULY 27
Texas Hold’em Poker Tournament Casual Pint - Farrgut, 6:30 pm KAM Family Fun Night with the Smokies, Smokies Stadium, 6:30 pm
TMA/KAM Payment Reform Roadshow, UTMCK Heart Hospital Conference Room, 8:00 am
AUGUST KAM/KAMA Family Picnic, Gettysvue 19 pavilion, 5:00 pm
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Blount County Medical Society Picnic Royal Oaks Country Club, 5:30 pm
KNOXVILLE MED CINE | 3
ACADEMY NEWS Region 7 Represented at House of Delegates
KAM KNOXVILLE ACADEMY OF MEDICINE
The Tennessee Medical Association recently held the 181st Annual House of Delegates meeting. Physicians from around the state came together in Murfreesboro, Tennessee to discuss issues important to the practice of medicine. Delegates from the Knoxville Academy of Medicine submitted a resolution that would expectantly limit the number of babies born with Neonatal Abstinence Syndrome (NAS) by supporting efforts to require women of childbearing age taking opioids to also use birth control. KAM Member Debbie Christiansen, MD, presented the resolution which was adopted the House of Delegates. KAM Resident Member, Patrick McFarland, MD also addressed the House of Delegates in support of a resolution, which was also adopted, that would increase funding of Graduate Medical Education in an effort to increase the number of resident positions available in the future.
Many thanks to this year’s delegates who represented the Knoxville Academy of Medicine, Blount County Medical Society and the Roane Anderson County Medical Society. This year’s regional delegates included: Knoxville Academy of Medicine: Debbie Christiansen, MD; James Choo, MD; Elise Denneny, MD; Jeffrey Ollis, MD; Leonard Brabson, MD; Matt Mancini, MD; Neil Coleman, MD; Thomas Pollard, MD; Patrick McFarland, MD; Timothy Wilson, MD; David Gerkin, MD; Richard Briggs, MD; and Richard DePersio, MD. Blount County Medical Society: Aaron Bussey, MD and Robert Proffitt, MD Roane Anderson County Medical Society: Edward Capparelli, MD, George Smith, MD and Kenneth Luckmann, MD
KAM Member Patrick McFarland, MD addresses the TMA House of Delegates
Debbie Christiansen, MD discussess the NAS epidemic
National Doctors’ Day Celebrated Each year on March 30, National Doctor’s Day is celebrated to recognize physicians and their contributions to our community. The holiday was officially signed into U.S. law in the early 1990s by President George H.W. Bush, however, the history of Doctors’ Day dates back to the early 1930s. It is believed that the idea of the holiday was first conceived by a physician’s wife, Eudora Brown Almond of Georgia. The very first Doctors’ Day in 1933 consisted of a few doctors’ wives putting together a luncheon for the local physicians in Winder Georgia, northeast of Atlanta. The date of March 30th was eventually chosen to celebrate Doctors’ Day because it is the anniversary of the day that anesthesia was first administered to a patient.
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The Knoxville Academy of Medicine Alliance (KAMA) keeps the tradition alive of hosting an annual luncheon for local physicians. This year, KAMA hosted the Annual Doctors’ Day Luncheon on March 28th at Lakeside Tavern. This year’s guest speaker was KAM member, Sister Mariana Koonce, MD. Many people are aware of the “Truck Driving Nun” that makes it her mission to go to the rural areas and offer medical assistance through the St. Mary’s Legacy Clinic; however, guests at the luncheon were offered insight into how this group was founded, as well as, the history of the area that inspired the project. All that were in attendance enjoyed her visit and were grateful for the presentation.
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ACADEMY NEWS New Members
KAM
KNOXVILLE ACADEMY OF MEDICINE No Picture Available
Julia Arana, MD
A big welcome to our newest members! We are excited that you have decided to join the Knoxville Academy of Medicine. JULIA ARANA, MD
PEDIATRICS Children’s Pediatric Group at ETCH 2018 W. Clinch Ave Knoxville, TN 37916
FARRELL PIERSON, MD CARDIOLOGY GE Health 2330 Southern Shade Blvd. Knoxville, TN 37932
Farrell Pierson, MD
Additionally, we would like to welcome the following new transferred KAM Resident Members: Matthew Allison, MD, Jonathan J. Allred, MD
UT Medical Center Names Dr. Jerry Epps Chief Medical Officer The University of Tennessee Medical Center recently named KAM member, Jerry Epps, MD, as Senior Vice President and Chief Medical Officer. Dr. Epps has previously served as Chair of the Department of Anesthesiology with the medical center and UT Graduate School of Medicine. He has more than three decades of experience as an anesthesiologist and also in physician leadership. Dr. Epps will continue to practice anesthesiology at the medical center, in a reduced schedule, so that he may continue to further understand the evolving needs of patients and clinicians. Dr. Epps also currently serves on the KAM Foundation Endocarditis Project, as well as maintaining a hospital liaison position on the KAM Board of Trustees. Congratulations Dr. Epps!
The KAM Poker Tournament Continues On... In April, several poker players turned out to enjoy an evening of cards, BBQ and brew at the Casual Pint of Farragut. The evening winners were Dr. Jeff Fuqua (First Place) whose efforts were rewarded with a gift card to Fleming’s Steakhouse. Second place went to Dr. Mile Wilson who enjoyed a large bottle of Gentleman Jack. The third place winner also received a bottle of Gentleman Jack. Many thanks to the players and, of course, our Texas Hold’em sponsor, Capitol Financial. Mark your calendar now, sign up online and join us for our next tournament play on June 20th! Beginning poker players are encouraged to attend! Dr. Pollard happily supplies “cheat sheets” upon request. For more information on the Poker Tournament, contact Margaret Maddox, KAM Member Services Director at mmaddox@knoxvillemedicine.org or at (865) 531-2766.
The Knoxville Academy of Medicine mourns the recent loss of this physician member. Joseph Delozier, MD 4/4/1930 – 4/8/2016 Retired from Baptist Hospital Interfaith Health Clinic Volunteer
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Robert Avery, MD 6/14/1938 – 5/24/2016 45 year member
John Wall, MD 5/13/1937 – 4/1/2016 47 year member Retired from Knoxville Pediatric Associates
KAM BME Update
By: Reeves Johnson, MD This past April, 28-30, I served as the delegate from the Tennessee Board of Medical Examiners to the Federation of State Medical Boards Annual Meeting in San Diego. The FSMB as it is called, is made up of 70 state medical boards, both medical and osteopathic in all 50 states, D.C., Puerto Rico, the Virgin Islands and other US territories. It serves as the national resource for the state medical boards in assisting them to promote excellence in medical practice, licensure and regulation. The Keynote speaker was Vice Admiral Vivek Murthy, our current Surgeon General. Three of the issues he is addressing are opioid abuse, mental health access and physician burnout. Also discussed was the Interstate Compact, developed by the FSMB, which allows licensed physicians meeting strict qualifications from a member state to be easily licensed in another member state. This will become important as Telemedicine becomes more wide spread as generally, you must be licensed in the state where the patient is located. In 2013, there were an estimated 350,000 telemedicine encounters. It is projected to rise to 7 million by 2018. To be a member state, that particular state’s legislature has to pass a law incorporating the Compact’s Rules and Policies. So far, 16 states have joined the Compact and several others are in the process. At this point, Tennessee has not begun the process. One concern is that some of the medical practice act would have to be amended. Also, it would
VA Gives Full Practice Authority to APRNs As anticipated, on May 25th, the Veterans Health Administration published a Proposed Rule that would give full practice authority to four categories of APRNs: Certified Nurse Practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), or Certified Nurse-Midwife (CNM). The Proposed Rule defines “full practice authority” to mean that an APRN working within the scope of VA employment would be authorized to provide services without the clinical oversight of a physician, regardless of State or local law restrictions on that authority. APRNs working outside of VA facilities would remain subject to state laws on APRN scope of practice. Federal preemption will be used to side-step state medical licensure laws such that APRNs who work for the VA will have full authority inside the VA. It is common knowledge that the VA is under tremendous pressure to reduce the wait times for appointments that veterans are experiencing. Consequently, this Proposed Rule was anticipated, and was the subject of many conversations with VA and AMA physician leadership, including AMA Board Members David Barbe, MD and Jesse Ehrenfeld, MD.
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KNOXVILLE ACADEMY OF MEDICINE
require changing some of the rules of our Board and could allow licensed physicians who have been out of clinical practice for several years to now be able to obtain an unrestricted license. Regarding this last issue, at the FSMB meeting, I spoke of this concern and was told it had been overlooked during the development of the compact and was assured that it will be addressed. Here in Tennessee, KAM Debbie Christiansen, MD, Melanie Blake, MD (a Chattanooga internist) and I have been appointed to a task force to draft and recommend a policy to the Board outlining possible pathways for physicians who have been out of clinical practice for a certain length of time to demonstrate or regain competency to resume active clinical practice. The FSMB is also working to develop a single graduate medical education accreditation system such that MDs and DOs will be able to train in either program and there only be one “Match”. Another important issue we must deal with in Tennessee has to do with interprofessional collaboration. This is not just pertaining to primary care by replacing an expensive provider with a less expensive one, but much broader addressing issues such as population health management, community health programs, access quality and cost. Finally, I was honored by Governor Haslam to be reappointed to the Board for a 5 year term. I certainly appreciate the support of the Knoxville Academy of Medicine and the TMA.
At press time, the Knoxville Academy of Medicine has been informed that a press release from the AMA to express disappointment in the direction the VA has proposed will be forthcoming. AMA has had a longstanding policy opposing APRN independent practice and intends to comment on the Proposed Rule consistent to that policy. This move by the VA is being applauded by many nursing associations. KAM, Blount, Roane, and Anderson members are encouraged to communicate to the VA with their opposition, as well. The deadline to submit comments on the Proposed Rule is Monday, July 25. Written comments may be submitted to http://www/regulations.gov or by mail to: Director Regulations Management (02REG) Department of Veterans Affairs 810 Vermont Avenue, NW Room 1068 Washington, CC 20420 Faxes are also accepted at (202) 273-9026. Comments should indicate that they are submitted in response to “RIN 2900-AP44-Advance Practice Registered Nurses”
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ACADEMY NEWS
KAM
KAPA’s Boot Scootin’ Ball April 8, 2016
KNOXVILLE ACADEMY OF MEDICINE
THANK YOU! Diamond Sponsors • Covenant Health • Tennova Healthcare • UT Medical Center • SouthEast Bank Media Sponsors • Bandit Lites • WBIR • WIVK Gold Sponsors • Alphagraphics • Ole Smoky Tennessee Moonshine • Stages West Silver Sponsors • Capital Financial Group • East TN Children’s Hospital • Contemporary Women’s Health • Law offices of Ogle, Elrod, and Baril • First Tennessee Bank • Knoxville Comprehensive Breast Center
KNOXVILLEMEDICINE.ORG
Rodney Atkins comes home for KAPA’s Boot Scootin’ Ball On April 8, country artist and Knoxville area native, Rodney Atkins, performed for KAPA’s Boot Scootin’ Ball, held at the Knoxville Marriott. The annual event is hosted by the Knoxville Academy of Medicine Foundation and all proceeds benefit Knoxville Area Project Access, also known as KAPA. The event included a private concert by Rodney Atkins, in addition to a southern buffet and bottomless beverages. The silent auction was also a highlight of the evening as this year’s auction boasted of more than 83 packages from which to choose. The KAPA’s Boot Scootin’ Ball helps continue the work of a much needed program in our area. Since 2006, KAPA has coordinated more than $175 million in donated care to low income individuals that have no any other access to health care through either government programs or employersponsored insurance. KAPA is always looking for physicians to join the fight to serve our neighbors in need. If you are not currently participating in KAPA, contact the KAPA office today at 531-2766.
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ACADEMY NEWS My Reflection on Residency
By: Niva Misra-Sammons, MD PGY3 (Third Post-graduate Year) IM Resident UT Graduate School of Medicine, Dept. of Medicine It is hard to believe that the last three years of my life as an Internal Medicine resident will be coming to a close in one month. Graduation is a day I have long awaited over this journey. Being at the end of my training takes me back to my inspiration to become a physician. My late father was a physician and passed away when I was 15. His presence in my life inspired me to go forward and pursue my dream to become a doctor. Although my mom is not a physician, she continually encouraged me throughout my life to work hard in order to reach my goals. In addition, my sister’s determination to be a physician motivated me. I have had physician mentors throughout my life who have encouraged me. I am thankful for these people. I was fortunate to be accepted to James H. Quillen College of Medicine- my first choice medical school. I was blessed to match residency at UT Knoxville Internal Medicine which was also my first choice. My husband, Brandon, also matched at UT and is now an upcoming third year Medicine resident. It has been wonderful to have him by my side to motivate me during this challenging time in training. Residency has not only trained me to become a doctor-It has taught
me much more. I have had three years to work on communication with patients and with medical staff. This practice seems to have paid off, and I am finally feeling confident. Along with good communication, I have learned to be empathetic. I see that anger and anxiety is often coming from a threatened individual and being considerate helps. This same concept has also taught me to be more patient and relaxed. I have seen patience will pay off on a busy day. One must also be patient when learning the skills of medicine. Internal Medicine, for example, is a wide subject that requires continual studying and practice to gain medical knowledge. I have promised myself that I will work every day for the rest of my career to increase my knowledge. In learning the knowledge, one must develop the characteristic of dedication. Being dedicated takes strength-the strength to work 24 hour shifts and endure the unknown at times. Being strong teaches you that negative feedback sometimes makes you a better person. Strength inspires other people around you which I hope I have done. Finally, I have learned to be proud of myself. I take good care of myself with a healthy diet and exercise. I am proud of what I have accomplished and will continue to work hard to be the best physician I can be. I will be starting in a hospitalist position with StatCare Hospitalists in September and am very excited to start the next phase of my career serving Knoxville alongside wonderful physicians. I have enjoyed the opportunity to write this column and am thankful to KAM for giving me the opportunity.
Strategies for managing
DEMENTIA CARE
Gregory A. Jicha, MD, PhD Monica Crane, MD Here for YOU since 1983
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P R E S E N T S
th
T H E
Annual Alzheimer’s Disease
Management & Research Symposium
at The Clayton Center, Maryville College
Gregory A. Jicha, MD, PhD, is a professor in the Department of Neurology and Sanders-Brown Center on Aging at the University of Kentucky (UK). He holds the Robert T. & Nyles Y. McCowan Endowed Chair in Alzheimer’s research at UK and is the Director of the Clinical Core of the UK, NIA-funded Alzheimer’s Disease Center. He also serves as the Medical Director for KY Telecare and directs the Telemedicine Cognitive Clinic at UK. He is the principle investigator at UK for the National Alzheimer’s Disease Cooperative Study Group and also serves on the Clinical Task Force and Steering Committee for the National Institute of Aging Alzheimer’s Disease Center Program.
Monica Crane, M.D. is the Associate Director of the Senior Assessment Clinic at Cole Neuroscience Center, UT Medical Center, in Knoxville where she is focused on clinical care, Alzheimer’s disease and related dementias research and management. She serves on the Board of Directors of Alzheimer’s Tennessee. Dr. Crane completed her residency, fellowship training and research fellowship in Geriatric Medicine at the Hospital of the University of Pennsylvania in Philadelphia where she later held a faculty position. Dr. Crane was the director of the Memory Health Clinic in Charlotte, NC. She has been recognized by the National Institute of Mental Health for New Investigators in dementia research.
ACCME & CNE Credits Available. Call for details.
865.544.6288
For more information please call Statewide Toll-free: 888.326.988
Online registration NOW OPEN: www.alzTennessee.org/symposium2016
Alzheimer’s Tennessee is offering a special rate of two day’s admission for the price of one for Knoxville Academy of Medicine members.
JUNE 23 & 24 2016
KAM Do you know about these KAMF projects? Knoxville Area Project Access (KAPA) – This program helps to serve the uninsured of Knox County and is the largest Project Access in the nation. KAPA has a staff that screen potential patients and case manages medical care to those enrolled. This program covers the truly needy who have no other access to care through either governmentsponsored or employer-sponsored health programs. Patients are reevaluated every 90 days to ensure they still meet the guidelines. KAPA also employs the only federally-certified Navigators in a 15 county region to assist the community in finding health insurance for those who qualify for a federal subsidy. KAPA has shown a decrease in emergency room visits and provided patient education, thus changing lives and impacting our community. To date, we have facilitated over $175 million dollars in donated health care. Are you a KAPA provider? All KAPA patients can be seen right in your office, eliminating the need to take off work to volunteer. We provide a way that you can give back to the community, help pre-determine your giving goals, and ensure the patient need is valid by screening all applicants. If you would like to participate as a KAPA volunteer, contact Sonnie Campbell at scampbell@knoxvillemedicine.org or call (865) 531-2766. East Tennessee Quality Alliance (ETQA) – One of the Foundation’s most recent programs is partnering with the University of Tennessee Medical Center Knoxville, Covenant Health System, Tennova Healthcare, Children’s Hospital, Blount Medical Center and the Knox County Health Department in a group called East Tennessee Quality Alliance (ETQA). The ETQA provides a vital forum for healthcare organizations and professionals to collaborate and address health challenges of East Tennessee communities. Successful past projects have included a Hand-Washing Campaign in Knox County Schools to eradicate MRSA, Hospital Rapid Response Teams, and a Ventilator-associated Pneumonia Project. Currently, the ETQA is working on two important
KNOXVILLE ACADEMY OF MEDICINE
projects. These projects are Conversation Ready and a new Endocarditis Project. Conversation Ready - In 2014, the Knoxville Academy of Medicine Foundation enrolled with the Institute for Healthcare Improvement (IHI) as one out of 23 pilot sites across the U.S engaging in Conversation Ready. The collaborative project involves area hospitals, providers and other institutions. The IHI is very data driven, so the project includes frequent evaluations of current state and interventions for improvement. The physicians and staff involved are also heavily involved in education oriented towards the providers, the community and patients. The goal is to make advance care plans as much a part of the medical record as allergies. Conversation Ready is also collaborating with etHIN to work towards ensuring advance directives show up in community medical records. In Lacrosse, Wisconsin, where a very similar project has been running for 25+ years, the effort shows results that include close to 90% of the community having advance directives. Nationally, a patient averages over 30 days in the hospital in their final two years of life, in Lacrosse, the number is 13 days. Spearheaded by the Gundersen Clinic, the protocol there calls for three “asks.” Once when the patient is young and healthy, again with age > 55 or onset of chronic illness and a third time when a potentially life ending illness is encountered. The Knoxville Academy of Medicine is very pleased to be part of this national pilot program. The Endocarditis Project (NEW) – This group has recently begun the task of addressing the drug-related endocarditis cases that are steadily rising. This group realizes that the problem is deeper than a costly heart valve replacement and seeks to find a solution that will increase the success rate. KAM physicians have brought together area hospital administration, Helen Ross McNabb, Metropolitan Drug Commission, and recovery centers to tackle this issue and impact the community. If you are interested in participating in either of these projects, please contact the KAM office at (865) 531-2766.
UT Chief Medical Officer, Dr. Lacey, Retires KAM Member, John “Jack” Lacey, III, MD, Senior Vice President and Chief Medical Officer of The University of Tennessee Medical Center retired recently after nearly four decades of service with UTMCK. Dr. Lacey is a past president of the Knoxville Academy of Medicine and 2011 Recipient of the TMA Outstanding Physician Award. “Dr. Lacey is not only one of the best doctors and most skilled physicians I’ve known, but he’s also one of the finest individuals I’ve ever had the pleasure of meeting,” said Joseph R. Landsman, Jr., President and CEO of The University of Tennessee Medical Center. “Jack’s compassion, as well as, his dedication to his patients and our community, is demonstrative of the leadership he has provided to our team members and this campus for nearly forty years.” In addition to his position with UTMCK, Dr. Lacey was instrumental in the formation of Knoxville Area Project Access (KAPA), a program of the KAM Foundation, in which he has been the medical director since its inception in 2006. Dr. Lacey will continue his efforts with KAPA, though retired. Congratulations on your retirement, Dr. Lacey!
KNOXVILLEMEDICINE.ORG
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ACADEMY NEWS
KAM KNOXVILLE ACADEMY OF MEDICINE
Legislative Update By: Elise Denneny, MD
The Tennessee General Assembly has adjourned for 2016 and KAM/TMA was successful on several fronts. Some of these successes included preserving the ability of physicians to provide in-office dispensing; relieving physicians of regulatory licensure as a medi-spa for minor cosmetic procedures; establishing reasonable conditions for licensure of pain clinics and addiction treatment centers; heading off the nurse independent practice bill and diverting it into a summer task force; amending over-the-counter oral contraceptives; giving TAG teams in the Tennessee Payment Reform plan a voice in the general assembly; and the defeat of Patients for Fair Compensation Bill. Other successes can be found on the TMA website. Payor Accountability (also known as the Provider Stability Act) almost passed falling short by only a handful of votes. If you recall, this bill was introduced three years ago as an attempt to hold payors accountable to their contractual agreements. Reform was iterated on several fronts. It met severe resistance from the insurance industry to the extent that “exaggerated” actuarial data were promulgated to the legislators. TMA was able to educate legislators to the excessive barriers payors present to physicians and their patients and inaccuracies misrepresented by the insurance industry. Remember success is not always defined as the passage of sponsored bills. Our voiced opposition to several bills introduced this year prevented further intrusion into the practice of medicine. Specifically I would bring attention to the Patient for Fair Compensation bill. This bill is the brainchild of Mr. Rick Jackson of Jackson Healthcare (Healthcare staffing) based in Alpharetta, Georgia. He introduced this as a solution to what he perceives as a failed tort system. His proposal is to reinvent reform through a system loosely based on the Workman’s Compensation model. Under this model, patient compensation for negative outcomes will not be measured by “negligence” but rather be mea-
sured by was it “avoidable”? How does one truly define “avoidable” as physicians have less control over the delivery of healthcare than ever before? With each regulatory mandate on physicians and healthcare, comes the inevitability of yet another metric or “click” that must be satisfied to payors. At the risk of alarmism, envision the day when the simple task of using a 4x4 sponge will require documenting where it was manufactured, distributed, stored, sterilized, opened, utilized, disposed, etc. With each step there is the element of human error over which the physician has no control. So…was the outcome “avoidable”? Mr. Jackson’s argument for the need for tort reform is based on the belief that the cost of defensive medicine is a hidden driver, raising the cost of healthcare. This is wrong. Since 2011, with the passage of Tennessee tort reform bill, malpractice premiums have dropped 30-40%. Rising health care costs are at best, only marginally driven by malpractice premium and defensive medical practice of ordering tests. Larger drivers include, expensive technology, high patient expectation, uncoordinated care, high cost of drugs, unhealthy behaviors (we are getting older, sicker and fatter) and expensive end of life care costs. Finally, Jackson argues his proposal for medical malpractice could create thousands of jobs. That prophesizes yet another administrative layer of bureaucracy… nightmare of red tape that we have already seen realized in Workers Compensation. This would increase the system’s complexity. Patient for Fair Compensation was opposed by the Georgia Medical Society. Likewise, the TMA and SVMIC believe there is a better way. Physicians should strive to implement systems to protect our patients and value-based care. The bill has gone to summer study and I encourage you to remind your legislators that Patient for Fair Compensation, as presently conceived, will harm efforts to deliver quality value-based care to our patients. If only legislation, as in medicine, be guided by “primum non nocere”.
Monday, June 20, 2016 6:30 pm Casual Pint - Farragut $50 Entry fee All KAM Physicians and invitational guests are welcome to join us for a Texas Holdem Poker Tournament. Tournament slots are limited so reserve your slot today! Entry fee is $50.00 and will benefit Knoxville Area Project Access (KAPA), with the top 3 tournament players receiving prize winnings! Dinner starts at 6:30 pm Tournament starts at 7:00 pm Register at knoxvillemedicine.org or email Margaret Maddox at mmaddox@knoxvillemedicine.org KNOXVILLEMEDICINE.ORG
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KAMA CORNER By: Barbara Crist, KAMA President KAMA had good representation at the 88th TMAA Annual Meeting and Convention held in Murfreesboro April 28th - May 1st. KAMA members Jo Terry, Robin Hutchins, Sandra Huddleston, Cynthia Gash, Jacque Prince, Sheila Barnett, and Barbara Crist attended. KAMA’s own Gail Brabson, TMAA President for the 2015-2016 year, presided over the meeting. Our Philanthropic meeting was held in April and we are very proud that our hard work this past year has enabled us to give $200,000.00 to our community! Health grants and Nursing School Scholarships were recipients of some of these funds. Endowed Nursing Scholarships were established for the UT School of Nursing and TN Wesleyan College Fort Sanders Nursing Dept, as well as one Endowed Medical Scholarship for a UT Medical Student, thus creating a lasting legacy for KAMA. The funds used to establish the endowments came from the KAMA Philanthropic Endowment Fund at the East TN Foundation (formerly the KAMA Health Discovery Fund). Our KAMA membership has grown by 15% this year! This was due to a team effort which included several enjoyable membership events throughout the year, as well as members reaching out one on one to friends and acquaintances. Our May 5th KAMA meeting was a very festive event at the Cherokee Country Club. It included a Past President’s Luncheon to honor former KAMA presidents for their service and the installation of new officers. Newly installed officers are: Barbara Crist, President; Tina Callicutt, President-Elect; Sharon Griffin, 1st Vice-President; Michele Maves, 2nd Vice-President; Paula Kelley, Recording Secretary; Kirstin Kropilak, Corresponding Secretary; Sheila Barnett, Treasurer; Swannee Sexton, Asst.
Poonam Harsh, Barbara Crist, and Juliann Chavez
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Treasurer; and Sandy Ange, Historian. Presentation of KAMA’s new endowed scholarships were given to representatives of the respective nursing schools. KAMA had a very successful booth at the 5th “Let’s Move Knoxville” event at Victor Ashe Park. Our booth theme, “I Can Be Healthy,” included a game used to teach children about how to be healthy. Juliann Chavez, KAMA Health Promotions Chairperson, designed the activity. KAMA members who participated were Jacque Prince, Poonam Harsh, Michelle Bishop and Barbara Crist. Looking toward the next few months, KAMA will have several members attending the annual AMAA Meeting June 12-14th in Chicago. Additionally, the Third Annual Summer Welcome Picnic, hosted jointly by KAMA and KAM, will be held August 19th (with a rain date scheduled for August 26th) at the lower pool area of Gettysvue Country Club. It’s been a very popular event the past two years, with an excellent turnout! The picnic is open to young physicians and their families in addition to physician families who are new to town. However, if you know of a physician family who you’d like to introduce them to KAMA and KAM, please contact Andrea Brown at abrown@knoxvillemedicine.org or (865) 531-2766. KAM will be sending out invitations with more details later this summer. If you would like to learn more about KAMA, visit us on Facebook, follow us on Twitter (KAM_Alliance), Pinterest and on our website www. kamalliance.org Barbara J. Crist KAMA President 2016-2017
Alliance Officers
TECHNOLOGY NEWS etHIN’s Clinical Portal...Soon to be Better Than Ever Additional functionality available this summer by: Leigh Sterling etHIN Executive Director
East Tennessee Health Information Network’s (etHIN) clinical portal is getting a new name and will offer enhanced functionality to users this summer. etHIN is currently upgrading its core system and expects the improvements to be available to users in July. The clinical portal, currently called the Virtual Health Record or VHR, will now be known as the etHIN Health Information Portal, or eHIP for short. etHIN continues to respond to its healthcare community’s needs as they have changed during the past several years, driven by evolving patient needs as well as Federal initiatives. We listened to input from the community during our search for system enhancements, and with the upgrade, we will now be able to offer a system that includes Natural Language Processing, analytics, more robust reporting capabilities, and identification for potential gaps in care. Natural Language Processing, or NLP, is the ability of a computer program to understand human speech as it is written or spoken. In this instance, etHIN’s core system will be able to identify the contents of a
KAM KNOXVILLE ACADEMY OF MEDICINE
transcribed narrative report, for example, allowing users to search by keyword for information that is in the body of the report. This capability will greatly increase the ability of etHIN users to more easily locate specific data they need without having to search through all the contents of numerous reports. The upgraded system also features fully integrated analytics and enhanced reporting capabilities. With these enhancements, etHIN will begin to offer more reporting options including stronger Quality, eMeasures, HEDIS and Star reporting to participants that use etHIN. Analysis for potential gaps in care is another new feature that will be available in the upgraded system that leverages the Natural Language Processing feature within the software. The potential gaps in care list is created as a talking points guideline for providers during a patient’s visit. The list is based on information that has been reported to etHIN; therefore, it is not a definitive list nor does it predict or exclude other patient problems or diagnoses. The new features offered in the etHIN Health Information Portal could be useful in your daily practice as well as supporting your quality reporting requirements. Contact etHIN at 865-691-8433 for more information or a demonstration. .
Blount County Medical Society Quarterly Update Dr. Jerome Heiny
We are pleased to welcome the following 18 new members to our group: James D Briggs, MD-East Tennessee Medical Group, David K. Calvert, MD-Blount Memorial Occupational Health Center At Springbrook, Veronica M Gubatan, MD-Parkway Psychiatric Service, Paul Warrick Miller, MD-Parkway Psychiatric Service, Lee Ellen Naramore, MD-Parkway Psychiatric Service, Stephen Earl Pacifico, MD-East Tennessee Medical Group , Melissa Joy Rodgers, MD-East Tennessee Medical Group, Karen Sawabini Mullins, DO-East Tennessee Medical Group, Bryan Brooks Thompson, MD-Blount Memorial Occupational Health Center At Springbrook, Julia Kristina Wood, MD-Parkway Psychiatric Service, Kristen O. Broadhead, DO-East Tennessee Medical Group, Bruce M. Hairston, MD-East Tennessee Medical Group, Ravindra Narayana Murthy, MD-Smoky Mountain Gastroenterology, James Allen Rigell, MD-Parkway Psychiatric Service, Justin A Bennett, MD-East Tennessee Medical Group, Brett L. Smith, DO-East Tennessee Medical Group, Leonard Scott Sole, MD-East Tennessee Medical Group, Sarah E. Smith, MD-Blount Memorial Weight Management Center As our membership continues to grow we look forward to a more active medical society. Please join us for a family friendly Summer Cook Out on Saturday August 20th! Save the date and plan on attending as details will follow shortly! 15
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We believe it is essential to understand our clients’ investment goals and provide them the best in financial services. We offer our clients services for: • • • •
Wealth Management Retirement Strategies Tax Reduction & Investment Strategies Investment Strategies
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Business Strategies Life & Disability Income Strategies Qualified Retirement Plans Asset Protection Strategies
Contact Travis S. McCurry Phone: 865.246.1697 Cell: 865.556.5873
Travis S. McCurry is a Registered Representative of and offers Securities, Investment Advisory, and Financial Planning Services through MML Investors Services, LLC, Member SIPC, 8 Cadillac Drive, Suite 150, Brentwood, TN 37027 (615) 309-6300.
J. Todd Williams Phone: 865.246.2955 Cell: 865.368.1945
J. Todd Williams is a Registered Representative of and offers Securities, through MML Investors Services, LLC, Member SIPC, 8 Cadillac Drive, Suite 150, Brentwood, TN 37027 (615) 309-6300.
www.capitalfinancialgroup.net 8320 E. Walker Springs Lane, Suite 100 Knoxville, TN 37923 CRN201411-166573
LEGAL NEWS
KAM
CMS Proposes New Changes to the Provider Enrollment Process By: Jeremy Goolsby, London Amburn, P.C.
On March 1, 2016, Centers for Medicare and Medicaid Services (CMS) proposed new regulations implementing sections of the Affordable Care Act that would require “Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) providers and suppliers to disclose certain current and previous affiliations with other providers and suppliers.” If finalized, the proposed regulations would allow CMS to remove or prevent the enrollment of healthcare providers and suppliers that have attempted “to circumvent Medicare’s enrollment requirements through name and identity changes as well as through elaborate, interprovider relationships.” The proposed provisions also address other program integrity issues and vulnerabilities, including instances where providers and suppliers avoid paying Medicare debts by re-enrolling as a different entity. Under the proposed regulations, Medicare, Medicaid, and CHIP providers and suppliers would have to disclose affiliations with providers or suppliers that: (1) currently have uncollected debt to Medicare, Medicaid, or CHIP; (2) have been or are subject to a payment suspension under a federal healthcare program or subject to an Office of Inspector General exclusion; or (3) have had their Medicare, Medicaid, or CHIP enrollment revoked. CMS would then have the authority to deny or revoke billing privileges based on an affiliation determined to pose an “undue risk of fraud, waste, or abuse.” The disclosure of affiliations has a proposed look-back period of five years, and affiliation is defined very broadly to include owning or managing individuals or directors. Furthermore, CMS would require that physicians or eligible professionals who order, certify, refer, or prescribe any Part A or B service, item, or drug be enrolled in or validly opted out of Medicare. The
KNOXVILLE ACADEMY OF MEDICINE
documentation of any such orders must be kept and maintained for a period of seven years and the physician must furnish access to such documentation upon request. If this information reveals a pattern or practice of improper ordering, certifying, or prescribing of Medicare Part A or B services, items, or drugs, enrollment may be revoked. The proposed regulations also place an even higher significance on filing Changes of Information (CHOI). CMS proposes expanded revocation authority for failure to report. It would apply to all types of providers and suppliers who fail to submit required CHOI filings, and to all types of enrollment reporting requirements. Providers would be required to submit an 855 CHOI to report new or changed information regarding existing affiliations. Currently, CMS may revoke enrollment if the provider/supplier fails to report a change in its practice location or a final adverse legal action status within 30 days of the change. Under the proposed regulations, the revocation authority would apply to failure to report all types of enrollment reporting requirements, not just changes of address and adverse legal actions. Essentially, the proposed rule seeks to enable CMS “to take action against unqualified and potentially fraudulent entities and individuals” in hopes of deterring other parties from engaging in the same behavior. The rule would go into effect on January 1, 2018. Providers and suppliers are encouraged to seek the advice of counsel in regards to how this proposed rule may affect their practice. Jeremey Goolsby 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. Goolsby at (865) 637-0203 or visit www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.
KAM Family Fun Night with the Smokies
Friday, June 24, 2016 6:30 PM
$10 adult $5 children
The Smokies play the Pensacola Blue Wahoos (Cincinnati Reds Double A team) Tickets Include: • One ticket good for access to the Calhoun’s at the Yard Pavilion • An all-you-can-eat buffet provided by Calhoun’s served 30 minutes before first pitch • Smokies baseball cap
Register at Knoxvillemedicine.org 17
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ACADEMY NEWS Dr. Roland Gray Speaks at RACMS Meeting On May 17th, Roland Gray, MD gave a presentation to the Roane Anderson County Medical Society and their guests from Region 7 regarding the “Distressed Physician.” The meeting was held at the Event Center at Calhoun’s in Oak Ridge. Dr. Gray is the Medical Director of the Tennessee Medical Foundation’s Physicians’ Health Program and has had extensive experience working with physicians who are burdened by the stresses of the profession. In his presentation, Dr. Gray pointed out that all physicians must deal with the pressures of the position and it is imperative to ask for help when it becomes overwhelming. Many times, manifestations of uncontrolled emo-
Edward Capparelli, MD
tion can range from outbursts within the office to burnout, depression, marital problems, substance abuse, and in extreme cases, even suicide. Often, just the inability to “get-along” with colleagues and the nursing staff can jeopardize hospital privileges which effects our livelihood. The next meeting of the Roane Anderson County Medical Society will be held in August and will feature special guest speaker, Tommy Farmer, of the TBI. Officer Farmer will discuss ways to stay in compliance with controlled substance prescriptions guidelines and prevent a possible investigation of a medical practice. Time and location details are forth coming. For more information about RACMS meetings, contact Andrea Brown via email at abrown@knoxvillemedicine.org or by calling the KAM at (865) 531-2766.
Roland Gray, MD
A BIG Thank You to the Sponsors of KAPA’s Boot Scootin’ Ball! Robin Thomas Vice President Medical Private Banking 865-971-2128 • rlthomas@ftb.com
©2016 First Tennessee Bank National Association. Member FDIC. www.firsttennessee.com
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