East TN Medical News Sept 2013 by FW Publishing

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PHYSICIAN SPOTLIGHT PAGE 3

Dr. Homero Rivas II ON ROUNDS

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Jolie Sparks National BRCA1 Conversation

Wellmont certiﬁed genetic counselor provides answers

By StACy FENtRESS

HEALTHCARE LEADER: Alex Stockdale For Alex Stockdale, a career in healthcare has meant focusing on the small things, but also being able to look at a much, much bigger picture ... 4

This past May, actress and director Angelina Jolie made news around the world when she announced she had undergone a preventive double mastectomy because she tested positive for the BRCA1 gene. Her revelation sparked conversations and renewed interest in the idea of genetic testing to determine cancer risk, and it caused women to ask themselves, “What would I do?” For Debbie Pencarinha, a certified genetic counselor with the Wellmont Cancer Institute, this isn’t a new discussion. But Pencarinha recognizes that Jolie’s story has brought genetic testing to the forefront. “Angelina Jolie’s story brought a lot of education to the public and showed people that it’s okay to make big decisions to take control of your health,” Pencarinha said. “You don’t

Debbie Pencarinha, a licensed, board certiﬁed genetic counselor, provides genetic testing services at the Wellmont Cancer Institute

(CONTINUED ON PAGE 14)

Enjoying East Tennessee “Days Gone By” Museum of Appalachia –Norris, Tennessee Storytelling is a gift, and it can truly make the past come alive ... 7

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Shining a Light on Physician, Industry Relationships Physician Payments Sunshine Act Now in Effect By CINDy SANDERS

If you’ve recently enjoyed a golf outing with your friendly pharmaceutical rep or a nice dinner with a device manufacturer, that information will soon be available for all to see. The Physician Payments Sunshine Act went into effect Aug. 1 of this year and requires applicable manufacturers to report certain interactions with physicians and teaching hospitals that are deemed to have value. ‘Applicable manufacturers’ are defined as pharmaceutical, device, biologic and medical supply manufacturers whose products either require a prescription to be dispensed or for which payment under federal healthcare programs is available. “The Sunshine Act generally applies when physicians or teaching hospitals receive transfers of value from applicable manufacturers, and the applicable manu(CONTINUED ON PAGE 8)

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PhysicianSpotlight

Dr. Homero Rivas II By JENNIFER CULP

Dr. Homero Rivas II has a deep appreciation for the importance of spinal health and pain management. At age 19, Rivas—who was extraordinarily physically active in his youth, participating in sports ranging from soccer to windsurfing to mountain climbing—suffered a terrible accident that could have killed him. Instead, it set him on a new course in life. Intending to study aerospace engineering and become a Naval pilot, Rivas attended the Naval Academy after graduating from high school. “Unfortunately, in my second year at the Academy, I had a very serious accident where I fell about four floors and spent August 26 of 1990 to July 3 of 1991 in the hospital,” he summarized the incident succinctly. On late-night weekend security watch, Rivas fell through the space in the middle of a winding stairwell to land in a concrete basement. He woke up in an intensive care unit in Baltimore on the following Monday morning with no memory of the accident. He suffered dreadful injuries, including— among others—a shattered pelvis, fractured vertebrae, a broken left hip and broken right ribs, dislocated right shoulder, and fractured right wrist. Due to osteomyelitis resulting from infection of the screws placed in his left hip, surgeons eventually fused the hip, rather than attempt to perform a hip replacement. Rivas was discharged from the Navy due to the severity of his injuries,

and the recovery process was long and difficult. “I had to use a cane just to get around up until probably the fall of ‘93. It took a good solid three years after that to get back to normal— well, as normal as you can be,” he explained. “Unfortunately, the first fracture of L4 damaged the spinal cord, so there was damage to the nerves going to the bowel and bladder, as well as the right leg. I still have a lot of residual weakness in the right leg and a lot of atrophy because of that nerve damage, along with some minor nerve damage to the bowel and bladder.” Fused vertebrae also affected his movement. In 1992, the hip fusion had to be redone, putting Rivas back in a body cast for another three months of that year and delaying his return to college, and normal life, still further. In spite of his numerous injuries and grueling years of rehabilitation, Rivas didn’t let the accident keep him down. “I remember telling myself, ‘If I never set foot in a hospital again for the rest of my life, I’ll be happy,’” he said. Starting over, he went back to college and earned a degree in Mechanical Engineering from the University of Texas in Austin, Texas. Researching the design of hip implants gave him a better understand-

ing of their shortcomings and the reasons his treatment team chose fusion as the best option in his own case, leading to his interest in attending medical school, with a particular focus on physical medicine and rehabilitation. The accident also indirectly led to another of Rivas’ enduring interests: scuba diving. “At that time, I was still getting around with a cane. I was looking for something I could do to be active that would take some weight off of my back and my hip, and diving was sort of a natural thing to try,” he said. Nearly 20 years and many more dive certifications later, he still takes trips to dive with some of the friends he made while earning his initial open water dive certification. Rivas’ expertise in non-surgical spine care and scuba diving both come into play in his brand-new practice, Chattanooga Spine & Body. The practice approaches the treatment of back pain, neck pain, and related spinal conditions through conservative management, utilizing physical therapy, medication, and injections, and also offers non-surgical treatments for musculoskeletal pain. A member of the Referral Physician Network for the Divers Alert Network with recognized training in hyperbaric medicine and diving medicine, Rivas also offers predive physical examinations for those who need clearance prior to taking a SCUBA class or diving. Chattanooga Spine & Body is a cashonly practice, which Rivas believes will allow freedom to provide the best possible treatment options for patients, while keep-

ing prices fair and affordable. Over the course of his career, Rivas became frustrated over past experiences in which patients were denied coverage for beneficial treatments by their insurers and suffered reduced quality of life as a result. Rather than relying on insurance companies to determine which treatments are medically necessary or have resulted in sufficient improvement to warrant further treatment, the cash-only model allows the physician and patient to determine the appropriate course of action for each patient’s individual circumstances. Outside of work, Rivas stays very active. He most often dives in caves, rather than open water, visiting the Florida Panhandle and north central Florida to cave dive. After years of cave diving, he developed an interest in dry caving, leading him to spend a good deal of time in one cave or another. This led to further interests in photography and videography. “People always ask me, ‘Why do you dive? Why do you cave? Why do you cave dive?’” he said, “so now I can show them photographs or video to show them what I see underwater, or underground, to see why I do it.” Interested parties might get the chance to hear Rivas, too; he is also a didgeridoo player with over 10 years experience, and even plays in caves! Rivas refused to allow tragedy and physical injury to limit the scope of his life, and in his work at Chattanooga Spine & Body, he hopes to help others overcome pain in order to live their lives to the fullest.

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SEPTEMBER 2013

HealthcareLeader

Broader perspective Healthcare exec helps practices analyze, improve operations By JOE MORRIS

For Alex Stockdale, a career in healthcare has meant focusing on the small things, but also being able to look at a much, much bigger picture. As the owner of Next Level Strategy Solutions, based out of Knoxville and Charlotte, NC, Stockdale works with healthcare providers, pharmaceutical companies, and other healthcare-related entities to help them find effective administrative solutions for their practices, as well as navigate technology upgrades and the many other components of the Affordable Care Act. But as a longtime administrator for medical groups, he also has years of experience working within just one organization on the minutiae that can mean the difference between a successful practice and one that struggles no matter how healthy its patient volume. “With my own company, I help them with the day-to-day operations sometimes, but also with much larger strategic decisions, such as hiring a COO,” Stockdale said. “My role is to guide them through any area where they are having issues, or might need some outside perspective.” Becoming a healthcare-business expert wasn’t on his radar when he got a marketing degree from the University of Tennessee, but through some social connections, he found himself working for an Oak Ridge-based physician who had just gotten into the then-new ultrasound technol-

ogy in a big way, and needed some help promoting its various attributes. “This was a technology that was just as good for a veinogram or arteriogram, and it didn’t involve the invasive procedures and the risk,” Stockdale recalled. “He had the machine, which had cost several hundred thousand dollars, and didn’t really have much beyond that. A friend connected us, and I worked with him to create a marketing plan and other details for what was then a new entity, the diagnostic center.” Stockdale eventually returned to school at Tennessee Tech for a Master’s degree in finance, but also helped his initial client

build a vascular surgery practice. Once that was up and running, he opted to tie into a small group of specialty ophthalmologists and help build another enterprise from its starting point. “Over time, we grew that group from about 12 people to more than 200, and at the time, they were the largest retina group in the country,” he said. “But when I left them, I had really been thinking about becoming my own boss, and taking what I’d been doing and building my own company around it.” His goal, both then and now, is to allow physicians to separate their practices into two tracks: patient focus and business side. By doing so, they can give each the time and attention it needs to make the whole operation run successfully, Stockdale said. “They often are at cross purposes; if they do the business part correctly, they sometimes will let the patient side get behind, and if they are only patient focused, and doing all the right things there, it’s easy to let the business side get behind,” he said. “The two really work hand in hand, and when everything gets the proper attention, they will have a successful business and also be doing a better job helping patients. It’s really a lot like engineering, when the job is to figure out the best way to get a desired outcome.” Decisions that must be made can include how to approach the market, which means everything from figuring out the geographic area to be served all the way

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down to specific products and services, as well as plans for potential growth. “If they are making decisions that benefit the patients, the financial side will usually take care of itself,” Stockdale said. “But a lot of times, I am able to bring in some knowledge of best practices that they may not have. I can take a snapshot of the company, then look at the industry’s best practices, and finally compare the two. Quickly, we can see that some areas need more attention than others.” He also makes sure to listen to the physicians involved, as they will have specific ideas about what they want to accomplish, and some very clear priorities in that regard. Those also will drive the practice, and must be folded into any forwardthinking business plan. It all sounds fairly straightforward, but in a healthcare climate that’s changing daily, and with multiple large-scale unknowns still looming as the Affordable Care Act is fully deployed in the coming months, the challenges are still fairly robust. “We’re in an environment of decreasing fees, so every practice is having to learn how to do more with less,” Stockdale said. “How do you make your processes more efficient? Margins are shrinking, there are more governmental regulations and dictates on everything from electronic medical records to privacy issues, but the bottom line is that all this must be handled while doing a better and more efficient job taking care of patients.” To that end, he says, the goal will be to stay on top of any and all innovations, from technology to drug therapies, in order to keep practices viable. “I think that the really progressive practices who are tackling these issues now are going to be very well positioned for success in the future. They are implementing new technologies, they are shoring up their geographic and physician coverages, and that means they are working through their efficiency challenges. Physicians and practices have proven over the last 20 years that they can work in an environment of declining fees and reforms, and always figure out a better way to deliver care. Their outcomes prove that. We’re in another realignment period now, but I am very optimistic about how the smart practices will survive the changes.”

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LegalMatters

Online Event Calendar

BY DIANA L. GUSTIN, ESQ.

HIPAA Five-O: Complaints, Compliance, and the Privacy Police

How does an investigation begin? An individual has the right to file a complaint with the Secretary of Health and Human Services if that person believes a covered entity or business associate is not complying with HIPAA(4). The Secretary will investigate any complaint when a preliminary review of the facts indicates a possible violation due to willful neglect. The comments in the Federal Register indicate the Secretary currently conducts a preliminary review of every complaint received and proceeds with an investigation where the facts indicate a possible violation of the HIPAA Rules. (Mandatory reports for breach may also trigger a complaint and investigation.) When does an investigation become a compliance review? If the investigation indicates there

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might be facts to support the possibility of a violation due to willful neglect, the Secretary must conduct a compliance review. The Secretary will conduct a compliance review of the covered entity or business associate to determine if there is compliance with the applicable administrative simplification provisions when a preliminary review of the facts indicates a possible violation due to willful neglect(5). The Secretary also retains discretion to conduct a compliance review in any other circumstance(6). What is “willful neglect”? The term “willful neglect” is defined at 45 C.F.R. §160.401 to mean the conscious, intentional failure or reckless indifference to the obligation to comply with HIPAA. The comments in the Proposed Rule listed examples of willful neglect as 1. disposal of a hard drive in an unsecured dumpster where the covered entity failed to implement policies and procedures to safeguard PHI during the disposal process; 2. failure to respond to an individual’s request for restriction of the uses of PHI where the covered entity did not have any policies and procedures in place for consideration of the request for restriction; 3. a covered entity’s employee loses a laptop that contains unencrypted PHI and the covered entity feared for its reputation if the incident became public and decided not to provide the appropriate notification(7). The facts in the above examples were described as situations where the covered entities had actual or constructive knowledge of the violations. It is important to recognize that two examples focused upon the covered entities failure to have policies and procedures in place, which was described as “a conscious intent or reckless disregard” of their compliance obligations. Who should have compliance policies and procedures? Covered entities, business associates, and subcontractors need to have appropriate policies and procedures in place to protect the privacy and security of individual’s medical information. The comments to the Proposed Rules note it was assumed that business associates in compliance with their contracts would have already designated personnel to be responsible for formulating the organization’s privacy and security policies, performed a risk analysis, and invested in hardware and software to prevent and monitor for internal and external breaches of protected health information(8). To emphasize the requirement, the risk of criminal and/or civil monetary penalties

was referenced as an incentive for organizations to bolster their security and privacy policies. What does it all mean? The law continues to evolve through a complex system of rules, regulations, and guidance. Keep it simple by making your patients’ privacy a priority. Update your compliance program and train your staff to stay current with the law, as well as the technology.

To submit or view local events visit the East Tennessee Medical News website.

Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice. 78 Federal Register 5566, January 25, 2013 See 45 C.F.R. §160.402 and §160.404 3. 45 C.F.R. §160.308 4. 45 C.F.R. §160.306 5. 45 C.F.R. § 160.308(a) 6. 45 C.F.R. § 160.308(b) 7. 75 Federal Register 40879, July 14, 2010 8. 75 Federal Register 40909, July 14, 2010 1. 2.

Diana L. Gustin is an attorney practicing at London & Amburn, P.C. Her practice focuses on defense of clients responding to government and private payor reimbursement claims, healthcare compliance and regulatory matters, including HIPAA. For more information on HIPAA or other health law matters, you may contact Ms. Gustin by visiting www. londonamburn.com.

A user name and password are required to submit an event. Under Member Options, go to “free sign up” to register.

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Opening Night: Tragedy to Triumph

featuring Cherylonda Fitzgerald, Cello Saturday, October 12, 7:30 p.m. Mary B. Martin Auditorium at Seeger Chapel, Milligan College

Johnson City Symphony Orchestra

As Detective Steve McGarrett would often say on the classic television show Hawaii Five-O: “Book ‘em, Danno.” Only in this case, it’s not “murder one” on the Hawaiian islands – it’s for violation of the HIPAA Privacy Rule. On January 25, 2013, the Office of Civil Rights published the Final Rule to implement modifications to HIPAA Privacy, Security, and Breach Notification rules(1). The basis for the imposition of a civil money penalty was revised to include business associates. The potential amount for a civil penalty increased to permit an assessment of the maximum of $1.5 million for identical violations during a calendar year. The penalty is based upon the facts and circumstances in a four tier system: (i) the covered entity (or business associate) did not know and by exercising reasonable diligence would not know of the violation: $100 - $50,000/violation and up to $1,500,000; (ii) the violation was due to reasonable cause: $1,000 - $50,000/violation and up to $1,500,000; (iii) the violation was due to willful neglect: $10,000 - $50,000/violation and up to $1,500,000; (iv) the violation was due to willful neglect and was not corrected within 30 days of knowledge (actual or constructive): $50,000/violation and up to $1,500,000(2). Enforcement provisions now require a formal investigation if a complaint (and the preliminary investigation of the facts) indicates a violation was due to willful neglect(3). Covered entities and business associates must carefully consider the status of their HIPAA compliance program. Failure to implement HIPAA policies and procedures could be construed as willful neglect and result in significant financial penalties. Protected health information (PHI) must be protected by law.

Cherylonda Fitzgerald is principal cellist of the Johnson City Symphony Orchestra and a member of the Asheville Symphony and the Kingsport Symphony of the Mountains. As a chamber musician, Ms. Fitzgerald performs with The Paramount Chamber Players, the Shelbridge Chamber Players, and Signature Strings. Ms. Fitzgerald has taught cello/bass and chamber music at Milligan since 2005 and is an adjunct instructor at East Tennessee State University. She maintains a private cello studio and is director of the East Tennessee Cello Choir. She holds a bachelor’s degree in performance and music education from the University of Louisville and a master’s degree in cello performance from S.U.N.Y. at Stony Brook.

Evening Program

Antonin Dvorak: Concerto for Cello in B minor, Op. 104 Jean Sibelius: Symphony No. 2 in D Major, Op. 43

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.

SEPTEMBER 2013

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SEPTEMBER 2013

ClinicallySpeaking BY NORMAN A. ASSAD, MD, FRCS (C)

Infertility in 2013 Infertility is not a rare condition. Unfortunately, it affects one in six couples. Approximately 40% of the time the cause is related to female factors, 40% of the time male factor, and 15% of the time there may be more than one factor. The primary consideration prior to starting treatment is to make a diagnosis and base treatment on the underlying cause of infertility, rather than to perform arbitrary treatment with the hope that something will work. Common Causes The most common cause of female fertility are ovulation disorders. This can account for up to half of all female fertility, and many patients with anovulation have Polycystic Ovarian Syndrome. It is important to control the manifestations of this condition, for without proper diagnosis and treatment, these patients can frequently progress to full blown Metabolic Syndrome with all of its catastrophic consequences in later life. The second most common cause of infertility in the female is Endometriosis, and, again, it is import to diagnose and treat this condition so it does not progress to later stages of the disease, which can have significant consequences on quality of life and other pain issues. The third most common factor, which accounts for only 10% of patients with infertility, are tubal factors. Many of these are secondary to endometriosis, while others are related to STD’s. Diagnosis is important as these patients are very susceptible to tubal pregnancy when they occur. For known medical conditions, these can often be diagnosed and treated using the patients insurance benefits, as many of these services are covered. The majority of insurances that we deal with also have diagnostic coverage for infertility. Disturbing Trends Several disturbing trends are emerging in 2013. Many men are using testosterone supplements for symptoms associated with “low T,” and these medications can have a profound effect on lowering sperm count. Many women are given compounded substances for infertility. Many of these contain progesterone, which can have a contraceptive effect if used prior to ovulation, as they affect sperm transport. We are also seeing a decrease in ovarian reserve, particularly in young women. This seems to be a national trend, and no one can come up with an exact etiology. We are measuring antimullerian hormone levels, which are cycle independent

and seems to be a more accurate assessment of ovarian reserve than the FSH or Estradiol levels. Cost Considerations Most patients are treated at any level of therapy, for a finite number of cycles (usually 3), as national statistics reveal a leveling off of success rates with more cycles than this. As these cycles are mostly paid for by the patient, it is important not to exhaust their financial and emotional resources with therapies that have little chance of success. We increasingly recommend treatment based on outcomes, and explain the cost effectiveness ratio with each level our therapy. For instance, Gonadotrophin/IUI cycles are three times as effective as Clomiphene/IUI cycles; however, the cost of the former is about triple the amount of the latter. At Quillen ETSU Physicians, we attempt to do global pricing for all cash pay cycles which make it easier for patients to plan therapy, with few financial surprises. Our success rates are in line with national statistics and with IVF, we enjoy one of the higher rates in the State, but at cost effective prices. The latter are at the lower end of the spectrum both statewide and nationally, and we have endeavored to keep these prices low given the population that we serve. The success rate of infertility treatments continue to improve with advanced technology; however, it is important to maintain the “human” side of treatment as this condition and its treatments can be very difficult for young couples. Norman A. Assad, MD, FRCS(C) serves as Fertility Services Division Director for Quillen ETSU Physicians’ Department of Obstetrics and Gynecology. A board-certified obstetrician and gynecologist, Assad is a specialist in reproductive and menopausal medicine. He is a member of the American Society for Reproductive Technologies, the American College of Obstetricians and Gynecologists, and the American Association of Gynecologic Laparascopy. He earned his medical degree and completed residency training at The University of Western Ontario and is a Fellow of the Royal College of Obstetricians and Gynecologists of Canada. Assad has been practicing medicine in the Tri-Cities since 2002 and joined Quillen ETSU Physicians’ OB/GYN Department in January 2005, serving as an associate professor at East Tennessee State University Quillen College of Medicine. For more information or to make a referral, visit www.etsuphysicians.com/medical-services/ fertility.html.

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Enjoying East Tennessee

“Days Gone By” Museum of Appalachia –Norris, Tennessee By LEIGH ANNE W. HOOVER

Storytelling is a gift, and it can truly make the past come alive. For our adult children, some of their fondest memories are from family gatherings and hearing their elders share stories from the past. Whether it’s a funny tale from a grandparent’s childhood or an uncle’s rendition of a family escapade, they are simply mesmerized by the past. The Museum of the Appalachia founder John Rice Irwin shares this same fascination, and his “hobby” of collecting relics, stories, and preserving the past became his life’s work. Today, Irwin is 83-years-old and retired. However, his legacy lives own through collections showcased in a nonprofit jewel of a museum, which is simply like no others. Just 16 miles north of Knoxville, Museum of Appalachia is situated on 65 acres of picturesque countryside complete with 36 authentic log cabin structures. The facility has been featured in numerous publications, including the Smithsonian, National Geographic Traveler, Southern Living, Reader’s Digest, and many others. Anyone from infamous dignitaries and celebrities to those just seeking a respite and an escape to the past has walked the grounds, and the museum has shared a story or two and a true slice of Appalachia with each one. In fact, prior to the 1982 World’s Fair, Irwin and the late Alex Haley, Pulitzer Prize-winning author of “Roots,” once served on the Tennessee Entertainment & Music Commission (TFEMC) together, and Irwin introduced Haley to his museum. Haley fell in love with the museum and even built a house in Norris, Tennessee, close to the property and remained close friends with Irwin and his family. Today, Irwin’s daughter, Elaine Meyer, serves as president of the museum and continues her father’s mission of keeping the past alive and preserving the Appalachian heritage. Museum of Appalachia became a not-for-profit 501(c)(3) museum in 2003, and all proceeds support the mission of “not only preserving physical artifacts of an earlier time but also instilling in the community, regionally, nationally, and internationally, a greater knowledge and appreciation for the Appalachian history and heritage.” “In the early days, John Rice just collected things –especially tools and different farm implements…that were housed in our garage,” explained Meyer. “At some point, they filled the garage to the ceiling and gravitated outside on the lawn.” Meyer remembers people stopping by and wanting to “trade” with her father. During inclement weather, Irwin used a tarp to cover his collection to protect it from the rain. However, this was the impetus that necessitated the first outbuilding, which was the General Bunch cabin that was obtained from the very remote New River area of Anderson County. “My mother took pride in the appeareasttnmedicalnews

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ance of the house and lawn, and she did not like all of that ‘stuff’ in the yard,” explained Meyer. So, the outbuildings grew, and one cabin led to another on the property forming an eventual museum, which was founded in 1969. From one room shanties, to a schoolhouse and many others, a virtual pioneer village has been recreated. There is even a cabin that belonged to Mark Twain’s family on the grounds. Meyer can remember a “gas station” type bell that would ring in their house when a visitor drove up, and she, her sister, or mother would meet guests and take them on guided tours. As president of the Museum of Appalachia, Meyer has added vision with an increased interest in preserving her father’s vast collection. In 2007, the museum was officially adopted as a Smithsonian Institution Affiliations Program. “Growing up, the Smithsonian was just the pinnacle…, and to be a part of that is just more wonderful than I can even describe,” said Meyer. “Senator Howard Baker is a member of our board of directors…, and he decided that we were worthy of being a Smithsonian affiliate.” According to Meyer, this “worthiness” led Baker to pursue visits from the Smithsonian. The affiliation designation recognizes the museum’s efforts to preserve, treasure, and share the past for others as a living, realistic snapshot of pioneer life right here in East Tennessee. Relics too numerous to count are housed in additional museum properties, and each has its own individual story and familial connection. Documented stories and signage allow visitors to read and appreciate as much of the history as desired. There is even a dedicated area to the early days of medicine. “These people had strong ethics and morals, and they were brilliant in making do with what they had,” explained Meyer. “They could build, think, and figure things out without someone telling them what to do.” In fact, for the 34th year, October 11th-13th the museum will celebrate with the Tennessee Fall Homecoming, which began as a way to showcase the many dying crafts and pioneer activities. Today, those

same historic demonstrations continue with all of the expected sights and smells as the sounds of music also echo through the mountains. The very best musicians from genres, including bluegrass, old-time country, Southern gospel and Americana perform throughout the weekend on five, unique stages. “When they [visitors] get out of their cars, the first thing that they hear is the music of the area,” said Meyer. “It sets the tone for the day.” Wagons, pulled by vintage tractors, pickup guests, and they take rides over to

the museum festival activities. In addition to the music, smells of fried apple pies, pinto beans, sassafras teas, and other specialties envelop guests in the essence of days gone by. If antiques are your interest, a “Days of the Pioneer” antique show presented by A Simple Life Magazine will take place September 13th-14th at the Museum of Appalachia. Dealers from throughout the country will showcase and sell the very best of the 18th and 19th century. “I love the fact that people connect [through the museum], and they enjoy talking to their parents and their grandparents,” said Meyer. “That oral history really brings people together and [links] generations. The love of family is what brings people here, and when they leave, there is a greater appreciation of their ancestors and themselves.” For additional information on the Museum of Appalachia, visit http://www.museumofappalachia.org 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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SEPTEMBER 2013

Shining a Light on Physician, Industry Relationships, continued from page 1 facturers receive actual or potential value in return,” explained Tom Baker, a shareholder in the Baker Donelson Health Law group. Baker, who practices in the firm’s Atlanta office, pointed out the manufacturer doesn’t actually have to receive financial Tom Baker benefit in exchange for the ‘value transfer,’ which can take a wide variety of forms, including donated items, payment to a physician for consulting services or expenditures for entertainment. “It’s enough that it might influence a physician,” he noted. “The Sunshine Act is about transparency in two different fundamental ways,” he continued. “First, there is the potential interference in medical judgment in clinical trials required for FDA approval of drugs or medical devices. Second, there is potential interference in medical judgment in terms of ordering an item or service for which federal reimbursement is available.” Baker said the policy is to shine a light on interactions that could be construed to unduly influence a physician or teaching hospital and to ferret out conflicts of interest. “It’s not saying that transfers of value are, per se, illegal but that the public has a right to know when medical judgment might be influenced by the value transfer,” he continued. Relationships between physicians and industry will now be on display for patients, auditors, personal injury lawyers and others to see when the Centers for Medicare and Medicaid Services (CMS) begins publishing the reported data next fall.

The Back Story

Championed by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.), the impetus behind the Sunshine Act came from mounting concern over potential conflicts of interest within the industry. These conflicts were highlighted by several egregious incidents involving clinical trials and devices up for FDA approval where physicians received large payments from the manufacturers of the drugs or devices being studied. Grassley publicly described a number of academic physicians taking money from the National Institutes of Health when those physician-scientists had direct financial interests in their own research. Among the worst offenders, the former chairman of the Psychiatry Department at Stanford University received an NIH grant to study a drug when he owned $6 million in stock in the company seeking FDA approval. Similarly, the former chair of the Psychiatry Department at Emory failed to report hundreds of thousands of dollars from GlaxoSmithKline while researching the company’s drugs. Harvard also had to discipline three researchers who received almost $1 million each in outside income while heading up several NIH grants. Outside of these flagrant examples, the concern persists that much smaller 8

SEPTEMBER 2013

gifts might also influence medical decisions. Earlier this year, Pew Charitable Trust published Persuading the Prescribers: Pharmaceutical Industry Marketing and its Influence on Physicians and Patients, which stated the drug industry spent nearly $29 billion marketing their products in 2011 (Source: Cegedim Strategic Data). Of that amount, $25 billion was spent directly marketing to physicians. After unsuccessfully introducing the legislation in 2007, the Sunshine Act was incorporated into the Affordable Care Act. A couple of missed rulemaking deadlines by CMS pushed the law’s effective date to Aug. 1, 2013 for the balance of this calendar year and requires annual reporting going forward.

What is a Transfer of Value?

With 12 major exceptions (see box), any direct payment or transfer of value of $10 or more (or an aggregate of $100 or more in a calendar year) to a physician or teaching hospital must be reported. Additionally, indirect transfers through an intermediary or third party are also subject to reporting. There are 14 main reporting categories. These include consulting fees, compensation for services other than consulting, gifts, entertainment, food, travel, charitable contributions, education, grants, research, royalty or licensing fees, current or prospective ownership or investment interest, direct compensation for serving as faculty or a speaker for a medical education program, honoraria. Under the new rules, Baker said a physician could accept a ballpoint pen or pad of sticky notes from a manufacturer without it being included in the annual report, but most meals, tickets, or gifts probably will fall under one of the reporting categories considering the $10 threshold. “The days of the pharmaceutical company taking a group of physicians to the Super Bowl are over … or at least it will be disclosed and expose you to the risk of Anti-Kickback statute prosecution,” Baker said. “It’s the entertainment part of it that physicians would probably like to have exposed the least,” he added. The law also requires applicable manufacturers and GPOs (group purchasing organizations) to report ownership interests by physicians or their immediate family members. It should be noted, however, that purchased industry stocks and mutual funds that are generally available to the public are not reportable. If Dr. Smith buys 50 shares of ABC Pharmaceutical stock, which is publicly traded, it doesn’t have to be reported. If a representative of ABC Pharmaceutical gives Dr. Smith stock, then it does. Ultimately, a patient whose doctor recommends a specific device or drug will be able to search the CMS database to see if there is a connection between the physician and the manufacturer. “You’re going to know when your physician has a personal financial interest in your healthcare beyond the physician’s professional services,” Baker pointed out.

Disputing a Report

So what happens if your name appears on a report, and you disagree with the data? Baker said CMS is going to notify physicians of all their reported relationships. Once access is granted to the online portal housing the consolidated report, a physician should have at least 45 days to challenge the data and try to resolve the dispute with the reporting entity. Those who cannot agree will be given an additional 15 days to come to a resolution before the information is made public. If no agreement can be reached, the data will be published but flagged as disputed. Physicians cumulatively have up to two years to dispute reports even after the data is published. “While physicians aren’t required to track transfers of value, they are encouraged to do so,” said Baker. “How in the world are you going to be able to refute a report if you don’t have evidence to the contrary.” Baker pointed out you might not think you received an influential ‘gift’ from a device manufacturer by grabbing a bite of lunch, but even a sandwich, tea, tip and tax is often over the $10 threshold. Short of asking to see the bill, it would be difficult to gauge the cost per person at the table; and without a copy of the receipt, it would be difficult to dispute the reported item. “As a practical rule, doctors probably aren’t going to be good at refuting the evidence,” Baker said. However, he added, CMS has created a smartphone app with a version for industry and another for physicians to make it easier to keep track of reportable transfers. “Open Payments Mobile” is available at no charge through the Apple Store and Google Play Store.

Timeline

Data accumulation for 2013 has already begun. Below is a timeline of upcoming key dates in the process. • Jan. 1, 2014: Anticipated launch date for CMS physician portal where doctors can register to receive notice when their individual consolidated report is ready for review. This portal also provides a means for physicians to contact manufacturers and GPOs about disputes in accuracy. • March 31, 2014: Partial year data (August-December 2013) must be turned into CMS. • June 2014: Anticipated access to individual consolidated reports from 2013. Physicians have a minimum of 45 days by law to seek corrections or modifications to the information by contacting manufacturers/GPOs through the portal. September 2014: Searchable reports are published and open to the public.

Be Prepared

“The act itself is vexing,” said Baker. Adding to the frustrations, he continued, is that CMS is interpreting the Sunshine Act very broadly. “The applicable manufacturers are not going to take any chances,” Baker continued. He noted, those who acciden-

tally fail to disclose required data will face penalties of not less than $1,000 and not greater than $10,000 per incident up to a cap of $150,000 annually. Those who knowingly withhold reportable information face penalties between $10,000 and $100,000 for each value transfer with an annual cap of $1 million. “Physicians need to know other people are going to be talking about them,” concluded Baker. “One would hope everything reported is within the legal boundaries … but if you are testing those boundaries, you better stop.”

12 Key Exemptions to the Reporting Rule Certified and accredited CME. Buffet meals, snacks, coffee breaks that are provided by a manufacturer at a large-scale conference or event when the items are generally available to all attendees. Product samples that are not intended for sale and are for patient use. Educational materials that directly benefit patients or are intended for patient use. The loan of a medical device for evaluation during a short-term trial period (not to exceed 90 days). Items or services provided under a contractual warranty in the purchase or lease agreement for a device. The transfer of any item of value to a physician when that physician is a patient and not acting in his or her professional capacity. Discounts including rebates. In kind items for use in providing charity care. A dividend or other profit distribution from, or ownership or investment in, a publicly traded stock or mutual fund. Transfer of value to a physician if the transfer is payment solely for the services of the physician with respect to a civil or criminal action or an administrative proceeding. A transfer of anything with a value of less than $10 unless the aggregate amount transferred to, requested by, or designated on behalf of the physician exceeds $100 in the calendar year.

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In Case of Emergency

Tennessee Department of Health’s Role in Protecting the Population By CINDY SANDERS

Between immunizations, primary care services, licensure and regulation of health facilities, analyzing health statistics and launching preventive care initiatives, it’s easy to think of the Tennessee Department of Health as more ‘Clark Kent’ than “Superman.’ Yet, as the recent multi-state fungal meningitis outbreak clearly reminded us, addressing emergency situations is a key part of the TDH’s core function. In fact, the departDr. John ment was primarily Dreyzehner established to combat lifethreatening outbreaks of cholera, yellow fever and other deadly diseases in the late 1880s. Preventing or stopping public health threats remains a top priority. Sometimes those threats warrant local, state or national attention, but often the TDH staff quietly goes about that part of their workday without much fanfare. “Our mission is to protect, promote and improve the health and well-being of Tennesseans. The emergency preparedness aspect is all about protecting the population,” noted TDH Commissioner John Dreyzehner, MD, MPH.

The types of emergencies range from natural or manmade disasters to addressing or preventing communicable and infectious diseases to investigating outbreaks. “We take an all hazards approach,” explained Dreyzehner. “We never know when the next event will be … but we know it’s coming.” With the State Public Health Laboratory in Nashville and additional labs in east and west Tennessee, the TDH has approximately 130 staff members who perform close to 1.5 million lab tests annually. Not only do the labs have the ability to run a broad spectrum of health assays, the staff also is called upon to analyze substances of concern, such as an unidentified powder, that might come to the attention of law enforcement officials. “This occurs more frequently than people realize,” Dreyzehner noted. While biohazards are a small part of the overall lab workload, the state labs also play an integral role in analyzing environmental samples, conducting newborn screening panels, and identifying West Nile and other arboviral diseases. Equally important is the state’s work in preparing for threats that haven’t yet arrived. “Right now we have spent a good bit of time and resources on MERS-CoV — Middle East respiratory syndrome corona-

virus — and H7N9, a new strain of flu,” Dreyzehner said. “I hasten to add that neither of those have come to our shores.” Being ready, however, has set Tennessee apart. When H1N1 did strike America several years ago, the State Public Health Lab was on the forefront of running tests. At one point, Tennessee was doing testing for other states that didn’t yet have the capacity to analyze incoming samples. Since health threats come from many different arenas, it’s difficult to anticipate every scenario. “A key lesson is we never know where the next hazard is going to come from. We have spent a lot of time creating the infrastructure, relationships, tools, and capacity to respond to any hazard,” explained Dreyzehner. That was made abundantly clear in the recent issues with preservative-free methylprednisolone acetate (MPA). He noted that in the fungal meningitis outbreak, the TDH relied heavily on the relationships and partnerships that were put in place well in advance of the crisis to effectively work with victims and to communicate information both internally and externally. “We were able to use some existing capacities in some very innovative and novel ways to great success,” Dreyzehner said. One example, he noted, was using

preparedness software developed for another purpose to track patients who had been exposed to the tainted MPA. The team also relied on their capacity to collect and analyze data to predict the most effective treatment protocols and to identify those at risk. As Dreyzehner pointed out, going into this crisis there was virtually no literature on the particular type of fungus involved in the meningitis outbreak. “We were dealing with a situation that no one had ever encountered before.” Calling on relationships with federal agencies, national experts, and academic centers, Dreyzehner said the team quickly gathered and disseminated information to local provider resources across Tennessee — including public health nurses and county public health staff — who have regularly reached out to inform and update those impacted by the tainted MPA. Dreyzehner was quick to add this work is ongoing. “More than 13,500 people were affected by this … ranging from disconcerting to catastrophic,” he said. “This is still affecting more than 700 people around the country — 749 cases have currently been identified, and 63 people unfortunately lost their lives. The need for a rapid and accurate information loop has spurred the state to (CONTINUED ON PAGE 14)

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JANUARY 2013

Give your patients every advantage in the fight against cancer. Trust the Wellmont Cancer Institute for the region’s state-of-the-art radiation oncology care.

ou’ve always depended on the Wellmont Cancer Institute to provide compassionate, highly skilled cancer care – including the region’s most robust radiation oncology services. Since 2004, we’ve offered the CyberKnife radiosurgery system, which has helped make an enormous difference in our patients’ lives. And more recently, we were proud to announce the arrival of the Trilogy linear accelerator at Holston Valley Medical Center. With these two systems, as welll as the radiation oncology capabilities at our Southwest Virginia Cancer Center in Norton, Va., the Wellmont ellmont Cancer Institute is providing your patients the most hensive scope of servicess in the region. comprehensive

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Introducing Trilogy – our new power for fighting cancer Our radiation oncologists use the Trilogy’s high-powered X-ray beam to destroy tumors and cancers. Its other benefits include: • A high dose rate for shorter, faster treatments – and lower radiation exposure • Finely detailed, real-time ct images, which allow us to situate patients accurately and quickly • Adjustable radiation beams, so we can account for breathing movements

Trilogy is so precise, we’re able to deliver highly concentrated doses of radiation directly to tumors – sparing healthy tissue to a previously unimaginable extent.

Its flexible range of motion means we can treat any area of the body. And its unique design allows us to treat p patients from any angle, making it the most comfortable experience experi possible.

Advanced robot robotic technology w with CyberKnife When the CyberKnife radiosurgery rradiosu system arrived at Bristol Regiona al Med Regional Medical Center, it was one of only a handful handful nationwide. na And now, it’s still the only Cy yberKn offered in CyberKnife our region. CyberKnife uses its robo otic arms ar to precisely robotic direct the radiation dose es to tu doses tumors and other

diseased tissues. The cancer is pinpointed by CyberKnife’s image-guided technology – similar to that used by the military to target cruise missiles.

Because the radiation is delivered with submillimeter accuracy, tumors and other abnormalities receive a concentrated dose of radiation, but the impact on surrounding healthy tissue is minimized. The CyberKnife allows physicians to treat tumors throughout the body and central nervous system – including tumors that once would have been inoperable. Treatment is completely noninvasive, requires no anesthesia and is usually completed on an outpatient basis.

Comprehensive services – in the heart of the Tri-Cities and beyond For patients in Southwest Virginia, the Wellmont Cancer Institute’s cancer center in Norton provides more than 7,000 square feet of dedicated radiation oncology space in a luxurious, lodge-like setting.

At the Southwest Virginia Cancer Center, we provide high-quality services, including intensity-modulated radiation therapy and imageguided radiation therapy.

With our telemedicine capabilities, our oncologists can conference and collaborate with physicians across our system – without having to take time away from patients to drive long distances. And if further services are needed, patients at the Southwest Virginia Cancer Center have seamless access to the services and caregivers at Holston Valley and Bristol Regional.

No matter where you are in Northeast Tennessee or Southwest Virginia, your patients have access to some of the region’s most comprehensive cancer care, including: • Our radiation oncology technology in Kingsport, Bristol and Norton • An accredited breast center in Johnson City, as well as comprehensive breast centers in Kingsport and Bristol • Targeted therapy, chemotherapy and other infusion and injection services in Kingsport, Bristol, Johnson City and Norton • The region’s only board-certified genetic counselor in Kingsport, Bristol, Johnson City and Norton • Clinical trials in Kingsport, Bristol, Johnson City and Norton

Strength for today and hope for tomorrow Above all, we believe treatment should begin – and end – with hope. Because where there is hope, there is the strength to fight and the optimism to survive. With hope as its focus, the Wellmont Cancer Institute is committed to helping patients have the chance to live out their dreams long after cancer is only a distant memory.

To refer a patient, please call 1-855-878-8550. Or visit wellmont.org to learn more about the Wellmont Cancer Institute.

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SEPTEMBER 2013

Transparency in Healthcare What does it Mean to You? By Heather Ripley

You have probably seen the word “transparency” used in newspaper headlines, on network and cable TV news shows, on website stories, blogs, Facebook and Twitter, to name a few communication platforms. Transparency is the latest buzzword businesses, and especially healthcare businesses, will need to think about as they look for new and more effective ways to communicate openly with their audiences - both in business-to-business and businessto-consumer relationships.

Healthcare and Transparency

Not surprisingly, transparency in the healthcare industry is at the top of the list, and not just with consumers. It’s something

the healthcare industry as a whole is talking about. As an example, at the recent 2013 America’s Health Insurance Plans Institute (AHIP) event, the topic of healthcare transparency increased 400 percent in Twitter conversations during and after the event. Google the phrase “healthcare industry transparency” and you’ll likely find there are more than two million search returns in approximately .26 seconds. The healthcare industry is being urged to adopt more transparency from within the medical community as well. For example, the American Medical Association recently issued a recommendation requesting insurers to provide physicians and their staff with better tools to determine a patient’s treatment cost prior to treatment. It’s pretty clear, healthcare businesses will be under more scrutiny than ever before, and becom-

ing more transparent will be a necessity, not a choice. But creating a culture and corporate identity that employs transparency is no easy task, and many business owners have tried to adopt some form of corporate transparency on their own with various degrees of success. Some have decided it is too much trouble or not worth it. I have consulted with many businesses, creating marketing strategies that maintain integrity and security while embracing a culture of openness and honesty. For those businesses that have a hard time determining what transparency means for them, engaging a professional with social, public relations, reputation management and crisis communications experience can be a huge help.

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A recent article on INC.com highlighted transparency in business, noting that transparency for businesses also means being more transparent with employees, not just business partners or clients. Some businesses are going so far as to share salaries – including CEO salaries—with employees. Some feel this transparency makes for a more unified team. Other business-to-business firms are making their financials more available to their business partners and vendors in a twist that they hope will allow them to obtain more or better credit. If they reveal how good their numbers are, their suppliers, vendors, clients and business partners might be more willing to use that information to give businesses with good, solid financials better financial arrangements. This is only useful if your business is financially stable. An example of a business that worked transparency into its business model with great success is Zappos. Already wellknown for its great customer service, Zappos wanted to include employees, vendors and its partners in its culture. In a surprising move, the Zappos executive team decided to televise the company’s annual meetings for all to see. They also started a blog called “Zappos Insights” so they could communicate directly with their employees, customers and other businesses about the Zappos culture. The blog offers ways other businesses can learn from Zappos’ experiences through webinars, training, coaching and more.

Transparency and Trust

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One of the cornerstones of Zappos’ company culture is trust. Zappos manager Robert Richman’s thoughts on transparency mirror the company mandate, “The quickest way to trust is through transparency.” In the healthcare business especially, there is more to transparency than just being more open about your business. Trust is a big issue in the healthcare industry, and creating a corporate culture of trust - both internally and externally - can be a make-it or break-it business decision, particularly in today’s business climate. Price Waterhouse Cooper’s website recently featured an article titled, “Trust but verify: From transparency to competitive advantage,” addressing the ways businesses can employ transparency to gain trust. But it also stresses a point I strongly agree with: “While transparency is an all-important first step in building trust, it is not the entire solution. Without credibility, transparency remains an unverified promise.” Don’t let the idea of transparency in your business keep you up at night. When you are honest, open and willing to communicate often and listen to your vendors, partners, stakeholders and employees, your business will be more successful. It’s not a matter of if transparency is coming, it’s a matter of when. Will you be ready? Heather Ripley is the president and founder of Ripley PR, a national B2B public relations agency specializing in Healthcare IT. For more information, visit www.ripleypr.com or email hripley@ ripleypr.com.

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Patient-Centered Practices

New Oncology Facility at Johnson City Medical Center will improve Environment of Care, Capacity of Care for Tri-Cities Community

ancer care has long been a service that hospitals have provided, but, until recently, featuring hospital cancer services was unheard of. Perhaps an attempt at “if you don’t see it, it doesn’t exist,” nationwide, cancer programs were tucked away in hospital corners. But according to Kyle Colvett, MD, a radiation oncologist and the Medical Director for Oncology Services at Mountain States Health Alliance (MSHA), that pessimistic attitude toward cancer care is no longer the case. Colvett has been working in Oncology Services at MSHA since 1995. “Over the years that I’ve been here, our volume has grown tremendously—about five times the size, but our current facility opened in 1988, and it was not designed to accommodate anywhere near the volume we have presently,” he explained. “Our current facility is not only small, but it wasn’t designed in a patient-friendly manner. It has almost an industrial Dr. Kyle Colvett feel, with exposed concrete and no natural light. Besides the fact that our volumes have grown, we have been frustrated that we don’t have the best environment for patient care.” Over the decades, MSHA’s oncology service line has improved its technology tremendously, seeing results that others are seeing nationwide: cancer is being treated successfully with very few side effects. Understandably, though, when the facility doesn’t match the technology or hightech workflows, delivering the best cancer care can be tough. “Times have changed, though,” Colvett said. “A new building is being constructed adjacent to Johnson City Medical Center, the upper level

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of which will house new operating rooms, the lower level, adjacent to our current department, provides a great opportunity for us to expand out and add space for oncology. In the process, we are adding a more pleasant, patient-oriented environment.” Some of the patient-centered features of the new oncology facility include a new, separate parking lot, dedicated to oncology patients; a weather-protected entrance; lots of natural light, as well as two fireplaces; a waiting room designed with alcoves to respect patient privacy; and a separate waiting room for children. “One unique thing about our specialty is that we take care of everybody, from infants to people that are 100,” shared Colvett. “Children have different interests and needs, so the area has video games and other kid-centric activities, a different décor, and an entrance to separate exam rooms.” Beyond the waiting areas, Colvett pointed out that new dressing rooms are being added, designed much like the locker room at a health club. Each patient can have a locker, adjacent to a private changing room, with a private entrance to the treatment area. Patients and staff are scheduled to begin using the facility in September, but a full roll out, utilizing all of the program’s technology, is expected in 12 to 18 months.

“Budgets are difficult in our current healthcare environment, so the Mountain States Foundation took this new facility on as a focus of interest,” said Colvett. “They have been a tremendous friend to us.” Pat Holtsclaw, president of the Mountain States Foundation, explained that although cancer mortality rates have dropped, the prevalence rate is higher, making it difficult for the current facility to serve the increased volume. “This new facility will accommodate patients throughout our service area and will give us the opportunity to transform the patient environment for care and the capacity for care,” she explained. “We are in the process of acquiring new technology that runs into millions of dollars, so we are delighted to have Clarinda Jeanes Pat Holtsclaw serving as Chair of the Radiation Oncology Capital Campaign and Dr. Jim Gibson as Honorary Chair to lead this effort. They have been long-term supporters of the Foundation and Mountain States Health Alliance,” added Holtsclaw. “Very few people have not been touched by cancer,” Holtsclaw said, “so the new radiation oncology facility will not only serve the patient’s needs, but will also make a difference in the community by improving the area’s cancer care.” Presented in Partnership by East Tennessee Medical News and Mountain States Health Alliance All source data for this article has been provided by

SEPTEMBER 2013

Jolie Sparks National BRCA1 Conversation, continued from page 1 have to wait until cancer happens.” When Jolie came forward, some people assumed that genetic testing for cancer was only available to the wealthy. But genetic testing is available for women and men with particular family risk.

Who should have genetic testing?

“If you have at least one relative who was diagnosed with breast cancer under the age of 50, you need to consider testing,” Pencarinha said. “But it is best – if possible – to test the relative that had cancer first.” Pencarinha says it is also important to consider your own age. “Some younger women, under the age of 20, say they wish they had waited to get the test,” she said. “They feel like there’s nothing they can do until they reach 25. But if you have relatives who were diagnosed with cancer in their 20s and you carry the gene, you could start getting scans earlier.” Also – men can carry breast cancer genes as well, so testing isn’t only for women. “Men are often hesitant to do genetic testing, but men with the BRCA gene have a 7% risk of breast cancer and a 20% risk of prostate cancer, and the risk is higher in some families,” Pencarinha said. While there are no standard criteria for recommending or referring someone for BRCA1 or BRCA2 mutation testing, some generally agreed upon guidelines include: • Personal history of breast cancer at age 50 or younger • Personal or family history of male breast cancer • Personal history of ovarian cancer • A parent, sibling, child, grandparent, grandchild, uncle, aunt, nephew, niece, or first cousin diagnosed with breast cancer at age 45 or younger • A mother, sister, daughter, grandmother, granddaughter, aunt, niece, or first cousin diagnosed with ovarian cancer • A family history of both breast and ovarian cancers on the same side of the family

Getting genetic testing

Patients interested in genetic testing should first talk to their physician about their family history and risk factors. Pencarinha – and most other genetic counselors across the country – only see patients that have been referred by their physicians. Once the patient has been referred, their genetic counseling can begin. “When you come to a genetic counseling appointment, we will first talk about why you want genetic testing,” Pencarinha said. “Then we will talk about your medical history. We’ll talk about family history going back three generations. We will talk about the pros and cons of genetic testing and how much it will cost. I will answer questions about insurance and address any concerns about insurance discrimination.” The actual genetic test requires only a blood sample. “Most patients are surprised at how easy the process of genetic testing is,” Pencarinha said. “There can be anxiety related to waiting for the results of the test, but I have found that patients generally anticipate a higher risk than they actually end up having. Plus, once they know if they have the gene or not, they can take action to prevent cancer.”

Addressing patient concerns about genetic testing

Pencarinha sees patients with a variety of concerns, ranging from fear of knowing they have an increased risk of cancer to fear of insurance or employer discrimination if they are found to have the BRCA1 or BRCA2 genes. For patients worried about insurer or employer discrimination if they test positive, she educates about the Genetic Information Nondiscrimination Act (GINA) of 2008. The law was passed to protect individuals from medical insurance and employer discrimination. “Patients and their physicians were worried they could lose their medical in-

surance or that their employers would know if they tested positive for the BRCA1 or BRCA2 gene,” Pencarinha said. “Discrimination based on genetic testing was never a widespread problem, but the fear kept people from coming in for genetic testing.”

Paying for genetic testing

Another concern patients may have about genetic testing is the cost. According to the National Cancer Institute, the cost for BRCA1 and BRCA2 mutation testing usually ranges from several hundred to several thousand dollars. Some insurance plans will pay for testing, and there are also grants from organizations such as Susan G. Komen for the Cure to help with the expenses of genetic testing. The Wellmont Cancer Institute has a Komen grant for women with no or low insurance coverage. “Most insurance will cover genetic testing with appropriate family history,” Pencarinha said. “Medicare will cover genetic testing only if you’ve had cancer.”

After genetic testing – Being a ‘Previvor’

“We call people who test positive and take steps to prevent cancer previvors,” Pencarinha said. “They survive cancer by never getting it in the first place.” Previvors have a variety of options. While surgeries such as preventive mastectomy and removal of fallopian tubes and ovaries are an option, many previvors prefer to do regular screenings, to modify their behavior to reduce risk of cancer, or to take medications or participate in clinical trials in hopes of reducing their risk of developing cancer. “Younger women who learn they have the gene generally opt to do screenings, with mammograms and MRIs starting at age 25,” Pencarinha said. “They will alternate these tests every six months. By screening regularly, we can catch cancer early and treat it.” Another important thing for previvors to remember: “Testing positive for

Mark Your Calendar

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

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SAVE THE DATE!

Date: Thursday, September 19th Location: Downtown Marriott, Knoxville, TN 37919 Get the latest in healthcare updates, must-have information for the current trends and changes in the industry. For more information or to register, visit www.kamgma.com

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.

Jenny Harvey

SEPTEMBER 2013

the BRCA1 or BRCA2 gene doesn’t mean you have cancer – and it doesn’t mean you will have cancer,” Pencarinha said. Research studies and clinical trials “In our practice, we work with patients to connect them with the research studies and trials that may be beneficial to them, and we also encourage patients to do their own research as well,” Pencarinha said. When looking into research studies and clinical trials, and in deciding to have genetic testing in the first place, Pencarinha sums up why very simply: “Having knowledge is empowering.”

In Case of Emergency, continued from page 9

enhance communication tools. “We need to be able to push our information to our healthcare partners and receive information from them in a more real time and cooperative space,” explained Dreyzehner. To that end, he said Tennessee is creating the Health Joint Information Center, which is a concept derived from the National Incidence Management System. “In order to provide the best information to the public and media partners, we create a place where partners and entities can pool information to make sure we are providing the right answers in a rapid fashion.” Ultimately, it all comes down to building a scalable infrastructure, and a big part of that infrastructure comes from creating and maintaining relationships. “An emergency is the last place you want to be meeting people for the first time,” Dreyzehner pointed out wryly. The smooth interaction between local providers, the TDH staff, and federal officials during the meningitis outbreak underscored just how important it was to have previously developed relationships in place when it came time to act. “Just like community health providers and centers are our eyes and ears, the state health departments are the eyes and ears for the CDC,” Dreyzehner said. “We in public health rely on a variety of surveillance tools to detect concerns and to protect health,” he continued, adding the TDH relies on local healthcare personnel, hospitals and health departments to draw attention to concerns. “We’re always thinking of the continuum of reporting,” Dreyzehner continued. The first call, he added, should be to the local health department to report the incident. “They are certainly able to escalate that rapidly if there is a need,” he said, adding each department has a medical director and direct access to the state’s subject matter experts. Dreyzehner said the best defense to protect against or respond to public health threats is working together. “To the healthcare community, we appreciate you … we depend on you … and we will make every effort to keep you informed and work with you to protect life and health before, during and after an event.” easttnmedicalnews

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The Possibility Dogs

theLiteraryExaminer

by Susannah Charleson; c.2013, Houghton Mifflin Harcourt; $27.00 / $33.95 Canada, 260 pages

BY TERRI SCHLICHENMEYER

Up: How Positive Outlook Can Transform Our Health and Aging by Hilary Tindle, MD, MPH.; c.2013, Hudson Street Press; $25.95 / $27.50 Canada, 277 pages Let’s look on the bright side. You’ve probably heard that sentiment several hundred times in your life; so much, perhaps, that it’s basically meaningless to you by now. Honestly, can turning a frown upside down really make a difference? In the new book Up: How Positive Outlook Can Transform Our Health and Aging by Hilary Tindle, M.D., M.P.H., you’ll see how a positive attitude can make every year a better one. According to Hilary Tindle, attitude has “the potential to influence every facet of our health.” Doctors, for instance, have long known that positive patients are more likely to follow medical instructions, “seize opportunities,” and avoid sabotaging their own healing. In short, upbeat patients are easier to treat – which leads to less illness and longer lives. Research further shows that quickness to anger can predict your likelihood for heart disease. That, and a snarly attitude, can also “predict… risk factors that are known to cause… major illnesses of aging” such as high blood pressure and diabetes. These factors, which can stem from a negative outlook on life, begin to manifest

themselves as early as childhood and they can add up over the years. To counteract a lifetime of sourpussness, Tindle says that change is necessary (just about everybody needs some change) and definitely possible. Learn how to manage responses to problems, first of all. If you’re prone to descending into a “negative cycle,” know how to escape it. Don’t think you have to be sunshiny all the time; there are many “faces” of optimism. Acknowledge your accomplishments throughout every step of life, follow “typical” doctor advice, get in touch with nature now and then, and stop being so self-critical. Then, buck up. Says Tindle, “… outlook can be one of our strongest allies in the aging process.” It would be way too trite and simplistic to say that “Up” is a book about positivity. No, author, researcher, and self-proclaimed optimist Hilary Tindle offers cutting-edge information on why it’s never too late to seize change and seek a better outlook in order to reap the rewards of contented aging with fewer health issues. Knowing that it’s not that easy, however, Tindle gives readers tips on altering one’s attitude, climbing out of the doldrums, and reaching for community as a bolster. I liked this book – though I think there’s a lot here that I’ve heard before – and I liked that its advice is mixed with real evidence. Curmudgeons, crabs, and grumps beware: this book could change your outlook and, says the author, every little bit helps. So smile once in awhile and grab Up… because if you do, the sky’s the limit.

Your dog has a one-track mind, one thing at a time. So wouldn’t you be surprised at what else he can do? In the new book The Possibility Dogs by Susannah Charleson, you’ll see your dog’s hidden potential. As the human half of a Search-andRescue team, Susannah Charleson knows what it takes to teach a dog an important task. Using the innate talents and personality of her golden retriever, Puzzle, Charleson taught her girl to find lost or injured people. So when Charleson met a man with a “psych dog” (a service dog for someone suffering psychiatric disorders), she was intrigued. Most everybody knows about guide dogs and hearing-assistance dogs, but what kind of canine Einstein would it take to help a person whose disabilities weren’t quite as visible? With the encouragement of her extended pool of contacts, Charleson decided to find out. She already had a houseful (two cats, Puzzle, and a small herd of Pomeranians), but she began to search for the perfect-personality puppy – which arrived unexpectedly when a neighbor who knew about Charleson’s love of dogs hastily dropped off an emaciated, terribly sick, half-starved puppy at her Dallas-area doorstep. Could this little guy be like Haska, who helps her person withstand PTSD?

Would he be like Merlin, who assisted both father and son to overcome disabilities? Could the puppy be like Annie, who gives a teacher control over OCD; or like Juice Box, who helped his partner deal with depression and social problems? Could the puppy she named Jake Piper someday assist with loneliness, fear, illness, or isolation? Or would he be just a dog – cherished, pampered, and special only in the eyes of his human? Charleson wasn’t sure if the little guy would be trainable, or even if he’d live. One thing was sure, though: she was going to give him every possible chance… Take a look at the cover of this book. Who could resist a face like that, huh? Not author Susannah Charleson, and in this wonderful book, you’ll meet that boy, and others – but don’t think that the potential in The Possibility Dogs is only canine. Through interviews and personal experiences, Charleson shows how these highly trained (though very intuitive) dogs can make an amazing difference in the lives of people who might have otherwise had to suffer at home, in silence. Those stories will touch your heart, and they might spur you to think about finding your own dog to raise or help. To that end, Charleson offers subtle advice with her addicting tales. This slice-of-life is about dogs that nobody initially wanted – but if you’re a pet-lover or are interested in service dogs, you’ll definitely want this book, so fetch The Possibility Dogs. It’s a story you’ll like very well. 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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SEPTEMBER 2013

GrandRounds Turkey Creek Medical Center First in Area to Perform Partial Knee Replacement Surgery Offering Lifetime Implant Warranty KNOXVILLE—Turkey Creek Medical Center, located in Knoxville, became one of the first hospitals in Tennessee to perform a partial knee replacement surgery utilizing the Signature™ Personalized Patient Care System. The system complements the Oxford® Partial Knee by providing surgeons with a technique to use instrument guides specifically tailored to the patient’s anatomy. Gregory Hoover, MD, orthopedic surgeon, performed the surgery using the Oxford® Partial Knee with Signature™ technology and is the only knee replacement system with a Lifetime Implant Replacement Warranty in the United States. Biomet, an orthopedics company and manufacturer of the Oxford® Partial Knee, is offering the warranty With the Signature™ Personalized Patient Care System, surgeons are able to utilize a magnetic resonance imaging (MRI) scan to create a three-dimensional joint reconstruction. The scans help create personalized femoral and tibial positioning guides for patients, enabling surgeons to plan a partial knee replacement. They also have access to enhanced detail and precision for implant position and alignment before surgery. Another benefit is that with the Lifetime Implant Replacement Warranty, Biomet will cover the cost of replacement implants for patients who received the Oxford® Partial Knee with Signature™ technology on or after September 10, 2012 in the event they require knee revision surgery. Biomet’s warranty specifically covers the cost of the replacement implant.

Parkridge Medical Center Names New Clinical Coordinator for Pelvic Floor Center

LeConte Sports Medicine and Four Sevier County High Schools Receive Safe Sports School Award

CHATTANOOGA– Wendy Holloway, RN, has been named the new clinical coordinator of the Pelvic Floor Center at Parkridge Medical Center. Holloway holds a degree in Nursing from Jacksonville State University. Before coming to Parkridge Medical Center, she worked in the Emergency Department at DeKalb Regional Medical Center in Ft. Payne, Ala.

SEVIERVILLE—Gatlinburg-Pittman, Pigeon Forge, Seymour and Sevier County High Schools, in conjunction with LeConte Sports Medicine, have all been selected as the recipients of the National Athletic Trainers’ Association (NATA) Safe Sports School Award for their Secondary School Athletics. The award champions safety and recognizes secondary schools that provide safe environments for student athletes. The award reinforces the importance of providing the best level of care, injury prevention, and treatment. Since 2001 LeConte Sports Medicine has provided Certified Athletic Trainers, medically-licensed healthcare providers, to cover all sports at Sevier County’s four high schools. LeConte Sports Medicine coordinates the athletic healthcare for students, providing comprehensive on-site services for Gatlinburg-Pittman, Pigeon Forge, Seymour and Sevier County High Schools. For more information about NATA or the award please visit: www.athletictrainers.org.

Patterson Named Executive Director of CONTACT Care Line OAK RIDGE– CONTACT Care Line, a crisis line that has provided a listening ear to East Tennesseans for 40 years, has named Deborah Patterson as its new executive director. Patterson is a University of Tennessee alumna with experience in a variety of social service settings and a master’s degree in business administration. She takes the reins at CONTACT as the Oak Ridge-based organization works to build a Knoxville presence and expand services to 24 hours a day, seven days a week. CONTACT fields some 10,000 calls per year from East Tennesseans needing a listening ear, referral to community resources, or crisis intervention. The agency also makes reassurance calls to homebound individuals and provides training in active listening skills in “The Art of Listening,” a class open to the public. Patterson earned a Bachelor’s degree majoring in art and psychology as well as her MBA from UT. She also earned a Master’s in social service administration from the University of Chicago. In addition to her work with NASW, Patterson has held a variety of social service positions in Knoxville and Chicago.

Erlanger Health System welcomes new physician to Academic Urologists CHATTANOOGA–Anand Shridharani, MD, has joined Erlanger Health System as the newest member of Academic Urologists at Erlanger. Shridharani specializes in diagnosing and offering state-of-the-art treatments for disorders Dr. Anand of male reproduction, Shridharani male hypogonadism, erectile dysfunction and Peyronie’s disease.

Mark Your Calendar

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

2ND THURSDAY

3RD THURSDAY

JOHNSON CITY MGMA MONTHLY MEETING

KINGSPORT MGMA MONTHLY MEETING

Date: The 2nd Thursday of Each Month Time: 11:30 AM – 1:00 PM Location: Quillen ETSU Physicians Clinical Education Building, 325 N. State of Franklin Rd., Johnson City

Date: The 3rd Thursday of Each Month Time: 11:30 AM – 1:00 PM Location: Indian Path Medical Center Conference Room, Building 2002, Second Floor, Kingsport

Save the Date: Don’t miss the September meeting, comedian Matt Fore will be performing. 16

SEPTEMBER 2013

Shridharani received a medical degree at the University of Massachusetts Medical School. He completed a preliminary internship in urology and general surgery at the University of Louisville and a urology residency program at the Medical College of Wisconsin in Milwaukee. He also received advanced fellowship training in Andrology and Erectile Dysfunction from the Medical College of Wisconsin.

Laura Findeiss Joins University Radiology, UTMC KNOXVILLE—University Radiology and The University of Tennessee Medical Center and Graduate School of Medicine are pleased to welcome Laura K. Findeiss to the practice as Chairman of the Department of Radiology and as a clinical Interventional Radiologist. Dr. Findeiss Dr. Laura K. comes to UTMC from the Findeiss University of California at Irvine Medical Center where she was Division Chief of Vascular and Interventional Radiology and also served as the co-director of UCI’s Ablative Oncology Center. Dr. Findeiss entered Diagnostic Radiology residency at Virginia Mason Medical Center in Seattle and graduated in 2004. She followed this with a Vascular and Interventional Radiology fellowship at the University of Washington Medical Center, completed in 2005. Prior to her position in California, Dr. Findeiss also practiced in the Vascular Center of Excellence at Charleston Area Medical Center in West Virginia and as the Chief of Vascular and Interventional Radiology at the University of Utah in Salt Lake City. In 2012, Findeiss was named one of “America’s Top Doctors” for Southern California by Castle Connolly Medical Ltd for her expertise in treating Aortic Aneurysm, Peripheral Vascular Disease and Vascular Malformation. Dr. Findeiss lectures nationally on a range of Vascular/Endovascular topics, image-guided treatment of vascular anomalies, and minimally invasive cancer interventions, including tumor ablation. Dr. Findeiss holds national leadership roles as a member of the Executive Council of the Society of Interventional Radiology, and as a member of the SIR Foundation Board of Directors. She also participates as a member of the Leadership Committee of the American Heart Association’s Cardiovascular Radiology and Intervention Council. Besides certifications in Diagnostic Radiology and Vascular and Interventional Radiology, Findeiss is certified by the American Board of Vascular Medicine in Endovascular Medicine and is a Registered Physician in Vascular Interpretation. She has been honored as a Fellow in the Society of Interventional Radiology (FSIR), as well as obtaining Fellow status in the American Heart Association. easttnmedicalnews

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GrandRounds Peninsula Welcomes Liquete to Psychiatric Staff KNOXVILLE—Dr. Maria Theresa Liquete joins Peninsula, a division of Parkwest Medical Center, as a staff psychiatrist. Liquete will work with patients in the Peninsula Outpatient Clinics in Blount and Sevier counties. Liquete has eight years of experience in the field of clinical psychiatry. She comes to Peninsula from Wellmont Health System, where she worked in the inpatient psychiatric unit at Ridgeview Pavilion in Bristol, Va. Liquete holds a Bachelor’s degree in biology from Saint Louis University and a doctor of medicine degree from Saint Louis University College of Medicine in Baguio City, Philippines. She completed her residency at East Tennessee State University in Johnson City, Tenn.

Hamm Joins Psychiatric Staff at Peninsula KNOXVILLE—Dr. Robert Hamm has joined Peninsula, a division of Parkwest Medical Center, as a staff psychiatrist. Hamm will work with adult and adolescent patients at Peninsula Outpatient Clinics in KnoxDr. Robert Hamm ville and Loudon, and will

occasionally see patients at Peninsula Hospital. Hamm comes to Peninsula from Life Management Center of Northwest Florida where he served in both the inpatient Crisis Stabilization Unit and the outpatient clinic. Prior to this role, he worked as a volunteer physician and professor in Dominica, West Indies, teaching problem-based learning and introduction to clinical medicine to medical students. Hamm holds undergraduate degrees in biology and psychology from the University at Buffalo and a doctor of medicine degree from Ross University School of Medicine in Dominica, West Indies. He served his residency in psychiatry at East Tennessee State University in Johnson City, Tenn.

She will work closely with the dedicated team members at Peninsula to provide excellent care to clients and throughout the organization. Jett has 13 years of nursing experience at Parkwest Medical Center, beginning as a nurse extern in 2000. She became a clinical nurse educator and nurse manager of the cardiac, pulmonary and renal care unit in 2004. Jett holds a Master’s degree in Health Service Administration from the University of St. Francis and an Associate’s degree in Nursing from Roane State Community College. She is currently pursuing her Bachelor’s degree in Nursing from The University of Tennessee, Knoxville. Jett is also a member of the Tennessee Nurses Association.

Heather Jett Promoted to Director of Patient Care Services at Peninsula Hospital

Suzanne Miller Promoted to Director of Patient Care Services at Parkwest Medical Center

KNOXVILLE–Heather Jett, nurse manager of the cardiac unit at Parkwest Medical Center, has been selected to serve as director of patient services at Peninsula Hospital. In this role, she will direct dayto-day operations while reporting to Liz Clary, VP Heather Jett of Behavioral Medicine.

KNOXVILLE–Parkwest Medical Center has announced the promotion of Suzanne Miller to director of patient care services. Miller will oversee the management of clinical services for several areas at Parkwest. Additionally she will continue to work Suzanne Miller with the Senior Leader-

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

ship Team and staff to promote high quality patient care throughout the organization. Miller has more than 27 years of nursing experience, with 15-plus of those at Parkwest. She holds an MBA from Lincoln Memorial University and a Nursing degree from Sinclair College. She is a member of the first Covenant Nursing Leadership Series class, a program created in partnership with The University of Tennessee’s College of Business Administration and College of Nursing to develop world class nursing leadership.

UT Professor Marian Roman Honored for Psychiatric Care KNOXVILLE—Marian Roman, an associate professor of nursing at the University of Tennessee, Knoxville, has been honored for her work in aiding the mentally ill in the Knoxville community. She is the recipient of the 2013 Award for Inno- Marian Roman vation from the American Psychiatric Nursing Association (APNA). The APNA Annual Awards recognize nurses who exemplify excellence across the spectrum of psychiatric-mental health nursing practice, education, leadership, research and innovation.

Want to advance your nursing career? Information Sessions at LMU-Cedar Bluff October 3 and November 4 from 3 p.m. to 7 p.m.

1-800-325-0900 ext. 6324 for more information

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SEPTEMBER 2013

GrandRounds Jim McDaniel Named as Hutcheson Volunteer of the Month FORT OGLETHORPE—Jim McDaniel has been named as the hospital’s Volunteer of the Month for August. McDaniel has volunteered in Hutcheson’s Emergency Department for four years. McDaniel volunteers in 12 hour shifts, mostly during weekends, when emergency room volumes are typically higher. As Volunteer of the Month, McDaniel received a basket with gift certificates and gift items from The Hutch Gift Shop. (from left to right): Chareen Humble, manager of Hutcheson Volunteer Services; Roger Forgey, President and CEO; Jim McDaniel, Volunteer of the Month; and He was awarded use Jennifer Daniel, Director of ED and ICU. of the Volunteer of the Month parking space and his name will be added to the recognition plaque by the hospital’s information desk.

FOCUS ON ONCOLOGY SPONSORED BY WELLMONT HEALTH SYSTEM

Name: Kathy Visneski, APN, AOCN, APHN-BC Position: Oncology Clinical Nurse Specialist for Wellmont Cancer Institute At a Glance: An employee with the Wellmont Cancer Institute since 1982, Kathy Visneski teases that she’s “their girl Friday” because “I do whatever needs to be done.” Over the years, Visneski has served in many different capacities, including educator, facilitator, and caregiver. She teaches the Institute’s chemotherapy course to nurses, as well as oncology education for staff members. She also navigates inpatient oncology patients, making sure that when they go home, “all the things that need to happen are happening,” she explained. Of all of her different responsibilities, Visneski said her favorite job is facilitating the cancer support group Survive and Thrive, which she has been doing every year for 26 years. “I get so much more out of it than I give,” she enthused. “I have learned so much from them about surviving. It changes your whole life when you work in cancer care.” Visneski shared that the notion cancer care is a depressing thing is false. “I don’t know if that it’s only nice people get cancer or that they get nice once they get it, but I have the most awesome patients. They appreciate everyone who helps them.” Her dedication to her patients has been nationally recognized. In 2009, Visneski received the Lane Adams Quality of Life Award from The American Cancer Society, a prestigious award given each year to health professionals who provide consistently excellent and skilled care to cancer patients. Sometimes the care Visneski gives is given unexpectedly. As she explained, just a few weeks ago, she sat at her desk with tears rolling down her face over the fact her hairdresser of 30 years had abruptly retired. “Then a patient knocks on my door, who had just had a PET scan, and the results were not good. He would have to change his chemo, start radiation, and I felt ashamed to tell him why I was upset,” she recalled. “He walked around my desk, patted me on the shoulder, and assured me that it would be okay. It took me two seconds to think ‘Who cares if she retired?’ “And, even more, it made him feel better that in his bad place, he could help me! They put your life in perspective for you very quickly.”

SEPTEMBER 2013

Summit Welcomes Ben Huff to Deane Hill Location KNOXVILLE—Summit Medical Group, the region’s leading primary care organization, adds a new primary care physician to its Deane Hill location, 7211 Wellington Drive, Knoxville. Huff is a family practice physician specializDr. Ben Huff ing in pediatric, adolescent, geriatric, and adult care. He is a graduate of The University of Tennessee Health Science Center at Memphis and completed his residency in family medicine at the University of Tennessee Graduate School of Medicine. He is board-certified in family medicine and is a member of the American Association of Family Physicians, the Tennessee Association of Family Physicians and the American Board of Family Medicine. A native of Scott County, Tennessee, Huff resides in Rockford.

Parkridge Medical Group Battleﬁeld Welcomes Nurse Practitioner Robin T. Jones CHATTANOOGA – Parkridge Medical Group Battlefield is pleased to announce the addition of nurse practitioner Robin T. Jones to the practice. Jones has over 30 years of nursing experience. She holds a diploma in Nursing from Robin T. Jones Fort Sanders School of Nursing, a Bachelor’s degree in Nursing from the University of Tennessee, and a Master’s degree in Nursing from the University of Tennessee. Jones joins Dr. Tiku Bhutwala, Dr. David Bosshardt, Dr. William Horton, Dr. Terri Jones, and Lisa Brooks, DNP at the Ringgold, Ga. office.

Mothers and Infants Sober Together (M.I.S.T.) services expand in East TN OAK RIDGE—The state of Tennessee has made reducing neonatal abstinence syndrome (drug exposed infants) a priority and has established a reporting system to help track the problem. Mothers and Infants Sober Together (M.I.S.T.) is a program that works with pregnant women who are addicted to drugs before and after delivery, and with their babies that are born with neonatal abstinence syndrome (NAS) or substance exposed infants. M.I.S.T. began in 2009 when Ridgeview Behavioral Health Services was awarded a grant to support and serve drug exposed infants and their families in Roane and Anderson counties. However, the new M.I.S.T program in Campbell County is unique and innovative in that it utilizes an approach which integrates health care and behavioral health care. The Campbell County M.I.S.T. program was officially launched on July 11,

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GrandRounds at Indian Mountain State Park in Jellico. Scott Pierce, BlueCare Tennessee president and C.E.O.; Cheryl McClatchey, manager of Behavioral Health Programs for BlueCare; Geogy Thomas, M.D., medical director of Dayspring Family Health Center; Erik Wangsness, C.E.O. of Jellico Community Hospital; Brian Buuck, C.O.O. of Ridgeview and David R. Reagan, M.D., chief medical officer for the Tennessee Department of Health, pledged their support to improve the lives of families in the area, one mom and one baby at a time. M.I.S.T services are being made available to mothers-to-be in Campbell County through a two-year, $290,000 grant from the BlueCross BlueShield of Tennessee Health Foundation. Ridgeview partners with Dayspring Family Health Center, Jellico Community Hospital and BlueCare Tennessee to work with mothers who demonstrate a desire and commitment to staying drug free and providing a safe and stable home for their babies. The Ridgeview team consists of Program Manager Michelle Jones, a master’s level therapist and three case managers that conduct substance abuse and mental health assessments and work with the parents and their infant intensively for approximately six months. Staff also works closely with hospitals, primary care physicians, pediatricians, foster parents, DCS, juvenile court judges and family members. For information about M.I.S.T. or other Ridgeview programs, visit the website at www.ridgevw.com.

Announcing the 2013 Take Steps Chattanooga Event CHATTANOOGA—On October 19th, 2013 the Crohn’s & Colitis Foundation’s Tennessee Chapter will hold the 3rd annual Take Steps for Crohn’s & Colitis fundraising walk and celebration at Coolidge Park. Take Steps is the nation’s largest event dedicated to finding a cure for digestive diseases that affects over 1.4 million Americans, including 30,000 Tennesseans. Take Steps is a family-friendly walk and fundraising event, celebrating our strides towards a future free from Crohn’s disease and ulcerative colitis- collectively known as Inflammatory Bowel Diseases (IBD). Participants are encouraged to form teams of friends, family members and co-workers to walk together and enjoy this meaningful event. Monies raised will continue to fund CCFA mission-critical research, support and educational programs for patients, as well as Camp Oasis, a summer camp for children battling IBD. Attendees will enjoy a onemile walk through Coolidge Park, music provided Paul Hadfield and The Tucker Hollow Band, food, fundraising incentives and more. Young ones will have a blast in our Kid’s Corral, featuring fun activities for kids of all age. The event will also feature Mission Moments to spread awareness about IBD, featuring local Honored Heroes, 6 year old Kenny Smith and 18 year old Jerica Davis.

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East Tennessee Kidney Foundation Names 2013-2014 Board KNOXVILLE—The East Tennessee Kidney Foundation recently named its 2013-2014 board of directors. “I’m delighted to continue working with such a committed group of community leaders and volunteers,” said WATETV 6’s Sarah Burton, who was reappointed as East Tennessee Kidney Foundation president.Other board members include board secretary Edith “Dickie” Kaserman; board treasurer Charles “Wes” Carruthers

Jr. of Downey Oil/KenJo Markets; Sharon Azevedo; Shashi Dhingra of Realty Executives Associates; Danielle Faulkner of Fresenius Medical Care; Terry Gillingham of South Central Media; Dianne Hagey of Knoxville Dialysis Center; Brent Hannah of UT Medical Center; Vandaly Jeffers of Dialysis Clinic Inc.; Curtis McGinnis of Cedar Springs Christian Stores; Amy Pangelinan of Pinnacle Financial Partners; Richard Pangelinan of Tennessee Appraisal Group; and Steve Winfree of Visit Knoxville. Advisory board members include

Katrina Atchley Arbogast of Lewis, King, Krieg & Waldrop PC; Stephanie Burgett of Nephrology Associates; Brian Carlin of McKesson Medical-Surgical; Dr. Oscar Grandas of UT Medical Center; David Hammontree of A&W Office Supply and Design; Craig Horsley of AAA East Tennessee; Chanda Hurst of Qsource; Mark Moon of Cherokee Country Club; Ronald Sherrill of Care Max Home Medical; Dr. Denise Rivers of Nephrology Associates; Dr. Paul Serrell of Nephrology Associates; and Dr. Urath Suresh of Nephrology Associates.

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

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

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.”

Mutual Interests. Mutually Insured. Contact Randy Meador or Susan Decareaux at mkt@svmic.com or 1-800-342-2239. SVMIC is endorsed exclusively by the Tennessee Medical Association and its component societies. Follow us on Twitter @SVMIC

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SEPTEMBER 2013

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