Summer magazine 2017 by Knoxville Medicine Magazine

Volum e L X X IV, No . 2 • S u mme r 2 0 1 7

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

CHARLIE DANIELS ROCKED IT AGAIN! KAPA’S 2017 BOOT SCOOTIN’ BALL RECAP

KAM KNOXVILLE ACADEMY OF MEDICINE

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Academy Officers

KAM CEO MESSAGE By: Kim Weaver, PhD

Neil Coleman, MD PRESIDENT

Tim Wilson, MD PRESIDENT ELECT

Daniel Bustamante, MD SECRETARY

Jeff Ollis, MD TREASURER

Thomas Pollard, MD

IMMEDIATE PAST PRESIDENT

Kimberly Weaver, PhD CEO

Board of Trustees Michael Brunson, MD Brian Daley, MD David Harris, MD Zack 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 Lorraine Johnson -KAMA Mike Maggart, MD Patrick McFarland, MD Robert Page, MD

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

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

Its summertime and we are halfway through our administrative year here at the Knoxville Academy of Medicine. As always, the KAM Board of Trustees and staff are working hard to meet the needs of our membership and promote community wellness. Here are just a few of the new projects currently in force: Knoxville Area Project Access (KAPA), a program of the KAM Foundation, is now in its 11th year and continues to grow. This year, KAPA began a pilot program to enhance services offered to our low-income neighbors in need. The pilot, KAPA Connects, is the next step in addressing public health as it recognizes that good health care outcomes many times rely on breaking down the socio-economic barriers. To that end, the KAM Foundation Board of Governors have created a unique collaboration with existing agencies which provide services such as housing, food, transportation, health education, and substance recovery services. This partnership will allow KAPA Case Managers to work with patients and coordinate services based on the individual need of the patient. Additionally, KAPA is developing new members of this team which will be known as Community Connectors. Community Connectors will be volunteers who live, work, or worship within an identified community and will be trained to identify barriers. These Community Connectors (or Barrier Busters, as Dr. Jack Lacey loves to refer to them) will contact KAPA Case Managers so that the individual can be evaluated and established with the services needed. What sets this program apart is the communication system which is fueled by ETHIN (East Tennessee Health Information Network). This means that patient’s physician will be able to see which socio-economic interventions have been made and incorporate into the medical record. With many payment models requiring some sort of social service intervention depending on diagnosis, KAPA will help our physicians meet this requirement. The first year of the pilot program has been funded through grants from both Humana and the TN Department of Health. After the pilot has been successfully completed, it is hoped that all services will be funded by payors interested in the overall health of their subscribers. Many of you may have recently read an article in the Knoxville News Sentinel about the Endocarditis Project. Almost two years ago, then KAM President, Dr. Tom Pollard, brought an idea to the KAM Board to address the problem of patients with substance abuse issues who develop endocarditis and often require multiple heart value replacements. Under Dr. Pollard’s leadership, a collaboration of KAM physicians along with hospital CMOs, public health officials, and substance abuse professionals have been

KAM

KNOXVILLE ACADEMY OF MEDICINE meeting to address this epidemic within our community. Recently, Dr. Pollard and KAM Staff sat down with Cornerstone of Recovery to discuss the possibility of heart valve replacement recipients obtaining both needed after-surgery intravenous antibiotics while being treated for substance abuse. You should be hearing more about this unprecedented program in the coming months. Membership within our association continues to grow. As of July 1, KAM membership has increased by 138 members since this time last year. Currently, our membership stands at 1247 members. In June, the KAM staff attended the University of Tennessee Resident Orientation as we have done for many years. Dr. Matt Mancini spoke to the new residents regarding the importance of organized medicine and subsequently, 54 new residents have joined our ranks. This month, all new and returning residents are invited to a Taco and Tequila Mixer at the Market Square Soccer Taco. This is sponsored by Capital Financial. Stay tune for dates this fall for a Pizza and Politics Mixer for our residents and students. Pizza and Politics is a fun evening which educates our younger physicians on the importance of participation in the political system with regards to medicine. Additionally, the KAM Membership Services staff is working on adding new membership benefits. Check out the back page of this issue to learn about a new, guaranteed-issue, lump sum disability program just for KAM Members. This program is just one of the many new member benefits which will be added this year. More to come…. This is just a sampling of the programs currently being developed by the membership of the KAM. Thank you all for your support in this association! We are better together!

Calendar of Events

JULY 18

Tacos and Tequila Resident Mixer Soccer Taco, Market Square, 6:00 pm

AUGUST 25

KAM/KAMA Young Physicians Picnic Gettysvue Lower Pool, 5:00 pm

SEPTEMBER 28

FASHIONDRAMA 2017 Gettysvue County Club

OCTOBER 19

OSHA Seminars Knoxville Marriott 8:00am and 6:00 pm

Legislative Dinner Gettysvue Country Club, 6:30 pm

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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. GAYATHRI BALJEPALLY, MD

JERRY J. CROOK II, MD

________________________________________________

RAJ BALJEPALLY, MD

LAURA FINDEISS, MD

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ROSALIND CADIGAN, MD

DAVID GALLEGOS, MD

________________________________________________

MATT J. CHUA, MD

JEFFREY B. HIRSH, MD

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JAMES W. COX, JR., MD

RUSSELL HUNTSINGER, JR., MD

CARDIOVASCULAR DISEASE University Cardiology 1940 Alcoa Hwy E310 Knoxville, TN 37920

OB/GYN OB/GYN Professionals of East TN 9330 Park West Blvd Suite 592 Knoxville, TN 37932

CARDIOVASCULAR DISEASE University Cardiology 1940 Alcoa Hwy E310 Knoxville, TN 37920

RADIOLOGY University Cardiology 1940 Alcoa Hwy E310 Knoxville, TN 37920

RADIOLOGY University Radiology 1924 Alcoa Hwy Knoxville, TN 37920

OTOLARYNGOLOGY Greater Knoxville ENT Associates 7557A Dannaher Dr Ste 220 Knoxville, TN 37849

CARDIOVASCULAR DISEASE University Cardiology 1940 Alcoa Hwy E310 Knoxville, TN 37920

Left Column Top to Bottom: Gayathri Baljepally, MD; Raj Baljepally, MD; Rosalind Cadigan, MD; Matt J. Chua, MD; James W. Cox, Jr., MD. Right Column Top to Bottom: Jerry J. Crook II, MD; Laura Findeiss, MD; David Gallegos, MD; Jeffrey B. Hirsh, MD; Russel Huntsinger, Jr., MD.

Stay Connected

So be sure to like us on Facebook and follow us on Twitter! - facebook.com/Knoxdocs - twitter.com/KnoxMedicine

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KAM KNOXVILLE ACADEMY OF MEDICINE

JULIE JETER, MD

J. CHRISTOPHER SCOTT, MD,

________________________________________________

JOSEPH C. LIU, MD,

BENJAMIN I. SHEPPLE, MD,

________________________________________________

W. JEREMY MAHLOW, MD,

CHRISTOPHER TAYLOR, MD

________________________________________________

TJUAN L. OVERLY, MD,

CARMELO V. VENERO, MD,

________________________________________________

JEFFREY PEEKE, MD

BEN WILKINSON, MD

FAMILY MEDICINE UT Primary Care 1924 Alcoa Hwy U67 Knoxville, TN 37920

CARDIOVASCULAR DISEASE University Cardiology 1940 Alcoa Hwy E310 Knoxville, TN 37920

DERMATOPATHOLOGY University Radiology 1924 Alcoa Hwy Knoxville, TN 37920

CARDIOVASCULAR DISEASE University Cardiology 1940 Alcoa Hwy E310 Knoxville, TN 37920

OPHTHALMOLOGY Campbell Cunningham and Taylor PC 1124 E. Weisgarber Rd. Ste 100 Knoxville, TN 37909

CARDIOVASCULAR DISEASE University Cardiology 1940 Alcoa Hwy E310 Knoxville, TN 37920

RADIOLOGY Provision Center for Proton Therapy 6450 Provision Cares Way Knoxville, TN 37909

Left Column Top to Bottom: Julie Jeter, MD; Joseph C. Liu, MD; W. Jeremy Mahlow, MD; Tjuan L. Overly, MD; Jeffrey Peeke, MD. Right Column Top to Bottom: J. Christopher Scott, MD; Benjamin I. Shepple, MD; Christopher T. Taylor, MD; Carmelo V. Venero, MD; Ben Wilkinson, MD.

Additionally, we would like to welcome the following new KAM Resident Member and LMU Students: Alexander Nourse, DO Justin Harrell Anna Carr Josh Cooper Mohanned Knefati John Kriese Zachary Kirkland Genevieve Kemp Ryan Sauls Sean Dornbush Parker Hunt Juan Querubin KNOXVILLEMEDICINE.ORG

Matthew Crabtree Sterling McClain Justin Humphrey Lauren Hansen Katherine Watson Michele Lam Margaret Sabourin Jacob Agner Akshar Ashwin Brahmbhatt Chelsey Lynn Haley Ambreen Iqbal

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ACADEMY NEWS LMU Graduation

KAM KNOXVILLE ACADEMY OF MEDICINE

The LMU-DCOM Class of 2017 celebrated graduation on Saturday May 13, 2017 at their main campus in Harrogate TN. Robert S. Juhasz, DO, FACOI, FACP, past president of the American Osteopathic Association (AOA), served as commencement speaker. The DeBusk College of Osteopathic Medicine proudly announced that they had placed 99.5% of its graduating class into postgraduate training programs. The members of the Class of 2017 will be practicing in 16 different specialties in 175 different residency programs in 35 states.

Match Day Held at UT for Residency Programs On March 17th thirteen students participated running to the 50-yard line at Neyland stadium to open their letters to see which residency program that they matched with. Participants matched with UT Graduate School of Medicine, UT Chattanooga, UT Health Science Center, University of Kentucky Medical Center, Trident Medical Center (Charleston, South Carolina), University of Louisville School of Medicine, St. Vincent Hospital (Worchester, Massachusetts), Barnes Jewish Hospital (St. Louis, Missouri), Medical College of Georgia (St. Augusta, Georgia), George Washington University (Washington D.C.), Palmetto Health Richland (Columbia, South Carolina) and Madigan Army Medical Center (Tacoma, Washington). The University of Tennessee Graduate School of Medicine also celebrated a 100% fill of all of its residency positions among its 11 residency programs.

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ACADEMY NEWS KAPA’s Boot Scootin’ Ball April 7, 2017

THANK YOU! Diamond Sponsors • Covenant Health • Tennova Healthcare • UT Medical Center • SouthEast Bank • Dynasty Spas Media Sponsors • Bandit Lites • WBIR • WIVK Platinum Sponsors • Knoxville Comprehensive Breast Center Gold Sponsors • Alphagraphics • Ole Smoky Tennessee Moonshine • Stages West Silver Sponsors • Home Federal Bank • DeRoyal 8

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The Charlie Daniels’ Band a Hit at the KAPA Boot Scootin’ Ball On April 7th the Charlie Daniels Band performed to a capacity crowd. The evening festivities were kicked off as guests arrived and gathered to hear music performed by Blonde Bones. This year’s silent auction was the largest to date and featured many unique experiences and items. Guests enjoyed free moonshine tasting samples from Ole Smoky Tennessee Moonshine as well as an opportunity to purchase this year’s signature drink the “KAPA Big Orange Bootkicker” made with orange moonshine. Bottomless beer served in Mason jar mugs was also enjoyed throughout the night. When the Charlie Daniels Band took to the stage all were on their feet to enjoy the intimate concert. At 80 years young, he brought the house down! He even made himself available for a few meet and greet opportunities throughout the evening. This annual event allows funding to support the KAM Foundation’s, Knoxville Area Project Access (KAPA), which is the largest Project Access in the country. KAPA provides medical assistance to many of the uninsured of Knox County and has been proven to positively impact the Knoxville community. Corporate Table Sponsors: Capital Financial, University Anesthesiologists, Greater Knoxville Ear Nose and Throat (GKENT), Dermatopathology Partners, University Surgeons Associates and the Knoxville Academy of Medicine Alliance (KAMA). In addition to our sponsors many thanks to the KAM physicians that supported the event by purchasing a private table. These physicians included: Dr. Matthew Mancini, Dr. Brian Daley, Dr. Elmer Pinzon and Dr. Thomas Pollard. The KAPA premiere signature event raised much needed proceeds from ticket sales, drink sales and the silent auction. Planning has already begun for next year’s event scheduled for April 13, 2018!

KAM KNOXVILLE ACADEMY OF MEDICINE

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Henry S. Nelson, Jr., M.D. Nicole Kissane-Lee, M.D. Bruce Ramshaw, M.D. Sherard Chiu, M.D.

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Fax 865.525.3460

KNOXVILLE MED CINE | 9

ACADEMY NEWS BME Update

By: Reeves Johnson, MD POLICY UPDATE The BME routinely develops policies to help clarify how the Board interprets and acts on some of the statutes and rules that govern the practice of medicine. Currently, there are 23 policies; however, many were adopted over 10 years ago. We have begun a process of reconsidering some of the Board’s older policies to ensure that they are current and reflective of current standards of practice. The Board does not expect that every policy will be rewritten. In fact, we have been pleased to find that many of the policies—even some of the oldest documents—contain information that is still relevant and reflective of best practices. This is a testament to the work of previous boards and the quality of deliberation that went into consideration of each document. POLICY: PRESCRIBING FOR ONESELF AND ONE’S FAMILY At our meeting in May, the Board chose to clarify and emphasize the following points: • • • • • •

Definition of one’s immediate family A reminder that records must be kept Self-treatment is only permitted in emergencies Self-prescribing of scheduled drugs is prohibited Treating immediate family members is limited to minor, self-limited conditions and emergencies Prescribing scheduled drugs to immediate family members is only allowed in emergencies

The Board began its reconsideration of policies with this document because the Board’s administrative office reported an increasing number of inquiries on this topic. As part of the Board’s deliberations, the Board examined the policies of other states and the AMA. A hypothetical situation considered by the Board was one in which a doctor treats his elderly home-bound mother for hypercholesterolemia. Since this is not a minor, self-limited illness, treating her would be a violation of this policy. The Board would have concerns that the physician may not be totally objective and other areas of her health may be overlooked.

Likewise, physicians can not always be objective treating themselves. And with the opioid crisis in our state to which physicians themselves are not immune, they should not take a self-prescribed scheduled drug. This Policy with its clarifications can be viewed at: https://tn.gov/assets/entities/health/attachments/g4056347.pdf If you ever have a question that you would like to have considered by the Board, the Board’s rules authorize licensees of the Board to request advisory opinions. The form is available on the Board’s website at: https:// tn.gov/assets/entities/health/attachments/Advisory_Ruling_form.pdf NEW ONLINE APPLICATION In May, the Board starting accepting online applications for a full medical license. Go to: https://lars.tn.gov/datamart/login.do;jsessionid=XY54s 4hjJfZKhNZP8Jo7V9pU NEW NOTABLE LAWS PASSED THIS SESSION: MAINTENANCE OF CERTIFICATION AND BOARD CERTIFICATION NOT REQURIED FOR LICENSURE Public Chapter 438: the BME may not deny a licensed based on the physician not participating in Maintenance of Certification (MOC) or being Board Certified. Also a Task Force was developed to review the use of MOC by hospitals, insurance companies and other licensing entities and to look for improvement in and alternatives to MOC. EXTENDERS ALLOWED TO TREAT STDS IN MINORS WITHOUT PARENTAL CONSENT P.C. 266: NPs, PAs and midwifes with an appropriate supervising physician are allowed to treat minors with an STD without parental knowledge or consent. INTERSTATE MEDICAL LICENSURE COMPACT P.C. 365: TN became the 21st state to enact the Interstate Medical Licensure Compact. Effective 1/1/2019, a physician licensed in one of the 20 other participating states that meets the strict criteria of the Compact will be automatically issued an unrestricted TN medical license. The first Compact license was issued in April and took less than 2 weeks to process. In the same manner, a TN licensed physician meeting the Compact criteria will also qualify for an expedited license in any of those 20 states. The law may be seen at: http://publications.tnsosfiles.com/acts/110/ pub/pc0365.pdf - The criteria are in Section 2(k).

The Knoxville Academy of Medicine mourns the recent loss of these physician members

Coy Freeman, MD 9/29/1942 – 3/6/2017 42 year member 10 | KNOXVILLE MED CINE

William Henry Gardner, MD 5/8/1923 – 3/16/2017 61 year member

Walter C. Shea, MD 10/21/1926 – 4/19/2017 56 year member

KAM Resident Resolution Receives Pass from TMA

By: Patrick McFarland, MD PGY3 (Third Post-graduate Year) AN Resident Dept. of Anesthesiology, UT Medical Center Knoxville The Tennessee Medical Association (TMA) voted, this past April, to support resident involvement in, and protect time for, organized medicine during residency training. Prior to the vote, the Knoxville Academy of Medicine Board unanimously approved a revised version of the resolution, which was initially drafted by Knoxville residents in the TMA Resident Fellow Section. The resolution passed on the house floor before the TMA House of Delegates at the 2017 annual meeting in Nashville. In coordination with Graduate Medical Education, the resolution seeks to dedicate time during residency training for professional experiences. For those interested, the resolution aims to establish leadership and professionalism programs for residents to complete during their training, regardless of specialty. Professionalism is a core competency of the Accreditation Council of Graduate Medical Education (ACGME) and plays a vital role in resident education. Despite how the concept is fundamental in developing physician leaders during the transition from medical school to medical practice, professionalism remains a somewhat ambiguous term. Unlike the other core competencies (e.g. medical knowledge or clinical skills), professionalism is not easily defined and measured. Detailing how professionalism progresses from PGY-1 to PGY-3, and beyond, is not a simple task. From an educational perspective, milestones for pro-

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KNOXVILLE ACADEMY OF MEDICINE

fessionalism tend to be more challenging to assess and to interpret. This complexity sometimes leads to case-by-base evaluations with more emphasis on subjective information than objective data. This is not inherently bad. Plenty can be assessed from subjective information with regards to professionalism; however, increasing the objective data at our disposal may help increase awareness of educational opportunities falling under the professionalism umbrella, on both a resident and departmental level. There is no argument over the importance and growing need for physician leaders in todayâ&#x20AC;&#x2122;s society and this resolution seeks to directly confront this issue. Ideally, the resolution would entail the development of leadership and/or professionalism tracks that would be similar to the research and scholarly activity tracks many residency institutions have already in place. In addition, the resolution would devote time during residency training to complete this track for those willing to do so. A step ahead on this topic, TMA has already developed the LEAD (Learn, Engage, Advocate, Develop) program which seeks to recognize medical student and resident involvement in organized medicine through tracking participation in certain approved activities. Approved activities include, but are not limited to, attending local medical society meetings, visiting the Tennessee State Capitol during the legislative session, and participating in a grassroots effort. Programs like these could provide the objective data sought in order to better evaluate professionalism and interpret its progression as a core competency during residency training. Successful passage of this resolution serves as another step in the right direction towards supporting the development of our future physician leaders.

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ACADEMY NEWS Legislative Update By: Elise Denneny, MD

TMA/KAM legislative agenda 2017 was successful in achieving the passage of four TMA led bills, opposing several bills introduced which would have negatively impacted medicine and patients, and amending bills to its best interests. Some bills were the synthesis of other specialty societies working conjointly with TMA and other bills have gone forward with a summer study. Many issues were influenced by your presence in Nashville; “Day on the Hill” event. The following is a recapitulation of TMA’s activities in 2017: Provider Stability Act- PC88. For the past four years, we have fought payors from capricious contractual changes, which negatively impact our revenue stream at any point in the fiscal year. This year, we reaped the harvest of our efforts with passage of the Provider Stability Act. Tennessee is now the first state in the nation to require health insurance companies to give a 60-day notice to a provider of changes in reimbursement if it is a result of a policy change. It will also allow changes to a fee schedule only once in a 12-month period and require a 90-day notice of those changes. Peer review Organizations for Osteopathic Physicians- PC4: This clarifies osteopathic peer review and ensures that doctors of osteopathy have the same peer review protections as medical doctors. Physician Oversight of APRNs. Each year physicians fight scope of practice issues. Physicians oppose any expansion in the scope of clinical practice of paramedicals that may harm the public. The issue concerns not “turf protection”, but rather the responsibility when paramedicals are allowed to practice medicine without adequate training engendering decreased quality of care with increased cost. Patient safety has always been paramount in physician care. (A new threat to “scope of practice” issues is the DTC “Direct to consumer” practice. Certain laboratories are soliciting patients to “self- request” tests without a physician order.) For the past several years we have fought independent practice by NPs. Nurses say independent practice will solve the “access to care” problem. Is their level of training adequate for practice without physician oversight? Are there supervising physicians who do so in name only without true supervision? Will total health care dollars increase with the expansion of independent practice? Is the Board of Nursing adequate or does Tennessee need a comprehensive “Medical Board of Health”? These and other questions were discussed by a collaborative task force and an agreement was reached on the following points: 1. More joint study needs to be done by both the BME and BON on impact of independent practice issues 2. The TMA and TNA will honor a moratorium on bringing any scope of practice issues for the next three years. 3. The word ”collaboration” is substituted for “supervision” in some of the nursing statues without changing the meaning of the physician/ nurse practitioner relationship. Over the next three years, data will be collected to answer questions regarding the impact of independent nurse practice. The TMA continues to advocate Patient-Centered, Physician-Led, Team Based Health Care as the model that provides quality care.

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Maintenance of Certification –SB 407: As filed, this bill would have prohibited discrimination based on MOC by hospitals, health plans, and licensing boards. As amended, it now prevents MOC from being required for state licensure. Additionally, it creates a task force to study MOC as it relates to hospital hiring practices, admitting privileges and insurance networks. As many medical specialty MOC programs have changed criteria for certification, we need your input on how burdensome MOC is to physicians and whether or not it is requisite to hospitals and health plans. $1 million added to state budget; to cover for cancer drugs for patients with dual Medicare TennCare eligibility. Buprenorphine Prescribing Guidelines- PC112; Effective January 2018, guidelines on prescribing buprenorphine will apply to all with a DEA-x. In order to prescribe buprenorphine, a provider may take an 8-hour on line course to get a DEA-x number. Currently, there are over 600 DEA-x in Tennessee and the new federal regulations have expanded the number of patients allowed to be written prescriptions from 100 to 275 in hopes of mitigating the effects of reduced pain pill mills. Medical Licensure Compact: Effective January 2019, eligible doctors will have a process for expedited licensure in Tennessee and other member states of the compact. Health Professional Licensure Omnibus Changes (SB 1204): This serves to protect the confidentiality of physician exam scores and any investigatory action by the DOH. It also articulates the “standard of care” in disciplinary action to be defined by the respective board and amends the time required for the CEO of a health care facility to report disciplinary action to 60 days Chiropractor scope (PC 163 and SB 313): TMA limited chiropractors from expanding their scope of practice and prohibits them from self-referring as primary care physicians. Episodes of Care (SB1171): TMA has been an active advocate against the TN Payment Reform known as Episodes of Care. We pushed for more transparency and the State agreed to discuss with providers program improvements and not to roll out mandatory participation from commercial payors. We continue to educate legislators of the flaws associated with Episodes of Care; its lack of transparency, meaningless data and flawed “value” measures. TMA opposed successfully: • the corporate practice of medicine (SB425); • permitting nurse practitioners to authorize youth athlete to return to play after evaluate for concussion (SB 1055), and • the 72 hour time stipulation for supervision physicians to review at least 20% charts monitored(SB943). Many other bills TMA opposed never made it to committee or died in committee. Additionally, TMA successfully opposed Patients for Fair Compensation 2017 (tort reform aka Jackson plan). No doubt this will again be proposed with “new window dressing” for 2018. Overall on your behalf in addition to its legislative bills passed, TMA amended over 40 bills, tracked over 300 bills and reviewed 1466 bills in 2017. That’ll do…

KAM KAPA Connects Quarter 1 Recap On May 25th, KAPA Connects held its first quarter recap meeting. In attendance were leadership from The University of Tennessee Medical Center, Covenant Health, Tennova, Cherokee Health Systems, etHIN, and several members from the Tennessee Department of Health. In addition all partner agencies were represented: Knox County Health Department, CAC Transportation, Mobile Meals, YMCA, Flenniken Landing, UT AG Extension, and Second Harvest Food Bank. The meeting began with a recap of the KAPA Connects initiative whose goal is to utilize case managers, trained volunteers, and shared communication to help patients find community agency advocates to assist them in overcoming barriers to better health and well-being. Development Committee members presented their progress with the project for the Community Connector, Risk Stratification Tool, and Connectivity workgroups. Since the beginning of the pilot, the workgroups have developed a Community Connector guide for training community volunteers and setup an initial date to train volunteers and staff with current partner agencies. They have also created an automated risk stratification tool which assesses a patient’s risk level into a low, moderate,

KNOXVILLE ACADEMY OF MEDICINE

or high risk category. Committee members have gathered partner agency eligibility so patients are only referred to agencies for which they qualify. In addition, all partner agencies are connected to the KAPA hub by way of etHIN’s Direct Secure Messaging system. Testing for all agencies to send and receive secure referrals has been successfully performed. Since January, KAPA has surveyed over 150 patients for their medical and social needs. Out of these patients, 87% scored moderate in the medical category. In the social category, 71% scored moderate and 6% scored high. The barriers that were most prevalent were transportation and health literacy. All patients have been contacted by KAPA Case Management to coordinate services as appropriate. The KAPA Connects initiative continues to move forward as we seek to secure funds for project sustainability. KAPA has received two grants to cover project startup and expenses directly assigned to our Community Connector training. Stay tuned for more exciting news regarding KAPA’s new expansion. For more information please contact Danielle Sims at dsims@knoxvillemedicine.org.

Day at the Smokies This year had a record turn out of 92 in attendance for the annual Day at the Smokies event that was hosted by SouthEast Bank on Sunday June 4th. New this year, was a private box with special balcony seating offering a much cooler enjoyable environment. An array of food catered from Calhoun’s featured hot dogs, burgers and chicken to pair with all the sides and cookies. Weather, unfortunately, did not co-operate and after a rain delaying the start, the game was cancelled. All in attendance enjoyed the hours spent socializing and were given rain check tickets to be used for a future game.

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TECHNOLOGY NEWS

Meet Your MIPS Performance Measures with etHINâ&#x20AC;&#x2122;s Help A 5% bonus* can be earned in the ACI performance category score for Meet Your MIPS Performance Measures with By: Sharon Woods submitting syndromic surveillance or clinical data to one or more public etHINâ&#x20AC;&#x2122;s Help health or clinical data registries. etHIN can submit your data to those regetHIN Communications Manager by: Sharon Woods - Communications Manager,

istries for you, along with your immunization data, helping to streamline

East Tennessee Health Information Network and reduce the reporting burden on you and your staff. Combining existing quality programs under the larger MACRA initiative has been confusing for the healthcare In addition to assisting with meeting MIPS objectives, etHIN can also industryexisting in some PQRS, MU, andinitiaVBP have been consolidated are now part MIPS. Where a Combining qualityrespects. programs under the larger MACRA provide analytics reports on yourand patient population data toof help with your how to start to address MIPS requirements are questions many have been considering for the past several tive has been confusing for the healthcare industry in some respects. PQRS, Quality, HEDIS, STARs, and other reporting requirements. We are happy MU, months. and VBP have been consolidated and are now part of MIPS. Where to customize any report to fit your specific needs.

and how to start to address MIPS requirements are questions many have To find out more about how etHIN can assist you and your practice, been The considering for the past several months. contact us at 865-691-8433 email info@ethin.org. good news is that etHIN can help you meet five of the eleven 2017orAdvancing Care Information (ACI) The good news is that etHIN can1 help you meet five of the eleven 2017 1 https://qpp.cms.gov/ those five meas performance metrics , including one ACI Base Score measure. The following chart describes Advancing Care Information (ACI) performance metrics1, including one and the etHIN solutions that can assist you. ACI Base Score measure. The following chart describes those five measures and the etHIN solutions that can assist you.

ACI Measure

Description

etHIN Solution

Required for Base Score

Performance Score Weight

Health Information Exchange

Use CEHRT to create a summary of care record and electronically transmit the summary to another clinician

Direct Secure Messaging or Interface between Physician EHR and etHIN, with etHIN routing

Yes

Up to 20%

Medication Reconciliation

Perform medication reconciliation for a patient being transitioned to another MIPS clinician

etHIN Health Information Portal or Interface between Physician EHR and etHIN, with etHIN routing

Up to 10%

Immunization Registry Reporting

Actively engaged with public health agency to submit immunization data

Immunization Gateway

0 or 10%

Syndromic Surveillance Reporting

Actively engaged with public health agency to submit syndromic surveillance data

Syndromic Surveillance Reporting

Clinical Data Registry Reporting

Actively engaged with public health agency to submit data to a specialized registry

Cancer Registry and ELR Reporting

bonus* can beCINE earned 14A|5% KNOXVILLE MED

in the ACI performance category score for submitting syndromic surveillance or clinical data to one or more public health or clinical data registries. etHIN can submit your data to those regis for you, along with your immunization data, helping to streamline and reduce the reporting burden on you and

FINANCIAL NEWS

KAM KNOXVILLE ACADEMY OF MEDICINE

by John Arnold Executive Chairman, SouthEast Bank Managing Your Financial Goals One of the most challenging things about setting financial goals is managing two short-term goals at once. What should you do if one of your goals is to pay down debt as quickly as possible, but you want to build an emergency fund or save for a down payment on a home as well? If you are trying to juggle saving and paying off debt at the same time, here are some questions to ask to help you decide which to prioritize. How Much Do You Have in Savings Right Now? Do you have money set aside in case of an emergency? Ensuring that you are prepared for anything life throws your way is a fundamental step toward financial health. Experts recommend having three to six months of living expenses set up to protect against unexpected events. Without it, you could risk falling into more debt. If you do not have an emergency fund set up, that should be your first priority. How Much Does Your Debt Cost You? If you have multiple loans and credit card balances, list all of them and include the corresponding interest rates. Multiply the interest rate by the debt amount to see how much each debt or loan is costing you per year. Then, write out the total amount of cash you have in savings and multiply it by the interest rate of the account. What is the rate of return on your savings? How does that compare to what your debts are costing you per year? This could help put everything in perspective,

not only to help you decide to start focusing on paying off your debts faster, but to know which debt to tackle first. Could You Lower the Cost of Your Debts? Whether you have credit card debt, student loan debt, or both, you could potentially lower the cost of your debts through a few different strategies. If credit card debt is weighing you down, you could transfer your balance onto a new card. Look for cards that charge no interest for at least a year and don’t have a transfer fee. From there, use an online calculator to calculate the amount you will need to pay per month to knock out your credit card debt by the time the promotional interest rate expires. For education loans, find out if you qualify for student loan refinancing or consolidation through a private lender such as ELFI. People with strong credit histories and reliable income could take advantage of one single payment with potentially lower interest rates or lower monthly payments. Should You Save or Pay Off Debt? A typical rule of thumb is to focus on establishing an emergency fund first, then shift to paying off your debts as quickly as possible so that you can move on to other goals like purchasing a home or a car. Next, assess your debts to decide which ones to begin paying off first. While it might require determination and sacrifice, the feeling of being debt free with a secure savings account is worth the effort.

We believe it is essential to understand our clients’ investment goals and provide them the best in financial services. We offer our clients services for: • • • •

Wealth Management Retirement Strategies Tax Reduction & Investment Strategies Investment Strategies

• • • •

Business Strategies Life & Disability Income Strategies Qualified Retirement Plans Asset Protection Strategies

Contact: Travis S. McCurry Phone: 865.246.1697 Cell: 865.556.5873

Travis S. McCurry is a Registered Representative of and offers Securities, Investment Advisory, and Financial Planning Services through MML Investors Services, LLC, Member SIPC, 8 Cadillac Drive, Suite 150, Brentwood, TN 37027 (615) 309-6300.

J. Todd Williams Phone: 865.246.2955 Cell: 865.368.1945

J. Todd Williams is a Registered Representative of and offers Securities, through MML Investors Services, LLC, Member SIPC, 8 Cadillac Drive, Suite 150, Brentwood, TN 37027 (615) 309-6300.

www.capitalfinancialgroup.net 1225 E. Weisgarber Rd, Suite 180, Knoxville, TN 37909 CRN201411-166573 KNOXVILLEMEDICINE.ORG

KNOXVILLE MED CINE | 15

KAMA CORNER By: Tina Callicutt KAMA President, 2017-2018 KAMA has just finished another incredible year. This year was an outstanding year of fundraisers that allowed us to award quite a few scholarships and grants in our community. We were so pleased of the job that our members did, and we were so thankful for the community and KAM’s support. Our fight to help the opioid epidemic was a strong focus of our year as well. We were highly committed to educate and stop this awful crisis sweeping our nation. We had such tremendous speakers from Hallerin Hilton Hill to Dr. Mitch Mutter for our monthly meetings. We all enjoyed our occasional social events too. We had a bowling night in April for membership recruitment that went great for example. The TMAA annual meeting in Nashville this past April had a great representation from us here in Knox County. Our year ended with our wonderful May meeting which serves as both our new officer installation and our past presidents’ luncheon. It truly was a fantastic year for our KAMA members. It was definitely one to be very proud of our accomplishments. As the summer approaches, we are already working toward our new year. At our March retreat, it was decided that we would undertake 3 major fundraisers for our upcoming year. The first is in the planning stages now. It will be our daytime Fashiondrama. Yes, we brought back our day luncheon fashion show at the request of its many fans. Of course, we are planning

on doing our annual Doc Rock for another season. It will come along with a venue change this year that has excited us about the new possibilities of this event, and it will be moved to January to avoid conflicting with the many events that have been on our February date. We had such a great success with our night fashion gala, so we are planning on still having a nighttime gala in the spring that won’t be a fashion show. We are looking forward to exploring the many directions to make this event extraordinary, and an event that people will look forward to attending for years to come. In all, we will have a fall, winter, and spring event for our fundraising efforts. We are hoping for continued support from our KAM members and community. We have plans to continue the opioid epidemic fight, and we hope to come up with new ideas and ways to aid in this. We also have plans to continue and further our partnership with KAM. Needless to say, we are gearing up for what we hope to be an exceptional year. We look forward to our annual new physicians and membership picnic we host along with KAM on August 25, 2017 at Gettysvue Country Club. This event has always been such a perfect kickoff to our upcoming year. We are very pleased to have another year to investigate the immense possibilities to accomplish things in our community. If you would like any information about KAMA, we are on Facebook (Knoxville Academy of Medicine Alliance and our website www.kamalliance.org. Tina Callicutt, KAMA president 2017-2018

Dr. Elmer G. Pinzon, MD, MPH

Dr. Elmer G. Pinzon, MD, MPH USSS, PLLC 10710 Murdock Drive, Suites 103-104 USSS, PLLC

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GIVE YOUR FINANCES THE SAME CARE AS YOU DO YOUR PATIENTS. In today’s uncertain markets, having a bank that tends to your financial health is vital. First Tennessee Medical Private Banking can help with today’s needs and tomorrow’s goals. Our Relationship Managers offer guidance and solutions tailored to medical professionals. So you can focus on your priority: your patients. To make an appointment with a Relationship Manager, please contact: Michelle Hardin Senior Vice President and Manager Medical Private Banking ph: 865-971-2117 email: jmhardin@ftb.com

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LEGAL NEWS The “Incident To” Conundrum

By: Luke P. Inhen and Erin B. Williams London & Amburn, P.C. The rules regarding Medicare “incident to” billing are still misunderstood by many providers and, therefore, result in incorrectly billed claims. In 2016, violations of “incident to” billing protocols resulted in high profile settlements with the government, including one for $700,000 and another for $4.4 million. “Incident to” services are furnished incident to physician professional services, usually in the physician’s office.1 The services are commonly provided by non-physician practitioners such as physician assistants or nurse practitioners, but the services are billed as if they were provided by the physician. In addition, “incident to” services can only be billed for established patients and may not be billed if the patient is being seen for the first time or for a new problem. Some providers may misunderstand the supervision requirement of the rule. Under CMS rules and regulations, “incident to” services must be furnished “under the direct supervision of the physician.”2 Direct supervision means the physician “must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.”3 Therefore, if no physician is on-site, the service must be billed under the non-physician practitioner providing the service. It is important to remember that the physician who regularly sees and treats the patient may not be the supervising physician for the purposes of “incident to” billing. Despite its complex requirements, there are advantages to billing “incident to.” Because it allows non-physician practitioners to submit claims under the supervising physician, the practice receives reimburse-

ment for the service provided by the non-physician practitioner at 100% of the Medicare Physician Fee Schedule. Claims submitted under the nonphysician practitioner are only reimbursed at 85% of the fee schedule. In addition, almost any non-physician practitioner employed by the practice can bill “incident to,” so long as they are licensed or leased employees, or independent contractors. Utilizing “incident to” billing allows the practice to increase the number of patients for which it receives the higher reimbursement rates without adding additional physicians to the staff. Improperly billed claims could also subject the practice to a post-payment audit, or worse, allegations of fraud. Improperly billed “incident to” claims create an overpayment that must be reported and refunded under Federal regulations within 60 days after identification.4 Overpayments that are not refunded within the 60 day timeframe may subject the practice to the harsh fines and penalties under the False Claims Act. Accordingly, it is important to identify any issues with “incident to” billing, address the problem including the timely refund of any resulting overpayments, and swiftly implement corrective action. Failure to do so may cost you. ______________________________ 1 42 U.S.C. § 1395x(s)(2)(A); 42 C.F.R. § 410.26. 2 42 C.F.R. § 410.26(b)(5) (emphasis added). 3 42 C.F.R. § 410.32(b)(3)(ii) (emphasis added). 4 81 Fed. Reg. 7653 (Feb. 12, 2016). Luke Inhen and Erin 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.

KAM/KAMA Young Physicians Picnic Welcoming new and prospective members and their families! Friday, August 25, 2017 5:00 - 8:00 pm Gettysvue Lower Pool

| KNOXVILLE MED CINE

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

• NO health questions necessary during this open enrollment • Easy online enrollment through custom KAM member site • Discounted rates for active KAM members Your Response Requested - Visit www.protectingincomes.com/KAM for details and enroll or decline coverage. For all questions email support@protectingincomes.com or call 865.999.3000.



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



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

To take advantage of this member-only benefit visit knoxvillemedicine.org or call (865) 531-2766 1Offer available for KAM member age 65 and under, no medical questions or exams required if you have been actively at work for the past 60 days. This policy is issued by Lloyds of London. See sample policy at www.protectingincomes.com/KAM for complete details including provisions, exclusions, and limitations.