Tri Cities Medical News June 2015

FOCUS TOPICS MEN’S HEALTH PATIENT CARE MODELS

June 2015 >> $5

PHYSICIAN SPOTLIGHT PAGE 2

Helping Men Get Healthy

By CINDy SANDERS

Curtis Jantzi, DO

ON ROUNDS Emphasis on Innovation A Look at the Tennessee Health Care Innovation Initiative The move away from feefor-service healthcare is sweeping across the country as payers and providers come together to search for innovative ways to improve outcomes while lowering costs. With Tennessee’s robust resources, the state is well positioned to take a lead role in transforming the delivery of healthcare ... 3

Getting the word out Men’s Health Network targets awareness of male-specific illnesses Health and wellness information for women and children is more accessible than ever before.

From better living through diet and exercise to the importance of preventive measures such as mammograms, there are resources in most every community. For men, however, facts and figures are a little scarcer on the ground ... 8

Special Advertising Physician to Physician ... 12

ONLINE: EASTTN MEDICAL NEWS.COM

American men live sicker and die younger than their female counterparts. However, Men’s Health Network is working to change the status quo by reaching out to men where they work, live, play and pray.

“We want to make sure we are every place where men can be reached,” stated Ana N. Fadich, MPH, CHES, vice president of Men’s Health Network (MHN).

It’s mission critical, she noted, given some of the sobering statistics about men and their well-being. Men have lower rates of health insurance coverage, a higher prevalence of death rates for nine of the 10 leading causes of death, fewer physician visits and cultural barriers to seeking help.

“A lot of times, men feel they are invincible,” Fadich said. She added phrases like ‘man up,’ or ‘big boys don’t cry,’ or ‘walk it off’ are deeply engrained in the American experience. A lack of awareness and education coupled with persisting cultural behaviors have

had a sustained, negative impact on men’s health in the United States. To reverse this trend, MHN is employing a number of strategies in an effort to impact health in five key areas: • Reducing premature mortality of men and boys, • Enhancing physical and mental health of men for happier, fuller, healthier lives, • Reducing cycles of violence and addiction, • Energizing government involvement in men’s health issues, and • Encouraging women to expand on their traditional role as the family’s healthcare leader to promote healthcare services and healthy choices.

The Weaker Sex

While males might celebrate their physical prowess, the reality is men are statistically the weaker sex. Fadich said men start out at a slight advantage with 105 boys being born for every 100 girls. How(CONTINUED ON PAGE 6)

The Competing P’s: Provision & Payment Changing reimbursement for new models of care

By CINDy SANDERS

First the good news … providers are generally excited about the idea of moving to more holistic, integrated care with a focus on prevention, quality and outcomes. Now the not-so-good news … we have to figure out how to pay for it.

“Providers are on board for the potential benefits from changes to the way we provide care, which is different from the way we pay for care,” noted Dion P. Sheidy, a partner in KPMG’s Health Care Advisory Practice. “This is a little bit of the elephant in the room.”

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PhysicianSpotlight

Curtis Jantzi, DO

By JENNIFER CULP

have any specific specialty I was

trying to help people avoid problems in

interested in. I didn’t want to pi-

the first place.

There was a sudden muffled

geonhole myself into one specific

Jantzi and his wife, a former art

scuffling noise, a crash, breaking

area,” he remembered, and then

teacher and current yoga instructor, “defi-

off the conversation. “Sorry about

the ideal solution became clear:

nitely have a case of wanderlust,” he said,

that,” Dr. Curtis Jantzi laughed,

general medicine. After residency

and love to travel both separately and to-

returning to the phone a moment

and an extra year working as chief

gether during their spare time. Jantzi has

later. He had just received an

resident, he joined the group that

visited Alaska, gone diving in the Gala-

overly enthusiastic welcome home

trained him and spent four years

pagos, studied in Italy and Germany,

from his three golden retrievers.

working in primary care in Her-

and gone on medical missions to the Phil-

mitage, Pennsylvania, where he

lipines, Taiwan, and Vietnam, among

met his wife.

other adventures. The couple became en-

Jantzi grew up in western Pennsylvania, “part of the snow belt,” as he described it, and de-

Ready to live in a more

gaged in Estonia, after a bit of confusion

camped briefly to the Midwest to

temperate climate after years in

on Jantzi’s part: when he misheard his

go to college in Goshen, Indiana.

Pennsylvania, the couple began

future wife’s desired destination as “Mace-

Growing up, Jantzi often heard

to search for a new place to relo-

donia,” he was puzzled when she started

that he’d make a good doctor

cate. They both liked East Tennes-

talking about cold weather and seeing the

someday (his father joking that

see and felt drawn to the Smoky

Northern Lights. A surreptitious scan of a

he had the terrible handwriting

Mountains, and then he found a

map set him straight, and he made it to

for it), but wasn’t particularly fo-

perfect professional home with

the right place to propose to her in North-

cused on the idea. As a chemistry major,

cine was meant to be, and he earned his

Holston Medical Group in Kingsport.

ern Europe. His bucket list travel destina-

he intended to pursue chemical engi-

medical degree from Lake Erie College of

At Holston, Jantzi found himself working

tions include Scotland and Machu Picchu,

neering, but fate intervened in the form

Osteopathic Medicine in Erie, Pennsylva-

with an older patient population—mostly

where he’d like to hike the Inca Trail.

of unpleasant coursework: “When I took

nia, close to his childhood home.

65 plus—which he found himself appre-

Jantzi does a good deal of hiking at home,

physics, I realized that I hated physics,” he

Following med school, Jantzi un-

ciating. “Developing relationships with

too, as well as yoga with his wife. He likes

said. With engineering off the table, Jantzi

dertook a year of internship “where I

patients and their families and manag-

to read, and loves to cook and have guests

was unsure of his future direction, but he

basically did everything—primary care,

ing their care over a period of time is my

over for meals, which ties in well with his

loved chemistry and biochemistry, and

internal medicine, pediatrics, obstetrics,

favorite thing,” he said. “I always say I

traveling hobby. “That’s exactly what we

many of his friends were preparing to take

gynecology,” he recalled. Finding that

try to help my patients keep their golden

do! We always buy two or three cooking

the Medical College Admission Test. On

he really enjoyed pediatrics, he consid-

years as golden as possible.” He greatly

books on a trip, and that’s what we’ll be

a whim, he signed on to take the MCAT

ered pursuing neonatal care. After a year

enjoys the variety of primary care work.

eating for the next year or so.” He laughed.

too, reasoning that if he did well enough,

of pediatric work at Mercy Hospital of

“You really have no idea what’s going to

“You never know what you’re going to get

he would apply to medical school. With

Pittsburg, Jantzi realized that, although

walk through the door, and what you’re

when you come over here!”

two weeks of study prior to the test, “I

he greatly enjoyed the work itself, he re-

going to have to deal with,” he said.

And with that, it’s time for Dr. Jantzi

didn’t do GREAT on it, but I did do well

alized that the on-call emergency care

“That makes it fun!” He notes that the

to go. When three excited golden retriev-

enough!” he laughed. A career in medi-

lifestyle wasn’t for him. “I didn’t really

majority of his practice is preventative,

ers are ready for a walk, it’s hard to say no.

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Emphasis on Innovation A Look at the Tennessee Health Care Innovation Initiative

By CINDY SANDERS

The move away from fee-for-service healthcare is sweeping across the country as payers and providers come together to search for innovative ways to improve outcomes while lowering costs. With Tennessee’s robust resources, the state is well positioned to take a lead role in transforming the delivery of healthcare.

“In 2013 Governor Haslam launched the Tennessee Health Care Innovation Initiative to move from volume to value,” said Brooks Daverman, director of Strategic Planning and Innovation for the Tennessee Division of Health Care Finance and Administration (HCFA).

Brooks “Our mission is to reDaverman ward providers for the outcomes that we want – high quality and efficient treatment of medical conditions and better health over time.”

Key Stakeholders & Background During a joint session of the Tennessee Legislature in the spring of 2013, Gov. Haslam pledged Tennessee would become “a model for what true healthcare reform looks like.”

Central to achieving this goal is the involvement of key players representing payers, providers, patients and purchasers across the state. “We’re trying to create an aligned approach for all the stakeholders,” noted Daverman. He added that by late May 2015, he and his team had held more than 440 meetings with interested parties to share information and receive input. From consumer groups like the Common Table Health Alliance to employer organizations including the Memphis Business Group on Health and East Tennessee’s HealthCare 21 Business Coalition, Daverman said payment reform could not occur in a vacuum.

Ongoing meetings with payers, providers and workgroups are used to design strategies to be broadly implemented across the state. Routine meetings are held with major provider organizations including the Tennessee Medical Association (TMA), Tennessee Hospital Association (THA), Hospital Alliance of Tennessee (HAT) and Tennessee Nurses Association (TNA), along with a host of specialty statewide organizations representing family physicians, physician assistants, pediatricians, children’s hospitals, mental health organizations, primary care providers, and medical education. In addition, Amerigroup, BlueCross BlueShield of Tennessee, Cigna, and UnitedHealthcare meet regularly with the team.

While the initiative took off in May 2013, Daverman said the roots of payment reform go back even further to a vision task force, which included members of TMA, THA, Darin Gordon from HCFA, and others. “It was a group of likeminded, influential people in the state thinking about how we can move things forward in terms easttnmedicalnews

.com

of healthcare payment and delivery,” Daverman noted. “I think the strategies we have chosen are all ones that were discussed in those meetings.”

As a result of stakeholder input, strategies in three key areas are being implemented: primary care transformation, episodes of care, and long-term services and supports. There is a Technical Advisory Group (TAG) for each strategic area to provide guidance on quality measures and program design.

Primary Care Transformation Daverman noted this component focuses on the “primary care provider – preventing illness, managing chronic illness and coordinating with other providers such as specialists.” He continued, “This is rewarding activities that are very important in primary care that aren’t necessarily paid for now.”

Daverman pointed out coordinating with a specialist takes time and effort for the primary care provider but isn’t necessarily reimbursable. Yet, the results of that coordination are often critical to a patient’s health.

“With all our strategies, we want to put the doctor in the driver’s seat,” he said.

Daverman added this focus on outcomes might require changes in communication, clinic hours, phone staffing, and other patient engagement activities in order to improve health and cut down on expensive emergency room visits. “If it results in better outcomes for quality and utilization, we want to reward that.”

Although he praised with work being done by ACOs, Daverman stressed the primary care transformation strategies are different and easily scalable. “All of our strategies are feasible for providers without making significant changes to business relationships,” he said.

The starting point is with patient centered medical Homes (PCMH), health

homes for SMPI (serious and persistent mental illness) patients, and provider alerts for hospital and emergency department admissions, discharges and transfers. “We’ll start with about a dozen practices and want to go statewide within a couple of years,” Daverman said of programming, which is slated to launch in mid-2016.

Whether or not providers are in a PCMH, those who sign up can tap into the web-based statewide alert system. “We’re going to work to have real-time notices every time a patient goes to the emergency room of a hospital,” Daverman said of the data being populated by participating payers. In addition, he said the system would be able to generate a ‘gaps in care’ report and alert providers to their patients’ drug fills.

“It’s really, really important information to have if you want to manage your patients.”

Episodes of Care “This is the strategy that’s the furthest along,” Daverman noted of aligning incentives with desired outcomes. Episodes reward high quality care, promote the use of clinical pathways and evidence-based guidelines, and encourage coordination to reduced ineffective or inappropriate care.

Under the initiative, episode-based payment is being rolled out in waves with the goal of implementing 75 episodes by the end of 2019.

Wave 1 launched in May 2014 with three episodes of care: acute asthma exacerbation, perinatal, and total joint replacement. For six months, more than 500 providers received detailed preview reports from TennCare and commercial payers before the wave went live in 2015.

“Providers are getting new information they’ve never had before in quality reports,” Daverman explained. “They can see how they compare to their peers on cost, and we break down those costs into categories to

make it actionable.”

He continued, “Providers who have the most expensive average episode cost for the year across the state are penalized by a portion of their excess cost.” However, Daverman noted, the threshold for a penalty is set pretty high and is considered only after adjusting for exclusions such as high-risk patients or extraordinary events. Ultimately, the projection is the most expensive 10 percent of providers will face a penalty. On the other hand, he said, “It’s very important we reward providers who meet quality measures and provide efficient care with shared savings.” Daverman predicted, “The majority of providers will have no change or will get rewarded.”

Preview reports for Wave 2 – acute COPD exacerbation, screening and surveillance colonoscopy, outpatient and nonacute inpatient cholecystectomy, and acute and non-acute PCI – began at the end of last month. The advisory group has just completed their process for Wave 3, which will roll out preview reports next year and go live at the beginning of 2017.

Long-Term Services & Supports Daverman said the main premise of this strategy is to tie payment to quality and acuity. “Some of the measures are around the patient experience, and some of the quality measures are around the caregivers,” he said.

Key points include implementing quality- and acuity-based payment for nursing facilities and home- and community-based services, value-based purchasing initiatives for enhanced respiratory care, and focusing on workforce development.

More Information Details on each of the strategies is available online in the Strategic Planning and Innovation Group section of HCFA at tn.gov.

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LegalMatters

BY J. SPENCER FAIR, LONDON & AMBURN, P.C.

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Patient Care Models: Patient Portal Security Risks The American Recovery and Reinvestment Act of 2009 (“ARRA”) instituted incentives through the Center for Medicare and Medicaid Services (“CMS”) for the “meaningful use” of certified electronic health record technology (“EHR”).

Once a provider has established meaningful use of EHR, the next step can involve the use of patient portals, which allow patients to access electronic protected health information (“e-PHI”) online, among other things (1).

As with any confidential information accessed online, a natural concern accompanying the increased use of patient portals relates to cyber security and Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) compliance.

HIPAA’s “minimum necessary” standard requires providers to evaluate their practices and enhance safeguards as needed to limit unnecessary or inappropriate access to and disclosure of protected health information (2). Online data breaches are prevalent worldwide even despite preventative efforts, and maintaining HIPAA

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compliance while utilizing patient portals creates potential challenges for providers.

What are patient portals?

A patient portal is a secure online website that gives patients 24-hour access to e-PHI online (3). Patient portals also allow providers to use secure electronic messaging to communicate with patients on relevant health information (4). Patient portals are part of Stage 2 of the ARRA’s Medicare and Medicaid EHR Incentive Program, available only after a provider has demonstrated Stage 1’s “meaningful use” (5).

What steps are required by HIPAA for a provider to secure EHR and patient portals?

All “covered entities” under HIPAA are required to perform a risk analysis to secure EHR systems and patient portals (6). The installation of a certified EHR does not alone fulfill the meaningful use security risk analysis, and EHR vendors are not responsible for making their products compliant with HIPAA Privacy and Security Rules (7).

HIPAA requires providers to conduct an accurate and thorough analysis of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of e-PHI (8). Beyond this risk analysis, a healthcare provider must take any additional “reasonable and appropriate” steps to reduce identified risks, and must continue to review, correct, modify, and update security protections (9). All e-PHI created, received, maintained, or transmitted by a provider is subject to the HIPAA Security Rule (10). There is no one-size-fitsall security risk analysis for every provider, but the HIPAA Security Rule requires providers to “[i]mplement policies and procedures to prevent, detect, contain, and correct security violations” (11).

Although a provider is required to protect e-PHI, the HIPAA Security Rule does not create an unreasonable burden to accomplish this requirement. The HIPAA Security Rule requires providers to evaluate risks and vulnerabilities in their environments and to implement reasonable and appropriate security measures to protect against reasonably anticipated threats or hazards to the security or integrity of e-PHI (12). CMS recommends the following considerations in conducting a

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risk analysis: 1) Review the existing security infrastructure in your medical practice against legal requirements and industry best practices; 2) Identify potential threats to patient privacy and security and assess the impact on the confidentiality, integrity, and availability of your organization’s e-PHI; and 3) Prioritize risks based on the severity of their impact on your patients and practice (13).

What are some practical safeguards for patient portals to help achieve compliance with HIPAA? For patient portals specifically, many providers have successfully used certain safeguards to comply with the HIPAA Security Rule. One safeguard involves hosting the patient portal on a secure connection with access only permitted pursuant to an encrypted, password-protected login (14). Another safeguard that should be utilized is a patient portal audit trail feature which keeps a record of who has accessed the EHR, what changes were made, and when (15). A provider should also actively monitor the patient portal, and timely respond to and inform patients of any potential breaches (16).

While these safeguards are by no means exhaustive, they offer reasonable steps that are appropriate and available to most providers.

Notes 1. See CMS EHR Stage 2 Overview Tipsheet, available at: http://www.cms.gov/regulations-andguidance/legislation/ehrincentiveprograms/downloads/stage2overview_tipsheet.pdf.

2. See 45 C.F.R. 164.502(b).

3. See http://www.healthit.gov/providers-professionals/faqs/what-patient-portal.

4. See CMS EHR Stage 2 Overview Tipsheet.

5. See Federal Register, Vol. 77, No. 171, Part II, September 4, 2012; 42 CFR Parts 412, 413, and 495.

6. See EHR Security Risk Analysis Tipsheet, available at: http://www.cms.gov/Regulationsandguidance/Legislation/EHRIncentivePrograms/ Downloads/SecurityRiskAssessment_FactSheet_Updated20131122.pdf.

7. See Id. 8. See Id. 9. See Id., citing 45 CFR 164.308(a)(1)(ii).

10. See EHR Security Risk Analysis Tipsheet, referencing Guidance on Risk Analysis Requirements Under the HIPAA Security Rule, available at: http:// www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/rafinalguidancepdf.pdf, citing 45 C.F.R. §§ 164.302-318.

11. See Id., citing 45 C.F.R. § 164.308(a)(1).

12. See Guidance on Risk Analysis Requirements Under the HIPAA Security Rule.

13. See EHR Security Risk Analysis Tipsheet.

14. See National Learning Consortium, Frequently Asked Questions about the Patient Portal, available at: www.healthit.gov/sites/default/files/nlcfaqs-about-patient-portal.docx.

15. See Id. 16. See Kao, Christine, “Three Ways to Calm Patients’ Concerns About Patient Portal Security,” available at: http://www.carestream.com/ blog/2014/06/10/three-ways-to-calm-patients-concerns-about-patient-portal-security/.

Attorney J. Spencer Fair focuses his practice on medical malpractice defense, nursing home and longterm care defense, and general health law matters.

For more information, you may contact Mr. Fair by visiting www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

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East Tennessee

Daylily Bloom Festival – Oakes Daylily Farm

By LEIGH ANNE W. HOOVER

I love daylilies. A couple of gorgeous red varieties with brilliant yellow centers are planted near the road in two beds by columns at our driveway. If we can keep the deer away, their splendor is a yearly delight and one anticipated and enjoyed each summer.

Years ago, I attended an in-depth garden and horticulture study club meeting with my late mother, Corrie M. Whitlock, at the home of a daylily grower in South Carolina. These special daylilies are treasures from that meeting and always remind me of learning more about God’s beauty exhibited through flowers with her.

In my latest adult Christian book, For Better or Worse…Unless Annulment Comes First, there is a chapter titled “God Knows,” which mentions her many talents. Mama was a past president of the Garden Club of South Carolina, a South Atlantic Regional Director serving on the National Garden Club board, master gardener, master flower show judge, and the list continues.

The first time I experienced flowers planted together in mass was on a family trip to Holland and visiting the worldfamous floral garden, Keukenhof. Its brilliance is only displayed for an eight-week time span. This was truly a “bucket list” check for my husband and our children that it was open, and we were able to go see its grandeur.

Just this past spring, my father pointed out tulips, which one of my brothers purchased on a visit to Keukenhof years ago, and they were blooming, yet again, in a flowerbed.

From above, where varieties are planted for commercial use, Holland in springtime looks like God poured huge paint buckets in rows of color.

Last fall, when I interviewed Ken Oakes about the Corn Maze and Pumpkin Patch at Oakes Farm in Corryton, Tenn., I learned about the summer Daylily Bloom Festival celebrated yearly in June and just knew I would write about it, too. The Oakes family farm spans generations.

“My father and grandfather always enjoyed growing all types of plants,” explained Ken Oakes. “They started growing daylilies in the 70s…Daylilies come in so many shapes and sizes, they lend themselves to collecting.”

Daylilies, which are relatively easy to grow, became the Oakes’ passion, and they began growing and selling daylilies from the front yard. A black and white catalog was first produced in 1981.

“Folks would come to my grandfather’s house,” explained Oakes. “That was one of my summer jobs in high school— digging plants for them when they’d come during bloom season and pick out what they liked.”

Ken Oakes officially joined the business in 1990 and helped produce the first

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color catalog, which made Oakes Daylilies available to even more customers. Today, orders come in from all of the United States and also many countries overseas.

With increased demand, it became difficult to be open throughout bloom season. So, Oakes Daylilies began a “bloom festival,” which is always the last Friday and Saturday in June, to be open to the public. This year marks the 15th annual Oakes Daylily Bloom Festival.

“We do get a lot of folks from around the country that make plans to come and visit the festival,” said Oakes. “We have a map and put up with pushpins to show us where you are from, and we kind of get an idea what states are represented.”

In addition to the display garden, which gives visitors an idea of how to plant the lilies, an additional six acres offer plenty of lilies for visitors to easily walk and enjoy picking out varieties. Oakes says

the experience has even been compared to the tulip fields in Holland.

“It’s not something you’re going to see too many places in the world,” explained Oakes. “This many daylilies are all in full bloom, and it’s just a beautiful sight. There are over 1,500 different varieties in all different colors, and it’s free.”

Oakes likes to joke the last lily he saw is always his favorite. With so many varieties, in many different sizes and every color but blue, there are many selections for gardeners.

Oakes Daylilies sells large plants, which are guaranteed to bloom the first year.

Supply determines the price on the lilies. As the supply grows, the cost comes down.

Years ago, the most expensive lily was named benchmark, and Oakes’ grandfather paid $75 for the large lavender variety, which now sells for around $14.95.

“We thought they’d ‘lost it’ when they brought home the one they paid $75 for,” said Oakes, speaking about his father and grandfather. “We’ve paid more than that since then!”

In addition to growing and selling daylilies, the Oakes also hybridize daylilies. Over 30 have been registered with the American Hemerocallis Society.

Oakes notes all daylilies can be divided, and it is good to do this every three to five years. In personal gardens, September is a great month to divide daylilies.

This year’s Daylily Bloom Festival is June 26th and 27th from 9:00 a.m. – 3:00 p.m. both days.

“You get a lot of pleasure growing daylilies. It’s just a lot of fun to be able to plant something, and when you know it grows and blooms and is gorgeous, you can show it off to your friends,” said Oakes. “It’s very rewarding, and I enjoy sharing that with folks.”

In addition to admiring the lilies, the Oakes have activities during the festival for the children, including hayrides, food and music. Plus, everyone who visits leaves with a free daylily!

“We have just been really blessed to make a living growing daylilies,” said Oakes. “I mean, you can’t plan something like that!”

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

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Helping Men Get Healthy, continued from page 1 ever, she continued, “Once they hit (age) 34, the numbers for men begin to decline.

At retirement age, there are about 80 men to every 100 women.”

In general, men’s life expectancy tends to be five years less than that of women – 76.3 vs. 81.1 years, according to the latest data from the National Vital Statistics System. For non-Hispanic black males, life expectancy is even lower at 71.6 years.

Additionally, the gender gap widens during teenage years and early 20s when more men than women are lost to accident, violence and suicide.

In fact, suicide across all age groups is more prevalent in men. In 2013, men had a suicide rate of 20.2 vs. a rate of 5.5 for women. That year, death by suicide was 77.9 percent male compared to 22.1 percent female, according to the 2013 CDC Fatal Injury Report.

A December 2013 report from the U.S. Department of Justice noted the nation’s homicide rate fell to 4.7 homicides per 100,000 residents in 2011, the lowest level since 1963. Even so, of the 14,610 homicides in 2011, men accounted for 11,370 victims. From 2002 to 2011, the average homicide rate for males was 3.6 times higher than that of females, and young adults ages 18 to 24 had the highest homicide rate of any age group.

Changing Trends

Fadich said strategies including national awareness and educational campaigns, partnering with providers and

organizations nationwide, and conducting screenings at events where men gather all enhance MHN’s efforts to change those trends.

From experience, Fadich noted, when a man is asked why he hasn’t gone to the doctor, the answer more often than not is because he can’t afford the time away from work. The answer, she continued, is to bring the ‘doctor’s office’ to the workplace.

Fadich said MHN has been to worksites from John Deere to Harley Davidson. “We bring the information to them,” she said.

“Sometimes we do screenings – cholesterol, glucose, blood pressure, body fat and grip assessment.” Fadich added MHN also works with partners nationwide to provide information and brochures for those planning health fairs or lunch and learn series at workplaces throughout the country.

The organization and its partners also have a strong presence at sporting events and in churches. “That’s where we do a lot of screenings and events – in the ‘play and pray’ portion of our mission,” Fadich said.

She noted they have worked with the National Football League, National Basketball Association, and Major League Baseball in an attempt to reach men and boys.

Churches also play a key role in getting the message across. “A lot of the folks we reach are underserved and minority populations, and they are very connected to their churches,” she explained. Fadich added, “We always recommend they speak to their healthcare provider, but we get the conversation started.”

Provider Push

Fadich said physician visits really drop off for men after they age out of a pediatrician’s office. After that, she noted, “Women get called all the time for their pap smear or mammogram. Men aren’t getting those kinds of calls.”

Knowing that physician encounters aren’t as frequent, the hope is that providers will start deeper conversations with men about family history, diet, prostate and testicular cancer, and other health concerns any time an opportunity presents … whether it’s after a sports injury, work accident or a collegiate STD scare.

“We want men to start thinking about health at a younger age and recognize what they are doing now will affect health in their 50s and 60s,” Fadich said.

Men’s Health Month

Fadich noted Men’s Health Week – the week leading up to Father’s Day – started in 1994 and was signed into law

by President Bill Clinton. “We encourage men to wear blue during that week in recognition of men’s health,” said Fadich, who added the number of events has grown so significantly over the years that one week is no longer sufficient. “Now we use the entire month of June to raise awareness about men’s health.”

To request materials and resources or to learn how to partner with MHN, go online to menshealthnetwork.org or call (202) 543-MHN1 (6461).

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Help on The Hill In April, Rep. Markwayne Mullin (R-Okla.) and Rep. Donald Payne, Jr. (D-N.J.) were announced as cochairs of the newly re-authorized Congressional Men’s Health Caucus of the American Public Health Association.

The Caucus is dedicated to raising awareness of male health issues, encouraging men and boys to take an active role in their personal health, and promoting legislation that has a positive impact on the health of American men, boys and their families.

The bipartisan Caucus, which was formed in 2010, works closely with Men’s Health Network to ensure issues affecting men and boys have a place in government healthcare priorities.

The Caucus has established a Prostate Cancer Task Force, which is charged with increasing awareness of the disease. The group is also conducting outreach to three groups with especially high risk of developing prostate cancer – African-Americans, veterans exposed to Agent Orange, and individuals with a family history of the disease. Additionally, the Caucus, in conjunction with Men’s Health Network, has led briefings on a number of topics impacting men’s health and will continue these efforts to educate Congress and the general public.

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The Literary Examiner

BY TERRI SCHLICHENMEYER

The Man Who Touched His Own Heart: True Tales of Science, Surgery, and Mystery

by Rob Dunn; c.2015, Little, Brown; $27.00 / $30.00 Canada, 384 pages

Last weekend, you almost ran yourself ragged.

In the end, you were beat. Finished, and in need of a rest - but doing so completely would mean the end of you. Find out more in The Man Who Touched His Own Heart by Rob Dunn.

Long ago, before there were hospitals and physicians to staff them, doctors operated under the assumption that the heart was the seat of emotion. Aristotle believed the brain was “nothing more than mucus,” that the heart was where thoughts originated. Hearts were mostly “untouchable,” and only observed when a patient was dead.

All that changed in the summer of 1893 when an African American doctor had no other choice but to do the unthinkable.

Dr. Daniel Hale Williams founded Provident Hospital and Training Association in Chicago specifically because of racial issues and lack of care for black

patients. On the evening of July 9, an expressman was brought in with a knife wound that initially looked superficial but had, in fact, penetrated “all the way into the heart.” It was a “remarkably common” wound, and most people died of it. Williams, however, cut into his patient’s chest, repaired a hole in the man’s pericardium, and saved his life.

When he performed his feat, Williams was not without knowledge of the heart. In ancient times, Galen studied gladiators and their heartbeats. Leonardo da Vinci reportedly did autopsies to aid in his study of the human body, as did others a few decades later. By the early 1800s, scientists even understood circulation.

A cigar chomping, heavy drinker figured out how to thread a catheter into the heart by experimenting on himself, for which he won a Nobel Prize. A World War II volunteer crafted the heart-lung machine, an inventor created the first pacemaker, and hundreds of dogs died in the quest for transplant knowledge.

And what happens next?

Research. Says Dunn,” We know far less about hearts than doctors, scientists, and everyone else thinks.”

You hear about hearts on the radio.

Hearts are in everyday conversation, playing cards, and slogans. But what do you know about them? Plenty, after you’ve finished reading this book.

But The Man Who Touched His Own

Heart is much more than a story of our tickers. Author Rob Dunn also touches upon ancient history, medical history, philosophy, literature, and culture. Readers get a brief (but thorough) look at how we know what we know, how we can keep our hearts healthy, ways to live longer despite that science thinks we have a finite number of years in us, and what’s on the horizon. That makes a lively, sometimes humorous, and very helpful book to read.

If you’re curious about what makes you tick, this book can’t be beat.

Welcome to My Breakdown

by Benilde Little; c.2015, Atria; $26.00 / $32.00 Canada, 288 pages You’re tired of crying; tired of an empty soul, runny nose, and dry mouth, but you know there are more tears inside you and they need to come out. Whoever said that big girls don’t cry needs to know that that’s not true: as in the new book Welcome to My Breakdown by Benilde Little, sometimes crying is only the beginning.

For many years, Clara Little liked to say that she knew her last child would be a girl. She predicted it, and it happened

– perhaps through force of will because, says her daughter, Clara was that kind of person: self-reliant and strong.

Clara worked long overnight shifts, but made sure that her house was spotless.

She helped care for her neighbors and her family, giving her children a good uppermiddle-class life at a time when that was a rare thing in their mostly-African American New Jersey community. Her giving spirit and her no-nonsense personality remained well-known for the rest of her life, and when Clara died, her many friends mourned along with her family.

For Benilde Little, the death of her mother was a crushing blow – the biggest in a series of events that bruised her alreadyfragile, sensitive soul. Two months prior, Little lost her father-in-law.

After her mother’s death, her best friend’s mother died, the financial market collapsed, the Littles’ income fell, Little’s dog got sick, menopausal symptoms exacerbated, and her husband was diagnosed with cancer.

For months, Little could barely function without dissolving in tears. She had trouble getting out of bed, she stopped calling on friends, and her writing career all but halted. Seemingly everybody had advice and most offered support but, powerless to pull herself up and knowing that this was more than just grief, Little began seeking help for a diagnosis of clini(CONTINUED ON PAGE 8)

The Competing P’s: Provision & Payment, continued from page 1 Nashville-based Sheidy said the Centers for Medicare and Medicaid Services have stated their plans to significantly increase value-based payments to providers over the next few years. In a fact sheet released in late January, CMS noted improving quality and affordability of healthcare was as much a pillar of the Affordable Care Act as expanding access. The goal, the memo continued, is to reward value (measured by quality of outcomes) and care coordination and efficiency rather than volume and duplication. To that end, the Department of Health and Human Services has adopted a framework of four categories of payment: • category 1: fee-for-service with no link of payment to quality, • category 2: fee-for-service with a link of payment to quality, • category 3: alternative payment models built on fee-for-service architecture, and • category 4: population-based payment.

Value-based purchasing includes payments in categories two through four.

The stated goal is to have 30 percent of Medicare payments in alternative payment models (categories three and four) by the end of 2016 and 50 percent by the end of 2018. Additionally, HHS hopes to easttnmedicalnews

.com

have 85 percent of Medicare fee-for-service payments in categories two through four by the end of 2016 and 90 percent by 2018.

“Although they have put that out there, they have yet to put out guidance about how they expect to achieve it,” noted Sheidy. “These are huge jumps.

We’re going to go from less than 10 percent in fiscal year 2015 to 90 percent with some link to quality in fiscal year 2018.”

Sheidy added there is some ambiguity as to what CMS calls ‘alternative fee arrangements’ and that at this point there are a lot more questions than answers.

While he doubts normal market forces would push payment reform fast enough to hit the HHS targets in the next three years, he said regulatory changes could be the driver to hasten the transition to valuebased payment.

“There are elements of the Affordable Care Act that have some pretty significant unknowns attached such as the Cadillac tax,” he continued. The chief unknown, he continued, is “Does the Cadillac plan tax survive and get implemented as it stands today?” That question, he added, probably won’t be answered until after the presidential election.

The 40 percent excise tax, which is currently scheduled to go into effect in

2018, is levied on healthcare benefits that exceed certain pre-set limits. Despite the name of the tax, Sheidy said its impact would be felt far beyond affluent circles. In fact, the thought is that a significant number of employers could wind up incurring the tax. “This cuts across political parties when it comes to the impact of this,” he said, noting teachers, labor unions and public officials often have strong healthcare benefit packages. “You’re talking about having an excise tax that indirectly impacts a significant amount of the population through employer-provided benefits.”

He continued, “If this Cadillac tax survives, employers are going to be faced with having to change benefits, maintain benefit levels under a different cost structure, or pay the tax.” Sheidy added that since there doesn’t seem to be much enthusiasm for paying the tax, employers are going to look at how to bend plan design or the cost curve and will be more willing to consider value-based network designs.

“The government … through statements around the move to the 80 percent (value-based purchasing) along with the continuing lingering effects of the Affordable Care Act … has really set the industry up for the opportunity for some significant impact on payment reform over a fairly

short time frame,” he noted. “On the payer side, CMS is looking to change the payment mechanism. On the commercial side, we’re looking at the Cadillac tax and how to get costs under control. And all of those things share the potential to come into play over the next several years. It’s almost like the perfect storm.”

It’s not that the industry hasn’t taken any steps to prepare for a move to a different type of payment mechanism. Sheidy said the industry is already involved in demonstration projects, quality reporting and capturing data points. However, he pointed out, the true impact on payment of all that collection and monitoring is still pretty narrow.

“People confuse population health with risk and payment,” he said. Now, we’re at the intersection of how to more effectively, efficiently manage the health of a population while simultaneously figuring out how to link payment to these new practice models.

While the industry has floated along with a foot in both the fee-for-service and value-based worlds for quite a while, Sheidy said the drivers are now in place, barring any changes, to force the movement to a more outcomes-based payment methodology in a very short window of time.

JUNE 2015

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The Literary Examiner, continued from page 7

cal depression. She tried therapy sessions, prescriptions, distractions, and exercise but she still couldn’t stop crying and she couldn’t erase certain mental images that plagued her. There were good days, but they were eclipsed by the very, very bad ones - until she began to see things that further opened her eyes.

We’ve all had times in our lives when nothing goes right. Welcome to My Breakdown, shows what it feels like when one of Those Days lasts for years.

Indeed, although it’s hard to accurately explain the depths of depression or grief, author Benilde Little still gives readers a good sense of the senseless, and of the confusion that’s felt when one is completely, totally powerless to explain why certain harmful emotions are so sticky and can’t abate. We’re also taken on a trip through a few of the various treatments that work – and don’t – before Little finds a shaky conclusion.

Be aware that there’s quite a bit of back-story filler and empty name-dropping here, but since this book could be a comfort to anyone experiencing grief or depression, the pay-off might be worth the journey.

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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HealthcareLeader

Getting the word out

Men’s Health Network targets awareness of male-specific illnesses

By JOE MORRIS

Health and wellness information for women and children is more accessible than ever before. From better living through diet and exercise to the importance of preventive measures such as mammograms, there are resources in most every community. For men, however, facts and figures are a little scarcer on the ground.

“There really aren’t any programs out there that are tailor-made for men,” said Mike Leventhal, executive director of the Tennessee chapter of the Men’s Health Network (MHN).

“We are the premier organization in the state promoting the health of men and boys, and have been around for about 12 years. We reach out to men, providing community awareness events and things like prostate cancer screenings so that more men in Tennessee can be made aware of the specific health issues they face, and what they need to be doing in order to avoid problems, or to prevent problems from getting worse.”

The organization, which relies heavily on volunteer efforts, works to partner with everyone from the Tennessee Dept. of Health down to, and through, insurers, hospitals, clinics and community-health organizations. That way, Leventhal explains, MHN can piggyback off wider outreach efforts and get in front of the men who might be in attendance. Of particular interest to him are men in uninsured and underserved populations, which can be anywhere from urban homeless groups to rural communities.

“We want to find, and talk to, the guys who don’t have access to healthcare,” he said. “We are always working to build coalitions with others stakeholders in the community who care about men’s health.

Prevention messages, screenings programs, and education materials are how we get it out there, but our main goal is making sure that the men we talk to, and their families, find a qualified physician and then get in front of that doctor to get checked out.”

To that end, Leventhal says he and the MHN volunteer network act as navigators.

If they meet a man who is around 50, for example, at a health fair and he indicates there’s a history of prostate cancer in his family, they don’t just provide information about screenings.

“We help them find a doctor, and if they don’t have access to healthcare due to being uninsured or other issues, we try to get them to a free or low-cost clinic in their

community,” Leventhal said. “We work with the federally qualified health centers, or FQHCs, in the state so we make the connections guy will need in order to get care.”

As the Tennessee chapter’s founding executive director, Leventhal has seen it, as well as the national MHN organization, grow by leaps and bounds. A University of Tennessee graduate, he says his position combines an interest in government and public-health policy with a family history of prostate cancer that led to a heightened awareness of that disease and its treatment challenges.

“I’ve always been an exercise enthusiast and I try to eat well, so I’m doing a lot of the things I tell these gentlemen they should be doing,” he said. “But we continue to build an organization that’s not just about giving advice, but is really about changing the status of men’s health care in Tennessee, which statistically has some of the unhealthiest men in the country, if not the world.”

Making meaningful change means not just getting in touch with men over 50 who might need a colonoscopy, or overweight youth at risk of type 2 diabetes, but men and boys of all ages. That’s why MHN relies on an active board of directors who are connected into health systems across Tennessee, to build partnerships whenever

and wherever possible, but also on creating unique programs of its own. One of those, which is launching in Tennessee now in a shared pilot program with the East Tennessee State University College of Public Health, is “Save the Doodads” (savethedoodads. org), which focuses on testicular cancer.

“We wanted to bring humor to a serous subject,” Leventhal said. “We are hoping to take this to all colleges around the state, and eventually around the country, to promote testicular cancer awareness and the importance of self examination. “This type of cancer is prevalent in men between the ages of 15 and 35, so this is a perfect demographic for us to reach out to,” Leventhal said. “What we’re hoping is that this will help start healthy habits that will stay with a man throughout his life — that he’ll go to the doctor not just when he needs antibiotics for a cold, but for preventive visits and tests. We want to plant the seed with men to make these visits in the same way other organizations do with women regarding annual mammograms.”

So whether it’s putting out its own materials about eating right, or helping men in rural areas find (and see) a physician, Tennessee’s MHN chapter has its hands full. In June, which is Men’s Health Month, Leventhal said he expects to be crisscrossing the state continuously — and that’s just fine.

“We want to meet men where they live, and encourage them to see a physician and just get everything checked out,” he said.

“In the 12 years we’ve been around, we’ve been able to make some very strong inroads.

About 70 percent of the men we’ve reached out to make, or will make, an appointment to see their primary care physician, and that’s a statistic we are very proud of.”

In the meantime, he added, “We’ll be out there asking guys if they know their blood pressure, cholesterol, and PSA. Those are the numbers every man should know, and if they don’t, then we’ll get a conversation started. We have a lot of very well educated men in our state, but we also have a lot who are very unaware of the health issues they face. We get on a person’s level and work to lead them to a doctor’s office. I befriend a lot of people, as do our volunteers.

We’re working to build people up because a lot of the men we help turn around and become some of our best volunteers. That’s how we get in front of fraternities, service groups, church congregations, workplaces … wherever there are men, we want to get in there and talk to them.” easttnmedicalnews

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Five Ways Millennials Have Shaken Up Healthcare

By JULIE PARKER

The most influential demographic group – millennials, ages 21-32, empowered by advances in technology – is turning America’s healthcare landscape upside down.

In a recently released survey commissioned by PNC Healthcare, more than 5,000 participants nationwide explored the impact of patient-centered care among various age groups, including millennials, Generation X or Gen-Xers (ages 33-49), baby boomers (ages 50-71) and seniors (72+). The most significant finding: online shopping for doctors, webbased diagnostic tools and research about treatment options have a role in healthcare decisions for millennials, replacing the single-source, primary care physician (PCP) favored by older generations.

“As millennials overtake boomers as the nation’s biggest consumer buying group, they will expect more efficient ways to make healthcare payments via digital channels that are consistent with their experiences in other industries,” said Shane Print, vice president of PNC Healthcare for Florida, Alabama and Georgia. “It’ll be important for payers and providers to work together to meet these payment expectations by progressing further along the technology continuum, especially considering that much of the growth in the healthcare payments industry has been driven by a rise in patient responsibility.

Those insurers and healthcare providers that thrive will be those that adapt sooner than later to the preferences of this fastpaced, technology-driven generation.”

Growing trends among the millennials that are driving change in healthcare include:

and Healthgrades, when shopping for a healthcare provider, compared to 40 percent of baby boomers and 28 percent for seniors.

“The timely management of social media is critically important to the growth and success of healthcare,” said Print. “Bad patient reviews can come too easy, so making sure positive reviews greatly outnumber the negative ones is a

constant challenge for all practices. Getting happy patients engaged with sharing their positive experience will continue to be important for a practice’s success.”

Kick the tires online before buying

Half of millennials and 52 percent of Gen X-ers checked online information about their insurance options during

Word-of-mouth marketing

Nearly 50 percent of millennials and Gen-Xers use online reviews, such as Yelp easttnmedicalnews

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Good faith, upfront estimates

One of five people surveyed by PNC (CONTINUED ON PAGE 10)

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When it comes to the drive-thru generation, millennials prefer retail (34 percent) and acute care clinics (25 percent) double that of boomers (17 and 14 percent, respectively) and seniors (15 and 11 percent, respectively). On the flip side, seniors (85 percent) and boomers (80 percent) visited their PCP significantly more than millennials at 61 percent.

For example in Florida, Print noted that urgent, specialty and retail clinics over the last four years have grown dramatically. “Quick Care” availability has been recognized as a top priority by many healthcare organizations, and even large retailers and several pharmacy chains. Millennials expressed concern about this method of care and the quality of the patient’s care, based on who’s consulting with the patient (level of education), possible lack of patient’s accurate healthcare background, and pressure of being a “quick appointment.”

their last enrollment period, compared to 25 percent of seniors, who prefer printed materials (48 percent) or a company representative (38 percent) before selecting their plan.

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GrandRounds Asbury Place Names Sandra Brown Kingsport Campus Executive Director KINGSPORT – Sandra Brown, RN, has been named the executive director of Asbury Place Kingsport.

Brown has a long and successful career with Asbury Place, which she joined as a part-time certified nursing assistant (CNA) while in nursing school.

Sandra Brown “Sandra has immersed herself in our culture of meeting residents’ needs – emotional, social, physical and spiritual – and has demonstrated her commitment to our mission of enabling residents to celebrate life in every way possible,” said Marjorie Shonnard, chief operating officer of Asbury Place. “With Sandra’s strong leadership capabilities, dedication to mission and clinical experience, she is the perfect person for the job.”

Brown began her career with Asbury in 1995 and has served in various clinical positions with the organization, including Director of Nursing. She has also served

Five Ways, continued from page 9 listed unexpected/surprise bills as the No. 1 billing-related issue. With out-of-pocket costs on the rise, millennials are more inclined (41 percent) to request and receive estimates before undergoing treatment.

Only 18 percent of seniors and 21 percent of boomers reported asking for or receiving information on costs upfront. Unfortunately, 34 percent noted the final bill was higher than the estimate; only 8 percent reported a bill lower than estimate.

“What we’ve found with our clients in the southeast is that healthcare practices are now more motivated than before to improve the patient’s experience around billing, payment plans, and care and insurance coverage education due to the need to comply with healthcare reform requirements and for the sake of improving the profitability of the practice,” added Print.

Kicking care down the road.

All age groups agreed that medical care is too expensive (79 percent) and healthcare costs are unpredictable (77 percent). But more than half of millennials (54 percent) and Gen-Xers (53 percent) reported delaying or avoiding treatment because of cost, compared to seniors (18 percent) and boomers (37 percent).

“What we’ve found locally,” added Print, “is that with many patients neglecting their care due to costs, practices are addressing this issues by offering free/low cost healthcare clinics, healthcare education, and automated patient payment programs.”

PNC Healthcare is a member of The PNC Financial Services Group Inc. The survey was conducted by Shapiro+Raj in January.

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JUNE 2015

as administrator of Asbury Place Kingsport - Steadman Hill Assisted Living.

As Kingsport’s executive director, Brown is responsible for overseeing the continuing care retirement community that includes residential villas and apartments, assisted living and a health care center with rehabilitation services.

“I look forward to continuing to develop relationships with prospective and current members of our community to ensure that Asbury Place provides excellent services that meet older adults’ needs now and in the future,” said Brown.

Brown added that she is blessed to work with an outstanding, collaborative team. “We’re all working together for the good of residents and those receiving rehabilitation services; that common denominator makes for a terrific work environment,” she said.

Brown lives in Church Hill, Tenn. She has an 18-year-old son who works parttime as a server in the Asbury Place dining room while attending school and a 15-year-old daughter.

For more information about Asbury Place, visit http://www.asburyplace.org.

Asbury Place is a CARF-CCAC accredited continuing care retirement community with campuses in Kingsport and Maryville, Tenn.

ETSU doctor receives $340,000 grant to study effect of stress on immune system JOHNSON CITY – Dr. Deling Yin, a professor at East Tennessee State University’s Quillen College of Medicine, has received a federal grant to study the effect of stress on the immune system.

The $340,000 grant from the National InstiDr. Deling Yin tutes of Health will allow Yin to continue research he has been working on for more than a decade.

Chronic stress, Yin noted, is any period of stress that lasts more than six hours.

It is this type of constant and persistent stress that can be most damaging to the immune system, Yin explained.

Funded by the NIH since 2005, Yin’s previous work on the topic has determined that different genes play important roles in controlling the influence of immune responses during stress. However, the mechanisms by which stress affects the immune system, he explained, remain unclear.

With the new three-year grant, Yin plans to examine the mechanisms through which the immune system is influenced by stress with the hope of developing specific treatments or drugs that may improve the interaction of stress and the immune system.

Drs. Mohamed Elgazzar and Gregory Hanley, also Quillen faculty members, are co-investigators on the grant.

AHS, Takoma Win Gallup Great Workplace Award Again For Fifth Consecutive Year GREENEVILLE – Adventist Health System (AHS), which manages Takoma Regional Hospital, has received the prestigious 2015 Gallup Great Workplace Award for the fifth consecutive year.

“This international award recognizes organizations that create an engaged workplace that, in turn, drives business outcomes,” Jack Lister, Takoma’s human resources director, said. “Employee engagement is a top priority at Takoma because we know that engaged associates offer the best patient experience and healthcare delivery.”

Daniel Wolcott, Takoma’s president and CEO, agreed, saying: “This awarddemonstrates the deep connection our associates have with our mission to extend the healing ministry of Christ, and with our vision to be the best place to work, practice medicine and receive care.”

The Gallup organization compares companies across a workplace research database comprised of work teams in more than 100 countries. This year, Gallup honored 40 organizations, including AHS, a faith-based health care organization headquartered in Altamonte Springs, Fla. A national leader in quality, safety and patient satisfaction, AHS has around 70,000 employees, including nearly 600 at Takoma.

Takoma recently was also named one of only 150 “Great Places To Work In Healthcare” by Becker’s Hospital Review, joining the Mayo Clinic, Johns Hopkins Medicine, and Cleveland Clinic, to name a few.

Dr. Chad Couch Named Bristol Regional’s Chief Medical Officer, Brings 25 years of Experience as Physician BRISTOL – Chad Couch, M.D., a highly respected urologic surgeon who has practiced at Bristol Regional Medical Center for 15 years, has been named the hospital’s chief medical officer.

A physician for 25 years, Dr. Couch will use Dr. Chad Couch his extensive experience to foster continued collaboration between the medical staff and administration to continue Bristol Regional’s delivery of superior health care with compassion.

He joins the leadership team with the hospital in excellent shape, earning high rankings from multiple national organizations for patient safety and clinical excellence.

“Dr. Couch has been an integral part of Bristol Regional for 15 years,” said Greg Neal, the hospital’s president.

“His clinical skills and knowledge of our health care system, staff and community will be a tremendous asset at a time that requires greater cooperation than ever.

“We are blessed with a remarkable

number of physician leaders who care passionately about delivering the highest quality care available anywhere. Dr. Couch is absolutely one of those leaders, and I’m confident that with his leadership in this pivotal role, Bristol Regional will continue to rise to the challenge of meeting the increasing needs of our community well into the future.”

As chief medical officer, Dr. Couch will be instrumental in further assisting Bristol Regional’s physicians to engage and succeed in essential leadership roles.

He will also help the hospital develop and sustain evidence-based approaches to care, practice appropriate stewardship of resources and embrace innovation required to succeed in the transition to new reimbursement models implemented by health care reform.

Couch joined Bristol Regional’s medical staff and began practicing with Bristol Urological Associates in 2000. He has served on the hospital’s board of directors, as chairman of Bristol Regional’s surgery department and as a member of the medical executive committee. He is also a member of Bristol Regional’s Physician Clinical Council.

He has also served as president of the Sullivan County Medical Society and since 2008 has been a member of the board of directors of State Volunteer Insurance Co., which provides coverage to about 14,000 physicians in the South, including about 10,000 in Tennessee.

As he examined the future of his medical career, Dr. Couch concluded he could assist on the administrative side of health care.

Couch said he regularly hears from patients who say they receive remarkable care from all the staff at Bristol Regional.

He agrees with the assessment, saying Bristol Regional has a high-caliber medical staff, as well as outstanding nurses and other dedicated clinical personnel.

He is also impressed with the technology Bristol Regional has added since he joined the medical staff. This includes TrueBeam STx with Brainlab and CyberKnife Robotic Radiosurgery System for radiation oncology care. It also encompasses da Vinci Surgical System, endoscopic ultrasound and electromagnetic navigational bronchoscopy.

Plus, Bristol Regional, in partnership with leading philanthropists in the community, has made multiple investments in its facilities in recent years, including the Alpha Natural Resources Center for Interventional Cardiology, the Leonard Family Comprehensive Breast Center and the renovation of the Deborah H. Quillen Birthing Center.

Couch received a bachelor’s degree in microbiology from the University of Georgia before going to medical school.

He graduated from the Medical College of Georgia in Augusta in 1989 and then completed an internship and residency in urology, which included surgery training, at Wake Forest University Medical Center.

He is certified by the American Board of Urology. easttnmedicalnews

.com

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Wellmont Foundation Attains Goal for NICU Project, Pursues Center for Women and Infants at Holston Valley Project KINGSPORT – Strong community support has enabled Wellmont Foundation to meet its $2.5 million goal to enhance services available in the neonatal intensive care unit at Holston Valley Medical Center and move it to a bigger space in the hospital.

Now, Holston Valley is embarking on another beneficial project, unveiling a $2 million fundraising campaign to create a Center for Women and Infants that will consolidate services such as the birthing unit, post-partum care, the NICU, pediatrics and gynecology on one floor of the hospital. One of the cornerstones of the plan will be creation of a separate entrance and elevator to take patients and family members to that area of Holston Valley.

“We’ve been honored to serve Kingsport and other parts of the region with high-quality health care for 80 years and are excited to embark on these next initiatives that will further position us as the hospital of choice,” said Tim Attebery, Holston Valley’s president.

“This next phase of progress will enhance the comfort and convenience for our patients and ensure that excellent care remains close to home.”

Representatives of Holston Valley, the foundation and Wellmont Health System participated in a news conference Thursday, May 14, at the hospital to discuss the completion of the Next Generation campaign that was initiated in 2014 for the NICU. They also kicked off the Holston Valley Generations campaign, which will raise the necessary funds to place all women’s and infants’ services on the hospital’s Laura Feagins, whose son Higgs received care in the neonatal intensive care unit at Holston Valley Medical Center, third floor. speaks at the news conference celebrating the completion of the campaign to expand and relocate the NICU and create a Center for Women and Infants at the hospital.

“Our region has been extraordinarily generous in supporting the needs of the women and children we are privileged to serve,” said Todd Norris, the foundation’s president and Wellmont’s senior vice president for system advancement. “We are grateful to the community for backing our NICU project and invite others in the region to further strengthen the services we offer women and infants in this new campaign.”

The foundation launched the Next Generation campaign to bolster the caliber of care in the NICU, which Holston Valley has operated since 1986. These funds will empower Holston Valley to achieve multiple goals, including: • Doubling the amount of room for each newborn • Building a specialized procedures room for patients needing invasive treatments • Creating a dedicated isolation room that will contain negative air pressure and specialized filtration • Opening a private step-down room for parents to spend the night with their child before returning home • Community backing for this campaign included major gifts and Children’s Miracle Network Hospitals funds. Wellmont is the Children’s Miracle Network affiliate for Northeast Tennessee and Southwest Virginia, and all money raised in this area stays local to improve children’s health.

Attebery said Holston Valley plans to start construction on the NICU project in August and complete it in early 2016.

“Holston Valley has been proud of the way it has empowered patients in fragile medical condition to not only survive but thrive in our NICU,” said Laurie Kaudewitz, Holston Valley’s director of women’s and children’s services. “Now, many of these graduates have grown into adulthood and had children of their own, and knowing our unit played a role in making that possible gives us great joy. We look forward to helping even more children begin their life journey successfully.”

The new NICU will be located on the third floor, and Holston Valley officials are ready to pursue the next phase, which will create a dynamic center for women’s and infants’ health in that area of the hospital with further support from the community. The pediatrics unit will join the NICU in the move from the second floor to the third floor, where Holston Valley will also continue to provide exceptional labor and delivery, post-partum and gynecologic care.

Bringing all these services together on one floor will benefit women greatly, Kaudewitz said. For example, a woman who is still a patient in the hospital after giving birth to a child that has been admitted to the NICU will not have to take an elevator to see her child.

Plus, when the project is complete, children born by caesarean section on the floor’s operating room who need NICU services will have immediate access because they will be located adjacent to each other.

Kaudewitz said the elevator tower and designated drop-off near the hospital’s Conference Center will be a tremendous addition for expectant mothers and gynecologic patients. These additions will give them direct access to the third floor instead of needing to reach their destination through other routes.

In addition, Holston Valley is focused on the needs of family members by developing a plan to dramatically increase the size of the waiting room.

“These changes will provide a great deal of comfort and security to women who entrust us with their care,” said Robert Saunders, M.D., an obstetrician and gynecologist with Wellmont Medical Associates Women’s Health. “Our patients will appreciate the detailed attention we are paying to their well-being and the valuable part their family members play in the total care experience.”

Holston Valley will also take the opportunity to renovate that part of the hospital by installing new flooring, ceiling tiles and lighting and relocate and expand the Williams Media Center in the pediatrics unit.

Along with other cosmetic changes, the third floor will serve as a model for an optimal patient experience, Attebery said. He said patients should feel as if they have entered a new hospital while still retaining the same level of superior clinical care.

Bart Hove, Wellmont’s president and CEO, said this is an exciting time for women’s and infants’ services at Holston Valley.

“We thank our patients for selecting us to deliver their care for eight decades and are pleased we can take these steps to reach the next level of excellence with these revisions to the hospital,” Hove said. “We have assembled an outstanding team of physicians, nurses and other health professionals who have been committed to producing the best results for our patients.

“Now, we are further connecting with the community to have cutting-edge facilities for the women and children we treat that will complement the remarkable care for which we have long been known.”

For more information about these campaigns and opportunities to give, please visit www.wellmontfoundation.org. For more information about Holston Valley, please visit www.wellmont.org.

JUNE 2015

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11

Physician to Physician

Diagnosis and Treatment of Peripheral Artery Disease

By Tariq Haddadin, MD, FACC, FSCAI

used to diagnosis PAD.

Peripheral artery disease (PAD), Treatment which causes blockages in the Smoking cessation is the first arteries supplying extremities with and most important step to be nutritious blood flow (i.e. blood taken by a patient. An aggressive carrying oxygen and nutrients to control of diabetes, hypertension the feet), is a strong predictor of and high cholesterol is also essential. adverse cardiovascular outcomes.

Surgery involving bypass graft, Unfortunately, most patients are which is a very high risk surgery unaware of their disease. on PAD patients, may be necessary Risk factors include age (patients for patients who, most of the time, of advanced age are particularly have comorbidities, including heart Blood flow, post-intervention Blood flow, pre-intervention susceptible), diabetes (especially if disease. not well-controlled), smoking or Another treatment option is history of smoking, hypertension, catheter-based endovascular therapy hyperlipidemia (i.e. high while the patient is mildly sedated. cholesterol), and history of heart Endovascular therapy includes disease. multiple modalities to improve Greater awareness and earlier blood flow to the feet. We use diagnosis of PAD could help improve angioplasty, stenting, chronic total adverse cardiovascular outcomes. A occlusion devices and atherectomy large percentage of PAD patients are devices in the Johnson City Medical either asymptomatic or have very Center Cardiac catheterization Pre procedure: cold foot with heel ulcer for the past 6 months. Post procedure: Two weeks later, endovascular intervention, warm foot with healed ulcer. minimal symptoms of pain or feet laboratory. Compared to open numbness. However, the following bypass surgery, endovascular are some of the symptoms and signs of PAD catheter-based therapy has many advantages, possible gangrene. that may be recognizable: including minimal recovery time, same day • foot, calf, thigh and hip pain, especially treatment, lower risk of infection, has up to Diagnosis when walking (claudication); 90% success rates, and up to 90% 2-5 year Diagnostics which can be ordered • resting pain in the lower extremities limb salvage rates. to support PAD diagnosis include both (feet); noninvasive and invasive testing. ABI (Ankle• numbness or tingling of the feet, brachial index) is the first noninvasive Dr. Tariq Haddadin is a fellow of the American College of • pale, bluish discolored feet, test to do after a thorough history and Cardiology and the Society for • slow healing foot ulcers or wounds. physical exam. ABI <0.90 is indicative of Cardiovascular Angiography Once pain in the feet is persistent, PAD. The lower the number, the worse the and Interventions. He serves as medical director of the Cardiac with or without tissue loss, it’s at a stage disease. Other noninvasive tests include Catheterization Laboratory at of critical limb ischemia, where arterial segmental pressure and pulse Johnson City Medical Center intervention is a must before amputation. volume recordings, CT angiography, and and as chief of Interventional Cardiology at the Veterans On exam, patients may present with weak magnetic resonance angiography (MRA).

Affairs Medical Center, Mountain Home. or absent pulses, discolored feet, and Arteriography, although invasive, can also be

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