East Tn Medical News May 2015

FOCUS TOPICS WOMEN’S HEALTH HIT

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PHYSICIAN SPOTLIGHT PAGE 2

Dr. Craig Towers ON ROUNDS

Society for Women’s Health Research

Celebrating 25 years of moving the science forward

By CINDy SANDERS

Are women being adequately represented in clinical trials at the National Institutes of Health?

That simple question, pondered by Florence Haseltine, PhD, MD more than a quarter of a century ago, has led to sweeping changes in the way women are viewed on a physical, behavioral … and now … molecular basis.

Enjoying East TN OUR BODY THE UNIVERSE WITHIN – Hands On! Museum When we use life experiences to help others, the outcome is always amazing. In physics, this theory is referred to as “the butterfly effect,” where the flapping of a single butterfly’s wings on one side of the earth can possibly cause a hurricane on the other side ... 5

HEALTHCARE LEADER: Matthew Nadaud Like all doctors, Matthew Nadaud wants to see results.

And like his patients, he wants to see those results quickly ... 7

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Changing the Status Quo

In the mid-1980s, Haseltine was working at the National Institute of Child Health and Human Development, which focused almost exclusively on women’s health in terms of maternal issues. Haseltine, who coined the term ‘sex-based biology,’ began gathering friends and colleagues together to champion additional women’s health concerns including endometriosis and ovarian cancer. Quickly, the mission grew to encompass much

broader issues that disproportionately or differently impact women beyond the narrow scope of gynecologic disease.

The result was the formation of the Society for Women’s Health Research (SWHR) in 1990. One of the people tapped to be part of that early volunteer board was Phyllis Greenberger, who agreed to go to Capitol Hill with Haseltine to speak to the Congressional Caucus for Women’s Health Issues. “It turns out there was a 1985 Public Health Service report that was written by two doctors at the NIH that looked at whether there was enough attention on women’s health issues and were women being included in research.

We used that report as ammunition,” Greenberger recalled, noting the answer to both questions was a resounding ‘no.’

At the behest of Greenberger and other SWHR volunteers, several members of Congress asked the Government Accounting (CONTINUED ON PAGE 8)

HIT: Optimization Through Integration

By CINDy SANDERS

You can love it, hate it, fear it or revere it … but technology has become an integral part of healthcare processes on both a clinical and operational level.

Therefore, you might as well learn to optimize it.

That was a key part of the message Chris Miller, principal with Nashville-based Cumberland Consulting Group, and Deb Dulac, director of PRISM and business systems for the University of Vermont Medical Center, shared with audiences at the recent HIMSS15 Annual Conference & Exhibition. More than 38,000 professionals flocked to Chicago last month to attend the premier health information technology conference, which included more than 300 peer-reviewed education sessions, vendor exhibits touting the latest technology options, updates on government regulations impacting the industry and keynote speakers ranging from (CONTINUED ON PAGE 8)

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PhysicianSpotlight

Craig Towers

By JENNIFER CULP

When Dr. Craig Towers began his medical training, he thought he wanted to become a pediatrician. He really enjoyed training in obstetrics and maternal-fetal medicine, however, and reassessed his initial plan.

As a high-risk perinatologist, Towers still ended up working with children, in a way: he cares for their mothers and helps them arrive safely into the world. With 30 years in high-risk obstetrics under his belt, “I’ve been doing it a while!” he said.

Towers took a circuitous route to his current residence in Knoxville, Tennessee. He grew up in California, where he earned his undergraduate degree in chemistry, then traveled halfway across the country to attend the University of Kansas School of Medicine. He remained in Kansas to complete his internship and residency in obstetrics and gynecology, where he had the good fortune to meet Kelly, the woman who became his wife. “She was in charge of the sonography department! OB uses a lot of ultrasound, so that’s when I met her, when I was doing my ultrasound rotation,” he explained.

The couple traveled back to Cali-

fornia, where he became specialized in maternal-fetal medicine, and remained on the West Coast to raise their three children. Or perhaps “remained” is the wrong word: the family hobby of road trips kept the Towers traveling extensively over the next fifteen years. Towers’ children have each visited 49 of the 50 United States, save Alaska, and Towers and his wife have

Meet Some of the Faces Behind Our Healthcare Experience.

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set foot in all 50. Their favorite trip, however, was through the South. “We really enjoyed Louisiana, Mississippi, Alabama, Tennessee, and Georgia… we just love the South,” he said.

When their youngest child finished high school, Towers was interested in a position that would allow him to access more funding for research, and his fondness for the states below the Mason-Dixon line remained. High Risk Obstetrical Consultants (HiROC) in Knoxville had a place for a perinatologist, “so that’s how I ended up in Tennessee! I’m not going to leave; this is where I’m going to retire,” he said.

He travels back to California regularly to visit his parents, but considers East Tennessee his own home. “Knoxville is a great city—great people, great place.” He particularly singled out his colleagues at HiROC, Drs. Hennessy, Howard, and Wolfe, for recognition on the “great people” list: “It’s a very busy practice, and a wonderful group!”

High-risk obstetrics, Towers stated frankly, is a job of extremes. “It’s a tough field, I would have to say. You get attached to a lot of your patients,” many of whom are facing extremely difficult circumstances, he explained.

“I don’t think I go a week without breaking somebody’s heart, somewhere along the line. That’s just the nature of the business. I really enjoy what I do, but I can tell you that every week there’s a high and a low. So there are bad parts of my job where I have to deliver terrible news, but then turn around and deliver a complicated pregnancy that maybe wasn’t going to make it but then we succeed, and get a healthy baby in the long-term. The rewards outweigh the sadness, but it’s a mixture in our business,” he said.

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Katie Graham 865.862.3020 (direct) kgraham@lbmc.com Manager – Healthcare Consulting Katie works directly with medical practices to enhance the overall levels of efficiency and profitability. With over ten years of experience, she has extensive experience in operational and revenue cycle assessments, EMR/ PM consulting, fee schedule analysis and needs assessments. Katie is active in Healthcare Information and Management Systems Society (HIMSS) and Knoxville Area Medical Group Management Association (KAMGMA), and enjoys biking, listening to local music and spending time with her family.

She appreciates the outdoors and is often outside playing with her two dogs.

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In addition to succeeding and achieving good results for mothers and babies in complicated cases, Towers finds fulfillment and balance in other aspects of his work. He greatly enjoys teaching medical students, nurses, and residents, which he has done since 1985. “That’s always fun because you see the people that you teach learn things and improve. I’m involved with residents every day, so I get to see them ultimately become senior residents, graduate, and go off into their own practices, and realize that part of what I taught them, they’re taking with them.”

The third major component of Towers’ work—and one of the reasons he originally decided to relocate to Knoxville—is research. Towers maintains about 20-25 ongoing studies, and has published and presented extensively. (He conducted the interview for this profile, in fact, from the airport in Minneapolis, where he had traveled to give a lecture!)

“The research side of things, you don’t get to see the patient one-on-one, but you find a question in obstetrics that’s not been answered or answered fully and you create a study that analyzes that and comes up with a better way of treating something. You basically theoretically help hundreds, if not thousands, with what you discovered. That’s always fulfilling,” he said.

Towers researches a wide variety of topics, including infectious diseases and pregnancy, fetal monitoring, fetal lung maturity, and the effect of drugs and substances on pregnancy. “Not just illicit drugs but any kind of drugs—over-thecounter medications and antibiotics, to verify that the dosages we’re using are correct. I do a lot of research on substances and pregnancy, whether or not they can pass to the baby and potentially whether they have an effect, anywhere from illicit stuff to things in the environment,” he explained.

Given unlimited funding, what would Towers choose to study? The effects of hair dye and other common cosmetic and environmental substances on pregnancy. “That’s what we need to study,” he exclaimed. “I can’t tell you how many pregnant women ask, ‘Can I get my hair permed? Can I get my nails done? Can I be in the room when my husband paints the baby’s nursery?’ There are ways to study this, but the answer is, ‘It’s never been studied!’ So when a patient asks those questions, ‘Can I get my hair colored safely,’ the answer is, ‘We don’t know,’ and it needs to be studied because every pregnant patient asks that question!

Someday maybe I’ll be able to get funding from somebody who wants to study that, because that question’s been around for my whole career and we still don’t have answers. That’s what we need to answer.

Someday maybe before I’m too old I’ll get a chance to do it!”

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LegalMatters BY: KELLY S. STREET, LONDON & AMBURN, P.C.

Pay Close Attention to Your Vendor Contracts Most medical practices rely heavily on third-party vendors for services like telephones, internet, billing, and waste disposal. Vendors may also provide a host of other services, including office equipment maintenance, marketing, shredding, and bottled water. Each of these relationships is unique, but one common feature is that they are usually subject to a contract prepared by the vendor with very little, if any, input from the medical practice.

These vendor contracts may seem routine, but it is important not to overlook their terms. In 2013, for example, a Midwestern community health center was denied access to more than 40,000 patient charts when it terminated its contract with its electronic medical records vendor to go with a competitor. The vendor then demanded almost $300,000 in satisfaction of the contract, and both parties proceeded to sue. This type of lawsuit has been on the rise in recent years, involving everything from disputes over electronic medical records to disagreements over internet marketing.

Vendor relationships also probably represent a considerable portion of your practice overhead, and it is financially wise to understand, scrutinize and monitor the contracts closely. Failure to do so can take money from your bottom line and impact your employees’ productivity.

Inattention can also draw your practice into costly contract disputes, and in rare circumstances, expose you to legal liability when vendors fail to deliver on their obligations. The next time your practice is presented with a vendor contract, consider the following suggestions before signing on the dotted line.

Read vendor contracts closely. While the sales pitch may be straightforward, many contracts contain voluminous fine print, footnotes, and internal cross-references. They may also reference other documents that are only available on the vendor’s website, such as standard terms and conditions (of which there could be multiple versions and revisions). The actual language in a vendor’s contract can depart considerably from the proposal made by your sales representative. Also, most agreements contain a clause that affirms the written contract as the “entire agreement” and disclaims any statements made to you by the sales representative.

Watch out for terms and other language that favor the vendor. It should be no surprise that you are at a disadvantage when presented with a vendor’s form contract. Their lawyers have worked hard to draft terms that promote their business interests and limit their liability. With that said, you should not hesitate to ask probing questions or negotiate on important terms (even so-called “boilerplate” terms). This is particularly important when reviewing multi-year contracts that obligate your practice for large sums of easttnmedicalnews

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money. If the contract’s value warrants it, consider hiring an attorney to advise you or negotiate on your behalf.

Make sure you have a competent person approving the contract. Many practices delegate vendor responsibility to an employee who has technical knowledge of the subject area. Remember that this person may have experience with their subject area - how the transcription service works, for example - but he or she may be less concerned with the fine print in the vendor’s contract. Choose this person carefully to avoid problems later.

Check the rates. You should always have a clear understanding of the vendor’s contracted rate. For example, is the rate fixed or subject to change? Can the vendor raise the rate for things like increased fuel costs, regulatory expenses, or inflation? These types of terms show up in vendor contracts on occasion, and over the course of a multi-year agreement, they can really add-up.

Understand the contract term and termination. Most vendor contracts contain provisions that describe when and how the contract ends. Some outline a fixed date. Others delineate a set period of time. Still others provide that the contract will expire upon the occurrence of some event. Make sure you understand these terms. You should also pay close attention to penalties your practice might incur for early termination and be aware of the conditions under which you can terminate without a penalty. You should also understand the parties’ rights and obligations at termination. For example, if you utilize a cloud-based service to store records, what happens to your data once the contract ends? What happens to it if the vendor goes out of business?

Choose your vendors wisely. Whenever possible, try to obtain information from your colleagues and associates about their experiences with potential vendors. You may also want to pay closer attention to vendors selling new technologies or capabilities, as these can be more legally volatile. Keep in mind that if the vendor will be provided with any patient information, you should consider HIPAA requirements and may need to obtain a HIPAA-compliant business associate agreement.

Finally, no one expects you to be a contract law expert, and no list can ever replace sound legal advice from an attorney you trust. The good news is that disputes between a practice and its vendors are rare. Nevertheless, careful reading and consideration up-front will save time and money later.

Attorney Kelly Street focuses his practice on representing the interests of healthcare providers, hospitals, and healthcare-related businesses in civil matters of all types. For more information on health law matters, or to contact Mr. Street, visit www. londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

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ClinicallySpeaking

BY JESSICA L. VINSANT, MD, GENERAL SURGEON, PREMIER SURGICAL ASSOCIATES

Lumps, Bumps & Lesions – When should they be surgically removed?

Skin lumps, bumps and lesions is a big subject – so let’s focus on skin cancers. Three common kinds of skin cancers are Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), and Malignant Melanoma (MM).

Nonmelanoma Skin Cancers Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC) are the most common types of malignant neoplasms in the world and the incidence is rising each year. An estimated 1 in 5 Americans will be affected by a nonmelanoma skin cancer during their lifetime. After a patient’s initial diagnosis of BCC or SCC, the risk for development of an additional skin cancer is estimated at 35% in 3 years and 50% in 5 years.

Basal Cell Carcinoma is slowgrowing with no precursor lesion. BCC commonly infiltrate, but rarely metastasize. There are four distinct growth patterns: nodular, pigmented, cystic and superficial.

Squamous Cell Carcinoma has higher mortality rate than BCC. It does have a precursor lesion: actinic keratoses. The first site of metastasis is usually the regional lymph nodes. Patients commonly present with palpable scaling lesions that become ulcerated centrally and have raised edges.

Because most SCC occur on the sun-exposed surfaces of the head and neck, sunlight is thought to be a major causative factor. People who are especially susceptible include those with fair skin, blonde hair, and blue

eyes. Other risk factors include patients with compromised immunity (transplant patients, lymphoma, leukemia, autoimmune diseases); those who have occupational and environmental exposures to arsenic, organic hydrocarbon, ionizing radiation, and cigarette smoke; and people with chronic conditions of the skin, such as ulcers, infections, and poorly-healing wounds.

Treatments Treatment options of nonmelanoma skin cancer includes field therapy techniques such cryotherapy, topical fluorouracil, electrodessication and radiation. Radiation is highly effective for preserving wide areas of skin in the head and neck region, and for treating areas at high risk for recurrence after extensive surgical excision. Another treatment option is standard surgical excision. The needed margin of resection is generally one that is histologically free of carcinoma.

An alternative surgical approach to standard surgical excision is Moh’s Microgrpahic Excision (MME). It has a high rate of local tumor control with the use of horizontal frozen sections, which is continued until clear margins are obtained. This technique is very good for high-risk patients and for anatomic areas where it is important to preserve as much tissue as possible (around the eyes, ear, nose, mouth).

Malignant Melanoma Only 4-5% of all skin cancers are malignant, but they cause the majority

of deaths from skin cancer. Melanoma is the 8th most common cancer in the US and the incidence is rising faster than any other type of cancer. Lifetime probability of developing melanoma is 1 in 57 for males and 1 in 81 for females. Melanomas more commonly arise on the lower extremities in women and on the trunk and head and neck in men. The median age of diagnosis is 45 to 55 years old.

Highest risk population is individuals with fair complexion who receive intermittent doses of UV radiation that results in severe sunburns. Factors that increase the risk of developing melanoma include: dysplastic nevus syndrome, xeroderma pigmentosum, a history of non-melanoma skin cancer and a family history of melanoma. Individuals with congenital nevi have an increased risk for melanoma proportional to the size and number of nevi. Giant congenital nevi (1 in 20,000 newborns) carries a lifetime risk of 5-8%.

Four major types of melanoma: lentigo maligna melanoma- 10%older individuals with sun-damaged skin; appears as a flat, darkly pigmented lesion with irregular borders and a history of slow development; prognosis is generally better than for other types. superficial spreading melanoma70%- most common histologic type; initially appear as a flat, pigmented lesion growing in a radial pattern. acral lentiginous melanoma- 5%confined to the subungal areas and the glabrous skin of the palms and soles.

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.

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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

Date: The 3rd Thursday of Each Month Time: 11:30 AM – 1:00 PM

Location: Summit Leadership Foundation 3104 Hanover Rd. Johnson City

Location: Indian Path Medical Center Conference Room, Building 2002, Second Floor, Kingsport

MAY 2015

Most common histologic variant in African Americans. Overall prognosis is poor. nodular melanoma- 15%- worst prognosis, early vertical growth pattern.

Unknown Primary Nodal or distant mets may be the first evidence of melanoma (less than 2% of all melanoma cases and less than 5% of all cases of metastatic melanoma). Work up should include: histologic review of all previously removed skin lesions, inquiry into skin lesions that resolved without treatment, and inspection of areas that may have been previously missed (scalp, external auditory canal, oral and nasal mucosa, nail beds, genitalia, anal canal, and the eye). Melanoma is one of the most frequent tumors that metastasizes to the GI tract.

Surgery for Malignant Melanoma The fundamental principle in the management of primary melanoma is to resect the tumor and minimize the risk for local recurrence. Management is based primarily on thickness and ulceration (ulceration indicates a significantly worse prognosis). For MM on the fingers and toes, amputation is required.

Lymphoscintigraphy is a procedure where a radioactive colloid is injected into the skin and then a gamma camera is used to identify the sites of uptake (sentinel lymph nodes).

Recurrence of MM “Local recurrence” is defined as tumor appearing in skin or subcutaneous tissue within 5cm of the primary wide excision site. Local recurrence is treated with surgical resection to attain histologically clear margins. Isolated hyperthermic limb perfusion involves the use of cannulation of the principle extremity artery and vein, a tourniquet, and hyperthermic perfusion with L-phenylalanine mustard or another chemotherapeutic agent.

Skin cancers are a pervasive problem throughout the world. Encourage patients to do regular skin self exams and use the A-B-C-D-E method of observation – look for moles and spots that change in asymmetry, border, color, diameter and evolve. Early detection and diagnosis plays an important role in the treatment of these malignancies.

Jessica L. Vinsant, MD, is a general surgeon with Premier Surgical Associates Tennova North Knoxville and Physicians Regionals offices. Premier Surgical is the Knoxville area’s largest surgical group, performing general, vascular, bariatric, breast and laparoscopic procedures.

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Enjoying East Tennessee OUR BODY THE UNIVERSE WITHIN – Hands On! Museum

By LEIGH ANNE W. HOOVER

When we use life experiences to help others, the outcome is always amazing. In physics, this theory is referred to as “the butterfly effect,” where the flapping of a single butterfly’s wings on one side of the earth can possibly cause a hurricane on the other side.

Could becoming an organ donor accomplish the same effect by allowing many others to have the gift of life? Donate Life embraces and epitomizes this same sentiment.

Personally, I have witnessed the selfless act and amazing miracle of organ donation at work through fellow church members, David and Barbara Lively.

As an East Tennessee State University (ETSU) college senior, their handsome son, Adam, was involved in a tragic car accident. When his Kingsport, Tenn., parents were faced with an organ donation decision, they knew exactly what to do. Because Adam had expressed his wishes to be an organ donor, the Livelys agreed and have since become ambassadors for the Donate Life program in Tennessee and Virginia.

“I think of my 95 year old father,” explained David Lively. “Most of his life he has had to deal with partial blindness. Eight years ago, he lost all sight. Adam donated his corneas to two people in Knox County. He gave those people the gift of sight. Dad’s experience has given us a better understanding of the gift Adam gave them.”

I have read the heart is hollow. However, my theory on why this is so is because this organ is able to hold so much love. I know Adam’s heart was given to another, and I read where Adam’s organs saved five lives and enhanced over 50.

That is amazing!

“Adam’s donation has helped us make some sense out of our tragedy,” said Lively.

Today with the phenomenal exhibit, OUR BODY: THE UNIVERSE WITHIN, currently on display through the Hands On! Museum in Johnson City, Donate Life is partnering and also educating others about the importance of organ donation. Adam’s story is one among others shared in the exhibit.

Additional participating partners include ETSU Academic Health Sciences Center, Mountain State Health Alliance, Blood Assurance, and Northwestern Mutual to showcase the world-renowned actual human body exhibit, which has been easttnmedicalnews

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on tour in major cities across the globe.

Since last month’s column, “Human Plus: Real Lives + Real Engineering at the Creative Discovery Museum” in Chattanooga also focused on the body and challenges for budding engineers, what better segue than exploring an exhibit featuring actual human bodies?

“We want people to learn about their health and their body in a way that they’ve never experienced before and why it’s important and inspire future generations of medical professionals,” explained Hands On! Museum Executive Director, Andy Marquart.

“Organ donation is extremely important to people with severe health problems, and we don’t think any museum and organ donation partnership anywhere else has done this.”

Although the specimens are actual human bodies, the exhibits are preserved through polymer impregnation, or plastination, where all body fluids have been replaced. The specimens almost appear to be artificial, but they are real organs, bones, and cadavers.

The exhibit gives an inside view of the

body, including the musculoskeletal, cardiovascular, head and nervous, digestive, respiratory, urinary, and reproductive systems. It may be too graphic for very young children. Yet, for those interested in pursuing a career in medicine, it is truly extraordinary this exhibit is in our region through August 2nd.

“This [OUR BODY: THE UNIVERSE WITHIN] is a major market exhibition that we’re fortunate to have here.

Bringing it to the community so people do not have to get on a plane to see it is really neat,” said Marquart.“We chose this one because of its educational content. It’s the most educational and family friendly.”

Although it may initially appear an unusual partnership, the exhibition stands alone with a separate venue entrance and ticket price. Therefore, adults are able to enter the exhibition without going through the museum and vice versa.

Our Body is primarily visited by older students and adults, but according to Marquart, it is also amazing to witness parents interacting and teaching their children about the human body.

“Kids are not embarrassed by the body at six or seven years old,” said Marquart. ‘That comes later in life. So, they see things that they have… and are in awe of that.”

The exhibit is certainly very detailed and educational on many levels. OUR BODY continues to inspire students to enter the medical field and encourages those who are currently in it. The exhibit also outlines the function of the body and why health is so very important.

With ETSU’s Quillen College of Medicine also located in Johnson City, volunteers serve to answer questions.

“ETSU is one of our biggest partners, and our exhibit is staffed almost daily by nursing students,” said Marquart. “They wear their scrubs and are identified as volunteers. If people have questions or want to know about something, it really adds to the experience.”

The OUR BODY exhibition has been compared to an art exhibit, and it is very professionally displayed. It’s simply amazing to glimpse the complexity of internal parts and eliminates some of the reservations about becoming an organ donor.

“The exhibit has definitely inspired people to sign up and be an organ donor, and on the museum’s end, it has allowed people to look and appreciate their health and body differently and inspired people to go into the medical profession as well,” said Marquart.

“It’s a win across the board for all of us!”

For additional information about OUR BODY: THE UNIVERSE WITHIN at the Hands On! Museum, visit www.handsonmuseum.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.

Monroe at the Mansion in May It’s not summer without a great book by beloved, New York Times bestselling author Mary Alice Monroe! She returns to Kingsport, Tenn., on Wednesday, May 27, 2015, for a boxed literacy luncheon. This is the only book tour stop in the region.

“Monroe at the Mansion in May,” is part of her book tour for The Summer’s End, which is the third novel in her beloved Lowcountry summer trilogy. The event will be held at Allandale Mansion in Kingsport, and the boxed literacy luncheon will begin at 11:30 a.m.

“Monroe at the Mansion in May” is sponsored locally by Citizens Bank and Seasons for Women, a member of the Holston Medical Group family. Monroe will speak, take Q&As from the audience and following her talk, she will also sign books.

East Tennessee is very fortunate to have Monroe for another return visit to the area as part of her book tour for another coastal-themed novel. The literacy event will benefit the Literacy Council of Kingsport, Inc., a ProLiteracy Worldwide affiliate and a member agency of the United Way of Greater Kingsport, and Friends of Allandale.

As a bestselling author of seventeen novels and two children’s books, once again, Monroe endears readers with human relationships that parallel nature. In what has become true Monroe fashion, doing research, weaving in the message and capturing the hearts of readers, a wild dolphin named “Delphine” creates awareness of perils facing the Atlantic bottlenose dolphin.

Although each novel certainly stands alone, readers were first introduced to the lives of three half-sisters and Delphine in The Summer Girls, which is Monroe’s first book in the summer trilogy set on Sullivan’s Island, South Carolina. They were revisited in the The Summer’s Wind. Now, Monroe returns with the third novel— The Summer’s End. “Mary Alice Monroe is my friend and mentor, and because she also incorporates factual information throughout her novels, she has endorsed my two children’s books, The Santa Train Tradition and Festus and His Fun Fest Favorites,” said local author ETMN columnist, Leigh Anne W. Hoover.

“Most recently, she endorsed my second adult Christian book For Better or Worse…Unless Annulment Comes First and Reading with Ralph –A Journey in Christian Compassion, which is about my adult reading student, and my relationship with Mary Alice is detailed in the book. When I speak at events and conferences, I also share her two children’s books.”

Both Monroe and Hoover share a desire to educate, create awareness and to give back. Each believes her first responsibility is as a storyteller, yet factual information is woven throughout their stories.

Hoover’s two children’s books and both of her new adult Christian books will also be available for purchase at the event. She and Monroe will sign together following Monroe’s presentation.

A portion of the proceeds from Hoover’s books also benefits the Literacy Council of Kingsport, Inc. Advanced registration is required, and tickets are limited. The new novel will be sold in conjunction with ticket sales prior to her appearance. Tickets, which include a copy of the new release, are just $45. There is also an event only ticket available for $35. For additional information, register online visit www.literacycouncilofkingsport.org or www.maryalicemonroe.com 0r call the Literacy Council of Kingsport (423) 392-4643.

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PHiiT: Statewide Initiative Addresses Pressing Pediatric Issues

By CINDY SANDERS

In the fall of 2013, the Tennessee Chapter of the American Academy of Pediatrics (TNAPP) launched a bold new initiative to address pediatric quality issues in primary care through the formation of the Pediatric Healthcare Improvement Initiative for Tennessee (PHiiT). Following a successful first pilot program in East Tennessee, PHiiT is now expanding its education and quality improvement efforts across the state.

The collaborative – which is inclusive of all Tennessee parties utilizing pediatric care, delivering pediatric care, measuring outcomes or structuring payment systems – came about as a result of conversations with key stakeholders over the course of several years. Allen Coffman, Jr., MD, FAAP, who Dr. Allen serves as medical direc- Coffman, Jr. tor of PHiiT, said many practices were struggling in the wake of the recession. At the same time, practices were being asked to revamp many of their processes.

“All of this was coming at one time,” said Coffman, a practicing pediatrician with Highland Pediatrics in Chattanooga and past president of TNAPP. “Providers were overwhelmed with the financial changes, care delivery changes, and changes on how our board certification processes were happening … so we asked, ‘How can we do this better?’”

As discussions became more formalized, Coffman said TNAPP realized it would take a broad coalition to address the changes providers faced and drive quality to improve the health of the state’s youngest citizens. PHiiT’s main goals are: to educate providers about high value process changes for practices to impact serious population health concerns, to bring together stakeholders to organize and prioritize what those population health priorities are and develop measures to assess outcomes, and to ensure providers and patients have the tools they need to be successful.

“We’re really focusing on that patient-provider space and making sure the patient and provider have the tools they need to make that a better working relationship,” Coffman said. After all, he continued, “The only ones who can really change healthcare delivery are providers in concert with patients.”

Working with the National Improvement Partnership Network out of the University of Vermont, PHiiT set about to develop and implement quality improvement projects around pediatric health concerns that are high cost, consistent with 6

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state

and federal priorities, have poor outcomes, are difficult for patients, and/or cause frustration for practitioners. Coffman said each quality improvement project also includes a Continuing Medical Education component and standardization of metrics and outcomes reporting so the collaborative could analyze data and broadly share information and best practices.

The first initiative – Breastfeeding Sustainment and Smoking Cessation Project – was piloted through practices in Chattanooga, Knoxville and Oak Ridge with funding from the Tennessee Department of Health and data support from the Tennessee Initiative for Perinatal Quality Care (TIPQC). Coffman said the project kicked off in the summer of 2014 and winds up this month. An educational program was hosted over two weekends to get providers – which included physicians, nurses, nurse practitioners, and medical students – up to speed on ways to extend breastfeeding and discourage tobacco use around infants, and preliminary data has been very encouraging.

“When you look at breastfeeding, one-third will breastfeed no matter what you do, one-third won’t no matter what, and one-third in the middle are undecided, ambivalent,” Coffman said.

“There is a high value window during the newborn period. We know the sooner you get them (mothers) in and the better you engage them that first two weeks, you maximize the chance they will continue to breastfeed,” he explained, adding this newborn period is also the most motivated time for caregivers to quit smoking.

“We have been able to improve the frequency of patients seen within 72 hours of hospital discharge from 76 percent at baseline to 85 percent at our first followup,” Coffman said. “Our two-month breastfeeding rate has increased from 56 percent at baseline, which was better than anyone expected, to 62 percent at our first follow-up,” he continued. Coffman did note the higher-than-normal baseline breastfeeding rate could be attributed to the type of practices that participated in in the pilot, which were already working to engage parents around the importance of breastfeeding.

As for the second part of the project, Coffman noted, “Only 60 percent of newborns were being screened for tobacco exposure at baseline. We were able to increase that to three-quarters, 76 percent, at our first follow-up.” He added that in-

stead of just asking if the child was exposed to tobacco, which Coffman said could feel judgmental and garner a biased response, PHiiT trained providers to reframe the conversation. “What we tried to teach was to positively engage the family around their care network and then go back and ask if each of those persons used tobacco.”

Ultimately, Coffman noted, providers need effective tools they can use to engage with patients. “We know there is a finite amount of time that the provider

and patient have so we look for the high value propositions … what really works.”

He continued, “We really push our education faculty to choose what are high value changes and then communicate that to providers and patients in a way that is useful.”

Coffman said an important part of the equation that has been missing is feedback as to what is sustainable and then using that feedback to help develop payment structures that incentivize continued process improvement. While the information is critical to inform practice and impact (CONTINUED ON PAGE 10)

TPCA, United Health Foundation Connect for Quality Last month United Health Foundation awarded $900,000 to the Tennessee Primary Care Association to help support “Tennessee Quality Connect,” a clinical initiative connecting healthcare professionals and patients through Community Health Centers (CHCs) in person or by utilizing telehealth technology.

CHCs, which are often located in communities where primary healthcare providers and hospitals are not easily accessible, serve as a primary source of care for one in 17 Tennesseans. However, when a patient’s condition requires the attention of a physician not on staff at a CHC, a range of barriers from a lack of transportation to not having adequate childcare to not being able to take time off work can stand in the way of seeing the specialist. The United Health Foundation grant is focused specifically on providing access to behavioral health and nutritional counseling services for individuals with hypertension, diabetes and depression to help combat these chronic issues.

The ability to leverage telehealth technology extends the reach of urban-based specialty care providers, improving access to critical health services in remote and underserved areas. More than 10 million people nationwide directly benefited from using telemedicine last year, according to the American Telemedicine Association.

“The Tennessee Primary Care Association’s work in the community has shown significant success in connecting people with quality healthcare services, and we are grateful for the opportunity to support its efforts to bring new, innovative approaches to healthcare,” said Rita Johnson-Mills, CEO of UnitedHealthcare Community Plan of Tennessee.

Announced at Neighborhood Health in Nashville, the grant is part of United Health Foundation’s “Helping Build Healthier Communities.” The funds will be awarded over three years and will support the Tennessee Quality Connect initiative at 17 CHCs, which collectively represent 104 health center sites serving more than 300,000 residents across 44 counties.

Officials gathered to celebrate the United Health Foundation grant to the Tennessee Primary Care Association last month. Pictured (L-R): UnitedHealthcare Community Plan of Tennessee COO Richard Reeves, Tennessee Primary Care Association CEO Kathy Wood-Dobbins, State Rep. Harold Love, State Rep. John Ray Clemmons, Neighborhood Health CEO Mary Bufwack, and UnitedHealthcare Community Plan of Tennessee CEO Rita Johnson-Mills. easttnmedicalnews

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HealthcareLeader

Better & Faster

Evolutions in hip & knee replacement offer challenges, opportunities

By JOE MORRIS

Like all doctors, Matthew Nadaud wants to see results. And like his patients, he wants to see those results quickly. Now throw in some of the most cutting-edge tools and techniques in medicine, and you have one of East Tennessee’s most sought-after hip and knee replacement surgeons.

“My dad was a family-practice doctor, and so that got me in the door in terms of wanting to be a doctor,” Nadaud said. “I really admired him for what he did in his community. But once I was in medical school, I began to work with some people I also admired and respected, and the more I found out about orthopedics, the more I knew that was really what I wanted to do.”

After completing a Bachelor’s degree in chemistry from Miami University in Ohio, Nadaud received his medical degree from the Medical College of Ohio. A fellowship in adult reconstructive surgery in North Carolina followed, and about 14 years ago, he joined the Knoxville Orthopaedic Clinic.

“It was a wonderful opportunity for me, because they were some of the first joint specialists in this area, and I wanted to continue to develop my hip and knee replacement practice,” Nadaud said.

His early interest in orthopedics has never flagged, he says, noting that there are elements of sports medicine and other disciplines that come into play because of the wide variety of patients he sees.

“It’s also a bit self serving because I enjoy being able to give people pain relief very quickly,” he explained. “That really hooked me, and still does. I have seen some spinal surgeries and hand surgeries that are amazing, but just seeing how quickly we can help someone with a hip or knee continues to amaze me.”

The immediacy of the treatment has only grown in the last couple of decades, as both joint replacements themselves, as well as the techniques for putting them into place, have advanced. Nadaud saw much of that research and development firsthand during his med-school days, and continues to track advancements so that he can bring them to his patients.

“I realized early on that I would have opportunities to contribute to the field, and that was an exciting aspect to it,” he said. “And the evolution of what we do has been remarkable. I’m in my 14th year of practice, and I can’t say that there’s been any one milestone that’s represented a quantum shift in what we do. There’s no single technique or material, but rather easttnmedicalnews

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the whole experience has continued to evolve. Some procedures may fall out of favor, then come back around, while others are continually built upon.”

On a broader scale, he says that orthopedics as a specialty service line is tracking the overall move in healthcare to become even more patient-centric, and to ensure that the patient experience continues to become even better.

“The guys who taught me how to do hips and knees, they were doing

amazing work when people were only having to stay in bed for 10 days,” Nadaud recalled. “They were afraid to move anybody, but that’s where the field was, and the patients were still in better shape.

Now we do this work all day long, and the patients I operate on in the morning will be up and walking that afternoon.”

Smaller incisions, better pain management, fewer side effects from medication and anesthesia and the advanced surgical techniques and instruments all play a part, and all come together to allow him to offer his services to a much wider array of patients than even 10 years ago.

“People are getting this work done later in life,” he explained.

“These operations used to be for people who were between 65 and 75 years old. Now there are a lot of much younger people, many in their 40s, who have developed endstage arthritis, and we have these options for them. I also see people in their 90s choosing to have elective joint replacement because they want to maintain an independent-living lifestyle. Hip and knee replacement has a much farther reach than it ever has before, and I think that will continue.”

Because hip and knee replacement hospital stays have been drastically shortened, he also predicts more younger people, such as those in their 50s, may begin to view the procedure with less trepidation as well.

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“I think we’ll continue to get healthier and younger patients, and be able to provide effective pain relief for them,” he said. “At the same time, we’ll be making the procedures even safer for our older population.”

That group’s procedures fall under Medicare more often than not, which is why his practice is currently taking part in the Centers for Medicare and Medicaid’s Bundled Payments for Care Improvement Initiative, which focuses on reimbursement around financial performance accountability. It’s in its early days, but Nadaud says he believes programs like this can be of great benefit to all parties involved.

“We are on the leading edge of this kind of program, and I think it’s going to evolve and hopefully result in safer programs and better results for patients without compromising access to care,” he said.

“That’s the goal for the whole program, and by getting doctors and hospitals on board and making sure we’re all on the same page, we can have reforms and figure out the smartest ways to do things.

When we all do that, then the patient really benefits.”

It’s no surprise that Dr. Nadaud would want to be in on anything that’s leading edge, be it a surgical technique or a new government initiative. That’s what drives him, along with that desire to see good results — fast.

“I enjoy the heck out of what I do,” he said. “I love the technical challenges, I love the patient interaction, and I love seeing those results in a follow-up visit.

It’s just so satisfying. I put in far too many hours to not love what I’m doing!”

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Society for Women’s Health Research, continued from page 1 Office (GAO) to investigate the NIH’s inclusion of women. Greenberger noted at that time the focus was on the disease without consideration of gender … even when the disease in question was Phyllis known to disproportion- Greenberger ately affect women, such as osteoporosis. “Nobody had any sort of separate designation for women, and it was mostly men in clinical trials,” she said. Greenberger added the safety profiles and effectiveness data of many drugs were based on outcomes of the mostly young, healthy, white men who populated clinical trials.

In the aftermath of the severe birth defects that resulted from use of thalidomide and DES, women of childbearing years had been generally excluded from participating in pharmaceutical trials by a Food & Drug Administration (FDA) guideline released 13 years earlier. When NIH directors were effectively ‘called on the carpet’ as a result of the GAO audit, Greenberger said the excuse for not using more women (of any age) was pinned on hormonal changes that could make it more difficult to measure results, coupled with a belief that men and women were basically alike except for the reproductive system.

A Big Year for Change

By 1993, the volunteer group made the decision to formalize and become a 501(c)(3) organization. Greenberger, who viewed the daunting task of changing the status quo as “fun and challenging,” applied for the founding staff leadership position with SWHR. As president and CEO, Greenberger has witnessed tremendous change in how women are assimilated into bio- Martha Nolan medical research but still sees the long road ahead to fully embrace diversity from bench to bedside.

That same year, Congress passed the NIH Revitalization Act of 1993, which SWHR had worked tirelessly to get passed.

The legislation mandated women and minorities be included in clinical research and required Phase III trials be analyzed by gender. In light of the changes at the NIH, the FDA rescinded its earlier guideline mandating the exclusion of women with childbearing potential.

Moving the Science Forward

Although 1993 was a landmark year in terms of new rules and regulations for women’s health, Martha Nolan, JD, vice president of Public Policy for SWHR, noted it was simply a starting point. “Just changing the law didn’t necessarily turn a switch and have everyone be in agreement,” she said. “There was a lot of pushback.”

One example of the uphill battle to institute change is evident in the amount of time it took to codify various women’s health initiatives across the federal govern8

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ment. The 1993 Revitalization Act made ety of diseases and conditions including the the Office of Research on Women’s Health autoimmune system, cardiovascular health at the NIH permanent. However, a numand addiction. ber of other similar initiatives were soon Although getting more women into launched across federal agencies such as trials was certainly important, Nolan said the Substance Abuse and Mental Health it was only part of the battle. “Just includServices Administration (SAMHSA) ing women in equal numbers doesn’t and CDC. The Women’s Health matter if you’re not analyzing for differences,” she noted. Who Office Act (WHOA) was an efFor more fort to make these new entibenefitted? Who got hurt? information on ties permanent.

Was it equal among subthe organization’s “In 1994, then Rep. groups, or was one outcome work and upcoming (Olympia) Snowe (Rmore predominant among initiatives, go online Maine), who became Sen. men or women? Drilling to swhr.org.

Snowe, introduced this legdown in the data was crucial. islation for the first time,” In fact, Greenberger Nolan said. “It became law in noted, “A 2001 GAO report 2010 when it passed in the Affordthat was an investigation of the FDA able Care Act.” Greenberger added, “It found that eight out of 10 of the most retook us 16 years to get the women’s health cent drugs pulled off the market had disoffices into law to protect them.” proportionate adverse effects for women.”

It only took about one-third of that Recently, Nolan added, another victime to get the Institute of Medicine to tory was achieved in moving the needle on acknowledge the validity of sex-based bimeaningful analysis by SWHR and other ology. The organization submitted a proadvocacy organizations. “In 2012, we posal to Congress to have the IOM chart managed to get an amendment attached the future of medical research in terms of to a ‘must pass’ bill – the FDA Safety & Insex in 1996. Five years later, “Exploring the novation Act – on demographic reporting Biological Contributions to Human Health: Does that forced the agency to really look at how Sex Matter?” concluded that, indeed, it does. well demographic subgroups were repre“Phyllis’ effort between 1993 and sented in drugs already approved and to 2001 was to try to change the scientific and what extent demographic analysis played medical practice perspective,” said Nolan. in the approval process and issue a report SWHR launched scientific advisory meet… which it did in 2013.” ings designed to engage the research comSince then, she said, an action plan munity in debate and discussion about the has been crafted to explain how the FDA role of sex and gender differences in a variwill address research gaps. “There are

27 points to that action plan, which gives us much to digest and work on with the agency,” she noted.

Drilling Even Deeper

“What we learned after the IOM report is it isn’t just clinical science, it’s basic research, too,” Greenberger said.

Nolan added, “Our priorities are a continued focus on both the FDA and NIH due to changes that have occurred over the last several years. One is the determination by the director of NIH that sex be a variable and be considered in pre-clinical research. This is wonderful … it’s something we’ve been focused on for quite some time.”

While recognizing it will take time to implement such changes, Nolan promised, “The key is they’re going to do it, and we’re going to make sure they do it.”

Similarly, SWHR’s attention on molecular diagnostics and precision medicine also aims to discover the benefits of drilling deeper to find genomic variations and mutations impacting women’s health and treatment options.

What started as a simple question about how women were plugged into medical research and discovery has turned into a 25-year journey toward better health for half the nation’s population. Although there are many more miles to go, the SWHR remains committed to its unwavering goal of optimizing women’s health through education, advocacy, and research.

HIT: Optimization Through Integration, continued from page 1 Bruce Broussard, president and CEO of Humana, to George W. Bush, 43rd president of the United States of America.

“Over the past five years, there has been a huge shift towards technology largely because of the HITECH Act of 2009 and government programs like Meaningful Use that have helped drive the technology in healthcare,” Miller said.

Although slower to adopt technology into daily operations – particularly in a clinical setting – than many other industries, healthcare has increasingly been pressed to take an ‘all in’ stance.

Miller noted that over the last few years, technology has fundamentally changed the way providers … both large and small … operate. He added the challenge is balancing the adoption of technology with everything that brings.

“Today anything a healthcare organization wants to change in a business or clinical process requires a change in their technology, and likewise, any change in their technology has an impact on the care they provide or their revenue,” he said. “I think healthcare entities were used to thinking of technology as a separate entity, but now it’s so intertwined,” added the Atlantabased HIT expert.

In their HIMSS presentation, Miller said he and Dulac focused on how to manage and optimize technology now that it has become so pervasive, while at the same time accounting for all the other changes happening in healthcare including a swi-

tchover to ICD-10, meeting ongoing and new Meaningful Use requirements, actively engaging patients, supporting accountable care models, and the myriad other programs that require attention.

The bottom line is that thinking of each of these mandates or initiatives as individual tasks to conquer leads to madness … or at least extreme frustration. Instead, Miller said the question should be, “How can organizations effectively manage all of those together with a higher degree of efficiency and lower overall cost?”

He continued, “When I think implementation, somewhere between 25-30 percent of the time spent on these changes is spent on testing so if you can group – effectively overlap testing on these programs – you can significantly save time.”

More than just testing, though, Miller said very deliberately grouping initiatives under a single governance project structure helps with a range of other issues from interoperability to simplification for end users. “Being able to group things together almost makes it irrelevant as to what changes were made,” he said of the finished product in the minds of those actually using the technology.

The ‘ripping off the bandage’ approach means one educational update for those end users as opposed to having to create an educational module for each individual initiative. Not only does a rolling schedule of changes often feel more overwhelming, but also the time away from

desks learning the new processes would typically be less under a grouping structure than to have 10 separate trainings for 10 separate initiatives.

Miller was quick to admit that creating overarching technology structures could be difficult without staff or contracted expertise, which makes it more problematic for small practices.

“Whether you see it as a good or bad thing, there’s certainly a lot of consolidation in the market. Small private practices are becoming more and more rare,’ he said.

“I think one of the reasons is it’s becoming increasingly difficult for groups like that to manage all these changes.”

Miller added larger practices or health systems enjoy the economies of scale that make it easier to incorporate the rapid number of changes taking place. However, he added that in addition to HIT consultants, software vendors typically also offer at least some assistance in helping clients assimilate new processes into their workflow.

“Managing technology is only getting more complex,” he concluded. “Organizations need to be intentional and strategic in how they do that … whether that’s implementing analytics platforms, system upgrades, system optimization, Meaningful Use programs, or ICD-10. They need to be looking at ways they can consolidate those initiatives to be more effective with their resources and increase the return on their technology investment.” easttnmedicalnews

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The Literary Examiner

BY TERRI SCHLICHENMEYER

Tales from Kentucky Nurses

by William Lynwood Montell; c.2015, University Press of Kentucky; $24.95 / higher in Canada, 281 pages

Ah, the wonders of modern medicine!

It’s nothing like it was when you were a child, naturally, but as you’ll see in the new book Tales from Kentucky Nurses by William Lynwood Montell, there’s so much more to the story.

Remember when doctors made house calls? It’s not unheard-of today, but it’s rare – so imagine your medical care arriving on horseback, from a professional who stayed for a few days to ensure your recovery. That was what residents of many “mountain counties” in Kentucky used to expect.

From the 1920s until as recent as the early 1970s, it was often impossible to practice Medicine As Usual: many Appalachian homes were inaccessible by road, indoor plumbing was sometimes scarce, and medical facilities were far apart. This book is filled with oral histories from nurses who worked under those conditions in both the Frontier Nursing Service and in small-town Kentucky hospitals and clinics.

In rural areas, as many nurses point out, folk remedies and home treatments were often used instead of modern medicine. That led to medical complaints and attempted cures that major hospitals would never see today. In a few stories here, you’ll read about people who had never seen a doctor in their lives, until situations became dire.

You’ll read tales of babies born “at home or in a neighbor’s house,” sometimes with a midwife’s help and sometimes not. Superstitious beliefs often show up in these stories, and you’ll read about tragedy as well as joy.

Here, you’ll read of nurses who stood up to authority, and why. Payment, for some of the nurses here, was made in eggs or meat – if payment even came. Patient care was often simple and low-tech, pantsuits were forbidden, nurses were expected to stand when “a physician walked in,” white stockings were mandatory, and caps were “pinned neatly to our hair.” People (including doctors) still smoked in the hospital.

One nurse tells of a calf being named in her honor. And one mourns because “nurses are human and we can’t save everyone.”

There’s something to be said about walking a mile in someone’s (white nursing) shoes – which is easy to do when you read Tales from Kentucky Nurses. easttnmedicalnews

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Through interviews with “local individuals who can tell their favorite stories” and oral histories collected from other sources, author William Lynwood Montell takes readers back as far as 90 years in Kentucky medicine and culture in stories of varying length and emotion. I was captivated by the breadth of experience inside this book, and by the memories of nurses whose work would otherwise be unsung.

Be aware that tales are often not edited, which might be challenging but which preserves particular language nuances. And that, of course, is what you want in an oral history book so find a chair, find Tales from Kentucky Nurses and, well, you know the procedure.

Body of Truth

by Harriet Brown; c.2015, DaCapo LifeLong; $25.99 / $32.50 Canada, 274 pages

Your summer clothes don’t fit this year.

You’ll admit that you weren’t paying attention: too many holiday cookies, too little New Years’ resolving. The pounds crept up and you need to lose them before they multiply again.

It’s for your health and well-being, right?

Or maybe not. In the new book Body of Truth by Harriet Brown, you’ll see that everything you thought you knew about weight may be a big fat lie.

Some twenty-five years ago on

a “sticky summer evening,” Harriet Brown sat in a therapist’s chair, sobbing about her weight. Once, she’d been thin but “three pregnancies and a whole lot of living” later, she couldn’t take off the pounds.

She was absolutely stunned when the therapist asked if she could learn to be okay with the body she had. She “couldn’t even consider the possibility” that having a few extra pounds wasn’t such a bad thing.

Even the language we use for weight has changed in the past few years: what was once chubby or husky is now “obese” or “overweight,” words that carry a meaner stigma. Yes, as a society, we’ve gained weight but our eating habits and our sedentary lives are not solely to blame. There are, says Brown, several reasons for weight gain, one of which is that dieting is generally detrimental.

Statistically speaking, just five percent of dieters keep the weight off, long-term; the other 95 percent of calorie-counters usually gain back any weight lost, and then some. We understand that yo-yo dieting is unhealthy, but we may not know that some researchers believe there’s no increased risk of death due to extra weight. Even so, says Brown, physicians sometimes admit to having “weight bias,” and treat (or don’t treat) patients accordingly.

But our obsession with weight goes much deeper than just physical effects.

Negative social pressure can affect our mental health, which suffers when we loathe our bodies and indulge in “fat talk.” What’s worse is that our emphasis on weight adversely affects future generations: some pediatricians recom-

mend that infants be put on diets and one study found three-year-old children who were “unhappy with their bodies.”

Says Brown, “Something is definitely wrong with this picture.”

Food for thought. No pun intended, but that’s what you’ll find in Body of Truth. You’ll also find a good amount of controversy.

For readers who struggle with their weight, there’s a certain Ahhhhh-feeling of freedom that comes with author Harriet Brown’s urging for acceptance. It’s hard not to see that our attitudes about being overweight have gone overboard, and it’s equally hard to argue with the experts and research she cites.

Definitely, this could cause weightwatching readers’ heads to spin – but Brown is quick to reassure the flummoxed: “There’s no one-size-fits-all approach…” when it comes to weight or loss thereof.

Overall, I really liked this book – in part, because it provides more balance in a world where new diets come out seemingly every day.

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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Mark Your Calendar

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

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

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

Registration is required. Visit www.kamgma.com.

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

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

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GrandRounds Tennessee Doctors Tackle Big Issues at TMA Annual Convention Education and Policies Focus on Public Health, End of Life Care, Payment Reforms NASHVILLE – Approximately 300 of the state’s leading physicians, medical practice managers and other healthcare professionals met in Nashville last weekend for MedTenn15, a medical convention sponsored by the Tennessee Medical Association. The event was held at the Opryland Resort & Convention Center and featured exclusive medical education, professional networking and social events.

EVENT HIGHLIGHTS Tennessee Department of Health Commissioner John Dreyzehner, MD, MPH, FACOEM delivered an address on Tennessee’s biggest public health challenges.

A panel of physician experts discussed end of life care during a luncheon on Sat-

PHiiT, continued from page 6 outcomes, Coffman was quick to say that PHiiT provides tools and data but allows providers the freedom to be innovative in how they address issues with patients.

With the first pilot successfully drawing to a close, PHiiT is looking to expand that project and others across the state.

The collaborative recently announced an award of a $1.49 million, three-year contract with the Bureau of TennCare to take PHiiT’s efforts statewide.

The next project is to develop a pediatric metric dashboard with the assistance of all four pediatric residency programs in Tennessee. PHiiT’s quality coach will assist participating practices in gathering data pertaining to the measurement of the metrics. “That will give practices ongoing feedback as to what their practice is doing compared to the state aggregate,” Coffman said of the dashboard, known as the Provider Best Practice Resource.

From there, specific quality improvement projects will be added. Coffman said asthma would be among the first initiatives with obesity, behavioral health and developmental screening modules as other likely candidates to roll out in the near future.

“What we’re hoping is to give practices real data to make business decisions around investing in quality improvement,” he said. “I think providers are going to learn a lot about the way they deliver care.”

PHiiT has begun enrolling additional practices to participate in the expanded programming. Coffman said pediatric, family and general practices that see children are all welcome to participate. In addition, school-based clinics, health department clinics and federally qualified health centers are also encouraged to enroll. For more information, contact Becky Brumley via email at becky.brumley@ tnaap.org.

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urday, April 11, including how healthcare providers can help patients and families engage in difficult conversations and make important choices about advance care directives.

TMA’s in-house experts delivered two separate presentations about theTennessee Healthcare Innovation Initiative, the state’s effort to move from a fee-for-service to a value-based payment model, and the current state and federal healthcare reform landscape.

Dr. Roland Gray of the Tennessee Medical Foundation delivered a two-hour session focusing on the state’s growing prescription drug abuse epidemic.

TMA POLICY UPDATES Medical education sessions at MedTenn15 complemented the TMA House of Delegates, the governing body and deliberative forum for the Association.

Physicians serving on the House discussed a number of policies affecting the practice of medicine in Tennessee, and patient health. Among the notable resolutions: Build a statewide and national consensus regarding the future physician shortage crisis and ensure that an adequate supply of physicians will be available for the next generation.

Improve the state’s Controlled Substance Monitoring Database report so that each prescription reported includes the name of the midlevel prescriber as well as the midlevel prescriber’s supervising physician.

Develop a state-specific database for drug shortages, and develop strategies to mitigate drug shortages, working with the Tennessee Department of Health, Tennessee Pharmacy Association, Tennessee Hospital Association and other pertinent stakeholders.

Pursue legislation to oversee the implementation of the Tennessee Health Care Innovation Initiative and allow physicians and other pertinent stakeholders the opportunity to address relevant issues to the General Assembly.

Use results from a membership survey on Maintenance of Certification (MOC) to improve the process for Tennessee physicians.

NEW TMA OFFICERS Dr. Springer’s one-year term as TMA’s top elected physician officially ended during the event, as the Association ushered in John W. Hale, Jr., MD, a Union City family physician, as its 2015-2016 President.

Several other TMA member physicians officially began their terms for 20152016 leadership positions.

Dr. Michel McDonald, a Nashville dermatologist/Mohs surgeon, will serveChair of the TMA Board of Trustees. She is the first ever female physician elected to serve in this capacity.

Dr. James Batson, a Cookeville pediatrician, will serve Vice‐Chairman of the TMA Board of Trustees.

Dr. Ted Taylor, a pediatrician in Johnson City, was appointed asSecretary/Trea-

surer for the TMA. Dr. Keith Anderson, a Memphis cardiologist, will serve asPresident-Elect and a member of the TMA Board of Trustees.

AWARDS TMA recognizes during its annual meeting individual physician members and other organizations for exceptional leadership, contributions to medicine, and community service. The 2015 honorees are: Outstanding Physician: James Eason, MD in Memphis, Eric Raefsky, MD in Nashville (given posthumously and accepted by daughter Stacy Macuik) and J. Mack Worthington, MD in Chattanooga Distinguished Service: Michael D. Brunson, MD from Knoxville and William Mariencheck, MD in Memphis Community Service: Blood Assurance, Inc. in Chattanooga, Our Kids in Nashville, Representative Bill Dun in Knoxville and the Shelby County Health Department in Memphis

East Tennessee Health Information Network Introduces Image Gateway

KNOXVILLE – East Tennessee Health Information Network (etHIN) introduces Image Gateway, a first-of-its-kind system for exchanging patient images that is specific to the East Tennessee healthcare community.

Image Gateway is a feature within the Virtual Health Record (VHR) that has the capability to save time for providers by allowing immediate access to recent and prior imaging studies from connected external PACS. It may help reduce healthcare costs by eliminating unnecessary duplicate imaging procedures, which can ultimately improve patient safety. Further, web-based image availability may positively impact the common problems of lost or non-viewable CDs and large file transfers.

By allowing participating providers to view images on etHIN’s zero-footprint Health Viewer® ZF, which is a diagnostic quality image viewer, Image Gateway shortens the process of obtaining images from off-site locations down to seconds when it traditionally can take hours or days to obtain images.

Image Gateway offers users PACS-like manipulation tools and a real-time collaboration feature, which allows multiple clinicians to collaborate on the same imaging exam from wherever they are.

Currently, seven Covenant Health hospitals, the University of Tennessee Medical Center, East Tennessee Children’s Hospital, and Blount Memorial Hospital are providing images through Image Gateway. Several imaging centers in the area have also expressed interest in providing images to the etHIN community through Image Gateway.

For more information on Image Gateway, contact etHIN at 865-691-8433 or visit www.ethin.org.

Erlanger’s air medical program receives Service of the Year Award from EMS Director’s Association CHATTANOOGA – Erlanger’s LIFE FORCE air medical program recently received the Southeastern EMS Director’s Association Service of the Year award for the program’s outstanding emergency medical services for patient care.

The LIFE FORCE program operates four helicopters and services four states.

Accredited by the commission for medical transport since 2011, LIFE FORCE is nationally ranked as one of the highest performing air medical services in the country.

It is the only air ambulance program in the region that carries ultrasound, blood and plasma and is credentialed by physicians at Erlanger to perform emergency surgical procedures. All LIFE FORCE flight nurses and paramedics have board certification in critical care transport. LIFE FORCE is one of only 5% of the programs in the country that has achieved this standard.

This is the second year the organization has hosted an awards banquet for its members. It is held in conjunction with the annual Southeastern Emergency Services Director’s Association Conference, which is one of the largest area conferences for first responders and presents educational seminars to emergency medical services personnel from around the region.

31st Annual Shirley LoganRenia Williams Charity Golf Tournament to Benefit the Walter E. Boehm Birth Defects Center CHATTANOOGA –The 31st Annual Shirley Logan-Renia Williams Little Angels Golf Tournament will be held on June 13, 2015, at the Calhoun Elks Lodge in Calhoun, GA. Presented by Philips Van-Heusen and local area Teamsters, this charity event raises money for the Walter E. Boehm Birth Defects Center, a local non-profit that provides medical, financial and psychosocial support children born with neural tube defects. To date, the tournament has raised over $945,000 for the Center.

The tournament has tee times at 8:00 a.m. and 1:30 p.m. with select shot, two-person teams with a minimum of four flights. A driver will be given for each player of the leading team of each of the flights and a Ping bag awarded for each player of the second place team in each of the four flights.

The entry fee is $100 per player and includes green fees, cart, one mulligan, one team photo, and food and refreshments throughout the day. The cut-off date is Thursday, June 11, 2015, at 5:00 p.m. or the first 224 paid applicants.

For tournament application, sponsorship forms, or more information, please visit www.boehmbdc.com or call 423.778.2222.

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LeConte Announces New Chief Nursing Officer SEVIERVILLE — LeConte Medical Center is pleased to welcome Jennifer DeBow, RN, BSN, as Vice President/Chief Nursing Officer. DeBow is transferring to LeConte from Fort Sanders Regional Medical Center, where she serves as the Cardiovascular Service Line Director, and brings with her over 21 years of professional nursing experience including critical care and cath lab nursing leadership roles.

DeBow’s professional excellence has been recognized through receiving multiple Covenant Health performance excellence awards, including the silver quality award, the gold service award, and most innovative project award. She is also the 2002 recipient of the Peggy Gilbertson Award for clinical excellence presented by nursing leadership at Fort Sanders Regional Medical Center.

DeBow cites some of her most recent professional accomplishments as participating in the recertification of the Cardiac Diagnostics Echocardiography Laboratory, coordinating with the architect and hospital administration to relocate cardiology unit to a different floor, participating in the process of developing and implementing Mission Lifeline in conjunction with Rural Metro and local facilities, and coordinating efforts with sister facilities and physicians to implement the collection and submission of data to the Society of Thoracic Surgeons Database for Coronary Artery Bypass Graft patient populations.

DeBow received her Bachelor’s in Nursing from East Tennessee State University, and will complete her MBA from ETSU in September.

Children’s Hospital Nurse Practitioner recognized for child abuse advocacy CHATTANOOGA – For the third year in a row, the Child Abuse Protection Team at T.C. Thompson Children’s Hospital at Erlanger has been recognized by the Children’s Advocacy Center (CAC) of Hamilton County.

The One with Courage Awards Dinner on April 9 celebrated champions of children who enrich their lives through help, hope and healing and honor individuals who support the children through giving, service and voluntarism.

This year’s event recognized Ashley O’Barr, a pediatric nurse practitioner at Children’s Hospital, as the Child Protection Investigation Team Member of the Year.

The award honors Ms. O’Barr for the dedication, service and advocacy she provides to the team and patients. Her role on the team provides medical expertise and treatment to the victims of sexual assault.

Other Children’s Hospital team members recognized by CAC in recent years include Lillie Rucker, CMA; Julie Zielinski, MD; and Karla Garcia, MD. They each won awards for their service to the children and caring for victims of child abuse.

The Children’s Advocacy Center is

a non-profit agency that provides a safe and caring environment for abused children so that they can receive the services they need in one comprehensive facility.

The center is accredited by the National Children’s Alliance and provides forensic interviews, medical examinations, therapy and family advocacy, which are offered at no charge to children referred by the Department of Children’s Services or law enforcement. For more information about the Children’s Advocacy Center, visit www.cachc.org.

Heart Study at Erlanger holds PROMISE CHATTANOOGA – A groundbreaking clinical trial conducted at Erlanger Health System and other sites across the nation confirms what cardiologists and radiologists have long suspected: coronary computed tomographic angiography (coronary CTA, also known as cardiac CT) is extraordinarily effective in accurately diagnosing patients with low to moderate chest pain.

The findings of the study revealed that a cardiac CT scan may be a better way to diagnose chest pain than the current standard tests such as an EKG or stress tests.

Erlanger already clinically utilizes the new CT technology that was tested in the trial, and qualifying patients with chest pain are now clinically evaluated at Erlanger with this exciting new technology.

Erlanger was invited to be a test site for this important trial sponsored by the National Institutes of Health to study the use of cardiac imaging for diagnosing problems associated with chest pain, the most common clinical cardiology problem. The PROspective Multicenter Imaging Study for the Evaluation of Chest Pain, or PROMISE study, was led by Duke Clinical Research Institute (DCRI) and the Duke Cooperative Cardiovascular Society (DUCCS Research Network.

The results of the PROMISE study also provide valuable information to insurance carriers that have traditionally insisted on patients receiving older technology, such as a nuclear stress test, to diagnose chest pain. With this data, insurance companies may be more willing to pay for cardiac CT scans as a diagnostic tool.

Moreover, with rapidly progressing technology in the world of imaging, these results will continue to lead to increasingly better results with progressively decreasing radiation doses.

Results of the PROMISE study were recently published in the New England Journal of Medicine and simultaneously revealed at the American College of Cardiology 2015 Scientific Assembly.

Participants in the PROMISE trial were randomly assigned to one of two groups for the study. One group received cardiac CT imaging tests, while the other group received traditional testing for chest pain.

Erlanger was selected to participate in the trial due to its ongoing collaborative research relationship with DCRI and DUCCS, and because the Erlanger Insti-

tute for Clinical Research provided the necessary research infrastructure. Critical support and participation were also provided by Erlanger’s Cardiology, Emergency Medicine, and Radiology departments.

Battlefield Lung Specialists Welcomes Experienced Nurse Practitioner to its Medical Team FORT OGLETHORPE, Ga. – Melissa Smeltzer will be serving patients at Battlefield Lung Specialists as the Fort Oglethorpe facility’s newest nurse practitioner, practicing alongside Battlefield’s respected pulmonologist, Dr. Timothy Ashburn.

Melissa Melissa Smeltzer Smeltzer comes to Battlefield Lung Specialists with a comprehensive background as a critical care nurse and educator. She has nearly 20 years of experience as a registered nurse as well as 7 years as Director of Education at Hutcheson Medical Center. After earning her Bachelor of Science degree in nursing from Albany State University, Melissa graduated from Southern Adventist University with a Master of Science degree in nursing with an emphasis as a Family Nurse Practitioner.

Parkridge Medical Center recognized with Gold-Plus Award for heart failure care CHATTANOOGA — Parkridge Medical Center has received the Get With The Guidelines®–Heart Failure Gold-Plus Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association/American College of Cardiology Foundation’s secondary prevention guidelines for patients with heart failure.

This marks the 5th year that Parkridge Medical Center has been recognized with a quality achievement award.

Get With The Guidelines–Heart Failure is a quality improvement program that helps hospital teams provide the most up-to-date, research-based guidelines with the goal of speeding recovery and reducing hospital readmissions for heart failure patients. Launched in 2005, numerous published studies have demonstrated the program’s success in achieving patient outcome improvements, including reductions in 30-day readmissions.

Parkridge Medical Center earned the award by meeting specific quality achievement measures for the diagnosis and treatment of heart failure patients at a set level for a designated period. These measures include evaluation of the patient, proper use of medications and aggressive risk-reduction therapies. These would include ACE inhibitors/ARBs, beta-blockers, diuretics, anticoagulants, and other appropriate therapies. Before patients are discharged, they also receive education on managing their heart failure and overall health, get a follow-up visit scheduled, as well as other care transition interventions.

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InSights Healthy Vision for Life Regular eye exams should begin at 6 months of age.

Your eye doctor will test for excessive or unequal amounts of nearsightedness, farsightedness, astigmatism, muscle and other eye problems. These issues are easier to correct if treatment begins early.

Johnson City Eye Clinic is the only practice in the region that specializes in pediatric ophthalmology and strabismus.

Dr. Jeffrey Carlsen is the only fellowship trained pediatric ophthalmologist in the TriCities and has carefully trained the JCEC pediatric team to better serve our younger patient population.

Diabetic patients have a greater risk of developing glaucoma, retinal disease and cataracts. In fact, people over 40 with diabetes are THREE TIMES more likely to develop glaucoma. Johnson City Eye Clinic is proud to have three fellowship trained glaucoma specialists on staff. Drs. Michael Shahbazi, James Battle and Jennifer Oakley make use of the most up to the minute technologies in the diagnosis and treatment of glaucoma.

Women’s vision fluctuates during pregnancy. Usually these changes are temporary and tend to be minor, not requiring a new prescription.

Blurry vision during pregnancy could signal high blood pressure or gestational diabetes; a visit to the eye doctor is essential.

Avoiding smoking or quitting, is one of the best investments you can make in your long-term eye health. Smoking increases your risks for cataract and Age-related Macular Degeneration. While no macular degeneration treatment is likely to COMPLETELY restore vision lost to the eye disease, there are new treatments available which may be able to slow or prevent additional vision loss. There is also the possibility of improving remaining vision to some extent. Dr. John Johnson, Johnson City Eye Clinic has a special interest in the treatment of Age-related Macular Degeneration.

Smoking also increases the risks for cardiovascular diseases that could affect your eyes’ health. Second hand smoke can worsen Dry Eye, a very real and uncomfortable condition most common in post-menopausal women.

Eye infections are caused by bacteria, fungi, or viruses. These can occur in different parts of the eye, affecting one or both. Most common are the very contagious Conjunctivitis (pink eye) and Styes; a bump on the eyelid happening when bacteria get into the eyelash hair follicle. Styes are often associated Blepharitis. Symptoms of eye infections may include redness, itching, swelling, discharge, pain, or vision problems. Depending

Your partner in superior eye care since 1942

on the cause of the infection, your doctor may prescribe compresses, eye drops, creams or antibiotics. Discontinue wearing your contact lens if you are experiencing an eye infection. Also, replace any exposed contact lens after the infection has cleared and you resume wear. The physicians at Johnson City Eye Clinic have extensive training and expertise in the treatment of the myriad of eye and vision issues.

Protective eye wear is essential to those participating in sports as are sunglasses for protection from harmful UV radiation. Your eye doctor recommends you wear 99% Ultraviolet Radiation absorbent sunglasses if you wear contacts lens or whenever you are in the sun for long periods, especially during summer months. Sunglasses with 100% UV absorption are a must when you are at the beach, in the water or if you are using medications that may cause light sensitivity.

Cataracts are the leading cause of vision loss among adults over 55.

Symptoms include cloudy vision, halos, and frequent changes in vision, double vision, poor night vision, light sensitivity or washed-out colors.

There are many options when considering cataract surgery. Basic cataract surgery is an out-patient procedure performed in less than 30 minutes and is covered by major medical or Medicare. Bladeless, laser-guided cataract surgery and new technology lenses offer another option for those who wish to decrease dependence on glasses following surgery.

These advancements are considered elective and your insurance provider or Medicare will allow you to pay for additional services over and above the covered services.

Johnson City Eye Clinic and Surgery Center is among the first in the nation and one of only two in Tennessee to offer the Centerion, Verion and LenSx vision and cataract systems. This state-of-the-art system delivers more precise incisions and customized treatment for each patient’s individual eye. Talk with Drs. Randal Rabon, Alan McCartt or one of ten qualified physicians at Johnson City Eye Clinic to learn if these customized options are right for you.

Johnson City Eye Clinic & Johnson City Eye Surgery Center Johnson City • Bristol Phone: (423) 929-2111 • Fax: (423) 929-0497 johnsoncityeye.com

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