Tri Cities Medical News July 2013 by FW Publishing

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PHYSICIAN SPOTLIGHT PAGE 2

David Hecht, MD ON ROUNDS HEALTHCARE LEADER: Troy Sybert, MD As a young resident in Louisiana, Troy Sybert, MD, was given a gift—a jar of Mayhaw jelly— from one of his patients. Made from the berries of Hawthorne trees, this jelly is considered a rare, special treat ... 4

CLINICALLY SPEAKING: New Nursing Specialty is Improving Care for Bariatric Patients Morbid obesity affects an estimated 1 in every 50 American adults. An individual is considered morbidly obese if he or she has a Body Mass Index (BMI) of 40 or more ... 9

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The Move to DNP

Nurses embrace advanced degree program to address the increasingly complex healthcare practice environment By cINDy sANDERs

In October 2004, member schools of the American Association of Colleges of Nursing (AACN) voted to endorse the organization’s position statement calling for the transition of the level of preparation needed for advance practice nursing from the master’s degree to the doctorate level by 2015 through the addition of the DNP — Doctor of Nursing Practice. “Will we have all of our APRN programs transition to DNP by the 2015 deadline? Probably not … but we will have a critical mass that are,” said Jane Kirschling, PhD, RN, FAAN, dean of the School of Nursing for the University of Maryland who serves

as 2012-2014 board president for AACN. “I feel like we’ve reached the tipping point,” she added. Indeed, the growth of DNP programs nationwide has been remarkable. By spring 2013, programs existed in 40 states and the District of Columbia. “We are extremely pleased that we currently have 217 Doctor of Nursing Practice programs up and running in the United States. If you go back to 2004, we only had seven programs,” Kirschling noted. “In addition, we have 97 new programs under development.” She added enrollment has jumped from 170 DNP students in 2004 to 11,575 last year. (CONTINUED ON PAGE 11)

Recruiting in an Era of Reform New Landscape Requires Different Leadership Skills By cINDy sANDERs

As healthcare continues to transform and evolve, the skill sets needed to be an effective leader and provider are changing, too. From HIPAA and HITECH to the Affordable Care Act, the regulatory and reimbursement environments have impacted the recruiting process by demanding that physicians, nurses and management teams be able to provide the best outcomes in the most efficient manner possible. “The hospital model is changing so those leaders don’t look the same anymore,” said Brian Kelley, a partner with The

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Buffkin Group, LLC. “You better have a deep bench,” he continued of the need to have an executive team with different areas of expertise. Just as the ideal applicant is changing, the most effective way to recruit that candidate is also undergoing a transformation. “We’re doing a lot of things differently than we did five or six years ago,” noted Susan Masterson, national vice president of provider recruitment for TeamHealth. “The day of placing an ad and waiting for the right candidate to appear is long gone.” As for the true impact of health reform on job recruitment, the experts all agreed that has yet to fully play out. “We’re building (CONTINUED ON PAGE 10)

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PhysicianSpotlight

David Hecht, MD sponded Hecht, when asked what

recalled Hecht. “I took care of a surgeon’s

he likes most about his job. “I also

daughter from Elizabethton while I was in

For most physicians, moon-

enjoy being able to affect many vet-

Jacksonville; she was in a bad car accident.

lighting wouldn’t be a possibility,

erans care, as opposed to just indi-

So he invited me to take a look up here.”

with demanding, on-call sched-

vidual care.”

By BRIDGET GARLAND

Hecht entered private practice for

ules, but David S. Hecht, MD,

Hecht grew up in Cranford,

almost 8 years, as a solo general surgeon

MBA, doesn’t have a choice.

New Jersey, but moved to the South

at first, but eventually created a multispe-

As dad to two young daugh-

when he attended the University

cialty group—Mountain Empire Medical

ters, he jokingly calls transport-

of Virginia, receiving a Bachelor’s

and Surgical Associates, PLLC. When an

ing them to soccer practice and

degree in Psychology in 1992. As

opening for the Chief of General Surgery

horseback lessons his second job.

a student, he had always loved sci-

at Mountain Home VA became available,

“That’s what takes most of my

ence, so he knew for a long time that

he applied and was selected for the posi-

time outside of work,” shared

a physician was what he wanted to

tion. He served in that capacity for two

Hecht, Chief of Staff at Moun-

be. So after graduating, Hecht at-

years, and then became Chief of Surgery,

tain Home VA Medical Center.

tended the University of Medicine

until being appointed to his current posi-

“Every weekend it’s something;

and Dentistry of New Jersey/Rob-

tion of Chief of Staff.

we are always traveling, even

ert Wood Johnson Medical School

While serving as Surgery Chief,

recently as far as Chattanooga,

and completed a general surgery

Hecht assisted with significant process im-

Nashville, and Memphis.”

residency at the University of Flor-

provements in the OR and surgical wards,

ida and Shands Hospital in Jack-

as well as worked on quality improvement

But as the doting father of Emma and Caroline, Hecht doesn’t seem

sector,” he explained. “It’s part of an ex-

sonville, finishing in 2001. He was Chief

initiatives as measured by the National

to mind the extra responsibility, as do

ecutive leadership team that decides the

Resident and received the Emmett F. Fer-

Surgical Quality Improvement Program.

most proud fathers, and is thankful that

course of the facility and its outlying loca-

guson, Jr., Award for Outstanding Surgi-

“I really couldn’t have done what I’ve

his schedule affords him the opportunity.

tions, which consists of the director, the as-

cal Resident. “I choose surgery because

done without my family’s support,” he ac-

Come Monday mornings, however,

sociate director, the chief of staff, and the

of its very hands-on approach,” he said.

knowledged.

Hecht is back to his primary job, either

director of nursing services. Then we must

“And for the more immediate gratification

“I am very excited about the VA’s

at his desk, in clinic, or in the operating

report to a regional office in Nashville,

in terms of healing patients of the prob-

role in guiding the future of healthcare,”

room, as his position of Chief of Staff has

and they then report to Washington.”

lems for which they present.”

shared Hecht. “At our facility, we per-

him wearing several different hats. Ap-

Although he is grateful for the op-

It was while he was in medical school

form many types of general and vascular

pointed to the position in July 2012, Hecht

portunity to serve, he admitted that the

that Hecht met his wife Rachel, who is

surgery, but what we can’t provide at our

is responsible for all clinical issues that af-

position isn’t without its challenges. “It is

now a pediatrician in Elizabethton. The

facilities, such as cardiothoracic surgery,

fect the medical staff and for overseeing

very challenging to coordinate the goals of

couple trained together in Jacksonville,

we work closely with our partners to co-

the clinical, teaching, and research ser-

Washington with the goals of the facility

and when it came time to find a place to

ordinate care.

vices provided by it. In addition, he serves

level,” he said.

settle, they looked to compromise. “My

“Surgery’s movement toward more

as Clinical Associate Professor of Surgery

In addition to his administrative

wife is from New Orleans, and I am origi-

minimally invasive surgeries and robotic

at East Tennessee State University’s James

tasks, Hecht continues to operate one day

nally from New Jersey, and there were

surgery is also very exciting,” he contin-

H. Quillen College of Medicine.

a week and to see patients in clinic one

not many general surgery opportunities

ued. “It allows us to get patients back on

day a week.

when I graduated, so we decided to go

their feet a lot sooner.”

“The chief of staff position here is very unique, as compared to the private

“I really like problem solving,” re-

geographically between the two families,”

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Enjoying East Tennessee

Music at the Mansion - Allandale Amphitheater and Symphony of the Mountains By LEIGH ANNE W. HOOVER

Facing picturesque Bays Mountain, Allandale Mansion in Kingsport, Tennessee, sits beneath a canopy of trees hugged by boxwoods on 500 acres of grandeur. Reflecting the exquisite opulence of a bygone era, the Allandale ambience is quite simply unrivaled. Originally the home of Harvey and Ruth Brooks, Allandale Mansion was gifted to the City of Kingsport upon his death in 1969. One of the conditions of Brooks’ will was that Allandale “shall be open to the public and held for public use and benefit.” In 1983, the city government supported a group of citizens in their efforts to renovate the facilities and develop the usage of the facility. The organization is Friends of Allandale (FOA). In addition to ongoing efforts supporting Allandale, FOA is now proudly celebrating the long-awaited inaugural opening of the Amphitheater at Allandale Mansion with “Music at the Mansion” by the Symphony of the Mountains on Sunday, July 28, 2013. This regional celebration, highlighted by a ribbon cutting, promises to be an extraordinary concert event. The Kingsport Area Chamber of Commerce, City of Kingsport and FOA are joining together to open the Allandale Amphitheater for the region, and following the official opening, the facility may be booked by professional musical groups, rented by the public for weddings, family celebrations, school performances, graduations, and church events. “Music at the Mansion” on Sunday, July 28, 2013, is a first time event marking the culmination of a five-year project initiated by the late Dr. Harry W. Coover, the founding benefactor of the facility. The FOA is hosting the Symphony of the Mountains (SOTM) in a full-length, pops/light classical concert with an intermission for the community and the entire surrounding region. The stage sits behind historic Allandale Mansion at the base of a gentle hill, and patrons are invited to bring folding chairs or blankets to sit on in a relaxed, family friendly atmosphere for an early evening of entertainment, which is scheduled to begin at 6:00 p.m. Patrons are also encouraged to bring picnic suppers and beverages to the event. “Year-round seasonal beauty has always beckoned visitors to Allandale Mansion and its scenic campus,” said Curator easttnmedicalnews

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Rod Gemayel. “From mansion events, like parties and weddings, to intimate receptions in the elegant courtyard gardens, Allandale offers a host of available amenities, and we are so proud of the newest state-of-the art venue—our Allandale Amphitheater.” While many cities are losing symphonies, SOTM, the region’s only fullyprofessional orchestra, continues blessing

Northeast Tennessee and Southwest Virginia with a musical heritage that began as a dream in 1946. Led by conductor Cornelia Laemmli Orth, the Allandale Amphitheater opening concert is an important stop on the symphony’s summer schedule. “Music at the Mansion,” in the Allandale Amphitheater, is one of three performances in a touring symphony series beginning at Chetola in Blowing Rock, North Carolina, traveling to Wise, Virginia, for a performance at University of Virginia—Wise and ending with the finale in Kingsport, Tennessee. “I strongly believe that music can touch our souls and make a difference in people’s lives,” explained Laemmli Orth. “I am excited about this wonderful collaboration, and I hope that we will reach people of all ages and show them that orchestra music is fun.”

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Media partners include Charter, Kingsport TimesNews and VIP SEEN Tri-Cities Magazine. Tickets will be available on-line through Vendini, at the SOTM office, or at the amphitheater on the day of the event. The concert will happen rain or shine, and in case of rain, the venue will be moved to the Robinson Middle School auditorium in Kingsport. Ticket prices are: Adults - $20; Children/Students $5; and Seniors (55+) - $15. Groups of 10 or more will be: Adults - $15 and Children/Stu-

dents - $3. Free parking is available in front of the mansion, barn or in the field behind the venue. Guests are also invited to bring picnic dinners and beverages. The lower level of Allandale Mansion will also be open to visitors. Guests can also glimpse the surrounding grounds. “Because ‘Music at the Mansion’ is part of a touring concert event, we are expecting patrons from neighboring states,” said Gemayel. “Opening the Allandale Amphitheater is such an exciting celebration, and ‘Music at the Mansion’ promises to be a highlight of the summer!” For additional information visit www. symphonyofthemountains.org or www. allandalemansion.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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HealthcareLeader

Troy Sybert, MD By BRIDGET GARLAND

As a young resident in Louisiana, Troy Sybert, MD, was given a gift—a jar of Mayhaw jelly—from one of his patients. Made from the berries of Hawthorne trees, this jelly is considered a rare, special treat because of the short harvest season and the enormous effort it takes to gather the fruit. Perhaps not an uncommon gesture deep in the land of Southern hospitality, but for Sybert, the gift has stood out as a revealing moment throughout his years in healthcare. “It’s that component that drives my love of medicine,” shared Sybert, “That individual patient interaction and their appreciation of our time and service.” In his current position, however, Sybert isn’t afforded that interaction with patients. Instead, he is equipping other physicians with the ability to maintain that personal relationship with the patient, in an era of healthcare where the computer often takes a seat between the patient and the provider—and when productivity tends to be more of a priority than quality. Named Chief Quality and Medical Information Officer for Wellmont Health Systems last year, Sybert works system wide to improve performance and patient

safety operations. He also oversees clinical informatics personnel, at a time when Wellmont is developing a new electronic medical record system through a contract with Epic Systems, a software developer for mid-size and large medical groups, hospitals, and integrated healthcare organizations. Sybert’s vision is to match the medical information workflow with patient flow. “A patient’s journey is chronicled in the electronic medical record [EMR], and the medical information should match the

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journey the patient is taking. And if it isn’t documented, it never happened, right?” he posed. “My skill set is efficient process design. I have a knack for redesigning workflow to produce better outcomes. It’s one of my strengths. It’s my contribution to healthcare now.” Publicly health trained, Sybert is now looking at the health of many rather than the individual. “My skill sets lend themselves to public health—system process thinking. I ask, ‘what are the problems?’” he explained. But asking that question can have its challenges. The introduction of new technology, or at least “undesirable” new technology like an EMR, Sybert clarified, can be intrusive to workflow. “Whereas a big new robot is new technology, that’s desirable technology; everybody wants a new robot,” he said. “But EMR is different. It’s undesirable. So balancing workflow engineering with the EMR implementation becomes trying to help everybody be as happy as possible. “We are all people, human, and we resist change,” he continued. “And this kind of change effects everyone in the hospital or clinic—all providers, clinical staff, office staff, everyone.” Sybert shared a poignant example from the book Who Moved My Cheese? by Spencer Johnson, a business parable that describes four typical reactions to change. “We are no different than the book’s examples of response to change,” he said. “We may ‘sniff and scurry’ or maybe ‘hem and haw’ but we adapt in different ways.” Although Wellmont has been well onboard the health information trek, currently, the health system has four different EMRs being used in its facilities. “The implementation of Epic will solve several problems at several levels,” Sybert said. “We will move forward with a single record—it should be ‘one patient, one record.’ All Wellmont clinics will be in line with each other, which will improve patient care.” Added Sybert, “One way we are looking at it is that it’s the patient’s record, and all Wellmont facilities are the steward of

that record.” Citing John Kotter’s change management strategies, Sybert believes “the momentum of the movement” will carry people throughout the new Epic integration, set for this December. Although most Wellmont providers are already using an EMR system, switching to a new system will require several hours of training, a big time commitment for everyone in the office. When asked about strategies he would recommend to others looking at implementing new information technology, Sybert explained that getting users to understand the bigger picture of EMR implementation is essential for any group moving from paper to electronic. “There are some sacrifices, but there are also tremendous gains,” he said. “You don’t have to hunt down the paper record, for example. It’s immediate now, wherever you are. People tend to focus on the cons, but for their overall goals—the best patient care possible—the pros will outweigh the cons. EMR is good for the patient.” Sybert joined Wellmont in March 2010 and was promoted to his new position last October. Before making the move to Tennessee, he served as chief medical officer for the University of Texas Medical Branch in Galveston, Texas. He received his medical degree from the University of Texas Southwestern in Dallas, and received a Master’s degree in public health from the University of Texas Medical Branch Graduate School of Biomedical Sciences in Galveston. Board-certified in public health and general preventive medicine, he completed a fellowship in hospital medicine at the Mayo Clinic in Rochester, Minn. In addition to his position at Wellmont, Sybert is an adjunct faculty member for East Tennessee State University, where he lectures on informatics related to public health. He is a member of the American College of Preventive Medicine, the American Society for Quality, and the American College of Physician Executives. Sybert is married and lives in the Piney Flats/ Johnson City area, where you might find him spending time with his three young children… or perhaps enjoying a jar of Mayhaw jelly.

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How Social Media is Reshaping Healthcare By Heather Ripley

While many industries have embraced the use of social media to grow and promote their businesses, healthcare organizations have remained cautious. This is changing swiftly, and if you are not using social media for your B2B or consumer-oriented healthcare businesses now, you will be soon. The shift in social media adoption by healthcare organizations offers an enormous opportunity. Still not convinced? Some of the nation’s top medical facilities are social champions and employ various social media platforms with great success. Take the prestigious Mayo Clinic this well-known medical facility has developed a successful social media program and has been using and tweaking social media strategies since its first foray into the “social” world in 2007. The facility’s social strategies have been used as an example for other hospitals and healthcare providers to follow. The clinic’s social successes include: • Identifying and signing up recruits for new medical studies, something that had been a challenge before the use of social media • Creating a Social Media Health Network, encouraging candid discussions online between medical practitioners and healthcare providers worldwide • Developing a YouTube channel in

2008 that is currently the most popular medical channel on the service, with more than 10,600 subscribers and 9,266,000 video views • Building a Facebook presence going from zero to more than 418,955 “likes” since 2007 The 2012 release of a book for other healthcare organizations to use as a social media guidebook called, Bringing the Social Media Revolution to Healthcare The Cleveland Clinic is another hospital group with a strong social media presence, believing in direct communication with patients and providers via social media. According to Content Marketing World, Clevelandclinic.org is believed to be the number one, most-visited, multispecialty hospital website in the country. The clinic’s senior director of multi-channel marketing, Scott Linabarger, also manages its social media channels and developed a new blog site in 2012. Linabarger was quoted recently saying the new site, Health Hub, “is about furthering or enhancing the Cleveland Clinic brand. We want this content to be seen or interacted with and engaged with and liked by as many people as possible.” I have long been a proponent of online social interaction as an integral component of a public relations strategy for B2B and B2C businesses. I’ve created and implemented fully-integrated social media initiatives for small businesses, nonprofits,

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and national healthcare IT businesses. Part of that experience has led me to offer social media training sessions for my clients’ employees, from in-depth social instruction to managing entire corporate social programs. If you cannot partner with a social media/public relations expert to help you start off on the right foot, here are some basic social “Dos & Don’ts” for healthcare businesses:

Social Media in Healthcare Dos

Do start slowly. If you are just starting out, think small and pick one platform to begin with. Stick to it and do it well. Do it regularly. This means if you decide to start a Facebook page, make a commitment to post to it every day or every other day. Many businesses lose Facebook inertia after the first few months by simply not posting or responding to comments. Do offer relevant, quality information. Find a way to present helpful information without offering actual medical advice. Do have your legal advisors help you create and post a legal disclaimer for the information you disseminate on your social channel. You’ll be glad you did. Do listen and respond to feedback. One of the problems with healthcare-related social media efforts is the lack of follow-through. If you have a social channel,

you need to regularly monitor and reply to comments, questions, and feedback. Do create a social media policy. Many companies fail to do this step, and with healthcare, it’s even more important to have one in place before you write your first post.

Social Media in Healthcare Don’ts

Don’t deliver medical advice. This is a big one, and it’s difficult to maintain your objectivity. Defer to your legal advisors about what constitutes medical advice, and keep your posts informative but generic, if possible. Don’t use social media as an advertising tool. Remember your audience wants information and news, not a sales pitch. Don’t forget to maintain professionalism no matter what. It can be hard to read critical comments or posts, but take a breath and respond to them with kindness and compassion. If necessary, take the conversation offline. Don’t use social media as a personal platform. Remember, your social efforts are to improve your brand’s social presence, not yours. Heather Ripley is the president and founder of Ripley PR, a B2B public relations agency specializing in Healthcare IT. For more information, visit www. ripleypr.com or email hripley@ripleypr. com.

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What’s Happening in Chattanooga? By Rae Bond

Youth Leadership Forum Praised by Students Twenty-four outstanding Hamilton County high school students participated in the eighth annual Youth Leadership Forum on Medicine, which was held June 3-6. The program is sponsored by the Chattanooga-Hamilton County Medical Society, Medical Foundation of Chattanooga, and University of Tennessee College of Medicine. More than 80 nominations of rising high school juniors and seniors were considered. The four-day program is designed to encourage rising juniors and seniors to learn more about life as a physician. During the course of the week, students spend time shadowing a variety of physicians and enjoy daily lectures and roundtable discussions with physicians. Former Medical Society President Mark Brzezienski established the program in 2006. “I decided to pursue a career in medicine after participating in a program like this,” Brzezienski said. “We hope this experience will encourage and inspire talented students to enter the field of medicine.” Based on evaluation comments, the students seem to think it is working. “The information and experiences shared by different doctors is invaluable,” one student commented. “I have never

Area doctors were recently recognized for Doctor’s Day Appreciation. Honorees were nominated by local residents and were presented the award by The Chattanooga-Hamilton County Medical Society, Medical Foundation of Chattanooga, Medical Alliance, and Project Access.

gotten the chance to have doctors talk and lecture to us like I have through this. Shadowing and actually getting a feel for the (medical) field is invaluable.” Local Physicians Honored during Doctors’ Day Salute The Chattanooga-Hamilton County Medical Society, Medical Foundation of Chattanooga, Medical Alliance, and Project Access are recognizing local physicians by saluting ten honorees for Doctors’ Day Appreciation. The honorees were selected from nominations submitted by local residents. The ten honorees are: Tracy Dozier, MD, Academic Internal Medicine Annesofie Dubeck, MD, Diagnostic

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Center Hunter Jennings, MD, Chattanooga Surgical Oncology Todd Levin, MD, Chattanooga Allergy Clinic Vicente Mejia, University Surgical Associates Melissa Phillips, MD, TCFPA Family Medical Center Phillip Pollock, MD, Diagnostic Pathology Associates Marty Scheinberg, MD, Plaza Urology Mark Thel, MD, Chattanooga Heart Institute Stephen Thomas, MD, Ophthalmologist Patients submitted almost 100 nominations of Chattanooga-area physicians this year. National Doctors’ Day provides a time for people to show appreciation to the doctors who care for them or their loved ones. The first Doctors’ Day observance was March 30, 1933, in Winder, Georgia, on the anniversary of the first use of general anesthetic in surgery. The U.S. House of Representatives adopted a resolution commemorating Doctors’ Day on March 30, 1958. In 1990, Congress established March 30 each year as the National Doctors’ Day. This year’s observance also salutes the 625 volunteer physicians who care for low-income uninsured residents of our community through Project Access. The event was held in cooperation with News 12 This Morning and BlueCross BlueShield Community Trust.

OSHA SEMINAR OFFERED FOR MEDICAL OFFICES The Medical Society and Doctor’s Management are offering the 2013 OSGA Seminar: Annual Compliance Training for Health Care Workers. Separate sessions will be held on Wednesday, July 31, from 10 a.m.-noon or from 1:30-3:30 p.m. at Diagnostic Center Conference Room in Chattanooga. Advance registration is required. The cost is $50 per person for offices in which at least half of physicians are Medical Society members, and $75 for nonmembers. For information and a registration form, contact Kevin Lusk at 423-622-2872 Project Kickball Tournament Coming in September Prepare for a fun day of running the bases, fellowshipping with friends, and, well kicking a ball. What better way to have fun, and raise money for Hamilton County Project Access, than bring back a favorite childhood game and play it as adults? Medical practices are encouraged to put together a team for the first Project Kickball tournament on September 28 at Warner Park in Chattanooga. A limit of 20 teams will be allowed to participate in the tournament. The teams will consist of 7-15 players in a double elimination tournament, guaranteeing at least two games per team. Trophies will be awards to the winner, but also award prizes for special categories like “Best Costumes,” “Best Team Name,” etc. There will be a registration fee of $250 to participate. This would be a great way for practices to get involved by sponsoring a team and encouraging employees to participate. For information and a registration form, contact Kevin Lusk at 423-622-2872. The Chattanooga-Hamilton County Medical Society, established in 1883, is an advocate for physicians and for the continual improvement of community health. The Society protects and promotes the patient-physician relationship. The Medical Foundation is an affiliated nonprofit organization that provides access to healthcare for low-income uninsured residents and works to promote community health.

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Wine 201

Sparkling Summertime Rosé By Rick Jelovsek, CSW

I wrote about rosé wines last summer, but cannot resist expounding their virtues again. This time, however, I want to concentrate on sparkling rosé wines—those bubbly, effervescent wines that refresh. They are an ideal summer porch sipping drink. Pink sparklers are usually light in alcohol (less than 13%), served refrigerator cold, and have that special tingle on the tongue and mouth. In general, sparkling wines are all purpose. They are great for meditation, celebration, sipping with appetizers or desserts, or just for a general mood lifter. Madame Lily Bollinger, of the French Champagne house of the same name, has a quote that I think applies to all sparkling wines: I only drink champagne when I’m happy and when I’m sad. Sometimes I drink it when I’m alone. When I have company I consider it obligatory. I trifle with it if I’m not in a hurry and drink it when I am, otherwise I never touch the stuff, unless I am thirsty. Rosé Champagnes and sparkling wines vary from white styles in that they are pink to pale orange in color. This comes from pigment in the skins of red grapes. Either a small amount of red wine is added to the white wine to make a rosé or a small amount of red grapes are fermented with a majority of white grapes to result in the light red color. The taste of rosé sparkling wines is

altered only slightly from white styles by the added flavor of the red grapes or red wine used, and also by the slight amount of tannins from red grape skin pigment. These tannins contribute a minor astringent mouth feel that helps clear the palate and hints of red or black fruit aromas and flavors. Most sparkling wines are moderately acidic as are white wines. A winemaker can counterbalance the tartness by how much residual sugar is left in the finished wine. The sugar decreases tartness. Sweetness levels can range from dry (extra brut, brut) to slightly sweet (extra dry, sec, demi sec) to sweet (doux). I favor the slightly sweet versions as a general rule-of-thumb. Almost every winemaking region in the world makes a sparkling rosé wine. They all use grapes that flourish in their areas. Basically, there are several methods of transforming still wine into a carbonated, sparkling wine. The traditional method is used in France for Champagne and Crémant. Other regions who use the traditional method will indicate that on the bottle label. In the traditional method style, a precisely measured, additional dose of unfermented grape juice or sugar solution with yeast is added to the bottle which is then recapped. As that additional sugar ferments, the carbon dioxide bubbles are trapped in the bottle, carbonating the wine. Some of the top California sparkling wines are made this way as well as all of the Cava from Spain. The wine remains with yeast in the bottle for

a long time, often one to three years before the yeast plug is disgorged. Disintegrated yeast cells (lies) are what impart a toasty, bready aroma and taste to the Champagne style wine. A second method of sparkling wine production is called the Charmat, or closed tank method. This is commonly used for Prosecco and Spumante production in Italy. The still wine is placed in a tank and the dosage of grape juice or sugar solution is added to the entire tank. Fermentation takes place in the tank under pressure and the finished wine is also bottled under pressure to keep the carbon dioxide dissolved in the wine. Since the wine does not sit on the yeast lees for long, there is no toasty, yeasty taste. The pure fruit flavor of the grape dominates. Another method to carbonate sparkling wines is simply to bubble carbon dioxide through the wine just as you might for the production of drinking soda. While this method produces coarser bubbles, it still produces an exciting beverage with the dominant fruit taste of the grape variety. The best known French sparkling rosé wines include pink Champagnes such as those from Charles Heidsieck, Duval Leroy, Moet & Chandon, and the sommelier›s favorite, Billecart-Salmon Brut Rosé. Outside of France›s Champagne region, rosé sparkling wines made by the traditional method in France are called Crémants. Examples might include Lucien Albrecht

Cremant d›Alsace Brut Rose, Domaine des Baumard Cremant de Loire Rosé, Crémant d›Bordeaux (Reserve de Sours Sparkling Rosé), and Crémant d›Burgundy (Le Grand Courtâge Brut Rosé). Italian examples include Banfi Rosa Regale, Canella Rosé Spumante, and Berlucchi Franciacorta Rosé. Spain boasts several rosé Cavas such as Jaume Serra Cristalino Brut Rosé Cava, Freixenet Brut Rosé Cava, and Segura Viudas Brut Rosé. Australia has Jansz Brut Rosé and Jacob›s Creek Sparkling Rose among many others. In the U.S., examples might include Treveri Cellars Sparkling Rose from Washington State and from California, J Vineyards NV Brut Rose Russian River Valley, Domaine Carneros Brut Rosé Cuvée de la Pompadour, Schramsberg Mirabelle Brut Rosé, Roederer Estate Brut Rosé, and Gloria Ferrer Brut Rosé. When the hot weather comes, you will want to savor this wonderful beverage. Chill up a few bottles of any sparkling rosé wine this summer, put on Neil Diamond›s 1970 song «Cracklin› Rosie,» sip away and enjoy! Rick Jelovsek is a retired physician, a Certified Specialist of Wine, and a member of the Society of Wine Educators. He is also author of a book available from Amazon on Wine Service for Wait Staff and Wine Lovers. You may contact him with wine questions at tnwinelover@ gmail.com or visit his website at www. winetasteathome.com.

Meet Some of the Faces Behind Our Healthcare Experience.

Shatita Daniels

Greg Gilbert

Katie Graham

Andrew McDonald

Brooke Thurman

Meet Stacy Schuettler 865.862.3037 (direct) / sschuettler@lbmc.com President - LBMC Technologies

LBMC has assembled a uniquely experienced team of over 40 healthcare professionals that clearly differentiate us from other service providers Accounting - consulting - HR - tecHnology KNOXVILLE | NASHVILLE | CHATTANOOGA ph: 865.691.9000 | www.lbmc.com

– all with deep financial experience as well as practical experience working in the field of healthcare.

Stacy has an extensive and diverse background in developing and managing IT consulting businesses. Her IT career started at IBM Corporation where she was responsible for selling computer hardware and software. Since that time she has focused on assisting clients in defining technology solutions that support their business functions and objectives. Under Stacy’s leadership, LBMC Technologies is continually recognized nationally in various rankings related to software and IT service offerings. She has a passion for helping businesses succeed and is involved in community and industry organizations focused on entrepreneurial initiatives.

Where Great Companies Come to Grow.

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JANUARY 2013

The Trust Company: Founded to service retirement plan needs of physicians

n 1987, The Trust Company’s founder, Sharon Miller Pryse, recognized a need for an independent trust company specifically to focus on retirement plan needs for physicians. “We have a long and successful history with medical groups,” said Pryse. “My late husband was a physician, and it was at his suggestion, and with his support, that The Trust Company was founded.” Over the years, The Trust Company has expanded the industries and individuals it serves, but it still maintains a high concentration of medical focus -- of more than 200 corporate retirement plans with more than 28,000 participants in 16 states, almost 70 (35%) are for physician groups in East Tennessee. Why is The Trust Company a great financial resource for medical clients? Because of their depth of experience with medical clients, they can offer plan design with flexibility, taking on the responsibility of retirement programs and removing the liability from physicians. A single-source provider, The Trust Company assumes full fiduciary oversight of its clients’ retirement plans. Without the administrative burden or legal exposure of serving as plan trustee, clients can focus on what they do best—ensuring the success of their own businesses. The Trust Company’s top notch team of trust professionals includes specialists in qualified retirement plans, investment management, wealth management, trust administration, and estate planning. That expertise is put to work to develop personalized strategies for each client and determine portfolio managers that match each client’s investment needs and circumstances. Busy physicians especially enjoy having immediate access to professionals across the financial landscape. Because The Trust Company is independent of any large bank or corporation, its professionals have the flexibility and customer focus to be problem solvers who often are able to offer considerable savings because there is no need for outsourcing to multiple providers. One interesting solution for medical groups is cash balance plans. “Cash balance plans are one of the fastest growing segments of the qualified retirement plan arena due to their ability to significantly increase contributions in tax-deferred accounts,” said Daniel Carter, EVP, and chief administration officer. “These types of ‘hybrid’ plans can be extremely beneficial to physicians when used properly.”

Expansion Throughout East Tennessee Unlike other regional and super-regional banks, The Trust Company is privately owned and independent, allowing it to respond quickly to market changes. This agility allowed it to quickly expand with new offices in Johnson City and Chattanooga (opened in 2011 and 2012, respectively), and the company presently has more than $2.1 billion in assets under management. Its Knoxville headquarters office includes a staff of 35 in its retirement services division alone to provide the highest level of service to plan administrators and plan participants alike, with a 95% historical retention rate for retirement plan clients. The Trust Company has carried its commitment to being a role model in its support of the community—organizationally as well as individually—to the newer locations in Johnson City and Chattanooga. The company supports more than 60 East Tennessee non-profit organizations, and its Trust Officers collectively sit on more than 25 boards of directors. In addition to these ongoing commitments, the company prides itself in being a quick responder to needs in East Tennessee and beyond. Off the clock, staff members average 2 hours per week of volunteer work with

Our Johnson City office provides full service to clients in the Tri-Cities. Left to right: Nathan Woods, Steve Alexander, Shawn Weems, Susanne Hauk.

The Chattanooga team serves clients from its offices in The Volunteer Building. Standing left to right: Fred Speakman, Stacy Roettger, Daniel Carter, Susanne Hauk. Seated left to right: Pam Dietrich, James Woods.

more than 40 organizations. To help clients make informed financial decisions, the company provides a full complement of wealth management services. Its investment consulting and wealth management service is driven by one overriding objective: to simplify the complexities of clients’ financial lives through sound investment advice and responsible wealth management, committed to providing impartial counsel, exceptional service, and measurable results. Whether it’s securing funds for a fulfilling retirement, tax-efficient stock option planning, deciphering a complex benefits package, or ensuring that cash flow meets a client’s daily needs, the Trust Company is a trusted resource for sound advice. KNOXVILLE 4823 Old Kingston Pike, Suite 100 Knoxville, TN 37919 P.865.971.1902 | F. 865.971.1020 JOHNSON CITY 862 MedTech Parkway, Suite 205 Johnson City, TN 37604 P.423.232.0280 | F. 865.971.1020 www.thetrust.com

CHATTANOOGA The Volunteer Building 832 Georgia Avenue, Suite 505 Chattanooga, TN 37402 P. 423.308.0374 | F. 423.971.1020

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JULY 2013

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ClinicallySpeaking BY JAMA STINNETT, LPN, CPHQ

New Nursing Specialty is Improving Care for Bariatric Patients Morbid obesity affects an estimated 1 in every 50 American adults. An individual is considered morbidly obese if he or she has a Body Mass Index (BMI) of 40 or more. Normal BMI ranges from 20-25. Severe obesity not only interferes with basic physical functions like breathing and walking, but it is also associated with more than 30 other diseases and conditions including diabetes, high blood pressure, heart disease, sleep apnea, asthma, gastroesophageal reflux disease, osteoarthritis, cancer, and infertility. The need for effective and long lasting treatment has led to an explosion in the field of bariatric surgery in the past two decades. The number of weight loss surgeries performed in the United States has grown to roughly more than 250,000 procedures each year. Many bariatric centers, such as New Life Center for Bariatric Surgery in Knoxville, Tennessee, recognize the unique challenges of morbidly obese patients and have embraced the need for specialized bariatric nursing caregivers. Both Nursing Coordinators on New Life’s staff, Sarah Grimes, RN, CBN, and Robin Saunders, RN, BSN, CBN, have received the prestigious designation of Certified Bariatric Nurse (CBN) from the American Society for Metabolic and Bariatric Surgery (ASMBS). Nurse Coordinator Sarah Grimes was one of the first nurses in the country to earn this distinction. “I was in the first group of people to take the bariatric nursing exam when it was first offered in 2007,” explained Grimes. “I felt it was an important step to staying current in my field, and being able to take my dedication to bariatric care to the next level.” Before joining New Life Center for Bariatric Surgery in 2004, Grimes spent several years caring for bariatric

Many programs like New Life Center for Bariatric Surgery in Knoxville are employing advanced practice nurses. New Life has two designated Certified Bariatric Nurses (CBN) on staff. Pictured from left to right are: Robin Saunders, RN, BSN, CBN; New Life Office Manager Jama Stinnett, LPN, CPHQ; and Sarah Grimes, RN, CBN.

patients as a nurse on a hospital surgery unit. “I started taking care of bariatric patients on the floor and loved having patients who were so educated about their surgery and engaged in the whole process,” remembered Grimes. “It was amazing to see the beginning of their weight loss journey. I really wanted to be able to follow up with them past that point and work with them through the entire process.” Nurse Coordinator Robin Saunders was a labor and delivery nurse for 25 years before turning to bariatric care. “I like working with patients who need special one-on-one care,” she said. “Bariatric patients are sometimes fragile emotionally and really appreciate care that’s attentive and respectful.” Saunders says becoming a Certified Bariatric Nurse was another way she could connect with her patients. “Bariatric patients are often well edu-

cated about the surgery and it puts them at ease to know that you have that extra clinical training that’s tailored precisely to their unique needs.” The American Society for Metabolic and Bariatric Surgery (ASMBS) developed the Certified Bariatric Nurse (CBN) program to access the skills and

knowledge of bariatric nursing practitioners. Candidates must hold an RN license, have at least two years experience caring for morbidly obese and bariatric surgery patients, and pass the extensive CBN examination. The exam encompasses different aspects of care including patient education, safety and emotional support. “Certification requires a heightened level of knowledge and cultural awareness of the obese patient’s special needs,” said Grimes. Bariatric surgeon Dr. Stephen Boyce says ensuring that heightened awareness is an important benefit for New Life’s patients. “Part of being a comprehensive weight loss center is having nurses and staff who are uniquely dedicated and qualified to guide people through their surgical journey. Our patients’ lives and health are truly transformed , and we feel so proud and privileged to be a part of that.” Jama Stinnett, LPN, CPHQ, is the Office Manager for New Life Center for Bariatric Surgery located at Turkey Creek Medical Center in Knoxville, Tennessee. The Tennova Center for Surgical Weight Loss is the only Level One facility in Knoxville accredited by the Bariatric Surgery Center Network (BCN) Accreditation Program of the American College of Surgeons (ACS).

Trust for Generations As the oldest independent trust company headquartered in Tennessee, The Trust Company has specialized in helping individuals, businesses, and foundations reach their financial goals for more than 25 years, with $2.1 billion in assets under management. You deserve the benefits of world-class expertise and the personalized service of a local firm. We offer both, and we’d like to be a part of your success story.

State Pharmacy, continued from page 7 to be the last. A workgroup from the Board of Pharmacy is collaborating with staff at the TDH to identify additional measures and improvements to address the manufacturing and distribution process. Items under consideration include more proactive inspection with additional emphasis on critical reviews of maintenance and quality control records, interim self-assessment and applicable reporting by the licensed entities, and adoption of applicable U.S. Pharmacopeia Standards. Additionally, three more licensed pharmacists are being recruited by the Board of Pharmacy to serve as inspectors and another administrative staff person will be added to facilitate the new self-assessment and reporting responsibilities. “It’s a great challenge to strike a easttnmedicalnews

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thoughtful, protective balance between addressing the daily drug shortages faced by patients and healthcare providers across Tennessee with the absolute need to assure safety and effectiveness in the compounded product,” said TDH Commissioner John Dreyzehner, MD, MPH. “While we wish the current situation associated with a Tennessee Dr. John pharmacy had not hapDreyzehner pened and that patients had not been affected, the actions taken by the board, along with legislation passed recently, are moving us forward in assuring the safety and availability of important medications.”

Knoxville 4823 Old Kingston Pike, Suite 100, Knoxville, TN 37919 | P. 865.971.1902 Johnson City 862 MedTech Parkway, Suite 205, Johnson City, TN 37604 | P. 423.232.0280 Chattanooga The Volunteer Building, 832 Georgia Ave., Suite 505, Chattanooga, TN 37402 P. 423.308.0374

www.TheTrust.com

JULY 2013

Recruiting in an Era of Reform, continued from page 1 the plane engine as we fly it,” Masterson said wryly. So how are recruiting and management firms attracting and retaining the right people in a period of great transition, and what skills should candidates hone to answer new challenges posed by the nation’s complex healthcare system? Medical News asked a number of recruiters to share their insights. Brian Kelley

Physicians

In addition to her national provider recruitment duties with TeamHealth, Masterson is a past board member and committee chair for the National Association Susan of Physician Recruiters Masterson and a current committee member for the Association of Staff Physician Recruiters. On the national front, she said the need for primary care physicians is anticipated to rise dramatically. Yet, she continued, only about a quarter of the applicants coming out of training are headed that direction. “We need more family practice and internal medicine physicians,” she said. “The government is going to have to make more slots for internship and residency, and they’re going to have to incentivize physicians to be primary care doctors,” Masterson added of anticipated demand in the wake of ACA. “Regardless of the specialty,” she continued, “I think there are different competencies for doctors that are a ‘must have’ today than (were necessary) years ago.” A focus on quality, prevention and evidencebased medicine were included on her list. Masterson also noted the need to be comfortable with technology and said two of the biggest skills were to be team-oriented and effective in mentoring and working alongside advanced practice clinicians (APCs). “Another thing I think we’ll see is there will be a lot of physicians that are in small, private practices that will choose to join larger companies or hospitals,” Masterson said. She added that her company is recruiting many physicians who are ready to hang up their shingle because of heavy workload, decreasing reimbursements, increased regulation and uncertainty over how healthcare reform will impact their practice. Another factor driving this trend, she added, is that the ‘new millennials’ (born between the early 1980s and 2000s) are very focused on a work-life balance and value personal time as much as career … which often translates into a willingness to be hospital employees rather than taking on the stress of owning their own practices. In her own company, Masterson said they have taken a much more proactive strategy to recruit residents for their key focus areas of emergency medicine, anesthesiology, urgent care and the ‘ists’ — hospitalists, laborists, surgicalists. TeamHealth has created a number of support services … from online resources to shadowing 10

JULY 2013

opportunities to hosting discipline-specific boot camps … to help the young recruits settle into their new roles. “We’re also signing many more APCs … probably three or four times more than we did just four or five years ago,” she noted of the increased demand for physician assistants, nurse practitioners, nurse anesthetists and other mid-level providers. As demand increases for providers, it has become increasingly competitive to fill open spots. Locum tenens companies have been springing up, said Masterson. Where those temporary providers had been filling in for short periods during vacation or maternity leave, Masterson said it is increasingly common to see them in place for months at a time while the search continues for a permanent hire. TeamHealth has their own internal group known as Special Ops physicians to answer this need. Hiring, however, is only one part of the puzzle. “It’s one thing to recruit the doctors, but then we have to retain them so there is a tremendous focus on retention,” Masterson said.

Advanced Practice Providers

MedPlacer, a national recruitment and operational process improvement firm, places healthcare providers and executives in a variety of positions. However, said Jeff E. McCracken, founder and managing director, the company’s core business is on emergency, surgical and cardiovascular service placement. “When Jeff we originally founded McCracken our company, we had a broader approach,” he noted. Over time, he continued, “We’ve really focused in more on a couple of key niche areas, and it’s really driven by the market.” McCracken added, “About 90 percent of the professionals we place have a nursing background of some sort.” The company, he explained, has three main divisions — permanent nursing leadership recruitment, staff nursing recruitment, and interim departmental leadership. Although MedPlacer doesn’t always put an interim director on site, when the company does have a leader on the ground, that person helps clients assess operations, identify weaknesses, outline process improvements, set departmental objectives and align staff appropriately to achieve those goals. McCracken said the strategy has been to not only glean the technical needs of a department but to understand the culture to recruit the right person. “The retention rate has been much higher because we’ve had an on-the-ground experience within the hospital,” he noted. Like physicians, McCracken said nurses are now recruited nationally. As the housing market has improved, he has found an increased willingness among nurses to consider positions in other parts of the country. An area of rapid growth has been placing staff level nurses in departments to help alleviate dependence on travel nurses. He was quick to add that travel nurses play

an important role in helping a facility staff up for seasonal peaks or to meet the needs of increased patient populations for short periods of time. However, he added, hospitals ultimately want staff members who are engrained in their community. Kipper Latham, RN, chief clinical officer for MedPlacer, is the person on the inside. “It helps the nurse understand that hospital before they pick up and move from Pittsburgh to Texas,” he said of being embedded in the hospital while assessing a department’s operations, staffing and processes. Additionally, he spends his time learning about the area … schools, activities, the housing market, and quality of life … to best match a job candidate with both the hospital and community. He added finding the right match is more than just aligning skill sets. “You have to look not only on paper but also understand that professional’s longrange goals and motivation,” he said. Like McCracken, Latham said travel nurses play an important role in staffing solutions but likened them to renters vs. owners. “Travelers are needed, but it’s not the same as if 80-90 percent of your nurses are part of the community,” he explained. During a seven-month stint in the emergency department at a Texas hospital, Latham saw the number of travel nurses decrease from 25 to two, and the Press Ganey hospital scores rise from the bottom 25th percentile to the top 15 percent. “Patient satisfaction scores went through the roof because now you had ownership in the community,” Latham noted. As with physician recruitment, retention is a key to success. McCracken reiterated turnover not only hurts the bottom line, but it takes a heavy toll on key areas impacting quality and efficiency including morale, institutional knowledge, cultural sensitivity, and patient and employee satisfaction. He added there is no crystal ball to know exactly how ACA will impact hospital staffing, but McCracken pointed out increased volumes are often seen in the Emergency Department first and then have a domino effect in other areas of operation. He said MedPlacer is working collaboratively with colleagues in other firms to try to prepare for increased demand. “We’re continuing our strategic alliance with other recruitment companies nationally. That way we can scale appropriately,” he concluded.

The Executive Suite

The Buffkin Group focuses primarily on placements at the C-suite level for service providers and end payers. The landscape … and the skills needed to successfully navigate the new terrain … are definitely changing. “When you’re in the heat of your business, it’s sometimes difficult to take a strategic look at your executive team and ask, ‘Do Craig Buffkin we have the team in place to meet the regulatory demands that take place in 2014?’” said Craig Buffkin, man-

aging partner and founder of the firm. For non-profit hospitals, he added, that could mean a shift in attention. Previously, these facilities were much more focused on outcomes than on cost factors. Now, both must be equally weighed. “It’s put a lot of pressure on having a different type of leader in different parts of their organizations that didn’t exist five years ago because not only do they have to worry about outcomes but also on driving costs and efficiencies,” Buffkin said. The new regulatory environment and shifts in reimbursement models have brought about some consolidation of acute care facilities and hospitals taking over physician practices. In the short run, said Buffkin, consolidation shrinks the leadership market. However, he continued, “In the long term, it typically increases the need as companies get bigger.” In fact, he continued, “We’ve doubled the number of searches we’ve been completing on an annual basis in the last several years, and the majority of that demand has come from our healthcare clients because of regulatory pressures.” Brian Kelley, a partner based in the firm’s Connecticut office, added the complex delivery and regulatory environment has made it nearly impossible for one person to have all the skills necessary to meet the hospital’s or practice’s needs. Three areas he identified as ‘critical in any management setting’ are knowledge and experience of healthcare services, profit and loss expertise to understand reimbursement challenges and a robust understanding of IT from both a quality and efficiency perspective. “You have to have a team … it’s not one person,” he said. “For one person to have all three of those skill sets is few and far between.” That, however, has opened the door for others to break into healthcare. In hospitals, Kelley said, “The old world was to build from within … not so much anymore. They are willing to recruit from outside the hospital’s four walls,” he continued, noting this is particularly true in terms of technology positions. Buffkin added it has also opened a greater need for marketing professionals … both to draw patients and to reach healthcare professionals as demand begins to exceed supply. “We work with academic medical centers, and one of the areas we’re seeing an increase is in chief marketing officers. They are increasing their marketing departments as they try to attract more applicants to medical school and nursing school to meet the rising demand.” On the flip side, the push for quality has also opened the door for more physicians to take on leadership roles. Kelley said he is seeing more doctors return to school to get a graduate degree in business. Ultimately, he noted, you have to look at the leadership in place at any given facility and fill in the gaps. “We all are seeing more candidates who are taking the time to be better educated,” he added. “Healthcare has a lot of complexities, and I think people are preparing themselves better for the changes.”

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The Move to DNP, continued from page 1 Rooted in the desire to deliver the highest quality of care in the practice setting, Kirschling said the addition of the DNP was consistent with what is happening in other healthcare disciplines including pharmacy, audiology and physical therapy. Grounded in evidence-based

PhD vs. DNP Jane Kirschling, PhD, RN, FAAN, president of the American Association of Colleges of Nursing, said the addition of the Doctor of Nursing Practice (DNP) degree was the clinical complement to the long-standing Doctor of Philosophy (PhD) or Doctor of Nursing Science (DNSc) degrees, which prepare students for scientific research. The PhD, she noted, “is really intended to prepare the next generation of scientists for new discovery so they are generating new knowledge for the discipline.” In addition to an interest in a nursing faculty career with a research component, Kirschling said it was fairly common for nurse executives to obtain a PhD as they sought to increase leadership roles. With the addition of the DNP, nurses now have two terminal degree tracks from which to choose — research and practice. The newer DNP quickly overtook PhD and DNSc programs in terms of the number being offered across the country. Currently, there are 131 research-focused programs in the U.S. The number of research doctoral programs grew from 103 to 131 between 2006 and 2012. During that same time period, DNP programs grew from 20 to 217. As the field looks to increase the number of doctoral-prepared nurses, the good news is enrollment is up in both researchbased and practice-based doctorate programs, although the newer DNP degree has seen much more rapid growth as more academic institutions have begun offering the option. Between 2004 and 2012, the number of students enrolled in DNP programs increased from 170 to 11,575. The number of students seeking a PhD in nursing grew from 3,439 to 5,110 during the same timeframe.

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practice, she said the hope is that these doctoral-prepared nurses will take existing discoveries and more rapidly drive that knowledge to the bedside. Additionally, she said the degree is anticipated to prepare these nurses to provide leadership in an increasingly multifaceted healthcare environment. “What I project we’ll see with time as we graduate more from the DNP program is they will actually partner with PhD nurses to create some really interesting synergy to solve really difficult clinical issues and to solve them in a quicker timeline that directly impacts patient care,” stated Kirschling. The reason for the DNP movement is multifactorial. In addition to aligning with other health profession disciplines that offer a clinical doctorate, Kirschling said the degree also recognizes the complexity of the nation’s evolving healthcare delivery system. The number of hours and amount of academic work required to become an advanced practice registered nurse provided another impetus behind the DNP movement, Kirschling noted. Nursing had already moved to increase and expand practical knowledge in APRN master’s programming. Where many master’s degrees in other fields require 30-36 credit hours, the four recognized APRN master’s programs — Nurse Practitioner, Clinical Nurse Specialist, Nurse Anesthetist, and Nurse Midwife — already required a minimum of 40-55 credit hours. With the newer doctoral degree, students need, on average, 80 credit hours in the baccalaureate to DNP program and an additional 39 credits in the master’s to DNP path. “Healthcare in the county has changed dramatically,” Kirschling concluded. “The depths of knowledge and the skill set any provider needs have just increased over time. We, as a discipline, felt it was critical that our graduates be prepared to meet the demands of the future.”

theLiteraryExaminer BY TERRI SCHLICHENMEYER

A Dog Walks into a Nursing Home by Sue Halpern; c.2013, Riverhead Books; $26.95 / $28.50 Canada, 320 pages They say it can’t be done. You can’t teach an old dog new tricks, they say, but you’ve spent a good amount of time doing it successfully anyhow. Sit, stay, down, you’ve taught ‘em all. It just took patience and love. And in the new book A Dog Walks into a Nursing Home by Sue Halpern, it takes patients and love – and sometimes, the teaching role is reversed. Sue Halpern had her work cut out for her. When she decided to train her seven-year-old Labradoodle, Pransky, to be a therapy dog, Halpern knew it would be a challenge. For most of her life, Pransky was a country dog, unaccustomed to leash, used to wide-open romps in the Vermont woods. She understood all kinds of words (including every synonym for “walk”), but teaching her the tasks she needed to know to formally visit the local nursing home wouldn’t be easy. The requirements were overwhelming, but Halpern “soldiered on.” Six weeks after they began, she called County Nursing and Rehabilitation Home. Not long afterward, she went through orientation, agreed to several stipulations and a criminal background check, and Pransky passed the Therapy Dog test. It was official: the Halpern-and-Pransky team was approved to visit County’s dementia unit… but Halpern felt uneasy. Nothing she’d ever done had prepared her for what they were about to do. She needn’t have worried: her dog had it covered.

Theologians, Halpern says, recognize seven virtues: love, faith, hope, prudence, fortitude, justice, and restraint. Once Pransky started “working,” she taught Halpern to see those virtues in herself, staff, and the residents they visited. There was faith for Clyde, a “big flirt” who told everyone that he was leaving County on the arm of a beautiful woman; love for Dottie and Iris, dear friends who couldn’t live without one another; restraint for Scotty, who’d been a teacher before dementia set in; prudence for Stella with a “beautiful singing voice;” and fortitude for Lizzie, suffering from a rare disease. And through it all, “Hope was the thing with wispy, tan tail feathers, that was fortythree pounds, that came when called.” Though Mom warned me not to, I have to admit that I judged this book by its cover. A Dog Walks into a Nursing Home looks, at first blush, like it might consist of humorous, rompish anecdotes of nursing home life. Nope. While you will find a few unintentional nursing home chuckles here, author Sue Halpern spends most of her pages filling readers with goodness and stories of the near-miraculous relationship between pups and people. Hers is a quiet, Zen-like book packed with philosophy, theology, and a dog. It’s more reflective, more spiritual than other dog books, and it will make you look at your canine kids with a little more wonder. Definitely, dog lovers and TDI teams will want to read this book, but I also think there’s plenty in here for Eldercare workers, too. If that’s you, then fetch this book because missing A Dog Walks into a Nursing Home just can’t be done.

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.

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 JOHNSON CITY 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

3RD THURSDAY KINGSPORT MGMA MONTHLY MEETING

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

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

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

July’s Topic: Workplace Violence and Active Shooter Situations presented by Officer Joe Hartman, JCPD.

July’s topic: Intro and Info of An ACO presented by Amanda Hall, BCTI

JULY 2013

GrandRounds MSHA named one of AARP’s 50 best U.S. employers JOHNSON CITY – Mountain States Health Alliance (MSHA) has been recognized by AARP as one of the 50 best employers in the nation for workers over 50. MSHA is the only company in Tennessee to receive the honor this year. Any U.S.-based employer with at least 50 employees is eligible to apply for the Best Employers award. Candidates are vetted to ensure that practices meet the needs of mature workers, and applications are reviewed by an independent panel of judges composed of private sector, nonprofit and government labor experts. Areas of consideration include recruiting practices; opportunities for training, education and career development; workplace accommodations; alternative work options, such a flexible scheduling, job sharing and phased retirement; employee health and pension benefits; and benefits for retirees. In 2011, MSHA created a committee made up of several dozen team members over the age of 50, and asked them to come up with suggestions for making the health system an attractive employer for mature workers. At the recommendation of the committee, MSHA leaders made several changes, including the addition of a Retiree Relationship Manager

who is available to advise team members on retirement plans, benefit questions, and other issues. The health system also created a job sharing program for team members who are nearing retirement. The program allows workers to ease into retirement by reducing their hours without losing benefits. For a full list and for more information on the 2013 Best Employers, visit www.aarp.org/bestemployers, which includes background on employers’ workforce practices and a description of the selection process.

Robot Gives Alzheimer’s Caregivers Peace of Mind JOHNSON CTY—According to the Alzheimer’s Association, there are more than 15 million caregivers of people with Alzheimer’s or Dementia, providing 17 billion hours of unpaid work a year. Is it possible for a therapeutic robot to give these caregivers a break and their loved ones some peace of mind? Yes, it is. PARO, a robotic baby harp seal, has been shown to improve the emotional and physical well-being of patients of all sorts by simulating the mental therapeutic methods of animal-assisted therapy. PARO is programmed to behave as much like a real animal as possible, and offers all the benefits of pet therapy 24 hours a

day, 7 days a week. Sheba, Appalachian Christian Village’s (ACV) PARO seal, provides therapeutic comfort and companionship whenever needed. He enjoys cuddling, responds by name, understands audio cues, such as praise, and even nuzzles your hand when you pet him. Just like a regular animal, Sheba uses its five senses to connect with the patient, and assists in bringing the patient back to society. ACV, a senior living community located in Johnson City, TN, is one of 31 companies in the United States and currently the only community in Tennessee that has the privilege of owning a PARO robot. ACV has been using Sheba as a part of their Memory Care unit since February 2013, and has been incorporated into the daily routine of many Memory Care residents at ACV, as well as used at impromptu times to calm an upset resident by offering companionship.

Frontier Health Nets Silver, Merit Healthcare Advertising Awards JOHNSON CITY—Frontier Health received Silver and Merit 30th Annual Healthcare Advertising awards sponsored by Healthcare Marketing Report. The agency’s 2012 annual report, “Recovery, Success & Independence” netted one of only 241 silver awards granted

among more than 4,000 entries. The Healthcare Advertising Awards is the largest healthcare advertising awards competition; and one of the 10th largest of all advertising awards. It is the oldest, largest, and most widely respected healthcare advertising awards competition. Frontier Health’s newly redesigned external website, www.frontierhealth.org, received a merit award based on creativity, quality, message effectiveness, consumer appeal, graphic design and overall impact. Frontier Health’s external newsletter, Impressions in Behavioral Health Care, also received a merit award based on the same criteria. The Impressions newsletter is mailed to nearly 2,400 area businesses, industries, regional and state leaders. The newsletter includes information on the organizations commitment to the highest standards of excellence, behavioral health news, public health awareness campaigns, and information on the agency’s anti-stigma effort, StoptheWhispering.org and the facebook.com/FrontierHealth page. The StoptheWhispering mini-site is nearing completion. Overall, only nine silver awards were presented for annual reports. Within the specialty category, there were only three merit awards presented for publications and only three merit awards presented for websites.

Experience the Biggest Conference for Pediatric Health Care Professionals

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Pre-conference sessions and events start Friday, October 25 at the Orange County Convention (West Building). Early Bird Registration ends September 13, 2013.

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For more information visit AAPexperience.org/register aap.orlandomeetinginfo.com

JULY 2013

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GrandRounds AHS, Takoma Win Gallup Great Workplace Award for Third Year GREENEVILLE – Adventist Health System, which is comprised of 44 hospital campuses including Takoma Regional Hospital, has received the prestigious 2013 Gallup Great Workplace Award for the third consecutive year. AHS received the award at the 2013 Gallup Summit in Omaha, Nebraska, May 7-9. Jack Lister, Takoma’s human resource director, said that the prestigious award demonstrates that AHS – and Takoma – has one of the best-performing and most-productive and engaged workforces in the world. “Takoma’s vision is to be the best place to work, practice medicine and receive care,” Lister said. We are on a journey to provide worldclass healthcare right here in Greeneville. This Gallup award, along with the other awards we have received lately, shows the excellent progress we are making toward achieving that goal.”

Wiles receives 2013 Hope Award JOHNSON CITY –Dr. David Wiles was presented with the 2013 Hope Award on May 4, 2013, at the Spine Health Foundation annual fundraiser. The Hope Award symbolizes excellence in accomplishing the mission of the Spine Health Foundation. This annual award is offered to an individual who has selflessly provided his or her time to help fulfill our goals of helping others get back to life. Wiles is a neurosurgeon with East Tennessee Brain and Spine Center, P.C. in Johnson City, TN. He received his Bachelor of Science degree from Auburn University, and his doctor of medicine degree from Tulane University. He then completed his General Surgery internship and Neurosurgical residency at the University of Tennessee-Memphis.

Mountain Home VA Medical Center Selects Mental Health Leader MOUNTAIN HOME –Heidi Vermette, MD, was selected as the new Associate Chief of Staff (ACOS) for Mental Health. The ACOS for Mental Health is responsible for development of strategies to meet the mental health goals of the facility, VISN, Dr. Heidi Vermette and VA. Vermette started her VA career as a staff psychiatrist in the Dallas Veterans Affairs Medical Center in 2004. She moved to Tennessee in 2008 after being selected as the Assistant Chief for Psychiatry. She graduated from Tarleton State University in 1989 with a BS in Biology and Texas Tech University in 1993 with an MD. She completed a residency in Psychiatry and fellowship in Law and Psychiatry at the University of Massachusetts. Vermette has published and preeasttnmedicalnews

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sented nationally in the area of police and correctional officer training and has developed a number of telehealth programs.

ETSU Family Medicine’s education series in Bristol focuses on breast cancer BRISTOL – Dr. Sue Prill, a Bristol cancer specialist with the Wellmont Cancer Institute, provided information and answered questions about breast cancer on June 13, as part of a series of public lectures at the Bristol Public Library that is being co-sponsored by the medical residency program at ETSU Family Physicians of Bristol. The series will continue throughout the year on the second Thursday of each month with a wide range of health issues, including such specific diseases as cancer and diabetes, as well as public health concerns. Dr. Raymond “Robin” Feierabend, an ETSU professor of Family Medicine and director of graduate medical education, is the series moderator. The July discussion will feature Dr. Tim Urbin, a clinical psychologist at ETSU Family Physicians of Bristol and an assistant professor with East Tennessee State University’s James H. Quillen College of Medicine. Urbin will lead a discussion on the topic “Dementia: Myth and Reality.”

ETSU faculty members among gathering of statewide experts to address infant and maternal concerns

JOHNSON CITY – Two faculty members from the East Tennessee State University Department of Pediatrics helped highlight the progress being made to improve infant and maternal health in Tennessee at a statewide conference. A wide-ranging group of more than 350 stakeholders – including physicians, nurses and hospital administrators – attended the annual meeting of the Tennessee Initiative for Perinatal Quality Care (TIPQC) in Franklin. TIPQC is funded by a grant from the State of Tennessee through the Department of Health. Dr. Mike DeVoe, director of Neonatology and interim chair of the ETSU Department of Pediatrics, and Dr. Karen Schetzina, an associate professor of Pediatrics and director of Community Pediatrics Research at ETSU’s James H. Quillen College of Medicine, have led the development of TIPQC initiatives and participated in the conference. Devoe is on the state oversight committee for TIPQC and Schetzina is a statewide leader for the TIPQC Breastfeeding Promotion in the Hospital project. The three-day program featured sessions on maternal and child health issues and quality improvement projects. The attendees, including leaders from the Vermont Oxford Network State Collaborative – an organization with members from 10 states – were able to sharpen their projects and objectives through collaborative sharing, benchmarking and learning from national and state experts. New statewide TIPQC projects were also

selected. Danielle Moze, neonatal dietitian with the Northeast Tennessee Regional Perinatal Center, shared a report on efforts to increase the amount of breast milk consumption by infants in the Neonatal Intensive Care Unit (NICU) at Niswonger Children’s Hospital. The Neonatalogy Division at Quillen partners with Niswonger Children’s Hospital, which treats over 400 patients each year in its NICU. Neonatal abstinence syndrome is a group of problems that may occur in babies born to mothers who take narcotics or other addictive drugs during pregnancy. Prior to the conference, TIPQC unveiled a new program, the Neonatal Abstinence Syndrome Project, to address issues related to infants who are born with drug addiction. Schetzina said that although North-

east Tennessee has made strides in improving infant health through the TIPQC Breastfeeding Promotion project, there is more to be gained. The Johnson City Medical Center (JCMC) Family Birth Center has recently joined the TIPQC Breastfeeding Promotion project to share its experience and expertise in improving hospital breastfeeding support. Chasta Hite, manager of lactation services for Mountain States Health Alliance, said the hospital system has been working on several performance improvement projects to increase breastfeeding rates since 2010. Dr. John Dreyzehner, Tennessee’s commissioner of health, attended and recognized TIPQC with the Commissioner’s Outstanding Service Award. Tennessee has gone from 47th in the nation in infant mortality rate to 39th since the inception of TIPQC.

Name: Cindy Luttrell Position: Director of Social Services at Takoma Regional Hospital At a Glance: Honored with Takoma’s prestigious “Crystal Dove” award, Cindy Luttrell received the award at the hospital’s annual Service Awards Banquet held at the General Morgan Inn. Luttrell was described by Daniel Wolcott, Takoma’s president and CEO as “creative; loved by patients, families and staff alike; appreciated for tenacity; a problem solver; talented; involved in the community; cares about youth; lives our values; is trusted by physicians; knows how to help patients in difficult situations; understands her job and excels in her field; can have difficult conversations well; isn’t afraid to stand up for what she believes in; is fun; and is a leader.” Luttrell’s job is to help patients transition to the right place after receiving care at Takoma. “That means she deals with patients who want to go home, but can’t; and patients who don’t want to go home, but have to,” Wolcott said. “She deals with patients who can’t take their babies home yet. She deals with families who have just lost loved ones. She helps doctors find placement for patients whose conditions can’t be treated here because they need long-term care. These are important and difficult conversations, and Cindy does them all day long with grace and compassion.” She also teaches the hospital’s corporate-wide “SHARE” orientation class for new associates. Luttrell is an elected member of the Greeneville City School Board and was recently recognized for her community contribution in that role. She is married to Alan and they have two daughters, Rachael and Chelsea.

JULY 2013

GrandRounds American Cancer Society Announces Upcoming Research Study and Celebrates 100th Birthday at Recent Kickoff Rally TRI CITIES, TN – The American Cancer Society recently celebrated its 100th birthday with a kickoff rally to announce its upcoming Cancer Prevention Study-3 coming to five locations across Northeast Tennessee and Southwest Virginia August 6-9, 2013. In partnership with Wellmont Cancer Institute and YWCA of Bristol, the organization is looking to enroll 600 participants across the region in the free research study. The Society is looking for local men and women between the ages of 30 and 65 from various racial/ethnic backgrounds with no personal history of cancer to help reach full enrollment of at least 300,000 people nationwide. Enrollment will take place at various locations across Northeast Tennessee and Southwest Virginia: • YWCA of Bristol, 106 East State Street, Tuesday, August 6, 2:00 pm – 6:30 pm • Bristol Regional Medical Center, 1 Medical Park Boulevard, Wednesday, August 7, 9 am – 1:30 pm • Holston Valley Medical Center, 130 West Ravine Road, Thursday, Aug 8, 8 am – 12:30 pm • Southwest Virginia Cancer Center, 671 Highway 58 East, Friday, August 9, 7 am – 11:30 am to Right: Kathy Waugh, Executive Director of the YWCA of Bristol, Suzanne Rollins, Survivor, Karen Heaton, Health • Wellmont Medical Associates On- Left Initiatives Representative with the American Cancer Society, and Sue Lindenbusch, Vice President of the Wellmont Cancer cology & Hematology at Allandale, 4485 Institute West Stone Drive, Friday, August 9, 1 pm - 5:30 pm Signing up requires a one-time in-person visit to read and sign a consent form, complete a survey, have your waist measured, and give a small non-fasting blood sample like what you’d do during a routine doctor visit. Participants will also complete a more detailed survey at home and will continue to receive periodic follow-up surveys in the future that researchers will use to look for more clues to cancer’s causes. CPS-3 is the latest addition to the Society’s groundbreaking cancer prevention studies, which have been instrumental in helping identify major factors that can affect cancer risk. For more information or to learn how to become involved with CPS-3, visit cps3northeasttn.org (TN) or cps3swva.org (VA), email cps3@cancer.org, or call toll-free 1-888-604-5888.

PUBLISHED BY: SouthComm, Inc. CHIEF EXECUTIVE OFFICER Chris Ferrell PUBLISHER Jackson Vahaly jvahaly@southcomm.com 615.844.9237 ASSOCIATE PUBLISHER Cindy DeVane cindy@easttnmedicalnews.com 423.426.1142 EDITOR Bridget Garland bridget@easttnmedicalnews.com 423.523.4729 CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Christie Passarello CONTRIBUTING WRITERS Sharon Fitzgerald, Cindy Sanders, Lynne Jeter, Terri Schlichenmeyer, Bridget Garland, Leigh Anne W. Hoover, Rick Jelovsek, Brad Lifford, Joe Morris ACCOUNTANT Kim Stangenberg kstangenberg@southcomm.com CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: editor@easttnmedicalnews.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 • Two years $78 Become a fan on Facebook, and Follow us on Twitter@EastTNMedNews SOUTHCOMM Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Business Manager Eric Norwood Director of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Director of Content / Online Development Patrick Rains East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.        All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.

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Wellmont Physician Connection

From discovery to recovery, we are dedicated to your patients. The new Leonard Family Comprehensive Breast Center offers a full spectrum of breast care in one convenient location. A diagnosis of breast cancer is one of the scariest experiences a woman or man can have. We aim to ease patients’ fears by providing a brand new comprehensive breast center in a healing environment with cutting-edge medical equipment and the care of compassionate physicians, nurses and other highly trained staff.

10 percent of the nation in women’s health and cancer care in 2013, making the comprehensive breast center the perfect addition to our state-ofthe-art facility. A unique approach to breast health

Dr. Sue Prill, medical oncologist Bristol Regional Medical Center Leonard Family Comprehensive Breast Center

A new collaborative model for breast cancer care

We recognize that every breast cancer is different, and no two patients are the same. With this in mind, we have created a breast cancer clinic that features radiologists, medical oncologists, radiation oncologists, pathologists, lymphedema specialists, nurse navigators and other integrated caregivers working together to plan your patients’ treatment options in a new collaborative care model. During cancer conference meetings, each diagnosed case is discussed among the team. We then arrive at a care plan tailored to each patient’s case and circumstances. This model streamlines treatment and empowers our patients to make better-informed decisions regarding their breast cancer treatments. The highest-quality breast care in the region

The Leonard Family Comprehensive Breast Center offers convenient access to expert physicians, advanced technology and unmatched support for any breast health need.

The Leonard Family Comprehensive Breast Center offers a full spectrum of breast cancer care – from prevention and screening to detection, diagnosis, treatment and survivorship – in one convenient facility.

Services and amenities offered by the breast center include: • Multidisciplinary team approach to breast care • Dedicated radiologists with sub-specialized training in breast health • Oncology nurse navigators who offer one-onone education and guidance • Screening and diagnostic digital mammography • Breast ultrasounds • Bone densitometry • Ultrasound guided biopsies and stereotactic biopsies • Designated patient parking outside the new breast center entrance • A comforting, spa-like atmosphere Giving guidance to your patients

We believe patients shouldn’t have to navigate the care process alone. And we also recognize the value of comfort and convenience to help match your patients’ busy schedules. Patients shouldn’t have to worry about scheduling their own appointments, waiting inordinate amounts of time to see their physicians or deciphering the next steps of their treatments. That’s why nurse navigators strive to ensure no patient gets lost in the system.

A nurse navigator will stay in contact with the patient from the beginning to coordinate appointments, ensure adequate case presentation and communicate with our team. The navigator will ensure each patient moves through the care process quickly and knowledgeably. In addition, the navigator will introduce the patient to supportive care information and resources, such as social workers, nutritionists or lymphedema specialists.

At the Leonard Family Comprehensive Breast Center, we want to be there for our patients. That is why we are creating a lifelong bond with them and their families, and that is what we want for your patients. By combining premier technology with a well-respected, compassionate staff, we are delivering the best possible breast care to the region. Help your patients get the care and support they need.

If you would like to schedule an appointment for your patients or tour our facility, please call 423-844-4584. To learn more about our breast care services, visit wellmont.org. Leonard Family Comprehensive Breast Center

Bristol Regional Medical Center 1 Medical Park Blvd., Suite 100w Phone: 423-844-5600 • Fax: 423-844-5609

Our staff works together to provide the best, most comprehensive care for patients diagnosed with breast cancer. By following and exceeding national standards for breast care, the Leonard Family Comprehensive Breast Center is one of only two facilities in the state of Tennessee to earn accreditation from the National Accreditation Program for Breast Centers. The center is also accredited by the American College of Radiation and has been awarded its Breast Imaging Center of Excellence Award. CareChex, a national health-quality ratings organization, ranked Bristol Regional in the top

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- Paid Advertorial -

JULY 2013

Attention

Important information for people with BlueCross BlueShield of Tennessee Insurance Coverage

MSHA & BCBS Reach Agreement. We are pleased to announce that Mountain States Health Alliance and BlueCross BlueShield of Tennessee have reached a new multi-year agreement. The new contract allows you, your family and other BlueCross members to continue to use services at MSHA on an in-network basis. There will be no disruption to patients who have BlueCross commercial insurance plans with P, S or V networks, Federal Employee Program (FEP) plans or BlueCross plans from outside of Tennessee.

Your health is our number one priority, and that’s why in our talks with BlueCross we worked diligently to protect your access to MSHA facilities and services. We know you have a choice as to where you receive your care. That’s why we are so focused on providing you high-quality care and access to a wide range of primary care and specialty services in convenient settings — from numerous outpatient care sites to our family of hospitals, including Niswonger Children’s Hospital.

Thank You. MSHA is grateful to be able to continue providing care to you and your family. We especially appreciate your patience and support as we worked through negotiations with BlueCross. If you have any questions, please feel free to call us at 423-431-6647 or e-mail CampbellSB@msha.com.