Newsletter for Physicians
WINTER 2015
In This Issue
2014 Service Excellence Award
Winners Recognized Trinity Clinic Celebrates 20 Years and more
In This Issue:
Dear Fellow Physicians:
President’s Address............................ 1
W
Service Excellence Award Winners..... 2 20 Year Celebration........................3-4 Human Interest Story........................ 5 Quality Update................................. 5 Doc-to-Doc – PAD........................... 6 ConnectCARE Update...................7-8 CME Calendar.................................. 8 Patient Centered Medical Home....... 9 Women With Heart........................ 10 On the Shoulders of Giants............. 10 Physician Liaison Team................... 11 Welcome New Providers.................. 11 Trinity Clinic digest Trinity Mother Frances Marketing 500 S. Beckham Ave. Tyler, Texas 75701 Email: marketing@tmfhc.org Managing Editor Del Shankle Editorial Board William Dooley Ann Gilbert Chris Glenney Steven Keuer, MD Scott Smith, MD
elcome to the first of many future issues of Trinity Clinic digest, a new publication designed for Trinity Clinic providers to showcase the good work going on at Trinity Mother Frances Hospitals and Clinics and provide timely and relevant information that will help you continue providing your patients the best care available in East Texas. In this issue of Trinity Clinic digest, we celebrate the accomplishments of seven Service Excellence Award winners, each of whom has been recognized for their exceptional performance or behavior in the areas of Clinical Quality; Patient Safety; Education/Research; Innovation; Leadership; Mission/ Service and Customer Service. It is their tireless commitment and dedication to their specialties that reinforces our mission of enhancing the health of our community through service with compassion, excellence, and efficiency. Also in this issue we celebrate the 20th anniversary of Trinity Clinic. Just 20 years ago, Tyler’s medical community consisted only of a number of small physician practices, each of which worked independently to provide care to the residents of Smith County. Three physician groups – Cardiovascular Consultants, Tyler Gastroenterology and Tyler Medical Surgical Clinic – representing 35 physicians, had the foresight to join forces and form one entity. Today, Trinity Clinic is the area’s preferred multi-specialty medical group, with over 350 physicians and advanced practice providers representing 40 specialties in 36 clinic locations serving East Texas. That is quite an accomplishment, and I personally thank each of you for your hard work in helping position us as the preferred provider of care in East Texas. Also in this issue, several of your peers provide updates on key areas of focus that are relevant today to us as providers, and to our patients. These include the work we are doing around our primary care medical home, our ongoing efforts in the area of patient quality and safety, and updates related to ConnectCARE, our system for electronic health records powered by Epic. In this and future issues, you’ll also learn what Trinity Clinic physicians are doing outside of the office – such as Dr. Mark Barrett’s recent medical mission trip to Africa. It is our hope that you will find the information in this publication helpful and informative, both in terms of your daily work at Trinity, but also in terms of what is going on throughout the organization. I encourage you to please send suggestions for future topics and/or feedback to marketing@tmfhc.org Again, thank you for your continued commitment and dedication to helping Trinity Mother Frances make a difference in the lives of our physicians, staff and our community. Sincerely,
Graphic Design Holly Izard Steven Keuer, MD President and Chief Medical Officer Trinity Mother Frances Hospitals and Clinics 1 Trinity Clinic digest WINTER 2015
2014 Service Excellence Award Winners Recognized At Trinity Mother Frances Hospitals and Clinics, service excellence is part of the foundation of our culture. The Trinity Clinic Service Excellence Award recognizes exceptional performance or behavior that meets or exceeds the expectations of our established service standards. This year, more than 20 nominations were submitted by co-workers, managers and physicians. “The number of nominations we received is a direct reflection of the good work of our providers to provide quality care to our community,” says Mark Anderson, MD, Trinity Clinic Board President. “Each of our award winners embodies our mission of enhancing community health through service with compassion, excellence, and efficiency. They are to be commended.” Amy Starr, MD, People and Culture Committee Chair, recognized the following award recipients at the 2014 Trinity Clinic Excellence Award celebration held in November.
C O N G R A T U L A T I O N S
Clinical Quality Roger Fowler, MD Family Medicine Dr. Fowler has worked diligently to help create quality dashboards that show providers how well their patients are being managed and provides tools and suggestions for meeting quality goals.
Innovation Feng Li, MD Gastroenterology Dr. Li was trained in ERCP, endoscopic ultrasound and balloon-assisted enteroscopy, three important techniques previously unavailable at Trinity Clinic Gastroenterology and has helped us to grow and advance the level of comprehensive care we provide our patients with digestive diseases.
Mission/Service J. Rick Rogers, MD Pediatrics Serving as a missionary for six months prior to starting his private practice in Tyler, Dr. Rogers maintains the heart of a missionary as he serves patients in East Texas and around the world. He is influential in initiating others into the realm of missionary service by his leadership and his example.
Customer Service Hans Schuricht, MD Ophthalmology In addition to providing the highest quality eye care, Dr. Schuricht’s excellent bedside manner endears him to his patients. While serving in Iraq, he not only helped soldiers retain their vision but also worked to improve their appearance following devastating trauma.
Leadership C. Fagg Sanford, MD Cardiology Consistently at the forefront of developing the medical community in Tyler and in cardiac care, Dr. Sanford has further demonstrated his leadership acumen by working to refine our mission and culture, and leading our liaison with the Studer Group.
Patient Safety Shawn Dunn, MD Pain Medicine Dr. Dunn created an opioid clinic and chronic pain service to ensure that at-risk patients are receiving the proper (and safe) doses of opioid medicines that have high risk of abuse.
Education/Research Thomas Hargrove, MD Pediatrics An early advocate for the use of electronic medical records, Dr. Hargrove led the implementation of Epic and continues to utilize the information within the EMR to further provide quality and efficient patient care. tmfhc.org 2
Trinity Clinic Celebrates 20 Years Twenty years ago, several small Tyler practices worked independently to care for residents of Smith County. With an eye toward the future, three practices joined forces to form Trinity Clinic, which today is the preferred multispecialty medical group in the area, with over 350 physicians and advanced practice providers representing 36 specialties in 31 clinic locations serving East Texas. “We realized that together, our specialties could provide better, coordinated care for our patients,” says Steven Keuer, MD, President and Chief Medical Officer of Trinity Mother Frances Hospitals and Clinics, and founding member of Trinity Clinic. One year later, Trinity Clinic merged with Mother Frances Hospital to create Trinity Mother Frances Hospitals and Clinics. “Trinity Clinic has a history of having well-respected, highly trained providers delivering quality, compassionate care,” says Chris Glenney, Chief Administrative Officer and Senior Vice President of Trinity Clinic. “That culture has led to the success of the clinic for 20 years and will continue to lead us in the future.”
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Matters of the Heart Mark Barret, MD
Seven years ago, I made a decision to bring my family to Uganda for spring break. To be honest, the purpose was totally unclear at the time. Little did I know that God was about to grab my heart and those of my family members for a new and challenging purpose. Before we could blink an eye, we found ourselves as executive directors of a vital ministry that today employs 125 people. Never in my wildest imagination did I think I would be traveling to East Africa four times a year and also leading the 48th Parental Care Ministries (PCM) trip in early March 2015 while still seeing as many patients at TMF as I ever have! When our family first visited Uganda in 2008, PCM had one school of 120 children with little or no food, clean water or hope for any kind of future. Yet, deep inside these hurting children’s precious hearts was a fullness of joy and gratitude that was undeniable. Glimpses of a great hope have compelled us to return again and again and again! Today, PCM oversees seven schools and nearly 2,000 children – all needy and some orphaned. We have nearly 900 of the children currently sponsored by local families. We are about to open our first ever PCM Omwana “baby” House for those children who are thrown away or abandoned. PCM now has three farms where we grow as much of our own
food as we can. We are sharing Jesus in 70 rural churches and supporting the pastors with our Cows for the Kingdom program and bicycle programs. In November of 2014, PCM was given its first ever radio station, and we will be on the air very soon. With prayer and the help of our two providers and four nurses, we are making a difference at the PCM Kate Medical Clinic. This spring the PCM Choir #3 will be performing and the first stop is Tyler, Texas on April 8-28. To follow along with Dr. Barret and hear more of the good news that is growing, visit pcmonline.org
Quality Update
By: Andria Cardinalli-Stein, MD, Chair, Trinity Clinic Quality Committee Quality can be defined as the combined benefit of appropriateness of care, good outcomes, and service divided by the cost of providing that service. Or for those who work better with equations:
( )
(
O+S Outcome + Service –––––––––––– Q = A ––– W Quality = Appropriateness Waste
)
Over the last several months, the Quality Committee has taken forward steps in these areas: For patient safety as well as customer service, we have challenged all providers to provide InBasket coverage when absent for more than four days so that important results do not go unseen or unaddressed; while allowing ourselves and our partners a much needed break at times to avoid burnout. By facilitating communication with colleagues at Tyler Radiology Associates, we have worked together to improve the quality of our radiology reports. We ask that physicians continue to use the ‘P ADDENDUM REQUEST IMAGING SERVICES’ InBasket within ConnectCARE to get timely clarifications or revisions to reports when needed. Issues can also be addressed by calling the radiologists directly as they are now listed in the Trinity Mother Frances Physician Directory. 5 Trinity Clinic digest WINTER 2015
In the interest of safety, we now provide condensed versions of MedWatch summaries from the FDA to better distribute medication information. We are also revising our Sample Medication Policy to reduce risk to our organization and provide this service in the most appropriate manner possible, and move to maintain a supply of only those medicines necessary for patient safety and high quality outcomes. Similarly, we have provided education on how to prescribe and appropriately document hydrocodone-containing prescriptions with the new classification. Please remember that while we want to limit prescription of hydrocodone-containing compounds only to patients who really benefit from them, we do not want to abruptly stop prescribing these medicines without addressing a patient’s pain in another manner. All of the work toward quality improvement that we have done as an organization has been recognized and we are achieving high quality. The PQRS (Physician Quality Reporting System) summary report for 2013 showed us to be among the organizations nationally which provide higher quality care, however we do so at a higher cost than average. This is an area where we and other members of our organization will be focusing additional efforts. Thank you for your efforts to provide high quality care to our patients each and every day.
Doc-to-Doc Peripheral Artery Disease Affects Many, But Can Be Prevented If a patient complains of pain or cramping in his legs or feet, especially after walking or climbing stairs, it is not something to ignore. It could be peripheral arterial disease (PAD), which affects one in 20 Americans over the age of 50. “PAD is the narrowing or blockage of the vessels that carry blood from the heart to the legs and is caused by the build up of plaque in the arteries, known as atherosclerosis,” says Todd P. Smith, MD, Trinity Clinic Vascular Surgery. “PAD is caused by the same risk factors that lead to heart disease, including smoking, hypertension, diabetes, high cholesterol and obesity,” he says. According to the National Institute of Health, PAD most commonly affects blood flow to the legs, and is a warning sign that other arteries, including those in the heart and brain, may also be blocked–increasing the risk of a heart attack or stroke. When blood flow is blocked, pain and numbness often occur. This also can increase chances of infection and make it difficult for the body to fight infection. In worst cases, blocked blood flow can cause gangrene. In fact, PAD is the leading cause of leg amputation. To correctly diagnose PAD, it’s important to perform a thorough history and physical exam of the patient. Some of the tests that may help diagnose PAD include: • Ankle-Brachial Index • Magnetic Resonance Angiogram • Doppler Ultrasound • Arteriogram • Treadmill Test • Blood Tests After diagnosis, Dr. Smith says there are a number of ways to treat PAD. “Treatment ranges from conservative management with exercise programs and medication, to more invasive treatments of arteriogram and possible angioplasty/stent placement or bypass surgery,” he says. The good news is that a person can lower his or her risk for PAD by taking steps to learn about the disease and how to prevent it. “The prognosis for PAD is excellent if diagnosed and treated early,” says Dr. Smith. “Patients should quit smoking, control their blood pressure and diabetes, eat a healthy diet and participate in an exercise program. These not only decrease the risk of developing PAD, but also decrease the risk of complications following treatment for PAD.” For more information, contact Trinity Clinic Vascular Surgery at (903) 606-1400.
Other PAD symptoms to watch for: • Color changes in skin, paleness, • Pain, aching, and heaviness in the muscles • Cramping in the legs, thighs, and calves • A weak or absent pulse in the legs or feet • Sores or wounds on toes, feet, or legs that heal slowly, poorly, or not at all
or blueness • Lower temperature in one leg compared to the other leg • Poor nail growth and decreased hair growth on toes and legs
Risk of PAD increases for those who: • Are over the age of 50 • Smoke or used to smoke. Those who smoke or have a history of smoking have up to four times greater risk of developing PAD. • Have diabetes. One in every three people over the age of 50 with diabetes is likely to have PAD. • Have high blood pressure. Also called hypertension, high blood pressure raises the risk of developing plaque in the arteries. • Have high blood cholesterol. Excess cholesterol and fat in your blood contribute to the formation of plaque in the arteries, reducing or blocking blood flow to your heart, brain, or limbs. • Have a personal history of vascular disease, heart attack, or stroke. If you have heart disease, you have a one in three chance of also having PAD. • Are African American. African Americans are more than twice as likely to have PAD. Source: National Institute of Health, National Heart, Lung and Blood Institute tmfhc.org 6
ConnectCARE Update By: Mary Peterson, Manager, IT Service, Communications and Training
With 2014 behind us, we can look back on a year of challenge, change and accomplishment for Information Technology at Trinity Mother Frances Hospitals and Clinics.
Trinity Mother Frances Achieves HIMSS Analytics Stage 6 Tom Hargrove, MD, CMIO Receives Board Certification in Clinical Informatics Tom Hargrove, MD, already board-certified in Pediatrics, recently added certification in Clinical Informatics by demonstrating professional experience in this field to the American Board of Preventive Medicine, and then passing the board certification examination in October 2014. Clinical Informatics is a new subspecialty – the American Board of Medical Specialties approved it in 2011 – and the first certificates were awarded in 2013. For Dr. Hargrove to complete this subspecialty so expediently is a testament to his demonstrated skills in this evolving field, and his commitment to apply these skills to improve the health outcomes of the patients of Trinity Mother Frances Hospitals and Clinics. Congratulations Dr. Hargrove!
The Healthcare Information and Management Systems Society (HIMSS) created the Electronic Medical Record Adoption Model (EMRAM) to provide a methodology for evaluating the progress and impact of electronic medical record (EMR) systems for acute care and ambulatory delivery environments. Achieving Stage 6 is a significant milestone for Trinity Mother Frances and reflects the focus and commitment of the entire organization. To achieve HIMSS Analytics Stage 6, institutions must have established clear goals for improving safety, minimizing errors, and prioritizing IT implementations. Stage 6 organizations are positioned to successfully address many of the upcoming industry transformations such as HIPAA Claims Attachment, pay for performance, and government quality reporting programs. There are seven stages in the HIMSS EMR Adoption Model. Only 17.7 percent of hospitals in the U.S. have achieved Level 6 as of December 2014. Trinity Clinic shares in this achievement with 63 of the 279 Stage 6 Texas providers and 2,265 nationally.
Meaningful Use This past year, Trinity Mother Frances achieved several significant Meaningful Use milestones. First, 99 percent of Trinity Mother Frances’s Stage 2 eligible providers successfully attested for Meaningful Use. Secondly, Mother Frances Hospitals in Tyler, Jacksonville and Winnsboro all successfully attested for the second time. Third, we are now sending electronic referrals and discharge instructions to the majority of providers and health care organizations in the region through our HISP connection and TrinLink. The combined efforts of providers, nurses, support staff and the ConnectCARE team help Trinity Mother Frances achieve Meaningful Use performance requirements, improving care for the patients we serve.
What’s Next in Meaningful Use? The 2015 Meaningful Use reporting period for all providers began January 1 and will run the entire year. The reporting period for Trinity Mother Frances is October 1, 2014 through September 30, 2015. All hospitals and the majority of our providers will be measured on Stage 2 Meaningful Use guidelines. Please pay close attention to the upcoming ConnectCARE Flash updates as they include important and specific details on your Meaningful Use performance role and how you can continue to improve the quality of care we deliver to our patients one click at a time. For more information on Meaningful Use guidelines, visit cms.gov or contact your Meaningful Use Team at (903) 606-4238.
ConnectCARE Upgrade The year 2014 marked the second year of being live on the ConnectCARE electronic health record, powered by Epic. In November, a major Epic upgrade, from Epic 2010 to the 2014 version, brought enhancements and improvements to our end users, physicians and patients. As of December 2014, over 61,000 patients are actively using the MyChart patient portal, now with new features including online bill pay, online appointment scheduling and additional results reporting. 7 Trinity Clinic digest WINTER 2015
Coming Soon! Transcribe, edit and write all by voice!
Outlook Migration Over a 90-day period ending in June 2014, email and calendars were migrated from GroupWise to Microsoft Outlook, a significant achievement touching almost every Trinity Mother Frances employee. Over 4,522 individuals and 69 shared resources made the transition. To support the change, multiple live classes were held and a training site developed. This was part of a multi-phased transition that will culminate with an enterprise-wide rollout of Windows 7 and Office 2013 in 2015.
Computer-Assisted Coding
In August, Trinity Mother Frances implemented 3M’s 360 Encompass computer-assisted coding system, which merges clinical and financial data into one system. This allows for the analysis, supplementation and proactive execution of key clinical and financial data at the point of care, resulting in significant impact on patient outcomes and hospital reimbursement
Looking Ahead
Dragonis the world’s best-known speech recognition software that merges fast, accurate speech recognition with versatile transcription to fit the way our physicians and advanced practice providers work. This application is integrated with ConnectCARE and will be tested by a number of providers before it is launched system-wide. This enhancement will provide improved efficiency for our caregivers.
Trinity Mother Frances will launch implementation of Cerner Millennium lab information system with an expected November 2015 activation. ICD-10 coding update will be a major focus with an implementation date of October 2015.
CME Calendar Mar. 6
MD/RN Grand Rounds - 1.0 CME Credit
Mar. 17
Family Practice/Internal Medicine Conference - 1.0 CME Credit Wisenbaker Conference Center
Mar. 19
Medical Spiritual Ethics - 1.0 Ethics Credit
Mar. 19
Pediatric Grand Rounds - 1.0 CME Credit (provided by UTHCT) ETMC Pavilion
Apr. 10
MD/RN Grand Rounds - 1.0 CME Credit
Wisenbaker Conference Center
Apr. 11
Orthopedic Symposium - 4.5 CME Credits
Wisenbaker Conference Center
Apr. 16
Medical Spiritual Ethics - 1.0 Ethics Credit
Haddad Hall
Apr. 16
Pediatric Grand Rounds - 1.0 CME Credit (provided by UTHCT) ETMC Pavilion “Recognition and Evaluation of Physical Abuse” Jayme Coffman, MD Cook Children’s Family Practice/Internal Medicine Conference - 1.0 CME Credit Trinity Clinic Douglas Conference Room 12:15-1:15pm Lunch provided
Apr. 21
Wisenbaker Conference Center
Wisenbaker Conference Center
Noon-1pm Lunch provided Noon-1pm Lunch provided Noon-1pm Lunch provided Noon-1pm Lunch provided Noon-1pm Lunch provided 7:30am-1pm Breakfast provided Noon-1pm Lunch provided Noon-1pm Lunch provided
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Patient Centered Medical Home/Population Health Update By: Roger Fowler, MD, Lead Physician, Patient Centered Medical Home Congratulations to Trinity Clinic Primary Care for receiving recertification as a level III practice, the highest level of recognition by the National Committee for Quality Assurance (NCQA). What does that mean to you and the organization for which you work? At Trinity Mother Frances Hospitals and Clinics, we are focused on seven principles that describe the Patient-Centered Medical Home. These principles were adopted by the American Academy of Family Practice, the American Academy of Pediatrics, the College of Physicians and American Osteopathic Association in 2007, and include: •O ngoing relationship with personal physician • Team-based and physician-directed medical practice • Whole person orientation •C oordination of care across the health system •Q uality and safety • E nhanced access to care • P ayment recognizes the value added This is also known as the Triple Aim: Population Health, Patient Experience and Per Capita Cost of Care. The newest element of the Trinity Clinic Medical Home is the Intensive Medical Home Clinic (IMHC) in Douglas Clinic. Under the medical direction of Kimberley Bryant, DO, Kelly Smith, FNP-C, is an advanced practice provider who helps with the clinical care and a robust team of caregivers helps formulate and fulfill a care plan for patients with the greatest need. The accompanying figure (fig 1) identifies that population. They are the group at the peak of
{
TMF Medical Home Health Care Spend Percentage of Total Cost
1%
29%
2-5%
27%
6-15%
23%
16-30%
31-100%
Figure 1 9 Trinity Clinic digest WINTER 2015
13%
7%
Membership Distribution Percentage of Total
{
Intensivist Medical Home Model (6.5 FTEs) 1. S pecialized Care Team MD (.5), NP (1), NN (4), CC (1) 2. Medication Therapy Management 3. Extended Office Visits 4. 24/7 Access 5. Membership Card 6. Direct Line
the pyramid that utilizes the greatest amount of healthcare defined by utilization and dollars. This is an internal IMHC referral for patients with defined criteria that are found in the referral box within the referral module of ConnectCARE. The team includes an RN nurse navigator, another RN for triage, a pharmacist and eventually, a mental health provider, in addition to a medical assistant and office assistant. Typically, this population of patients has no primary care provider and often seeks treatment in the emergency department. They may be discharged from hospitalization, and have a great need for immediate follow up. They may also have chronic medical conditions with multiple co-morbidities. The medical home team is very sensitive to all of the needs of the patient. This includes health literacy, income, transportation, language, other psychosocial needs, later life planning as well as medical needs. This is not a surgical or trauma follow up clinic. The team is not equipped for addiction or chronic pain management or complex psychiatric disease. Our goal is to ensure the highest measurable quality for our primary care medical home measures as well as a reduction of emergency department and hospital admissions. For more information regarding Trinity Clinic’s IMHC, call (903) 606-7034, or refer to the HealthStream MD/RN Grand Rounds from December 2014. If you have a qualifying patient, please do not hesitate to reach out to this team for help.
Care Coordination Program 1. Preventive Care Screenings 2. Chronic Illness Maintenance 3. Education and Outreach Objectives 1. Increase Visits 2. Downstream Revenue 3. Lower No-shows
Physician Engagement Survey Why Medical Staff feedback is crucial to strategic and operational planning for the system
What The survey will be distributed online, individually, by confidential email How Administered through the Advisory Board Coming March 2015
On the Shoulders of Giants Reflections from Ken Cushman, MD, Family Practice and Founding Member of Trinity Clinic Kenneth Cushman, MD, is a family practitioner at Trinity Clinic Douglas and also a founding member of Trinity Clinic. A native of Toronto, Can., Dr. Cushman came to Tyler in 1977 to join Tyler Medical Surgical Clinic. Forming Trinity Clinic “In 1995, my colleagues and I felt that expansion was necessary, with all the changes in healthcare coming – such as insurance regulation and governmental intrusions. We chose Cardiovascular Consultants and Tyler Gastroenterology because they were highly skilled and trustworthy. That is where the name Trinity came from. Mother Frances Hospital had the same vision we did. A year later, we formed Trinity Mother Frances.”
The Success of Trinity Clinic “As one of the founding physicians, it’s gratifying to see how it’s all come together. We now have 300-400 practitioners as well
as doctors who are not a part of our group, but with whom we work very closely. That’s something.”
What makes Trinity Clinic successful? “I think it still comes down to the doctor patient relationship. You have to have good quality physicians whom patients appreciate and get along with. At Trinity Clinic, we can care for a patient’s entire life’s worth of healthcare issues all underneath one roof, in one system. And, we try to give good access to people so they can be seen when they need to be seen.”
The Future of Trinity “Primary care is the bedrock of our clinic. A strong primary care group is what makes a health care system function well – we’ve maintained the strength of primary care and will likely expand that in the future. When we formed Trinity Clinic, our doctors were all high quality physicians. If we continue in that vein, Trinity Clinic will continue to succeed.” tmfhc.org 10
Trinity Mother Frances Hospitals and Clinics 800 E. Dawson Tyler, Texas 75701
tmfhc.org Trinity Clinic digest is
published quarterly as part of an ongoing effort to serve the needs of Trinity Clinic providers. For referral information or general assistance, please contact: Mike Hines General Physician Relations 500 S. Beckham Tyler, Texas 75702 Phone (903) 530-8914 Fax (903) 525-1206 mike.hines@tmfhc.org John Idrogo Cardiology Physician Relations 500 S. Beckham Tyler, Texas 75702 Phone (903) 530-8914 Fax (903) 525-1206 john.idrogo@tmfhc.org Jerod Kersh Imaging Services 500 S. Beckham Tyler, Texas 75702 Phone (903) 521-4743 Fax (903) 525-1206 jerod.kersh@tmfhc.org
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Welcome New Providers Doug Hodde, MD TMF Whitehouse Family Medicine
Jason Barnette, CRNA Mother Frances Hospital Tyler TC Anesthesia
Lauren Leviton, CRNA Mother Frances Hospital Tyler TC Anesthesia
Brady Thompson, CRNA Mother Frances Hospital Tyler TC Anesthesia
Lisa Ferguson, FNP TMF Lindale Family Medicine
Diana LaBumbard, ACNP, GNP TC Gastroenterology
Nalini Patel, FNP TC Pain Management
Allyson Thompson, FNP TMF Kilgore
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