East TN Medical News June 2015

FOCUS TOPICS MEN’S HEALTH PATIENT CARE MODELS

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PHYSICIAN SPOTLIGHT PAGE 2

Helping Men Get Healthy

By CINDy SANDERS

Wesley White, MD

ON ROUNDS Emphasis on Innovation A Look at the Tennessee Health Care Innovation Initiative The move away from feefor-service healthcare is sweeping across the country as payers and providers come together to search for innovative ways to improve outcomes while lowering costs. With Tennessee’s robust resources, the state is well positioned to take a lead role in transforming the delivery of healthcare ... 3

Getting the word out Men’s Health Network targets awareness of male-specific illnesses Health and wellness information for women and children is more accessible than ever before.

From better living through diet and exercise to the importance of preventive measures such as mammograms, there are resources in most every community. For men, however, facts and figures are a little scarcer on the ground ... 8

Special Advertising Physician to Physician ... 12

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American men live sicker and die younger than their female counterparts. However, Men’s Health Network is working to change the status quo by reaching out to men where they work, live, play and pray.

“We want to make sure we are every place where men can be reached,” stated Ana N. Fadich, MPH, CHES, vice president of Men’s Health Network (MHN).

It’s mission critical, she noted, given some of the sobering statistics about men and their well-being. Men have lower rates of health insurance coverage, a higher prevalence of death rates for nine of the 10 leading causes of death, fewer physician visits and cultural barriers to seeking help.

“A lot of times, men feel they are invincible,” Fadich said. She added phrases like ‘man up,’ or ‘big boys don’t cry,’ or ‘walk it off’ are deeply engrained in the American experience. A lack of awareness and education coupled with persisting cultural behaviors have

had a sustained, negative impact on men’s health in the United States. To reverse this trend, MHN is employing a number of strategies in an effort to impact health in five key areas: • Reducing premature mortality of men and boys, • Enhancing physical and mental health of men for happier, fuller, healthier lives, • Reducing cycles of violence and addiction, • Energizing government involvement in men’s health issues, and • Encouraging women to expand on their traditional role as the family’s healthcare leader to promote healthcare services and healthy choices.

The Weaker Sex

While males might celebrate their physical prowess, the reality is men are statistically the weaker sex. Fadich said men start out at a slight advantage with 105 boys being born for every 100 girls. How(CONTINUED ON PAGE 6)

The Competing P’s: Provision & Payment Changing reimbursement for new models of care

By CINDy SANDERS

First the good news … providers are generally excited about the idea of moving to more holistic, integrated care with a focus on prevention, quality and outcomes. Now the not-so-good news … we have to figure out how to pay for it.

“Providers are on board for the potential benefits from changes to the way we provide care, which is different from the way we pay for care,” noted Dion P. Sheidy, a partner in KPMG’s Health Care Advisory Practice. “This is a little bit of the elephant in (CONTINUED ON PAGE 7) the room.”

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PhysicianSpotlight

Wesley White, MD

By JENNIFER CULP

How did Dr. Wesley White become interested in medicine? “When my male modeling career didn’t pan out, I went for something a little more attainable,” he offered dryly.

In actuality, White’s attention was captured when he took part in Dr. Fred Hurst’s future DOCS program in high school. On a tour of the hospital in which White and his peers “got to dress up and go into the operating room and act like we were important,” he recalled, White had the opportunity to observe a heart bypass surgery in progress.

“I was like, ‘Man, this is awesome!’” he said. “And I thought the coolest job was the guy who was running the transfusion machine. I didn’t really know who was doing what, but I knew the guy who was down there recycling the blood out of the person who was getting the bypass—I thought that was the coolest job!”

A few years later, White did a summer internship while attending the University of Tennessee. Interested in cancer care, he ended up under the supervision of radiation oncologist Daniel Green, who, realizing the energetic young student might be feeling under stimulated, introduced him to surgical oncologist John Bell. White spent the rest of his summer observing the operating room, and left the internship with a mentor and an intention to pursue oncology. White worked with Dr. Bell to complete his capstone project as a member of the College Scholars Program at UT before leaving to attend medical school at the University of Tennessee, Memphis. Returning to Knoxville in the summers, White worked with Bell to fill the time and gain experience. But one day, Bell wasn’t around, and White’s future took an unexpected turn when a gruff urologist noticed him and called him into surgery.

“I think he misconstrued my level of training, he may have thought I was a resident or a more advanced medical student

or something,” White remembered, “but he was doing an open partial nephrectomy, where you remove just the tumor and leave the healthy tissue behind. Back then everything was done open-incision. I walked in and he didn’t have anybody else helping him do the procedure besides the scrub techs who were passing him instruments and stuff. He said, ‘Come here,’ and he had me grab the person’s kidney and squeeze it while he sewed up the defect where all the bleeding was coming from. I was like, ‘Man, this is AWESOME!!’ I had been learning how to scrub like 30 minutes beforehand, and I was already holding somebody’s kidney, so I kind of got a little fascinated with urology.”

Still, White wasn’t quite sold on specializing in urology…until he met his future wife, Nikki Zite, now an OB/GYN at UT Medical Center. At the time, Zite was a few years further into her medical training than White, and happened to count several urologists as friends. (“For some reason urologists and OB/GYNs tend to

run in similar social circles; make your own jokes,” White noted.)

White saw how happy the urologists of his acquaintance seemed to be, and decided he liked the balance of surgery and clinical care the field offered. Furthermore, it seemed like a potentially more enjoyable lifestyle than, say, cardiac surgery might offer. “Other than somebody getting shot in the kidney or having the commercialized erection that lasts for more than four hours, there really aren’t a lot of emergencies in urology, right?” White mused.

At this time, UT was working to implement a urology residency program.

White knew Dr. Frederick Klein and Dr. Bedford Waters from his experiences at the hospital, and was asked if he would be interested in becoming the program’s first resident. With a little bit of trepidation and a great deal of excitement for the opportunity, White agreed. “I was basically put in the deep end of the pool. There was no hand-holding, these guys work extremely hard, and that was basically it!” he said.

Following residency, he did a fellowship in minimally invasive oncology in Cleveland, Ohio, and then brought his new knowledge and skills back home to Knoxville.

Currently, White splits his time between surgery and clinical work, taking great satisfaction in both. He greatly appreciates the opportunity for continuity of care in his field, allowing him to form relationships with patients. While helping a patient survive kidney cancer is obviously gratifying, he said, so is the opportunity to alleviate pain and embarrassment caused by seemingly mundane problems such as incontinence and kidney stones. “My wife and I frequently get into screaming—well, I won’t say screaming matches—‘informed and heated’ discussions regarding which is worse: childbirth or kidney stones. I think that the vast majority of people who have had both would fall on the side of kidney stones. One is a joyous occasion and the other is not, necessarily,” he laughed.

When White and Zite aren’t working, their attention is absorbed by their two boys, ages 8 and 6. “Between two physicians and having two kids, it’s pretty much get up at the crack of dawn, work all day, come home usually around 5:00 or so if we’re lucky,” White said of his day-today routine. Both boys play baseball and swim, and nights when Zite—a residency director at UT—has to take in-house calls, White gets busy with “boys’ nights” of food at Chipotle or Moe’s and some shopping at Dick’s Sports.

“Both the kids are into baseball very heavily, they both swim, they’re running their first triathlon in two weeks, so it’s really when we’re not doing work stuff, we’re really trying to focus on them,” he said frankly. “I don’t want to sound corny, or scripted, saying this, but we feel very compelled to spend the majority of our time with our kids because we often do get torn in many different directions. It’s really a concerted effort to make sure we get to all the plays and all the games and that sort of stuff, and make sure they’re the central part of our life.”

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Emphasis on Innovation A Look at the Tennessee Health Care Innovation Initiative

By CINDY SANDERS

The move away from fee-for-service healthcare is sweeping across the country as payers and providers come together to search for innovative ways to improve outcomes while lowering costs. With Tennessee’s robust resources, the state is well positioned to take a lead role in transforming the delivery of healthcare.

“In 2013 Governor Haslam launched the Tennessee Health Care Innovation Initiative to move from volume to value,” said Brooks Daverman, director of Strategic Planning and Innovation for the Tennessee Division of Health Care Finance and Administration (HCFA).

Brooks “Our mission is to reDaverman ward providers for the outcomes that we want – high quality and efficient treatment of medical conditions and better health over time.”

Key Stakeholders & Background During a joint session of the Tennessee Legislature in the spring of 2013, Gov. Haslam pledged Tennessee would become “a model for what true healthcare reform looks like.”

Central to achieving this goal is the involvement of key players representing payers, providers, patients and purchasers across the state. “We’re trying to create an aligned approach for all the stakeholders,” noted Daverman. He added that by late May 2015, he and his team had held more than 440 meetings with interested parties to share information and receive input. From consumer groups like the Common Table Health Alliance to employer organizations including the Memphis Business Group on Health and East Tennessee’s HealthCare 21 Business Coalition, Daverman said payment reform could not occur in a vacuum.

Ongoing meetings with payers, providers and workgroups are used to design strategies to be broadly implemented across the state. Routine meetings are held with major provider organizations including the Tennessee Medical Association (TMA), Tennessee Hospital Association (THA), Hospital Alliance of Tennessee (HAT) and Tennessee Nurses Association (TNA), along with a host of specialty statewide organizations representing family physicians, physician assistants, pediatricians, children’s hospitals, mental health organizations, primary care providers, and medical education. In addition, Amerigroup, BlueCross BlueShield of Tennessee, Cigna, and UnitedHealthcare meet regularly with the team.

While the initiative took off in May 2013, Daverman said the roots of payment reform go back even further to a vision task force, which included members of TMA, THA, Darin Gordon from HCFA, and others. “It was a group of likeminded, influential people in the state thinking about how we can move things forward in terms easttnmedicalnews

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of healthcare payment and delivery,” Daverman noted. “I think the strategies we have chosen are all ones that were discussed in those meetings.”

As a result of stakeholder input, strategies in three key areas are being implemented: primary care transformation, episodes of care, and long-term services and supports. There is a Technical Advisory Group (TAG) for each strategic area to provide guidance on quality measures and program design.

Primary Care Transformation Daverman noted this component focuses on the “primary care provider – preventing illness, managing chronic illness and coordinating with other providers such as specialists.” He continued, “This is rewarding activities that are very important in primary care that aren’t necessarily paid for now.”

Daverman pointed out coordinating with a specialist takes time and effort for the primary care provider but isn’t necessarily reimbursable. Yet, the results of that coordination are often critical to a patient’s health.

“With all our strategies, we want to put the doctor in the driver’s seat,” he said.

Daverman added this focus on outcomes might require changes in communication, clinic hours, phone staffing, and other patient engagement activities in order to improve health and cut down on expensive emergency room visits. “If it results in better outcomes for quality and utilization, we want to reward that.”

Although he praised with work being done by ACOs, Daverman stressed the primary care transformation strategies are different and easily scalable. “All of our strategies are feasible for providers without making significant changes to business relationships,” he said.

The starting point is with patient centered medical Homes (PCMH), health

homes for SMPI (serious and persistent mental illness) patients, and provider alerts for hospital and emergency department admissions, discharges and transfers. “We’ll start with about a dozen practices and want to go statewide within a couple of years,” Daverman said of programming, which is slated to launch in mid-2016.

Whether or not providers are in a PCMH, those who sign up can tap into the web-based statewide alert system. “We’re going to work to have real-time notices every time a patient goes to the emergency room of a hospital,” Daverman said of the data being populated by participating payers. In addition, he said the system would be able to generate a ‘gaps in care’ report and alert providers to their patients’ drug fills.

“It’s really, really important information to have if you want to manage your patients.”

Episodes of Care “This is the strategy that’s the furthest along,” Daverman noted of aligning incentives with desired outcomes. Episodes reward high quality care, promote the use of clinical pathways and evidence-based guidelines, and encourage coordination to reduced ineffective or inappropriate care.

Under the initiative, episode-based payment is being rolled out in waves with the goal of implementing 75 episodes by the end of 2019.

Wave 1 launched in May 2014 with three episodes of care: acute asthma exacerbation, perinatal, and total joint replacement. For six months, more than 500 providers received detailed preview reports from TennCare and commercial payers before the wave went live in 2015.

“Providers are getting new information they’ve never had before in quality reports,” Daverman explained. “They can see how they compare to their peers on cost, and we break down those costs into categories to

make it actionable.”

He continued, “Providers who have the most expensive average episode cost for the year across the state are penalized by a portion of their excess cost.” However, Daverman noted, the threshold for a penalty is set pretty high and is considered only after adjusting for exclusions such as high-risk patients or extraordinary events. Ultimately, the projection is the most expensive 10 percent of providers will face a penalty. On the other hand, he said, “It’s very important we reward providers who meet quality measures and provide efficient care with shared savings.” Daverman predicted, “The majority of providers will have no change or will get rewarded.”

Preview reports for Wave 2 – acute COPD exacerbation, screening and surveillance colonoscopy, outpatient and nonacute inpatient cholecystectomy, and acute and non-acute PCI – began at the end of last month. The advisory group has just completed their process for Wave 3, which will roll out preview reports next year and go live at the beginning of 2017.

Long-Term Services & Supports Daverman said the main premise of this strategy is to tie payment to quality and acuity. “Some of the measures are around the patient experience, and some of the quality measures are around the caregivers,” he said.

Key points include implementing quality- and acuity-based payment for nursing facilities and home- and community-based services, value-based purchasing initiatives for enhanced respiratory care, and focusing on workforce development.

More Information Details on each of the strategies is available online in the Strategic Planning and Innovation Group section of HCFA at tn.gov.

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LegalMatters

BY J. SPENCER FAIR, LONDON & AMBURN, P.C.

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Patient Care Models: Patient Portal Security Risks The American Recovery and Reinvestment Act of 2009 (“ARRA”) instituted incentives through the Center for Medicare and Medicaid Services (“CMS”) for the “meaningful use” of certified electronic health record technology (“EHR”).

Once a provider has established meaningful use of EHR, the next step can involve the use of patient portals, which allow patients to access electronic protected health information (“e-PHI”) online, among other things (1).

As with any confidential information accessed online, a natural concern accompanying the increased use of patient portals relates to cyber security and Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) compliance.

HIPAA’s “minimum necessary” standard requires providers to evaluate their practices and enhance safeguards as needed to limit unnecessary or inappropriate access to and disclosure of protected health information (2). Online data breaches are prevalent worldwide even despite preventative efforts, and maintaining HIPAA

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compliance while utilizing patient portals creates potential challenges for providers.

What are patient portals?

A patient portal is a secure online website that gives patients 24-hour access to e-PHI online (3). Patient portals also allow providers to use secure electronic messaging to communicate with patients on relevant health information (4). Patient portals are part of Stage 2 of the ARRA’s Medicare and Medicaid EHR Incentive Program, available only after a provider has demonstrated Stage 1’s “meaningful use” (5).

What steps are required by HIPAA for a provider to secure EHR and patient portals?

All “covered entities” under HIPAA are required to perform a risk analysis to secure EHR systems and patient portals (6). The installation of a certified EHR does not alone fulfill the meaningful use security risk analysis, and EHR vendors are not responsible for making their products compliant with HIPAA Privacy and Security Rules (7).

HIPAA requires providers to conduct an accurate and thorough analysis of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of e-PHI (8). Beyond this risk analysis, a healthcare provider must take any additional “reasonable and appropriate” steps to reduce identified risks, and must continue to review, correct, modify, and update security protections (9). All e-PHI created, received, maintained, or transmitted by a provider is subject to the HIPAA Security Rule (10). There is no one-size-fitsall security risk analysis for every provider, but the HIPAA Security Rule requires providers to “[i]mplement policies and procedures to prevent, detect, contain, and correct security violations” (11).

Although a provider is required to protect e-PHI, the HIPAA Security Rule does not create an unreasonable burden to accomplish this requirement. The HIPAA Security Rule requires providers to evaluate risks and vulnerabilities in their environments and to implement reasonable and appropriate security measures to protect against reasonably anticipated threats or hazards to the security or integrity of e-PHI (12). CMS recommends the following considerations in conducting a

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risk analysis: 1) Review the existing security infrastructure in your medical practice against legal requirements and industry best practices; 2) Identify potential threats to patient privacy and security and assess the impact on the confidentiality, integrity, and availability of your organization’s e-PHI; and 3) Prioritize risks based on the severity of their impact on your patients and practice (13).

What are some practical safeguards for patient portals to help achieve compliance with HIPAA? For patient portals specifically, many providers have successfully used certain safeguards to comply with the HIPAA Security Rule. One safeguard involves hosting the patient portal on a secure connection with access only permitted pursuant to an encrypted, password-protected login (14). Another safeguard that should be utilized is a patient portal audit trail feature which keeps a record of who has accessed the EHR, what changes were made, and when (15). A provider should also actively monitor the patient portal, and timely respond to and inform patients of any potential breaches (16).

While these safeguards are by no means exhaustive, they offer reasonable steps that are appropriate and available to most providers.

Notes 1. See CMS EHR Stage 2 Overview Tipsheet, available at: http://www.cms.gov/regulations-andguidance/legislation/ehrincentiveprograms/downloads/stage2overview_tipsheet.pdf.

2. See 45 C.F.R. 164.502(b).

3. See http://www.healthit.gov/providers-professionals/faqs/what-patient-portal.

4. See CMS EHR Stage 2 Overview Tipsheet.

5. See Federal Register, Vol. 77, No. 171, Part II, September 4, 2012; 42 CFR Parts 412, 413, and 495.

6. See EHR Security Risk Analysis Tipsheet, available at: http://www.cms.gov/Regulationsandguidance/Legislation/EHRIncentivePrograms/ Downloads/SecurityRiskAssessment_FactSheet_Updated20131122.pdf.

7. See Id. 8. See Id. 9. See Id., citing 45 CFR 164.308(a)(1)(ii).

10. See EHR Security Risk Analysis Tipsheet, referencing Guidance on Risk Analysis Requirements Under the HIPAA Security Rule, available at: http:// www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/rafinalguidancepdf.pdf, citing 45 C.F.R. §§ 164.302-318.

11. See Id., citing 45 C.F.R. § 164.308(a)(1).

12. See Guidance on Risk Analysis Requirements Under the HIPAA Security Rule.

13. See EHR Security Risk Analysis Tipsheet.

14. See National Learning Consortium, Frequently Asked Questions about the Patient Portal, available at: www.healthit.gov/sites/default/files/nlcfaqs-about-patient-portal.docx.

15. See Id. 16. See Kao, Christine, “Three Ways to Calm Patients’ Concerns About Patient Portal Security,” available at: http://www.carestream.com/ blog/2014/06/10/three-ways-to-calm-patients-concerns-about-patient-portal-security/.

Attorney J. Spencer Fair focuses his practice on medical malpractice defense, nursing home and longterm care defense, and general health law matters.

For more information, you may contact Mr. Fair by visiting www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

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East Tennessee

Daylily Bloom Festival – Oakes Daylily Farm

By LEIGH ANNE W. HOOVER

I love daylilies. A couple of gorgeous red varieties with brilliant yellow centers are planted near the road in two beds by columns at our driveway. If we can keep the deer away, their splendor is a yearly delight and one anticipated and enjoyed each summer.

Years ago, I attended an in-depth garden and horticulture study club meeting with my late mother, Corrie M. Whitlock, at the home of a daylily grower in South Carolina. These special daylilies are treasures from that meeting and always remind me of learning more about God’s beauty exhibited through flowers with her.

In my latest adult Christian book, For Better or Worse…Unless Annulment Comes First, there is a chapter titled “God Knows,” which mentions her many talents. Mama was a past president of the Garden Club of South Carolina, a South Atlantic Regional Director serving on the National Garden Club board, master gardener, master flower show judge, and the list continues.

The first time I experienced flowers planted together in mass was on a family trip to Holland and visiting the worldfamous floral garden, Keukenhof. Its brilliance is only displayed for an eight-week time span. This was truly a “bucket list” check for my husband and our children that it was open, and we were able to go see its grandeur.

Just this past spring, my father pointed out tulips, which one of my brothers purchased on a visit to Keukenhof years ago, and they were blooming, yet again, in a flowerbed.

From above, where varieties are planted for commercial use, Holland in springtime looks like God poured huge paint buckets in rows of color.

Last fall, when I interviewed Ken Oakes about the Corn Maze and Pumpkin Patch at Oakes Farm in Corryton, Tenn., I learned about the summer Daylily Bloom Festival celebrated yearly in June and just knew I would write about it, too. The Oakes family farm spans generations.

“My father and grandfather always enjoyed growing all types of plants,” explained Ken Oakes. “They started growing daylilies in the 70s…Daylilies come in so many shapes and sizes, they lend themselves to collecting.”

Daylilies, which are relatively easy to grow, became the Oakes’ passion, and they began growing and selling daylilies from the front yard. A black and white catalog was first produced in 1981.

“Folks would come to my grandfather’s house,” explained Oakes. “That was one of my summer jobs in high school— digging plants for them when they’d come during bloom season and pick out what they liked.”

Ken Oakes officially joined the business in 1990 and helped produce the first color catalog, which made Oakes Daylilies

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available to even more customers. Today, orders come in from all of the United States and also many countries overseas.

With increased demand, it became difficult to be open throughout bloom season. So, Oakes Daylilies began a “bloom festival,” which is always the last Friday and Saturday in June, to be open to the public. This year marks the 15th annual Oakes Daylily Bloom Festival.

“We do get a lot of folks from around the country that make plans to come and visit the festival,” said Oakes. “We have a map and put up with pushpins to show us where you are from, and we kind of get an idea what states are represented.”

In addition to the display garden, which gives visitors an idea of how to plant the lilies, an additional six acres offer plenty of lilies for visitors to easily walk and enjoy picking out varieties. Oakes says the experience has even been compared to

the tulip fields in Holland.

“It’s not something you’re going to see too many places in the world,” explained Oakes. “This many daylilies are all in full bloom, and it’s just a beautiful sight. There are over 1,500 different varieties in all different colors, and it’s free.”

Oakes likes to joke the last lily he saw is always his favorite. With so many varieties, in many different sizes and every color but blue, there are many selections for gardeners.

Oakes Daylilies sells large plants, which are guaranteed to bloom the first year.

Supply determines the price on the lilies. As the supply grows, the cost comes down.

Years ago, the most expensive lily was named benchmark, and Oakes’ grandfather paid $75 for the large lavender variety, which now sells for around $14.95.

“We thought they’d ‘lost it’ when they brought home the one they paid $75 for,” said Oakes, speaking about his father and grandfather. “We’ve paid more than that since then!”

In addition to growing and selling daylilies, the Oakes also hybridize daylilies. Over 30 have been registered with the American Hemerocallis Society.

Oakes notes all daylilies can be divided, and it is good to do this every three to five years. In personal gardens, September is a great month to divide daylilies.

This year’s Daylily Bloom Festival is June 26th and 27th from 9:00 a.m. – 3:00 p.m. both days.

“You get a lot of pleasure growing daylilies. It’s just a lot of fun to be able to plant something, and when you know it grows and blooms and is gorgeous, you can show it off to your friends,” said Oakes. “It’s very rewarding, and I enjoy sharing that with folks.”

In addition to admiring the lilies, the Oakes have activities during the festival for the children, including hayrides, food and music. Plus, everyone who visits leaves with a free daylily!

“We have just been really blessed to make a living growing daylilies,” said Oakes. “I mean, you can’t plan something like that!”

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

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Helping Men Get Healthy, continued from page 1 ever, she continued, “Once they hit (age) 34, the numbers for men begin to decline.

At retirement age, there are about 80 men to every 100 women.”

In general, men’s life expectancy tends to be five years less than that of women – 76.3 vs. 81.1 years, according to the latest data from the National Vital Statistics System. For non-Hispanic black males, life expectancy is even lower at 71.6 years.

Additionally, the gender gap widens during teenage years and early 20s when more men than women are lost to accident, violence and suicide.

In fact, suicide across all age groups is more prevalent in men. In 2013, men had a suicide rate of 20.2 vs. a rate of 5.5 for women. That year, death by suicide was 77.9 percent male compared to 22.1 percent female, according to the 2013 CDC Fatal Injury Report.

A December 2013 report from the U.S. Department of Justice noted the nation’s homicide rate fell to 4.7 homicides per 100,000 residents in 2011, the lowest level since 1963. Even so, of the 14,610 homicides in 2011, men accounted for 11,370 victims. From 2002 to 2011, the average homicide rate for males was 3.6 times higher than that of females, and young adults ages 18 to 24 had the highest homicide rate of any age group.

Changing Trends

Fadich said strategies including national awareness and educational campaigns, partnering with providers and

organizations nationwide, and conducting screenings at events where men gather all enhance MHN’s efforts to change those trends.

From experience, Fadich noted, when a man is asked why he hasn’t gone to the doctor, the answer more often than not is because he can’t afford the time away from work. The answer, she continued, is to bring the ‘doctor’s office’ to the workplace.

Fadich said MHN has been to worksites from John Deere to Harley Davidson. “We bring the information to them,” she said.

“Sometimes we do screenings – cholesterol, glucose, blood pressure, body fat and grip assessment.” Fadich added MHN also works with partners nationwide to provide information and brochures for those planning health fairs or lunch and learn series at workplaces throughout the country.

The organization and its partners also have a strong presence at sporting events and in churches. “That’s where we do a lot of screenings and events – in the ‘play and pray’ portion of our mission,” Fadich said.

She noted they have worked with the National Football League, National Basketball Association, and Major League Baseball in an attempt to reach men and boys.

Churches also play a key role in getting the message across. “A lot of the folks we reach are underserved and minority populations, and they are very connected to their churches,” she explained. Fadich added, “We always recommend they speak to their healthcare provider, but we get the conversation started.”

Provider Push

Fadich said physician visits really drop off for men after they age out of a pediatrician’s office. After that, she noted, “Women get called all the time for their pap smear or mammogram. Men aren’t getting those kinds of calls.”

Knowing that physician encounters aren’t as frequent, the hope is that providers will start deeper conversations with men about family history, diet, prostate and testicular cancer, and other health concerns any time an opportunity presents … whether it’s after a sports injury, work accident or a collegiate STD scare.

“We want men to start thinking about health at a younger age and recognize what they are doing now will affect health in their 50s and 60s,” Fadich said.

Men’s Health Month

Fadich noted Men’s Health Week – the week leading up to Father’s Day – started in 1994 and was signed into law

by President Bill Clinton. “We encourage men to wear blue during that week in recognition of men’s health,” said Fadich, who added the number of events has grown so significantly over the years that one week is no longer sufficient. “Now we use the entire month of June to raise awareness about men’s health.”

To request materials and resources or to learn how to partner with MHN, go online to menshealthnetwork.org or call (202) 543-MHN1 (6461).

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ACCEPTING NEW PATIENTS

GIforKids 2015 Camp Oasis Sponsorship by KidsFACT. A drawing was held April 6, 2015 sending two of our patients to summer camp.

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2100 Clinch Avenue, Suite 510 | Children's Hospital Medical Office Building | Knoxville, TN 37916

www.giforkids.com (865) 6

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546-3998

Help on The Hill In April, Rep. Markwayne Mullin (R-Okla.) and Rep. Donald Payne, Jr. (D-N.J.) were announced as cochairs of the newly re-authorized Congressional Men’s Health Caucus of the American Public Health Association.

The Caucus is dedicated to raising awareness of male health issues, encouraging men and boys to take an active role in their personal health, and promoting legislation that has a positive impact on the health of American men, boys and their families.

The bipartisan Caucus, which was formed in 2010, works closely with Men’s Health Network to ensure issues affecting men and boys have a place in government healthcare priorities.

The Caucus has established a Prostate Cancer Task Force, which is charged with increasing awareness of the disease. The group is also conducting outreach to three groups with especially high risk of developing prostate cancer – African-Americans, veterans exposed to Agent Orange, and individuals with a family history of the disease. Additionally, the Caucus, in conjunction with Men’s Health Network, has led briefings on a number of topics impacting men’s health and will continue these efforts to educate Congress and the general public.

Bee Fit 4 Kids is a family oriented pediatric weight management program using evidenced based research to help overweight children & their families. We are now accepting insurance.

KidsFACT is a nonprofit support group created

by GI for Kids, PLLC for those diagnosed with pediatric Inflammatory Bowel Disease (IBD) & their family members.

Our behavior clinicians are experienced in helping a variety of disorders.

Support group helping the Knoxville region with celiac disease & gluten intolerance. www. celi-act.com

easttnmedicalnews

.com

The Literary Examiner

BY TERRI SCHLICHENMEYER

The Man Who Touched His Own Heart: True Tales of Science, Surgery, and Mystery

by Rob Dunn; c.2015, Little, Brown; $27.00 / $30.00 Canada, 384 pages

Last weekend, you almost ran yourself ragged.

In the end, you were beat. Finished, and in need of a rest - but doing so completely would mean the end of you. Find out more in The Man Who Touched His Own Heart by Rob Dunn.

Long ago, before there were hospitals and physicians to staff them, doctors operated under the assumption that the heart was the seat of emotion. Aristotle believed the brain was “nothing more than mucus,” that the heart was where thoughts originated. Hearts were mostly “untouchable,” and only observed when a patient was dead.

All that changed in the summer of 1893 when an African American doctor had no other choice but to do the unthinkable.

Dr. Daniel Hale Williams founded Provident Hospital and Training Association in Chicago specifically because of racial issues and lack of care for black

patients. On the evening of July 9, an expressman was brought in with a knife wound that initially looked superficial but had, in fact, penetrated “all the way into the heart.” It was a “remarkably common” wound, and most people died of it. Williams, however, cut into his patient’s chest, repaired a hole in the man’s pericardium, and saved his life.

When he performed his feat, Williams was not without knowledge of the heart. In ancient times, Galen studied gladiators and their heartbeats. Leonardo da Vinci reportedly did autopsies to aid in his study of the human body, as did others a few decades later. By the early 1800s, scientists even understood circulation.

A cigar chomping, heavy drinker figured out how to thread a catheter into the heart by experimenting on himself, for which he won a Nobel Prize. A World War II volunteer crafted the heart-lung machine, an inventor created the first pacemaker, and hundreds of dogs died in the quest for transplant knowledge.

And what happens next?

Research. Says Dunn,” We know far less about hearts than doctors, scientists, and everyone else thinks.”

You hear about hearts on the radio.

Hearts are in everyday conversation, playing cards, and slogans. But what do you know about them? Plenty, after you’ve finished reading this book.

But The Man Who Touched His Own

Heart is much more than a story of our tickers. Author Rob Dunn also touches upon ancient history, medical history, philosophy, literature, and culture. Readers get a brief (but thorough) look at how we know what we know, how we can keep our hearts healthy, ways to live longer despite that science thinks we have a finite number of years in us, and what’s on the horizon. That makes a lively, sometimes humorous, and very helpful book to read.

If you’re curious about what makes you tick, this book can’t be beat.

Welcome to My Breakdown

by Benilde Little; c.2015, Atria; $26.00 / $32.00 Canada, 288 pages You’re tired of crying; tired of an empty soul, runny nose, and dry mouth, but you know there are more tears inside you and they need to come out. Whoever said that big girls don’t cry needs to know that that’s not true: as in the new book Welcome to My Breakdown by Benilde Little, sometimes crying is only the beginning.

For many years, Clara Little liked to say that she knew her last child would be a girl. She predicted it, and it happened

– perhaps through force of will because, says her daughter, Clara was that kind of person: self-reliant and strong.

Clara worked long overnight shifts, but made sure that her house was spotless.

She helped care for her neighbors and her family, giving her children a good uppermiddle-class life at a time when that was a rare thing in their mostly-African American New Jersey community. Her giving spirit and her no-nonsense personality remained well-known for the rest of her life, and when Clara died, her many friends mourned along with her family.

For Benilde Little, the death of her mother was a crushing blow – the biggest in a series of events that bruised her alreadyfragile, sensitive soul. Two months prior, Little lost her father-in-law.

After her mother’s death, her best friend’s mother died, the financial market collapsed, the Littles’ income fell, Little’s dog got sick, menopausal symptoms exacerbated, and her husband was diagnosed with cancer.

For months, Little could barely function without dissolving in tears. She had trouble getting out of bed, she stopped calling on friends, and her writing career all but halted. Seemingly everybody had advice and most offered support but, powerless to pull herself up and knowing that this was more than just grief, Little began seeking help for a diagnosis of clini(CONTINUED ON PAGE 8)

The Competing P’s: Provision & Payment, continued from page 1 Nashville-based Sheidy said the Centers for Medicare and Medicaid Services have stated their plans to significantly increase value-based payments to providers over the next few years. In a fact sheet released in late January, CMS noted improving quality and affordability of healthcare was as much a pillar of the Affordable Care Act as expanding access. The goal, the memo continued, is to reward value (measured by quality of outcomes) and care coordination and efficiency rather than volume and duplication. To that end, the Department of Health and Human Services has adopted a framework of four categories of payment: • category 1: fee-for-service with no link of payment to quality, • category 2: fee-for-service with a link of payment to quality, • category 3: alternative payment models built on fee-for-service architecture, and • category 4: population-based payment.

Value-based purchasing includes payments in categories two through four.

The stated goal is to have 30 percent of Medicare payments in alternative payment models (categories three and four) by the end of 2016 and 50 percent by the end of 2018. Additionally, HHS hopes to easttnmedicalnews

.com

have 85 percent of Medicare fee-for-service payments in categories two through four by the end of 2016 and 90 percent by 2018.

“Although they have put that out there, they have yet to put out guidance about how they expect to achieve it,” noted Sheidy. “These are huge jumps.

We’re going to go from less than 10 percent in fiscal year 2015 to 90 percent with some link to quality in fiscal year 2018.”

Sheidy added there is some ambiguity as to what CMS calls ‘alternative fee arrangements’ and that at this point there are a lot more questions than answers.

While he doubts normal market forces would push payment reform fast enough to hit the HHS targets in the next three years, he said regulatory changes could be the driver to hasten the transition to valuebased payment.

“There are elements of the Affordable Care Act that have some pretty significant unknowns attached such as the Cadillac tax,” he continued. The chief unknown, he continued, is “Does the Cadillac plan tax survive and get implemented as it stands today?” That question, he added, probably won’t be answered until after the presidential election.

The 40 percent excise tax, which is currently scheduled to go into effect in

2018, is levied on healthcare benefits that exceed certain pre-set limits. Despite the name of the tax, Sheidy said its impact would be felt far beyond affluent circles. In fact, the thought is that a significant number of employers could wind up incurring the tax. “This cuts across political parties when it comes to the impact of this,” he said, noting teachers, labor unions and public officials often have strong healthcare benefit packages. “You’re talking about having an excise tax that indirectly impacts a significant amount of the population through employer-provided benefits.”

He continued, “If this Cadillac tax survives, employers are going to be faced with having to change benefits, maintain benefit levels under a different cost structure, or pay the tax.” Sheidy added that since there doesn’t seem to be much enthusiasm for paying the tax, employers are going to look at how to bend plan design or the cost curve and will be more willing to consider value-based network designs.

“The government … through statements around the move to the 80 percent (value-based purchasing) along with the continuing lingering effects of the Affordable Care Act … has really set the industry up for the opportunity for some significant impact on payment reform over a fairly

short time frame,” he noted. “On the payer side, CMS is looking to change the payment mechanism. On the commercial side, we’re looking at the Cadillac tax and how to get costs under control. And all of those things share the potential to come into play over the next several years. It’s almost like the perfect storm.”

It’s not that the industry hasn’t taken any steps to prepare for a move to a different type of payment mechanism. Sheidy said the industry is already involved in demonstration projects, quality reporting and capturing data points. However, he pointed out, the true impact on payment of all that collection and monitoring is still pretty narrow.

“People confuse population health with risk and payment,” he said. Now, we’re at the intersection of how to more effectively, efficiently manage the health of a population while simultaneously figuring out how to link payment to these new practice models.

While the industry has floated along with a foot in both the fee-for-service and value-based worlds for quite a while, Sheidy said the drivers are now in place, barring any changes, to force the movement to a more outcomes-based payment methodology in a very short window of time.

JUNE 2015

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The Literary Examiner, continued from page 7

cal depression. She tried therapy sessions, prescriptions, distractions, and exercise but she still couldn’t stop crying and she couldn’t erase certain mental images that plagued her. There were good days, but they were eclipsed by the very, very bad ones - until she began to see things that further opened her eyes.

We’ve all had times in our lives when nothing goes right. Welcome to My Breakdown, shows what it feels like when one of Those Days lasts for years.

Indeed, although it’s hard to accurately explain the depths of depression or grief, author Benilde Little still gives readers a good sense of the senseless, and of the confusion that’s felt when one is completely, totally powerless to explain why certain harmful emotions are so sticky and can’t abate. We’re also taken on a trip through a few of the various treatments that work – and don’t – before Little finds a shaky conclusion.

Be aware that there’s quite a bit of back-story filler and empty name-dropping here, but since this book could be a comfort to anyone experiencing grief or depression, the pay-off might be worth the journey.

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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JUNE 2015

HealthcareLeader

Getting the word out

Men’s Health Network targets awareness of male-specific illnesses

By JOE MORRIS

Health and wellness information for women and children is more accessible than ever before. From better living through diet and exercise to the importance of preventive measures such as mammograms, there are resources in most every community. For men, however, facts and figures are a little scarcer on the ground.

“There really aren’t any programs out there that are tailor-made for men,” said Mike Leventhal, executive director of the Tennessee chapter of the Men’s Health Network (MHN).

“We are the premier organization in the state promoting the health of men and boys, and have been around for about 12 years. We reach out to men, providing community awareness events and things like prostate cancer screenings so that more men in Tennessee can be made aware of the specific health issues they face, and what they need to be doing in order to avoid problems, or to prevent problems from getting worse.”

The organization, which relies heavily on volunteer efforts, works to partner with everyone from the Tennessee Dept. of Health down to, and through, insurers, hospitals, clinics and community-health organizations. That way, Leventhal explains, MHN can piggyback off wider outreach efforts and get in front of the men who might be in attendance. Of particular interest to him are men in uninsured and underserved populations, which can be anywhere from urban homeless groups to rural communities.

“We want to find, and talk to, the guys who don’t have access to healthcare,” he said. “We are always working to build coalitions with others stakeholders in the community who care about men’s health.

Prevention messages, screenings programs, and education materials are how we get it out there, but our main goal is making sure that the men we talk to, and their families, find a qualified physician and then get in front of that doctor to get checked out.”

To that end, Leventhal says he and the MHN volunteer network act as navigators.

If they meet a man who is around 50, for example, at a health fair and he indicates there’s a history of prostate cancer in his family, they don’t just provide information about screenings.

“We help them find a doctor, and if they don’t have access to healthcare due to being uninsured or other issues, we try to get them to a free or low-cost clinic in their

community,” Leventhal said. “We work with the federally qualified health centers, or FQHCs, in the state so we make the connections guy will need in order to get care.”

As the Tennessee chapter’s founding executive director, Leventhal has seen it, as well as the national MHN organization, grow by leaps and bounds. A University of Tennessee graduate, he says his position combines an interest in government and public-health policy with a family history of prostate cancer that led to a heightened awareness of that disease and its treatment challenges.

“I’ve always been an exercise enthusiast and I try to eat well, so I’m doing a lot of the things I tell these gentlemen they should be doing,” he said. “But we continue to build an organization that’s not just about giving advice, but is really about changing the status of men’s health care in Tennessee, which statistically has some of the unhealthiest men in the country, if not the world.”

Making meaningful change means not just getting in touch with men over 50 who might need a colonoscopy, or overweight youth at risk of type 2 diabetes, but men and boys of all ages. That’s why MHN relies on an active board of directors who are connected into health systems across Tennessee, to build partnerships whenever

and wherever possible, but also on creating unique programs of its own. One of those, which is launching in Tennessee now in a shared pilot program with the East Tennessee State University College of Public Health, is “Save the Doodads” (savethedoodads. org), which focuses on testicular cancer.

“We wanted to bring humor to a serous subject,” Leventhal said. “We are hoping to take this to all colleges around the state, and eventually around the country, to promote testicular cancer awareness and the importance of self examination. “This type of cancer is prevalent in men between the ages of 15 and 35, so this is a perfect demographic for us to reach out to,” Leventhal said. “What we’re hoping is that this will help start healthy habits that will stay with a man throughout his life — that he’ll go to the doctor not just when he needs antibiotics for a cold, but for preventive visits and tests. We want to plant the seed with men to make these visits in the same way other organizations do with women regarding annual mammograms.”

So whether it’s putting out its own materials about eating right, or helping men in rural areas find (and see) a physician, Tennessee’s MHN chapter has its hands full. In June, which is Men’s Health Month, Leventhal said he expects to be crisscrossing the state continuously — and that’s just fine.

“We want to meet men where they live, and encourage them to see a physician and just get everything checked out,” he said.

“In the 12 years we’ve been around, we’ve been able to make some very strong inroads.

About 70 percent of the men we’ve reached out to make, or will make, an appointment to see their primary care physician, and that’s a statistic we are very proud of.”

In the meantime, he added, “We’ll be out there asking guys if they know their blood pressure, cholesterol, and PSA. Those are the numbers every man should know, and if they don’t, then we’ll get a conversation started. We have a lot of very well educated men in our state, but we also have a lot who are very unaware of the health issues they face. We get on a person’s level and work to lead them to a doctor’s office. I befriend a lot of people, as do our volunteers.

We’re working to build people up because a lot of the men we help turn around and become some of our best volunteers. That’s how we get in front of fraternities, service groups, church congregations, workplaces … wherever there are men, we want to get in there and talk to them.” easttnmedicalnews

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Five Ways Millennials Have Shaken Up Healthcare

By JULIE PARKER

The most influential demographic group – millennials, ages 21-32, empowered by advances in technology – is turning America’s healthcare landscape upside down.

In a recently released survey commissioned by PNC Healthcare, more than 5,000 participants nationwide explored the impact of patient-centered care among various age groups, including millennials, Generation X or Gen-Xers (ages 33-49), baby boomers (ages 50-71) and seniors (72+). The most significant finding: online shopping for doctors, webbased diagnostic tools and research about treatment options have a role in healthcare decisions for millennials, replacing the single-source, primary care physician (PCP) favored by older generations.

“As millennials overtake boomers as the nation’s biggest consumer buying group, they will expect more efficient ways to make healthcare payments via digital channels that are consistent with their experiences in other industries,” said Shane Print, vice president of PNC Healthcare for Florida, Alabama and Georgia. “It’ll be important for payers and providers to work together to meet these payment expectations by progressing further along the technology continuum, especially considering that much of the growth in the healthcare payments industry has been driven by a rise in patient responsibility.

Those insurers and healthcare providers that thrive will be those that adapt sooner than later to the preferences of this fastpaced, technology-driven generation.”

Growing trends among the millennials that are driving change in healthcare include:

and Healthgrades, when shopping for a healthcare provider, compared to 40 percent of baby boomers and 28 percent for seniors.

“The timely management of social media is critically important to the growth and success of healthcare,” said Print. “Bad patient reviews can come too easy, so making sure positive reviews greatly outnumber the negative ones is a

constant challenge for all practices. Getting happy patients engaged with sharing their positive experience will continue to be important for a practice’s success.”

Kick the tires online before buying

Half of millennials and 52 percent of Gen X-ers checked online information about their insurance options during

Word-of-mouth marketing

Nearly 50 percent of millennials and Gen-Xers use online reviews, such as Yelp easttnmedicalnews

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Good faith, upfront estimates

One of five people surveyed by PNC (CONTINUED ON PAGE 10)

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When it comes to the drive-thru generation, millennials prefer retail (34 percent) and acute care clinics (25 percent) double that of boomers (17 and 14 percent, respectively) and seniors (15 and 11 percent, respectively). On the flip side, seniors (85 percent) and boomers (80 percent) visited their PCP significantly more than millennials at 61 percent.

For example in Florida, Print noted that urgent, specialty and retail clinics over the last four years have grown dramatically. “Quick Care” availability has been recognized as a top priority by many healthcare organizations, and even large retailers and several pharmacy chains. Millennials expressed concern about this method of care and the quality of the patient’s care, based on who’s consulting with the patient (level of education), possible lack of patient’s accurate healthcare background, and pressure of being a “quick appointment.”

their last enrollment period, compared to 25 percent of seniors, who prefer printed materials (48 percent) or a company representative (38 percent) before selecting their plan.

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GrandRounds Dr. Mukesh K. Sharma Joins Tennova’s Medical Staff Oak Ridge heart specialist will see new and existing patients at East Tennessee Heart Consultants in West Knoxville KNOXVILLE – Tennova Healthcare welcomes Mukesh K. Sharma, M.D., cardiologist and interventional cardiologist, to his new medical practice at East Tennessee Heart Consultants.

Sharma is a distinguished heart specialist with significant experience as an interventional cardiDr. Mukesh K. ologist. He specializes in Sharma a broad range of coronary and peripheral interventions. Dr. Sharma has a special interest in treating patients with structural heart disease, valve disorders, cardiomyopathy, and those needing pacemakers and defibrillators.

As a medical director of cardiovascular research, Dr. Sharma has been a principal investigator for numerous cardiovascular clinical trials. He will be joining Tennova Healthcare’s Cardiovascular

Five Ways, continued from page 9 listed unexpected/surprise bills as the No. 1 billing-related issue. With out-of-pocket costs on the rise, millennials are more inclined (41 percent) to request and receive estimates before undergoing treatment.

Only 18 percent of seniors and 21 percent of boomers reported asking for or receiving information on costs upfront. Unfortunately, 34 percent noted the final bill was higher than the estimate; only 8 percent reported a bill lower than estimate.

“What we’ve found with our clients in the southeast is that healthcare practices are now more motivated than before to improve the patient’s experience around billing, payment plans, and care and insurance coverage education due to the need to comply with healthcare reform requirements and for the sake of improving the profitability of the practice,” added Print.

Kicking care down the road.

All age groups agreed that medical care is too expensive (79 percent) and healthcare costs are unpredictable (77 percent). But more than half of millennials (54 percent) and Gen-Xers (53 percent) reported delaying or avoiding treatment because of cost, compared to seniors (18 percent) and boomers (37 percent).

“What we’ve found locally,” added Print, “is that with many patients neglecting their care due to costs, practices are addressing this issues by offering free/low cost healthcare clinics, healthcare education, and automated patient payment programs.”

PNC Healthcare is a member of The PNC Financial Services Group Inc. The survey was conducted by Shapiro+Raj in January.

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JUNE 2015

Research team at Turkey Creek Medical Center, which offers patients new therapies and devices for the treatment of carotid artery stenosis, coronary artery disease, heart failure, hypertension, hyperlipidemia, atrial fibrillation, stroke prevention, and peripheral vascular disease.

Most recently, Sharma was in private practice in Oak Ridge. He has served the community for nearly 22 years. He earned his medical degree from Christian Medical College in Ludhiana, India. He completed an internship and residency at Christian Medical College and Hospital; and a residency at the University of Oklahoma Health Sciences Center, Oklahoma City. Dr. Sharma also completed fellowship training in interventional cardiology at the University of Iowa Hospitals and Clinics, Iowa City. He is board certified in cardiovascular disease.

“I am committed to offering my patients the latest treatment options for cardiovascular disease including minimally invasive procedures that use catheters and small incisions,” Dr. Sharma said. “In addition to helping my patients manage their risk factors for heart attacks and stroke, I am pleased to participate in global clinical trials, which are crucial to discovering more effective treatments and saving the lives of heart patients.”

Tennova Healthcare offers cardiology services at Physicians Regional Medical Center, Turkey Creek Medical Center, North Knoxville Medical Center, Jefferson Memorial Hospital, Lakeway Regional Hospital, LaFollette Medical Center and Newport Medical Center. With more than 30 cardiologists, cardiothoracic surgeons and other specialists at multiple locations throughout the region, the health system is dedicated to offering better ways to treat and beat heart disease—close to home.

LMU-DCOM Honors Class of 2015 Members at Awards Ceremony HARROGATE - The faculty and administration of Lincoln Memorial UniversityDeBusk College of Osteopathic Medicine (LMU-DCOM) handed out several awards to members of the graduating class at its awards day ceremony on May 8, 2015.

The ceremony was held prior to the Class of 2015 graduation ceremony on May 9.

The Dean’s Award went to Robert “Bobby” Theodore Lawrence, III of Memphis, Tennessee. The Dean’s Award is presented to a member of the graduating class who displays a strong commitment to academic excellence, embodies empathy and compassion toward others, exemplifies personal integrity and professionalism and has earned the respect and trust of classmates and faculty.

The LMU-DCOM Service Award was presented to Brendan Michael Williams of Jamestown, Tennessee. The award is given to students who exemplify the mission statement of LMU-DCOM in the following areas: serving the health and wellness needs of the people within both the Appalachian region and beyond;

focusing on enhanced access to comprehensive health care for underserved communities; and embracing compassionate, patient-centered care that values diversity, public service and leadership as an enduring commitment to professionalism and the highest ethical standards.

The Valedictorian Award, for the graduate deemed to be the highest academically ranked student in the class, was presented to Ashley Marie Harris of Estill Springs, Tennessee. The Salutatorian Award, for the graduate deemed to be the second highest academically ranked student in the class, was presented to William David Robinson of Oak Ridge, Tennessee.

Harris also was named the Outstanding Molecular Fundamentals of Medicine Student and the Outstanding Medical Physiology Student. The Outstanding Molecular Fundamentals of Medicine Student award is presented to the student who displays a mastery of the molecular fundamentals of medicine as evidenced by academic achievement and enthusiasm for the subject matter. The Outstanding Medical Physiology Student Award is presented to the student who displays a mastery of the molecular fundamentals of medicine as evidenced by academic achievement and enthusiasm for the subject matter.

The Tennessee Osteopathic Medical Association (TOMA) Spirit of Excellence Award was given to Lucie Elisabeth Noriscat Mitchell of Oxford, Alabama.

The award is presented annually to a graduating student who has achieved distinction among his or her peers through academic superiority, leadership qualities, community service and a commitment to serve the citizens of Tennessee.

Mitchell also received the Preventive Medicine and Public Health Award.

The award is presented to an outstanding student who has made significant contributions to public health and preventative medicine through leadership, vision, originality and innovation.

Danielle Katherine Harrell of Maynardville, Tennessee, received the award for Outstanding Anatomy Student. The award is given to a student who performs in the top 5% of the class academically and exhibits enthusiasm for the subject matter.

Lindsay Marie Huckabee of Florence, Kentucky, received the Outstanding Pharmacology Students. This award is presented to the student earning the highest grade in pharmacology.

Jade Palazzola Gallimore of Morristown, Tennessee, received the Scalpel Award for Excellence in Surgery.

The award is presented to a graduating student pursuing a career in surgery and who has demonstrated excellence in the areas of patient care, academic excellence and technical prowess.

The Outstanding Osteopathic Principles and Practice Student award was given to Lauren Ashley Davis of Mullica Hill, New Jersey, and Craig Allen Wells of Wapakoneta, Ohio. The award is presented to the students who best exemplify the practical implementation of osteopathic ma-

nipulation into the practice of medicine.

Ashley Jennae Houser of Newton, Kansas, received the Family Medicine Award, presented to the student who best exemplifies what an osteopathic family physician should be. This individual has provided excellent care to a wide variety of patients with a multitude of clinical problems in a kind, concerned and professional manner, and has matched into a family practice residency.

The Internal Medicine Award went to Michael Chad Cozart of Manchester, Tennessee. The award honors one student who has shown uncommon interest and aptitude in the field of internal medicine.

Courtney Jeannine Laird of Aliquippa, Pennsylvania, received the Obstetrics/ Gynecology Award. The award is given in recognition of the student who has displayed an outstanding commitment to assisting women achieve and maintain health and wellness.

Angelina Rose Hall of Louisville, Tennessee, received the Pediatrics Award, presented to an outstanding student entering the field of pediatrics.

Bianca Judy Choe of Plano, Texas, received the Emergency Medicine Award, presented to an outstanding student entering the field of emergency medicine.

The Behavioral Medicine Award was presented to Derek Alan Goff of Piney Flats, Tennessee. This award is presented to the graduating student who demonstrates excellence in the area of biopsychosocial treatment for patients with mental illness.

The Donna Jones Moritsugu Memorial Award, awarded by the American Osteopathic Foundation, was presented to Glenn Goodwin, husband of Patricia Brooks Goodwin of Fort Lauderdale, Florida. The award honors and recognizes the spouse of a graduating osteopathic medical student who best exemplifies the role of a professional’s partner by providing immeasurable support of his or her mate, family and the osteopathic profession while being an individual in their own right.

Covenant Health Hospitals Earn ‘A’ Grades for Patient Safety in Leapfrog’s Spring 2015 Hospital Safety Score KNOXVILLE - Fort Loudoun Medical Center, Fort Sanders Regional Medical Center, Methodist Medical Center, Morristown-Hamblen Healthcare System and Parkwest Medical Center have been recognized for dedication to patient safety by being awarded an “A” grade in the Spring 2015 Hospital Safety Score. The Safety Score rates how well hospitals protect patients from preventable medical errors, injuries and infections within the hospital.

In addition to receiving As for the spring quarter, both Methodist Medical Center and Parkwest Medical Center received “Straight A” recognition, signifying that the hospitals have never received a grade lower than “A” from the Hospital Safety Score since the Score first launched in June 2012. They are among 182 hospieasttnmedicalnews

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GrandRounds PUBLISHED BY: SouthComm, Inc. PRESIDENT Chris Ferrell ASSOCIATE PUBLISHER Sharon Dobbins sdobbins@easttnmedicalnews.com 865.599.0510 EDITOR Bridget Garland bridget@easttnmedicalnews.com 423.483.1015 CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com 931.438.8771 GRAPHIC DESIGNERS Katy Barrett-Alley, Amy Gomoljak James Osborne, Christie Passarello CONTRIBUTING WRITERS Cindy Sanders, Julie Parker, Terri Schlichenmeyer, Bridget Garland, Leigh Anne W. Hoover, Joe Morris, Jennifer Culp CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: editor@easttnmedicalnews.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 • Two years $78 Become a fan on Facebook, and Follow us on Twitter@EastTNMedNews SOUTHCOMM Chief Executive Officer Paul Bonaiuto President Chris Ferrell Chief Financial Officer Ed Tearman Executive Vice President Of Digital And Support Services Blair Johnson Director Of Financial Planning And Analysis Carla Simon Vice President Of Human Resources Ed Wood Vice President of Content Patrick Rains Vice President Of Production Operations Curt Pordes Group Publisher Eric Norwood Chief Revenue Officer Dave Carter Director Of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2015 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited.

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tals to receive the recognition.

The Hospital Safety Score is compiled under the guidance of the nation’s leading patient safety experts and administered by The Leapfrog Group, a national nonprofit organization focused on initiating improvements in safety, quality and health care affordability for Americans.

Developed under the guidance of Leapfrog’s Blue Ribbon Expert Panel, the Hospital Safety Score uses 28 measures of publicly available hospital safety data to produce a single A, B, C, D, or F score, representing a hospital’s overall capacity to keep patients safe from preventable harm. More than 2,500 U.S. general hospitals were assigned scores in April 2015, with about 31 percent receiving an “A” grade. The Hospital Safety Score is fully transparent, offering a full analysis of the data and methodology used in determining grades on the website.

Note: The [Leapfrog] Hospital Safety ScoreSM grades hospitals on data related to how safe they are for patients. For more information visit www.hospitalsafetyscore.org.

HealthSlide Launches ROI Cost Calculator National health IT company launches all-new cost calculator created to improve bottom line for nation’s hospitals KNOXVILLE – HealthSlide, Inc., a healthcare IT company that provides innovative interoperability solutions for hospitals nationwide, has announced the launch of its propriety ROI cost savings calculator. Hospital CIOs and CTOs can access the calculator on the company’s website at healthslide.com. The calculator shows both initial and ongoing sav-

ings of switching to the company’s flagship offering, Boomerang.

As the company’s flagship product and Enterprise Application Interoperability Server, Boomerang is designed for healthcare organizations and provides protocol switching, data transformation, and system monitoring in an easy to configure package.

HealthSlide’s cost comparison calculator aims to assist the hospital C-suite in determining the exact cost of decluttering and streamlining their system integration. Taking into account different vari-

ables, the calculator shows initial and ongoing savings. By inputting current costs of software, hardware, hardware fees, operating system support fees, consultants, training, and staff salaries, HealthSlide can compare a healthcare organization’s spending with the cost of implementing Boomerang.

To find out more about HealthSlide, Inc. and the healthcare interoperability solutions they provide, visit http://www. healthslide.com/.

Medical Center Receives National Innovation Award KNOXVILLE - Recently at the 2015 Health Information Management Systems Society (HIMSS) meeting, The University of Tennessee Medical Center received the “Most Innovative Use Case” award from the Intelligent Health Association as the best example of innovative use of technology in a healthcare facility.

The award was a result of a partnership between UT Medical Center and DeRoyal Industries, an international medical equipment manufacturer and distributor. For the past year, UT Medical Center used Continuum®OR, a DeRoyal system, to track supplies via wireless technology instead of manual entry. Radio-frequency identification (RFID) tags were utilized to locate and track the movement of items in and out of orthopaedic operating rooms at the medical center.

“As a result of this type of innovative automation, UT Medical Center has seen advancements relative to patient safety, automated inventory UT, and surgical supply availability,” said Becky Ashin, vice president of the Advanced Orthopaedic Center at UT Medical Center. “We are honored to be recognized as a leader in innovation.”

According to Ashin, UT Medical Center placed first and was recognized among other national healthcare leaders including The University of Pittsburg Medical Center, The University of Chicago Medicine, and The Ochsner Health System.

UT College of Nursing Establishes Collaboration with Nurses in Zimbabwe KNOXVILLE—Clinical Assistant Professors Lynn Blackburn and Karen Lasater have laid the groundwork for a partnership between the UT College of Nursing and nurses in Bulawayo, Zimbabwe.

Supported by the college and the Knoxville Rotary, Blackburn and Lasater traveled to Zimbabwe earlier this year to begin the collaborative relationship between UT’s College of Nursing and St. Philip’s School and the National University of Science and Technology in Zimbabwe.

“The College of Nursing wants to establish a long-term working relationship with Zimbabwe health care workers—to improve the health status of Zimbabwe residents, set up potential clinical sites for our nursing students and identify potential research projects focusing on improving the health of Zimbabwe,” Lasater said.

Lasater helped establish the school›s nursing library and trained local nurses in the HINARI system, a computer program set up by World Health Organization to give third world healthcare providers free access to the latest health literature and research.

Blackburn taught continuing education classes for practicing Sitting, from left to right, are Colleta Gwatiringa, MBA, and Judith Chamisa, PhD. left to right, are Lynn Blackburn, DNP; Cynthia Chaibva, PhD; and Karen midwives at St. Philip›s and several midwifery classes at the medical Standing, Lasater, DNP. Lasater and Blackburn are assistant professors at UT’s College of school. Additionally, faculty from the College of Nursing participated Nursing; the other three women are the faculty of the MScMidwifery Education Program at the National University of Science and Technology in Bulawayo, in educational offerings through distance- based technologies.

Zimbabwe.

Blackburn said she valued interacting with the nurses in Zimbabwe and working «through another cultural lens» during her two weeks abroad.

«Trips of this kind enhance my cultural competency, and make me a better role model and professor for my students,» she said.

Additionally, the two professors assisted in teaching a two-day breast health lecture with Jenny Edge, the South African physician who developed the program.

«The health issues in Zimbabwe are significant,» explained Victoria Niederhauser, dean of the College of Nursing. «With education, nurses can play a vital role in improving the health and health care in communities» Blackburn and Lasater agreed that the nearly 9,000-mile trip was a great experience. Lasater looks forward to returning and is «very eager to learn and collaborate with UT in the future to improve health in Zimbabwe.»

JUNE 2015

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11

Physician to Physician

Diagnosis and Treatment of Peripheral Artery Disease

By Tariq Haddadin, MD, FACC, FSCAI

used to diagnosis PAD.

Peripheral artery disease (PAD), Treatment which causes blockages in the Smoking cessation is the first arteries supplying extremities with and most important step to be nutritious blood flow (i.e. blood taken by a patient. An aggressive carrying oxygen and nutrients to control of diabetes, hypertension the feet), is a strong predictor of and high cholesterol is also essential. adverse cardiovascular outcomes.

Surgery involving bypass graft, Unfortunately, most patients are which is a very high risk surgery unaware of their disease. on PAD patients, may be necessary Risk factors include age (patients for patients who, most of the time, of advanced age are particularly have comorbidities, including heart Blood flow, post-intervention Blood flow, pre-intervention susceptible), diabetes (especially if disease. not well-controlled), smoking or Another treatment option is history of smoking, hypertension, catheter-based endovascular therapy hyperlipidemia (i.e. high while the patient is mildly sedated. cholesterol), and history of heart Endovascular therapy includes disease. multiple modalities to improve Greater awareness and earlier blood flow to the feet. We use diagnosis of PAD could help improve angioplasty, stenting, chronic total adverse cardiovascular outcomes. A occlusion devices and atherectomy large percentage of PAD patients are devices in the Johnson City Medical either asymptomatic or have very Center Cardiac catheterization Pre procedure: cold foot with heel ulcer for the past 6 months. Post procedure: Two weeks later, endovascular intervention, warm foot with healed ulcer. minimal symptoms of pain or feet laboratory. Compared to open numbness. However, the following bypass surgery, endovascular are some of the symptoms and signs of PAD catheter-based therapy has many advantages, possible gangrene. that may be recognizable: including minimal recovery time, same day • foot, calf, thigh and hip pain, especially treatment, lower risk of infection, has up to Diagnosis when walking (claudication); 90% success rates, and up to 90% 2-5 year Diagnostics which can be ordered • resting pain in the lower extremities limb salvage rates. to support PAD diagnosis include both (feet); noninvasive and invasive testing. ABI (Ankle• numbness or tingling of the feet, brachial index) is the first noninvasive Dr. Tariq Haddadin is a fellow of the American College of • pale, bluish discolored feet, test to do after a thorough history and Cardiology and the Society for • slow healing foot ulcers or wounds. physical exam. ABI <0.90 is indicative of Cardiovascular Angiography Once pain in the feet is persistent, PAD. The lower the number, the worse the and Interventions. He serves as medical director of the Cardiac with or without tissue loss, it’s at a stage disease. Other noninvasive tests include Catheterization Laboratory at of critical limb ischemia, where arterial segmental pressure and pulse Johnson City Medical Center intervention is a must before amputation. volume recordings, CT angiography, and and as chief of Interventional Cardiology at the Veterans On exam, patients may present with weak magnetic resonance angiography (MRA).

Affairs Medical Center, Mountain Home. or absent pulses, discolored feet, and Arteriography, although invasive, can also be

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