East TN Medical News December 2014

Marta Wayt, DO, FACP

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Enjoying East TennesseeTennessee Theatre Music has always been part of the atmosphere in our household, and I especially love Christmas music. Whether it was a classic Firestone - Your Favorite Christmas Music album featuring a beautiful, brightly colored bow, which I remember anticipating listening to each year as a child, hymns played on the piano, or holiday classics from my favorite artists, carols fi lled our home ... 5

HEALTHCARE LEADER: Jerry VagnierThe Helen Ross McNabb Center, a not-for-profi t provider of behavioral health services founded in 1948, has a simple, straightforward mission statement: “Improving the lives of the people we serve.” ... 6

By cINDy SANDERS

On average, it takes 12 years and more than $500 million … sometimes signifi cantly more … to move a new drug from bench to bedside in the United States. But what happens when there is an ur-gent or emergent need for new drugs, vaccines and biologics to be developed in the wake of a public health crisis?

The recent attention on Ebola brought with it an increased interest in the approval process of the U.S. Food and Drug Administration. The FDA is tasked with fi nding the criti-cal balance between urgent public need and overall safety and effi cacy of drugs being distributed … even in a limited, experimental manner.

Under Normal Circumstances Of the 5,000-10,000 compounds entering the research and de-

velopment pipeline at any given time, only about 250 make it to the pre-clinical phase of testing. From there, only about fi ve will make it

to clinical trials in humans with only one drug ultimately receiving FDA approval.

Generally, developers should expect to spend three-six years in the discovery and pre-clinical phase of the pro-cess. If enough supportive data results from conduct-

ing research and animal model studies, then a company

approaches the FDA to ask for con-sideration of clinical trials. Only about

one of every 1,000 compounds being tested will prove promising enough for a

company to fi le an Investigational New Drug (IND) application.

Approval of the IND by the FDA and an Insti-tutional Review Board leads to another six-seven years

being invested in phased human trials. If, after running that gauntlet, the product has the evidence to back its effi cacy and safety, a New Drug Application (NDA) is fi led for FDA review. From there, drug

(CONTINUED ON PAGE 8)

FOCUS TOPICS POST ACUTE CARE AUDITS/COMPLIANCE

Urgent & EmergentGetting new treatments through the FDA pipeline

By cINDy SANDERS

After the sticker shock that accompanied last year’s tax code regulations, many will be happy that 2014 is going out on a quieter note. However, there are still some changes and lingering questions about a number of extenders that could adversely impact your bottom line on both a personal and professional basis.

Tony Jones, CPA, a tax services manager for HORNE LLP, said many high-earning individuals are still adjusting to the major changes in 2013 that included higher rates on net investment income and the additional Medicare tax. “’13 was also the year that personal exemptions and line item deductions phased out for high income taxpayers,” he added of the resurfacing of

tax rules for individuals with an adjusted gross income over $250,000 and married couples with AGI over $300,000.

“In Tennessee, the sales tax deduction is pretty im-portant to us, and that has not been extended … yet,” he said in early November, adding the extender could be approved before the end of the year. “It’s also important to Florida and any state that doesn’t have a state income tax,” he continued.

In addition to the sales tax deduction, Jones said ac-countants had their collective eyes on a number of other extenders included in separate U.S. Senate and House

bills. The general consensus was that no decision on the fate of these

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2 > DECEMBER 2014 e a s t t n m e d i c a l n e w s . c o m

By BRIDGET GARLAND

If blindly looking over Dr. Marta Wayt’s curriculum vitae, one might guess it belonged to someone much older. As a 2012 honoree of the The Business Journal’s 40 under Forty, however, Wayt’s accom-plishments are simply a product of indus-trious youth.

Wayt grew up in West Virginia, and throughout school, enjoyed the sciences in high school. Although she initially thought she wanted to be a veterinarian, Wayt said she felt a calling to go into med-icine and specifically liked the philosophy and care model she had seen at a visit to the West Virginia School of Osteopathic Medicine.

After completing her undergraduate degree at Bridgewater College in West Virginia, Wayt was accepted at the West Virginia School of Osteopathic Medicine, but wasn’t certain at first what direction she wanted to take.

“When I was looking to specialize, I thought about Family Medicine, but de-cided my heart was for the elderly,” she reflected. “I liked difficult disease states so Internal Medicine was a very good fit for me. So I choose Pittsburgh to do my training, and had a great experience.”

Soon after finishing her residency at Mercy Hospital of Pittsburgh, Wayt headed south to escape the Pennsylvania weather and ended up in the Tri Cities, where she found cheaper malpractice rates, the beauty of the mountains, and a much nicer climate.

It was while establishing her practice in the Tri Cities that Wayt discovered her affinity for caring for nursing home pa-tients. “While I did some clinicals in nurs-ing homes as a medical student, I didn’t

have the opportunity in my residency. But I had an attending once who said I re-ally should try and see if it [working in a nursing home] fits because there aren’t a lot a doctors who do nursing home care...and nursing homes need good docs,” she recalled. “I kept that in the back of my mind, and when I came down here and was trying to build a practice, I thought it would be a nice way to have a few pa-tients and get out in the community a little more. The more patients I had in the nursing home, the more I liked being there and caring for them. In many ways, it fit the whole spectrum of care for me.

“I have my practice and then I prac-tice at the hospital, and then I either transition them back into their home or into a nursing home setting. It’s a nice continuum of care, and I can be there for them through all the steps along the way,” Wayt explained.

Although she initially started her nursing home practice at another facility, Wayt found her way to Wellmont Health System’s Wexford House, a skilled nurs-ing facility located in Kingsport, Tenn., where she now serves as medical director.

“We have a lot of exciting develop-ments at Wexford, including a telemedi-cine program, which makes specialty care much more convenient for the pa-tient; they don’t have to be transported to another facility for consultation. Trans-portation can be a discomfort and an anxiety,” she shared. “We have started a CHF program, and we are in the midst of starting a COPD program. And a third program we are going to try to take off the ground is a wound care clinic. We have also begun some internal quality metrics for disease management, looking at out-comes of diabetics in the nursing home, and trying to look at long-term difficult disease states, such as congestive heart failure and COPD, making sure we re-duce readmissions by taking better care of them.”

Wexford House also boasts a venti-lator unit, which Wayt explained is very much needed in the area. “There is only one other [ventilator unit] in the King-sport area, so we have recently expanded our capacity. It’s difficult for people with lung disease to find a place to stay after leaving the hospital until they are stable enough to breathe on their own.”

In addition to Wexford House and her Internal Medicine practice with Well-mont Medical Associates (WMA), Wayt serves as WMA’s Regional Medical Di-rector for the Kingsport region, encom-passing Johnson City, Gray, Church Hill, Rogersville, and Kingsport.

“There are several practices within

that region that fall under my purview, so I work with my regional director admin-istrative counterpart to make sure those practices are running smoothly and the doctors are getting their needs met, what-ever they may be, whether it’s how func-tional their space is, or even if they have enough staff,” she explained. “I also like to communicate news from higher level administration, so we try to meet face-to-face with the docs and let them know we are supporting them.”

Wayt meets on a regular basis with WMA administration to discuss the sta-tus of each of the practices in her region and where the group as a whole is going. “Wellmont Medical Associates is a mul-tispecialty group that needs to stay con-nected and support each other,” she said. “We have doctors at every level of admin-istration so that we have that input.”

Considering WMA’s recent accom-plishments, their strategy appears to be working. “In the almost three years I’ve been with the group, we’ve put into place a dyad model of leadership, with the doc-tors flanking an administrative counter-part; we’ve developed a Patient Centered Medical Home and a hospitalist program; we’ve increased our physician employ-ment by 50 to 60 percent; and we recently received the prestigious Acclaim Award from the American Medical Group Asso-ciation, recognizing premier, functional medical groups.”

If her plate didn’t seem full enough, Wayt also serves on the WMA Board of Directors and as Chairman of the Internal Medicine Department at Holston Valley Medical Center. And perhaps what she is most excited about is the time she spends seeing patients at the Providence Medical Clinic, a free clinic set up through First Baptist Church in Kingsport and sup-ported through several churches and do-nors in the area.

Patients receive free medical care if they meet certain financial criteria. “It’s just a part-time clinic, but we provide a very good service, so I get excited when more doctors or services step up to the plate and say they can help,” she enthused. “I stay busy, but I enjoy it very much.”

Personally, Wayt has several com-mitments locally. Both her mother and grandmother moved to the Tri Cities, so she enjoys spending time with them, although Wayt said her mother stays busier here than she ever has been, being involved in the community, including vol-unteering at Wayt’s free clinic.

Wayt is married, and her husband Tom is a sergeant with the Kingsport Police Department, working as a crime analyst. “We met in Pittsburgh when he worked in the emergency room where I was doing my residency,” she recalled. “Although he’s working on his MBA right

PhysicianSpotlight

Marta J. Wayt, DO, FACP


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By MIchELLE hENRy

When my husband began the process of choosing our health insurance plan, I gave only one directive: “Make sure my doctors are on there.” As a cancer survi-vor, the link to my doctors is particularly strong – I believe their care is part of the reason I’m still here. Even when cancer is not part of the equation, most people feel the same kind of connection to their physi-cians. The doctor-patient relationship is an important one.

An article on the subject (by Drs. Susan Dorr Goold and Mack Lipkin, Jr. that appeared in the Journal of General Inter-nal Medicine) describes it well when it says “the doctor–patient relationship is remark-able for its centrality during life-altering and meaningful times in persons’ lives, times of birth, death, severe illness, and healing.”

It is impossible to put a price tag on a solid patient-physician relationship built on trust. But when it comes to choosing a health insurance plan, far too many people may be forced to do just that. If a physician isn’t on an affordable plan or one offered by an employer, the only option is to find another physician.

The recent announcement by Sum-mit Medical Group that in 2015 it will

participate in BlueCross BlueShield of Tennessee’s Network S means fewer East Tennessee residents will have to make that difficult decision. Summit estimates its in-clusion in Network S increases its ability to provide in-network primary care services to a total of more than 109,000 lives.

“This is significant for us given we have not been a part of this network for the past 12 years,” Summit Chief Executive Officer Tim Young said. “We’re pleased to reach a contractual agreement for 2015 and know that this arrangement will be beneficial for our custom-ers who will now have additional access to Sum-mit providers through BlueCross.”

Young noted changes in the health-care marketplace made being part of Net-work S more attractive to Summit.

Summit also participates in BlueCross BlueShield’s Blue Network PSM (Network P). BlueCross BlueShield offers two distinct Blue networks, each with its own group of doctors, hospitals, and other healthcare providers. Network P, a more expensive plan, includes access to the widest selec-tion of doctors and hospitals. Network S, which is more affordable, includes access

to a narrower selection of doctors and hos-pitals. With its lower premium, Network S is more affordable for employers and more accessible to the average person.

BlueCross BlueShield and Summit Medical invested months of discussion re-garding Summit’s participation in Network S, and both parties agree the arrangement is good for all concerned, especially con-sumers.

“We are happy to announce this agreement,” BlueCross BlueShield CEO Bill Gracey said. “Summit Medical Group has a strong history in East Tennessee and serves a large percentage of our customer base, which will now have even more qual-ity and cost-effective providers they can ac-cess across the region.”

“The consumer is the ultimate win-ner,” Young said. “They will benefit from a higher quality of care at a lower cost.”

Summit has earned national recogni-tion for its level of care. The National Com-mittee for Quality Assurance (NCQA), a private, 501(c)(3) nonprofit organization dedicated to improving health care qual-ity, has ranked Summit in the top 10 in the country for all three categories of NCQA recognition: Patient Centered Medical Home, Diabetes Recognition Program and Heart/Stroke Recognition Program.

Organizations earning the NCQA seal

first must pass a rigorous, comprehensive review and annually report on their perfor-mance. For consumers and employers, the seal is a reliable indicator that an organi-zation is well-managed and delivers high quality care and service.

“Choosing the right physician and health care provider can be one of the most important choices a person makes,” said Dr. C. Edward McBride, Summit’s vice president of clinical services. “NCQA recognition programs provide patients with the data they need to make informed decisions.”

Summit Medical Group was formed in 1995 by 37 Knoxville physicians. Today, it is one of the largest primary care based organizations in East Tennessee with 215 physicians and more than 100 advanced practitioners providing care at 53 practice locations in 12 East Tennessee counties. Summit also consists of four diagnostic centers, seven physical therapy centers, three express clinics, corporate wellness program, cen-tral laboratory and sleep services center. Summit provides healthcare services to a total of 308,000 patients, averaging 81,000 encounters each month.

Summit Medical Group to Participate in Blue Network S

Tim YoungDr. C. Edward

McBride


LegalMatters

Profit and Loss: The Top Ten Things Providers Need to Know Part VIII: Medicare Overpayment Appeals—Hurry Up and Wait

BY ERIN B. WILLIAMS AND DIANA L. GUSTIN, LONDON AMBURN, P.C.

This article is the final installment in a series which explores the top ten health law issues and their potential financial consequences on a provider’s practice.

A letter from the Centers for Medicare and Medicare Services (CMS) arrives at your doorstep demanding refund within 30 days of an extrapolated overpayment in the amount of $1 million. Interest will begin accruing monthly on the $1 million overpayment unless payment in full is received within 30 days of the date of the demand letter. Recovery through recoupment may begin if payment is not received or other steps taken. If you act quickly, you may be able to stop Medicare from recouping the extrapolated overpayment for almost six months.

How can I stop Medicare from recouping?

The Medicare Modernization

Act, Section 935, contains statutory protection for your cash flow if you file appeals early. A provider can stop Medicare from recouping an overpayment if a Request for Redetermination, the first level of appeal, is received within 30 days of the date of the CMS demand letter. Providers should be aware that the 30 days begins to run from the date on the letter, not the date the provider receives it.

The Redetermination Decision is made by the Medicare contractor who processed the original claim. If the provider receives an unfavorable or partially unfavorable Redetermination Decision, the provider may also receive a revised demand letter with the interest added for a new overpayment amount. Recoupment of the revised overpayment will begin unless a Request for Reconsideration, the second level appeal, is filed within 60 days of the date of the revised demand letter (calculated from the date of the

demand letter and not the date the provider receives the letter) or within 60 days of the Redetermination Decision. The Request for Reconsideration is filed with the Medicare Qualified Independent Contractor (QIC). To avoid collection, providers should file the Request for Reconsideration within 60 days of the Redetermination Decision since the Carrier may not always send a revised overpayment demand letter.

Although recoupment is delayed during the first two levels of appeal, interest will continue to accrue each month. Providers may decide to make financial arrangements to pay the overpayment to avoid accrual of interest during the pendency of the appeals process.- The federal regulations allow 120 days for filing the Request for Redetermination and 180 days to file a Request for Reconsideration. Early filing for the first two levels of appeal will prevent recoupment and preserve the provider’s cash flow for a few months.

What happens after the first two levels of appeals?

After the provider receives the Reconsideration Decision, any outstanding balance many be recovered by CMS through administration offset (recoupment of the overpayment from accounts receivable). The provider may decide to continue with the appeals process by filing a Request for Administrative Law Judge Hearing within 60 days of the Reconsideration Decision. According to statistics reported by the Office of Inspector General for the Department of Health and Human Services, approximately 56% of claims are fully reversed at the ALJ level in favor of the appellant and 6% are partially reversed.1

Unfortunately, providers cannot stop the collection process (recoupment) after the first two levels of appeal. Filing a Request for Administrative Law Judge Hearing does not preclude Medicare from recouping the remaining overpayment (and accrued interest).

What happens at the ALJ level of appeal?

Federal Regulations require an ALJ decision to be rendered within 90 days from the date that a Request for ALJ Hearing is received.2 However, CMS announced earlier this year that there was a severe backlog of Medicare appeals at the ALJ level, resulting

in an average wait time of 407 days. The Office for Medicare Hearings and Appeals (OMHA) has seen a 225% increase in appeals from 2007 to 2013, and CMS has suspended assignment of most new requests for ALJ hearings for at least two years. During this wait time, interest will accrue and Medicare will continue to recoup extrapolated and actual overpayments identified in the audit.

If the extended wait time for an ALJ hearing will cause a financial hardship, providers may request an extended repayment plan from CMS or may request escalation to the Medicare Appeals Counsel (the fourth level of appeal), if certain criteria is met.

The backlog of Medicare appeals has been the subject of recent congressional hearings, and the Center for Medicare Advocacy filed a class action lawsuit to compel the Secretary of the Department of Health and Human Services to meet statutory deadlines for review Medicare claim denials, specifically the 90 day deadline for ALJ Determinations.3

So, what should you do?Providers should quickly move

through the first two levels of appeals to prevent withholding. This will protect cash flow, and allow providers time to consider the options and make any necessary financial arrangements for repayment of the debt if the claims are not reversed at the first or second level of appeal. The OMHA recently solicited suggestions from stakeholders for addressing the substantial growth in the number of requests for ALJ hearings being filed. The key to success is often the ALJ Hearing. The delay providers are currently experiencing must be resolved by Medicare, or if necessary, by Order of the Court if litigation is needed to keep your business alive and well.

Notes1OIG (HHS), Improvements Are Needed at the Administrative Law Judge Level of Medicare Appeals, OEI-02-10-00340 (Nov. 2012).2See 42 USC § 1395ff(d)(1)(A) and 42 CFR § 405.1016(a)3See Lessler et al. v. Burwell, 3:14-cv-01230, filed 8/26/14 (Dist. of Conn.).

Attorneys Erin B. Williams and Diana L. Gustin focus their practice on healthcare compliance and regulatory matters. For more information on any health law or compliance matters, you may contact Ms. Williams or Ms. Gustin at (865) 637-0203 or visit www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.Where advanced cytogenetic technology meets old-fashioned service

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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 [email protected].

By LEIGh ANNE W. hOOVER

Music has always been part of the atmosphere in our household, and I es-pecially love Christmas music. Whether it was a classic Firestone - Your Favor-ite Christmas Music album featuring a beautiful, brightly colored bow, which I remember anticipating listening to each year as a child, hymns played on the piano, or holiday classics from my favorite artists, carols filled our home.

Our adult children tease that I would listen to Christmas music anytime of the year. For this reason, Christmas CDs, yes, I still play them, begin rotating early and are often left in the sound system well into the New Year.

As a December baby, my birthday usually includes a Christmas musical out-ing, and this has been a shared tradition since I was a little girl. In fact, our daugh-ter remembers many of our own special mother-daughter “dates” being to holiday arts activities.

During December, our region has nu-merous opportunities to enjoy the sounds of the season with your family. Many are coming to the Tennessee Theatre in Knoxville, including Jim Brickman’s “On a Winter’s Night,” the Knoxville Jazz Or-chestra, the classic musical movie “White Christmas,” with preceding entertainment from The Mighty Wurlitzer Organ, Joy— An Irish Christmas, the Nutcracker ballet, and even a performance from Mannheim Steamroller Christmas by Chip Davis.

Known as Knoxville’s “Grand Enter-tainment Palace,” the Tennessee Theatre is also the State Theatre of Tennessee, which was designated by the state legisla-ture in 1999. Since its doors first opened in 1928, the historic venue has welcomed countless visitors and entertainment icons.

“For the first 50 or so years of its life, [the Tennessee Theatre] was a movie the-atre,” explained Executive Director, Becky Hancock. “Movies were shown every day of the week, except Sunday, with several showings per day, so thousands and thou-sands of people came…every week.”

During that era, there was a house band and an organist. Going to a first run movie or to see a touring show in a movie palace was truly a grand affair. Many re-call memories of their grandparents’ first dates and even proposals, and some of these stories are shared on the Tennessee Theatre’s website.

According to Hancock, the theatre was a first run movie house from 1928 until 1972, but it went through a strug-gling time in the 1960s. When the down-town declined, the theatre was forced into showing second run films.

In 1977, the Tennessee Theatre closed for the first time and would expe-rience several openings and closings until businessman Jim Dick, owner of Dick Broadcasting, purchased the theatre in 1980.

“He [Dick] did that mostly for the

World’s Fair, which happened in 1982, but also because he loved the theatre and wanted to preserve it,” said Hancock. “His com-pany ran it for 15 years from 1980 until 1995.”

Although the City of Knoxville de-clined Dick’s offer to donate the Tennes-see Theatre, this opened the door for the nonprofit 501(c)3 to be formed and re-ceive the donation. A board still governs the theatre today, as the Tennessee His-toric Theatre Foundation, with a goal of preserving and seeing the theatre thrive as a performing arts venue.

From the marquee sign, to the 56-foot tall horizontal “TENNESSEE” sign, the Tennessee Theatre is truly a recogniz-able Knoxville landmark. Known as one of East Tennessee’s most precious build-ings, the theatre was restored to its former grandeur in 2005. Today, the facility is a state-of-the-art performing arts center, where “past opulence and current tech-nology” have been married.

“It was a completely comprehensive

project,” explained Hancock. “It was a one hundred per-cent renovation

and restoration…back to the 1928 feel and

look in terms of original car-pet pattern, all the draperies and curtains and valances were replaced…and all of the paint surfaces were completely re-stored to original colors and brightness.”

To bring the facility up-to-date, the backstage area was demolished and rebuilt offering a much larger, modernized space. However, just walking into the lobby truly brings patrons back to an era of grandeur and great expectation.

“There’s no other building like it in the world,” said Hancock. “Movie palaces were built by the hundreds in the late 20s, but there aren’t that many left today.”

According to Hancock, about 40 touring shows and six Broadway titles are presented at the venue per year. Addition-ally, many scheduled shows are rentals. Each appears to a diverse audience with something for everyone.

December presents an opportunity

for many to enjoy a variety of shows at the Tennessee Theatre, such as Mannheim Steamroller and others, and experience the holiday season in a very special way.

“New generations of people, espe-cially since 2005, are creating those same kinds of memories that their parents and grandparents were able to create in the 30s, 40s, and 50s,” said Hancock. “It’s one of the things we are most proud of is to introduce the theatre and its beauty and memorable moments to new generations of people.”

Hancock enjoys seeing patrons arrive and experience the atmosphere of the Ten-nessee Theatre for the first time. In addi-tion to the grand lobby and staircases, there are five, massive Czechoslovakian crystal chandeliers, valued at $250,000 each, which are breathtaking. With the impres-sive domed ceiling, plaster ornamentation, and burgundy velvet seating, the inside of the auditorium is also awe inspiring.

“They just don’t build them like this anymore,” said Hancock. “The setting does add to the overall experience… Not only are the audience members enjoying themselves, but the musicians and the cast and crew of these touring shows are enjoy-ing themselves as well because it’s such a pretty place.”

For additional information of the Tennessee Theatre and upcoming shows, visit www.tennesseetheatre.com

Now, let’s go enjoy some Christmas music!

Enjoying East TennesseeTennessee Theatre


HealthcareLeader

Jerry VagnierBy JENNIFER cULP

The Helen Ross McNabb Center, a not-for-profit provider of behavioral health services founded in 1948, has a simple, straight-forward mission statement: “Im-proving the lives of the people we serve.” This mission, and the dedi-cation required to carry it out, is plainly embodied in the life and work of the McNabb Center’s president and CEO, Jerry Vagnier.

Vagnier became CEO of the McNabb Center recently, stepping into the role upon the retirement of his predecessor Andy Black in July 2014, but he is not new to the or-ganization. Originally interested in pursuing family medicine, Vagnier developed a passion for psychology and social work over the course of his college education. He joined the McNabb Center as a social worker for children and adolescents after earning his Master’s degree in clini-cal social work from the University of Tennessee. Vagnier found the work sat-isfying and loved the organization, and has devoted himself to the McNabb Center in the 26 years since. “This is my professional home, and I absolutely love it, and love our mission. It’s really been amazing to be a part of this organization and watch it grow over the years,” he said.

Initially, Vagnier provided direct care to children and families, but the scope of his responsibilities expanded over time. When offered an opportunity to try his hand at management, he found it equally, if differently, rewarding as working di-rectly with clientele, and particularly en-joyed being able to support other staff members in delivering care. Vagnier was

instrumental in working to expand chil-dren’s services at McNabb in the 1990s, making it the rare behavioral services pro-vider that devotes approximately half its services to children and youth and half to adults, and helped design the organiza-tion’s delivery system for TennCare ser-vices and managed care. This proved to be one of the most challenging periods of his career, and he remains grateful that the McNabb Center was able to survive as a standalone entity during a time when many behavioral service facilities were forced to merge or close.

“I’m very proud of our staff, that we were not only able to survive but to thrive in that market,” he remembered.

He served as Vice President of Operations prior to taking on the role of President in 2013. When former CEO Black announced his intent to retire, the Board of Directors voted to name Vagnier the McNabb Center’s new CEO on the very same day, ensuring a smooth transition.

“I had a great predecessor for eleven years, Andy Black, in that role, and we have a tremendous board. That kind of strategic plan-ning and continuity is not common in a lot of organizations, and I’m grateful,” Vagnier said. Vagnier’s new duties as CEO include in-creased interaction with the Board of Directors (“a big change, but a positive one!” according to Vag-nier), and involvement with the Helen Ross McNabb Foundation, which works to raise, hold, and in-vest funds on behalf of the Center in support of the Center’s stability and growth.

The McNabb Center has grown prodigiously in the last year, tak-ing on four mergers in approximately a twelve-month time span to add Mercy Shelter in Morristown, the Fortwood Center in Chattanooga, Child and Fam-ily Tennessee of Knoxville, and the Sex-ual Assault Center of East Tennessee to the facilities and services it encompasses. Vagnier feels fortunate that the McNabb Center possessed the infrastructure and leadership to tackle the challenge, and ex-cited about the increased range of services the mergers allow the Center to offer. In addition to expanding the Center’s geog-raphy (“now we’re from Chattanooga to Newport, and LaFollette to Maryville,” he explained), Vagnier is particularly excited

about the expanded range of women’s ser-vices the Center will be able to offer.

Vagnier is full of praise for the McNabb Center’s staff: “The people we have here are unique in that they’re just so passionate about what we do,” he said. “They’re all hard-working, they love what they do, and they’re so pleasant to work with. They’re our biggest asset.”

As CEO, he aspires to create and maintain a culture that not only attracts dedicated, talented staff, but also inspires them to work toward improving the Cen-ter. “We’ve got to get better all the time,” he said.

Vagnier’s positive work ethic and focus on improvement carries over into his leisure time. Outside of business hours, he is an avid athlete who enjoys running, playing golf, and racquetball, and “basi-cally anything I can find a little adventure in,” he said, in addition to being an active member of the Foothills Church congre-gation in Maryville. Around the same time he took on the responsibilities of CEO at work, Vagnier underwent a major change in his home life as well. “I have always found myself to be engaged in the lives of my children, but I have just become an empty-nester!” he laughed.

With his wife, an elementary school principal he describes as a “consummate professional,” Vagnier has raised three children, two sons who are an elemen-tary school teacher and a senior sociology major at East Tennessee State University, respectively, and a daughter who is study-ing to be a nurse at Belmont University. “They’re all finding their way,” he said proudly.

In his own expanding role at the ever-growing Helen Ross McNabb Center, it seems that Vagnier is doing an excellent job of finding his way himself, too.

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Although Wayt could easily take credit for all of her accomplishments, she humbly concedes: “I have to give credit to the Lord’s influence in my life and his direction, especially professionally; it has been remarkably providential. I prayer-fully consider everything that I do.

“Also, I would not have had so many opportunities had it not been for Well-mont. Since joining Wellmont, doors have opened up, and I feel like they really value females in higher levels of position.To me, that has made a big difference,” she continued. “I could be anywhere and be busy, I know that, but I feel like I’ve been recognized more and had a lot more op-portunities and career advancements since being with Wellmont.”

Physician Spotlight, continued from page 2


Managing your healthcare costs during retirement

BY WILLIAM M. MORRIS, CDFA, CERTIFIED DIVORCE FINANCIAL ANALYST, UBS FINANCIAL SERVICES INC.

With healthcare costs skyrocketing, all retirees need to consider how their finances will be affected. In fact, medical care is usually one of the single biggest costs during retirement. So, as we work together to prepare for your retirement, we thought these ideas might provide clarity on this complicated topic.

Time and inflation, plus the effects of aging, will make healthcare a growing part of your budget in later years. In fact, medical inflation is a key factor to consider. Through April 2014 alone, CPI medical care costs rose 2.4%, whereas other CPI categories rose an average of 0.3% (1). According to the Health and Human Services (HHS) services, 70% of Americans need some form of long term care during their lifetimes. The cost of all kinds of long-term care varies depending upon where in the country you live. An assisted living facility, for example, can cost up to $72,000 annually (2). Medicare does not cover long term care services, making them yet another retirement expense to consider.

If you plan to retire before age 65

In the past, employers provided post-retirement health benefits for early retirees beginning at age 55. As the result of escalating healthcare costs, few companies continue to offer this retiree healthcare. Retiring early might have forced you to look for health insurance in the open market. Fortunately, the Affordable Care Act (ACA) has created new options for healthcare for early retirees.

One the most important provisions of the ACA for you as an early retiree is the establishment of state health insurance exchanges. You can no longer be declined coverage for age or a pre-existing condition. These exchanges offer at least two health insurance carriers and varying levels of coverage you can purchase. The exchange operates in the same way a large employer plan does: younger, healthier individuals are included so the cost can stay lower for everyone.

You may also meet the requirements for health insurance

premium subsidies available through the public exchanges. Your eligibility for these subsidies depends on upon MAGI (modified adjusted gross income). In order to qualify, your MAGI cannot be more than 400% above the Federal Poverty Level (FPL). For example, in 2013-2014 a 60-year- old couple with $62,000 MAGI would be able to take advantage of premium subsidies in a public health insurance exchange.

Age 65: Medicare at a glanceBeginning at age 65, Medicare

will continue to be the foundation of your healthcare coverage. As a retiree, while there is no need to enroll in a health insurance exchange. Medicare shouldn’t be your only coverage. Medicare does provide protection against many healthcare services; it does have relatively high deductibles, cost sharing requirements and gaps. Here’s a brief overview:

• Part A covers inpatient hospital stays, and hospice care. It is free to individuals and their spouses who have paid into Medicare for 10 years, or 40

quarters. Part A benefits are subject to a deductible ($1,216 per benefit period in 2014) and coinsurance.

• Part B pays physician visits, outpatient services, preventative services added by the ACA, and home health visits. Premiums vary based on income ranging from $104.90 to $335.70 per month.

• Part C refers to the Medicare Advantage program through which individuals can enroll in a private health plan such as HMOs, PPOs, and fee for service plans and receive all Medicare Parts A and B benefits. It is also possible to include a Part D plan to Medicare Advantage as well for an additional fee. Coverage, premiums and out-of-pocket costs vary because Medicare Advantage is offered by private companies. Beneficiaries purchase Medicare Advantage to assist in covering expenses not generally covered through Parts A and B. It is not a national plan; therefore Medicare Advantage isn’t offered everywhere.

• Part D is a voluntary, subsidized

theBottomLine


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Knoxville MGMA Monthly MeetingDate: 3rd Thursday of each month

Time: 11:30 AM until 1:00 PMLocation: Bearden Banquet Hall, 5806 Kingston Pike,

Knoxville, TN 37919Lunch is $10 for regular members.

Come learn and network with peers at our monthly meetings. Topics are available on the website.

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Chattanooga MGMA Monthly MeetingDate: 2nd Wednesday of each month

Time: 11:30 AMLocation: The monthly meetings are held in Meeting Room A of the Diagnostic Center building, Parkridge Medical Center, 2205

McCallie Avenue, Chattanooga, TN 37404 Lunch is provided at no cost for members, and there is currently no cost to a visitor who is the guest of a current member. Each member is limited to one unpaid guest per meeting, additional guests will be $20 per guest. All guests must be confi rmed on

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Mark Your CalendarYour local Medical Group Managers Association is Connecting Members and

Building Partnerships. All area Healthcare Managers are invited to attend.

developers will probably wait another six months-two years for the FDA to complete the review process.

Speeding Up the TimelineHowever, noted Jennifer Rodriquez, a

spokesperson for the FDA, “There are sev-eral paths for making drugs and biologics that qualify available as rapidly as possible … such as Fast Track, Priority Review, Ac-celerated Approval and Breakthrough Des-ignation.”

Fast Track is a process to facilitate development and expedite review for drugs to treat serious conditions and fill unmet medical needs, which is defined as providing a therapy where none exists or providing a therapy that could potentially be better than anything currently available.

Priority Review allows for a quicker process and indicates the FDA’s goal is to take action on an application within six months of receiving data.

Accelerated Approval gives the FDA a mechanism to get drugs that fill an unmet condition approved using a surro-gate or an intermediate clinical endpoint

rather than waiting the years it could take to fully show a drug is clinically meaning-ful over the long haul. Such surrogate or intermediate endpoints – ranging from laboratory measures to improved morbid-ity and mortality rates – are reasonably likely to predict the clinical benefit of a drug.

Breakthrough Designation is given to drugs or therapies intended to treat serious conditions that are deemed to offer substantial improvement over other avail-able therapies.

“Under certain circumstances, the FDA can also enable access for individu-als to investigational products through mechanisms outside of a clinical trial, such as through an Emergency Investigational New Drug (EIND) application under the FDA’s Expanded Access program,” Ro-driguez said. “In order for an experimental treatment to be administered in the United States, a request must be submitted to and authorized by the FDA.”

She added the FDA is ready and will-ing to work with companies and investi-gators focused on serious public health

issues, such as caring for Ebola patients in dire need of treatment, “to enable access to an experimental product where appro-priate.”

Rodriguez continued, “Under the FDA’s Emergency Use Authorization (EUA) mechanism, the agency can also enable the use of an unapproved medical product, or the unapproved use of an ap-proved medical product, during emergen-cies when … among other circumstances … there are no adequate, approved and avail-able alternatives.”

She explained the EUA is an important way for the FDA to allow broader access to available products. It was the mechanism put in play this past August that allowed the FDA to authorize use of a diagnostic test developed by the U.S. Department of Defense to detect the Ebola Zaire virus in individuals.

In times of public health crisis or epi-demic, Rodriguez noted, “The FDA’s role during situations like this involves sharing information about medical products in de-velopment, as well as communicating our assessment of product readiness and clarify-

ing regulatory pathways for development.” She added the FDA works with other U.S. government agencies, international part-ners, and medical product sponsors to move products forward in development as quickly as possible without compromising patient safety.

She also noted the FDA plays an impor-tant role in disseminating evidence-based information to the public. “Unfortunately, during outbreak situations, fraudulent products claiming to prevent, treat or cure a disease almost always appear,” she said of those who play on public fears.

While the agency has a number of mechanisms to move the science more rapidly through the pipeline, Rodriguez stressed that doesn’t mean the agency gets away from its primary goal of making sure the American public has access to safe, ef-fective treatment options.

“It’s important to note that every FDA regulatory decision is based on a risk-benefit assessment of scientific data that includes the context of use for the product and the patient population being studied,” she con-cluded.

Urgent & Emergent, continued from page 1

extenders would be made until after the No-vember elections. This year, all 435 seats in the House of Representatives and one-third of the seats in the Senate were in play.

Retirement FundsJones said most physician practices still

operate on a cash basis and are still mak-ing a profit. To avoid higher corporate tax rates, it’s quite common to distribute ‘left-over’ cash to partner physicians in the form of a bonus where it will be taxed at the in-dividual rate.

“There is one deduction they can ac-crue and pay later, and that’s retirement plans,” Jones noted. “You get a deduction for the money that goes into retirement plans. Then you don’t have to pay taxes on

any of that until you do pull it out … and hopefully, by then, you’re in a lower tax bracket.”

For those who wish to take advantage of the tax benefits that come with funding a retirement plan, Jones said there are sev-eral options. The easiest is to put money in a traditional or Roth IRA, but that limits an individual to $5,500 for the year ($6,500 for those aged 50 or older).

“If they want to save more, they need to look at another type of retirement plan where they can put away up to about $55,000 depending on the vehicle,” he said. Jones continued, “It’s too late to put a 401K plan in place for ’14, but if they don’t al-ready have one, they (physician practices) should definitely think about it in 2015.

Section 179 Depreciation“In the past several years, a business

could expense up to $500,000 of new, fixed asset purchases during the year,” Jones said. On top of that, he continued, “They could also expense 50 percent of new equipment purchases … a 50 percent bonus deprecia-tion.”

That, however, has changed dramati-cally. “In 2014, that $500,000 limit dropped to $25,000, and that 50 percent bonus de-preciation is not in effect either at this time,” Jones said, adding the bonus depreciation extender could well be reinstated when Congress reconvenes after the elections. “We hope they’ll reinstate it, but we don’t know for sure.”

Jones went on to explain what the limit changes might look like for a physician practice. Using a hypothetical example, he said if a physician had a net income of $450,000 in 2013 and purchased a piece of equipment with a price tag of $400,000, the doctor could effectively drop his or her net income to $50,000. Then, using the bonus depreciation rules, that remaining $50,000 could also be expensed out to pull the tax-able amount down to zero.

“But in 2014, in that same scenario of $450,000 net income, you could only take $25,000 plus regular depreciation off the top,” Jones said, adding the tax burden would be much higher this year. (Note, there are also rules that come into play pertaining to annual dollar thresholds that are not included in this simplified example). If the bonus depreciation extender is ulti-mately put back in play, then the physician could deduct another $200,000 tied to the new equipment purchase plus normal dep-recation and the $25,000 covered under 179 depreciation.

Although, the latter scenario is clearly preferable, Jones pointed out that with or without the bonus depreciation, physicians should expect to pay more in taxes for 2014 than would have occurred under the much more generous 2013 rules. For those who have purchased new equipment this year or are planning to do so by Dec. 31, it will be particularly important to follow any last minute changes to the bonus depreciation extender.

As for the bottom line, Jones noted, “In 2013, there were so many changes. In 2014, there hasn’t been quite as much. It’s pretty much more of the same.”

Jones is based in the Jackson, Tenn. office of HORNE, one of the top 50 ac-counting and business advisory firms in the country with offices in Alabama, Louisiana, Mississippi, Tennessee and Texas.

Tax Time: Getting Your Financial House in Order, continued from page 1


The Literary ExaminerBY TERRI SCHLICHENMEYER

On Immunity by Eula Biss; c.2014, Graywolf Press, $24.00 / $27.99; Canada, 207 pages

You’re question-ing the viability of a rite that children have undergone for decades: vaccinate or not?

You’ve read the pros and the cons, and your mind swims. But once you read On Immunity: An Inoculation by Eula Biss, you’ll understand a little more.

While modern medicine is surely that, vaccination has been around for quite awhile: in the mid-1700s, many no-ticed that milkmaids exposed to cowpox were immune to smallpox, and they acted accordingly. Even before that, though, parents in China and India practiced a form of vaccination called variolation. And before that, birth was “the original inoculation.”

As the daughter of a doctor, Eula Biss got the full round of vaccines that most babies of her generation received. She debated, however, about vaccinating her own son from a strain of fl u that was going around when he was an infant, which led to the greater question: which vaccines – if any - are necessary?

The complication, she learned, is that we can’t see vaccine “just in terms of how it affects a single body, but also in terms of how it affects the collective body of… com-munity.” Total world-wide immunization against disease is nearly impossible, but sta-tistics show that if the right percentage of a population is immunized, it can halt an epidemic. The majority effectively protects the minority.

So is it better to receive natural immu-nity from a disease by contracting it?

Not necessarily, says Biss. While it’s true that we wouldn’t be a species with-out viruses (a “surprising amount” of our genomes consist of “debris from ancient viral infections”), allowing your children to catch certain childhood diseases now can be detrimental to them later in their lives.

Hand sanitizers aren’t the answer, either, since they kill “indiscriminately,” promote antibiotic resistance, and leave behind traces of unsavory chemicals. And part of the vaccine-or-not issue is that mis-information can, well, go viral.

And yet, “uncomfortable with both sides” of the argument, and “overwhelmed by information,” Biss went ahead with the schedule of inoculations for her son. “I still believe,” she says, “there are reasons to vaccinate that transcend medicine.”

When you see something these days about vaccinations, it’s easy to conclude that it might fi ercely be for or against. Not so with On Immunity.

With cautious deliberation and care-ful refl ection, author Eula Biss offers read-ers a good balance in this debate, which is

delightfully welcome. As a mother, she’s obviously had to ponder the issue and her conclusions are based in fact and personal anecdote, al-though she also includes the perfect amount of history and literature for entertainment.

I’m not sure this book will change any minds, but it does offer a fair mix to consider if you’re a parent facing the decision.

Being Mortal: Medicine and What Matters in the Endby Atul Gawande; c.2014, Henry Holt; $26.00, 304 pages; c.2014, Doubleday; $32.95 Canada, 304 pages

As with many fi nales, that perfect ending to a perfect meal left you satisfi ed for the rest of the evening. It was, like some conclusions - a little night-cap, a fi nal chapter, a last dance, the lin-gering notes of a favorite song - a thing to savor.

Can the end of life be so sweet? Per-haps. There are steps to make it so, as you’ll see in the new book Being Mortal by Atul Gawande.

For about the last century, the aver-age lifespan for North Americans has been increasing. Modern medicine has taught doctors how to save lives but, until rela-tively recently, it didn’t teach them how to deal with life’s end.

That, says Gawande, is unfortunate. In many cases, doctors feel extremely un-comfortable discussing the end of life with their patients. That often leads to protocol that precludes quality of life when there isn’t much life left to have.

We’ve come to this point, this reluc-tance to face death, because we’re no lon-ger familiar with it. A century ago, people died at home, often after self-treating their ailments. Hospitals were not places to get better, says Gawande; medicine back then usually had little impact on life or death. When penicillin, sulfa, and other drugs be-came available, however, hospitals became places for cure. Nursing homes, he says, were for people who needed additional care before going home.

But medicine isn’t the only thing that’s changed: aging has, too. We live longer, we expect our parts to last longer, and we’re surprised when health fails. But does that make aging a medical problem?

To a geriatrician, it might be – but Gawande says there aren’t enough doctors of geriatrics and, without them, we have a lessened chance to sidestep problems that could diminish the quality of life in later years. He says, in fact, that the elderly don’t dread death, so much as they dread the losses leading up to it: loss of indepen-

dence, of thought, of friends.But long before that happens, Gawa-

nde says, there are conversations that need having; namely, what treatments should, or should not, be done? How far would you want your physician to go?

Let me tell you how much I loved this book: I can usually whip through 300 pages in a night. Being Mortal took me three.

Part of the reason is that author Atul Gawande offers lingering food for thought in practically every paragraph – whether he

writes about the history of aging and dying, one of his patients, or someone in his own family. I just couldn’t stop thinking about the points he made with his anecdotes and with this information, how it could radicalize our lives, and how it fi ts for just about everybody.

We are, after all, not getting any younger.

I think if you’re a caretaker for an elderly relative or if you ever plan on growing old yourself and want to maintain quality of life, this book is an

absolute must-read. For you, Being Mortal is informative to the end.

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.

As with many fi nales,

and with this information, how it could radicalize our lives, and how it fi ts for just about everybody.

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drug benefi t. These plans are offered through private insurers who have been approved by Medicare. Part D is also offered on a sliding scale depending upon income. Each company determines its own premiums and the prescription drugs it covers. Before enrolling in a Part D plan or adding it to other Medicare plans, be sure that the drugs you take are part of the program.

Medigap is a supplement to Medicare A and B and is sold by private insurance companies. It is coverage that can help pay some of the healthcare costs that Parts A and B don’t cover, such as copayments, coinsurance and deductibles. Some Medigap policies also offer coverage for services that original Medicare doesn’t cover, such as medical care when you travel outside of the United States. Unlike Medicare Advantage, Me digap policies don’t include original Medicare cover age—they supplement it. Also, Medigap policies don’t cover Part D, so an additional prescription plan must be purchased to get Part D coverage.

Be sure that you make note of the deadlines for applying for Medicare for the fi rst time, renewing or changing carriers. Missing deadlines can result in penalties that will impact your Medicare going forward.

Consider how to pay for long-term care

As noted above, most Americans will eventually need long-term care—ongoing care to help them with the activities of daily living. This may be ongoing care for someone with an injury, chronic illness or disability. A long-term care insurance policy, or a life insurance policy with a long-term care rider, generally pays a daily benefi t for eligible services provided at home, at an adult daycare center, or in as assisted living facility or nursing home. Details of coverage vary widely from plan to plan, but generally the younger you are when you buy the policy, the lower the premiums will be. Whether you purchase long-term care insurance or choose other strategies to pay for long-term care, careful fi nancial planning can help you preserve assets and cope with these challenges.

Disclaimer: This article has been written and provided by UBS Financial Services, Inc. for use by its Financial Advisors. Neither UBS Financial Services, Inc. nor its employees provide tax or legal advice. You should consult with your legal and/or tax advisors when making decisions about retirement plans and retirement plan distributions. The information contained in this article is based on sources believed to be reliable, but its accuracy cannot be guaranteed.

Notes1US Department of Labor, Bureau of Statistics, Consumer Price Index as of 4/14.2Genworth Cost of Care Study 2013.

The Bottom Line, continued from page 7


GrandRounds


East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2014 Medical News Commu-nications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore uncondition-ally assigned to Medical News for publication and copyright purposes.

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Tennova LaFollette Outpatient Rehabilitation Center Moves to New HomePhysical, occupational and speech thera-pies offered in renovated storefront on Jacksboro Pike

KNOXVILLE – Tennova LaFollette Out-patient Rehabilitation Center has relocated to 2221 Jacksboro Pike, Suite C-19, LaFol-lette. The rehabilitation center was formerly located a block away at 2146 Jacksboro Pike.

The newly renovated 6,000-square-foot rehabilitation center is conveniently located in Woodson’s Mall near Food City. It is eas-ily accessible and has plenty of free parking, including several disabled/handicapped parking spaces. Same-day and next-day ap-pointments are now available.

Tennova LaFollette Outpatient Reha-bilitation Center offers physical, occupation-al and speech therapies. All treatments are provided by licensed staff. Services include:

• Orthopedic rehabilitation of the neck, back, hip, knee, shoulder, elbow and hand

• Neurological rehabilitation for stroke, brain injury and spinal cord injury

• Pediatric rehabilitation• Post-surgical rehabilitation• Workers’ compensation rehabilita-

tion• Sports medicine• Splinting• Massage therapy (sport, relaxation

and cranial-sacral massage) A physician referral is required.

Hutcheson Awarded Hospital Accreditation from The Joint Commission

FORT OGLETHORPE, Ga.– Hutcheson Medical Center announced that it has earned The Joint Commission’s Gold Seal of Approval® for Hospital Accreditation by demonstrating continuous compliance with its performance standards. The Gold Seal of Approval® is a symbol of quality that re-flects an organization’s commitment to pro-viding safe and effective patient care.

Hutcheson underwent a rigorous, un-announced on-site survey in July as part of the accreditation process. During the review, a team of Joint Commission expert surveyors evaluated compliance with hospi-tal standards related to several areas, includ-ing emergency management, environment of care, infection prevention and control, leadership, and medication management. Surveyors also conducted on-site observa-tions and interviews.

Hutcheson Adds Hand Therapist and Speech Pathologist to Rehabilitation Team

FORT OGLETHORPE, Ga.– Gay Rice, Physical Therapist and Certified Hand Therapist, andMatthew Meredith, Certified Speech-Language Pathologist, have joined the rehabilitation team at Hutcheson Medi-cal Center.

Gay Rice, PT, CHT graduated from Georgia State University with a Bachelors in Physical Therapy, and became board certified in Hand Therapy in 2003. Rice has worked at Hamilton Medical Center, where she served as the hospital’s Director of Re-habilitation Care, and was owner of Rice Rehabilitation Associates in Dalton. She has over 29 years of physical therapy experi-ence and will be assisting patients both at

the hospital’s rehabilitation center and at the Lafayette clinic.

Matthew Meredith, MA, MS, CCC-SLP, graduated from MTSU with a Bachelor’s in Spanish and French, obtained his Master’s in Spanish Linguistics at University of Iowa, and received his Masters in Speech-Language Pathology degrees from the University of Tennessee. Meredith most recently prac-ticed at Holston Valley Medical Center in Kingsport, TN, where he performed Modi-fied Barium Swallow Studies and treated patients of all ages on an inpatient and out-patient basis. He is certified to perform Vi-talStim swallowing treatments and focuses on patients with swallowing and communi-cation disorders including voice, aphasia, and dysarthria. Meredith is also bilingual and treats patients in English and Spanish.

Tennessee Doctors, Physician Assistants Align in Support of Physician-Led, Team-Based Healthcare

NASHVILLE – The Tennessee Medical Association and the Tennessee Academy of Physician Assistants have announced their mutual commitment to improve healthcare in Tennessee by promoting and participat-ing in integrated healthcare delivery teams. TMA and TAPA will work together to advo-cate for patient-centered, physician-direct-ed teams that deliver quality, cost-effective healthcare to all Tennesseans.

The governing Boards of each organi-zations have approved a joint statement:

We, the Tennessee Medical Associa-tion and the Tennessee Academy of Physi-cian Assistants, are mutually committed to continuing to improve access to safe and ef-fective, patient-centered quality care within an integrated, coordinated, physician-led team.

Coordinated care models continue to take shape across the U.S. as healthcare providers are challenged to find ways to de-liver better care at a lesser cost. Provisions in the Affordable Care Act and payers shifting from fee-for-service to value-based payment models create a need – and opportunity – for better collaboration between physicians, PAs and other health professionals.

Physician-led teams also improve pa-tients’ access to the care they need without compromising the quality. TMA and TAPA officials stress the importance of drawing upon the medical training of all members of the healthcare team to maintain compliance with state laws and regulations, and achieve the best possible outcome for the patient.

TMA and TAPA represent a combined 9,000 members in Tennessee.

Change in Name, Logo Part of Unified National Branding Effort by Catholic Health Initiatives

CHATTANOOGA – Memorial Health Care System has a new name and logo – it’s now called CHI Memorial, a change that is part of a system-wide branding strategy by parent organization Catholic Health Initia-tives, one of the nation’s largest nonprofit health systems.

A new name and logo will be imbed-ded in each of Catholic Health Initiatives’

markets over the next several months, high-lighting a unified brand that strengthens local links to a nationally recognized health system that operates 89 hospitals and hun-dreds of outpatient centers, assisted living and other facilities in 18 states.

CHI’s new symbol is the image of a guiding star and cross – four shapes that come together to create a visual represen-tation of the organization’s passion around its common mission to create healthier communities. The varying shapes, which signify the diversity of the national health care system, also exemplify the seamless integration of CHI Memorial with Catho-lic Health Initiatives – together with all of its partner organizations across the nation.

Provectus’ Intralesional PV-10 Clinical Data Published in the Annals of Surgical OncologyArticle Now Available as an Epub Ahead of Print

KNOXVILLE—Provectus Biopharma-ceuticals, Inc., a development-stage oncol-ogy and dermatology biopharmaceutical company (“Provectus”), announced that data on its investigational new drug PV-10, obtained in clinical trial PV-10-MM-02 (Clini-calTrials.gov Identifier NCT00521053), has been published by the Annals of Surgical Oncology (ASO). The peer-reviewed article, entitled “Phase 2 Study of Intralesional PV-10 in Refractory Metastatic Melanoma,” is available as an Epub ahead of print, and may be accessed at http://dx.doi.org/10.1245/s10434-014-4169-5.

The Annals of Surgical Oncology is the official journal of the Society of Surgical Oncology (SSO) and the American Society of Breast Surgeons. Annals is published monthly by Springer.

New Helen Ross McNabb Center outpatient center in Morristown will increase access to mental health, addiction and social services

MORRISTOWN—The Helen Ross McNabb Center held a groundbreaking ceremony for its new outpatient facility in Morristown on Monday, Nov. 3.

The Helen Ross McNabb Center will construct and furnish an approximately 7,000 square foot facility to provide ade-quate operating space for both its current and anticipated needs. The completion of the new clinic will increase the facility’s ser-vice capacity by 50 percent and will allow the Helen Ross McNabb Center to serve more children, adults and families. In support of the Center’s goal, the City of Morristown donated a sizable lot adjacent to its current location where the new facility will exist. This site is ideal as it is located adjacent to the HMRC’s adolescent residential treatment fa-cility and youth emergency shelter.

The new facility will allow sufficient space for psychiatrists, psychiatric nurses, Master’s level clinicians, and community-based case managers to provide quality mental health care for residents in and sur-rounding Hamblen County. Additionally, each facility will act as a home base for ther-apists and case managers to go out into the community’s schools and homes to meet clients’ needs.

The Helen Ross McNabb Center has provided high quality mental health and addiction treatment services to children, adults, and families for six years through two locations in Morristown.


GrandRoundsParkridge Medical Group-East Ridge Becomes Chattanooga’s First Level 2 Patient-Centered Medical Home

CHATTANOOGA – Parkridge Medical Group leaders announced that the system’s East Ridge practice has been designated as Chattanooga’s first Level 2 Patient-Centered Medical Home (PCMH) by the National Committee for Quality Assurance (NCQA).

“The Patient-Centered Medical Home concept is designed to revitalize primary care by bringing together healthcare pro-viders in a team whose services emphasize treating the whole person,” explains inter-nist Shannon McCallie, MD. “This arrange-ment requires everyone in our practice - from office managers and care coordinators to nurses and physicians - to work together to provide safe, comprehensive, high-quali-ty treatment that meets the needs and inter-ests of our patients.”

There are five functions and attributes key to the creation of a PCMH – to earn the designation, a practice must provide care that is accessible, comprehensive, coordi-nated, patient-centered, and focused on quality and safety. The Level 2 qualification indicates that Parkridge Medical Group - East Ridge has processes in place to coor-dinate the care that patients are given in or-der to ensure that each patient receives the best possible treatment. Existing patients also benefit from the group’s commitment to providing same-day access to a member of the practice’s care team.

“This type of focused, comprehensive practice is ideal for everyone, and it is es-pecially important for patients with chron-ic health conditions and more complex needs,” notes Dr. McCallie. “In the patient-centered medical home approach, we are responsible for meeting not only the physi-cal healthcare needs of a patient – we also focus on overall well-being and on building relationships with the people we serve. We cover everything from wellness and preven-tion to acute treatment and support for mul-tiple health issues.”

Tennova Center for Surgical Weight Loss Named an Optum Center of Excellence Turkey Creek Medical Center Recognized for Quality Patient Care and Support

KNOXVILLE—The Tennova Center for Surgical Weight Loss at Turkey Creek Medi-cal Center has been designated a member of the Optum Centers of Excellence net-work in the area of Bariatric Resource Servic-es. Tennova is the only health system in East Tennessee to receive this national designa-tion. Optum is a subsidiary of UnitedHealth Group.

Optum uses criteria developed by its Clinical Sciences Institute, which is com-prised of practicing experts around the world. To receive Optum Center of Excel-lence designation, the Tennova Center for Surgical Weight Loss was assessed and identified to be a provider of choice for safe, successful and cost-effective care.

According to Optum, receiving ser-vices at a Center of Excellence can help to ensure that weight loss surgery and care are delivered in a manner that meets high standards, and increases the likelihood of superior outcomes with support before and after surgery.

The Optum Centers of Excellence net-work was established in 1986 to provide consumers with information about hospitals

that meet or exceed performance standards for complex medical conditions. This infor-mation enables patients and payers to make informed healthcare decisions about where they receive medical and surgical care.

To learn more about bariatric surgery options at the Tennova Center for Surgical Weight Loss, visit TennovaWeightLoss.com.

Pua-Vines Joins Parkridge Health System Medical Staff

CHATTANOOGA – Family medicine physician Zynia Pua-Vines, MD, has joined the medical staff of Parkridge Health Sys-tem.

A Chattanooga native and alumna of Girls Preparatory School, Dr. Pua-Vines earned a Bachelor of Arts degree in psy-chology from the University of Chicago and a Bachelor of Science degree in biology from the University of Alabama. She earned a Master of Science in Community Health and a Doctorate of Medicine from the Uni-versity of Alabama School of Medicine, and completed a residency in Family Medicine with the Tuscaloosa Family Medicine Resi-dency Program.

Dr. Pua-Vines will practice with Parkridge Medical Group – East Ridge, re-cently designated as Chattanooga’s first Level 2 Patient-Centered Medical Home. She is a Diplomate of the American Board of Family Medicine.

Tennova Healthcare Announces New CEO for Turkey Creek Medical Center

KNOXVILLE—Tennova Healthcare has named Ben Youree as chief executive officer of Turkey Creek Medical Center, effective December 1.

Since 2008, Youree has served in leadership roles at Dyersburg Regional Medi-cal Center in Dyersburg, Tennessee. He joined the hospital as assistant chief executive officer and was subsequently named chief operating officer, ethics and compliance of-ficer in 2010. Promoted to chief executive officer of the hospital in 2012, he has cham-pioned quality, patient-centered care.

During his tenure at Dyersburg Region-al Medical Center, the hospital increased the quality of care as reflected in The Joint Commission “Top Performer Award” in 2011, 2012 and 2013, and full accreditation as a Chest Pain Center this year. Youree also worked to expand services and grow vol-umes including full development of the car-diovascular service line. His recruitment has successfully brought primary and specialist physicians to the Dyersburg community. Hospital enhancements included the addi-tion of a 15-bed medical/surgical unit and exterior renovations.

“Ben is a great fit for the role at Turkey Creek Medical Center,” said Neil Heatherly, chief executive officer of Tennova Health-care. “His strong track record of advancing the care and experience for patients will benefit our health system and the commu-nity.”

Youree earned his Bachelor’s degree at Freed-Hardeman University in Henderson, Tennessee, and his Master’s in business ad-ministration and Master’s in health adminis-tration at The University of Alabama at Bir-mingham.

Tennova Healthcare and MDSave Help Patients Save on Imaging ServicesTransparent pricing, quality ratings and online bookings allow patients to save up to 60 percent on medical services

KNOXVILLE—Tennova Healthcare and MDSave are working together to help lo-cal residents without insurance or with high deductible health plans to save money and better manage their healthcare imaging needs. Through MDSave, patients at Physi-cians Regional Medical Center and Turkey Creek Medical Center can save up to 60 percent on procedures*, including MRIs, X-rays, and CT scans, through transparent pricing, educational resources and simple appointment booking.

“In today’s marketplace, healthcare can be confusing and expensive, especially for consumers who are uninsured or carry high deductible insurance plans,” said Rhonda Maynard, chief financial officer at Physicians Regional Medical Center. “This new service can help patients access the same quality healthcare they have come to expect at our hospitals at a lower cost.”

MDSave offers a combination of edu-cational information, transparent pricing data and quality ratings to give consumers more control over their healthcare decision-making. Consumers with a physician’s order can simply visit MDSave.com or MDSave’s mobile app to determine what service best fits their needs—and at what cost.

For example, an MRI might cost a pa-tient without health insurance $1,000 or more, while a patient with a high deduct-ible plan may pay almost that amount as well. By researching and booking through MDSave, that same patient could receive an MRI at Physicians Regional Medical Center or Turkey Creek Medical Center for less than $500. Similar savings are available for most imaging services, such as X-ray, CT scan, ul-trasound and mammography.

To learn more, visit MDSave.com.*Savings are calculated based on the

MDSave price compared to average market cost of offered medical services.

Premier Surgical Achieves MGMA “Better Performer” Status

KNOXVILLE –The Medical Group Man-agement Association (MGMA) has named Premier Surgical Associates as a “better performer” medical practice. The designa-tion is earned because of Premier’s superior operational performance compared with similar medical group practices nationwide. The recognition is part of the MGMA’s “Per-formance and Practices of Successful Medi-cal Groups: 2014 Report Based on 2013 Data.”

Premier Surgical Associates is classi-fied as a better performer in the area of Ac-counts Receivables and Collections. This is the 9th year Premier has been recognized as a better performer.

“The ‘better performer designation demonstrates Premier Surgical’s commit-ment to administrative performance, which positively affects patients,” said Premier CEO Kevin Burris. “We are pleased Premier is among such a successful assembly of peer medical groups.”

The MGMA report, a benchmarking standard among medical groups for more than a decade, was produced using data from respondents to the MGMA Cost Sur-vey: 2014 Report Based on 2013 Data, as well as data from a questionnaire that as-sessed management behaviors, practices, and procedures of better performers. The report profiles medical practices that have demonstrated success in one or more ar-eas: profitability and cost management; productivity, capacity and staffing; accounts receivable and collections; and patient sat-isfaction.

Ben YoureeErlanger’s Chief Nurse Executive Earns Top Management Credential

CHATTANOOGA – Erlanger Health System Chief Nurse Executive, Jan Keys, DNP, FACHE, recently became a Fellow of the American College of Healthcare Executives, the nation’s foremost professional society for healthcare leaders.

Fellow status represents achievement of the highest standard of professional devel-opment. Only 7,500 healthcare executives hold this distinc-tion, according to the Ameri-can College of Healthcare Executives (ACHE). To ob-tain fellow status, candidates must pass a comprehensive examination, meet academic and experiential criteria, earn continuing education credits, and demonstrate professional and community involvement. ACHE fellows must undergo recertification every three years.

Keys has been Chief Nurse Executive of the Erlanger Health System since 2013. She is a graduate of Dalton State College of Nursing and earned a Bachelor of Science degree and a Master of Science degree in Nursing from State University of West Georgia. She has a Wharton Business School Fellowship from the University of Pennsylvania and has a doctorate degree in nursing practice from the University of Tennessee.

She is a member of several regional, state and national healthcare organizations and has served as a member of the board of directors of several local and state organizations.

“We are extremely proud of Dr. Keys and her achievement of obtaining fellow status in such a prestigious society,” said Kevin M. Spiegel, FACHE, Erlanger President & CEO. “She truly represents the highest standards of healthcare leadership, and we at Erlanger are fortu-nate to have her on our team of professionals.”

Erlanger President & CEO, Kevin M. Spiegel, FACHE, congratulations Chief Nurse Executive Jan Keys, DNP, FACHE, on achieving fellow status with the AmericanCollege of Healthcare Executives.

Independent member of the medical staff

Niswonger Children’s Hospital brings a new specialty to the region. Dr. Valentine T. Nduku

is helping to establish the Tri-Cities’ first pediatric neurosciences program, an important

part of our continuing expansion of specialized services for children. He comes to Johnson

City from Cincinnati Children’s Hospital, recently ranked as the fourth best pediatric

neurosurgery and neurology program in the country.

With the medical direction of Dr. Nduku, Niswonger Children’s Hospital will be able to

provide treatment for a wide range of pediatric neurosurgery needs, including:

www.msha.com/children

New service.

New surgeon.

New program.

• Epilepsy and seizure disorders

• Congenital neurological diseases

• Pediatric head trauma

To learn more about this program, please visit msha.com/pediatricneurosurgery.

East TN Medical News December 2014

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Transcript of East TN Medical News December 2014