FOCUS TOPICS BEHAVIORAL HEALTH & ADDICTION PRACTICE MANAGEMENT
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PHYSICIAN SPOTLIGHT PAGE 2
Howard L. Cummings, MD
Marijuana, Medicine & Addiction
A conversation with ASAM President Dr. Stuart Gitlow
ON ROUNDS
Enjoying East TN Creative Discovery Museum—Human Plus: Real Lives + Real Engineering With spring’s arrival, I mentioned last month needing two columns to discuss some recent happenings in Chattanooga that are just in time for spring break outings ... 5
HEALTHCARE LEADER: Karen Williams To Karen Williams, her current role as the Executive Director of Operations with Wellmont Medical Associates just feels natural. “I think health care chose me,” she said. “I started out by working in a physician’s office when I was in college, and I just haven’t left that environment.” ... 6
By CiNDy SANDERS
With three states plus the District of Columbia sanctioning recreational use of marijuana and virtually all other states either allowing for or considering decriminalization and/or medical use of the drug, the great marijuana debate has become a legislative hot topic over the last three years. For Stuart Gitlow, MD, MPH, DFAPA, however, talk of medical benefits associated with inhaling the plant is just smoke and mirrors. Gitlow, who concludes his term as president of the American Society of Addiction Medicine this month, said there are two major issues with the drug … addiction and toxicity. The double board-certified psychiatrist, who has a private practice in Rhode Island, is concerned by the possibility of adding marijuana to the mix of alcohol and tobacco as yet another substance with the potential to do more harm than good.
The Drug
Marijuana refers to the dried leaves, flowers, stems and (CONTINUED ON PAGE 8)
Survey Says … A Digital Disconnect Exists Between Patients, Practices By CiNDy SANDERS
Patients increasingly want to access online services to enhance convenience and communication with providers, according to a recent national survey conducted by TechnologyAdvice Research. Yet, the majority of respondents in the “2015 Trends in Patient Engagement” survey said a number of digital solutions that would be helpful are not offered by their primary care practices. “Only 19 percent said their physician offered online appointment scheduling,” noted Cameron Graham, survey author and managing editor for TechnologyAdvice, a company that conducts research and analysis of IT products in a number of industries including healthcare. “Only 17 percent said their physician offered online bill pay.” In addition to scheduling and payment functions, Graham said viewing test results or diagnoses online also ranked high among survey participants. However, only 27.8 percent said their physician provided that option. Graham pointed out all three of the most desired (CONTINUED ON PAGE 4)
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PhysicianSpotlight
Howard L. Cummings, MD By STACY FENTRESS
Before Howard Cummings earned his degree in medicine, he was a person who really liked science and wanted to help people. He also happened to be surrounded by ophthalmologists – his neighbor and his best friend’s dad. His own father was a scientist too – a mechanical engineer. “At the time, I couldn’t have predicted I would become an ophthalmologist,” he said. “But I was in an environment that led me to the decision to become an ophthalmologist.” It’s a decision that led him around the country and overseas as he earned degrees and completed his fellowship, residency, and internship. And it’s a decision that led him to finally settle in the Tri-Cities as part of the team of specially trained medical doctors and skilled retinal and vitreous ophthalmology surgeons with Southeastern Retina Associates. But first, this New England native had to earn his Bachelor’s degree – and he did in 1982, graduating magna cum laude with a degree in chemistry from Duke University. As part of his undergraduate education, he was also able to study 10th Century British History in England at the University of Oxford’s International Summer Graduate School. “I was majoring in chemistry and knew medicine would be my career, but I wanted to broaden my horizons and see what the British education system was like,” he said. “They were really focused on small seminar classes. It was similar to the way some graduate-level classes in the U.S. are designed.” Cummings went on to earn his medical degree at the University of Texas,
Southwestern Medical School, in Dallas. He finished an internal medicine internship at Boston University Medical Center and then moved to Maryland for a residency in ophthalmology at the Greater Baltimore Medical Center. From there, he studied ophthalmic pathology at the Wilmer Institute of the Johns Hopkins University School of Medicine. He then took a postgraduate retina and vitreous fellowship in Lexington with the Retina and Vitreous Associates of Kentucky. He acknowledges that the road to becoming a physician is long and arduous. “My advice for anyone considering becoming a physician is that they really need to look at the long-term ramifications,” he said. “The journey to become a physician isn’t short – it takes a long time and can be difficult in the sense that you are sacrificing in the short term to meet long term goals.” Once Cummings finished his formal educational journey, he practiced at the
Carolina Eye Associates in Raleigh, NC, and then the Springfield Clinic Eye Institute in Springfield, Ill. In 1999, he moved to the Tri-Cities and joined Southeastern Retina Associates. It’s a decision he’s happy he made. “I really like working with the group of ophthalmologists we have at Southeastern Retina Associates,” he said. “This is a bright, hardworking group that wants to help others. We have a comradery. It’s a good environment and we work very well together.” Many of the patients Cummings sees come to him for chronic conditions, such as diabetic retinopathy and age-related macular degeneration. Thanks to advances in technology, patients have treatment options for these conditions that didn’t exist years ago. “Technology has evolved in our specialty specifically,” he said. “Now we have biopharmaceuticals that can attack diseases in a targeted fashion. They have improved outcomes dramatically.” But these medications require patients come to visit frequently – often once a month. “Some current treatments require close observation and frequent retreatment to get results,” he said. “If a patient with macular degeneration wants to be able to keep reading or to keep driving, that patient may need to be seen monthly for up to two years. We can keep patients who keep up with therapy functioning well.” Cummings appreciates the relationships he is able to develop with patients. “We see people frequently, and, as we get
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to know them, they get comfortable with the staff,” he said. “When you get used to seeing a friendly face, you start talking on a more personal level. Our patients will get to know us and will tell us about their children and grandchildren, and we tell them about ours.” According to Cummings, technology in the field of ophthalmology continues to improve. Through his work with Southeastern Retina Associates, he gets to be a part of improving the technology. The group participates in a variety of clinical trials and has been recognized as the Top Site in 2013 and 2014 by the Diabetic Retinopathy Research Group (DRCR). DRCR is a group funded by the National Eye Institute, part of the National Institutes of Health. “We are trying to answer questions about trying to treat diabetic retinopathy and we are doing in through participation in research trials,” Cummings said. “This is about evidence-based medicine. We participate in trials to answer important questions and to try to improve treatment options for patients.” For Cummings, getting to practice ophthalmology in the Tri-Cities with Southeastern Medical Associates is a dream come true. “When I went to Duke, I fell in love with the Southeast and I knew I wanted to practice medicine in the Southeast,” he said. “I fell in love with the seasons and the people. After I left Duke and ventured to the Southwest for medical school, I longed for the Southeast. This is just the place for me.” When Cummings isn’t working, he can be found on tennis courts across the Tri-Cities. He also enjoys playing guitar and taking the time to learn about new things. His most current project is participation in a wine club. “It’s not just about drinking the wine,” he laughed. “I enjoy learning about wine and talking with the other members. It’s a lot of fun.”
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Priority Ambulance takes community approach to marketing By Michelle Henry
Marketing nonemergency ambulance service to patients and medical facilities is not about flashy advertisements and slick brochures. The most effective marketing is rooted in face-to-face customer service that builds personal relationships with patients, caseworkers, and medical facilities. Celina Bradsby, marketing manager for Priority Ambulance, summed it up thusly: “We have a fleet of beautiful Mercedes-Benz ambulances equipped with the latest lifesaving technology, and we focus on the comfort of our patients by using hypoallergenic pillows and blankets. We have these critical pieces, but what really sets us apart is the personal interaction, patient care, and customer service. Our marketing strategy focuses on building and maintaining relationships with our target audiences – nursing homes, hospitals, dialysis clinics, the general community, and the elderly.” Bradsby visits facilities daily to establish relationships with potential clients and maintain regular contact with current ones. “I want to know if everything is going OK, if the crew is providing an excellent
Priority Ambulance Marketing Manager Celina Bradsby (center) assists NHC Healthcare residents Linda Aims and Dorothy Anderson with their Bingo game. Bradsby helps organize the Bingo game at NHC Healthcare every week to build relationships with NHC residents and staff.
level of care, arriving on time, and meeting requests,” she said. “Priority is more focused on ensuring patient care and service, which is a different approach and what I think sets us apart.” On a personal level, Bradsby volunteers at NHC HealthCare every Thursday to play Bingo with residents. She knows
most of them by name, and the personal interaction has helped to put patients at ease when they need to travel by ambulance to medical appointments. “Celina is always positive and helpful. She puts residents first,” said Diana Melendy, NHC HealthCare activities director. “In addition to being here for the
weekly Bingo games, Celina brings items for birthday parties and Bingo prizes and participates in holiday events. The residents anticipate her arrival each Thursday. They can tell she doesn’t see them as a transport or a diagnosis, and they appreciate her compassionate care.” Melendy also is impressed by Priority Ambulance crew members. “Whenever I see Priority Ambulance employees, they are professionally dressed and have a pleasant demeanor,” Melendy said. “They are very kind to the residents.” Priority Ambulance’s customer service also is recognized at Kindred Nursing and Rehabilitation Northhaven. A Northhaven patient required weekly dialysis visits, and when asked by a family member for a referral on an ambulance provider, Rhonda Cochran, director of social services, recommended Priority. “He said the hospital told him to choose an ambulance company, and I told him we prefer Priority,” Cochran said. “He asked why, and I told him because of the excellent customer service. After he informed the hospital, he said the hospital agreed that Priority has great customer service.” Bradsby said Priority Ambulance employees are happy and committed; she (CONTINUED ON PAGE 10)
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As managing partner for the Knoxville office Greg works closely with a variety of industries including physician practices, law firms, other professional services, automobile dealerships, construction, manufacturing, and not-for-profit organizations. He provides estate, corporate, limited liability entity, and individual tax planning services. He has spent his entire professional career in the public accounting sector and enjoys sharing his talents by serving on various boards and committees including the finance committee at the Helen Ross McNabb Foundation, the East TN Historical Society and the 1956 Society at UT Medical Center. Outside of the office, you are likely to find Greg on the golf course enjoying time with long-time clients who are now friends or his son Gregory.
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LegalMatters BY ERIN B. WILLIAMS, LONDON & AMBURN, P.C.
Medicare Meaningful Use Audits and Appeals Most healthcare providers are probably familiar with the term “meaningful use,” which generally means using certified electronic health record technology (EHR) to improve patient care and maintain the privacy and security of patient health information.1 The American Recovery and Reinvestment Act of 2009 authorized the Centers for Medicare and Medicaid Services (CMS) to provide financial incentives to eligible professionals who adopt, use, or otherwise show “meaningful use” of certified electronic health record technology (EHR). Eligible professionals who have enrolled in the Medicare EHR Incentive Program will receive payments for up to five continuous years throughout the duration of the program. Those who enrolled at the outset of the program in 2011 are eligible to receive total payments of $43,720.2 However, like other Medicare programs, enrolling in the Medicare EHR Incentive Program will subject you to audits by Medicare. Failure to properly and timely comply with an audit request will put your meaningful use payments at risk for recoupment. For large practice settings with several participating providers, the recoupment could be significant. What is a meaningful use audit? Providers receive meaningful use payments after submitting an attestation
that the provider met the required goals for a particular stage. Post-payment audits occur when providers are contacted to provide supporting documentation to validate the payment. In 2013, CMS also began performing pre-payment audits, which require providers to present supporting documentation to validate the attestation before the incentive payment is made. A provider being audited will receive a letter sent electronically from Figliozzi & Company, the designated CMS contractor, requesting that the provider supply documentation to support the attestation for meaningful use objectives and clinical quality measures. An initial review of the documentation will be performed and additional documentation may be requested. An on-site review may also be requested, which can include a required demonstration of the provider’s EHR system. At the conclusion of the audit process, the provider will receive a Determination Letter from CMS with the audit findings. If the provider was found not to be eligible for the incentive payment, the payment will be recouped. CMS may take action against a provider if fraud and abuse is suspected, including all available civil and criminal sanctions. Can I appeal the audit findings? Yes, providers can appeal the find-
ings of a meaningful use audit. However, the appeal must be submitted electronically within 30 days of the date of the Determination Letter. All documentation submitted with the appeal must be in the proper format. Failure to properly comply with these procedures could result in denial of the appeal. CMS will not review any documentation submitted for an appeal if the provider failed to respond to the initial request for documentation during the audit.3 During the appeals process, providers may choose not to refund the incentive payment(s) at issue; however, interest will continue to accrue during the pendency of the appeals process. Therefore, providers who receive unfavorable appeals results will not only have to refund the principal payment, but also any accrued interest. How should I prepare for an audit? CMS recommends that documentation to support the attestation for meaningful use objectives should be retained for six years after the attestation is made. Depending on the capabilities of the EHR system, providers may not be able to access the system as it existed when the attestation was made, which may significantly complicate the ability to supply supporting documentation during a post-payment audit. Providers should consider printing or taking screen
shots of the EHR system reports or other objective measures so that providers will have available accurate information used at the time of the attestation in the event of a post-payment audit.4 Keeping organized, accurate records of supporting documentation used at the time an attestation was submitted will prove invaluable if you are selected for an audit. Furthermore, providers should stay up-to-date on the most recent meaningful use regulations, guidelines, and deadlines to ensure compliance with the Medicare EHR Incentive Program. A request for documentation signals the start of an audit. Providers should immediately alert management and develop a protocol to coordinate efforts to ensure a timely and accurate response. Attorney Erin B. Williams focuses her practice on healthcare compliance and regulatory matters. For more information visit www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice. Notes: 1. See www.healthit.gov/providers-professionals/ meaningful-use-definition-objectives. 2. See www.cms.gov/Regulations-and-Guidance for more information about the EHR incentive programs. The Medicaid incentive programs are operated by the statues 3. Eligible Professional (EP) Appeal Filing Request, available at: www.cms.gov/Regulations-and-Guidance. 4. EHR Incentive Programs Supporting Documentation for Audits (Feb. 2013), available at: www.cms.gov/ Regulations-and-Guidance.
Survey Says … A Digital Disconnect Exists, continued from page 1 digital services are fundamental patient portal features. With that in mind, he continued, “There’s a big discrepancy between what patients report having access to and the EHR adoption rate among physicians.” Graham said electronic health record adoption rates are in the “high 70s, low 80s” by office-based physicians Cameron Graham in the United States. “A lot of those systems should have online appointment and bill pay capabilities,” he said, adding some of the older systems might not have those options but virtually all newer products offer robust patient portal resources. “I think one of the big takeaways is that the patients don’t seem to be aware of the tools their physicians probably have,” he said. The other option, Graham continued, is that offices have these capabilities but are not using them. Either answer could spell trouble for practices. “When we asked how important these services were when people were choosing a physician, 60.8 percent said it was ‘important’ or ‘somewhat important,’’ Graham said. “If physicians are offering 4
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these in-demand digital services, a more proactive approach to promoting them is needed and could create an advantage in attracting and retaining patients.” Graham added he also believes physicians need to more fully embrace digital services. “Patients value them a lot. Physicians think of them as an extra or add-on.” With meaningful use requirements staged to increase health information exchange and promote patient engagement, Graham noted the effective use of patient portals could help practices hit the necessary benchmarks to access incentives. However, he noted, there probably won’t be a ‘one size fits all’ solution when it comes to patient engagement. “We did find age played a role in which services patients wanted their physicians to offer,” he said. Not surprisingly, the demand was much higher by younger adults than in the senior population. “Among the 25- to 34-year-old demographic, almost 40 percent said they would like to have a smart phone app for scheduling appointments; but among the 65 and older demographic, only 3.8 percent said that would be something they’d want.” Similarly, 35.3 percent of patients ages 25-34 would like for their physician practice to offer secure messaging outside
of office hours compared to just 11.5 percent of those ages 65 and older. Of the six digital services listed on the survey (online appointment scheduling, smartphone app for scheduling, online test results/diagnoses, online bill pay, secure messaging, and health resources/educational material), 23.5 percent of those ages 25-34 reported they didn’t want their physician to offer any of the services, while 44.2 percent of participants 65 and older had that same response. Graham continued, “I think it’s important for physicians to be aware of what these different demographic groups want.” He added such information could help providers tailor their message accordingly when discussing the different ways patients could access the practice and engage with providers. Another disconnect highlighted by the survey was provider follow-up. While 68.6 percent of respondents said it was either ‘very important’ or ‘somewhat important’ that a physician follow up with them, only 30 percent reported receiving any follow-up from the practice that wasn’t tied to bill pay. “They’re very good about following up related to money,” Graham pointed out, but patients want more than that. In addition to building rapport with
a patient, Graham said digital communication offers an easy way to make sure instructions were understood and are being followed, check on medication adherence, share prevention tips, and remind patients about the need to schedule routine screenings and services. The “Trends in Patient Engagement” survey included responses from more than 400 adults across the United States regarding their digital experience at primary care practices. The survey was conducted Jan. 5-7, 2015. A download of the survey whitepaper is available at technologyadvice.com/research. TechnologyAdvice, which is headquartered in Brentwood, Tenn., offers free, neutral research and analysis of IT products to connect businesses with technology options that best address each company’s specific needs. The company works with businesses and practices looking for the right software for just a few people up to large enterprises in need of solutions for thousands and has assisted Apple, Oracle and HP in selecting new technology. Last year, TechnologyAdvice was named to the top half of the Inc. 5000 list of America’s fastest-growing private companies.
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Enjoying East Tennessee
Creative Discovery Museum—Human Plus: Real Lives + Real Engineering By: LEIGH ANNE W. HOOVER
With spring’s arrival, I mentioned last month needing two columns to discuss some recent happenings in Chattanooga that are just in time for spring break outings. Only two blocks from the Tennessee Aquarium, families can also visit the Creative Discovery Museum. Ranked by Child Magazine as one of the very best in the United States, this downtown museum inspires children to create and explore through innovative activities that focus on both the arts and sciences. The Creative Discovery Museum (CDM) is currently hosting Human Plus: Real Lives + Real Engineering = Zero Impossibilities, and this top floor exhibit will be at the museum through May 10th. According to museum officials, this amazing exhibit does not dwell on body deficiencies. Rather, it invites visitors of all ages to engage in amazing developments with unbridled potential for enjoying life at its fullest accomplishing everyday activities and even lifelong dreams. “Human Plus is a much more high tech version of ‘Kids Like You, Kids Like Me,’ which was an exhibit housed annually at CDM for many years,” explained Director of Exhibit and Capital Projects, Shannon Johnson.“Key messages are the same. ‘Children with disabilities can do all the same things that you can do; they just may do them a little differently or use special equipment.’ Human Plus gives children and their families an environment to explore some of this equipment. In this way, when a child sees a person using similar equipment, it has taken the mystery or unknown out of the experience.” When my husband and I recently visited, I was amazed to see what science has done to enhance the lives of differently able individuals. Both of us were immediately reminded of the young United States Paralympics athlete, Blake Leeper, who is also from Kingsport, TN. Born missing both legs below the knees, Leeper has worn prosthetics since the age of nine. This has never stopped the determined athlete, and even during childhood basketball games, we remember him often “losing a leg” on the court, putting it right back on, and continuing to play the game. Exemplifying the motto, “The only disability in life is a bad attitude…,” as a Paralympics medalist on the USA team, Leeper excelled in track & field as a bladerunner, winning both an individual silver and bronze medal. Today, he continues to inspire others by sharing his story of success in life. In this fascinating exhibit, similar stoeasttnmedicalnews
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ries of inspiration are shared through videos and simulations utilizing real-life tools. Stations throughout also offer participants a chance to exercise creative minds to devise possible solutions and create tools for real-life challenges. The Human Plus: Real Lives + Real Engineering exhibit at CDM was created by the New York Hall of Science in partnership with the Oregon Museum of Science and Industry and the Quality of Life Technology Center, with funding from the National Science Foundation. It is certainly both interactive and intriguing. “It is such a different take on an engineering and a design exhibit,” said Johnson. “The personal stories of users and developers of the adaptive equipment really resonate with guests.” Whether it’s designing a tool to enable a wheelchair bound individual to feed a pet, or personally experiencing the sensation of an ability enhancing tool, the Human Plus exhibit is engaging. “The simulations are very popular,” explained Johnson. “The mono-ski in the ‘Every Body Plays’ display is a favorite in the exhibit; kids and caregivers can sit in a mono-ski and use their body movement to ski down a simulated slalom course. At the ‘Imagine the Possibilities’ kiosk, there are several design challenges to draw solutions for real users, like a canoe for a man who has no arms.” On our visit, we saw several children trying their hands at creating a tool to help in feeding a pet. I also heard a mechanical voice say, “love you.” I quickly realized my husband had just typed the message into a voice simulator for me, and the experience brought tears to my eyes, while imaging what it would be like for an individual to finally “hear” these words from a voice impaired spouse. Amazing! “Guests have designed some really great solutions to the design challenges. Several of them are displayed at the kiosk,” said Johnson. “It is always fun to see their creations and how they are applying engineering and design concepts to the design challenges.” Fillauer, which is celebrating 100 years in Chattanooga, TN, and is a global leader in manufacturing, fabrication, de-
velopment and education of orthotic and prosthetic solutions in the United States, is the exhibit local sponsor. “Fillauer is a natural partner and sponsor for the Human Plus exhibit,” explained Johnson. During Human Plus, there is a complimentary display of the types of orthotic and prosthetic solutions that are developed and produced by Fillauer as well as information about the history of their company.” I applaud the Creative Discovery Museum for hands-on arts and science learning opportunities that are fun and located throughout the facility. Specifically
for this exhibit, I believe it would be amazing to stimulate the mind of a budding engineer. “CDM offers a variety of traveling exhibits geared toward different ages and complimenting or adding to content that is represented in our permanent exhibits,” continued Johnson. “Human Plus provides strong science, engineering and design content and has exhibit components geared towards older children. This is a good compliment to the Thomas & Friends™: Explore the Rails exhibit that will be at CDM this summer.” For additional information on the Human Plus exhibit and others at Creative Discover Museum, visit www.cdmfun.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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Karen Williams By STACy FENTRESS
To Karen Williams, her current role as the Executive Director of Operations with Wellmont Medical Associates just feels natural. “I think health care chose me,” she said. “I started out by working in a physician’s office when I was in college, and I just haven’t left that environment.” As she’s earned college degrees and moved through the ranks, she’s never forgotten the importance of remembering where she started. “I always tell anyone who starts as a practice manager to spend the first six weeks in their new office getting the lay of the land,” she said. “You need to answer the phone and to learn the basics about the computer system. You need to learn about what the other staff members in the office do. Not only will you be better at your job, but you will also earn the respect of people around you.” Even though Williams is responsible for the operations for the 64 medical offices throughout Northeast Tennessee and Southwest Virginia that comprise Wellmont Medical Associates, she still knows how the phone and computer systems in all of those offices work. “I take trainings on any new systems side-by-side with the nurses and frontline staff,” she said. “Can I register someone as quickly as our front office staff can? No. But I can do it.” Another skill Williams has honed is the ability to switch gears quickly – sometimes in the course of a couple of minutes. “There is never a dull moment,” she said. “That’s one of the things I like about this job. There is some kind of challenge in front of me every day.” When Williams says she dabbles in everything, she isn’t joking. “I may go from a strategic planning session to a
meeting on the revenue cycle to a meeting with nursing staff,” she said. “With all the snow this winter, I’ve spent a lot of time deciding things like, ‘Do we open the office because it snowed today?’ and talking about what to do about an office that’s having roofing issues because of all of the snow that’s fallen.” Williams has been a fixture in the Tri Cities healthcare community for more than 30 years. She spent 11 years as the office manager for Holston Medical Group and has worked in a variety of business management positions with Holston Valley Medical Center and with the Bristol Surgery Center before joining Wellmont Medical Associates. She has served as the Executive Director of Operations with Wellmont Medical Associates since 2012. Throughout her career, Williams has attained a variety of degrees and certifications. She holds a Master of Business
Administration from King College and a Master of Public Health Administration from East Tennessee State University (ETSU). She also holds a Master Graduate Certificate in Health Care Administration from ETSU. She is certified as a Licensed Nursing Home Administrator and is a Certified Health Education Specialist. But of all the degrees and certifications, Williams says one of the accolades she’s proudest of in her career happened in 2014 when Wellmont Medical Associates was honored with the American Medical Group Association’s 2014 Acclaim Award. “The AMGA only recognizes a select few groups each year and we were the first group in our region to earn this award,” she said. “They recognize the top-performing medical groups in the U.S. This award put us in the company of groups including the Mayo Health System and the Cleveland Clinic Foundation.” One of the reasons Wellmont Medical Associates earned the Acclaim Award is their hospital readmission rate – it’s less than 11 percent, compared to the national average of 17 percent. Wellmont Medical Associates was also recognized for reaching the highest percentile for the safe prescribing of high-risk medications, and for providing access – same day in many instances – to primary care services for 95 percent of their patient population, exceeding the Medicare Advantage Target of 85 percent. “One of the reasons we’ve been able to achieve such high quality is that we are physician led and professionally managed,” Williams said. “Each of our regional directors works with a physician partner. This helps us understand each other – both the medical and the adminis-
trative sides – and come up with solutions that ultimately benefit patients.” Benefitting patients is Williams’ top goal. “I never forget that everything we do is centers on the patient and that patient is a person that may be feeling bad and scared,” she said. “We need to do all we can to be sure that person gets the best care in the most efficient way possible. “We want to provide a patient-centered medical home for our patients where they are part of a care team,” she continued. “We remind our patients to get their mammograms and other important tests and make sure they make it through the continuum of care and that they have a good experience.” Although Williams may not be a direct-care provider, she’s interfaced with enough patients and pushed enough stretchers during her hospital days to feel a part of the care team. “I once had a surgeon tell one of my co-workers that I was the only administrator he had seen that would come down in stilettos and push a stretcher,” she said. “I just think it is important to have the willingness to do whatever you need to do to get the job done.”
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The Importance of Business Continuity for the Healthcare Industry By Heather Ripley
The healthcare industry relies heavily on data being transmitted back and forth between hospitals, insurance providers, pharmacies, nurses, physicians, etc. and while secure, that information is still susceptible to disasters, both natural and man-made. The recent hack of insurance provider Anthem that saw approximately 80 million individual records breached should be proof enough of the importance of a business continuity and contingency plan. Even if your healthcare business is small, creating advance arrangements and procedures that enable your company to continue operating securely following a disaster is not only important, it’s federally required. Of the multiple parts to the Health Insurance Portability and Accountability Act (HIPAA) enacted in 1996, business continuity and disaster recovery are a major component. Under the Administrative Safeguards Section of the HIPAA Security rule, contingency plans are a required standard for healthcare organizations governed by the federal act. Set to address the issue of availability, these plans aim to ensure authorized healthcare personnel always have access to vital systems and data, despite a disaster that could cause on-site attendance
to be impossible. According to HIPAA, the following contingency plans are required for the healthcare industry: Data Backup Plan, Disaster Recovery Plan, Emergency Mode Operation Plan, and an Emergency Access Procedure. Given the federal requirements, having a continuity plan for your healthcare business is highly important, but where do you start? Here are a few key components of a well-developed plan: Identify all possible disasters: Healthcare continuity plans cover more than data breaches as, in many cases, ex-
treme weather can result in outages and employee absenteeism. For example, if your physician’s office is located in the foothills of the Great Smoky Mountains, unpredictable winter weather can easily turn a sunny morning into a disastrously snowy afternoon, requiring contingency, especially if data access is needed. Identifying all possibilities will help your healthcare business maintain compliance with HIPAA’s Emergency Access Procedure, as well. Identify recovery strategies: Once a disaster has passed, how will your healthcare business move forward? If your data is breached, it’s recommended to issue a pre-prepared statement immediately to tell the truth as quickly as possible in an effort to control public relations and messaging. If a hurricane causes an extended power outage at your insurance headquarters, your patient information should be accessible on outside servers or, the “cloud” network. Identify remote working possibilities: Can your healthcare business temporarily operate without an office? If at all possible, setting up a remote working structure with access to data using webbased portals to access enterprise systems can ensure your practice, insurance com-
pany, etc. doesn’t have to take a day off in the event of a natural disaster. Identify your eHealth protection: As per the HIPAA requirement, Emergency Mode Operation Plan, healthcare businesses must protect their vital data, such as records, governed by HL7 standards. This may require you to outsource your information system, but utilizing a proven software product can mean the difference between continued operation and a crisis. Business continuity plans have their place in multiple industries, but with healthcare, they need to be a top priority. Having a well-communicated plan can have a drastic effect on your public relations, as well. For all healthcare entities, maintaining positive public opinion can be a tricky balancing act that can turn sour in an instant. However, by communicating to your patients, buyers, business partners, and investors that, no matter the outcome, your system is secure under a robust continuity plan can ensure your healthcare business stays strong for years to come. Heather Ripley is the founder and CEO of Ripley PR, a national public relations agency specializing in healthcare. For more information, visit www.ripleypr.com or email hripley@ripleypr.com.
GI Bleeding in Children YOUHANNA S. A-TAWIL, MD Gastrointestinal (GI) bleeding is among the most common gastrointestinal disorders and can range from microscopic bleeding to massive bleeding leading to hypovolemia and shock. In children, GI bleeding requires prompt assessment, diagnosis, and treatment. Two issues should be addressed immediately: the child’s appearance, mental status, blood pressure and heart rate, and the likelihood of ongoing bleeding. It is important to determine whether the bleeding is from an upper or lower GI source because this will help in the diagnosis and treatment. GI bleeding may have different clinical presentations ranging from hematemesis or hematochezia with or without hemodynamic instability, to melena or rectal bleeding. Hematemesis refers to the vomiting of fresh red blood or coffee-ground material from lesions in the esophagus, stomach or proximal bowel. Blood losses are often more marked in upper than in lower GI bleeding. Hematochezia (red blood passed per rectum) usually indicates a lower GI source and usually in the colon. Melena (black, tarry, foul-smelling stool) usually indicates an upper intestinal source. Occult bleeding, a positive stool guaiac, is usually found after clinical manifestation of chronic blood loss. Patients may have chronic GI bleeding with asymptomatic iron-deficiency anemia, or hemoccult-positive stool on evaluation of children with gastro intestinal problems. Accounting for 10-15% of referrals to pediatric gastroenterologists, GI bleeding can be categorized by location as well as broken down into age groups. In neonates, the most common upper GI bleeding is from swallowed maternal blood. Rectal blood should be tested for fetal hemoglobin to rule out maternal blood. Stress gastritis is found mainly in neonates in intensive care and highly correlated with prematurity, neonatal distress, and mechanical ventilation. Hemorrhagic disease of the newborn is caused by a deficiency in vitamin K and has nearly disappeared since the introduction of routine vitamin K administration shortly after birth. In infants and children, esophagitis is the most common cause of upper GI bleeding caused by severe gastroesophageal reflux, and is present in infants with regurgitation, dysphagia, and failure to thrive. Children may present with bleeding as a result of ulcerating or erosive esophagitis. Other causes include mechanical injury from a foreign body, chemical injury, or medication and infection. Gastritis is often associated to Helicobacter pylori infection. Other causes are from nonsteroidal anti-inflammatory drug use, Zollinger-Ellison syndrome, inflammatory bowel disease, and esophageal and gastric varices secondary to portal hypertension. Peptic ulcer disease is most common in children older than one year and is the most common cause of hematemesis. Trauma can be a cause of bleeding in rare cases. Anorectal fissures are the most common cause of lower GI bleeding in neonates and children. When associated with constipation, they respond well to stool softeners and lubricants. Necrotizing enterocolitis (NEC) is common in premature infants. Symptoms of this condition include abdominal distension, poor feeding, vomiting, diarrhea, frank or occult bloody stools, lethargy and apneas. Newborns who have malrotation with midgut volovulus or proximal outlet obstruction typically present with abdominal distension, billous emesis,
and melena. Malrotation is life threatening and requires emergent evaluation and treatment. A limited upper gastrointestinal contrast series is the best examination to visualize the duodenum. Intussusception is the most common cause of intestinal obstruction in infants between 6 and 36 months of age. Approximately 60% of children are younger than 1 year, and 80% are younger than 2 years old. Symptoms include severe abdominal pain, which causes them to be irritable and draw up their legs. They may vomit and pass bloody stools and then improve for a while before the cycle repeats. When it is suspected, an emergency surgery referral is important. Milk or soy-induced colitis is an inflammatory enteropathy caused by ingestion of milk or soy proteins, and occurs almost exclusively in infants. Up to 25 % of patients with cow’s milk protein intolerance will have a cross-reaction to soy protein. Treatment involves eliminating the protein from the diet if the infant is breastfeeding, or the use of casein-hydrolysate formula. Meckel’s diverticulum is the most important source of small bowel hemorrhage in children. It is present in 2% of the population less than 2 years old. Diagnosis is by radionuclide scan or surgical exploration. Beyond infancy, juvenile polyps are the most common source of significant rectal bleeding. Children present with painless bleeding per rectum, which often streaks the stool with fresh blood. Sometimes the patient will report prolapse of a mass from the rectum. Infectious diarrhea and inflammatory bowel disease (ulcerative colitis and crohn’s disease) can cause significant GI bleeding. Bleeding may be less common in crohn’s disease, but both may consist of bloody diarrhea, which can lead to acute or persistent bleeding resulting in anemia. Recent antibiotic use raises suspicion for antibiotic associated colitis and clostridium difficile colitis. Vascular lesions consist of a variety of malformations that include hemangiomas, arteriovenous malformations, and vasculitis. These can lead to bleeding making localizing the bleeding practically difficult. Many things children eat can look like blood. Red food coloring found in foods like Jell-O or Kool Aid, as well as fruit juices and beets may resemble blood, if vomited. Melena may be confused with dark or black stool from iron supplementation, bismuth subsalicylate, dark chocolate, grape juice, spinach, cranberries, or blueberries. A simple Hematest performed at the bedside can confirm presence of blood in gastric contents or in stools. In the neonate, the Apt test will differentiate maternal from infant blood. An upper or lower endoscopy can be used to evaluate GI bleeding and is the procedure of choice for a diagnosis; and sometimes used in emergency cases. Where endoscopy is non-diagnostic, a bleeding scan, Mickel’s Diverticulum Scan, Capsule Endoscopy or Angiogram can be used. At East Tennessee Children’s Hospital, we have a state of the art endoscopy suite supported by multiple pediatric specialists that include surgeons, anesthesiologists, intensive care specialists, radiologists, hematologists, and other specialists on call, as needed, to help our team manage and care for these patients. If you have any patients or questions about your patient, please do not hesitate to call (865) 546-3998. For more information on our testing and services, please refer to our website: www. GIforkids.com.
GI for Kids, PLLC www.giforkids.com
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Marijuana, Medicine & Addiction, continued from page 1 seeds from the hemp plant Cannabis sativa, which contains the mind-altering chemical delta-9-tetrahydrocannabinol (THC), along with other compounds. The National Institute on Drug Abuse (NIDA) has found marijuana to be the most common illicit drug in America and one for which usage is on the rise. The national organization stated marijuana’s Dr. Stuart popularity, particularly Gitlow since 2007, has coincided with a diminishing public perception of the drug’s risks. However, at the same time risk perception has been declining, the drug’s potency has actually been on the rise. In looking at the amount of THC in marijuana samples confiscated by the police, the THC concentration averaged close to 15 percent in 2012 as compared to around 4 percent in the 1980s, according to the NIDA fact sheet on marijuana. Gitlow agreed, saying, “The marijuana that is available today is much different, much more potent, than the marijuana that was available in the ‘60s. More research needs to be done to see if there are even more long-term issues with this more potent form.”
Addiction
Gitlow noted marijuana works like any other addictive drug. “There’s not
debate at all within the medical community that it’s addictive … that’s a given,” he said. “It’s like any other psychoactive drug … it’s not addictive to the majority of those using it once or twice.” However, he continued, “There’s no way of knowing if a person is going to have a problem with the drug until they try it … and then they are playing Russian roulette.” Gitlow explained, “Addictive disease is not about the drug, it’s about a brain abnormality. It exists before somebody picks up the drug.” The three factors required for addiction, he said, are a genetic abnormality, environmental trigger and the drug. “Addictive disease is in only, give or take, 15 percent of the population.” He added popular consensus is that about 9 percent of adults and 17 percent of adolescents who use marijuana become addicted. In addition, NIDA’s marijuana fact sheet noted addiction rates jump in daily users, with as many as 25-50 percent becoming addicted.
Toxicity
“There’s a second issue with marijuana, and it’s independent of addiction. Marijuana has toxic ramifications,” Gitlow said. “Marijuana makes you stupid,” he stated bluntly. “It lowers IQ. It causes slowing of the processing speed. It causes abnormalities of attention and focus. It basically dumbs you down, and it does that more or less universally.” When marijuana is smoked, the
THC passes quickly from the lungs into the bloodstream and to the brain. THC targets cannabinoid receptors, which have a higher density in areas of the brain that influence pleasure, memory, concentration, coordination, thinking and time perception. Additionally, THC’s chemical makeup is similar to a naturally occurring brain chemical called anandamide. That similar structure lets THC be ‘recognized’ by the brain, allowing the outside compound to alter normal brain communication. Of major concern is the affect marijuana has on brain development when used heavily among adolescents. A recent study showed marijuana users who began in adolescence had fewer connections in the areas of the brain that control memory and learning. A large, long-term New Zealand study found those who began heavily smoking marijuana in their teens lost an average of eight IQ points between ages 13 and 38. However, that impact on IQ wasn’t replicated in the study among those who didn’t begin smoking until adulthood. NIDA also cited issues with cardiopulmonary and mental health. Gitlow said, “There’s a five-fold increase in psychotic disorders among those who use marijuana as compared to those who don’t.”
Alcohol vs. Tobacco, Marijuana
Last month, results of a new study stating marijuana is 114 times less lethal
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than alcohol made the media rounds and became fodder for late night comics. Gitlow said comparing the two is like comparing apples and oranges. “They affect different parts of the brain,” he said. Gitlow also noted it is possible to ingest enough alcohol in one sitting to kill you, which isn’t really true of marijuana or tobacco. “So I could make the argument that cigarettes are safer than alcohol,” he said. However, there aren’t many physicians recommending a patient give up the occasional glass of wine and take up smoking tobacco instead. “We’re not prohibitionists,” Gitlow continued. “No one at the American Society of Addiction Medicine says alcohol should be banned, but all these drugs collectively are an enormous burden on the American public from an economic and health-related standpoint.” Considering the dangers of tobacco and alcohol, Gitlow said he couldn’t fathom why, as a country, we would want to add marijuana to the mix. “Why would we want to make our burden worse?” he questioned.
Possible Benefits
Gitlow reiterated his frustration at claims of marijuana being a medical marvel. “There is no medical purpose. No one has ever proven through a double-blinded trial a medical benefit of marijuana.” He continued, “That’s not to say there aren’t components within the plant that might not have medical application.” However, Gitlow said breaking down the more than 100 components in marijuana would require scientific investigation just like any other drug in this country seeking approval from the Food and Drug Administration. He added marijuana lobbyists bringing anecdotal evidence to legislators interested in the bottom line doesn’t constitute a thorough research endeavor. NIDA’s viewpoint is similar, noting that so far clinical evidence does not show the therapeutic benefits of marijuana outweigh the health risk. In it’s assessment of the drug, the national organization stated, “To be considered a legitimate medicine by the FDA, a substance must have welldefined and measurable ingredients that are consistent from one unit (such as a pill or injection) to the next. As the marijuana plant contains hundreds of chemical compounds that may have different effects and that vary from plant to plant, and because the plant is typically ingested via smoking, its use as a medicine is difficult to evaluate. “However, THC-based drugs to treat pain and nausea are already FDA approved and prescribed, and scientists continue to investigate the medicinal properties of other chemicals found in the cannabis plant – such as cannabidiol, a non-psychoactive cannabinoid compound that is being studied for its effects at treating pain, pediatric epilepsy, and other disorders.” With the increased attention being given to marijuana around the country, it’s a safe assumption that opponents and proponents will continue the debate.
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The Literary Examiner BY TERRI SCHLICHENMEYER
Touch: The Science of Hand, Heart, and Mind by David J. Linden; c.2015, Viking; $28.95 / $33.00 Canada, 261 pages
Something’s wrong, and you can’t quite put your finger on it. Everything feels so drab, so negative. It’s Murphy’s Law on overdrive, nothing in your day is going right, and your mood just took another nosedive. Looks like someone needs a hug, and in the new book Touch: The Science of Hand, Heart, and Mind by David J. Linden, you’ll see why that could truly help. Shaking hands, patting someone on the shoulder, caressing a cheek, or grabbing a wrist. There’s no mistaking the meaning behind any of those actions, but why do we understand them, even if they happened wordlessly? Skin, says Linden. It’s a social medium. We humans (as well as most mammals) are born needing to be nurtured and touched: researchers believe it’s the first sense we developed as fetuses, and if we’re denied its pleasure, “the consequences are dramatic.” Children who are touch-deprived in infancy show higher incidences of obesity, heart disease, and type 2 diabetes later in life. But social glue isn’t the only reason scientists are touching upon this sense… Chances are right now, for instance, that you’re touching something – a newspaper or phone, perhaps - and you’re doing it “almost automatically, with very little mental effort.” You can thank touch sensors and nerve fibers for that. Glabrous skin (that without hair, such as what’s on your lips, palms, and the bottoms of your feet) has a dense amount of sensors at its surface while hairy skin contains fewer sensors. The various sensors allow you to perform a multitude of actions, such as grabbing, retrieving, determining, and grasping, and they collect information that goes to your brain at different speeds, taking with it experiences, emotions, and context so you can act (or don’t overreact) to what your skin feels. These sensors also help make a “touch map” inside the brain, which connects information being collected and identifies the source of the touch. While there’s still much to learn, scientists know that your personal touch map can be affected by aging and disease – and if you’re feeling touchy about that, take heart: they also say that maps can change through practiced sensory habits. Doesn’t that make you feel better? If you could only have one sense, which would it be? Read Touch: The Scieasttnmedicalnews
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ence of Hand, Heart, and Mind and your answer will be clear. I only wish the book was, too. In between lively, illustrative stories that can completely capture interest, author David J. Linden immerses his readers in deep neurology, complete with scientific terms that could boggle a layman’s mind. We’re handed a lot here, including alphabet-soup language, and while that’s certainly not bad, it does mean that this book is best consumed slowly and in small bites with rapt attention.
Parentology: Everything You Wanted to Know about the Science of Raising Children but Were Too Exhausted to Ask by Dalton Conley; c.2014, Simon & Schuster; $25.00 / $28.99 Canada, 239 pages
Please. It’s such a basic word. One syllable, easy to pronounce, with a satisfying purse of the lips in the beginning and a drawn out middle that makes you smile if you stretch it out. As your mother might’ve once said, it is, indeed, a “Magic Word.” So why is it so difficult for your child to say? There could be a scientific answer to that aggravation. In the book Parentology by Dalton Conley, you’ll see how manners and more are now coming
from the lab. From the moment a dad- or momto-be announces they’re expecting, they usually receive overwhelming amounts of parenting advice. That’s because, says Conley, we lack a “common culture,” and we’re “constantly improvising” on child-raising. To counteract that childrearing willy-nilliness, Conley says that he raised his kids with “parentology,” a method which “involves first and foremost reading and deciphering the scientific literature… and applying them to your kids.” When he and his then-wife were expecting their firstborn, for instance, he says they carefully researched how birth weight affects a fetus – not just immediately, but in decades to come: their daughter E was born prematurely, which could have affected her likelihood of graduating high school. Maternal experiences also matter; pregnant mothers living near the epicenter of Chilean earthquakes birthed children who “suffered in their reading and math scores later on.” A kid born in the fall does “best,” says Conley, and what you name that kid really does matter. Siblings (and space between them) might make a difference in a child’s future socioeconomic success, perhaps because they affect parental involvement. And talking to your kids as babies – even if it’s just narrating your day or reading aloud – can be a major key in development. Know the statistics about schools and homework, and don’t worry about the former too much. Let your kids have “a healthy dose of germs” and be open to having pets; both might help boost immune systems. Insist that man-
ners extend to people in all walks of life, and teach the difference between “front stage and backstage.” And don’t sweat it if you make a mistake: parental actions mean a lot, but so does your child’s DNA. If you’re a parent, you may take away a lot of information in Parentology. Or, on the flip-side, you might also rear up in horror. As for me, I liked this book. Author and social scientist Dalton Conley meshes parenting with science quite nicely but it’s important to note that, in the beginning, he says one of the hallmarks of Parentology is “drawing your own conclusions…” That might not include allowing your child to aim profanity at you (as Conley does) or cosleeping well into childhood (ditto) but, as he indicates, it worked for his family. Go back and read that again: “drawing your own conclusions…” In other words, like with most parenting books, use what you can here and throw out the rest. You might be happy with your own parenting style, but what you’ll find in Parentology may also make you pleased. If you’re a parent, you know by now that a sense of humor is imperative – which is why you may also want to look at How Not to Calm a Child on a Plane by Johanna Stein. No, it won’t teach you how to put a baby down for a nap or how to lose those last 10 pounds of baby weight… but it will teach you how to laugh about both.
Terri Schlichenmeyer has been reading since she was 3 years old, and she never goes anywhere without a book. She lives on a hill in Wisconsin with two dogs and 11,000 books.
Mark Your Calendar
Your local Medical Group Managers Association is Connecting Members and Building Partnerships. All area Healthcare Managers (including non-members) are invited to attend.
2ND THURSDAY
3RD THURSDAY
JOHNSON CITY MGMA MONTHLY MEETING
KINGSPORT MGMA MONTHLY MEETING
Date: The 2nd Thursday of Each Month Time: 11:30 AM – 1:00 PM
Date: The 3rd Thursday of Each Month Time: 11:30 AM – 1:00 PM
Location: Summit Leadership Foundation 3104 Hanover Rd. Johnson City
Location: Indian Path Medical Center Conference Room, Building 2002, Second Floor, Kingsport
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GrandRounds Lord Joins Watauga Orthopaedics JOHNSON CITY – Dr. Kent Lord has joined Watauga Orthopaedics and will be seeing patients primarily at their Kingsport location on 117 W. Sevier Ave., Suite 200. Lord attended the University of South Alabama for his undergraduate stud- Dr. Kent Lord ies and received his medical degree from the University of Alabama School of Medicine in 2006. While there, he was president of the Christian Medical and Dental Association Student Chapter for a year. He completed his orthopaedic surgery residency at the Medical College of Georgia – Department of Orthopaedic Surgery in 2011. He is board certified by the American Board of Orthopaedic Surgery, as well as fellowship trained in foot and ankle and hand/upper extremity. He was an assistant professor in the Department of Orthopaedics at the Medical College of Georgia/Georgia Health Sciences University and is a member of the American Academy of Orthopaedics Surgeons. Lord lives in Sullivan County with his wife and two daughters, and his hobbies
include golf and other sports, hunting, fishing, music, and spending time with his family. For more information, visit www. wataugaortho.com.
Wellmont Hosts Inaugural Neuroscience Conference, Experts from Hospital Medical Staffs to Speak KINGSPORT – Area medical professionals interested in learning about the latest developments in brain and spinal care can expand their knowledge at Wellmont Health System’s inaugural Neuroscience Conference. The event will be held Friday, April 24, at MeadowView Conference Resort & Convention Center in Kingsport. Activities will begin at 7 a.m. and end at 4:05 p.m. Topics to be presented include artificial disc surgery, brain tumors, endovascular treatment of cranial disorders, headaches, neurological stereotactic radiosurgery, outpatient spine surgery, radiographic interpretations, seizures and spinal stenosis. Medical staff members of Holston Valley Medical Center and Bristol Regional Medical Center will speak at the event. They are:
Priority Ambulance, continued from page 3 credits those attributes to Priority’s working environment and corporate culture. “We have a real family atmosphere at Priority,” Bradsby said. “We are all here for each other. This is our place. We’ve been here since it started, and we want it to succeed. Happy, committed employees deliver the kind of service that translates into happy, committed clients.” In early 2014, Priority Ambulance opened its corporate headquarters in Knox County. The company brought more than 50 jobs to the area and became the only national ambulance company headquartered in East Tennessee. Priority Ambulance provides pre-scheduled ambulance service to Knox and Blount counties and is the official E-911 ambulance provider in Loudon County. “Our company motto is: ‘Our community. Our priority’,” said Rob Webb, vice president of Tennessee operations. “As a newcomer in the East Tennessee ambulance market, our strategy was to recruit the best local employees who shared our same commitment to community involvement and patient care. “We have gathered a compassionate, talented team of local EMTs and paramedics that are drawing recognition from patients and medical facilities for the level of care and service they show to patients and their families.” Webb added Priority Ambulance also is devoted to supporting important community causes and promoting awareness of public health issues. “We know that we best serve our community when we are connected to the causes and organizations that matter to 10
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our patients and their families,” he said. For example, Priority Ambulance has provided standby emergency service, first aid and sponsorship to local community events such as the Senior Companion Program Snowflake Ball, the Smoky Mountain Scottish Festival & Games, East Tennessee Kidney Foundation Lucky Kidney Run, East Tennessee Kidney Foundation Christmas in July Blanket Drive, Epilepsy Foundation of East Tennessee Mardi Gras, and the Loudon County and Blount County Boys & Girls Clubs fundraising dinners. “We are very active with the East Tennessee Kidney Foundation,” Bradsby said. “By supporting the organization we know that our money stays right here in our community and goes to dialysis patients who really need the help.” Bradsby noted dialysis patients require transport three times a week for treatments that take four or five hours each time. “These patients can be sick and weak and need to be treated with compassion,” she said. “I’m proud to work for a company that delivers the kind of care these patients deserve. After building relationships with these patients over many weeks, our EMTs and paramedics look at them as family members and treat them as they would their own loved ones.” Priority Ambulance’s marketing strategy doesn’t center on an ambitious advertising campaign, but instead is committed to customer service and improving the quality of life for patients and the community. “That’s what makes Priority special,” Bradsby said.
James Brasfield, M.D., neurosurgeon, Bristol Neurological Associates Greg Corradino, M.D., neurosurgeon, East Tennessee Brain and Spine Center Timothy Fullagar, M.D., neurosurgeon, East Tennessee Brain and Spine Center Tim Himel, M.D., neurohospitalist, Wellmont Medical Associates Hospitalists Jeremiah Marsh, M.D., neurohospitalist, Wellmont Medical Associates Hospitalists Chris Metzger, M.D., interventional cardiologist, Wellmont CVA Heart Institute Ken Smith, M.D., neurosurgeon, Blue Ridge Neuroscience Center David Wiles, M.D., neurosurgeon, East Tennessee Brian and Spine Center Matthew Wood, M.D., neurosurgeon, Highlands Neurosurgery Bristol Regional is an established leader in stroke care, with the region’s first Primary Stroke Center, which ensures timely and effective intervention. The hospital’s neurological care has been recognized by the American Heart Association’s Get With The Guidelines Stroke Plus Quality Achievement Award, as well as a No. 1 ranking in the Tri-Cities area for medical excellence in major neurosurgery from CareChex, an independent ratings organization and a division of Comparion. Furthermore, Holston Valley recently expanded its suite of neurological care with the addition of Drs. Himel and Marsh as the first neurologists to join Wellmont Medical Associates. Specializing in inpatient medicine, they work with a team of highly regarded medical staff leaders in the neurosciences at Holston Valley. The physicians fill a growing need for brain and spine care, especially as medical research offers additional insight into ways those areas of the body affect a variety of medical conditions. Registration is $30 for Wellmont coworkers and $40 for other clinicians. Preregistration is required. Those who are interested can sign up at www.wellmont. org/neuroconference.
Health Care Veteran Lisa Smithgall Named Holston Valley’s Vice President of Patient Care Services KINGSPORT – Lisa Smithgall, a highly respected administrator with more than 30 years’ experience in healthcare, has been named vice president of patient care services at Holston Valley Medical Center. Smithgall comes to Holston Valley after serving as associate vice president of nursing for Geisinger Medical Center in Danville, Pennsylvania, since 2012. During her tenure, she oversaw a number of units, including adult intensive care, telemetry, orthopedics and respiratory therapy. In addition, Smithgall facilitated the creation and implementation of the Geisinger Nurses Emerging as Leaders program for nurse leader development and (continued on page 11)
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GrandRounds succession planning across the health system. She also completed the Geisinger High Potential Leadership Development program. Now, she returns to the Tri-Cities, where she served in healthcare leadership roles for 20 years, and will become a member of the executive leadership team for Wellmont Health System’s largest hospital. Smithgall will be responsible for the overall quality of nursing care at Holston Valley, which includes the critical care, cardiovascular, medical/surgical and trauma units, as well as the emergency department and other patient care services. Smithgall will assume her role at Holston Valley on April 20. “We’re excited Lisa will be sharing her extensive knowledge and dynamic leadership skills with our nationally recognized hospital,” said Tim Attebery, Holston Valley’s president. “Lisa is well-known and highly regarded by many nurses in the region. Plus, she understands the fabric of our region and will be attuned to our patients’ needs as she helps us enhance the world-class care for which we have long been known.” From 1992 until 2012, Smithgall received multiple promotions at Johnson City Medical Center and, later, Mountain States Health Alliance. She began her career there as clinical manager in the neonatal intensive care unit in The Children’s Hospital at Johnson City Medical Center. She later served as director, executive director, assistant vice president and vice president of the women’s and children’s strategic service unit, first at Johnson City Medical Center and subsequently at other Mountain States hospitals as well. She concluded her Mountain States career as vice president of the women’s strategic service unit after the health system split the leadership responsibilities for women and children. Smithgall began her medical career in 1983 as a staff nurse in the neonatal intensive care unit at Harrisburg Hospital in Harrisburg, Pennsylvania. She advanced to clinical manager of that unit in 1987 and continued in that position for five years. Smithgall is board-certified as a nurse executive advanced by the American Nurses Credentialing Center. She has also been certified as a pediatric nurse practitioner by the National Certification Board of Pediatric Nurse Practitioners and Nurses and as a neonatal intensive care nurse by the National Certification Corp. Having earned a Bachelor’s degree in nursing from Bloomsburg University of Pennsylvania, Smithgall secured her Master’s in that field from the University of Tennessee and became a nurse practitioner. She completed her education with a doctorate degree in nursing from East Tennessee State University in 2010. Smithgall has received multiple honors during her career, such as the Meritorious Service Award for Executive Staff from the Tennessee Hospital Association, easttnmedicalnews
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a Tribute to Women award from the YWCA Bristol and a Health Care Hero award from the Business Journal of Tri-Cities Tennessee/Virginia. She is a member of the American Organization of Nurse Executives, the American Nurses Association and the Association of Women’s Health, Obstetric and Neonatal Nurses. When she is not overseeing patient care, people are likely to find Smithgall helping the community in other ways. When she last lived in the region, she served on the boards of directors of the Southern Appalachian Ronald McDonald House Charities and Johnson City Communities in Schools and was a Girl Scout leader.
New ‘Emerging Leaders in Medicine’ program awarded funding by honor medical society JOHNSON CITY – A new leadership program is headed to East Tennessee State University’s Quillen College of Medicine after receiving approval and funding from the national Alpha Omega Alpha Honor Medical Society earlier this month. The “Emerging Leaders in Medicine” program will be an extracurricular fellowship allowing for the implementation of leadership development and multidisciplinary education into current extracurricular schedules for interested medical students at ETSU. “This really fills a huge void,” said Dr. Reid Blackwelder, medical professor, director of Medical Student Education for the Department of Family Medicine and faculty advisor for the project. “With medical school education, there’s a very structured process of education, a very strict curriculum. It’s a rigorous set of things that have to be done. The things that get left out are really the components of leadership.” Through the new program, Blackwelder hopes participants will obtain a skill set that includes more educational opportunities in interprofessional work, leadership and advocacy. A predominantly student-led effort, the program includes a community service component as well as a team-based simulation laboratory aspect and significant focus on multidisciplinary education. “The Quillen College of Medicine and the ETSU Academic Health Sciences Center are very much committed to leadership development and interprofessional work,” Blackwelder noted. “I’m hoping this ‘Emerging Leaders’ program will help us see significant curriculum and structure change for all health sciences students. This is a great step to creating a foundation for a very large paradigm shift (in health sciences education).” A total of $9,000 in funding from Alpha Omega Alpha will stretch over three years to get the program started, with the Quillen College of Medicine providing matching funds. “It is a three-year project at the mo-
ment, but we want this to be something that could become sustaining in such a way that this institution can’t live without it,” Blackwelder said. “I would like to see this take off and that is what these students want, too. We need to keep moving forward with developing leaders.”
Quillen College of Medicine ranked 8th in nation for rural medicine JOHNSON CITY – East Tennessee State University’s Quillen College of Medicine has been ranked eighth in the nation for rural medicine training by U.S. News & World Report. The 2016 U.S. News & World Report’s “Best Graduate Schools” rankings were released today. In recent years, ETSU consistently has ranked in the top 10 for rural medicine. For the rankings in specific specialties such as rural medicine, medical school deans and senior faculty selected the best programs.
Tillman tapped as new associate dean in College of Nursing JOHNSON CITY – The College of Nursing at East Tennessee State University has named Ken Tillman its new associate dean of academic programs. Tillman was previously serving as the director of undergraduate programs for the College of Nursing and has been with ETSU since 2013. In addition to his role as associate dean, Tillman serves as an associate professor in the nursing college. Prior to coming to ETSU, Tillman served as an assistant professor and coordinator at Southeastern Louisiana University School of Nursing. He earned a Bachelor of Science in nursing from the University of South Alabama and a Master of Science in nursing from the University of Texas Health Sciences Center at Houston. In 2006, Tillman earned a Ph.D. from Louisiana State University.
Appalachian Christian Village Celebrates 6th Annual Employee Service Awards Employees recognized for their excellence and years of service JOHNSON CITY – Recently, Appalachian Christian Village (ACV), one of the first established Continuing Care Retirement Communities (CCRC) in East Tennessee, held its 6th Annual Employee Service Award Ceremony to honor the commitment and loyalty of its long-standing employees. Among those were 15-year veterans Jennifer Banner, Connie Cook and Sue Bailey. One of 3 children, Jennifer Banner, began her career in May 1999 as a receptionist. After years of working at ACV, Banner now holds the title of Executive Assistant, Capital Projects Coordinator. She’s currently resides in Jonesborough, Tenn. with her husband, Mark.
Similar to Banner, Connie Cook is also one of three children. She began her career in June 1999 as a Housekeeper. Cook is currently the Housekeeping Team Leader at ACV. She currently resides in Elizabethton, Tenn., and has one child and one grandchild. In her spare time, Cook enjoys reading. Lastly ACV honored 15-year service veteran, Sue Bailey, who began her career in January 1999 as a Caregiver in Resident Services. Bailey continues to hold that role, as well as the Wellness/Activities Assistant. Bailey has two children and four grandchildren. She currently resides in Johnson City, Tenn. Bailey enjoys gospel and country music, quilting, and Jigsaw puzzles in her free time. During the Employee Service Award presentation, the ladies received a certificate and pin to commemorate their 15 years of service and dedication to the community. Additionally, Appalachian Christian Village honored employees who had completed two to 10 years with the senior living community. Those recognized for their 10 years of service included Jeri Linthicum of Johnson City, Bethany Martin of Bluff City, Vilma Fair of Jonesborough, Angela Engle of Erwin, and Katherine Nidiffer of Limestone. Fiveyear veterans included Johnson City residents Kim Miller, Brandie Barnett, Robert Gregory, Joseph Jones, Judy Payne, Linda Jonas, Winfred Copney, and Carol Seggio; Rex Massey of Limestone; Vicky Tolley and Vickie Hale of Jonesborough; April Catherman of Bluff City; and Tracy Hartley and Rebekah Nunley of Elizabethton. Employees completing their second year of service included: Tomica Gibbs, Johnson City; Felicia Dixon, Johnson City; Alyssa Fair, Jonesborough; Jeffrey McNabb, Jonesborough; Scotty Campbell, Johnson City; John Garcia, Piney Flats; Arthur Kennedy, Johnson City; Jessalyn Rogers, Johnson City; E. Keith Taylor, Elizabethton; Donald Valentine, Bluff City; Chad Taylor, Elizabethton; Tamera Bulla, Johnson City; Debra Gibson, Kingsport; Barbara Hoxworth, Jonesborough; Cassandra McCloud, Butler; Teresa Montgomery, Johnson City; Kayla Crosswhite, Elizabethton; Shawna Davis, Johnson City; Mary Farrington, Johnson City; Victoria Holtsclaw, Johnson City; Vanessa Humphrey, Johnson City; Stephanie Laughren, Johnson City; Lisa Miller, Elizabethton; Monica Pierson, Johnson City; Melanie Thomas, Johnson City; Tracy Thomas, Blountville; Jeralyn Walker, Johnson City; Gary Watts, Johnson City; Erica Clifton, Elizabethton; Megan Peters, Kingsport; Heather Cash, Johnson City; Laurie Mirlas, Johnson City. Additionally, five staff members received the “Making a Difference Award,” which is a resident, resident family member(s), and guest nominated award. Juanita Dooley of Limestone; Kathy Simerly of Jonesborough; Angela Clark of Johnson City; Megan Peters of Kingsport; Candice Thomason of Johnson City APRIL 2015
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Humana proudly salutes our network providers who have achieved service excellence.*
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Your health and well-being is their top priority. These providers have ranked among the highest overall in our health plan based on Medicare quality measures*, which include: • Providing preventive services • Managing diabetes • Providing cancer screenings
• Controlling cholesterol levels • Preventing heart disease • Medication management
They take the time to see you frequently and closely follow those with chronic conditions. It’s the little things they do every day that can help keep you in good health. That can reduce your healthcare costs in the long run.
We are proud to salute: State of Franklin Healthcare Associates Blue Ridge Family Medicine Blackmore, Ronald Bowling, Gretchen French, Jason Robins, Guy Way, Brian
Family Physicians of J.C. Hutchins, Christina McLaughlin, Dean
Grosserode, Michael Hemphill, Chris Monderer, Rachel Pearson, Michael Proffitt, Amy
First Choice Health Care Family Bertotti, Marian J.C. Internal Medicine Merrifield, Angela Brown, Jr., Paul Ross, Charles Cary, Matthew Cook, Keith First Choice Health Care Dykes, James T. Internal Medicine El Bazouni, Hadi Forbush, F. Alan Freemon, David
Gibson, Mary Jane Hansen, James Hansen, Shoko Hatjioannou, Jason Hodges, Stanley Hoover, Randy Johnson, Frank Khezeri, Azadeh Malik, Sulleman Matherne, Craig Moulton, David Nerren, Bryan Rafai, Ali
Rolen, Richard Shankle, Victoria Sweet, Kevin Williams, Mark Pinnacle Family Practice Colyar, Allan Humston, Elizabeth Manginelli, Stephanie Nave, Ellen
*Providers were ranked based on their 2013 Healthcare Effectiveness Data and Information Set (HEDIS) and Pharmacy Claims Data metrics. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Helping you stay healthy in the community
Humana is a Medicare Advantage organization with a Medicare contract. Enrollment in a Humana plan depends on contract renewal. Other providers are available in our network. Y0040_GHHHL2ZHH_15