East TN Medical News November 2014

FOCUS TOPICS HEALTH EDUCATION RADIOLOGY & IMAGING

November 2014 >> $5

PHYSICIAN SPOTLIGHT PAGE 11

Phil W. Jones, MD ON ROUNDS

Enjoying East Tennessee The Santa Train Tradition Marking the beginning of the holiday season… the CSX train, known as the Santa Train, has become a much anticipated, treasured tradition. Winding through the mountains of Appalachia, its arrival welcomes Christmas ... 3

HEALTHCARE LEADER: Dr. Phillip Jackson Healthcare is indeed a business.

Hospital management is a complicated and multi-tiered task ... 8

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The Case for Covering LowDose CT Lung Cancer Screening Proponents cite ROI of early detection, reduced mortality

sociate chair for Clinical Affairs and division director for Cardiothoracic Radiology at the University Perhaps it is only appropriate the Centers for of Michigan. “I firmly believe that screening for lung Medicare & Medicaid Services is scheduled to ancancer with CT saves lives,” she stated. An expert in nounce its highly anticipated coverage decision for the field, Kazerooni’s long list of credentials includes low-dose computed tomography (LDCT) lung cancer serving as a trustee on the American Board of Rascreening in November. After all, this is officially ‘Nadiology, chair of thoracic imaging for the American tional Lung Cancer Awareness’ month.

College of Radiology’s Commission on Body ImagFor proponents of using the diagnostic imaging ing, chair of ACR’s Committee on Lung Cancer study for early detection, the cost/benefit analysis is Screening, vice chair of the National Comprehensive simple … LDCT saves lives in a cost efficient manCancer Network’s Lung Cancer Screening Panel, ner among a targeted, high-risk population. Mediand past president of the American Roentgen Ray care already covers broad-based screenings for colon, Society. breast and prostate cancers. According to the Ameri“Medicare received two formal requests for a Dr. Ella A. Kazerooni can Cancer Society Cancer Facts & Figures 2014, the national coverage decision,” she explained of actions combined estimated annual deaths from those three taken earlier this year precipitating the CMS detertypes of cancer is still significantly less than deaths from lung cancer mination. “They statutorily have until Nov. 10 to post their draft (120,220 vs. 159,260). coverage decision,” Kazerooni continued, noting a final decision One of the most vocal supporters for extending coverage to was expected in February 2015 following a comment period.

Medicare beneficiaries is Ella A. Kazerooni, MD, MS, FACR, as(CONTINUED ON PAGE 12)

By CINDy SANDERS

The Transformation of Med Ed

AMA continues quest to accelerate change in physician training

By CINDy SANDERS

A little more than a year ago, the American Medical Association announced $11 million in grants to 11 academic medical centers to fundamentally change the way physicians are educated and trained.

“There has been a universal call to transform the teaching of medicine to shift the focus of education toward real-world practice and competency assessment, which is why the AMA launched the Accelerating Change in Medical Education initiative,” AMA President Robert M. Wah said in a statement.

“Over the last year, we have made significant progress in transforming curriculum at these medical schools that can and will help close the gaps that currently exist between how medical students are trained and the way healthcare is delivered in this country now and in the future.”

In late September, a consortium of thought leaders from the 11 academic (CONTINUED ON PAGE 6)

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Dr. Susan Skochelak at the podium addressing the consortium meeting at Vanderbilt.

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Enjoying East Tennessee The Santa Train Tradition Marking the beginning of the holiday season… the CSX train, known as the Santa Train, has become a much anticipated, treasured tradition. Winding through the mountains of Appalachia, its arrival welcomes Christmas.

These words are from the first page of my children’s book entitled The Santa Train Tradition. Although a fictitious family is incorporated in the book, theirs is the true story of what many families in our region have been enjoying for over 70 years.

In fact, the Santa Train makes its annual trek through the Appalachian Mountains each year on the Saturday before Thanksgiving. Traveling 110 miles from Shelby, KY, to Kingsport, TN, and making 14 stops, at names including Marrowbone, Toms Bottom, St. Paul, and others, families gather to welcome Santa and usher in the holidays. The Santa Train has become known as the “world’s largest” Santa parade!”

When I first rode the Santa Train as a journalist, I wrote an article, which was published in US Airways Magazine. It covered the basic who, what, where, when, and why of the event, but when I got off the train and talked with the people gathered, I knew the Santa Train was much more than an article. It is a tradition!

My little, hardback children’s book The Santa Train Tradition (Word of Mouth Press 2008) captures much of the nostalgia and what was shared with me by families who have gathered with their parents, grandparents, and now their own children to experience the hope and joy of the Santa Train.

Illustrator Carol Bates Murray of Marion, VA, has beautifully illustrated the book, and it is the eighth published book she has illustrated. In the classic fashion, each page

PHOTO ©ED RODE

By LEIGH ANNE W. HOOVER

is actually an individual watercolor painting. You can feel the chill in the air, smell the coffee and hot chocolate, and sense the impending excitement. When I visit schools, I delight in sharing Murray’s talent and showing students the actual paintings, which create feelings and stimulate imaginations even before we read the first word.

My presentations to civic and professional organizations center on the importance of reading—especially reading aloud and connecting children to literacy and the region. By reading books that also allow them to go see and experience the adventure, reading is enjoyed on an even more personal level.

The Santa Train is a program of the Kingsport Area Chamber of Commerce, and it is also sponsored by CSX, Food City, and Dignity U Wear. Originating in 1943, the Santa Train provided a way for the business community to thank the surrounding region for their patronage in Kingsport.

Many became aware of the Santa Train when the late Charles Kuralt rode in 1982 for an infamous “On the Road” feature, which brought international attention

to the train.

Today, the Santa Train travels with over 15 tons of donated gifts, toys, candies, and clothing.

Although Santa used to toss hard candy from the train to those gathered along the railroad, safety precautions now prohibit this, and all items are tossed from the back of the Santa Train at designated stops.

“We receive a wide variety of donations,” explained Amy Margaret Allen, Marketing Director-Kingsport Convention and Visitors Bureau. “Everything from financial contributions, to toys purchased from stores, and even handmade items [are on the train.] Knitted scarves, hats, and gloves are often sent from church groups and individuals who have a talent and want to share their gifts with the children of Appalachia.”

Allen adds one of her personal favorite gifts one year was from a group that drove to Kingsport, TN, from Indiana to bring stuffed bears for the Santa Train. According to Allen, each bear was wearing a personally knitted sweater and scarf.

“It is so special when people take the

time to hand deliver their donations to the chamber,” said Allen. “We’re able to put the faces with the gifts, and I think that is one of the most touching parts of receiving and coordinating the donations.”

Although very few individuals actually are able to ride the Santa Train, which is due to safety reasons, there are many volunteer opportunities to become involved with the Santa Train.

“Just because you can’t ride the train does not mean you can’t be part of the train,” explained Allen. “The packing night at Food City is always a great way for people to be able to volunteer and have their hand in the Santa Train experience.”

As one of the annual sponsors of the Santa Train, Food City hosts the packing night on Wednesday at the Eastman Road store location in Kingsport before the train runs on Saturday. Volunteers are always needed for this.

When my book was going through the publishing process, just like the Santa Train, I wanted it to also benefit others. Food City came on board, and for the first three years, the book was sold in their grocery stores in three states along the route of the train.

The goal was for a portion of the proceeds to be donated to the Santa Train Scholarship, which is awarded annually to a graduating high school senior along the route.

However, Food City donated 100 percent of the proceeds, and, to date, over $10,000 has been donated to the scholarship from the sale of “The Santa Train Tradition” in their stores. A portion of sales also benefits the Literacy Council of Kingsport, Inc. Celebrity guests have also become synonymous with the Santa Train experience, and many have ridden more than once. Over the years, names including Naomi and Wynonna Judd, Alison Krauss, Thompson Square, Patty Loveless, who has written a song about the Santa Train, Kathy Mattea, and Kree Harrison of American Idol have ridden the train. This year, six-time Grammy-winner Amy Grant will be on board.

The Santa Train always runs on the Saturday before Thanksgiving. This year, Saturday November 22, 2014, marks the 72nd running of the annual Santa Train.

“Everybody coming together to donate for such a great cause is heartwarming,” said Allen. “And, actually getting to see it into fruition is definitely my favorite part.”

For more information about the Santa Train, visit http://www.teamsantatrain. org/ or https://www.facebook.com/santatrain and to order “The Santa Train Tradition,” visit www.wordofmouthpress.us or www.thesantatraintradition.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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Short of Breath

COPD Foundation Sheds Light on State’s High Rate of Progressive Lung Disease

By CINDy SANDERS

With 8.7 percent of residents suffering from chronic obstructive pulmonary disease, Tennessee has one of the highest rates of COPD in the country. During November, National COPD Awareness Month, it seemed appropriate to share data and insights into the third leading cause of death in the United States and in Tennessee.

Unlike most major illnesses, chronic lower respiratory diseases have actually increased in frequency over the past three decades, and the numbers rise even higher when factoring in those who are misdiagnosed or underdiagnosed. Currently, close to 15 million Americans are living with known COPD. However, Jamie Sullivan, senior director of Public Policy and Outcomes for the COPD Jamie Sullivan Foundation, noted, “The NIH estimates there are about 12 million nationally who have COPD symptoms but haven’t received a diagnosis.”

Sullivan continued, “There tend to be more women who are misdiagnosed than men.” Compounding the issue,

COPD tends to affect women disproportionately with a national average of 6.7 percent having COPD compared to 5.2 percent of men. “That disparity between men and women is actually worse in Tennessee than in the nation.” Sullivan said data from the Behavioral Risk Factor Surveillance System shows the COPD rate for women in Tennessee is 11.7 percent compared to 6.7 percent for men.

The Volunteer State, she added, has the third highest rate of COPD overall in the country at 8.7 percent compared to the national average of 6.3 percent. Tennessee trails only Kentucky and Alabama in prevalence.

Deb McGowan, senior director of Health Outcomes for the COPD Foundation, noted the reasons behind Tennessee’s higher rates are multifactorial including environmental issues and smoking rates in the South. Although TennesDeb see has made significant McGowan strides in sharing smoking cessation strategies, nearly a quarter of the state’s adult men (24.7 percent) and one-fifth of the state’s adult women (19.7 percent) still smoke.

While there can be a genetic compo-

Home for the Holidays featuring City Youth Ballet of Johnson City Saturday, December 13, 7:30 p.m.

nent to COPD, McGowan said smoking leads the way as a key contributor to the chronic illness. A quarter of those with COPD have never smoked with the condition likely linked to genetics, occupational and environmental pollutants, leaving the other 75 percent related to smoking.

Sullivan added, “Definitely exposure to tobacco is the main risk factor, but it’s not just current smokers who are at risk, it’s people who had a history of smoking.”

She noted these are individuals who followed the recommendations and quit smoking but 10-15 years later begin to have trouble with their breathing.

The COPD Foundation embarked on a listening tour this past summer and spent time in East Tennessee to learn more about the incidence rates for COPD. Sullivan said one thing they heard over and over again was the air quality in the valley exacerbated asthma and the ability to breathe easily. The problem isn’t limited to the eastern part of the state, however.

The Asthma and Allergy Foundation of America routinely includes Tennessee’s largest cities in its annual list of “Most Challenging Places to Live with Asthma.”

In 2014, Memphis ranked second, Chattanooga sixth, Nashville 38th and Knoxville 41st.

In addition to smoking history and environment, Sullivan said other risk factors include a history of asthma, early nutrition and prenatal events, early childhood infections, age, and socio-demographic status.

She noted nearly one in five adults with annual incomes under $15,000 (19 per-

Mary B. Martin Auditorium at Seeger Chapel, Milligan College

Johnson City Symphony Orchestra

sponsored by BedInABox 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 “The Polar Express” Concert Suite composed by Alan Silvestri and Glen Ballard. The program will also include holiday-related music from Victor Herbert, Mel Tormé, George Fredrich Handel, John Finnegan, Adolphe Adam, Walter Kent and Kim Gannon, and Nicolai Rimsky-Korsakov.

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.

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NOVEMBER 2014

Online Event Calendar To submit or view local events visit the East Tennessee Medical News website. easttnmedical news.com

cent) have COPD. As with most chronic diseases and conditions, early detection, intervention and education improve quality of life and reduce healthcare costs and economic burden. McGowan said providers could help by being more aware of COPD when taking a patient’s personal history. Instead of asking if someone smokes, McGowan urges physicians and nurses to ask if an individual has ever smoked. “Around 100 cigarettes lifetime is where you start thinking differently,” she said of risk factors for COPD. Additionally, McGowan said providers should be attuned to any respiratory symptoms that seem to be ongoing.

“We don’t have to have a patient hit the hospital before we test them,” she noted of diagnosing COPD. “You do that through spirometry testing. It’s a simple breathing measure and can be done in a primary care office.”

Although billable, McGowan said most outpatient clinics and practices are not aggressively utilizing the test to screen appropriate patients with symptoms.

Many practices don’t have spirometers … or if they do, too often the equipment is sitting on a shelf collecting dust. Yet, she noted, getting that early diagnosis is critical to properly educating and treating patients. She added a number of studies have shown “patients who are uneducated and not activated in their care are twice as likely to be admitted to the hospital.”

Unfortunately, she continued, “We find a lot of patients don’t even know how to use their inhalers correctly. Not all inhalers work the same.” She added patients should call their doctor if they aren’t getting relief from their inhaler, have a fever, stronger cough, more productive cough, or noticeable discoloration in mucus. “All those signs and symptoms indicate you’re heading down the wrong path.”

McGowan said a common, easy way for patients to think about COPD is to use the ‘green, yellow, red light’ approach. The green light, she explained, is no change in what a patient is able to do.

A yellow light means a patient is showing some symptoms and signs and should call a doctor. The red light means nothing is working, and the patient should proceed directly to the ER. “It’s more about taking care of yourself and being aware of your body every day,” she said of managing COPD. Sullivan added, “We do have resources that are designed for healthcare providers. We also have resources they can use with their patients.” The Pocket Consultant Guide (PCG) even has an app attached to it for information on the go.

Physicians could also join a moderated online community with discussion about particularly difficult cases and various treatment options. Additionally, there is a quarterly digital magazine tailored to providers. To sign up for the magazine or access other resources, go online to copdfoundation.org. easttnmedicalnews

.com

LegalMatters

BY JENNIFER PEARSON TAYLOR AND ERIN B. WILLIAMS, LONDON & AMBURN, P.C.

Profit and Loss: The Top Ten Things Providers Need to Know Part VII: State Board Investigations and Inspections This article is the seventh installment in a series which explores the top ten health law issues and their potential financial consequences on a provider’s practice.

Failure to appropriately respond when facing a Board investigation or inspection can have a serious financial impact on a medical practice. Board investigations can be time-consuming and costly. In addition to any potential monetary penalties, providers may also be at risk for disciplinary action, including a suspended or revoked What control do the Tennessee Health Related Boards have over healthcare providers?

The Board is charged with licensing and regulating all physicians in Tennessee. As a part of this duty, the Board, through the Division of Health Related Board’s Department of Investigations, investigates all complaints filed against Tennessee physicians.

If I do not commit criminal or grossly negligent acts, will I ever be subject to discipline by the Board?

While it is understood that the Tennessee Board of Medical Examiners can sanction a physician for fraud, gross malpractice, false advertising, criminal convictions and the like, many underestimate the Board’s ability to sanction a physician for less egregious, unprofessional conduct. Thus, a multitude of issues can serve as the impetus for investigation by the Health Related Boards. For example, in the last six months, Tennessee physicians have been sanctioned for unprofessional conduct for failing to: • Formulate a written treatment plan; • Maintain adequate and accurate medical records; • Document all prescribed medications for patients; • Complete, sign, and medically certify death certificates in a timely manner; • Remain in Board ordered treatment for drug addiction; • Correct a misrepresentation on a licensure renewal application; and • Comply with a lawful request for medical records.

What does a complaint

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investigation by the Board mean to my practice?

The defense of a complaint before the Board begins with participation during the investigation. Such investigations, which are sometimes but not always covered by insurance, can significantly impact the provider’s practice, consuming the provider’s time and expending costs for attorneys’ fees. Complaints deemed meritorious can lead to formal Board proceedings against the provider in which a widerange of sanctions can be imposed, including licensure suspension or revocation. The Board has discretion to discipline the above by imposing any of the following sanctions: • Private or public censure or reprimand • Probation • Licensure suspension • Revocation with leave to reapply • Permanent licensure revocation • Monetary penalty up to $1,000 per statutory violation Can my controlled substance prescribing practices lead to a Board investigation?

The Tennessee Health Related Boards Office of Investigation added five new investigative positions to assist with excessive prescribing complaints and pain management clinic investigations and surveys (1). Providers prescribing controlled substances as part of their regular practice should be aware that a Board investigation may begin based solely upon the data contained in the Controlled Substance Monitoring Database (CSMD). The CSMD Committee has a duty to examine information on the CSMD to identify unusual patterns of prescribing and dispensing of controlled substances. If the Committee determines that the provider has an unusual pattern of dispensing high amounts of controlled substances or may have otherwise committed a violation of the law, the Committee will refer the provider to the appropriate licensure Board for an investigation.

A Board investigation may also begin through a report from the Tennessee Department of Health. The Tennessee Department of Health is now required to identify the top 50 prescribers of controlled substances by July 31 of each year. The provider will

have an opportunity to demonstrate the amounts prescribed were justified and medically necessary. However, if the Department still has concerns regarding the provider’s prescribing, the provider may be referred to the Board to initiate an investigation.

Additionally, anything sent in response to the “top 50” letter will be maintained by the Department for 5 years and may be used by Board investigators at any time for disciplinary action.

What are Board inspections of a pain management clinic?

The Rules of the Tennessee Department of Health Division of Pain Management Clinics permit Board representatives access to the pain management clinic and the records contained therein for an inspection of the clinic. The Board investigator may look at the clinic’s policies and

procedures to determine compliance with the laws, rules and regulations, or may request patient medical records to assess the prescribing practices.

The Board has already begun these inspections, which are performed at random and without prior warning to the pain management clinic. Providers practicing at pain management clinics should be sure to have their compliance policies and procedures in place and up-to-date to avoid any Board disciplinary actions or penalties following an inspection.

Notes 1. Controlled Substance Monitoring Database Advisory Committee Meeting Minutes (8-21-12), available at https://health.state.tn.us.

Attorneys Jennifer Pearson Taylor and Erin B. Williams focus their practice on healthcare compliance and regulatory matters. For more information on any health law or compliance matters, you may contact Ms. Taylor or Ms. Williams at (865) 637-0203 or visit www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

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The Transformation of Med Ed, continued from page 1 centers convened on the campus of Vanderbilt University School of Medicine in Nashville to discuss progress and barriers in implementing individual projects, offer insights and innovations, give and receive feedback on the conceptual model for the master adaptive learner, and share other lessons learned in the first year. Much of the meeting’s focus was centered on the master adaptive learner (MAL), which is the AMA consortium’s term for an expert, self-directed, self-regulated, lifelong workplace learner. Developing this type of skill is considered critical to prepare physicians for careers in a healthcare environment that is constantly changing and evolving.

During the two-day event, Susan Skochelak, MD, MPH, group vice president of Medical Education for the AMA,

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and Bonnie Miller, MD, senior associate dean for Health Sciences Education and associate vice chancellor for Health Affairs at Vanderbilt, hosted a media roundtable to discuss the transformative initiative.

Skochelak said it makes sense for the AMA to be at the forefront of such an ambitious project. Upon being founded in 1847, the physician’s organization undertook two major tasks — to write the first code of professional ethics and to set the standards for medical education.

She added the AMA again took a lead role 100 years ago when there was a major movement to change medical education. Skochelak said the AMA published the standards of what medical education should look like and that became the basis for the Flexner Report.

“The Flexner Report really changed medical education to say it has to be science-based, and it has to be connected with knowledge generation,” she explained. “It made a great leap forward in the quality of medical education. But here we are a century later, and our format for training physicians remains almost identical to the structure that we described a hundred years ago.”

Skochelak added, “It’s not that the training is broken, it’s just that it hasn’t kept up with what’s going on in healthcare delivery today.”

She said the work being done as part of the Accelerating Change in Medical Education initiative is built on recommen-

dations for change that have been well accepted for more than a decade by the medical education community. “We’re working in a great sense of consensus,” Skochelak noted. However, the fact that there has been broad agreement but little change points to impediments that must be addressed. “If it was easy, it would have already been done.”

To address the barriers and make it possible to move forward, Skochelak said, “The AMA wanted to provide resources and leadership to schools that are really ready to make the change.” That decision led to the grant program now in place for the 11 lead schools in the initiative.

In choosing the academic medical centers, Skochelak said the AMA was looked for programs that concentrated on key areas, including: • Getting students into the real world environment early on so they understand healthcare systems in a way that isn’t currently happening; • Emphasizing important core concepts in medical school education like team-based care, patient safety and outcomes, patient-centered approaches to care, and population management; and • Changing the way students progress through the educational system to provide more flexibility and individualized learning.

Miller, a general surgeon by training, has been involved in shaping medical education at Vanderbilt for more than

15 years in an official capacity and even longer as a faculty member. She noted Vanderbilt had already undergone a major transformation to their traditional curriculum from 2004-2007. Yet, she added, it became clear that even more needed to be done to support continuous learning throughout a career.

“We came to the conclusion that in order to do that you really did have to start at the beginning … that we couldn’t put our learners through our programs as usual and then expect magically at the end of their training they would be expert lifelong learners if we didn’t start to build those habits from the start,” Miller said of the decision to rework Vanderbilt’s programming for a second time.

“Curriculum revision is hard work,” she continued. “It’s not just a matter of developing new lesson plans. It really is a lot about culture change. We really felt that it was important to go back to the drawing board and start something new right away.”

Miller continued, “One of the things we thought a lot about was the context of learning. We felt that all learners need to work so that you’re really rapidly applying what you’re learning in the workplace … and that all workers need to learn.”

That mantra became a foundational principle of Vanderbilt’s Curriculum 2.0.

Miller added other tenets of the programming was that it should be team-based, interprofessional, modular to allow for dif(CONTINUED ON PAGE 7)

Milk Protein Hypersensitivity M. SAMAR AMMAR, MD Milk protein hypersensitivity or allergy is a diagnosis often used in conjunction with breast milk, cow’s milk or soy milk to describe groups of symptoms seen in pediatric patients, including infants. The protein in milk triggers such hypersensitivity. It is not IgE mediated, and lack of specific suggestive symptoms, along with absence of sensitive diagnostic testing, adds complexity to such diagnosis. The intensity of milk protein hypersensitivity or allergy may vary from mild to severe.

Cow’s milk-sensitive enteropathy was the first recognized food allergic enteropathy and remains the most common one. Associated clinical features may include colic, gastroesophageal reflux, vomiting, failure to thrive, rectal bleeding, or extragastrointestinal manifestations including eczema. Up to 40 % of infants with classic cow’s milk-sensitive enteropathy are also sensitized to soy, often after an initial period when it is tolerated.

Food protein-induced enterocolitis syndrome is a severe and sometimes life-threatening form of mucosal food hypersensitivity. Although usually triggered by cow’s milk or soy ingestion, food protein-induced enterocolitis syndrome may be induced by a verity of foods, including rice, oat, barley, vegetables and poultry. Milder symptoms can be seen in breast-fed infants, triggered by milk protein in the mother’s diet. Most cases show negative skin-prick tests. The infant usually presents with severe vomiting and diarrhea, requiring emergency admission to the hospital. Some demonstrate melena and passage of mucus per rectum, and may even undergo a laparotomy if the diagnosis is not recognized.

Food-induced proctocolitis usually occurs in the first few weeks or months of life and is most often secondary to cow’s milk or soy protein hypersensitivity.

Infants usually have occult or gross blood in their stools with or without mucous stool or diarrhea. Aside from occasional apparent pain on defecation, and eczema in a few cases, infants with food-induced proctocolitis generally appear healthy and

have normal weight gain. Proctocolitis related to cow’s milk protein allergy may also occur in exclusively breast-fed infants because of sensitization to cow’s milk protein entering into the mother’s milk. Sensitization to other trophallergens via mother’s milk, such as egg, fish or peanuts, is also possible.

Based on clinical presentation, work up is indicated to rule out other potential medical and surgical conditions. Referral is warranted to establish diagnostic and treatment plan.

Although the classic milk protein hypersensitivity or allergy is usually self-limiting, rational treatment must be based on clinical presentation and a correct diagnosis. Whenever treatment is indicated, infants with milk protein hypersensitivity should be fed a substitute hypoallergenic formula. Because breast milk is an optimal source of nutrition for infants through the first year of life, maternal diet restrictions should be attempted to alleviate symptoms of infants with milk protein allergy whenever treatment is justified prior to hypoallergenic formula use. Health care providers should be cautious about the introduction of dietary food other than breast milk or hypoallergenic formula to infants with cow’s milk protein hypersensitivity.

Once a change is made, whether through hypoallergenic formula use, or maternal diet restrictions, symptomatic improvement is expected within one to two weeks. That by itself may validate the presumed diagnosis. On the other hand, lack of improvement should trigger more thinking about potential underlying cause of the infant’s presentation.

The vast majority of infants with milk protein hypersensitivity are expected to outgrow their intolerance, whereas a handful of them may carry on their hypersensitivity into childhood. These may manifest different forms of food allergy.

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The Transformation, continued from page 6 ferent entry and exit points, and include new content areas to help students understand the context of healthcare delivery, as well as what is happening on a molecular and genetic basis. The new curriculum rolled out last year with the incoming class of 2013.

During the recent consortium meeting, Vanderbilt and other participants shared their progress and discussed barriers to change. Skochelak said that unlike a research grant, where a recipient is given money and works on an individual project, the AMA initiative was designed to pool information and work in collaboration.

“We told the schools if you receive grant monies, you will be part of a consortium of schools. Right from the beginning we’ll work together, and we’re going to share ideas because we want your projects to benefit from each other … and our ultimate goal is to share this with all of the schools,” Skochelak said.

Over the next four years, the AMA will continue to track, gather data and report on the progress of the 11 medical schools and their collective work in order to identify and broadly disseminate best practices to retool medical educational models across the country. Skochelak added the lessons learned would be shared with institutions educating other health professionals, as well.

Snapshot of Grant Projects Indiana University School of Medicine is working to create a virtual health care system (vHS) and a teaching electronic medical record (tEMR) to teach clinical decision-making and ensure competencies in system, team, and population-based healthcare skills.

Mayo Medical School is creating an innovative educational model based on the science of healthcare delivery to prepare students to practice within patient-centered, community-oriented, science-driven collaborative care teams to deliver high-value care. The curriculum’s experiential learning program focuses on how interprofessional teams, patients, communities, public health resources and healthcare delivery systems impact care, outcomes and cost.

NYU School of Medicine is launching the NYU by the Numbers Curriculum, which is a flexible three-year, individualized, technology-enabled blended curriculum to improve care coordination and quality improvement.

Oregon Health & Science University School of Medicine is implementing a learner-centered, competency-based curriculum that enables medical students to advance through individualized learning plans as they meet pre-determined milestones. A portfolio-based system will track milestone achievement and clinical experiences, allowing some students to complete medical school in less than four years.

Penn State College of Medicine has collaborated with Penn State Hershey Health System leaders to design educational experiences that align medical education with health system needs. The Systems Navigation Curriculum (SyNC) prepares students to work throughout the continuum of care. During school, students are embedded in clinical sites across central Pennsylvania as patient navigators to help them better understand patient and health system issues.

The Brody School of Medicine at East Carolina University is implementing a new core curriculum in patient safety for all medical students that features integration with other health-related disciplines to foster interprofessional skills to prepare students to lead healthcare teams for a systems-based approach.

The Warren Alpert Medical School of Brown University is establishing a dual MD/MS degree program to create a new type of physician leader with expertise in population health. The master’s degree program, which includes nine courses, emphasizes teamwork and leadership, population science and behavioral and social medicine and includes two courses being introduced to all students on health disparities and epidemiology/biostatistics.

University of California, Davis School of Medicine is working in partnership with Kaiser Permanente and UC Davis’ residency program to create a three-year medical school pathway called the Accelerated Competency-based Education in Primary Care (ACE-PC). Those enrolled in ACE-PC will simultaneously be considered for acceptance into local primary care residencies.

University of California, San Francisco School of Medicine is crafting the three-phase UCSF Bridges Curriculum, which seeks to create physicians who learn to work expertly in interprofessional teams to continuously improve the safety, quality and value of healthcare.

University of Michigan Medical School’s innovative curriculum includes a two-year foundational “trunk” consisting of integrated scientific and clinical experiences followed by flexible professional development “branches,” which are development tracks to cultivate advanced skill sets within clinical domains at a student’s own pace.

Vanderbilt University School of Medicine has launched Curriculum 2.0 to create master adaptive learners who are embedded in the healthcare workplace during their undergraduate medical education. Students will also use their own competency-based performance data to complete self-assessments and devise individualized objectives to hone self-directed learning skills.

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

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As managing partner for the Knoxville office Greg works closely with a variety of industries including physician practices, law firms, other professional services, automobile dealerships, construction, manufacturing, and not-for-profit organizations.

He provides estate, corporate, limited liability entity, and individual tax planning services. He has spent his entire professional career in the public accounting sector and enjoys sharing his talents by serving on various boards and committees including the finance committee at the Helen Ross McNabb Foundation, the East TN Historical Society and the 1956 Society at UT Medical Center.

Outside of the office, you are likely to find Greg on the golf course enjoying time with long-time clients who are now friends or his son Gregory.

NOVEMBER 2014

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7

HealthcareLeader

Dr. Phillip Jackson

By JOHN SEWELL

Healthcare is indeed a business. Hospital management is a complicated and multi-tiered task that integrates accounting, human resources, policy, strategizing, public relations—and the dreaded numbers crunching to make it all come out in the black. Still, hospital management involves people: people in trauma, people who are undergoing some of the most crucial and dramatic points in their lives. As such, an effective healthcare manager is ever-aware of the human factor. The job requires a deeply ingrained sense of service, honor and commitment.

For Dr. Phillip Jackson, newly appointed (as of September, 2014) Vice President and CEO for Erlanger East and Erlanger North hospitals, healthcare management is a calling—the culmination of a life of service. Jackson began his healthcare career in the military around 35 years ago. Since then, the tireless administrator has acquired a number of degrees and certificates while ascending through the ranks of several healthcare organizations in both public and private sectors. Throughout his career, Jackson remains aware of the onus of service that the job entails.

“For me, the primary element of my job is this idea of service—that’s just the most important thing,” says Jackson.

“When I joined the military in 1978, I immediately got into healthcare. And from there I progressed: I got promoted, I went

to college, and I learned on the job. My passion for healthcare has been there from the get-go. Service has just always been a part of who I am. The service has been very, very personal to me. It’s been [and continues to be] my foundation.”

Jackson’s newly acquired position at Erlanger is not just the endpoint of a series of promotions. Jackson says that his life is an ongoing process of education and personal reassessment.

Sure, Jackson is in healthcare and has the appellation of doctor—but he’s not a physician per se. Jackson has a doctorate degree, which is no small feat in itself.

Among his many titles, Jackson holds a DSL (Doctor of Strategic Leadership)

and is a Fellow of the American College of Healthcare Executives. With these titles and an ongoing commitment to selfimprovement, Jackson continues to hone his craft—always mindful that his primary commitment is to the patients and community he serves.

“The new position at Erlanger is going really well,” enthuses Jackson. “I’m in the process of learning Chattanooga’s healthcare landscape, meeting people from the community and local officials, and being involved with the hospital’s expansion.”

Jackson, who came to Erlanger from Memphis, says that his transition has been smooth.

“So far I feel like I’m prepared for the job,” explains Jackson. “When I was living in Memphis is would come here [to Chattanooga] a lot and I’ve had a good relationship with the CEO of this health system for quite a long time. So the new job doesn’t seem that different thus far.

Before I came here I had a sense of what my marching orders would be, so to speak.” (Once a military man, always a military man.)

“Just dealing with the changed landscape of laws and regulations is a big challenge that we continue to grapple with here at Erlanger,” Jackson continues. “It’s amazing how much things have changed in my career, especially in terms of the technology. And I’m always gaining an awareness of how big the industry is—and

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NOVEMBER 2014

how much of the GNP that the healthcare sector consumes. So I’m just trying to reach out and meet the local officials and let people know who I am.”

Jackson says that his present task is to assist in the ongoing expansion of Erlanger East Hospital. He is also excited about the continued expansion of Erlanger’s Sports Medicine Institution.

“We just had our certificate of Need extended,” explains Jackson. “So we’re in the process of building a four-story service tower which includes a lot of additional beds and new operation tables.”

Jackson’s transition from Memphis to Chattanooga has run smoothly—but the transition is being deployed in stages, again with military precision. Jackson’s wife Hyung, a retired military officer, has remained in Memphis while their daughter, Jessica, finishes high school this year.

After that, Hyung will make the move to Chattanooga. An older daughter, Sarah, attends college where she is a pre-med student.

In the rare instances when Jackson has a moment to himself, he continues his quest of self-improvement through education.

“I don’t know if you’d call it a hobby, but I’m a lifelong learner,” explains Jackson. “It’s an ongoing process. I’ve spent time in higher education, both studying and teaching in Christian institutions.

It’s because I have this passion for learning and education—trying to help other people succeed in life. Education is so fundamentally important to what I do. I’ve taught at other institutions, and I intend to resume teaching at a university at a Master’s level once I get better established here in Chattanooga.”

For Jackson, healthcare administration is much more than just a job. It is an essential part of his very being. And this entails a deeply-rooted sense of responsibility and commitment to the community.

Asked what advice he would have for anyone seeking to follow his career path, Jackson is characteristically humble.

“I think my advice would be to work hard, believe in yourself and always do what’s right. And that requires a lot of focus. But it all connects back with what I learned from the military, those ideas of service, honor and commitment that run so deep.”

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Considering Eyelid or Brow Surgery?

While some doctors or plastic surgeons are qualified to perform cosmetic eyelid surgery, you’ll probably agree that it’s best to choose an ophthalmic plastic surgeon like Dr. Jeff Carlsen, Johnson City Eye Clinic. The Tri-Cities only fellowshiptrained oculoplastic surgeon specializing in cosmetic eyelid surgery, Dr. Carlsen has had extensive training and his expertise in eyelid surgery is second to none. Many types of physicians perform eyelid surgery, including dermatologists, general plastic surgeons, ear nose and throat surgeons, even oral surgeons.

When choosing someone to perform surgery on the delicate area around your eyes, finding a surgeon with Dr. Carlsen’s unique expertise just makes sense.

Before & Afters*

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NOVEMBER 2014

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9

Patient Centered Practices

Heads above the rest Pediatric neurosurgeon adds depth to Niswonger physician team

By JOE MORRIS

advancing pediatric care means that Dr. Nduku has been able to hit the ground running, much

A

dvancements in pediatric medicine

to the relief of children and parents who now

mean that there are more treatments

can keep to a normal schedule while receiving

for childhood illnesses and conditions

the most comprehensive care possible.

now than ever before. But often people in East

“Patients are very, very appreciative of the

Tennessee had to travel to Knoxville, Nashville,

fact that I am here, and that the program is

Atlanta or even Cincinnati to see specialists.

developing,” Dr. Nduku said. “Now they can

That began to change with the advent of

stay home, but still see a surgeon who can

Niswonger Children’s Hospital, and now even

help them. That means no taking off several

more specialized services are available here

days from school and work for traveling back

at home with the addition of Dr. Valentine T.

and forth, but just focusing on getting the care

Nduku, who will head up the hospital’s new

itself.”

pediatric neurosciences program.

As the neuroscience program ramps up,

“Not only have we found a high quality

Dr. Nduku says he looks forward to expanding

doctor, but we recruited him from one of

on the surgeries he now performs so that more

the best pediatric neuroscience programs

and more pediatric patients can receive their

in the nation,” said Steven Godbold, CEO

full spectrum of care at Niswonger. And in the

of Niswonger Children’s Hospital. “This is a

meantime, he plans to oversee their care even

huge win for families in the Tri-Cities, and I’m

if it means travel for him as well.

proud that Niswonger and Mountain States

“If a procedure is very complicated and

Health Alliance have made this a priority. I also want to thank the physicians associated

my commitment to come here and provide

currently do not have, then I will be giving

with East Tennessee Brain & Spine Center.

services.

that patient and his or her family the option

Their devotion to quality and partnership is

Before his time in Cincinnati, Dr. Nduku

of traveling to Cincinnati Children’s Hospital,

going to help make our region a leader in the

graduated from Georgia State University with

as I am a credentialed surgeon there as well,”

neurosciences.”

a Bachelor of Science degree in biology and

he said. “That way, I can still perform the

chemistry, and then completed his Doctor

operation, but then that patient can return

Niswonger Children’s Hospital, Mountain

of Osteopathic Medicine training at the

home, and I can follow up with them here.

States Health Alliance, and East Tennessee

Virginia College of Osteopathic Medicine. He

This means that at Niswonger, we really won’t

Brain & Spine Center. Dr. Nduku is the first

completed his internship at Michigan State

be sending any patients away because they will

pediatric neurosurgeon in the region, treating

University and his residency in osteopathic

be under my care the whole time.”

a variety of conditions, including epilepsy and

medicine at the Philadelphia College of

seizure disorders, congenital neurological

Osteopathic Medicine. Dr. Nduku is a member

8301 for appointments or more information.

diseases, and pediatric head trauma.

of the American Medical Association and the

To learn more about East Tennessee Brain &

American College of Osteopathic Surgeons –

Spine Center, visit www.etbscenter.com. For

Neurosurgery.

more information about Niswonger Children’s

The program is a joint partnership between

The opportunity to build a program from the ground up was one of the major draws from Dr. Nduku, who recently finished his

His training at the Cincinnati Children’s

specialized fellowship training at Cincinnati

Hospital means that Dr. Nduku spent time at

Children’s Hospital. He also liked the idea of

a facility ranked as fourth best in the nation

bringing specialized pediatric neurosurgery

by US News and World Report. His arrival at

services to an area where there were none.

Niswonger further cements ties between the

Dr. Nduku may be reached at 423-232-

Hospital, call 423-431-6111 or visit www. msha.com/children.

two hospitals, and it’s worth noting that in

Presented in Partnership by East Tennessee Medical News and Mountain States Health Alliance

community where I am working, and I liked

addition to its relationship with Cincinnati

All source data for this article has been provided by

what I saw here in the adult neurosurgical

Children’s, Niswonger is one of only six

community,” Dr. Nduku said. “But no pediatric

children’s hospitals in the United States to be

neurosurgeon meant that patients were having

affiliated with St. Jude Children’s Research

to travel an hour and a half, or even more,

Hospital in Memphis.

“I like to make an impact in the

to see a doctor. That is really what drove

10

complex in that it would require services we

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NOVEMBER 2014

That kind of high-profile commitment to

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PhysicianSpotlight

Phil W. Jones, MD

By BRIDGET GARLAND

Ask around the Johnson City area for recommendations on tires, and you’ll probably be sent to a member of the Jones family. Surprisingly, you’ll get the same recommendation if you ask about a good allergist.

Since 1952, Jones OK Tire Store has been in operation in the Tri Cities, a family business that Phil W. Jones, MD, board certified in Allergy & Immunology and Pulmonology, once spent several hours a day working in as a summer job. Although he confessed that there are aspects of that job he misses, Jones decided as an 18-year-old Science Hill High School graduate that he wanted to pursue a career in dentistry. As such, he packed his bags and headed to the University of Alabama in Tuscaloosa, where he earned his Bachelor’s degree, and then moved on to the University of Alabama Birmingham School of Medicine to earn his medical degree and serve his residency.

“I loved studying dentistry,” Jones recalled, “especially the artistry and creativity of the field. I even thought about oral surgery, since it was so enjoyable to me.

But as I looked at my options, I decided to go to medical school, and while I was there, fell in love with Pulmonology.”

In turn, Jones was offered a combined fellowship in Allergy, Immunology, Pulmonary, and Critical Care at Vanderbilt University School of Medicine in Nashville, Tenn. After finishing at Vanderbilt in 2003, Jones returned home to Johnson

City to join Pulmonary Associates of East Tennessee.

A year later, Jones joined his present practice, The Allergy, Asthma & Sinus Center, which at the time was looking to expand into Johnson City, a perfect fit for Jones.

“I had completed my fellowship at Vanderbilt with John Overholt, so I knew the practice was wanting to expand here, but it’s not always easy to recruit to the area,” explained Jones, who has now been with the group for 10 years.

One of the country’s largest allergy

practices, The Allergy, Asthma & Sinus Center currently has 14 allergists practicing at offices located in Greater Knoxville, as well as in Athens, Cookeville, Crossville, Johnson City, Maryville, Morristown, Mt. Juliet, Oak Ridge, Old Hickory, Sevierville, Corbin, KY, and Macon, GA. During typical office hours, Jones has the opportunity to see a wide range of patients, from pediatric to geriatric, as he treats them for their allergy and asthma symptoms.

But that’s not the end of the day for Jones, who also has a thriving hospital practice. As an adult pulmonologist and Chief of Staff, Jones sees patients at Franklin Woods Community Hospital, part of the Mountain States Health Alliance.

Prior to joining the staff at Franklin Woods, Jones formed an interdisciplinary team at the former Northside Hospital, which received various accolades for its tremendous outcomes in pulmonary patient care. He has continued that approach at Franklin Woods, in which a multi-disciplinary team comprised of the pulmonologist, the respiratory therapist, the pharmacist, and critical care staff collaborate to form a plan for the patient’s care that day.

As a recipient of the Mountain States Health Alliance Servant’s Heart Award in 2009, Jones attributes the recognition to the whole patient care his team delivers. “Our team would often be sent patients that others had given up on,” Jones shared. “And to see those patients get bet-

ter….it’s very rewarding.”

Jones also explained that better technologies, such as ventilators that adjust to the patient’s needs, as well as respiratory team protocols, are improving outcomes, alleviating costs, and decreasing hospital stays nationally for pulmonary patients.

He is equally excited about the excellent treatments available for his allergy patients. For these individuals, who may suffer year round with environmental allergies, new medications and immunology therapies are making a huge difference in alleviating their symptoms.

Outside of his busy career, Jones spends his time with family. He and his wife Jennifer have been married for 23 years. Jennifer, who is also from Johnson City, met Jones while he was on a break from college. After the couple married, Jones says Jennifer was a big support to him while finishing school, often working two or three jobs at a time. Now she is a full-time mom to their two children, 17-year-old Madison and 15-year-old Jared, who are both students at Science Hill High School.

Although the family has varied interests, Jones said that they try to carve out time every week to eat dinner together and catch up with each other. He and Madison, who is a varsity cheerleader for Science Hill, share a love of sports, and together cheer on Jones’ alma mater, the University of Alabama.

He and Jared, a World War II buff, have restored a 1942 Ford Jeep and collect mechanic sets from the era. When surveying the photos on the wall of Jones’ office, you’ll find mementos from B17 and B24 flights that the two have taken together. Whether it’s at home or at work, Jones takes an avid interest in his job, as a parent and a physician.

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NOVEMBER 2014

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11

ClinicallySpeaking

BY GEORGE A. PLIAGAS, MD, FACS

The Role of Imaging in Screening & Diagnosis With peripheral arterial and vascular disease affecting some 8 million Americans, imaging technology to evaluate blood flow and venous function has become an invaluable tool. Imaging methods such as Vascular Ultrasound, Magnetic Resonance Angiography (MRA), and Computed Tomographic (CT) Angiogram are increasingly used to screen, diagnose, and treat vascular issues.

Vascular ultrasound uses sound waves, not radiation, to produce real time images that show the structure and movement of blood flow throughout the body. Doppler ultrasound scans visualize blood flow through blood vessels and major arteries, enabling physicians to identify and pinpoint blockages, blood clots, and abnormalities. Ultrasound also aids physicians in planning effective treatment by assessing the size and condition of blood vessels.

As a non-invasive, inexpensive, and widely available technology, ultrasound has become a primary diagnostic tool.

The fact that ultrasound equipment is often portable, and is a safe, painless

test, makes it particularly valuable in screening at-risk patients for peripheral arterial, carotid disease, venous insufficiency, aneurysms, and a host of other vascular issues. The future is bright for ultrasound as new advances in technology allow it to become a three-dimensional tool aiding in the diagnosis of vascular disease.

Despite its benefits, vascular ultrasound does have some limitations. Smaller and deeper vessels can be more difficult to evaluate and image with vascular ultrasound. In some cases, ultrasound cannot differentiate between an occluded blood vessel and one that is significantly narrowed. Calcifications may also obstruct the ultrasound beam. In those cases, other imaging tests such as Magnetic Resonance Angiography (MRA) or CT Angiogram may be necessary.

MRA is a non-invasive test that uses strong magnetic waves to produce detailed images of the vascular system.

An MRA can show the location of a blocked blood vessel and the condition of the blood vessel walls. It is especially

accurate for larger blood vessels. In some cases, MRA can provide information that can’t be obtained from an ultrasound or CT scan.

During the MRA procedure, the area of the body being imaged is placed inside a MRI machine. The narrow tunnel and long scan times can be problematic for obese patients or those with claustrophobia. Contrast dye may be used to increase visualization of blood vessels. While MRA is a safe and valuable procedure for studying blood vessels, it is more expensive than other imaging methods and may not be available in all medical facilities.

CT angiography is a minimally invasive test that uses x-ray beams to scan the body and produce detailed cross-section images of blood vessels and tissues. In most cases an iodine-rich contrast material is injected and used to highlight the area being studied. For patients with vascular disease, lower extremity CT angiography is especially effective at delivering precise detail in small blood vessels. It is also valuable

in the work up and planning therapy of thoracic and abdominal aortic aneurysms. Many vascular patients can undergo CT angiography instead of a traditional catheter angiogram. This method is quicker and more comfortable for most patients. The CT angiography is also valuable in screening and detecting the narrowing or obstruction of blood vessels and venous disease before symptoms are present. Limitations include the slight risk of cancer from radiation exposure and possible reaction to the iodine-rich contrast dye.

As imaging technology continues to advance, with improved clarity that includes capabilities such as 3-D visuals, vascular patients will benefit from more accurate screening and diagnostic methods that lead to earlier treatment and better outcomes. The future of imaging is bound to enhance and make the future brighter for vascular patients.

George A. Pliagas, MD, FACS is a vascular surgeon with Premier Surgical Associates in Knoxville, Tennessee.

The Case for Covering Low-Dose CT Lung Cancer Screening, continued from page 1 The Science

While CMS will complete the coverage decision process in a 12-month period, proponents say the science supporting CT scans for diagnosing lung cancer goes back several decades. Considering the current poor survival rates, this delay in integrating the scientific research into routine practice has been particularly frustrating for providers.

Kazerooni said more than threequarters of lung cancers are found in a late stage when the disease has spread, making surgical intervention ineffective or impossible. Patients are typically asymptomatic until the disease has progressed, which contributes to dismal survival rates.

Currently, more than 90 percent of those diagnosed annually with lung cancer will die from the disease.

Research from the International Early Lung Cancer Acton Program (IELCAP), which was formed in 1992, has shown annual CT screening to be an effective tool. In the original study, more than 1,000 high-risk, asymptomatic patients were screened. Of those who received a lung cancer diagnosis, more than 80 percent were at a clinical Stage 1.

Subsequently, findings from a much larger international pool were published in several publications in 2006 after longterm follow-up of more than 31,000 asymptomatic study participants. While less than 2 percent of those screened received a lung cancer diagnosis, 86 percent were found in Stage 1 with an overall cure rate of 80 percent.

Similarly, the National Lung Screening Trial (NLST), one of the largest and most expensive clinical trials ever under12

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NOVEMBER 2014

taken in the United States, evaluated the impact of screening methods on survivability. The trial, which ran from 2002-2010 and included more than 53,000 participants, compared outcomes when screening with standard chest x-ray vs. LDCT. The results published in 2011 in the New England Journal of Medicine demonstrated a 20 percent reduction in lung cancer mortality for those screened by LDCT. In both arms of the trial, more than 94 percent of positive screening results turned out to be false positives upon further testing, which is one of the arguments against annual screening. It should be noted, however, that the false positive difference between LDCT and conventional x-ray was less than 2 percent, yet decreased mortality with LDCT was 20 percent.

The available science led the United States Preventive Services Task Force (USPSTF) to assign a grade of B to lung cancer screening among high-risk patients —current or former heavy smokers, ages 55-80, with a smoking history of at least 30 pack-years. The USPSTF website defines the evidence behind a grade of B as being strong enough to recommend the service be provided.

The task force isn’t the only organization to support LDCT screening for high-risk patients. In fact, Kazerooni said most every major clinical healthcare professional society, including the American Medical Association, has stepped up to voice support for CMS adopting coverage.

“There’s overwhelming professional support,” Kazerooni said. “We also have a lot of support from the House and Senate,” she added, noting congressional support is bipartisan.

The Decision

The irony, Kazerooni continued, is the USPSTF recommendation led to a screening inclusion in the federally mandated Affordable Care Act requiring third party payers cover LDCT for those at high risk of developing lung cancer. “It’s not a ‘recommended;’ it’s not a ‘they should;’ it’s a ‘must,’” Kazerooni said of the screening becoming a covered benefit beginning Jan. 1, 2015.

If CMS doesn’t reverse current policy, then those who have received annual screenings for as much as a decade will abruptly lose the benefit when they hit 65 and qualify for Medicare coverage.

“The average age of lung cancer diagnosis is 70 so to not offer lung cancer screening as they enter their peak years of risk would be a tragedy,” Kazerooni stated.

Among the issues being weighed by CMS are patient safety, frequency of testing, impact of false positive results, consistent quality across screening facilities, evidence-based data to identify eligible patients and inform follow-up and treatment, and cost of screening in relation to improved outcomes.

Kazerooni noted CMS is undertaking the normal due diligence that goes into releasing a national coverage analysis decision. She and colleagues across a number of medical specialties have provided information and parameters for the screening. For example, she noted, the American Association of Physicists in Medicine has created specific exam protocols. The ACR, which is one of three bodies that accredits CT facilities, has developed a practice standard for the

screening. Proponents, she stressed, are specifically calling for low-dose, rather than standard dose, scans to improve the safety profile. Providers also agree smoking cessation counseling should be part of the overall professional intervention for all high-risk individuals who qualify for screening.

As for cost, Kazerooni said, “Lowdose CT screening is at least as cost effective, if not more so, than breast cancer screening. When you’re talking about breast cancer screening, you’re talking about every woman of a certain age. Even though CT scans are more expensive, we’re targeting resources to a smaller, high-risk group.”

Bolstering that assertion, a study published in August in American Health and Drug Benefits found LDCT to be cost effective in the Medicare population.

The researchers found implementing the screening cost less than $20,000 per lifeyear saved, which is less than the costs associated with cervical and breast cancer screening.

Kazerooni is favorably encouraged CMS will follow suit with private payers and cover LDCT screenings for those with the necessary inclusion criteria who are not suffering from another medical condition that would significantly limit life expectancy. However, she added, she is interested to see what conditions CMS attaches to approval.

“It’s hard to believe they would do anything else but cover it,” she concluded of CMS. “There is a huge need for this, and we want to see it brought forward to benefit individual patients and the public at large.” easttnmedicalnews

.com

How Web Design Will Alter the Future of Healthcare

By HEATHER RIPLEy

According to Pew Research, the way Americans view healthcare is now driven heavily by the internet. Seventy-two percent of U.S. internet users say they have looked for health information online within a year, and 52 percent of smartphone users say they regularly research healthcare information on their phones.

With the growing trend of online healthcare consultation, physicians can no longer just get by with a simple landing page. As 2014 comes to a close, it is a wise

business decision to evaluate your medical practice’s website and determine if any changes need to be made in order to keep up with the future of healthcare trends.

When reviewing your website, make sure it meets these key points: Responsive on all platforms: Single website layouts can be detrimental to any business’s growth, but the repercussions can be even more serious on healthcare providers. As mobile device users increase, a physician’s website should have the ability to transition from mobile, tablet, and desktop versions automati-

cally. People’s search habits are different depending on the device and having options such as “Request Appointment,” “Contact Us,” or “Emergency” first on a mobile device layout might not be a bad idea.

Interactive: From the popularity of WebMD came a trend of patients who self-diagnose. While this can be empowering for members of the public, it can become frustrating for dedicated physicians.

Having interactive tools that encourage patients to make appointments for checkups or call urgent care numbers can lessen

The Literary Examiner

BY TERRI SCHLICHENMEYER

The Map of Heaven

by Eban Alexander, MD (with Ptolemy Tompkins); c.2014, Simon & Schuster; $21.99 / $26.99 Canada, 208 pages

If you don’t know what path you’re taking, you can’t be sure where you are.

But in The Map of Heaven by Eban Alexander, MD (with Ptolemy Tompkins), you may find the plat you need, to know where you’re going.

You are a star.

Literally, some of what’s inside you came from “ancient, now long-dead stars.” We are “organic chemistry and biochemistry,” and the Bible says we will return to dust when we die. But since time began, humans have wondered if there’s “more to the story.”

Lately, science has tried to answer that with a “Theory of Everything.” The problem is that that doesn’t settle profound questions on the meaning of existence. We can look to religion, but that may not have an answer, either.

Instead, says Alexander, “The key to understanding this world... is to remember the place above and beyond, where we really came from.” Heaven, he believes, is what makes us human and, without it, “life makes no sense.” Furthermore, when we become open to the “larger world behind the one we see around us every day,” we will find the “Gifts of Heaven.”

The Gift of Meaning, for instance, is something that “people are starving for,” but that is already inherent in life. Part of understanding it lies in understanding that coincidences are not coincidental, but may be messages from beyond.

The Gift of Vision allows us to see how we’re connected with one another and with every living thing. The Gift of Belonging helps us know that we are where we need to be, and that “higher worlds” surround us. The Gift of Strength teaches that we will someday be much more than we are today. The Gift of Hope tells us that we “must not forget that [this world] is not all there is.”

Imagine yourself standing at the edge of the Grand Canyon, looking down. easttnmedicalnews

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What you’d see is not quite how deep “The Map of Heaven” is.

Using ancient philosophy, modern psychology and medicine, science, etymology, letters from readers, several different religious tenets, and a big dose of New Age, author Eben Alexander, MD, attempts to put the Afterlife in context for us on Earth.

This expounding on his previous book (“Proof of Heaven”) is provocative, but also quite disorienting. Alexander bounces from one discipline to another so quickly (sometimes in the same sentence) and so often without context that I gen-

erally had a very hard time following his thoughts before he careened to the next idea.

It could be argued, I suppose, that this imparts a sort of excitement to what’s said here, and the meaning behind the meaning of life. That could be so, but just know that The Map of Heaven is as deep as they come, and it may cause your brain to recalculate.

the doubt often associated with symptom checkers and strengthen your doctor-patient relationships.

Holds a unique voice: Is the only thing separating your website from the local competition’s a street address? For Primary Care Physicians especially, adding a unique voice such as a blog to your website can showcase a dose of personality and position your practice as the friendly experts. This might just be enough to sway patients your way.

Minimalist Design: Having a flashy website is nice for flamboyant companies but can be harmful for healthcare providers. By implementing what’s called Flat Design, your website can strip down the visuals and concentrate on what’s important - the content. Use clear backgrounds, flat colors, and crisp fonts but be careful as there is a difference in Flat Design and boring.

In just the past few years, website design has advanced greatly and with the ever increasing technology spectrum, keeping up with consumer demands is something all professionals should be aware of. For physicians, having a good website that is friendly, professional, inviting, and useful on all devices is paramount for success in this modern world. It’s what can make your practice stand out from the rest.

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.

Heather Ripley is the founder and CEO of Ripley PR, a national public relations agency specializing in healthcare. For more information, visit www.ripleypr.com or email hripley@ripleypr.com.

ARE YOU A LEADER WITH A PROVEN SALES RECORD? RESPONSIBILITIES:

Southcomm Inc seeks a Publisher for East Tennessee Medical News, a publication covering the medical community in East Tennessee and Southwest Virginia. The Publisher is responsible for operational, strategic and financial success of the paper and for establishing a culture of continued success and for achieving operational and financial results. The successful publisher will actively be involved in the local medical community and have a proven sales track record.

• Leadership of the publication and setting the strategic vision • Lead sales and marketing efforts to achieve company objectives and builds strong relationship with key advertisers • Be informed and knowledgeable of local and national healthcare industry • Build sustainable value propositions for subscriptions and advertising revenue • Ensure audience development and subscriber retention strategy is active and aligned with advertiser priorities QUALIFICATIONS/EXPERIENCE • Bachelor’s Degree or higher • Demonstrated track record of increasing top line revenue • A history of successful leadership, innovation and goal achievement.

• Able to effectively manage and coordinate in an environment of accountability.

TO APPLY FOR THIS POSITION: EMAIL YOUR RESUME ALONG WITH A COVER LETTER TO: PATRICK RAINS, GROUP PUBLISHER AT PRAINS@SOUTHCOMM.COM.

SOUTHCOMM, INC. IS AN EQUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE ON THE BASIS OF RACE, RELIGION, SEX, AGE, NATIONAL ORIGIN.

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GrandRounds CME Program offered as Joint Sponsorship between LMU-DCOM & The University of New England College of Osteopathic Medicine Program Title: Best Practices in Clinical Teaching: A Panel Presentation Date: November 6, 2014 Time: 6:00 pm – 8:00 pm Location: Kingsport Chamber of Commerce Cost: Free with dinner provided CME: 2.0 AMA PRA Category 1 Credit(s)TM and 2.0 University of New England contact hours for non-physicians has been approved. 2.0 hours of AOA Category 1-A CME credit is pending.

Program Description: Clinical settings offer rich environments for teaching opportunities. Evidence-based teaching methods and instructional strategies provide value to the educational experience and improve teaching and learning for the preceptor and student and ultimately, patient care outcomes.

This CME activity uses a panel of clinical teaching experts to present discussion topics on precepting in a busy practice, promoting student learning, and the art of precepting to improve teaching and learning at rotation sites in consideration of practice time constraints.

To register: http://dcomcme.lmunet. edu/best-practices-clinical-teaching-panelpresentation-live-2014

LMU-DCOM and ORAU Online CME Program “Increasing Patient Safety” Available Through December 30, 2014 Program Available Online at Minimal Charge HARROGATE—Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) in Harrogate, Tenn., in partnership with Oak Ridge Associated Universities (ORAU) radiation emergency medicine physicians and experts has created an online Continuing Medical Education (CME) program entitled “Increasing Patient Safety: Recognition and Management of Acute Local Radiation Injury (LRI).”

The online CME program was re-

leased in December 2013 and will be available through the end of this year.

The two-hour online program addresses acute local radiation injuries, providing a deeper understanding of the subject matter through the study of current publications, addressing related case study issues and with a panel discussion highlighting subjects of concern for osteopathic physicians. Primary care physicians will usually be the first health care providers to see the conditions that result from accidental or malevolent overexposure to ionizing radiation. This online CME delivers education and training curricula to address the time and resource constraints of the busy practitioner who traditionally does not have the time or resources to engage in disaster medicine CME offerings.

The faculty includes: Dr. Doran M. Christensen, ORAU associate director/staff physician; Dr. Ronald E. Goans, ORAU senior scientific/medical advisor; Dr. Carol J. Iddins, ORAU staff physician; and Dr. Michael Seaman, assistant professor of family medicine and emergency medicine at LMUDCOM. Registration cost is $40 and is available online at https://www.docmeonline. com/. The program is best viewed through a computer internet browser, such as Chrome or Internet Explorer. It is recommended that participants view the online program on a computer with an operating system of Windows 7 or higher. The program is not optimized for viewing on a mobile device.

Two hours of Category 1-A AOA credit will be available to current AOA members. The program is made possible by a grant from the American Osteopathic Association.

AMA’s New Fact Sheet for Physicians Aims to Help Ensure Patients Continue to Have Access to Medically Necessary Treatment Under New DEA Rule WASHINGTON – The American Medical Association (AMA) has released a new fact sheet to assist physicians in complying with new federal regulations on prescribing hydrocodone and help avoid disruptions in patient care. The rule, effective October 6,

2014, reschedules hydrocodone combination products (HCPs) into Controlled Substance Schedule II. Millions of patients will be impacted by this new rule from the Drug Enforcement Administration (DEA), and the new resource will help physicians understand the rule and avoid interruptions in access to medically necessary HCPs for their patients.

Prescriptions for HCPs issued before October 6 that have authorized refills can be dispensed in accordance with current DEA rules for refilling, partial filling, transferring, and central filling of Schedule III-V controlled substances until April 8, 2015.

However, due to state laws and limitations on some pharmacy and insurance processes - some health insurers and pharmacies may deny requests for refills on or after October 6. To help ensure continuity of care for patients and reduce confusion, the AMA is encouraging prescribers to act now to provide new hard copy or electronic prescriptions for patients, rather than depending on existing refills.

In addition to providing helpful resources like these to physicians, AMA intends to continue its advocacy efforts for a multi-pronged approach to address prescription drug abuse and diversion.

For more information, please visit www. ama-assn.org.

Tennessee Cancer Specialists Welcomes Dr. Sudarshan Doddabele to Group KNOXVILLE—Tennessee Cancer Specialists welcomes Sudarshan Doddabele, MD, to their practice. Doddabele completed his medical degree at Karnatak Medical College, an internship and residency in internal medicine at East Tennessee State University, and a fellowship in hematology at Baylor College of Medicine. He is board certified in medical oncology, hematology, and internal medicine, and has been practicing since 2000.

Doddabele is returning to the East Tennessee area after 7 years. He had a previously thriving practice in the Morristown, Tenn., area, and most recently was in Sioux City, IA.

Mark Your Calendar

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

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, John Sewell 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

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

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

Registration is required. Visit www.kamgma.com.

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

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

Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Chief Operating Officer/Group Publisher 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. ©2014 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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GrandRounds Renowned Neuroscientists at UT Medical Center to Lead Researcher Team in Studying the Brain KNOXVILLE—Two of the world’s most renowned neuroscientists are now based at The University of Tennessee Medical Center and will lead a collaborative team of researchers in the Knoxville region to advance research studies of the brain.

Dr. Helen A. Baghdoyan and Dr. Ralph Lydic, a married couple and research team who were recruited to Knoxville from the University of Michigan, are charged to build a nationally recognized neuroscience research program in the UT Medical Center’s Department of Anesthesiology through further enhancing interaction, collaboration and exchange between UT’s main campus, Oak Ridge National Laboratory, UT Medical Center, and the medical center’s Cole Neuroscience Center.

The Chattanooga Heart Institute Welcomes Vinay Madan, MD CHATTANOOGA–The Chattanooga Heart Institute at Memorial welcomes Vinay Madan, MD. Madan is board certified cardiovascular diseases and specializes in interventional cardiology.

He completed fellowships in cardiovascular disease and interventional cardiology at New York University Dr. Vinay Madan Langone Medical Center.

Madan completed his internship and residency in internal medicine at BarnesJewish Hospital at Washington University School of Medicine. He is a graduate of the University of Alabama at Birmingham School of Medicine and holds a degree in biochemistry from Rhodes College in Memphis, TN.

Hutcheson Votes to Resume Labor & Delivery Services Hospital Will Once Again Be “The Place Where Babies Come From” FORT OGLETHORPE, Ga. –Citing overwhelming demand from physicians and the community to once again offer maternity services, the Board of Directors for Hutcheson Medical Center voted today to resume the hospital’s Labor, Delivery, and inpatient pediatric services by the end of the calendar year.

In preparation for reopening the service, Hutcheson has remodeled the Labor and Delivery unit to compete with other area birthing facilities. “Today, it’s not enough to provide excellent quality medical care.

Mothers and families want an aesthetically pleasing environment with modern amenities in which to give birth, and our new wing offers just that,” stated Sandra Siniard, Vice President of Patient Care at Hutcheson.

Darrell Weldon, MD, an OB/Gyn physician who has delivered over three generations of babies at Hutcheson and serves as Chairman of the hospital’s Authority Board, says he is very excited about Labor and Delivery reopening. “Many families want to deliver their baby at Hutcheson because of the level of service excellence they have

experienced in the past. The hospital has made substantial renovations to the Labor and Delivery center and I believe patients will be pleasantly surprised and impressed with the facility.”

Generous Gift to the UT Center for Advanced Medical Simulation Helps Keep Medical Clinicians Prepared KNOXVILLE—The University of Tennessee Medical Center and the UT Graduate School of Medicine recognized the generous gift of $300,000 to the UT Center for Advanced Medical Simulation from Mike West and Back Porch Vista Capital

Management. The unveiling of the plaque occurred on the anniversary of the Front Street Baptist Church bus accident. It provided the occasion to show how the Simulation Center is utilized for medical education throughout the region.

When rapid and accurate assessment, along with the ability to resuscitate and stabilize is required, skills needed to manage critically injured patients must be instinctive. Such instincts are acquired through training and dedicated practice which is facilitated at the UT Center for Advanced Medical Simulation.

The UT Center for Advanced Medi-

“WorkIng WIth SVMIC haS been an extreMeLy PoSItIVe exPerIenCe.” — Dr. Olawale Morafa Family Practitioner Health First Family Care PC Memphis, TN Policyholder Since 2002 “With SVMIC, I am constantly reassured of having the best liability insurance coverage available. Over the years, I have also saved money with SVMIC because it is mutually owned.

Not only have my premiums come down, but SVMIC has helped me manage my practice more

Medical Professional Liability Insurance

efficiently. SVMIC has assessed my practice two times in the past four years. Working together, we have been able to identify trends in our financial management that have been very useful. As a result of SVMIC’s analysis and recommendations, I have been able to improve the operating and financial performance of my medical practice.”

More Grand Rounds Online

cal Simulation, located on the UT Medical Center campus, is the place where physicians, nurses, pharmacists and many other clinical staff - locally, regionally, nationally and even internationally - perfect their skills in not only treating and caring for critically injured patients, but for all patients. At the simulation center, new techniques are taught and practiced, surgeries are rehearsed, and medical teams use hands-on and realistic exercises of various life threatening scenarios in order to be prepared for whatever may occur.

Follow us @SVMIC

Mutual Interests.

Mutually Insured. www.svmic.com Contact Deborah Hudson or Susan Decareaux at 1-800-342-2239 or mkt@svmic.com

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Niswonger Children’s Hospital brings a new specialty to the region. Dr. Valentine T. Nduku is helping to establish the Tri-Cities’ first pediatric neurosciences program, an important

New service.

part of our continuing expansion of specialized services for children. He comes to Johnson City from Cincinnati Children’s Hospital, recently ranked as the fourth best pediatric neurosurgery and neurology program in the country.

With the medical direction of Dr. Nduku, Niswonger Children’s Hospital will be able to provide treatment for a wide range of pediatric neurosurgery needs, including: • Epilepsy and seizure disorders • Congenital neurological diseases • Pediatric head trauma

New surgeon.

New program.

www.msha.com/children

Independent member of the medical staff

To learn more about this program, please visit msha.com/pediatricneurosurgery.