East Tn Medical News August 2013

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PHYSICIAN SPOTLIGHT PAGE 2

Marcio Fagundes, MD ON ROUNDS

AAOS Updates Clinical Practice Guidelines for Osteoarthritis of the Knee

By CINDy SANDERS

HEALTHCARE LEADER: Tammy Pietrzak

The American Academy of Orthopaedic Surgeons (AAOS) recently released a revised clinical practice guideline for treatment of osteoarthritis of the knee with key changes to recommendations regarding the dosage of acetaminophen and use of intra-articular hyaluronic acid (HA).

David S. Jevsevar, MD, MBA, chair of the AAOS Evidence Based Quality & Value Committee and chair of the workgroup for OA of the knee, said the 2013 edition of the clinical practice guideline (CPG) contains 15 recommendations and replaces the first edition of the CPG, which had elicited some concern over the methodology employed in garnering some of the evidence … specifically that attached to the use of HA. Jevsevar, a board-certified orthopedic surgeon at Intermountain Zion Orthopedics & Sports Medicine in St. George, Utah, said it is the policy of the AAOS to do all CPG data

Tammy Pietrzak can remember back to those days of clinical rotations, when her colleagues in nursing school almost universally dreaded clinical rotations in behavioral ... 4

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Making the Marriage Work Filling in the Gaps

Alignment & Integration Strategies to Strengthen Physician, Hospital Unions

From galas to golfing, fundraisers plug healthcare providers’ budget holes

By CINDy SANDERS

When it comes to new equipment, facility renovations and expanded services, the capital-expenses wish list for hospitals and healthcare providers ... 7

… And they all lived happily ever after.

In fairytales, the two protagonists manage to overcome many barriers to ultimately ride off into the sunset … presumably for a lifetime filled with sunshine and roses. In the real world, we only have to look to divorce statistics to know that ‘wedded bliss’ frequently dissolves into angry recriminations, mistrust and broken vows.

As it turns out, marriage makes for an interesting analogy to the wave of physicians, practices and hospitals rushing to the altar under the new world order of healthcare reform. Thanks to economic strain, the market has seen quite a few shotgun weddings lately. In other cases, such as some ACO affiliate agreements, the parties have opted to cohabitate rather than legally wed. And in

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PhysicianSpotlight

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Marcio Fagundes, MD

By BRIDGET GARLAND

Although he may be living in a new state, Marcio Fagundes, MD, a board-certified radiation oncologist, is working in familiar territory. As the newly appointed medical director of the Provision Center for Proton Therapy and a physician with Provision Medical Group in Knoxville, Fagundes has spent many years researching, developing, educating about, and treating patients with proton therapy. Recruited to help start up the center, Fagundes first became interested in proton therapy as a fellow at Massachusetts General Hospital in Boston. “I fell in love with protons,” said Fagundes. “They are a very innovative way of doing therapy.”

Unlike traditional cancer treatments, proton therapy gives the physician the ability to treat selectively. Radiation, for instance, when delivered, goes all the way through the body, but proton particles stop at the tumor.

Classic indications for proton therapy have been used for decades, first used at Mass General in the 1970s. Tumors located at the base of the skull, for example, require a lot of radiation, but such doses put the patient at risk for blindness. With proton therapy, however, the tissues surrounding the tumor are spared during treatment, reducing common side effects.

Other classic indications include eye melanomas, pediatric cancer, spine tumors, and prostate cancers, all of which can be complicated to treat with traditional therapy.

Fagundes’ enthusiasm for protons can’t be disguised as he explains the tremendous benefits to the patient and the emerging indications for protons. “They maximize tumor control and minimize side effects,” he enthused. “Protons do not replace other therapies; when surgery is needed, it’s needed. But protons are noninvasive, and organ preservation is a huge benefit.”

Fagundes comes by his passion for protons honestly. Originally from Brazil, Fagundes first came to the United States as a young boy with his parents, who were training in the field of radiation—his father, to be a radiation oncologist, and his mother, to be a radiation therapist. A family affair, Fagundes has a brother who is also a radiation oncologist.

His parents moved the family back to Brazil after completing their training, where Fagundes attended medical school at the Universidade Federal do RGS in Porto Alegre. He returned to the U.S. to easttnmedicalnews

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complete his internship and residency at the University of Miami Jackson Memorial Hospital and his fellowship at Harvard Medical School, where he first treated patients with proton therapy.

In collaboration with his colleagues, Fagundes has published several peer-reviewed papers on the treatment of various cancers with proton therapy and continues to research and explore new protocols and emerging indications for the therapy. He is currently the principal investigator for the University of Pennsylvania’s retreatment protocol using protons, which he began while working in Oklahoma City at the ProCure Proton Therapy Center in Oklahoma City. Fagundes also worked in St. Louis, Missouri, for 4 years, where he practiced with his brother at the Kling Center for Proton Therapy.

Fagundes has a particular interest in proton therapy used to treat cancers of the breast. “In traditional therapy, especially when the lymph node areas are included, breast cancers encompass a large area for treatment, which exposes the heart and coronaries,” said Fagundes. Citing a study published in the New England Journal of Medicine on March 13, 2013, Fagundes explained that a large percentage of the study’s participants developed major cardiac events after radiotherapy. “However, using proton therapy,” explained Fagundes, “we are able to selectively spare the coronaries.”

Other emerging indications for proton therapy include cancers of the lung, if the tumor cannot be resected; the liver, which often presents with resistant tumors requiring higher doses of radiation; the esophagus; pelvic tumors; and re-treatment for recurrent large tumors. For each of these indications, the major advantage of proton therapy is the ability to deliver large doses of radiation with a significantly reduced rate of negative side effects.

In one study conducted by the University of Texas MD Anderson Cancer Center, for locally advanced nonsmall cell lung cancer treated over six to seven weeks with high dose conventional therapies, the rate of esophagitis was 18-44%; with protons, it was reduced to 5%. The incidence of pneumonitis was 9-30% using traditional therapies but was reduced to 2% with proton therapy.

Currently, there are over 100 active proton therapy clinical trials to advance indications, including prostate, GI, breast, and pediatric. Prostate cancer will be the first cancer treated at the new Provision Center for Proton Therapy in Knoxville, one of only 14 centers in the United States and 30 worldwide. Although more

are scheduled to open soon, the scarce amount of centers begs the question of why proton therapy isn’t more widely available, considering the tremendous benefits to the patient.

“Cost and complexity--,” Fagundes explained, “those are the main reasons why proton therapy isn’t more wide spread. It started slowly in the 70s and 80s, but in the last decade, it has taken off exponentially because there is growing evidence it is a superior treatment. ...One goal of ours here at Provision is to have people from other places come here to gain knowledge to develop their own center.”

Provision plans to open for treating patients in early 2014. Until then, Fagundes will spend time educating the community and other physicians about proton therapy. “We are educating the physician population, from general practitioners to specialists, and are expecting a lot of growth,” he said. “We are still trying to optimize the best uses for this treatment modality, working with other specialists.

Together, we will have a better result.”

Fagundes is married and has a 22-year-old stepdaughter who attends school in Miami. He and his wife are looking forward to living in the Knoxville area.

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HealthcareLeader

Tammy Pietrzak, CNO, COO, Parkridge Valley

By BRAD LIFFORD

Tammy Pietrzak can remember back to those days of clinical rotations, when her colleagues in nursing school almost universally dreaded clinical rotations in behavioral health. Pietrzak felt just the opposite, felt strongly enough that she could clearly see her career before her.

“When I was in nursing school,” Pietrzak remembered, “I was drawn to behavioral health. You either love it or you hate it; you’re either drawn to it or not, and I was drawn to it. It’s always fascinated me with the way the mind works.

And now there’s so much more research and development in the past 15 years, so much progress.

“It’s always been fascinating to me the influence the mind has over the body.”

A Certified Psychiatric and Mental Health Nurse, Pietrzak is as excited about her field now as she ever has been, with a new leadership post at a well-regarded Tennessee leader in behavioral health. Pietrzak recently accepted a position as Associate Chief Nursing Officer and Chief Operating Officer at Parkridge Valley, the two-campus behavioral health facility of Parkridge Health System.

Pietrzak’s appointment to Parkridge is fortuitous for her and for the organization. The facility has served the Tri-State area for 40 years – providing comprehensive, expert treatment for behavioral and chemical dependency problems – and the 35-year career Pietrzak has enjoyed in healthcare has mostly been in the behavioral health field.

She spent the bulk of her career working in the Knoxville area, and then

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moved to Asheville, N.C., to work at Mission Hospital. It’s a hospital with a sterling reputation and Pietrzak was doing well as Compliance Manager of Behavioral Services, but when a recruiter at Parkridge Valley got in touch, she had no choice but to make her stint at Mission a short one.

“I did compliance at Mission, and I was good at it, but I’m more of an operations person and when you’re doing compliance, you’ve got to keep your hands out of operations,” Pietrzak said. “My history is to be at places 10 or 20 years, and I’ve turned down opportunities before. But when this opportunity [at Parkridge Valley] came up, I thought, ‘I’ve got to do this.’’’

It has been a time of change for Parkridge Valley, and Pietrzak considers it to be an exciting one. The facility completed in June a transition to its two campuses. With the opening of a new 64bed Adult & Senior Campus, the existing Parkridge Valley facility became known as the Parkridge Valley Child & Adolescent Campus.

Pietrzak said having specific service lines for children and adolescents in one facility, with a separate place for adults, serves patients best now and in the future with the promise of growth. The new adult campus, which is where Pietrzak’s office is based, serves as the home to behavioral health and addiction services for adults as well as senior adults with both psychiatric and medical needs – also a new integration of services for Parkridge Valley.

“There is a clear distinction of the separation of services,” Pietrzak said, “and I think that gives us a number of new opportunities. We’ve got a lot of growth potential, and there’s a lot of things we can do to make this service progressive, to be cutting-edge.

“I think eventually we’ll be able to move all [behavioral] outpatient programs here, for everything to be centered on this campus. The goal with any medical service is to try to keep people in the

community and move toward outpatient treatment and to avoid hospitalization whenever you can. Some people do need hospitalization, but if you can deliver the services they need on an outpatient basis, it makes sense to do that.”

Before her time at Mission, Pietrzak was Director of Inpatient Services and Regional Behavioral Health Line Leader with Tennova Healthcare in Knoxville.

She also held behavioral health leaderships positions at Peninsula Behavioral Health and Oak Ridge’s Methodist Medical Center.

A member of the Tennessee Organization of Nurse Executives, Pietrzak received her nurse and executive leadership training in Ohio. After earning an Associate of Science in nursing degree from Kettering College of Medical Arts in Kettering, Ohio, she completed a Bachelor’s degree in nursing from Dayton University.

She also earned her Master of Business Administration degree there. Pietrzak is also a member of the Tennessee Hospital Association Psychiatric Section Steering Team and the Sigma Theta Tau honor society.

Pietrzak and her husband, who have two daughters, enjoy water skiing, reading, and gardening in their spare time. She is a healthcare professional with real clarity in terms of her career, but there is one thing where clarity does elude her: pronunciation of her name. It’s ‘Pet-Shock.’

“I tell people not to bother trying to sound it out,” she said with a laugh.

Even in the early days of her newfound professional home, she sees a bright future ahead.

“This is only week five for me here, and I’m just still kind of getting my feet on the ground and really just learning the processes and learning to be part of Parkridge Valley,” said Pietrzak, “but it has already been great. I have a lot of experience in this field, and I’ve found so many people here who have been willing to help.”

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ICD-10: Are You Ready?

By BILL HEFLEY, MD

With the rapidly approaching ICD-10 ‘go live’ date of October 1, 2014, medical practices should be well on their way in preparing for the transition. With implementation of ICD-10, physician offices accustomed to the 13,000 ICD-9 codes must be prepared to transition seamlessly to a new set of 68,000 codes. More specifically, a physician or billing clerk currently using ICD-9 to properly code the diagnosis of ‘patella fracture’ must choose between two possible codes; when utilizing ICD-10 that number explodes to 480 codes. Yes. Get ready.

In 1992 the World Health Organization (WHO) published the International Classification of Diseases, Tenth Revision. The U.S. made modifications to the WHO ICD-10 creating the ICD-10-CM (Clinical Modification) which is the diagnosis code set that will replace ICD-9-CM Volumes 1 and 2. The Department of Health and Human Services (HHS) published a regulation requiring the replacement of ICD-9 with ICD-10 and later pushed back the compliance date one year to October 1, 2014. Farzad Mostashari, MD, the National Coordinator for Healthcare Information Technology, asserted last month that there would be no extension of the deadline.

While many physicians see the transition to ICD-10 as an unnecessary burden, other physicians and industry stakeholders believe that the ICD-9 code sets are obsolete and inadequate. ICD-10 codes have more characters and a greater number of alpha characters creating space for new codes and flexibility for future medical advances. ICD-10 has increased specificity that will improve the ability to identify diagnosis trends, public health needs, epidemic outbreaks, and bioterrorism events.

In addition, ICD-10 will improve claims processing, quality management and benchmarking data.

A successful ICD-10 transition requires exhaustive preparation by medical practices. Yet recent research by the Medical Group Management Association indicates that only 4.7 percent of practices reported that they have “made significant progress” when rating their “overall readiness level for ICD-10 implementation.”

The research was derived from respondents in 1,200 medical practices in which more than 55,000 physicians practice.

Preparing to practice medicine in the world of ICD-10 is no small undertaking.

It will require time and money. Having an experienced billing clerk “coder” in the practice will no longer be sufficient to generate accurate codes. Simply converting the practice’s ICD-9 superbill to ICD-10 is problematic. Many industry experts don’t see the superbill being preserved at all. The American Academy of Professional Coders (AAPC) recently issued a two page ICD-9 superbill which when crosswalked to ICD10 became nine pages long. Another industry consultant sites an example of a two page ICD-9 superbill translating into a 48page ICD-10 superbill. easttnmedicalnews

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Preparation for the medical practice begins with internal training and testing of all parties involved in producing proper coding. Administrators must establish a training and implementation schedule; set deadlines; create a project team; identify training resources; perform documentation gap analysis; evaluate and modify the practice’s forms; budget for transition expenses; communicate with practice management (PM) software and EHR vendors; assess hardware and software update requirements; and arrange testing with clinical and billing staff, PM and EHR vendors, clearinghouses and major health plans.

Providers must be trained on the changes in clinical concepts and the level of detail in ICD-10, so that their documentation supports the ability to code to the highest level of detail. For many specialties, it is highly recommended that physicians take anatomy and physiology refresher courses. Billing staff must increase their knowledge of anatomy and physiology, learn and adopt a completely different coding system and be able to code to the greatest level of detail.

Training options include sending staff for offsite training, hiring an outside trainer to come to the practice, online training, webinar training and book-based training. Frequent testing and trial coding for all staff is also highly recommended in the months leading up to the ICD-10 ‘go live’ date.

In addition to internal preparation, medical practices must also arrange testing with their PM vendor, EHR vendor, clearinghouse and major health plans.

Many PM vendors and EHR vendors will not be ready to meet the October 1, 2014 ICD-10 compliance date. Practices must communicate with their vendors months in advance to schedule software upgrades and testing to assure readiness. If the practice’s PM or EHR vendor is not going to be prepared for the ICD-10 launch, the practice will need to make plans to switch in time for the transition date. Many practices with in-house billing departments will weigh the benefits of outsourcing the practice’s revenue cycle management.

Costs associated with the prepara-

tion for the ICD-10 transition are not insignificant. Industry experts suggest budgeting $200,000 to $280,000 for an eight-physician practice. Expenses include training, testing, hardware upgrades and PM/EMR software upgrades. In addition to the one-time costs associated with implementation, many practices will experience ongoing, recurring costs related to the need for increased coding staff, consulting services, subscriptions to print and software-based coding aids and reduced productivity as a result of increase need for documentation and coding complexity.

The ICD-10 transition will undoubtedly eclipse Y2K and the HIPAA 4010 to 5010 transition in terms of the impact on the healthcare industry. Unprepared practices will face painful disruptions in cash flow and a chaotic scramble to regain practice productivity. Even well-prepared practices that execute ICD-10 implementation flawlessly will likely experience some disruption in cash flow. Remember, a successful revenue cycle requires every entity in the claims processing chain to be fully prepared for ICD-10. The PM system, EMR system, clearinghouse and payer must all communicate properly electronically and adjudicate ICD-10 claims correctly. Some bugs are inevitable. Practices should have in place a line of credit sufficient

Myths Associated with ICD-10 The Go-Live date will most likely get delayed again The only staff members affected will be coders and billing specialists My EMR and PM vendor will be automatically compliant General Equivalence Mappings are a good solution to coding an individual clinical chart After October 1, 2014 payers and clearinghouses will aid practices by automatically cross-walking submitted 9 codes to 10 codes

to cover three months operating expenses prior to ‘go live.’ Preparation will take considerable planning, time and money and should begin immediately. October 1, 2014 is just around the corner.

Bill Hefley, M.D., is President and CEO of MedEvolve, providers of Practice Management Software, EHR, and billing services to thousands of physicians across the US. In addition, he has an orthopedic surgery practice in Little Rock, specializing in minimally invasive surgeries for the knee, hip and shoulder including arthroscopic and joint replacement procedures.

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Making the Marriage Work, continued from page 1 some instances, the belief is that the union completes and complements each party to the ultimate benefit of both.

No matter how the parties entered the relationship, once the honeymoon phase wears off, both are left to figure out how to navigate this new partnership and work as a team. Of course if that was easy, there wouldn’t be such a high divorce rate. You only have to look back to the rash of mergers and buyouts in the ‘90s to know that many of these marriages between practices and hospitals don’t end harmoniously.

So what can you do to beat the odds?

Medical News had the opportunity to chat with Ken Hertz, FACMPE, principal with MGMA Health Care Consulting Group, about the keys to creating a lasting union. Hertz, who has nearly 40 years of management experience, has Ken Hertz held leadership positions with primary care and multispecialty care organizations, as well as large integrated systems. He works with practices and hospitals on strategic planning, integration, operational improvements, compensation, conflict resolution and governance issues.

Marry in Haste, Repent at Leisure

In the current transformational landscape, Hertz has seen a lot of hasty mergers

and alignment contracts executed without taking the time for proper due diligence … the ‘chicken little’ syndrome. “I tell people I’m not necessarily sure the sky is falling or that the world is ending. What we’re dealing with is this funny word called ‘change,’ and some of us can barely say it without stroking out,” he noted.

Hertz was quick to add that change is scary, but that’s all the more reason to take time to prepare properly on the front end to ensure each partner stays committed when the relationship hits an inevitable rough patch down the road. He noted the rush to ‘do something’ happens on both sides with physicians worried about the changing regulatory and reimbursement landscape and hospitals snapping up practices before a competitor has the opportunity to grab them.

It’s probably wise to note, however, that few couples married at a Las Vegas drive-thru chapel at 3 a.m. make it to their golden anniversary celebration. Instead, many of them wake up the next day with the question of ‘Now what?’ hanging heavily in the air.

Premarital Counseling

“It’s like the Yogi Berra line, ‘If you don’t know where you’re going, there’s a good chance you won’t get there,’” Hertz said. “When we work with physician practices and they say, ‘We need to get aligned with the hospital or need to merge with another practice,’ the first thing we ask is

why?”

It’s important, he said, to really explore what each partner hopes to accomplish through the alignment or merger.

How does each of you define success?

Once the ‘why’ has been sufficiently vetted, the attention shifts to the ‘who.’

Hertz said it is essential to honestly evaluate your core values and deal-breakers and then see how those align with your potential partner.

“The key to any relationship is you’ve got to understand what makes you tick and what’s important to you … and … you’ve got to understand what makes your partner tick and what’s important to them,” Hertz said.

Ultimately, Hertz noted, each party is aligning themselves to a vision. “It’s really critical, I think, that there be a shared vision … and the shared vision can’t be just about money.”

Prenup

Chances are not everyone is going to get everything they want in any relationship, but both parties should address the ‘must haves’ and ‘won’t dos’ and write those into the contract. The reimbursement plan, governance structure, conflict resolution protocol, and practice pattern expectations should all be thoroughly discussed on the front end and clearly outlined in the final agreement. Equally, the repercussions for both parties of not living up to the agreement should be spelled out.

Making the Marriage Last

Although it might seem like the heavy lifting happens in the planning stage, anyone who has been married long knows

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that once the honeymoon is over, the real work begins. “Each party has to put in a hundred percent. It is the only way this works,” Hertz said.

For physicians used to making snap decisions and having their orders carried out, following the maze of corporate protocols that are inherent in most health systems and large practices can be frustrating.

For hospitals shifting from a volume-based to an outcomes-based reimbursement model, it can be equally difficult to understand how less truly can mean more.

The best antidote for frustrations that build up and fester over time is open communication. Hertz pointed out, “Communication is broadcasting, but it’s also receiving. The notion of two-way communication is critical.”

Not only does there have to be communication, but it must also be meaningful. “Most of the physicians I know were absent the day they taught mind-reading in their training programs,” he said. It does no one any good to have an administrator walk into a physician’s office at the end of the month, tersely tell the doctor the numbers aren’t where they ought to be, and walk out … which Hertz has witnessed. Instead, he said, the two need to work together to figure out where the problem lies and what steps could be taken to fix it.

Being open to different viewpoints allows both physicians and administrators to see care delivery issues in a new light.

It’s one reason why physician governance is critical to the health of the overall organization. Having physicians involved in planning for the future keeps them engaged in the mission and shared vision.

Having a voice, however, doesn’t always mean one party gets their way.

Hertz noted, it’s better to hear an honest ‘no’ than a sugar-coated answer that is meaningless. Trust and transparency, he said, are the cornerstones of any good relationship.

“Do what you say you’re going to do when you say you are going to do it,” he stated, noting the axiom is equally true for physicians as it is for administrators.

Hertz continued, “If I’m a system, and I’m going to pay you based on work RVUs or based on charges or visits or collections or whatever, I need to make sure I can do a really good job of collecting that information; that it is accurate; that it’s timely; and that you trust it. If we don’t trust each other, it doesn’t work so well.”

Ultimately, those who have realistic expectations and are willing to put in the work to achieve the shared vision enjoy the strongest partnerships. “You’ve got to know what is going on in the world around you … so you’ve got to be informed. You must do your due diligence.

You must know yourself, and you’ve got to do this with your eyes open — wide open — and never assume. Those are the top five things,” Hertz said.

“The bottom line is none of this is brain surgery, but there is no silver bullet, no magical answer. It’s darn hard work,” he concluded.

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Filling in the Gaps From galas to golfing, fundraisers plug healthcare providers’ budget holes

By JOE MORRIS

When it comes to new equipment, facility renovations and expanded services, the capital-expenses wish list for hospitals and healthcare providers usually far exceeds what’s realistic. But with creative fundraising, that gap can sometimes be narrowed significantly.

For some organizations, it’s a golf outing; for others, black-tie ball. But whatever the case, the goal is to raise much-needed funds to supplement the bottom line.

Take the Niswonger Golf Classic, which raised almost $700,000 for Niswonger Children’s Hospital over two days earlier this summer. Since its founding 22 years ago, it has grown to include a roster of celebrity golfers and even a concert, all of which serve to increase the amount of money raised, said Patty Bolton, corporate director of events for the Mountain States Foundation, which organizes the event.

“We have a year-round committee because we are putting on a huge production now,” Bolton said. “As our services have grown, including building a new hospital in 2004, we needed the event to do more. Before we were tickled to death if it brought in $20,000. But we’ve watched and learned from other golf-related events, and have gotten more people, and more celebrities,

Front row (seated, left to right): Dan Marino, Jason Witten, Steve Johnson, Scott Niswonger, Emmitt Smith, Corey Pavin, Darius Rucker; standing, Niswonger Children’s Hospital mascot Scrubs the Bear, Tom Purtzer, Larry Mize, Condredge Holloway, Dell Curry, Jim Stuckey, Bill Bates, Phil Fulmer, Bruce Smith, Frank Beamer, Rick Carlisle, Bruce Pearl, Victor Jones, Mike Smith.

involved, and been creative in how we’ve grown the event.”

It doesn’t hurt that the event benefits a children’s hospital, and promoters make sure that everyone involved knows where the money is going. This year, for example, proceeds will help purchase syringe pumps, highly specialized and expensive equipment. Planners also ensure that everyone involved gets the red-carpet treatment, so that the entire experience is that much more memorable.

Next up for the foundation is its

Dragon Boat Festival, an 8-year-old event

that raises funds for all 13 hospitals that the organization services through its fundraising and outreach efforts. Like the golf classic, the ongoing challenge is to keep the event fresh, and to monitor what works, and what doesn’t, in that regard.

“The boat race will be dedicated to radiation oncology, so it’s quite specific in what it is for,” Bolton said. “We think it’s important people know that. We are break-

ing records these days, but that’s because we’re trying to grow our events by 10 percent each year. We set modest goals, but then we look at how many donors we have, how many more people were involved over the previous year, and those things help us measure how we’re doing as far as telling the stories of the hospitals and the healthcare system.”

Healthcare organizations also have found success partnering with other groups for events. That way, they don’t have to bear the cost of the event in question, but as a beneficiary, reap the proceeds. Sometimes that does involve a fair amount of work just the same, but in other cases, it’s as simple as providing a logo for marketing materials.

For example, the Color Me Rad 5K run benefits East Tennessee Children’s Hospital, with the hospital helping to promote the event and then provide volunteers on race day. Children’s does helm some well-known major events, such as Dancing with the Knoxville Stars, the black-tie Center Stage, holiday Fantasy of Trees, Peyton Manning Golf Classic, and Radiothon.

“We’ve got a lot of events because our development department is tasked with providing about 40 percent of all hospital expenses for the whole year,” said Seth (CONTINUED ON PAGE 8)

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experience as well as practical experience working in the field of healthcare.

Jenny Harvey, RHIIT, CPC, CPHQ, CPhT 865.862.6544 (direct) / jharvey@lbmc.com Coding Consultant – Healthcare Consulting

Jenny, a member of the American Academy of Professional Coders (AAPC), the American Health Information Management Association (AHIMA), and the National Association for Healthcare Quality (NAHQ) has over 20 years of extensive experience in the healthcare field.

During her career, Jenny has worked in the fields of inpatient and outpatient hospital coding, physician coding/billing, payer services, and pharmacy services.

Her education for physicians and other providers, regulatory and payer compliance, fee schedule analysis, and billing review for compliant reimbursement.

Jenny has taught CPT coding and medical terminology at Roane State Community College. She is a music nut, loves discovering small indie artists before they become a big deal, going to see live music and is an avid collector of vinyl (record albums) over 2,000 and counting. She also enjoys spending time outdoors with her husband and dogs on their property in Ozone, TN.

JANUARY 2013

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theLiteraryExaminer

BY TERRI SCHLICHENMEYER

Your Survival Instinct is Killing You

by Marc Schoen, PhD; c.2013, Hudson Street Press; $25.95 / $27.50 Canada, 259 pages The commute to work this morning was a bear.

Subsequently, you arrived at work late, ready to chew nails, only to find a pile of paper on your desk that you didn’t put there.

You have a headache. You need a vacation. Or, maybe you just need to read Your Survival Instinct is Killing You by Marc Shoen, PhD. This morning, you got out of bed, performed your ablutions, and got to work – and you probably don’t remember doing half of what you did to get there. That’s because you’ve taught yourself to act habitually; in fact, your body effortlessly operates on habit much of the time.

But habits are, of course, both good and bad.

Take your irritation, for instance. It’s a habit, says Shoen, that stems from ancient survival instincts and is exacerbated by today’s rush-rush-rush world. The trick is to learn a new habit – one of calmness, say – in place of the irritation.

Part of learning a new, more beneficial habit, he says, is to learn to deal with discomfort. We have “access to an enormous number of conveniences,” which leads to us being “less tolerant of being uncomfortable.” That causes your survival instinct to kick in because it “tends to view all discomfort and fear as an ultimate threat to survival.” You then overreact with headache, irritation, and possible serious illnesses.

The key to thwarting this overreaction is to teach your “three brains” to embrace a certain amount of discomfort. Not surprisingly, the more discomfort you can withstand, the more you’ll grow.

Teaching your brains won’t be easy, but to do it, start by turning off technology early in the evening and take “a breather.”

Learn that nothing is ever perfect and that it’s possible to slow down. Practice gratitude. Stop trying to do it all but don’t procrastinate, either. Expand your comfort zone by creating some discomfort.

Lastly, learn to delay your need for gratification and groom yourself to withstand pressure. After all, “pain is inevitable, but suffering is not.”

So you need a little bit of paper courage? Something that helps you harness an inner fire that you sense isn’t doing you any good? You might find that info in this book.

And then again, you might not.

Trouble is that Your Survival Instinct is Killing You is repetitive and not all that easy to grasp. Author Marc Schoen, PhD, offers readers a lot of info on mind-body medicine, but each new point gets buried inside statements that have already been made in different ways. I lost interest in this book several times, but soldiered on – only to find an exciting passage before losing interest again.

Yes, there’s help inside this book, but there’s also a lot to weed through to find it.

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AUGUST 2013

What Doctors Feel: How Emotions Affect the Practice of Medicine

by Danielle Ofri, MD; c.2013, Beacon Press; $24.95 / $28.95 Canada, 240 pages In the new book What Doctors Feel by Danielle Ofri, MD, provides a glimpse of the thought processes that go through a doctor’s head.

For decades, we’ve been conditioned to believe that doctors are supposed to keep an emotional distance from their patients. We expect a certain detachment and formality – but we also expect compassion.

Is this a contradiction in demand?

Dr. Danielle Ofri says no. Though remaining businesslike may often be essential, the physician-patient interaction “is still primarily a human one.” No matter how aloof the doctor or sick the patient, we still connect on a one-to-one basis.

We shouldn’t be surprised, therefore, to note that doctors are mortals who sometimes “fall short on empathy” when an illness doesn’t make sense or a wound isn’t obvious, when patients don’t follow advice, display entitlement, or steadfastly maintain bad habits. In those cases, frustration rises and remaining empathetic is “challenging,” but as a young medical student, Ofri learned from “an act of compassion” that finding empathy is possible, as well as essential.

We shouldn’t feel surprised to note that medicine is like many professions, and certain clients are “problem” clients. As in many jobs, doctors use dark humor and “derogatory terms” to deal with personal discomfort, show solidarity, ease unpleasantness, or bring levity to the situation. And, as in every job, some topics are off-limits.

Doctors fear harming their patients, missing something important, making mistakes. They become overwhelmed by neediness and illness, and by reams and reams of paperwork necessary in today’s medical world. They can succumb to the kinds of maladies and addictions they see every day, they can be stubborn in their decisions, they momentarily forget things, and they surely experience burn-out.

And yes, doctors do have favorite patients. And they cry when those patients die.

With incredible insight, lyrical beauty, humor, and consideration, author Danielle Ofri, MD, gives readers the kind of comfort we need when faced with any sort of medical anything by revealing exquisite vulnerability in an esteemed profession. She successfully portrays the processes of diagnosis and treatment as more human than clinical, and that’s likewise soothing.

But not everybody will enjoy what’s here.

Medical personnel might be unhappy that Ofri exposes certain, darker bedside manners. Indeed, the section on medical slang is uncomfortable to read – and yet, because that blunt truth follows with the spirit of this book, it belongs.

Overall, I couldn’t let go of this graceful, elegant, honest book, and I think you’ll love it, too. If you’re a doctor or if you’re anyone’s patient, What Doctors Feel is a book to read – stat.

Terri Schlichenmeyer has been reading since she was 3 years old, and she never goes anywhere without a book. She lives on a hill in Wisconsin with two dogs and 11,000 books.

Filling in the Gaps, continued from page 7 Linkous, marketing and communications director for the hospital. “That covers any kind of new equipment, for which there is a continual need, so everything we do needs to keep growing.”

The marketing and development team at Children’s has found success with a mix of events it controls as well as those where it just lends support, Linkous said, as it keeps the hospital’s name in front of many different segments of the public throughout the course of a year.

“When it’s something big, like Fantasy of Trees, we can work to saturate the market with ads and promotions so we can get as many people as we can,” Linkous said.

“But for these others, we do very little work and then really benefit from all the people they reach out to and bring in.”

Regardless of the involvement level, all programming comes under scrutiny before, during, and after to see if it’s meeting targeted goals. If not, then the decision is made to refresh, or retire, the activity.

“A prime example is the Children’s Miracle Network,” Linkous said. “We did that telethon for about 30 years. When it started, viewers had three channels and were at home on Saturday and Sunday nights. Over the years, as cable came along and added more channels, ratings went down. So we looked at the trend and decided that we would be better off putting our resources into other programming.”

In the end, he said, “We have some people who will go to the Fantasy of Trees and pay that ticket price, but who would not be able to pay for a black-tie event. When ‘Dancing With the Stars’ fades out, we’ll probably phase that event out. You have to monopolize the market when you can, and always keep an eye out for that next great idea.”

A narrower approach focusing on two major annual events, pays dividends for Siskin Children’s Institute, in large part because each of those has become embedded in the community, said Jan Hollingsworth, director of marketing and communications, and Maria Currier, events and corporate relations manager.

“We are really known for StyleWorks, a spring fashion-based event that we have produced for 37 years, and for Star Night, a concert event in late summer that celebrated its 50th anniversary last year,” Currier said. “They are both very much tied into our name.”

StyleWorks stays fresh with added attractions such as a marketplace and luncheon, as well as a fashion show, and also by extending it over two days so that more people can be looped into its different components, Currier said. Siskin also benefits from strong partnerships, such as the one with Belk that drives the fashion show itself, as well as the many different vendors who exhibit in the marketplace.

“We also have celebrities when we can, such as Cynthia Bailey, a supermodel for many years who now is on ‘The Real Housewives of Atlanta,’” Currier said. “We really do try to shake it up and keep things interesting so that people will want to return each year.”

The event’s main purpose is highlighted organically when several children

Color Me Rad 5K run

who have graduated from the Siskin Early Learning Centers serve as child models.

“That’s a great way to showcase what we are here for,” Hollingsworth said. “They walk the runway, and have a great time.

Everyone loves that part of the event.”

Star Night, which is a more formal evening with a concert by a well-known artist or group, also is holding up well. The 2012 event was shaped largely around the 50th anniversary as a theme, but every year a concerted effort is made to land a well-known name, such as Josh Turner, Hootie & the Blowfish, and this year’s headliner, Wilson Phillips.

“We have amazing, committed volunteers, and we always reach out to people in the community who have great reach to chair these events,” Currier said. “And we listen to everyone involved to see what they want to do, and what they want to change.

That’s led to a preview party for Style Works, so that people who can’t attend the day events can still be involved. We want to make sure we bring in as many different groups of people as possible.”

The funds raised go back into Siskin’s general operating budget, and between this year’s StyleWorks and last year’s anniversary-themed Star Night, they brought in upwards of $600,000. That’s good, but there’s always a move afoot to get those totals even higher.

“There’s always a shortfall because we serve a lot of children,” Hollingsworth said.

“That’s why we now are doing a special request for more donations at the events.

We’ve had good success by just going to the people who are already there, and asking for just that little bit more.”

And like StyleWorks’ weaving in some Siskin graduates to its fashion show, there’s also an instructional element to be found during the Star Night proceedings.

“We engage the attendees through a speaker who has a personal connection to the institute, or through a video about what we do and our mission,” Currier said.

“These people are here to have a good time, but they also are here to listen to us talk about the children and the families that we serve. We package that information in an engaging way, however, and so that gives us another tool to inspire people to give.” easttnmedicalnews

.com

Enjoying East Tennessee Lost Sea Adventure

By LEIGH ANNE W. HOOVER

Escape the sweltering summer heat by visiting the sea. Enjoy year-round comfortable temperatures of 58 degrees, and for this month’s late summer respite, you won’t even need your bathing suit!

Known as “America’s largest underground lake,” the Lost Sea is located 140 feet below ground in Sweetwater, Tennessee, and it is truly a year-round must see experience. From winding pathways through the enormous caverns that once housed Cherokee Indians, Confederate soldiers, and even moonshiners, to the spectacular boat ride on the trout-filled lake below, your family will be truly in awe of this “adventure.”

“While you may go to a lot of different caverns that have other things in them, the Lost Sea is the main feature,” explained General Manager Lisa McClung. “People just don’t expect to see something that large underground. It’s really what sets us apart from a lot of other caves.”

A Member of the National Cave Association (NCA), the Lost Sea is part of Craighead Caverns, which is named for Chief Craighead, an early Native American owner believed to have discovered the original, natural cave entrance around 1820.

Its formation of anthodites, which is a Greek word that means cave flower, also makes it very unique. These rare formations are from condensation mixed with specific minerals forming the crystal-like flowers that are found in very few caves.

The large number in the Lost Sea earned the honor of being designated as a Registered National Natural Landmark.

During the Civil War era, the cave served as a resource for the coveted saltpeter, potassium nitrate, which was used to make gunpowder. The cave was rich in mineral deposits and bat guano, and this made it an ideal mining location.

Because of its notable involvement, and the authentic 1863 date from a Confederate torch inside the cave, the location has also been recently recognized as a Tennessee Civil War Trails marker.

During 1947, there was also a period when the cave was even a “cavern tavern.”

According to McClung, three moonshine stills were actually found in the cave prior to being opened commercially.

“They say that because of the high humidity in the cave, and the constant cold temperatures, people would not feel the effects of the alcohol until they tried climbing the 127 steps to get back out to the cave entrance. The higher they got to the surface and the temperature and humidity change, the realization of drunkenness would occur,” explained McClung.

Sweetwater native, Ben F. Sands, is actually credited with discovering the lake. However, what he knew existed as a 13-year-old boy in 1905 would take a lifetime to prove to others. easttnmedicalnews

.com

According to documented cave history, Sands crawled through a tiny crevice that put him knee-deep in water and led to the discovery.

“Normally, there was some water in the cave…, but this particular year that he discovered the lake, Ben Sands was able to go more and more into the cave because of a drought,” explained McClung. “Keep in mind, his only light was a lantern…. So, he made mud balls and threw them in all directions to see if he could hear them touching the sides of the walls. All he heard was the splashing of water; so he knew it was huge, but he had no idea how big.”

Others knew water existed below, but Sands’ discovery was dismissed until another drought occurred in the 1960s.

Although the caverns were opened as Craighead Caverns for a short time in 1927 for tours, the lake was still not ac-

knowledged. However, it was the first time electricity was used, and although very crude and exposed wires existed, it was an exceptional accomplishment.

“It was quite a feat to have electricity in the cave in 1927,” said McClung. “A lot of the homes in this area did not even have electricity.”

However, the cave closed during the Great Depression, and tourism stopped until the 1960s brought another drought.

A team exploring the possibility of opening the cave as a tourist attraction was able to also go beyond the opening leading to the lake and confirm what Sands had discovered years ago.

At 71 years-old, Ben Sands was finally recognized for his boyhood discovery of the lake. Local attorney Van Michael was very instrumental in developing and promoting the Lost Sea Caverns as a tourist attraction, and it opened in June of 1965.

Rumor has it that Sands was aboard one of the first tourist boat rides.

Although the Lost Sea is approximately 800 feet long and 220 feet wide, with depths up to 60 feet, it is believed that it may even be twice as large. However, it is simply cost prohibitive to explore and prove this.

When visitors tour the caverns and arrive at the actual underground lake, they are divided into groups and helped aboard glass-bottom, electronically-controlled boats.

To me and my husband, Brad, the whole experience was reminiscent of Andrew Lloyd Webber’s adaptation of “Phantom of the Opera,” when the phantom takes Christine under the Paris opera house on a boat ride through the underground caverns. Like the musical, as you embark on a boat ride through the lake, (CONTINUED ON PAGE 10)

AUGUST 2013

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AAOS Updates Clinical Practice Guidelines, continued from page 1 analysis in-house. However, the earlier guideline utilized synthesized data from three outside sources — the Agency for Healthcare Research and Quality, Osteoarthritis Research Society, and Cochrane Database of Systematic Reviews.

Both those who sell and manufacture HA, as well as a number of AAOS members, were specifically concerned about the issue of viscosupplementation, which garnered an ‘inconclusive’ recommendation in the first issue. Jevsevar said the committee was clear that a more vigorous internal review of the use of Dr. David S. Jevservar intra-articular hyaluronic acid could result in the same outcome, a stronger recommendation backing the use of HA … or a reversal recommending physicians not use the treatment option.

“When we actually did the analysis, that’s what happened,” he said of the reversal, which resulted in a ‘cannot recommend’ designation for the use of HA for patients with symptomatic OA of the knee.

“When you use clinical significance as your bar for recommendation — and we took the 14 best studies out there — it really doesn’t support the use of viscosupplementation, or HA,” he said. “Although a few individual studies found statistically significant treatment effects, when combined together in a meta-analysis, the evidence did not meet the minimum clini-

cally important improvement thresholds.”

Jevsevar went on to explain there is a difference in statistical significance and clinical significance. He noted that on the clinical pain analysis where 0 is no pain and 10 is the worst pain, having patients move from a 9 to an 8.8 after treatment could be considered statistically significant but wouldn’t feel much different to the person with OA. “We use the higher bar of clinical significance,” he continued. ”We feel that’s the one most important to patients.”

Perhaps not surprisingly, the strong recommendation against the use of HA has created some pushback from physicians. “They feel like we have very few treatments for osteoarthritis that work so they are always concerned when we take one away,” he said. However, Jevsevar continued, “Doing something that is expensive and hasn’t been proven isn’t the right thing either.”

He said it’s hard to gauge the true effectiveness of various treatments in the clinical setting for a couple of reasons.

“Arthritis research is hard because osteoarthritis patients don’t have the same level of pain everyday,” he explained. “Many of those patients want to do anything but surgery, which is understandable,” Jevsevar continued. “They want the treatment to work, but that creates a placebo effect or bias for whatever is being used.” More research, he added, is certainly needed.

One concern for physicians using HA is that insurance companies will quit

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AUGUST 2013

reimbursing for the treatment. “We synthesize the evidence, but we don’t make recommendations for insurance,” Jevsevar said. However, he admitted insurance companies could misapply the guidelines for financial purposes. Still, he noted, discontinuing reimbursement for viscosupplementation might not be to a payer’s benefit since it could drive more OA patients to opt for the much more expensive knee implant.

Furthermore, Jevsevar said treatment decisions should replicate the foundation of a three-legged stool — 1) the evidence, 2) physician expertise and experience, and 3) patient preferences and values. “You have to take all three into account when treating a patient. One doesn’t trump the other,” he said.

In addition to the controversial HA ‘no’ recommendation, the work group also reduced the recommended dosage of acetaminophen from 4,000 mg to 3,000 mg a day, which mirrors an overall change made by the Food and Drug Administration for individuals using acetaminophen for any purpose. In patients with symptomatic OA of the knee, Jevsevar said, “Actually, there’s not a lot of evidence to support the use of acetaminophen.”

Other important recommendations that remained the same in the revised guidelines included: • Patients who only display symptoms of OA and no other problems, such as loose bodies or meniscus tears, should not be treated with arthroscopic lavage.

• Patients with a body mass index (BMI) greater than 25 should lose a minimum of five percent of their body weight.

Jevsevar noted telling patients to lose weight and get active are “tough discussions” to have but important ones. Low impact exercises including swimming, walking and using an elliptical machine have been proven effective to slow the progression of OA of the knee.

The work group strongly recommended against the use of glucosamine and/or chondroitin sulfate or hydrochloride and against the use of acupuncture.

A “strong” strength of recommendation means the quality of the supporting evidence was high with an implication that practitioners should follow strong recommendations unless a clear and compelling rationale for an alternative approach exists. Jevsevar added the ‘no’ recommendations were based on a lack of efficacy rather than a potential for harm. The group also had a moderate recommendation against custom lateral wedge insoles.

A moderate recommendation also is compelling, but the quality or applicability of the existing evidence is not as strong.

Due to a lack of research, the CPG was unable to recommend for or against the use of physical agents including elec-

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trotherapeutic modalities, manual therapy, bracing, growth factor injections and/or platelet rich plasma.

In the second edition, all included studies had to have a sample size of at least 30 participants and a follow-up period of at least four weeks. More than 10,000 separate pieces of literature were reviewed during the evidence analysis phase. When completed, Jevsevar said the updated OA knee CPG was subjected to the most extensive peer review to date for any AAOS CPG. Ultimately, 16 peer reviewers representing multiple specialty societies submitted formal reviews. “Each meticulously dissected the final recommendations of the document and, based on their well-informed and insightful comments, important changes were made to the final document,” Jevsevar said in an AAOS editorial.

For more information on the second edition OA knee CPG, go online to: www.aaos.org/research/guidelines/ GuidelineOAKnee.asp

Enjoying East Tennessee, continued from page 9

everything has a glow, and we could almost hear the music.

Of course, when the infamous rainbow trout approached our boat for a daily feeding, we also thought of the music from the movie “Jaws!”

“After the tours had been going for a year or so, they decided to put the fish in as an experiment just to see how they could survive down there,” said McClung.

“They really were curious to see if the fish would come out anywhere, and they did not. They realized that the fish were contained, and the water was not going out into streams nearby.”

The fish have been a hit, and they are continually stocked. According to McClung, the rainbow trout do not reproduce because the lake does not have a needed swift current, and the slick clay bottom prohibits egg attachment. To prevent over feeding, food is always monitored.

The Lost Sea Adventure is truly a Tennessee treasure. Although McClung has been an employee for over 25 years, you can still hear the passion in her voice.

“I love the Lost Sea, and it’s a part of me” explained McClung. “If we have this huge lake down here, what else is out there that we don’t even know about?”

For additional information about the Lost Sea, visit www.thelostsea.com Leigh Anne W. Hoover is a native of South Carolina and a graduate of Clemson University. She has worked for over 25 years in the media with published articles encompassing personality and home profiles, arts and entertainment reviews, medical topics, and weekend escape pieces. Hoover currently serves as immediate president of the Literacy Council of Kingsport. Contact her at hoover@chartertn.net.

easttnmedicalnews

.com

LegalMatters

BY ERIN B. WILLIAMS

New Legislation Means More Changes to Controlled Substance Prescribing Laws Named after Addison Sharp, a young Knoxville resident who overdosed on prescription medications in 2012, the Addison Sharp Prescription Regulatory Act of 2013 (“2013 Act”) yet again changes the laws relative to controlled substance prescribing and pain management clinics.1 A sponsor of the legislation, Senator Ken Yager, described prescription drug abuse as an epidemic in Tennessee, and the new legislation was designed to tighten the regulations on prescribers and pain management clinics.2 Below is a brief summary of the important changes created by the new law, most of which become effective October 1, 2013.

Changes to the CSMD Laws In 2012, the Tennessee General Assembly passed the Tennessee Prescription Safety Act of 2012 (“2012 Act”), which required prescribers to register in the Controlled Substance Monitoring Database (“CSMD”) by January 1, 2013.3 As of April 1, 2013, prescribers (or their designated healthcare practitioner extenders) were required to check the CSMD before prescribing an opioid or benzodiazepine as a new course of treatment lasting more than seven days and then at least annually during the course of treatment, unless an exception applied.4 Effective immediately, the 2013 Act adds an exception to checking the CSMD for patients to whom a controlled substance is directly administered during the course of inpatient or residential treatment in a hospital or nursing home.

The 2013 Act further amends portions of the 2012 Act by permitting a prescriber to authorize his or her designated healthcare practitioner extender to check the CSMD for other prescribers in the same practice. However, prescribers remain responsible for the acts of their designated healthcare practitioner extenders. Prescribers are also responsible for revoking an extender’s access to the CSMD immediately at the end of the extender’s relationship with the prescriber.

Pain Management Clinics Perhaps most significantly, the 2013 Act expands the definition of “pain management clinic” to include: (1) privatelyowned practices in which a majority of the patients are issued a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol for more than 90 days in a 12-month period; and (2) any privately-owned clinic, facility, or office which advertises in any medium for any type of pain management services and in which at least one employee prescribes controlled substances.

Further, the penalties for the operation of an uncertified pain management clinic have significantly increased under the 2013 Act to at least $1,000 per day (not to exceed $5,000 per day) for each day a practice meeting the definition of a pain management clinic operates witheasttnmedicalnews

.com

out certification. The expansion of the definition will require more practices to obtain certification as a pain management clinic, and with such certification the practice is required to comply with additional laws, rules, and regulations.

Practitioners who do not prescribe controlled substances to a majority of their patients and who do not wish to register as a pain management clinic should carefully review their practice’s advertising and promotional materials to ensure the materials do not unintentionally cause the practice to fall within the definition of a pain management clinic, especially considering the increased penalties associated with the operation of an “uncertified” pain management clinic.

Treatment Guidelines The 2013 Act requires the Commissioner of the Department of Health to develop recommended treatment guidelines for the prescribing of opioids, benzodiazepines, barbiturates, and carisoprodol to be utilized by the prescribers in Tennessee. The health-related licensure boards are charged with reviewing the guidelines and recommending to its licensed prescribers how to incorporate such guidelines into their practice.

Also, as part of the 2013 Act, prescriptions for opioids or benzodiazepines may not be dispensed in quantities greater than a 30-day supply. Prescribers, however, may still write prescriptions for greater than 30 days.

Continuing Education Requirements Beginning on July 1, 2014, all prescribers with DEA numbers who prescribe controlled substances will be required to complete a minimum of two CME hours related to controlled substance prescribing biennially. The CME must include instruction on the Department of Health’s treatment guidelines for controlled substances, but may also include other topics approved by the health-related boards.

1. 2013 Tenn. Laws Pub. Ch. 430 (SB 676).

2. See “Addison Sharp Prescription Regulatory Act Gains Committee Approval,” The Chattanoogan.com (Friday, March 29, 2013).

3. For a summary of the 2012 Act see “New Laws for Controlled Substance Prescribing in Tennessee,” East Tennessee Medical News, September 2012.

4. For a summary of the laws requiring providers to check the CSMD, see “Tennessee Providers Now Required to Check Controlled Substance Monitoring Database, East Tennessee Medical News, April 2013 Erin B. Williams is an attorney practicing at London & Amburn, P.C. Her practice includes medical malpractice defense and health law issues, such as board investigation defense and regulatory compliance. For more information on the CSMD or other health law matters, you may contact Ms. Williams by visiting .

Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

Inflammatory Bowel Disease and Pediatric Patients In the past few years, we have seen more and more pediatric patients with Inflammatory Bowel Disease (IBD). IBD is a chronic disorder characterized by autoimmune-related inflammation of the lining of the digestive tract including the colon and intestines, and includes both Crohn’s Disease (CD) and Ulcerative Colitis (UC). CD inflammation can spread deep into the layers of the affected bowel tissue, while UC usually affects only the innermost lining of the colon. While the exact cause of IBD is unknown, it may occur at any age, in both males and females, and the disorder often runs in families, although a person can develop it even though no other family members have it.

At GI for Kids, PLLC, our providers may suspect a child has IBD based on his/her medical history and presenting signs and symptoms, but testing is needed to confirm the diagnosis. Common symptoms of IBD include diarrhea or constipation, abdominal pain, loss of appetite and weight loss, delayed growth, vomiting, skin rash, joint pain, fever, and bleeding in the digestive tract.

If a child presents with some or all of these signs and symptoms, our providers will perform one or more diagnostic procedures to help confirm or rule out IBD. These diagnostic tests include blood tests, stool samples, magnetic resonance enterography (MRE), CT enterography, capsule endoscopy, upper endoscopy (also called esophagogastroduodenoscopy or EGD), and colonoscopy. Capsule endoscopy is new technology that makes it possible for children with IBD to be diagnosed earlier, often preventing a child’s condition from drastically deteriorating before being diagnosed. We perform EGD and colonoscopy procedures in our state-of-the-art endoscopy suite located in East Tennessee Children’s Hospital, where we have complete access to specialized pediatric anesthesiologists and nurses.

Once IBD has been confirmed, our goal for treatment is to reduce the inflammation causing damage to the intestines.

Our clinic has a multidisciplinary approach to treating IBD. We treat the whole patient, including their families, by providing a variety of professional services, including multiple medical providers, dieticians, behavior health providers, a hospital inpatient practitioner, and a medical infusion nurse specialist. Since IBD, and particularly CD, is often associated with poor digestion and malabsorption, children with IBD may benefit from seeing one of our dieticians for nutritional support and assistance with diet modification.

Our behavior health providers can offer support, advice, and help with emotional and psychological

issues related to adjustment to illness, depression, anxiety, and school attendance. They can also assist with pain management by teaching relaxation techniques and distraction strategies, thus reducing the need for pharmaceutical pain management.

Our clinic also offers in-office Remicade infusions, which enables us to provide more convenient and timely infusions as well as giving the child less exposure to potential contagious illnesses compared to a hospital setting.

Unfortunately, it is not unusual for our IBD patients to require inpatient hospital care, and our inpatient practitioner will collaborate with our team of professionals to ensure that our patients receive thorough, comprehensive, and timely care during any hospital stay. This synthesis of care has proven to be a great benefit to our patients as they frequently achieve remission in a shorter period of time and often avoid dependence on long-term steroid treatment.

Also during the past few years, GI for Kids, PLLC, and Dr. Youhanna S. Al-Tawil realized there was a great need in the community to support our children and families coping with IBD. KidsFACT (Kids Fighting Against Crohn’s and Colitis Together) was created out of the recognition of this need. KidsFACT is a nonprofit support group to help kids and families with IBD through support and advice. The mission of KidsFACT is to help make strides towards improved quality of life and advance knowledge in order to contribute to better treatments and, ultimately, a cure. The mission is achieved through education, family support, and research. KidsFACT raises awareness of the disorder and funding through an annual golf tournament and rodeo. Anyone can join the KidsFACT discussion forum where helpful advice and support from others with IBD is available by visiting their website at www. kidsfact.org.

GI for Kids, PLLC, also performs clinical research and participates in clinical trials. Data from the research has been presented at national conferences.

If you have young patients struggling with IBD, we hope you will consider the services we provide. Please contact our clinic at (865) 546-3998 to make a referral for a comprehensive consultation or visit our websites at www.giforkids. com and www.kidsfact.org.

www.giforkids.com • 865.546.3998

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GrandRounds Dobbins Joins East Tennessee Medical News as New Associate Publisher for Knoxville, Chattanooga A life-long resident of Knoxville, Sharon Dobbins recently joined the East Tennessee Medical News (ETMN) staff as the new associate publisher for the Knoxville and Chattanooga markets. She replaces Bridget Garland, current editor of ETMN, who temporarily held the position until a more local associate could be hired.

Given her familiarity with the area and successful sales career, Dobbins couldn’t be a more perfect fit. Dobbins grew up in Fountain City and attended Central High School and the University of Tennessee in Knoxville. She has been a lifetime member of Fountain City United Methodist Church and is on the Board of Directors for Wesley House Community Center.

Dobbins spent the majority of her career with IBM and Xerox in sales before retiring and has been spending her extra time enjoying the things she is passionate about. She is a huge animal lover and has an English Springer Spaniel named Kayte.

She is also a huge college football fan, especially of her alma mater, the UT Vols.

“I go to all the home games and I have for over 50 years,” she enthused. “I started when I was a young girl.”

Additionally, Dobbins enjoys meeting new people and talking with them, so she is particularly excited for the opportunity to work with ETMN. She and ETMN’s Tri-Cities Associate Publisher, Cindy DeVane, have a long history together. They became friends while sales professionals with IBM in the 70’s and 80’s working in Knoxville and the Tri Cities. “What goes around comes around,” DeVane said. “I couldn’t be happier about working with Sharon again. She is deeply rooted in the Knoxville market and brings a wealth of knowledge and long standing relationships to our publication.

Dobbins can be contacted by call-

ing (865) 599-0510 or emailing sharon@ easttnmedicalnews.com.

Memorial Names Hospital Presidents CHATTANOOGA – Memorial Health Care System recently revised its leadership structure to better meet the challenges of operating and delivering healthcare in the communities it serves.

The role of president and chief executive officer transitioned to chief executive officer of Memorial Health Care System and each of the system’s hospitals, Memorial Hospital and Memorial Hospital Hixson, now has a president to focus on overall operational management of their respective facilities in accordance with the mission, vision and values of Memorial.

James M. Hobson is chief executive officer of Memorial Health Care System.

As CEO, Jim will focus his efforts on innovative strategies to integrate and enhance the care continuum across the region.

Debra L. Moore is president of Memorial Hospital Hixson. Deb previously served as senior vice president, Memorial Hospital Hixson. She joined Memorial in 1987 as a graduate nurse and has served in a variety of leadership roles throughout her Memorial tenure. Deb is a graduate of the University of Tennessee at Chattanooga with a Bachelor of Science degree in nursing and holds Masters’ degrees in business administration and nursing from Southern Adventist University.

Ricky D. Napper is president of Memorial Hospital. He most recently served as president/chief executive officer of Magnolia Regional Health Center, a 200bed located in Corinth, Mississippi. Rick has more than 18 years of healthcare leadership experience at several systems throughout the South. He received a Master’s degree in business from EmbryRiddle Aeronautical University, Daytona Beach, Florida; a Bachelor of Science degree in healthcare management from Park

College, Missouri; and a licensed practical nurse diploma from Academy of Health Sciences, Fort Sam, Houston, Texas.

Missy Kane Receives Community Leadership Award from President’s Council on Fitness, Sports & Nutrition KNOXVILLE – The President’s Council on Fitness, Sports & Nutrition has selected Covenant Health fitness advocate Missy Kane to receive a 2013 PCFSN Community Leadership Award. The award is given annually to individuals or organizations who imMissy Kane prove the lives of others within their communities by providing or enhancing opportunities to engage in sports, physical activities, fitness or nutrition-related programs.

This year the Council presented the Community Leadership Award to 34 recipients across the country for making sports, physical activity, fitness, and nutrition-related programs available in their communities. Kane is the only recipient from East Tennessee and one of only two honored statewide.

A graduate of the University of Tennessee, Kane is an Olympian and former collegiate track and field coach. Her expert advice and input has been sought

by Runner’s World magazine, ESPN, NBC, and Fox networks. Kane also hosts a fitness show on East Tennessee Public Television, where she exercises alongside guests of all walks of life and all levels of ability, proving her motto, “Life is more fun when you’re fit.”

Knoxville Professional Speaks at National Conference KNOXVILLE – Christie Knapper, Marketing Supervisor for LBMC in Knoxville, Tenn., recently spoke at the 2013 Asso-

Mark Your Calendar

Your local Medical Group Managers Association is Connecting Members and Building Partnerships. All area Healthcare Managers (including non-members) are invited to attend.

2ND THURSDAY

3RD THURSDAY

JOHNSON CITY MGMA MONTHLY MEETING

KINGSPORT MGMA MONTHLY MEETING

Date: The 2nd Thursday of Each Month Time: 11:30 AM – 1:00 PM

Location: Quillen ETSU Physicians Clinical Education Building, 325 N. State of Franklin Rd., Johnson City August’s topic: OSHA Update with Todd Reeves

Date: The 3rd Thursday of Each Month Time: 11:30 AM – 1:00 PM Location: Indian Path Medical Center Conference Room, Building 2002, Second Floor, Kingsport August’s topic: “Motivating and Coaching to Retain Quality Personnel” by Phillip Dickey, Doctors’ Management Jenny Harvey

Save the Date: Don’t miss the September meeting, comedian Matt Fore will be performing.

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ciation for Accounting Marketing Summit. The conference was held at the Bellagio in Las Vegas, Nevada, with a theme of “Win Your Race: Inspire Innovation.

Realize Results.”

The conference was held in partnership with the AICPA Practitioners Christie Knapper Symposium and Tech+ Conference. The three-day event hosted over 1,400 attendees with over 400 marketing professionals. The program addressed marketers of every level from first year to experienced veterans.

Knapper’s session titled “You’re Sitting on a Goldmine: How to take existing clients to a new level of service and finish the race” focused on developing authentic and personal relationships with clients and earning the opportunity to introduce additional service lines to your existing client base.

Children’s Hospital Announces Plans for New Building KNOXVILLE – On Tuesday, June 18, Children’s Hospital’s Board of Directors approved plans for construction of a new building adjacent to the current facility in the Fort Sanders neighborhood in Knoxville, Tenn. The plan includes a new fivestory building offering 245,000 square feet of new hospital space, 146 parking spaces, and renovations of selected areas within the hospital once the new building is occupied.

The proposed site is on White Avenue between 20th and 21st streets. The groundbreaking is expected within the next 12-14 months; the building will take approximately two years to complete.

Additional renovations will take another year with an expected completion date of fall 2017.

Key features of the project include a new 44-bed private room Neonatal Intensive Care Unit (NICU), a new perioperative surgery center, two levels of parking and enhanced family areas, such as roof-top gardens. Patient families and staff have participated in the planning process since the beginning and will continue to play a large role in design moving forward.

Estimated cost for the project is $72 million- $75 million. The hospital plans to pay for this largely with internal funds.

Children’s Hospital will look to the community for additional help.

During construction, all services will continue to be offered at Children’s Hospital.

Harvey Joins LBMC’s Healthcare Practice, Earns AHIMA ICD-10 Ambassador Designation KNOXVILLE – Lattimore Black Morgan & Cain, PC (LBMC), has added coding consultant, Jenny Harvey, to its Knoxville office.

Claudia Werner

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GrandRounds Jenny Harvey has joined the healthcare consulting division bringing with her a wealth of medical coding experience.

Originally from Knoxville, TN., Jenny previously worked as coding consultant for Lexicode Corporation. She brings a solid foundation of knowledge of the ever-changing healthcare environment including holding the following certifications: AHIMA Approved ICD-10 Trainer, Registered Health Information Technician, Certified Professional Coder, Certified Professional in Healthcare Quality, and Certified Pharmacy Technician. She currently serves on the board of directors of the Tennessee Association for Healthcare Quality.

Most recently, Harvey earned the designation of American Health Information Management Association (AHIMA) ICD-10 Ambassador. With the October 1, 2014 deadline fast approaching in regards to ICD-10, Harvey will be the lead on all training to assist area healthcare organizations in training for this vast change in medical coding. As a result of her newest designation, all AHIMA and AAPC Credentialed Coders attending her sessions will receive Continuing Education Units (CEU).

Peninsula Welcomes New Clinical Services Manager KNOXVILLE – Claudia Werner, LPC, NCC, has been named Clinical Services Manager at Peninsula, a division of Parkwest.

Werner will be directly responsible for overseeing the provision of clinical services and the implementation of therapeutic programming. She will also provide clinical and administrative leadership for continuous performance improvement for Peninsula’s services, operations and functions.

Werner has 14 years of clinical and administrative experience in psychiatric and acute care. In addition to providing proven, successful counseling services, her professional background includes operations, research, strategic planning, program coordination and development, crisis intervention and fiscal management.

Werner is a member of the National Board for Certified Counselors (NBCC).

She earned her bachelor’s degree in psychology from the College of New Jersey (formerly Trenton State College) and went on to receive her master’s degrees in counseling psychology (College of Saint Elizabeth) and business administration (Fairleigh Dickinson University).

East TN Physician’s Wife is National AMA Alliance President NASHVILLE – The Tennessee Medical Association (TMA) and Tennessee Medical Association Alliance (TMAA) are proud to announce the installation of Jo Terry of Knoxville as president of the American Medical Association Alliance for 2013‐2014. The ceremony was held

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Tuesday, June 18, during the AMA Alliance Leadership Development Conference and annual meeting in Chicago.

The wife of TMA member Dr. Bill Terry of Jo Terry Knoxville Pediatric Associates, Terry has been active in the AMA Alliance organization for physician support at the national, state and county level. She previously served as secretary, director and chair of the AMA Alliance Health Promotion Committee, and as the Alliance representative to the National Health Collaborative on Violence and Abuse.

A native of Bowling Green, KY, she graduated with a BSN from Baylor University in 1972 and an MSN from the University of North Carolina-Chapel Hill in 1976.

Connie Wagner Appointed to 2013 TNCPE Board of Examiners NASHVILLE— Connie S. Wagner, Director of Radiology for Parkwest Medical Center, has been appointed by the Board of Directors of the Tennessee Center for Performance Excellence (TNCPE) to the 2013 Board of Examiners. Every year, the TNCPE award Connie S. Wagner program recognizes organizations demonstrating excellence in business operations and results.

As an examiner, Wagner is responsible for reviewing and evaluating organizations that apply for the TNCPE Award.

The Board of Examiners comprises experts from all sectors of the regional economy, including healthcare, service, non-profit, manufacturing, education and government.

Fortwood Center’s Dot Stephens retires after devoting 22 years to the mental health field CHATTANOOGA – Fortwood Center Senior Vice President of Services, Dorthy “Dot” Stephens, has retired after 22 years of dedicated service.

Stephens began her career at Fortwood Center in 1991 as a therapist. Over the years, she has worked to uphold the Center’s tradition of providing quality and compassionate care to individuals facing mental illness and social challenges. In her role as the Senior Vice President of Services, Stephens oversaw care for more than 3,000 children, adolescents and adults in the greater Chattanooga community. In April, Fortwood Center officially merged with the Helen Ross McNabb Center. Stephens was instrumental in ensuring a smooth transition for staff and individuals served by Fortwood Center.

Throughout her career, Stephens was very active in her community, always using her leadership position to educate others about the challenges of living with mental illness. Stephens is well-known in her community as a leader in the mental health field. She served as the chair for the Center’s United Way campaigns several times. Stephens also serves as an adjunct professor in psychology with the University of Tennessee at Chattanooga.

Stephens earned her bachelor’s degree in psychology and master’s degree in school psychology from UTC.

LeConte Medical Center named Most Beautiful Hospital in U.S. SEVIERVILLE –Soliant Health, a leading specialty healthcare staffing provider and part of Adecco Group, announced today that LeConte Medical Center located in Sevierville, Tennessee, was named the 2013 Most Beautiful Hospital

in the U.S. Last year, the hospital placed third in the competition.

The beautiful LeConte Medical Center opened in 2010, and was created with a “mountain modern” theme in mind, trying to respect the beauty in our community and the beautiful Great Smoky Mountains National Park.

LeConte Medical Center took this year’s rankings by storm with an incredible 16,250 votes.

UT College of Nursing Students Receive Scholarships, Help Fill Nursing Shortage KNOXVILLE—A grant awarded to the College of Nursing at the University of Tennessee, Knoxville, is helping fill the nation’s nursing shortage. For the second year in a row, the Robert Wood Johnson Foundation New Careers in Nursing Scholarship Program is awarding $10,000 scholarships to select students—those who are making a career switch to nursing and are members of a group underrepresented in the field.

This year, eight students will receive scholarships. Last year, five students did. The students are enrolled in the accelerated Bachelor’s degree in nursing program for the 2013-14 academic year and are either members of an underrepresented group or from a disadvantaged background.

The grant addresses national needs cited in a report by the Institute of Medicine, which recommended increasing the proportion of nurses with a baccalaureate degree or higher and increasing the diversity of students.

The accelerated program enables students with a Bachelor’s degree in another field to complete the Bachelor’s degree in a year of full-time study. Students are then eligible to take the national Registered Nurse licensure examination.

Mark Your Calendar

Your local Medical Group Managers Association is Connecting Members and Building Partnerships. All area Healthcare Managers are invited to attend.

3RD THURSDAY Knoxville MGMA Monthly Meeting Date: 3rd Thursday of each month Time: 11:30 AM until 1:00 PM Location: Bearden Banquet Hall, 5806 Kingston Pike, Knoxville, TN 37919 Lunch is $10 for regular members.

Come learn and network with peers at our monthly meetings. Topics are available on the website.

Registration is required. Visit www.kamgma.com.

2ND WEDNESDAY Chattanooga MGMA Monthly Meeting Date: 2nd Wednesday of each month Time: 11:30 AM Location: The monthly meetings are held in Meeting Room A of the Diagnostic Center building, Parkridge Medical Center, 2205 McCallie Avenue, Chattanooga, TN 37404 Lunch is provided at no cost for members, and there is currently no cost to a visitor who is the guest of a current member. Each member is limited to one unpaid guest per meeting, additional guests will be $20 per guest. All guests must be confirmed on the Friday prior to the meeting.

RSVP to Irene Gruter, e-mail: irene@chattmedsoc.org or call 622.2872. For more information, visit www.cmgma.net.

Save the Date: KAMGMA Fall Conference is set for September 19th at the Knoxville Marriott “Change…..the Only Constant” AUGUST 2013

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GrandRounds LBMC Announces Graham Promotion

McStayPromoted to Nurse Manager of Surgery

KNOXVILLE – Lattimore Black Morgan & Cain, PC (LBMC), is pleased to announce Katie Graham’s promotion, which was effective on June 1, 2013.

Graham has been promoted to a manager in the healthcare consulting division. She was previously a Katie Graham senior in the department.

With over ten years of healthcare industry experience, she has been employed by a medical billing and consulting company as well as a regional accounting firm.

KNOXVILLE – Parkwest Medical Center announces that Deena McStay, BSN, has been named nurse manager of the Operating Room (OR)/Surgery unit.

McStay has an extensive background in surgical administration. She has been with Parkwest for four years, serving as the Neuro/Spine coordinator in the OR prior to her current role. McStay also has 10 years prior experience as an OR Nurse Manager at another area hospital.

In her previous role as Neuro/Spine coordinator, McStay served on the Spine Team, which sought to streamline and improve OR processes. McStay also served on the Quality and Efficiency Team.

McStay earned an Associate’s Degree in Nursing (AD) from Walters State Community College and went on to receive her Bachelor of Science in Nursing (BSN) from Carson-Newman.

Middle Tennessee Pharmacy Services and Guardian Pharmacy LLC Open Longterm Care Location in Knoxville KNOXVILLE – Middle Tennessee Pharmacy Services (MTPS), one of the largest long-term care pharmacies in Tennessee, in partnership with Guardian Pharmacy, LLC, announced the opening of East Tennessee Pharmacy Services (ETPS) in Knoxville. This follows the group’s recent opening of Guardian MidSouth Pharmacy in Memphis. The strategic expansion completes the Tennessee footprint and enables the company to seamlessly serve residents in group homes, assisted living, and skilled nursing communities throughout the entire state.

The new 6,000 sq. ft. Knoxville pharmacy will open with 10 employees.

The team expects to grow this number throughout 2013.

Two Physicians Join Summit Medical Group UT Medical Center Stroke Team awarded Get With The Guidelines: Stroke Gold Plus and Get With The Guidelines: Target Stroke Honor Roll by American Heart Association representative Jim Groover (far right in suit).

UT Medical Center Earns Four American Heart Association Awards for Quality of Patient Care KNOXVILLE – A representative of the American Heart Association presented four awards to leaders at The University of Tennessee Medical Center for excellence in the treatment of cardiovascular and stroke patients. The awards include the following: • Get With The Guidelines: Stroke Gold Plus • Get With The Guidelines: Target Stroke Honor Roll • Get With The Guideline: Heart Failure Gold Plus • Get With The Guidelines American College of Cardiology Foundation’s NCDR ACTION Registry-GWTG Bronze Performance Achievement Award.

The recognition signifies that UT Medical Center has met the stringent criterion outlined by the AHA and American College of Cardiology, according to Jim Groover, director of Quality Improvement Initiatives for Georgia and East Tennessee Heart Association. Groover presented the awards at a special ceremony at the medical center.

Physician Assistant Program at LMU-DCOM Holds White Coat Ceremony HARROGATE - Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) held the White Coat Ceremony for the Physician Assistant Program Class of 2014 on Saturday, June 15. Dr. Ryan Stanton, President of the Kentucky Chapter of the American College of Emergency Physicians, was the keynote speaker.

The members of the LMU-DCOM PA Program Class of 2014 recite the Physician Assistant oath after receiving their white coats during the The White Coat Ceremoceremony. ny is an important, public demonstration of a student’s commitment to patient care and professionalism. The Ceremony is considered to be a rite of passage, in that an individual has demonstrated the qualities and abilities to provide competent care and can move on to the next phase of his or her training.

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KNOXVILLE – Summit Medical Group, the region’s leading primary care organization, expands in the North Knoxville region with the addition of two physicians. Dr. Alan Haney joins Fountain City Family Physicians and Dr. Shane Kelley joins Halls Family Physicians.

Haney is a primary care physician specializing in pediatric, geriatric, and adult care. He is a graduate of The University of Tennessee Health Science Center and completed his residency at the University of Tennessee Medical Center.

Kelley is an internal medicine specialist providing comprehensive care for all ages. He is a graduate of the University of Tennessee College of Medicine and completed his residency at the University of Tennessee Graduate School of Medicine. Kelley is board-certified in internal medicine.

UT Medical Center Recognized in U.S. News & World Report’s ‘America’s Best Hospitals’ Edition KNOXVILLE – For the second year in a row, The University of Tennessee Medical Center is recognized in the “America’s Best Hospitals” edition of U.S. News & World Report. The 2013-2014 report ranks the medical center No. 3 in the state of Tennessee and No. 1 in the Knoxville region, based on its patient care performance and other key factors.

The U.S. News & World Report “2013-2014 America’s Best Hospitals” is available at, http://health.usnews.com/ best-hospitals, and will appear in print on newsstands and at bookstores beginning August 27.

PUBLISHED BY: SouthComm, Inc. CHIEF EXECUTIVE OFFICER Chris Ferrell PUBLISHER Jackson Vahaly jvahaly@southcomm.com 615.844.9237 ASSOCIATE PUBLISHER Sharon Dobbins sdobbins@easttnmedicalnews.com 865.599.0510 EDITOR Bridget Garland bridget@easttnmedicalnews.com 423.523.4729 CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com 931.438.8771 GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Christie Passarello CONTRIBUTING WRITERS Sharon Fitzgerald, Cindy Sanders, Lynne Jeter, Terri Schlichenmeyer, Bridget Garland, Leigh Anne W. Hoover, Rick Jelovsek, Brad Lifford, Joe Morris, Jennifer Culp ACCOUNTANT Kim Stangenberg kstangenberg@southcomm.com CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: editor@easttnmedicalnews.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: Become a fan on Facebook, One year • Two and$48 Follow us years on $78 Twitter@EastTNMedNews SOUTHCOMM Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Business Manager Eric Norwood Director of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Director of Content / Online Development Patrick Rains East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited.

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