Volum e L X X V, N o . 1 • S p r in g 2 0 1 8
Se r ving the Gr e ate r M e tr opolitan Knoxvi l l e Area
2018 TMA PRESIDENT-ELECT ELISE DENNENY, MD PAGE 5
KAM KNOXVILLE ACADEMY OF MEDICINE
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Friday, April 27, 2018 6:30 pm Knoxville Marriott
KAPA’s Boot Scootin’ Ball has become one of Knoxville’s most talked about annual charity events and 2018 will prove to be even better! This year’s special guests will be the award-winning Montgomery Gentry Band! KAPA’s Boot Scootin’ Ball is a high-end, western-themed event with great country music, line dancing, signature drinks by Ole Smoky Tennessee Moonshine, mouth-watering dinner, and bottomless beer in your own souvenir mug! But hold on, that’s not all… find yourself a treasure in KAPA’s Texas-sized silent auction, all proceeds to benefit Knoxville Area Project Access (KAPA).
So get your boots on and join us for the KAPA Boot Scootin’ Ball! For more info & tickets visit kapabootscootin.com or call (865) 531-2766
KNOXVILLE ACADEMY OF MEDICINE
KNOXVILLEMEDICINE.ORG
Academy Officers
PRESIDENT’S MESSAGE
KNOXVILLE ACADEMY OF MEDICINE
Neil Coleman, MD
By: Neil Coleman, MD
Tim Wilson, MD
Congratulations to Dr. Elise Denneny on being elected to serve as the 2019 President of the Tennessee Medical Association. Thanks to all those who voted for Dr. Denneny, she is an amazing individual who works tirelessly and passionately to improve healthcare in our community and state. Congratulations also to Dr. Tim Wilson on being elected to the TMA Board of Trustees and Dr. Jack Lacey on his election to the TMA Judicial Council. These positions require sacrifice of time and energy, and their willingness to serve is greatly appreciated. With TMA President Elect Dr. Matt Mancini about to start his term in May, the TMA will be in great shape in the years to come. On March 6th, I had the privilege of joining with physicians across the state for Day on the Hill. From Knoxville, we had a bus full of practicing physicians, as well as medical students and residents from UTMCK and LMU. For a good visual of the day, visit twitter.com/tnmedonthehill to see the efforts of our colleagues at this great event. In preparation for this legislative session, the TMA Legislative Committee, which includes KAM members, does an outstanding job of identifying the bills we need to focus on and where support or opposition is needed. On www.tnmed.org/, the Governmental Affairs section tracks the hot topics of the day, including improving or amending the Governor’s Opioid Initiative, halting Episodes of Care until they can be shown to be effective, and insuring that balance billing proposals are not one sided in favor of insurance payors. For more detailed information on the legislation that is being drafted in Tennessee, www. capitol.tn.gov/legislation/ and legiscan.com/ provide drafts of legislation and videos of the subcommittee discussions on proposed legislation. Hearing what our lawmakers are actually saying about these issues on camera can be enlightening, and help us see who is acting on our guidance.
PRESIDENT
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, or company has appeared in a KAM publication shall not be referred to in collateral advertising. The KAM reserves the right to accept or reject any advertising in
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the publication.
KAM
My impression from our day on the hill is that our elected officials do care about making the healthcare system better, and are sympathetic to our concerns, but it is vital that we continue to make our voices heard, to help them see the practical impact their actions have on the care patients receive. It is a privilege, not a right, that we practice medicine in Tennessee, and this privilege is given to us by the State of Tennessee to care for its residents. The more informed we can make our legislators about the unique needs of patients in our community, and our challenges in caring for them, the better chance we have to gain their trust as allies in fixing our healthcare system. Finally, please support this year’s Knoxville Area Project Access fundraiser by attending the Boot Scootin’ Ball on April 27th. What a fantastic event coordinated by our amazing KAM staff, and a great opportunity to bolster the impact that KAPA has on our community! Thanks again to all who support the Knoxville Academy of Medicine and best wishes in the coming year. Sincerely, Neil Coleman, M.D. 865-474-8866 ncoleman@dermpathpartners.com
Calendar of Events APRIL 27
KAPA’S BOOT SCOOTIN’ BALL Knoxville Marriott, 6:30 pm
MAY 5
TMA House of Delegates Nashville Airport Marriott
JUNE 17
Day at the Smokies Smokies Stadium
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ACADEMY NEWS New Members A big welcome to our newest members! We are excited that you have decided to join the Knoxville Academy of Medicine. STEVEN DOLACKY, MD
GARNETTA MORIN-DUCOTE, MD
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ALLISON M. JOHNSEN, MD
DAVID PERKEL, MD
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BRENDAN KNOWLES, DO
JOEY EDWARD M ROQUE, MD
CARDIOLOGY University Cardiology 1940 Alcoa Hwy Knoxville, TN 37920
RADIOLOGY Abercrombie Radiology 1112 Weisgarber Rd Knoxville, TN 37909
INTERNAL MEDICINE Summit Medical Group 501 20th Street Knoxville, TN 37916
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Left Column Top to Bottom: Steven Dolacky, MD; Allison M. Johnsen, MD; Brendan Knowles, DO. Center Column Top to Bottom: Alma Leaird, MD; Garnetta Ioana Morin-Ducote, MD; David Perkel, MD.
ALMA LEAIRD, MD
RHEUMATOLOGY The Allergy, Asthma and Sinus Center 801 Weisgarber Rd. Ste 200 Knoxville, TN 37909
RADIOLOGY University Radiologists 1924 Alcoa Hwy Knoxville, TN 37920
CARDIOLOGY University Cardiology 1940 Alcoa Hwy Knoxville, TN 37920
PHYSICAL MEDICINE/RADIOLOGY Patricia Neal Rehabilitation Center 1901 W. Clinch Ave Ste 301E Knoxville, TN 37916
Additionally, we would like to welcome the following new KAM LMU Student Member: Rebecca Johnson
Right Column Top to Bottom: Joey Edward M Roque, MD.
Many thanks to these medical groups that have chosen to support organized medicine with their “all in” group memberships! Your profession is better, the region is stronger and your voice is louder because of your commitment to organized medicine! Abercrombie Radiology Allergy and Asthma Affiliates Allergy Asthma and Sinus Center Anderson Rahman Dermatology Blount Memorial Group Dermatology Associates of Knoxville Dermatopathology Partners Ear Nose and Throat Consultants of East Tennessee East Tennessee Eye Surgeons, PC Greater Knoxville Ear Nose Throat Associates Knoxville Pediatric Association
New Life Center for Bariatric Surgery Pain Consultants of East Tennessee Premiere Surgical Summit Medical Group Healthcare Services Tennessee Cancer Specialists Tennessee Urology - Oak Ridge The Skin Wellness Center University Anesthesiologists University Cardiology University General Surgeons Vista Radiology
The Knoxville Academy of Medicine mourns the recent loss of these physician members
Edward Buonocore, MD 4/21/1931 – 2/15/2018 51 year member 4
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John Edgar Campbell, Jr., MD 7/24/1928 – 1/23/2018 60 year member
James B. Cox 2/3/1924 – 2/26/2018 22 year member
Kenneth Raulston, MD 6/28/1938 – 2/14/2018 39 year member
KAM Dr. Elise Denneny Wins TMA State Election! Congratulations to Dr. Elise Denneny for her win of the Tennessee Medical Association President Elect position! This time last year we were celebrating KAM physician Dr. Matt Mancini on his victory of winning his election for TMA President-Elect. Prior to then our region had not been represented since 2009 when we had Dr. Richard DePersio. A region having back to back TMA presidents has never occurred before, this is truly a grand victory. Dr. Denneny faced opposition from Nashville’s Dr. Jane Siegel whom has been TMA’s House of Delegates Speaker of the House. Dr. Denneny’s 30 years of practicing medicine across every kind of practice setting, has allowed her to see the relevance and impact of organized medicine. She understands that It impacts the lives of physicians, patients, families and communities. Looking forward, she intends to leverage the recent TMA momentum and stand to influence discussion on issues that will define the immediate and long term future. Her platform focuses on issues such as, improving clinical workflow and mitigating burnout, better access for patients and reducing payer obstructions, and navigating the transitioning reimbursement landscape. She is a TMA Board of Trustees Member, TMA Legislative Committee Member and TMA Professional Relations Committee Member and Former Chair. Dr. Denneny has also served KAM as a KAM Past President, KAM Foun-
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dation Governor, KAM Legislative Committee Chair and a KAM Drug Task Force Representative. During the month of February Dr. Denneny traveled the state visiting with TMA members and sharing her vision and passion for organized medicine. The race grew close in the end and Region 7 KAM members once again rose to the occasion to make sure that the victory was seized. In the final days, members worked phones, sent emails, and dug in to make sure that fellow physicians’ votes were cast and counted. Many thanks also to the Knoxville Academy of Medicine Alliance (KAMA), the KAM spousal organization, who rallied their member spouses to vote and helped to spread the word. Membership is important! A strong active Region 7 membership insures that our area is well represented and helping to lead our state in health related topics. There are many changes that can potentially impact physicians and patient care, our members are making sure that we are part of this conversation. With another Region 7 TMA President your voice has never been louder! East Tennessee will soon have a TMA Speaker of the House, TMA Past President, President and President Elect. This is the time to encourage your colleagues to join the ranks in organized medicine and protect the profession and patients. Congratulations Dr. Denneny, Region 7 and the entire state of Tennessee on this great victory!
Update from the Board of Medical Examiners By: Reeves Johnson, MD
More Online Your Board is bringing more services online. Our latest newsletter is available at www.tn.gov. There is an option to “opt-in” to the Board’s online portal https:// apps.tn.gov/hlrs. It will enable you to receive communications electronically from your Board, update and renew your license. Also, you can update your supervisory/collaborative relationships, allowing you to review, modify or terminate the relationship. More New Tennessee Physicians Your Board has seen an uptick in applications for new licensure. In 2013, there were 1626 applications and by 2017, that number rose to 1983, a 22% increase. The number of licenses actually granted has risen from 940 to 1698 (81% increase). Tennessee currently has 22,438 licensed physicians; however, 16,000 actually have a Tennessee address. The others include those with multiple state licenses, practice telemedicine, are locum tenens, etc. Gender Shift According to 2016 data from the Federation of State Medical Boards, nearly 3/4 of all Tennessee physicians were male. However, female physicians made up over 60% of those less than 50 years old. Pharmacists to Prescribe Hormonal Contraceptives A law passed in 2016 allowing licensed pharmacists to directly provide hormonal contraceptives. However, this requires a valid collaborative pharmacy practice agreement that contains a nonpatientspecific prescription order. It also required your Board along with the Board of Osteopathic Examination to collaborate with the Board of Pharmacy as they develop rules regarding this practice. Proposed rules have been developed and once adopted, will require this agreement along with the pharmacist completing approved education and training, notification of the Board of the agreement, using approved risk assess-
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ments and proper record keeping. Collaboration vs. Supervision With the recent law regarding Advanced Practice (Registered) Nurses (APN) substituting the words collaborate and its derivatives for supervise and its derivatives, your Board has developed a task force to determine the effects this will have on physicians that utilize APNs. The current rules in effect will need to be amended to reflect this change. The task force will be reviewing other rules to see if they need to be updated. Since many of these rules are similar to the ones for supervising Physician’s Assistants (PA), they too will be reviewed. Any change to these rules requires a rule-making hearing for which there is advanced notice and an opportunity for public comment. Your Board relies on these comments to develop rules that improve the quality of medical care. Sexual Misconduct Several months ago, a task force was developed to update the Board’s Policy on Sexual Misconduct. As this policy was originally written many years ago, with the proliferation of electronic communication and social media and the desire to help our physicians better understand their responsibility in the area of sexual boundaries, your Board adopted the task force’s updated policy. It is available on your Board’s website under “Policies”. Buprenorphine A law was passed last year requiring the development of guidelines regarding the prescribing of Buprenorphine. A large task force of stakeholders representing many areas of medicine came together, developed and recently published these guidelines. Your Board recently adopted these Guidelines as a Policy which is also available on the Board’s website under “Policies” https://www.tn.gov/health/.
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ACADEMY NEWS Match Day University of Tennessee Graduate School of Medicine (UTGSM) Medical Students participated in the “Run for the Envelope” at Neyland Stadium as part of their Match Day on Friday March 16th. Envelopes were placed on the 50-yard line and students made their way down the field from the south end zone for the envelope with families waiting for them for the big reveal. This year there were 17 students that participated in the event and 5 of those matched with UTMCK! Following field activities students and guests proceeded thru the north end zone tunnel to the Wolf Kaplan Center for a buffet lunch. Dean Neuthens addressed the group and congratulated the students on their successes thus far. Students were then allowed the opportunity to place their marker on a large map as to where they will be completing their residency. It was apparent the bond that the students now have with their faculty, peers and the Knoxville area. One student while placing his marker, pronounced that while he did not match with UTMCK he will forever be a “Vol for Life!”. Missy Maples, Student Affairs Coordinator for the UTGSM, shared that this map finds its home directly outside her door and serves as a reminder of the students that have passed through the doors on their journey. Congratulations to those that have graduated and will soon be taking their next step on their journey!
ANNOUNCING A NEW BENEFIT EXCLUSIVELY FOR KAM MEMBERS
KAM is pleased to announce it has secured an arrangement with the law firm of London Amburn to provide the following new benefits to KAM members: • Discount on legal services for KAM members • Complimentary subscription to periodic email updates on significant developments in health law • Participation in London Amburn’s General Counsel Services Program • Access to free health law education programs produced by the firm London Amburn is a full service law firm that has provided legal services to the physician community for over a quarter of a century and donates numerous hours of legal services to the Knoxville Academy of Medicine each year. We are excited to partner with London Amburn to make these new benefits available for our members. The availability of legal services and acceptance of clients are subject to the firm’s policies. Details on each of these new benefits are available from London Amburn. The benefits provider under this program are free with your KAM membership, but to receive these benefits, KAM members must be enrolled in the program. For more information and to enroll, contact Dale Amburn or Ian Hennessey at (865) 637-0203, or via email at kam@londonamburn.com.
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ACADEMY NEWS Day On The Hill
KAM KNOXVILLE ACADEMY OF MEDICINE
On March 6th KAM and TMA partnered to provide area physicians an opportunity to participate in the Annual Doctor’s Day on the Hill. Traveling to Nashville on a chartered motor coach, our area physicians joined others from across the state to wear their “White Coats” and share their thoughts, praises and concerns with legislators. Physicians had the opportunity to convey with a unified voice the positions on many bills concerning Opioids, Balance Billing, MOC and Episodes of Care. In route to Nashville physicians were briefed by Dr. Elise Denneny on the many legislative issues set to impact the profession and the position of the TMA. Talking points were given on all topics and discussions enabled many to get a clearer understanding. This year we were pleased to have Dr. Matt Mancini on the bus to discuss in depth the issues of Episodes of Care and the reasoning of the imperative need for TMA’s stance to “Pause and Patch” this program. Dr. Mancini will take office as TMA’s next President in April, in addition to continuing to address the Opioid Crisis, we can expect to see Episodes of Care being a major focus. Ian Hennessey with the law offices of London and Amburn also was on the bus to provide valuable information and was able to answer questions as they arose. Thank you for all those who attended and we look forward to seeing you next year!
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ACADEMY NEWS Legislative Update Our fight for truth in the Tennessee HealthCare Innovation Initiative/ Episodes of care (EOC) requires perseverance, patient advocacy, pause and patch action. This cubed three sided geometric approach addresses the volume of time spent and action yet to invest in Episodes of Care. If you remember Episodes of Care started in 2014 and is Tennessee healthcare innovation (THII) initiative on bundled payments of care. (Figure 1)
1. “But EOC has not impacted me” False. It is only a matter of time before bundled payments become the standard for third party payors. A facsimile of bundled payments is slowly being introduced through the “cost” factor of CMS ‘ MACRA/MIPS. IN FACT, TMA advocacy for physicians prevented EOC expansion to third party payors. 2. “I am not a quarterback so it will not matter.” False. Under this model all Hospital employed physicians may potentially be held accountable for health care costs they cannot control. Episodes of Care may not be felt directly but what about that diminishing paycheck or bonus? Physicians are healers, we want the best outcomes for our patients. Clinical decisions for our patients should not be impacted by cost. Health
More than 34 episodes of care have rolled out impacting Tennessee physicians participating in Tenncare and State Employee health care plans. The design of the program is to bundle all aspects of care surrounding a single episode i.e. asthma or cholecystectomy into one payment given to the quarterback. Quarterbacks are generally either physicians or hospitals. There are several flaws in the program. TMA in the past has PERSEVERED and worked with Tenncare bureau to address these flaws. Dr. Matt Mancini, TMA President Elect, has spent countless hours testifying to the problems with Episodes of Care. All of this to no avail and we now find ourselves resorting to legislative action. Members of 2018 Tennessee’s General Assembly are introduced and educated on EOC’s structure and Tenncare’s top down Leviathan implementation. Fellow physicians are being penalized for costs they cannot control. Physician staff and CFO’s are spending extra time sorting out episode of care’s meaningless reports and arduous appeal process. Does this matter? You bet!
systems want us to control cost but give us no control over drivers of healthcare cost. The situation is untenable. Yet the cost of Medicaid/Tenncare continues to stress state coffers. Dr. Mancini has prioritized episodes of care. Bottom line...Episodes of care as presently structured will drive down quality of care for Tennesseans at the cost of saving state monies. We are PATIENT ADVOCATES and as such we have a duty to hold the present administration accountable and together design a better program that both saves money and improves quality. It is time to PAUSE AND PATCH. TMA is assembling a data war chest on Episodes of care. It is time for you or your administrator to contact TMA and add your story to the war chest. Happy Spring, Elise
“P” Cubed By: Elise Denneny, MD
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KAM Telemedicine: A Two-Part Series
By: Patrick McFarland, MD Resident Physician, PGY-4 Department of Anesthesiology University of Tennessee Graduate School of Medicine Between the opioid crisis and healthcare reform, there is a lot of change happening in medicine, as always. Working together, providers and legislators seek to develop better strategies for opioid abuse prevention, treatment, and recovery, all while implementing the paradigm-shifting transition to value-based reimbursement of care. Quality improvement, cost reduction, and crisis management all in one. Yet, I think one more player can be added to the picture, being telemedicine. Why? Because patients need access to affordable, high quality care, and we have yet to solve that problem. Looking ahead, patient volumes continue to rise in the face of a relative provider shortage. This concept makes providing access to quality care quite the challenge. Still considered new-age, telemedicine may be able to help in this regard. First, what is telemedicine, or how is it defined? Per state law, telemedicine, and its parent telehealth, means the use of real-time interactive telecommunications services (audio-only, e-mail, and fax excluded), to deliver healthcare services to a patient when the provider is at a site other than where the patient is located1. Also, telecommunications services come in various forms: live video, store and forward, and remote patient monitoring. Live video equates to provider-patient telecommunication in real-time. Store and forward pertains to telecommunications that are recorded at one location, then transmitted to a different location to be viewed at any time. Remote patient monitoring speaks for itself. How can these services help provide access to high quality care? In its current form, telemedicine can help diagnose and treat when provider and patient are separated. In addition, telemedicine can help remove socioeconomic barriers to care, as missed appointments and transportation issues are major contributors to inefficient and costly care. JAMA recently highlighted a study showing that even free, prescheduled trans-
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portation, via ride-sharing programs such as Lyft and Uber, did not help reduce missed patient appointments2. Furthermore, given the opioid crisis and the new guidelines for treating acute and chronic pain, it appears pain specialists will be in demand now more than ever. Consider that most opioid abuse cases and overdose deaths occur in rural areas where there is lack of access to care, I say there is real opportunity for telemedicine to contribute. Experts appear to agree, stating that telemedicine will be an estimated $36.3 billion US dollar market by 20203. So, what’s the catch? Barriers to telemedicine’s success include the lack of face-to-face interaction (i.e. the physical exam), costly installation and maintenance of equipment and technology, provider training, and regulation and restriction with regards to implementation and reimbursement by state and federal agencies. All valid issues, yet I believe with the right support and funding, each barrier can be adequately addressed, and in the process, we will see increased access to affordable, high-quality care with significant cost reductions, all while battling the opioid epidemic. Imagine patients, clinics, medication-assisted treatment facilities, etc. in rural areas having access to expert consultation just a click away! More to come in the next issue, Telemedicine: Volume Two. References 1. “Center for Connected Health Policy: Telehealth Policy - Tennessee.” Public Health Institute. Accessed February 17, 2018. < http:// www.cchpca.org/jurisdiction/tennessee.> 2. Chaiyachati KH, Hubbard RA, Yeager A, et al. “Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments.” JAMA Intern Med. February 5, 2018. doi:10.1001/ jamainternmed.2017.8336 3. “Global Telemedicine Market: With a Robust CAGR of 14.30%, Market Value Expected to Reach US$36.3 BN by 2020, Finds TMR.” Transparency Market Research. Press Release posted January 23, 2018. < https://www.transparencymarketresearch.com/pressrelease/ telemedicine-market.htm.>
CME Blitz Focused on the Opioid Crisis In December KAM offered the annual CME Blitz to members of the Academy and their affiliated membership societies, Blount, Monroe, Roane and Anderson Counties. This annual event was held at the UT Medical Center and allowed physicians to secure up to 4 CME hours including the 2 hour prescribing practices requirements. The event, as always, was free to members and nonmembers were offered the rate of $25 per CME. The focus for the blitz was opioids and featured speakers from London and Amburn, Knoxville Police Department, Knox County Regional Forensic
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Center and Pain Consultants of East Tennessee. Speakers covered everything from legal impact on physicians (Ian Hennessey and Jennifer Pearson Taylor with London and Amburn), alternatives to opioids (Dr. James Choo), effects on a community (Chief David Rausch) as well as the proper prescribing practices (Dr. Darinka Mileusnic-Polchan). Many thanks to those that participated, we look forward to seeing you at our next CME offering.
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ACADEMY NEWS Physician-Friendly MOC Bill Approved by Tennessee Legislature After 2 years, Senate passes MOC bill giving doctors relief from extensive costly requirements. Physicians are grateful that the bill also unanimously passed in the House. Members of organized medicine have spent two years educating state lawmakers to persuade them to take action on what has become a hot button issue for physicians across the nation. The Tennessee Senate passed the bill (SB1824) by a vote of 33-0 after the House unanimously passed the companion bill (HB1927). KAM member Sen. Richard Briggs, MD sponsored the Senate bill while House Republican Caucus Chairman Ryan Williams from Cookeville led the effort in the larger chamber. Sen. Briggs and Rep. Williams worked with TMA in 2017 to pass another law that prevents MOC from being required for state licensure. That same bill created a task force to study MOC as it relates to hospital hiring practices, admitting privileges and insurance networks. Legislators who served on the task force returned to session in 2018 ready to give Tennessee physicians some relief and ensure the arbitrary MOC process no longer interferes with Tennesseans’ access to care. These new changes will give doctors options for maintaining and improving their professional competency. Doctors should not be forced by hospitals or insurance companies to participate in an arbitrary certification process that has not been shown to improve quality of care. This bill
gives much-needed relief for doctors who may choose Continuing Medical Education or other forms of ongoing learning. Thanks to Sen. Briggs, Rep. Williams and the other members of our state legislature, Tennessee is now one of few states developing real solutions to this national issue,” said Nita W. Shumaker, MD, TMA President 2017-2018. The new law carries two important provisions for doctors who have pleaded for relief from the MOC requirements levied by the American Board of Medical Specialties, insurance companies, hospitals and health systems. • It prohibits health insurance companies from excluding physicians from health plan networks based solely on a physician’s MOC status. • It allows the medical staff at each hospital to determine whether to require MOC or accept other forms of competency measures (such as Continuing Medical Education) for credentialing and/or admitting privileges. Hospitals requiring MOC must adopt bylaws making it a stipulation for work or network participation. The state’s new MOC laws, coupled with a favorable medical liability climate should improve the state’s efforts to recruit and retain the best physicians. Organized medicine plays a critical role in the protection of patient care and your profession. Thank you for your investment, your voice has never been louder.
FOCUS ON HELPING OTHERS. “It was the first note I ever got in crayon. ‘Thank you for making my daddy feel better.’ I keep it on my desk, where I pore over patient records and cash flow statements. Because even if the medical field seems to be changing by the day, the reasons I practice never do.”
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LEGAL NEWS
KAM KNOXVILLE ACADEMY OF MEDICINE
THE “STARK” REALITY OF GROUP PRACTICE ANCILLARY SERVICES By: Patti T. Cotten and Erin B. Williams London & Amburn, P.C.
Federal law, commonly known as the “Stark Law,” prohibits physicians from making referrals of certain ancillary services, called “designated health services” (DHS), payable by Medicare/Medicaid to an entity with which the physician (or an immediate family member of the physician) has a financial relationship. The Stark Law directly impacts compensation arrangements within group practices offering DHS to their patients. The Stark Law “in-office ancillary services” exception (the “IOAS exception”) allows a physician to refer within his/her own group practice so long as each element of the IOAS exception is fulfilled. The group’s compensation model will determine whether or not that Stark “referral” falls within the IOAS exception. Accordingly, the group must ensure that its allocations of overhead and expenses and its calculation of profit-sharing derived from these ancillary services are “not determined in any manner which is directly related to the volume or value of referrals.” First, the group must determine, in advance, how it is going to allocate expenses associated with its ancillary services. That allocation may be changed any number of times so long as it is applied prospectively. Second, it is crucial that the group avoid any allocation of the overall profits derived from DHS in a manner that is directly related to the physician’s volume or value of DHS referrals. The Stark regulations actually enumerate three approved compensation methods for distributing DHS profits, but group practices may also devise their own indirect allocation method. It is a common misconception that all ancillary DHS revenues of the
group practice allocated equally among the physician in the group will always be Stark-compliant. In fact, large groups can run afoul of the Stark Law even with equal allocations of profits among fewer than five (5) physicians. Consider, for example, a group of 10 physicians where only 4 physicians use the group’s ultrasound. Even if the group allocates those ultrasound revenues equally among the 4 referring physicians, that arrangement violates the Stark Law, which requires a “pod” of at least five (5) physicians to share in such profits. Thus, groups must tread carefully in crafting their DHS allocations and ensure they understand the complexity of the Stark Law for group compensation. If a group does not qualify as a “group practice” because it incorrectly allocates DHS profits but nevertheless bills the Medicare program for DHS ordered by its physicians, it violates the Stark Law. That means that monies received for those DHS services are actually overpayments, which must be reported and refunded within sixty (60) days of identification pursuant to the Affordable Care Act (ACA). Failure to timely report and refund identified overpayments can result in liability, including hefty penalties, under the False Claims Act. Would it not be better for your group practice to review its compensation methodology and ensure Stark compliance than to have a disgruntled former employee become a whistleblower and convince the government to do it for you? Patti T. Cotten and Erin B. Williams are attorneys with London Amburn, a law firm based in Knoxville, Tennessee, which represents providers in the area of healthcare law, including regulatory, compliance, HIPAA, malpractice and nursing home defense, employment, mergers and acquisitions, corporate and business matters. For more information, you may contact them at (865) 637-0203 or visit www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.
Blount County Medical Society Quarterly Update By: Travis Groth, DO BCMS President The New Year has exciting changes in the works for the Blount County Medical Society. I am serving as your new BCMS President and look forward to an active membership. To provide a brief update, we have added 16 new members, will be working on installing 3 new bulletin boards and have finalized our new logo. The new and improved logo will be displayed in the Blount Memorial Hospital. We are also working diligently towards practice improvement in light of the opioid crisis. Blount County has set high standards to implement reform in how we prescribe and manage narcotics. Through CME events and implemented changes to practice management, we hope to improve patient care and safety. We will be releasing more information on CME in the months to come. Over the next few years we anticipate numerous changes in healthcare. We will continue to strive for excellence in every aspect of patient care. We believe that organized medicine is vital to the future of medicine, quality patient care and curbing physician burnout. This year we are also looking at many fun activities to bring the
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BCMS members together in a social setting. We are looking forward to having a BCMS section at this year’s KAPA Boot Scootin’ Ball featuring Montgomery Gentry. The evening includes a stick to your ribs dinner, bottomless beer, moonshine tasting and access to a large silent auction. Those interested can contact Margaret Maddox at (865) 531-2766 for more information. Also, save the date to spend Father’s Day by taking Dad to the ballpark! We will have a private box, catered menu and private seats at the Smokies ball park!
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TECHNOLOGY NEWS Receiving Alerts Can Help Improve Patient Care and Monitoring
etHIN provides hospital and clinical information alerts to care managers and physicians by: Leigh Sterling, Executive Director East Tennessee Health Information Network Real-time alerts from etHIN are a way to stay informed about your patient’s clinical encounters that occur outside of your practice. Valuable patient information such as encounters, diagnoses, labs, hospital admissions and more can be sent to you electronically, giving you the most recent data about your patients’ wellbeing. Receiving alerts can also reduce costs by decreasing wait time for staff members who are trying to obtain patient information or results. Alerts can improve care transitions, coordination, and management of patient health, as well as reducing avoidable ED visits and preventing hospital readmissions. According to HHS.gov, “Organizations using ADT alerts have shown reductions in 30-day readmissions (and) improved outcomes… Other organizations have demonstrated that ADT alerts can be used to reduce the number of ED to inpatient transitions.” 1 While alert fatigue can be a concern in the healthcare industry, you are
in control when you receive patient alerts from etHIN. You decide what information that you want to receive and which patients you want to receive alerts for. Receiving different alerts containing specific information for your different patient cohorts is another way to stay in control. For example, A1C test results can be sent for your diabetic patients, follow-up imaging and lab testing for return office visits, and hospital admits/discharges for frequent ED visits or your transitions of care patients are just a few of the alerts that are available. The volume and types of alerts you receive is based on what is most important to your practice. If etHIN receives the information, alerts can be sent to you. etHIN can deliver alerts in numerous ways, including directly into your EMR if integrated to etHIN, by Direct secure messaging, in a report that you initiate at your convenience, FTP, and possibly by a customized delivery method if none of the other options meet your needs. Increased awareness of patient’s care events with other providers and hospitals can improve the quality of care, assist in better care coordination, and reduce the likelihood of hospital readmission – all ultimately lowering healthcare costs. Contact etHIN to learn more about how receiving etHIN Alerts can benefit your practice and your patients – 865-691-8433 or info@ethin.org. 1https://www.hhs.gov/idealab/projects-item/health-information-exchangeaccelerators/
Monroe County Medical Society Gathers at Club LeConte Monroe County Medical Society gathered at Club LeConte last December to enjoy some social time with colleagues, spouses and guests. Those in attendance enjoyed an incredible meal, at an exceptional venue, while enjoying a spectacular view of downtown. MCMS meets on a regular basis and is a growing medical society, if you would like more information on membership please contact Margaret Maddox at (865) 531-2766.
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KAMA CORNER By: Tina Callicutt KAMA President, 2017-2018 Our KAMA year will draw to a close in May of this year. During our May meeting along with our regular KAMA business, we will have our installation of our 2018-2019 officers. I am astounded that it is just around the corner. We have truly had a tremendous year so far. In January, we had our annual Doc Rock fundraiser. It was our thirteenth year. The bands that competed were Ruby Knox, Whiskey Compass who played for your KAPA, Dr. Zoster and the Pox, No Recall, and Remedy. The winner this year was Dr. Zoster and the Pox. They represented Vine Medical Clinic who will receive 50% of the night’s funds. The other 50% will be divided among the other health charities. They were St. Mary’s Legacy Mobile Unit, Knox Metro Drug Coalition, Interfaith Health Clinic, and KAPA. The event was held at The International, and we had a wonderful crowd turnout. This event was chaired by Jacque Prince who has chaired the last 13 years, and this was her last year to lead this fundraiser. She has been an incredible leader over the last 13 years. We are excited
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about the future of this event as we look forward to its fourteenth year. We have already met to talk about next year’s Doc Rock as well as 2018’s Fashiondrama. In the March, we not only had our retreat where we planned for our 2018-2019 year, we had members go to Doctor’s Day on the Hill, and had a Doctor’s Day luncheon for our Knoxville retired physicians. Our Med task force met in February to continue to make plans for our fight against the massive drug abuse problem in our area and nationally. Our Philanthropic board will be meeting as well to look at grant request, and we will decide on the organizations who will receive funds from KAMA. This is the time when we get to see the benefit of our efforts. This KAMA year has been very rewarding not only to us, but our community. We thank everyone for their continual support. A special thank you to the Knoxville Academy of Medicine for all of its support. KAMA members are looking forward to supporting Boot Scootin’ Ball this April. With us working together for our community, our local region will continue to get better and better. For any information on KAMA go to our website www.kamalliance.org.
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