Knoxville Medicine Magazine Spring 2020

Vol u m e L X X VI I , N o. 1 • Sp ri n g 2 02 0

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

Vitality Initiative Project Conference with Keynote Speaker, Wayne Sotile, PhD

Presented by:

V

ITALITY KAM

Knoxville Academy of Medicine’s

KNOXVILLE ACADEMY OF MEDICINE

Initiative Project

Dr. Sotile is the author of the “Medical Marriage”, “The Resilient Physician”, and “The Thriving Physician”.

Friday, August 21 Bridgewater Place

& Saturday, August 22

LMU DeBusk College of Osteopathic Medicine Knoxville Campus To register, visit knoxvillemedicine.org/events or call (865) 531-2766!

Members of KAM, BCMS, RACMS, and MCMS will receive complimentary registration if registered by July 15, 2020.

KAM KNOXVILLE ACADEMY OF MEDICINE

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KNOXVILLE ACADEMY OF MEDICINE

KNOXVILLEMEDICINE.ORG

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 Mark Browne, MD Richard Briggs, MD Debbie Christiansen, MD Randal Dabbs, MD Elise Denneny, MD Richard DePersio, MD Keith Gray, MD Terry Nowell, MD Robert Page, MD Kirstin Kropilak -KAMA Brandon Theriault - 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 reserves the right to accept or reject any advertising in the publication.

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KNOXVILLE ACADEMY OF MEDICINE

The medical profession, with its unrelenting schedules, depersonalization, emotional exhaustion and often, lack of fulfillment is causing many physicians to feel burned out. According to a recent survey by Medscape of more than 15,000 physicians representing 29 specialties, 42% of physicians surveyed reported that they are burned out. Specialties that have been among the top in burnout rates over the past 5 years include critical care, emergency medicine, family medicine, internal medicine, neurology, and urology. What is interesting is that physicians between the ages of 40-54 had noticeably higher rates of burnout than that of other age groups.

This statistic would suggest that possibly the rates were higher because in addition to the already amplified stressors associated with the profession, additional stress from trying to manage work-life balance (caring for children, aging parents, devoting adequate time to your spouse) also contributed to the increased rate of burnout. Additionally, every age group cited high ratios of burnout effecting their personal relationships.

One of the most dangerous effects of burnout is the impact on medical errors. According to a study led by researchers at the Stanford University School of Medicine, physicians with burnout had more than twice the odds of the self-reported medical errors.

The leadership of the Knoxville Academy of Medicine, in conjunction with Roane-Anderson County Medical Society and Blount County Medical Society is presenting an extraordinary opportunity for the physicians in East Tennessee to attend a two-day conference to aid our colleagues in identifying potential burnout and engaging measures that will reduce stress and help manage the strain associated with the practice of medicine. The conference, presented as part of The KAM Vitality Initiative Project (VIP), will be on August 21-22, 2020. Please note that we have postponed this conference later in the year since the uncertain public health climate has impacted registrations for the original March date.

Let me encourage you to attend this great conference! We are so excited to have nation-

ally-known speaker, Wayne Sotile, PhD as our keynote speaker both Friday night and Saturday morning. Dr. Sotile has spoken to audiences for the AMA, American College of Surgeons, American Orthopaedic Association, American Academy of Dermatology, and American College of Cardiology, just to name a few.

The VIP Conference starts with a Physician-Spouse Dinner at Bridgewater Place Conference Center with Dr. Sotile speaking on The Thriving Medical Family: New Challenges, New Solutions. This dinner will focus on the stressors unique to the medical family. We encourage physicians to bring their spouse to this event. CME will be awarded to attendees of this event.

The Saturday CME Conference will begin with a Breakfast Keynote by Dr. Wayne Sotile on Choosing Resilience: The Key to Thriving through Change. This seminar is specifically designed for physicians to improve career fulfillment. The Saturday CME Conference will be located at the Knoxville LMU DCOM Campus adjacent to Pellissippi Hwy, near the Dutchtown Road Exit. Additionally, 3 more CME sessions will be offered that day including: • Managing Burnout Through Mindfulness, by Clifton Tennison, Jr., MD • Red Tape and Regulations: How to Immunize Yourself from EHR Burnout, by Ian Hennessey, JD • Physician Burnout & Financial Independence, by Rusty Harmon, Rhett Lankford, and Darin Patterson Please mark your calendar now to attend this special conference! To register, visit the KAM website at knoxvillemedicine.org/events.

Members of KAM, Blount, Roane-Anderson, and Monroe County Medical Societies will receive complimentary registration for both the physicians and spouses if you register prior to July 15, 2020. We truly want this conference to be of a benefit to our physicians. Please invite non-members and your hospital administration staff to attend. I hope to see you there!

Timothy S. Wilson, MD KAM President

KNOXVILLE MED CINE | 3

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.

First Row Left to Right: Kristy Carter, MD; Rob Gathings, MD; Anil Harsh, MD. Second Row Left to Right: Brian Hughes, MD, PhD; Thomas Lowry, MD; Melissa Witte Meyer, MD. Third Row Left to Right: Meghan Peters, MD; Wilson Powers, MD; Stephanie Russ-Barber, MD.

KRISTY CARTER, MD PEDIATRICS Summit Medical Group 125 Huxley Rd Knoxville, TN 37922 ___________________________________

MELISSA WITTE MEYER, MD PEDIATRICS Summit Medical Group 125 Huxley Rd Knoxville, TN 37922 ___________________________________

ROB GATHINGS, MD DERMATOLOGY Knoxville Dermatology Group 123 Fox Rd Knoxville, TN 37922 ___________________________________

MEGHAN PETERS, MD PEDIATRICS Summit Medical Group 11021 Chapman Hwy Seymour, TN 37865 ___________________________________

ANIL HARSH, MD PEDIATRICS Summit Medical Group 11021 Chapman Hwy Seymour, TN 37865 ___________________________________

WILSON POWERS, MD PEDIATRICS Summit Medical Group 11021 Chapman Hwy Seymour, TN 37865 ___________________________________

BRIAN HUGHES, MD, PHD INTERNAL MEDICINE Summit Express Clinic – Farragut 10820 Kingston Pike Ste 11 Knoxville, TN 37934 ___________________________________

STEPHANIE RUSS-BARBER, MD PEDIATRICS Summit Medical Group 2587 Willow Point Way Knoxville, TN 37931 ___________________________________

THOMAS LOWRY, MD PEDIATRICS Summit Medical Group 2587 Willow Point Way Knoxville, TN 37931

JESSICA TAYLOR, MD GENERAL SURGERY University General Surgeons, PC 1932 Alcoa Hwy, Ste 270 Knoxville, TN 37920 (no photo)

Private Screening of DO NO HARM Movie On Thursday, Feb 20, the KAM was pleased to present DO NO HARM: Exposing the Hippocratic Hoax as part of our new Vitality Initiative Project (VIP) to improve physician wellness and address physician burnout.

The full-length documentary focused on the stressors that physicians face daily and the growing epidemic of physician suicide. The event was held at the Regal Pinnacle theatre and attended by more than 100 physicians and spouses. A big thank you to movie sponsors First Bank, Blount County Medical Society and Roane-Anderson County Medical Society.

The next VIP event will be a special education conference with nationally-known speaker, Wayne Sotile, PhD, on August 21-22, 2020. Dr. Sotile is the author of The Medical Marriage and The Resilient Physician. Members of KAM, Blount, Roane-Anderson, and Monroe County Medical Society receive complimentary registration if you register before July 15, 2020. To register or for more information, visit knoxvillemedicine.org/events.

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Calendar of Events JUNE 21

KAM Day at the Smokies

21 -22

Vitality Initiative Project Conference 21st Bridgewater Place & 22nd LMU Knox

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KAPA’s Boot Scootin’ Ball Bridgewater Place

AUGUST OCTOBER

FOR MORE INFO ON ALL EVENTS, VISIT WWW.KNOXVILLEMEDICINE.ORG

KAM The Confidence Curve

KNOXVILLE ACADEMY OF MEDICINE

By: Terry Nowell, MD PGY2, Dept of Anesthesiology Resident Liaison to KAM Anosognosia is a neurologic condition in which a person with a neurologic deficit is unaware of having it. Although this is undeniably pathologic in its true form, our brains are hardwired with faulty ways of thinking called cognitive biases that are nearly inalterable. In a way, our denial of these underlying faulty heuristics is anosognosic. One cognitive bias that dramatically effects medical education is known as the DunningKruger Effect.

Psychologist David Dunning identified this phenomenon after being inspired by an amateur attempt at a bank robbery. Technically, the robbery was successful, but the robber, McArthur Wheeler, was easily apprehended. This is because Wheeler walked into two banks without a mask, in broad daylight, and looked directly into the cameras. Later, when he was apprehended, he was dumbfounded that the cameras could see his face. Convinced he would be rendered invisible to the cameras, Wheeler smeared lemon juice all over his face.

Dunning and his grad student, Justin Kruger, began to investigate the

question: When people are incompetent, do they know they’re incompetent? Over the past two decades, multiple studies have led to resounding answer to this question: No. Being “unskilled and unaware of it” (the title of Dunning’s original article on the topic) has been seen in many stages of medical education. A 2005 study from Friedman, et al. compared the confidence and accuracy in medical diagnoses of fourth-year medical students, senior internal medicine residents, and faculty internists.

What was shown is that the students were neither confident nor accurate in their diagnoses, the faculty were generally confident and accurate, while residents were overconfident relative to their accuracy.

Similarly, a 2011 retrospective analysis of surgical residents found that the lowest-performing residents were least able to identify weaknesses, while topquartile residents underestimated their competencies. However, the resident’s peers, attendings, and nurses were able to predict their performance on competency assessments. Simply put, confidence outpaces competence at the beginning of training.

So, how can this inflated confidence be combatted? First, awareness of the cognitive trap and thinking about our own thinking, i.e. “metacognition,” will help residents and young attendings identify when they have fallen prey to this hubris. Second, seeking out and embracing honest feedback and evaluations is vital. As described in the study of surgical residents, attendings and nurses alike were able to accurately identify weak points in performance.

Having enough humility to reflect and assimilate feedback is vital.

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KNOXVILLE MED CINE | 5

4th Annual

Essentials of Clinical Medicine Conference sponsored by the LMU-DCOM Alumni Association

June 12-14, 2020 Dollywood’s DreamMore Resort and Spa Pigeon Forge, Tennessee Keynote Speaker: Dr. Patch Adams Join us for a balanced weekend of lectures and leisure time. Earn CME credit while enjoying a fun-filled weekend with your family and friends. An optional ENT for the Primary Care Practitioner program is available, using demonstrations and realistic learning experiences, that will provide the learner with an appreciation of allergy testing, protocols for evaluating hearing loss and dizziness, Osteopathic Manipulative Treatment (OMT) and the in-office flexible nasolaryngoscopy procedure. Call 1-800-DOLLYWOOD to make your room reservation at the guaranteed rate of $245 plus tax per night. Up to 17 hours of CME credit anticipated to be available for DOs and MDs, physician assistants and nurse practitioners.

Registration Rates: Attending Physicians: $200 | $300 with ENT for the PCP PAs/NPs: $150 | $250 with ENT for the PCP Resident Physicians: $100 | $200 with ENT for the PCP Professional Students: $25 Confirmed topics include: gastroenterology, endocrinology, immunization updates, cardiology, antibiotic updates, psychiatry, orthopedics, and OB/GYN. Register Online at: DCOMalumni.LMUnet.edu/2020CME For more information contact amy.drittler@LMUnet.edu

KAM Blount County Medical Society Quarterly Update

KNOXVILLE ACADEMY OF MEDICINE

By: Aaron Bussey, MD - BCMS President

2020 promises to be a banner year for Blount County Medical Society as we look to grow both membership and participation. Our immediate past-president, Travis Groth, DO, did a fantastic job over the past two years of breathing new life into the organization. Not only did he establish the first board of officers at BCMS in many years but he also began the important work of reviving a true sense of community for Blount County physicians. Dr. Groth was so effective, in fact, that the BCMS members refused to let him leave our executive board and voted him into the position of vice-president.

Bob Haralson, MD continues to serve effectively as BCMS treasurer and provides a steady hand guiding the board to be better stewards of our finances. In 2019 we focused on protecting our assets with prudent investing.

Major goals for 2020 are the establishment of a sound budget and efforts to grow our income in order to provide more and better services to the members.

Jennifer Winbigler, MD stepped into a new official role of secretary but unofficially serves as our “social chair”. She and her husband, Brian Winbigler, PharmD, provided the venue for our Fall Pig Roast the past two years and have pledged to do so again. As a practicing hospitalist at Blount Memorial Hospital she also serves as the board’s chief liason to our hospital based colleagues.

My priority as recently elected board president is to maintain and

build on the momentum established by Dr. Groth and the 2019 board.

We now have a monthly social gathering for members and their spouses, “Beers with Peers”, that is growing in popularity. We’ve learned, however, that too many of our eligible members just aren’t aware of the event. My board and I have set a goal of updating the membership contact information to better publicize all BCMS events and offerings.

I am particularly excited to roll out a new quarterly social event that is also clinically relevant. Every three months instead of our usual Beers with Peers we will have night with a clinical theme in an informal setting.

Our “Quarterly Curbside” will feature physicians with specific clinical interests or expertise as they present cases and topics of interest for discussion with the members.

This promises to be a great opportunity to pick the brains of local clinical leaders while also deepening our sense of a true clinical community. Our first Quarterly Curbside is slated for March as local endocrinologists discuss all things hormonal. The exact venue hasn’t been nailed down at time of this publication so watch your email inbox, reach out to a board member, or contact KAM for details.

I am excited to serve as your BCMS president for 2020 and look forward to seeing you at one of our many events soon.

Sincerely, Aaron Bussey, MD

KAMA Corner

By: Judy Akers, KAMA President

WE CARE Communicate Active Relationships Excitement I want to take this opportunity to thank the Knoxville Academy of Medicine for all of their support over this past year. It has truly been a pleasure learning more about KAM through the KAMA relationship.

We are grateful to have such strong support for both organizations.

Doc Rock has just concluded and what an event it was. We were at the Concourse and they graciously donated their venue for the event on Saturday, January 25, 2020. We had a sellout crowd which danced the night away. The three judges (Chris Doody, Rey Pineda and Paul Jones) were amazing and definitely an asset to the evening. The five

KNOXVILLEMEDICINE.ORG

bands who participated were dynamic and so fun to watch. The bands and the non-profits they played for are listed below. I would like to thank everyone involved for all of their hard work before, during and after the event.

Dr. Zoster and the Pox – Knox Area Project Access B.B.S. – St. Mary’s Legacy Mobile Clinic Remedy – Interfaith Health Clinic No Recall – The Muse Children’s Education Museum Whiskey Compass – East TN Children’s Hospital In closing, I am always available to hear any ideas or answer questions. Please reach out to me at judyakers5@gmail.com.

KNOXVILLE MED CINE |

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LEGAL NEWS

KAM KNOXVILLE ACADEMY OF MEDICINE

RECENT $285,000 SETTLEMENT PROVIDES WARNING REGARDING “INCIDENT TO” BILLING PRACTICES By: Erin Williams and Patti Cotten

In January 2020, a Knoxville family physician paid $285,000 in a False Claims Act settlement related to billing for services provided by nurse practitioners under the physician’s NPI. The qui tam case1 was filed in 2015 by one of the practice’s former nurse practitioners, who was paid $51,300 as a result of the settlement.

Billing for services performed by an advanced practice clinician (“APC”) under the supervising physician has been a source of confusion for years. In the wake of this settlement, here are some answers to the most frequently asked questions we receive regarding “incident” to billing.

What is “incident to” billing?

While the term “incident to billing” is often used colloquially in the healthcare industry to mean billing for services performed by an APC, “incident to” billing is a Medicare payment rule applicable only to Medicare claims. “Incident to” billing may only be utilized in an office setting (i.e., POS 11) and does not apply to professional services provided in a hospital or other facility (although the “split/shared rules” may apply in those settings). Additionally, the following criteria must be met to bill APC services under the NPI of the supervising physician: (1) the physician initiates the course of treatment, (2) direct supervision is required, (3) the APC must be enrolled in Medicare, and (4) the APC must be a direct financial expense to the physician for whom the services are billed “incident to” (i.e., the APC must be an employee, leased employee or independent contractor of the group). If any one of these criteria are not met, the Medicare “incident to” billing requirements have not been met and the services performed by the APC must be billed under the APC’s provider number at the lower reimbursement rate.

If “incident to” is a Medicare rule, how do I bill the other payors?

While some payors adopt Medicare “incident to” rules and guidelines for billing under the supervising physicians, some do not. While ensuring that you meet Medicare “incident to” billing requirements for Medicare claims is certainly a good start, it does not necessarily mean that you are meeting the billing requirements for all payors. It depends on each payor’s specific payment rules and policies. TennCare MCOs, Medicare Advantage plans, and commercial payors all have different rules for billing APC services under the supervising physician. Sometimes, the billing rules may be different even between a payor’s own product lines.

Why bill under the supervising physician?

Depending on the payor, the reimbursement rates for services performed by APCs are generally lower than the physician rate for the

KNOXVILLEMEDICINE.ORG

same services. For Medicare claims, the APC rate is 85% of the physician rate. Some payors require billing under the APC for informational purposes, but do not reduce reimbursement rate for the services provided. Still, other payors who do not adopt the “incident to” rules, do require APC billing and do reduce reimbursement. So, there may a financial incentive to bill under the supervising physician for services performed by an APC, but that may vary from payor to payor.

What do I do if I’ve done it wrong?

If you believe you may have incorrectly billed Medicare or other payors for services performed by APCs, you will need to determine if you received an overpayment for services improperly billed under the physician’s number and, if so, make a voluntary refund. Federal law requires that Medicare/Medicaid/TennCare overpayments be reported and returned to governmental payors within 60 days of identification.2 The regulations provide that it should generally take about 6 months to identify the overpayment amount, which then must be returned within 60 days. Failure to return an identified overpayment may result in False Claims Act liability3, including treble damages, penalties of $11,463 to $22,927⁴ per claim, and often entering into a 5-year Corporate Integrity Agreement (CIA). Private payors may also have refund requirements for overpayments, so be sure to check your provider manuals.

What’s the bottom line?

Billing under the supervising physician’s number for services performed by an APC is an available option for many payors, but can be complicated. Know and keep up with the billing requirements for each payor. When in doubt, bill under the rendering provider’s number.

Ms. Williams and Ms. Cotten are attorneys with London Amburn, a law firm dedicated to delivering clientdriven 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 See United States and State of Tennessee ex rel. Forester v. Chang-Wen Chen, M.D. and Chang-Wen Chen, M.D., P.C., Case No. 3:18-cv-51 (E.D. Tenn).

2 See 81 Fed. Reg. 7653.

3 See 31 U.S.C. 3729. ⁴ As of February 1, 2019, but subject to adjustment for inflation.

KNOXVILLE MED CINE | 9

FINANCIAL NEWS Avoid These Financial Traps

By: Darin Patterson SVP, Managing Director - First Bank Investment Money. It’s hard to get and easy to lose. It doesn’t take long for the wealth you’ve accumulated to disappear if you don’t manage your money well or have a plan to protect your assets from sudden calamity.

Snares like the ones mentioned below could easily threaten your financial security. Planning ahead can protect you and your loved ones from getting caught.

Undisciplined Spending The more you have, the more you spend -- or so the saying goes. But not paying close attention to your cash flow may prevent you from saving enough money for your future. Manage your income by creating a spending plan that includes saving and investing a portion of your pay. Your financial professional can help identify planning strategies that will maximize your savings and minimize your taxes.

High Debt With the easy availability of credit, it isn’t hard to understand how many people rack up high credit card balances and other debt. Short-term debt will become long-term debt if you’re paying only the minimum amount toward your balances. If you can’t pay off your credit card debt all at once, consider transferring the balances to a card with a lower interest rate.

Unprotected Assets Your life, your property, and your ability to work should all be protected.

Life insurance can provide income for your family if you die. Homeowners and automobile insurance can help protect you if your home or car is damaged or destroyed and provide liability coverage if someone is injured.

Disability insurance can protect your income if you’re unable to work.

Unmanaged Inheritance A financial windfall is great, but it also can be dangerous. Without solid advice on managing and investing the money, you could find that your inheritance is gone in a much shorter time than you would have thought possible. Your financial professional can help you come up with a plan for managing your wealth. Setting aside a portion of the money to spend on a trip or other luxury while investing the rest may be one way to reward yourself and still preserve the bulk of your assets.

Neglected Investments Reviewing your investments to make sure they’re performing as you expected -- and making changes in your portfolio if they’re not -- is essential.

But it’s also essential to periodically review your investment strategy. You may find that your tolerance for risk has changed over time. You’ll also want to assess the tax implications of any changes you plan to make to help minimize their impact.

Retirement Shortfall If you’re not contributing the maximum amount to your employer’s retirement savings plan, you’re giving up the benefits of pretax contributions and potential tax-deferred growth. Maximizing your plan contributions can

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start you on your way to a comfortable retirement -- hopefully with no traps along the route.

Darin Patterson is a 20-year investment industry veteran and is the Managing Director and Senior Vice President. Patterson is a graduate of the University of Memphis. He is a Certified Retirement Counselor, holds a Series 7 and 66 with LPL Financial. Patterson and his wife, Sharon, have two children, DJ and McKenzie.

Because of the possibility of human or mechanical error

by DST Systems, Inc. or its sources, neither DST Systems, Inc. nor its sources guarantees the accuracy, adequacy, completeness or availability of any information and is not responsible for any errors or omissions or for the results obtained from the use of such information. In no event shall DST Systems, Inc. be liable for any indirect, special or consequential damages in connection with subscriber’s or others’ use of the content. © 2019 DST Systems, Inc. Reproduction in whole or in part prohibited, except by permission. All rights reserved. Not responsible for any errors or omissions.

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New Date!

Friday, October 23, 2020 6:30 PM

New Location!

Bridgewater Place

KNOXVILLE’S MOST TALKED ABOUT FUNDRAISING EVENT

They say hindsight is 20/20… so in 2020 we’ll be taking KAPA’s Boot Scootin’ Ball Back to the 80s!!!!!!

To celebrate the 80s in style, our special guests for the 2020 KAPA’s Boot Scootin’ Ball will be the Journey Tribute Band, RESURRECTION! Come hear all the great Journey music from the 80s like Don’t Stop Believing, Any Way You Want It and Faithfully!!! Step back in time with a remarkable Journey Tribute Experience along with a great dinner, dancing, and a variety of beers in your own bottomless souvenir glass, and a large silent auction. Be sure and dust off those neon bracelets, leg warmers, high waisted jeans and tease that hair!!!!! KAPA’s Boot Scootin’ Ball is going BACK TO THE 80s!

All proceeds to benefit Knoxville Area Project Access (KAPA).

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