FOCUS TOPICS ONCOLOGY TRANSPARENCY
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PHYSICIAN SPOTLIGHT PAGE 3
John Ehrenfried, MD, FACS
ON ROUNDS
FOCUS ON ONCOLOGY SPONSORED BY WELLMONT HEALTH SYSTEM
Jolie Sparks National BRCA1 Conversation
Wellmont certified genetic counselor provides answers
By STACy FENTRESS
HEALTHCARE LEADER: Karla Lane Simply put, running a healthcare organization is a timeconsuming, tedious process. Dealing with the nonstop deluge of documents and bureaucratic ... 4
This past May, actress and director Angelina Jolie made news around the world when she announced she had undergone a preventive double mastectomy because she tested positive for the BRCA1 gene. Her revelation sparked conversations and renewed interest in the idea of genetic testing to determine cancer risk, and it caused women to ask themselves, “What would I do?” For Debbie Pencarinha, a certified genetic counselor with the Wellmont Cancer Institute, this isn’t a new discussion. But Pencarinha recognizes that Jolie’s story has brought genetic testing to the forefront. “Angelina Jolie’s story brought a lot of education to the public and showed people that it’s okay to make big decisions to take control of your health,” Pencarinha said. “You don’t
Debbie Pencarinha, a licensed, board certified genetic counselor, provides genetic testing services at the Wellmont Cancer Institute
(CONTINUED ON PAGE 14)
Enjoying East Tennessee “Days Gone By” Museum of Appalachia –Norris, Tennessee Storytelling is a gift, and it can truly make the past come alive ... 7
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Shining a Light on Physician, Industry Relationships Physician Payments Sunshine Act Now in Effect By CINDy SANDERS
If you’ve recently enjoyed a golf outing with your friendly pharmaceutical rep or a nice dinner with a device manufacturer, that information will soon be available for all to see. The Physician Payments Sunshine Act went into effect Aug. 1 of this year and requires applicable manufacturers to report certain interactions with physicians and teaching hospitals that are deemed to have value. ‘Applicable manufacturers’ are defined as pharmaceutical, device, biologic and medical supply manufacturers whose products either require a prescription to be dispensed or for which payment under federal healthcare programs is available. “The Sunshine Act generally applies when physicians or teaching hospitals receive transfers of value from applicable manufacturers, and the applicable manu(CONTINUED ON PAGE 8)
To promote your business or practice in this high profile spot, contact Cindy DeVane at East TN Medical News. 423-426-1142 • ceedevane@gmail.com PRINTED ON RECYCLED PAPER
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PhysicianSpotlight
FOCUS ON ONCOLOGY SPONSORED BY WELLMONT HEALTH SYSTEM
John Ehrenfried, MD, FACS renfried and his wife Lorna, an
present films, a pathologist will present
anesthesiologist who currently
slides of biopsies, and there might also
The adage “Something good
practices at East Tennessee
be plastic surgeons, surgical oncologists,
always comes out of something bad”
Ambulatory Surgery Center in
medical oncologists, and radiation oncolo-
can be aptly applied to the life and
Johnson City, started searching
gists present,” Ehrenfried explained. “Ev-
career of John Ehrenfried, MD, a
for a place to relocate. When a
eryone is there to see and hear the story,
surgical oncologist with Surgical
colleague from MD Anderson
understand the patient, give an opinion,
Associates of Kingsport. Although
turned down a position in King-
and come to a consensus about the best
his grandfather was diagnosed and
sport in order to move to Chat-
treatment plan, without the patient hav-
treated for cancer at MD Anderson
tanooga, his recommendation to
ing to see each provider. The conferences
Cancer Center, Ehrenfried said that
the practice was to recruit Eh-
help to guide the care and make sure it’s
his grandfather’s experience was
renfried. “So while we were in
the most timely and appropriate care for
partly responsible for his decision to
Houston, they called about an
each individual patient.”
become a surgical oncologist.
interview,” he shared. “We were
Also part of the Institute’s inter-mul-
“As a very young child, I al-
looking for a place with four sea-
tidisciplinary approach to care is making
ways thought that doctors did sur-
sons, rivers, mountains, lakes,
sure that after surgery, patients are seen
gery—they kind of went together for
and good schools, so I said ‘yes,
by the appropriate physicians for follow-
me, but when I was in junior high,
I’ll come look,’ but I was think-
up treatment and care, if needed, he ex-
I also heard all about my grandfa-
ing, ‘no one in my family ever
plained. Designated as patient navigators,
ther’s cancer and treatment at MD
went East.’ However, I came and
these oncology nursing specialists work
Anderson,” he recalled. “So when
looked, and here I am.”
with patients to ensure they get where
By BRIDGET GARLAND
I was in medical school, on surgery rota-
he shared, “So the joke is that my parents
The Ehrenfrieds have three chil-
tion, one of the chief residents was going
had three doctors—an animal doctor, a
dren—two daughters, who are students
Ehrenfried is enthusiastic about the
to MD Anderson to do extra training in
plant doctor, and I’m the people doctor.”
at the University of Tennessee-Knoxville,
progress being made in the treatment of
cancer surgery. I had no idea I could do
After receiving his medical degree,
and a 15-year-old son, who is a student at
cancers, especially in the breast. “The use of
that, but decided then that that’s what I
he moved to Galveston, Texas, to com-
Dobyns-Bennett High School.
MRI and genetic testing of tumor samples
was going to do.”
plete a surgical residency and two years
Since arriving in the area 13 years ago,
helps guide care for treatment after surgery,
Ehrenfried grew up in Norfolk, Ne-
of NIH surgical research at the University
Ehrenfried has become a valued member
such as with chemotherapy,” he said. “There
braska, and naturally pursued his medi-
of Texas Medical Branch. From there, he
of the Tri-Cities medical community. Cur-
are also new medications for people with ad-
cal degree at the University of Nebraska
left for MD Anderson in Houston to finish
rently the only fellowship-trained surgical
vanced disease that are showing promise. In
in Omaha. Although neither of his par-
a two-year fellowship in surgical oncology.
oncologist in the region (the closest oth-
the breast, for example, advances are being
ents had careers in medicine—one was a
“I always felt like surgery was so
ers being in Knoxville), Ehrenfried helps
made that save people from having to have
teacher and the other worked in the insur-
hands-on, such direct care. You can see
train East Tennessee State University resi-
a lymph node dissection.”
ance department of a bank—Ehrenfried
a result directly,” said Ehrenfried. “And
dents on rotation and is actively involved
More information about the Well-
and his two brothers have a long-standing
with surgical oncology, specifically, I am
in multi-disciplinary planning conferences
mont Cancer Institute’s inter-multidisci-
joke about their career choices. “I have an
able to practice the part of surgery that in-
for newly diagnosed cancer patients at the
plinary team approach to cancer care is
older brother and younger brother. My
terested me the most, the potential to cure
Wellmont Cancer Institute.
available online at www.wellmont.org,
older brother is a veterinarian, and my
someone of a life threatening disease.”
younger brother works in horticulture,”
After completing his fellowship, Eh-
“Case presentations are made by members of the team—a radiologist might
they need to be following surgery.
and then click on the Wellmont Cancer Institute link.
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HealthcareLeader
FOCUS ON ONCOLOGY SPONSORED BY WELLMONT HEALTH SYSTEM
Karla Lane Director of Southwest Virginia Cancer Center By John Sewell
Simply put, running a healthcare organization is a time-consuming, tedious process. Dealing with the nonstop deluge of documents and bureaucratic tedium that is part and parcel of the administrative process can wear anyone down eventually. This incessant number-crunching and form-filing can be somewhat dehumanizing—creating a barrier between the patient and the administrator. For Karla Lane, Director of Wellmont Cancer Institute’s Southwest Virginia Cancer Center in Norton, Virginia, being an administrator is not such a cold and distanced vocation. With a background in nursing, Lane brings the warmth, conviction, and compassionate focus of a nurse to her job. “I’m a bedside nurse and I think having that experience has helped me greatly in my management role,” said Lane. “The nurse in me is very much patientcentered. I don’t want to toot my own horn, but my process is about the whole experience. I’m not just concerned with the bureaucratic angle. I’m concerned with the patient’s physical, emotional, spiritual, and financial needs—the whole package.” Lane began her career as an oncology nurse and slowly rose through the ranks to attain the administrative position
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she’s held at the Southwest Virginia Cancer Center for almost two years. One of Lane’s first goals in her new position was to fine tune the organization’s processes in ways that better deal with urgent human needs encountered on a day-to-day basis. “One of the things that surprised me most when I started the job was that the patient focus was somewhat lacking,” explained Lane. “The patient assistance process was already there, of course, but it was not exactly sharpened if you will—
it was still a little bit fragmented. So I’ve been continually working to facilitate the process for the patients. “One of the first things that we do when the patient first comes through the door is to try to ascertain exactly what their needs are, and I don’t mean just their treatment needs,” Lane continued. “Some of the patients are insured, others are uninsured, and some have other special needs. So one of the first things we do is try to figure out what copays or assistance that a patient needs. We also work with outside drug companies to attain assistance for free medication and that kind of thing. When I came here, these things were already being done—but the process wasn’t nearly as hardwired in the system as it is now.” Lane explains that her primary challenge as Director has been dealing with America’s ever-evolving and sometimes confusing insurance system. “There are always changes these days,” said Lane, bemusedly. “It’s really a big challenge to operate as lean as you can and still offer the patients the very best healthcare available. “I remember back when I was a nurse, I was only concerned about the treatments patients were getting,” Lane continued. “But today—and especially from an administrative point of view— you have to think about what the treat-
ment will cost, what is the overhead, etc. So with all the changes in how insurance is handled, well, these are challenging and difficult times.” Sure, treating cancer is a daunting job. There is a lot of drama involved, and the pace is relentless. But Lane faces her job with unrelenting positivity, focusing on the ways she can best benefit patients. “I think one of the most important things for anyone in the oncology field is to remember not to become complacent,” enthused Lane. “When you do something as serious as this for days, months, years, you can become hardened to it. So you always have to remember the fears and anxieties that a patient with this [cancer] diagnosis will have. Even though what we do may be a bit of a routine, we have to remember that it’s something new that can be really scary for the patients. Keeping the patients in perspective and paying attention to their feelings is absolutely crucial. “A lot of times people will talk to me about my job, and they’ll say that it must be depressing,” Lane continued. “And, you know, it’s really not. I knew early on that oncology was where I wanted to be for my entire career. Oncology patients are so brave and humble, and they’re going through tough times. So it’s important for me to be able to help these people in these important times of their lives. So, I don’t go home thinking ‘this is too hard.’ This job fulfills me.” Thankfully, life is not all seriousness for Lane. Her leisure time activities include hiking, camping, and going to the lake with her son Camden, her daughter Kaegan, and her husband William. Lane strives to continually upgrade the services at the Southwest Virginia Cancer Center, which is no small task. Among upcoming changes, the center is preparing to attain accreditation from the American College of Surgeons (ACOS). “Right now we are fine tuning both our community outreach and research for the accreditation,” said Lane. “We’re on our way, and will be assessed early next year. That will be a feather in our cap.” For Lane, her profession is more of a calling than a vocation. She expects to stay with Wellmont for the remainder of her career. “I’ve always said I’ll do oncology till I retire,” said Lane. “That way I can continue to make a difference in patient’s lives. “I think we’re all put here for a purpose, and oncology must be mine,” Lane continued, laughing. “I want to continue to help as an administrator or in any other way that I can. I just really look forward to all the progress we’ll see in the future, maybe even curing cancer. That would be the ultimate.”
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LegalMatters
Online Event Calendar
BY DIANA L. GUSTIN, ESQ.
HIPAA Five-O: Complaints, Compliance, and the Privacy Police
How does an investigation begin? An individual has the right to file a complaint with the Secretary of Health and Human Services if that person believes a covered entity or business associate is not complying with HIPAA(4). The Secretary will investigate any complaint when a preliminary review of the facts indicates a possible violation due to willful neglect. The comments in the Federal Register indicate the Secretary currently conducts a preliminary review of every complaint received and proceeds with an investigation where the facts indicate a possible violation of the HIPAA Rules. (Mandatory reports for breach may also trigger a complaint and investigation.) When does an investigation become a compliance review? If the investigation indicates there
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might be facts to support the possibility of a violation due to willful neglect, the Secretary must conduct a compliance review. The Secretary will conduct a compliance review of the covered entity or business associate to determine if there is compliance with the applicable administrative simplification provisions when a preliminary review of the facts indicates a possible violation due to willful neglect(5). The Secretary also retains discretion to conduct a compliance review in any other circumstance(6). What is “willful neglect”? The term “willful neglect” is defined at 45 C.F.R. §160.401 to mean the conscious, intentional failure or reckless indifference to the obligation to comply with HIPAA. The comments in the Proposed Rule listed examples of willful neglect as 1. disposal of a hard drive in an unsecured dumpster where the covered entity failed to implement policies and procedures to safeguard PHI during the disposal process; 2. failure to respond to an individual’s request for restriction of the uses of PHI where the covered entity did not have any policies and procedures in place for consideration of the request for restriction; 3. a covered entity’s employee loses a laptop that contains unencrypted PHI and the covered entity feared for its reputation if the incident became public and decided not to provide the appropriate notification(7). The facts in the above examples were described as situations where the covered entities had actual or constructive knowledge of the violations. It is important to recognize that two examples focused upon the covered entities failure to have policies and procedures in place, which was described as “a conscious intent or reckless disregard” of their compliance obligations. Who should have compliance policies and procedures? Covered entities, business associates, and subcontractors need to have appropriate policies and procedures in place to protect the privacy and security of individual’s medical information. The comments to the Proposed Rules note it was assumed that business associates in compliance with their contracts would have already designated personnel to be responsible for formulating the organization’s privacy and security policies, performed a risk analysis, and invested in hardware and software to prevent and monitor for internal and external breaches of protected health information(8). To emphasize the requirement, the risk of criminal and/or civil monetary penalties
was referenced as an incentive for organizations to bolster their security and privacy policies. What does it all mean? The law continues to evolve through a complex system of rules, regulations, and guidance. Keep it simple by making your patients’ privacy a priority. Update your compliance program and train your staff to stay current with the law, as well as the technology.
To submit or view local events visit the East Tennessee Medical News website.
Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice. 78 Federal Register 5566, January 25, 2013 See 45 C.F.R. §160.402 and §160.404 3. 45 C.F.R. §160.308 4. 45 C.F.R. §160.306 5. 45 C.F.R. § 160.308(a) 6. 45 C.F.R. § 160.308(b) 7. 75 Federal Register 40879, July 14, 2010 8. 75 Federal Register 40909, July 14, 2010 1. 2.
Diana L. Gustin is an attorney practicing at London & Amburn, P.C. Her practice focuses on defense of clients responding to government and private payor reimbursement claims, healthcare compliance and regulatory matters, including HIPAA. For more information on HIPAA or other health law matters, you may contact Ms. Gustin by visiting www. londonamburn.com.
A user name and password are required to submit an event. Under Member Options, go to “free sign up” to register.
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Opening Night: Tragedy to Triumph
featuring Cherylonda Fitzgerald, Cello Saturday, October 12, 7:30 p.m. Mary B. Martin Auditorium at Seeger Chapel, Milligan College
Johnson City Symphony Orchestra
As Detective Steve McGarrett would often say on the classic television show Hawaii Five-O: “Book ‘em, Danno.” Only in this case, it’s not “murder one” on the Hawaiian islands – it’s for violation of the HIPAA Privacy Rule. On January 25, 2013, the Office of Civil Rights published the Final Rule to implement modifications to HIPAA Privacy, Security, and Breach Notification rules(1). The basis for the imposition of a civil money penalty was revised to include business associates. The potential amount for a civil penalty increased to permit an assessment of the maximum of $1.5 million for identical violations during a calendar year. The penalty is based upon the facts and circumstances in a four tier system: (i) the covered entity (or business associate) did not know and by exercising reasonable diligence would not know of the violation: $100 - $50,000/violation and up to $1,500,000; (ii) the violation was due to reasonable cause: $1,000 - $50,000/violation and up to $1,500,000; (iii) the violation was due to willful neglect: $10,000 - $50,000/violation and up to $1,500,000; (iv) the violation was due to willful neglect and was not corrected within 30 days of knowledge (actual or constructive): $50,000/violation and up to $1,500,000(2). Enforcement provisions now require a formal investigation if a complaint (and the preliminary investigation of the facts) indicates a violation was due to willful neglect(3). Covered entities and business associates must carefully consider the status of their HIPAA compliance program. Failure to implement HIPAA policies and procedures could be construed as willful neglect and result in significant financial penalties. Protected health information (PHI) must be protected by law.
Cherylonda Fitzgerald is principal cellist of the Johnson City Symphony Orchestra and a member of the Asheville Symphony and the Kingsport Symphony of the Mountains. As a chamber musician, Ms. Fitzgerald performs with The Paramount Chamber Players, the Shelbridge Chamber Players, and Signature Strings. Ms. Fitzgerald has taught cello/bass and chamber music at Milligan since 2005 and is an adjunct instructor at East Tennessee State University. She maintains a private cello studio and is director of the East Tennessee Cello Choir. She holds a bachelor’s degree in performance and music education from the University of Louisville and a master’s degree in cello performance from S.U.N.Y. at Stony Brook.
Evening Program
Antonin Dvorak: Concerto for Cello in B minor, Op. 104 Jean Sibelius: Symphony No. 2 in D Major, Op. 43
Tickets: $35; Seniors (65+) $30; Students $10 For more information: 92-MUSIC (926-8742) or visit www.jcsymphony.com Free bus service: 6:15 (Colonial Hill); 6:30 (Maplecrest & Appalachian Christian Village); 6:45 (City Hall)
This concert is funded under an agreement with the Tennessee Arts Commission and the National Endowment for the Arts.
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The premiere opportunity to showcase healthcare products and services in Tennessee Attendees Include Hospital CEOs and Department Heads, Plus Many More Healthcare Executives! For exhibit information, call 615-256-8240 or 800-258-9541. Print the exhibit prospectus on THA’s web site: www.tha.com. 6
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ClinicallySpeaking BY NORMAN A. ASSAD, MD, FRCS (C)
Infertility in 2013 Infertility is not a rare condition. Unfortunately, it affects one in six couples. Approximately 40% of the time the cause is related to female factors, 40% of the time male factor, and 15% of the time there may be more than one factor. The primary consideration prior to starting treatment is to make a diagnosis and base treatment on the underlying cause of infertility, rather than to perform arbitrary treatment with the hope that something will work. Common Causes The most common cause of female fertility are ovulation disorders. This can account for up to half of all female fertility, and many patients with anovulation have Polycystic Ovarian Syndrome. It is important to control the manifestations of this condition, for without proper diagnosis and treatment, these patients can frequently progress to full blown Metabolic Syndrome with all of its catastrophic consequences in later life. The second most common cause of infertility in the female is Endometriosis, and, again, it is import to diagnose and treat this condition so it does not progress to later stages of the disease, which can have significant consequences on quality of life and other pain issues. The third most common factor, which accounts for only 10% of patients with infertility, are tubal factors. Many of these are secondary to endometriosis, while others are related to STD’s. Diagnosis is important as these patients are very susceptible to tubal pregnancy when they occur. For known medical conditions, these can often be diagnosed and treated using the patients insurance benefits, as many of these services are covered. The majority of insurances that we deal with also have diagnostic coverage for infertility. Disturbing Trends Several disturbing trends are emerging in 2013. Many men are using testosterone supplements for symptoms associated with “low T,” and these medications can have a profound effect on lowering sperm count. Many women are given compounded substances for infertility. Many of these contain progesterone, which can have a contraceptive effect if used prior to ovulation, as they affect sperm transport. We are also seeing a decrease in ovarian reserve, particularly in young women. This seems to be a national trend, and no one can come up with an exact etiology. We are measuring antimullerian hormone levels, which are cycle independent
and seems to be a more accurate assessment of ovarian reserve than the FSH or Estradiol levels. Cost Considerations Most patients are treated at any level of therapy, for a finite number of cycles (usually 3), as national statistics reveal a leveling off of success rates with more cycles than this. As these cycles are mostly paid for by the patient, it is important not to exhaust their financial and emotional resources with therapies that have little chance of success. We increasingly recommend treatment based on outcomes, and explain the cost effectiveness ratio with each level our therapy. For instance, Gonadotrophin/IUI cycles are three times as effective as Clomiphene/IUI cycles; however, the cost of the former is about triple the amount of the latter. At Quillen ETSU Physicians, we attempt to do global pricing for all cash pay cycles which make it easier for patients to plan therapy, with few financial surprises. Our success rates are in line with national statistics and with IVF, we enjoy one of the higher rates in the State, but at cost effective prices. The latter are at the lower end of the spectrum both statewide and nationally, and we have endeavored to keep these prices low given the population that we serve. The success rate of infertility treatments continue to improve with advanced technology; however, it is important to maintain the “human” side of treatment as this condition and its treatments can be very difficult for young couples. Norman A. Assad, MD, FRCS(C) serves as Fertility Services Division Director for Quillen ETSU Physicians’ Department of Obstetrics and Gynecology. A board-certified obstetrician and gynecologist, Assad is a specialist in reproductive and menopausal medicine. He is a member of the American Society for Reproductive Technologies, the American College of Obstetricians and Gynecologists, and the American Association of Gynecologic Laparascopy. He earned his medical degree and completed residency training at The University of Western Ontario and is a Fellow of the Royal College of Obstetricians and Gynecologists of Canada. Assad has been practicing medicine in the Tri-Cities since 2002 and joined Quillen ETSU Physicians’ OB/GYN Department in January 2005, serving as an associate professor at East Tennessee State University Quillen College of Medicine. For more information or to make a referral, visit www.etsuphysicians.com/medical-services/ fertility.html.
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Enjoying East Tennessee
“Days Gone By” Museum of Appalachia –Norris, Tennessee By LEIGH ANNE W. HOOVER
Storytelling is a gift, and it can truly make the past come alive. For our adult children, some of their fondest memories are from family gatherings and hearing their elders share stories from the past. Whether it’s a funny tale from a grandparent’s childhood or an uncle’s rendition of a family escapade, they are simply mesmerized by the past. The Museum of the Appalachia founder John Rice Irwin shares this same fascination, and his “hobby” of collecting relics, stories, and preserving the past became his life’s work. Today, Irwin is 83-years-old and retired. However, his legacy lives own through collections showcased in a nonprofit jewel of a museum, which is simply like no others. Just 16 miles north of Knoxville, Museum of Appalachia is situated on 65 acres of picturesque countryside complete with 36 authentic log cabin structures. The facility has been featured in numerous publications, including the Smithsonian, National Geographic Traveler, Southern Living, Reader’s Digest, and many others. Anyone from infamous dignitaries and celebrities to those just seeking a respite and an escape to the past has walked the grounds, and the museum has shared a story or two and a true slice of Appalachia with each one. In fact, prior to the 1982 World’s Fair, Irwin and the late Alex Haley, Pulitzer Prize-winning author of “Roots,” once served on the Tennessee Entertainment & Music Commission (TFEMC) together, and Irwin introduced Haley to his museum. Haley fell in love with the museum and even built a house in Norris, Tennessee, close to the property and remained close friends with Irwin and his family. Today, Irwin’s daughter, Elaine Meyer, serves as president of the museum and continues her father’s mission of keeping the past alive and preserving the Appalachian heritage. Museum of Appalachia became a not-for-profit 501(c)(3) museum in 2003, and all proceeds support the mission of “not only preserving physical artifacts of an earlier time but also instilling in the community, regionally, nationally, and internationally, a greater knowledge and appreciation for the Appalachian history and heritage.” “In the early days, John Rice just collected things –especially tools and different farm implements…that were housed in our garage,” explained Meyer. “At some point, they filled the garage to the ceiling and gravitated outside on the lawn.” Meyer remembers people stopping by and wanting to “trade” with her father. During inclement weather, Irwin used a tarp to cover his collection to protect it from the rain. However, this was the impetus that necessitated the first outbuilding, which was the General Bunch cabin that was obtained from the very remote New River area of Anderson County. “My mother took pride in the appeareasttnmedicalnews
.com
ance of the house and lawn, and she did not like all of that ‘stuff’ in the yard,” explained Meyer. So, the outbuildings grew, and one cabin led to another on the property forming an eventual museum, which was founded in 1969. From one room shanties, to a schoolhouse and many others, a virtual pioneer village has been recreated. There is even a cabin that belonged to Mark Twain’s family on the grounds. Meyer can remember a “gas station” type bell that would ring in their house when a visitor drove up, and she, her sister, or mother would meet guests and take them on guided tours. As president of the Museum of Appalachia, Meyer has added vision with an increased interest in preserving her father’s vast collection. In 2007, the museum was officially adopted as a Smithsonian Institution Affiliations Program. “Growing up, the Smithsonian was just the pinnacle…, and to be a part of that is just more wonderful than I can even describe,” said Meyer. “Senator Howard Baker is a member of our board of directors…, and he decided that we were worthy of being a Smithsonian affiliate.” According to Meyer, this “worthiness” led Baker to pursue visits from the Smithsonian. The affiliation designation recognizes the museum’s efforts to preserve, treasure, and share the past for others as a living, realistic snapshot of pioneer life right here in East Tennessee. Relics too numerous to count are housed in additional museum properties, and each has its own individual story and familial connection. Documented stories and signage allow visitors to read and appreciate as much of the history as desired. There is even a dedicated area to the early days of medicine. “These people had strong ethics and morals, and they were brilliant in making do with what they had,” explained Meyer. “They could build, think, and figure things out without someone telling them what to do.” In fact, for the 34th year, October 11th-13th the museum will celebrate with the Tennessee Fall Homecoming, which began as a way to showcase the many dying crafts and pioneer activities. Today, those
same historic demonstrations continue with all of the expected sights and smells as the sounds of music also echo through the mountains. The very best musicians from genres, including bluegrass, old-time country, Southern gospel and Americana perform throughout the weekend on five, unique stages. “When they [visitors] get out of their cars, the first thing that they hear is the music of the area,” said Meyer. “It sets the tone for the day.” Wagons, pulled by vintage tractors, pickup guests, and they take rides over to
the museum festival activities. In addition to the music, smells of fried apple pies, pinto beans, sassafras teas, and other specialties envelop guests in the essence of days gone by. If antiques are your interest, a “Days of the Pioneer” antique show presented by A Simple Life Magazine will take place September 13th-14th at the Museum of Appalachia. Dealers from throughout the country will showcase and sell the very best of the 18th and 19th century. “I love the fact that people connect [through the museum], and they enjoy talking to their parents and their grandparents,” said Meyer. “That oral history really brings people together and [links] generations. The love of family is what brings people here, and when they leave, there is a greater appreciation of their ancestors and themselves.” For additional information on the Museum of Appalachia, visit http://www.museumofappalachia.org Leigh Anne W. Hoover is a native of South Carolina and a graduate of Clemson University. She has worked for over 25 years in the media with published articles encompassing personality and home profiles, arts and entertainment reviews, medical topics, and weekend escape pieces. Hoover currently serves as immediate president of the Literacy Council of Kingsport. Contact her at hoover@chartertn.net.
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Shining a Light on Physician, Industry Relationships, continued from page 1 facturers receive actual or potential value in return,” explained Tom Baker, a shareholder in the Baker Donelson Health Law group. Baker, who practices in the firm’s Atlanta office, pointed out the manufacturer doesn’t actually have to receive financial Tom Baker benefit in exchange for the ‘value transfer,’ which can take a wide variety of forms, including donated items, payment to a physician for consulting services or expenditures for entertainment. “It’s enough that it might influence a physician,” he noted. “The Sunshine Act is about transparency in two different fundamental ways,” he continued. “First, there is the potential interference in medical judgment in clinical trials required for FDA approval of drugs or medical devices. Second, there is potential interference in medical judgment in terms of ordering an item or service for which federal reimbursement is available.” Baker said the policy is to shine a light on interactions that could be construed to unduly influence a physician or teaching hospital and to ferret out conflicts of interest. “It’s not saying that transfers of value are, per se, illegal but that the public has a right to know when medical judgment might be influenced by the value transfer,” he continued. Relationships between physicians and industry will now be on display for patients, auditors, personal injury lawyers and others to see when the Centers for Medicare and Medicaid Services (CMS) begins publishing the reported data next fall.
The Back Story
Championed by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.), the impetus behind the Sunshine Act came from mounting concern over potential conflicts of interest within the industry. These conflicts were highlighted by several egregious incidents involving clinical trials and devices up for FDA approval where physicians received large payments from the manufacturers of the drugs or devices being studied. Grassley publicly described a number of academic physicians taking money from the National Institutes of Health when those physician-scientists had direct financial interests in their own research. Among the worst offenders, the former chairman of the Psychiatry Department at Stanford University received an NIH grant to study a drug when he owned $6 million in stock in the company seeking FDA approval. Similarly, the former chair of the Psychiatry Department at Emory failed to report hundreds of thousands of dollars from GlaxoSmithKline while researching the company’s drugs. Harvard also had to discipline three researchers who received almost $1 million each in outside income while heading up several NIH grants. Outside of these flagrant examples, the concern persists that much smaller 8
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gifts might also influence medical decisions. Earlier this year, Pew Charitable Trust published Persuading the Prescribers: Pharmaceutical Industry Marketing and its Influence on Physicians and Patients, which stated the drug industry spent nearly $29 billion marketing their products in 2011 (Source: Cegedim Strategic Data). Of that amount, $25 billion was spent directly marketing to physicians. After unsuccessfully introducing the legislation in 2007, the Sunshine Act was incorporated into the Affordable Care Act. A couple of missed rulemaking deadlines by CMS pushed the law’s effective date to Aug. 1, 2013 for the balance of this calendar year and requires annual reporting going forward.
What is a Transfer of Value?
With 12 major exceptions (see box), any direct payment or transfer of value of $10 or more (or an aggregate of $100 or more in a calendar year) to a physician or teaching hospital must be reported. Additionally, indirect transfers through an intermediary or third party are also subject to reporting. There are 14 main reporting categories. These include consulting fees, compensation for services other than consulting, gifts, entertainment, food, travel, charitable contributions, education, grants, research, royalty or licensing fees, current or prospective ownership or investment interest, direct compensation for serving as faculty or a speaker for a medical education program, honoraria. Under the new rules, Baker said a physician could accept a ballpoint pen or pad of sticky notes from a manufacturer without it being included in the annual report, but most meals, tickets, or gifts probably will fall under one of the reporting categories considering the $10 threshold. “The days of the pharmaceutical company taking a group of physicians to the Super Bowl are over … or at least it will be disclosed and expose you to the risk of Anti-Kickback statute prosecution,” Baker said. “It’s the entertainment part of it that physicians would probably like to have exposed the least,” he added. The law also requires applicable manufacturers and GPOs (group purchasing organizations) to report ownership interests by physicians or their immediate family members. It should be noted, however, that purchased industry stocks and mutual funds that are generally available to the public are not reportable. If Dr. Smith buys 50 shares of ABC Pharmaceutical stock, which is publicly traded, it doesn’t have to be reported. If a representative of ABC Pharmaceutical gives Dr. Smith stock, then it does. Ultimately, a patient whose doctor recommends a specific device or drug will be able to search the CMS database to see if there is a connection between the physician and the manufacturer. “You’re going to know when your physician has a personal financial interest in your healthcare beyond the physician’s professional services,” Baker pointed out.
Disputing a Report
So what happens if your name appears on a report, and you disagree with the data? Baker said CMS is going to notify physicians of all their reported relationships. Once access is granted to the online portal housing the consolidated report, a physician should have at least 45 days to challenge the data and try to resolve the dispute with the reporting entity. Those who cannot agree will be given an additional 15 days to come to a resolution before the information is made public. If no agreement can be reached, the data will be published but flagged as disputed. Physicians cumulatively have up to two years to dispute reports even after the data is published. “While physicians aren’t required to track transfers of value, they are encouraged to do so,” said Baker. “How in the world are you going to be able to refute a report if you don’t have evidence to the contrary.” Baker pointed out you might not think you received an influential ‘gift’ from a device manufacturer by grabbing a bite of lunch, but even a sandwich, tea, tip and tax is often over the $10 threshold. Short of asking to see the bill, it would be difficult to gauge the cost per person at the table; and without a copy of the receipt, it would be difficult to dispute the reported item. “As a practical rule, doctors probably aren’t going to be good at refuting the evidence,” Baker said. However, he added, CMS has created a smartphone app with a version for industry and another for physicians to make it easier to keep track of reportable transfers. “Open Payments Mobile” is available at no charge through the Apple Store and Google Play Store.
Timeline
Data accumulation for 2013 has already begun. Below is a timeline of upcoming key dates in the process. • Jan. 1, 2014: Anticipated launch date for CMS physician portal where doctors can register to receive notice when their individual consolidated report is ready for review. This portal also provides a means for physicians to contact manufacturers and GPOs about disputes in accuracy. • March 31, 2014: Partial year data (August-December 2013) must be turned into CMS. • June 2014: Anticipated access to individual consolidated reports from 2013. Physicians have a minimum of 45 days by law to seek corrections or modifications to the information by contacting manufacturers/GPOs through the portal. September 2014: Searchable reports are published and open to the public.
Be Prepared
“The act itself is vexing,” said Baker. Adding to the frustrations, he continued, is that CMS is interpreting the Sunshine Act very broadly. “The applicable manufacturers are not going to take any chances,” Baker continued. He noted, those who acciden-
tally fail to disclose required data will face penalties of not less than $1,000 and not greater than $10,000 per incident up to a cap of $150,000 annually. Those who knowingly withhold reportable information face penalties between $10,000 and $100,000 for each value transfer with an annual cap of $1 million. “Physicians need to know other people are going to be talking about them,” concluded Baker. “One would hope everything reported is within the legal boundaries … but if you are testing those boundaries, you better stop.”
12 Key Exemptions to the Reporting Rule Certified and accredited CME. Buffet meals, snacks, coffee breaks that are provided by a manufacturer at a large-scale conference or event when the items are generally available to all attendees. Product samples that are not intended for sale and are for patient use. Educational materials that directly benefit patients or are intended for patient use. The loan of a medical device for evaluation during a short-term trial period (not to exceed 90 days). Items or services provided under a contractual warranty in the purchase or lease agreement for a device. The transfer of any item of value to a physician when that physician is a patient and not acting in his or her professional capacity. Discounts including rebates. In kind items for use in providing charity care. A dividend or other profit distribution from, or ownership or investment in, a publicly traded stock or mutual fund. Transfer of value to a physician if the transfer is payment solely for the services of the physician with respect to a civil or criminal action or an administrative proceeding. A transfer of anything with a value of less than $10 unless the aggregate amount transferred to, requested by, or designated on behalf of the physician exceeds $100 in the calendar year.
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In Case of Emergency
Tennessee Department of Health’s Role in Protecting the Population By CINDY SANDERS
Between immunizations, primary care services, licensure and regulation of health facilities, analyzing health statistics and launching preventive care initiatives, it’s easy to think of the Tennessee Department of Health as more ‘Clark Kent’ than “Superman.’ Yet, as the recent multi-state fungal meningitis outbreak clearly reminded us, addressing emergency situations is a key part of the TDH’s core function. In fact, the departDr. John ment was primarily Dreyzehner established to combat lifethreatening outbreaks of cholera, yellow fever and other deadly diseases in the late 1880s. Preventing or stopping public health threats remains a top priority. Sometimes those threats warrant local, state or national attention, but often the TDH staff quietly goes about that part of their workday without much fanfare. “Our mission is to protect, promote and improve the health and well-being of Tennesseans. The emergency preparedness aspect is all about protecting the population,” noted TDH Commissioner John Dreyzehner, MD, MPH.
The types of emergencies range from natural or manmade disasters to addressing or preventing communicable and infectious diseases to investigating outbreaks. “We take an all hazards approach,” explained Dreyzehner. “We never know when the next event will be … but we know it’s coming.” With the State Public Health Laboratory in Nashville and additional labs in east and west Tennessee, the TDH has approximately 130 staff members who perform close to 1.5 million lab tests annually. Not only do the labs have the ability to run a broad spectrum of health assays, the staff also is called upon to analyze substances of concern, such as an unidentified powder, that might come to the attention of law enforcement officials. “This occurs more frequently than people realize,” Dreyzehner noted. While biohazards are a small part of the overall lab workload, the state labs also play an integral role in analyzing environmental samples, conducting newborn screening panels, and identifying West Nile and other arboviral diseases. Equally important is the state’s work in preparing for threats that haven’t yet arrived. “Right now we have spent a good bit of time and resources on MERS-CoV — Middle East respiratory syndrome corona-
virus — and H7N9, a new strain of flu,” Dreyzehner said. “I hasten to add that neither of those have come to our shores.” Being ready, however, has set Tennessee apart. When H1N1 did strike America several years ago, the State Public Health Lab was on the forefront of running tests. At one point, Tennessee was doing testing for other states that didn’t yet have the capacity to analyze incoming samples. Since health threats come from many different arenas, it’s difficult to anticipate every scenario. “A key lesson is we never know where the next hazard is going to come from. We have spent a lot of time creating the infrastructure, relationships, tools, and capacity to respond to any hazard,” explained Dreyzehner. That was made abundantly clear in the recent issues with preservative-free methylprednisolone acetate (MPA). He noted that in the fungal meningitis outbreak, the TDH relied heavily on the relationships and partnerships that were put in place well in advance of the crisis to effectively work with victims and to communicate information both internally and externally. “We were able to use some existing capacities in some very innovative and novel ways to great success,” Dreyzehner said. One example, he noted, was using
preparedness software developed for another purpose to track patients who had been exposed to the tainted MPA. The team also relied on their capacity to collect and analyze data to predict the most effective treatment protocols and to identify those at risk. As Dreyzehner pointed out, going into this crisis there was virtually no literature on the particular type of fungus involved in the meningitis outbreak. “We were dealing with a situation that no one had ever encountered before.” Calling on relationships with federal agencies, national experts, and academic centers, Dreyzehner said the team quickly gathered and disseminated information to local provider resources across Tennessee — including public health nurses and county public health staff — who have regularly reached out to inform and update those impacted by the tainted MPA. Dreyzehner was quick to add this work is ongoing. “More than 13,500 people were affected by this … ranging from disconcerting to catastrophic,” he said. “This is still affecting more than 700 people around the country — 749 cases have currently been identified, and 63 people unfortunately lost their lives. The need for a rapid and accurate information loop has spurred the state to (CONTINUED ON PAGE 14)
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Give your patients every advantage in the fight against cancer. Trust the Wellmont Cancer Institute for the region’s state-of-the-art radiation oncology care.
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ou’ve always depended on the Wellmont Cancer Institute to provide compassionate, highly skilled cancer care – including the region’s most robust radiation oncology services. Since 2004, we’ve offered the CyberKnife radiosurgery system, which has helped make an enormous difference in our patients’ lives. And more recently, we were proud to announce the arrival of the Trilogy linear accelerator at Holston Valley Medical Center. With these two systems, as welll as the radiation oncology capabilities at our Southwest Virginia Cancer Center in Norton, Va., the Wellmont ellmont Cancer Institute is providing your patients the most hensive scope of servicess in the region. comprehensive
Drs. Scott Coen, oen, md,, Byron May, md, and John Fincher, cher, md
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Introducing Trilogy – our new power for fighting cancer Our radiation oncologists use the Trilogy’s high-powered X-ray beam to destroy tumors and cancers. Its other benefits include: • A high dose rate for shorter, faster treatments – and lower radiation exposure • Finely detailed, real-time ct images, which allow us to situate patients accurately and quickly • Adjustable radiation beams, so we can account for breathing movements
Trilogy is so precise, we’re able to deliver highly concentrated doses of radiation directly to tumors – sparing healthy tissue to a previously unimaginable extent.
Its flexible range of motion means we can treat any area of the body. And its unique design allows us to treat p patients from any angle, making it the most comfortable experience experi possible.
Advanced robot robotic technology w with CyberKnife When the CyberKnife radiosurgery rradiosu system arrived at Bristol Regiona al Med Regional Medical Center, it was one of only a handful handful nationwide. na And now, it’s still the only Cy yberKn offered in CyberKnife our region. CyberKnife uses its robo otic arms ar to precisely robotic direct the radiation dose es to tu doses tumors and other
diseased tissues. The cancer is pinpointed by CyberKnife’s image-guided technology – similar to that used by the military to target cruise missiles.
Because the radiation is delivered with submillimeter accuracy, tumors and other abnormalities receive a concentrated dose of radiation, but the impact on surrounding healthy tissue is minimized. The CyberKnife allows physicians to treat tumors throughout the body and central nervous system – including tumors that once would have been inoperable. Treatment is completely noninvasive, requires no anesthesia and is usually completed on an outpatient basis.
Comprehensive services – in the heart of the Tri-Cities and beyond For patients in Southwest Virginia, the Wellmont Cancer Institute’s cancer center in Norton provides more than 7,000 square feet of dedicated radiation oncology space in a luxurious, lodge-like setting.
At the Southwest Virginia Cancer Center, we provide high-quality services, including intensity-modulated radiation therapy and imageguided radiation therapy.
With our telemedicine capabilities, our oncologists can conference and collaborate with physicians across our system – without having to take time away from patients to drive long distances. And if further services are needed, patients at the Southwest Virginia Cancer Center have seamless access to the services and caregivers at Holston Valley and Bristol Regional.
No matter where you are in Northeast Tennessee or Southwest Virginia, your patients have access to some of the region’s most comprehensive cancer care, including: • Our radiation oncology technology in Kingsport, Bristol and Norton • An accredited breast center in Johnson City, as well as comprehensive breast centers in Kingsport and Bristol • Targeted therapy, chemotherapy and other infusion and injection services in Kingsport, Bristol, Johnson City and Norton • The region’s only board-certified genetic counselor in Kingsport, Bristol, Johnson City and Norton • Clinical trials in Kingsport, Bristol, Johnson City and Norton
Strength for today and hope for tomorrow Above all, we believe treatment should begin – and end – with hope. Because where there is hope, there is the strength to fight and the optimism to survive. With hope as its focus, the Wellmont Cancer Institute is committed to helping patients have the chance to live out their dreams long after cancer is only a distant memory.
To refer a patient, please call 1-855-878-8550. Or visit wellmont.org to learn more about the Wellmont Cancer Institute.
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SEPTEMBER 2013
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Transparency in Healthcare What does it Mean to You? By Heather Ripley
You have probably seen the word “transparency” used in newspaper headlines, on network and cable TV news shows, on website stories, blogs, Facebook and Twitter, to name a few communication platforms. Transparency is the latest buzzword businesses, and especially healthcare businesses, will need to think about as they look for new and more effective ways to communicate openly with their audiences - both in business-to-business and businessto-consumer relationships.
Healthcare and Transparency
Not surprisingly, transparency in the healthcare industry is at the top of the list, and not just with consumers. It’s something
the healthcare industry as a whole is talking about. As an example, at the recent 2013 America’s Health Insurance Plans Institute (AHIP) event, the topic of healthcare transparency increased 400 percent in Twitter conversations during and after the event. Google the phrase “healthcare industry transparency” and you’ll likely find there are more than two million search returns in approximately .26 seconds. The healthcare industry is being urged to adopt more transparency from within the medical community as well. For example, the American Medical Association recently issued a recommendation requesting insurers to provide physicians and their staff with better tools to determine a patient’s treatment cost prior to treatment. It’s pretty clear, healthcare businesses will be under more scrutiny than ever before, and becom-
ing more transparent will be a necessity, not a choice. But creating a culture and corporate identity that employs transparency is no easy task, and many business owners have tried to adopt some form of corporate transparency on their own with various degrees of success. Some have decided it is too much trouble or not worth it. I have consulted with many businesses, creating marketing strategies that maintain integrity and security while embracing a culture of openness and honesty. For those businesses that have a hard time determining what transparency means for them, engaging a professional with social, public relations, reputation management and crisis communications experience can be a huge help.
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A recent article on INC.com highlighted transparency in business, noting that transparency for businesses also means being more transparent with employees, not just business partners or clients. Some businesses are going so far as to share salaries – including CEO salaries—with employees. Some feel this transparency makes for a more unified team. Other business-to-business firms are making their financials more available to their business partners and vendors in a twist that they hope will allow them to obtain more or better credit. If they reveal how good their numbers are, their suppliers, vendors, clients and business partners might be more willing to use that information to give businesses with good, solid financials better financial arrangements. This is only useful if your business is financially stable. An example of a business that worked transparency into its business model with great success is Zappos. Already wellknown for its great customer service, Zappos wanted to include employees, vendors and its partners in its culture. In a surprising move, the Zappos executive team decided to televise the company’s annual meetings for all to see. They also started a blog called “Zappos Insights” so they could communicate directly with their employees, customers and other businesses about the Zappos culture. The blog offers ways other businesses can learn from Zappos’ experiences through webinars, training, coaching and more.
Transparency and Trust
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One of the cornerstones of Zappos’ company culture is trust. Zappos manager Robert Richman’s thoughts on transparency mirror the company mandate, “The quickest way to trust is through transparency.” In the healthcare business especially, there is more to transparency than just being more open about your business. Trust is a big issue in the healthcare industry, and creating a corporate culture of trust - both internally and externally - can be a make-it or break-it business decision, particularly in today’s business climate. Price Waterhouse Cooper’s website recently featured an article titled, “Trust but verify: From transparency to competitive advantage,” addressing the ways businesses can employ transparency to gain trust. But it also stresses a point I strongly agree with: “While transparency is an all-important first step in building trust, it is not the entire solution. Without credibility, transparency remains an unverified promise.” Don’t let the idea of transparency in your business keep you up at night. When you are honest, open and willing to communicate often and listen to your vendors, partners, stakeholders and employees, your business will be more successful. It’s not a matter of if transparency is coming, it’s a matter of when. Will you be ready? Heather Ripley is the president and founder of Ripley PR, a national B2B public relations agency specializing in Healthcare IT. For more information, visit www.ripleypr.com or email hripley@ ripleypr.com.
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Patient-Centered Practices
New Oncology Facility at Johnson City Medical Center will improve Environment of Care, Capacity of Care for Tri-Cities Community
C
ancer care has long been a service that hospitals have provided, but, until recently, featuring hospital cancer services was unheard of. Perhaps an attempt at “if you don’t see it, it doesn’t exist,” nationwide, cancer programs were tucked away in hospital corners. But according to Kyle Colvett, MD, a radiation oncologist and the Medical Director for Oncology Services at Mountain States Health Alliance (MSHA), that pessimistic attitude toward cancer care is no longer the case. Colvett has been working in Oncology Services at MSHA since 1995. “Over the years that I’ve been here, our volume has grown tremendously—about five times the size, but our current facility opened in 1988, and it was not designed to accommodate anywhere near the volume we have presently,” he explained. “Our current facility is not only small, but it wasn’t designed in a patient-friendly manner. It has almost an industrial Dr. Kyle Colvett feel, with exposed concrete and no natural light. Besides the fact that our volumes have grown, we have been frustrated that we don’t have the best environment for patient care.” Over the decades, MSHA’s oncology service line has improved its technology tremendously, seeing results that others are seeing nationwide: cancer is being treated successfully with very few side effects. Understandably, though, when the facility doesn’t match the technology or hightech workflows, delivering the best cancer care can be tough. “Times have changed, though,” Colvett said. “A new building is being constructed adjacent to Johnson City Medical Center, the upper level
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of which will house new operating rooms, the lower level, adjacent to our current department, provides a great opportunity for us to expand out and add space for oncology. In the process, we are adding a more pleasant, patient-oriented environment.” Some of the patient-centered features of the new oncology facility include a new, separate parking lot, dedicated to oncology patients; a weather-protected entrance; lots of natural light, as well as two fireplaces; a waiting room designed with alcoves to respect patient privacy; and a separate waiting room for children. “One unique thing about our specialty is that we take care of everybody, from infants to people that are 100,” shared Colvett. “Children have different interests and needs, so the area has video games and other kid-centric activities, a different décor, and an entrance to separate exam rooms.” Beyond the waiting areas, Colvett pointed out that new dressing rooms are being added, designed much like the locker room at a health club. Each patient can have a locker, adjacent to a private changing room, with a private entrance to the treatment area. Patients and staff are scheduled to begin using the facility in September, but a full roll out, utilizing all of the program’s technology, is expected in 12 to 18 months.
“Budgets are difficult in our current healthcare environment, so the Mountain States Foundation took this new facility on as a focus of interest,” said Colvett. “They have been a tremendous friend to us.” Pat Holtsclaw, president of the Mountain States Foundation, explained that although cancer mortality rates have dropped, the prevalence rate is higher, making it difficult for the current facility to serve the increased volume. “This new facility will accommodate patients throughout our service area and will give us the opportunity to transform the patient environment for care and the capacity for care,” she explained. “We are in the process of acquiring new technology that runs into millions of dollars, so we are delighted to have Clarinda Jeanes Pat Holtsclaw serving as Chair of the Radiation Oncology Capital Campaign and Dr. Jim Gibson as Honorary Chair to lead this effort. They have been long-term supporters of the Foundation and Mountain States Health Alliance,” added Holtsclaw. “Very few people have not been touched by cancer,” Holtsclaw said, “so the new radiation oncology facility will not only serve the patient’s needs, but will also make a difference in the community by improving the area’s cancer care.” Presented in Partnership by East Tennessee Medical News and Mountain States Health Alliance All source data for this article has been provided by
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Jolie Sparks National BRCA1 Conversation, continued from page 1 have to wait until cancer happens.” When Jolie came forward, some people assumed that genetic testing for cancer was only available to the wealthy. But genetic testing is available for women and men with particular family risk.
Who should have genetic testing?
“If you have at least one relative who was diagnosed with breast cancer under the age of 50, you need to consider testing,” Pencarinha said. “But it is best – if possible – to test the relative that had cancer first.” Pencarinha says it is also important to consider your own age. “Some younger women, under the age of 20, say they wish they had waited to get the test,” she said. “They feel like there’s nothing they can do until they reach 25. But if you have relatives who were diagnosed with cancer in their 20s and you carry the gene, you could start getting scans earlier.” Also – men can carry breast cancer genes as well, so testing isn’t only for women. “Men are often hesitant to do genetic testing, but men with the BRCA gene have a 7% risk of breast cancer and a 20% risk of prostate cancer, and the risk is higher in some families,” Pencarinha said. While there are no standard criteria for recommending or referring someone for BRCA1 or BRCA2 mutation testing, some generally agreed upon guidelines include: • Personal history of breast cancer at age 50 or younger • Personal or family history of male breast cancer • Personal history of ovarian cancer • A parent, sibling, child, grandparent, grandchild, uncle, aunt, nephew, niece, or first cousin diagnosed with breast cancer at age 45 or younger • A mother, sister, daughter, grandmother, granddaughter, aunt, niece, or first cousin diagnosed with ovarian cancer • A family history of both breast and ovarian cancers on the same side of the family
Getting genetic testing
Patients interested in genetic testing should first talk to their physician about their family history and risk factors. Pencarinha – and most other genetic counselors across the country – only see patients that have been referred by their physicians. Once the patient has been referred, their genetic counseling can begin. “When you come to a genetic counseling appointment, we will first talk about why you want genetic testing,” Pencarinha said. “Then we will talk about your medical history. We’ll talk about family history going back three generations. We will talk about the pros and cons of genetic testing and how much it will cost. I will answer questions about insurance and address any concerns about insurance discrimination.” The actual genetic test requires only a blood sample. “Most patients are surprised at how easy the process of genetic testing is,” Pencarinha said. “There can be anxiety related to waiting for the results of the test, but I have found that patients generally anticipate a higher risk than they actually end up having. Plus, once they know if they have the gene or not, they can take action to prevent cancer.”
Addressing patient concerns about genetic testing
Pencarinha sees patients with a variety of concerns, ranging from fear of knowing they have an increased risk of cancer to fear of insurance or employer discrimination if they are found to have the BRCA1 or BRCA2 genes. For patients worried about insurer or employer discrimination if they test positive, she educates about the Genetic Information Nondiscrimination Act (GINA) of 2008. The law was passed to protect individuals from medical insurance and employer discrimination. “Patients and their physicians were worried they could lose their medical in-
surance or that their employers would know if they tested positive for the BRCA1 or BRCA2 gene,” Pencarinha said. “Discrimination based on genetic testing was never a widespread problem, but the fear kept people from coming in for genetic testing.”
Paying for genetic testing
Another concern patients may have about genetic testing is the cost. According to the National Cancer Institute, the cost for BRCA1 and BRCA2 mutation testing usually ranges from several hundred to several thousand dollars. Some insurance plans will pay for testing, and there are also grants from organizations such as Susan G. Komen for the Cure to help with the expenses of genetic testing. The Wellmont Cancer Institute has a Komen grant for women with no or low insurance coverage. “Most insurance will cover genetic testing with appropriate family history,” Pencarinha said. “Medicare will cover genetic testing only if you’ve had cancer.”
After genetic testing – Being a ‘Previvor’
“We call people who test positive and take steps to prevent cancer previvors,” Pencarinha said. “They survive cancer by never getting it in the first place.” Previvors have a variety of options. While surgeries such as preventive mastectomy and removal of fallopian tubes and ovaries are an option, many previvors prefer to do regular screenings, to modify their behavior to reduce risk of cancer, or to take medications or participate in clinical trials in hopes of reducing their risk of developing cancer. “Younger women who learn they have the gene generally opt to do screenings, with mammograms and MRIs starting at age 25,” Pencarinha said. “They will alternate these tests every six months. By screening regularly, we can catch cancer early and treat it.” Another important thing for previvors to remember: “Testing positive for
Mark Your Calendar
Your local Medical Group Managers Association is Connecting Members and Building Partnerships. All area Healthcare Managers are invited to attend.
3RD THURSDAY
2ND WEDNESDAY
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Chattanooga MGMA Monthly Meeting
SAVE THE DATE!
Date: Thursday, September 19th Location: Downtown Marriott, Knoxville, TN 37919 Get the latest in healthcare updates, must-have information for the current trends and changes in the industry. For more information or to register, visit www.kamgma.com
Date: 2nd Wednesday of each month Time: 11:30 AM Location: The monthly meetings are held in Meeting Room A of the Diagnostic Center building, Parkridge Medical Center, 2205 McCallie Avenue, Chattanooga, TN 37404 Lunch is provided at no cost for members, and there is currently no cost to a visitor who is the guest of a current member. Each member is limited to one unpaid guest per meeting, additional guests will be $20 per guest. All guests must be confirmed on the Friday prior to the meeting. RSVP to Irene Gruter, e-mail: irene@chattmedsoc.org or call 622.2872. For more information, visit www.cmgma.net.
Jenny Harvey
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the BRCA1 or BRCA2 gene doesn’t mean you have cancer – and it doesn’t mean you will have cancer,” Pencarinha said. Research studies and clinical trials “In our practice, we work with patients to connect them with the research studies and trials that may be beneficial to them, and we also encourage patients to do their own research as well,” Pencarinha said. When looking into research studies and clinical trials, and in deciding to have genetic testing in the first place, Pencarinha sums up why very simply: “Having knowledge is empowering.”
In Case of Emergency, continued from page 9
enhance communication tools. “We need to be able to push our information to our healthcare partners and receive information from them in a more real time and cooperative space,” explained Dreyzehner. To that end, he said Tennessee is creating the Health Joint Information Center, which is a concept derived from the National Incidence Management System. “In order to provide the best information to the public and media partners, we create a place where partners and entities can pool information to make sure we are providing the right answers in a rapid fashion.” Ultimately, it all comes down to building a scalable infrastructure, and a big part of that infrastructure comes from creating and maintaining relationships. “An emergency is the last place you want to be meeting people for the first time,” Dreyzehner pointed out wryly. The smooth interaction between local providers, the TDH staff, and federal officials during the meningitis outbreak underscored just how important it was to have previously developed relationships in place when it came time to act. “Just like community health providers and centers are our eyes and ears, the state health departments are the eyes and ears for the CDC,” Dreyzehner said. “We in public health rely on a variety of surveillance tools to detect concerns and to protect health,” he continued, adding the TDH relies on local healthcare personnel, hospitals and health departments to draw attention to concerns. “We’re always thinking of the continuum of reporting,” Dreyzehner continued. The first call, he added, should be to the local health department to report the incident. “They are certainly able to escalate that rapidly if there is a need,” he said, adding each department has a medical director and direct access to the state’s subject matter experts. Dreyzehner said the best defense to protect against or respond to public health threats is working together. “To the healthcare community, we appreciate you … we depend on you … and we will make every effort to keep you informed and work with you to protect life and health before, during and after an event.” easttnmedicalnews
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The Possibility Dogs
theLiteraryExaminer
by Susannah Charleson; c.2013, Houghton Mifflin Harcourt; $27.00 / $33.95 Canada, 260 pages
BY TERRI SCHLICHENMEYER
Up: How Positive Outlook Can Transform Our Health and Aging by Hilary Tindle, MD, MPH.; c.2013, Hudson Street Press; $25.95 / $27.50 Canada, 277 pages Let’s look on the bright side. You’ve probably heard that sentiment several hundred times in your life; so much, perhaps, that it’s basically meaningless to you by now. Honestly, can turning a frown upside down really make a difference? In the new book Up: How Positive Outlook Can Transform Our Health and Aging by Hilary Tindle, M.D., M.P.H., you’ll see how a positive attitude can make every year a better one. According to Hilary Tindle, attitude has “the potential to influence every facet of our health.” Doctors, for instance, have long known that positive patients are more likely to follow medical instructions, “seize opportunities,” and avoid sabotaging their own healing. In short, upbeat patients are easier to treat – which leads to less illness and longer lives. Research further shows that quickness to anger can predict your likelihood for heart disease. That, and a snarly attitude, can also “predict… risk factors that are known to cause… major illnesses of aging” such as high blood pressure and diabetes. These factors, which can stem from a negative outlook on life, begin to manifest
themselves as early as childhood and they can add up over the years. To counteract a lifetime of sourpussness, Tindle says that change is necessary (just about everybody needs some change) and definitely possible. Learn how to manage responses to problems, first of all. If you’re prone to descending into a “negative cycle,” know how to escape it. Don’t think you have to be sunshiny all the time; there are many “faces” of optimism. Acknowledge your accomplishments throughout every step of life, follow “typical” doctor advice, get in touch with nature now and then, and stop being so self-critical. Then, buck up. Says Tindle, “… outlook can be one of our strongest allies in the aging process.” It would be way too trite and simplistic to say that “Up” is a book about positivity. No, author, researcher, and self-proclaimed optimist Hilary Tindle offers cutting-edge information on why it’s never too late to seize change and seek a better outlook in order to reap the rewards of contented aging with fewer health issues. Knowing that it’s not that easy, however, Tindle gives readers tips on altering one’s attitude, climbing out of the doldrums, and reaching for community as a bolster. I liked this book – though I think there’s a lot here that I’ve heard before – and I liked that its advice is mixed with real evidence. Curmudgeons, crabs, and grumps beware: this book could change your outlook and, says the author, every little bit helps. So smile once in awhile and grab Up… because if you do, the sky’s the limit.
Your dog has a one-track mind, one thing at a time. So wouldn’t you be surprised at what else he can do? In the new book The Possibility Dogs by Susannah Charleson, you’ll see your dog’s hidden potential. As the human half of a Search-andRescue team, Susannah Charleson knows what it takes to teach a dog an important task. Using the innate talents and personality of her golden retriever, Puzzle, Charleson taught her girl to find lost or injured people. So when Charleson met a man with a “psych dog” (a service dog for someone suffering psychiatric disorders), she was intrigued. Most everybody knows about guide dogs and hearing-assistance dogs, but what kind of canine Einstein would it take to help a person whose disabilities weren’t quite as visible? With the encouragement of her extended pool of contacts, Charleson decided to find out. She already had a houseful (two cats, Puzzle, and a small herd of Pomeranians), but she began to search for the perfect-personality puppy – which arrived unexpectedly when a neighbor who knew about Charleson’s love of dogs hastily dropped off an emaciated, terribly sick, half-starved puppy at her Dallas-area doorstep. Could this little guy be like Haska, who helps her person withstand PTSD?
Would he be like Merlin, who assisted both father and son to overcome disabilities? Could the puppy be like Annie, who gives a teacher control over OCD; or like Juice Box, who helped his partner deal with depression and social problems? Could the puppy she named Jake Piper someday assist with loneliness, fear, illness, or isolation? Or would he be just a dog – cherished, pampered, and special only in the eyes of his human? Charleson wasn’t sure if the little guy would be trainable, or even if he’d live. One thing was sure, though: she was going to give him every possible chance… Take a look at the cover of this book. Who could resist a face like that, huh? Not author Susannah Charleson, and in this wonderful book, you’ll meet that boy, and others – but don’t think that the potential in The Possibility Dogs is only canine. Through interviews and personal experiences, Charleson shows how these highly trained (though very intuitive) dogs can make an amazing difference in the lives of people who might have otherwise had to suffer at home, in silence. Those stories will touch your heart, and they might spur you to think about finding your own dog to raise or help. To that end, Charleson offers subtle advice with her addicting tales. This slice-of-life is about dogs that nobody initially wanted – but if you’re a pet-lover or are interested in service dogs, you’ll definitely want this book, so fetch The Possibility Dogs. It’s a story you’ll like very well. Terri Schlichenmeyer has been reading since she was 3 years old, and she never goes anywhere without a book. She lives on a hill in Wisconsin with two dogs and 11,000 books.
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GrandRounds Rebekah English Named Northeast Regional Director NASHVILLE–Rebekah English, RN, MPH, has been appointed the new director of the Tennessee Department of Health’s Northeast Region. She assumes the role after serving as assistant regional director for the TDH Northeast Region since 2010. English will provide leadership for all administrative, clinical, non-clinical and medical services within the TDH Northeast Region. In her new role, she will oversee management of county health departments in Carter, Greene, Hancock, Hawkins, Johnson, Unicoi and Washington Counties. Located in Johnson City, the Northeast Regional Office is also responsible for providing guidance within the region in areas of community emergency preparedness, communicable and environmental disease control, health education and outreach. English holds a Master of Public Health degree and a Bachelor of Science in Nursing degree from East Tennessee State University. She succeeds Fred Adams, who retired in June after 45 years of service with TDH. English brings extensive expertise and public health experience to her new position as regional director. Before serving as assistant regional director for the TDH Northeast Region, she served as county health director for the Greene County Health Department. English also served as coordinator of the Breast and Cervical Program and later as Maternal and Child Health director while working as a public health nurse in the Northeast Regional Office. Prior to joining TDH as a public health nurse, English worked as a nurse with a home health agency. English is a member of the Tennessee Public Health Association and the East Tennessee State University College of Public Health Leading Voices Advisory Committee. She also serves as a board member with Frontier Health.
Franklin Woods One of Four Hospitals Honored for Commitment to Quality SAN DIEGO – Four U.S. hospitals were recognized for their leadership and innovation in quality improvement and safety. The 2013 American Hospital Association-McKesson Quest for Quality Prize was awarded to Beth Israel Deaconess Medical Center in Boston, which will receive $75,000. Franklin Woods Community Hospital in Johnson City, Tenn. was honored as a finalist and will receive $12,500. St. Mary’s Hospital in Centralia, Ill. and Vidant Medical Center in Greenville, N.C. received the Citation of Merit. The American Hospital AssociationMcKesson Quest for Quality Prize is presented annually to honor leadership and innovation in quality improvement and safety. The prize is supported by a grant from the McKesson Corporation. This year’s awardees were recognized on July 25 at the Health Forum and American Hospital Association Leadership Summit in San Diego. Franklin Woods Community Hospital serves Johnson City as well as the surrounding rural areas. As a new hospital, it has been strategically designed to provide patient-centered, high quality care. By impressively aligning their goals from a strategic level to an operational and personal level, the hospital truly involves staff in quality and process improvement.
Tracy Byers to join Unicoi County Memorial Hospital as Administrator ERWIN – Tracy Byers has been selected to serve as the administrator for Unicoi County Memorial Hospital (UCMH). The hospital, which is currently under a management agreement with Mountain States Health Alliance (MSHA), is in the process of joining
MSHA, pending approval of the acquisition by the Unicoi County Commission and the Tennessee Attorney General. The UCMH Board of Control and Erwin Town Council have already approved the sale. Byers will begin working with interim CEO Jete Edmisson on Sept. 9, and Edmisson will remain at UCMH until Sept. 30. Byers comes to UCMH from Great Plains Regional Medical Center in Elk City, Ok., where he serves as Chief Operating Officer. He has also served as Chief Operating Officer for Harton Regional Medical Center in Tullahoma, Tenn.; Chief Executive Officer for Muhlenberg Community Hospital in Greenville, Ky.; and Assistant Administrator and Long-Term Care Administrator for Hugh Chatham Memorial Hospital in Elkin, NC. In addition to operating long-term care facilities, Byers has overseen multiple capital construction projects, enhanced hospital operations through the recruitment of new physicians, and improved patient satisfaction using the nationally-recognized Studer Program. He earned a Master of Healthcare Administration degree at the University of North Carolina, Chapel Hill, a Master’s degree in clinical psychology from the University of Louisville, and a Bachelor’s degree in psychology from David Lipscomb University.
East Tennessee retirement community deploys the MIMI mobile health monitoring solution CHARLOTTESVILLE, Va. — Status Solutions today announced that Appalachian Christian Village, one of the first established Continuing Care Retirement Communities in East Tennessee, has introduced the Motion into Meaningful Information (MIMI) mobile
Mark Your Calendar
Your local Medical Group Managers Association is Connecting Members and Building Partnerships. All area Healthcare Managers (including non-members) are invited to attend.
2ND THURSDAY
3RD THURSDAY
JOHNSON CITY MGMA MONTHLY MEETING
KINGSPORT MGMA MONTHLY MEETING
Date: The 2nd Thursday of Each Month Time: 11:30 AM – 1:00 PM Location: Quillen ETSU Physicians Clinical Education Building, 325 N. State of Franklin Rd., Johnson City
Date: The 3rd Thursday of Each Month Time: 11:30 AM – 1:00 PM Location: Indian Path Medical Center Conference Room, Building 2002, Second Floor, Kingsport
health monitoring solution to residents in its Personal Care Plus program. This real-time, nonintrusive system provides health alerts to family members and community staff to proactively monitor residents’ health care needs. Powered by AFrame Digital, MIMI tracks vitals and daily activities via a wristwatch device to create personalized care models and trend reports. If a change in any baseline occurs, a notification automatically goes to caregivers to assist them in determining if modifications to a resident’s health care are needed. Appalachian Christian Village’s Personal Care Plus program is comprised of Independent Living residents who need some health care assistance. With MIMI’s implementation, the senior living community will log blood pressure, capture sleeping patterns, and track glucose levels. MIMI also is being integrated with Status Solutions’ Situational Awareness and Response Assistant (SARA) to provide fall-detection alerts. SARA has been used for automated alerting and response management across Appalachian Christian Village’s spectrum of care since January 2008.
ETSU pharmacy, dietetic students collaborate on diabetes education classes JOHNSON CITY – Students and faculty from East Tennessee State University’s Bill Gatton College of Pharmacy and the College of Clinical and Rehabilitative Health Sciences is holding an interprofessional series of diabetes education classes for the general public. ETSU student pharmacists and graduate students in the ETSU dietetic internship program collaborate on the classes, which are held at Johnson City Community Health Center (JCCHC). After organizing an initial series of classes earlier this year, the Gatton College of Pharmacy decided to move diabetes education efforts to JCCHC and invite members of the ETSU nutrition and foods program to contribute their expertise. All classes are held from 6-7 p.m. one Tuesday of each month, and each focuses on a different topic that will provide useful information for those who have diabetes or know someone who does. Topics and dates include “Advanced Carbohydrate Counting” on Sept 17; “Glucose Monitoring 101” on Oct. 22; and “Sweet Tips for Healthy Holiday Eating” on Nov. 19. Located behind Woodridge Hospital at 2151 Century Lane, JCCHC is managed by the ETSU College of Nursing in partnership with the College of Clinical and Rehabilitative Health Sciences. Admission is free. For questions or more information, send e-mails to OperationDiabetesETSU@gmail.com.
Save the Date: Don’t miss the September meeting, comedian Matt Fore will be performing. 16
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GrandRounds Mountain States Health Alliance announces new CEO Alan Levine to bring health policy, operations experience
JOHNSON CITY – Mountain States Health Alliance (MSHA) officials announced that Alan Levine has been named by the Board of Directors to serve as President and Chief Executive Officer effective January 6, 2014. Levine will succeed Dennis Vonderfecht upon his retirement at the end of 2013. Levine, 46, will join MSHA after more than 20 years in hospital operations and in public service. Having led large, complex, multi-hospital organizations as well as leading two state health systems as the senior regulator and health policy advisor to two Governors, Levine is uniquely qualified to lead MSHA through the challenges and opportunities that lie ahead for the health care system. Prior to his current role as Group President overseeing the operations of more than 40 hospitals and their affiliated services for Health Management Associates, Levine served as Secretary of the Louisiana Department of Health and Hospitals and Senior Health Policy Advisor to Governor Bobby Jindal, where he oversaw the state’s Medicaid program and led the state’s healthcare system through two major hurricanes,
the pandemic flu, the Deepwater Horizon oil spill, major health care reform and the restructuring of the state’s charity hospital system. In partnership with the Attorney General of Louisiana, Levine also led a major and successful effort to crack down on fraud in the Medicaid program. Prior to his service in Louisiana, and prior to his service as President of one of the nation’s largest not-for-profit public hospital systems, Levine served as Deputy Chief of Staff and Senior Health Policy Advisor to Florida Governor Jeb Bush before being appointed by Governor Bush to serve as Secretary of Florida’s Agency for Health Care Administration, the state’s regulatory and Health Policy agency with a budget of more than $17 billion. In addition to overseeing one of the nation’s largest Medicaid programs, Levine led Florida’s health care system through eight major hurricanes making landfall, sought and received federal and legislative approval for the most sweeping Medicaid reforms in the nation, and was one of the first health secretaries in the nation to publish hospital cost and quality outcomes for consumers. His efforts to crack down on fraud and abuse in the Medicaid program led to recognition for his Agency by Florida TaxWatch.
Ca y l o r S c h o o l o f Nu r s i n g
Beth Bulawa Joins TMA’s Surgery Team GREENEVILLE – Dr. Beth Bulawa has joined the surgery team at Takoma Medical Associates. She specializes in general, breast and laparoscopic surgery. Bulawa, who is board certified, has joined Dr. Robert Bridges at the sur- Suzanne Miller gery practice located on the second floor of the TMA building at 438 E. Vann Road. Bulawa received her medical degree from Downstate Medical Center in Brooklyn, N.Y., and completed her general surgery residency and her general surgery chief residency at Albany Medical Center, also in New York.
Local Residents Show Up to Support Historic Cancer Research Study Tri Cities, TN - Over 475 people throughout Northeast Tennessee and Southwest Virginia are now part of Cancer Prevention Study-3 (CPS-3), a historic study into what causes – and what could possibly prevent – cancer. The 2030 year study, which is open to individuals between the ages of 30-65 who have not been diagnosed with cancer, will look at genetic, lifestyle and environ-
mental factors that may cause or prevent cancer. The previous Cancer Prevention Studies by the American Cancer Society resulted in discovering the link between smoking and lung cancer and certain lifestyle factors associated with increased cancer risks. During August 6-9, participants enrolled in CPS-3 at one of five sites throughout Northeast Tennessee and Southwest Virginia thanks to a partnership with Wellmont Cancer Institute and YWCA of Bristol. To enroll in the study, individuals were asked to read and sign an informed consent form; complete a comprehensive survey packet that asks for information on lifestyle, behavioral, and other factors related to his/her health; had a waist circumference measured; and gave a small blood sample. The Society will now send periodic follow-up surveys to update enrollee information and annual newsletters with study updates and results. Periodic follow-up surveys of various lengths are expected to be sent every few years to enrollees. The voluntary, long-term commitment by participants is what will produce benefits for decades to come. For more information about CPS-3, visit cancer.org/cps3.
Want to advance your nursing career? Information Sessions at LMU-Cedar Bluff October 3 and November 4 from 3 p.m. to 7 p.m.
1-800-325-0900 ext. 6324 for more information
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GrandRounds VCU names Dr. Wilsie Bishop to list of ‘120 Visionary Leaders’ JOHNSON CITY – The Virginia Commonwealth University (VCU) School of Nursing recently published a list of “120 Visionary Leaders” who are alumni or faculty from its School of Nursing, and that list includes Dr. Wilsie Bishop, vice president for Health Affairs and chief operating officer for East Tennessee State University. VCU identified 120 visionary leaders to commemorate the 120th anniversary of its nursing school. Bishop earned a bachelor’s degree in nursing from VCU in 1970 and a Master’s degree in 1978. She later graduated from the University of Southern California with graduate degrees in education and public administration, as well as the doctor of public administration degree. A member of the ETSU faculty for
over 30 years, Bishop has a long history in executive academic leadership that echoes from her time as a VCU student, when she held offices in the National Student Nurses Association at the local, state and national levels. Bishop became dean of what was then known as ETSU’s College of Public and Allied Health in 1994. Later, as vice president for Health Affairs, she was instrumental in the growth process that resulted in the college evolving into two independent entities, the College of Public Health and the College of Clinical and Rehabilitative Health Sciences. A native of Appomattox, Va., Bishop has been ETSU’s chief operating officer since 2004. As the leader of the university’s Health Affairs division, she has guided ETSU to the establishment of an Academic Health Sciences Center that, with colleges of medicine, nurs-
FOCUS ON ONCOLOGY SPONSORED BY WELLMONT HEALTH SYSTEM
Name: Kathy Visneski, APN, AOCN, APHN-BC Position: Oncology Clinical Nurse Specialist for Wellmont Cancer Institute At a Glance: An employee with the Wellmont Cancer Institute since 1982, Kathy Visneski teases that she’s “their girl Friday” because “I do whatever needs to be done.” Over the years, Visneski has served in many different capacities, including educator, facilitator, and caregiver. She teaches the Institute’s chemotherapy course to nurses, as well as oncology education for staff members. She also navigates inpatient oncology patients, making sure that when they go home, “all the things that need to happen are happening,” she explained. Of all of her different responsibilities, Visneski said her favorite job is facilitating the cancer support group Survive and Thrive, which she has been doing every year for 26 years. “I get so much more out of it than I give,” she enthused. “I have learned so much from them about surviving. It changes your whole life when you work in cancer care.” Visneski shared that the notion cancer care is a depressing thing is false. “I don’t know if that it’s only nice people get cancer or that they get nice once they get it, but I have the most awesome patients. They appreciate everyone who helps them.” Her dedication to her patients has been nationally recognized. In 2009, Visneski received the Lane Adams Quality of Life Award from The American Cancer Society, a prestigious award given each year to health professionals who provide consistently excellent and skilled care to cancer patients. Sometimes the care Visneski gives is given unexpectedly. As she explained, just a few weeks ago, she sat at her desk with tears rolling down her face over the fact her hairdresser of 30 years had abruptly retired. “Then a patient knocks on my door, who had just had a PET scan, and the results were not good. He would have to change his chemo, start radiation, and I felt ashamed to tell him why I was upset,” she recalled. “He walked around my desk, patted me on the shoulder, and assured me that it would be okay. It took me two seconds to think ‘Who cares if she retired?’ “And, even more, it made him feel better that in his bad place, he could help me! They put your life in perspective for you very quickly.”
ing, pharmacy, public health, and clinical and rehabilitative health sciences, is among the most diverse in the nation in terms of academic programming. Bishop is one of only 11 academic leaders in the nation and the only one in Tennessee who serve as board members for the Association of Academic Health Centers.
Seven More Physicians Enroll in Wellmont Osteopathic Family Medicine Residency in Southwest Virginia BIG STONE GAP, Va.– Another group of medical residents is reinforcing Wellmont Health System’s commitment to develop highly skilled physicians and increase access to primary care in Southwest Virginia. Seven physicians who have enrolled in the osteopathic family medicine residency program created by Wellmont recently participated in a white-coat ceremony at Lonesome Pine Country Club. They are the third class to have joined this innovative program that is bolstering the level and quality of care for patients in this region. The program now has about 20 residents and is nearing the maximum of 24 Wellmont has been approved to enroll. The new residents and their medical school are Dr. David Bhola, Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, Fla.; Dr. Menalin Ganal, Touro University College of Osteopathic Medicine, Vallejo, Calif.; Dr. Zehra Hussain, University of North Texas Health Science Center, Fort Worth; Dr. Dwayne Likens, University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, Ky.; Dr. Veronica Robinson, A.T. Still University School of Osteopathic Medicine, Mesa, Ariz.; Dr. Joshua Yeary, Lincoln Memorial University-DeBusk College of Osteopathic Medicine, who previously worked as a lab technician at Hancock County Hospital in Tennessee; Dr. Anthony Yount, LMU-DCOM, who previously worked as an emergency department nurse at Hancock County. As they complete their residency, these seven physicians will deliver compassionate care at Mountain View Regional Medical Center, Lonesome Pine Hospital and Lee Regional Medical Center in Virginia. They will also receive some of their specialty rotation training at Holston Valley Medical Center and Bristol Regional Medical Center in Tennessee. In addition, these physicians will improve patients’ lives by treating them at the Wellmont Osteopathic Family Medicine Residency Clinic at 295 Wharton Lane, Norton.
PUBLISHED BY: SouthComm, Inc. CHIEF EXECUTIVE OFFICER Chris Ferrell PUBLISHER Jackson Vahaly jvahaly@southcomm.com 615.844.9237 ASSOCIATE PUBLISHER Cindy DeVane ceedevane@gmail.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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GrandRounds Neal Carter Joins Wellmont CVA Heart Institute as Cardiothoracic and Vascular Surgeon KINGSPORT – Dr. Neal Carter, a cardiothoracic and vascular surgeon who was trained at the world-renowned Texas Heart Institute, has joined the Wellmont CVA Heart Institute. Carter will deliver expert care to patients at Dr. Neal Carter The Heart Center, 2050 Meadowview Parkway, and perform cases at Holston Valley Medical Center, which has repeatedly been recognized for its stellar cardiovascular care. Carter received a Bachelor’s degree in international studies from Brigham Young University in Provo, Utah, before embarking on his medical career. He graduated from Des Moines University College of Osteopathic Medicine in Iowa and then completed a general surgery residency at St. Elizabeth Health Center in Youngstown, Ohio. His most recent training was a fellowship in cardiothoracic surgery at the Texas Heart Institute at the Baylor College of Medicine in Houston. That institute is internationally recognized for its premier cardiothoracic program. Carter is trained in advanced procedures to treat heart, lung and vascular disease. Carter is certified with the American Board of Surgery. He was a resident member of the American College of Surgeons and the American College of Cardiology. He also served as a clinical instructor in surgery at Northeastern Ohio Universities College of Medicine in Rootstown.
and acting district director with the Virginia Department of Health, Dreyzehner serves as an adjunct faculty member at East Tennessee State University’s College of Public Health, visiting assistant professor in Public Health Sciences for the University of Virginia, and is founding faculty for the Healthy Appalachia Institute at University of Virginia‐Wise. Board certified by the American Board of Preventive Medicine in Occupational and Environmental Medicine, he is a Fellow of the American College of Occupational and Environmental Medicine
and a Diplomate of the National Board of Medical Examiners. Along with the TMA, his other professional associations include the American Medical Association (AMA), and the Association of State and Territorial Health Officials (ASTHO). Dreyzehner began his medical service in 1989 as a U.S. Air Force flight surgeon. Following honorable discharge as a major, he spent several years practicing occupational medicine, joining the Virginia Department of Health in 2002. He also concurrently practiced addiction medicine for several years while
working on substance abuse prevention in his public health role. He joined Tennessee Governor Bill Haslam’s cabinet as Commissioner of Health in September 2011. He graduated from the University of Illinois at Champaign‐Urbana Magna Cum Laude with a Bachelor of Science in psychology. He received his Doctor of Medicine degree from the University of Illinois at Chicago, and earned his Master of Public Health at the University of Utah, where he also completed his residency in Occupational Medicine.
I don’t just have insurance. I own the company.
Gary E. Meredith, M.D. Pediatric Diagnostic Associates Chattanooga, TN Pediatrics
TN Health Comm. John Dreyzehner is TMA Public Health Champion NASHVILLE—Tennessee Health Commissioner John J. Dreyzehner, MD, MPH, FACOEM, of Nashville, has been named a TMA Quarterly Public Health Champion for 2013. The honor recognizes TMA member physicians for their outstanding public health contributions across the state of Tennessee. Dreyzehner is being recognized for over 20 years of service and leadership in clinical and public health at the federal, state and local levels, most recently as an advocate for a healthier Tennessee as state health commissioner. Dreyzehner has been instrumental in tackling a variety of public health issues, particularly the Volunteer State’s prescription drug abuse problem and its consequences. Working with the Tennessee Medical Association and other stakeholders, he helped pass new laws aimed at monitoring controlled substance prescriptions and stemming the prevalence of Neonatal Abstinence Syndrome. A former district director for Virginia’s Cumberland Plateau Health District
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