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PHYSICIAN SPOTLIGHT PAGE 2

Erin Reid, MD, MPH

ON ROUNDS

AAOS Updates Clinical Practice Guidelines for Osteoarthritis of the Knee

By CINDy SANDERS

HEALTHCARE LEADER: T. Watson Jernigan, MD, MA

The American Academy of Orthopaedic Surgeons (AAOS) recently released a revised clinical practice guideline for treatment of osteoarthritis of the knee with key changes to recommendations regarding the dosage of acetaminophen and use of intra-articular hyaluronic acid (HA).

David S. Jevsevar, MD, MBA, chair of the AAOS Evidence Based Quality & Value Committee and chair of the workgroup for OA of the knee, said the 2013 edition of the clinical practice guideline (CPG) contains 15 recommendations and replaces the first edition of the CPG, which had elicited some concern over the methodology employed in garnering some of the evidence … specifically that attached to the use of HA. Jevsevar, a board-certified orthopedic surgeon at Intermountain Zion Orthopedics & Sports Medicine in St. George, Utah, said it is the policy of the AAOS to do all CPG data

His blood may run blue as a self-confessed University of Kentucky Wildcats fan, but Tom Jernigan, MD, didn’t let that stop him from making the move to Tennessee over three decades ago ... 4

(CONTINUED ON PAGE 10)

Making the Marriage Work Alignment & Integration Strategies to Strengthen Physician, Hospital Unions

Filling in the Gaps From galas to golfing, fundraisers plug healthcare providers’ budget holes

By CINDy SANDERS

When it comes to new equipment, facility renovations and expanded services, the capital-expenses wish list for hospitals and healthcare providers ... 7

… And they all lived happily ever after.

In fairytales, the two protagonists manage to overcome many barriers to ultimately ride off into the sunset … presumably for a lifetime filled with sunshine and roses. In the real world, we only have to look to divorce statistics to know that ‘wedded bliss’ frequently dissolves into angry recriminations, mistrust and broken vows.

As it turns out, marriage makes for an interesting analogy to the wave of physicians, practices and hospitals rushing to the altar under the new world order of healthcare reform. Thanks to economic strain, the market has seen quite a few shotgun weddings lately. In other cases, such as some ACO affiliate agreements, the parties have opted to cohabitate rather than legally wed. And in

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PhysicianSpotlight

Erin Reid, MD, MPH

By JENNIFER CULP Currently in her first year of practice at Dermatology Associates in Kingsport, Erin Reid, MD, is never bored. Reid was initially attracted to the field of dermatology because of its variety and complexity.

“You get to basically do medicine, pathology, and surgery in dermatology, and that’s what I liked about it,” she explained.

Additionally, the specialty allows Reid to see patients of all ages and treat a wide range of problems, everything from lifethreatening skin cancers to social life-threatening teenage acne.

“Many of the patient problems are limited to the skin, but an interesting thing with dermatology is that you also see a lot of internal problems that manifest on the skin. A lot of times people think that we just treat acne, but we actually get to see a lot of interesting diseases,” she said.

No skin problem, however, is trivial to Reid. “Things like acne and most rashes and skin cancers are not necessarily life-threatening,” she acknowledged, “but they do affect quality of life, which is important.”

Reid was born and raised in Williamsburg, Kentucky, about an hour north of Knoxville on the Tennessee/Kentucky border, and chose to attend undergraduate and medical school in her home state.

After completing a double major in German and biology at the University of Louisville (and spending two extended periods

practicing her language skills in Germany itself), she relocated to Lexington for medical school, where she earned a joint medical degree and Master’s degree in public health with a concentration in epidemiology from the University of Kentucky (and she is still a die-hard UK Wildcats fan).

Following graduation from UK, she was accepted into the residency program at Southern Illinois School of Medicine, and in June 2012, completed a fellowship in Mohs micrographic surgery. The American College of Mohs Surgery (ACMS) fellows are only admitted to the program after completing a highly competitive review and selection process. Fellowship graduates are required to complete at least 500 cases of varying complexity over months of training under the supervision of an experienced, ACMS-approved Mohs surgeon in order to finish the pro-

gram. Along with Chad Thomas, MD, Reid is now one of two ACMS fellowship-trained Mohs surgeons on staff at Dermatology Associates.

Mohs surgery (also known as Mohs chemosurgery, Mohs microscopically controlled surgery, and Mohs micrographic surgery) was developed by Dr. Frederic Mohs in 1938 and has undergone further modification and refinement over the years since. The procedure is most often used to treat basal cell carcinomas and squamous cell carcinomas on highly visible, cosmetically sensitive areas such as the head and neck. The procedure spares as much healthy skin as possible, while ensuring that all cancerous tissue is removed. After each removal of tissue, the specimen is examined for cancer cells, which helps the surgeon determine where to remove tissue next and allows for a high cure rate and narrow surgical margin. The surgery is done in-office under local anesthesia while the patient remains awake. In fact, the patient may even read, knit, or carry on a conversation while waiting on tissue to be processed. Reid spends two days each week practicing general dermatology and two days performing Mohs surgery, and cites the time she spends with Mohs patients as one of her favorite parts of the job. “I enjoy getting to meet all the different patients,” she said. “Mohs surgery takes place over the course of the day and the patients are awake during their surgery, so usually we have a nice conversation while I’m repairing the tissue.

On Mohs days, I get to interact a little bit more with people and get to know the pa-

tients better that way.”

Other problems Reid commonly sees include acne, eczema, psoriasis, autoimmune diseases such as lupus, and, of course, skin cancers. “Most skin cancers are caused by sun damage, and a lot of them (like basal cell skin cancers and squamous cell skin cancers) are easy to treat if you catch them early,” she said, continuing, “It’s when they’re left on the skin for a long time that they become more difficult to treat.

“One of the types of skin cancer we really worry about is melanoma, which we’re seeing more and more of. If you catch it early enough, it’s actually very treatable, but if it goes undiagnosed too long it can be fatal,” she explained.

Skin checks help catch cancers early, before the problem becomes life-threatening.

Reid is settling into her Tennessee home after joining Dermatology Associates in September 2012. “In the future, I’d like to get more involved with the community,” she said.

She loves to read, and is a member of a local book club in the area. Reid has a 20-month-old daughter, Juliet, with her husband Josh, who teaches English at East Tennessee State University, and the couple is currently preparing to expand their family further. “I have another baby on the way in August, so I don’t want to make too many plans beyond that!” she laughed.

Reid is passionate about dermatology, but her greatest joy comes from spending time with her loved ones. “I’m very focused on my job,” she said, “but also on raising a family.”

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AUGUST 2013

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HealthcareLeader

T. Watson Jernigan, MD, MA

By BRIDGET GARLAND

His blood may run blue as a selfconfessed University of Kentucky Wildcats fan, but Tom Jernigan, MD, didn’t let that stop him from making the move to Tennessee over three decades ago.

Now serving as the Associate Dean of Clinical Affairs at East Tennessee State University’s James H. Quillen College of Medicine, Jernigan, a generalist OB/ GYN, is using his myriad experience to help improve the educational experience of the next generation of physicians.

Jernigan lived in Lexington, Kentucky, from the age of 7 until he was 16, when his father, a West Point graduate and veteran of the Korean War, was transferred there for work. Transplanted from Lexington, Jernigan graduated high school in 1967 from Charleston, West Virginia. His choice for college had him moving states again, when he attended Denison University in Granville, Ohio, following the plans he had laid out as a sophomore in high school.

“I took a course on advanced biology and fell in love with medicine. So I read a book that was put out by the American Medical Association called ‘So You Want to be a Doctor?’ I started

planning my life one year at a time, full aware that I had 17 years to go,” he recalled. “I got a copy of the course requirements for medical school in the United States, so I knew what courses I needed to take and what grades I needed to make, as well as what testing I would have to have before I went to college.

The only thing that wasn’t planned was my major.

“I thoroughly enjoyed history, so I choose to be a history major, completed

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AUGUST 2013

all of my medical school requirements, and graduated in 1971,” he continued.

Jernigan was accepted into the University of West Virginia Medical School and did well, especially in his clinical years, when remembering details is critical. “You have to remember what went with what patient—labs items, the history and physical—it was exactly like remembering historic data,” he said.

“And my liberal arts background helped me with dealing with patients; I could communicate with them very easily.”

It was during his third year of medical school that he decided on obstetrics and gynecology, citing the exact reasons he now shares with the medical students at Quillen: long-term patient relationships, the surgical aspect, and the “special honor and privilege” of delivering babies.

Jernigan considered two options for his residency, one academic, but never planning to work in an academic setting, he choose Akron City Hospital in Ohio, which he described as a “very well-rounded, generalist” education. “I delivered babies; I took care of sick patients; I took care of infertility; I took care of patients with cancer. I developed a broad background,” he said.

Feeling prepared to take on whatever life might put before him, Jernigan moved to Johnson City in 1979 to join the practice of Gordon, Ruffin, Hillman, and Miller, one of only two groups in town. For two and a half years he practiced as a member of the group, but soon after the new Johnson City Medical Center opened, he went into solo practice.

In 1986, Jernigan decided that with such a hectic schedule (he was delivering at least 20 babies a month, performing surgeries, and being father to his three young daughters), joining the university might be a good idea, and indeed, it was.

For over a decade, he worked in several different positions, learning the jobs associated with an academic practice, and serving as the Department of Obstetrics and Gynecology’s clinical coordinator for five years, as clerkship director for third-year students for five years, as well as interim chairman for a year.

With his family grown, Jernigan decided to return to private practice, and joined the OB/GYN group at State of Franklin Healthcare Associates (SoFHA). Looking back, he considers time spent at SoFHA a tremendous learning experience.

“This is what I really learned—I learned about being in a multi-specialty practice. SoFHA is made up of pediatricians, internists, family practitioners, and OB/GYNs. I learned a tremendous amount of information from Mr. Richard Panek, CEO of SoFHA, about

dealing with the complexities of medical practices, and I saw how the OB’s interacted at a level with the other specialties.

“Adding that experience, I’ve now been in a single specialty group, a multispecialty group, in solo practice, and in an academic multi-specialty group,” he explained. “Those experiences are what I brought back with me when the Dean asked me to come back to Quillen to serve as interim chair.”

Jernigan indeed came back to Quillen in 2009, and shortly after serving in that capacity, Jernigan was appointed as Associate Dean of Academic Affairs in November 2011, a position created to address the complexities healthcare reform has added to the operations of the medical school.

“When I came back, the complexities that I learned about at SoFHA were magnified at the university because our job is not the same as a private practitioner,” he said. “Our job is to educate and prepare the next generation of physicians, to prepare them for their career as a doctor.”

In his new position, Jernigan oversees all the clinical operations within the College of Medicine, which has included the implementation of electronic health records, preparing for the implementation of ICD 10 coding, reevaluation of compliance, as well as preparation for the integration of an accountable care organization.

“There’s great opportunity as we move into this era of healthcare reform…, and I’ve positioned myself here to try to help,” he shared. “I have a background that allows me to see how we have handled things in the past and how to deal with things as we move forward. It’s a progression and what I’ve tried to do, what I see for the future—it’s going to take individuals who are aware of not only the needs of the medical community but also the needs of populations.”

Jernigan is particularly proud of the opportunity afforded by Dean of Medicine Philip Bagnell, MD, to present a series of lectures on Healthcare Reform for first- and second-year medical students.

“They may not be involved in the clinics yet, but these types of changes involve what they’re going to do for the rest of their lives, so we are starting to teach the business of medicine at this medical school,” he said. Specific lectures will also be offered to third- and fourth-year students, informing them about the latest updates to the Reform.

“We are preparing the next generation of doctors in a way we have not done in the past, and we are doing it not only through work duty hours but through exposure to things such as sim(CONTINUED ON PAGE 10)

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ICD-10: Are You Ready?

By BILL HEFLEY, MD

With the rapidly approaching ICD-10 ‘go live’ date of October 1, 2014, medical practices should be well on their way in preparing for the transition. With implementation of ICD-10, physician offices accustomed to the 13,000 ICD-9 codes must be prepared to transition seamlessly to a new set of 68,000 codes. More specifically, a physician or billing clerk currently using ICD-9 to properly code the diagnosis of ‘patella fracture’ must choose between two possible codes; when utilizing ICD-10 that number explodes to 480 codes. Yes. Get ready.

In 1992 the World Health Organization (WHO) published the International Classification of Diseases, Tenth Revision. The U.S. made modifications to the WHO ICD-10 creating the ICD-10-CM (Clinical Modification) which is the diagnosis code set that will replace ICD-9-CM Volumes 1 and 2. The Department of Health and Human Services (HHS) published a regulation requiring the replacement of ICD-9 with ICD-10 and later pushed back the compliance date one year to October 1, 2014. Farzad Mostashari, MD, the National Coordinator for Healthcare Information Technology, asserted last month that there would be no extension of the deadline.

While many physicians see the transition to ICD-10 as an unnecessary burden, other physicians and industry stakeholders believe that the ICD-9 code sets are obsolete and inadequate. ICD-10 codes have more characters and a greater number of alpha characters creating space for new codes and flexibility for future medical advances. ICD-10 has increased specificity that will improve the ability to identify diagnosis trends, public health needs, epidemic outbreaks, and bioterrorism events.

In addition, ICD-10 will improve claims processing, quality management and benchmarking data.

A successful ICD-10 transition requires exhaustive preparation by medical practices. Yet recent research by the Medical Group Management Association indicates that only 4.7 percent of practices reported that they have “made significant progress” when rating their “overall readiness level for ICD-10 implementation.”

The research was derived from respondents in 1,200 medical practices in which more than 55,000 physicians practice.

Preparing to practice medicine in the world of ICD-10 is no small undertaking.

It will require time and money. Having an experienced billing clerk “coder” in the practice will no longer be sufficient to generate accurate codes. Simply converting the practice’s ICD-9 superbill to ICD-10 is problematic. Many industry experts don’t see the superbill being preserved at all. The American Academy of Professional Coders (AAPC) recently issued a two page ICD-9 superbill which when crosswalked to ICD10 became nine pages long. Another industry consultant sites an example of a two page ICD-9 superbill translating into a 48page ICD-10 superbill. easttnmedicalnews

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Preparation for the medical practice begins with internal training and testing of all parties involved in producing proper coding. Administrators must establish a training and implementation schedule; set deadlines; create a project team; identify training resources; perform documentation gap analysis; evaluate and modify the practice’s forms; budget for transition expenses; communicate with practice management (PM) software and EHR vendors; assess hardware and software update requirements; and arrange testing with clinical and billing staff, PM and EHR vendors, clearinghouses and major health plans.

Providers must be trained on the changes in clinical concepts and the level of detail in ICD-10, so that their documentation supports the ability to code to the highest level of detail. For many specialties, it is highly recommended that physicians take anatomy and physiology refresher courses. Billing staff must increase their knowledge of anatomy and physiology, learn and adopt a completely different coding system and be able to code to the greatest level of detail.

Training options include sending staff for offsite training, hiring an outside trainer to come to the practice, online training, webinar training and book-based training. Frequent testing and trial coding for all staff is also highly recommended in the months leading up to the ICD-10 ‘go live’ date.

In addition to internal preparation, medical practices must also arrange testing with their PM vendor, EHR vendor, clearinghouse and major health plans.

Many PM vendors and EHR vendors will not be ready to meet the October 1, 2014 ICD-10 compliance date. Practices must communicate with their vendors months in advance to schedule software upgrades and testing to assure readiness. If the practice’s PM or EHR vendor is not going to be prepared for the ICD-10 launch, the practice will need to make plans to switch in time for the transition date. Many practices with in-house billing departments will weigh the benefits of outsourcing the practice’s revenue cycle management.

Costs associated with the prepara-

tion for the ICD-10 transition are not insignificant. Industry experts suggest budgeting $200,000 to $280,000 for an eight-physician practice. Expenses include training, testing, hardware upgrades and PM/EMR software upgrades. In addition to the one-time costs associated with implementation, many practices will experience ongoing, recurring costs related to the need for increased coding staff, consulting services, subscriptions to print and software-based coding aids and reduced productivity as a result of increase need for documentation and coding complexity.

The ICD-10 transition will undoubtedly eclipse Y2K and the HIPAA 4010 to 5010 transition in terms of the impact on the healthcare industry. Unprepared practices will face painful disruptions in cash flow and a chaotic scramble to regain practice productivity. Even well-prepared practices that execute ICD-10 implementation flawlessly will likely experience some disruption in cash flow. Remember, a successful revenue cycle requires every entity in the claims processing chain to be fully prepared for ICD-10. The PM system, EMR system, clearinghouse and payer must all communicate properly electronically and adjudicate ICD-10 claims correctly. Some bugs are inevitable. Practices should have in place a line of credit sufficient

Myths Associated with ICD-10 The Go-Live date will most likely get delayed again The only staff members affected will be coders and billing specialists My EMR and PM vendor will be automatically compliant General Equivalence Mappings are a good solution to coding an individual clinical chart After October 1, 2014 payers and clearinghouses will aid practices by automatically cross-walking submitted 9 codes to 10 codes

to cover three months operating expenses prior to ‘go live.’ Preparation will take considerable planning, time and money and should begin immediately. October 1, 2014 is just around the corner.

Bill Hefley, M.D., is President and CEO of MedEvolve, providers of Practice Management Software, EHR, and billing services to thousands of physicians across the US. In addition, he has an orthopedic surgery practice in Little Rock, specializing in minimally invasive surgeries for the knee, hip and shoulder including arthroscopic and joint replacement procedures.

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Making the Marriage Work, continued from page 1 some instances, the belief is that the union completes and complements each party to the ultimate benefit of both.

No matter how the parties entered the relationship, once the honeymoon phase wears off, both are left to figure out how to navigate this new partnership and work as a team. Of course if that was easy, there wouldn’t be such a high divorce rate. You only have to look back to the rash of mergers and buyouts in the ‘90s to know that many of these marriages between practices and hospitals don’t end harmoniously.

So what can you do to beat the odds?

Medical News had the opportunity to chat with Ken Hertz, FACMPE, principal with MGMA Health Care Consulting Group, about the keys to creating a lasting union. Hertz, who has nearly 40 years of management experience, has Ken Hertz held leadership positions with primary care and multispecialty care organizations, as well as large integrated systems. He works with practices and hospitals on strategic planning, integration, operational improvements, compensation, conflict resolution and governance issues.

Marry in Haste, Repent at Leisure

In the current transformational landscape, Hertz has seen a lot of hasty mergers

and alignment contracts executed without taking the time for proper due diligence … the ‘chicken little’ syndrome. “I tell people I’m not necessarily sure the sky is falling or that the world is ending. What we’re dealing with is this funny word called ‘change,’ and some of us can barely say it without stroking out,” he noted.

Hertz was quick to add that change is scary, but that’s all the more reason to take time to prepare properly on the front end to ensure each partner stays committed when the relationship hits an inevitable rough patch down the road. He noted the rush to ‘do something’ happens on both sides with physicians worried about the changing regulatory and reimbursement landscape and hospitals snapping up practices before a competitor has the opportunity to grab them.

It’s probably wise to note, however, that few couples married at a Las Vegas drive-thru chapel at 3 a.m. make it to their golden anniversary celebration. Instead, many of them wake up the next day with the question of ‘Now what?’ hanging heavily in the air.

Premarital Counseling

“It’s like the Yogi Berra line, ‘If you don’t know where you’re going, there’s a good chance you won’t get there,’” Hertz said. “When we work with physician practices and they say, ‘We need to get aligned with the hospital or need to merge with another practice,’ the first thing we ask is

why?”

It’s important, he said, to really explore what each partner hopes to accomplish through the alignment or merger.

How does each of you define success?

Once the ‘why’ has been sufficiently vetted, the attention shifts to the ‘who.’

Hertz said it is essential to honestly evaluate your core values and deal-breakers and then see how those align with your potential partner.

“The key to any relationship is you’ve got to understand what makes you tick and what’s important to you … and … you’ve got to understand what makes your partner tick and what’s important to them,” Hertz said.

Ultimately, Hertz noted, each party is aligning themselves to a vision. “It’s really critical, I think, that there be a shared vision … and the shared vision can’t be just about money.”

Prenup

Chances are not everyone is going to get everything they want in any relationship, but both parties should address the ‘must haves’ and ‘won’t dos’ and write those into the contract. The reimbursement plan, governance structure, conflict resolution protocol, and practice pattern expectations should all be thoroughly discussed on the front end and clearly outlined in the final agreement. Equally, the repercussions for both parties of not living up to the agreement should be spelled out.

Making the Marriage Last

Although it might seem like the heavy lifting happens in the planning stage, anyone who has been married long knows

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that once the honeymoon is over, the real work begins. “Each party has to put in a hundred percent. It is the only way this works,” Hertz said.

For physicians used to making snap decisions and having their orders carried out, following the maze of corporate protocols that are inherent in most health systems and large practices can be frustrating.

For hospitals shifting from a volume-based to an outcomes-based reimbursement model, it can be equally difficult to understand how less truly can mean more.

The best antidote for frustrations that build up and fester over time is open communication. Hertz pointed out, “Communication is broadcasting, but it’s also receiving. The notion of two-way communication is critical.”

Not only does there have to be communication, but it must also be meaningful. “Most of the physicians I know were absent the day they taught mind-reading in their training programs,” he said. It does no one any good to have an administrator walk into a physician’s office at the end of the month, tersely tell the doctor the numbers aren’t where they ought to be, and walk out … which Hertz has witnessed. Instead, he said, the two need to work together to figure out where the problem lies and what steps could be taken to fix it.

Being open to different viewpoints allows both physicians and administrators to see care delivery issues in a new light.

It’s one reason why physician governance is critical to the health of the overall organization. Having physicians involved in planning for the future keeps them engaged in the mission and shared vision.

Having a voice, however, doesn’t always mean one party gets their way.

Hertz noted, it’s better to hear an honest ‘no’ than a sugar-coated answer that is meaningless. Trust and transparency, he said, are the cornerstones of any good relationship.

“Do what you say you’re going to do when you say you are going to do it,” he stated, noting the axiom is equally true for physicians as it is for administrators.

Hertz continued, “If I’m a system, and I’m going to pay you based on work RVUs or based on charges or visits or collections or whatever, I need to make sure I can do a really good job of collecting that information; that it is accurate; that it’s timely; and that you trust it. If we don’t trust each other, it doesn’t work so well.”

Ultimately, those who have realistic expectations and are willing to put in the work to achieve the shared vision enjoy the strongest partnerships. “You’ve got to know what is going on in the world around you … so you’ve got to be informed. You must do your due diligence.

You must know yourself, and you’ve got to do this with your eyes open — wide open — and never assume. Those are the top five things,” Hertz said.

“The bottom line is none of this is brain surgery, but there is no silver bullet, no magical answer. It’s darn hard work,” he concluded.

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Filling in the Gaps From galas to golfing, fundraisers plug healthcare providers’ budget holes

By JOE MORRIS

When it comes to new equipment, facility renovations and expanded services, the capital-expenses wish list for hospitals and healthcare providers usually far exceeds what’s realistic. But with creative fundraising, that gap can sometimes be narrowed significantly.

For some organizations, it’s a golf outing; for others, black-tie ball. But whatever the case, the goal is to raise much-needed funds to supplement the bottom line.

Take the Niswonger Golf Classic, which raised almost $700,000 for Niswonger Children’s Hospital over two days earlier this summer. Since its founding 22 years ago, it has grown to include a roster of celebrity golfers and even a concert, all of which serve to increase the amount of money raised, said Patty Bolton, corporate director of events for the Mountain States Foundation, which organizes the event.

“We have a year-round committee because we are putting on a huge production now,” Bolton said. “As our services have grown, including building a new hospital in 2004, we needed the event to do more. Before we were tickled to death if it brought in $20,000. But we’ve watched and learned from other golf-related events, and have gotten more people, and more celebrities,

Front row (seated, left to right): Dan Marino, Jason Witten, Steve Johnson, Scott Niswonger, Emmitt Smith, Corey Pavin, Darius Rucker; standing, Niswonger Children’s Hospital mascot Scrubs the Bear, Tom Purtzer, Larry Mize, Condredge Holloway, Dell Curry, Jim Stuckey, Bill Bates, Phil Fulmer, Bruce Smith, Frank Beamer, Rick Carlisle, Bruce Pearl, Victor Jones, Mike Smith.

involved, and been creative in how we’ve grown the event.”

It doesn’t hurt that the event benefits a children’s hospital, and promoters make sure that everyone involved knows where the money is going. This year, for example, proceeds will help purchase syringe pumps, highly specialized and expensive equipment. Planners also ensure that everyone involved gets the red-carpet treatment, so that the entire experience is that much more memorable.

Next up for the foundation is its

Dragon Boat Festival, an 8-year-old event

that raises funds for all 13 hospitals that the organization services through its fundraising and outreach efforts. Like the golf classic, the ongoing challenge is to keep the event fresh, and to monitor what works, and what doesn’t, in that regard.

“The boat race will be dedicated to radiation oncology, so it’s quite specific in what it is for,” Bolton said. “We think it’s important people know that. We are break-

ing records these days, but that’s because we’re trying to grow our events by 10 percent each year. We set modest goals, but then we look at how many donors we have, how many more people were involved over the previous year, and those things help us measure how we’re doing as far as telling the stories of the hospitals and the healthcare system.”

Healthcare organizations also have found success partnering with other groups for events. That way, they don’t have to bear the cost of the event in question, but as a beneficiary, reap the proceeds. Sometimes that does involve a fair amount of work just the same, but in other cases, it’s as simple as providing a logo for marketing materials.

For example, the Color Me Rad 5K run benefits East Tennessee Children’s Hospital, with the hospital helping to promote the event and then provide volunteers on race day. Children’s does helm some well-known major events, such as Dancing with the Knoxville Stars, the black-tie Center Stage, holiday Fantasy of Trees, Peyton Manning Golf Classic, and Radiothon.

“We’ve got a lot of events because our development department is tasked with providing about 40 percent of all hospital expenses for the whole year,” said Seth (CONTINUED ON PAGE 8)

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

Jenny Harvey, RHIIT, CPC, CPHQ, CPhT 865.862.6544 (direct) / jharvey@lbmc.com Coding Consultant – Healthcare Consulting

Jenny, a member of the American Academy of Professional Coders (AAPC), the American Health Information Management Association (AHIMA), and the National Association for Healthcare Quality (NAHQ) has over 20 years of extensive experience in the healthcare field.

During her career, Jenny has worked in the fields of inpatient and outpatient hospital coding, physician coding/billing, payer services, and pharmacy services.

Her education for physicians and other providers, regulatory and payer compliance, fee schedule analysis, and billing review for compliant reimbursement.

Jenny has taught CPT coding and medical terminology at Roane State Community College. She is a music nut, loves discovering small indie artists before they become a big deal, going to see live music and is an avid collector of vinyl (record albums) over 2,000 and counting. She also enjoys spending time outdoors with her husband and dogs on their property in Ozone, TN.

JANUARY 2013

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theLiteraryExaminer

BY TERRI SCHLICHENMEYER

Your Survival Instinct is Killing You

by Marc Schoen, PhD; c.2013, Hudson Street Press; $25.95 / $27.50 Canada, 259 pages The commute to work this morning was a bear.

Subsequently, you arrived at work late, ready to chew nails, only to find a pile of paper on your desk that you didn’t put there.

You have a headache. You need a vacation. Or, maybe you just need to read Your Survival Instinct is Killing You by Marc Shoen, PhD. This morning, you got out of bed, performed your ablutions, and got to work – and you probably don’t remember doing half of what you did to get there. That’s because you’ve taught yourself to act habitually; in fact, your body effortlessly operates on habit much of the time.

But habits are, of course, both good and bad.

Take your irritation, for instance. It’s a habit, says Shoen, that stems from ancient survival instincts and is exacerbated by today’s rush-rush-rush world. The trick is to learn a new habit – one of calmness, say – in place of the irritation.

Part of learning a new, more beneficial habit, he says, is to learn to deal with discomfort. We have “access to an enormous number of conveniences,” which leads to us being “less tolerant of being uncomfortable.” That causes your survival instinct to kick in because it “tends to view all discomfort and fear as an ultimate threat to survival.” You then overreact with headache, irritation, and possible serious illnesses.

The key to thwarting this overreaction is to teach your “three brains” to embrace a certain amount of discomfort. Not surprisingly, the more discomfort you can withstand, the more you’ll grow.

Teaching your brains won’t be easy, but to do it, start by turning off technology early in the evening and take “a breather.”

Learn that nothing is ever perfect and that it’s possible to slow down. Practice gratitude. Stop trying to do it all but don’t procrastinate, either. Expand your comfort zone by creating some discomfort.

Lastly, learn to delay your need for gratification and groom yourself to withstand pressure. After all, “pain is inevitable, but suffering is not.”

So you need a little bit of paper courage? Something that helps you harness an inner fire that you sense isn’t doing you any good? You might find that info in this book.

And then again, you might not.

Trouble is that Your Survival Instinct is Killing You is repetitive and not all that easy to grasp. Author Marc Schoen, PhD, offers readers a lot of info on mind-body medicine, but each new point gets buried inside statements that have already been made in different ways. I lost interest in this book several times, but soldiered on – only to find an exciting passage before losing interest again.

Yes, there’s help inside this book, but there’s also a lot to weed through to find it.

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What Doctors Feel: How Emotions Affect the Practice of Medicine

by Danielle Ofri, MD; c.2013, Beacon Press; $24.95 / $28.95 Canada, 240 pages In the new book What Doctors Feel by Danielle Ofri, MD, provides a glimpse of the thought processes that go through a doctor’s head.

For decades, we’ve been conditioned to believe that doctors are supposed to keep an emotional distance from their patients. We expect a certain detachment and formality – but we also expect compassion.

Is this a contradiction in demand?

Dr. Danielle Ofri says no. Though remaining businesslike may often be essential, the physician-patient interaction “is still primarily a human one.” No matter how aloof the doctor or sick the patient, we still connect on a one-to-one basis.

We shouldn’t be surprised, therefore, to note that doctors are mortals who sometimes “fall short on empathy” when an illness doesn’t make sense or a wound isn’t obvious, when patients don’t follow advice, display entitlement, or steadfastly maintain bad habits. In those cases, frustration rises and remaining empathetic is “challenging,” but as a young medical student, Ofri learned from “an act of compassion” that finding empathy is possible, as well as essential.

We shouldn’t feel surprised to note that medicine is like many professions, and certain clients are “problem” clients. As in many jobs, doctors use dark humor and “derogatory terms” to deal with personal discomfort, show solidarity, ease unpleasantness, or bring levity to the situation. And, as in every job, some topics are off-limits.

Doctors fear harming their patients, missing something important, making mistakes. They become overwhelmed by neediness and illness, and by reams and reams of paperwork necessary in today’s medical world. They can succumb to the kinds of maladies and addictions they see every day, they can be stubborn in their decisions, they momentarily forget things, and they surely experience burn-out.

And yes, doctors do have favorite patients. And they cry when those patients die.

With incredible insight, lyrical beauty, humor, and consideration, author Danielle Ofri, MD, gives readers the kind of comfort we need when faced with any sort of medical anything by revealing exquisite vulnerability in an esteemed profession. She successfully portrays the processes of diagnosis and treatment as more human than clinical, and that’s likewise soothing.

But not everybody will enjoy what’s here.

Medical personnel might be unhappy that Ofri exposes certain, darker bedside manners. Indeed, the section on medical slang is uncomfortable to read – and yet, because that blunt truth follows with the spirit of this book, it belongs.

Overall, I couldn’t let go of this graceful, elegant, honest book, and I think you’ll love it, too. If you’re a doctor or if you’re anyone’s patient, What Doctors Feel is a book to read – stat.

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.

Filling in the Gaps, continued from page 7 Linkous, marketing and communications director for the hospital. “That covers any kind of new equipment, for which there is a continual need, so everything we do needs to keep growing.”

The marketing and development team at Children’s has found success with a mix of events it controls as well as those where it just lends support, Linkous said, as it keeps the hospital’s name in front of many different segments of the public throughout the course of a year.

“When it’s something big, like Fantasy of Trees, we can work to saturate the market with ads and promotions so we can get as many people as we can,” Linkous said.

“But for these others, we do very little work and then really benefit from all the people they reach out to and bring in.”

Regardless of the involvement level, all programming comes under scrutiny before, during, and after to see if it’s meeting targeted goals. If not, then the decision is made to refresh, or retire, the activity.

“A prime example is the Children’s Miracle Network,” Linkous said. “We did that telethon for about 30 years. When it started, viewers had three channels and were at home on Saturday and Sunday nights. Over the years, as cable came along and added more channels, ratings went down. So we looked at the trend and decided that we would be better off putting our resources into other programming.”

In the end, he said, “We have some people who will go to the Fantasy of Trees and pay that ticket price, but who would not be able to pay for a black-tie event. When ‘Dancing With the Stars’ fades out, we’ll probably phase that event out. You have to monopolize the market when you can, and always keep an eye out for that next great idea.”

A narrower approach focusing on two major annual events, pays dividends for Siskin Children’s Institute, in large part because each of those has become embedded in the community, said Jan Hollingsworth, director of marketing and communications, and Maria Currier, events and corporate relations manager.

“We are really known for StyleWorks, a spring fashion-based event that we have produced for 37 years, and for Star Night, a concert event in late summer that celebrated its 50th anniversary last year,” Currier said. “They are both very much tied into our name.”

StyleWorks stays fresh with added attractions such as a marketplace and luncheon, as well as a fashion show, and also by extending it over two days so that more people can be looped into its different components, Currier said. Siskin also benefits from strong partnerships, such as the one with Belk that drives the fashion show itself, as well as the many different vendors who exhibit in the marketplace.

“We also have celebrities when we can, such as Cynthia Bailey, a supermodel for many years who now is on ‘The Real Housewives of Atlanta,’” Currier said. “We really do try to shake it up and keep things interesting so that people will want to return each year.”

The event’s main purpose is highlighted organically when several children

Color Me Rad 5K run

who have graduated from the Siskin Early Learning Centers serve as child models.

“That’s a great way to showcase what we are here for,” Hollingsworth said. “They walk the runway, and have a great time.

Everyone loves that part of the event.”

Star Night, which is a more formal evening with a concert by a well-known artist or group, also is holding up well. The 2012 event was shaped largely around the 50th anniversary as a theme, but every year a concerted effort is made to land a well-known name, such as Josh Turner, Hootie & the Blowfish, and this year’s headliner, Wilson Phillips.

“We have amazing, committed volunteers, and we always reach out to people in the community who have great reach to chair these events,” Currier said. “And we listen to everyone involved to see what they want to do, and what they want to change.

That’s led to a preview party for Style Works, so that people who can’t attend the day events can still be involved. We want to make sure we bring in as many different groups of people as possible.”

The funds raised go back into Siskin’s general operating budget, and between this year’s StyleWorks and last year’s anniversary-themed Star Night, they brought in upwards of $600,000. That’s good, but there’s always a move afoot to get those totals even higher.

“There’s always a shortfall because we serve a lot of children,” Hollingsworth said.

“That’s why we now are doing a special request for more donations at the events.

We’ve had good success by just going to the people who are already there, and asking for just that little bit more.”

And like StyleWorks’ weaving in some Siskin graduates to its fashion show, there’s also an instructional element to be found during the Star Night proceedings.

“We engage the attendees through a speaker who has a personal connection to the institute, or through a video about what we do and our mission,” Currier said.

“These people are here to have a good time, but they also are here to listen to us talk about the children and the families that we serve. We package that information in an engaging way, however, and so that gives us another tool to inspire people to give.” easttnmedicalnews

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Enjoying East Tennessee Lost Sea Adventure

By LEIGH ANNE W. HOOVER

Escape the sweltering summer heat by visiting the sea. Enjoy year-round comfortable temperatures of 58 degrees, and for this month’s late summer respite, you won’t even need your bathing suit!

Known as “America’s largest underground lake,” the Lost Sea is located 140 feet below ground in Sweetwater, Tennessee, and it is truly a year-round must see experience. From winding pathways through the enormous caverns that once housed Cherokee Indians, Confederate soldiers, and even moonshiners, to the spectacular boat ride on the trout-filled lake below, your family will be truly in awe of this “adventure.”

“While you may go to a lot of different caverns that have other things in them, the Lost Sea is the main feature,” explained General Manager Lisa McClung. “People just don’t expect to see something that large underground. It’s really what sets us apart from a lot of other caves.”

A Member of the National Cave Association (NCA), the Lost Sea is part of Craighead Caverns, which is named for Chief Craighead, an early Native American owner believed to have discovered the original, natural cave entrance around 1820.

Its formation of anthodites, which is a Greek word that means cave flower, also makes it very unique. These rare formations are from condensation mixed with specific minerals forming the crystal-like flowers that are found in very few caves.

The large number in the Lost Sea earned the honor of being designated as a Registered National Natural Landmark.

During the Civil War era, the cave served as a resource for the coveted saltpeter, potassium nitrate, which was used to make gunpowder. The cave was rich in mineral deposits and bat guano, and this made it an ideal mining location.

Because of its notable involvement, and the authentic 1863 date from a Confederate torch inside the cave, the location has also been recently recognized as a Tennessee Civil War Trails marker.

During 1947, there was also a period when the cave was even a “cavern tavern.”

According to McClung, three moonshine stills were actually found in the cave prior to being opened commercially.

“They say that because of the high humidity in the cave, and the constant cold temperatures, people would not feel the effects of the alcohol until they tried climbing the 127 steps to get back out to the cave entrance. The higher they got to the surface and the temperature and humidity change, the realization of drunkenness would occur,” explained McClung.

Sweetwater native, Ben F. Sands, is actually credited with discovering the lake. However, what he knew existed as a 13-year-old boy in 1905 would take a lifetime to prove to others. easttnmedicalnews

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According to documented cave history, Sands crawled through a tiny crevice that put him knee-deep in water and led to the discovery.

“Normally, there was some water in the cave…, but this particular year that he discovered the lake, Ben Sands was able to go more and more into the cave because of a drought,” explained McClung. “Keep in mind, his only light was a lantern…. So, he made mud balls and threw them in all directions to see if he could hear them touching the sides of the walls. All he heard was the splashing of water; so he knew it was huge, but he had no idea how big.”

Others knew water existed below, but Sands’ discovery was dismissed until another drought occurred in the 1960s.

Although the caverns were opened as Craighead Caverns for a short time in 1927 for tours, the lake was still not ac-

knowledged. However, it was the first time electricity was used, and although very crude and exposed wires existed, it was an exceptional accomplishment.

“It was quite a feat to have electricity in the cave in 1927,” said McClung. “A lot of the homes in this area did not even have electricity.”

However, the cave closed during the Great Depression, and tourism stopped until the 1960s brought another drought.

A team exploring the possibility of opening the cave as a tourist attraction was able to also go beyond the opening leading to the lake and confirm what Sands had discovered years ago.

At 71 years-old, Ben Sands was finally recognized for his boyhood discovery of the lake. Local attorney Van Michael was very instrumental in developing and promoting the Lost Sea Caverns as a tourist attraction, and it opened in June of 1965.

Rumor has it that Sands was aboard one of the first tourist boat rides.

Although the Lost Sea is approximately 800 feet long and 220 feet wide, with depths up to 60 feet, it is believed that it may even be twice as large. However, it is simply cost prohibitive to explore and prove this.

When visitors tour the caverns and arrive at the actual underground lake, they are divided into groups and helped aboard glass-bottom, electronically-controlled boats.

To me and my husband, Brad, the whole experience was reminiscent of Andrew Lloyd Webber’s adaptation of “Phantom of the Opera,” when the phantom takes Christine under the Paris opera house on a boat ride through the underground caverns. Like the musical, as you embark on a boat ride through the lake, (CONTINUED ON PAGE 10)

AUGUST 2013

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AAOS Updates Clinical Practice Guidelines, continued from page 1 analysis in-house. However, the earlier guideline utilized synthesized data from three outside sources — the Agency for Healthcare Research and Quality, Osteoarthritis Research Society, and Cochrane Database of Systematic Reviews.

Both those who sell and manufacture HA, as well as a number of AAOS members, were specifically concerned about the issue of viscosupplementation, which garnered an ‘inconclusive’ recommendation in the first issue. Jevsevar said the committee was clear that a more vigorous internal review of the use of Dr. David S. Jevservar intra-articular hyaluronic acid could result in the same outcome, a stronger recommendation backing the use of HA … or a reversal recommending physicians not use the treatment option.

“When we actually did the analysis, that’s what happened,” he said of the reversal, which resulted in a ‘cannot recommend’ designation for the use of HA for patients with symptomatic OA of the knee.

“When you use clinical significance as your bar for recommendation — and we took the 14 best studies out there — it really doesn’t support the use of viscosupplementation, or HA,” he said. “Although a few individual studies found statistically significant treatment effects, when combined together in a meta-analysis, the evidence did not meet the minimum clinically important improvement thresholds.”

Jevsevar went on to explain there is a difference in statistical significance and clinical significance. He noted that on the clinical pain analysis where 0 is no pain and

10 is the worst pain, having patients move from a 9 to an 8.8 after treatment could be considered statistically significant but wouldn’t feel much different to the person with OA. “We use the higher bar of clinical significance,” he continued. ”We feel that’s the one most important to patients.”

Perhaps not surprisingly, the strong recommendation against the use of HA has created some pushback from physicians. “They feel like we have very few treatments for osteoarthritis that work so they are always concerned when we take one away,” he said. However, Jevsevar continued, “Doing something that is expensive and hasn’t been proven isn’t the right thing either.”

He said it’s hard to gauge the true effectiveness of various treatments in the clinical setting for a couple of reasons.

“Arthritis research is hard because osteoarthritis patients don’t have the same level of pain everyday,” he explained. “Many of those patients want to do anything but surgery, which is understandable,” Jevsevar continued. “They want the treatment to work, but that creates a placebo effect or bias for whatever is being used.” More research, he added, is certainly needed.

One concern for physicians using HA is that insurance companies will quit reimbursing for the treatment. “We synthesize the evidence, but we don’t make recommendations for insurance,” Jevsevar said. However, he admitted insurance companies could misapply the guidelines for financial purposes. Still, he noted, discontinuing reimbursement for viscosupplementation might not be to a payer’s benefit since it could drive more OA patients to opt for the much more expensive

Healthcare Leader, continued from page 4

ulation, which we do such a fabulous job here at ETSU, but also in regards to how they will see the medical landscape once they get out there. That’s really important in my mind,” explained Jernigan. “We have a unique opportunity to make a better physician—one that’s compassionate, one that will listen, but one who is also aware of the changes that are going on around him.”

Although he admits that gaps do exist in the current educational design, Jernigan emphasized that Quillen’s leadership is trying to keep their eye on the goal and do all that they can to produce a well-rounded, well-educated physician going out into practice prepared to make a difference, whether it’s with the patient that is right in front of her or with the population in which she lives.

Jernigan just celebrated his 30th wedding anniversary with his wife Linda, who retired as director of medical records from Mountain States Health Alliance (MSHA). “She is my rock,” he shared. And the couple’s three daughters are all grown, the oldest a PharmD, who graduated from the Mercer School of Pharmacy and currently works for MSHA, the second oldest, who graduated with a Master’s in Education and works in the Charlotte area, and the 10

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youngest, who just graduated from the University of Tennessee School of Law and is studying for the Bar Exam. “I’m very proud to say that between my three daughters, there are seven advanced degrees!” Jernigan is also the proud grandfather of five grandchildren, ranging in age from 17 months to 17 years.

Never one to stop learning or stop improving, in 1999 at the age of 50, Jernigan went back to college at ETSU to earn his Master of History degree, graduating with the class of 2005. “I really, really enjoy reading history,” he enthused. “My emphasis or what I would call myself, is a nineteenth-century historian. I like everything from the Louisiana Purchase to the annexation of Hawaii, and I also have a major interest in the American Civil War.” Jernigan also enjoys playing golf and participating in road races, the most recent of which was with his granddaughter through Girls on the Run. Although he enjoys a variety of recreational activities, “My first love is baseball, he shared, “and I’m known at the College of Medicine as somewhat of a baseball trivia expert.” When accused of being a “nerd,” he confessed, “In my spare time, I’ve been known to read The Baseball Encyclopedia.”

knee implant.

Furthermore, Jevsevar said treatment decisions should replicate the foundation of a three-legged stool — 1) the evidence, 2) physician expertise and experience, and 3) patient preferences and values. “You have to take all three into account when treating a patient. One doesn’t trump the other,” he said.

In addition to the controversial HA ‘no’ recommendation, the work group also reduced the recommended dosage of acetaminophen from 4,000 mg to 3,000 mg a day, which mirrors an overall change made by the Food and Drug Administration for individuals using acetaminophen for any purpose. In patients with symptomatic OA of the knee, Jevsevar said, “Actually, there’s not a lot of evidence to support the use of acetaminophen.”

Other important recommendations that remained the same in the revised guidelines included: • Patients who only display symptoms of OA and no other problems, such as loose bodies or meniscus tears, should not be treated with arthroscopic lavage.

• Patients with a body mass index (BMI) greater than 25 should lose a minimum of five percent of their body weight.

Jevsevar noted telling patients to lose weight and get active are “tough discussions” to have but important ones. Low impact exercises including swimming, walking and using an elliptical machine have been proven effective to slow the progression of OA of the knee.

The work group strongly recommended against the use of glucosamine and/or chondroitin sulfate or hydrochloride and against the use of acupuncture.

A “strong” strength of recommendation means the quality of the supporting evidence was high with an implication that practitioners should follow strong recommendations unless a clear and compelling rationale for an alternative approach exists. Jevsevar added the ‘no’ recommendations were based on a lack of efficacy rather than a potential for harm. The group also had a moderate recommendation against custom lateral wedge insoles.

A moderate recommendation also is compelling, but the quality or applicability of

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the existing evidence is not as strong.

Due to a lack of research, the CPG was unable to recommend for or against the use of physical agents including electrotherapeutic modalities, manual therapy, bracing, growth factor injections and/or platelet rich plasma.

In the second edition, all included studies had to have a sample size of at least 30 participants and a follow-up period of at least four weeks. More than 10,000 separate pieces of literature were reviewed during the evidence analysis phase. When completed, Jevsevar said the updated OA knee CPG was subjected to the most extensive peer review to date for any AAOS CPG. Ultimately, 16 peer reviewers representing multiple specialty societies submitted formal reviews. “Each meticulously dissected the final recommendations of the document and, based on their well-informed and insightful comments, important changes were made to the final document,” Jevsevar said in an AAOS editorial.

For more information on the second edition OA knee CPG, go online to: www.aaos.org/research/guidelines/ GuidelineOAKnee.asp

Enjoying East Tennessee, continued from page 9

everything has a glow, and we could almost hear the music.

Of course, when the infamous rainbow trout approached our boat for a daily feeding, we also thought of the music from the movie “Jaws!”

“After the tours had been going for a year or so, they decided to put the fish in as an experiment just to see how they could survive down there,” said McClung.

“They really were curious to see if the fish would come out anywhere, and they did not. They realized that the fish were contained, and the water was not going out into streams nearby.”

The fish have been a hit, and they are continually stocked. According to McClung, the rainbow trout do not reproduce because the lake does not have a needed swift current, and the slick clay bottom prohibits egg attachment. To prevent over feeding, food is always monitored.

The Lost Sea Adventure is truly a Tennessee treasure. Although McClung has been an employee for over 25 years, you can still hear the passion in her voice.

“I love the Lost Sea, and it’s a part of me” explained McClung. “If we have this huge lake down here, what else is out there that we don’t even know about?”

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

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.com

LegalMatters

BY ERIN B. WILLIAMS

New Legislation Means More Changes to Controlled Substance Prescribing Laws Named after Addison Sharp, a young Knoxville resident who overdosed on prescription medications in 2012, the Addison Sharp Prescription Regulatory Act of 2013 (“2013 Act”) yet again changes the laws relative to controlled substance prescribing and pain management clinics.1 A sponsor of the legislation, Senator Ken Yager, described prescription drug abuse as an epidemic in Tennessee, and the new legislation was designed to tighten the regulations on prescribers and pain management clinics.2 Below is a brief summary of the important changes created by the new law, most of which become effective October 1, 2013.

Changes to the CSMD Laws In 2012, the Tennessee General Assembly passed the Tennessee Prescription Safety Act of 2012 (“2012 Act”), which required prescribers to register in the Controlled Substance Monitoring Database (“CSMD”) by January 1, 2013.3 As of April 1, 2013, prescribers (or their designated healthcare practitioner extenders) were required to check the CSMD before prescribing an opioid or benzodiazepine as a new course of treatment lasting more than seven days and then at least annually during the course of treatment, unless an exception applied.4 Effective immediately, the 2013 Act adds an exception to checking the CSMD for patients to whom a controlled substance is directly administered during the course of inpatient or residential treatment in a hospital or nursing home.

The 2013 Act further amends portions of the 2012 Act by permitting a prescriber to authorize his or her designated healthcare practitioner extender to check the CSMD for other prescribers in the same practice. However, prescribers remain responsible for the acts of their designated healthcare practitioner extenders. Prescribers are also responsible for revoking an extender’s access to the CSMD immediately at the end of the extender’s relationship with the prescriber.

Pain Management Clinics Perhaps most significantly, the 2013 Act expands the definition of “pain management clinic” to include: (1) privatelyowned practices in which a majority of the patients are issued a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol for more than 90 days in a 12-month period; and (2) any privately-owned clinic, facility, or office which advertises in any medium for any type of pain management services and in which at least one employee prescribes controlled substances.

Further, the penalties for the operation of an uncertified pain management clinic have significantly increased under the 2013 Act to at least $1,000 per day (not to exceed $5,000 per day) for each day a practice meeting the definition of a pain management clinic operates witheasttnmedicalnews

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out certification. The expansion of the definition will require more practices to obtain certification as a pain management clinic, and with such certification the practice is required to comply with additional laws, rules, and regulations.

Practitioners who do not prescribe controlled substances to a majority of their patients and who do not wish to register as a pain management clinic should carefully review their practice’s advertising and promotional materials to ensure the materials do not unintentionally cause the practice to fall within the definition of a pain management clinic, especially considering the increased penalties associated with the operation of an “uncertified” pain management clinic.

Treatment Guidelines The 2013 Act requires the Commissioner of the Department of Health to develop recommended treatment guidelines for the prescribing of opioids, benzodiazepines, barbiturates, and carisoprodol to be utilized by the prescribers in Tennessee. The health-related licensure boards are charged with reviewing the guidelines and recommending to its licensed prescribers how to incorporate such guidelines into their practice.

Also, as part of the 2013 Act, prescriptions for opioids or benzodiazepines may not be dispensed in quantities greater than a 30-day supply. Prescribers, however, may still write prescriptions for greater than 30 days.

Continuing Education Requirements Beginning on July 1, 2014, all prescribers with DEA numbers who prescribe controlled substances will be required to complete a minimum of two CME hours related to controlled substance prescribing biennially. The CME must include instruction on the Department of Health’s treatment guidelines for controlled substances, but may also include other topics approved by the health-related boards.

1. 2013 Tenn. Laws Pub. Ch. 430 (SB 676).

2. See “Addison Sharp Prescription Regulatory Act Gains Committee Approval,” The Chattanoogan.com (Friday, March 29, 2013).

3. For a summary of the 2012 Act see “New Laws for Controlled Substance Prescribing in Tennessee,” East Tennessee Medical News, September 2012.

4. For a summary of the laws requiring providers to check the CSMD, see “Tennessee Providers Now Required to Check Controlled Substance Monitoring Database, East Tennessee Medical News, April 2013 Erin B. Williams is an attorney practicing at London & Amburn, P.C. Her practice includes medical malpractice defense and health law issues, such as board investigation defense and regulatory compliance. For more information on the CSMD or other health law matters, you may contact Ms. Williams by visiting .

Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

Inflammatory Bowel Disease and Pediatric Patients In the past few years, we have seen more and more pediatric patients with Inflammatory Bowel Disease (IBD). IBD is a chronic disorder characterized by autoimmune-related inflammation of the lining of the digestive tract including the colon and intestines, and includes both Crohn’s Disease (CD) and Ulcerative Colitis (UC). CD inflammation can spread deep into the layers of the affected bowel tissue, while UC usually affects only the innermost lining of the colon. While the exact cause of IBD is unknown, it may occur at any age, in both males and females, and the disorder often runs in families, although a person can develop it even though no other family members have it.

At GI for Kids, PLLC, our providers may suspect a child has IBD based on his/her medical history and presenting signs and symptoms, but testing is needed to confirm the diagnosis. Common symptoms of IBD include diarrhea or constipation, abdominal pain, loss of appetite and weight loss, delayed growth, vomiting, skin rash, joint pain, fever, and bleeding in the digestive tract.

If a child presents with some or all of these signs and symptoms, our providers will perform one or more diagnostic procedures to help confirm or rule out IBD. These diagnostic tests include blood tests, stool samples, magnetic resonance enterography (MRE), CT enterography, capsule endoscopy, upper endoscopy (also called esophagogastroduodenoscopy or EGD), and colonoscopy. Capsule endoscopy is new technology that makes it possible for children with IBD to be diagnosed earlier, often preventing a child’s condition from drastically deteriorating before being diagnosed. We perform EGD and colonoscopy procedures in our state-of-the-art endoscopy suite located in East Tennessee Children’s Hospital, where we have complete access to specialized pediatric anesthesiologists and nurses.

Once IBD has been confirmed, our goal for treatment is to reduce the inflammation causing damage to the intestines.

Our clinic has a multidisciplinary approach to treating IBD. We treat the whole patient, including their families, by providing a variety of professional services, including multiple medical providers, dieticians, behavior health providers, a hospital inpatient practitioner, and a medical infusion nurse specialist. Since IBD, and particularly CD, is often associated with poor digestion and malabsorption, children with IBD may benefit from seeing one of our dieticians for nutritional support and assistance with diet modification.

Our behavior health providers can offer support, advice, and help with emotional and psychological

issues related to adjustment to illness, depression, anxiety, and school attendance. They can also assist with pain management by teaching relaxation techniques and distraction strategies, thus reducing the need for pharmaceutical pain management.

Our clinic also offers in-office Remicade infusions, which enables us to provide more convenient and timely infusions as well as giving the child less exposure to potential contagious illnesses compared to a hospital setting.

Unfortunately, it is not unusual for our IBD patients to require inpatient hospital care, and our inpatient practitioner will collaborate with our team of professionals to ensure that our patients receive thorough, comprehensive, and timely care during any hospital stay. This synthesis of care has proven to be a great benefit to our patients as they frequently achieve remission in a shorter period of time and often avoid dependence on long-term steroid treatment.

Also during the past few years, GI for Kids, PLLC, and Dr. Youhanna S. Al-Tawil realized there was a great need in the community to support our children and families coping with IBD. KidsFACT (Kids Fighting Against Crohn’s and Colitis Together) was created out of the recognition of this need. KidsFACT is a nonprofit support group to help kids and families with IBD through support and advice. The mission of KidsFACT is to help make strides towards improved quality of life and advance knowledge in order to contribute to better treatments and, ultimately, a cure. The mission is achieved through education, family support, and research. KidsFACT raises awareness of the disorder and funding through an annual golf tournament and rodeo. Anyone can join the KidsFACT discussion forum where helpful advice and support from others with IBD is available by visiting their website at www. kidsfact.org.

GI for Kids, PLLC, also performs clinical research and participates in clinical trials. Data from the research has been presented at national conferences.

If you have young patients struggling with IBD, we hope you will consider the services we provide. Please contact our clinic at (865) 546-3998 to make a referral for a comprehensive consultation or visit our websites at www.giforkids. com and www.kidsfact.org.

www.giforkids.com • 865.546.3998

AUGUST 2013

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GrandRounds USA Today features HMG’s William Bestermann, MD, as success story in “treating obesity” KINGSPORT – The USA Today July 4, 2013 article “Obamacare requires most insurers to tackle obesity” highlights HMG internal medicine physician William Bestermann, MD, as a success story “when it comes to treating obesity,” noting that some doctors, like Bestermann, are “ahead of the curve.”

According to Bestermann, and the USA Today article, a survey of 500 of Bestermann’s patients found that they had successfully lost, on average, 25 pounds each.

How did they do it?

“We don’t talk about calories or amounts. I tell them to cut back on rolls, biscuits, breads and corn bread, sugar, white potatoes and fat,” noted Bestermann, who serves as the director of chronic condition management at HMG. “I recommend they eat lean meats, eggs, low-fat dairy, seafood, beans, fruits, and vegetables.”

With many of Bestermann’s patients having type 2 diabetes or pre-diabetes, Bestermann’s efforts to encourage weight loss are motivated by the tangible health results his patients will experience. To aid success, Bestermann provides his patient’s nutrition information and recommends helpful resources such as the book, The South Beach Diet.

The USA Today article focuses on new obesity screening and counseling requirements covered under a preventive services benefit of the Affordable Care Act. The full article is available online at usatoday.com or via this URL address: http://www.usatoday.com/story/news/ nation/2013/07/04/obesity-disease-insurance-coverage/2447217/

ETSU gains approval to offer PharmD-MBA degree option JOHNSON CITY – East Tennessee State University has received approval to offer a degree option that includes the Doctor of Pharmacy and Master of Business Administration (PharmD-MBA), putting ETSU in a select group of universities nationwide that offer this option to student pharmacists.

The Tennessee Board of Regents granted approval for the articulated curriculum, developed between ETSU’s Bill Gatton College of Pharmacy and the ETSU College of Business and Technology, which enables pharmacy students to pursue concurrently the PharmD and MBA degrees beginning in fall 2013. According to the American Association of Colleges of Pharmacy, the Gatton College of Pharmacy is one of only 14 institutions nationwide that offers students the PharmD-MBA and another degree option, the Doctor of Pharmacy and Master of Public Health (PharmD-MPH). ETSU began offering the PharmD-MPH in 2012.

Members of the Gatton College of Pharmacy Class of 2017 will be the first ETSU students eligible for enrollment in the program.

Quillen appoints Geraci as chair of Internal Medicine JOHNSON CITY – East Tennessee State University’s James H. Quillen College of Medicine has appointed Dr. Stephen Geraci as professor and chair of the ETSU Department of Internal Medicine.

Geraci comes to ETSU from the University of MisDr. Stephen Geraci sissippi School of Medicine in Jackson, where he served as professor and vice chairman of internal medicine. A

practicing cardiologist, Geraci is boardcertified in internal medicine and cardiovascular diseases.

Geraci has extensive experience at prestigious institutions in addition to the University of Mississippi School of Medicine, where his other posts included professor of medicine in the Division of Pulmonary, Critical Care and Sleep Medicine and director of Clinical Research and Faculty Development. He established the faculty development program at University of Mississippi Medical Center and also served five years as chief of medicine at G.V. Montgomery Veterans Affairs Medical Center in Jackson.

A graduate of Jefferson Medical College in Philadelphia, Geraci completed his internship and residency in internal medicine at Columbia-Presbyterian Medical Center in New York. He then entered fellowship training in cardiovascular diseases at the University of Texas Health Sciences Center in Houston, and did additional work in critical care medicine at the University of Pittsburgh’s Presbyterian University Hospital.

Geraci then finished an additional two-year fellowship in clinical pharmacology with the U.S. Food and Drug Administration/Uniformed Services University of the Health Sciences Cooperative Program in Maryland.

Steven Miller Named CFO At Takoma GREENEVILLE – Steven Miller, who has more than a decade of progressive healthcare finance experience, has been named the new chief financial officer at Takoma Regional Hospital.

Miller graduated from Southern Adventist Uni- Steven Miller versity in Collegedale with a bachelor’s degree in accounting. He

Mark Your Calendar

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

2ND THURSDAY

3RD THURSDAY

JOHNSON CITY MGMA MONTHLY MEETING

KINGSPORT MGMA MONTHLY MEETING

Date: The 2nd Thursday of Each Month Time: 11:30 AM – 1:00 PM

Location: Quillen ETSU Physicians Clinical Education Building, 325 N. State of Franklin Rd., Johnson City August’s topic: OSHA Update with Todd Reeves

Date: The 3rd Thursday of Each Month Time: 11:30 AM – 1:00 PM Location: Indian Path Medical Center Conference Room, Building 2002, Second Floor, Kingsport August’s topic: “Motivating and Coaching to Retain Quality Personnel” by Phillip Dickey, Doctors’ Management Jenny Harvey

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

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served as CFO for Seven Rivers Regional Medical Center in Crystal River, Fla., for the past five years. Miller also has experience with Adventist Health System in their Midwest Region, where he worked for six years.

Miller is filling a position vacated when Tom VandenHoven moved to California to be closer to family.

Miller was born in Orlando, Fla.; grew up in rural Alabama; and fell in love with Tennessee while going to school in Collegedale.

Miller and his wife, Nuryhan, have three children: Emma, 4; Simon, 8; and Nicolas, 10. The family enjoys outdoor activities, including hiking.

Kotay Retires, Leaving Extensive Legacy as Surgeon at Mountain View Regional and in Southwest Virginia NORTON, Va. – When Dr. Sreenivasan Kotay first visited Southwest Virginia in the 1970s, he was serving as a chauffeur of sorts for a fellow physician establishing a practice in the region.

He would return a few years later to establish his own orthopedic surgery practice and become a beloved physician who made a tremendous difference in the quality of life for thousands of patients.

Fellow physicians, other caregivers, and administrators of Mountain View Regional Medical Center celebrated Kotay’s outstanding contributions to the hospital and the region at a special ceremony Wednesday, June 19. After 34 years of making Southwest Virginia patients feel better, Kotay is retiring to pursue more leisurely activities.

In addition to improving people’s lives, this Wellmont Medical Associates Orthopedics physician has made his mark on Mountain View Regional. He served as chief of staff for two years and as chief of surgery for four years and as a member of the Mountain View Regional board of directors for about seven years.

Kotay went to Calicut Medical College in the city of Kozhikode in Kerala, India. After completing a residency there, he obtained his master’s degree in orthopedic surgery from Central Institute of Orthopedics in New Delhi, India. He then came to New York and completed a residency in orthopedic surgery at Maimonides Medical Center in Brooklyn.

Kotay has been board-certified in orthopedic surgery since 1978.

Germ-zapping robot enhancing patient safety at Johnson City Medical Center JOHNSON CITY – As hospitals across the nation look for new and innovative ways to battle deadly pathogens and kill multi-drug resistant organisms that put patients at risk, Johnson City Medical Center (JCMC) has taken a leap into the future with the installation of two germ-zapping robots that eliminate hardto-kill bugs in hard-to-clean places.

The two Xenex robots, affectionately named “Gizmo” and “The Germinator” easttnmedicalnews

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GrandRounds

by JCMC team members, use pulsed xenon ultraviolet (UV-C) light that is 25,000 times more powerful than the sun to destroy harmful bacteria, viruses, fungi, and even bacterial spores. The system is effective against even the most dangerous pathogens, including Clostridium difficile (C. diff), norovirus, influenza, and staph bacteria, including methicillin-resistant staphylococcus aureus, better known as MRSA. The Xenex system can disinfect a room in minutes and is easily portable, allowing it to be used in virtually any location within the hospital. JCMC is the first hospital in Tennessee to implement the Xenex system, which has been credited for helping other healthcare facilities in the U.S. decrease their MRSA and C.diff rates.

Because the Xenex robot uses UV light, it is able to reach every surface in the room, and it does not leave a chemical residue. Each treatment takes about 5 minutes. To disinfect a room after standard cleaning procedures are complete, hospital team members wheel the Xenex robot into the room, position it beside the bed, begin the automated sequence, and then leave the room. A sign is placed outside the room warning people not to enter while the robot is in operation, and a motion sensor on the robot automatically shuts off the machine if anyone should enter. The process is then repeated on the other side of the bed and in the bathroom, for a total of 15 minutes to thoroughly clean each room.

in their care regimens.

For more than a decade, they have relied on those prayers, as well as his impressive oncology skills and special brand of patient-centered care, to Dr. David Miller help them tackle one of life’s toughest health battles.

Now, after nearly 40 years of improving patients’ lives, Miller is retiring in September.

When Miller accepted a position in 2000 at the cancer center – at that time a small, brick building in downtown Norton – he brought those prayers with him.

And Miller saw that small brick building grow into an 11,000-square-foot, state-of-the-art facility that delivers superior cancer treatment options in a convenient location.

He also observed the smaller staff blossom to now include such dedicated caregivers as Dr. Daryl Pierce and Dr. Hayan Moualla, who are medical oncologists and hematologists; Dr. Byron May and Dr. Scott Coen, who are radiation oncologists; and oncology nurse practitioner Kelley Mayden. All five physicians are medical doctors, while Mayden has special training in oncology. Working together, these medical experts will continue the tradition of outstanding care close to home for Southwest Virginia residents.

Upcoming Concert to Raise Funds for Cancer Patient Assistance Fund at Bristol Regional Medical Center

JOHNSON CITY – Google chose a small number of “explorers” to test the next wave in computers, and one of those beta testers is a professor at East Tennessee State University who is incorporating Google Glass into medical education at the James H. Quillen College of Medicine. Google Glass is a wearable computer with an optical, head-mounted display.

Dr. Martin Olsen, director of the med-

BRISTOL — A September concert is one more link in the supportive chain a local business owner and the Wellmont Cancer Institute are using to help lift local cancer patients who have potentially burdensome everyday expenses.

To help provide funds to those patients in need, The Now Fund concert, sponsored by Crooked Road General Store owned by Marla Edwards, is bringing Mark Lowry to Bristol’s Paramount Theatre on Sept. 7.

Tickets for the show are $30 in advance and $35 at the door. They can be purchased in advance by calling the Paramount at 423-274-8920 or visiting etix. com.

Proceeds from the concert go into the No Worries (NOW) fund administered

by Wellmont Foundation. The cancer institute works with the foundation to distribute the money to those who need financial help for emergency and personal needs during their treatment at Bristol Regional Medical Center.

Southwest Virginia Oncologist Prepares to Say Farewell

NORTON, Va. – Patients at the Southwest Virginia Cancer Center affectionately call Dr. David Miller “the praying doctor” for his incorporation of divine assistance easttnmedicalnews

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Google Glass: ETSU professor uses scarce, high-tech tool in medical education

ical residency program in the ETSU Department of Obstetrics and Gynecology, is already using Google Glass in conjunction with Surgical Chloe™ – a full-body, high-fidelity surgical simulator developed via a partnership between ETSU and Gaumard Scientific – to teach medical residents and students at the College of Medicine.

Olsen is one of only 8,000 people worldwide selected for a program Google calls “Google Glass explorers.” He traveled in June to New York City to buy this tiny computer that looks like high-tech eyeglasses. The device isn’t expected to be made available to the public until 2014.

Olsen said there are other physicians who are using Google Glass, but as far as he knows, ETSU is one of the very few institutions where the device is being used for medical education.

Google held an open contest where participants could make a case, through a short essay, why they should become a Google Glass explorer. Olsen is well versed in medical terminology and technique, but he turned to the language of poetry to convince Google that its wearable computer could enhance the training of doctors – especially through the hands-free ability to make video recordings of simulated surgical procedures and interactions with patients. The device is operated by user voice commands such as “OK, Glass, record a video” and “OK, Glass, take a picture,” or by touching a pad on the side of the unit.

Essays could be no more than 50 words or 140 characters and must include the hashtag #ifihadglass. Olsen called his winning entry “bad poetry,” but Google judged otherwise.

He wrote: Med students in the nation Would get great surgical simulation Improvements in patient care

Could be found in hospitals everywhere All this could come to pass #ifihadglass

Olsen said Google Glass dovetails seamlessly in teaching with Surgical Chloe™, a surgical simulation manikin that was developed and created by Olsen and other ETSU faculty members.

Gaumard Scientific, which specializes in manufacturing simulators for health education, was so enthusiastic about the possibilities of pairing Google Glass with Surgical Chloe™ and its other simulators that the company supported Olsen’s efforts to be part of the explorer program.

Olsen said Google Glass became a vital part of learning in its first week of use alongside Surgical Chloe™ in the ETSU Human Patient Simulation Lab at Quillen.

The physician maintains a Google+ site – tagged Chloe Glass – where he posts narrative and video updates that illustrate this new technology and its influence on medical education. Residents in the OB/ GYN program have worn the glasses to record video during a simulated surgery, while Olsen and other faculty members can monitor that surgery in real-time from a remote monitor.

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.

Save the Date: KAMGMA Fall Conference is set for September 19th at the Knoxville Marriott “Change…..the Only Constant” AUGUST 2013

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GrandRounds Wellmont One Air Transport, Sullivan County Emergency Medical Services Receive Statewide Award KINGSPORT – Highly skilled emergency care from experienced medical professionals aboard WellmontOne Air Transport and Sullivan County Emergency Medical Services has repeatedly improved patient lives in the region and earned the respect of their peers in Tennessee.

For the third time in five years, WellmontOne received the 2013 EMS Star of Life award, and it has once again been joined on the stage by Sullivan County EMS. This year’s award recognized the two agencies’ efforts in 2012 to save the life of a man involved in a twovehicle wreck.

The award was recently presented in Nashville to crew members from WellmontOne and Sullivan County EMS by the Tennessee Emergency Medical Services for Children. The goal of the EMS Star of Life award is to recognize exemplary front-line care provided by agencies and providers to children and adults.

Deployed Wellmont Executive Assisting Naval Intelligence Operations in Afghanistan KINGSPORT – For three years, Kent Petty has used his spirit to serve to help develop Wellmont Health System’s electronic medical records initiatives and implement other essential information systems programs to benefit patients.

A Wellmont vice president and chief information Kent Petty officer, Petty is now taking that dedication to Kabul, Afghanistan, where he will command the Joint Intelligence Operation Center.

Petty is a commander in the U.S. Navy Reserve and is being deployed to that country to assist a team of intelligence analysts in transforming raw data into vitally important military intelligence.

The assignment calls for Petty to serve in Afghanistan for a year, taking him away from his day-to-day duties in Wellmont’s information systems department.

Petty has served in the Navy Reserve for nearly 30 years, being deployed for seven of them. He was deployed as part of Operations Desert Shield and Desert Storm during the first Iraq war and as part of Operation Enduring Freedom following the 9/11 attacks. His reserve unit also assisted with Operation United Response, which provided relief in Haiti following a 2010 earthquake.

Recognizing the vital and advancing role information technology plays in healthcare, Wellmont recently welcomed William Showalter to its executive leadership team. As senior vice president of information technology, Showalter will have extensive leadership responsibility in a variety of areas. And as part of his position, Showalter will oversee the department of information technology and perform the

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duties of chief information officer during Petty’s absence.

He has held similar positions at a variety of healthcare institutions in the Eastern United States for the last 20 years. He holds Bachelor’s and Master’s degrees from the University of Pittsburgh.

HEAL Appalachia announces winners of two ‘5210’ community grants JOHNSON CITY – Thanks to HEAL Appalachia, the students at St. Mary’s Catholic School in Johnson City and the kids at Smart Beginnings Wythe Bland in Wytheville, Va., will be learning more about healthy lifestyles.

With the help of funding from Mountain States Health Alliance (MSHA) and United Way Virginia Highlands, HEAL (Healthy Eating Active Living) Appalachia is awarding two community grants, each in the amount of $5,210, to these two community groups.

The program at St. Mary’s Catholic School will be spearheaded by its Wellness Council and will focus on several environmental changes throughout the school to cultivate a culture of health. The environmental changes include a redesign of the school cafeteria menu to promote healthful foods that have been taste-tested and approved by its students, a school-based garden, reduction of screen time and additional support of its Kids Run the Nation student running program.

Smart Beginnings Wythe Bland also has proposed a program that encourages a healthier learning environment by promoting active play, reducing screen time, limiting sugared drinks and candy and making fresh fruits and vegetables available for both Smart Beginnings students and staff. Smart Beginnings plans on partnering with its local farmers’ market to provide workshops on container gardening and preparing healthy foods for its students and their parents.

Mountain States Health Alliance and United Way Virginia Highlands jointly announced the funding opportunity for the additional two $5,210 grants at the symposium. The focus of the HEAL Appalachia Community Grant program is to inspire, promote and create models for successful grassroots programs that promote the healthy eating and active living tenets that are central to HEAL Appalachia’s mission to wane the epidemic of childhood obesity in Northeast Tennessee and Southwest Virginia.

For more information about HEAL Appalachia, visit www.healappalachia. com.

ETSU pediatricians develop unique baby book to encourage healthy, active living JOHNSON CITY – Pediatricians at East Tennessee State University’s James H. Quillen College of Medicine have designed a unique, keepsake baby book that is being given to new parents to help encourage healthier living for families

and their young children.

New parents are being given the “ReadNPlay Baby Book” during office visits to Quillen ETSU Pediatrics. The book is one component of an overarching ETSU Pediatrics program, ReadNPlay for a Bright Future, which encourages healthy, active living during well-child visits in the first 18 months of life.

The baby book is funded by a grant from the American Academy of Pediatrics (AAP) and MetLife Foundation. The ETSU Department of Pediatrics shared the $25,000 award with the Tennessee Chapter of the AAP. Dr. Karen Schetzina, an associate professor of Pediatrics and director of Community Pediatrics for ETSU, is the project director for ReadNPlay. ETSU was one of six sites nationwide to receive the AAP/MetLife grant.

Two resident physicians from the Department of Pediatrics, Drs. Jessica Albright and Eun Kyung Song, got the project started, Schetzina said. Albright recognized an opportunity to apply for AAP funding to promote healthy, active living among families with young children, and Song suggested the creation of a baby book to spearhead the project.

The emphasis on looking at books together and being active as a family builds on Reach Out and Read, a reading program at the ETSU Department of Pediatrics clinic.

“The message about reading is reinforced by the fact that it is coming from the pediatrician,” said Dr. Gayatri Jaishankar, associate director of the ETSU Pediatric Residency Program. “It is exciting that by the age of 5 our patients have a library of at least 15 books that we have given them.”

Schetzina said the baby book project – from conception to design and distribution to parents – could not have occurred without the work of many organizations and individuals who collaborated with the Department of Pediatrics. Those include the Appalachian Association for the Education of Young Children, Niswonger Children’s Hospital, the Tennessee Department of Health, the Johnson City Public Library, BABE Breastfeeding Coalition of Northeast Tennessee, the ETSU Department of Psychology and the ETSU Claudius G. Clemmer College of Education.

For more information, email Schetzina at schetzin@etsu.edu or visit www. readnplay.org. ReadNPlay is also on Facebook and Twitter.

East TN Medical News Follow us on Twitter

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