East Tn Medical News October 2015

FOCUS TOPICS NEUROLOGY HEALTH EDUCATION

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PHYSICIAN SPOTLIGHT PAGE 5

Dr. Douglas Stofko TRI CITIES

PHYSICIAN SPOTLIGHT PAGE 7

Dr. Tim Himel ON ROUNDS

Finding Neuronal Needles in the Haystack Technology Opens the Door to More Data, Potentially More Answers

By CINDy SANDERS

Enjoying East Tennessee Glorious Grandfather Mountain

With 100 billion neurons in the brain, singling one out can be a Herculean task – much like finding a needle in the haystack. However, new technology by Utah-based Blackrock NeuroMed LLC can make that undertaking easier … and potentially help researchers find answers, or at least point to new questions to ask, in the quest to better understand a host of neurologic disorders.

“What makes us really unique is we have the capability of recording signals from individual neurons in the brain,” said Andy

Being in East Tennessee, we are positioned close to the mountains of North Carolina, Tennessee and Virginia.

During October, and the peak of autumn’s grandeur, it’s a picturesque slice of heaven to behold and another opportunity to grab your sweater and come outside! ... 2

News of Note in Training Innovations

By CINDy SANDERS

Recent Settlements (Part II of III)

ONLINE: EASTTN MEDICAL NEWS.COM

(CONTINUED ON PAGE 3)

Covering the Healthcare Education Spectrum

Cybersecurity And Patient Privacy The importance of c ybersecurity is becoming increasingly evident in the context of protecting patient information ... 4

Gotshalk, CEO of Blackrock NeuroMed, a pioneering EEG monitoring technology company headquartered in Salt Lake City.

Where standard EEG technology measures the energy of tens of thousands of neurons at once, Blackstock’s technology also measures and records signals from each tiny neuron, allowing clinicians and researchers unprecedented precision in identifying underlying causes of disruption in the brain’s natural circuitry.

Using a large forest with millions of trees as an analogy for the human brain, Gotshalk said traditional EEG alerts physicians and

Dr. Susan Skochelak addresses the need to fundamentally transform the way we train physicians in America.

The AMA has recently announced it will extend grant funding as part of the organization’s Accelerating Change in Medical Education initiative.

By mandate and practical necessity, healthcare professionals are lifelong learners.

Whether at the starting point of undergraduate or graduate education or further along in careers and looking to hone skills, a wide array of resources exist to help providers be better prepared to deliver effective, efficient care.

A number of national organizations are looking ahead to assess the way professional teams will need to interact within the delivery system of the future to dispense the highest quality of care, along with ways to help communities and patients take a more interactive role in managing their health.

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Enjoying East Tennessee Glorious Grandfather Mountain By: LEIGH ANNE W. HOOVER

Being in East Tennessee, we are positioned close to the mountains of North Carolina, Tennessee and Virginia. During October, and the peak of autumn’s grandeur, it’s a picturesque slice of heaven to behold and another opportunity to grab your sweater and come outside!

As a South Carolina native, our family used to enjoy packing a picnic and driving to the nearby mountains. Back then, my mama would fry chicken and make homemade deviled eggs and potato salad using Duke’s Mayonnaise, of course!

Something about food eaten outdoors in the fall brings back all of those wonderful memories.

We’d leave the lingering heat of the Upstate behind for a respite and an afternoon in the mountains. In our region, we can do the same thing.

Whether it’s driving a few miles to a state or city park or crossing the state line, the mountains await in their tapestry of color.

One of the most renowned is Grandfather Mountain near Linville, North Carolina. Part of the Morton family for years, the late Hugh Morton inherited the mountain in 1952 and began developing it, while preserving the natural beauty, for tourists to visit and enjoy.

His vision was to allow others to experience Grandfather’s highest peaks.

The world-famous Mile-High Swinging Bridge, which is the highest suspension foot bridge in America, was built to connect two of these.

“Practicality spawned popularity that became one of our star attractions,” said Grandfather Mountain Stewardship Foundation Director of Marketing & Communications, Frank Ruggiero.

The mile-high bridge is still a “must

see” at Grandfather Mountain, and visitors are requested to wear rubber soled shoes when traversing the bridge and surrounding rock outcroppings.

Hugh Morton passed away in 2006 at 85, but the family is still very involved.

The state purchased the backcountry of the mountain and established the Grandfather Mountain State Park as North Carolina’s 34th state park. The tourist side of the mountain formed a 501 c (3) as the Grandfather Mountain Stewardship Foundation, where Morton’s legacy lives on through nature education and preservation.

Native Americans originally called the mountain “Tanawha,” meaning fabulous bird or hawk. The “grandfather” moniker refers to the mountain’s profile, which appears as an old man lying on his back.

“Grandfather Mountain is the kind of place where nature and people can connect,” said Ruggiero. “It’s rugged, as we say, but just civilized enough.”

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OCTOBER 2015

Families, couples and individuals have been coming to Grandfather Mountain for years. In fact, my nephew, Myles Whitlock, and his wife, Alexandrea, were engaged there overlooking the natural beauty of God’s creation.

“The fall colors are unparalleled up here,” said Ruggiero. “Already impressive viewscapes transfer into a kaleidoscope of fall color. It’s simply stunning.”

According to Ruggiero, one of the best ways to take it all of the beauty is by engaging in a “The Colors of Grandfather” program. These guided walks are led by experienced naturalists to the most colorful spots on the mountain and take place during weekends through October 18th. The special hikes are included in the day’s admission cost, and tours are arranged depending on the most colorful spots on the mountain.

Since color is the season’s sweet reward, I contacted well-known “fall color guy,” Dr. Howard Neufeld at Appalachian State University. Neufeld has been predicting color for years, and since this article is being penned well in advance of the season, readers can even check his Facebook page prior to visiting the mountains for the most current updates.

“There was the beginning of a mild drought in the mountains, but as it began to develop, several fronts moved through, and relieved us of the drought situation,” said Neufeld. “Given that, I would say we are on track to have a good leaf color season.”

Neufeld explained fall color depends largely on what the weather is like in September.

“It is the month that has the most effect on the quality of fall color, especially the reds,” said Neufeld. “If it begins to get cool, but stays largely sunny in September, that would suggest excellent fall colors. The lack of drought means some trees that drop leaves early, like tulip poplars, may hold on to their leaves longer,

and if so, those trees turn a bright yellow.”

The renowned “fall color guy” noted if weather cooperates, we should experience glorious fall color. Neufeld also stated color peaks will vary throughout October depending on elevation.

Hugh Morton devoted his life to nature preservation and education. This vision lives on at Grandfather Mountain and through his infamous photography.

Described as a photographer’s paradise, Ruggiero says Grandfather Mountain is one of the most photographed places on earth, and many in publication were taken by Morton.

“You get a near-panoramic view of the world from on top of the peak,” explained Ruggiero.

“You can see pretty much just a sea of color expanding through the High Country to the Piedmont. You can even see Charlotte on a clear day from up here.

You can pretty much see autumn as a whole, and it’s just marvelous.”

In addition to the miles of trails, additional popular attractions include the nature museum and the animal habitats, including animal encounters.

“Animal encounters are when our naturalists will give the animals an enrichment,” said Ruggiero. “It’s just something to break up any tedium in one’s day. It can be a new toy, a treat or even a scent.

That’s when guests will see the animals at their most active, and it’s lots of fun.”

The animal habitats include black bears, cougars, deer, eagles and otters that are all in natural surroundings. The geological history can be seen through the nature museum. There is also a documentary film theater, restaurant and a fudge shop on the mountain.

“A visit to Grandfather Mountain is an indelible experience and something you will remember for generations,” said Ruggiero. “Grandfather is more than just a clever name. It really is part of the family.”

For additional information about Grandfather Mountain, please visi http://www.grandfather.com/ And, for the most accurate information about the fall colors, visit Dr. Neufeld’s Facebook https://www.facebook.com/FallColorGuy or http://biology.appstate. edu/fall-colors Leigh Anne W. Hoover is a native of South Carolina and a graduate of Clemson University. With a Bachelor of Arts degree in secondary education/ English and a minor in general communications, Hoover has worked for over 30 years in the media. She is the author of several books, including well-known children’s book The Santa Train Tradition, and two adult Christian books. You may contact her at hoover@ chartertn.net or https://www.facebook. com/LeighAnneWHoover

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THA 2015 Conference Overview

THA’s 77th Annual Conference Addressed Industry Challenges, Shortfalls

By MELANIE KILGORE-HILL

Each year, more than 1,000 healthcare professionals from Memphis to the Tri-Cities converge in Nashville for the Tennessee Hospital Association’s annual meeting. The 2015 conference, “Mission Innovation: The Power of People,” took place Sept. 30 – Oct. 2 at the Gaylord Opryland Resort & Convention Center. This year’s event focused on navigating trends and overcoming shortfalls in an evolving healthcare delivery system.

A Changing Industry

“A lot of the meeting has to do with the sharing of information and best practices, and it’s really important for attendees to hear from national speakers to help them continue to improve on quality indicators,” explained THA President Craig Becker.

He said the biggest change facing hospitals is the evolution of reimbursement. “We’ve done things the same way for 50 years, and now we’re seeing a significant swing in how we’ll be paid,” Craig Becker Becker explained in a late-September interview with Medical News. “We have to be able to provide care in a much more cost effective way, and we have to do more for less. We want to use innovation but not leave behind the people who have to do the innovating,” he said, referencing the event’s theme.

Becker readily admitted there are many ways to accomplish that, with “population-based health” being an especially popular buzzword that’s garnered lots of conversation but no concrete answers.

Becker said the difficulty is populations vary by state, region and hospital. “Still, we wanted to get speakers to get people to think about how to best take care of our populations,” Becker said. “We need leaders to understand that things aren’t staying the same … and if you’re standing still, you’re going to get run over.”

Quality, Safety, Value

Few speakers can communicate the challenges of the quality, safety and value movement like THA’s leadership summit keynote speaker Robert M. Wachter, MD. Wachter serves as professor and interim chairman of the Department of Medicine at the University of CaliDr. Robert M. fornia, San Francisco and Wachter is chief of the Division of Hospital Medicine. His 2015 book, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age,” was a New York Times science bestseller.

“It’s become a relatively familiar refrain that we’re now being pressured to improve quality, safety, patient experieasttnmedicalnews

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ence and cost effectiveness in ways we never have before,” Wachter said in a preconference interview. “People get that. In some ways we’re getting better at it, but we’re beginning to understand how hard it is.”

Among today’s challenges are the added pressures on clinicians. “In the beginning of value-based care, there was a feeling that you could load this responsibility up on top of a clinician’s existing work,” Wachter said. “While some can be baked into existing work, we’ve come to realize that if you have an overwhelmed, overworked group of clinicians, it’s hard to have them engaged.”

He continued, “We have a new appreciation and understanding of the importance of training clinicians and making sure they have bandwidth and enthusiasm to do this well.”

Wachter said it was also naïve to believe information technology would solve all the problems. He admits advances have been more beneficial than harmful but said many unintended IT-related consequences are still coming to light. “Innovation and technology should ultimately help, but when you just throw technology at a dysfunctional process, you speed up dysfunction,” Wachter said.

Bottom line, he added, is everybody is overwhelmed.

“What we’ve done is said to everybody in the healthcare system, ‘Keep doing what you’ve been doing in terms

of volume … and layer on top of that a huge number of new imperatives,’” he explained, pointing to the growing numbers of signatures and committee involvement required of each provider. “In a vacuum it doesn’t sound bad, but in the big picture it’s 1,000 ‘one more things,’” Wachter said.

“I tell students all the time, what’s weird isn’t that we’re being asked to improve quality, safety and efficiency.

What’s weird is that we’re just being asked to do it today, where it hasn’t traditionally been expected in the healthcare system,” he concluded.

Engaging Your Board

The types of changes impacting healthcare have trickled up from patient rooms to boardrooms, and that’s where THA guest speaker Kimberly McNally, MN, RN, focused her attention in her conference presentation, “Strategies to Engage your Board as Quality Champions.”

The president of Seattle-based McNally & Associates told MediKimberly cal News common safety McNally and quality challenges are facing hospital boards nationwide.

“Boards should include a triad of collaborative leadership – meaning the board, executive team and physician leaders working together,” she said. “Their influ-

ences are connected so it’s important to have all three sides of the triangle working collaboratively.”

Not unlike clinicians, the biggest obstacles for board members are busy schedules. That’s why having a shared understanding of direction is critical. “Without that, it’s very hard to get everyone pointed in the same direction,” she said, adding it begins with education and letting board members know why quality initiatives are important. “Education like that at THA is essential because people need to know why they’re doing what they’re doing,” McNally said. “People have to feel like they’re making a difference so meetings about safety and quality can be effective with clear roles.”

She noted common board mistakes include not being certain on the front end about intended pictures of success or not having clear metrics. “Oftentimes members aren’t prepared for the role they’re expected to be in, and board members aren’t typically people with clinical training,” she said.

McNally also urged hospitals to seek board members from industries with a shared focus on quality and safety. She said she also encourages the use of patient stories to help set a tone for a meeting, to avoid using insider medical jargon, and to ensure lay explanations are given for industry terms. “Invest in leadership development so members can make their optimal contribution,” McNally said.

Finding Neuronal Needles in the Haystack, continued from page 1 researchers if there is a fire in a large sector of the forest or if a disease has struck thousands of trees. The current standard of care picks up on those large signals, he explained.

“But if there was just one tree on fire or had a disease, traditional EEG would not pick that up …

Andy but our equipment can,” Gotshalk he said of being able to drill down to signals from a single neuron.

The Cervello® EEG/LTM systems combine research and clinical applications to allow data collection on epileptic patients with surgically implantable electrodes. While the electrodes aren’t anything new, Gotshalk said the way Blackrock’s amplifiers work to pickup extremely small signals and then get those signals from the brain to the computer display monitor without interference is unique. The system incorporates three primary technologies – an electroencephalogram, a high-definition video camera, and a data-recording device that can monitor the brain’s electrical activity.

And, Gotshalk continued, “It’s done with precise synchronization – these signals are very quick; they’re on a millisecond scale – making sure a clinician knows

when these neurons are firing.”

Gotshalk noted there are already a significant number of epileptic patients being monitored across the country with implantable electrodes. The American Association of Neurological Surgeons (AANS) estimates nearly 30 percent of patients with epilepsy are considered medically resistant and are not well controlled by diet and medication. From this pool of patients, many will be evaluated through noninvasive monitoring, but a portion will go on to have subdural or depth electrodes implanted for more precise monitoring.

With the Blackrock technology, hours and hours of brain data collected while waiting for a seizure can now be processed with the hope that the information will offer new insights into how the brain works. Gotshalk said the technology could help clinicians better see when and where seizures are starting and how they are progressing across the brain.

However, the goal for the collected images and data is not only to impact the treatment of epilepsy but also other conditions including ALS, Alzheimer’s, depression, and Parkinson’s.

“Central to our company’s mission is unraveling the mystery of what causes different neurological disorders,” Gotshalk stated. “It’s technology like ours that is

going to give clinicians and researchers better data and a much better understanding of how the diseases are manifesting themselves so we can provide better solutions.”

While still in the early stages – the company was spun out from Blackrock Microsystems in 2012 – Gotshalk said there are already major installations throughout the Epilepsy Monitoring Units at Cedars-Sinai, Swedish Medical Center Seattle, Children’s Hospital of Wisconsin, and Children’s of Alabama in Birmingham. In addition, individual pieces of monitoring equipment are being used by a number of researchers, including some at UCLA. Recognizing this is new technology, Gotshalk said the company is moving slowly to ensure clinicians are comfortable with the system’s clinical use, which still allows them to view traditional EEG data while simultaneously giving them the new ability to monitor individual neuron signaling. However, he reiterated, the hope is absolutely that researchers and physician-scientists will take advantage of this expanded data with an eye toward impacting other neurological conditions.

“The goal is to get a much better understanding of how the brain is functioning … which hopefully will give us better insight when the brain isn’t functioning properly,” he concluded.

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LegalMatters

BY KOURTNEY HENNARD, LONDON & AMBURN, P.C.

Cybersecurity And Patient Privacy Recent Settlements (Part II of III)

The following article is the second in a three-part series, which will educate you about emerging issues in cybersecurity and recommend ways to protect your practice.

The importance of cybersecurity is becoming increasingly evident in the context of protecting patient information. Whether posed by external hackers, negligent employees, outdated hardware or software, or innocent mistakes, the risks to providers in the HIPAA context are numerous and significant. The HHS Office for Civil Rights (the “OCR”) enforces the HIPAA Privacy, Security, and Breach Notification Rules. Violations of these Rules may result in crippling civil monetary penalties and, in some cases, criminal penalties as enforced by the Department of Justice. This article provides an overview of some recent cybersecurity-related settlements for alleged breaches of the HIPAA Rules.

Stolen Laptops On September 2, 2015, HHS an-

nounced a $750,000 HIPAA settlement highlighting the importance of enterprise-wide risk analysis and device and media control policies. The settlement involved Cancer Care Group, P.C., a private radiation oncology practice with thirteen physicians serving hospitals

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and clinics throughout Indiana. In 2012, the company notified the OCR that a laptop and unencrypted backup media, which contained ePHI of approximately 55,000 current and former patients of the company, had been stolen from an employee’s car. The OCR found the company to be in widespread noncompliance with the HIPAA Security Rule. In particular, the company had not conducted an enterprise-wide risk analysis, which likely would have revealed the common practice of employees removing unencrypted media from company facilities. Nor did the company have a written policy specific to removal of hardware and electronic media containing ePHI from the facilities.

Two other settlements related to stolen laptops were announced by the OCR in April of 2014, totaling nearly $2 million. One laptop had been stolen from a Concentra facility after the company had identified a critical risk in the area of ePHI storage on unencrypted devices, but the company had taken incomplete and inconsistent steps to complete encryption. The OCR found the company also had insufficient security management processes in place to safeguard patient information. In another settlement, an unencrypted laptop was stolen from the car of an employee of QCA Health Plan, Inc. The OCR found that the company had failed to comply with multiple requirements of the HIPAA Privacy and Security Rules over a seven-year period.

Internet-Based Document Sharing Another recent settlement announced on July 10, 2015, totaling $218,400, involved the use of an internet-based document sharing application by employees of St. Elizabeth’s Medical Center. The OCR alleged that the employees had used, without first analyzing the risks, the application to store documents containing ePHI of approximately 500 patients. The company had failed to timely identify and respond to the security incident, to mitigate the effects of the incident, or to document the incident and its outcome. The settlement also covered the company’s HIPAA breach relating to unsecured ePHI stored on a former employee’s personal laptop and flash drive.

Network Security The largest HIPAA settlement to date, coming in at $4.8 million, was announced in May 2014 and arose out of alleged joint breaches of the

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OCTOBER 2015

Privacy and Security Rules by New York Presbyterian Hospital and Columbia University. The entities shared a data network and firewall that was administered by employees of both entities; the network linked to patient information systems containing ePHI. When a physician employed by Columbia, who had developed applications for both entities, attempted to deactivate a personally-owned computer server on the network, ePHI from the patient information systems became accessible via internet search engines. The OCR found that neither entity had made efforts prior to the breach to assure that the server was secure and contained appropriate software protections, nor had either entity conducted an accurate and thorough risk analysis to identify what systems could access the ePHI. Relatedly, neither entity had developed an adequate risk management plan. Furthermore, New York Presbyterian had failed to implement appropriate policies and procedures for authorizing access to its databases, and it had failed to comply with its existing policies on information access management.

Conclusion While the facts surrounding each of these settlements differ, two overarching lessons emerge: 1. effective encryption is critical; and 2. robust compliance programs, policies, and procedures are indispensable. What constitutes reasonable and appropriate policies and procedures for a given entity will vary based on the nature of the business and its size, complexity, and resources. Covered entities and business associates are encouraged to review compliance training materials provided by the federal government and, where possible, consult with experts who specialize in health care data security (1). As the OCR continues to ramp up its cybersecurity-related enforcement efforts, the stakes are too high to give short shrift to HIPAA compliance.

Notes 1. E.g.,http://www.healthit.gov/providersprofessionals/cybersecurity-shared-responsibility; http://www.hhs.gov/ocr/privacy/hipaa/understanding/ training

Kourtney Hennard is an attorney with London Amburn, a law firm based in Knoxville, Tennessee, which represents providers in the area of healthcare law, including regulatory, compliance, HIPAA, malpractice and nursing home defense, employment, mergers and acquisitions, corporate and business matters.

For more information, you may visit www. londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice. easttnmedicalnews

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Knoxville/Chattanooga

PhysicianSpotlight

When Seconds Matter

Stofko Looks to Improve Neurological Care and Outcomes

By JOE MORRIS

When most athletes suffer an injury, they see a doctor. That was true for Douglas Stofko, but he decided to take things one step further and become a physician himself.

“Medicine was not always something I wanted to do, but I was heavily involved in sports and a got a lot of injuries along the way,” Dr. Stofko said. “I became good friends with a orthopedic surgeon, who operated on me many times, and when I realized my pursuits of a higher level of sports weren’t going to happen any more, I thought becoming an orthopedic surgeon would be a good idea. So I began to shadow him around when I was in high school and college.”

Stofko eventually became a neurosurgeon and expanded his training to include both neurosurgical techniques, as well as endovascular procedures. This makes him one of only a few doctors doing so in the country, and the only one in East Tennessee when he joined Tennova Neurosciences in Knoxville earlier this year.

The move into neurosurgery was an outgrowth of his original interest in orthopedics, and came about when he saw what neurosurgeons could do for patients, Dr. Stofko explained.

“In addition to following my orthopedic surgeon around, I also had a family friend who was a neurosurgeon,” he said. “I started following him around as well. I saw what he was able to do for a young woman who’d suffered a gunshot to the head as the result of a domestic violence situation. He took her from a very sick person to someone who would have a pretty good quality of life, and that drastic change really affected me. That’s how I got into neurosurgery.”

Stofko studied at the Philadelphia College of Osteopathic Medicine, where he received his medical degree. He then completed an internship at Mercy Catholic Medical Center in Philadelphia, fol-

lowed by a residency at Philadelphia College of Osteopathic Medicine Consortium of Hospitals. He has received fellowship training in cerebrovascular/ endovascular surgery and neurocritical care at Capital Institute for the Neurosciences in Trenton, New Jersey. He came to East Tennessee for the area’s rich quality of life, but also because it’s part of the “Stroke Belt,” a part of the country that will provide him the opportunity to make a real difference in many lives.

“I really saw a clean slate here for a neuroscientist,” he said. “I am now with a healthcare system where I can build a

program the right way, with a solid foundation. It’s hard to do that where there’s already a program in place, or physicians doing this kind of work, because you have to deconstruct that and get everyone reorganized. I think I have the chance to create a successful neurosciences program that will provide the best patient care in the area. That’s certainly our vision.”

He hopes to build a “hub and spoke” model, where Physician Regional Medical Center (PRMC) is the flagship facility for neuroscience treatment. The most acute patients will come to him here, where he will treat brain and blood vessel conditions including stroke, brain aneurysms, arterial venous malformations, brain and spine tumors, complex spine disorders, hydrocephalus, and peripheral nerve disorders.

Other facilities in the network will serve as primary stroke and acute stroke-ready centers, and will feed patients into Stofko and his team at PRMC as needed.

“When a patient comes into the ER and is seen by a doctor, if they deem him or her to have a neurological problem, then they’ll call me directly,” he said. “I have set up a direct line, 844-55-BRAIN, so that they can tell me what’s going on.

That’s very important, because every minute, every second, matters to these patients. The faster we figure out the best course of action, the better.”

If a patient is sent to PRMC, he or she will be placed on either the neurological intensive care unit, which is a closed unit managed by highly trained neurointensivists, or onto the neurological floor, which is run by neurohospitalists.

“These are all highly trained practitioners, and they are there 24/7,” Stofko said.

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Our clinical psychologist, Dr. Regina Hummel, and Licensed Clinical Social Worker, Kate Christian, are here to provide support to patients and families with issues related to gastrointestinal diseases and other general behavioral issues. A very common problem we treat is encopresis. Encopresis is a problem that causes soiling (leakage of stool). It can be very embarrassing for the child and is something the child cannot control. Providing patience and understanding is very important for the child. We have a team of behavioral health providers who are happy to assist your patients with this problem.

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“We’re not just going to put people onto a unit and then I see them when I’m back in the hospital. They are going to get the proper care, right away. The overall model we are implementing is one where the person making the decisions about what procedures or measures to take has complete control of the neuroscience patients. That means we take a lot of time off the period between diagnosis to treatment.”

There’s also a search under way for another neurosurgeon to help share the workload with Stofko. When that person arrives, it will only help to deepen the ability to care for critically ill patients faster, better, and more effectively, he said.

“Eventually, we’ll have four neurologists here at PRMC, and two at the North Knoxville Medical Center and two at the Turkey Creek Medical Center,” Stofko said. “And then we also will be adding two more for outpatient neurological services as we continue to expand the program outward.”

From adding physicians to more intensive rounding procedures, Stofko said everything is designed to revolve around the best patient care possible.

“All my team does is neurology,” he said. “I have my own operative team, and we have our own angiography suite. We have put a lot of resources into place to treat the individuals who are suffering from these conditions of the brain, spinal cord, peripheral nerves and cerebrovascular system on a daily basis, and it really sets us apart from what anyone else in the community is doing. And it will make a real difference in how these patients are treated, and how well they are able to recover and get back to their lives.”

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OCTOBER 2015

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HealthcareLeader

Connecting The Dots

ETSU, Niswonger Collaboration Will Boost Pediatric Care And Outreach

By JOE MORRIS

A career in academic medicine that also focused on poor and underserved children has given Dr. David Wood the perfect vantage point for his new, twin roles: Chairman of ETSU’s Department of Pediatrics and Chief Medical Officer at Niswonger Children’s Hospital. And he couldn’t be more pleased and ready to tackle the challenges that he and other pediatric healthcare providers in East Tennessee face.

“I have helped create program for kids in a wide variety of situations, but almost always the common elements were that they were poor, often homeless or in foster care, and often developmentally disabled,” Wood said. “As I’ve moved along in my career, I began to want a chance to both chair a university medicine department and also come to a children’s hospital. That’s a very common shared position, actually, because there’s a lot of synergy between those two entities. The hospital needs the department to supply doctors for its staff, and the department desperately needs the hospital, because you can’t build a pediatric specialty prac-

tice alone anymore.”

Indeed, pediatric specialists are increasingly scarce around the country, and being able to offer strong clinical and academic components gives ETSU and Niswonger a leg up on getting tomorrow’s specialists today. But above all that, Wood came because he saw a population that needed what he can offer.

“I saw an area with significant needs, a lot of kids that I felt like I could help,” he said. “Both the university and Mountain States Health Alliance are very committed to doing that. I can’t do anything on my own, but working through these two organizations that are really in synch now, I and the team I am building can do a lot.

Everyone here in these organizations is very much committed to helping meet the unmet needs of this region’s children.”

Since arriving in October 2014, he’s been laying the groundwork for standing up some programs similar to ones he ran in Jacksonville, where he served in a variety of professional and academic positions with the University of Florida College of Medicine, the state of Florida and other organizations. He also has some ideas that will capitalize on current trends in healthcare around patient navigation, wellness and prevention, as well as inpatient and chronic care.

“I’d like to see a primary care program for youth and young adults with medical complexity, but that can range across all ages,” Wood said. “I’ve also been spending a lot of time getting a plan in place to help staff the children’s hospi-

tal and really recruit specialists so we can start getting organized around the services and specialties we want to offer.”

Perhaps his largest initiative to date is an advocacy center, which will be a true hospital-university collaboration. The Center for Healthy Children and Families, which will be based in the hospital, will facilitate many different activities, including health and wellness activities that Niswonger already is doing, but with a push to reach out to physician practices so that more people can be reached without them having to come to the hospital.

“We have so many pediatric practices, family physicians and nurse practitioners who are seeing kids, and so we want to start putting a navigation piece in place so that we have direct care engagement, no matter where the patient and his or her family may be.”

What that means for now is hiring a nurse navigator, nurse care coordinator, and social worker, who will form the initial team to interact with children and their parents.

“We’ve been told that we could have 100 patients the first day just from the hos(CONTINUED ON PAGE 8)

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Tri Cities

PhysicianSpotlight

Neurohospitalist Tim Himel Always Prepared To Help Stroke Patients

By JOHN SEWELL

Choosing a physician entails something of a “leap of faith.” And, ideally at least, the relationship between the patient and doctor is grounded in trust—a sense that the physician knows best. When we trust our doctors, we feel a sense of control and order in our lives.

Of course, real life is never so simple.

And in emergency situations, we rarely have the wherewithal or agency to pick and choose a physician. This is especially true for patients experiencing neurological traumas such as strokes.

Based at Kingsport’s Holston Valley Hospital, Neurohospitalist Dr. Tim Himel is at the ready to treat patients suffering strokes and other neurological issues. Himel is among a team of neurohospitalists at the Wellmont facility, all of whom are facilitating the hospital’s effort to best serve its patients, offering a team of specialists on hand to address whatever crises may emerge. And in the medical world, crises are inevitable.

“The role of a neurohospitalist has kind of evolved,” explained Himel.

“More and more neurologists have been limiting their practice to just their office.

So here at Holston Valley and some of the other, larger hospitals, there has been a bit of trouble finding neurologists who are available. So the hospital administrators started looking down the road and saying, what’s the feasibility of having a neurologist that just handles inpatient? With a neurohospitalist, someone is always available. This setup allows people in the hospital to have pretty much immediate access to the services of a neurologist— and that’s crucial.”

Himel explained that getting a patient who is suffering a stroke to the emergency room as quickly as possible may be key to their survival—and is most certainly the factor that determines to what degree the patient can recover. In other words, with stroke sufferers, every second

is pivotal.

Himel and the team of neurologists at Holston Valley are introducing new therapies for stroke patients. First and foremost, the team is improving patient accessibility to a type of medicine classified as a tissue plasminogen activator, or TPA for short.

“TPA is something that is very exciting because it’s an agent that actually dissolves blood clots,” explained Himel.

“It’s different than other anti-coagulant medications because those prevent clotting, but they don’t dissolve clots. This medicine [TPA] was originally used with heart attacks. And the push is on to make it more available for stroke patients. And by having neurohospitalists available, we can coordinate the access to this medicine.”

Again, time is of essence when treating strokes.

“We have what we call a therapeutic window, and that’s the period of time

where we can best minimize the damages of a stroke,” said Himel. “That’s where the TPA comes in. The therapeutic window for intravenous TPA used to be three hours, but we’ve expanded that to four and a half hours. And the therapeutic window for inter-arterial TPA seems to be even longer—up to six hours. That gives us another option.

“We try to get the patients in here as soon as possible and begin the evaluations to find out whether or not it’s safe to use the TPA medicine. And the sooner we get to introduce the medicine, the sooner it gets to work. So ideally you want to administer the medicine within the first hour. So the onus is on the patient to come to the hospital as soon as possible.

My motto around here is ‘time is brain’ for a stroke.”

But TPA certainly isn’t the only stroke-combatting weapon in Himel’s arsenal. There are other somewhat more conventional (but still groundbreaking) approaches available as well.

“Also the technology has been improving for more invasive treatments,” explained Himel. “We have a thing we call a clot retrieval mechanism that actually goes in and removes a clot that’s formed in an artery in the brain. It can open the artery back up. And studies suggest that this leads to much better outcomes for patients down the road.”

Now enjoying his second year in East Tennessee, Himel is a Louisiana native.

The physician explains that his move to East Tennessee was motivated by a desire to simplify his life (Albeit only somewhat. After all, dealing with neurological traumas in emergency situations requires great expertise and nerves of steel wherever it occurs) and an appreciation for the beauty of the area.

“Prior to coming here, I was in a solo practice—mostly working out of an office,” explained Himel. “So my free time was somewhat limited in Louisiana. Here in East Tennessee, I work seven days and

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then I’m off seven days. The seven days that I’m working are really long days— but it’s manageable. I’m able to make up for those long days with my family on the days off. I’m still expanding my repertoire of things to do with my family. But my work/life balance is a bit more even here, and that was one of the reasons we decided to move.

“I’ve been here about a year and a half,” Himel continued. “And my wife [Sherry] and youngest child came here last September. The little one [Grant, 11], he’s in the sixth grade. My two older kids [Thomas, 22, and Andrea, 19] are in college back in Louisiana; They come here for the summers. At present, I’m just making new acquaintances, developing social circles, things like that. I look forward to doing a lot of outdoor things like hiking and fishing here because the area is very beautiful. But so far, Grant is keeping me busy playing football and basketball (laughing).”

So, the neurohospitalist’s life is certainly something of a balancing act. And for Himel, having the ability to help people in a time of crises is perhaps topmost among a litany of rewards of an abundant, multifaceted life well-lived. More simply put, Himel saves lives on the job and has a great family at home—and he’s happy.

“For me, the practice of medicine combines the ability to meet a bunch of new people and the ability to be in a position to help these people who need help,” enthused Himel. “I get to interact with people and establish relationships with them—and also hopefully be of service to them. I guess you’d say that we’re making a difference in their lives going forward. Neurological conditions often have big impacts on the quality of life for the patients. And when we can help them, the patients are really appreciative.

I just enjoy having that opportunity. To see somebody get better is always a great feeling.”

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Covering the Healthcare Education Spectrum, continued from page 1 AMA Expanding Med Ed Initiative

Less than two years after the American Medical Association (AMA) launched an initiative to reshape medical education in America, the national organization has announced funding for up to 20 additional medical schools to join the AMA’s Accelerating Change in the Medical Education Consortium.

The consortium was originally created in 2013 with an $11 million grant initiative to 11 of the country’s top medical schools. Each of the participants is looking at innovating curriculum redesign to better prepare medical students to deliver care in today’s evolving healthcare landscape.

At the Indiana University School of Medicine, leaders have created a virtual healthcare system (vHS) and are using a teaching electronic medic record to ensure competencies in system-, team- and population-based healthcare, as well as clinical decision-making. At Vanderbilt University Medical Center, the new curriculum looks to create master adaptive learners who will engage in self-assessment and adapt to change throughout their medical career. The Vanderbilt program is also embedding students in the healthcare workplace from the earliest phases of undergraduate medical education. A synopsis of all 11 current programs is available at changemeded. org.

“In such a short amount of time, our consortium schools have made impressive strides toward creating the medical school of the future. Many of the schools have already implemented new curriculum models that are supporting innovative training for 7,000 medical students who will one day care for more than 12.2 million patients each year,” said AMA President Steven J. Stack, MD. He continued, “It is Dr. Steven J. because of this tremenStack dous progress that we’ve decided to collaborate with more medical schools and continue on the path to spreading innovation across the entire medical education system to close the gaps that exist between the way physicians are educated and how healthcare will be delivered in the future.”

As part of this second phase of the Accelerating Change in Medical Education initiative, the AMA is calling on medical schools to build upon and implement the education models created by the 11 founding consortium schools, as well as offer unique projects that can be shared with medical schools nationwide.

A national advisory panel is currently reviewing grant proposals, which were due last month. Proposals are being evaluated with an eye toward: Developing flexible, competency-

based pathways, Teaching and/or assessing new content in healthcare delivery science, Working with healthcare delivery systems in novel ways, Making technology work to support learning and assessment, Envisioning the master adaptive learner, and Shaping tomorrow’s leaders.

“Bringing systemic change to our medical education system as we know it will require many more partners and many more schools,” said AMA Group Vice President for Medical Education Susan E. Skochelak, MD, MPH. “We are excited about the high level of interest that we’re seeing from medical schools for changing and enhancing medical education in our country and look forward to growing the community of innovation that we’ve created with new ideas and fresh perspectives from additional medical schools.”

AACN Futures Task Force

Last year, the American Association of Colleges of Nursing established the Futures Task Force with a broad charge to develop recommendations to ensure the nursing workforce meets future demands, and that the national organization stays at the forefront of innovation in nursing education.

The final report will be presented at the AACN’s fall meeting on Monday,

Oct. 26. For information on the findings, visit the organization’s website at aacn. nche.edu.

HCEA

The Health Care Education Association (HCEA) – a multi-disciplinary organization of professional healthcare educators who look to improve outcomes through evidence-based education for patients, families, staff and the community – is prepping for the organization’s 2015 conference Oct. 15-17 in Indianapolis.

“Education on the Fast Track: Transforming the Patient Experience” will focus on patient engagement and the ways in which educators and healthcare workers impact the healthcare experience. Among the 21 breakout sessions at the biannual meeting are discussions on generational diversity and teaching adolescents how to evaluate health information, explaining numbers and risk with patients, working with the LGBT community, and several sessions emphasizing health literacy strategies.

A conference roundup will be posted after the event, and past educational conference summaries are available online through the Education Center tab at hcea-info.org. In addition, the website’s Resources tab includes links to publications, educational tools, and the organization’s Learning Center Network.

Connecting The Dots, continued from page 6

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OCTOBER 2015

pital’s NICU graduates, so we know the kids are out there,” Dr. Wood said. “We just have to get up and running and begin to connect people to the services they need efficiently and effectively.”

That means tackling three levels of patients: The first group just needs wellness care, so for them any programming will be about well-child visits, immunizations and programs around fitness and diet. The second group is children with conditions like asthma and ADHS who need more consistent management, and the third group are children with serious, or terminal, illnesses who require a steady stream of ongoing services and in some cases, assistance with transitioning into the adult healthcare system as they age.

“We’re going to be working with all the doctors, and all the practices, so we can embed more support and care coordination into the community,” Wood explained. “We no longer can treat just one patient at a time. It’s about population management now, and what the center can do is work with each of these major groups to ensure that all the kids in them are getting exactly the care and support they need.”

Most of the pieces are there, he said, and once the missing elements are identified and put into place, the job for healthcare providers is making sure everything is properly connected.

“It really is like a puzzle,” Wood said.

“We’re working with children, who are developing, to make sure that they have the most optimal development possible. Their health doesn’t remain static. They are growing, and without proper care and plan, even the well ones can experience a decline. We have to have the continuum of services in place to deal with them at every opportunity so that they can get well, and stay well.”

Without committing to timelines, Dr. Wood does admit that five years from now he’d like to see shared medical records throughout the community, and an active, online patient portal that patens and their families are actively engaged in, so that everyone partners in care.

“Healthcare is way too complicated for so much of the care burden to fall on families because they don’t know where to go, or who to talk to,” he said. “If we have navigators and other people helping them figure out what insurance is or isn’t going to pay for, that will help. If we are able to help primary care physicians provide more complex conditions so that specialists aren’t overwhelmed, that will help as well. We have wonderful opportunities with things like telemedicine that we’re going to explore. Basically, our goal is going to be to minimize the travel, and maximize the proximity of services, for all these children.”

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The Literary Examiner

BY TERRI SCHLICHENMEYER

PUBLISHED BY: SouthComm Business Media, Inc.

Black Man in a White Coat

by Damon Tweedy, MD; c.2015, Picador $26.00 / $29.99 Canada, 295 pages Lately, you haven’t been feeling like yourself.

You’ve always been a bounce-outof-bed kind of person, but not anymore: you’re achy now, tired, and you can’t think straight. Did you pick up a bug of some kind or – as you’ll learn in the new book Black Man in a White Coat

by Damon Tweedy, MD – does the color of your skin have something to do with it?

Damon Tweedy knew he was a rarity.

In 1996, the year he entered medical school at Duke University, just seven percent of all medical students in the U.S. were black. That minority-within-a-minority, he says, led to unintended racism in the classroom.

Working at the hospital, he also saw racism’s effects: many of Tweedy’s patients were black, and the state of their health opened his eyes. He’d grown up in a solidly middle-class neighborhood with two parents who demanded education.

Those were things that most of Tweedy’s black patients never had, and that mattered.

As he worked his way from student to intern to resident, Tweedy gained experience and tried several branches of medicine before deciding on psychiatry as a specialty. But long before that, he worked in Labor & Delivery and learned that “more than 70 percent of black children are born to unmarried women,” a rate that’s more than twice that of white babies. He saw the affects of poverty while volunteering at a “safety-net clinic” in rural North Carolina. There, he found that “poor blacks were four times as likely as the general population to receive care” at such facilities.

Hypertension is “50 percent more common in black people than in whites…”

Homicide is the leading cause of death for black male teens, which can lead to survivor guilt. AIDS, once a death sentence, is treatable today – although “black people… are more than eight times as likely as whites to be diagnosed with HIV.” Overall, “Being black can be bad for your health” but there are windows of good news…

When you first glimpse Black Man in a White Coat, you may wonder if it’s about health or if it’s a memoir. It’s both, actually, but that scarcely matters when a book is this good.

With a calm voice that belies the REPRINTS: If you would like to order a reprint of a Medical News article in a PDF format or request an additional copy of an issue, please email: subscribe@medicalnewsinc. com for information.

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urgency he so apparently feels about the subject, author Damon Tweedy, M.D. explains why African Americans need to pay better attention to their health and the care they get. How the system fails black patients is of particular interest to him (he, in fact, relates an anecdote of his own as illustration), and he offers opinions on the Affordable Care Act. In between this obviously useful info, Tweedy also shares with readers his long and personal path to becoming a doctor and how he grew with each step.

This is one of those books you wish wouldn’t have to end. It’s interesting, gently humorous, and – more importantly – it may save lives. ###

Mess: One Man’s Struggle to Clean Up His House and His Act

by Barry Yourgrau; c.2015, W.W. Norton; $25.95 / $30.95 Canada, 276 pages

Once again, you couldn’t find your keys.

You were pretty sure you put them down on the kitchen counter. On top of last weeks’ mail. Which you’d laid next to a shirt you bought on sale in April, breakfast dishes from who-knowswhen, five plastic bags, and a dead plant. Yeah, your house is cluttered, but it’s not so bad – which is what Barry Yourgrau thought until, as he says in his memoir Mess, he began to look around…

The apartment hadn’t always been his.

It had, in fact, belonged to Barry Yourgrau’s girlfriend once, and she’d bequeathed it to him when she moved and he needed a place to stay. So when Cosima knocked on the door of the apartment one afternoon, she was surprised that Yourgrau wouldn’t let her in.

He couldn’t, because Yourgrau was a hoarder “at wit’s end.”

Postcards, old calendars, paper bags, souvenirs, and bric-a-brac littered the floors of his home, covered with dust, stored in boxes, slung across furniture and countertops. Not only were the rooms cluttered, but so was Yourgrau’s mind: as a writer, he couldn’t seem to stay focused.

His home was too much of a distraction.

Cosima gave him an ultimatum: clean or else. So why not make it a “Project”?

Yourgrau decided that de-cluttering – and understanding his compulsion to hoard – might make an interesting story, perhaps even a book.

A twin with a younger singleton brother, Yourgrau had spent his childhood helping his family to move; his father was a professor, and had worked his way around to a series of jobs. Yourgrau remembered his mother’s death with deep sorrow, but recalled his father as “domineering.” Still, getting rid of their “stuff” was an emotional struggle.

But, then again, getting rid of his own possessions wasn’t easy, either. Yourgrau sought counseling. He read up on hoarding and its psychology, attended a twelvestep program, accepted help from several places, spoke with other hoarders and experts, procrastinated, and tried tackling the mess on his own.

Of his struggles, he says, “A man who cannot let go: that would be me.”

There are a lot of pages here in which “Mess” lives up to its title.

That disappointed me; I had such high hopes for this memoir, but a first-half hodgepodge makes author Barry Yourgrau’s story initially very hard to follow. It doesn’t help that Yourgrau sprinkles his narrative with highbrow literary references and other edge-of-mainstream nods; a sense of mania and referring to people by a series of nicknames only adds to the chaos.

Fortunately, things turn around about halfway through the book.

There, Yourgrau starts to dig into the reasoning and psychology of hoardi n g by consulting experts, which tampers the frenzy. Indeed, the second half of this book is more introspective, more down-to-brass-tacks, and much more interesting.

Ultimately, I don’t think this will help much if you need advice on hoarding or cleaning. It’s just too cluttered for that, but, if entertainment is your goal, here’s your book.

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.

GROUP PUBLISHER Dennis Triola dtriola@southcomm.com 310.422.6637

ASSOCIATE PUBLISHER Sharon Dobbins sdobbins@easttnmedicalnews.com 865.599.0510 EDITOR Bridget Garland bridget@easttnmedicalnews.com 423.483.1015 STAFF WRITERS Cindy Sanders, Leigh Anne W. Hoover, Joe Morris, John Sewell, Terri Schlichenmeyer, Lynne Jeter CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley, Amy Gomoljak James Osborne, Christie Passarello CONTRIBUTING WRITER Kourtney Hennard 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

Become a fan on Facebook, and Follow us on Twitter@EastTNMedNews SOUTHCOMM BUSINESS MEDIA, INC. Chief Executive Officer Chris Ferrell Chief Financial Officer Ed Tearman Chief Operating Officer 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 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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Knoxville/Chattanooga GrandRounds Summit Medical Group Welcomes Perra KNOXVILLE — East Tennessee’s leading primary care group announces the addition of Lenette Perra, MD, who joins Michael Passarello, MD, in practice at 501 20th Street, Suite 404, on the Fort Sanders Regional Medical Center campus.

Dr. Lynette Perra Prior to joining Summit, Dr. Perra was in practice with Tennessee Internal Medicine. She earned her medical degree from the University of Munich, Ludwig Maximilians University.

Perra is a two time recipient of the International Exchange Program Scholarship for medical research from the University of Hannover. She is board certified in internal medicine and is a member of the American Medical Association and the American College of Physicians.

BlueCross Announces Leadership Transition CHATTANOOGA — BlueCross BlueShield of Tennessee CEO Bill Gracey is retiring effective at the end of August and will be succeeded by J.D. Hickey, who has served as chief operating officer since 2012 and CEO-elect since June.

Hickey joined J.D. Hickey BlueCross in 2011 as CEO of the BlueCross Medicaid managed care subsidiary BlueCare Tennessee, and was named chief operating officer of the parent company less than a year later.

The BlueCross board is appreciative of Gracey’s leadership as CEO, a period of strong performance by the company. Prior to being named COO in 2010, Gracey had served on the BlueCross board of directors after retiring as executive vice president and chief operating officer of LifePoint Hospitals. He became CEO in 2013 when Vicky Gregg retired.

The healthcare landscape has evolved rapidly in recent years, driven primarily by federal health care reform. During this time, the company has posted significant gains in membership and strong operating performance.

Before coming to BlueCross, Hickey was a principal at McKinsey & Co., where he led strategic health care consulting and management teams for one of the world’s leading management consulting firms.

There he was recognized as the top expert on health care reform.

As a member of former Tennessee Gov. Phil Bredesen’s cabinet, Hickey served as director of the TennCare Bureau from 2004 to 2006. In this role, he led efforts to reform the TennCare program and ultimately return it to financial stability.

Hickey graduated magna cum laude with a Bachelor’s degree from Colgate University. He also earned a medical degree from the Duke University School of Medicine and a juris doctorate from the Duke University School of Law.

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OCTOBER 2015

Asbury Place Maryville Names Daniel Livingston Director Of Nursing MARYVILLE — Asbury Place continuing care retirement communities recently named Daniel Livingston director of nursing for its Maryville campus.

An individual who has devoted his entire nursing career to caring for seniors, Livingston joined Asbury Daniel Livingston Place Maryville in January as skilled unit clinical mentor and previously served as registered charge nurse at Blount Memorial Transitional Care Center in Maryville.

Livingston, a lifelong Maryville resident and recipient of Alzheimer’s Tennessee’s Caring Hearts Award, says that he was drawn to Asbury Place because of its friendly environment and culture of providing care in a more homelike environment.

Livingston earned his nursing degree from Lincoln Memorial University in Harrogate, Tenn.

CHI Memorial Medical Group Welcomes Rose To CHI Memorial Laparoscopic And General Surgery CHATTANOOGA – CHI Memorial Medical Group Welcomes Walter B. Rose, MD, FACS, to CHI Memorial Laparoscopic and General Surgery.

Rose received his medical degree at the University of Tennessee Center for Health Sciences, Memphis, TN. He completed his internship and residency at the University of Tennessee, Chattanooga, TN. Dr. Rose is board-certified in general surgery and is a fellow of the American College of Surgeons.

LBMC Names Brummett Partner In Healthcare Valuation KNOXVILLE – LBMC, one of the Southeast’s largest accounting and business consulting firms proudly announces the naming of Joshua P. Brummett, CPA/ ABV/CFF as Partner in LBMC’s Valuation and Litigation Support Services Division.

Brummett specializes in healthcare valuation and serves as the practice leader for Compensation Valuation (CV) services for LBMC. He has extensive experience in this area including valuations for employment, call-coverage, medical director services and collections guarantees/subsidies. Josh’s other healthcare experience includes valuations of physician practices, ambulatory surgery centers, hospitals and various other types of healthcare companies.

Brummett graduated with his Bachelor of Business Administration and Master of Accountancy degrees from Belmont University. He is a CPA and holds the Accredited in Business Valuation (ABV) and Certified in Financial Forensics (CFF) certifications. Josh is also active with Leadership Healthcare and is a member of the

Tennessee Healthcare Financial Management Association. He serves as a Board Member for the Brentwood Family YMCA and as a member of the Phoenix Club of Nashville, benefitting the Boys and Girls Clubs of Middle Tennessee.

CHI Memorial Medical Group Welcomes Pigg CHATTANOOGA – CHI Memorial Medical Group is pleased to welcome Richard Pigg, MD to CHI Memorial Primary Care Associates. Pigg received his medical degree from Ross University School of Medicine. He completed his residency in family medi- Dr. Richard Pigg cine at the University of Tennessee at Chattanooga.

Pigg joins Oana L. Andreescu, M.D., Owen F. Speer, D.O., and Erin R. Martin, MSN, FNP at CHI Memorial Primary Care Associates. They are accepting new and established patients age 18 and older.

Located in Hixson, Tennessee, the office is especially convenient for those who live and work in the North Chattanooga, Hixson, Red Bank and Soddy Daisy areas.

CHI Memorial Medical Group Introduces Speer CHATTANOOGA – CHI Memorial Medical Group announces a new physician at CHI Memorial Primary Care Associates. Owen Speer, DO, received his medical degree from Edward Via Virginia College of Osteopathic Medicine in Blacksburg, Virginia. He completed a residency in family medicine at Riverside Regional Medical Center in Newport News, Virginia and a primary care sports medicine fellowship at the Palmetto Health/ University of South Carolina School of Medicine. He is certified by the American Board of Family Medicine. His specialty is family practice.

Speer joins Oana L. Andreescu, MD, Richard Pigg, MD, and Erin R. Martin, MSN, FNP at CHI Memorial Primary Care Associates. The practice is accepting new and established patients age 18 and older.

Located in Hixson, Tennessee the office is especially convenient for those who live and work in the north Chattanooga, Hixson, Red Bank and Soddy Daisy areas.

CHI Memorial Medical Group Welcomes McKenzie CHATTANOOGA – CHI Memorial Medical Group is pleased to welcome Mary McKenzie, DO, to CHI Integrative Medicine Associates. Dr. McKenzie received her medical degree from Ohio University College of Osteopathic Medicine in Athens, Ohio. She completed her residency at University of Tennessee, Chattanooga.

CHI Memorial Integrative Medicine Associates is a primary care practice focused on health promotion and illness prevention. The practice defines integrative medicine as healing-oriented medicine that takes account of the whole

person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between the medical provider and patient, is informed by evidence, and makes use of all appropriate therapies.

CHI Memorial Integrative Medicine Associates primary care providers include: Jeffery Jump, MD; Matthew McClanahan, DO, MA; Mary McKenzie, DO, Jenny Phillips, PA-C, and Franklin Baker, PA. The practice offers a range of services to supplement primary care including nutritional counseling, clinical counseling, acupuncture, physical therapy, integrative soft tissue therapy, hormone replacement therapy and more.

CHI Memorial Medical Group Welcomes Castrilli CHATTANOOGA – CHI Memorial Medical Group is pleased to announce David Castrilli, MD, has joined CHI Memorial Internal Medicine Associates. Castrilli received his medical degree from St. George’s School of Medicine. He completed his residency at University of Tennessee, Chattanooga. His specialty is internal medicine.

CHI Memorial Medical Group Welcomes Garcia-Rosell CHATTANOOGA – CHI Memorial Medical Group is pleased to announce Melinda Garcia-Rosell, MD, has joined CHI Memorial Arthritis & Rheumatology Associates. Garcia-Rosell received her medical degree from University of Tennessee of Health Science Center where she also completed her residency and fellowship.

Dr. Garcia-Rosell has certification from the American Board of Internal Medicine with a specialty in rheumatology.

Dr. Garcia-Rosell joins Dr. Natalie Braggs at CHI Memorial Arthritis & Rheumatology Associates.

Gastrointestinal Associates Welcomes Gilbert

KNOXVILLE – Dr. Jeffrey “Jeff” Gilbert has joined Gastrointestinal Associates (GIA), one of the Southeast’s leading GI practices.

Gilbert serves as a member of the American College of Gastroenterology, American Society for Gastrointestinal Endoscopy and American Gastroenterological Association. He is board certified by the American Board of Internal Medicine in both internal medicine and his primary specialty, gastroenterology.

Prior to joining GIA, Gilbert served for six years as a physician at Oak Ridge Gastroenterology Associates in Oak Ridge, Tennessee, where his clinical interests included gallbladder and bile duct disorders, cirrhosis and liver disorders, and colon cancer prevention. Gilbert previously served as an assistant professor in the Division of Digestive Diseases & Nutrition at the University of Kentucky.

After earning his undergraduate degree at the University of Tennessee in Knoxville, Gilbert completed his medical doctorate degree at the UT College of

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Tri Cities GrandRounds Gangewere Named Bristol Regional’s Director Of Environmental Services And Patient Transport BRISTOL – Lori Gangewere, who has steadily risen through the ranks during her 10 years of employment at Bristol Regional Medical Center, has been promoted to serve as the hospital’s director of environmental services and patient transport.

Gangewere was most Lori Gangewere recently the hospital’s support services operations manager for three years, with responsibilities that included overseeing the day-to-day operations of environmental services, linen distribution, valet services and patient transport. She was also responsible for maintaining the hospital’s cleanliness to ensure compliance with infection prevention and regulatory guidelines.

Beginning her Bristol Regional career in 2005 as secretary in the environmental services department, Gangewere advanced a year later to patient transport supervisor.

She held that position for four years, performing various duties such as participating in process improvement activities, visiting with patients to ensure they were satisfied with their care and monitoring hand hygiene compliance. She became a certified transport trainer through the National Association of Healthcare Transport Management.

From 2010-2012, Gangewere served as training and development coordinator, with responsibilities that included departmental orientation and training of new environmental services and patient transport co-workers. She also helped identify opportunities for staff development and provided team-building exercises at monthly staff meetings.

Gangewere holds a Bachelor’s degree in organizational management from Virginia Intermont College and a Master’s degree in business administration with a healthcare concentration from King College.

Hunt Selected To Supervise Six Leading-Edge Services At Bristol Regional Medical Center BRISTOL – Teresa Hunt, a 26-year medical professional with extensive management experience in the area, has been promoted to supervise multiple leadingedge services at Bristol Regional Medical Center.

Hunt has been named director of the hospital’s Teresa Hunt pulmonary, neurophysiology and wound care departments, and she will also be responsible for the sleep laboratory, vascular laboratory and post-acute care skilled respiratory program. She will oversee about 100 co-workers.

Prior to assuming her additional duties, Hunt was manager of the neurophysiology and sleep labs at Bristol Regional for 11 years.

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Hunt is licensed in Tennessee as a polysomnography technologist and is nationally registered in that field by the Board of Registered Polysomnographic Technologists. She also holds a certificate as a sleep educator through that organization and is nationally registered as an electroencephalographic technologist through ABRET Neurodiagnostic Credentialing and Accreditation.

Ladley Elected Chairman Of Mission: Lifeline In Tennessee, To Serve Two-Year Volunteer Term KINGSPORT – Herb Ladley, MD, who has helped shape the quality of heart attack care in the region, has been elected to serve as chairman of the American Heart Association’s Mission: Lifeline program in Tennessee.

Ladley will hold this voluntary role for two years Dr. Herb Ladley while continuing to practice as an interventional cardiologist for the Wellmont CVA Heart Institute and serve as interim chief medical officer at Holston Valley Medical Center.

In this statewide position, Ladley will be committed to advancing the systems of care for patients who have a heart attack.

The goal is to reduce mortality and morbidity for these patients and improve overall quality of care by following the guidelines and recommendations of the heart association and the American College of Cardiology.

Ladley has devoted hundreds of hours to working with local emergency medical services agencies in Northeast Tennessee and Southwest Virginia on the importance of networking and streamlining patient care.

Mountain States Medical Group Family Medicine/ Internal Medicine In Elizabethton Welcomes Two New Providers ELIZABETHTON – Dr. Ryan Andrew Hackett and Dr. Rebekah Livingston Swink have joined Mountain States Medical Group Family Medicine/Internal Medicine in Elizabethton.

Both Dr. Hackett and Dr. Swink are board-certified by The American Board Dr. Andrew Hackett of Family Medicine.

Hackett holds a medical degree from The Ohio State University College of Medicine in Columbus, Ohio, and completed his family medicine residency at University of Nebraska in Dr. Rebekah Livingston Omaha. He is a member of Swink the American Academy of Family Physicians and the Uniformed Services Academy of Family Physicians.

Swink holds a medical degree from James H. Quillen College of Medicine in Johnson City and completed her family

medicine residency at East Tennessee State University in Bristol, Tenn. She is a member of the American Academy of Family Physicians and the Tennessee Medical Association.

Mountain States Medical Group – Infectious Disease Welcomes Elmezayen KINGSPORT – Mountain States Medical Group – Infectious Disease welcomes Rabab I. Elmezayen, MD, PhD, to the medical staff. Dr. Elmezayen is board certified in Internal Medicine and will be practicing at both the Abingdon, Va., and Kingsport locations.

Elmezayen specializes in treating infectious diseases, which are conditions transmitted from person to person. Some examples of bacterial infections she treats are pneumonia, meningitis, arthritis, skin infections and endocarditis. She also treats viral infections such as influenza and atypical pneumonia.

Elmezayen holds a PhD in clinical immunology and completed the fellowship training program in infectious diseases at East Tennessee State University.

Kelly Joins Mountain States Medical Group General Surgery In Marion MARION, Va. – Dr. Gordon M. Kelly Jr. has joined Mountain States Medical Group General Surgery in Marion.

Kelly received his medical degree from the Medical College of Georgia in Augusta, Ga. and completed a residency in general surgery at Greenville Health System, Clinical University in Greenville, S.C. Kelly is board-certified by the American Board of Surgery and is a certified Healogics-Wound Care physician. He is also a fellow member of the American College of Surgeons.

Pierce Joins Community Physicians Oncology in Norton NORTON, Va. – Community Physicians Oncology welcomes Daryl Pierce, MD, MS, to its medical staff.

Pierce specializes in the diagnosis and treatment of cancer and hematologic disorders utilizing chemotherapy and other medications. He is a distinguished Dr. Daryl Pierce oncologist and hematologist who has provided personalized cancer care for patients in Norton and surrounding communities since 2004.

Pierce is board certified in medical oncology as well as palliative and hospice care, and will bring newcancer services to Community Physicians Oncology in Norton located at 98 15th St. NW, Suite 202. Pierce welcomes new and existing patients.

Singh Receives $423,000 For Research Project Related To Ischemic Heart Disease JOHNSON CITY – Dr. Krishna Singh, a professor in the Department of Biomedical

Sciences in East Tennessee State University’s Quillen College of Medicine and physiologist at the Quillen VA Medical Center, has received a $423,485 grant from the National Institutes of Health.

Through the grant, Singh will research the role of a protein called ATM, or ataxia telangiectasia mutated kinase, in ischemic heart disease.

Mutations in the ATM gene cause a rare genetic disorder known as Ataxia-telangiectasia, or A-T, which affects multiple organs in the body and leads to severe disability. Individuals carrying both copies of the mutated ATM gene die in their teens or early 20s. Patients with one normal and one mutated copy of the ATM gene are spared from most of the symptoms of the disease.

However, they are more susceptible to cancer and ischemic heart disease.

The investigations will be focused on examining the role of ATM in heart muscle cell death and heart function.

Drs. Mahipal Singh and Gary Wright will join Singh as co-investigators in the research effort.

Singh also currently holds a VA Merit Review Award from the Department of Veterans Affairs for nearly $1 million to study the role of a protein called osteopontin in heart disease.

NIH Awards $2.7 Million Grant For Study Of C-Reactive Protein JOHNSON CITY – A $2.7 million grant from the National Institutes of Health awarded to East Tennessee State University’s Quillen College of Medicine will support research into the link between a blood protein and inflammatory diseases such as rheumatoid arthritis and atherosclerosis.

The protein, called C-reactive protein, or CRP, has been the focus of Dr. Alok Agrawal’s research for the past 31 years.

Agrawal says every person has a baseline level of CRP, but in patients suffering from rheumatoid arthritis and atherosclerosis, levels of CRP in the blood rise.

Agrawal says CRP is a protein involved in the functioning of the immune system and he believes it may offer protective mechanisms against inflammatory diseases.

In his previously published studies, he has shown that CRP requires a certain “microenvironment” to function.

In his lab, Agrawal has shown that when the structure of CRP was modified artificially using genetic engineering methods the engineered CRP could bind to bad cholesterol (a molecule related to atherosclerosis) and autoantibodies (a molecule related to rheumatoid arthritis). He hypothesizes that this interaction inhibits the proinflammatory properties of bad cholesterol and autoantibodies resulting in the prevention of the disease.

Now, with the NIH grant, he will test various modified forms of CRP in animal models to see what protective effects it might have on atherosclerosis and rheumatoid arthritis.

OCTOBER 2015

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