Knoxville Medicine Magazine Spring 2019 by Knoxville Medicine Magazine

Vol u m e L X X VI , N o. 1 • S p ri n g 2 01 9

Ser v in g t h e G rea t er Met ropolit a n Kno x vi l l e A r e a

CRAIG MORGAN APRIL 5, 2019 KAPA’S BOOT SCOOTIN’ BALL

KAM KNOXVILLE ACADEMY OF MEDICINE

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KAM Day at the Smokies May the 4th be with You! SATURDAY, MAY 4, 2019 For All Medical Society Members and Their Families

Enjoy a Star Wars themed night at Smokies Stadium including Star Wars music, graphics, on-field games, characters roaming around the concourse, unique food and drinks. All guests get a free light saber! Gates open at 5:30 pm Dinner is served at 6:30 pm Game starts at 7:00 pm

Members and their guests - $20 Member’s children (under 12) - $10

Tickets Include: • The Clubhouse on the first base side, where you can enjoy the game in a private, climate controlled indoor setting in addition to outdoor seating. • A bar is available to purchase a variety of beers. • An all-you-can-eat buffet provided by Calhoun’s

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Sponsored By:

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PRESIDENT’S MESSAGE

KAM

Academy Officers Tim Wilson, MD PRESIDENT

Jeff Ollis, MD

PRESIDENT ELECT

Daniel Bustamante, MD SECRETARY

Brian Daley, MD TREASURER

Neil Coleman, MD

IMMEDIATE PAST PRESIDENT

Kimberly Weaver, PhD CEO

Board of Trustees Michael Brunson, MD David Harris, MD Zac Jumper, MD James Choo, MD

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

Publisher Kim Weaver, PhD

Editor Jonathan Weaver

Production/Advertising Margaret Maddox

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

KNOXVILLE ACADEMY OF MEDICINE

This is my first message as president of The Knoxville Academy of Medicine. I am honored to serve as president and humbled by the great men and women who have preceded me. I especially want to thank Neil Coleman for his leadership the last two years and Elise Denneny for always encouraging me to be more involved. I am fortunate to work with an enthusiastic board and great KAM staff. KAM will continue to need your support, energy, and involvement to address issues that are important to our physicians and our community. There are numerous opportunities and challenges ahead for us. Knoxville Area Project Access continues to grow and provide excellent care for our neighbors in need. We are working on a physician wellness program that will be of great benefit to our area physicians. Scope of practice issues will continue. The TMA continues to promote physician-led, team-based healthcare delivery models in Tennessee. There is a moratorium on new legislation dealing with scope of practice for the nurses and PA’s, but this is set to expire in 2019. We expect more scope of practice legislation to be introduced. Balance billing will continue to be a legislative priority. As lawmakers look for ways to address the issue of “surprise medical bills”, the TMA will fight to defend physician’s right for fair payment for out of network services that they provide. Episodes of care continues to be an issue for Tennessee physicians. We will continue to fight for fair reimbursement models and transparency in the metrics used. Our current TMA president, Matt Mancini, has worked tirelessly on this issue and was able to obtain a moratorium on new episodes of care being introduced. Doctor’s Day on the Hill is March 26. We will be taking a bus from Knoxville to the capitol to meet with our legislators. The legislators really do seem to enjoy our visit and want to hear from us about issues that are important to doctors and our patients. We must help our

legislators understand how their legislation impacts us. I encourage you to join us on this free and interesting trip. The Boot Scootin’ Ball is Friday April 5. Craig Morgan will entertain us. This is a great event and our biggest fundraiser for KAPA. I encourage all to attend, buy tables, or be a sponsor. Knoxville is well represented at the TMA board with current president, Matt Mancini, president-elect, Elise Denneny. I am the region 7 trustee. Edward Capperelli of Jacksboro is our Speaker of The House. If you haven’t already voted for TMA president, I encourage you to do so. Increasing membership is one of my goals as president. We will continue to recruit large physician groups as well as hospital employed physicians. I encourage you to get your partners and colleagues involved with the KAM and TMA. With greater unity, we have a stronger voice. I look forward to an exciting year and hope to see you all at Doctor’s Day on the Hill and KAPA’s Boot Scootin’ Ball! Timothy S. Wilson, MD

Calendar of Events MARCH 26

Day on the Hill 2019, 8:00 am - 7:00 pm Cordell Hull Building in Nashville

APRIL 5

MAY

KAPA’s Boot Scootin’ Ball Knoxville Marriott, 6:30 pm - 11:00 pm Craig Morgan performs

KAM Day at the Smokies - (Star Wars Day) Smokies Stadium, Gates open at 5:30 pm, Dinner at 6:30 pm, Game Starts at 7:00 pm

1719

TMA House of Delegates Cool Springs Marriott, Franklin

reserves the right to accept or reject any advertising in

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the publication.

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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. THOMAS BROWNING, MD

KEITH GRAY, MD

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BRITTANY N. COOK, MD

JASON GREEN, DO

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FRANKIE E. CRAIN-RUF, MD

LAURA GREEN, MD

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EDWARD DOWNEY, DO

SAM KABBANI, MD

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DANIEL FOWLER, MD

DONALD S. KEEBLE, MD

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STEPHEN FRANKLIN, MD

ALMA LEAIRD, MD

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THOMAS GAINES, MD

MATTHEW LOWRANCE, DO

OPHTHALMOLOGY Tennessee Eye Care 6354 Lonas Spring Dr Knoxville, TN 37909

OPHTHALMOLOGY Baptist Eye Surgeons 4528 Chapman Hwy Knoxville, TN 37920

PEDIATRIC CRITICAL CARE Childrenâ&#x20AC;&#x2122;s Pediatric Group 2018 Clinch Ave Knoxville, TN 37916

RADIOLOGY Vista Radiology 2001 Laurel Ave Ste N304 Knoxville, TN 37916

PLASTIC SURGERY Knoxville Center for Dermatology and Plastic Surgery 6408 Parkside Drive, Knoxville, TN 37939

OPHTHALMOLOGY Center for Sight 7800 Conner Rd Powell, TN 37849

SURGERY University Heart Surgeons 1940 Alcoa Hwy Ste E260 Knoxville, TN 37920

GENERAL SURGERY University Surgical Oncology 1926 Alcoa Hwy Bldg F Ste 330 Knoxville TN 37920

INTERNAL MEDICINE University Pulmonary Critical Care 1940 Alcoa Hwy Ste E210 Knoxville, TN 37920

INTERNAL MEDICINE Allergy Asthma and Sinus Center 11416 Grisgby Chapel Rd #103 Knoxville, TN 37934

NEUROLOGY East Tennessee Neurology Clinic 9000 Executive Park Dr Ste A207 Knoxville, TN 37923

FAMILY MEDICINE University Family Physicians 1924 Alcoa Hwy Knoxville, TN 37920

RHEUMATOLOGY Summit Medical Group 8975 Executive Park Drive Knoxville, TN 37923

OPHTHALMOLOGY Tennessee Eye Care 1798 Roane State Hwy Harriman, TN 37748

Left Column Top to Bottom: Thomas Brown, MD; Brittany N. Cook, MD; Frankie E. Crain-Ruf, MD; Edward Downey, DO; Daniel Fowler, MD. Center Column Top to Bottom: Stephen Franklin, MD; Thomas Gaines, MD; Keith Gray, MD; Jason Green, DO; Laura Green, MD. Right Column Top to Bottom: Sam Kabbani, MD; Donald S. Keeble, MD; Alma Leaird, MD; Matthew Lowrance, DO.

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KAM KNOXVILLE ACADEMY OF MEDICINE

New Members Continued A big welcome to our newest members! We are excited that you have decided to join the Knoxville Academy of Medicine. JACOB NOE, MD

DYLAN SIMMONS, DO

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NICHOLAS PANELLA, MD

AFSHIN SKIBBA, MD

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J. RANDOLPH REISSER, MD, FACS

STEVEN STERLING, MD

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J. MICHAEL ROTHWELL, MD

BURTON WEST, MD

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JOSEPH RUSNAK, MD

THOMAS WOOLDRIDGE, MD

RADIOLOGY University Radiology 2240 Sutherland Ave Ste 107 Knoxville, TN 37919

OTOLARYNOLOGY Ear Nose and Throat Consultants of East TN 9430 Parkwest Blvd Ste 330 Knoxville, TN 37923

VASCULAR SURGERY Premiere Surgical Turkey Creek Medical Center 10810 Parkside Dr, Ste 05 Knoxville, TN 37934

Left Column Top to Bottom: Jacob Noe, MD; Nicholas Panella, MD; J. Randolph Reisser, MD; J. Michael Rothwell, MD. Center Column Top to Bottom: Joseph Rusnak, MD; Dylan Simmons, DO; Afshin Skibba, MD. Right Column Top to Bottom: Steven Sterling, MD; Burton West, MD; Thomas Wooldridge, MD.

URGENT CARE MEDICINE Well-Key Urgent Care 6606 Clinton Hwy Knoxville, TN 37912

RADIOLOGY Vista Radiology 2001 Laurel Ave Ste N304 Knoxville, TN 37916

RADIOLOGY Abercrombie Radiological Consultants 1112 E Weisgarber Rd Ste 201 Knoxville, TN 37909

GENERAL SURGERY Premiere Surgical 6408 Papermill Dr Ste 200 Knoxville, TN 37919

OPHTHALMOLOGY Steven Sterling, MD PC 2607 Kingston Pike Ste 182 Knoxville, TN 37919

INTERNAL MEDICINE Statcare Hospitalist Group 2240 Sutherland Ave Ste 104 Knoxville, TN 37919

RADIOLOGY Vista Radiology 2001 Laurel Ave Ste N304 Knoxville, TN 37916

Additionally, We would like to welcome the following new KAM Student and Resident Members: Resident: Danilo Martins, MD Student: Mariam Alshagra Alexandra Ballard Ashley Barnes Patrick Brown, Jr Lillie Campbell Hayden Caraway Eric Cobb Tara Corwell Hannah Crotty Claudia De La Flor Alexander Dixon Mathilde Djiogan Paul Doucet

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Colleen Fleming Eric Freeman Gene Gerlach Caleb Greene Joshua Grover Meridith Hawkins Mackenzie Herzig Daniel Higgins Matthew Holland Staci Hunter Brittney Johnston Beatrice Jourdain Gurprit Kaur Eric Klingeman Samuel Lee Felice Liu Carina Lorenzen

Caleb Lowe Laine Lyles Philip Mardock Clare McDonald Maurice McGlone Margaret McLoughlin Dora Meyer Corey Morris Jared Odom Cene Ovincy Bhavin Patel Shirley Payson Kyle Penny Kesley Peterson Alexandra Piampiano Kristen Piwowarski Bracken Roberts

Lauren Roberts Carolina Roddy Michael Sechuk Logan Shaver Isaac Stevens Jacob Tallen Samuel Ting Emily Towery Luan Tran Catherine Traylor Erica Wahlers Derek Wakefield Boyang Wang Amber Watson Pooya Zardoost

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ACADEMY NEWS Update from the Board of Medical Examiners New CME Options on the Horizon By: Reeves Johnson, MD

To maintain your license, every 2 years, you are required to obtain 40 hours of Continuing Medical Education sponsored by an organization accredited by the Accreditation Council of Continuing Medical Education (ACCME) designated as AMA Category 1 or by the American Academy of Family Practice as Prescribed Credit. This must be completed during the 2 calendar years before the year your license is due to expire. That is, if your license expires June 30, 2020, you must complete the 40 hours by December 31, 2019. Also, unless practicing in a certified pain clinic or board certified in a pain related specialty (see TCA 63-1402(c)), every 2 years, at least 2 hours of accredited CME must be related to controlled substance prescribing including instruction in the Department of Health’s treatment guidelines on opioids, benzodiazepines, barbiturates and carisprodol. Currently, you must be able to prove compliance by retaining your record of completion of this CME and present it to the BME if audited. During auditing, many physicians submit multiple 1 hour CME credits which is trying for both the physician and the BME. Fortunately, there is a new program in development by the ACCME and

some CME sponsoring organizations to simplify this process. When you complete a CME program by one of these participating organizations, your record of completion is sent directly to the ACCME. It is the desire that through this program, you will be able to provide any State Board, Specialty Board, Hospital, etc. with your accredited CME, thus saving you the trouble of gathering and sending multiple certificates of completion. In addition, you will be notified periodically of your current number of CME credits so that you will know if you are meeting the requirements of your Board, etc. Also in development is a program made possible from a grant from the CDC. Dr. David Reagan, Chief Medical Office of the TN Dept. of Health is working with Vanderbilt University to develop 1TN, Quiztime. This is an accredited CME program that will send a daily question to your cellular phone. After answering it, you will be given the answer and references regarding the answer. By completing this program, this will count for the 2 hours of required CME on controlled substance prescribing as mentioned above. Stay tuned…

Dr. Keith Gray named as CMO and Vice President for UTMC Dr. Keith Gray who is a surgical oncologist will be the new chief medical officer of University of Tennessee Medical Center. Gray, who has been at the University of Tennessee Medical Center since 2007, will succeed Dr. Jerry Epps, who recently announced his retirement. Joe Landsman, President and CEO of the University of Tennessee Medical Center said that Dr. Gray’s leadership throughout the past decade has been incredibly valuable to patients, team members, physicians, and the entire community. Mr. Landsman added, “He’s proven his ongoing commitment to benefit the health of those we serve by advancing his own learning and skills, while also developing and inspiring fellow physicians and others around him. Keith is going to be an excellent chief medical officer.” As VP and CMO, Gray will oversee the clinical vision and direction of the medical center; enact policies and protocols to further improve patient care; and promote wellness and success for physicians and staff. Gray said he also plans to

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partner with community and statewide leaders to promote health equity and raise awareness about social determinants that contribute to disparities in health. “From the establishment of Knoxville Area Project Access to championing the fight against opioid abuse, the chief medical officer role at UTMC is steeped in a legacy of servant leadership,” said Gray. Dr. Gray, a Knoxville Academy of Medicine member, feels honored that he will succeed KAM members Dr. Jerry Epps and Dr. Jack Lacey and looks forward to working with team members and strategic partners to engage the community, continue to meet the comprehensive health care needs of the region, and improve the health status of the state. Dr. Gray has stated that he plans to continue to practice medicine and said he believes it will help him see where improvements are needed and continue to relate to the evolving needs of patients, physicians and team members.

ACADEMY NEWS KAM’s President’s Bash Celebrates Dr. Tim Wilson

KAM KNOXVILLE ACADEMY OF MEDICINE

Early in January many turned out for this year’s President’s Bash as KAM’s newest president took office. The evening event this year was held at Gettysvue Country Club and featured a delicious dinner and a brief meeting followed by an evening of musical entertainment by Whiskey Compass. Outgoing KAM President Dr. Coleman in swore in Dr. Wilson as he passed the responsibility of the presidency to his new successor. Dr. Wilson will serve two years leading KAM in efforts to advance efforts that protect and unify Knoxville physicians. Having served numerous years on the KAM board, he understands the importance of organized medicine and has lent his efforts to promote membership. Dr. Wilson has actively worked the last 2 years campaigning for Dr. Matthew Mancini (TMA President) and Dr. Elise Denneny (TMA President Elect) to ensure that the voices of East Tennessee physicians are heard. Dr. Wilson has also recently accepted a board position with the Tennessee Medical Association and has committed to being another strong voice for our region. Whiskey Compass, a local band that features physician musicians, rocked the night. Whiskey Compass a few years ago chose to support KAM’s KAPA (Knoxville Area Project Access) project as their benefactor in the KAMA annual event “Doc Rock”. In the last few years with their selection of KAPA as their chosen charity, KAPA has received several thousand dollars in funding. KAPA continues to grow and serve the community and has currently facilitated over 300 million dollars in donated care to those in need in Knox County. KAM is grateful to have the support of such an incredibly talented musical group such as Whisky Compass and thankful for their willingness to perform at this inaugural event.

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ACADEMY NEWS Legislative Update 2019 Advocacy By: Elise Denneny, MD FAAO-HNS, FACS KAM Legislative Chair

First allow me to expostulate on “TMA membership has no value” Where would Tennessee physicians be without advocacy? Most physicians swamped by the daily disruptions in patient care have little time to understand legislative activity impacting their work. Physicians do not have time to keep abreast with changing regulatory pressures that increase overhead and complicate workflow. Time spent on advocacy is time out of the office resulting in negative revenue. Employed physicians”, although free from the “business side of medicine” still face productivity quotas, satisfaction scores and compensation reduction. TMA advocates daily for us in the general assembly, state committees/ boards and on federal issues. Advocacy against the continued erosion of physician autonomy, increasing senseless work interruptions and declining reimbursement. Three issues dominate the state landscape; nurse independent practice, balance billing and opioid regulation. Advocacy includes a physician led team based health care delivery model, preservation of physician out of network reimbursement through fair health and adjustments to the current opioid legislation. Issues on the federal landscape can be captured under “physician burnout”. EHR, the primary driver of burnout, morphs physicians into data monkeys. The Office of the National Coordinator for Health Information Technology (ONC for HIT) recently released their report entitled “Strategy on Reducing Regulatory and Administrative Burden relating to the use of Health IT and EHRs. Public comment period ended January 28 but YOU CAN still send your comments on EHR to: • Senator Marsha Blackburn. https://www.blackburn.senate.gov/contact_marsha • Senator Lamar Alexander: https://www.alexander.senate.gov/public/index.cfm/email A sample text would be: Dear Senator, Electronic Health records negatively impact health care. They add to physician overhead to the tune of greater than $32,000 per physician CMS’ consulting firm StrategyGen database underestimates the cost to physician practices. EHR reduce face to face physician-patient time, and increased risk of errors. Finally EHR’s increase physician burnout driving early retirement. It simply is not an issue of money. Waking up and going to work every day knowing it will take a minimum of six clicks to order a blood count is untenable. Further examples of EHR burnout can be found in “V.O.M.I.T. in the ER. Just the other day I was called to the ER and tried to retrieve data on a 8

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patient. Fifteen minutes was spent entering three user name/password sign ins and still no information was retrievable. Systems crash and encryption software is a nightmare, dual verification, and key fob accessibility delayed by bandwidth. Patient care suffers The government, while well intended, is turning physicians into data monkeys. Additional insult from CMS comes from their frequent annual changes in its quality payment program (QPP) which increases overhead and the cost of doing business for physicians and hospitals. They change the rules for CHERT, QCDR, APM, MIPS …on and on. This is analogous to congress passing annual federal tax reform. You have the 80,000 foot perspective on this problem but we, the boots on the ground are the foundation of that perspective. Include PRACTICING physicians at the table developing and implementing health policy, ONC/HIT and support their recommendations including standardization of EHR systems. Thank you for your time Sincerely, Finally let me with gratitude thank each of you who are champions of organized medicine and inculcate this philosophy to their medical students, residents and colleagues. For a moment let’s envision our world without advocacy successes this past decade. 1. We would pay more liability insurance 2. We would be paying Medicaid for value based overages 3. We would have more difficulty accessing the CSMD 4. Increased network limitation 5. Greater CME hours These are just a few. Physician advocacy over the past thirty years has been arduous to say the least. Maybe we have lost ground because we do not have the money to invest in advocacy. Monies necessary for advocacy come from membership dues. You may be tired and worn out from the constant erosion to our profession but I remain grateful that you care for patients and exhort you to be intentionally joyful with daily smiles of hope. Blessings, Elise Denneny, MD Appendix state contact resources The Senate Health and Welfare committee is chaired by Sen. Rusty Corwe: sen.rusty.crowe@capitol.tn.gov You can find the committee web site here: www.capitol.tn.gov/senate/committees/health-welfare.html Senator Becky Massey is again on Senate Health and Welfare: sen.becky.massey@capitol.tn.gov Senator Art Swann from Maryville is also on Senate Health and Welfare: sen.art.swann@capitol.tn.gov Send them your daily concerns about the problems in medicine that stop you from taking care of patients. EHR problems is a perfect story. In the House the health committee is chaired by Dr. Byron Terry: www.capitol.tn.gov/house/members/H48.html

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Creating Value in Healthcare by: Dr. Nowell

The traditional fee-for-service (FFS) model that has dominated healthcare reimbursement is slowly exiting the industry. Over the course of young physician’s careers, FFS will become a thing of the past. For many, this is good riddance. FFS has been implicated in the perpetual increasing of US healthcare expenditure without increasing the value of care. To put it simply, FFS rewards quantity of services rather than quality of services. Thus, healthcare reforms over the past decade have sought alternative payment models (APM) that incentivizes valuable care. Over the past five years, one APM has taken root in Tennessee - bundled payments for episodes of care (EOC). Despite flaws, bundled payments are quickly becoming a fixture in the American healthcare system. What impact will this have on physician compensation and hospitals’ bottom line? The new model predetermines total allowable prices for an EOC (e.g. asthma exacerbation, total knee replacement, etc.). Therefore, doctors and hospitals will increasingly have to accept the financial burdens of adverse outcomes, complications, and inefficiencies of management. Without addressing these costs, profit margins will dwindle. Thus, the medical community must invest in identifying opportunities in quality and efficiency of care. One proven model is a perioperative surgical homes (PSH); these have been shown to improve outcomes, eliminate waste, and provide valuable data on factors affecting perioperative care. Often, hospitals have no control over a patient’s pre-hospitalized state; in other words, hospitals cannot prehabilitate patients before they are admitted for pneumonia. However, non-emergent surgical patients can be prepared for the operation, hospitalization, and recovery. This

creates an opportunity for hospitals and surgeons to ensure the patient has the lowest risk of adverse events while maximizing economic efficiency. PSH’s — specifically preoperative clinics — give clinicians a time to identify and mitigate risk while optimizing a patient’s comorbidities. Addressing risk factors, such as cigarette smoking or malnutrition, preoperatively has dramatic effects on adverse events. Moreover, prehabilitation focused on improving functional capacity has been shown to shorten a patient’s return to normal. The relative cost of prehabilitation and lifestyle interventions are negligible when considering the costly preventable complications. Additionally, a well-run PSH provides unique insights into variables that impact a patient’s perioperative care. Data gathered from a standardized perioperative experience will allow clinicians to recognize previously unforeseen risk factors. For instance, medical factors or comorbidities may prove to increase OR time, post-anesthesia care unit (PACU) discharge, or length of stay. On the other hand, socioeconomic or geographic variables may highlight a trend in rehospitalization rates. This data can be used by hospitals during negotiations with insurers on reimbursement for specific EOCs and by surgeons during preoperative evaluations of patients. More importantly, identifying these variables gives hospitals and physicians the opportunity to provide more individualized and valuable care. Altogether, the PSH is just one example of the use of multidisciplinary teams to provide more valuable and efficient care. It must be recognized by all medical professionals that insurers are demanding, and that patients deserve, care that is based in quality — not quantity.

Blount County Medical Society Quarterly Update By: Travis Groth, DO BCMS President

“Be always at war with your vices, at peace with your neighbors, and let each New Year find you a better man.” –Benjamin Franklin. Last year was good but 2019 has brought new growth to Blount County Medical Society that will make us great! I finished up my first Board meeting as the current active president of the medical society and was left feeling even more inspired and excited about the upcoming year and the events to follow. To kick off the New Year the society mixes a little business with Day on the Hill (March 26th) with a little pleasure as KAPA hosts the Boot Scootin Ball on April 5th with music from Craig Morgan. This won’t be at the Redneck Yacht Club but rather the luxurious Knoxville Marriot. Come out for fellowship and fun with physicians and families from the entire East Tennessee region. What better way to get to know our colleagues than over a cold drink and some good music. However, we must not forget with all the fun that major issues are affecting our healthcare practices and patients so we must have a strong showing at Day on the

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Hill. Transportation and food provided for this day trip to Franklin Tennessee for a private meeting with our local representatives. If meeting our regional representatives and hearing good country music was not enough, Blount County Medical Society has decided to start “Cheers with Peers.” We plan on meeting up with our peers on the first Thursday of every month. Stay tuned for more updates. Lastly, we plan on getting more involved in the community that we all know and love. We are truly blessed to live in Blount county, Tennessee where we have 4 seasons (not the ones led by Frankie Vlli), good football, now great basketball, and excellent healthcare all while enjoying mountain views of the beautiful Smokeys. It is time to give back. This will be a theme moving forward in 2019. I am very thankful for the elected Board and for all their help and support. As we commence the new year, don’t look back, fix your eyes forward, strive for greatness, don’t accept failure, and let’s make this the best year yet. Cheers!

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EXCELLENCE ISN’T CLAIMED, IT’S EARNED. Being recognized for high performance by Tennessee’s only statewide quality program means we are committed to continuous organizational improvement for the benefit of our community.

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LEGAL NEWS

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HIPAA Reminder: Keep An Eye On Vendor Agreements By: Ian Hennessey, esq. London & Amburn, P.C.

By now, everyone knows that integrating HIPAA compliance into the operations of a medical practice is mandatory. But failing to see that there is more to HIPAA compliance than just your internal operations could cost your practice dearly. One area that deserves closer attention is the relationship between a medical practice and its vendors. In today’s healthcare sector, a multitude of companies offer any number of business solutions to a medical practice: billing software, marketing, electronic communication, etc. When a vendor performs certain functions or activities that involve the use or disclosure of protected health information (“PHI”) for a covered entity (e.g. a medical practice), then that vendor is considered a “business associate” under HIPAA. Business associates are subject to HIPAA, and covered entities must have a written business associate agreement (“BAA”) with each of its business associates. In addition, each BAA must include certain provisions in order to be HIPAA-compliant. As the old saying goes, however, “the devil is in the details.” Unfortunately, terms and conditions found in vendor agreements are sometimes expressly contrary to HIPAA. In other cases, vendor agreements drastically reduce or even eliminate a vendor’s liability when the vendor is responsible for a HIPAA breach. The following is a non-exhaustive list of questions to consider when determining whether to enter into a vendor agreement: 1. Will this vendor have access to PHI? 2. Does the underlying agreement reflect that the vendor is aware of its obligation to comply with HIPAA and has taken the necessary steps to be in compliance? 3. Is the BAA itself HIPAA-compliant? Which party produced it? Does the BAA include any non-required provisions that could be detrimental to the medical practice, such as limitations on liability or indemnification provisions? 4. Do any of the terms of the underlying agreement between the parties contradict the BAA or HIPAA requirements in general? 5. What is the timeframe for the vendor to provide notice of a HIPAA breach?

6. What happens with respect to PHI when the underlying agreement is terminated or a party is in breach? 7. Does the vendor carry any cyber-liability insurance, and is that reflected in the underlying agreement? The modern medical practice often relies on a range of third party vendors to help serve its patient population, obtain reimbursement, and maintain compliance with a myriad of government rules and regulations. Business associates, however, are just as susceptible to committing HIPAA violations as any medical practice. Thoroughly review the fine print of your vendor agreements before signing on the dotted line to help ensure HIPAA compliance on the front end. Failure to do so could be disastrous to your practice in terms of its patient relationships, its reputation in the community, and its bottom line. Mr. Hennessey is an attorney with London Amburn, a law firm dedicated to delivering client-driven legal services to its healthcare clients. For over 25 years, London Amburn has provided legal services encompassing health law, including regulatory and compliance, mergers and acquisitions, corporate and business, and employment matters, as well as medical malpractice and nursing home defense. Disclaimer: The contents of this article are for general informational purposes only and are not to be construed as legal advice. You should consult an attorney regarding any specific legal questions. _______________________________________________ 1 Not having a business associate agreement in place could cost your practice. In 2017, the Center for Children’s Digestive Health paid HHS $31,000 to settle potential HIPAA violations for failing to have written business associate agreement in place with one of its vendors: https:// www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/ccdh/index.html (last visited February 4, 2019). 2 See, e.g., 45 C.F.R. 164.504(e). 3 See HHS Office of Civil Rights’ “Wall of Shame” detailing HIPAA breaches affecting 500 individuals or more during the past 24 months: https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf (last visited February 4, 2019).

University Anesthesiologists Address: 1924 Alcoa Hwy U - 109 Knoxville, TN 37920 KNOXVILLEMEDICINE.ORG

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ACADEMY NEWS KAPA Update This year and every year, we are amazed at the dedication of our 1,800 physicians, physician extenders, and all Knox area hospitals who have committed to serving the uninsured population. This year we hit a milestone for KAPA: $300 million in donated healthcare services from our generous provider network. We sincerely THANK YOU for your time and hope you know the difference you are making in patient lives. Your service goes above and beyond and we are grateful for providers like YOU! But don’t just take our word for it. Please read a note from a KAPA patient: “I am so thankful to have been in your hands. When I was hopeless, you gave me hope. When I was sick, doctors did their part to help me to feel

better. KAPA people were warm hearted and patient with me. The staff became a friend that cares. Thank you all.” This is just one note of many we have received throughout the years. Not to mention, the patients who come in the office to say in person how grateful they are for KAPA’s services and how they are now able to work again and are provided insurance through their employer. These patient stories are why we continue to do what we do. KAPA has been extremely blessed throughout the thirteen years of coordinating care for patients and we look forward to many years to come. Thank you again for your commitment! For more information regarding KAPA, please contact Danielle Sims at dsims@knoxvillemedicine.org or 865-531-2766.

Knoxville Area Project Access Know someone or have a patient who is uninsured? Send them to KAPA! Here’s how!

1. Send a physician referral form to KAPA 2. KAPA will contact the patient to screen them for the program 3. If eligible, you will be notified of the patient’s enrollment in KAPA 4. KAPA will ensure the patient has a PCP and coordinate any specialty care It’s that easy!

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A Program of the Knoxville Academy of Medicine )RXQGDWLRQ

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For more information, please contact Danielle Sims at 865-531-2766 or dsims@knoxvillemedicine.org. 12

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KAMA CORNER By: Kirstin Kropilak, KAMA President I Love our KAMA TEAM! February is the month of love & appreciation and what better way than to shower our Doc Rock TEAM with just that. I greatly appreciate Jacque Prince stepping up to take over the helm of this fun event! For those of you new to this, Doc Rock is an evening event where the funds raised go directly to benefit the non-profit that each band represents. I’m so thankful for each Kama member who takes a lead: Susan Brown managed reservations & the VIP area; Cynthia Gash & Swannee Sexton secured our corporate sponsors; Sheila Barnett organized volunteers; Sharon Griffin decorated like a pro; Sandy Ange is our personal pro photographer, capturing many aspects of this event. Jenny Bushkell was our amazing communicator on social media. She kept the Facebook page loaded with info. Emily Munderloh arranged for some great TV spots for publicity, along with recruiting resident spouses as volunteers! Way to go, TEAM!

Here is the list of bands, non-profits they play for & KAMA liaisons: • Remedy/InterFaithClinic (Jacque Prince) • BBS/ St Mary’s Legacy Medical Mobile (Cynthia Gash) • Dr Zoster and Pox/Knox Metro Drug Coalition (Barbara Crist) • Code Black/ Cancer Support Community of ET (Carolyn Cates) • Whiskey Compass/ KAPA (Abigail Jumper) • No Recall/ MUSE (Jamie Singer) We don’t have all the numbers in yet, but we do know that REMEDY received the most number of votes that night. They will receive the largest portion of money to be given to The InterFaith Clinic. All of the other charities will also be given money as well. The band members of REMEDY are pictured below.

KAMA Members at the photo shoot. L-R: Susan Brown, Carolyn Cates, Jacque Prince, Sheila Barnett, Kirstin Kropilak & Jamie Singer. Sandy Ange is the real Rock Star behind the camera, capturing all these wonderful pictures. Thank you, Sandy!

UT Resident Orientation dinner. L to R: Kirstin Kropilak, KAMA President; Lili Vincent, membership co-chair; Emily Munderloh, Resident Spouse Liaison.

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Friday, April 5, 2019 6:30 pm Knoxville Marriott

Knoxville’s Most Talked about Fundraising Event Craig Morgan will be our special guest at the 2019 KAPA’s Boot Scootin’ Ball! Craig is known for Top 20 Hits such as Bonfire, International Harvester, Redneck Yacht Club, That’s What I Love About Sunday, and many more! The evening will be packed with great country music, line dancing, a western-themed dinner, a variety of beers in your own bottomless souvenir mug, and a huge silent auction. All proceeds to benefit Knoxville Area Project Access (KAPA).

FOR MORE INFO & TICKETS VISIT KAPABOOTSCOOTIN.COM OR CALL (865) 531-2766