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PHYSICIAN SPOTLIGHT PAGE 3

Robert M. Overholt, MD ON ROUNDS LEGAL MATTERS: WHAT? ME WORRY? Physician Reporting Obligations Under the Tennessee Healthcare Consumer Right-To Know Act Recently, the Tennessee Board of Medical Licensure and other healthcare related boards around the state have been cracking down on failure of physicians or other providers to report payments made as a result of malpractice actions ... 7

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Early Warning System: Researchers Identify Diabetes Risk Biomarker By CINDy SANDERS

What if a simple blood test could provide information that your patient had a significantly elevated risk of developing diabetes within the next decade? What might that mean from the standpoint of early intervention and prevention? While it’s much too soon for this type of clinical application, researchers at the Vanderbilt Heart and Vascular Institute (VHVI) and Massachusetts General Hospital have identified a novel biomarker that lends itself to such intriguing questions. Led by Thomas J. Wang, MD, director of the Division of Cardiovascular Medicine at Vanderbilt and physician-in-chief for VHVI, the team recently published results of their discovery of elevated 2-aminoadipic acid (2AAA) as a precursor to diabetes in The Journal of Clinical Investigation. Tapping into the rich data source of the Framingham Heart Study, Dr. Thomas J. Wang

(CONTINUED ON PAGE 6)

Gaining Perspective on the Reimbursement Landscape: Glass Half Empty … or Half Full By CINDy SANDERS

To see something in a different light often requires a shift in perspective. David A. Williams, CPA, MPH, FHFMA, leader of healthcare reimbursement and advisory services for HORNE LLP, believes this certainly holds true for practices and facilities facing ever-increasing budget pressures.

Glass Half Empty

Williams, a partner in HORNE’s Ridgeland, Miss. office, noted for many healthcare providers, any incremental increase in revenue is eaten up by rising costs — from increased wages to higher prices for supplies to hikes in rent and utilities. He pointed out that for hospitals, the largest revenue stream is for inpatient stays, and the largest single payer is Medicare, which can represent from the low 40s to the high 60s in terms of percentage of patients. “There has been a mar(CONTINUED ON PAGE 12)

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PhysicianSpotlight

Robert M. Overholt, MD By BRIDGET GARLAND

A familiar face to many East Tennesseans, Robert Overholt, MD, or “Dr. Bob” as he is more familiarly known, says he never imagined over 15 years ago how popular “The Dr. Bob Show”—his educational health and wellness show—would become. “People will recognize my voice and face, and to me, it’s a nice thing. I enjoy people,” Overholt said. “I try to take time for people if I see them in a public place….Many, many times I have people say, ‘I’ve never met you, but you’re my doctor,’ or ‘I hate to bother you, but I want you to know, you have changed my life.’” Overholt’s television show, however, is only a portion of what he has given back to his community. A life-long resident of Knoxville, Overholt has practiced medicine in the region since 1970. Specializing in adult and adolescent allergy, asthma, and clinical immunology, Overholt boasts having the career he always wanted. “My father was a physician, and the kindest, most wonderful man in the world. He got up at 4:30 a.m. to work and came home at 9 p.m.; he was extremely hard working. But when he took a vacation, he always took it with his children because we were very important to him. We had a wonderful childhood, and I enjoyed watching him take care of people,” he recalled. “So, as early as junior high school, I knew I wanted to go into medicine like my father.” Although born in Battlecreek, Michigan, Overholt came to Knoxville with his family when he was only six months old. But on the day Pearl Harbor was bombed, his father immediately left his practice and signed up with the United States Army. The family traveled with the military a few years, living in both Texas and Florida, but soon came back to Knoxville when the war ended in 1944. “My father bought a house in Sequoyah Hills, ...and I attended local schools and graduated from West High School,” he shared. “I was a football All-American in elementary school, we were Pop Warner champions. I was All-State in football and basketball, I played baseball. Nobody knew it, but I had an offer from the Brooklyn Dodgers to sign.” On top of all his accolades in sports, Overholt also received attention for his perfect academic record in high school, being offered a scholarship from Yale even. “But I wanted to play football, so I attended the University of Tennessee on a scholarship, under Coach Bowden Wyatt,” he said. Recruited as a tailback, Overholt inspired to be the next Bobby Dodd, but after his freshman year, the coach called him aside. “He told me, ‘You’d be a good tailback, except for three things: you can’t kick, you can’t pass, and you can’t run. I want you to play left end.’ And so I played left end,” chuckled Overeasttnmedicalnews

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holt, recalling the humbling experience. “We beat Texas A&M in the Gator Bowl that year, but after my second knee operation, I told my coach it was time to go to medical school.” Overholt headed to Memphis in 1959, where he went to the University of Tennessee Medical School. Finishing up in 1962, he and his wife Carole Campbell, who he married during his last quarter of school, moved to Pennsylvania for Overholt’s internship at Philadelphia General Hospital, one of the leading rotating internships in the country. “My internship was extremely hard. For almost six months of the year, I almost didn’t sleep. Of the 90 interns in the program, nine of them cracked mentally. It was just too much,” he recalled. “I worked very hard for six months. I made $88 a month, our rent was $110 month, so Carole worked in West Philadelphia as a dental hygienist.”

Surviving the program, Overholt went to Ann Arbor, Michigan, for his Internal Medical residency, greatly appreciative of the education he received from the full-time professors, at a much more relaxed pace. “I got lots of hands-on training in Philadelphia—I delivered over 40 babies, preformed appendectomies, lumbar punctures, everything, you name it, so I loved the three-years of teaching following that,” he said. But like many other physicians at the time, Overholt was drafted during the Vietnam War and sent to Fort Myer in Virginia, where he lived on post. “I lived in temporary World War 2 housing, the Arlington graves were 75 yards from my house, the Pentagon was 500 yards away. I was a mile from the Lincoln Memorial, and 700 yards from the Iwo Jima Memorial,” Overholt shared. “But our housing was free, I was making $700 a month, and I was the richest I ever was. It was great! I bought a Volkswagen and a washer and dryer.” After serving, Overholt returned to Ann Arbor to complete a two-year allergy fellowship from 1968-70, which he described as a wonderful training program. After finishing, he brought that training back to Knoxville, where he immediately began practicing. “I grew up here, played football here, and my father and brother were here,” he explained. “My older brother is also a physician, Gene Overholt, who invented the fiber optic sigmoidoscope, which diagnosed Reagan’s cancer,” he boasted. “I tell everybody my father is my hero in private practice, and my brother Gene is also my hero. He is a wonderful man, a wonderful physician; we are very close and have a great love for each other.”

Overholt also has two other siblings—sisters, and all four of the Overholts still live in Knoxville. “We all love it. It’s the greatest place in the United States to live....We’ve got everything—recreation, a small college town, good transportation and education; it’s a wonderful place to live,” he enthused. Overholt moved from his original practice location (located at the soon-tobe World’s Fair site) to the Weisgarber area in 1979 and where he continues to practice today. However, as Overholt explained, in 1990, a big change transpired as physicians were faced with what to do about managed care. “You had to decide if you were going to put your head in the sand and not participate, or be proactive with managed care,” he said. “We decided to be proactive and go geographically and womb to tomb. That’s where we started, me and eight people.” Remarkably, over the years, The Allergy, Asthma & Sinus Center has grown exponentially, with approximately 18 providers and 26 locations, reaching into Kentucky and recently into Middle Tennessee. “We are a big practice, but our purpose remains the same—to serve the people and be the best allergy practice in the United States,” Overholt said. Around the same time the practice started its expansion, Overholt began another venture in a slightly different direction—to the television screen. Approached by WBIR Channel 10 News, Overholt was asked to appear on their new weekend program. He started on Sunday mornings, and “I liked the camera and the camera liked me,” he shared. “Remember, I played football in front of people, I liked to teach, I liked medicine, (CONTINUED ON PAGE 10)

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HealthcareLeader

Cathy Kerby By JENNIFER CULP

When considering the driving forces behind Cathy Kerby’s 33-year career at The University of Tennessee Medical Center, two words come to mind: commitment and quality. Born in the Knoxville area and raised in Jefferson City, Kerby has lived in Tennessee all her life. After graduating from Jefferson City High School, she earned a Bachelor of Science in Nursing from The University of Tennessee and then went to work at UT Medical Center. “When I came here right out of college as a young person, I never intended on staying,” Kerby said. “I thought, ‘I’ll come here and work for a few years and then move on,’ but I ended up staying, ended up loving the place, and it’s just been a great, great career.” Kerby’s decision to stay has also been a boon to her organization. For the majority of her career at UT Medical Center, she has worked in management. As a young nurse, she quickly transitioned into working as a charge nurse, then assistant nurse manager, and eventually became nurse manager. When she went back to graduate school for a Master’s of Science in Nursing (which she earned in 2004), she became interested in the American Nurses Credentialing Center’s Magnet Recognition Program, which was developed to motivate and show appreciation for healthcare organizations that achieve quality patient care, nursing excellence, and innovation in professional nursing practice. While researching the Magnet program for her graduate work, Kerby became convinced that it would be beneficial to her own workplace, all the while unknowing that the hospital’s leadership was interested in seeking Magnet recogni-

tion as well. “In 2006, I went to my first Magnet conference in Denver, and from that experience, I was more convinced than ever that it would be the right thing to do for our organization,” she recalled. In 2007, a position for Magnet coordinator was posted, and Kerby applied and was chosen for the job. “It’s been wonderful,” she said of the years since. UT Medical Center is one of only three hospitals in Tennessee to receive Magnet recognition, along with Johnson City Medical Center and Vanderbilt University Medical Center. Magnet recognition is not an award, but rather a performance-driven measurement of quality nursing and patient outcomes. The designation is good for four years, at which time it must be renewed. “You don’t just get it and rest,” Kerby explained. “You have to keep the momentum going.” Kerby submits annual reports each

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October in order to meet Magnet requirements, and continues to monitor current data and work to achieve constant improvement and innovation in all criteria. The recognition is a source of pride for the nurses of UT Medical Center, Kerby said. “It’s about the nurses! They take care of the patients. They are here 24 hours a day providing patient care, and it’s about recognizing them and wanting them to be proud of their work,” she said. The honor of Magnet recognition attracts employees who want to work at a Magnet-recognized organization, motivates nurses in their work, promotes a safe environment for nurses and patients, and ultimately results in high quality patient care. Kerby is currently involved in planning a nursing leadership retreat for Magnet re-designation kick-off, and anticipates that UT Medical Center will successfully renew its Magnet-recognized status in 2016. “So, we’re busy! We can’t stop,” she concluded. Kerby’s commitment to ensuring and improving quality in the place she lives isn’t limited to her work with the Magnet program. Recently, she was reappointed to the 2013 Board of Examiners for the Tennessee Center for Performance Excellence. TNCPE is modeled after the Baldrige Performance Excellence Program, which recognizes excellence in various organizations across the nation. “It’s a way for organizations to measure their progress and improve their performance. It’s a way to create alignment. There are all kinds of different organizations in TNCPE; it’s not just for healthcare,” Kerby explained. Examiners must reapply and be accepted each year, and undergo annual training prior to beginning each year’s review process. Kerby is currently in her second year volunteering as an examiner

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for TNCPE. The program serves to uplift and improve the entire community, Kerby said, recognizing various organizations in many fields. “My experience with Magnet has definitely influenced my work with TNCPE,” she said. “It’s just on a much broader scale. Both Magnet and TNCPE are about excellence for your organization. They’re both about making us better.” Feedback from the examiners, who conduct site visits, review applications independently, and participate in a consensus evaluation, allows a panel of judges to determine each applicant’s level of recognition. Kerby’s positive mindset of constantly moving forward and striving for improvement is evident even in the language she uses when discussing about the examination process; she speaks of identifying each applicant’s “strengths and opportunities,” never weaknesses or failings. Kerby’s enthusiasm for the Magnet Recognition Program, TNCPE, and especially UT Medical Center is palpable. “I’m just proud of who we are and the accomplishments that we’ve achieved. Knowing that healthcare is such a rapidly changing environment, we have to strive for efficiency to be successful. Being involved in these programs keeps us moving forward. We want to be a top organization, and we’re certainly striving to do that,” she said. Kerby’s work allows her to interact with “all kinds of different people,” which she enjoys, and her pride in her hometown and the people with whom she works is evident. She raised her three children in the Knoxville area, and avidly supports the UT football team. “I love the Knoxville area; I love the East Tennessee area,” she said. In her contributions to her workplace and community, Kerby’s love and dedication shows.

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Keeping Tennessee Roads Safe

Diabetes Alert Sticker Assists Diabetic Drivers, Law Enforcement Ofﬁcers By BRIDGET GARLAND

It happens all too often. A law enforcement officer pulls over a vehicle, suspicious that the driver is impaired, but rather than being under the influence of alcohol or drugs, the driver is having a glycemic event. It’s no surprise that police officers would make such a mistake because all of the signs and symptoms of a hyper- or hypo- event mimic those of substance impairment. Recognizing a need to help law enforcement officers identify diabetic drivers, Wellmont Health System, in collaboration with Mountain States Health Alliance, began an initiative in November 2009 to provide Diabetes Alert window stickers to persons on the road or in an accident that may be having a diabetic emergency. “Anyone who has diabetes, and especially Type 1, is subject to a hyper- or hypo- event, … and law enforcement is seeing this almost daily,” shared Jim Perkins, System Director of the Wellmont Diabetes Centers. “It happens all the time, and people get put in jail and then sue the police de- Jim Perkins

partment. The thought that law enforcement should have a heads up, that it might be something else, created this program. “One of things that law enforcement wanted, though, was to make sure that everyone who has a sticker truly has diabetes,” he said. This assurance is provided to officers through a prescription sheet that must accompany the sticker. Only patients who are given an order from their physician or a diabetes representative can receive the sticker. Another request from law enforcement which the program has implemented is the distribution of pocket cards to officers so that they can identify the signs and symptoms of a diabetic event. “Every patrol officer in the state has access to them,” said Perkins. “Initially, we listed the signs and symptoms and went to the Kingsport Police Department to ask which ones mimicked impaired driving. ‘Each and every one of them’ was the response we got.” The cards not only help the officers identify the signs and symptoms of a glycemic event, but also list treatment options for the officer to follow until EMS arrives. “In most cases, EMS will come right away, but we do offer a 2-hour, POSTaccredited program for training of law enforcement on diabetes,” Perkins ex-

Ca y l o r S c h o o l o f Nu r s i n g

Hypoglycemia (Low Blood Sugar) less than 70 mg/dL on meter. Officer Observed Signs/Symptoms Include: Shaky, Blurry Vision, Nervous or Upset, Fast Heartbeat, Sweaty, Dizzy or Confused, Anxious, Hungry, Headache, Weak or Tired (Sleepy) If possible, have person to do blood sugar check. Treatment (Choose One): • 3 to 4 glucose tablets • 3 to 5 hard candies (chewed quickly) • 4 ounces of fruit juice • ½ can (6 ounces) regular soda pop • 7 Life Savers (chewed quickly) Wait 15 minutes and recheck blood sugar, if still below 70 mg/dL treat again.

plained. “Diabetes is so prevalent, though, that some places already teach diabetes awareness.” Since implementing the program in the Tri Cities, interest and participation in the program has grown statewide, presently totaling 27 hospitals across the state.

Hyperglycemic Event (Diabetic Ketoacidosis – DKA) can occur with blood glucose levels as low as 250 mg/dL. Officer Observed Signs/Symptoms Include: Strong Fruity Breath Odor (similar to alcoholic breath); Confusion; Rapid, Deep Breathing; Drowsiness; Flushed, Hot, Dry Skin; Difficulty Waking Up; Blurry Vision; Vomiting; Abdominal Pain If possible, have person do a blood sugar check. Treatment: CALL EMS

“As part of the State Diabetes Advisory Counsel, I meet every quarter with them and I report what we are doing here in the Tri Cities,” Perkins said. “When I brought up the sticker program, it was liked so much that it was implemented into the state plan. We received grant money to take it across the state.” The statewide distributed stickers look almost identical, except for the participating hospital’s logo, allowing the (CONTINUED ON PAGE 6)

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Early Warning System: Researchers Identify Diabetes Risk, continued from page 1 which is now following its third generation of participants, the Wang research team studied blood samples gathered more than a decade ago from 188 individuals who ultimately developed type 2 diabetes and 188 who did not develop diabetes. Using these blood samples, the investigators were able to compare levels of metabolites to see if there were any differ-

ences between the group that went on to develop diabetes and the group who did not. Wang noted newer technology now makes it possible to profile hundreds of metabolites at one time. “One of the things that really lit up when we looked at the people who developed diabetes was 2-aminoadipic acid,” he said. “Having elevated levels of 2-AAA

Keeping Tennessee, continued from page 5 organization to promote their individual program. Any patient with diabetes can participate by calling the Diabetes Center for that particular health system or hospital. In West Tennessee, participating organizations include McKenzie Medical Center, Bruceton Clinic, Dresden Specialty Clinic, Jackson Madison County General Hospital, LeBonheur Children’s Hospital, Methodist Healthcare – University Hospital, and Methodist LeBonheur Healthcare – Germantown Hospital; In Middle Tennessee, Baptist Diabetes Center, Macon County General Hospital, MTMC Diabetes Center, Gateway Medical Center, and Stones River Hospital; In East Tennessee, Wellness Place at Methodist Medical Center (MMC), Fort Sanders Diabetes Center (FSDC), Erlanger Health System, and Chattanooga Lifestyle Center; In Northeast Tennessee, Holston Valley Medical Center-Diabetes Treatment Center, Bristol Regional Medical Center-Diabetes Treatment Center, Wellmont Urgent

Care, Hawkins County Memorial Hospital, Takoma Regional Hospital, and Mountain States Health Alliance: Health Resource Center in the Mall at Johnson City. For providers wanting to find out more about the program, they can visit the website mydiabetesalert.com or locally, call in Kingsport (423) 224-3575 or in Bristol (423) 8442950. Perkins emphasized the benefits of the program. “Physicians realize this is a real problem, but the people who really understand how much the program is helping are the law enforcement people out on the street. These events happen all the time,” said Perkins. “I talked to one officer who had recently pulled over six people with the sticker, and they all were having glycemic problems. The police department sees it every day….And it doesn’t stop in the home or in the workplace. Every sticker we distribute identifies another driver driving with diabetes who may need help one day.”

predicted risk above and beyond their blood sugar at baseline, their body weight, or other characteristics that put them at risk.” Wang added there doesn’t appear to be a specific threshold of risk at this point … the higher the levels of 2-AAA, the higher the risk of developing diabetes. In fact, those in the top quartile of 2-AAA concentrations had up to a fourfold risk of developing diabetes during the 12-year follow-up period compared to those in the lowest quartile. Interestingly, the researchers found 2-AAA might not be just a passive marker. As part of the same study, the team conducted mouse model testing and discovered giving 2-AAA to the mice actually altered the way the animals metabolized glucose. “It suggests the molecules might be playing a direct role in how the body processes glucose rather than being an innocent bystander in the process,” Wang said. He added that elevated levels of 2-AAA don’t necessarily mean the molecule is bad for the body. Instead, it could be a defense mechanism where the body is producing higher levels to fight risk from another, as yet unknown, source. Figuring out the metabolite’s exact role in the functioning of pancreatic cells is one area for future research. If, indeed, 2-AAA turns out to be a defense mechanism to stave off diabetes, the good news is that the metabolite could be given to humans in the form of nutritional supplements. On the other hand, if 2-AAA turns out to be harmful to the body’s glucose regulation system, further research could reveal methods to lower the metabolite’s presence. Wang was quick to say the next step

is to conduct additional research to measure 2-AAA in other human populations outside of the Framingham study through both retrospective and prospective studies. More in depth animal model studies are also in the pipeline. “A lot of the effort will be focused on trying to understand the biologic effect of 2-AAA in developing diabetes,” he said of the work going forward. However, Wang said the current research results at least raise the possibility that somewhere in the future knowing how high a person’s circulating 2-AAA levels are could impact clinical practice by allowing providers to adopt a more aggressive intervention posture among those at highest risk, whether that be through exercise, weight loss or pharmacologic measures. It is conceivable that 2-AAA might be the type of red flag for diabetes that high cholesterol is for heart disease. “Understanding why diabetes occurs and how it might be prevented is a very intense area of investigation because of the serious consequences of having the disease,” Wang said. “Down the road, this might be one part of the armamentarium of tests that could be considered. If this were proven useful in further studies and could be used clinically, it would be an easy test to administer.” As for the impact of the findings right now, Wang added, “In 2013, it highlights a specific pathway that might be related to diabetes risk that we previously didn’t know about.” Considering the prevalence of type 2 diabetes and growing obesity epidemic in the United States, that is an important lead for researchers working to develop strategies to interrupt the disease progression and stop risk from becoming a reality.

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LegalMatters BY JASON H. LONG

WHAT? ME WORRY? Physician Reporting Obligations Under the Tennessee Healthcare Consumer Right-To Know Act Recently, the Tennessee Board of Medical Licensure and other healthcare related boards around the state have been cracking down on failure of physicians or other providers to report payments made as a result of malpractice actions. Many physicians have been caught by surprise regarding their duties, in particular under the Tennessee Healthcare Consumer Right-to-Know Act, with respect to their reporting obligations. Often, a physician assumes that once a malpractice matter is resolved, either through litigation or settlement, his or her duties are over and it is time to move on. However, that is not always the case. Following are important questions to which every Tennessee provider should know the answer. Q. Who is required to maintain a profile with the Department of Health pursuant to the Tennessee Healthcare Consumer Right-to-Know Act? A. The list is long and specific, but comprehensive. According to the Tennessee Healthcare Consumer Right-to-Know Act, the following individuals must establish a profile with the Department of Health: Physicians, osteopathic physicians, chiropractors, dentists, podiatrists, optometrists, dietitians, nutritionists, physician assistants, respiratory care practitioners, pharmacists, audiologists, speech pathology therapists, certified nurse practitioners, registered nurse anesthetists, social workers, psychologists, professional counselors, marital and family therapists, clinical pastoral therapists, massage therapists, medical laboratory personnel, alcohol and drug abuse counselors, occupational therapists, physical therapists, dispensing opticians, electrologists, veterinarians, and nursing home administrators.

A. Yes. The statute requires that providers update their profile with the Department of Health within 30 days of any information changing event. For example, a change of practice or address would warrant an update. That notification should be in writing to the Department of Health. Q. If I am involved in litigation and there is a settlement, isn’t it enough that I am reported to the National Practitioner Data Bank? A. No. The reporting requirements of the National Practitioner Data Bank (NPDB) and the Tennessee Department of Health pursuant to the Tennessee Healthcare Consumer Right-to-Know Act fall under separate and distinct statutory schemes and require independent reporting. The NPDB is a confidential clearinghouse created by Congress with the goal of improving healthcare quality and reducing fraud and abuse. Access to the database is generally limited to hospitals, other healthcare entities and professional societies with formal peer review, state medical and dental boards and healthcare practitioners performing a self-query. Typically, where a settlement or

judgment in a medical malpractice action against a provider has occurred, the provider’s insurance carrier will report the matter to the NPDB. The Tennessee Healthcare Consumer Right-to-Know Act is a state statutory scheme. It requires reporting of all court judgments or arbitration awards where a payment is made to a complaining party. In addition, any settlements of healthcare liability claims in which a payment is made to a complaining party must be reported as well. There are statutory thresholds which define a reportable event. Providers are only required to report where the judgment, arbitration award, or settlement is in excess of: $75,000 for physicians, $50,000 for chiropractors, $25,000 for dentists, and $10,000 for all others. Q. Isn’t it my attorney or insurer’s responsibility to make sure that a report is made? A. No. The statute makes clear that it is the provider’s responsibility to update their profile with the Department and is silent as to whether anyone can make that report on their behalf. Hopefully, a provider’s attorney will counsel them regarding the need to update the provider’s

profile at the conclusion of the case and assist in that regard. However, the responsibility lies upon the physician’s shoulder to assure that has occurred. Q. How long do I have to make a report? A. Updates must be made within thirty (30) days of a reportable event (settlement or judgment). Q. What are the penalties for failure to report? A. Failure to report can result in a Board complaint and disciplinary action. It is essential, at the conclusion of any malpractice litigation, whether by judgment, arbitration, settlement, or otherwise, that a provider assess whether he or she is obligated to report any action to the Tennessee Department of Health. Failure to do so may result in a new and frustrating set of obstacles for the provider down the road. Jason H. Long is an attorney practicing at London & Amburn, P.C. The focus of Mr. Long’s practice is medical malpractice defense, long-term care, general civil litigation, healthcare regulatory compliance, and appellate practice. He chairs the ﬁrm’s Civil Trial Practice. For more information, you may contact Mr. Long by visiting www.londonamburn.com.

Q. Once I have a profile established, do I ever need to revisit it?

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ClinicallySpeaking BY MARK A. COLQUITT, MD, FACS, FASMBS

Something to celebrate: Bariatric surgery leads to healthier lives In December, my partner, Dr. Jonathan Ray, and I have the opportunity to take part in something special – the Foothills Weight Loss Specialists and Blount Memorial Weight Management Center fashion show featuring bariatric surgery patients. The annual event provides an opportunity for participants to show off a bit – walk the catwalk and talk about what a difference their weight loss has made in their health and lifestyles. This year’s celebration will mark the 11th annual fashion show. How has the event reached the 10-year mark and beyond? The secret to its success is simple, really. First, it is remarkable to see the models’ change in appearance and to consider the amount of weight lost. Seeing patients with their former “fat” clothes or viewing before and after photos is always stunning. The 26 patients who participated in the 2012

Foothills Weight Loss Specialists surgeon Dr. Mark Colquitt, right, praised the success of patient/models during the 10th Annual Bariatric Fashion Show in December 2012. With him is Blount Memorial Weight Management Center’s bariatric coordinator Dana Bradley, who is also a patient who lost 100 pounds within 10 months of her laparoscopic sleeve gastrectomy.

fashion show represented a combined weight loss of 2,600 pounds. To put it in perspective, Ferrari is pioneering its next hybrid supercar, expected to come in at just under 2,500 pounds. Second, the patient testimonials are compelling. The positive energy

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and gratitude are palpable in the air as participants share stories of newfound confidence, improved health, and the ability to wear fashionable clothes. Often emotional and uplifting, testimonials also do a good job of conveying the significant benefits of having surgery. Below are a few examples from past events: Carson Lynn lost 250 pounds in 18 months following his gastric bypass and said the surgery saved his life. “I was on oxygen, had high blood pressure, and my heart was out of rhythm. If I hadn’t had the surgery, I’d probably be in the ground tonight.” “I didn’t realize how tired I was,” said patient Tami Hargis. “Now I’m ready to go every day!” Hargis lost 114 pounds following her gastric band procedure. “I was taking three shots of insulin a day. Now I’m taking none,” said patient Larry Webb, who lost 125 pounds following surgery. James Lawson lost 215 pounds in 15 months following his surgery. “I went from taking 17 pills a day to nothing. My diabetes is gone. This is the best thing you can ever do, and it can save your life,” said Lawson. Diana Parton lost 66 pounds from August through December. “I came back from the hospital and got off my diabetes medicine, which I had to take twice a day. I took a handful of pills every morning, and now I only take three.” While the fashion show is a “feel good” event that provides an excellent congratulatory platform for patients who have lost tremendous amounts of weight, Dr. Ray and I hope that it can also be an impetus for change. Each year, among the crowd of patients, friends and family members are individuals trying to decide if bariatric surgery is right for them. The fashion show affords these individuals the opportunity to hear real stories from real people and see what is possible if they are willing to commit to change. And, while far too many people still consider bariatric surgery a purely cosmetic procedure, its health

Comorbidity Of 26 bariatric surgery patients, number to reach resolution of chronic health condition Sleep apnea

Depression

Anxiety

Joint Pain

Hypertension

GERD (Gastroesophageal reﬂux disease)

Diabetes

High Cholesterol

Polysistic Ovarian Syndrome

Congestive Heart Failure

benefits are far too significant to ignore. Consider the statistics for the 26 models from 2012 (see chart). The link between bariatric surgery and resolution of diabetes is further confirmed by STAMPEDE, a study published in the March 26, 2012, issue of the New England Journal of Medicine. The study concluded that bariatric surgery resulted in better glucose control than medical therapy in severely obese patients with Type 2 diabetes. The results of the study were significant. At two years, diabetes remission had occurred in no patients in the medical therapy group versus 75 percent in the gastricbypass group and 95 percent in the biliopancreatic diversion group. The results also showed that remission was independent of weight loss, suggesting that the positive outcomes are a result of metabolic changes achieved through surgery. Do you have morbidly obese patients who have repeatedly failed at all efforts to lose weight? If they seem truly ready for and committed to change, I encourage you to consider recommending bariatric surgery. I’d love to see them on the catwalk in a year or two. Mark A. Colquitt, MD, FACS, FASMBS, is Director of Metabolic and Bariatric Surgery at Blount Memorial Hospital in Maryville, Tenn., and is a bariatric surgeon with Foothills Weight Loss Specialists, a division of Premier Surgical Associates. Colquitt is board certiﬁed by the American Board of Surgery. He is a fellow of the American College of Surgeons and of the American Society of Metabolic and Bariatric Surgery and is a member of the Society of American Gastrointestinal and Endoscopic Surgeons. For more information, visit http://www.foothillsweightloss.com.

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Tennessee Hospital Association Reinventing Tomorrow’s Healthcare Every Day for 75 Years By CINDY SANDERS

Established in 1938, the Tennessee Hospital Association has adopted the tagline “reinventing tomorrow’s healthcare every day for 75 years” as an ongoing theme for 2013. Over the years, the staff of the THA might have had many days … often stretching into many months … to help members prepare for and implement change. However, in the face of industrywide transformation, being nimble enough to reinvent the hospital’s role in healthcare delivery on a daily … if not hourly … basis has become the norm. Helping its membership navigate the challenges that come with sweeping reform was central to the programming at the THA Annual Meeting, held Oct. 31-Nov. 1 at Gaylord Opryland Resort and Convention Center. “I’ve always said healthcare moves glacially, but we’re getting up to lightening speed now,” THA President Craig Becker said with a rueful laugh. “It has been a tough road to hoe right now for our members.” Yet, Becker continued, he ultimately views the transformation process as ‘constructive deconstruction.’ Going into 2014, he continued, “Our number one issue is the Affordable Care Act and trying to get people enrolled …

not only the ones that are eligible through the federal exchange but to try to convince the governor and Legislature to expand TennCare to include the poorest of the poor.” Becker added there Craig Becker are approximately 500,000 Tennesseans who should be eligible for enrollment through the federal exchange. However, there are another 400,000 currently left out of coverage opportunities unless Gov. Haslam and the Centers for Medicare and Medicaid Services can come to an agreement about expanding TennCare rolls, and the Tennessee Legislature approves the plan. “We’re having a hard time getting the Legislature to separate this from Obamacare,” Becker said. However, he noted negotiations with CMS are ongoing, which he said was an encouraging sign. “We’ve got $5.4 billion worth of cuts over 10 years under the Affordable Care Act,” Becker pointed out. Those cuts were more palatable when hospitals thought Medicaid rolls would be expanded. When the individual mandate was upheld but not the Medicaid expansion, anticipated coverage for large chunks of the population evaporated.

“I’m really concerned about my rural hospitals. They don’t have the reserves some of the bigger hospitals do,” Becker said. However, he added no facility is immune to the looming financial stressors. Addressing the key point of coverage for the 400,000 left out, Becker stated, “If we don’t get it, some of our hospitals cannot make it. I guarantee that.” Three hospitals have recently shut down operations in Tennessee. While two in West Tennessee probably had more to do with the number of facilities in comparison to the population, one in East Tennessee simply couldn’t make it in healthcare’s new financial reality. Scott County residents now have to go elsewhere for care. “The hospital was struggling. When the (ACA) cuts came, it was the death nail for them,” Becker said. The Tennessee Hospital Association is also focused on the Tennessee Payment Reform Initiative, which is initially slated to be rolled out for the TennCare and state employee populations. Tennessee has received a CMS grant to transform the state’s healthcare payment system. While details are still being ironed out, the governor’s vision is to incentivize ‘quarterbacks’ (typically physicians) to provide the highest quality, least costly care. As part of that plan, the quarterbacks would receive

a bonus for sending patients to facilities with the best quality and lowest prices. However, Becker said there are concerns arising from geographic location and from skewed price comparisons. He pointed out large academic medical centers with high-cost service lines including trauma centers and burn units and other unusual expenses such as graduate medical education cannot fairly be compared to community hospitals without those same factors. In areas with only one nearby hospital, referring patients to a facility farther away that has a better cost structure might not be feasible … or desirable … depending on the urgency of the situation. Becker noted, “Seventy-five percent of physicians admit to one hospital only so I’m not sure it makes a lot of sense. I’m not sure that this will change physician admitting patterns.” However, he continued, the general consensus is that the plan will move forward so THA staff is preparing for implementation while addressing their issues with government and provider stakeholders in an effort to design a workable plan. Despite any reservations about the plan’s mechanics, Becker applauded the general concept of shared information. “I think the more transparent and the more (CONTINUED ON PAGE 14)

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JANUARY 2013

Enjoying East Tennessee Biltmore Estate - Deck the Halls! By LEIGH ANNE W. HOOVER

Just over the mountains in Asheville, North Carolina, visitors to Biltmore Estate can truly step back in time, and there is no better time to visit than during the holidays. The experience is outstanding any time of the year, but dressed up for the holidays, Biltmore is simply spectacular. My late mother, Corrie M. Whitlock’s, life’s work was beautification. As a past president of the Garden Club of South Carolina, South Atlantic Regional Director for the National Garden Club, landscape critic, master flower show judge, master gardener, and the list goes on and on, my mother would have loved being able to interview Cathy Barnhardt, floral displays manager and holiday décor expert for the Biltmore Estate. She would have enjoyed Barnhardt and been truly fascinated with her gift. Beautification was Mama’s gift, and everything she touched through her service in South Carolina and elsewhere was simply magnificent. In fact, once in an interview prior to Mama’s passing, I remember explaining this to a journalist. “If there’s a garden club in heaven, she will be in it. If not, she will organize one and make us all join!” Barnhardt shares this same gift, and her talents have been featured on Today, CBS This Morning, HGTV, and in many national magazines. With a Bachelor of Science degree in ornamental horticulture and landscape design and a minor in art history from the University of Tennessee, the woman is amazing! “My degree from UT is horticulture and landscape design, so when I came to Biltmore, I was hired to work in the greenhouse,” explained Barnhardt. After a year of managing the greenhouse, Barnhardt was faced with a challenge. She was asked whether she wanted

‘‘

We have to make sure that patient care is foremost.

to stay in the greenhouse or move full time to the estate house, arranging flowers and “doing Christmas.” According to Barnhardt, prior to her arrival and agreeing to take on the monumental assignment, Christmas at Biltmore had been done on a much smaller scale. For over 36 years, Barnhardt’s talents have been on display at the grandest show house in the world. During Christmas, her expertise truly takes center stage. “When I was at UT, I also loved history, and I loved art,” continued Barnhardt. “I think that when you combine a love of flowers, design, history, and art, Biltmore’s my perfect job, and that’s why I have been here for 36 years.” Growing up just beyond Biltmore’s gates in Kenilworth, Barnhardt always knew that she wanted to come back to the mountains of western North Carolina to work at Biltmore, one of the reasons she feels this is her “perfect job.” Although she decorates her own home, Barnhardt attests the Cape Cod style home is nothing like decorating the estate. How-

Physician Spotlight: Robert M. Overholt, MD, continued from page 3 I liked crowds, I liked people, and I was camera friendly. So within a week, they asked me if I wanted to go on Live at 5 on Thursday afternoons.” Eventually, Overholt was plugged into a 30-minute program, what is now “The Dr. Bob Show” produced by PBS. The show broadcasts 26 shows a year, the purpose of which is to educate the public about health, wellness, and fitness. “I think the reason the show has been so popular is that we speak on a level that people can understand rather than pretend we are smart doctors and use big doctor words,” Overholt said. “If you are my guest, and you say something medical, I always ask what particular words mean. I want to make sure that people understand. For instance, if you say, ‘a catheter is inserted 10

NOVEMBER 2013

into the coronary artery,’ what does that mean?” Overholt says he picks topics that people want to know about and talks very little on allergy. “I have about two shows a year on allergy, the rest are anything from OB/GYN, to cardiology, to orthopedics, to general surgery, to neurology and Alzheimer’s, all sorts of topics,” he explained. Overholt recalled that the nicest comment he has received about the show came from Lynn Massingale, Executive Chairman of TeamHealth. “He said, ‘You portray to the public the image that we as physicians want to portray to the public— as kind, happy, positive people who are here to help,’” Overholt repeated. “I will always cherish that compliment.”

’’

ever, she does incorporate a theme in her home, too. Years ago, Barnhardt’s daughter separated their personal ornaments by color, and this has helped her alternate colors like her team does at Biltmore. In fact, sorting by theme and color is a tip Barnhardt always gives others for their homes. Christmas begins early at Biltmore, and the annual “umbrella” themes are decided years in advance. Teams, including marketing, events, museum services, and horticulture, gather to map out themes for upcoming years. Barnhardt says they consider events both past and current to decide on the overall, umbrella theme. Dressed in its holiday best, the estate, known as “America’s largest home,” officially ushers in the season on November 2, 2013. For a 250 room chateau, it is only befitting that the holiday décor remains through January 12, 2014, and this year’s theme is “The Nature of Christmas.” According to history, George Vanderbilt actually opened Biltmore House to family and friends for the very first time on Christmas Eve in 1895. Over the years, it has remained a truly festive and special time of celebration for the estate. This year, the large banquet hall, which exhibits the infamous 35-foot tall decorated Fraser fir from Newland, North Carolina, will be in a whimsical fashion celebrating children and the festive spirit of Christmas. “We want the Christmas tree to be fresh throughout the season. We want the guests that come in December to enjoy it just as much as those who come during the first week of November,” explained Barnhardt. In order to ensure this, two signature trees are used in the banquet hall. The “great switch” of the 35-foot tree occurs on December 11th this year. Barnhardt explained the switch begins at 4:00 in the morning with laundry bins on wheels for storing 500 ornaments, 500 lights, and 500 gift boxes for redecorating. “500 is our number,” said

Barnhardt.”And, the reason is in some old, old periodicals, there is reference to 500 gifts, and that just seemed like a good number for the banquet hall. We have descriptions of that 35-foot tree, electric lights, ornaments that were hung on the tree, evergreen garlands, holly berries, and shining green leaves that tell us a little about what the decorations might have looked like here, but a lot of it is also our interpretation. We are inspired by what was here.” With essentially every employee, and some on reserve, the holiday transition occurs. The tree is dismantled with a chainsaw in sections onto tarps, which are draped across the banquet room floor. According to modern-day tradition, the engineers even hide a used light bulb ornament somewhere on the tree. “Guests love seeing the process,” said Barnhardt. “Each year, we pick out two trees. The first tree usually is a little slimmer. The second tree is a little bigger, and the reason is we can change that first tree out quickly and put that bigger tree in throughout Christmas.” According to Barnhardt, these trees are grown specifically for the estate at a tree farm in Avery County. After they are removed, they are ground into mulch, which is later used in the gardens. The first tree raising day has become an annual tradition for many. Beginning in November, visitors to Biltmore can come early in the season to obtain all kinds of ideas that can be used in their own homes. “We love to get feedback from guests when they ask, ‘How did you do that? I want to do that at my house,’” said Barnhardt. “It will be fun to see what the main interest is this year because last year, it was two little topiary trees that were on the breakfast room table made out of kumquats and oranges.” Barnhardt notes that even though themes are changed, to always add a little something different and to keep everyone inspired, her decorators are “masters at repurposing” and reusing items. Once they are too worn, items are denoted to Habitat for Humanity for their retail shop. “We have a lot of freedom in deciding decorations based on the historical framework,” said Barnhardt. “And, I think we’ve been able to do that successfully through the years.” For additional information about holiday happenings, visit www.biltmore.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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InSights New Technologies are Improving, Keeping Eye Care Local By BRAD LIFFORD Dr. Jeffrey O. Carlsen has demonstrated that he doesn’t mind traveling thousands of miles to bring the best in eye care to patients in other parts of the world. Carlsen went far afield earlier this year to deliver eye care – he saw patients on a medical mission trip to a small town in Guatemala – but he doesn’t want his patients to have to travel far to receive care. When he can bring very specialized eye care to children close to home, it gives him a particular sense of fulfillment. In the case of those who have pediatric cataracts, although there is only a small population locally, it is one that Carlsen and his colleagues do feel a sense of commitment to, nonetheless. “Everyone will develop cataracts as we grow older, as part of the normal aging process,” Carlsen said, “but pediatric cataracts are congenital; they are hereditary. You’re not talking a large number of cases here – it might be a dozen a year. But they still need our help, and it’s a service we feel like we should provide to the community.” Fortunately, with the recent purchase of a highly specialized surgical device at Niswonger Children’s Hospital, Carlsen and the pediatric care team at Johnson City Eye Clinic are able to offer pediatric cataract surgeries locally; he had his first cases in September. “We really needed this,” Carlsen said, “because kids who did need this procedure were required to travel to Nashville or Knoxville. “Traveling for eye care takes a toll on the children and their families because for kids who have cataract surgery, it’s a lifelong commitment to regular eye care and a particularly big commitment during that first year or so. That first year could mean six to ten trips to Nashville for check-ups. That’s a lot on a child and the child’s family.” The physicians of Johnson City Eye offer a wide scope of services in their clinic in Med Tech Park, as well as a surgery center that is a component of delivering comprehensive care that includes the treatment of glaucoma, macular degeneration, pediatric ophthalmology, retinal disease, and cosmetic and reconstructive surgeries. In the coming weeks, patients will also see availability of a new facet at the Johnson City Eye Surgery Center: femtosecond laser surgery for cataracts. Carlsen said installation of this new, cutting-edge device could happen around the beginning of 2014. Unlike traditional cataract procedures performed with a surgical blade, a femtosecond laser uses tightly focused laser energy to allow for incredibly precise incisions. “It’s exciting, and I think we will be the first in the region

to offer femtosecond cataract surgery,” Carlsen said. “It’ll be appropriate for many patients, especially those with astigmatism.” The surgery center in Med Tech Park enables patients to undergo same-day procedures in a facility that has earned the status as an Accreditation Association for Ambulatory Health Care, Inc., a distinction that is awarded only after a center has shown it meets the highest standards of quality care. In addition to practicing pediatric and general ophthalmology, Carlsen’s clinical interests include cosmetic and reconstructive plastic surgery, as well as strabismus surgery. He completed fellowships in pediatric ophthalmology and strabismus, as well as an ophthalmic plastic and facial surgery fellowship. Carlsen is one of eight physicians who serve a wide spectrum of the ophthalmic needs not only of Tennesseans but also of patients in Virginia, North Carolina, and Kentucky, with a heritage of excellence that spans more than 70 years. In addition to Carlsen, the medical staff currently includes Drs. John C. Johnson Jr., Michael F. Shahbazi, Amy B. Young, Alan N. McCartt, James W. Battle, Randal J. Rabon, Calvin L. Miller, and Peter Lemkin, a doctor of optometry. Dr. Carlsen is also very pleased to announce that Bristol native, Dr. Jennifer L. Oakley, a glaucoma specialist, will be joining the practice next month. More than 100 healthcare professionals make up the team at Johnson City Eye Clinic. Another feature of the practice, located adjacent to the clinic, is Cosmetic Laser Skin Care, an extension of the physicians’ interest in plastic surgery for upper and lower eyelids and full face laser resurfacing, plastic, cosmetic, and reconstructive surgeries. In addition to the cosmetic surgeries and services available there – which includes Botox Cosmetic, Juvederm, and Restalyn, the skin care clinic offers a large variety of day spa services.

Johnson City Eye Clinic & Johnson City Eye Surgery Center 110 Med Tech Park • Johnson City, TN 37604 225 Medical Park Drive, Bristol Phone: (423) 929-2111 • Fax: (423) 929-0497 Email: info@JohnsonCityEye.com

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Winter Wonderland featuring City Youth Ballet of Johnson City Saturday, December 14, 7:30 p.m.

Johnson City Symphony Orchestra

Mary B. Martin Auditorium at Seeger Chapel, Milligan College sponsored by Ferguson Enterprises and Roadrunner Markets

The City Youth Ballet is a chartered, not-for-profit performance organization offering an extensive repertoire of classical and contemporary ballet performances for the general public and school groups throughout the year. The CYB provides high quality performances of classical ballets and contemporary and lesser known ballets. Original, commissioned works are also part of the CYB’s repertoire. Under the direction of Susan Pace-White, the City Youth Ballet will join the Johnson City Symphony Orchestra in performance of excerpts from Pytor Illych Tchaikovsky’s “Nutcracker Suite.” The program will also include holiday-related music from Gabriel Pierne, Wolfgang Amadeus Mozart, Anatol Liadov, Irving Berlin, Georges Bizet, Frederick Delius, and Leroy Anderson.

Tickets: $35; Seniors (65+) $30; Students $10 For more information: 92-MUSIC (926-8742) or visit www.jcsymphony.com Free bus service: 6:15 (Colonial Hill); 6:30 (Maplecrest & Appalachian Christian Village); 6:45 (City Hall) This concert is funded under an agreement with the Tennessee Arts Commission and the National Endowment for the Arts.

NOVEMBER 2013

ket basket update, but for the last couple of years, it’s been less than 2 percent,” he said. Williams noted the government puts in the full market basket update but then begins reducing the rate by looking at adjustments tied to value-based purchasing, readmission rates and acquired conditions, in addition to other factors. “Normally you’re seeing very minimal increases. It’s caused a flattening of revenue per patient,” he said. Then, Williams continued, after payment increases are netted out, “Medicare is subject to a 2 percent reduction to fulfill the sequestration order.” He added that Medicaid, which typically covers anywhere from 5-15 percent of patients … or higher depending on location and a hospital’s safety net status, is not currently subjected to sequestration. Yet, he said, hospitals are faced with mounting concerns about Medicaid expansion, uncompensated care, and cuts to disproportionate share hospital payments. For hospitals in states that didn’t opt to expand Medicaid rolls, administrators are worried about rising levels of uncompensated care for those that fall into the gap in the Affordable Care Act between traditional Medicaid eligibility and qualifying for federal subsidies on the healthcare exchange. Even for providers who are in states that did expand Medicaid, Williams said uncertainty still exists about how reimbursement will actually net out. Traditionally, Medicaid has reimbursed providers at a set match rate for direct patient services and a 50 percent rate for the administrative portion of the episode of care. Although the ACA Medicaid expansion plan covers 100 percent of patient services for three years and then rolls down incrementally to 90 percent over subsequent years, the administrative match remains at 50 percent so the state does incur additional cost by expanding rolls. Additionally, Williams said certain provisions of the ACA require mandatory changes for states regardless of expansion, including: welcome mat population or those who were eligible for Medicaid but had not enrolled previously, foster children expansion to age 26, expanded eligibility for children, primary care physician fee increase, and health insurer fee. In Mississippi, a nonexpansion state, the estimated amount of the mandatory changes is between a $272 - $436 million increase in spending. With this amount of growth, the state is not expected to increase the reimbursement rate for a full episode of care. Medicare DSH payments also are causing administrators to lose sleep at night. Initially, the ACA plan called for a 75 percent reduction in Medicare DSH payments. However, Williams said part of the final regulation that went into effect Oct. 1 of this year moderated that number a bit by moving to an empirical DSH payment for uncompensated costs … a complex, calculated cut that softens the blow some by looking at a hospital’s relative share of Medicaid inpatient utilization as a proxy for uncompensated patients. Williams said that for one hospital in the Mississippi Delta, the original Medicare DSH reduction would have meant a loss of $5.6 million. “But,” he continued, “because of the additional payment to fund the uncompensated cost, it was actually a

reduction of $2 million.” While that is still a significant loss, “It could have been worse,” Williams noted. Still, he continued, “You’re faced with the fact your revenue isn’t growing as fast as your expenses. It’s very concerning to most every healthcare organization around.”

Glass Half Full

So if revenue isn’t going up, the logical place to increase margins is to decrease costs. Yet, healthcare providers want to make sure they provide the best care possible without sacrificing a patient’s well being simply to save a few dollars. “A lot of people equate higher quality with higher cost, but that’s not necessarily true,” Williams pointed out. In fact, he said, doing the right thing in the right way is often significantly more cost efficient. “A major cost in providing care to patients is variation in the clinical process of care,” Williams said. He added it is easy to find real world examples of this type of variation where one hospital’s cost for an average hip replacement is $45,000, yet another one might have an average cost of $22,000. “What’s the disconnect?” he asked of the two cost scenarios. “A lack of standardization of using evidence-based protocols,” he answered. By using data available through electronic health records coupled with a partnership with technology company Health Catalyst, Williams said HORNE is able to mine the available information to look at clinical pathways and search out deviation from standard protocols that adds to the cost of care. He was quick to add that the technology doesn’t seek to stop physicians from exercising their medical judgment but does highlight where there are outliers when it comes to following clinical protocols. “Best practices and evidence-based medicine say that these are the best protocols out there,” he pointed out. Following those protocols not only saves money, but also should optimize quality. With increased transparency, payers and patients will have access to information regarding those positive outcomes and lower costs, which could ultimately drive volume.

A Foot in Both Boats

Administrators and chief financial officers are caught between the fee-for-service and value-based payment worlds right now. Williams said they are trying to keep their heads above water in the current payment system … and now reimbursement experts want them to shift their focus to population management. Although making the move is understandably frustrating, Williams believes it is also the best option to ultimately improve the bottom line. “There has to be a change in culture from what it’s been in the past,” he noted. “We tell them, ‘Let’s prepare for it by being the most efficient, effective deliverer of care and eliminating patient waste.’ That puts you in a competitive advantage over those providers that have a higher cost structure.” It is a different mindset, Williams continued, to stop attacking reimbursement from the top and instead improve revenue by cutting costs. “If you deliver high quality at a lower cost, then your margins are going to be greater. We see opportunities,” he concluded. easttnmedicalnews

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Putting Content to Work for your Healthcare Business By Heather Ripley

What strategies and tactics does your healthcare business use to promote its products or services to other businesses? The usual, right? A mix of print advertising, email marketing, social media posts and promotions, online ads and payper-click, press release distribution, website promotion, white papers and reports and, well, you get the picture. Or maybe you want to, but you don’t have the time or staff to manage all the above. All of those marketing tactics depend on content. And, all that “content” takes time and effort to research, write, and produce. The fact is, creating and distributing your content is probably taking a lot more time than you thought it would. When you hear the term “content marketing,” it not only means getting the content you write to the correct targets in a consistent manner, it means writing it correctly, too. In my industry, healthcare public relations and marketing, content is not only “king,” it’s everything. And according to the recent B2B Content Marketing Report authored by Holger Schulze, manager of the B2B Technology Marketing Community on LinkedIn, more than 82 percent of the business respondents plan to increase

their content production next year. This means the trend toward businesses becoming, in essence, their own publishers is not far off the mark. One of the challenges for healthcare businesses in the coming year will be in finding a definitive way to answer the question: “Where is that content going to come from?” In the past, content came from various sources: your website, your marketing department (if your business had one), staffers who could write well, CEOs, other executives, freelance writers, or even staff members’ friends and family. These sources may have been adequate in the past, but as more and more B2B companies plan on adopting some form of content marketing for the future, depending on staffers who are not trained or experienced in content marketing can end up costing your business more than you think. A content marketing plan is something businesses are going to need. And not just any plan, one that includes integrating content across multiple channels and platforms for branding, continuity, purpose, identity, promotion, and for Internet search rankings (SEO). Last year one of the biggest problems businesses had was creating engaging content, and that is still a major problem

going forward. According to the LinkedIn survey, the content challenges for B2B marketing in 2014 will be: • Finding the staff time/bandwidth to create content (55 percent) • Creating engaging content (49 percent) • Producing enough varied content to capture interest across multiple channels (39 percent) The key to good content though is not in the quantity, rather, it’s in the quality, and that’s where some businesses feel they lack the needed expertise to really engage and inform their audiences. It’s no secret that telling a compelling story is one of the most effective ways to create interest, but not every business is able to (or even wants to) employ a staff of experienced content marketers to write stories. And across multiple channels with the necessary keywords and search engine optimization techniques tailored to each channel of communication. Creating a cohesive and directed content marketing plan is even more challenging when you consider the increasing number of channels content needs to fill. According to Marketing Profs and the Content Marketing Institute’s recent B2B Marketing Content report for 2013,

“B2B marketers are spending more, using more tactics, and distributing their content on more social networks than they have in years past. Unfortunately, there is also more uncertainty. B2B marketers are more uncertain whether they are using various content marketing tactics effectively.” Rather than create an in-house publishing department to handle the content needs of your B2B organization, firms offering content marketing services to this industry can be a worthwhile alternative. Before you make a decision on how to handle your B2B content marketing efforts, consider your staff’s time, your businesses’ ability to hire and manage content marketing staff, and how you will determine whether the return on investment (ROI) of your marketing efforts is successful or not. I think about it this way: content may be king but ROI is the master of the universe. Until you know which efforts are successful and why, it’s almost impossible to chart your future content marketing path. Heather Ripley is the president and founder of Ripley PR, a business-tobusiness (B2B) public relations agency specializing in Healthcare IT. For more information, visit www.ripleypr.com or email hripley@ripleypr.com.

APhA2014

Get Ready to Realize the Power and Promise of Pharmacy In March 2014, the American Pharmacist Association Annual Meeting makes its mark in Orlando, Florida—and registration is open! Sign up early for a discounted rate and guarantee yourself a place at the event dedicated to your profession. When this many pharmacists unite, the experience is powerful. Exchange ideas and recharge your bond with our profession’s promise—all while discovering the latest innovations and resources for future growth. Use the connections you make and the knowledge you gain as a positive force in your career and for the health of your patients. It all happens at APhA2014. We’ll see you there! Visit www.aphameeting.org now to learn more. 13-378

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Tennessee Hospital,

theLiteraryExaminer

continued from page 9

BY TERRI SCHLICHENMEYER

information you get in the hands of our physicians and hospitals, the better off we are,” he said. While the immediate future brings many challenges, Becker said the message of the annual meeting was a hopeful one. “This is the constructive destruction of the health system as we knew it. It will be very different going forward.” As for the THA’s role in helping hospitals shift to population management models, Becker succinctly noted, “It’s coming, and we’re here to help you do it.” He continued, “We’ve really put an increased emphasis on quality. We’ve put an increased emphasis on education and on sharing best practices and process improvement data. Our data is all geared toward giving transparent information to our members so they understand how they stack up against others.” He added the THA has also been hands-on in helping hospitals help their patients. In a move unique among hospital associations, Becker said, “We actually took $3 million out of reserves and put it aside for grants for hospitals to enroll people in the exchange.” He continued, “We touch 350,000 uninsured people every year in our emergency rooms.” Becker noted identifying those who qualify for the federal exchanges and getting them covered is a win/win for families and facilities. Hospitals have until the end of November to apply for the grants. “We’re excited to have a good opportunity to give back to our members and hopefully help our hospitals get ahead of the curve in signing people up,” he said. Despite the obvious pain points that come with transformational change, Becker and his staff are keeping an eye on the prize. “We’ll have a far better healthcare system once we get to the other side,” he concluded.

Knocking on Heaven’s Door: The Path to a Better Way of Death by Katy Butler; c.2013, Scribner; $25.00 / $28.99 Canada, 322 pages Indeed, the worst part about making a decision can be the regret that’s possible at the end of the choice. And in the new book Knocking on Heaven’s Door by Katy Butler, a seemingly no-brainer decision tears a family apart. Jeff Butler cheated death many times. As a child, he narrowly missed dying in a car accident. In World War II, he lost an arm, but not his life. And in November 2001, at age 79, he suffered a stroke that nearly killed him. A year later, he received a pacemaker. And that, says his daughter Katy, kept him alive but didn’t “prevent his slide into dementia, incontinence, nearmuteness, misery, and helplessness.” Jeff and his wife Val were forward thinkers. He was a college professor. She was a perfectionist with fierce drive. They had been “in control of their lives, and they did not expect to lose control of their deaths.” But that’s exactly what happened: as Jeff’s health continued to decline, his abilities dwindled and his cognizance weakened – all of which he was aware. He indicated dismay at his diminished life and said that he’d “unfortunately” lived too long. On the other side of the country, Katy Butler worried. She’d always been closer to her father than to her mother, but arguments and old hurts continued

to sting. Still, she flew home to Connecticut to help because she was, after all, their daughter – statistically, the one who bore the brunt of parenting a parent. But as Jeff’s dementia worsened, so did Val’s tolerance and her health. She was “stoic,” but impatient, snappish, and exhausted, and only accepted outside help when she became overwhelmed. Butler says she knew her mother “clouted” her father, and shouted at him in frustrated anger. By this time, Butler was convinced that the pacemaker her father had wasn’t the medical miracle it was meant to be. And she learned that pacemakers could be turned off… So much went through my mind as I read this beautiful, emotionally brutal book. With sorrow, grace, and growing exasperation, author Katy Butler writes of her father’s long, messy death; her mother’s quiet, dignified passing; and the parallel story of how modern medicine, drug companies, and government rules promoted the former. That’s a lot of hard reading, made gentler with Butler’s Buddhist values and serenity. And yet, it’s not easy to avoid outrage as she points out the unfairness of aging, the cruelty of physical decline, and the knowledge that those – and the surety of caretaking – are somewhat inevitable for many Baby Boomers today. This is a stunning book, truthful and its dignified, and it could be a conversation-starter. If there’s a need for that in your family – or if you only want to know what could await you – then read Knocking on Heaven’s Door. 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.

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One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine by Brendan Reilly, MD; c.2013, Atria Books; $28.00 / $32.00 Canada, 464 pages In the new book One Doctor by Brendan Reilly, MD, you’ll see that motheaten testing methods may beat modern. “New York doctors don’t work weekends.” That’s what one of Brendan Reilly’s patients claimed, surprised to see Reilly at her bedside on an early Saturday morning at New York’s Presbyterian Hospital. He was there because he believes that the doctor who “knows you best” is the one who should assume the majority of the caregiving. That’s not the way most medical centers work these days, but it’s the way he prefers to practice medicine. For Reilly, doing things the old-fashioned way is often better than technology, when making a proper diagnosis. Machines, he points out, can miss the smallest of symptoms: a non-dilated pupil, an errant reflex, a hidden blood clot, rare bacteria that mimics something else. “Diagnosing disease,” he says, “has something to do with patterns.” Good doctors – “grandmasters,” he calls them – know how to recognize those patterns without “wasteful, redundant, or ineffective” medical intercession. Such recognition, near-intuition, and the ability to deal with a day when “doctoring feels like pinball” are talents he cultivates in his residents and students. Even so, there are times when a doctor is stumped by a medical mystery that requires rapt attention and sleuthing skills. That’s when it’s mandatory to listen to a patient, the patients’ ailing body, and one’s own subconscious, as well as medical knowledge new and old. Such mysteries may result in instinctual reaction, and a cure. Other times, they might end with the surety that it’s time to stop. And on that, says Reilly, doctors “know about regret. But we don’t talk about it. Ever.” Broken up into thirds, One Doctor is a mixed (medical) bag. Author Brendan Reilly, M.D. starts his book in the wee hours of a typical on-service day in a busy New York hospital, and we’re treated to a whirlwind of intriguing medical cases, AHA! moments, and solutions worthy of a Sherlockian novel. The end of that long day, and the cases of his own parents, are where Reilly wraps up. I would have been more enthusiastic about this book, had that been the sum of it. No, instead, the middle third here is taken up by the story of a couple that Reilly knew some 30 years ago, the care of which still resonates in his career. That was interesting at first, but I thought it became overly long. And yet, I did enjoy this book, overall, and I think lovers of medical dramas will, too. If that’s you, and you’re maybe willing to skip bits that lose your interest, then One Doctor tests out well. easttnmedicalnews

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East TN Medical News joins with these providers to support the prevention of diabetes through a healthy lifestyle which includes regular screenings, exercise, personal well being, and good nutrition.

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NOVEMBER 2013

GrandRounds Daniel Branham, MD, Joins Tennessee Orthopaedic Clinics KNOXVILLE, TN – Dr. Daniel Branham has joined Tennessee Orthopaedic Clinics specializing and board-certified in hand and upper extremity procedures. Originally from the Clinton area, he has returned to his East TennesDr. Daniel see roots after practicing Branham at a Level II trauma center in Melbourne, Florida, for the last six years. Following the obtainment of his medical degree from the University of Tennessee Memphis, he completed his residency at the Medical College of Virginia. A fellowship in Orthopaedic Hand

and Upper Extremity Surgery at the University of Florida in Gainesville further developed his expertise in patient care. Branham is a member of the American Academy of Orthopaedic Surgeons as well as the University of Florida Hand Fellows.

Parkridge Health System Welcomes Bement as Executive Director of Surgical Services CHATTANOOGA, TN – Jared Bement has been selected as the Executive Director of Surgical Services for Parkridge Health System. Bement has many years of experience in nursing leadership. He comes to Parkridge from a position as Director of Perioperative Services at Baylor University

Children’s Hospital Foundation welcomes New Board Members CHATTANOOGA, TN – Children’s Hospital Foundation at Erlanger is proud to announce the appointment of five new board members to its team of supporters. Jeff Eversole, Wal-Mart Market Manager, has been a supporter of Children’s Hospital through Wal-Mart’s campaigns with the Children’s Miracle Network Hospitals. Lisa Lowry-Smith, M.D., a Neonatologist at Children’s Hospital at Erlanger, has treated patients and worked with the hos(Left to right) Amber Wattenbarger, Children’s Hospital Foundapital staff since 2011. Nita tion Co-Chair Carrie Kennedy, Christie Kizer Burbank, and Jeff Shumaker, MD, pediatrician Eversole. (Not pictured: Dr. Lisa Lowery-Smith and Dr. Nita at Galen Medical Group, Shumaker.) also serves on ChattanoogaHamilton County Hospital Authority Board of Trustees. She was nominated to serve as the Authority Board’s representative on the foundation council. Amber Wattenbarger is an independent consultant who is experienced in demand and supply planning. Christie Kizer Burbank, member of Miller & Martin PLLC, concentrates her legal practice exclusively in health care regulatory and transactional law and has served as a member and ambassador in other healthcare organizations in the community.

Medical Center in Dallas. Bement holds a Bachelor of Science degree in nursing from the Baptist College of Health Sciences in Memphis, Tenn. He also holds a Master of Business Administration degree from East Tennessee State University. Bement is a member of the American Nurses Association (ANA), the American College of Healthcare Executives (ACHE), and the Association of PeriOperative Registered Nurses (AORN) Top 25 Surgical Services Summit.

St. Barnabas Multi-Sensory Room Opens Tennessee’s first multi-sensory room in a healthcare facility promotes patient well-being CHATTANOOGA, TN – St. Barnabas announces the addition of a multi-sensory room to its program offerings. St. Barnabas’s multi-sensory room is state-funded by UnitedHealthcare Community and State Plan, and can be set to either relaxation mode or stimulation mode. The room can be staged to provide a multi-sensory experience or single sensory focus, simply by adapting the lighting, atmosphere, sounds, and textures to the specific needs of the individual at the time of use. Specific therapeutic outcomes aren’t expected – instead, the focus is to help users gain the maximum pleasure possible from the multi-sensory activity. Because it does not rely on verbal communication, it may be beneficial for people with dementia and those who would otherwise be almost impossible to reach. Sensory stimulation can decrease behavioral issues arising from mental health and dementia diagnoses, according to researchers. The CHOICES program, part of TennCare, requires managed-care organizations to participate in a quality of life project, and St. Barnabas was selected to pilot Tennessee’s first multi-sensory room in a health care facility.

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.

NOVEMBER 2013

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.

LMU-DCOM’S Wieting Among Mentor of the Year Finalists at Annual Osteopathic Medical Conference and Exposition HARROGATE, TN - Dr. Michael Wieting, senior associate dean at Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) in Harrogate, Tenn., was recently named as a finalist in the American Osteopathic Association’s (AOA) Dr. Michael Wieting Mentor of the Year recognition program. The recognition program was conducted by the AOA in association with Pfizer Inc. Wieting was selected as one of five finalists for the Mentor of the Year award from more than 175 nominated mentors. Wieting was honored during a breakfast reception on Sept. 30 at the AOA’s OMED 2013, the Osteopathic Medical Conference & Exposition in Las Vegas. Wieting is board certified in physical medicine and rehabilitation and is a fellow in the American Osteopathic College of Physical Medicine and Rehabilitation as well as the American Academy of Physical Medicine and Rehabilitation.

McNabb Center welcomes board members and officers for 2013-2014

KNOXVILLE, TN –Andy Black, Helen Ross McNabb Center CEO, welcomes board members and officers to the Center’s board of directors. 2013-2014 Helen Ross McNabb Center Board of Directors with elected officers: Dr. Harold Black; Ms. Linda Gay Blanc; Mrs. Susan Conway, Chair; Mr. Joe Connell, Past Chair; Mr. Wade Davies, Chair Elect; Mr. Joe Fielden; Mr. Charles Finn, Secretary; Ms. Mai Bell Hurley; Mrs. Debbie Jones, Treasurer; Mrs. Ellie Kassem; Mr. Ford Little; Mr. Richard Maples; Mrs. Della Morrow; Mr. Joe Petre; Mr. James Schaad; Mr. Ross Schram, III; Dr. Karen Sowers; Mrs. Nikitia Thompson; Mrs. Traci Topham; Mrs. Linda Vaughn; Mrs. Dedra Whitaker; Mr. Chris Kittrell.

Award Recognizes New App for Smart Phones to Help Smokers Kick Habit

KNOXVILLE, TN – In 2012 Covenant Health and the Will Rogers Institute began offering a new app for smart phones to help smokers make the smart choice to kick the habit. Now the Stop Smoking App has received a special honor for that mission. The Dr. Peter Carter Award recognizes contributions to tobacco prevention in Knox County and surrounding communities. During a recent award ceremony, Jon Dalton received the Dr. Peter Carter Award for the stop smoking app on behalf of Covenant Health. Dalton is manager of Parkwest cardiopulmonary wellness and rehabilitation, and was instrumental in creating the app. To download the Stop Smoking app for a phone or other mobile device, go to www.covenanthealth.com/stopsmoking. easttnmedicalnews

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GrandRounds Watkin named Director of Privacy for Covenant Health KNOXVILLE, TN – Janice Watkin, former health information management director and privacy officer at Parkwest, has been named director of privacy for Covenant Health’s centralized privacy office. The office is part of the health system’s integrity compliance pro- Janice Watkin gram, and Watkin works closely with Tish Breeding, corporate integrity and privacy officer, to ensure appropriate protections and processes for HIPAA (Health Insurance Portability and Accountability Act) compliance, as well as other federal and state privacy requirements.

Covenant Health Renews Sponsorship of Knoxville Marathon, Celebrates TenYear Anniversary KNOXVILLE, TN — The Covenant Health Knoxville Marathon celebrates its 10th anniversary in 2014, and Covenant Health, which has sponsored the event for the past nine years, recently committed to keep the marathon (and the marathoners!) running for three more years. Proceeds from the marathon benefit the Knoxville Track Club’s scholarship and community fitness programs. In addition, a portion of the proceeds benefit the Patricia Neal Rehabilitation Center’s Innovative Recreation Cooperative. The 2014 marathon is set for Sunday, March 30, with the Covenant Kids Run scheduled for Saturday, March 29. Registration and information is available at www.knoxvillemarathon.com..

at McLaren Health Care Corporation’s Lapeer Regional Hospital, in Lapeer, Mich. Her leadership experience includes achievements in quality improvement, staff development, physician partnering, financial turnarounds, and technology innovation. Ellen Wilhoit was named president and CAO of then-Fort Sanders Sevier Medical Center in 1999. Prior to that time, she served as the hospital’s chief operating officer and chief nurse executive. With a focus on quality, strategic plan-

ning, physician recruitment and relations, financial management and nursing administration, Wilhoit helped the hospital achieve national recognition for patient satisfaction Ellen Wilhoit and customer service. She helped lead the development, construction, staff transition and opening of the new LeConte Medical Center in 2010. Named the most beautiful hospital in the U.S. in 2013, LeConte recently received a

5-star award from PRC for outpatient satisfaction. Hanson assumed her new duties on Oct. 14. Wilhoit will continue in a transitional leadership role, working alongside Hanson at LeConte Medical Center through the first quarter of 2014. Janice McKinley, Covenant Health senior vice president and CNO, will assume responsibilities as interim chief nursing officer at Fort Sanders Regional Medical Center.

I don’t just have insurance. I own the company.

Gary E. Meredith, M.D. Pediatric Diagnostic Associates Chattanooga, TN Pediatrics

Covenant Health Names Jenny Hanson to Succeed Ellen Wilhoit as LeConte CAO SEVIERVILLE, TN — Covenant Health has announced that Jennifer (Jenny) Hanson, vice president and chief nursing officer at Fort Sanders Regional Medical Center, will be the new president and chief administrative officer at LeConte Medical Center in SevierJenny Hanson ville. She will succeed Ellen Wilhoit, who will retire in early 2014. Hanson has been CNO at Fort Sanders Regional since 2007. During her tenure, Fort Sanders Regional Medical Center has received multiple awards for quality and patient care excellence, and has been named by U.S. News and World Report as one of the region’s top hospitals. The medical center and the Patricia Neal Rehabilitation Center have received certification as a comprehensive stroke center of excellence by The Joint Commission. Prior to joining Fort Sanders Regional, Hanson was vice president of patient care services and system nurse executive for Baptist Health System of East Tennessee. She also served as nurse executive, chief operations officer and interim CEO

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Medical Professional Liability Insurance “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.”

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NOVEMBER 2013

GrandRounds Covenant Receives Excellence in Healthcare Awards KNOXVILLE, TN — Covenant Health organizations recently received numerous Excellence in Healthcare awards from Professional Research Consultants (PRC), a Nebraska-based organization which measures patient satisfaction among its database of 300 hospitals nationwide. Among the award winners were: 4-Star Awards (Top 25 Percent of National Database, 75th-89th percentile) Overall Quality of Care: Fort Loudoun Medical Center – Outpatient Parkwest Medical Center – Inpatient, Emergency Department LeConte Medical Center – Inpatient Methodist Medical Center – Inpa-

tient Fort Sanders Regional Medical Center – Inpatient 5-Star Awards (Top 10 Percent of National Database, at or above 90th percentile) Overall Quality of Care: Fort Sanders Regional - Outpatient, 3 North Surgery, 7 North Complex Medical Unit, 3 West Nephrology Unit, 8 North Oncology Unit Patricia Neal Rehabilitation Center – Overall Inpatient Rehab, TBI/SCI Rehab, Ortho/Neuro Rehab Methodist Medical Center – Outpatient, Outpatient Surgery, 3 East Joint Replacement Center, 4 West Oncology Unit, TCSC – Oak Ridge, Outpatient Radiation Parkwest Medical Center – Outpa-

Name: Steve Shaffer Position:Volunteer, J.D. and Lorraine Nicewonder Cancer Center in Bristol and the Bristol Regional Medical Center Emergency Department At a Glance: January will mark three years that Steve Shaffer has been volunteering at the J.D. and Lorraine Nicewonder Cancer Center, as well as at the Emergency Department at Bristol Regional Medical Center. Every Monday and Wednesday, Shaffer devotes his time to helping patients at these facilities who may not have anyone else to accompany them to their visit. While patients at both facilities range in age, for Shaffer, his decision to volunteer came out of his love for one particular group. “I guess I’ve always had a soft spot for older folks; I like to sit down and talk about past experiences,” he said. “Some of them who have no one else come in by themselves, so I really like to socialize with them and try to understand what they are going through because we might go through the same thing one day. I like to give them as much of my time as I can.” Shaffer starts his shift by preparing snacks, coffee, and other refreshments, and then makes his rounds to ensure that everyone feels at ease, that breakfast and dinner orders have been put in, and that the patients are tolerating their meals, as some persons cannot tolerate food while receiving chemotherapy. “I really care for them, and sometimes you get attached to them. The other volunteers and I realize that the patients are coming in to get better, but the therapy has to work on them first,” he shared. “Patients can get to a point where they are down, depressed, and just want somebody, even hunger for somebody, to sit down with them and just listen to what they are saying. I pride myself on being a good listener.” Shaffer says that for him, all the reward or recognition that he needs comes from the very satisfying feeling that he has helped someone get through their troubling time because “they are in a lot of pain, and I love them all. On Wednesdays and Mondays, that’s what I get up for,” he said. “I guess you can say that I crave that interaction, too.” Of course, Shaffer says he couldn’t do what he does without the support of the other volunteers. “We have a great group of volunteers,” he said. “They care, and they try so hard. There are days they come in and don’t feel so good, but they still give all they can, and we just make each other laugh.”

tient, Childbirth Center, Cardiopulmonary Unit, Cardiac Specialty Unit LeConte Medical Center – Outpatient Thompson Cancer Survival Center - Outpatient, Thompson Breast Center, Thompson PET, Thompson Outpatient Radiation Oncology Crystal Overall Top Performer Award (at or above 100th percentile) Thompson Cancer Survival Center Breast Center

Leading Gastrointestinal Society Names Colleen M. Schmitt, MD, to PresidentElect DOWNERS GROVE, IL — The American Society for Gastrointestinal Endoscopy (ASGE) announces the appointment of Colleen M. Schmitt, MD, MHS, FACG, FASGE, of the Galen Medical Group, Chattanooga, TN., to president-elect. Schmitt assumed her duties in May during Digestive Disease Week in Orlando, FL. Her term will continue through May 2014 at which time she will become president. She became a member of ASGE in 1994 and has served on a number of committees. From 2005-2009 she served as chair of the Health and Public Policy Committee and was a member of the Research Committee for several years. Since 1994, Dr. Schmitt has been a reviewer for ASGE’s peer-reviewed scientific journal GIE: Gastrointestinal Endoscopy and was a member of the Editorial Review Board from 1999 to 2004. She is also a Fellow of the ASGE. Schmitt practices at the gastrointestinal specialty arm of Galen Medical Group which has expanded to include six adult GI specialists, one pediatric GI specialist and one hepatologist. She is also Medical Director at Memorial Research Center and was chief of the Division of Gastroenterology at the University of Tennessee College of Medicine, Chattanooga Unit.

Ridgeview Behavioral Health Services Names Buuck C.E.O. OAK RIDGE, TN – Ridgeview Behavioral Health Services recently announced the appointment of Brian D. Buuck to the position of Chief Executive Officer, effective January 1, 2014. Buuck will replace Bob Benning who retires at the end of December this year, after 27 years of service to Ridgeview. In his former position at Ridgeview as Chief Operating Officer for the past 10 years, Buuck was responsible for the dayto-day operations of Ridgeview’s clinical and support programs and was instrumental in expanding Ridgeview’s services through grants and networking with other area providers. Buuck holds a B.S. degree from the University of Louisiana, Lafayette, and a MSSW degree from the University of Tennessee. He is certified as a Licensed Clinical Social Worker.

PUBLISHED BY: SouthComm, Inc. CHIEF EXECUTIVE OFFICER Chris Ferrell ASSOCIATE PUBLISHER Sharon Dobbins sdobbins@easttnmedicalnews.com 865.599.0510 EDITOR Bridget Garland bridget@easttnmedicalnews.com 423.483.1015 CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com 931.438.8771 GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak James Osborne Christie Passarello CONTRIBUTING WRITERS Sharon Fitzgerald, Cindy Sanders, Lynne Jeter, Terri Schlichenmeyer, Bridget Garland, Leigh Anne W. Hoover, Joe Morris, Jennifer Culp, John Sewell, Stacy Fentress 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: One year $48 • Two years $78 Become a fan on Facebook, and Follow us on 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. Medical News will assume no responsibilities for unsolicited materials.        All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.

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NOVEMBER 2013

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GrandRounds Boyd Promoted to Manager of Volunteer Services KNOXVILLE, TN — Parkwest Medical Center announces that Becky Boyd has been named manager of Volunteer Services. She will also serve as co-administrator of the Patient Call Center and will be supervising the Guest Services department. In addition, she will act as Covenant Health’s “Journey to Excellence” coordinator for Parkwest. In her previous role, Boyd was Volunteer Services coordinator at Parkwest for more than six years. During this time, she was instrumental in significantly growing the number of active volunteers from 80 to more than 150. Boyd is a graduate of East Tennessee State University, holding a Bachelor of Science degree in business management. Prior to working at Parkwest, she was the Community Relations Manager for Tellico Village Property Owners’ Association and Executive Director of the Loudon County Visitors Bureau. Boyd is a member of DVS (Director of Volunteer Services) Tennessee Healthcare Volunteer Professionals.

It was the first note I ever got in crayon. “Thank you for making my daddy feel better.” I keep it on my desk, where I pore over patient records and cash flow statements. Because even if the medical field seems to be changing by the day, the reasons I practice never do.

New Memorial Vice Presidents Strengthen Care, Fiscal Responsibility

CHATTANOOGA, TN –Memorial Health Care System is proud to announce the addition of two new vice presidents to its award-winning staff. Danine Watson, MSN, RN assumes the newly created position of Vice President of nursing/associate chief nursing officer, and Michael Sutton has been named vice president of finance. Danine Watson joins the Memorial Health Care team in the role of vice president of nursing/associate chief nursing officer, having previously served as chief nursing officer (CNO) at Citizens Baptist Medical Center in Talladega, Ala- Danine Watson bama. She holds a Master’s Degree in Nursing and boasts more than 20 years of nursing in both clinical and leadership roles. As associate chief nursing officer, Watson is responsible for providing clinical leadership through the implementation of key strategic and operational initiatives, facilitating optimal care delivery, quality care, financial success, risk management and customer service. Michael Sutton has been promoted to vice president of finance of Memorial Health System. Since joining Memorial in 2001, Sutton has served in several capacities, including executive director of financial operations/performance im- Michael Sutton provement/revenue cycle for nearly five years. Sutton earned both his Bachelor of Science in Accounting and MBA from University of Tennessee at Chattanooga.

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NOVEMBER 2013

Hope is close to home. Hope is close to home.

We know you want the best cancer care as close to home as possible. We know you want the best cancer That’s why Mountain States Cancer Care care as close to home as possible. is here for you with locations throughout That’s why Mountain States Cancer Care Northeast Tennessee and Southwest is here for you with locations throughout Virginia. However, if you need a more Northeast Tennessee and Southwest advanced level of care that is not available Virginia. However, if you need a more at your community hospital, that’s no advanced level of care that is not available problem. Advanced cancer care services at your community hospital, that’s no are available through our cancer care problem. Advanced cancer care services network. Our physicians at Mountain are available through our cancer care States Medical Group will make sure network. Our physicians at Mountain you get the care you need at the most States Medical Group will make sure convenient location possible. you get the care you need at the most convenient location possible.

No matter where you are in your fight against cancer – whether you’ve been No matter where you are in your fight recently diagnosed, are recovering from against cancer – whether you’ve been surgery, in the middle of radiation recently diagnosed, are recovering from treatment or five years out – we are here surgery, in the middle of radiation for you and your cancer care needs. treatment or five years out – we are here for and Care yourNetwork: cancer care needs. Ouryou Cancer • Indian Center Our CancerPath CareMedical Network: • • • • • • • • •

Johnson City Medical Center Indian Path Medical Center Johnston Memorial Hospital Johnson City Medical Center Smyth County Community Hospital Johnston Memorial Hospital Sycamore Shoals Hospital Smyth County Community Hospital Sycamore Shoals Hospital