FOCUS TOPICS AUTOIMMUNE DISORDERS MARKETING/COMMUNICATIONS
May 2013 >> $5
PHYSICIAN SPOTLIGHT PAGE 3
Amy Young, MD
Unconventional Wisdom Rethinking the approach to some autoimmune disorders
ON ROUNDS Healthcare Leader: Dwayne Taylor “I enjoy putting things together that will make tomorrow better. Every single day we need to make it better. If we don’t do that, healthcare would look the same today as it did ten years ago,” said Dwayne Taylor, CEO of Sycamore Shoals Hospital ... 4
By Cindy sanders
What if the standard treatment approach was the wrong one? In the case of several autoimmune disorders, it’s a theory that is gaining traction bolstered by recent research findings. Stephen A. Paget, MD, FACP, FACR, MACR, physician-in-chief emeritus at the Hospital for Special Surgery in New York City, has spent his career researching and treating a range of inflammatory and autoimmune disorders. The rheumatologist, who is also a professor of Medicine and Rheumatic Disease at the Weill Medical College of Cornell University, said the potential exists for a paradigm shift in how clinicians view and treat some disorders including reactive arthritis, Whipple’s disease and persistent Lyme disease. Paget said the accepted concept has been “that in a genetically predisposed person, with some type of environmental trigger … probably virus or bacteria … they develop disease.” Although the initiation was from a microorganism, he continued, the conventional wisdom has been that the self-perpetuation of symptoms is Dr. Stephen A. due to the body’s subsequent response. “What you were left with was an inflammatory problem that Paget was no longer tied to the previous organism,” Paget explained. A good example would be persistent Lyme disease. The infectious trigger is the Borrelia burdorferi, a bacterial (CONTINUED ON PAGE 10)
Wine 201 Headaches from Wine - Is it the Sulfites? Some people claim to get headaches from only one glass of wine. Surely it’s not a hangover from one glass. Is it due to sulfites, an allergy, or dehydration? ... 6
The Move from Social Media Marketing to Social Business Strategies By Cindy sanders
Earlier this year, Andrew Dixon, senior vice president of marketing and operations with Igloo Software and the former chief marketing officer for Microsoft Canada, was invited to Dallas to share insights on how healthcare organizations can make the move from social media marketing to an integrated social business strategy during the CIO Healthcare Summit. At the core of a social business strategy is the desire to deepen connections, engagement and collaboration within various communities touched by the company or industry. For healthcare providers, those communities might be other practitioners, researchers, payers, staff, and … of course … patients. “Social business is no longer just for early adopters,” said Dixon. “It really is a modern way to help connect members together.” One of the first steps, however, is to understand the difference in social media and social business. “Social media is about analyzing how your brand is being received in
Special Advertising Constipation ... 9
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PhysicianSpotlight Amy Young, MD talk to them.
By Bridget Garland
for Young—she is married to Dr. Mark
“I think so many times physicians feel
Young, a gastroenterologist who practices
For some of her patients, Amy Young,
pressured to move more patients through
in Johnson City. The couple has been
MD, has been a familiar face for many
the system. Balancing that is difficult to do,
married for almost 23 years. They have
years. As a life-long resident of Johnson
it’s definitely a challenge,” she continued.
two 16-year-old children, a boy and a girl,
City, Young’s patients have known her as
“You can’t see only three patients a day,
who are twins.
a student, a nurse, an expectant mother,
obviously, but you also need to speak to
“That’s probably my biggest chal-
and, for the past two decades, as one of
people in a meaningful way about their
lenge—balancing my work with my home
their physicians.
problems.”
life,” Young explained in response to a
Young, an ophthalmologist at the
Young’s emphasis on the importance
question about the challenges in her ca-
Johnson City Eye Clinic, as her children
of patient education is aptly illustrated by
reer. “You want to spend time with your
do now, attended Science Hill High School
diabetic patients. “For patients with dia-
kids, you want to be involved, and you
and after graduation, went on to receive
betic retinopathy, we try to inform them
want to spend time with your husband;
a degree in nursing from East Tennessee
about the disease and how it affects the
that becomes a balancing act.”
State University (ETSU). She worked as a
see adults. In ophthalmology, you have a
eye because if they have a better under-
But Young, like so many other parents
nurse for several years before deciding to go
blend of everyone—male, female, young,
standing of what they’re going through,
who have careers in the field of medicine,
back to school as a pre-med student.
old—and I enjoy having that blend, where
they can do more to help themselves,”
has proven to be very good at maintaining
I see all kinds of people.”
she said. “If I explain that keeping blood
that balance. Some of her patients have
“Nursing is very important, and I enjoyed my years as a nurse, but I always
Young lived in Nashville for three
sugar down and will result in less diabetic
even taken an interest in Young’s fam-
felt like I wanted to do something more
years, but decided to move back to John-
changes to the eye overtime and em-
ily. “I have patients that will ask me how
for them,” Young explained. “I don’t
son City to be close to family. “I’ve been
phasize the need to keep their follow-up
old the twins are now. They remember
ever want to minimize the contribution of
working at the Johnson City Eye Clinic for
appointments with their primary care
me when I was pregnant,” she mused. “I
nurses because they do so much, but I just
20 years now, and I have truly enjoyed my
physician, hopefully, that information will
guess I’ve been around for a while.”
felt personally there was something more I
work here,” she enthused. “I enjoy helping
help them take better care of themselves
wanted to be doing for my patients.”
people, and I think that if you’re going to
in the future.”
Young’s dedication to her patients and family doesn’t leave time for many
Young was accepted at ETSU’s
be in medicine, you have to really enjoy
Considering herself a partner with the
other outside interests. She enjoys cook-
James H. Quillen College of Medicine,
being around people and helping them.”
primary care physician (PCP) in caring for
ing, but much of her and her husband’s
where she received her medical degree
Of course, Young admits that her work
the patient, Young praised this area’s inter-
spare time is spent with the kids, like
and completed an internship in Internal
can be challenging at times. “I think some-
nists and PCPs for their diligence in sending
watching her son play tennis for Science
Medicine. Soon after, she moved to Nash-
times there’s so much emphasis on seeing
their patients for their eye exams. “If they
Hill or attending her daughter’s chorus
ville to complete her ophthalmology resi-
patients quickly, we sometimes forget that
[patients] complain of decreased vision,
performances.
dency at Vanderbilt University. “Before I
we have to sit down and speak to patients
they [PCPs] get them here, especially if the
Young and her family certainly give
got into medical school, I knew I wanted
in a meaningful way—so that they can
patient has diabetes,” she said. “[PCPs] are
back to their community, and appreciate
to be an ophthalmologist,” she said. “In
understand their problems,” explained
very good about making sure patients get
the opportunity to live in the Tri Cities.
medicine, there are so many specialties
Young. “And they appreciate that. One
their yearly check-up because after age 60,
“We are very, very fortunate in this area
where you can only see one type of patient;
of the things that my patients communi-
everyone needs a yearly exam to check for
to have such excellent medical care,” she
for instance, you only see women in OB/
cate back to me when we do surveys is that
glaucoma and macular degeneration.”
said. “I enjoy what I do, and I hope to do
GYN or in Internal Medicine you only
they notice I actually try to sit down and
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MAY 2013
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HealthcareLeader
Dwayne Taylor By JENNIFER CULP
“I enjoy putting things together that will make tomorrow better. Every single day we need to make it better. If we don’t do that, healthcare would look the same today as it did ten years ago,” said Dwayne Taylor, CEO of Sycamore Shoals Hospital. This attitude is immediately apparent in Taylor’s dedication to his hospital and community. Modest about his own contributions and achievements, Taylor is not remotely shy when it comes to discussing the hard work of his colleagues, the merits of his hospital, and his love for the Elizabethton/Carter County area and its people. “I really, really enjoy getting to work with the people I work with,” he said. “Healthcare is a tough profession. The nurses and all the clinicians work really hard, and they all went into it for one reason: they love other people and want to take care of people. I am one of those folks who is lucky enough that I get to work with really great people every day. They’re very sincere, and they each have a servant’s heart. I love that; I really love it.” Taylor describes Sycamore Shoals as a “great community hospital,” which places special priority on the mature population it serves. In addition to surgeries, acute care medicine, and a full line of outpatient diagnostic tools available for physicians in the outlying areas, Sycamore Shoals has a geriatric psychiatry unit and a number of special services to promote patient wellness, such as a fitness center, chapel, and support and awareness groups. “The core of what we want to do with patient-centered care is to recognize
that we’re taking care of more than just someone who is coming in to have their gallbladder removed, for example. We really care about their mind, their body, and their spirit,” Taylor explained. “A lot of the things we’ve developed over the years—it didn’t happen overnight—are things that we’ve developed to help minister to some part of the whole person. We have the chapel because a lot of times in hospitals, people get news that is unexpected. We want to have a quiet place that they can go, where they can reflect on the news they just received, so that they can pray, so that maybe they can be there with their clergy. We also have a healing garden, a nice place where people can go sit and think.” Taylor’s pride in his hospital is obvious, as is his appreciation for his colleagues. “I have a phenomenal team. I’m blessed to have a great chief nursing of-
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MAY 2013
ficer, Melanie Stanton. She’s very quality driven, and has such a passion for patient care. If someone out there is doing something, it’s her belief that Sycamore Shoals can do it better. I also have a great medical staff—Dr. David May is the president—and they just do a super job. “I have a very engaged community board; they’re very focused on quality. I think most people would be impressed with the amount of time we devote to discussing quality in board meetings. We spend the majority of our time talking about quality issues, about opportunities and programs we could do for the community,” he continued. A native of Elizabethton, Taylor has an abiding love for the area and its people. In addition to praising the beauty of Carter County and the friendly, helpful nature of its inhabitants, Taylor remarked on the synergetic relationship between the hospital and the population it serves. “I have to give this community a lot of credit. They’ve always recognized the importance of wellness, that prevention is far better than dealing with problems after you’ve gotten a disease,” he said. For his own part, Taylor strives to keep the hospital performing to the highest possible standard at all times. “I always want to know the status of the facility,” he said. “The other thing,” he continued, “is being there and available for people. I always want everybody to know where I am, so if they need me for anything, they can get to me. I always want to be there to remove barriers.” Within the facility, however, Taylor stays on the move, a predilection that carries over into his interests outside of work. Taylor, his wife of nearly 24 years, Marsha, and their children, Kirsten and Weston, are all big University of Tennes-
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see sports fans. “We love to go watch the Vols, be it basketball, football, or anything UT sports, we’re into it,” he said. Taylor likes to cycle, and plays a lot of golf with his son, who is on the golf team at Elizabethton High School. “I just enjoy anything where I can be active; I don’t like to sit around. If you come to the hospital, you will rarely find me at my desk. I like to be moving around, and I tend to do that after hours and on the weekends as well,” he said. Taylor’s devotion to his work is well expressed in a statement he often makes while welcoming team members to the facility. “You’ll never get up, turn on the news, and hear on the snow report that Sycamore Shoals is closed. We’re never closed because of bad weather; we’re never on a snow schedule. You have committed yourself to a profession that’s open 365 days a year,” he tells new employees at orientation. “It has to be a calling,” he explained, “because otherwise—who wants to work on Christmas Day? Who wants to work on Easter Sunday? Yet, in every hospital in the United States, people are doing that. They’ve given up time with their families to be out, to be on call, to meet whatever need might arise. I am privileged to get to work with people like that.” The physicians and staff of Sycamore Shoals Hospital, it seems, are also privileged to work with a CEO as passionate and dedicated as Dwayne Taylor.
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LegalMatters BY J. DAVID WATKINS
Where’s the Beef?
Physician Advertising and Non-Compete Clauses Since the landmark Tennessee Supreme Court decision in Murfreesboro Medial Clinic, P.A. v. Udom, the law governing covenants not to compete in Tennessee has been in a state of flux. In Udom, the Supreme Court ruled that restrictive covenants limiting a physician’s right to practice medicine were void against public policy, and therefore, unenforceable. Since that time, however, the Tennessee General Assembly has adopted, and several times amended, a statute that allows for the enforcement of non-compete clauses in physicians’ employment agreements with certain geographic and time restrictions. While this statute opens the door for the enforcement of covenants not to compete, it is still important to carefully interpret the actual language of the non-compete clause in an employment agreement, as some forms of competition might still be permitted.
Where the solicitation of a practice’s patients is prohibited, what forms of advertisement are considered “solicitations”? Many restrictive covenants in physi-
cians’ contracts come in the form of a clause that prohibits the physician from soliciting the practice’s patients. This is called a non-solicitation provision. This type of language raises the question of what sort of advertisement is permissible without violating the restrictive covenant. In Rogers v. Hall, the Tennessee Court of Appeals addressed whether a newspaper advertisement containing a dentist’s name and contact information constituted solicitation in violation of the non-compete agreement with his former employer. The court ruled that this advertisement was not a solicitation,
and stated that holding that such “advertising efforts constituted ‘solicitation’ or ‘contact’ would unreasonably encroach” on the provider’s right to practice his profession. Applying this reasoning, the use of non-directed advertisements, such as billboards and newspaper advertisements merely containing a physician’s name do not constitute a “solicitation,” and would not violate a non-compete provision that only bars the solicitation of patients. With that said, the Rogers case also demonstrates that non-compete agreements that prohibit patient solicitation will be enforced with respect to some advertisements. In Rogers, the former provider also sent out mailers containing the phrase “you might be a former patient” and stating that he had moved to a different practice location. According to the court, this phrase alone rendered the mailer an improper “solicitation” in violation of the non-compete agreement. This case demonstrates that a provider may advertise even in the face of a non-compete agreement
that prohibits the solicitation of a practice’s patients. Nevertheless, a physician must be cautious to avoid violating a non-compete provision by carefully reviewing the actual language in his or her employment agreement.
Conclusion When a physician leaves a medical practice, the wording of his or her employment agreement can have a profound and lasting effect on the future of both the physician and the practice he or she is leaving. While non-compete agreements are now enforceable under Tennessee law, the presence of such a provision in an employment agreement does not necessarily close the door on all competitive activity. As such, physicians and physician practices should give careful consideration to the language contained in a non-compete agreement in order to protect the interests of both parties. J. David Watkins is an attorney practicing at London & Amburn, P.C. He focuses his practice in medical malpractice defense, health law, and general business and corporate matters. For more information, you can contact Mr. Watkins at dwatkins@londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.
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Wine 201
Headaches from Wine - Is it the Sulfites? By Rick Jelovsek CSW, FWS
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Some people claim to get headaches from only one glass of wine. Surely it’s not a hangover from one glass. Is it due to sulfites, an allergy, or dehydration? The answer is complex, but wine headaches are most likely due to biogenic amines, mostly histamine and tyramine. These are naturally occurring substances in many wines to which some people are quite sensitive. In addition, there may be proteins in wine that produce an allergic response. In this case, a wine drinker’s own body produces the histamine. Histamine causes brain blood vessels to dilate. This results in both non-migraine and migraine headaches. In the skin, it can produce hives or a nettle rash. It also causes mucous secretion (nasal stuffiness), bowel smooth muscle contraction (diarrhea, heartburn), blood pressure changes, and sometimes heart beat irregularities. The histamine symptoms can be experienced fairly quickly within an hour or delayed 10 hours or more. Add this to dehydration or low blood sugar and one cannot tell a delayed histamine response from a hangover. Within the wine industry, studies have shown that the major source of these biogenic amines is not from the primary yeast fermentation, but rather from secondary events such as wine spoilage bacteria like lactobacillus and pediococcus, natural or induced bacterial malolactic fermentation, and from the barrel aging process. This latter cause is also from spoilage bacterial in the nooks and crannies of previously used wine barrels. That is why red wines, most of which undergo malolactic fermentation and ageing in barrels rather than stainless steel, are the most frequently cited source of wine headaches. The reason why most people who drink red wines do not get these headaches is not entirely clear. The usual answer, from physicians who have studied this problem, is that most people do not have a “histamine intolerance.” They are not lacking in either of two gastrointestinal enzymes—histamine N-methyl transferase (HMT) and diamine oxidase (DAO) that are necessary to metabolize ingested histamine. They say that those who suffer the most headaches from wine have low levels of these enzymes. These individuals are also sensitive to other fermented products such as aged cheese, vinegar, sauerkraut, pickles, and soy sauce. However, most often the problem is just too much histamine from the winemaking process. In fact, the European union is considering regulations to limit histamine levels to less than 10 mg/liter for any wine exported to Europe. What about sulfites? Almost everyone who gets headaches from minimal amounts of wine mistakenly blames them on added sulfites. While sulfite forms free sulfur dioxide (SO2) which can produce allergic reactions, when it does, it almost always produces respiratory symptoms such as wheezing or an asthma attack, skin rash or itching, and, rarely, a severe swelling of the tongue and larynx leading to shock. An allergy to sulfites RARELY
produces headaches. Less than 1% of the population will have any allergic sulfite reaction. The most common reaction people have to excess SO2 in wine, is sneezing, or nasal membrane burning when they first smell a wine. On the other hand, people with a history of asthma are more prone to asthma flare-ups in reaction to SO2 (1 in 10 to 1 in 20). Sulfites naturally occur in grapes. But they are also added during the winemaking process to preserve wine. They convert to sulfur dioxide (SO2), which is a strong antioxidant. Wine with free SO2 binds any excess oxygen. It keeps white wine from turning deep yellow and red wines from turning brown. One winemaker states, “Without sulfites, a wine has no shelf life.” In fact, most people are not aware that sulfites can be added to “organic” wine, i.e., certifying agencies consider them an “organic” compound, and most organic and biodynamic wines have added sulfites. While a very few wineries produce wines with “no added sulfites”, it is unlikely that there will be many commercial examples in the near future because wineries cannot take a chance on having thousands of bottles of wine spoil. During early fermentation and aging, winemakers try to keep the free SO2 at about 80-100 parts per million (ppm) for white wines and about 50 ppm for red wines because red wines have more natural anti-oxidants than white wines do. Each time they move or pour the wine from one container to another, more oxygen is introduced, and free SO2 is bound, lowering the parts per million. Thus, sulfites are usually added more than once from fermentation to bottling. It might be common at bottling for a red wine to have 35 ppm, but by the time that bottle is a few weeks old, the free SO2 will be down to 25 ppm from combining with the oxygen left in the neck of the bottle. In the U.S., wines that have more than 10 parts per million (ppm) of free SO2 must be labeled as “containing sulfites.” Europe has no such labeling laws. When visitors to Europe return to the U.S. claiming they had no wine headaches from sulfite free wines produced there, they are just being fooled because the bottle label does not say that the wine contains sulfites. The best way to lower the sulfite level is to aerate the wine as you pour it into a glass. The oxygen in the air combines with SO2 to bind sulfur and decrease or eliminate any reactions to the sulfur. Aeration also releases some of the flavors of the wine, so I recommend either using an aerator or splashing the wine into the center of the glass as you pour. Some wine loving, sulfite-hating compulsives have even coined the term “super aeration” for wines poured into a blender prior to drinking! Rick Jelovsek is a retired physician, a Certified Specialist of Wine, and a member of the Society of Wine Educators. He is also author of a book available from Amazon on Wine Service for Wait Staff and Wine Lovers. You may contact him with wine questions at tnwinelover@ gmail.com or visit his website at www. winetasteathome.com.
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Enjoying East Tennessee Cycling Championships in Chattanooga By LEIGH ANNE W. HOOVER
Whether it’s for the health benefits, social interaction, or environmental concerns, cycling is a growing activity enjoyed by many. For others, it can also be an entertaining spectator sport. Listed as one of “America’s Top 50 Bike Friendly Cities” by Bicycling Magazine, it’s not surprising that Chattanooga will be the site of the USA Cycling Road and Time Trial National Championships May 25th-27th. In fact, Chattanooga will be the host city through 2015. Sponsored by Volkswagen of Amer-
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ica, Inc., the USA Cycling National Championship event will traverse all throughout downtown and up to Lookout Mountain in a weekend of activity. “Several governing bodies with the US Olympic Committee have a national championship…,” said Chris Aronhalt, managing partner with Medalist Sports. “This is the Olympic sport of cycling, and it is for the professional level only, which is the ‘cream of the crop’ for males and females.” According to Aronhalt, the national event originally began in Philadelphia, where it was held for over 20 years be-
fore being moved to Greenville, S.C., and Chattanooga, Tenn., has been awarded the championship for the next three years. “The community [of Chattanooga] was very proactive in approaching USA Cycling when the event was up for bid,” said Aronhalt. “Without question, being a cycling friendly community that understands and supports cycling was a great first step, and the terrain of Lookout Mountain literally in your backyard creates that championship course.” In addition to being the first time for the event to be held in the city, Chattanooga also marks a first for women competing in a national cycling championship. For each discipline, including the time trials and the road race, there will be one male and one female winner. Although the majority of the athletes will compete in both, Aronhalt compares the weekend to track and field events where athletes compete in specific specialties. The individual time trial competitions, where the women and men will race against the clock on a flat road course located near the actual Volkswagen factory, will kick-off the holiday weekend of competition on Saturday. The inaugural women’s event will begin in the morning and be followed by the men’s time trial competition in the afternoon. Following a rolling terrain with limited turns, cyclists will complete 19 miles, which includes two out-and-back runs. On Monday, Memorial Day brings the second part of the competition, which is the traditional road race and an all-day event. Women cyclists, including over 80 professionals, will compete in the morning, and a group of around 100 professional men will race in the afternoon. Although the national event does not serve as the only selection for the Olympics, it is considered part of the criteria. The weekend also carries a tremendous amount of pride connected to winning. “It’s a really big deal to be called the ‘national champion’ because they receive a special jersey with the stars and strips design that they will wear throughout the entire year in competitions all over the world,” said Aronhalt. “Wherever there is a professional event, the winner will be
called up to the line and recognized as the USA National Champion.” During the road race, cyclists travel in groups, and spectators can glimpse athletes multiple times during the approximate four and a half hours. The women’s event begins in the morning and covers 63.7 miles, and the men’s championship will follow in the afternoon and be decided over 102.7 miles. “With the start and finish located in downtown Chattanooga and going throughout all of the unique parts of downtown and traveling up Lookout Mountain for a total of five times, the road race is definitely ‘spectator friendly,’” explained Aronhalt.“Spectators can actually be at the start line, and then make their way up Lookout Mountain to get in position. Cyclists pass about every 40 minutes.” Although the road race begins with around 100 riders, typically only about 30 will finish in a national championship event, which exemplifies the competitive nature of the contest. During the festivities of Memorial Day, visitors can enjoy all that Chattanooga has to offer and also personally experience the pride of a world-class national sporting event. In addition to the many restaurants and attractions downtown, there will also be a sponsor event expo that will feature interactive exhibits. “You can also come and go and mingle…,” explained Aronhalt. “And, unlike football, basketball or baseball, professional cycling is totally free to the spectator.” For additional information on the USA Cycling Road and Time Trial National Championships, visit http://www. usacycling.org/2013/pro-road-time-trialnationals , and for Chattanooga tourism information see http://www.chattanoogafun.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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theLiteraryExaminer BY TERRI SCHLICHENMEYER
Living and Dying in Brick City
As memoirs go, this one’s a stunner and if you’re a medical professional, fan of medi-dramas, or if you just want a fastpaced book to read, don’t miss it. Grab Living and Dying in Brick City… and fire away.
by Sampson Davis (with Lisa Frazier Page c.2013, Spiegel & Grau; $25.00 / $29.95 Canada, 245 pages
My Parent Has Cancer and It Really Sucks
By accident or design, you’ve been in the wrong place at the wrong time, but somehow remained unscathed: the almost-hazard while driving, the near-miss at work, the moment you caught yourself just in time from falling. Things could’ve been worse – much worse - but you dodged a bullet. So, did it make your heart pound, or did it change your life? For author Sampson Davis, it was the latter because, as you’ll see in his new memoir Living and Dying in Brick City (with Lisa Frazier Page), the bullets were sometimes real. Sampson Davis hid his intelligence from his friends. He was an A-student and had, in fact, landed a college scholarship and was on his way to becoming a doctor. But since it wasn’t cool to be intelligent, he hid his smarts until he did something dumb: at age seventeen-and-a-half, he gave in to the streets, participated in a robbery, and was caught. Because he was a juvenile with no prior record, he got off easy with scholarship intact, but it was a sobering wake-up call. Grateful for a second chance, Davis buckled down and went to med school. When given the chance to intern in the emergency department at Newark’s Beth Israel Hospital, Davis seized it. He wanted to do something good for his community and working at the hospital where he drew his first breath seemed extraordinarily right. Time and again, Davis discovered to his dismay that he knew the people who lay on the tables in front of him; gunshot victims, domestic violence survivors, addicts, smokers, the sexually active, and the mentally ill. He knew them – or he knew he might’ve been one of them, if not for a youthful near-miss and a bullet dodged. Readers are treated to a heart-racing memoir filled with guns, blood, violence, and life’s unfairness. Rising above all that, though, is author Sampson Davis’ amazingly powerful sense of gratitude: he fully realized that he could very well have been a man on a gurney, rather than the man caring for the man on the gurney. But that’s not all. At the end of many chapters, Davis offers brief, helpful information and stats on STDs, heart attacks, AIDS, domestic violence, and other issues of particular interest to African Americans and inner-city residents. This information and the accompanying stories pretty much glued me to my chair.
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by Maya Silver & Marc Silver; c.2013, Sourcebooks; $14.99 / $16.99 Canada, 262 pages When you read My Parent Has Cancer and It Really Sucks by Maya Silver & Marc Silver, you’ll see that an angry outburst – among other things – is perfectly normal. Almost 3 million American teens live with a parent who’s dealt with cancer. Families experience a lot of changes. Someone may be asked to pick up some extra chores. Mom or Dad might be too tired to do the things they used to do. School might seem different, and friends may say stupid things. Adapting to these changes will be easier if the lines of parental communication are kept wide open for a few months. Also, in the effort to get an ailing parent back to health, teens need to take care of themselves, too. They should learn to speak up, ask for help if they need it, and learn to deal with stress. They can talk to a trusted teacher or adult and ask friends to listen. They should stay optimistic, but be realistic. And remember to pat themselves on the back now and then because, no matter how it all turns out, they’re a survivor, too. So they’ve heard the diagnosis, they’re terrified, sad, and worried. My Parent Has Cancer and It Really Sucks can help teens cope. Father-daughter authors Marc Silver & Maya Silver have both watched a loved one battle cancer, so they’re very qualified to offer a solid POV. They do it along with words of wisdom from other teens, clergymen, doctors and therapists and, for further help, they include a chapter for parents of their teen readers. I tried, but I couldn’t think of one cancer-related thing that Silver & Silver didn’t cover, which makes this teen how-to so comprehensive that the only question you’ll have left to ask is: where has a book like this been all these years? While it’s meant for 12-to-17-yearolds, I think this book will work for newlycoping college-age kids, too. It’s something you hope you’ll never need – but if you do, My Parent Has Cancer and It Really Sucks… definitely doesn’t. 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.
Constipation By M. Samer Ammar, MD, FAAP, FAGA What I am about to share with you would not be anything you don’t already know. I am just going to stress a few facts about constipation. Constipation, defined as a delay or difficulty in defecation present for two or more weeks, is a common pediatric problem encountered by both primary and specialty medical providers. Overall, behind infancy, less than three bowel movements a week and/or painful defecation is generally an accepted definition of constipation. A normal pattern of stool evacuation is felt to be a sign of health in children of all ages. Especially during the first months of life, parents pay close attention to the frequency and the characteristics of their children’s defecation. Any deviation from what is felt to be normal for children by any family member may trigger a call to the nurse or a visit to the pediatrician. Thus, it is not surprising that approximately 3% of general pediatric outpatient visits, and up to 25% of pediatric gastroenterology consultations, are related to a complaint of defecation disorder. In most children, constipation is functional, that is, without objective evidence of a pathological condition. The most common cause of functional constipation is the voluntary withholding of feces by a child who wishes to avoid an unpleasant defecation. Many events can lead to painful defecation including toilet training, changes in routine or diet, stressful events, intercurrent illness, unavailability of toilets, or postponing defecation because the child is too busy. These can lead to prolong fecal stasis in the colon with reabsorption of fluids and increase in the size and consistency of the stools. Few constipated patients have an underlying medical problem(s). Hirschsprung disease is the most common cause of lower intestinal obstruction in neonates and is a possible, but rare, cause of intractable constipation in toddlers and school-age children. It is characterized by a lack of ganglion cells, usually segmental, but can be diffused in the myenteric and submucous plexuses of the large bowel. Other possible etiologies of defecation disorder may include a food allergy, including allergy to gluten, gluten enteropathy,
and partial bowel obstruction related to different pathology of gastrointestinal diseases, including inflammatory bowel diseases and post surgical management of digestive or nondigestive diseases. Failure to respond to conventional therapy is the most warranted reason for a pediatric gastroenterology referral. Other reasons for a referral include fever, abdominal distension, anorexia, vomiting, weight loss or poor weight gain, or bloody stool. A complete physical examination is most helpful in approaching patients with defecation disorder. A digital rectal examination can aid in the differential diagnosis of constipation. It is an underused tool in routine practice. Based on the most likely suspected cause of the differential diagnosis list, work-up may be warranted. That may include, but is not limited to, a radiographic study(s). With only a few exceptions, the treatment for constipation is usually not surgical. Understanding the true etiology underlying the cause of the defecation disorder is the first step to a better outcome. Medication use may not be sufficient. Behavioral modification is proven to be effective, yet may not be for long term; and the benefit of biofeedback therapy is controversial. It is estimated that one fourth of children with functional constipation may continue to experience symptoms related to defecation disorder at adult age. Older age at onset, longer delay between onset of symptoms and referral to a specialized pediatric gastrointestinal clinic, and lower defecation frequency at presentation were related to poor clinical outcomes at adult age. Our GIforKids specialty clinic is staffed with dedicated physicians, mid-level providers, nutritionists, nurses, and a psychologist who provide comprehensive care for patients and their family. M. Samer Ammar, MD, FAAP, FAGA is a board-certified pediatric gastroenterologist who practices with GI for Kids, PLLC, in Knoxville, Tenn. He completed his Hepatology & Nutrition Fellowship in 2002 at the James Whitcomb Riley Hospital for Children in Indianapolis, Indiana. Prior to coming to Knoxville, he practiced in Grand Rapids, Michigan.
www.giforkids.com • 865.546.3998
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The Move from Social Media Marketing, continued from page 1 the marketplace,” Dixon explained. “Social business is modern communications brought into the business for the purpose of end-user productivity, collaboration and engagement.” He continued, “The most popular tool being used today to do that is email, but email was never intended to be a collaborative tool.” In a typical scenario, he continued, one person would email an attached document to 10 people for comments and input, which leads to 10 different documents with notes that might be conflicting to compile into one master file … which is then sent back out for further review. Ultimately, businesses need to connect three key elements together — processes, information and people. Dixon noted that while large investments have been made in processes, the chief tools of email and a word processor have been fairly stagnant for the last 20 years. To address this issue, social business software designers have taken a cue from technologies like Facebook and Twitter, which started in the consumer realm. Dixon said the beauty of these tools is that they are lightweight, easy to navigate, simple and very effective in keeping individuals connected to their social network, which is a sophisticated online community. The concept of online communities, he continued, isn’t new to healthcare. “Even back in the 1990s, people would have early dos-based discussion boards. Around 2000 … 2002 … we started to see the emergence of heath information repositories like WebMD. For consumers, it was the first time they could easily get information outside of a doctor’s visit,” Dixon said. He added that by mid-2005, those repositories had become more like communities where people with a similar interest could connect with each other. “Fast forward to where we are today, and what we really have are health networks. They really are communities, but they’ve introduced much richer communication and collaboration tools,” Dixon continued. He noted tools like microblogging, wikis and forums open the path to allow discussion around content within a community setting. “The reason social
business tools are so popular is not only do they work they way you do, but you can choose the one that’s most appropriate for the task at hand,” he added.
Creating Engaged Communities
Dixon said the ability to engage and connect in a community setting is one of the most powerful aspects of a social business model. Today, patients with similar ailments can tap into a network to share experiences, information and support. That said, he added the communities could be built with parameters to allow providers to monitor and moderate discussions. “It’s open communication, but at the same time, you introduce controls,” he explained. Although it does take some time to manage, Dixon added, “The scale and the reach you get with an online community far exceeds what you could ever get from an in-person visit.” That element also allows physicians to disseminate messages about wellness and disease management to large, targeted populations, which will be increasingly important in new accountable care delivery models. For physicians, the community setting lets providers who might not be geographically connected engage each other. One of Igloo’s clients is the American Academy of Family Physicians. The organization launched the Delta Exchange as a way for physicians from across the country to become more aligned. “They were able to coordinate all the different best practices and overall learning that various physicians had and bring each other along. It was a great way to be able to coordinate a geographically diverse set of practitioners,” Dixon said. Similarly, community settings that encourage discussion and idea exchange could work equally well for other groups including researchers, mid-level providers and practice managers. Internally, an intranet community allows for easy communication and collaboration. Using the same types of business tools employed in external communities, staff members can easily review documents, communicate information broadly across geographic locations, vote on policy, and share ideas.
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Security
“Security has to be built in as a core set of requirements in any social business tool,” said Dixon. “The technology is there,” he continued. “It’s one of the central things you look at when deciding which social business tool provider makes sense.” He added, “Any enterprise-class social business software firm can not only lock down the individual permissions but also has the ability to audit everything that has happened in that community.”
Avoiding Information Overload
Dixon said email is in danger of becoming less and less useful because of information overload. The same caveat also applies to information imparted through social business tools. “If you don’t implement properly, you risk making that problem worse,” he said.
However, social business tools can be offered in a very targeted manner through channels. Individuals choose which channels are of interest to them and subscribe. Drilling down even further, there are generally options within the channel to refine what information the subscriber receives and how.
The Bottom Line
With accountable care organizations and patient-centered models, supporting patients and colleagues by providing timely, pertinent information in an easilyaccessible manner has become even more critical, Dixon pointed out. “That means you need to be able to collaborate and communicate internally and externally. From a common sense perspective, those that do that best will attract the most patients and keep the most patients … those who don’t will find the opposite.”
Unconventional Wisdom, continued from page 1 species of the spirochete class, which is transmitted to humans through a tick bite. Skin rash in a bull’s-eye pattern (erythema migrans), fever, fatigue, chills and headaches are among early symptoms. Later symptoms could involve the joints, heart or central nervous system. For most, a prescribed course of oral or intravenous antibiotics takes care of the infection and symptoms. However, in some patients, synovial inflammation persists even after the bacteria have been nearly or totally eradicated. This has given rise to the belief that in predisposed patients, the initial Lyme disease triggers an ongoing autoimmune disorder. In his 2012 paper, “The Microbiome, Autoimmunity and Arthritis: Cause and Effect: An Historical Perspective,” which was published in Transactions of the American Clinical and Climatological Association, Paget noted that for more than 100 years, there has been “tantalizing but often inconclusive evidence” about the role of microorganisms in autoimmune diseases. He wrote, “Current therapy focuses on the pathogenesis rather than the etiology of these disorders. In order to rein in the overactive immune system we believe to be causing the disease, we employ immunosuppressive drugs, an act that would be counterintuitive if infection were the root cause of the problem.” A small but intriguing study out of the Division of Rheumatology at the University of South Florida College of Medicine published in the journal Arthritis Rheum in May 2010, found a six-month combination antibiotic regimen was effective in treating patients with the autoimmune condition Chlamydia-induced reactive arthritis. In the nine-month, prospective, double-blind, triple-placebo trial, researchers assessed a six-month course of combination antibiotics with a primary end point of the number of patients who improved by 20 percent or more in at least four of six variables without worsening in
any variable. At month six, the authors found significantly more patients in the active treatment group became negative for C trachomatis or C pneumonia. The primary end point was achieved in 63 percent of patients in the active arm of the trial, with 22 percent of those patients believing their disease had gone into complete remission. No patient in the placebo group achieved remission. Pointing to this study, Paget noted that one of the failures of antibiotic regimens in the past in treating autoimmune disorders might be the duration of the therapy. “If you give long courses of antibodies, you may very well calm the problem down,” he said. However, he noted, physicians currently switch to steroids, T-cell inhibitors, and other immunosuppressive drugs to ameliorate the ongoing inflammatory issue after treating the triggering microorganism with antibiotics or antivirals for a relatively short course, “It may very well be we have to improve the immune system response instead of suppress it, and that’s the interesting twist,” Paget continued. If the root cause of an autoimmune condition is infection, “You’d want the army active,” he said of augmenting the immune system. While much more research must be done, Paget said mounting evidence of the important connection between microorganisms and a number of autoimmune disorders provides ‘food for thought’ when it comes to the best course of action for treating these conditions and could ultimately portend a paradigm shift in the delivery of care. “In some of these, the organism is slow, smoldering … but still there in a lowgrade way that is triggering the inflammatory response. We have to be appreciative of the fact that we want to do the best thing for our patients … but what we’re doing (now) may be the worst thing,” he concluded. easttnmedicalnews
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East Tennessee CME Events Editor’s Note: In an effort to provide our readership with the latest professional healthcare news, East Tennessee Medical News is working with area institutions to provide this monthly listing of CME events throughout the East Tennessee region. For more information about each activity, please see the contact information provided for each event. Upcoming CME Events in the Greater Chattanooga area Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: May 2, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 2, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Fifth Annual Stroke Symposium: Managing the Complex Stroke Patient Name of CME provider/sponsor: University of Tennessee Medical Center Brain and Spine Institute and UT Graduate School of Medicine Date: Tuesday, May 7, 2013 Time: 7:30 a.m.-5:00 p.m. Place: University of Tennessee Conference Center, Knoxville, Tennessee Credits available: Approved for AMA and AAPA credits and CEUs Information: www.tennessee.edu/cme/Stroke2013 Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Details: The symposium offers presentations by experts addressing care for critically ill cerebrovascular patients and administration of thrombolytics for acute ischemic stroke. Guest speaker is Andrew D. Barreto, M.D., an assistant professor of Neurology at the University of Texas Medical School, Houston, and other speakers represent the specialties of neurology, radiology, anesthesiology, palliative care and pharmacy. Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: May 9, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 9, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190
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Name of activity: Medicine Grand Rounds: Osteoporosis Update 2013 Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 14, 2013 Times: 8-9 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: May 16, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 16, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: May 23, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville
Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 23, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Medicine Grand Rounds: Peripheral Neuropathy: Clinical Approach and Current Concepts Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: May 28, 2013 Times: 8-9 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: May 30, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University
of Tennessee Graduate School of Medicine and Department of Surgery Date: May 30, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190
Upcoming CME Events in the Greater Chattanooga area Name of activity: Family Medicine Update (28th annual) Name of CME provider/sponsor: University of Tennessee College of Medicine Date: June 12-15, 2013 Times: 8:00am-5:00pm on Wednesday-Friday, 8am-12:00pm on Saturday Place: The Chattanoogan Hotel Credits available: 24 AMA PRA Category 1 Credits™ Information: utcomchatt.org/cme Details: General Session Registration fees include: admission to all general sessions; issuance of continuing medical education credit certificates for physicians; light breakfast each day; fresh snacks during breaks; lunch at Broad Street Grille each day; and complimentary Riverbend Festival admission pins for use on a daily checkout basis (while supplies last). Name of activity: Southeast Wilderness Medicine Conference (9th) Name of CME provider/sponsor: University of Tennessee College of Medicine Date: June 21-26, 2013 Times: Various times each day, depending on involvement Place: Chattanooga Convention Center Credits available: 45 AMA PRA Category 1 Credits™ Information: utcomchatt.org/cme Details: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Tennessee College of Medicine and Still Waters Productions, LLC.
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
Date: The 3rd Thursday of Each Month
Time: 11:30 AM – 1:00 PM
Time: 11:30 AM – 1:00 PM
Location: Quillen ETSU Physicians Clinical Education Building, 325 N. State of Franklin Rd., Johnson City
Location: Indian Path Medical Center Conference Room, Building 2002, Second Floor, Kingsport
Speakers Vary Each Month, Covering Topics Such As Meaningful Use, Compliance, Coding, Legal Considerations, and More. To assist with appropriate catering preparation, please RSVP by the Monday prior to the meeting: Johnson City: Michael Manning @ MManning@painmedassociates.com. Kingsport: Frances Sizemore @ sizemorefn@msha.com or fax to (423)224-3901. Save the Date! Tri-Cities MGMA 2013 Spring Conference “Better Together” is May 15. Location: Millennium Centre, Johnson City
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GrandRounds MEDICAL MOVER MOMENT 9th Annual Denim & Diamonds Fundraiser
Chattanooga physicians and community leaders came together on Feb. 23, 2013, at the Chattanooga Convention Center for an evening of music and food, and a celebration of healing. The Denim and Diamonds fundraiser helps support the Project Access community health partnership and other community health initiatives and is organized by the Chatta- Dr. Peter and Courtney Lund nooga Hamilton-County Medical Society, Medical Foundation of Chattanooga, and Medical Alliance. Denim & Diamonds: Saturday Night Fever, presented by Dale Buchanan & Associates, Kindred Health, and University Surgical Associates celbrated the decade of disco – the 1970s and included dinner, dancing, and live and silent auctions. Attendees came dressed as their favorite star or icon from the 1970s. Polyester was brought back in style for one night only. Tracie & Dr. Chris Lesar.
Expanding Access to Care, Mental Health, Rx Drugs Top Issues at Tennessee Physicians’ Annual Meeting NASHVILLE – Physicians from across the state gathered in Franklin, Tenn., April 5-7, and considered a number of health policy positions for the Tennessee Medical Association, including support for expanding access to healthcare coverage, more funding of mental health screenings and treatment, transparency of patient charges for prescription drugs and hospital services, maternal mortality review, and amending restrictive guidelines for care provided by physicians in training. Following passionate debate, a resolution supporting expanded access to care for all Tennesseans was approved by a majority of delegates. The resolution supports expanded access under a three‐year trial program using Medicaid expansion funds to cover uninsured residents through health exchange purchased plans, similar to Gov. Haslam’s proposal, or direct expansion. The resolution calls for the TMA to continue to support access to affordable healthcare for all Tennesseans as put forth in its previous statement on health reform; to support a three‐year trial to expand access to care using Medicaid expansion funds to either subsidize plans purchased by the uninsured through the federal health insurance exchange
or through direct Medicaid expansion; and to insist that the benefits purchased through the exchange remain comparable to Medicaid/TennCare benefits. The TMA House of Delegates held its session as part of the association’s 178th annual meeting, MedTenn 2013. The event also offered CME and informational sessions on prescription drug abuse and neonatal abstinence syndrome, the mental health crisis in Tennessee, the state’s Controlled Substance Monitoring Database, which became mandatory for prescriber checks for certain pain medicine prescriptions on April 1, health reform, electronic health information exchange and quality incentive programs, ICD-10 coding changes, and more. RESOLUTIONS OF INTEREST Increasing Access to Care – The TMA House of Delegates (HOD) voted to support access to affordable healthcare for all Tennesseans; support a trial for three years to expand access to care by using Medicaid expansion funds either to subsidize uninsured residents to purchase health insurance through the federal insurance exchanges or through direct Medicaid expansion; and instructed the Association to make itself fully available to the governor and the state legislature to advocate for healthcare coverage in Tennessee. • Indigent Care – Delegates reaffirmed the importance of physicians pro-
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GrandRounds viding free and reduced-cost care to indigent patients and directed the Association to support and promote such activities. • Mental Health Screening – Delegates voted to support efforts for more state and federal money for mental health screenings and treatment in Tennessee. • Maternal Mortality Review – The HOD voted to support the establishment of a peer review-protected and HIPAAcompliant maternal mortality review process under the auspices of the Tennessee Department of Health to review maternal deaths in Tennessee and make recommendations for system changes to improve healthcare services for women in Tennessee. • Cosmetic Surgery – Delegates passed two resolutions to pursue expansion of the definition of the practice of medicine to include any surgical procedure for cosmetic or aesthetic purposes; and to support efforts to prevent unlicensed and unsupervised cosmetic surgical procedures through legislative action and enforcement by the Board of Medical Examiners. • Health Cost Transparency – Delegates passed separate resolutions supporting the required posting of patient out-of-pocket costs for prescription drugs and hospital charges. • Medical Education & Physician Involvement – The HOD voted to petition the American Medical Association to work with CMS and other federal authorities to remove onerous language from its guidelines on care by physicians in training; and petition the AMA for requirements that recognize more accurate documentation of care while allowing the profession to resume educating its future colleagues in a more cost-effective and efficient manner. AWARDS The TMA presented its 2013 annual awards to the following honorees: • Outstanding Physician: Winston P. Caine, MD, Chattanooga; Bobby Clark Higgs, MD, Jackson; John Lamb, Sr., MD, Nashville • Distinguished Service: Marion Dugdale, MD, Memphis; B W. Ruffner, Jr., MD, Signal Mountain • Community Service: Greater Memphis Greenline, Inc., Memphis; Hamilton County Project Access, Chattanooga; Cathy Self, PhD, Baptist Healing Trust, Nashville
U.S. Rep. Phil Roe presents MSHA with prestigious National Quality Healthcare Award
WASHINGTON, D.C. – Mountain States Health Alliance received a prestigious honor recently when it was named the recipient of the 2012 National Quality Healthcare Award, presented by the National Quality Forum. Only one recipient is chosen each year for the entire U.S. The reason for the honor: MSHA’s commitment to providing quality patient-centered care while working to lower costs. easttnmedicalnews
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MSHA leaders received the award at the NQF Annual Meeting, and it was presented by Dr. Phil Roe, U.S. Representative for the 1st District of Tennessee. This year, the NQF award focused on how much an organization provides patient-centered care and achieves better health outcomes at lower per-capita costs, representing the Triple Aim set forth by the Institute for Healthcare Improvement. Laura Miller, NQF’s interim president and CEO, Senior Vice President and COO, praised Mountain States for its comprehensive planning and successful deployment of programs focus-
ing on continuous quality improvement. According to the National Quality Forum, MSHA’s commitment to excellence and quality can be seen in all aspects of the system. MSHA has created and utilizes a set of 10 Patient-Centered Care Guiding Principles illustrating the importance of safe, customized care that is provided in a transparent manner and openly communicated with the patient, family and caregivers throughout the course of treatment. NQF recognized MSHA’s comprehensive approach to measurement – an increasingly important factor in promot-
ing increased quality and safety within a health care system. Performance measures used by MSHA are aligned with the National Quality Strategy. Metrics are reported to MSHA internal staff through their quality dashboard on a monthly and annual basis, compared against projected year-to-date targets, and tracked regularly by senior leadership and board members. MSHA staff exhibit a strong commitment to transparency – a Patient Safety Report on the staff intranet page monitors errors, and safety and performance information is regularly made available on a public website.
I don’t just have insurance. I own the company.
Chad T. Couch, M.D., FACS Bristol Urological Associates, P.C. Bristol, TN Urology
Medical Professional Liability Insurance “Eventually, every physician faces a critical moment when you must rely upon the abilities and resources of your liability insurance provider. And for me, when it comes to protecting my practice, my livelihood, and my peace of mind, SVMIC is the only choice. Their legal counsel and in-house support team are responsive, professional, and at your side every step of the way. Compared to other insurance companies, the difference is night and day. And SVMIC combines the strength and stability of a high financial rating with a proven commitment to serving physicians which spans more than 35 years. After all, SVMIC is owned by you, me, and over 14,000 other physicians just like you across the Southeast. So you know your interests as a physician will always come first.”
Mutual Interests. Mutually Insured. Contact Deborah Hudson or Susan Decareaux at mkt@svmic.com or 1-800-342-2239. SVMIC is endorsed exclusively by the Tennessee Medical Association and its component societies. Follow us on Twitter @SVMIC
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GrandRounds Senior Scam Topic of Presentation by Expert Gary Cordell at Appalachian Christian Village
JOHNSON CITY—To raise awareness of the national senior scam issue, Appalachian Christian Village, one of the first established Continuing Care Retirement Communities in East Tennessee, recently presented “Hands Up, Scam Artist” with Gary Cordell, Director of Tennessee Consumer Affairs Division. During the event, greater Tri-Cities area seniors and caregivers were educated on how to protect their finances by avoiding fraud, theft and scams. During the educational seminar, Cordell explained the importance of understanding how fraud such as identity theft, credit card fraud and fake lottery winnings occur. Additionally, he informed the attendees that seniors are targeted due to their potential money savings, good-hearted nature and their presence at home during the day. Cordell also educated attendees about how to be a smart consumer in 2013 by providing an outline of when and how to check their credit card reports, make smart investment choices, purchase their next car and avoid telemarketing scams. Additionally, he distributed an informative packet that included preventative steps and tips to avoid scam and becoming a victim. Attendees also received a calendar in the packet that provides monthly reminders on how to control and monitor finances.
Local physician receives Servant’s Heart Award from Mountain States Health Alliance
JOHNSON CITY – Dr. Melinda Lucas of Niswonger Children’s Hospital was one of five physicians from around the region this year to receive Mountain States Health Alliance’s (MSHA) highest honor – the Servant’s Heart Award, recognizing those who Dr. Melinda exemplify what it means Lucas to be a caregiver. She was nominated by co-workers and chosen by the MSHA executive team for the award. Lucas is often found working late hours in the pediatric intensive care unit, ensuring that each of her patients receives the highest quality of care possible. As a nomination letter stated, “Dr. Lucas puts the work of caring for families and children above anything else she does.” Lucas gives her time freely to the pursuit of quality care and education. She has also built a strong relationship with the Niswonger staff, including the volunteers who give their time in the hospital. Lucas always strives to make others feel appreciated. Each year during nurse’s week, she plans a picnic for the pediatric floor staff, setting aside a special time to celebrate her co-workers. She is also a strong supporter of familycentered rounds, during which she visits each patient on the floor to establish relationships with family members in order to best communicate the plans of care needed. The four other 2013 awards in the medical staff category were bestowed
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upon Dr. Douglas Pote of Glade Spring (Va.) Community Clinic, Dr. Damian Sooklal of Johnston Memorial Hospital in Abingdon, Va., Dr. Alfredo Cervantes of Clearview Psychiatric Unit at Russell County Medical Center in Lebanon, Va., and Dr. Thomas Renfro of Thomas E. Renfro Community Clinic in Coeburn, Va. Each doctor will receive a crystal trophy, framed certificate and $1,000 donated to the charity of their choice.
Laura Phillips White Joins Takoma Foundation Board
GREENEVILLE – Laura Phillips White has joined Takoma Regional Hospital’s Foundation board of directors. She currently serves as superintendent of the Greeneville Water Commission. White received her Bachelor of Science and Master’s degrees in environmental health from East Tennessee State University. Since graduating, she has worked as a water treatment operator for the City of Johnson City, and an environmental specialist and regulator for the Tennessee Department of Environment and Conservation in the water supply division. She also was superintendent of the City of Kingsport’s water treatment plant.
Bristol Regional Leadership Changes to Provide New Opportunities, Continue Tradition of Strength
BRISTOL – Bristol Regional Medical Center is making administrative changes that will build on the hospital’s tradition of success and provide leaders with new opportunities to enhance quality of care. Terry Eads, who has successfully guided Bristol Regional’s quality, accreditation and risk management initiatives, has been named to a similar role at Wellmont Health System. Eads will now serve as Wellmont’s director of quality, safety and acTerry Eads creditation. She will provide strategic direction in the development and measurement of the system’s accreditation processes. She will also develop a comprehensive medical safety program to enhance the safety of patients, visitors and Wellmont co-workers. Eads worked for Bristol Regional since 1990 in multiple risk management roles before being named director of quality, accreditation and risk management in 2005. She holds a Bachelor’s degree in safety engineering from Kennedy Western University and Bachelor’s and Master’s degrees in business administration from King College. Replacing Eads will be Penny Miller. Miller will be responsible for hospitalwide quality improvement projects, core data collection and reporting, accreditation requirements and Penny Miller risk management duties. She will also oversee the hospital’s quality, stroke and risk management programs. In another revision, Tim Anderson will now serve as Bristol Regional’s vice
president of patient care services and oversee all nursing care. Early in his career, Anderson worked as a nurse and nurse case manager at Bristol Regional. He reTim Anderson turned to Bristol Regional in 2011 to serve as director of acute care services. Anderson has a Bachelor’s degree in nursing from Old Dominion University and a Master’s degree in education from Virginia Tech.
Pelle Named Interim President of Community Hospital Division, Neal to Serve at Bristol Regional
KINGSPORT – Fred Pelle, a veteran healthcare executive with extensive experience at Wellmont Health System, has been named interim president of its community hospital division, effective May 1. Pelle will serve as the president of Mountain View Regional Medical Center, Lee Regional Medical Center and Lonesome Pine Hospital in Virginia and Hawkins County Memorial Hospital and Hancock County Hospital in Tennessee. He has been chief operating officer of the community hospital division since July. He was a Wellmont co-worker from 2002-2011, including several years as president of Hawkins County Memorial and Hancock County, before leaving to serve as president of a hospital in Kentucky. Pelle’s appointment by Denny DeNarvaez, Wellmont’s president and CEO, is a result of Greg Neal being selected as interim president of Bristol Regional Medical Center. Neal is succeeding Bart Hove, who is resigning, effective May 1, for health reasons. Since he rejoined Wellmont, Pelle has been a key figure in standardizing and coordinating care in the community hospitals.
Teresa Harper, Licensed Clinical Social Worker, Joins Wellmont Medical Associates’ Rogersville Practice
ROGERSVILLE – Wellmont Medical Associates has expanded mental health services in Hawkins County. Teresa Harper, a licensed clinical social worker with nearly 25 years of experience, has joined Wellmont Medical Associates in Rogersville. Harper will work alongside Dr. Liliana Murillo, a board-certified in- Teresa Harper ternist who provides both physical and psychiatric care for patients. Together with Murillo, Harper will provide evaluations and therapeutic interventions for patients with anxiety disorders, depression and post-traumatic stress disorder. As part of a comprehensive treatment plan, Harper will also help patients obtain nonmedical resources so they can adapt to living with a mental health disorder. Harper has an undergraduate degree from Tusculum College, a master’s degree from Virginia Commonwealth University and is a candidate for a doctorate in behavioral health from Arizona State University.
PUBLISHED BY: SouthComm, Inc. CHIEF EXECUTIVE OFFICER Chris Ferrell PUBLISHER Jackson Vahaly jvahaly@southcomm.com 615.844.9237 ASSOCIATE PUBLISHER Cindy DeVane cindy@easttnmedicalnews.com 423.426.1142 EDITOR Bridget Garland bridget@easttnmedicalnews.com 423.523.4729 CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Christie Passarello CONTRIBUTING WRITERS Sharon Fitzgerald, Cindy Sanders, Lynne Jeter, Terri Schlichenmeyer, Bridget Garland, Leigh Anne W. Hoover, Rick Jelovsek, Brad Lifford, Joe Morris ACCOUNTANT Kim Stangenberg kstangenberg@southcomm.com CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: editor@easttnmedicalnews.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 • Two years $78 Become a fan on Facebook, and Follow us on Twitter@EastTNMedNews SOUTHCOMM Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Business Manager Eric Norwood Director of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Director of Content / Online Development Patrick Rains East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.
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GrandRounds HMG’s Samuel Breeding, MD, becomes first in Tri-Cities’ region certified by the Federal Motor Carrier Administration
KINGSPORT – Holston Medical Group’s (HMG) Occupational Medicine Specialist Samuel Breeding, MD, recently obtained certification by the Federal Motor Carrier Safety Administration (FMCSA) for the National Registry of Certified Dr. Samuel Breeding Medical Examiners, making him the first in the Tri-Cities region to obtain this qualification. Beginning May 14, 2013, all physicians who perform physical qualification examinations for truck and bus drivers must hold this qualification. Breeding completed his undergraduate work at Virginia Tech in Blacksburg, Va., and received his medical doctorate from the Medical College of Virginia, Richmond. He completed his residency in Family Medicine at ETSU Quillen School of Medicine, Johnson City. Following his residency, Breeding served in the Air Force and became the chief of aeromedical services at Altus Air Force Base, Okla. Breeding is board certified in occupational medicine and family medicine but limits his practice to occupational medicine. He is also certified by the Federal Aviation Administration (FAA) as a senior medical examiner for pilots and is certified as a Medical Review Officer (MRO) to evaluate drug screen results. He has been practicing in Kingsport since 1984.
the Distance,” an elite panel of national speakers talked with providers concerning the advent of Medicare Accountable Care Organizations, focusing on improving care while reducing costs. Craig Samitt, MD, president and CEO of Dean Health System, Wisconsin, known throughout the nation for his leadership in advancing ACOs, addressed the group, telling participants the “top ten ways healthcare is likely to change.” Additional speakers and panelists included William Jennings, MD of Palmetto Health; Len Fromer, MD, of Group Practice Forum; Reid Blackwelder, MD, president-elect of American Academy of Family Physicians; Grace Terrell, MD, of Cornerstone Health Care; Robert Groves, MD, Banner Health; and Lori Nomura, a healthcare advisory attorney with Foster Pepper, PLLC.
Gatton College of Pharmacy residency programs receive full accreditation
JOHNSON CITY – East Tennessee State University’s Bill Gatton College of Pharmacy has been awarded full accreditation for its postgraduate year two (PGY2) residency programs from the American Society of Health-Systems Pharmacists (ASHP). ETSU received notification of full accreditation for its PGY2 programs in internal medicine and ambulatory care from the ASHP Commission on Credentialing, which conducted a site visit in October 2012. Members of the commission reviewed all components of the ETSU programs to confirm they meet accreditation standards that will ensure quality training of pharmacy residents.
(from left to right): Jenny Ackerman, Wanda Buchanan, Tammy Waddle, Virginia Cook, Roger Forgey, Hutcheson CEO, Denise Self, Carol Worley, Chareen Humble, Chris Lundeen, and Amy Bolden.
Name: Virginia Cook Position: Volunteer at Hutcheson Medical Center Launching its monthly volunteer recognition program, Hutcheson Medical Center, located in Fort Oglethorpe, Ga., named Virginia Cook as its April recipient of the inaugural award. Cook has volunteered at Hutcheson Medical Center for two and a half years in the hospital’s Day Surgery area and was unanimously nominated by the surgery staff. “Every surgery staff member nominated Virginia as Volunteer of the Month,” stated Chareen Humble, manager of volunteer services at Hutcheson. “Everyone said that she goes above and beyond to help surgery patients and is always asking what more she can do to help”. As Volunteer of the Month, Cook received a basket with gift certificates from Sears Shoe Store and Battlefield Salon, and gift items from The Hutch Gift Shop. Cook was awarded use of the Volunteer of the Month parking space during April and her name will be added to the recognition plaque by the hospital’s information desk.
Regional healthcare leaders gather at HMG-hosted forum
KINGSPORT – Holston Medical Group (HMG)physicians and providers recently gathered in Asheville, North Carolina, for the group’s “2013 Annual Meeting.” Focusing on healthcare industry changes, like-minded professionals joined HMG providers, including State of Franklin Healthcare Associates, Johnson City; Medical Care, LLC, Elizabethton; Mountain Region Family Medicine, Kingsport; Cornerstone Health Care, High Point, NC; the Jackson Clinic, Jackson, Tenn; as well as representatives of Highlands Physician’s, Inc., learning from some of the nation’s most-respected leaders in healthcare reform. A commonality shared by many attendees included participation in the new OnePartner Health Information Exchange (HIE), a physician-owned, patient-centric information exchange system, and Qualuable Medical Professionals, a new physician-directed, regional Accountable Care Organization (ACO) as designated by Centers for Medicare and Medicaid Service (CMS). “That’s what the weekend was all about -- doctors who are patient-care focused, who are committed to doing what’s right, and who are willing to go the distance to give patients a better care experience while delivering quality and value,” agreed Reid Blackwelder, MD, president-elect of American Academy of Family Physicians. With an event theme of “Going
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Attenti o n
Important Information for People with BlueCross BlueShield of Tennessee Insurance Coverage What does the word “transparent” mean to you?
(adjective) visibility or accessibility of information especially concerning business practices
Mountain States Health Alliance is committed to working with BlueCross BlueShield of Tennessee in an attempt to continue participation in their network. BlueCross has set the deadline at June 1 for reaching an agreement, but we have asked BlueCross for a 90-day extension in order to allow enough time to reach that agreement. There’s no good reason for BlueCross to refuse the extension. In fact, one reason we are currently pressed for time is because the first proposal we received from BlueCross contained an error that would have meant millions of additional dollars for MSHA. Per their request, we granted them a 60-day extension to correct it. Not only is it important to be trAnspArent , we believe doing the right thing is worth the time. We hope BlueCross will agree.
fAct:
The BlueCross CEO has warned subscribers that premiums for individual coverage will increase an average of 30% next year.*
fAct:
BlueCross is demanding significant cuts in reimbursement from MSHA.
question:
If your health care providers are being paid less and your health insurance premiums are going up, who is benefitting from this arrangement?
whAt cAn you do? Talk to your employer or HR department. Ask them to urge BlueCross to grant the extension.
fAct:
To learn more, visit www.msha.com/BCBSTN or email us at info@msha.com.
fAct:
*Memphis Business Journal, 4/4/13, “Insurance is going to cost more, and BlueCross wants you to know why”
MSHA granted BlueCross a 60-day extension when a payment model error was discovered. MSHA is again asking BlueCross to extend the contract for the benefit of our patients and our community, so we can come to an agreement.
Franklin Woods Community Hospital • Indian Path Medical Center • Johnson City Medical Center Johnson County Community Hospital • Niswonger Children’s Hospital • James H. & Cecile C. Quillen Rehabilitation Hospital Sycamore Shoals Hospital • Woodridge Hospital • First Assist Urgent Care • Mountain States Medical Group Medical Center HomeCare and Hospice • Mediserve Medical Equipment • HealthPlus & Pharmacy
www.msha.com/bcbsT