Fall magazine 2017

Volum e L X X IV, No . 3 • F a ll 2 0 1 7

Se r ving the Gr e ate r M e tr opolitan Knoxvi l l e Area

KAM/KAMA NEW MEMBER AND YOUNG PHYSICIANS PICNIC MORE ON PAGE 7

KAM KNOXVILLE ACADEMY OF MEDICINE

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KNOXVILLE ACADEMY OF MEDICINE

KNOXVILLEMEDICINE.ORG

Academy Officers

PRESIDENT’S MESSAGE By: Neil Coleman, MD

KAM KNOXVILLE ACADEMY OF MEDICINE

Neil Coleman, MD PRESIDENT

Tim Wilson, MD PRESIDENT ELECT

Daniel Bustamante, MD SECRETARY

Jeff Ollis, MD TREASURER

Thomas Pollard, MD

IMMEDIATE PAST PRESIDENT

Kimberly Weaver, PhD CEO

Board of Trustees Michael Brunson, MD Brian Daley, MD David Harris, MD Zac Jumper, MD Ceeccy Yang, MD

Ex- Officio Board Members Richard Briggs, MD Debbie Christiansen, MD Randal Dabbs, MD Elise Denneny, MD Richard DePersio, MD Jerry Epps, MD Barbara Crist -KAMA Mike Maggart, MD Patrick McFarland, MD Robert Page, MD Max Keeling -LMU

Publisher Kim Weaver, PhD

Editor Jonathan Weaver

Production Coordinator Margaret Maddox

Advertising David Caudill

ADVERTISING: For advertising information, call the Academy offices at (865) 531-2766. The magazine is published four times per year by the Knoxville Academy of Medicine (KAM). All rights reserved. This publication or any part thereof may not be reproduced without the expressed written consent of the KAM. The appearance of advertising in KAM publications is not a KAM guarantee/endorsement of the product or the claims made for the product by the manufacturer.

The fact that an advertisement for a product, service,

Dear Friends and Colleagues, What a wonderful phenomenon we experienced with the passing of the eclipse. For the vast numbers who experienced it across the state, it was a surreal few minutes that allowed us to see the world in a different light. The hype surrounding the eclipse was infectious, and it is that kind of energy that we, as physician leaders, need in order to accomplish real change for the better in our community’s healthcare delivery system.

The past decade has been an era of expansion for the Academy, in terms of membership and the services that the Academy provides for its membership.

Physician membership has grown, but we have also reached out to involve more medical students from LMU and UT who are spending their clinical years in the Knoxville region. Our top-notch staff, led by Kim Weaver, has worked hard to obtain grants and expand the services the Academy provides for the public, through the KAM Foundation with Knoxville Area Project Access, and now KAPA Connects, as well as, the benefits the Academy offers to its members. One new membership benefit is the offering of lump-sum disability insurance to our members. It is an exclusive opportunity to obtain disability insurance that may otherwise be unavailable to some. As part of the expansion in services the Academy provides, the KAM board is in the process of planning for a new home for the Academy, a building space that can accommodate the growing staff who help us to provide those services to the community.

Please plan to attend some of the upcoming fall KAM events, including the KAM Alliance Fashiondrama fundraiser in September. Of particular importance is the upcoming dinner with our legislators on October 26th, which is a unique opportunity for our membership to break bread with those who serve us in the State legislature. Hot topics, such as the of proper qualification and supervision of mid-level providers, limiting the burdens of Maintenance of Certification programs, and ensuring that we continue to practice in an environment that keeps excessive malpractice claims in check, are all important issues

that our legislators need to hear us weigh in on personally. I encourage everyone to read the TMA’s white paper entitled “A Blueprint for Team-based Healthcare”, which can be found on the tnmed.org website. A key component of that plan is that the team be physician-led. The delivery of healthcare in our region of Tennessee and across the state should be a team effort, led by those with the most experience and training in diagnosing and treating diseases. Please come out and show our legislators that we are ready to step up and lead.

We should all be proud of the Knoxville Academy of Medicine, which acts as a backbone of support for our practices, our patients, and our community’s health as a whole. Please contact me anytime if there is anything I can do for you.

Warm regards, Neil Coleman, M.D. ncoleman@dermpathpartners.com 865-474-8866 President, Knoxville Academy of Medicine

Stay Connected

So be sure to like us on Facebook and follow us on Twitter!

- facebook.com/Knoxdocs - twitter.com/KnoxMedicine

or company has appeared in a KAM publication shall not be referred to in collateral advertising. The KAM

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reserves the right to accept or reject any advertising in the publication.

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ACADEMY NEWS New Members

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KNOXVILLE ACADEMY OF MEDICINE

A big welcome to our newest members! We are excited that you have decided to join the Knoxville Academy of Medicine.

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MISHAL ABDULLAH, MD

NORMA EDWARDS, MD

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PIERCE ALEXANDER, MD

YI FENG, MD

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LISA BOWLING, MD

HESAMM GHARAVI, MD

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KEVIN CAMPBELL, MD

PHILLIP HAGGERTY, MD

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ANDREW CONRAD, MD

CELESTE HARNDEN, MD

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RUSSELL DEVORE, MD

HARRY R. HIXSON, MD

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TRACY DOBBS, MD

DANIEL IBACH, MD

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SCOTT DRYZER, MD

ROSS KERNS, MD

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SAJI EAPEN, MD

RICHARD LEE, MD, FACP

RHEUMATOLOGY Rheumatolgy Associates of East TN 8975 Executive Park Dr, Ste 200 Knoxville, TN 37923

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INTERNAL MEDICINE Summit Medical Inpatient Services 1225 E. Weisgarber Rd Ste N-200 Knoxville, TN 37909

FAMILY MEDICINE Summit Medical Group 9333 Park West Blvd Knoxville, TN 37923

FAMILY MEDICINE Summit Medical Group Deane Hill 7211 Wellington Dr, Ste 201 Knoxville, TN 37919

RADIOLOGY Vista Radiology 2001 Laurel Ave Ste 304 Knoxville, TN 37916

ONCOLOGY TN Cancer Specialists 900 E. Hill Ave, Ste 230 Knoxville, TN 37915

ONCOLOGY TN Cancer Specialists 900 E. Hill Ave, Ste 230 Knoxville, TN 37915

Left Column Top to Bottom: Mishal Abdullah, MD; Pierce Alexander, MD; Lisa Bowling, MD; Kevin Campbell, MD; Andrew Conrad, MD; Russell Devore, MD. Center Column Top to Bottom: Tracy Dobbs, MD; Scott Dryzer, MD; Saji Eapen, MD; Norma Edwards, MD; Yi Feng, MD; Hesamm Gharavi, MD. Right Column Top to Bottom: Phillip Haggerty, MD; Celeste Harnden, MD; Harry R. Hixson, MD; Daniel Ibach, MD; Ross Kerns, MD; Richard Lee, MD, FACP.

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PULMONARY MEDICINE Summit Medical Inpatient Services 1225 E. Weisgarber Rd Ste N-200 Knoxville, TN 37909

ONCOLOGY TN Cancer Specialists 900 E. Hill Ave, Ste 230 Knoxville, TN 37915

GENERAL SURGEON Premier Surgical Associates PLLC 9430 Park West Blvd Ste 310 Knoxville, TN 37923

ONCOLOGY TN Cancer Specialists 900 E. Hill Ave, Ste 230 Knoxville, TN 37915

ONCOLOGY TN Cancer Specialists 900 E. Hill Ave, Ste 230 Knoxville, TN 37915

ANESTHESIOLOGY Anesthesiology & Pain Management Consultants 2606 Greenway Dr. Ste 101 Knoxville, TN 37918

FAMILY MEDICINE Summit Medical Inpatient Services 1225 E. Weisgarber Rd Ste N-200 Knoxville, TN 37909

RADIOLOGY Vista Radiology PC 2201 Laurel Ave, Ste N304 Knoxville, TN 37916

ONCOLOGY TN Cancer Specialists 900 E. Hill Ave, Ste 230 Knoxville, TN 37915

ONCOLOGY TN Cancer Specialists 900 E. Hill Ave, Ste 230 Knoxville, TN 37915

ONCOLOGY TN Cancer Specialists 900 E. Hill Ave, Ste 230 Knoxville, TN 37915

KAM KNOXVILLE ACADEMY OF MEDICINE

New Members

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KNOXVILLE ACADEMY OF MEDICINE

KNOXVILLE ACADEMY OF MEDICINE

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A big welcome to our newest members! We are excited that you have decided to join the Knoxville Academy of Medicine.

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RANDY LOVELACE, MD

ELISE SCHRIVER, MD

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MITCHELL MARTIN, MD

ROBERT SCHUMAKER, MD

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ANDREA MEADOWS, MD

TIMOTHY WILLIAMS, MD

PULMONARY MEDICINE Summit Medical Inpatient Services 1225 E. Weisgarber Rd Ste N-200 Knoxville, TN 37909

ONCOLOGY TN Cancer Specialists 900 E. Hill Ave, Ste 230 Knoxville, TN 37915

PULMONOLOGY University Pulmonary and Critical Care 1940 Alcoa Hwy Suite E210 Knoxville, TN 37920

ONCOLOGY TN Cancer Specialists 900 E. Hill Ave, Ste 230 Knoxville, TN 37915

PEDIATRICS Knoxville Pediatric Associates 2201 Clinch Ave Knoxville, TN 37916

FAMILY MEDICINE Summit Medical Group Dean Hill 7211 Wellington Dr, Ste 201 Knoxville, TN 37919

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Left Column Top to Bottom: Randy Lovelace, MD; Mitchell Martin, MD; Andrea Meadows, MD. Center Column Top to Bottom: Jennifer Savage, MD; Elise Schriver, MD; Robert “David” Schumaker, MD

JENNIFER SAVAGE, MD

NEUROLOGICAL SURGEON Neurosurgical Surgical Associates 1921 Alcoa Hwy Ste 580 Knoxville, TN 37920

Right Column Top to Bottom: Timothy Williams, MD.

Additionally, we would like to welcome the following new KAM Resident Members and Students: Residents: Daniel Albarran, MD Ryan Alexander, DO Aaron Arroyoyave, MD Matthew Beidleman, MD Oliver Benton, IV, MD Stephen Burd, MD Robert Chalmers, DO Katherine Cochrane, MD Sujata Datta, MD Melissa Davis, MD Ryan Dorman, DO Randall Echols, MD Melissa Eggert, MD Mario Figueroa, MD Ernest Fonocho, MD Benjamin Ford, MD Brogan Fulks, MD Daniel Fulks, MD Alan Good, MD David Hales, MD Alexander Hicks, MD Wesley Ingram, MD Alan Itkin, MD

Dominic Jacobelli, MD Serena Jen, MD Courtney Jenny, MD Robert Jones, MD Thomas Kennedy, MD Anicka Kolarik, MD Morgan Lane, DO Paul Lesko, MD Spencer Leong, MD Michael Lew, MD Jacqueline Linton, MD James Livesay, DO George Lodeiro, MD Zachary Marlette, MD Tyler McLaurine, MD David McMillan, MD Amy Modlin, DO Charles Munderloh, MD Charles Nechtman, MD Alina Novoa, DO Evelina Pierce, MD Anne Rajkumar, MD Eric Riedinger, MD Jacob Robbins, DO

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Nathan Royal, MD Ashley Scheiderer, MD Emily Shelton, MD Erin Smith, MD Jacob Snyder, DO Ashish Thakkar, MD Sneha Thakur, MD Joseph Titon, MD Hunter Upton, MD David Wilson, DO Students: William Akin Natthew Arunthamakun Claudia Ayoub Connor Bartow Taylor Beckmann Jacek Bednarz Cassandra Blackwell Jesse Brookner Kristen Campbell Amber Chatta Vitaly Chenish William Clements John Collins

Andrew Crowe Michael Davis Michelson Dorime Phillip Dougherty Diane Angela Fernandes John Flach Stephen Fugua Alyssa Hall Sarah Haseen Amy Howk Kiara Jamison Andrew Kong Max Keeling Aly Kozacek Michelle Lam Sabina Mindy Lin Allison Lubert Rebecca Lynn Stefania Markou Lauren McCartan Melanie McCown Christopher McDaniel Daniel Mok Grayson N Mynatt

Bishrut Nepal Terrance Nowell Sydney O’Gorman Alyssa Obermiller Oluwakemi Ogunmuko Katielynn Parrott Mishra Prishant Skyler Reed William Rogers Jesus Salas Ellen Schneider Morgan Shettle Micah Shook Rebecca Sekulich Corey Smith Kathryn Scheinberg Katherine Sullivan Bryce Taylor Megan Tuttle Leslie Uche Gabriella Verde Jason Villasenor Andrew Woods Brittany Zeller

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A Day at the Races

KAM KNOXVILLE ACADEMY OF MEDICINE

KAM & Capital Financial Group present: "A Day at the Races" Saturday, October 7 $65 Physician Members and Member Guests $75 Non-members

(Discounted Rate, Regularly $135)

Join us for a trip to Keeneland Racetrack in Lexington, KY for the best in Thoroughbred Horse Racing.

Register at knoxvillemedicine.org or call Andrea Brown at (865) 531-2766

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Ticket price includes: Private dining in the Phoenix Room overlooking the Paddock Chartered Motorcoach Meal on the bus returning to Knoxville Complimentary alcoholic beverages and sodas served to and from the event on the bus Private Betting Windows

As an added bonus... Earn CME on the trip there!

Free CME Course- Physician Contract Negotiation: A Practical Guide

Credit Information: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education by the Tennessee Medical Association. The Tennessee Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Tennessee Medical Association designates this live activity “Physician Contract Negotiation: A Practical Guide” for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ACADEMY NEWS KAM/KAMA New Member and Young Physicians Picnic

KAM KNOXVILLE ACADEMY OF MEDICINE

This year’s Annual KAM/KAMA New Member and Young Physician’s Picnic was well attended and offered our new members the opportunity to get connected with other area members. The family friendly event featured BBQ from Sweet P’s served poolside, great company and even a playground for the kids. Welcome new members! We are thankful that you have chosen to support your profession through organized medicine. We truly are better together!

- Photography by Sandy Ange

Tacos and Tequila New Resident Mixer a Success UTMCK residents gathered at Soccer Taco in Market Square to welcome the new residents to Knoxville and the Knoxville Academy of Medicine.

This year’s KAM New Resident event called “Tacos and Tequila,” was sponsored by Capital Financial. Residents enjoyed an expanded taco bar along with margaritas, beer and the opportunity to win numerous prizes. Resident liaison to the KAM Board of Trustees, Dr. Patrick McFarland, was also present and assisted in welcoming residents and ensuring that all had a great evening.

- Photography by Byron Maddox

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ACADEMY NEWS Legislative Update

External and Internal Regulation By: Elise Denneny, MD Older physicians are opting for early retirement faced with increasing external regulatory pressure from governmental bodies such as CMS (Center for Medicare and Medicaid services), NIH (National Institutes of Health), FDA (Food and Drug Administration), and HHS (Health and Human Services). Meanwhile young new physicians are coping with internal regulation from self-governing bodies such as ABMS (American Board of Medical Specialties), MOC (Maintenance of Certification) and BME/CME (Board of Medical Examiners/ Continuing Medical Examiners) Both argue the concept of “quality care” at the core of their mission.

If we had the courage to truly face ourselves we would acknowledge that money is driving these regulations. Under the guise of quality and competence, various member societies of the ABMS continue to extract time and dollars from their members for MOC. It is in our best interest to selfregulate but not self-penalize. Our respective boards were created to give us one voice for advocacy and collegiality. Why is it that our Specialty Boards have turned around and spent so much time on self-preservation, by creating “survival essential” generating revenues in the form of continuing education? As our specialty boards have expanded, commensurate staff needs and space have required more than just membership dues. As dues have risen physicians have been forced to choose which societies give the most value. Undoubtedly a measure of competence remains requisite lest we return to the days when one could buy a medical degree. Better that we work with our societies for reasonable internal self-regulation. Legis-

lation providing MOC relief has grown because our Specialty Societies either have a deaf ear or are slow to respond to member concerns. Too long, medical specialty boards have defaulted to the requirement of “board certification” for practice. This trump card does not confer the power to exploit. Some boards are reforming their process but many still lag behind.

We do not want the government in the process of creating metrics for physician competence. We have seen the problems with elimination of SGR and the creation of MIPS. As a very astute barrister posited to physicians, and I paraphrase, “you asked for elimination of the SGR but wait until you see MIPS.” In Tennessee we have “episodes of care” which while espousing to save the state monies, is forcing physicians to choose between levels of care. I encourage you to give your support to TMA President Elect Dr. Matt Mancini as he advocates for physicians and their patients on this difficult issue.

Advocacy is essential but traditionally not without sacrifice. Physicians are unique in that every minute we spend on advocacy is lost revenue generating time in the clinic. Over the years this has resulted in the absence of the physician voice at local, regional and national level of governmental health agencies that have daily implications on the practice of medicine.

If we are not present at these conversations our interests are not heard; a resulting negative impact.

Paid time for advocacy should be part of contractual agreements for employed physicians and other forms of remuneration should be created for other physicians.

Knoxville Academy of Medicine continues to advocate for you this upcoming year. I encourage you to exhort your colleagues to join in membership.

Calendar of Events LMU Grillin’ and Chillin’ Thursday, September 28, 2017 6:00 PM – 8:00 PM The University Inn

A Day at the Races - Trip to Keeneland

Saturday, October 7, 2017 Lexington, KY - Coach leaves from West Town Mall at 8:00 am

OSHA Workshops

Thursday, October 19, 2017 Knoxville Marriott

Pizza and Politics - LMU Monday, October 23, 2017 The University Inn at 6:00 pm

Legislative Dinner

Thursday, October 26, 2017 6:30 PM Gettysvue Country Club

Pizza and Politics for UT Residents and Med Students Thursday, November 2, 2017 UT Heart Hospital Conference Room 6:00 pm

RACMS Fall Meeting

Chief Medical Examiner for Knox County Darinka Mileusnic-Polchan, MD Thursday, November 9, 2017 6:30 PM Calhoun’s Oak Ridge

CME Saturday Blitz

Saturday, December 2, 2017 8:00 am - 12:30 pm Morrison’s Conference Center at UT Medical Center

BCMS Holiday Party

Featuring Sam Veneable Tuesday, December 5, 2017 6:30 PM Calhoun’s on the River

For more information and registration on all events visit knoxvillemedicine.org or call (865) 531-2766 8

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KAM The Time Is Now for Business in Medicine

By: Patrick McFarland, MD PGY4 (Fourth Post-graduate Year) AN Resident Dept. of Anesthesiology, UT Medical Center Knoxville A recent and noticeable trend in medicine has involved the incorporation of advanced business, financial, and management training into our medical education. From master’s degrees, to Lean Six Sigma training, additional non-clinical education is finding a niche in medicine. In fact, there are now two fellowships at the University of Tennessee Medical Center coupling a Physician’s Executive Masters in Business Administration (PEMBA) degree with their fellows’ clinical specialty training. Perhaps the demands of running operating rooms efficiently and effectively led to both the Departments of Anesthesiology and Surgery to consider offering these novel fellowship programs; however, the application of these advanced degrees extends throughout the hospital. From managing intensive care units and maintaining efficiency in emergency rooms, to improving quality care on hospital floors, this niche is becoming more of a consensus model, as it should be.

First, physicians’ roles are expanding. The fact patient populations are outgrowing development of healthcare providers is a contributing factor. We are seeing more patients and we are collaborating with multidisciplinary teams more often. All of this and more, while adhering to new quality and efficiency metrics in an ever-developing digital age, à la telemedicine and electronic records. Additionally, providers face the threat of penalization if certain metrics are not met in the new, up and coming, healthcare paradigm. Quite the juggling act, it may seem.

This is why the time for business in medicine is now. In providing

KNOXVILLE ACADEMY OF MEDICINE

healthcare for tomorrow, physicians’ roles and responsibilities will likely involve more leadership, management, and administrative duties, focusing on quality improvement and patient safety, in addition to daily clinical responsibilities.

In addition to assessing the expanding roles of physicians, we must also consider the change in job types available for physicians in today’s workforce. The individual or small group, “selfowned” practice model is becoming less common, being replaced by the “physicians-as-employees” model, either in large corporate practices or as outright hospital-based employees. In the former model, physicians are essentially buying into business in medicine, as their private practice depends on it. Business and managerial expertise becomes part of everyday decision-making. On-the-job training and real world experience go hand-in-hand with this model, obviating the need, somewhat, for advanced business education prior to entering the workforce.

The physicians-as-employees model, on the other hand, lacks this hands-on business experience, having little to no on-the-job training. This is particularly true for those who are less proactive. This model leaves physicians at the mercy of corporate and hospital executive boards, which may not always consist of physicians. Without physician representation on these boards, physicians’ interests may take a backseat in discussions that may affect them or their patients. Again, this is why the time is now for business in medicine; business acumen is required to function in corporate medicine and to ensure strong negotiating power. Following UTMC’s lead, we must put emphasis on business in medicine, not just in fellowships, but also in residency training and medical education. This is another necessary step in developing the future physician-leaders of tomorrow.

KAMA Corner

By: Tina Callicutt KAMA President, 2017-2018 The Knoxville Academy of Medicine Alliance is getting ready to start our 2017-2018 year. We kicked off the year with our annual KAM/ KAMA Young Physicians Picnic at Gettysvue on August 25. At our September 7th meeting, we were so fortunate to have humorist Sam Venable as our guest speaker. We were also lucky enough to have representatives from Premier Surgical Associates to present us with their generous gift of sponsorship for all three of our 2017-2018 KAMA fundraisers. This will mark our first success in a goal to obtain corporate sponsors for our organization.

Our financial focus this year is to continue to raise funds, so we can sustain our goal and pledge to serve our Knox County community. Our first fundraiser of the year, Fashiondrama, is already well underway.

We have formatted the fundraiser this year to save cost in such ways that have us very excited to see the final numbers that we may achieve.

These funds will go toward our scholarships and grants that we hand out at the end of our year. We have also been putting the final touches in acquiring a location for our annual Doc Rock fundraiser.

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We are looking forward to record numbers and record funds being raised this year with the change of time to January 20, 2018. Also, as our Fashiondrama team was hard at work securing donations and sponsorship for it, we were pleased to already get many commitments for our Spring Gala. We are really excited about the amazing possibilities that this new event will have for our organization. Along with our fundraising events, we have applied to some grants including one from Alliance Health Education Initiative (AHEI). This $1000 grant will help our KAMA Medication task force in our fight against drug abuse in our community. Our Sharing Card will also be a project in our efforts to raise funds again this year. KAMA’s endowed scholarships which include a University of Tennessee Medical School scholarship will be a few of the beneficiaries of our efforts as well.

KAMA wants to thank all of our KAM supporters. We could not do what we do every year if we did not have your aid. If you would like any information about KAMA, we are on Facebook under Knoxville Academy of Medicine Alliance, and our website is www.kamallliance. org. Tina Callicutt, KAMA president 2017-2018

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LEGAL NEWS

KAM

New State Reporting Requirements for Provider Drug Tests

By: Ian P. Hennessey, London & Amburn, P.C. A new state law meant to target healthcare providers who divert controlled substances for personal use includes reporting requirements for healthcare employers. Effective July 1, 2017, it is a violation of a healthcare provider’s practice act if such provider refuses to submit to a drug test or tests positive for any drug on “any government or private sector preemployment or employer-ordered confirmed drug test” and “does not have a lawful prescription for using the drug or a valid medical reason for using the drug.” T.C.A. § 63-1-160(b). If a healthcare provider refuses to submit to a drug test or tests positive under such circumstances, then the provider shall be given three days from the time he or she was notified of the confirmed test result to (1) produce a lawful prescription or valid medical reason for using the drug to the employer or (2) report to the applicable substance abuse peer assistance or treatment program for the provider’s licensing board.

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So long as the provider maintains the advocacy of the peer assistance or treatment program, the employer is not required to notify the appropriate board of the violation of the provider’s practice act unless otherwise required by law. If the provider fails to do so, the employer is required to notify the provider’s applicable licensing board. Providers who enter their board’s peer assistance or treatment program must comply with all of the program’s terms and conditions.

If the provider fails to comply, then the provider’s board is required to suspend the provider’s license. In addition, the board is not prohibited from taking any other disciplinary action authorized by law for conduct other than a positive drug test or refusal to submit to a drug test. It is yet to be seen how and to what extent the healthcare licensing boards will enforce the new law against employers who fail to report their providers.

Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

OPIOID CRISIS: A NATIONAL EPIDEMIC By: Edward Capparelli, MD On August 10, 2017, President Donald Trump declared the opioid crisis a national epidemic. Every evening the news is filled with stories of overdose deaths and drug-dependent babies. There are reports of increased restrictions on opioid prescribing and FDA mandated reductions in opioid production. In the northeast, increased restrictions on narcotics prescriptions have led to an increased use of heroin and heroin deaths. In all 59,000 overdose deaths were reported for 2016. This surpasses motor vehicle accident deaths and gun-related deaths combined. What can be done to impact this problem?

We first must understand that the opiate problem has been with us for centuries. Mary Todd Lincoln, the wife of President Abraham Lincoln was addicted to opium. In the late 1800s, tincture of opium, also known as laudanum, was used in many patent medicines for pain, sleep disorders, irritation, anxiety, menstrual cramps, and diarrhea. Nurses even gave it to babies to treat colic. Heroin was introduced by Bayer Pharmaceuticals in 1898 as a cough suppressant. From the earliest days opium derivatives were used and also abused.

As we focus now on preventing new persons from misusing opioids we cannot forget that there are thousands if not millions of users who would like to come off them. In other chronic disease states such as diabetes and COPD, we do not stop therapy at early education. Although obesity and tobacco abuse can be controlled, we also focus our research and funds on treatment of those afflicted. For opiate addiction our options are limited and often stop with prevention.

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Recent research has been focused on Medication-Assisted Treatment (M.A.T.). The main objective is counselling, but there are three medications currently approved for M.A.T: methadone, buprenorphine, and long-acting injectable naltrexone. Each therapy has its advantages and disadvantages. Methadone must be dispensed daily from a federally-monitored site of which there are only 12 in Tennessee. Buprenorphine must be dispensed by physicians who have acquired a special waiver to prescribe, and there is a limit to the number of buprenorphine patients each physician is allowed to treat. Naltrexone is a very expensive once monthly injection which requires real dedication from the patient. Each must be used in conjunction with extensive counselling.

New laws in Kentucky and West Virginia require 30 minutes of face-to-face counselling with an experienced addiction counselor every week for the first 90 days of therapy and then every two weeks for the remainder of the first year. No wonder so many treatment programs fail, as there is far too little counselling being done, often because there are far too few qualified professional counselors available.

As we move forward in dealing with this crisis, let us not stop with prevention or incarceration, but continue to move forward, using existing methodologies, to treat addicted individuals that want treatment.

Let us ever strive towards developing new and novel approaches that may free those individuals from the drugs that have enslaved them.

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KAM KNOXVILLE ACADEMY OF MEDICINE www.knoxvillemedicine.org

Announcing NEW Specialty Disability Insurance Exclusively for KAM Members Income Protection by Lloyd’s of London To Secure your Future, Assets, and Lifestyle  Single, lump-sum payment if unable to return to your practice due to illness or injury1  Flexible coverage options from $250,000 to $2,000,000  Your personal policy only available for eligible KAM members

• NO health questions necessary during this open enrollment • Easy online enrollment through custom KAM member site • Discounted rates for active KAM members Your Response Requested - Visit www.protectingincomes.com/KAM for details and enroll or decline coverage.

For all questions email support@protectingincomes.com or call 865.999.3000.

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Physicians have very specialized occupational duties. The inability to perform those duties due to unexpected illness or injury could be financially devastating.

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This specialty insurance policy, provided by Lloyd’s of London, can provide a single lump- sum payment event of a potential career-ending condition.

To take advantage of this member-only benefit visit knoxvillemedicine.org or call (865) 531-2766 1Offer available for KAM member age 65 and under, no medical questions or exams required if you have been actively at work for the past 60 days.

This policy is issued by Lloyds of London. See sample policy at www.protectingincomes.com/KAM for complete details including provisions, exclusions, and limitations.

TECHNOLOGY NEWS Improving Reimbursements With Community Data

by: Sharon Woods - Communications Manager, East Tennessee Health Information Network The healthcare industry continues to experience reduced reimbursements from Medicare and other third-party payers. Not surprisingly, providers and administrators are more focused than ever on how to improve reimbursements and reduce costs.

One of many ways to reduce cost to your practice is to eliminate the ordering of duplicate tests, which etHIN can help you achieve.

Medicare guidelines have become more rigid regarding how frequently imaging procedures can be performed and how many times a procedure can be updated due to certain indications. Research from the University of New Hampshire found that 1 in 5 hospital radiology tests are duplicates, costing the US healthcare system approximately $20 billion dollars annually. etHIN provides the ability to view image reports and studies that have already been conducted, allowing providers to determine whether a recently performed study is sufficient for their purposes rather than automatically ordering an image study that might not be reimbursable.

A study by Stanford Medicine showed that emergency visits at hospitals which shared information through an HIE like etHIN, patients were 59% less likely to have a duplicate CT Scan (TN reimbursement 71250 - $151.30) and 67% less likely to have a duplicate Chest X-Ray (TN reimbursement 71020 - $26.04). The research also found that patients were 44% less likely to have a duplicate ultrasound when the emergency department used information available in the HIE.

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Laboratory testing also sees much duplication. The main reason for duplication is multiple physicians ordering a test because they are not aware that another provider recently ordered that same test. One of the most commonly duplicated tests is Thyroid Stimulating Hormone Levels, which has a TN reimbursement (84443) of $22.93.

Users of the eHIP clinical portal have access to lab results submitted by numerous data participants in the local community, including several major hospitals. A quick check of your patient’s record in etHIN would show if an indicated test has been performed recently. While a $22.93 reimbursement may not seem significant, if only ten duplicate tests are ordered each month, that could mean more than $2,700 during a 12-month period that you would not receive for services that you and your staff have already performed.

In addition to lab results and radiology reports with their associated images, etHIN also has information about your patients’ medications, reported allergies, and problems, as well as detailed information about hospital stays that may be difficult to obtain in a timely manner through other methods.

Along with saving money by reducing duplicate testing, using etHIN can also allow you to better utilize employee resources and improve patient satisfaction by avoiding delays from traditional methods of sharing medical records such as faxing, calling, mailing, patient pickup, and couriers.

Contact etHIN at 865-691-8433 to learn more about how participating in your community health information exchange could have a positive impact on your bottom line.

Blount County Medical Society Quarterly Update By: Jerome Heiny, MD This year has been interesting as far as the debate nationally over the future of health care. I am sure you all have been watching with interest. In April I attended the Tennessee Medical Association (TMA) House of Delegates in Nashville with fellow delegates from our society, Dr. Marvin Beard and Dr. Bob Proffitt, also attending was Dr. John Ingram as past TMA president.

On September 19th we will have a dinner for the Blount County Medical Society and have invited Dr. Nita Shumaker, the current president of the TMA, to speak to our membership. This promises to be very informative and also

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provides us an opportunity to socialize with our colleagues.

Our annual Blount County Medical Society Christmas Dinner is planned for Dec 5 at Calhoun’s on the River. We are pleased to announce that our speaker will be Sam Veneable, and we are told to expect a funny holiday themed presentation from him. Further details will be forthcoming. We will also be conducting our election that evening and encourage all to consider actively serving in your medical society.

I hope to see you at these functions.

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