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WESTERN CAROLINA MEDICAL SOCIETY

THE BULLETIN Volume XXIV * Issue II

President’s Message

Frank Moretz, MD

Special Message about The Bulletin

Miriam Schwarz, WCMS CEO Dear Physicians and Key Partners, This is the last edition of The Bulletin. The primary reason for discontinuing this e-Magazine is that our other publications are far more timely and popular than The Bulletin. Vital Signs (our weekly eNewsletter for physician members and their practice managers) and Community Pulse (our monthly e-Newsletter for non-members and community leaders) both have very high open rates and are easier to navigate compared to The Bulletin. That said, we plan to pull forward into Vital Signs and Community Pulse the most popular sections of The Bulletin. We plan to continue the following columns:  President’s Message (Association)  Chair Report (Foundation)  Public Health Updates  New Members In this issue… If you enjoy a particular column in The Bulletin and wish for us to continue it, please let me know. Here’s wishing you all a very happy Thanksgiving and holiday season, Miriam ceo@mywcms.org

Special Message....................................... page 1 President’s Message................................. page 2 Foundation Chair Report ......................... page 3 Foundation Update .................................. page 4 Association Update .................................. page 6 Integrative Healthcare............................. page 8 Calendar of Events ................................... page 9 The Van Winkle Lawfirm....................... page 10 The History of Medicine ........................ page 13 Public Health Corner .............................. page 14 Welcome New Members ...................... page 15 Physician Directory ................................. page 18


WESTERN CAROLINA MEDICAL SOCIETY

THE BULLETIN Volume XXIV * Issue II

President’s Message

Frank Moretz, MD

WCMS members have asked me why the WCMS has not been more aggressive in its lobbying for the expansion of Medicaid in North Carolina. Unfortunately there is not a simple answer to this question. The Federal Government will pick up the whole tab for the expansion for the first three years and will pay for 90% thereafter leaving the states to pick up the remainder. In North Carolina in 1993 Medicaid represented 5% of the state budget, but in 2012, it represented 20% of the state budget and the numbers continue to climb. The concern among the legislators in Raleigh is that further increases in the cost of Medicaid may be enough to make the state insolvent. The state was encumbered by an antiquated billing and management system for Medicaid that is being updated this year. This updating process began under the direction of WNC’s own Lanier Cansler when he was Secretary of DHHS. Many processes, procedures, and policies need to be updated as well, and this takes time.

Frank Moretz, MD

Political capital is developed over time and must be used wisely. Do not fight battles that you cannot win. This will erode relationships that may be helpful in the future for this and other issues. The Republicans who controlled the House and Senate along with a Republican Governor all stated emphatically that there would be no expansion of Medicaid in NC. That does not mean that the subject is taboo. The WCMS along with the NCMS and other state medical societies have sent letters to the legislators recognizing the legislators’ concerns but encouraging serious consideration of expanding Medicaid. WCMS leadership has had many communications with WCMS membership and with legislators on this topic. I have e-mailed and phoned multiple times as well as meeting with legislators in WNC, and I made two trips to Raleigh on April 2 and on May 28 to discuss this and other issues directly with the legislators. On the May 28 visit, a “White Coat Wednesday” that the NCMS designated for the WCMS, only one other WCMS physician, Frank Sutton MD MBA made the trip. We had frank and open discussions with the legislators and also met with then-Medicaid director Carol Steckel. (By the way, two physicians out of the WCMS’s 800 does not send a strong signal to Raleigh that our physicians are serious about this matter. Physicians who take time to leave their busy practices to travel to Raleigh to meet with legislators have tremendous impact, and numbers do count). After the legislative visits, the WCMS Board voted to send another letter, this one written by us and supported by hard data. The letter was sent from WCMS on 7/11/13 , to the Governor, Speaker Pro Temp of the Senate, and the Speaker of the House encouraging the expansion of Medicaid in NC (click here to read letter). I would like to express special thanks to WCMS board member Jeff Heck MD and CEO Miriam Schwarz for their efforts in producing this letter. Additionally the WCMS sent a letter to Governor McCrory on April 12 expressing our concern about privatizing Medicaid with a for profit managed care entity (click here to read letter). We re-emphasized our concern with then-Director Steckel in our meeting on May 28. Experiences in other states with for-profit managed care organizations have resulted in reduced access and services to the patient and increased denials and reduced and delayed payments to the providers. North Carolina’s own CCNC is a non-profit managed care organization that has had much success in the primary care area, but it currently does not provide for specialty services. It is the feeling of the NCMS and the WCMS that it is preferable to develop CCNC into a full service MCO than to turn NC’s Medicaid over to an out of state for profit entity. (Continued on page 3)


(Continued from page 2) Since the expansion of Medicaid in NC does not appear to be occurring in the near future, Project Access® is as important as ever. With increasing fiscal demands on all organizations, Mission Health and the Buncombe County Commissioners have reduced their funding for Project Access®. Fortunately a Duke Endowment grant will compensate for these decreases. Regardless of this, I encourage your giving to the WCMS Foundation. The WCMS leadership cannot overcome the serious hurdles that we face in healthcare by ourselves. We need the involvement of most of the members to effect change. Get to know your legislators and establish a relationship and create dialogue. Financially support those who best represent your views. The candidate with the most campaign money usually wins. For those legislators who do not represent your views, try to find areas of commonality and establish dialogue. Remember that legislators and not physicians determine how we practice medicine in NC. If you are not at the table, you will be on the menu.

Frank Moretz, MD WCMS Association President

Foundation Chair Report

Winfield Word Sims, MD

Will the physicians of Buncombe County continue to provide leadership in caring for the poor? Physicians and other medical providers in Buncombe County have for 18 years provided a model of how to improve health care availability for the poor. Project Access® was started by physicians here in cooperation with Mission Hospital and other medical providers. Its administrative operations, including direct services such as patient eligibility screening, enrollment, navigation and interpreter services, are sustained by the Western Carolina Medical Society through its charitable arm, the WCMS Foundation, thanks to very generous grants from Winfield Word Sims, MD Buncombe County, Mission Hospital Community Benefits, The Duke Endowment, TD Bank, and HealthNet, as well as funds from individual donors. Prior to Project Access®, physicians used to see uninsured, low-income patients pro bono in their practices, but if their patients needed anything outside of the practice—a referral to a specialist, a medication, crutches, blood glucose monitors, a language interpreter—physicians had to spend inordinate amounts of time trying to advocate for each patient (read: beg, ask favors, make endless phone calls) to gain access to these services. Project Access® opens doors for patients in need. Project Access® saves physicians time and energy and, as many long-time PA physician volunteers will tell you, allows them to “practice medicine the way it was intended.” Project Access® is a coordinated network, with participation by most physicians from most specialties and with wraparound services to insure that patients can follow through on their treatment plans. Patients are able to get primary and specialty medical care, labs, x-rays, physical therapy, medications, durable medical equipment, interpreter services, and other services without having to wonder if they are going to be financially ruined, shamed in their efforts to get these services, or turned away altogether.

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(Continued from page 3) This great effort of providing for our neediest citizens is in the deepest spirit of what brought many of us to the practice of medicine: the desire to pay attention to suffering and to relieve it when we can. What is the role for this in an era of “insurance exchanges,” budget shortfalls and a sluggish economy?

Winfield Word Sims, MD WCMS Foundation Chair

Foundation Update

Sharon Lewis, Director of Foundation Programs

ACCESS TO CARE WCMS CEO Miriam Schwarz continues to arrange the very popular and welcome specialty provider-led discussions for the primary care providers at WNCCHS including Asheville Gastroenterology, Asheville Pulmonary Associates, Blue Ridge Bone and Joint, Cancer Care of Western North Carolina, and Asheville Eye Associates in 2012. So far in 2013 she has arranged presentations from Victoria Urological, Biltmore Dermatology and Asheville Cardiology. We are finding that specialists discussing referral issues directly with PCPs is a beneficial tool for both PCPs and specialists to work more effectively together. Specialists discuss how to diagnose and treat various illnesses in primary care, when to refer, how to prep the patient for referral and what to communicate to the specialist. If you are a specialist interested in making such a presentation, please call Miriam Schwarz at (828) 274-2267 or email her at miriam@mywcms.org. We’ve made a number of significant improvements with our Project Access® program to enhance its alignment with the original mission and enhance patient accountability:

On May 15th the Foundation Board approved the following recommendations by its Prescription Committee based on the latter’s collaboration with Community Care of Western North Carolina (CCWNC) and Mission’s Medication Assistance Program (MMAP) and a letter detailing these improvements was faxed to participating practices and pharmacies (Patients will be informed as they enroll throughout the coming year):  Participating physicians are encouraged to prescribe generic medications whenever possible (current rate is 88%we think we can do better!) and encourage their patients to use the discount plans of these eight pharmacies: Target, Wal-Mart/Sam’s, K-Mart, Rite Aid, Walgreens, CVS, Kerr Drug and Ingles.  For those occasions when participating physicians prescribe brand-name drugs to PA patients, PA will improve our partnership with Mission’s Medication Assistance Plan (MAP) by requiring said patients to apply for Mission MAP, which means a Mission MAP pharmacist will meet with enrolled patients every six months to review their medications, further reducing PA’s prescription expenses.  Finally, participating physicians are encouraged to contact Eric Christian, Integrated Care Manager at CCWNC 3482833/echristian@ccwnc.org for free chronic pain management consultative services (limited availability-first come, first served) designed to:  Improve the medical care received by chronic pain patients through the use of clinical tools and the employment of data and best practices,  Manage substance abuse issues associated with opioid misuse, and…  Reduce opioid-related overdoses. Our Project Access® Navigator co-location Memorandum of Understanding (MOU) with our biggest safety net partner, Buncombe County’s Federal Qualified Health Center (FQHC) Western North Carolina Community Health Services (WNCCHS) has seen our bilingual PA Navigator raise his ceiling on referrals from 96 to 112 patients per month, which (Continued on page 5)

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(Continued from page 4) meets or exceeds WNCCHS’ needs while enabling WCMS to deliver the quality of service to which we aspire for our partners, our patients and ourselves.

Project Access®  We are continuing to explore with our key partners locally, regionally and state-wide various scenarios for what Project Access® may look like in the years to come as the Affordable Care Act continues to be implemented, and will keep you apprised of the details as they become clear.

There's exciting news on the funding front. By way of Mission Foundation, WCMS was awarded a two-year, $200,000 a year grant by the Duke Endowment to support Project Access® in light of the NC government’s decision to forego Medicaid expansion. The absence of Medicaid expansion in our state leaves most of our low-income, uninsured residents without affordable insurance options under the Affordable Care Act. Because of the sluggish economy and lack of Medicaid expansion, both the County (our largest funder) and Mission reduced funding levels for Project Access® in 2014, by a total of $150,000. We continue to benefit from the HealthNet and TD Bank grants awarded at the beginning of this year ($45,000 and $8,500, respectively). If you have questions, comments or concerns about Project Access®, please contact Sharon Lewis at (828) 274-2267 ext. 305 or sharon@mywcms.org.

HEALTH PARITY The WNC Interpreter Network is now the WCMS Interpreter Network…but still WIN! Doctors are increasingly making WIN a part of their team. They do not hire interpreters as a mere courtesy to their Limited English Proficient (LEP) patients. They hire interpreters for many reasons including better communication and patient compliance, to provide confidentiality and protect patient privacy. However, they also do so to protect themselves from a host of liability issues and to protect patients from abuse. WIN EXPANSION In 2013, the Western Carolina Medical Society Interpreter Network was awarded a Janirve Legacy grant to expand into Henderson and Transylvania Counties! The aim of the grant is to educate the medical community and the Limited English Proficient (LEP) public about professional interpreter services. Services have been donated and/or offered at a reduced rate to 24 area hospitals and practices that see uninsured patients, and a contract signed with Park Ridge Health System. WIN is also working with Henderson County’s Federally Qualified Health Center, Blue Ridge Community Health Services, to reach the LEP community with educational resources. WIN Adds New Position To Accommodate Growth To support and sustain the expansion mentioned above WIN has been restructured from one Program Coordinator and one Program Assistant who focused on scheduling and billing to one Program Coordinator and two Program Administrators who will focus on:   

Telephone and online scheduling Billing clients and paying interpreters, and… Recruiting and retaining new clients and interpreters.

Contact Program Coordinator Todd Chamberlain (828) 274-0950 todd@mywcms.org, or Program Administrators Elena Ruiz (828) 274-0950 elena@mywcms.org and Andi Smith (828) 274-0950 andi@mywcms.org for more details on how your practice can benefit from this opportunity.

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Association Update

Donna Wiedrich, Director of Member Services

AFFINITY GROUPS! Early Career Physicians We have officially launched our newest affinity group, the Early Career Group and our first meeting was a smash hit at the Wicked Weed in downtown Asheville. This is a very energetic and enthusiastic group led by Dr. Ananda Vieages. Stay tuned for more exciting news from this group! If you are interested in attending an Early Career meeting please contact Donna Wiedrich at donna@mywcms.org. Women in Medicine Early Career Physicians at Wicked Weed The Women in Medicine Group is going strong after their first year. They have their own Facebook Group and are meeting on a regular basis. If you are interested in attending a Women in Medicine meeting please contact Donna Wiedrich at donna@mywcms.org. UPCOMING EVENTS Fall Conference This year’s Fall Conference is scheduled for November 13th at the Doubletree Hotel. We are excited to partner with the WNC Medical Managers Association again this year and have decided to merge their November luncheon meeting with our Fall Conference! The agenda for the Fall Conference will include our keynote speaker, Grace Terrell, MD (CEO, Cornerstone Healthcare) who will speak on “Leadership in a Changing Healthcare Environment.” She will also serve on a panel in the afternoon focusing on The Patient Centered Medical Home/Quality Measures. Additional topics include “Violence in the Workplace” and “ACA Update.” A big thank you to our Fall Conference Planning Committee: Lisa Wheeler of Pathways Medical Management, Barbara Isles of Allayant Pain Management, Dan Keller of MedOasis, Amanda Early of East Asheville Family Medicine, Jackson Norton of Mission Medical Associates and Donna Wiedrich. Many thanks to our sponsors to date:

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(Continued from page 6) VALUE ADDED BENEFITS Endorsed Vendors Check out our Endorsed Vendor program! Member practices can save money using our endorsed vendors and WCMS receives a revenue stream in return to help fund our physician-focused activities and programs. For more information contact Miriam Schwarz at miriam@mywcms.org or visit our website at http://www.mywcms.org/About/Partner-with-us/Vendors.         

ADN (Advanced Data and Network Solutions) (IT Management) OneWhoServes, Inc. (IT Management) Charter Communications (T1, WAN, Fiber Internet, Fiber Circuits to data centers) Mary Williams Matthews, Johnson Price Sprinkle PA (Accounting, Consulting & Technology Services)

Management Services on Call EMR Partners Consulting (EHR selection/implementation, Meaningful Use) Pathways Medical Management (Practice Management) Carolyn Coward, Van Winkle Law Firm (Healthcare Law) Evolution Healthcare Consulting (Practice Management) Parsec Financial (Asset Management and Investment) NEW!

NEW MEMBER BENEFIT - DOCBOOKMD This is a no-cost physician’s mobile app that helps saves lives, time and money. DocBookMD offers physicians a convenient way to share patient info at the point-of-care; fast, HIPAA-secure messaging, ability to attach high resolution images of X-rays, EKGs or wounds to any message; accurate, up-to-date physician contact information (eg, a physician directory); and details on local pharmacies. Physicians must be members to receive this benefit. To become a WCMS member and/or sign up for DocBookMD, contact Kristina Isenhour at kristina@mywcms.org or apply online. PHYSICIAN LEADERSHIP ACADEMY – UNDER DEVELOPMENT! MAHEC, Mission and WCMS are collaborating on this project. The vision is to initially offer to WNC physicians a 6 module series of case-based, facilitated discussions along with nuts and bolts info, moderated by content experts. The theme of the series is proposed to be "How do I survive in the coming world order of ACOs?" If enough interest is generated, the learning forum will continue. We are pleased to announce that Mark Jaben, MD, who is on the WCMS Association Board, has volunteered to be the “clinical champion” for WCMS. He will work closely with MAHEC's course coordinator to insure the Leadership Academy meets/exceeds our goals as well as those of the regional providers. REGIONALIZATION We are now deploying WCMS Staff out into the region to meet face-to-face with physicians and learning more about the challenges they are dealing with on a daily basis and sharing resources in response. If you are interested in having WCMS staff visit your practice please email Donna Wiedrich, Director of Member Services, at donna@mywcms.org. CUTTING EDGE BLOG We have launched a new program that highlights health innovations throughout the region via our new Cutting Edge blog. We are currently featuring Dr. Steve North’s School-based Telemedicine Program. Check out the Cutting Edge blog here. If you know of any physicians or practices that are stepping outside of the box, please contact Donna Wiedrich at donna@mywcms.org and we will pursue the lead.

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Lisa Wheeler, MS Ed, PA-C Pathways Medical Management, LLC

Integrative Healthcare: What’s In The Name?

Integrative Healthcare…what exactly is that? It is a buzzword we in the community (local, regional, state, national) seem to be throwing around as if there is one and only one model and definition. What I experience in conversations as a consultant, is people stating, “We want to implement integrative healthcare.” That is typically followed by another part of the sentence, such as: “to align ourselves with [someone’s] vision.” Some examples include: the Governor’s vision or Affordable Care Act vision or the path that insurance companies reimbursing primary care practices envision (ex: Patient Centered Medical Home]. This raises a problem, in that we don’t have a true universal definition of the term. In truth, integrative healthcare is a complex concept covering a variety of possible formations and structures for the implementation and delivery of healthcare. My intent in this article is not to attempt to definitively describe integrative healthcare, but to instead encourage dialogue about the concept and its impact on the practice of medicine. It is not as simple as the term might imply. Before I continue, I would ask the reader to stop reading at this point and ask oneself the question: “What is the definition of integrative healthcare?” Is there one definition that comes to mind? When you have completed reading this piece Google the term integrative healthcare. You will find many different definitions. Wiki (“knower of all”) is the first entry followed by World Health Organization (WHO). WIKI: Integrated care – also known as coordinated care, comprehensive care, seamless care and transmural care – is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems. WHO: Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality user satisfaction and efficiency. Moving out of a “one definition fits all” dimension for integrative healthcare (which is critical), consider various components and types. Kodner, et al., 2008 looked at multiple aspects of integrated healthcare and divided it into five archetypes: Archetypes of Integrative Healthcare, Kodner, et al., 2008 While all of these archetypes are important, I invite you to look at two of the archetypes that the reader is probably most familiar with: Breadth (horizontal verses vertical) and Degree (ad hoc, inter-organizational, or full integration ). Examples of integrated healthcare in the US, include:      

Partners Healthcare University of Pittsburgh Medical Center Sutter Health Kaiser Permanente Geisinger Mayo Clinic

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(Continued from page 8) I would encourage you to become familiar with the varying definitions of integrative healthcare. Ask clarifying questions when hearing the term used, and consider the archetypes identified above as a framework for those questions. Integrative healthcare is complex, and one size or term does not fit all. I did not even raise the issue of integrative healthcare and Accountable Care Organizations (ACO’s). Next article, maybe? For a list of references (as they are extensive), please e-mail me at lisa@pathwaysmedicalmanagement.com.

Calendar of Events November 6 .................................................. Quarterly Emeritus Luncheon, 11:30am, DoubleTree Biltmore Hotel November 11 .......................................................................................................Veteran’s Day, WCMS Closed November 13 ........................................................................................... Fall Conference, 8:00am, DoubleTree November 13 ................................................................................. Foundation Board Meeting, 6:00pm, MAHEC November 28-29 .................................................................................................... Thanksgiving, WCMS Closed December 2 .................................................................................... Association Board Meeting, 6:00pm, MAHEC December 6 .......................................................................... Development Council Meeting, 12:00noon, MAHEC December 24-25 .......................................................................................................... Christmas, WCMS Closed December 31 ..................................................................................................... New Year’s Eve, WCMS Closed January 1 ......................................................................................................... New Year’s Day, WCMS Closed

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The History of Medicine in Asheville Dr. Freeman Irby Stephens has given us an enduring gift. After retirement from medicine, having been revered by colleagues and patients as a pioneer specialist in internal medicine in Asheville, he undertook the writing of The History of Medicine in Asheville. The book covers two centuries: the years from 1800 to 2000. Dr. Stephens lived only a short time after completing the manuscript. Western Carolina Medical Society saw the book’s value to the members, to the whole state and to future generations. WCMS obtained the rights from the family to proceed with publishing the book. WCMS Director of Member Services, Donna Wiedrich, headed this effort in concert with Dr. Jim Powell. A “Committee to Publish,” composed of other community physicians, joined the project. Sponsors came forward, further enabling the completing of Irby’s goal, and the book is now here! The History of Medicine in Asheville is not a medical textbook and it is more than a historical chronology of medical events. It is a collection of stories about the people who made Asheville the quality center for medical care that it is today. These stories are set in the context of local, national and international events of the day. It is stories of the hospitals, their founding, their merging and their unique places in the progress of Asheville medicine. Here are words from Dr. Stephens: Medicine in the early days of Asheville is of interest primarily because of the absorbing life stories of the physicians who practiced during that period. In addition, the physicians and their practice of medicine in Asheville—in the antebellum days and during the difficult years of the Civil War and Reconstruction and for many years thereafter—present a striking contrast with the present day. Perhaps most interesting are the fifty-odd years beginning in the 1880s when Asheville became the nation’s best-known center for the treatment of tuberculosis, and its tuberculosis specialists were widely recognized as authorities in their field. Asheville’s medical history is replete with unusual and captivating characters from the earliest days to the most recent times. The little-publicized accomplishments of these individuals need to be recorded lest they be lost. Consequently, biographical sketches of many Asheville physicians are scattered throughout this history to acquaint the reader with these unusual men and women and their careers. Because they represent such an exceptional group, Asheville’s women physicians receive special attention. Similarly, because it is little known, the interesting story of Asheville’s black physicians also has a special section. The History of Medicine In Asheville, published by Asheville's downtown, traditional publisher, Grateful Steps, is complete with table of contents, index and photographs and is now available at www.gratefulsteps.org or by calling the Grateful Steps Bookshop and Gallery: 828-277-0998.

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Public Health Corner

Jennifer Mullendore, MD Buncombe County Department of Health and Human Services

Sexual and Reproductive Health Update HPV vaccine is helping to lower HPV infection rates in teenage females A study published in the June issue of The Journal of Infectious Diseases found that within 4 years of introduction of the human papillomavirus (HPV) vaccine, vaccine-type HPV prevalence decreased 56% (from 11.5% to 5.1%) among 14-19 year old females. Annually in the U.S., ~19,000 HPV-associated cancers occur in women, most commonly cervical cancer. About 8,000 HPV-associated cancers occur Jennifer Mullendore, MD annually in U.S. men, with oropharyngeal cancers being the most common. Although this study demonstrates that the HPV vaccine is effective, uptake of the vaccine continues to lag in the U.S.—only 1/3 of U.S. females 13-17 years of age have been fully vaccinated against HPV. Routine vaccination at 11-12 years of age for both boys and girls is recommended with a series of 3 shots over 6 months. HPV vaccination is also recommended for older teens and young adults who were not vaccinated when younger. The North Carolina Immunization Program provides free HPV vaccine for males and females 9-18 years of age. For men and women ages 19-26 years who do not have health insurance coverage of vaccines and who cannot afford to pay for the vaccine out of pocket (~$150/shot), the Buncombe County Department of Health and Human Services (BCDHHS) Immunization Clinic utilizes the Merck Patient Vaccine Assistance Program to obtain free HPV vaccine for those who qualify. Please encourage your teens and young adults to be vaccinated against HPV. If they are unable to obtain this vaccine from their medical home, you may direct them to the BCDHHS Immunization Clinic at 40 Coxe Ave. in Asheville. We are open Monday-Friday from 8am-5pm but ask that persons needing vaccines arrive before 4:30pm. No appointment is needed. For more information on the HPV vaccine, visit http://www.cdc.gov/std/hpv/default.htm or http://www.chop.edu/service/vaccine -education-center/a-look-at-each-vaccine/hpv-vaccine.html. _________________________________________________________ New Recommendations on Contraceptive Use Issued by CDC Unintended pregnancy continues to be a huge problem in the U.S. with nearly 50% of pregnancies fitting this description. These pregnancies are at increased risk of poor outcomes including low birth weight, increased risk of intimate partner violence and child abuse, poor child mental and physical health, and lower educational attainment for both mother and child. In ongoing efforts to combat this public health issue, the CDC has released the “U.S. Selected Practice Recommendations for Contraceptive Use, 2013: Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2nd Edition.” These evidence-based recommendations address common issues regarding initiation and use of contraception including:  

what criteria to use to start a woman on a contraceptive method immediately; how long a woman should use a back-up method when initiating contraception;

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  

how late a repeat depot medroxyprogesterone acetate injection can be given without the need for additional contraception; how to manage bleeding irregularities in women using contraception; and how to manage a woman with an intrauterine device who has pelvic inflammatory disease.

This is a companion document to the “U.S. Medical Eligibility Criteria for Contraceptive Use, 2010” which provides guidance on the safety of contraceptive method use for women with specific characteristics (e.g., postpartum, obese, smoker) and medical conditions. Want to know what birth control methods are safe to use in women with hypertension, migraines, or a history of a blood clot? See the Medical Eligibility Criteria. I encourage all providers of contraception to review both of these reports as they contain valuable practical information to ensure that the contraceptive needs of women are met safely. CME is available for the recently released report.

Welcome New WCMS Members—Buncombe County John T. Ashley, MD (Preventive Medicine) Dr. Ashley received his Medical Degree from the University of Missouri. Dr. Ashley completed his internship and his fellowship at University of Colorado Hospital. Dr. Ashley is associated with Asheville Health Benefits Management.

Virginia Barnhardt, MD (Family Practice) Dr. Barnhardt received her Medical Degree from the University of North Carolina School of Medicine. Dr. Barnhardt completed her residency with Mountain Area Health Education Center. Dr. Barnhardt is associated with CarePartners Hospice and Palliative Care.

Shayne E. Bates, MD (Pediatrics) Dr. Bates received his Medical Degree from Marshall University School of Medicine. Dr. Bates completed his internship and residency with Brenner Children's Hospital-WFUMBC. Dr. Bates is associated with Blue Sky Pediatrics.

James C. Brien, MD (Urology) Dr. Brien received his Medical Degree from Texas A&M HSC College of Medicine . Dr. Brien completed his internship and residency with Penn State Hershey Medical Center. He also completed a fellowship at Eastern Virginia Medical School/ Sentara. Dr. Brien is associated with Asheville Urological Associates.

Suzanne D. Dixon, MD (Obstetrics Gynecology) Dr. Dixon received her Medical Degree from the University of North Carolina School of Medicine. Dr. Dixon completed her internship and residency with Mountain Area Health Education Center. Dr. Dixon is associated with MAHEC Ob/Gyn Specialists.

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Welcome New WCMS Members—Buncombe County (Cont.) Grace G. Evins, MD (Obstetrics Gynecology) Dr. Evins received her Medical Degree from the University of North Carolina School of Medicine. Dr. Evins completed her residency with Mountain Area Health Education Center. Dr. Evins is associated with Grace Evins, MD.

Joshua S. Gettinger, MD (Family Practice) Dr. Gettinger received his Medical Degree from the University of CA/San Francisco. Dr. Gettinger completed his residency with University of Missouri Medical School. Dr. Gettinger is associated with MAHEC Family Health Center at Biltmore.

Margaret E. Goodwin, MD (Pediatrics) Dr. Goodwin received her Medical Degree from the University of South Carolina School of Medicine. Dr. Goodwin completed her residency with Duke University Medical Center. Dr. Goodwin is associated with Mountain Area Pediatric Assoc.

James “Adam” Graham, MD (Pulmonary Diseases) Dr. Graham received his Medical Degree from the Medical University of South Carolina. Dr. Graham completed his internship and residency with David Grant Medical Center. He also completed a fellowship at Wilford Hall Medical Center. Dr. Graham is associated with Asheville Pulmonary & Critical Care.

Karen M. Le Hew, MD (Family Practice) Dr. Le Hew received her Medical Degree from Rush Medical College of Rush University. Dr. Le Hew completed her internship with Naval Medical Center Portsmouth, VA and her residency with Portsmouth Family Medicine. Dr. Le Hew is associated with Mission My Care Plus– Leicester.

Stacey Miller, MD (Pulmonary Diseases) Dr. Miller received her Medical Degree from the University of South Alabama College of Medicine. Dr. Miller completed her residency with Wake Forest University Baptist Medical Center. Dr. Miller is associated with Asheville Pulmonary & Critical Care.

Dawson Mims, MD (Preventive Medicine) Dr. Mims received his Medical Degree from the University of North Carolina School of Medicine. Dr. Mims completed his internship and residency with UNC Hospitals. Dr. Mims is associated with Asheville Hospitalist Group.

Christopher Britt Peterson, MD (Psychiatry) Dr. Peterson received his Medical Degree from the University of North Carolina School of Medicine. Dr. Peterson completed his residency with University of New Mexico Hospitals. Dr. Peterson is associated with Mission Psychiatric Services.

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Welcome New WCMS Members—Buncombe County (Cont.) Emilie C. Ralston, MD (Radiology) Dr. Ralston received her Medical Degree from the University of Tennessee, Memphis, College of Medicine. Dr. Ralston completed her internship with Methodist Hospital-Indianapolis and her residency with Wake Forest Baptist Hospital. Dr. Ralston is associated with Asheville Radiology Associates.

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Annemarie I. Russell, MD (Psychiatry) Dr. Russell received her Medical Degree from the Medical College Of Georgia. Dr. Russell completed her internship and residency with San Mateo County Community Hospital. Dr. Russell is associated with Asheville Psychiatry at the Grove Clinic.

Aditi Sethi-Brown, MD (Hospice & Palliative Care) Dr. Sethi-Brown received her Medical Degree from the Medical College of Georgia School of Medicine. Dr. Sethi-Brown completed her internship and residency with Mountain Area Health Education Center. She also completed a fellowship at MAHEC/CarePartners Fellowship Program. Dr. Sethi-Brown is associated with CarePartners Hospice & Palliative Care.

Welcome New WCMS Members—WNC Steven D. Crane, MD (Family Practice) Dr. Crane received his Medical Degree from Case Western Reserve. Dr. Crane completed his residency with University of Missouri, Columbia. Dr. Crane is associated with Pardee Hendersonville Family Health Center.

Diana Curran, MD (Family Practice) Dr. Curran received her Medical Degree from the University of Michigan. Dr. Curran completed her residency with Mountain Area Health Education Center. She also completed a fellowship at UNC School of Medicine Division of Family Medicine. Dr. Curran is associated with the Henderson County Department of Public Health.

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Glenn A. Harris, MD (Cardiology) Dr. Harris received his Medical Degree from the University of Mississippi. Dr. Harris completed his residency with David Grant USAF Medical Center. He also completed a fellowship at Wilford Hall USAF Medical Center. Dr. Harris is associated with Western Carolina Cardiology.

Ann Marie Johnson, MD (Family Practice) Dr. Johnson received her Medical Degree from the University of Vermont College of Medicine. Dr. Johnson completed her residency with Mountain Area Health Education Center. Dr. Johnson is associated with Glenwood Family Medicine.

Eileen Keppler, MD (Obstetrics Gynecology) Dr. Keppler received her Medical Degree from Loma Linda University. Dr. Keppler completed her internship and residency with Loma Linda Medical Center. Dr. Keppler is associated with New Beginnings Ob/Gyn.

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Welcome New WCMS Members—WNC (Cont.) Photo not available

Philip E. Stack, MD (Gastroenterology) Dr. Stack received his Medical Degree from Oral Roberts School of Medicine. Dr. Stack completed his internship and residency with East Tennessee State University. He also completed a fellowship at Oral Roberts School of Medicine. Dr. Stack is associated with Western Carolina Digestive Consultants, PA.

Richard H. Steele, MD (Urology) Dr. Steele received his Medical Degree from Tulane University School Of Medicine. Dr. Steele completed his internship with the Tulane Department of Surgery and his residency with Tulane Urology. He also completed a fellowship at Tulane Research Fellows. Dr. Steele is associated with Blue Mountain Urology.

Jeremy Sylvanus, MD (Family Practice) Dr. Sylvanus received his Medical Degree from the University of Colorado School of Medicine. Dr. Sylvanus completed his residency with Mountain Area Health Education Center. Dr. Sylvanus is associated with Mission My Care Plus– Leicester.

Michael E. Toedt, MD (Family Practice) Dr. Toedt received his Medical Degree from Uniformed Services University. Dr. Toedt completed his internship and residency with Franklin Square Hospital Center. He also completed a fellowship at Franklin Square Hospital Center. Dr. Toedt is associated with Cherokee Indian Hospital.

Laura F. Verde, MD (Cardiology) Dr. Verde received her Medical Degree from Faculdade de Ciencias Medicas de Santos. Dr. Verde completed her internship and residency with Pitt County Memorial Hospital. She also completed a fellowship at Pitt County Memorial Hospital. Dr. Verde is associated with Asheville Cardiology Associates– Sylva.

WCMS Physician Directory (Blue Book) The 2013-2014 "Blue Book" is ready for ordering! This is a comprehensive directory of physicians produced by WCMS that: 

Includes physicians and practices from all 16 WNC counties

Is pocket size for easy access

Has a discounted price for practices with 100% members of WCMS!

If you would like to place an order, you can do that quickly and easily on our website or download an order form.

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WCMS Fall Bulletin 2013  

This is a thrice yearly publication by the Western Carolina Medical Society.

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