Tri Cities Medical News June 2013 by FW Publishing

FOCUS TOPICS SENIOR HEALTH RETIREMENT SUCCESSION PLANNING

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PHYSICIAN SPOTLIGHT PAGE 3

Mark Williams, MD

FOCUS ON SENIOR HEALTH SPONSORED BY STATE OF FRANKLIN HEALTHCARE

CONNECTing Caregivers to Prevent Patient Falls

ON ROUNDS Healthcare Leader: James W. Hansen, MD Meshing a medical practice with healthcare administration may not be a responsibility most physicians would relish, but for James W. Hansen, MD, his position as Chief Manager at State of Franklin Healthcare Associates (SoFHA) in Johnson City has been a rewarding experience. Hansen, an internist with SoFHA’s Johnson City Internal Medicine Associates, joined the group in 1999 and within five years, he had been offered and accepted his administrative position. He heads the SoFHA board and oversees its administration ... 4

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By CINDy SANDERS

Preventing America’s seniors from falling is a national health priority both in terms of injury and cost. Yet, fall prevention programs have only proven to be marginally successful over the long term. Cathleen S. Colón-Emeric, MD, MHS, and colleagues focused on the gap between quality improvement (QI) protocols and sustained bedside implementation in the nursing home setting. An associate professor of Medicine in the Division of Geriatrics at Duke University School of Medicine, Colón-Emeric said previous studies found the desired improvements occurred when outside trainers and researchers stepped in to create interventions. The external staff addressed multiple risk factors to help lower fall rates, recurrent falls and injurious falls. However, she continued, “When you try to train the existing nursing home staff to do those things, it doesn’t seem to work.” Based on social constructivist theory, complexity science, and prior studies, the research team believed there was a di(CONTINUED ON PAGE 8)

Selling Your Practice? Considerations for Ensuring Your Succession Plans Are Successful By IAN P. HENNESSEy

Succession planning in physician practices can take many forms, including options not traditionally thought of when planning to retire. While it is still common for practices to recruit younger physicians to purchase an ownership interest in the practice and, after some transition period, eventually buy out the retiring physician, trends over the past few years show a marked decline in the number of independently practicing physicians. In fact, a recent survey conducted by Accenture

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found that today only 39 percent of doctors nationwide are on their own, which is down from 57 percent in 2000. Perhaps, consequently, there appears to be increased willingness by physicians to consider selling their practice to hospitals and other healthcare organizations. While there are many advantages to selling your practice in anticipation of retirement, there are several potential issues to consider before you sign on the dotted line.

Purchase price…but with strings attached.

One perceived advantage of selling a (CONTINUED ON PAGE 12)

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Health eShare Direct Project Delivers Promise of Secure Exchange of Patient Information to State’s Healthcare Workers, and Then Some As the structure of Tennessee’s healthcare system takes shape around healthcare reform legislation, providers and patients have new opportunities to improve the way services are coordinated, funded and delivered to patients. Through a program called Tennessee Health eShare Direct Project, healthcare providers and their staffs are using a newly available, secure messaging protocol being piloted in Memphis, Chattanooga and Hickman County, with each community testing and developing use cases of the platform. The technology, known as Direct Messaging, was developed by the federal government and is being implemented nationwide. Direct is a protocol for secure exchange of health information from point to point. Direct improves workflow and increases efficiency for healthcare providers, administrative staff and healthcare organizations. For those who have taken the simple step of enrolling in the program, the advantages to their daily practices have included workflow and efficiency improvement – and then some. Tommy Preston is one of those individuals. As the assistant director of the Southeast Tennessee Area Agency on Aging and Disability, Preston knows the inefficiency of the healthcare system better than many of the healthcare providers he works with every day. As a participant in the Community-based Care Transitions Program (CCTP) in Chattanooga, Preston’s agency is responsible for connecting its high-risk clients discharged from hospital inpatient care settings with the community care, rehabilitation and ancillary services they need to recuperate, recover, and avoid costly hospital readmissions. Yet before enrolling in the Direct pilot, Preston’s staff, like the overwhelming majority of healthcare providers in Tennessee, had no means of securely sending or receiving patient discharge information or exchanging patient information electronically with its multiple hospital system and healthcare provider partners.

The solution? Frequent road trips to retrieve patient charts and discharge summaries from hospitals were the only option. Staff hours that should have been spent arranging home health visits, securing transportation to dialysis centers or scheduling visits to specialty care physicians were spent…in traffic. But once enrolled in the project and using Direct, the impact on Preston’s staff and the patients they serve was immediate. Preston says his staff began receiving patient discharge notifications and relevant information from patients’ clinical charts almost instantaneously. As a result, Tommy’s staff can immediately engage health coaches to reach out to patients, usually within hours of their discharge. Today Southeast Tennessee Area Agency on Aging and Disability staff login to Direct from wherever they are, identify information sent from one provider and send referral information on to an orthopedist, confirm ICD-9 codes, transmit patient clinical information, or confirm an address for the referral.

Direct is gaining traction in the state thanks to the increased visibility it’s receiving through Tennessee Health eShare. Access to the Direct technology is available now, and the cost of using Direct technology is more than covered by an incentive program offered by the state of Tennessee Office of eHealth Initiatives. That’s why a growing number of healthcare providers and eligible individuals across the state are signing up and using Direct through Tennessee Health eShare. Several healthcare organizations, including Erlanger Health Systems, have also signed up. If you work in healthcare and routinely handle patient information, chances are you can too.

Direct secure messaging technology is being implemented and supported by Qsource, a Tennessee-based nonprofit healthcare quality improvement and information technology company, working in cooperation with the Tennessee Office of eHealth Initiatives. To learn more about how you can get started using Direct, visit the Tennessee Health eShare Direct website at http://www.healthesharetn.com/. About the Office of eHealth: The mission of the Tennessee Office of eHealth Initiatives (OeHI) is to facilitate improvements in Tennessee’s healthcare quality, safety, transparency, efficiency, and cost effectiveness through statewide adoption and use of electronic health records (EHR) and health information exchange (HIE). OeHI received grant funding from the American Recovery and Reinvestment Act of 2009 (ARRA) to support this Direct Project and other projects to implement secure health information exchange. Through these stimulus funds, ARRA enables Tennessee the opportunity to advance the secure exchange of health information and to expand the adoption and Meaningful Use of EHRs and HIE. For more information, please visit http://www.tn.gov/ehealth/.

Pub:

East TN Medical News

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JUNEJune 20132013 >Insert:

Client: Qsource eas ttnmedicalnews.com Job No: QSO-40993 Title: Chattanooga Success Story

PhysicianSpotlight FOCUS ON SENIOR HEALTH

Mark Williams, MD “After I finished my training, I knew

and their interests. A lot of the older pa-

I wanted to move back to this area [of

tients like to reminisce a little bit about

Mark Williams, MD, usually begins

East Tennessee],” he explained. After in-

their early lives, or what they’ve enjoyed

his mornings at the hospital, where he

terviewing at several different places, he

throughout life, so just sitting and talking

sees several patients (often his own long-

discovered the perfect fit at Johnson City

with patients is probably my greatest joy,”

term patients who have been hospitalized),

Internal Medicine, which he described

he said.

before going to work at Johnson City In-

as “a great, quality group of physicians.”

Along with his wife, Nancy, Wil-

ternal Medicine, where he continues to

Williams enjoys spending time with pa-

liams teaches Sunday school classes and

see and treat patients until the end of the

tients each day, as well as his coworkers.

is involved with the youth at Westmin-

workday at 5:00. Fortunately, given the

“It is a lot of variety. We have a prepon-

ster Presbyterian Church. His daughter,

volume of ailing people he interacts with,

derance of geriatric patients, but I do

Elizabeth, just finished her third year at

talking to patients is the part of his job

treat all ages,” he said. Or rather, “I treat

the University of Tennessee in Knoxville,

Williams enjoys most. In fact, the lure of

all patients from age 16 to, you know,

and son, Alex, attends Providence Acad-

spending time with older patients, hear-

100!” he clarified. It’s plain after convers-

emy in Johnson City. Along with Alex,

ing their stories, and helping them with

ing with him that Williams is happy to

who recently became an Eagle Scout,

chronic illnesses strongly influenced Wil-

see centenarians in his office. “For a lot

Williams traveled to New Mexico last

liams’ decision to enter medical school and

of older people, coming to the doctor is

year to participate in a 10-day hiking and

familiar with all the laboratory tests, the

a social event to them, it’s one of the few

camping trip at Philmont Scout Ranch.

diagnosis and treatment of chronic medi-

times they get out of the house and are

Along with a group from East Tennes-

cal illnesses and diseases,” he explained.

around other people, so they enjoy com-

see, they backpacked for a total of 85

By JENNIFER CULP

become a physician. Born in Southwest Virginia, Williams grew up mainly in East Tennessee, where he attended Washington College Acad-

He went on to earn a doctorate of

ing to the doctor and interacting with the

miles over the course of the trip, climbing

emy in Limestone. He remained in the

medicine from the University of Ten-

physicians, the nurses, and the staff. We

through pine forests to the top of “Mount

area throughout his undergraduate studies

nessee College of Medicine in Memphis,

try to make it a pleasant experience for

Baldy” at an elevation of nearly 12,500

at East Tennessee State University, where

Tennessee, and went on to complete his

them as much as we can,” he said.

feet. “I got one shower in 10 days,” he

he earned a degree in microbiology, then

residency at the University of Tennessee-

A less pleasant part of the job? Insur-

admitted when asked, “but it was all guys,

decamped to the southwestern end of the

affiliated hospitals in Memphis. Internal

ance paperwork, if you ask Williams, who

so it didn’t really matter. It was really a

state where he lived and worked in Mem-

medicine proved to be a particularly at-

prefers to spend time interacting with pa-

neat experience.” Though the scenery of

phis for a total of twelve years.

tractive choice for Williams. “I enjoyed

tients and colleagues. Filling out compli-

New Mexico was very different from that

“I always liked healthcare, but it was

dealing with geriatric patients and older

cated forms just isn’t much fun. “That’s

of East Tennessee, Williams admires the

later in life when I decided to become a

folks, and I just enjoyed the personal in-

probably true of any business,” he said,

beautiful area he chooses to call home

doctor. I worked in the toxicology lab at

teraction with patients—diagnosis, treat-

“but,” he continued, “it’s a necessary

and the interesting people who live there.

Baptist Memorial Hospital in Memphis

ment, the long-term continuity of care you

evil.” Time spent talking to patients and

“I really enjoy where I am,” he said. “I

for four years, then decided I wanted to

have with patients in internal medicine,”

working to improve their lives makes up

plan to stay here; I’m committed to my

further my education,” he said. After

he said.

for the unpleasantry of dealing with con-

patients and hope to be here for a good long time.”

considering different options, he realized

Once finished with his training, Wil-

voluted paperwork. “My favorite part of

that he wanted to attend medical school.

liams knew he was on the right path in

the job is sitting and chatting with people,

“I worked in a hospital setting, so I was

life, but wasn’t yet in the right location.

talking with them about day-to-day things

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JUNE 2013

HealthcareLeader

James W. Hansen, MD By BRIDGET GARLAND

Meshing a medical practice with healthcare administration may not be a responsibility most physicians would relish, but for James W. Hansen, MD, his position as Chief Manager at State of Franklin Healthcare Associates (SoFHA) in Johnson City has been a rewarding experience. Hansen, an internist with SoFHA’s Johnson City Internal Medicine Associates, joined the group in 1999 and within five years, he had been offered and accepted his administrative position. He heads the SoFHA board and oversees its administration. “I enjoy decision making, even though it’s nothing I ever trained to do,” he explained. “We have a strong administration at SoFHA, which is necessary when difficult financial decisions have to be made.” Continued Hansen, “And as a multispecialty group, our board is comprised of many different viewpoints and every-

body has an equal say.” Specialties represented include Internal Medicine, OB/GYN, Family Practice, Pediatrics, Hospitalist Medicine, and Sleep Medicine Physician owned and board managed, SoFHA, PLLC, was formed in July 1998 and currently has 90 primary care providers, of which 71 are physicians. Hansen works closely with his colleague Ronald Blackmore, MD, who serves as chairman

of the board. Although Hansen never received formal training in healthcare administration, he brought with him a wealth of administrative experience. He grew up in Boone, Iowa, and attended the University of Iowa as an undergraduate, where he earned a Bachelor of Science degree in Chemistry. Board certified by the American Board of Internal Medicine, Hansen received his medical degree from Creighton University in Omaha, Nebraska in 1986, and continued on at Creighton for his Internship and Residency in Internal Medicine.

FOCUS ON SENIOR HEALTH Although his current practice is primarily general internal medicine, Hansen completed a pulmonary/sleep fellowship while at Creighton and is an American College of Chest Physicians Fellow. After finishing at Creighton, Hansen served in the Navy in Charleston, SC, for eight years, where he gained much of his experience in administration, as well as internal medicine and critical care. After finishing his service with the Navy, Hansen and his wife started considering places to relocate. After talking with his friend Richard Rolen, MD, who served in the Navy with him, Hansen was “prompted to take a look” at East Tennessee, and made the move to Johnson City to join Rolen in practice with Johnson City Internal Medicine Associates. His wife, Shoko Hansen, MD, also practices in Johnson City. Originally from Tokyo, Japan, she met her future husband while they were interns at Creighton. “She rescues greyhounds now,” shared Hansen. “Outside of medicine, that’s her passion.” As for passions, Hansen’s life-long pursuit has been medicine. “In the 6th grade, we went on a school field trip to the University of Iowa Hospital. We were able to see all of the equipment, and I was

fascinated,” he recalled. “That stuck with me.” Even before starting his residency, Hansen knew he wanted to do primary care, and while at Creighton, he decided to complete the pulmonary fellowship because of the strong, high quality program there. Throughout his career, Hansen has witnessed many technological advances in medicine, which makes him excited about the future of his profession. “We have made great advances in Alzheimer’s, diabetes, cancers, genetic testing, hypertension,” he said. “It’s so great that we can offer better treatments and quality of life, and people are living longer.” Of course, even with the great strides healthcare has made, it is not without its challenges. “The biggest challenge is the cost,” Hansen said. “Finding a solution is a difficult decision, but it needs to be addressed.”

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Southeastern Wilderness Medicine Conference Come Outdoors! By LEIGH ANNE W. HOOVER

For the ninth year, the city voted “best town ever” by Outdoor magazine will play host to the Southeastern Wilderness Medicine (SEWM) Conference June 21 – 26, 2013. Whether you are an outdoor enthusiast or a weekend warrior, earning continuing educational units is the most fun in Chattanooga. “Chattanooga is one of the few metropolitan areas in the country where you have such immediate access to the outdoors,” explained Chris Moore, MD, Founder & Program Director, Southeastern Wilderness Medicine. “This is a great location to be able to produce this conference.” In a world where continuing medical education (CME) credits can be obtained online, this conference offers education mixed with adventure. According to Moore, even if a physician is not particularly an outdoor enthusiast, the SEWM conference touts world renowned leading speakers on wilderness medicine and offers an opportunity to experience learning from the very best. “This conference will open avenues

JUNE 2013

to medical topics many doctors have never even thought about,” said Moore. “It’s probably one of the most interesting and enjoyable ways to earn lots of CME credits in an interactive setting among some of the most adventurous, creative doctors out there.” Unlike most wilderness medicine

conferences, sessions can also be selected to accommodate personal schedules and taken individually without committing to the entire event, and pricing is reflective of per day and even half-day sessions. “People are blown away by all of the outdoor amenities this conference provides, and with the summer event date, they can also bring their families. Many events and classes are available for them, too,” said Moore. “It’s one of the most enjoyable ways to earn continuing medical education that I know of!” For additional information visit www. sewm.net

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Multidisciplinary Rounds put emphasis on Holistic Care By JENNIFER CULP

The importance of patient-centered care is widely recognized. Treating a sick person in a holistic fashion and recognizing the import of his or her individual circumstances is known to improve patient outcomes and benefit healing. At Erlanger Health System and the University of Tennessee College of Medicine in Chattanooga, healthcare providers have coordinated their efforts in order to provide the best possible experience for patients in all aspects of care. “The goal was to incorporate a system that really promotes integrated, accountable, patient-centered care,” explained Mukta Panda, MD. “We wanted to really look at patient care from a different model, rather than having a hierarchical model where the doctor’s on the Dr. Mukta top, and then the nurse, Panda and so on. We wanted to put the patient in the center, with all the healthcare team around the patient working toward a common goal so that all patient care needs are met. So, not just looking at the physical healing of the patient, but also social, emotional, spiritual healing, and all the ways we could allocate resources to make sure that patient care is seamless and continuity is maintained,” she continued. The multidisciplinary rounding team, which meets weekly to discuss each patient and holds daily huddles on the floor to ensure that all issues are addressed in a timely fashion, consists of physicians, medicine trainees, a nurse practitioner, the floor nurse manager, nurses who care for each individual patient under care, a dietician, a pharmacist, therapists (physical, occupational, speech, and respiratory, as needed), a case management team (including case manager and documentation specialist), legal aid, and a chaplain. Each Wednesday morning, the physician team presents the patient from a medical standpoint and addresses any issues needing assistance from other disciplines, and then, in turn, the other disciplines represented in the team discuss each patient from their standpoints and address any issues they have uncovered. Following input from each member, the team collaborates to solve any outstanding problems. This interdisciplinary team is unique not only in coordinating efforts between members of different healthcare disciplines in order to strategize and maintain continuity of care both in and out of the hospital, but also in its inclusion of Legal Aid and pastoral care services. Legal Aid provides assistance for low-income patients who fall below the poverty line, allowing them to receive care without undue worry over financial or other legal concerns. Two chaplains offer pastoral easttnmedicalnews

.com

care, visiting patients in the hospital and their homes. “We know that spiritual healing is paramount to physical healing,” Panda said, continuing, “We have a unique opportunity here, where, in the Department of Medicine, we have two chaplains on the faculty.” The availability of legal aid and pastoral care benefits patients, patients’ families, and patients who have no family to rely on. The inclusion of these team members, as well as case managers, demonstrates a great commitment to whole-person, patient-centered care, respecting the needs of the patient, who, for example, might not have insurance or be able to afford out-of-pocket care but nonetheless finds herself in the hospital, or the family members of a patient who needs to be placed under conservatorship, or the patient who has no living family but needs counseling and comfort throughout the process of struggling with disease and treatment. The multidisciplinary team is equipped to provide for patients in ways that a single physician or provider simply could not accomplish alone. This multidisciplinary approach to care has also proved satisfying to team members. “Our communication has improved; we learn from each other,” said Panda. Since the project’s inception, team members have reported increased communication, better understanding of patients’ plans of care, better subjective “insight” into patients’ issues, better follow-up plans, easier navigation of social, ethical, and end-of-life issues, and increased education on documentation and its role in reimbursement. “There are times when we get caught in our focused tunnels of thinking, and it’s important to hear each other’s perspectives, because we are all trying to achieve the same shared covenant, which is to make sure that we provide the best evidence-based, coordinated care for our patients,” Panda explained. Improved communication between team members allows providers to better serve patients, and also seems to alleviate stressors on the part of team members. “As you know, healthcare providers and physicians probably are the worst at taking care of themselves, and I think this approach brings a mindfulness to medicine,” Panda said. “Everybody has different pressures on them, and we know that one person cannot always spend the time needed for each individual patient. What can we do to make sure that all of the patient’s needs are met? With the team, we continue care once the patient is discharged from the hospital, and we see them in our

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offices. We have all these resources available to them; they see that the chaplains are available to meet with them, the legal aid is available to them, the case managers are available, and, of course, the physician and other team members are there, also.” Within this framework, the patient truly occupies the center of team members’ efforts, which not only benefits the patient but spreads the burden of care among the team members. Panda, her colleagues in the Department of Medicine, the trainees, program director, and hospital hope to expand the multidisciplinary rounds program in the future. “We’ve had a lot of support from my own department, faculty, and residents, Erlanger, and the dean of the University of Tennessee,” Panda said. “The hospital leadership is really wanting to make this a part of every patient care unit now. We are looking toward that, and it is moving pretty quickly. We are really excited!” Even beyond Erlanger and the University of Tennessee’s efforts, Panda envisions this type of interdisciplinary care spreading in the future: “We’re training our future doctors in this system, so this type of care will be carried beyond the walls of Erlanger and the University of Tennessee Chattanooga.”

Online Event Calendar To submit or view local events visit the East Tennessee Medical News website.

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theBottomLine

Can’t Get There from Here The Worst Financial Planning Scenario

By Kevin Gormley Financial planning and investment management are not the same thing. The former creates a plan and the latter may be a piece of that plan. Financial planning involves the coordination of all or most of your financial issues— retirement planning, tax planning with tax professionals, college planning, estate and trust planning with attorneys, an evaluation of insurance needs, debt management, and investments. Investment management is about – simply put – investments. Unfortunately, the financial industry has added to the confusion by describing people who work with financial products with many similar names. They may be known as financial advisors, financial consultants, wealth managers, and other various names. There are some in the industry who say they do “financial planning” –but all they are really doing is putting numbers into a software program that spits out the reasons why one should invest, purchase insurance, buy annuities and other products –usually from their company. Your sound future is not their priority.

My focus as a financial planner is the financial plan and how it can help establish and clarify a family’s goals and take action with the use of ideas and well-considered, structured strategies to reach and protect those goals. Financial planning can help reinforce confidence in how one feels about their plans. It can inspire others towards action. Husbands and wives can become more comfortable discussing financial issues with a professional third-party planner and look to the future with a greater sense of control and calm. The financial plan document may ultimately be the tangible product that is produced, but the intangible benefits are the key to a good financial-planning engagement. What benefits can a financial plan produce for clients? • Compile data into an easy-to-review format, taken from various sources, including 401ks, IRAs, 529 plans, loans, personal assets, insurance policies, trusts, restricted stock, stock options, and Social Security expectations. • Motivate clients to save more, invest with purpose, get estate documents in order, have appropriate insurance

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coverage, and manage their credit cards and other debt. • Ensure that the fees being paid for all financial products are fair and reasonable • Improve the decision-making process around money. • Help minimize taxes on investments based on asset allocation, asset choices, and asset location (investments should be in appropriate account types). • Aid with decisions about the need or possibility of changing companies or careers where compensation plans are different or other major life events where financial decisions are part of the equation. • Possibly offer advice on investments. Despite all of these advantages, the real benefits of ongoing financial planning include the discussion during the planning phase, evaluating and breaking down and making sense of the numbers in relation to the desires and needs of the family, the presentation of initial ideas and alternatives, updates on tax laws, what the investment horizon looks like, and clarifying the family’s personal goals and needs. The most difficult financial plan to work on – the one that motivates me the most – is the one where the individual or couple is near the end of their working lives. They are extremely motivated to have a plan. Their needs, wants, and wishes may not match their assets and other income streams, creating a major problem. There is an obvious shortfall. The data is rechecked and the shortfall still exists. In the follow-up meeting, the concern is shared and it can be discouraging. There are obvious solutions – keep working, spend less, or take more risks with investments. None of these are greeted with excitement. The worst words to hear in the financial planning process: “Are you sure that is right?” What can be done to improve your outcomes? • Investment assets. Save and invest more. Maximize returns with lowcost investments. Minimize taxes. Persist through down markets. Simple advice but hard to follow. • Social Security. Social Security (SS) is not an entitlement. U.S. citizens pay for it and possibly pay more into it than one will ever receive. By working longer at higher income levels, one can increase benefits and if income is lower, there is no penalty. Surprisingly, many (76%) people apply for SS as soon as it is available (now age 62) and do no planning around Social Security income at all. There are at least six choices from which a married couple can choose and five (5) involve one of the spouses not

taking SS at age 62. Currently, if one waits until age 70 rather than taking it at age 66 there is an annual 8% growth in the amount of the benefit. Where can anyone get 4 years of guaranteed 8% growth in the marketplace today? Of course, the health of each individual must be discussed and wealth strategies reviewed. Software can show the amount of money that one will get at age 62-70 and every age in between. If the spouse is eligible, they can receive their own benefits or may receive spousal benefits at full retirement age (rules apply). One spouse may be able to continue to work and “file and suspend” – which allows the spouse to get spousal benefits. This area of financial planning is much more complex than most people believe. Get help. • Pension. The most frequently asked question for people who are considering leaving “Corporate America” is: “Should I take the pension money as an annuity payout or should I take the lump sum?” This is where a professional advisor needs to be an important participant in the discussion. Review the benefits and drawbacks of either choice with the advisor. The actuarial assumptions should be reviewed on the annuity pension. One should ask if the planner/ advisor has a conflict of interest, as the lump sum may create great income for the advisor and the annuity may not. With actuarial assumptions, there can be differences between what a different company’s actuaries believe will happen in the future concerning interest rates or mortality tables. Three other key issues are health, flexibility, and the diligence and discipline of an individual to invest the money rather than spend it. A million dollars is a lot of money when one is still working. But when one is living off of a million dollars, most data suggests that only $40,000 (known as the 4% rule) is the maximum that can be removed and keep the million dollars stable. With today’s interest- rate environment it may be even lower. Don’t let the phrase “Can’t get there from here” happen to you. There are limited options when one retires. You must know and understand those options. There are decisions that can be irreversible and time is no longer on the retiree’s side to make tangible adjustments. Plan, protect, save, invest –and keep repeating this. Otherwise, you may be caught in a situation of looking for directions on how to retire …. and not finding an easy path.

Kevin Gormley, CPA, PFS, CFP(R), is a certified financial planner with Patriot Investment Management and lives in Knoxville, Tenn. He may be contacted at kgormley@patriotinvestment.com.

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Enjoying East Tennessee Rhododendron Festival – Roan Mountain By LEIGH ANNE W. HOOVER

Each year, a single rhododendron blooms outside my kitchen window in a backyard flowerbed. It’s planted beside a statue of an angel that was given to me by my sister-inlaw nearly 10 years ago following my mother’s passing and stands as a reminder of her life’s work and passion for gardening. Growing up in South Carolina, we would take family outings to the nearby mountains of North Carolina to see our azaleas’ flowering cousins, the rhododendrons and mountain laurel. Although certain varieties of rhododendrons can endure the hot, humid summers of the upstate, they tend to thrive in higher, cooler, lush environments with nutrient rich soil free of clay. Nearly 30 years ago, when I moved to my husband’s home state of Tennessee, I was captivated by the gorgeous beauty of

the rhododendrons in flowerbeds and fascinated by their size. From June 15th -16th, the rhododendron is showcased in all of its glory during the annual Roan Mountain Rhododendron Festival. Originating in 1947, the Roan Mountain Citizen’s Club has been conducting this festival that celebrates God’s beauty in nature and beckons visitors to Roan Mountain State Park. Located near the Tennessee/ North Carolina state line, beauty

abounds, and the altitude offers a cooler calling for a summer outing on either side of the Mountain. In fact, the festival originally included both states. Today, the North Carolina side of the Roan celebrates with the North Carolina Rhododendron Festival in Bakersville, N.C., on the same weekend, June 14th and 15th. This way, visitors can experience both festivals and come to the Tennessee side on Sunday, June 16th. Years ago, the Tennessee festival was actually in the gardens, but it has since moved down the mountain in the state park. In addition to a variety of vendors with specified “personally handcrafted” items, visitors can also enjoy onstage musical entertainment. “This is the 66th annual Rhododendron Festival,” said Citizens Club Vice President Brian Tipton. “The festival is the largest event that the club puts on, and they usually try to always have it when the rhododendrons will be in full bloom.” Just seven miles up the mountain,

spectators can glimpse the “world’s largest,” natural rhododendron gardens, atop Roan Mountain. Spanning over 600 acres, the rhododendron catawbiense (Catawba rhododendron) blankets the top of Roan Mountain in all of its glory in natural gardens that attract visitors from all over the world. Sitting atop Roan Mountain, over 6,000 feet above sea level, the luxury Cloudland Hotel once attracted wealthy guests with breathtaking views to enjoy the higher altitude and offered a respite from hay fever. Although the famous hotel no longer exists, the spectacular views still prevail for current and future generations to experience and enjoy. “One of the things that is amazing to me is how the rhododendron have expanded to fill the space where the old Cloudland Hotel stood back in the late 1800s and how accessible the paths are for wheelchairs and walkers,” explained Emma Ruth Shomaker, secretary of the Roan Mountain Citizens Club. Festival activities are always the third weekend in June. However, with the higher altitude and the later blooming cycle, the colorful views usually are available throughout the remainder of the month. “If there is a time other than during (CONTINUED ON PAGE 8)

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JANUARY 2013

CONNECTing Caregivers to Prevent Patient Falls, continued from page 1 rect link between the failure to successfully deploy fall interventions and the hierarchical culture present in most skilled nursing facilities. Colón-Emeric, who also serves as associate director – clinical program for the Durham VA Geriatric Research, Education & Clinical Center (GRECC), noted the vertical command structure doesn’t foster broad-based, interdisciplinary staff interaction. “They lack the connections with their coworkers that they need to share information and problem solve,” she said. “Nursing home staff tend to work in silos.” Colón-Emeric continued, “Coordination of a multi-factorial risk reduction program requires a great deal of communication. Older adults don’t fall because of one risk factor … they fall because of five or six factors. To reduce risks, you have to intervene on all of those things.” She added reasons for a fall might include any number of factors from a long, diverse list ranging from poor vision and tripping hazards to a drop in blood pressure upon standing or suboptimal choice of an assistive device. “In order to improve fall rates,” Colón-Emeric said, “the team needs to know what the resident’s behavior is like.” However, the person with the most hands-on knowledge often isn’t the one creating that resident’s specific care plan. Colón-Emeric pointed out aides deliver the majority of care in the nursing home setting. Yet, nurse aides aren’t typically part of the decision-making process and are often expected to communicate only within the chain of command. “They are less likely to implement the care plan if they haven’t been involved in making it in the first place,” she noted.

In an article published in Implementation Science last year, the research team said QI programs could not reach optimal levels of staff behavioral changes unless the context of social learning was present. The team developed the CONNECT educational intervention to foster improved connections within and between disciplines, heighten communication flow and encourage cognitive diversity in solving problems on behalf of residents. The next step was to see if the ‘all hands on deck’ approach made a difference in fall rates in comparison to traditional QI initiatives that focus on an individual’s mastery of content and process change. Colón-Emeric said eight nursing homes in North Carolina and Virginia

Falls Hurt Physically & Financially According to the Centers for Disease Control & Prevention, one in every three adults age 65 and older falls each year. In this age group, falls are the leading cause of injury death and are the most common cause of nonfatal injuries and hospital admissions for trauma. In 2010, 2.3 million nonfatal fall injuries among older adults were treated in the emergency room with more than 662,000 requiring hospitalization. The direct medical cost of these falls, adjusted for inflation, was estimated to be $30 billion.

were selected with half randomized to receive three months of CONNECT training followed by three months of a traditional falls QI program and the other half receiving only the QI program training. The eight participants included a mix of community nursing homes and VA facilities. The CONNECT intervention included interactive in-class learning sessions, unit-based mentoring and relationship mapping. All activities were focused on helping the staff build networks and relationships for problem-solving activities. “We designed the CONNECT intervention to show staff where their communications weren’t working … where gaps existed … and to teach them some practical tools to better communicate,” she explained. Post-intervention, three areas were reviewed for both the CONNECT and control groups — staff communications measures, charting, and fall rates. ColónEmeric said to measure communication, the team used surveys before, during and after the intervention. The team also reviewed documentation of the types of prevention interventions in the medical record. Fall rates, she added, were viewed as an exploratory outcome in light of the small number of study sites. “What we found was that the staff communication levels improved a little bit in the CONNECT group but decreased in the control facilities,” she said, adding the net result was significant. Among the CONNECT group, increased communication was more pronounced in the community settings, as Colón-Emeric said the VA facilities already had high levels of communication. Charting turned out to be a non-fac-

tor. “Both groups improved a little bit and neither was significant,” she said, adding improved documentation did not correlate with decreased falls. “We don’t think the chart measures are really a good measure of what is happening at the bedside … at the site of patient care.” As for the most important outcome — preventing falls — Colón-Emeric said the team saw the desired trajectory. “There was no change in fall rates in the control group, but the fall rate in the CONNECT facilities improved … they went down about 12 percent,” she said. Colón-Emeric was quick to temper the significance of the outcome in light of the small number of participating study sites. However, she said the group is now in the second year of a larger trial of 24 nursing homes with 12 each in the CONNECT and control groups. “If we see the same magnitude of benefit, that would be statistically significant.” She continued, “We should be finished with our last nursing homes in 2014 and have the results out shortly thereafter.” Colón-Emeric added that if the improved collaboration is proven to positively impact falls QI initiatives, then it would be reasonable to apply the same tactics to other multi-factorial issues facing America’s growing senior population.

Enjoying, continued from page 7

festival weekend when someone can go to the top of the mountain to see the rhododendron, traffic will be less, and travel will be faster,” explained Shomaker. With hiking trails, fields, private camp sites and unrivaled views, Roan Mountain State Park is definitely a “must see.” According to Tipton, on a clear Fourth of July evening, fireworks can often be seen in Johnson City, Tenn., which is 45 minutes away in drive time. “The Roan Mountain State Park is also one of Tennessee’s best parks,” added Tipton. “Actually, a sign we have here on the mountain says, ‘Roan Mountain State Park is the crown jewel of all Tennessee state parks.’” The annual Rhododendron Festival serves as a fundraiser for the Roan Mountain Citizens Club, and all proceeds go back into the community for a college scholarship and beautification efforts to enhance the community and maintain its beauty. “Once you go up on top of the mountain, there’s fresh, cool air where you can enjoy the weather and not burn up doing it,” explained Tipton. “There’s also usually a 10 to 15 degree drop in temperature making Roan Mountain the place to go!” For additional information, visit www. RoanMountain.com Leigh Anne W. Hoover is a native of South Carolina and a graduate of Clemson University. She has worked for over 25 years in the media with published articles encompassing personality and home profiles, arts and entertainment reviews, medical topics, and weekend escape pieces. Hoover currently serves as immediate president of the Literacy Council of Kingsport. Contact her at hoover@chartertn.net.

JUNE 2013

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What You Need to Know About Non-emergency Medical Transportation

FOCUS ON SENIOR HEALTH

By AMANDA SHELL

Rural/Metro emergency medical technicians Lauren Luttrell (left) and Lindsay Wheeler transport patient Roosevelt Davis from NHC Healthcare to his dialysis treatment. In addition to being the ofﬁcial emergency services provider for Knox County, Rural/Metro also has a staff dedicated to non-emergency transport.

How much will it cost to transport my mother from the nursing home to her dialysis appointment by ambulance? Dad’s home from the hospital, but they want him back for a CAT scan. What do I do if I can’t fit his electric wheelchair into my car? Good questions. An ambulance is more than just an emergency vehicle. Patients often require ambulance transportation in nonemergency situations as well. And those requiring specialized transportation services are most often disabled or elderly. There are several non-emergency transport providers available in East Tennessee, and cost and coverage varies widely depending on the provider and level of care required. Before scheduling transportation, it is important to get the facts and be an informed consumer.

Does my insurance or Medicare cover non-emergency transportation? The short answer is sometimes – if it meets a medical necessity. Typically, insurance will cover all or part of nonemergency transportation for medical treatments, outpatient procedures, or post-operative check-ups if that transportation assistance is determined to be a medical necessity. According to Darlene Kitts, division marketing manager at Rural/Metro, the most important thing to know about getting a transport covered is to make sure the medical need for an ambulance is documented by a physician. “It’s important that a patient has a document from their doctor proving medical necessity,” said Kitts. “Medicare has forms specifically for this. This is such an important step for qualifying for payment that we will sometimes to into physicians’ offices to update them on proper documentation and provide information on how to code medical necessity on forms.” Additionally, some carriers require that the ambulance service provider be in the insurance carrier preferred network. Several require pre-certification, meaning the insurance carrier must be notified in advance about the ambulance transport. There may also be a deductible or co-pay involved. All or part of non-emergency transports are more likely to be covered if a patient is moving from one hospital or care facility to another, particularly if the patient is moving for specialized care or long-term rehabilitation. Some carriers, excluding Medicare, will cover transport for a doctor’s visit. Medicare and others also cover wound care at an approved hospital-based clinic. “Most reputable ambulance service providers, like Rural/Metro, will have a consumer advocate on staff that will easttnmedicalnews

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help customers determine eligibility requirements and what documentation is needed,” said Kitts. “Once we get all the information, we can usually let people know right then an estimate of costs.” To be certain, patients and caregivers are encouraged to check with their individual insurance providers for specific requirements and coverage, and Medicare provides information on their website, www.medicare.gov.

What type of service is best? There are a number of reasons a patient may need professional assistance with transportation. If the patient has a wheelchair that will not fit in a standard vehicle, has complex medical equipment

such as a ventilator or needs continual medical monitoring during transportation, an ambulance may be needed. There are several types of ambulances, and it is important to get the right one – for health and safety as well as cost savings. Patients do not want to pay for more than they need. For example, Rural/Metro has five different types of ambulance transportation available. The differences are based on the medical equipment on board and the qualifications of the personnel. ·• Wheelchair van service is ideal for patients who need an escort, assistance walking or have a wheelchair that will not fit in a standard car. No medical care is provided.

• A Basic Life Support (BLS) ambulance is required when a patient requires a little more assistance, such as medical monitoring, oxygen administration or oral suctioning. This ambulance has a minimum of two state-licensed emergency medical technicians (EMTs) and an automatic external defibrillator (AED) on board. • An Advanced Life Support (ALS) ambulance is needed for a patient with more intensive medical needs such as EKG monitoring, advanced airway management or medical administration. The ALS ambulance has and EMT as well as a paramedic and more advanced medical equipment available. • The Critical Care ambulance is for a patient needing medication administered via pump or ventilator, and is staffed with a paramedic trained in critical care. • A bariatric ambulance is equipped with a wider bariatric cot rated to carry patients weighing more than 300 pounds and require a wider stretcher. Specifying the level of assistance needed when scheduling non-emergency medical transport service ensures the patient will have the appropriate personnel and equipment for a safe transport. It also helps keep costs down, since most plans cover only the level of service medically necessary. It is best to check with a physician to specify clearly what services are required. (CONTINUED ON PAGE 12)

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JUNE 2013

Vision, Experience, Understanding. At State of Franklin Healthcare (SOFHA), we are continually searching for ways to improve services to our patients. We are pleased to share with you our program that has been designed to provide more advanced personalized health care services. The“Patient Centered Medical Home” was developed to enhance care by enabling our patients personalized medical access provided by a care coordinator under the direction of their primary care physician.

medical home is where the primary care physician leads a professional health care team that will be responsible for the ongoing care of the patient.

Patients are encouraged to self-manage their conditions through shared goals, education on disease states, and health coaches. The goal is to create partnerships between patients and their primary care physician. There is no additional cost to patients, just a signed agreement between the primary care physician/ physician extender and patient to participate. This program is being conducted at SoFHA for patients with certain chronic disease states such as diabetes. If you are someone with a chronic disease state, you may qualify for participation in this program. Patients participating in the PCMH have available and will be provided with the following: educational tools on their specific disease states; receive oneon-one assistance with their care coordinator on their specific disease state; assistance in scheduling appointments and referrals; receive proactive

healthcare services; assistance in making same day “urgent” appointments with their personal physician or a member of his/her healthcare team. Patients enrolled and participating in PCMH will have access to their personal care coordinator via e-mail and phone Monday -Friday 8:00am-5:00pm during operational business hours. The care coordinator will assist patients by triaging (determining medical priority) for same-day appointments with physician/physician extender. The care coordinator will follow-up with patients on a monthly basis for any needs or assistance in areas that may help in maintaining compliance with their on-going health care plan. Our medical team will assist patients in managing chronic disease states by providing education and ensuring any tests relevant to a particular disease state is performed as needed. In addition, patients will be provided with education related to preventive health screenings and any assistance with scheduling these screenings.

We at SoFHA want to provide you with the highest level of care possible and we feel this program will allow us to enhance your care by involving “you”, the patient, in all areas of your health care.

JUNE 2013

Our Clinics Blue Ridge Family Medicine 301 Med Tech Parkway - Suite 120 Johnson City, TN 37604 Phone: 423-794-1800 Fax: 423-794-1801 Family Physicians of Johnson City 303 Med Tech Parkway - Suite 100 Johnson City, TN 37604 Phone: 423-282-5611 Fax: 423-282-5712 FirstChoice Family Practice 301 Med Tech Parkway - Suite 140 Johnson City, TN 37604 Phone: 423-794-5530 Fax: 423-794-1824 FirstChoice Internal Medicine 301 Med Tech Parkway - Suite 280 Johnson City, TN 37604 Phone: 423-794-5550 Fax: 423-794-1829 FirstChoice Pediatrics 301 Med Tech Parkway - Suite 160 Johnson City, TN 37604 Phone: 423-794-5560 Fax: 423-794-5873 First Medical Ob/Gyn 1505 W Elk Ave. Elizabethton, TN 37643 Phone: 423-543-7919 Fax: 423-543-5323 Johnson City Internal Medicine Associates 301 Med Tech Parkway - Suite 240 Johnson City, TN 37604 Phone: 423-794-5520 Fax: 423-282-6940 Johnson City Pediatrics 301 Med Tech Parkway - Suite 180 Johnson City, TN 37604 Phone: 423-794-5540 Fax: 423-926-3187 Pinnacle Family Medicine 303 Med Tech Parkway - Suite 150 Johnson City, TN 37604 Phone: 423-282-8070 Fax: 423-282-8550 Riverside Pediatrics 1503 W Elk Ave. Elizabethton, TN 37643 Phone: 423-547-9400 State of Franklin OB/GYN Specialists 301 Med Tech Parkway - Suite 200 Johnson City, TN 37604 Phone: 423-794-1300 Fax: 423-794-1398

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MOR E AB OUT

Sleep Center

Physical Therapy

our services

Walk-In Clinic

REST ASSURED WE ARE HERE FOR YOU.

DEDICATED TO IMPROVING YOUR QUALITY OF LIFE.

JUST WALK IN AND WE’LL TAKE IT FROM THERE.

The SoFHA Sleep Center, which is accredited by the American Academy of Sleep Medicine, offers comprehensive testing for an array of sleep disorders. The studies are performed in a comfortable, homelike setting using stateof-the-art equipment. Our goal is to increase awareness of the importance and potential serious consequences of untreated sleep apnea and other sleep related disorders. We can improve the lives of our patients by educating, diagnosing, and managing these disorders. Above all else, our primary goal is to provide quality patient care.

The Physical Therapy Department of State of Franklin Healthcare is dedicated to making a positive difference in the quality of life of our patients. Our mission is to provide every patient with the best possible physical therapy services in a supportive and educational atmosphere to enable him or her to achieve goals. We strive to ensure the highest quality healthcare in a positive and forward thinking environment.

A consistent leader in ambulatory care in East Tennessee, State of Franklin Walk-In Clinic in Johnson City is dedicated to providing accessible, high-quality healthcare to the community we serve. Above all else, we strive for the highest standard of excellence in compassionate patient care. We love what we do and consider it a privilege to offer warm and welcoming care to you when you need it most – from our family to yours.

Our goal is to achieve measurable results, which are proven, in an environment that permits comfort and change. We also aim for the highest level of integrity, professionalism, honesty, and delivery of individualized care to improve the quality of life in all of our patients.

Designed with your busy lifestyle in mind, no appointment is necessary in the unfortunate event you should sustain an injury or become ill. Whether it’s a routine sports physical, an itchy case of poison ivy, or just cold or flu symptoms, our experienced providers will treat you with excellent and efficient care so that you may be on your way and on the mend in no time.

Tests are conducted by highly skilled, licensed sleep technologists and reviewed by sleep physicians certified by the American Board of Sleep Medicine (ABSM). The sleep technologists work with each patient to explain the procedures used in completing a sleep study. The recording techniques are noninvasive and all electrodes are applied to the surface of the skin. During the study, the electrodes will record the amount and quality of sleep. The data displayed will include measurements such as brain waves, heart rate, oxygen level, muscle activity, breathing pattern and various other activities throughout the study. We take referrals from SoFHA and non-SoFHA physicians as well as self-referrals. We also accommodate vendors and DME (medical equipment companies).

Our services include:

• Standard Polysomnogram (95810) • PAP Titration (95811) • Multiple Sleep Latency Test (95805) • Maintenance of Wakefulness Test (95805) • Consultation with Sleep Specialist • Follow-up with Sleep Specialist (w/o initial consultation)

Treatment options available are: • CPAP • Dental Appliance (Mild OSA) • Positional Therapy • Behavioral Modiﬁcation • Medications

We have been offering compassionate and highly skilled care to our patients in pursuit of their individual needs and goals since our doors opened in 2003. We welcome opportunities for professional development and advanced clinical training in order to ensure that our clinical practice aligns with the changing needs of our patient population. We treat and educate patients with medical problems and health-related conditions that interfere and/or limit their ability to move and perform functional activities in their daily lives. Proper movement and function are promoted through exercise and functional training in a “hands-on” care approach.

Visit us for ambulatory injuries and illnesses seven days a week – adults and children alike. Our family of staff is here for you Monday thru Friday from 8:00 AM to 8:00 PM and on Saturdays and Sundays from 9:00 AM to 5:00 PM. Unsure or just have a question? Email us at walkin@sofha.net.

Common conditions we treat include: all orthopedic injuries and dysfunctions (including spine, shoulder, hip, knee, etc.), muscular strains and sprains, sports injuries, post-operative conditions, and work-related injuries and repetitive conditions. By offering a variety of specialized treatment options for various populations, SoFHA Physical Therapy Department has the ability to successfully treat all physical therapy related conditions. Most of our therapists are certified in McKenzie Spine evaluation and treatment. Visit us Monday thru Fridays from 8:00 AM to 5:00 PM.

Some treatment options may require a referral to a specialist. These specialists may include a Dentist, Psychiatrist, Psychologist, Cardiologist, or an ENT (ear, nose, and throat). Our office hours are 8:00 AM – 5:00 PM with clinical hours being from 9:00 PM – 6:30 AM.

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Proud members of Qualuable Medical Professionals www.qualuable.com

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JUNE 2013

Selling Your Practice? continued from page 1 physician practice to a hospital or other healthcare organization is that the purchase price is paid at the time of the closing rather than in installments over time. In some transactions, however, only a portion of the purchase price is paid at closing, with the remaining amount paid over time and often with some strings attached. For instance, a purchase agreement may require you to continue your employment for a certain period of time after the closing to ensure a smooth transition. If you decide to retire before the end of the period, you may be required to forfeit some or all of the remaining payments of the purchase price. In addition, you may be required to indemnify the buyer against liabilities of the practice that arose prior to the transaction closing date. Accordingly, if you are considering selling your practice to another entity, it is important that you not only

become comfortable with the overall purchase price, but also with all of the terms and conditions associated with obtaining the full purchase price for the sale.

Becoming an employee. In many cases, a physician who sells his or her practice to a hospital or other healthcare organization will be required to continue practicing as a hospital employee. If you are considering such a sale as your succession plan, it is very important that you carefully review the terms of the proposed employment agreement in light of your personal retirement plans. In most cases, physicians directly employed by a hospital are likely to have fewer responsibilities and less time devoted to administrative, non-medical duties that come along with running a practice. On the other hand, this transition usually comes

with a marked decrease in your independence. Decisions regarding the call schedule, staffing, the location of your practice, vacation, and a host of other matters will now be in the hands of hospital management. Keep in mind that these issues and others are likely to have a significant impact on your lifestyle in the time between the sale and your retirement.

Restrictive covenants. Not all succession planning involves total retirement from the practice of medicine. Accordingly, before choosing a practice sale as a form of succession planning, you should be aware of the potentially broad restrictions that can be associated with the sale of your practice. If you continue as an employee after the closing, you may be subject to a covenant not to compete as part of your employ-

What You Need to Know About Non-emergency Medical Transportation, continued from page 9 What do you look for in nonemergency transport service? Whether scheduling transport from home or from a medical care facility, the patient has options. In order to make the best, most efficient and cost-effective decision, there are several things to look for when choosing a service provider. The first thing to consider is the level of service required. Some companies have only one type of ambulance, which may or may not meet the patient’s needs. When choosing a non-emergency medical transport service, patients should also consider the qualifications of both the service and the personnel. “It is important that patients use only licensed service providers. All non-emergency medical transportation providers are required to be licensed by the state of Tennessee,” said Kitts. “As the only CAAS-accredited service in East Tennessee, Rural/Metro goes above and beyond

the state requirements for licensure.” The Commission on the Accreditation of Ambulance Services (CAAS) is an independent commission that established a comprehensive series of standards for the ambulance industry determined to designate excellence in modern emergency medical services providers for clinical quality and operational efficiency. Licensed and trained EMTs and paramedics are another important consideration. These professionals are trained to move patients to avoid injury and can address medical emergencies if necessary during the transport. The state of Tennessee does not require an EMT on board for a wheelchair van transport, so patients should inquire whether the service they are scheduling has a medically trained person on board. “Rural/Metro strives to go above and beyond minimum state requirements,”

ACCEPTING NEW PATIENTS East Tennessee Children’s Hospital Gastroenterology and Nutrition Services is East Tennessee’s premier pediatric gastroenterology group. We are staffed with four of the area’s finest board certified pediatric gastroenterologists, in addition to three nurse practitioners, two behavior health clinicians, three registered dieticians, one physicians assistant, and a research coordinator. We serve all of east Tennessee and the surrounding areas. 2100 Clinch Avenue, Suite 510 | Children's Hospital Medical Office Building | Knoxville, TN 37916

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JUNE 2013

said Kitts. “We always staff wheelchair vans with a licensed EMT. Not every provider does, but we feel it’s always important to be prepared in case an emergency situation arises.”If a patient requires specialty equipment such as oxygen, it is important to know whether the carrier will have it on board or if the patient is expected to provide what is needed. With so many services to choose from and details that affect cost and coverage, selecting the right non-emergency medical transportation can become a complicated decision. The first and best decision is to consult with a doctor and insurance provider and choose an excellent and reliable service provider, like Rural/Metro, who can provide a patient with an advocate. Knowing what questions to ask can help prevent delays and perhaps cancellations if the right level of service is not dispatched.

Bee Fit 4 Kids is a family oriented pediatric weight management program using evidenced based research to help overweight children & their families. We are now accepting insurance. KidsFACT is a nonprofit support group created by GI for Kids, PLLC for those diagnosed with pediatric Inflammatory Bowel Disease (IBD) & their family members. Our behavior clinicians are experienced in helping a variety of disorders. Allergy 4 Food is a resource that allows you to shop for nutritional supplements without the frustration of driving all over town. www.allergy4food.com Support group helping the Knoxville region with celiac disease & gluten intolerance. www.celi-act.com

ment agreement. Under Tennessee law, noncompete provisions in physician employment agreements are enforceable if the restriction is for two years or less (1) and the geographical area of the restriction is the greater of a ten-mile radius from the physician’s primary practice site or the county in which the primary practice is located. Depending on the circumstances, a physician may be restricted from practicing at any facility at which the physician provided services during the term of the employment agreement. If the buyer is a hospital, however, the noncompete provision must also include a clause permitting the physician to buy back his or her medical practice. If the medical practice is repurchased from the hospital, the noncompete provision is void. Tennessee also permits physician noncompete agreements in conjunction with the sale of a medical practice, which are merely required to be “reasonable under the circumstances.” Moreover, there is a rebuttable presumption that such “deal noncompete” provisions are enforceable. While a healthcare organization (such as a large medical group, for example) may utilize deal noncompete provisions, there is currently some question regarding whether a hospital is permitted to utilize deal noncompete provisions in conjunction with the purchase of a physician’s practice. In any event, it is possible that a hospital or other healthcare organization acquiring your practice will seek to restrict your ability to provide patient care over a longer period and/or in a much wider area in which a hospital and its affiliates conduct business. In addition, it could also restrict your ability to perform other activities, such as providing consulting services, investing in other healthcare companies, or participating in other management activities that may “compete” with the company that purchases your practice. Therefore, if you are considering selling your practice as your succession plan, it is important that you evaluate any proposed restrictive covenants in light of your future plans. Selling your practice to a hospital or other healthcare organization may be a simpler, more attractive alternative to recruiting a younger physician to purchase your practice. As you move forward with your succession plan, however, be aware of the strings attached to a practice sale and what effect they may have on your future plans. Note: if the employing entity is a hospital, the duration of the restriction can be longer (though not to exceed five years) if it is determined by written mutual agreement that the extended period is necessary to comply with federal statutes, rules, regulations or IRS revenue rulings or private letters. See T.C.A. §63-6-204. Ian P. Hennessey is with London & Amburn, P.C. His practice focuses primarily on health law. He may be contacted at ihennessey@latlaw.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

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InSights Computer vision syndrome a widespread, growing problem By BRAD LIFFORD When Donald L. Wells began his career at Johnson City Eye Clinic, a vision problem that now affects untold millions of people was virtually unheard of. And one thing is sure: computer vision syndrome, commonly referred to as CVS, is hardly on the decline. “CVS is widespread,” Wells said, “and definitely growing.” Computer vision syndrome is a problem that encompasses a set of vision symptoms that – while not causing permanent damage – can cause serious discomfort and strain the eyes. The pervasiveness of high technology has enriched our productivity and work capabilities and opened up wondrous realms of entertainment, but staring at screens big and small has taken a toll. The American Optometric Association estimates that as little as 50 percent and as much as 90 percent of the U.S. adult population experiences CVS. Wells is well-versed in conditions related to the eye. A Master Optician, he began his career at Johnson City Eye in June of 1980. Johnson City Eye Clinic, located in Med Tech Park, has a tradition of eye excellence that dates to 1942. Interestingly enough, the first digital computers were being used in the same era when Johnson City Eye got its start, but just one of those computers was the size of a room. Today, 90 percent of Americans own a personal electronic device, according to the Pew Internet and American Life Project: computer, MP3 player, videogame console, cell phone, e-book reader, or tablet computer. And that’s not to mention the video monitors that capture our gaze at work. “Our doctors at Johnson City Eye don’t have a specific diagnosis for CVS,” Wells said, “but it’s a condition that is generally associated with secondary complaints of dry eyes, eye strain, blurred vision, and headaches. Those are some of the major complaints related to the eye, and those are often associated with musculoskeletal symptoms as well, such as shoulder and neck pain.” Wells said that our electronic devices literally hold our attention too long and often for uninterrupted duration. “One of the main contributors to CVS is probably dry eyes,” Wells said. “When people work on their computers, they don’t blink enough, and therefore they don’t spread their tears over the cornea, the clear front part of the eye. The cornea dries out, and it causes problems that can include blurred vision and burning eyes.” That fixation on video monitors large and small and, with computers, the related typing on a keyboard, differs from the typists of yesteryear, Wells said. “I have wondered why the typists of pre-computer years didn’t suffer the same symptoms,” Wells said. “But their habits were different. I’ve been told that typists then moved around more – both their eyes and body. In general, they took breaks from typing; they would get up and move around and deliver a typed letter to someone or get envelopes and stuff them. “People who work on computers have different habits. With no breaks

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and no movement, they can do everything electronically – receive and send e-mail, play games, buy things, read the news. You don’t have to move.” So moving around, blinking to keep the eyes moist and limiting those rapt gazes are advisable, Wells said. Another tip: Ensure your monitor or device is used in the right lighting. “Lighting can be another very important variable,” Wells said. “You should generally avoid working near windows or have too much lighting; you probably need to vary it in order to have the right lighting for you. Lighting can cause a lot of glare on monitors, too. Sometimes just tilting your screen a little can reduce glare, and you can use a non-glare screen and also have non-glare put on your glasses if you wear them.” Wells said the simplest solution for those experiencing symptoms that could be related to CVS is one that will benefit them regardless of whether they are actually experiencing CVS – and it that solution could offer a big return where their vision is concerned. “The problem area,” Wells said, “is that not enough people get their eyes examined.” Ample research backs that contention. Regular eye exams detect more serious and treatable conditions than CVS; the U.S. Centers for Disease Control estimates that 11 million Americans ages 12 and older could see better through measures that include reading glasses, contact lenses or eye surgery. “Anyone having any eye problems should start with a good eye exam,” Wells said. “They need to make sure their vision is corrected. As we age, it becomes more likely that we’ll need to have our vision corrected. For example, people who are approaching 40 may need correction for near vision.” Johnson City Eye Clinic provides a full spectrum of eye care and surgical services for adult and pediatric patients. In addition to comprehensive eye care, Johnson City Eye physicians specialize in cataract surgeries, the treatment of glaucoma, macular degeneration, reconstructive surgeries, pediatric ophthalmology and retinal disease. The medical staff at Johnson City Eye includes Drs. Alan N. McCartt, John C. Johnson Jr.; Dr. Jeffrey O. Carlsen; Amy B. Young; James W. Battle; Randal J. Rabon; Calvin L. Miller; Michael F. Shahbazi; and Peter Lemkin, a doctor of optometry.

Johnson City Eye Clinic & Johnson City Eye Surgery Center 110 Med Tech Park • Johnson City, TN 37604 225 Medical Park Drive, Bristol Phone: (423) 929-2111 • Fax: (423) 929-0497 Email: info@JohnsonCityEye.com

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theLiteraryExaminer BY TERRI SCHLICHENMEYER

What Makes a Baby by Cory Silverberg, illustrated by Fiona Smyth; c.2013, Seven Stories Press; $16.95 U.S. & Canada, 36 pages So your wee one knows that somebody’s going to have a baby… but you haven’t had The Talk yet. The new book What Makes a Baby by Cory Silverberg, illustrated by Fiona Smyth makes the conversation a little bit easier. Using ideas that are easy for smaller kids to understand, author Cory Silverberg tastefully explains how babies are conceived and born. Eggs and sperm are pretty special. Inside each egg, there’s a story about the person that the egg came from. The sperm is the same way: it contains a story, too. Not all bodies have sperm. Not all bodies have eggs. So when grown-ups want to make a baby, they use an egg from one person and a sperm from another person and they put them in a warm, safe place. That place is called a uterus, and even though it has the words “YOU” and “US” in it, not every body has one of those, either. When an egg and a sperm get together in the uterus, they do a sort of dance, and they talk to each other and share those stories about the bodies they came from. By the time the dance is done, they’re not an egg and sperm anymore – they’re a brand-new, tiny thing that might or might not grow. If it does, it becomes a baby just like you were a long time ago. Inside, a baby grows… and grows… and grows for about forty weeks until it’s ready to be born. Sometimes, the baby comes out on its own and sometimes a doctor decides when it’s time – but no matter how it arrives, it’s a pretty big deal for the baby and for the people who were happy for it to arrive. And one of those people who are happy to meet the baby is you! While the story itself is quick to read, the brightly colored illustrations by Fiona Smyth will make kids want to linger on each page. Those illustrations are, in fact, my favorite part of the book because they oh-sosubtly touch upon kids and families of all kinds. That inclusion means a fresh take on an age-old story. If your child is full of questions, make sure you’ve got this cute book around for easy answers. For curious 3-to-6-year-olds, not having What Makes a Baby is inconceivable. Is Work Killing You? A Doctor’s Prescription for Treating Workplace Stress by David Posen, MD; c.2013, House of Anansi, $18.95 US and Canada, 358 pages Your employees have had to push a little harder than they ever had to before, and they’ve endured some layoffs, but everybody seems to have adjusted. Still, you know that morale is low, and you’re think-

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ing a fun group event might help. According to David Posen, MD, you’re on the right track, but there are lots more things you can do for your employees. In his book Is Work Killing You? you’ll see how helping them will help you. In his medical practice, David Posen sees “first-hand and up close the psychological and physical damage” caused by workplace woes. Employees are stretched too thin, they’re doing more work for less money - some businesses even expect employees to work through lunches, weekends, holidays, and vacations – which often leads to headaches, forgetfulness, irritability, agitation, and depression that Posen directly attributes to work-related stress. “Workplaces are making people sick,” he says, and no one seems willing to discuss it. As he sees it, the biggest contributors to workplace stress are volume (an increase in workload, to the point of overload), velocity (accelerated speed at which employees are expected to work), and abuse (office bullies who “wreak havoc”). Other issues come into play, but these are the top three. Though it’s a “hard sell,” Posen says studies indicate that productivity, mental clarity, and energy actually improve when work hours are reduced, face-time and meetings become optional, vacation-taking is mandatory, and employees are encouraged to disconnect from work on a regular basis. As an employer, you’ll also get more out of your employees if you encourage healthy habits. If it’s feasible, let them go home early when work is finished. Share the wealth – or at least make salaries more equitable. Help employees deal with office politics. Know the difference between “excellent service and excessive service.” Prioritize projects wisely and discourage multitasking. Lastly, ease up. Your employees’ health and your bottom line both depend on it. As I was reading Is Work Killing You? there was one question that kept popping into mind: why isn’t this book taught in school? You’ll ask yourself that, too, as you devour this common-sense, how-to, rantslash-advice book because author and physician David Posen makes many good points for employees and business owners alike. In making those arguments, he underscores his research by sharing dozens of anecdotes from his patients and others, and some of them are jaw-droppingly uncomfortable to read. Posen doesn’t leave us hanging on those squirmy details for long, though; he offers pages and pages of ideas meant to make the business world better, do-able from dual sides of the paycheck. This is one of those books that could potentially benefit anyone who works for a living, and I’m excited to finally see this topic tackled. I think that if a stress-free workday is what your business needs, then reading Is Work Killing You? should be your goal.

Terri Schlichenmeyer has been reading since she was 3 years old, and she never goes anywhere without a book. She lives on a hill in Wisconsin with two dogs and 11,000 books.

Wine 201 Wines with Barbecue

Barbecue, barbeque, or BBQ? Each means slightly different cooking to different people. We have some friends from the UK who talk about grilling meat over charcoal or a gas grill and call it barbecue. In East Tennessee, however, we just call that ‘grillin.’ Barbecue to us refers to seasoned meat very slowly cooked over wood or wood charcoal and often finished with a glazing sauce containing vinegar and spices and varying degrees of sweetness from sugar, honey, or molasses. We admit that dry rub (spices only) barbecue exists, but for the most part, East Tennesseans favor slow cooked meats with added tangy sweet, tomato-based sauces. I must admit that beer is often just right with barbecue, but I usually prefer wine. The only time I switch to beer is if the meat or sauce contains a fair amount of red pepper hotness. In that case, the higher amount of alcohol in wine, compared to beer, further dissolves the capsaicin oil and makes the dish even “hotter”; I confess that I do not care for super hot BBQ. In Arkansas or Texas, I will grab a beer with BBQ, but in East Tennessee, the lower capsaicin hotness and dominant smoke-flavored meat with vinegary sweet and spicy sauces go extremely well with acidic wines with a touch of sweetness. Let me explain why. Basic food, sauce, and wine pairing rules include acidic wines with acidic foods; low acid wines with savory foods; slight sweetness with spicy (hot) foods, fat, and salt to cut tannins; and oaky wines with roasted meats. What these pairing rules do, if you choose to follow them, is to bring the wines into balance with the foods. You may not care for acidic wines, but following acidic foods, they taste much more balanced. If you don’t like astringent tannins in wine, have that tannic wine with some fatty, salted pulled pork, and you will be amazed at the difference. If you are just grilling, oaked red wines or an oaked Chardonnay bring that smoke taste into a delicious perspective. Over the years, I have found that some of the best wine combinations with barbecue or even just plain grilled foods include the following: Meat: Pulled Pork Sauce: East Tennessee/Western North Carolina, tomato/vinegary, slightly sweet sauce Wines: Fruity, California Cabernet Sauvignon (Bogle, Don Sebastiani, Robert Hall, Black Box); Apothic Red; eastern US Chambourcin or Chancellor Meat: Pulled Pork Sauce: East Carolina vinegary, peppery sauce Wines: Rosé, White Zinfandel, Chenin Blanc, Rieslings, Pinot Gris/Grigio Meat: Pulled Pork Sauce: South Carolina, mustardy

BBQ sauce Wines: New Zealand Sauvignon Blancs (Oyster Bay, Cloudy Bay, Kim Crawford) Meat: Chicken Sauce: Alabama white sauce Wines: Austrian Grüner Veltliner (GruVee) ribs

Meat: St Louis/Kansas City style

Sauce: Allspice in the sweet sauce Wines: Off dry reds (Apothic Red, Ménage à Trois Red) Meat: Texas Barbecue brisket Sauce: Mild hot sauce Wine: Zinfandel (Steele, Ridge, Rosenblum) or Spanish Tempranillo wines Meat: Grilled steaks or roasts Sauce: Salt, pepper, and butter only Wine: Petit Sirah (Bogle, Greg Norman, Foppiano); Carmenére (Concho y Toro); Bordeaux Meat: Cedar board grilled salmon or grilled smoked salmon Sauce: Any Wines: Oaked Chardonnays (Chalone, Chateau St Jean, Toasted Head,) Meat: Barbecued chicken Sauce: Red BBQ sauce Wines: Russian River Pinot Noir (Martin Ray, Merry Edwards, Martinelli, Rodney A Strong, Siduri) Meat: Grilled Italian or smoked sausages, bratwurst Wines: Alexander Valley or Napa Valley Cabernet Sauvignon, Italian Sangiovese or Chianti Meat: Grilled hamburgers and hot dogs Wines: Depends upon what condiments you like: California Sauvignon Blanc (St Supery, Ledford, Bogle ) with mustard, pickles, onions; Unoaked Chardonnay (Joel Gott, Sebastiani, Simply Naked, Toad Hollow) with tomato, mayonnaise, and lettuce; California Pinot Noir (Bogle, Mark West, Mondavi Coastal, Castle Rock) with catsup; Italian Pinot Grigio (Cavit, Ecco Domani, Cupcake) with chili and slaw I am getting hungry just writing this article. If you have not tried wines very often with barbecue, now is the time. Try it, you might like it! Rick Jelovsek is a retired physician, a Certified Specialist of Wine, and a member of the Society of Wine Educators. He is also author of a book available from Amazon on Wine Service for Wait Staff and Wine Lovers. You may contact him with wine questions at tnwinelover@ gmail.com or visit his website at www. winetasteathome.com.

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East Tennessee CME Events Editor’s Note: In an effort to provide our readership with the latest professional healthcare news, East Tennessee Medical News is working with area institutions to provide this monthly listing of CME events throughout the East Tennessee region. For more information about each activity, please see the contact information provided for each event.

CME Events in the Greater Knoxville Area Name of activity: Medicine Grand Rounds: Ethics and Allocation of Resources Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Medicine Date: June 11, 2013 Times: 8-9 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/ cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: June 13, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/ cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: June 13, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/ cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190

Name of activity: John Sullivan, DDS, Memorial Endowed Lecture Name of CE provider/sponsor: University of Tennessee Graduate School of Medicine and Department of General Dentistry Date: June 14, 2013 Time: 7:30 a.m.-5:00 p.m. Place: Heart Hospital Auditorium, University of Tennessee Medical Center, Knoxville Credits available: Approved for AGD credits and CEUs Contact: Department of General Dentistry: 865-305-9191, rlasorsa@ utmck.edu Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: June 20, 2013 Times: 7-8 a.m. Place: University of Tennessee Medical Center Cancer Institute, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/ cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery

Date: June 20, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/ cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Medicine Grand Rounds: Celiac Disease Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Medicine Date: June 25, 2013 Times: 8-9 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/ cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190

Medical Center Cancer Institute, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/ cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190 Name of activity: Surgery Grand Rounds Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery Date: June 27, 2013 Times: 7-8 a.m. Place: Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Credits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/ cme Contact: University of Tennessee Graduate School of Medicine, ContinuingEducation@utmck.edu, 865-305-9190

Name of activity: Pulmonary Tumor Board Series Name of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer Institute Date: June 27, 2013 Times: 7-8 a.m. Place: University of Tennessee

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Mark Your Calendar

Your local Medical Group Managers Association is Connecting Members and Building Partnerships. All area Healthcare Managers (including non-members) are invited to attend.

2ND THURSDAY JOHNSON CITY MGMA MONTHLY MEETING Date: The 2nd Thursday of Each Month

3RD THURSDAY KINGSPORT MGMA MONTHLY MEETING

Time: 11:30 AM – 1:00 PM

Date: The 3rd Thursday of Each Month

Location: Quillen ETSU Physicians Clinical Education Building, 325 N. State of Franklin Rd., Johnson City

Time: 11:30 AM – 1:00 PM

Save the Date: Don’t miss the September meeting, comedian Matt Fore will be performing.

Location: Indian Path Medical Center Conference Room, Building 2002, Second Floor, Kingsport

Speakers Vary Each Month, Covering Topics Such As Meaningful Use, Compliance, Coding, Legal Considerations, and More. To assist with appropriate catering preparation, please RSVP by the Monday prior to the meeting: Johnson City: Michael Manning @ MManning@painmedassociates.com. Kingsport: Frances Sizemore @ sizemorefn@msha.com or fax to (423)224-3901.

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JUNE 2013

GrandRounds HMG welcomes Heather Archer, PharmD

KINGSPORT, Tenn. – Holston Medical Group (HMG) welcomes Heather Archer, PharmD, to HMG Primary Care at the HMG Medical Plaza (105 W. Stone Drive, Suite 3A) in Kingsport, Tenn. Archer will be working alongside HMG providers in the area of patient medication counseling and manageHeather Archer ment. Archer received her doctor of pharmacy degree from Ohio Northern University in Ada, Ohio, and completed her residency in primary care specialty at the William Jennings Bryan Dorn VA Medical Center in Columbia, S.C. She holds a diabetic certification for pharmacists and is also certified in CPR and smoking cessation. Archer brings hospital pharmacy work experience to HMG.

Takoma Named ‘Safety Superstar’ By AARP Magazine

GREENEVILLE – Takoma Regional Hospital has been named a “safety superstar” by the international AARP The Magazine. The publication’s April/May edition highlights 66 of America’s safest hospitals in an investigative report that discusses how hospitals fight errors and how patients can protect themselves. Takoma was listed, along with several other top hospitals, including the Mayo Clinic Hospital in Phoenix, Beth Israel Deaconess Medical Center in Boston and Vanderbilt University Hospital in Nashville. For the full list of organizations featured as “hospital safety standouts,” please go to www.aarp.org/safehospitals. With nearly 33 million readers, AARP The Magazine is the world’s largest circulation magazine and the definitive lifestyle publication for Americans 50 and older. Daniel Wolcott, Takoma’s president and CEO, said he is excited about the recognition. “Takoma has an advantage of having two large parent organizations – Wellmont Health System and Adventist Health System,” Wolcott said. “The recognition of Takoma as a ‘Top Hospital’ is the result of two things: the technology and innovation provided by Adventist Health System; and the great work of our physicians and clinical staff who have caught the vision for being world class in patient safety.” According to the magazine article, more than 180,000 people die each year in U.S. hospitals from preventable accidents and errors. What’s more, an estimated one-third of hospital admissions result in harm to a patient. AARP explained that they wrote the article to draw attention to these tragic realities. AARP magazine teamed up with the nonprofit organization, The Leapfrog Group, to highlight the innovative steps some hospitals are taking to protect the health of their patients. The April/May issue, offered both inhome and online, showcases these “safety superstars” in the magazine’s first ever “Health” issue. From creating patient alerts to implementing electronic medical recordkeeping, the magazine reveals

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what these groundbreaking hospitals are doing to prevent mistakes and how patients can properly arm themselves against preventable errors. The article is available at: http://www.aarp.org/health/ healthy-living/info-04-2013/safe-healthcare.html?intcmp=ATMBB1 Leapfrog rates hospitals on 26 measures of safety – including infection rates from IV and catheter lines, secondary infections and hospital-acquired conditions like pressure ulcers. The data is compiled from the Centers for Medicare & Medicaid Services, the American Hospital Association and the Leapfrog Hospital Survey. Takoma has received an “A” grade for the past two years. To view area Hospital Safety Scores, please go to: http:// www.hospitalsafetyscore.org. Other hospitals featured in the magazine article include: • Allegheny General Hospital (Pittsburgh, Pa.) • Geisinger Medical Center (Danville, Pa.) • Kaiser Permanente (Multiple Locations) • The Methodist Hospital (Houston, Texas) • Rush University Medical Center (Chicago, Ill.) • St. David's Georgetown Hospital (Georgetown, Texas) • Stanford Hospital and Clinics (Stanford, Calif.) • Wake Forest Baptist Medical Center (Winston-Salem, N.C.)

use clinical and financial information from CareChex to assess the value of hospital services for employer contracting. Attaining successful results for patients is a relentless pursuit for the Wellmont CVA Heart Institute, a team of 46 physicians that oversees the cardiovascular program at Holston Valley and other Wellmont Health System hospitals. The heart institute has worked continuously to develop and refine its Level One Heart Attack Network to ensure blockages in patients’ arteries are cleared as soon as possible. The network is a partnership between physicians at the hospital and medical providers who respond to patients in the community. This process saves time because it gives personnel in the cardiac catheterization lab more time to mobilize prior to the patient’s arrival at the hospital. It has empowered Holston Valley cardiologists to restore blood flow in a clogged artery in less than 15 minutes after the patient comes through the hospital doors. Meanwhile, Holston Valley’s performance with coronary bypass surgery led to the hospital twice being recognized among the best in the country by the nation’s leading consumer magazine. The hospital is also one of only a limited number of facilities across the country – and the only one in the region – approved to perform transcatheter aortic valve replacements. Data from CareChex are publicly available at www.carechex.com.

Holston Valley Picked As One of Top 100 Hospitals in Country in Five Categories for Medical Excellence

4th consecutive year HMG Pediatrics receives award for 100% vaccine compliance

KINGSPORT – Holston Valley Medical Center, which has a long-standing reputation of delivering superior cardiovascular care to patients in the region, has been recognized as one of the top 100 hospitals in the nation by a leading ratings agency. Holston Valley earned this designation in five medical excellence categories – cardiac care, major cardiac surgery, coronary bypass surgery, heart attack treatment and vascular surgery – from CareChex, a division of Comparion that evaluates hospitals on multiple components of quality. In addition, Holston Valley was named among the top 10 percent in the nation in these five areas as well as in neurological care. CareChex ratings are based on a comprehensive review of nearly all general, acute, nonfederal hospitals in the United States. The company sifts through a collection of publicly available databases, such as the Centers for Medicare & Medicaid Services and the Hospital Quality Alliance, for its analysis. CareChex considers factors such as process of care, outcomes of care and patient satisfaction. The company’s reason for compiling the rankings is to help providers and healthcare consumers evaluate the quality of inpatient care. While CareChex focuses on evaluating the quality of hospitals, companies recognize the value of relying on this national ratings agency. For example, The Wall Street Journal said the National Business Coalition on Health planned to

KINGSPORT – The Vaccine for Children Program (VFC) has awarded Holston Medical Group (HMG) Pediatrics, Kingsport, Tenn., the “Hot Shot” award in recognition of the pediatrician’s demonstration of 100-percent compliance with all vaccine protocols. “It’s great recognition for our commitment to the children of our region,” says HMG Pediatrician and Pediatric Department Chair Donald Lewis, MD. The “Hot Shot” award is presented annually to VFC providers exemplifying outstanding dedication and commitment to the VFC program and to the children of Tennessee by demonstrating 100 percent compliance with all the protocols involving vaccine storage and handling, the screening of patients for program eligibility, documentation of immunizations and vaccine accountability. HMG Pediatrics has proven to be an immunization leader for the state of Tennessee and has been awarded the “Hot Shot” Award for four consecutive years.

Hawkins County Memorial Chosen Among Top 10 Percent in Nation for Patient Satisfaction

ROGERSVILLE – Hawkins County Memorial Hospital, a shining example of healthcare excellence for more than 50 years, was recently recognized by a national ratings agency for being among the top 10 percent of hospitals in the nation in patient satisfaction. The hospital received the honor from CareChex, a division of Comparion that independently evaluates hospitals on multiple components of hospital quality.

Hawkins County Memorial is part of an elite group in the nation for patient satisfaction in overall hospital care, medical care and surgical care. Hawkins County Memorial also achieved Stage 1 in the meaningful use of certified electronic medical records. This further reduced the potential for medical errors and increased secured sharing of patient data among providers. Hawkins County Memorial, which is accredited by The Joint Commission, has a team of 100 percent board-certified physicians and nearly 200 nurses, technicians and support staff.

Southwest Virginia Cancer Center Oncologist Earns Board Certification in Palliative, Hospice Care

NORTON, Va. – Dr. Daryl Pierce, a medical oncologist with the Southwest Virginia Cancer Center, passionately believes palliative care isn’t about treating illnesses – it’s about taking care of patients. This strong conviction motivated him to expand his knowledge base and Dr. Daryl Pierce attain board certification in hospice and palliative medicine through the American Board of Internal Medicine. He was already board-certified in medical oncology but viewed this latest credential as an opportunity to enhance his delivery of compassionate care. “Palliative and hospice medicine is really fascinating,” Dr. Pierce said. “I pursued the certification because I wanted to know more. The longer a physician practices medicine, he or she is entrusted to handle more complicated cases. It’s important for me to keep learning so I can continue providing patients with the best care.” Many people are familiar with hospice as a service to make the last segment of life more fulfilling and comfortable. Hospice care provides support at home for people in the end stages of progressive, incurable illnesses. Inpatient hospice care is an option for patients who have symptoms that can no longer be controlled at home. Hospice provides effective management of pain and other symptoms and supportive services for patients and families. Caregivers address the physical, emotional, social and spiritual needs of patients and families to offer hope, comfort and support. The concept of palliative care is not as well understood as hospice. Palliative care focuses on improving the lives of people of all ages who have serious, chronic and life-threatening conditions – including cancer, congestive heart failure, kidney failure, Alzheimer’s disease and chronic obstructive pulmonary disease. Part of coordinating palliative care means a team of doctors and nurses – and potentially social workers, counselors, chaplains and others who can assist – communicates clearly with one another, with other physicians and specialists and with patients to ensure patient comfort. Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

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GrandRounds Wellmont Receives Seven Honors from Tri-Cities Chapter of Public Relations Society of America

KINGSPORT – Wellmont Health System recently earned seven honors during the annual awards banquet for the TriCities chapter of Public Relations Society of America. Wellmont collected four Awards of Merit and three Awards of Quality for providing valuable health information to the communities it serves in Northeast Tennessee and Southwest Virginia. Two of the Awards of Merit recognized news releases. One concerned the expansion and renovation of the emergency department at Lee Regional Medical Center. The other pertained to an innovative program at Holston Valley Medical Center in which volunteers stay with dying patients who have no family. Another Award of Merit revolved around public service announcements promoting awareness of stroke symptoms and urging people to call 911 if they

show signs of this brain-impairing condition. The final Award of Merit was a direct mailer that promoted Holston Valley’s convenience and quality. Wellmont garnered an Award of Quality for a news release about Bristol Regional Medical Center’s Primary Stroke Center being honored with a national award from the American Heart Association and American Stroke Association. The remaining Awards of Quality were for a direct mail piece that promoted Spa Day at the Wellmont Breast Center in Johnson City and Wellmont Defined, the health system’s annual report for fiscal 2011. “We appreciate the external validation of these important materials, which were designed to inform and empower our patients and their loved ones about the services available at Wellmont,” said Nick Adams, the health system’s executive director of marketing communications. “The more information we can provide our communities, the better equipped those individuals are to make

healthy choices for themselves and their families.”

Chair of ETSU Department of Health Sciences co-authors new book

JOHNSON CITY – An East Tennessee State University professor who is a leading expert on the struggle by microorganisms to obtain iron – one of life’s essential building blocks – is the co-author and editor of a new book on the subject. Dr. Ranjan Chakraborty, professor and chair of the ETSU Department of Health Sciences in the College of Public Health, contributed the introduction and a chapter and served as editor of “Iron Uptake in Bacteria with Emphasis on E. Coli and Pseudomonas.” “Iron is actually the fourth-most abundant metal in Earth’s crust,” Chakraborty said, “but it’s a struggle for microorganisms – both inside and outside the body – to acquire iron in its soluble form. All living organisms, including us, need iron. Because iron is a vital component for living cells, microorganisms employ a variety of strategies to obtain it.” Chakraborty has focused his research on one method in particular that microorganisms use to acquire iron: compounds called siderophores. Microorganisms use these organic molecules, which can bind to iron, to latch onto the metal and return it to the cell to aid in respiration and reproduction. Chakraborty created the book as not only a means to publish current re-

search in the field but also as an ode to his mentor, the late Dr. Dick van der Helm. Chakraborty referred to him as the “ironman” of siderophore biology, and his work with van der Helm at the University of Oklahoma and Dr. Johann Deisenhofer, a Nobel Laureate at the University of Texas Southwestern Medical School, shaped his research career. Chakraborty has co-authored papers on the subject in several publications, including the academic journals Science and Nature. The siderophore’s role in human health looms large, as many pathogens rely on the compounds for iron. In Chakraborty’s lab, he and his group study in particular that transport mechanism in Escherichia coli, a bacterium commonly known as E. coli. By reaching a better understanding of that transport mechanism, Chakraborty said, scientists could design drugs that are more targeted and more effective in treating infections, as these transport systems are prevalent in bacteria, including many pathogens. Chakraborty said solving that siderophore transport model could also lead to better treatments for infections caused by bacteria, like Methicillin-resistant Staphylococcus aureus, which is potentially deadly and hard to treat. “Iron Uptake in Bacteria with Emphasis on E. coli and Pseudomonas” includes chapters from Drs. Volkmar Braun and Klaus Hantke of Tübingen, Germany, and Dr. Pierre Cornelis of Brussels, Belgium. It is published by Springer Briefs in Molecular Science.

We can help guide your path. Name: Thomas Myers Position: Emergency Response Vehicle driver, American Red Cross At a Glance: During his more than 20 years of service as a Red Cross volunteer, Thomas Meyers has seen more human suffering than most of us, as he has looked into the eyes of literally thousands of people facing the worst day of their lives. As a result, he understands that each of the 70,000+ people the Red Cross helps every year carries a personal story. Whenever horrific disaster scenes play out on TV and the Red Cross vans, also known as ERVs, appear delivering food to people who just lost everything, there’s someone like Thomas either behind the wheel or handing out meals. Although he delivers the basic human need of food into disaster situations, Myers gives something intangible but equally as healing. His assuring smile and calming demeanor brings comfort and hope that although the situation is bad now, it’s going to get better. For Myers, it’s about more than just driving through neighborhoods to deliver food. He knows the importance of the human touch. This great-grandfather and Vietnam-era veteran, along with other loyal Red Cross volunteers, hit the road with the ERV: Ready, Set, Rock & Roll Tour during the month of May. It was an opportunity for the Red Cross to recruit and train new disaster volunteers to deliver emergency services and help local communities be better prepared whenever the need arises.

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Incentive funding up to $63,750 is available for Eligible Professionals (EPs) within the Medicaid program seeking to achieve Meaningful Use of an EHR. Through special funding, tnREC is oﬀering free or low-cost health information technology services if an EP meets the Medicaid patient volume thresholds. We help healthcare providers take the right steps to implement new technologies that enhance and improve the quality of care available.

Apply online www.tnrec.org This presentation and related material was prepared by tnREC, the HIT Regional Extension Center for Tennessee, under a contract with the Oﬃce of the National Coordinator for Health Information Technology (ONC), a federal agency of The Department of Health and Human Services (HHS). Contents do not necessarily reﬂect ONC policy. 90RC0026/01 13.TREC.04.049

JUNE 2013

GrandRounds JCMC seeks to increase breastfeeding rates through OB/ GYN collaboration

JOHNSON CITY, Tenn. -- The Johnson City Medical Center Family Birth Center recently received a grant to help put two lactation specialists in local OB/ GYN practices so they can talk to expectant moms about breast feeding. The goal is to provide early education to women about the benefits of breast feeding and to increase the rate of breastfeeding mothers. “We’re looking more and more at preventative health care, and we’ve learned over the years that breast feeding is huge part of that,” said Chasta Hite, RNC, IBCLC and MSHA’s lactation services manager. “To increase the breastfeeding rate, we need to capture expectant mothers before they come into the hospital to have their baby and have already chosen their feeding method. “If we contact them in the doctors’ offices, hopefully we can influence their decision and prepare them for what to expect and what can help them have a better experience when they get to JCMC to have their baby.” Since exclusive breast milk feeding is a Perinatal Care Core Measure of The Joint Commission and the Center for Medicare and Medicaid Services, health care systems must seek out innovative ways to encourage this positive health choice for their patients. The JCMC Family Birth Center was the recipient of the Breastfeeding Support Funding opportunity through the U.S. Department of Health and Human Services, Office on Women’s Health. It will allow a lactation consultant to be present at the Johnson City OB/GYN and ETSU OB/GYN practices twice a week for a to-

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tal of six hours. The trial program began in March and will continue through mid-September. If the results are good, it could be expanded within MSHA. Having a lactation consultant available in obstetric offices prenatally will increase the opportunity for clients to ask questions, learn more about infant feeding options and talk with a professional regarding the best choice for feeding their infant. Allergies, asthma problems, obesity, heart disease, juvenile diabetes – breast-

feeding can help lower the chance of all these. It’s just a matter of letting more expectant mothers know all the benefits. “We have so many moms come in who’ve decided to bottle feed and we find out they may have misconceptions about breastfeeding,” Hite said. “This program puts information in the patients’ hands so they can make an informed decision.” For more on The Joint Commission’s efforts toward perinatal care, visit www. jointcommission.org/perinatal_care/.

MEDICAL MOVER MOMENT Derby Day

A fundraiser for the Spine Health Foundation, Derby Day, was held on May 4, 2013 at The Olde Farm. Attendees came together to celebrate and support the mission of The Spine Health Foundation, the only non-profit organization in the nation directly impacting lives by providing disadvantaged individuals access to specialized spine care. Guests walked the red carpet to have their Kim Nicewonder, Carol Conduff, Krista Wharton picture taken as they entered the Party Barn to join the pre-derby party festivities. A few highlights of the evening were traditional southern derby cuisine and mint juleps; a Best Derby Hats Contest; and a silent and live auction. Annually, the Spine Health Foundation honors one individual who has gone above and beyond to help those suffering with spinal disorders or injuries. Dr. Morgan Lorio presented the 2013 Hope Award to Dr. David Wiles of East Tennessee Brain and Spine Center, P.C. Dr. Wiles was not present, and Dr. Timothy Fullagar accepted on his behalf. Major sponsors included Alpha Natural Resources, Eastman Credit Union, Regions Bank, Depuy Synthes, Victory Orthotics & Prosthetics, Medtronic, Alphatec Spine, Integra Foundation, Bill Gatton Automotive.

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GrandRounds Mountain States Health Alliance, Vanderbilt announce strategic affiliation

JOHNSON CITY – The leaders of Mountain States Health Alliance (MSHA) and Vanderbilt University Medical Center (VUMC) announced that the two organizations have signed an affiliation agreement that will benefit MSHA, VUMC and the residents of Northeast Tennessee and Southwest Virginia. “We are pleased to announce this mutual affiliation between Vanderbilt and MSHA,” said Dennis Vonderfecht, president and CEO of MSHA. “This announcement represents the culmination of a three-year search process that MSHA leadership has undertaken, driven by the rapid changes taking place in our health care industry today. As part of our 10-year strategic plan, we have been diligently seeking a partner outside of our region who shares our vision for the future as well as our culture of quality and cost effectiveness. We believe we have found that partner in Vanderbilt University Medical Center.” As part of the affiliation agreement, VUMC will assist with recruitment of hardto-find specialists and subspecialists to serve the Northeast Tennessee/Southwest Virginia area. VUMC also brings to the table a number of evidence-based care models that will help MSHA to enhance the care of patients with certain diagnoses like diabetes, heart disease and asthma. “Evidence-based care models allow us to consistently provide the highestquality care across the entire continuum,” said Dr. Morris Seligman, MSHA senior vice president and chief medical officer. “These care models apply not just in the hospital, but in outpatient and home care settings as well. This allows us to ensure that we’re giving each patient the care they need not just to recover from an episode of illness, but to effectively manage their conditions so that they stay well all the time.” An internationally-renowned research institution, VUMC will also bring to MSHA’s service area a number of clinical trials that have the potential to benefit patients while making significant advances in medical research. The collaborative relationship between MSHA and VUMC is expected to grow and strengthen in future years as each organization finds new ways to provide better care through cooperation. At the outset, however, the two organizations are prepared to: • Share best practices in the areas of evidence-based care models; • Collaborate in the areas of medical research and clinical trials; • Develop consultative relationships among specialists and subspecialists; • Work together in the area of physician recruitment to facilitate access, especially to specialty services; • Collaborate clinically, with particular emphasis on cardiovascular and oncology services; and • Work together to develop a statewide clinically-integrated network to contract with payers for high-quality, efficiently-provided health care services.

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It was the first note I ever got in crayon. “Thank you for making my daddy feel better.” I keep it on my desk, where I pore over patient records and cash flow statements. Because even if the medical field seems to be changing by the day, the reasons I practice never do.

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JUNE 2013

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Important Information for People with BlueCross BlueShield of Tennessee Insurance Coverage What does the word “access” mean to you?

access (noun) the right or opportunity to use or benefit from something

We will do everything we can to stay in-network for all plans, but we want to be sure you know your options if MSHA is dropped from the BlueCross BlueShield of Tennessee network on July 1, 2013. You may want to consider other insurance options that would guarantee your aCCeSS to your local MSHA providers.

A list of other health plans that include MSHA facilities and physicians in their networks is below.

• Aetna • Beech Street Network • Stratose formerly Coalition America/NPPN • Coventry National Healthcare Network/ First Health • CrestPoint Health • Fortified Provider Network • Gateway Health • HumANA

• Integrated Health Plan (IHP) • Integrated Solutions Health Network LLC • magellan Health Services • medicare • mountain States Preferred Network • multiPlan Network • NovaNet Inc. • One Call medical (Norton, VA)

• Optima Health • OptumHealth Behavioral Solutions/ United Behavioral Health • PHCS Network • unitedHealthcare • Virginia Health Network • Virginia medicaid Plans • Virginia Premier Health Plan Inc.