FOCUS TOPICS AUTOIMMUNE DISORDERS MARKETING/COMMUNICATIONS
May 2013 >> $5
PHYSICIAN SPOTLIGHT PAGE 3
Malcolm Foster, MD
Unconventional Wisdom Rethinking the approach to some autoimmune disorders
ON ROUNDS Healthcare Leader: New TMA President Dr. Chris Young Pushes Doctors to Become Advocates for Care For most of his career, Chris Young, MD, has been putting people to sleep. These days, he wants them awake, and listening, as he advocates for Tennessee doctors and medical professionals ... 4
Wine 201 Headaches from Wine - Is it the Sulfites? Some people claim to get headaches from only one glass of wine. Surely it’s not a hangover from one glass. Is it due to sulfites, an allergy, or dehydration? ... 6
By ciNdy SaNdErS
What if the standard treatment approach was the wrong one? In the case of several autoimmune disorders, it’s a theory that is gaining traction bolstered by recent research findings. Stephen A. Paget, MD, FACP, FACR, MACR, physician-in-chief emeritus at the Hospital for Special Surgery in New York City, has spent his career researching and treating a range of inflammatory and autoimmune disorders. The rheumatologist, who is also a professor of Medicine and Rheumatic Disease at the Weill Medical College of Cornell University, said the potential exists for a paradigm shift in how clinicians view and treat some disorders including reactive arthritis, Whipple’s disease and persistent Lyme disease. Paget said the accepted concept has been “that in a genetically predisposed person, with some type of environmental trigger … probably virus or bacteria … they develop disease.” Although the initiation was from a microorganism, he continued, the conventional wisdom has been that the self-perpetuation of symptoms is Dr. Stephen A. due to the body’s subsequent response. “What you were left with was an inflammatory problem that Paget was no longer tied to the previous organism,” Paget explained. A good example would be persistent Lyme disease. The infectious trigger is the Borrelia burdorferi, a bacterial (CONTINUED ON PAGE 10)
The Move from Social Media Marketing to Social Business Strategies By ciNdy SaNdErS
Earlier this year, Andrew Dixon, senior vice president of marketing and operations with Igloo Software and the former chief marketing officer for Microsoft Canada, was invited to Dallas to share insights on how healthcare organizations can make the move from social media marketing to an integrated social business strategy during the CIO Healthcare Summit. At the core of a social business strategy is the desire to deepen connections, engagement and collaboration within various communities touched by the company or industry. For healthcare providers, those communities might be other practitioners, researchers, payers, staff, and … of course … patients. “Social business is no longer just for early adopters,” said Dixon. “It really is a modern way to help connect members together.” One of the first steps, however, is to understand the difference in social media and social business. “Social media is about analyzing how your brand is being received in
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PhysicianSpotlight Malcolm Foster, MD By Brad Lifford
As an interventional cardiologist and clinical researcher at Tennova’s Turkey Creek Medical Center, Malcolm Foster, MD, is accustomed to seeking the latest advancements that could be a breakthrough for patients. But to see a new procedure he performed become the subject of a major network drama ... that’s another thing altogether. The show is about doctors, but Foster said he doesn’t typically watched Grey’s Anatomy. He made an exception for this episode, however. “They featured the Parachute device for one of their patients; it was a patient with congestive heart failure,” Foster said, “so, yes, I did watch it that night.” Where Grey’s Anatomy was realistic fiction, Foster’s experience was wholly real. The TV drama came on the heels of Foster implanting the Parachute device into device into the heart of a Sevierville man with CHF. Foster, who practices with East Tennessee Heart Consultants, performed the procedure at the Tennova Heart Institute in a little over an hour and with minimal invasion. The patient, Gregg Fruchtnicht, benefited from the fact that Foster and ET Heart Consultants are on the leading edge of heart care. When Fruchtnicht underwent the procedure on Feb. 6, he became the first patient in Tennessee – and only the third in the nation – to participate in the Parachute IV clinical trial. Manufactured by California-based CardioKinetix, Inc., the Parachute Ventricular Partitioning Device possesses a name that reflects its form and function to the letter. When implanted in the heart, the device very much resembles a deployed parachute, and it is employed to as a means of partitioning off damaged heart muscle from the functional segment. Inserted by catheter through the femoral artery, the Parachute essentially remolds the enlarged heart muscle to improve its function, Foster explained. The Parachute is designed for implantation into the left ventricle, which is frequently enlarged in patients with heart failure. The condition leads to a decrease in cardiac output and can result in shortness of breath, one of the most pervasive symptoms for those with heart failure. Foster said that the procedure for Fruchtnicht went “extremely well,” and that he was encouraged by a nearly immediate improvement in the patient’s breathing. And Fruchtnicht, for his part, was hopeful not only for himself but also easttnmedicalnews
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During a procedure at Turkey Creek Medical Center, Malcolm Foster, MD, inserts the Parachute IV through the artery of patient Gregg Fruchtnicht who suffers with CHF (Congestive Heart Failure).
other men and women who share his predicament. “I can climb stairs now without becoming completely winded – something I could not do before this procedure,” Fruchtnicht said. “It’s gratifying to be a part of something that may become a standard treatment for others like me.” The randomized Parachute clinical trial will measure mortality, hospitalization for worsening heart failure and functional outcomes, along with other measures. Foster is encouraged that the procedure could be a difference maker.
“When we place the Parachute device,” Foster said, “we can change the geometry of the heart and reduce the ventricular volume by about 30 percent and improve the pumping function of the heart. With that first implant, we’ve already seen significant improvement not only in his breathing but also his exercise level. It’s an investigational device, so we’re still in the process of evaluating its safety and benefits.” It’s not possible to overstate the burden that congestive heart failure places on those who suffer from it or its impact on the healthcare system. More than six million Americans are affected by heart failure, and the heart’s inability to supply sufficient blood flow to the body can be debilitating or fatal. It also consumes a huge share of healthcare resources. “Congestive heart failure is the No. 1 admitting diagnosis for hospitals all across the county, at least for Medicare patients,” Foster said. “It’s a serious condition, a chronic condition, and we don’t have a cure. And patients with CHF have so many readmissions – we have a difficult time keeping them out of the hospital. Another issue is that it’s becoming more and more common with our aging popu-
lation.” Coronary artery bypass surgery is a possible treatment for some patients— Fruchtnicht had had five bypasses prior to Foster implanting the Parachute device—and even heart transplant is another option. But with the latter in particular, Foster said, the number of patients who would be candidates is limited. “There is the possibility of transplant, but it really only applies to a small percentage of patients,” Foster said. “There are only so many hearts available (for transplant), and that number hasn’t changed over time.” The Parachute device does show early promise, and Foster points to another device that he and colleagues turn to, with heart transplant being a remote option for most patients. A left ventricular assist device, or LVAD for short, is a sort of mechanical heart which can’t replace the organ, but can augment the function of a heart that has severe dysfunction. “It’s basically a mechanical pump,” Foster said, “that’s surgically implanted inside the heart. For patients with endstage heart disease, the LVAD has proved to be as good or better when compared to transplants; it’s at least had results comparable to transplants. We’ve had patients of ours who receive LVADs, who used to be patients who would have regular readmissions to the hospital, and now those patients are literally playing golf and farming and leading very active lives.” Foster and his colleagues at East Tennessee Heart Consultants will continue to search for the latest treatment modalities for patients, hence, his participation in the Parachute IV trial. That only the third procedure was performed in Knox(CONTINUED ON PAGE 4)
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HealthcareLeader
New TMA President Dr. Chris Young Pushes Doctors to Become Advocates for Care By JOE MORRIS
For most of his career, Chris Young, MD, has been putting people to sleep. These days, he wants them awake, and listening, as he advocates for Tennessee doctors and medical professionals. As the newly inaugurated, 159th president of the Tennessee Medical Association (TMA), Young will oversee the organization, while also serving as its public face. That means he’ll be speaking on behalf of almost 8,000 physicians, a job the board-certified anesthesiologist takes very seriously. “We are the largest physicians’ organization in Tennessee, and one that’s composed of local medical societies and physicians at large,” said Young, who practices at Erlanger Medical Center with Anesthesiology Consultants Exchange. “We are the voice of medicine in Tennessee, and so I think we can have an enormous amount of influence on how healthcare is delivered in Tennessee.” Healthcare has always loomed large in Young’s life. After growing up in Knoxville and working at what is now Fort Sanders Regional Medical Center, Young developed an interest in medicine. His father was a surgeon, and so he knew what to expect once he finished medical school at Georgetown University School of Medicine. Eventually, he found his way to anesthesiology, and after residency and
a teaching stint at SUNY Health Science Center in Syracuse, NY, he made his way back to Tennessee. “I like it [anesthesiology] because it’s just remarkable that we can give people drugs and make them invincible to dramatic invasions of the human body,” he explained. “And then we wake them up, and they are fine. It’s something of a miracle. And it’s just the same for local anesthesia, where we render a portion of the nervous system insensible for a temporary period of time. Being able to relieve pain in that way is something that is very appealing to me.” Another aspect of anesthesiology that appeals is that while it’s very procedure oriented, often he is dealing with critically ill people, and there’s a fairly fast pace no matter what’s going on. “I get to see all kinds of patients, from children to the elderly, as well as people who are very sick to women who are having babies, so it’s a wide spectrum,” he said. “That’s very appealing as well.” He’d never gotten heavily involved in practice administration, but did start to become more involved in the business side of medicine thanks to his involvement and leadership within the Tennessee Society of Anesthesiologists, and the legislative conferences that entailed. “I learned a lot about the interaction of government and medicine on the national level, and when I became that
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society’s president, I became even more aware of those interactions,” he said. “In 2007, I was elected to the board of trustees for the TMA, and began to understand that even though physicians are specialized, the similarities between us are far greater than our differences. The issues that confront us are virtually all the same.” He found working with physicians from all around the state quite gratifying, and just as he was finishing his board term, the Affordable Care Act was being debated in Congress. That meant changes, and so he opted to stay involved. “It was clear that whatever happened, there would be dramatic changes, and because I had a history of building relationships and advocacy, I thought I might as well be in the middle of it,” Young said. The legislative and legal journey of the ACA has meant that a lot of local actions were put on hold, but now that implementation is taking place, it’s more important than ever for physicians to make sure they know what’s going on, and how they can benefit, he explained. “This is just the beginning of reform,” Young predicted. “We face enormous challenges. We have a country that’s getting older; baby boomers are going onto the Medicare rolls at the rate of 10,000 a day. Our healthcare system is too expensive. On the one hand, we have the tremendous ability to bring incredible technology to healthcare, to practice in incredibly sophisticated ways. On the other hand, we have large populations that still lack even the most basic healthcare. Trying to bridge that gap in a way that provides quality care, at a lower cost, and includes access for everyone, is a difficult
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problem.” But even with that said, he feels that physicians will rise to the challenge, and do what they’ve always done when it comes to putting patients first. “There are opportunities now for physicians to step up and lead,” he said. “I think we’ve been reluctant to do that sometimes because, frankly, doctors are busy. We’re taking care of patients. But that means sometimes we haven’t been as involved in government relations, or the healthcare industry, as we should be. We have to get more involved now so that we can make sure we get the cost of healthcare down, but also make sure that the quality is still there.” That’ll mean everything from offering input on any Medicare, of TennCare, expansion, Young said, adding that “doctors continue to see the problems of people that don’t have any access to healthcare at all, and they usually have advanced cases of chronic illnesses that were treatable if we’d gotten to them earlier.” In the end, he says, “We’re going to take care of everybody eventually, so we want to do that as well as we can. My goal is to get more doctors to believe that they really can make a difference, and that they can do so in the public arena.”
Physician Spotlight: Malcolm Foster, continued from page 3
ville might come as a surprise to some, but when one considers the robust research program at Foster’s practice, it should come as no surprise at all. Foster is principal investigator for a research program that began 12 years ago and has grown immensely ever since. “We started in 2001, and since that time we’ve done dozens of clinical trials,” Foster said. “We do pharmaceutical and device trials, with an emphasis on device trials, and we’ve had very good success over the years. We know our physicians and our (trial) coordinators, and we’ve been very successful at finding patients and doing a very thorough job, and following through on research protocols with a high level of compliance and a high level of success. “There’s a relatively small community of people in the research world, and in the beginning of our program, we were often seeking out trials that would be appropriate for our patients. Now we have the luxury that we have a lot of trials coming to us, hoping that we’ll be a trial site for them, and we try to pick and choose the trials that will be most appropriate for us and our patients.” easttnmedicalnews
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LegalMatters BY J. DAVID WATKINS
Where’s the Beef?
Physician Advertising and Non-Compete Clauses Since the landmark Tennessee Supreme Court decision in Murfreesboro Medial Clinic, P.A. v. Udom, the law governing covenants not to compete in Tennessee has been in a state of flux. In Udom, the Supreme Court ruled that restrictive covenants limiting a physician’s right to practice medicine were void against public policy, and therefore, unenforceable. Since that time, however, the Tennessee General Assembly has adopted, and several times amended, a statute that allows for the enforcement of non-compete clauses in physicians’ employment agreements with certain geographic and time restrictions. While this statute opens the door for the enforcement of covenants not to compete, it is still important to carefully interpret the actual language of the non-compete clause in an employment agreement, as some forms of competition might still be permitted.
Where the solicitation of a practice’s patients is prohibited, what forms of advertisement are considered “solicitations”? Many restrictive covenants in physi-
cians’ contracts come in the form of a clause that prohibits the physician from soliciting the practice’s patients. This is called a non-solicitation provision. This type of language raises the question of what sort of advertisement is permissible without violating the restrictive covenant. In Rogers v. Hall, the Tennessee Court of Appeals addressed whether a newspaper advertisement containing a dentist’s name and contact information constituted solicitation in violation of the non-compete agreement with his former employer. The court ruled that this advertisement was not a solicitation,
and stated that holding that such “advertising efforts constituted ‘solicitation’ or ‘contact’ would unreasonably encroach” on the provider’s right to practice his profession. Applying this reasoning, the use of non-directed advertisements, such as billboards and newspaper advertisements merely containing a physician’s name do not constitute a “solicitation,” and would not violate a non-compete provision that only bars the solicitation of patients. With that said, the Rogers case also demonstrates that non-compete agreements that prohibit patient solicitation will be enforced with respect to some advertisements. In Rogers, the former provider also sent out mailers containing the phrase “you might be a former patient” and stating that he had moved to a different practice location. According to the court, this phrase alone rendered the mailer an improper “solicitation” in violation of the non-compete agreement. This case demonstrates that a provider may advertise even in the face of a non-compete agreement
that prohibits the solicitation of a practice’s patients. Nevertheless, a physician must be cautious to avoid violating a non-compete provision by carefully reviewing the actual language in his or her employment agreement.
Conclusion When a physician leaves a medical practice, the wording of his or her employment agreement can have a profound and lasting effect on the future of both the physician and the practice he or she is leaving. While non-compete agreements are now enforceable under Tennessee law, the presence of such a provision in an employment agreement does not necessarily close the door on all competitive activity. As such, physicians and physician practices should give careful consideration to the language contained in a non-compete agreement in order to protect the interests of both parties. J. David Watkins is an attorney practicing at London & Amburn, P.C. He focuses his practice in medical malpractice defense, health law, and general business and corporate matters. For more information, you can contact Mr. Watkins at dwatkins@londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.
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Wine 201
Headaches from Wine - Is it the Sulfites? By Rick Jelovsek CSW, FWS
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Some people claim to get headaches from only one glass of wine. Surely it’s not a hangover from one glass. Is it due to sulfites, an allergy, or dehydration? The answer is complex, but wine headaches are most likely due to biogenic amines, mostly histamine and tyramine. These are naturally occurring substances in many wines to which some people are quite sensitive. In addition, there may be proteins in wine that produce an allergic response. In this case, a wine drinker’s own body produces the histamine. Histamine causes brain blood vessels to dilate. This results in both non-migraine and migraine headaches. In the skin, it can produce hives or a nettle rash. It also causes mucous secretion (nasal stuffiness), bowel smooth muscle contraction (diarrhea, heartburn), blood pressure changes, and sometimes heart beat irregularities. The histamine symptoms can be experienced fairly quickly within an hour or delayed 10 hours or more. Add this to dehydration or low blood sugar and one cannot tell a delayed histamine response from a hangover. Within the wine industry, studies have shown that the major source of these biogenic amines is not from the primary yeast fermentation, but rather from secondary events such as wine spoilage bacteria like lactobacillus and pediococcus, natural or induced bacterial malolactic fermentation, and from the barrel aging process. This latter cause is also from spoilage bacterial in the nooks and crannies of previously used wine barrels. That is why red wines, most of which undergo malolactic fermentation and ageing in barrels rather than stainless steel, are the most frequently cited source of wine headaches. The reason why most people who drink red wines do not get these headaches is not entirely clear. The usual answer, from physicians who have studied this problem, is that most people do not have a “histamine intolerance.” They are not lacking in either of two gastrointestinal enzymes—histamine N-methyl transferase (HMT) and diamine oxidase (DAO) that are necessary to metabolize ingested histamine. They say that those who suffer the most headaches from wine have low levels of these enzymes. These individuals are also sensitive to other fermented products such as aged cheese, vinegar, sauerkraut, pickles, and soy sauce. However, most often the problem is just too much histamine from the winemaking process. In fact, the European union is considering regulations to limit histamine levels to less than 10 mg/liter for any wine exported to Europe. What about sulfites? Almost everyone who gets headaches from minimal amounts of wine mistakenly blames them on added sulfites. While sulfite forms free sulfur dioxide (SO2) which can produce allergic reactions, when it does, it almost always produces respiratory symptoms such as wheezing or an asthma attack, skin rash or itching, and, rarely, a severe swelling of the tongue and larynx leading to shock. An allergy to sulfites RARELY
produces headaches. Less than 1% of the population will have any allergic sulfite reaction. The most common reaction people have to excess SO2 in wine, is sneezing, or nasal membrane burning when they first smell a wine. On the other hand, people with a history of asthma are more prone to asthma flare-ups in reaction to SO2 (1 in 10 to 1 in 20). Sulfites naturally occur in grapes. But they are also added during the winemaking process to preserve wine. They convert to sulfur dioxide (SO2), which is a strong antioxidant. Wine with free SO2 binds any excess oxygen. It keeps white wine from turning deep yellow and red wines from turning brown. One winemaker states, “Without sulfites, a wine has no shelf life.” In fact, most people are not aware that sulfites can be added to “organic” wine, i.e., certifying agencies consider them an “organic” compound, and most organic and biodynamic wines have added sulfites. While a very few wineries produce wines with “no added sulfites”, it is unlikely that there will be many commercial examples in the near future because wineries cannot take a chance on having thousands of bottles of wine spoil. During early fermentation and aging, winemakers try to keep the free SO2 at about 80-100 parts per million (ppm) for white wines and about 50 ppm for red wines because red wines have more natural anti-oxidants than white wines do. Each time they move or pour the wine from one container to another, more oxygen is introduced, and free SO2 is bound, lowering the parts per million. Thus, sulfites are usually added more than once from fermentation to bottling. It might be common at bottling for a red wine to have 35 ppm, but by the time that bottle is a few weeks old, the free SO2 will be down to 25 ppm from combining with the oxygen left in the neck of the bottle. In the U.S., wines that have more than 10 parts per million (ppm) of free SO2 must be labeled as “containing sulfites.” Europe has no such labeling laws. When visitors to Europe return to the U.S. claiming they had no wine headaches from sulfite free wines produced there, they are just being fooled because the bottle label does not say that the wine contains sulfites. The best way to lower the sulfite level is to aerate the wine as you pour it into a glass. The oxygen in the air combines with SO2 to bind sulfur and decrease or eliminate any reactions to the sulfur. Aeration also releases some of the flavors of the wine, so I recommend either using an aerator or splashing the wine into the center of the glass as you pour. Some wine loving, sulfite-hating compulsives have even coined the term “super aeration” for wines poured into a blender prior to drinking! Rick Jelovsek is a retired physician, a Certified Specialist of Wine, and a member of the Society of Wine Educators. He is also author of a book available from Amazon on Wine Service for Wait Staff and Wine Lovers. You may contact him with wine questions at tnwinelover@ gmail.com or visit his website at www. winetasteathome.com.
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Enjoying East Tennessee Cycling Championships in Chattanooga By LEIGH ANNE W. HOOVER
Whether it’s for the health benefits, social interaction, or environmental concerns, cycling is a growing activity enjoyed by many. For others, it can also be an entertaining spectator sport. Listed as one of “America’s Top 50 Bike Friendly Cities” by Bicycling Magazine, it’s not surprising that Chattanooga will be the site of the USA Cycling Road and Time Trial National Championships May 25th-27th. In fact, Chattanooga will be the host city through 2015. Sponsored by Volkswagen of Amer-
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ica, Inc., the USA Cycling National Championship event will traverse all throughout downtown and up to Lookout Mountain in a weekend of activity. “Several governing bodies with the US Olympic Committee have a national championship…,” said Chris Aronhalt, managing partner with Medalist Sports. “This is the Olympic sport of cycling, and it is for the professional level only, which is the ‘cream of the crop’ for males and females.” According to Aronhalt, the national event originally began in Philadelphia, where it was held for over 20 years be-
fore being moved to Greenville, S.C., and Chattanooga, Tenn., has been awarded the championship for the next three years. “The community [of Chattanooga] was very proactive in approaching USA Cycling when the event was up for bid,” said Aronhalt. “Without question, being a cycling friendly community that understands and supports cycling was a great first step, and the terrain of Lookout Mountain literally in your backyard creates that championship course.” In addition to being the first time for the event to be held in the city, Chattanooga also marks a first for women competing in a national cycling championship. For each discipline, including the time trials and the road race, there will be one male and one female winner. Although the majority of the athletes will compete in both, Aronhalt compares the weekend to track and field events where athletes compete in specific specialties. The individual time trial competitions, where the women and men will race against the clock on a flat road course located near the actual Volkswagen factory, will kick-off the holiday weekend of competition on Saturday. The inaugural women’s event will begin in the morning and be followed by the men’s time trial competition in the afternoon. Following a rolling terrain with limited turns, cyclists will complete 19 miles, which includes two out-and-back runs. On Monday, Memorial Day brings the second part of the competition, which is the traditional road race and an all-day event. Women cyclists, including over 80 professionals, will compete in the morning, and a group of around 100 professional men will race in the afternoon. Although the national event does not serve as the only selection for the Olympics, it is considered part of the criteria. The weekend also carries a tremendous amount of pride connected to winning. “It’s a really big deal to be called the ‘national champion’ because they receive a special jersey with the stars and strips design that they will wear throughout the entire year in competitions all over the world,” said Aronhalt. “Wherever there is a professional event, the winner will be
called up to the line and recognized as the USA National Champion.” During the road race, cyclists travel in groups, and spectators can glimpse athletes multiple times during the approximate four and a half hours. The women’s event begins in the morning and covers 63.7 miles, and the men’s championship will follow in the afternoon and be decided over 102.7 miles. “With the start and finish located in downtown Chattanooga and going throughout all of the unique parts of downtown and traveling up Lookout Mountain for a total of five times, the road race is definitely ‘spectator friendly,’” explained Aronhalt.“Spectators can actually be at the start line, and then make their way up Lookout Mountain to get in position. Cyclists pass about every 40 minutes.” Although the road race begins with around 100 riders, typically only about 30 will finish in a national championship event, which exemplifies the competitive nature of the contest. During the festivities of Memorial Day, visitors can enjoy all that Chattanooga has to offer and also personally experience the pride of a world-class national sporting event. In addition to the many restaurants and attractions downtown, there will also be a sponsor event expo that will feature interactive exhibits. “You can also come and go and mingle…,” explained Aronhalt. “And, unlike football, basketball or baseball, professional cycling is totally free to the spectator.” For additional information on the USA Cycling Road and Time Trial National Championships, visit http://www. usacycling.org/2013/pro-road-time-trialnationals , and for Chattanooga tourism information see http://www.chattanoogafun.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.
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theLiteraryExaminer BY TERRI SCHLICHENMEYER
Living and Dying in Brick City
As memoirs go, this one’s a stunner and if you’re a medical professional, fan of medi-dramas, or if you just want a fastpaced book to read, don’t miss it. Grab Living and Dying in Brick City… and fire away.
by Sampson Davis (with Lisa Frazier Page c.2013, Spiegel & Grau; $25.00 / $29.95 Canada, 245 pages
My Parent Has Cancer and It Really Sucks
By accident or design, you’ve been in the wrong place at the wrong time, but somehow remained unscathed: the almost-hazard while driving, the near-miss at work, the moment you caught yourself just in time from falling. Things could’ve been worse – much worse - but you dodged a bullet. So, did it make your heart pound, or did it change your life? For author Sampson Davis, it was the latter because, as you’ll see in his new memoir Living and Dying in Brick City (with Lisa Frazier Page), the bullets were sometimes real. Sampson Davis hid his intelligence from his friends. He was an A-student and had, in fact, landed a college scholarship and was on his way to becoming a doctor. But since it wasn’t cool to be intelligent, he hid his smarts until he did something dumb: at age seventeen-and-a-half, he gave in to the streets, participated in a robbery, and was caught. Because he was a juvenile with no prior record, he got off easy with scholarship intact, but it was a sobering wake-up call. Grateful for a second chance, Davis buckled down and went to med school. When given the chance to intern in the emergency department at Newark’s Beth Israel Hospital, Davis seized it. He wanted to do something good for his community and working at the hospital where he drew his first breath seemed extraordinarily right. Time and again, Davis discovered to his dismay that he knew the people who lay on the tables in front of him; gunshot victims, domestic violence survivors, addicts, smokers, the sexually active, and the mentally ill. He knew them – or he knew he might’ve been one of them, if not for a youthful near-miss and a bullet dodged. Readers are treated to a heart-racing memoir filled with guns, blood, violence, and life’s unfairness. Rising above all that, though, is author Sampson Davis’ amazingly powerful sense of gratitude: he fully realized that he could very well have been a man on a gurney, rather than the man caring for the man on the gurney. But that’s not all. At the end of many chapters, Davis offers brief, helpful information and stats on STDs, heart attacks, AIDS, domestic violence, and other issues of particular interest to African Americans and inner-city residents. This information and the accompanying stories pretty much glued me to my chair.
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by Maya Silver & Marc Silver; c.2013, Sourcebooks; $14.99 / $16.99 Canada, 262 pages When you read My Parent Has Cancer and It Really Sucks by Maya Silver & Marc Silver, you’ll see that an angry outburst – among other things – is perfectly normal. Almost 3 million American teens live with a parent who’s dealt with cancer. Families experience a lot of changes. Someone may be asked to pick up some extra chores. Mom or Dad might be too tired to do the things they used to do. School might seem different, and friends may say stupid things. Adapting to these changes will be easier if the lines of parental communication are kept wide open for a few months. Also, in the effort to get an ailing parent back to health, teens need to take care of themselves, too. They should learn to speak up, ask for help if they need it, and learn to deal with stress. They can talk to a trusted teacher or adult and ask friends to listen. They should stay optimistic, but be realistic. And remember to pat themselves on the back now and then because, no matter how it all turns out, they’re a survivor, too. So they’ve heard the diagnosis, they’re terrified, sad, and worried. My Parent Has Cancer and It Really Sucks can help teens cope. Father-daughter authors Marc Silver & Maya Silver have both watched a loved one battle cancer, so they’re very qualified to offer a solid POV. They do it along with words of wisdom from other teens, clergymen, doctors and therapists and, for further help, they include a chapter for parents of their teen readers. I tried, but I couldn’t think of one cancer-related thing that Silver & Silver didn’t cover, which makes this teen how-to so comprehensive that the only question you’ll have left to ask is: where has a book like this been all these years? While it’s meant for 12-to-17-yearolds, I think this book will work for newlycoping college-age kids, too. It’s something you hope you’ll never need – but if you do, My Parent Has Cancer and It Really Sucks… definitely doesn’t. 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.
Constipation By M. Samer Ammar, MD, FAAP, FAGA What I am about to share with you would not be anything you don’t already know. I am just going to stress a few facts about constipation. Constipation, defined as a delay or difficulty in defecation present for two or more weeks, is a common pediatric problem encountered by both primary and specialty medical providers. Overall, behind infancy, less than three bowel movements a week and/or painful defecation is generally an accepted definition of constipation. A normal pattern of stool evacuation is felt to be a sign of health in children of all ages. Especially during the first months of life, parents pay close attention to the frequency and the characteristics of their children’s defecation. Any deviation from what is felt to be normal for children by any family member may trigger a call to the nurse or a visit to the pediatrician. Thus, it is not surprising that approximately 3% of general pediatric outpatient visits, and up to 25% of pediatric gastroenterology consultations, are related to a complaint of defecation disorder. In most children, constipation is functional, that is, without objective evidence of a pathological condition. The most common cause of functional constipation is the voluntary withholding of feces by a child who wishes to avoid an unpleasant defecation. Many events can lead to painful defecation including toilet training, changes in routine or diet, stressful events, intercurrent illness, unavailability of toilets, or postponing defecation because the child is too busy. These can lead to prolong fecal stasis in the colon with reabsorption of fluids and increase in the size and consistency of the stools. Few constipated patients have an underlying medical problem(s). Hirschsprung disease is the most common cause of lower intestinal obstruction in neonates and is a possible, but rare, cause of intractable constipation in toddlers and school-age children. It is characterized by a lack of ganglion cells, usually segmental, but can be diffused in the myenteric and submucous plexuses of the large bowel. Other possible etiologies of defecation disorder may include a food allergy, including allergy to gluten, gluten enteropathy,
and partial bowel obstruction related to different pathology of gastrointestinal diseases, including inflammatory bowel diseases and post surgical management of digestive or nondigestive diseases. Failure to respond to conventional therapy is the most warranted reason for a pediatric gastroenterology referral. Other reasons for a referral include fever, abdominal distension, anorexia, vomiting, weight loss or poor weight gain, or bloody stool. A complete physical examination is most helpful in approaching patients with defecation disorder. A digital rectal examination can aid in the differential diagnosis of constipation. It is an underused tool in routine practice. Based on the most likely suspected cause of the differential diagnosis list, work-up may be warranted. That may include, but is not limited to, a radiographic study(s). With only a few exceptions, the treatment for constipation is usually not surgical. Understanding the true etiology underlying the cause of the defecation disorder is the first step to a better outcome. Medication use may not be sufficient. Behavioral modification is proven to be effective, yet may not be for long term; and the benefit of biofeedback therapy is controversial. It is estimated that one fourth of children with functional constipation may continue to experience symptoms related to defecation disorder at adult age. Older age at onset, longer delay between onset of symptoms and referral to a specialized pediatric gastrointestinal clinic, and lower defecation frequency at presentation were related to poor clinical outcomes at adult age. Our GIforKids specialty clinic is staffed with dedicated physicians, mid-level providers, nutritionists, nurses, and a psychologist who provide comprehensive care for patients and their family. M. Samer Ammar, MD, FAAP, FAGA is a board-certified pediatric gastroenterologist who practices with GI for Kids, PLLC, in Knoxville, Tenn. He completed his Hepatology & Nutrition Fellowship in 2002 at the James Whitcomb Riley Hospital for Children in Indianapolis, Indiana. Prior to coming to Knoxville, he practiced in Grand Rapids, Michigan.
www.giforkids.com • 865.546.3998
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The Move from Social Media Marketing, continued from page 1 the marketplace,” Dixon explained. “Social business is modern communications brought into the business for the purpose of end-user productivity, collaboration and engagement.” He continued, “The most popular tool being used today to do that is email, but email was never intended to be a collaborative tool.” In a typical scenario, he continued, one person would email an attached document to 10 people for comments and input, which leads to 10 different documents with notes that might be conflicting to compile into one master file … which is then sent back out for further review. Ultimately, businesses need to connect three key elements together — processes, information and people. Dixon noted that while large investments have been made in processes, the chief tools of email and a word processor have been fairly stagnant for the last 20 years. To address this issue, social business software designers have taken a cue from technologies like Facebook and Twitter, which started in the consumer realm. Dixon said the beauty of these tools is that they are lightweight, easy to navigate, simple and very effective in keeping individuals connected to their social network, which is a sophisticated online community. The concept of online communities, he continued, isn’t new to healthcare. “Even back in the 1990s, people would have early dos-based discussion boards. Around 2000 … 2002 … we started to see the emergence of heath information repositories like WebMD. For consumers, it was the first time they could easily get information outside of a doctor’s visit,” Dixon said. He added that by mid-2005, those repositories had become more like communities where people with a similar interest could connect with each other. “Fast forward to where we are today, and what we really have are health networks. They really are communities, but they’ve introduced much richer communication and collaboration tools,” Dixon continued. He noted tools like microblogging, wikis and forums open the path to allow discussion around content within a community setting. “The reason social
business tools are so popular is not only do they work they way you do, but you can choose the one that’s most appropriate for the task at hand,” he added.
Creating Engaged Communities
Dixon said the ability to engage and connect in a community setting is one of the most powerful aspects of a social business model. Today, patients with similar ailments can tap into a network to share experiences, information and support. That said, he added the communities could be built with parameters to allow providers to monitor and moderate discussions. “It’s open communication, but at the same time, you introduce controls,” he explained. Although it does take some time to manage, Dixon added, “The scale and the reach you get with an online community far exceeds what you could ever get from an in-person visit.” That element also allows physicians to disseminate messages about wellness and disease management to large, targeted populations, which will be increasingly important in new accountable care delivery models. For physicians, the community setting lets providers who might not be geographically connected engage each other. One of Igloo’s clients is the American Academy of Family Physicians. The organization launched the Delta Exchange as a way for physicians from across the country to become more aligned. “They were able to coordinate all the different best practices and overall learning that various physicians had and bring each other along. It was a great way to be able to coordinate a geographically diverse set of practitioners,” Dixon said. Similarly, community settings that encourage discussion and idea exchange could work equally well for other groups including researchers, mid-level providers and practice managers. Internally, an intranet community allows for easy communication and collaboration. Using the same types of business tools employed in external communities, staff members can easily review documents, communicate information broadly across geographic locations, vote on policy, and share ideas.
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Security
“Security has to be built in as a core set of requirements in any social business tool,” said Dixon. “The technology is there,” he continued. “It’s one of the central things you look at when deciding which social business tool provider makes sense.” He added, “Any enterprise-class social business software firm can not only lock down the individual permissions but also has the ability to audit everything that has happened in that community.”
Avoiding Information Overload
Dixon said email is in danger of becoming less and less useful because of information overload. The same caveat also applies to information imparted through social business tools. “If you don’t implement properly, you risk making that problem worse,” he said.
However, social business tools can be offered in a very targeted manner through channels. Individuals choose which channels are of interest to them and subscribe. Drilling down even further, there are generally options within the channel to refine what information the subscriber receives and how.
The Bottom Line
With accountable care organizations and patient-centered models, supporting patients and colleagues by providing timely, pertinent information in an easilyaccessible manner has become even more critical, Dixon pointed out. “That means you need to be able to collaborate and communicate internally and externally. From a common sense perspective, those that do that best will attract the most patients and keep the most patients … those who don’t will find the opposite.”
Unconventional Wisdom, continued from page 1 species of the spirochete class, which is transmitted to humans through a tick bite. Skin rash in a bull’s-eye pattern (erythema migrans), fever, fatigue, chills and headaches are among early symptoms. Later symptoms could involve the joints, heart or central nervous system. For most, a prescribed course of oral or intravenous antibiotics takes care of the infection and symptoms. However, in some patients, synovial inflammation persists even after the bacteria have been nearly or totally eradicated. This has given rise to the belief that in predisposed patients, the initial Lyme disease triggers an ongoing autoimmune disorder. In his 2012 paper, “The Microbiome, Autoimmunity and Arthritis: Cause and Effect: An Historical Perspective,” which was published in Transactions of the American Clinical and Climatological Association, Paget noted that for more than 100 years, there has been “tantalizing but often inconclusive evidence” about the role of microorganisms in autoimmune diseases. He wrote, “Current therapy focuses on the pathogenesis rather than the etiology of these disorders. In order to rein in the overactive immune system we believe to be causing the disease, we employ immunosuppressive drugs, an act that would be counterintuitive if infection were the root cause of the problem.” A small but intriguing study out of the Division of Rheumatology at the University of South Florida College of Medicine published in the journal Arthritis Rheum in May 2010, found a six-month combination antibiotic regimen was effective in treating patients with the autoimmune condition Chlamydia-induced reactive arthritis. In the nine-month, prospective, double-blind, triple-placebo trial, researchers assessed a six-month course of combination antibiotics with a primary end point of the number of patients who improved by 20 percent or more in at least four of six variables without worsening in
any variable. At month six, the authors found significantly more patients in the active treatment group became negative for C trachomatis or C pneumonia. The primary end point was achieved in 63 percent of patients in the active arm of the trial, with 22 percent of those patients believing their disease had gone into complete remission. No patient in the placebo group achieved remission. Pointing to this study, Paget noted that one of the failures of antibiotic regimens in the past in treating autoimmune disorders might be the duration of the therapy. “If you give long courses of antibodies, you may very well calm the problem down,” he said. However, he noted, physicians currently switch to steroids, T-cell inhibitors, and other immunosuppressive drugs to ameliorate the ongoing inflammatory issue after treating the triggering microorganism with antibiotics or antivirals for a relatively short course, “It may very well be we have to improve the immune system response instead of suppress it, and that’s the interesting twist,” Paget continued. If the root cause of an autoimmune condition is infection, “You’d want the army active,” he said of augmenting the immune system. While much more research must be done, Paget said mounting evidence of the important connection between microorganisms and a number of autoimmune disorders provides ‘food for thought’ when it comes to the best course of action for treating these conditions and could ultimately portend a paradigm shift in the delivery of care. “In some of these, the organism is slow, smoldering … but still there in a lowgrade way that is triggering the inflammatory response. We have to be appreciative of the fact that we want to do the best thing for our patients … but what we’re doing (now) may be the worst thing,” he concluded. easttnmedicalnews
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East Tennessee CME Events Editor’s Note: In an effort to provide our readership with the latest professional healthcare news, East Tennessee Medical News is working with area institutions to provide this monthly listing of CME events throughout the East Tennessee region. For more information about each activity, please see the contact information provided for each event. Upcoming CME Events in the Greater Chattanooga area Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: May 2, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 2, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Fifth Annual Stroke Symposium: Managing the Complex Stroke Patient Name of CME provider/sponsor: University of Tennessee Medical Center Brain and Spine Institute and UT Graduate School of Medicine Date: Tuesday, May 7, 2013 Time: 7:30 a.m.-5:00 p.m. Place: University of Tennessee Conference Center, Knoxville, Tennessee Credits available: Approved for AMA and AAPA credits and CEUs Information: www.tennessee.edu/cme/Stroke2013 Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Details: The symposium offers presentations by experts addressing care for critically ill cerebrovascular patients and administration of thrombolytics for acute ischemic stroke. Guest speaker is Andrew D. Barreto, M.D., an assistant professor of Neurology at the University of Texas Medical School, Houston, and other speakers represent the specialties of neurology, radiology, anesthesiology, palliative care and pharmacy. Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: May 9, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 9, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190
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Name of activity: Medicine Grand Rounds: Osteoporosis Update 2013 Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 14, 2013 Times: 8-9 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: May 16, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 16, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: May 23, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville
Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 23, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Medicine Grand Rounds: Peripheral Neuropathy: Clinical Approach and Current Concepts Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 28, 2013 Times: 8-9 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: May 30, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University
of Tennessee Graduate School of Medicine and Department of Surgery Date: May 30, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190
Upcoming CME Events in the Greater Chattanooga area Name of activity: Family Medicine Update (28th annual) Name of CME provider/sponsor: University of Tennessee College of Medicine Date: June 12-15, 2013 Times: 8:00am-5:00pm on Wednesday-Friday, 8am-12:00pm on Saturday Place: The Chattanoogan Hotel Credits available: 24 AMA PRA Category 1 Credits™ Information: utcomchatt.org/cme Details: General Session Registration fees include: admission to all general sessions; issuance of continuing medical education credit certificates for physicians; light breakfast each day; fresh snacks during breaks; lunch at Broad Street Grille each day; and complimentary Riverbend Festival admission pins for use on a daily checkout basis (while supplies last). Name of activity: Southeast Wilderness Medicine Conference (9th) Name of CME provider/sponsor: University of Tennessee College of Medicine Date: June 21-26, 2013 Times: Various times each day, depending on involvement Place: Chattanooga Convention Center Credits available: 45 AMA PRA Category 1 Credits™ Information: utcomchatt.org/cme Details: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Tennessee College of Medicine and Still Waters Productions, LLC.
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.
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GrandRounds MEDICAL MOVER MOMENT 9th Annual Denim & Diamonds Fundraiser
Chattanooga physicians and community leaders came together on Feb. 23, 2013, at the Chattanooga Convention Center for an evening of music and food, and a celebration of healing. The Denim and Diamonds fundraiser helps support the Project Access community health partnership and other community health initiatives and is organized by the Chatta- Dr. Peter and Courtney Lund nooga Hamilton-County Medical Society, Medical Foundation of Chattanooga, and Medical Alliance. Denim & Diamonds: Saturday Night Fever, presented by Dale Buchanan & Associates, Kindred Health, and University Surgical Associates celbrated the decade of disco – the 1970s and included dinner, dancing, and live and silent auctions. Attendees came dressed as their favorite star or icon from the 1970s. Polyester was brought back in style for one night only. Tracie & Dr. Chris Lesar.
Expanding Access to Care, Mental Health, Rx Drugs Top Issues at Tennessee Physicians’ Annual Meeting
NASHVILLE – Physicians from across the state gathered in Franklin, Tenn., April 5-7, and considered a number of health policy positions for the Tennessee Medical Association, including support for expanding access to healthcare coverage, more funding of mental health screenings and treatment, transparency of patient charges for prescription drugs and hospital services, maternal mortality review, and amending restrictive guidelines for care provided by physicians in training. Following passionate debate, a resolution supporting expanded access to care for all Tennesseans was approved by a majority of delegates. The resolution supports expanded access under a three‐year trial program using Medicaid expansion funds to cover uninsured residents through health exchange purchased plans, similar to Gov. Haslam’s proposal, or direct expansion. The resolution calls for the TMA to continue to support access to affordable healthcare for all Tennesseans as put forth in its previous statement on health reform; to support a three‐year trial to expand access to care using Medicaid expansion funds to either subsidize plans purchased by the uninsured through the federal health insurance exchange or through direct Medicaid expansion; and to insist that the benefits purchased through the exchange remain comparable to Medicaid/TennCare benefits. The TMA House of Delegates held its
session as part of the association’s 178th annual meeting, MedTenn 2013. The event also offered CME and informational sessions on prescription drug abuse and neonatal abstinence syndrome, the mental health crisis in Tennessee, the state’s Controlled Substance Monitoring Database, which became mandatory for prescriber checks for certain pain medicine prescriptions on April 1, health reform, electronic health information exchange and quality incentive programs, ICD-10 coding changes, and more. RESOLUTIONS OF INTEREST Increasing Access to Care – The TMA House of Delegates (HOD) voted to support access to affordable healthcare for all Tennesseans; support a trial for three years to expand access to care by using Medicaid expansion funds either to subsidize uninsured residents to purchase health insurance through the federal insurance exchanges or through direct Medicaid expansion; and instructed the Association to make itself fully available to the governor and the state legislature to advocate for healthcare coverage in Tennessee. • Indigent Care – Delegates reaffirmed the importance of physicians providing free and reduced-cost care to indigent patients and directed the Association to support and promote such activities. • Mental Health Screening – Delegates voted to support efforts for more state and federal money for mental health screenings and treatment in Tennessee.
Celebrating the Class of 2013 12
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GrandRounds • Maternal Mortality Review – The HOD voted to support the establishment of a peer review-protected and HIPAAcompliant maternal mortality review process under the auspices of the Tennessee Department of Health to review maternal deaths in Tennessee and make recommendations for system changes to improve healthcare services for women in Tennessee. • Cosmetic Surgery – Delegates passed two resolutions to pursue expansion of the definition of the practice of medicine to include any surgical procedure for cosmetic or aesthetic purposes; and to support efforts to prevent unlicensed and unsupervised cosmetic surgical procedures through legislative action and enforcement by the Board of Medical Examiners. • Health Cost Transparency – Delegates passed separate resolutions supporting the required posting of patient out‐of‐pocket costs for prescription drugs and hospital charges. • Medical Education & Physician Involvement – The HOD voted to petition the American Medical Association to work with CMS and other federal authorities to remove onerous language from its guidelines on care by physicians in training; and petition the AMA for requirements that recognize more accurate documentation of care while allowing the profession to resume educating its future colleagues in a more cost-effective and efficient manner. AWARDS The TMA presented its 2013 annual awards to the following honorees: • Outstanding Physician: Winston P. Caine, MD, Chattanooga; Bobby Clark Higgs, MD, Jackson; John Lamb, Sr., MD, Nashville • Distinguished Service: Marion Dugdale, MD, Memphis; B W. Ruffner, Jr., MD, Signal Mountain • Community Service: Greater Memphis Greenline, Inc., Memphis; Hamilton County Project Access, Chattanooga; Cathy Self, PhD, Baptist Healing Trust, Nashville
saving benefits of early detection of breast cancer. It is the eleventh year that the program has received funding from the Avon Foundation for Women to support its work on this important health issue, and in recognition of the program’s excellence. BHOP at UT Medical Center will educate area women in 21 rural and remote counties in eastern Tennessee and refer them to low-cost or free mammograms and clinical breast exams in their own communities. The vital program will also provide free comprehensive education programs emphasizing the importance of the early detection of breast cancer.
UT’s College of Nursing Helps Launch Leadership Institute
KNOXVILLE—The University of Tennessee, Knoxville, College of Nursing is helping to address our state’s most pressing healthcare challenges—access, quality and cost—through the development of the Tennessee Nursing Institute for Leadership and Policy. The college is launching the institute on behalf of the Tennessee Action Coalition (TAC). The College of Nursing and AARP Tennessee are co-leaders for the TAC. The institute is made possible
through a two-year $150,000 grant from the Robert Wood Johnson Foundation’s Future of Nursing State Implementation Program and matching funds from several Tennessee organizations. The mission of the institute is to equip nurses in Tennessee with the knowledge and skills necessary to transform healthcare delivery. It will provide educational programming and training to practicing nurses and other health care professionals across the state. It also will provide expert analysis to promote access to high-quality patient-centered health care in Tennessee.
I don’t just have insurance. I own the company.
Gary E. Meredith, M.D. Pediatric Diagnostic Associates Chattanooga, TN Pediatrics
NEW OFFICERS In addition to Dr. Young’s inauguration as president, the following leaders were installed for 2013-2014: • Dr. Douglas J. Springer, a Kingsport gastroenterologist, will serve as president-elect and on the TMA Board of Trustees. • Dr. Keith G. Anderson, a Germantown cardiologist, was reappointed as chairman of the TMA Board of Trustees. • Dr. Bob Vegors, a Jackson internal and geriatric medicine specialist, is the new vice-chairman of the TMA Board. • Dr. James “Pete” Powell, internal medicine and pediatric physician from Franklin, was reappointed as secretary/ treasurer for the TMA.
“Like me, you’ve probably noticed some professional liability insurance providers recently offering physicians what seem to be lower rates. But when I took a closer look at what they had to offer, I realized they simply couldn’t match SVMIC in terms of value and service. And SVMIC gives me the peace of mind that comes when you’re covered by a company with more than 35 years of service and the financial stability of an “A” (Excellent) rating. At SVMIC, I know it’s not just one person I rely on...there are 165 professionals who work for me. That’s because SVMIC is owned by you, me, and over 14,000 other physicians across the Southeast. So we know our best interests will always come first.”
Avon Breast Health Outreach Program Awards Grant for Outreach at the University of Tennessee Medical Center Cancer Institute
Mutual Interests. Mutually Insured.
KNOXVILLE—The Avon Breast Health Outreach Program has awarded a $60,000 one-year grant to the Breast Health Outreach Program (BHOP) at The University of Tennessee Medical Center Cancer Institute to increase awareness of the life-
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Medical Professional Liability Insurance
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GrandRounds American Red Cross accepts $10,000 donation from TeamHealth
KNOXVILLE – The American Red Cross received a $10,000 donation on March 18 from TeamHealth to support its humanitarian services. The check was presented at the TeamHealth offices in Knoxville. The donation stems from TeamHealth’s 2012 holiday card campaign. Recipients of the annual TeamHealth holiday card were directed to a special website, TeamHealthGives.com, where they could vote for an organization to receive a $10,000 donation. The majority of participants cast ballots for the American Red Cross. The American Red Cross shelters, feeds and provides emotional support to victims of disasters; supplies about 40 percent of the nation’s blood; teaches skills that save lives; provides international humanitarian aid; and supports military members and their families. The Red Cross is a not-for-profit organization that depends on volunteers and the generosity of the American public to perform its mission.
Helen Ross McNabb Center and YES merger complete
MORRISTOWN—The Helen Ross McNabb Center, Inc. (HRMC) and the Youth Emergency Shelter, Inc. (YES) of Morristown, Tenn. merged operations on April 1. HRMC will continue to provide emergency shelter care in foster homes or facility-based care, conduct psychosocial assessments and offer communitybased casework to divert children from state’s custody and the repetitive need for emergency placement. HRMC also intends to provide an emergency placement and family preservation continuum for children temporarily removed from their home by law enforcement, the Department of Children’s Services, or by running away. Both agencies acknowledge that YES provides valuable services to children
and their families during a time of need. These services are provided with the philosophy that every child should have the opportunity to grow up in a nurturing family setting.
Clary Named Winner of 2013 Buscetta Award at Covenant Health
KNOXVILLE—Liz Clary, director of patient care services at Peninsula Hospital, is the winner of the 2013 Buscetta Award, given to outstanding Covenant Health managers or directors who personify leadership excellence. The award was presented Liz Clary by Covenant Health President and CEO Tony Spezia. The award is named for Samuel R. Buscetta, retired executive vice president for human resources, who was instrumental in launching Covenant Health’s Journey to Excellence initiative. Nominations for the award were submitted by Covenant Health’s senior leaders and Clary was selected from among seven finalists. Nominees were evaluated in areas such as quality, service, growth, finance/ cost management and developing people, along with achievements related to systemwide alignment and innovation. Other Buscetta Award finalists were: • Carol Burns, director, patient registration and financial services, Fort Sanders Regional Medical Center; • Phil Carney, director of diagnostic services, LeConte Medical Center; • Dorothy (Bernie) Hurst, director of women’s services, Fort Sanders Regional Medical Center; • David Newman, director of medical imaging, Methodist Medical Center; • Stephanie Nichols, director of clinical effectiveness, Morristown-Hamblen Healthcare System; • Jennifer Steely, director of clinical services, Patricia Neal Rehabilitation
Center.
Jones named ‘CEO of the Year’ of the Tennessee Division
KNOXVILLE—Lance Jones, CEO of Turkey Creek Medical Center, was one of two Eastern Group leaders to be named “CEO of the Year” by Health Management Associates. Jones was chosen for his outstanding leadership, dedication, and commitment Lance Jones to Turkey Creek Medical Center, its patients and the West Knoxville community. Jones was chosen by his Division leadership and was recently recognized at a company meeting. Jones joined Turkey Creek Medical Center in November 2011, when Mercy Health Partners was acquired by Health Management Associates.
Premier Surgical Names New COO
KNOXVILLE—Matthew West has joined Premier Surgical Associates as Chief Operating Officer. West comes to Premier Surgical from Carolina Healthcare System in Charlotte, North Carolina. There, he served as director of Carolinas Gastroenterology Centers. Previously, he was Matthew West an Administrative Resident at Carolinas Medical Center. West earned his Masters in Science in Healthcare Administration and a Masters of Business Administration degree from the University of Alabama at Birmingham. He completed his undergraduate education at Furman University in Greenville, South Carolina.
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GrandRounds University Surgical Associates Names New Marketing Manager
CHATTANOOGA – University Surgical Associates’ (USA) CEO, Craig Sarine announced today the hiring of former SunTrust Assistant Vice President and Director of Marketing, Vanessa McNeil Guin as the organization’s new marketing manager. Guin is a graduate of the University of Tennessee at Chattanooga and has worked for Unum, Siskin Children’s Institute and owned her own marketing consulting firm. Prior to joining USA she worked for SunTrust Bank’s Eastern Tennessee Region.
Summit Welcomes Three New Physicians: Hall, Kanabar, Petrilla
KNOXVILLE—Summit Medical Group, the region’s leading primary care organization, recently welcomed three new physicians. Dr. Glen Hall (formerly with Statcare Hospitalist Services) joins Internal Medicine Associates Dr. Glen Hall in Powell; Dr. Hasmukh Kanabar joins from Hometown Medical Clinic in Madisonville, and Dr. Diane Petrilla joins Statcare Hospitalist Services. Hall is a native of Morristown, Tennessee Dr. Hasmukh and a graduate of the UniKanabar versity of Tennessee. He originally joined Summit in 2003, serving as a hospitalist with Statcare. Dr. Hall is board certified in internal medicine. Kanabar is board certified in family medicine Dr. Dianne and a graduate of the Petrilla Universidad Autonoma de Ciudad Juarez Escuela de Medicina, Instituto de Ciencias Biomedicas. He has been practicing in Madisonville for many years, where he will remain. Petrilla is a graduate of Georgetown University School of Medicine and previously had a solo family practice in Sewanee, Tennessee.
into military programs. LMU-DCOM had the fourth highest osteopathic match rate in the country, which is the percentage of a school’s seniors and previous graduates that matched in the osteopathic match as compared to the total number of the school’s eligible participants (including non-participants).
Honorees Announced for Annual Doctors’ Day Salute
CHATTANOOGA -- The Chattanooga-Hamilton County Medical Society, Medical Foundation of Chattanooga, Medical Alliance, and Project Access recognized local physicians by saluting ten honorees for Doctors’ Day Appreciation. The honorees were selected from nominations submitted by local residents. The ten honorees were: • Tracy Dozier, MD, Academic Internal Medicine • Annesofie Dubeck, MD, Diagnostic Center • Hunter Jennings, MD, Chattanooga Surgical Oncology & Associates • Todd Levin, MD, Chattanooga Allergy Clinic • Vicente Mejia, MD, University Surgical Associates • Melissa Phillips, MD, TCFPA Family Medical Centers • Philip Pollock, MD, Diagnostic Pathology Services • Marty Scheinberg, MD, Plaza Urology • Mark Thel, MD, Chattanooga Heart Institute • Steven Thomas, MD, Ophthalmologist Patients submitted almost 70 nominations of Chattanooga-area physicians this year.
(from left to right): Jenny Ackerman, Wanda Buchanan, Tammy Waddle, Virginia Cook, Roger Forgey, Hutcheson CEO, Denise Self, Carol Worley, Chareen Humble, Chris Lundeen, and Amy Bolden.
Name: Virginia Cook Position: Volunteer at Hutcheson Medical Center Launching its monthly volunteer recognition program, Hutcheson Medical Center, located in Fort Oglethorpe, Ga., named Virginia Cook as its April recipient of the inaugural award. Cook has volunteered at Hutcheson Medical Center for two and a half years in the hospital’s Day Surgery area and was unanimously nominated by the surgery staff. “Every surgery staff member nominated Virginia as Volunteer of the Month,” stated Chareen Humble, manager of volunteer services at Hutcheson. “Everyone said that she goes above and beyond to help surgery patients and is always asking what more she can do to help”. As Volunteer of the Month, Cook received a basket with gift certificates from Sears Shoe Store and Battlefield Salon, and gift items from The Hutch Gift Shop. Cook was awarded use of the Volunteer of the Month parking space during April and her name will be added to the recognition plaque by the hospital’s information desk.
LMU-DCOM Announces Class of 2013 Residency Placements
HARROGATE—Approximately 78% of the members of the graduating class at Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMUDCOM) Class of 2013 will enter their first year of residency training in a primary care track residency, including family medicine, internal medicine, pediatrics, OB/GYN, emergency medicine, osteopathic manipulative medicine and transitional year/traditional rotating internship. The members of the Class of 2013 will be in 107 different residency programs in 33 states. LMU-DCOM has placed 100% of its graduating class into postgraduate training programs. Of the graduating class, 61% were placed into osteopathic residency programs. Twenty-eight percent accepted residency positions with allopathic programs, and 11% are going easttnmedicalnews
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Attenti o n
Important Information for People with BlueCross BlueShield of Tennessee Insurance Coverage What does the word “transparent” mean to you?
(adjective) visibility or accessibility of information especially concerning business practices
Mountain States Health Alliance is committed to working with BlueCross BlueShield of Tennessee in an attempt to continue participation in their network. BlueCross has set the deadline at June 1 for reaching an agreement, but we have asked BlueCross for a 90-day extension in order to allow enough time to reach that agreement. There’s no good reason for BlueCross to refuse the extension. In fact, one reason we are currently pressed for time is because the first proposal we received from BlueCross contained an error that would have meant millions of additional dollars for MSHA. Per their request, we granted them a 60-day extension to correct it. Not only is it important to be trAnspArent , we believe doing the right thing is worth the time. We hope BlueCross will agree.
fAct:
The BlueCross CEO has warned subscribers that premiums for individual coverage will increase an average of 30% next year.*
fAct:
BlueCross is demanding significant cuts in reimbursement from MSHA.
question:
If your health care providers are being paid less and your health insurance premiums are going up, who is benefitting from this arrangement?
whAt cAn you do? Talk to your employer or HR department. Ask them to urge BlueCross to grant the extension.
fAct:
To learn more, visit www.msha.com/BCBSTN or email us at info@msha.com.
fAct:
*Memphis Business Journal, 4/4/13, “Insurance is going to cost more, and BlueCross wants you to know why”
MSHA granted BlueCross a 60-day extension when a payment model error was discovered. MSHA is again asking BlueCross to extend the contract for the benefit of our patients and our community, so we can come to an agreement.
Franklin Woods Community Hospital • Indian Path Medical Center • Johnson City Medical Center Johnson County Community Hospital • Niswonger Children’s Hospital • James H. & Cecile C. Quillen Rehabilitation Hospital Sycamore Shoals Hospital • Woodridge Hospital • First Assist Urgent Care • Mountain States Medical Group Medical Center HomeCare and Hospice • Mediserve Medical Equipment • HealthPlus & Pharmacy
www.msha.com/bcbsT