Winter magazine 2015 by Knoxville Academy of Medicine

Volum e L X X II, N o . 4 • W in ter 2 0 1 5

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

KAM HOLIDAY SPECIAL ISSUE ACADEMY NEWS LEGISLATIVE DINNER HEALTHCARE HEROS

PLUS-KEENELAND “A DAY AT THE RACES!”

KAM KNOXVILLE ACADEMY OF MEDICINE

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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

Jack Benhayon, MD TREASURER

Pat O’Brien, MD

IMMEDIATE PAST PRESIDENT

Kimberly Weaver, PhD CEO

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

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

Publisher Kim Weaver, PhD

Editor Jonathan Weaver

Production Coordinator Margaret Dillingham

Advertising David Caudill

ADVERTISING: For advertising information, call the Academy offices at (865) 531-2766. The magazine is published four times per year by the Knoxville Academy of Medicine (KAM). All rights reserved. This publication or any part thereof may not be reproduced without the expressed written consent of the KAM. The appearance of advertising in KAM publications is not a KAM guarantee/endorsement of the product or the claims made for the product by the manufacturer. The fact that an advertisement for a product, service, or company has appeared in a KAM publication shall not be referred to in collateral advertising. The KAM reserves the right to accept or reject any advertising in the publication.

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It’s hard to believe that 2015 has passed so quickly! As physicians, we know that the year-end and holiday season can place even more demands on our already busy schedules. (That’s one reason I find myself typing this letter at 1 am!). My hope is that you will find time away from your practice this season to enjoy the special moments with family and friends. This is also a time of reflection, and as we look back on 2015 as an Academy, I think you’ll agree that we have much for which to be proud and thankful. There was much on our legislative agenda this year as Tennessee physicians faced challenges on several fronts including tort reform, fair and timely reimbursement from third party payers, and threats to practice integrity from allied organizations. A record number of physicians attended PITCH, a day of face-to-face conversation with our legislators back in March. Our voices were heard, and we were able to make significant strides on these most pressing issues. At our Legislative Dinner in November, members were provided another forum to directly express our views to our elected representatives. As you know, one of my main objectives this year as President was to increase socialization and networking among our Academy members. We greatly increased the number of social activities offered this year and had record attendance at varied events such as Doc Rock, the Boot Scootin’ Ball, and a Day at the Smokies Ballpark. Each of these events was self-supporting and most actually turned a profit to be used for other Academy activities. Also, our New

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KNOXVILLE ACADEMY OF MEDICINE Physician Mixer and Family Picnic served to strengthen our ties to resident physicians and to mentor new practioners in our community. Most importantly, the Academy remained true to its vision during 2015 and provided for the improved health of our community through several ongoing projects. Our Conversation Ready program educated the patients in our region regarding the importance of end-of-life planning. The Academy also partnered with the Emergency Department at UT Hospital to identify strategies to curb inappropriate usage of the ER by high volume clients. And, KAPA has continued to be a model organization in providing access to health care for the working poor and indigent. Once again, I thank you for all that you have done to make our organization a success! We will enter 2016 stronger than ever in terms of our number and enthusiasm. I look forward to working with you again in the coming year!

Tommy

Calendar of Events JANUARY President’s Dinner, The Foundry, 6:30 pm 29 FEBRUARY Doc Rock, NV Nightclub, 7:00 pm 20 MARCH Pitch 2016, Legislative Plaza, Nashville, 1 8:00 am - 3:00 pm

APRIL KAPA’S BOOT SCOOTIN’ BALL 8

Knoxville Marriott, 6:30 pm - 11:00 pm

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

MedTenn16, April 28 - May 1 Embassy Suites in Murfreesboro, TN

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ACADEMY NEWS

KAM KNOXVILLE ACADEMY OF MEDICINE

Report of the Nominating Committee According to Chapter IV, Section 6 of the Bylaws of the Knoxville Academy of Medicine, “the nominating committee shall submit a slate to the membership with at least one nomination for each vacant office… Any active member may oppose the slate by submitting a petition for a candidate with ten (10) signatures of Active/Veteran members to the Academy office within thirty (30) days after the newsletter is mailed announcing the slate. If after thirty (30) days there is no opposition to the slate, the Secretary shall cast an affirmative vote on behalf of the membership accepting the slate. If there is a qualified petition submitted opposing the slate, a dual slate will be sent to the Active and Veteran membership by the U.S. Postal Service with return mail ballot due thirty (30) days after it was mailed from the Academy office. Election of each office will be determined by simple majority of those ballots received. Ballots will be received and calculated by the Nomination Committee or designee.”

2016 President Thomas Pollard, MD

President-Elect Neal Coleman, MD

Secretary Ceeccy Yang, MD

Treasurer Tim Wilson, MD

Trustee 2016-2018 Jeff Ollis, MD

Trustee 2016-2018 David Harris, MD

Trustee 2016 Michael Brunson, MD

Trustee 2016 Daniel Bustamante, MD

Warmest Wishes for a Happy Holiday KNOXVILLEMEDICINE.ORG

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ACADEMY NEWS New Members A big welcome to our newest members! We are excited that you have decided to join the Knoxville Academy of Medicine. JEFFREY GILBERT, MD

GASTROENTEROLOGY Gastrointestinal Associates PC 801 Weisgarber Rd Suite 100 Knoxville, TN 37950

JOSE CARDENAS, MD

JEFFREY SCHLACTUS, MD

________________________________________________

JANE CONLEY, MD

NICOLE KISSANE-LEE, MD

________________________________________________

KARTHIK KRISHNAN, MD

AMY MCMASTER HAWES, MD

PEDIATRICS

The Allergy, Asthma and Sinus Center 801 Weisgarber Rd., Ste 200 Knoxville, TN 37909

No Picture Available

The Allergy, Asthma and Sinus Center 653 Morganton Square Dr Ste 611 Maryville, TN 37801 ________________________________________________

ALLERGY, ASTHMA, IMMUNOLOGY The Allergy, Asthma and Sinus Center 801 Weisgarber Rd., Ste 200 Knoxville, TN 37909

KNOXVILLE ACADEMY OF MEDICINE

ALLERGY, ASTHMA, IMMUNOLOGY

________________________________________________

NEUROLOGY Tennova North Neurology Clinic 7557 Dannaher Dr. Ste 130A Powell, TN 37849

KAM

TIDENCE PRINCE, MD

INTERNAL MEDICINE The Allergy, Asthma and Sinus Center 801 Weisgarber Rd., Ste 200 Knoxville, TN 37909

GENERAL SURGERY University Surgeons Associates, PC 1930 Alcoa Highway, Suite A-240 Knoxville, TN 37920

CLINICAL PATHOLOGY, FORENSIC Knox County Regional Forensic Center 2761 Sullins St Knoxville, TN 37919

Left Column Top to Bottom: Jeffrey Gilbert, MD; Jose Cardenas, MD; Jane Conley, MD; Karthik Krishnan, MD; Right Column Top to Bottom: Tidence Prince, MD; Jeffrey Schlactus, MD; Nicole Kissane-Lee, MD; Amy McMaster Hawes, MD

The Knoxville Academy of Medicine mourns the recent loss of these three physician members.

Elvin Bayard Noxon, MD 2/21/1922 - 9/9/2015

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I. Ray King, MD 9/15/1939 – 9/25/2015

Joseph Harb, MD Past President of the Knoxville Academy of Medicine 1981 10/25/1934 – 10/3/2015

KAM KNOXVILLE ACADEMY OF MEDICINE

BME Update

By: Reeves Johnson, MD This past July, the Board of Medical Examiners welcomed our own Deborah Christiansen, a former president of KAM and a pediatrician along with Melanie Blake, an internist from Chattanooga as new members. It is good to have 2 more physicians from East TN. We now have 4 physicians and one consumer (non-physician) member from this part of the state. We had a presentation from the Dept. of Health’s Legislative Affairs regarding recent legislation enacted. Of primary interest was the Telehealth bill. There are still some areas that need clarifying such as phone calls being included and whether store and forward technology is required. This may take additional legislation. Public Chapter 494 enacted this past spring requires anyone performing cosmetic services to register with the Dept. of Health. At this time, it will require self-reporting. The bill sets no registration fee or penalty, but the BME is authorized to take action. The BME is developing a process to implement this law. Public Chapter 26 repealed the intractable pain act and I worked with our chief legal counsel and executive director to rewrite our current rule that is affected by this new law. The new proposed rule does include a reference to the Commissioner’s guidelines (Chronic Pain Guidelines) and this will apply to all prescribing, including telehealth. Public Chapter 832 authorizes a collaborative practice arrangement between pharmacists and physicians. A workgroup of physicians, pharmacists and other stakeholders met on several occasions to hammer out a rule that would be acceptable to all. Pharmacists will have to have liability insurance and will NOT be allowed to write controlled substances. A rulemaking hearing by the Board of Pharmacy is scheduled for December 18. The proposed rule can be found at: http://share.tn.gov/sos/rules_filings/10-22-15.pdf During my tenure on the BME, we have seen several issues involving misconceptions about what happens to your medical license when you retire. To help clarify this, a manual has been prepared by Jack Butterworth, MD in conjunction with the TMA that addresses issues related to a MD retiring. It includes references to statutes and rules and other helpful information to assist a MD planning to retire. This can be obtained on the TMA website at: http://www.tnmed.org/Documents/Legal_Guide/Retiring%20Physician%20Manual.pdf

First KAMF Texas Holdem’ Poker Tournament Area KAM physicians and guests came out to support the first Knoxville Academy of Medicine Foundation Poker Tournament that was held at the Casual Pint of Farragut on October 5. Proceeds were donated to the Knoxville Area Project Access which facilitates care for those in our area that do not have access to healthcare. Congratulations to our winners, First Place - Travis McCurry (AKA Money Man) Second Place - Dr. Kevin Martinolich (AKA Kmart) and Third Place went to Dr. Jim Cox (AKA Salty Jim). In addition to bragging rights they were able to take home some nice prizes as well!

Travis McCurry 1st Place

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Dr. Kevin Martinolich 2nd Place

Dr. Jim Cox 3rd Place

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ACADEMY NEWS Legislative Report By: Elise Denneny, MD

Happy Holidays! The final quarter of 2015 will be busy legislatively as we prepare for the 2016 legislative session. Three recent developments will be of interest to you. 1. The Secretary of Health and Human Services responds to the problem of patient satisfaction surveys; 2. Priorities of the 2016 legislative package; and 3. Primer on federal transition from PQRS to MIPS, and Tennessee Healthcare Innovation Initiative reforms. Patient Satisfaction Surveys Rep. Bill Dunn reached out to Sen. Lamar Alexander’s office and raised the concern of all physicians, law enforcement officials and community leaders that patient satisfaction surveys actually encouraged the proliferation of over prescribing painkilling opioids. His effective representation to Sen. Alexander’s office was reinforced when Dr. Tom Frieden, head of the CDC, visited Knoxville last September. A room full of legislators, health care administrators and physicians heard enthusiastic support for Dr. Randal Dabbs’ comments on the negative impact of patient satisfaction surveys. They all heard the problem of physicians who were pressured by negative patient surveys, dissatisfied because they did not get a prescription for pain killing opioids. Our concerns were heard by HHS Secretary Burwell and they will look into the practice of surveys impacting on prescribing. See whitehouse.gov/the-press-office/2015/10/21/fact-sheet-obama-administration-announces-public-and-private-sector for a full report on recent federal initiatives to address the opioid epidemic. The Tennessee legislature will convene January 12, 2016 and the TMA will hit the ground running with three priorities; 1. Tennessee Health Care Improvement Act The bill is in the best interest of every physician and their patients. It establishes the model of a patient-centered physician-led team based health care. Under this model, the physician leads the coordination of patient care between all levels of providers. The model will allow for full collaboration of providers while ensuring access to care, best evidence-based outcomes and a value-based delivery health care system. All members should contact their representatives with an email supporting the future of a physician-led health care delivery model. 2. Healthcare Provider Stability Act. If you recall over the past two years we have fought for payors to be held accountable to contractual agreements for reimbursement. The act, sponsored by Sen Bo Watson,R-Hixson and Rep Jon Lundberg, RBristol will limit how many times payors can change fee schedules and payment policies and require more transparency. Medicine is a business with the need for reliable stable revenue projections to meet the best interests of their employees and patients. Reach out to your representative encouraging them to support the Healthcare Provider Stability Act. 3. Constitutional amendment clarifying that the general assembly can set caps on noneconomic damages In 2011 an amendment to cap noneconomic damages in all types of tort cases was passed. By law it must pass the General Assembly a second time before it can be placed on the ballot for a vote in 2018. If it doesn’t pass the Assembly in 2016 then the next window for tort reform will have to wait until 2022.

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KAM KNOXVILLE ACADEMY OF MEDICINE

The Federal SGR Repeal in 2015 We repealed the SGR in 2015 but now are dealing with the MPFS and MIPS. Since all these acronyms can be confusing below is a cheat sheet for your use. The changes coming after the repeal of the SGR are multiple with many new variables to measure quality and provide flexibility. Presently, CMS is collecting data from approved entities called Qualified Clinical Data Registries. Many QCDR are still in the early phases of development. QCDR will be used to measure quality and be one factor for participation in MIPS. In 2019 the MIPS will replace the SGR. MIPS will be a consolidation of data from the PQRS,VM and EHR programs. Most of you are familiar with the Meaningful Use (MU) criteria and EHR variables. If you are in a group of 100 or more, you will have already experienced the impact of the Value-based Modifier in your reimbursement. The Value Modifier does not apply to group physicians that participate in the Medicare Shared Savings Program ACO or Comprehensive Primary Care model for 2015 and 2016. From 2015 to 2019 payments will update by 0.5% each year. In 2019, physicians will have the option to participate in the MIPS and choose a way that fits their practice best. See cms.gov/newsroom/mediareleasedatabase/fact-sheets/2015-factsheets-items/2015-07-08.html Acronym

Full Name

ABLE

Achieving a Better Life Experience Act of 2014

CAHPS

Consumer Assessment Healthcare Providers & Systems

Eligible Professional

GPRO

Group Practice Reporting Options

IWPUT

Intra Service Work per Unit of Time

MACRA

Medicare Access and CHIP Reauthorization Act of 2015

MIPS

Merit based Incentive Payment system

MPFS

Medicare Physician Fee Schedule

ONC

Office of the National Coordinator Information Tech

PAMA

Protecting Access to Medicare Act of 2014

Practice Expense

PFS

Physician Fee Schedule

PQRS

Physician Quality Reporting System

QCDR

Qualified Clinical Data Registry

RUC

Relative Value Scale Update Committee

RVU

Relative Value Units

Value Based Modifier

The Tennessee Payment Reform was initiated in 2013 by Governor Bill Haslam as part of the Tennessean Health Care innovation initiative and initially included the lives of TennCare and state employee benefit participants. The reports that have been distributed to physician have already undergone revision and will hopefully continue to improve in simplicity and transparency. There is an appeal process for reports and Ms. Jackie Woeppel is the TMA Health Care Innovation Coordinator. She is a valuable resource for help in dealing with reimbursements and possible adjustments moving forward. Her email address is jackie. woeppel@tnmed.org. The legislative committee continues to monitor problems the physician community has with Tennessee Payment Reform and to seek relief and changes through possible legislative action. We invite all members to give feedback on this payment reform.

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Trust the team I trust. Peyton Manning – Former Tennova Patient

It doesn’t fit neatly in a trophy case, but earning someone’s trust is among the highest of accolades. When Peyton Manning needed a hospital he could count on, Tennova came through in the clutch. And the rest, as they say, is history. When it counts, put your trust in Tennova. For more information, call 1-855-TENNOVA (836-6682) or visit Tennova.com.

North Knoxville • Physicians Regional • Turkey Creek • Cleveland • Jefferson Memorial • LaFollette • Lakeway • Newport

ACADEMY NEWS Keeneland - “A Day at the Races!”

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And they’re off… A group of KAM physicians and invited guests boarded the chartered bus and headed for a fun filled day at Keeneland horsetrack in Lexington Kentucky. Horse enthusiasts and first time attendees had a fabulous day of great food, fellowship and entertainment. Special thanks to SouthEast Bank and Capital Finance for their sponsorship of this event. Be sure to check out the Calendar of Events on KnoxvilleMedicine.org often to stay current on all the upcoming events.

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ACADEMY NEWS Legislative Dinner On November 12, the Knoxville Academy of Medicine held its Annual Legislative Dinner at SouthEast Bank in Farragut. Physician members from KAM, Roane-Anderson County Medical Society, Blount County Medical Society, KAMA members and invited guests enjoyed live music, wine and appetizers as they mingled during the reception, providing them the opportunity to speak with legislators. Legislative guests included Sen. Richard Briggs, MD, Rep. Jason Zachary, Rep. Kent Calfee, Rep. Bill Dunn, Sen. Doug Overbey, Rep. Eddie Smith and Rep. Bob Ramsey. A fabulous dinner was catered by Chef Robert Allen of Citico’s and sponsored by SouthEast Bank. KAM’s Legislative Committee Chair, Elise Denneny, MD, along with TMA’s Julie Griffin shared highlights of legislation to be watching in 2016 and the effects on physician practices and their patients. Physicians and legislators were granted the opportunity to speak and share information in an open forum. Rep. Bill Dunn spoke regarding the progress that has resulted from the collaborative efforts of the Knox County Drug Task Force, co-sponsored by KAM and the Metropolitan Drug Commission. Many thanks to those that participated in this event. It is with a united voice that we are able to accomplish great things! Please continue to join us for all our events, as your presence and participation make a difference.

Dr. Elise Denneny, Rep. Kent Calfee, Senator Doug Overbey, and Dr. Bill Burkhart

Dr. Jack Lacey and Rep. Eddie Smith

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Dr. Matt Mancini, Rep. Bill Dunn, and Rep. Bob Ramsey

KAPA Providing Access to Healthcare Knoxville Area Project Access (KAPA) is an organization committed to assisting Knox County and East Tennessee residents with access to healthcare. So how can we help your uninsured patients? Well, KAPA has a couple different options when it comes to access to care: Enrollment through the Health Insurance Marketplace or enrollment in KAPA. Before patients go through the KAPA enrollment process, patients work with one of KAPA’s Navigators in verifying that they do not have access to affordable healthcare coverage through the Federal health insurance exchange (Marketplace). KAPA is the only federally selected East Tennessee Navigator Program for the Marketplace; KAPA serves 10 East Tennessee counties through our Navigator services. As the East Tennessee Navigator Program, KAPA has been federally trained to facilitate enrollment of eligible individuals and small businesses into qualified health plans in the Marketplace. Those that have access to affordable healthcare coverage in the Marketplace are not eligible for enrollment in KAPA. Those patients not eligible for subsidies or cost sharing credits on the Marketplace can move forward with their enrollment process in KAPA. Once a patient has verified that they cannot receive affordable healthcare coverage through the Marketplace or any other avenues, the patient will speak with a KAPA Enrollment Specialist. The Enrollment Specialist will arrange an intake appointment for the patient to fill out

Seventh Annual Health Care Heroes Honors KAM Members Congratulations to two KAM Members for being named 2015 Health Care Heroes. Robert Overholt, MD and Wahid Hanna, MD received this special recognition recently at the 7th Annual Health Care Heroes luncheon hosted by the Knoxville Business Journal and held at the Foundry. This year’s sold out event celebrated nine individuals who have had an impact on the medical profession and community in this area. It came as no surprise to have Drs. Overholt and Hanna among the recipients. Dr. Robert Overholt is a past President of both the Knoxville Academy of Medicine and the Knoxville Academy of Medicine Foundation. In addition to being a dedicated physician with the Asthma, Allergy and Sinus Center in Knoxville, he has greatly impacted the health and well-being of many people as the host of the Dr. Bob show, a nationally syndicated broadcast. In his acceptance speech, Dr. Overholt not

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KAM KNOXVILLE ACADEMY OF MEDICINE

an application. KAPA provides patients enrolled with access to a full continuum of donated medical care including: primary care, specialty physician care, hospital inpatient care, outpatient and ancillary services, psychiatric care, and pharmacy support. In order to qualify, the patient must meet the following criteria: • Must not have access or be eligible or any other type of insurance or government-sponsored healthcare program; • Must be a resident of Knox County; • Annual household income must be at or below 200% of the Federal Poverty Level In addition to coordinating and creating access to medical care for the uninsured of East Tennessee, KAPA continually looks for opportunities to meet other health related needs in the Knoxville community. KAPA is currently working on several initiatives focused on disease management and healthier outcomes for patients. One of these projects is centered on raising awareness and reducing Neonatal Abstinence Syndrome. KAPA is also working with the University of Tennessee Medical Center on a hospital specific Emergency Department Utilization Initiative. KAPA continues to meet the needs of the community and provide services to make Knoxville a healthier place. If your patient or someone you know is uninsured, please ask them to give KAPA a call at 865-531-2766 so we can assist.

only spoke of the importance of making a difference and helping others, which, according to him was instilled by his father, but was very gracious in his praise of his fellow physician members of the Knoxville Academy of Medicine. Dr. Wahid Hanna, a member of the Knoxville Academy of Medicine since 1995, is the Director of the UT Medical Center’s East TN Comprehensive Hemophilia Center. He has dedicated his life to helping those with blood disorders and cancer since 1972, when he treated one of his first acute leukemia patients, which opened the door to his lifelong passion. Dr. Hanna was described by Dr. John Bell, Director of the UT Medical Cancer Institute, as having “great character and a man who knows the value of life and encourages patients to stay positive and never give up.” The physician members of the KAM are honored to have these two doctors among the membership ranks. Thank you both for your dedication, passion, and integrity to the medical field.

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KAMA CORNER By: Lorraine Johnson, KAMA President As Thanksgiving and Christmas rapidly approach, I‘m reflecting on what a wonderful year KAMA has had thus far and all due to the hard work of our members! We have been involved in the community in numerous ways and I will highlight just a few of these special events. In August we held the Second Annual Summer Welcome Picnic at Gettysvue Country Club. This event was co-hosted by KAMA and KAM and once again it was very successful reaching out to young physicians and their families in addition to physician families who were new to town. TMAA Fall Update was held in Knoxville for the second year in a row. Gail Brabson (one of our own!) is the president of TMAA this year. We were proud that she led this important meeting which allowed the alliances in the state to share their ideas and plans for the future. Fashiondrama was held at Cherokee Country Club on Tuesday, September 29th and it was a huge success. The theme was “Destination Fash-

Chicken Pesto Bake By: Lorraine Johnson • • • • •

4 Boneless, skinless chicken breasts, on the thinner side Jar or container of prepared Pesto sauce 3-4 Roma tomatoes, sliced 6-8 oz Shredded Mozzarella cheese Pine nuts, toasted

Spray a 9 x 13 baking pan with Pam. Place chicken breasts in pan. Generously coat each chicken breast with the Pesto sauce. Next top with tomatoes followed by mozzarella. Bake 400 for 20 minutes (longer if chicken breasts are thick). Top with toasted pine nuts just before serving.

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ion” and tickets to the show sold out two weeks prior to the event, which was wonderful for KAMA! The proceeds from this fundraiser support local Nursing Scholarships and Health Grants to be presented in the spring. The next meeting, our Christmas meeting, will be held at the home of Dr. and Mrs. William Terry on Thursday, December 3rd at 10:30. This meeting is always a fun and festive time and I would like to welcome anyone who is interested in learning more about KAMA to please join us! You can contact me at lorrainejj@comcast.net. for additional information. Looking ahead to 2016, Doc Rock is our next big fundraiser. It will be held at NV in the Old City on Saturday, February 20th. This event features local doctors playing great music to raise money for health related charities in our community. With sincere appreciation for the dedication KAMA members have given to this wonderful organization, I wish you all the joys of this holiday season and a New Year filled with peace and happiness!

A favorite recipe that we use almost every time at Ronald McDonald is: Jenny's Crockpot Green Beans By: Barbara Crist • • • •

1 54 oz. can green beans 2 15 oz. cans of Bush’s Pinto beans 1/8 onion Tony Cachere's seasoning

- Drain green beans then put in crock pot. - Pour about a tablespoon of olive oil onto green beans. - Put pieces of onion on green beans. - Sprinkle some of the Tony Cachere's seasoning on beans. - Pour the pinto beans over the green beans (do not drain.) - Sprinkle more seasoning on pinto beans. - Cook on low for 5-6 hours.

TECHNOLOGY NEWS etHIN Implementing Community-Wide Transitions of Care Solution Local Healthcare Community Members Involved in Selection by: Leigh Sterling etHIN Executive Director

It is well known in the healthcare community that people with numerous or complex health issues may become higher utilizers of medical, behavioral, and social services. The overall annual cost of care for these patients often falls into the highest percentiles when reviewed against their peers. As we continue to move into value based payment models focusing on measuring outcomes and overall costs, it becomes critically important to providers to gain a broader overall understanding of the healthcare services being provided to their patients. Additionally, in order to work toward better outcomes for their patients, efficient care coordination, including strong referral relationships with clear sharing of patient information, is necessary. etHIN is working to support the needs of providers working in a value based payment environment by providing technology solutions that assist the local healthcare community in managing patients as they move between providers. One such new offering is a community-wide transitions of care and referrals management solution. etHIN community participants identified a high need for a cross-

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community workflow management solution to focus on the problem where patients are sent to other providers for services but the required patient data doesn’t seem to flow/track as easily between the sender and receiver of the referral. This past summer, etHIN formed a community workgroup of physician practices, pharmacies, social services, hospitals, and other healthcare providers to assist with determining criteria and selecting a vendor for a Transitions of Care/Referrals Management product. The workgroup recently completed its work by selecting Caredination, powered by Stella Technology. Caredination is a medical communication and care coordination (lite) platform that focuses on ensuring patients’ medical information does not get lost as the patients move between providers in today’s complex healthcare system. Caredination facilitates multi-directional, collaborative dialogue among healthcare service providers in a secure HIPAA-compliant environment. Three organizations including KAPA are participating in the initial Proof of Concept, which will be ongoing for the next several months. The community-wide launch of Caredination is anticipated mid-year in 2016, after the Proof of Concept period ends. Not only can Caredination assist in managing transitions of care and referrals, it can help you achieve Meaningful Use Stage 2, if that is a goal for your company. If you might be interested in participating with other organization during the Proof of Concept period, please contact etHIN at 865-691-8433.

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LEGAL NEWS Recent Cybersecurity-Related HIPAA Settlements

By: Kourtney Hennard, London Amburn, P.C. The importance of cybersecurity is becoming increasingly evident in the context of protecting patient information. Whether posed by hackers, negligent employees, or innocent mistakes, the risks to providers in the HIPAA context are numerous and significant. The HHS Office for Civil Rights (“OCR”) enforces the HIPAA Privacy, Security, and Breach Notification Rules. Violations of these Rules may result in crippling civil monetary penalties and, in some cases, criminal penalties as enforced by the Department of Justice. This article provides an overview of some recent cybersecurity-related settlements for alleged breaches of the HIPAA Rules. Stolen Laptops In September 2015, HHS announced a $750,000 HIPAA settlement involving a laptop and unencrypted backup media, containing ePHI of approximately 55,000 patients that had been stolen from an employee’s car. The OCR found the company to be in widespread non-compliance with the HIPAA Security Rule. The company did not have a written policy regarding removal of devices containing ePHI from its facilities, nor had it conducted an enterprise-wide risk analysis, which likely would have revealed the common practice of employees removing unencrypted media from company facilities. Two other settlements related to stolen unencrypted laptops, totaling nearly $2 million, were announced in April 2014. Internet-Based Document Sharing & Network Security Another settlement, announced in July 2015 and totaling $218,400, involved the use of an internet-based document sharing application containing ePHI of approximately 500 patients. The employees of a medical center had failed to analyze the risks of the application, and the company failed to timely identify, respond to, mitigate the effects of, or

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document the security incident. The largest HIPAA settlement to date, at $4.8 million, was announced in May 2014 and arose out of alleged joint breaches of the Privacy and Security Rules by New York Presbyterian Hospital and Columbia University. The entities shared a data network and firewall that was administered by employees of both entities; the network linked to patient information systems containing ePHI. Ultimately, ePHI from the systems became accessible via internet search engines. The OCR found that neither entity had conducted an accurate and thorough risk analysis, developed an adequate risk management plan, or made efforts to assure the server was secure and contained appropriate software protections. Furthermore, New York Presbyterian had failed to implement appropriate policies and procedures for authorizing access to its databases, and it had failed to comply with its existing policies on information access management. Conclusion Two overarching lessons emerge from these settlements: (1) effective encryption is critical; and (2) robust compliance programs, policies, and procedures are indispensable. Covered entities and business associates are encouraged to review compliance training materials provided by the federal government and, where possible, consult with experts who specialize in health care data security. As the OCR continues to ramp up its cybersecurityrelated enforcement efforts, the stakes are too high to give short shrift to HIPAA compliance. Kourtney Hennard 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 Ms. Hennard 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.

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ACADEMY NEWS Resident Article

By: Niva Misra-Sammons, MD PGY3 (Third Post-graduate Year) IM Resident UT Graduate School of Medicine, Dept. of Medicine While we make memories with family and indulge in wonderful parties this holiday season, it is important to remember to maintain healthy habits. This is not to say that we shouldn’t indulge in those ham and yams at Thanksgiving. This is just a great time of year to remind ourselves that good eating habits and staying active is essential. In July, I decided to take my health into my own hands. My second year of residency had predisposed me to eat cookies and gummy bears for breakfast after long call shifts. I was determined to lose a few pounds and exercise more. First, I joined a local Barre studio. The class is a combination of yoga, pilates, and use of ballet barre technique. I wasn’t very flexible in my first barre class, nor did I know what to expect. Eventually, I improved at stretching and I got more benefit out of the use of light weights. Second, I coerced my husband into joining a spin class at a local spin studio with me. The spin classes involve fast-paced peddling to burn calories and works muscles by going into a standing position on the bike. At first, I couldn’t stand up on the bike to participate in the “standing and

Giving Back to the KAM Foundation is EASY! Kroger Community Rewards: Register your Kroger Card online and select the Knoxville Academy of Medicine Foundation in the Community Rewards section. Each time you use your Kroger card at the checkout, the Foundation will receive a percentage. Amazon Smile: Simply go to smile.amazon.com and log into your account. Under the search bar, click “Supporting.” From the drop down, you should be able to add a charity. Search for the Knoxville Academy of Medicine Foundation and click “Select” to add. Now every time you make a purchase on Amazon Smile, the Foundation will receive a portion. If you have any questions, please contact the Knoxville Academy of Medicine at 865-531-2766.

climbing” workouts, which seemed to defeat the purpose of the class. I stayed with it and learned techniques to increase the resistance on the pedals, and I got a comfortable seat cover. It has also been a great way to spend time with my husband as we are both so busy in residency. About two months later, I started using a popular calorie-counting app on my phone. This has really been an eye-opener into the foods we eat every day. This helped me combine my healthy exercise habits with healthy eating habits. Using the app has also helped me relate better to my patients in clinic that want to lose weight. I have also met inspirational people and made new friends. One in particular that struck me is a new friend of mine in my barre class. She appears to be in great shape at age 40 and has two teenaged sons to keep up with. She related to me that she indeed had breast cancer several years ago but kept up with the barre classes. She told me how the stretching helped her and the exercise itself seemed to help her recovery. It has been wonderful to see not only this lady as an example, but so many adults taking time to care for themselves. It is too easy to neglect a healthy living when our schedules are full. We all need to take a step back and ensure we are doing what we need to do to have a healthy lifestyle. It is important to reflect at the holidays and maybe even make a dedicated new year’s resolution for 2016. Finally, I did lose the weight that I wanted and am still exercising!

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