East TN Medical News November 2014

Phil W. Jones, MD

PAGE 11

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Enjoying East TennesseeThe Santa Train TraditionMarking the beginning of the holiday season… the CSX train, known as the Santa Train, has become a much anticipated, treasured tradition. Winding through the mountains of Appalachia, its arrival welcomes Christmas ... 3

HEALTHCARE LEADER: Dr. Phillip JacksonHealthcare is indeed a business. Hospital management is a complicated and multi-tiered task ... 8

Special Advertising Milk Protein Hypersensitivity ... 6

Patient Centered Practices ... 10

By CINDy SANDERS

Perhaps it is only appropriate the Centers for Medicare & Medicaid Services is scheduled to an-nounce its highly anticipated coverage decision for low-dose computed tomography (LDCT) lung cancer screening in November. After all, this is offi cially ‘Na-tional Lung Cancer Awareness’ month.

For proponents of using the diagnostic imaging study for early detection, the cost/benefi t analysis is simple … LDCT saves lives in a cost effi cient man-ner among a targeted, high-risk population. Medi-care already covers broad-based screenings for colon, breast and prostate cancers. According to the Ameri-can Cancer Society Cancer Facts & Figures 2014, the combined estimated annual deaths from those three types of cancer is still signifi cantly less than deaths from lung cancer (120,220 vs. 159,260).

One of the most vocal supporters for extending coverage to Medicare benefi ciaries is Ella A. Kazerooni, MD, MS, FACR, as-

sociate chair for Clinical Affairs and division direc-tor for Cardiothoracic Radiology at the University of Michigan. “I fi rmly believe that screening for lung cancer with CT saves lives,” she stated. An expert in the fi eld, Kazerooni’s long list of credentials includes serving as a trustee on the American Board of Ra-diology, chair of thoracic imaging for the American College of Radiology’s Commission on Body Imag-ing, chair of ACR’s Committee on Lung Cancer Screening, vice chair of the National Comprehensive Cancer Network’s Lung Cancer Screening Panel, and past president of the American Roentgen Ray Society.

“Medicare received two formal requests for a national coverage decision,” she explained of actions taken earlier this year precipitating the CMS deter-

mination. “They statutorily have until Nov. 10 to post their draft coverage decision,” Kazerooni continued, noting a fi nal decision was expected in February 2015 following a comment period.

(CONTINUED ON PAGE 12)

FOCUS TOPICS HEALTH EDUCATION RADIOLOGY & IMAGING

East Tennessee Children’s Hospital Pediatric Gastroenterology, Hepatology & Nutrition Services

GI for Kids, PLLC865-546-3998 | www.giforkids.com

The Case for Covering Low-Dose CT Lung Cancer ScreeningProponents cite ROI of early detection, reduced mortality

Dr. Ella A. Kazerooni

By CINDy SANDERS

A little more than a year ago, the American Medical Association an-nounced $11 million in grants to 11 academic medical centers to fundamentally change the way physicians are educated and trained.

“There has been a universal call to transform the teaching of medicine to shift the focus of education toward real-world practice and competency as-sessment, which is why the AMA launched the Accelerating Change in Medi-cal Education initiative,” AMA President Robert M. Wah said in a statement. “Over the last year, we have made signifi cant progress in transforming cur-riculum at these medical schools that can and will help close the gaps that cur-rently exist between how medical students are trained and the way healthcare is delivered in this country now and in the future.”

In late September, a consortium of thought leaders from the 11 academic

The Transformation of Med EdAMA continues quest to accelerate change in physician training

(CONTINUED ON PAGE 6)Dr. Susan Skochelak at the podium addressing the consortium meeting at Vanderbilt.

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

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

Marking the beginning of the holiday season… the CSX train, known as the Santa Train, has become a much antici-pated, treasured tradition. Winding through the mountains of Appalachia, its arrival wel-comes Christmas.

These words are from the first page of my children’s book entitled The Santa Train Tradition. Although a fictitious fam-ily is incorporated in the book, theirs is the true story of what many families in our re-gion have been enjoying for over 70 years.

In fact, the Santa Train makes its an-nual trek through the Appalachian Moun-tains each year on the Saturday before Thanksgiving. Traveling 110 miles from Shelby, KY, to Kingsport, TN, and making 14 stops, at names including Marrowbone, Toms Bottom, St. Paul, and others, fami-lies gather to welcome Santa and usher in the holidays. The Santa Train has become known as the “world’s largest” Santa pa-rade!”

When I first rode the Santa Train as a journalist, I wrote an article, which was published in US Airways Magazine. It cov-ered the basic who, what, where, when, and why of the event, but when I got off the train and talked with the people gathered, I knew the Santa Train was much more than an article. It is a tradition!

My little, hardback children’s book The Santa Train Tradition (Word of Mouth Press 2008) captures much of the nostalgia and what was shared with me by families who have gathered with their par-ents, grandparents, and now their own chil-dren to experience the hope and joy of the Santa Train.

Illustrator Carol Bates Murray of Mar-ion, VA, has beautifully illustrated the book, and it is the eighth published book she has illustrated. In the classic fashion, each page

is actually an individual watercolor paint-ing. You can feel the chill in the air, smell the coffee and hot chocolate, and sense the impending excitement. When I visit schools, I delight in sharing Murray’s talent and showing students the actual paintings, which create feelings and stimulate imagi-nations even before we read the first word.

My presentations to civic and profes-sional organizations center on the impor-tance of reading—especially reading aloud and connecting children to literacy and the region. By reading books that also allow them to go see and experience the adven-ture, reading is enjoyed on an even more personal level.

The Santa Train is a program of the Kingsport Area Chamber of Commerce, and it is also sponsored by CSX, Food City, and Dignity U Wear. Originating in 1943, the Santa Train provided a way for the business community to thank the surround-ing region for their patronage in Kingsport.

Many became aware of the Santa Train when the late Charles Kuralt rode in 1982 for an infamous “On the Road” fea-ture, which brought international attention

to the train. Today, the Santa Train travels with

over 15 tons of donated gifts, toys, candies, and clothing.

Although Santa used to toss hard candy from the train to those gathered along the railroad, safety precautions now prohibit this, and all items are tossed from the back of the Santa Train at designated stops.

“We receive a wide variety of dona-tions,” explained Amy Margaret Allen, Marketing Director-Kingsport Convention and Visitors Bureau. “Everything from fi-nancial contributions, to toys purchased from stores, and even handmade items [are on the train.] Knitted scarves, hats, and gloves are often sent from church groups and individuals who have a talent and want to share their gifts with the children of Ap-palachia.”

Allen adds one of her personal favorite gifts one year was from a group that drove to Kingsport, TN, from Indiana to bring stuffed bears for the Santa Train. According to Allen, each bear was wearing a person-ally knitted sweater and scarf.

“It is so special when people take the

time to hand deliver their donations to the chamber,” said Allen. “We’re able to put the faces with the gifts, and I think that is one of the most touching parts of receiving and coordinating the donations.”

Although very few individuals actually are able to ride the Santa Train, which is due to safety reasons, there are many volun-teer opportunities to become involved with the Santa Train.

“Just because you can’t ride the train does not mean you can’t be part of the train,” explained Allen. “The packing night at Food City is always a great way for peo-ple to be able to volunteer and have their hand in the Santa Train experience.”

As one of the annual sponsors of the Santa Train, Food City hosts the packing night on Wednesday at the Eastman Road store location in Kingsport before the train runs on Saturday. Volunteers are always needed for this.

When my book was going through the publishing process, just like the Santa Train, I wanted it to also benefit others. Food City came on board, and for the first three years, the book was sold in their grocery stores in three states along the route of the train.

The goal was for a portion of the pro-ceeds to be donated to the Santa Train Scholarship, which is awarded annually to a graduating high school senior along the route. However, Food City donated 100 percent of the proceeds, and, to date, over $10,000 has been donated to the scholarship from the sale of “The Santa Train Tradition” in their stores. A portion of sales also benefits the Lit-eracy Council of Kingsport, Inc.

Celebrity guests have also become synonymous with the Santa Train experi-ence, and many have ridden more than once. Over the years, names including Naomi and Wynonna Judd, Alison Krauss, Thompson Square, Patty Loveless, who has written a song about the Santa Train, Kathy Mattea, and Kree Harrison of Amer-ican Idol have ridden the train. This year, six-time Grammy-winner Amy Grant will be on board.

The Santa Train always runs on the Saturday before Thanksgiving. This year, Saturday November 22, 2014, marks the 72nd running of the annual Santa Train.

“Everybody coming together to donate for such a great cause is heartwarming,” said Allen. “And, actually getting to see it into fruition is definitely my favorite part.”

For more information about the Santa Train, visit http://www.teamsantatrain.org/ or https://www.facebook.com/santa-train and to order “The Santa Train Tra-dition,” visit www.wordofmouthpress.us or www.thesantatraintradition.com

Enjoying East TennesseeThe Santa Train Tradition

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This concert is funded under an agreement with the Tennessee Arts Commission and the National Endowment for the Arts.

Free bus service: 6:15 (Colonial Hill); 6:30 (Maplecrest & Appalachian Christian Village); 6:45 (City Hall)

Tickets: $35; Seniors (65+) $30; Students $10For more information: 92-MUSIC (926-8742) or

visit www.jcsymphony.com

Home for the Holidaysfeaturing City Youth Ballet of Johnson City

Saturday, December 13, 7:30 p.m.

Mary B. Martin Auditorium at Seeger Chapel, Milligan College

sponsored by BedInABox

The City Youth Ballet is a chartered, not-for-profit per-formance organization offering an extensive repertoire of classical and contemporary ballet performances for the general public and school groups throughout the year. The CYB provides high quality performances of classi-cal ballets and contemporary and lesser known ballets. Original, commissioned works are also part of the CYB’s repertoire. Under the direction of Susan Pace-White, the City Youth Ballet will join the Johnson City Sym-phony Orchestra in performance of “The Polar Express” Concert Suite composed by Alan Silvestri and Glen Ballard. The program will also include holiday-related music from Victor Herbert, Mel Tormé, George Fredrich Handel, John Finnegan, Adolphe Adam, Walter Kent and Kim Gannon, and Nicolai Rimsky-Korsakov.

By CINDy SANDERS

With 8.7 percent of residents suffer-ing from chronic obstructive pulmonary disease, Tennessee has one of the high-est rates of COPD in the country. During November, National COPD Awareness Month, it seemed appropriate to share data and insights into the third leading cause of death in the United States and in Tennessee.

Unlike most major illnesses, chronic lower respiratory diseases have actually increased in frequency over the past three decades, and the numbers rise even higher when factoring in those who are misdi-agnosed or underdiag-nosed. Currently, close to 15 million Americans are living with known COPD. However, Jamie Sullivan, senior direc-tor of Public Policy and Outcomes for the COPD Foundation, noted, “The NIH estimates there are about 12 million nationally who have COPD symptoms but haven’t received a diagnosis.”

Sullivan continued, “There tend to be more women who are misdiagnosed than men.” Compounding the issue,

COPD tends to affect women dispropor-tionately with a national average of 6.7 percent having COPD compared to 5.2 percent of men. “That disparity between men and women is actually worse in Ten-nessee than in the nation.” Sullivan said data from the Behavioral Risk Factor Sur-veillance System shows the COPD rate for women in Tennessee is 11.7 percent compared to 6.7 percent for men.

The Volunteer State, she added, has the third highest rate of COPD overall in the country at 8.7 percent compared to the national average of 6.3 percent. Ten-nessee trails only Kentucky and Alabama in prevalence.

Deb McGowan, senior director of Health Outcomes for the COPD Foundation, noted the reasons behind Tennessee’s higher rates are multifactorial includ-ing environmental issues and smoking rates in the South. Although Tennes-see has made signifi cant strides in sharing smok-ing cessation strategies, nearly a quarter of the state’s adult men (24.7 percent) and one-fi fth of the state’s adult women (19.7 percent) still smoke.

While there can be a genetic compo-

nent to COPD, McGowan said smoking leads the way as a key contributor to the chronic illness. A quarter of those with COPD have never smoked with the condi-tion likely linked to genetics, occupational and environmental pollutants, leaving the other 75 percent related to smoking.

Sullivan added, “Defi nitely exposure to tobacco is the main risk factor, but it’s not just current smokers who are at risk, it’s people who had a history of smoking.” She noted these are individuals who fol-lowed the recommendations and quit smoking but 10-15 years later begin to have trouble with their breathing.

The COPD Foundation embarked on a listening tour this past summer and spent time in East Tennessee to learn more about the incidence rates for COPD. Sul-livan said one thing they heard over and over again was the air quality in the val-ley exacerbated asthma and the ability to breathe easily. The problem isn’t limited to the eastern part of the state, however. The Asthma and Allergy Foundation of America routinely includes Tennessee’s largest cities in its annual list of “Most Challenging Places to Live with Asthma.” In 2014, Memphis ranked second, Chatta-nooga sixth, Nashville 38th and Knoxville 41st.

In addition to smoking history and en-vironment, Sullivan said other risk factors include a history of asthma, early nutrition and prenatal events, early childhood infec-tions, age, and socio-demographic status. She noted nearly one in fi ve adults with annual incomes under $15,000 (19 per-

cent) have COPD.As with most chronic diseases and

conditions, early detection, intervention and education improve quality of life and reduce healthcare costs and economic burden. McGowan said providers could help by being more aware of COPD when taking a patient’s personal history. Instead of asking if someone smokes, McGowan urges physicians and nurses to ask if an individual has ever smoked. “Around 100 cigarettes lifetime is where you start think-ing differently,” she said of risk factors for COPD. Additionally, McGowan said pro-viders should be attuned to any respira-tory symptoms that seem to be ongoing.

“We don’t have to have a patient hit the hospital before we test them,” she noted of diagnosing COPD. “You do that through spirometry testing. It’s a simple breathing measure and can be done in a primary care offi ce.”

Although billable, McGowan said most outpatient clinics and practices are not aggressively utilizing the test to screen appropriate patients with symptoms. Many practices don’t have spirometers … or if they do, too often the equipment is sitting on a shelf collecting dust. Yet, she noted, getting that early diagnosis is critical to properly educating and treating patients. She added a number of studies have shown “patients who are uneducated and not activated in their care are twice as likely to be admitted to the hospital.”

Unfortunately, she continued, “We fi nd a lot of patients don’t even know how to use their inhalers correctly. Not all in-halers work the same.” She added patients should call their doctor if they aren’t get-ting relief from their inhaler, have a fever, stronger cough, more productive cough, or noticeable discoloration in mucus. “All those signs and symptoms indicate you’re heading down the wrong path.”

McGowan said a common, easy way for patients to think about COPD is to use the ‘green, yellow, red light’ ap-proach. The green light, she explained, is no change in what a patient is able to do. A yellow light means a patient is showing some symptoms and signs and should call a doctor. The red light means nothing is working, and the patient should proceed directly to the ER. “It’s more about taking care of yourself and being aware of your body every day,” she said of managing COPD.

Sullivan added, “We do have re-sources that are designed for healthcare providers. We also have resources they can use with their patients.” The Pocket Consultant Guide (PCG) even has an app attached to it for information on the go. Physicians could also join a moderated online community with discussion about particularly diffi cult cases and various treatment options. Additionally, there is a quarterly digital magazine tailored to providers. To sign up for the magazine or access other resources, go online to copd-foundation.org.

Short of BreathCOPD Foundation Sheds Light on State’s High Rate of Progressive Lung Disease

Jamie Sullivan

Deb McGowan

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LegalMatters

Profit and Loss: The Top Ten Things Providers Need to KnowPart VII: State Board Investigations and Inspections

BY JENNIFER PEARSON TAYLOR AND ERIN B. WILLIAMS, LONDON & AMBURN, P.C.

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

Failure to appropriately respond when facing a Board investigation or inspection can have a serious financial impact on a medical practice. Board investigations can be time-consuming and costly. In addition to any potential monetary penalties, providers may also be at risk for disciplinary action, including a suspended or revoked

What control do the Tennessee Health Related Boards have over healthcare providers?

The Board is charged with licensing and regulating all physicians in Tennessee. As a part of this duty, the Board, through the Division of Health Related Board’s Department of Investigations, investigates all complaints filed against Tennessee physicians.

If I do not commit criminal or grossly negligent acts, will I ever be subject to discipline by the Board?

While it is understood that the Tennessee Board of Medical Examiners can sanction a physician for fraud, gross malpractice, false advertising, criminal convictions and the like, many underestimate the Board’s ability to sanction a physician for less egregious, unprofessional conduct. Thus, a multitude of issues can serve as the impetus for investigation by the Health Related Boards. For example, in the last six months, Tennessee physicians have been sanctioned for unprofessional conduct for failing to:

• Formulate a written treatment plan;

•Maintain adequate and accurate medical records;

•Document all prescribed medications for patients;

•Complete, sign, and medically certify death certificates in a timely manner;

•Remain in Board ordered treatment for drug addiction;

•Correct a misrepresentation on a licensure renewal application; and

•Comply with a lawful request for medical records.

What does a complaint

investigation by the Board mean to my practice?

The defense of a complaint before the Board begins with participation during the investigation. Such investigations, which are sometimes but not always covered by insurance, can significantly impact the provider’s practice, consuming the provider’s time and expending costs for attorneys’ fees. Complaints deemed meritorious can lead to formal Board proceedings against the provider in which a wide-range of sanctions can be imposed, including licensure suspension or revocation. The Board has discretion to discipline the above by imposing any of the following sanctions:

• Private or public censure or reprimand

• Probation• Licensure suspension•Revocation with leave to reapply• Permanent licensure revocation•Monetary penalty up to $1,000

per statutory violation

Can my controlled substance prescribing practices lead to a Board investigation?

The Tennessee Health Related Boards Office of Investigation added five new investigative positions to assist with excessive prescribing complaints and pain management clinic investigations and surveys (1). Providers prescribing controlled substances as part of their regular practice should be aware that a Board investigation may begin based solely upon the data contained in the Controlled Substance Monitoring Database (CSMD). The CSMD Committee has a duty to examine information on the CSMD to identify unusual patterns of prescribing and dispensing of controlled substances. If the Committee determines that the provider has an unusual pattern of dispensing high amounts of controlled substances or may have otherwise committed a violation of the law, the Committee will refer the provider to the appropriate licensure Board for an investigation.

A Board investigation may also begin through a report from the Tennessee Department of Health. The Tennessee Department of Health is now required to identify the top 50 prescribers of controlled substances by July 31 of each year. The provider will

have an opportunity to demonstrate the amounts prescribed were justified and medically necessary. However, if the Department still has concerns regarding the provider’s prescribing, the provider may be referred to the Board to initiate an investigation. Additionally, anything sent in response to the “top 50” letter will be maintained by the Department for 5 years and may be used by Board investigators at any time for disciplinary action.

What are Board inspections of a pain management clinic?

The Rules of the Tennessee Department of Health Division of Pain Management Clinics permit Board representatives access to the pain management clinic and the records contained therein for an inspection of the clinic. The Board investigator may look at the clinic’s policies and

procedures to determine compliance with the laws, rules and regulations, or may request patient medical records to assess the prescribing practices. The Board has already begun these inspections, which are performed at random and without prior warning to the pain management clinic. Providers practicing at pain management clinics should be sure to have their compliance policies and procedures in place and up-to-date to avoid any Board disciplinary actions or penalties following an inspection.

Notes

1. Controlled Substance Monitoring Database Advisory Committee Meeting Minutes (8-21-12), available at https://health.state.tn.us.

Attorneys Jennifer Pearson Taylor and Erin B. Williams focus their practice on healthcare compliance and regulatory matters. For more information on any health law or compliance matters, you may contact Ms. Taylor or Ms. Williams 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.


Milk Protein Hypersensitivity

GI for Kids, PLLC

M. SAMAR AMMAR, MD

Milk protein hypersensitivity or allergy is a diagnosis often used in conjunction with breast milk, cow’s milk or soy milk to describe groups of symptoms seen in pediatric patients, including infants. The protein in milk triggers such hypersensitivity. It is not IgE mediated, and lack of specifi c suggestive symptoms, along with absence of sensitive diagnostic testing, adds complexity to such diagnosis. The intensity of milk protein hypersensitivity or allergy may vary from mild to severe.

Cow’s milk-sensitive enteropathy was the fi rst recognized food allergic enteropathy and remains the most common one. Associated clinical features may include colic, gastroesophageal refl ux, vomiting, failure to thrive, rectal bleeding, or extragastrointestinal manifestations including eczema. Up to 40 % of infants with classic cow’s milk-sensitive enteropathy are also sensitized to soy, often after an initial period when it is tolerated.

Food protein-induced enterocolitis syndrome is a severe and sometimes life-threatening form of mucosal food hypersensitivity. Although usually triggered by cow’s milk or soy ingestion, food protein-induced enterocolitis syndrome may be induced by a verity of foods, including rice, oat, barley, vegetables and poultry. Milder symptoms can be seen in breast-fed infants, triggered by milk protein in the mother’s diet. Most cases show negative skin-prick tests. The infant usually presents with severe vomiting and diarrhea, requiring emergency admission to the hospital. Some demonstrate melena and passage of mucus per rectum, and may even undergo a laparotomy if the diagnosis is not recognized.

Food-induced proctocolitis usually occurs in the fi rst few weeks or months of life and is most often secondary to cow’s milk or soy protein hypersensitivity. Infants usually have occult or gross blood in their stools with or without mucous stool or diarrhea. Aside from occasional apparent pain on defecation, and eczema in a few cases, infants with food-induced proctocolitis generally appear healthy and

have normal weight gain. Proctocolitis related to cow’s milk protein allergy may also occur in exclusively breast-fed infants because of sensitization to cow’s milk protein entering into the mother’s milk. Sensitization to other trophallergens via mother’s milk, such as egg, fi sh or peanuts, is also possible.

Based on clinical presentation, work up is indicated to rule out other potential medical and surgical conditions. Referral is warranted to establish diagnostic and treatment plan.

Although the classic milk protein hypersensitivity or allergy is usually self-limiting, rational treatment must be based on clinical presentation and a correct diagnosis. Whenever treatment is indicated, infants with milk protein hypersensitivity should be fed a substitute hypoallergenic formula. Because breast milk is an optimal source of nutrition for infants through the fi rst year of life, maternal diet restrictions should be attempted to alleviate symptoms of infants with milk protein allergy whenever treatment is justifi ed prior to hypoallergenic formula use. Health care providers should be cautious about the introduction of dietary food other than breast milk or hypoallergenic formula to infants with cow’s milk protein hypersensitivity.

Once a change is made, whether through hypoallergenic formula use, or maternal diet restrictions, symptomatic improvement is expected within one to two weeks. That by itself may validate the presumed diagnosis. On the other hand, lack of improvement should trigger more thinking about potential underlying cause of the infant’s presentation.

The vast majority of infants with milk protein hypersensitivity are expected to outgrow their intolerance, whereas a handful of them may carry on their hypersensitivity into childhood. These may manifest different

forms of food allergy.The family of an infant with milk protein hypersensitivity

needs support at different levels. It is very stressful to deal with fussy infants. At GI for kids, we have appropriate staffi ng to intervene and provide support as needed.

www.giforkids.com (865) 546-3998

The vast majority of infants with milk protein hypersensitivity are expected to outgrow their intolerance, whereas a handful of them may carry on their hypersensitivity into childhood. These may manifest different

forms of food allergy.

PAID ADVERTISEMENT

centers convened on the campus of Vanderbilt University School of Medicine in Nashville to discuss progress and barriers in implementing individual projects, offer insights and innovations, give and receive feedback on the conceptual model for the master adaptive learner, and share other lessons learned in the fi rst year. Much of the meeting’s focus was centered on the master adaptive learner (MAL), which is the AMA consortium’s term for an expert, self-directed, self-regulated, lifelong workplace learner. Developing this type of skill is considered critical to prepare physicians for careers in a healthcare environment that is constantly changing and evolving.

During the two-day event, Susan Skochelak, MD, MPH, group vice presi-dent of Medical Education for the AMA,

and Bonnie Miller, MD, senior associate dean for Health Sciences Education and associate vice chancellor for Health Affairs at Vanderbilt, hosted a media roundtable to discuss the transformative initiative.

Skochelak said it makes sense for the AMA to be at the forefront of such an am-bitious project. Upon being founded in 1847, the physician’s organization under-took two major tasks — to write the fi rst code of professional ethics and to set the standards for medical education.

She added the AMA again took a lead role 100 years ago when there was a major movement to change medical edu-cation. Skochelak said the AMA published the standards of what medical education should look like and that became the basis for the Flexner Report.

“The Flexner Report really changed medical education to say it has to be sci-ence-based, and it has to be connected with knowledge generation,” she ex-plained. “It made a great leap forward in the quality of medical education. But here we are a century later, and our format for training physicians remains almost iden-tical to the structure that we described a hundred years ago.”

Skochelak added, “It’s not that the training is broken, it’s just that it hasn’t kept up with what’s going on in healthcare delivery today.”

She said the work being done as part of the Accelerating Change in Medical Education initiative is built on recommen-

dations for change that have been well accepted for more than a decade by the medical education community. “We’re working in a great sense of consensus,” Skochelak noted. However, the fact that there has been broad agreement but little change points to impediments that must be addressed. “If it was easy, it would have already been done.”

To address the barriers and make it possible to move forward, Skochelak said, “The AMA wanted to provide resources and leadership to schools that are really ready to make the change.” That decision led to the grant program now in place for the 11 lead schools in the initiative.

In choosing the academic medical centers, Skochelak said the AMA was looked for programs that concentrated on key areas, including:

• Getting students into the real world environment early on so they understand healthcare systems in a way that isn’t cur-rently happening;

• Emphasizing important core con-cepts in medical school education like team-based care, patient safety and out-comes, patient-centered approaches to care, and population management; and

• Changing the way students progress through the educational system to provide more fl exibility and individualized learn-ing.

Miller, a general surgeon by train-ing, has been involved in shaping medi-cal education at Vanderbilt for more than

15 years in an offi cial capacity and even longer as a faculty member. She noted Vanderbilt had already undergone a major transformation to their traditional curriculum from 2004-2007. Yet, she added, it became clear that even more needed to be done to support continuous learning throughout a career.

“We came to the conclusion that in order to do that you really did have to start at the beginning … that we couldn’t put our learners through our programs as usual and then expect magically at the end of their training they would be expert lifelong learners if we didn’t start to build those habits from the start,” Miller said of the decision to rework Vanderbilt’s pro-gramming for a second time.

“Curriculum revision is hard work,” she continued. “It’s not just a matter of de-veloping new lesson plans. It really is a lot about culture change. We really felt that it was important to go back to the drawing board and start something new right away.”

Miller continued, “One of the things we thought a lot about was the context of learning. We felt that all learners need to work so that you’re really rapidly applying what you’re learning in the workplace … and that all workers need to learn.”

That mantra became a foundational principle of Vanderbilt’s Curriculum 2.0. Miller added other tenets of the program-ming was that it should be team-based, interprofessional, modular to allow for dif-

The Transformation of Med Ed, continued from page 1

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Greg Gilbert 862.862.6500 (direct) / [email protected] Partner – Tax Services & Managing Partner of Knoxville Office

As managing partner for the Knoxville office Greg works closely with a variety of industries including physician practices, law firms, other professional services, automobile dealerships, construction, manufacturing, and not-for-profit organizations. He provides estate, corporate, limited liability entity, and individual tax planning services. He has spent his entire professional career in the public accounting sector and enjoys sharing his talents by serving on various boards and committees including the finance committee at the Helen Ross McNabb Foundation, the East TN Historical Society and the 1956 Society at UT Medical Center. Outside of the office, you are likely to find Greg on the golf course enjoying time with long-time clients who are now friends or his son Gregory.

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Snapshot of Grant ProjectsIndiana University School of Medicine is working to create a virtual health care system (vHS) and a teaching electronic medical

record (tEMR) to teach clinical decision-making and ensure competencies in system, team, and population-based healthcare skills. Mayo Medical School is creating an innovative educational model based on the science of healthcare delivery to prepare

students to practice within patient-centered, community-oriented, science-driven collaborative care teams to deliver high-value care. The curriculum’s experiential learning program focuses on how interprofessional teams, patients, communities, public health resources and healthcare delivery systems impact care, outcomes and cost.

NYU School of Medicine is launching the NYU by the Numbers Curriculum, which is a flexible three-year, individualized, technology-enabled blended curriculum to improve care coordination and quality improvement.

Oregon Health & Science University School of Medicine is implementing a learner-centered, competency-based curriculum that enables medical students to advance through individualized learning plans as they meet pre-determined milestones. A portfolio-based system will track milestone achievement and clinical experiences, allowing some students to complete medical school in less than four years.

Penn State College of Medicine has collaborated with Penn State Hershey Health System leaders to design educational experiences that align medical education with health system needs. The Systems Navigation Curriculum (SyNC) prepares students to work throughout the continuum of care. During school, students are embedded in clinical sites across central Pennsylvania as patient navigators to help them better understand patient and health system issues.

The Brody School of Medicine at East Carolina University is implementing a new core curriculum in patient safety for all medical students that features integration with other health-related disciplines to foster interprofessional skills to prepare students to lead healthcare teams for a systems-based approach.

The Warren Alpert Medical School of Brown University is establishing a dual MD/MS degree program to create a new type of physician leader with expertise in population health. The master’s degree program, which includes nine courses, emphasizes teamwork and leadership, population science and behavioral and social medicine and includes two courses being introduced to all students on health disparities and epidemiology/biostatistics.

University of California, Davis School of Medicine is working in partnership with Kaiser Permanente and UC Davis’ residency program to create a three-year medical school pathway called the Accelerated Competency-based Education in Primary Care (ACE-PC). Those enrolled in ACE-PC will simultaneously be considered for acceptance into local primary care residencies.

University of California, San Francisco School of Medicine is crafting the three-phase UCSF Bridges Curriculum, which seeks to create physicians who learn to work expertly in interprofessional teams to continuously improve the safety, quality and value of healthcare.

University of Michigan Medical School’s innovative curriculum includes a two-year foundational “trunk” consisting of integrated scientific and clinical experiences followed by flexible professional development “branches,” which are development tracks to cultivate advanced skill sets within clinical domains at a student’s own pace.

Vanderbilt University School of Medicine has launched Curriculum 2.0 to create master adaptive learners who are embedded in the healthcare workplace during their undergraduate medical education. Students will also use their own competency-based performance data to complete self-assessments and devise individualized objectives to hone self-directed learning skills.

ferent entry and exit points, and include new content areas to help students under-stand the context of healthcare delivery, as well as what is happening on a molecular and genetic basis. The new curriculum rolled out last year with the incoming class of 2013.

During the recent consortium meet-ing, Vanderbilt and other participants shared their progress and discussed barri-ers to change. Skochelak said that unlike a research grant, where a recipient is given money and works on an individual project, the AMA initiative was designed to pool in-formation and work in collaboration.

“We told the schools if you receive grant monies, you will be part of a consor-tium of schools. Right from the beginning we’ll work together, and we’re going to share ideas because we want your projects to benefit from each other … and our ul-timate goal is to share this with all of the schools,” Skochelak said.

Over the next four years, the AMA will continue to track, gather data and report on the progress of the 11 medical schools and their collective work in order to identify and broadly disseminate best practices to retool medical educational models across the country. Skochelak added the lessons learned would be shared with institutions educating other health professionals, as well.

The Transformation, continued from page 6


HealthcareLeader

Dr. Phillip JacksonBy JOHN SEWELL

Healthcare is indeed a business. Hos-pital management is a complicated and multi-tiered task that integrates account-ing, human resources, policy, strategizing, public relations—and the dreaded num-bers crunching to make it all come out in the black. Still, hospital management involves people: people in trauma, people who are undergoing some of the most cru-cial and dramatic points in their lives. As such, an effective healthcare manager is ever-aware of the human factor. The job requires a deeply ingrained sense of ser-vice, honor and commitment.

For Dr. Phillip Jackson, newly ap-pointed (as of September, 2014) Vice President and CEO for Erlanger East and Erlanger North hospitals, healthcare man-agement is a calling—the culmination of a life of service. Jackson began his health-care career in the military around 35 years ago. Since then, the tireless administrator has acquired a number of degrees and cer-tifi cates while ascending through the ranks of several healthcare organizations in both public and private sectors. Throughout his career, Jackson remains aware of the onus of service that the job entails.

“For me, the primary element of my job is this idea of service—that’s just the most important thing,” says Jackson. “When I joined the military in 1978, I im-mediately got into healthcare. And from there I progressed: I got promoted, I went

to college, and I learned on the job. My passion for healthcare has been there from the get-go. Service has just always been a part of who I am. The service has been very, very personal to me. It’s been [and continues to be] my foundation.”

Jackson’s newly acquired position at Erlanger is not just the endpoint of a series of promotions. Jackson says that his life is an ongoing process of education and per-sonal reassessment.

Sure, Jackson is in healthcare and has the appellation of doctor—but he’s not a physician per se. Jackson has a doctor-ate degree, which is no small feat in itself. Among his many titles, Jackson holds a DSL (Doctor of Strategic Leadership)

and is a Fellow of the American College of Healthcare Executives. With these titles and an ongoing commitment to self-improvement, Jackson continues to hone his craft—always mindful that his primary commitment is to the patients and com-munity he serves.

“The new position at Erlanger is going really well,” enthuses Jackson. “I’m in the process of learning Chattanooga’s healthcare landscape, meeting people from the community and local offi cials, and being involved with the hospital’s ex-pansion.”

Jackson, who came to Erlanger from Memphis, says that his transition has been smooth.

“So far I feel like I’m prepared for the job,” explains Jackson. “When I was liv-ing in Memphis is would come here [to Chattanooga] a lot and I’ve had a good relationship with the CEO of this health system for quite a long time. So the new job doesn’t seem that different thu s far. Before I came here I had a sense of what my marching orders would be, so to speak.” (Once a military man, always a military man.)

“Just dealing with the changed land-scape of laws and regulations is a big chal-lenge that we continue to grapple with here at Erlanger,” Jackson continues. “It’s amazing how much things have changed in my career, especially in terms of the technology. And I’m always gaining an awareness of how big the industry is—and

how much of the GNP that the health-care sector consumes. So I’m just trying to reach out and meet the local offi cials and let people know who I am.”

Jackson says that his present task is to assist in the ongoing expansion of Erlanger East Hospital. He is also excited about the continued expansion of Erlanger’s Sports Medicine Institution.

“We just had our certifi cate of Need extended,” explains Jackson. “So we’re in the process of building a four-story service tower which includes a lot of additional beds and new operation tables.”

Jackson’s transition from Memphis to Chattanooga has run smoothly—but the transition is being deployed in stages, again with military precision. Jackson’s wife Hyung, a retired military offi cer, has remained in Memphis while their daugh-ter, Jessica, fi nishes high school this year. After that, Hyung will make the move to Chattanooga. An older daughter, Sarah, attends college where she is a pre-med student.

In the rare instances when Jackson has a moment to himself, he continues his quest of self-improvement through education.

“I don’t know if you’d call it a hobby, but I’m a lifelong learner,” explains Jack-son. “It’s an ongoing process. I’ve spent time in higher education, both studying and teaching in Christian institutions. It’s because I have this passion for learn-ing and education—trying to help other people succeed in life. Education is so fun-damentally important to what I do. I’ve taught at other institutions, and I intend to resume teaching at a university at a Mas-ter’s level once I get better established here in Chattanooga.”

For Jackson, healthcare administra-tion is much more than just a job. It is an essential part of his very being. And this entails a deeply-rooted sense of responsi-bility and commitment to the community.

Asked what advice he would have for anyone seeking to follow his career path, Jackson is characteristically humble.

“I think my advice would be to work hard, believe in yourself and always do what’s right. And that requires a lot of focus. But it all connects back with what I learned from the military, those ideas of service, honor and commitment that run so deep.”

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While some doctors or plastic surgeons are qualifi ed to perform cosmetic eyelid surgery, you’ll probably agree that it’s best to choose an ophthalmic plastic surgeon like Dr. Jeff Carlsen, Johnson City Eye Clinic. The Tri-Cities only fellowship-

trained oculoplastic surgeon specializing in cosmetic eyelid surgery, Dr. Carlsen

has had extensive training and his expertise in eyelid surgery is second to none. Many types of physicians perform eyelid surgery, including dermatologists, general plastic surgeons, ear nose and throat surgeons, even oral surgeons. When choosing someone to perform surgery on the delicate area around your eyes, fi nding a surgeon with Dr. Carlsen’s unique expertise just makes sense.

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Considering Eyelid or Brow Surgery?

*Actual Patients



By JOE MORRIS

Advancements in pediatric medicine

mean that there are more treatments

for childhood illnesses and conditions

now than ever before. But often people in East

Tennessee had to travel to Knoxville, Nashville,

Atlanta or even Cincinnati to see specialists.

That began to change with the advent of

Niswonger Children’s Hospital, and now even

more specialized services are available here

at home with the addition of Dr. Valentine T.

Nduku, who will head up the hospital’s new

pediatric neurosciences program.

“Not only have we found a high quality

doctor, but we recruited him from one of

the best pediatric neuroscience programs

in the nation,” said Steven Godbold, CEO

of Niswonger Children’s Hospital. “This is a

huge win for families in the Tri-Cities, and I’m

proud that Niswonger and Mountain States

Health Alliance have made this a priority. I

also want to thank the physicians associated

with East Tennessee Brain & Spine Center.

Their devotion to quality and partnership is

going to help make our region a leader in the

neurosciences.”

The program is a joint partnership between

Niswonger Children’s Hospital, Mountain

States Health Alliance, and East Tennessee

Brain & Spine Center. Dr. Nduku is the first

pediatric neurosurgeon in the region, treating

a variety of conditions, including epilepsy and

seizure disorders, congenital neurological

diseases, and pediatric head trauma.

The opportunity to build a program from

the ground up was one of the major draws

from Dr. Nduku, who recently finished his

specialized fellowship training at Cincinnati

Children’s Hospital. He also liked the idea of

bringing specialized pediatric neurosurgery

services to an area where there were none.

“I like to make an impact in the

community where I am working, and I liked

what I saw here in the adult neurosurgical

community,” Dr. Nduku said. “But no pediatric

neurosurgeon meant that patients were having

to travel an hour and a half, or even more,

to see a doctor. That is really what drove

my commitment to come here and provide

services.

Before his time in Cincinnati, Dr. Nduku

graduated from Georgia State University with

a Bachelor of Science degree in biology and

chemistry, and then completed his Doctor

of Osteopathic Medicine training at the

Virginia College of Osteopathic Medicine. He

completed his internship at Michigan State

University and his residency in osteopathic

medicine at the Philadelphia College of

Osteopathic Medicine. Dr. Nduku is a member

of the American Medical Association and the

American College of Osteopathic Surgeons –

Neurosurgery.

His training at the Cincinnati Children’s

Hospital means that Dr. Nduku spent time at

a facility ranked as fourth best in the nation

by US News and World Report. His arrival at

Niswonger further cements ties between the

two hospitals, and it’s worth noting that in

addition to its relationship with Cincinnati

Children’s, Niswonger is one of only six

children’s hospitals in the United States to be

affiliated with St. Jude Children’s Research

Hospital in Memphis.

That kind of high-profile commitment to

advancing pediatric care means that Dr. Nduku

has been able to hit the ground running, much

to the relief of children and parents who now

can keep to a normal schedule while receiving

the most comprehensive care possible.

“Patients are very, very appreciative of the

fact that I am here, and that the program is

developing,” Dr. Nduku said. “Now they can

stay home, but still see a surgeon who can

help them. That means no taking off several

days from school and work for traveling back

and forth, but just focusing on getting the care

itself.”

As the neuroscience program ramps up,

Dr. Nduku says he looks forward to expanding

on the surgeries he now performs so that more

and more pediatric patients can receive their

full spectrum of care at Niswonger. And in the

meantime, he plans to oversee their care even

if it means travel for him as well.

“If a procedure is very complicated and

complex in that it would require services we

currently do not have, then I will be giving

that patient and his or her family the option

of traveling to Cincinnati Children’s Hospital,

as I am a credentialed surgeon there as well,”

he said. “That way, I can still perform the

operation, but then that patient can return

home, and I can follow up with them here.

This means that at Niswonger, we really won’t

be sending any patients away because they will

be under my care the whole time.”

Dr. Nduku may be reached at 423-232-

8301 for appointments or more information.

To learn more about East Tennessee Brain &

Spine Center, visit www.etbscenter.com. For

more information about Niswonger Children’s

Hospital, call 423-431-6111 or visit www.

msha.com/children.

Presented in Partnership by East Tennessee Medical News and Mountain States Health Alliance

All source data for this article has been provided by

Heads above the restPediatric neurosurgeon adds depth to Niswonger physician team

Patient Centered Practices

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PhysicianSpotlight

By BRIDGET GARLAND

Ask around the Johnson City area for recommendations on tires, and you’ll probably be sent to a member of the Jones family. Surprisingly, you’ll get the same recommendation if you ask about a good allergist.

Since 1952, Jones OK Tire Store has been in operation in the Tri Cities, a family busi-ness that Phil W. Jones, MD, board certifi ed in Allergy & Im-munology and Pulmonology, once spent several hours a day working in as a summer job. Al-though he confessed that there are aspects of that job he misses, Jones decided as an 18-year-old Science Hill High School gradu-ate that he wanted to pursue a career in dentistry. As such, he packed his bags and headed to the University of Alabama in Tuscaloosa, where he earned his Bachelor’s degree, and then moved on to the University of Alabama Birmingham School of Medicine to earn his medical degree and serve his residency.

“I loved studying dentistry,” Jones re-called, “especially the artistry and creativ-ity of the fi eld. I even thought about oral surgery, since it was so enjoyable to me. But as I looked at my options, I decided to go to medical school, and while I was there, fell in love with Pulmonology.”

In turn, Jones was offered a combined fellowship in Allergy, Immunology, Pul-monary, and Critical Care at Vanderbilt University School of Medicine in Nash-ville, Tenn. After fi nishing at Vanderbilt in 2003, Jones returned home to Johnson

City to join Pulmonary Associates of East Tennessee.

A year later, Jones joined his present practice, The Allergy, Asthma & Sinus Cen-ter, which at the time was looking to expand into Johnson City, a perfect fi t for Jones.

“I had completed my fellowship at Vanderbilt with John Overholt, so I knew the practice was wanting to expand here, but it’s not always easy to recruit to the area,” explained Jones, who has now been with the group for 10 years.

One of the country’s largest allergy

practices, The Allergy, Asthma & Sinus Center currently has 14 allergists practicing at offi ces located in Greater Knoxville, as well as in Athens, Cookev-ille, Crossville, Johnson City, Maryville, Morristown, Mt. Ju-liet, Oak Ridge, Old Hickory, Sevierville, Corbin, KY, and Macon, GA.

During typical offi ce hours, Jones has the opportunity to see a wide range of patients, from pediatric to geriatric, as he treats them for their allergy and asthma symptoms.

But that’s not the end of the day for Jones, who also has a thriving hospital practice. As an adult pulmonologist and Chief of Staff, Jones sees patients at Franklin Woods Community Hospital, part of the Mountain States Health Alliance.

Prior to joining the staff at Franklin Woods, Jones formed an interdisciplinary team at the for-mer Northside Hospital, which received various accolades for its tremendous outcomes in pulmo-nary patient care. He has con-

tinued that approach at Franklin Woods, in which a multi-disciplinary team com-prised of the pulmonologist, the respira-tory therapist, the pharmacist, and critical care staff collaborate to form a plan for the patient’s care that day.

As a recipient of the Mountain States Health Alliance Servant’s Heart Award in 2009, Jones attributes the recognition to the whole patient care his team deliv-ers. “Our team would often be sent pa-tients that others had given up on,” Jones shared. “And to see those patients get bet-

ter….it’s very rewarding.”Jones also explained that better tech-

nologies, such as ventilators that adjust to the patient’s needs, as well as respiratory team protocols, are improving outcomes, alleviating costs, and decreasing hospital stays nationally for pulmonary patients.

He is equally excited about the excel-lent treatments available for his allergy patients. For these individuals, who may suffer year round with environmental al-lergies, new medications and immunology therapies are making a huge difference in alleviating their symptoms.

Outside of his busy career, Jones spends his time with family. He and his wife Jennifer have been married for 23 years. Jennifer, who is also from Johnson City, met Jones while he was on a break from college. After the couple married, Jones says Jennifer was a big support to him while fi nishing school, often work-ing two or three jobs at a time. Now she is a full-time mom to their two children, 17-year-old Madison and 15-year-old Jared, who are both students at Science Hill High School.

Although the family has varied inter-ests, Jones said that they try to carve out time every week to eat dinner together and catch up with each other. He and Madison, who is a varsity cheerleader for Science Hill, share a love of sports, and together cheer on Jones’ alma mater, the University of Alabama.

He and Jared, a World War II buff, have restored a 1942 Ford Jeep and col-lect mechanic sets from the era. When surveying the photos on the wall of Jones’ offi ce, you’ll fi nd mementos from B17 and B24 fl ights that the two have taken together. Whether it’s at home or at work, Jones takes an avid interest in his job, as a parent and a physician.

Phil W. Jones, MD

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The ScienceWhile CMS will complete the cover-

age decision process in a 12-month period, proponents say the science supporting CT scans for diagnosing lung cancer goes back several decades. Considering the current poor survival rates, this delay in integrat-ing the scientific research into routine practice has been particularly frustrating for providers.

Kazerooni said more than three-quarters of lung cancers are found in a late stage when the disease has spread, making surgical intervention ineffective or impossible. Patients are typically asymp-tomatic until the disease has progressed, which contributes to dismal survival rates. Currently, more than 90 percent of those diagnosed annually with lung cancer will die from the disease.

Research from the International Early Lung Cancer Acton Program (I-ELCAP), which was formed in 1992, has shown annual CT screening to be an effec-tive tool. In the original study, more than 1,000 high-risk, asymptomatic patients were screened. Of those who received a lung cancer diagnosis, more than 80 per-cent were at a clinical Stage 1.

Subsequently, findings from a much larger international pool were published in several publications in 2006 after long-term follow-up of more than 31,000 as-ymptomatic study participants. While less than 2 percent of those screened received a lung cancer diagnosis, 86 percent were found in Stage 1 with an overall cure rate of 80 percent.

Similarly, the National Lung Screen-ing Trial (NLST), one of the largest and most expensive clinical trials ever under-

taken in the United States, evaluated the impact of screening methods on survivabil-ity. The trial, which ran from 2002-2010 and included more than 53,000 partici-pants, compared outcomes when screening with standard chest x-ray vs. LDCT. The results published in 2011 in the New Eng-land Journal of Medicine demonstrated a 20 percent reduction in lung cancer mor-tality for those screened by LDCT.

In both arms of the trial, more than 94 percent of positive screening results turned out to be false positives upon further test-ing, which is one of the arguments against annual screening. It should be noted, how-ever, that the false positive difference be-tween LDCT and conventional x-ray was less than 2 percent, yet decreased mortality with LDCT was 20 percent.

The available science led the United States Preventive Services Task Force (USPSTF) to assign a grade of B to lung cancer screening among high-risk patients —current or former heavy smokers, ages 55-80, with a smoking history of at least 30 pack-years. The USPSTF website defines the evidence behind a grade of B as being strong enough to recommend the service be provided.

The task force isn’t the only orga-nization to support LDCT screening for high-risk patients. In fact, Kazerooni said most every major clinical healthcare pro-fessional society, including the American Medical Association, has stepped up to voice support for CMS adopting coverage.

“There’s overwhelming professional support,” Kazerooni said. “We also have a lot of support from the House and Sen-ate,” she added, noting congressional sup-port is bipartisan.

The DecisionThe irony, Kazerooni continued, is

the USPSTF recommendation led to a screening inclusion in the federally man-dated Affordable Care Act requiring third party payers cover LDCT for those at high risk of developing lung cancer. “It’s not a ‘recommended;’ it’s not a ‘they should;’ it’s a ‘must,’” Kazerooni said of the screening becoming a covered benefit beginning Jan. 1, 2015.

If CMS doesn’t reverse current pol-icy, then those who have received annual screenings for as much as a decade will abruptly lose the benefit when they hit 65 and qualify for Medicare coverage.

“The average age of lung cancer di-agnosis is 70 so to not offer lung cancer screening as they enter their peak years of risk would be a tragedy,” Kazerooni stated.

Among the issues being weighed by CMS are patient safety, frequency of test-ing, impact of false positive results, con-sistent quality across screening facilities, evidence-based data to identify eligible patients and inform follow-up and treat-ment, and cost of screening in relation to improved outcomes.

Kazerooni noted CMS is undertak-ing the normal due diligence that goes into releasing a national coverage analy-sis decision. She and colleagues across a number of medical specialties have pro-vided information and parameters for the screening. For example, she noted, the American Association of Physicists in Medicine has created specific exam pro-tocols. The ACR, which is one of three bodies that accredits CT facilities, has developed a practice standard for the

screening. Proponents, she stressed, are specifically calling for low-dose, rather than standard dose, scans to improve the safety profile. Providers also agree smok-ing cessation counseling should be part of the overall professional intervention for all high-risk individuals who qualify for screening.

As for cost, Kazerooni said, “Low-dose CT screening is at least as cost ef-fective, if not more so, than breast cancer screening. When you’re talking about breast cancer screening, you’re talking about every woman of a certain age. Even though CT scans are more expensive, we’re targeting resources to a smaller, high-risk group.”

Bolstering that assertion, a study published in August in American Health and Drug Benefits found LDCT to be cost effective in the Medicare population. The researchers found implementing the screening cost less than $20,000 per life-year saved, which is less than the costs as-sociated with cervical and breast cancer screening.

Kazerooni is favorably encouraged CMS will follow suit with private payers and cover LDCT screenings for those with the necessary inclusion criteria who are not suffering from another medical condition that would significantly limit life expectancy. However, she added, she is interested to see what conditions CMS attaches to approval.

“It’s hard to believe they would do anything else but cover it,” she concluded of CMS. “There is a huge need for this, and we want to see it brought forward to benefit individual patients and the public at large.”

The Case for Covering Low-Dose CT Lung Cancer Screening, continued from page 1

ClinicallySpeakingBY GEORGE A. PLIAGAS, MD, FACS

The Role of Imaging in Screening & DiagnosisWith peripheral arterial and vascular

disease affecting some 8 million Ameri-cans, imaging technology to evaluate blood flow and venous function has be-come an invaluable tool. Imaging meth-ods such as Vascular Ultrasound, Magnet-ic Resonance Angiography (MRA), and Computed Tomographic (CT) Angiogram are increasingly used to screen, diagnose, and treat vascular issues.

Vascular ultrasound uses sound waves, not radiation, to produce real time images that show the structure and movement of blood flow throughout the body. Doppler ultrasound scans visualize blood flow through blood ves-sels and major arteries, enabling physi-cians to identify and pinpoint blockages, blood clots, and abnormalities. Ultra-sound also aids physicians in planning effective treatment by assessing the size and condition of blood vessels.

As a non-invasive, inexpensive, and widely available technology, ultrasound has become a primary diagnostic tool. The fact that ultrasound equipment is often portable, and is a safe, painless

test, makes it particularly valuable in screening at-risk patients for peripheral arterial, carotid disease, venous insuf-ficiency, aneurysms, and a host of other vascular issues. The future is bright for ultrasound as new advances in technol-ogy allow it to become a three-dimen-sional tool aiding in the diagnosis of vascular disease.

Despite its benefits, vascular ultrasound does have some limita-tions. Smaller and deeper vessels can be more difficult to evaluate and image with vascular ultrasound. In some cases, ultrasound cannot differentiate between an occluded blood vessel and one that is significantly narrowed. Calcifications may also obstruct the ultrasound beam. In those cases, other imaging tests such as Magnetic Resonance Angiography (MRA) or CT Angiogram may be necessary.

MRA is a non-invasive test that uses strong magnetic waves to produce detailed images of the vascular system. An MRA can show the location of a blocked blood vessel and the condition of the blood vessel walls. It is especially

accurate for larger blood vessels. In some cases, MRA can provide informa-tion that can’t be obtained from an ultrasound or CT scan.

During the MRA procedure, the area of the body being imaged is placed inside a MRI machine. The nar-row tunnel and long scan times can be problematic for obese patients or those with claustrophobia. Contrast dye may be used to increase visualization of blood vessels. While MRA is a safe and valuable procedure for studying blood vessels, it is more expensive than other imaging methods and may not be avail-able in all medical facilities.

CT angiography is a minimally invasive test that uses x-ray beams to scan the body and produce detailed cross-section images of blood vessels and tissues. In most cases an iodine-rich contrast material is injected and used to highlight the area being studied. For patients with vascular disease, lower extremity CT angiography is especially effective at delivering precise detail in small blood vessels. It is also valuable

in the work up and planning therapy of thoracic and abdominal aortic aneu-rysms. Many vascular patients can undergo CT angiography instead of a traditional catheter angiogram. This method is quicker and more comfort-able for most patients. The CT angiog-raphy is also valuable in screening and detecting the narrowing or obstruction of blood vessels and venous disease before symptoms are present. Limita-tions include the slight risk of cancer from radiation exposure and possible reaction to the iodine-rich contrast dye.

As imaging technology continues to advance, with improved clarity that includes capabilities such as 3-D visu-als, vascular patients will benefit from more accurate screening and diagnostic methods that lead to earlier treatment and better outcomes. The future of imaging is bound to enhance and make the future brighter for vascular patients.

George A. Pliagas, MD, FACS is a vascular surgeon with Premier Surgical Associates in Knoxville, Tennessee.


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Southcomm Inc seeks a Publisher for East Tennessee

Medical News, a publication covering the medical

community in East Tennessee and Southwest Virginia. The Publisher is responsible for

operational, strategic and fi nancial success of the paper and for establishing a culture

of continued success and for achieving operational and fi nancial results. The

successful publisher will actively be involved in the local medical community and have a

proven sales track record. TO APPLY FOR THIS POSITION: EMAIL YOUR RESUME ALONG WITH A COVER LETTER TO: PATRICK RAINS, GROUP PUBLISHER AT [email protected].

SOUTHCOMM, INC. IS AN EQUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE ON THE BASIS OF RACE, RELIGION, SEX, AGE, NATIONAL ORIGIN.

The Literary ExaminerBY TERRI SCHLICHENMEYER

The Map of Heaven by Eban Alexander, MD (with Ptolemy Tompkins); c.2014, Simon & Schuster; $21.99 / $26.99 Canada, 208 pages

If you don’t know what path you’re taking, you can’t be sure where you are. But in The Map of Heaven by Eban Alexander, MD (with Ptolemy Tompkins), you may fi nd the plat you need, to know where you’re going.

You are a star.Literally, some of what’s inside you

came from “ancient, now long-dead stars.” We are “organic chemistry and biochemistry,” and the Bible says we will return to dust when we die. But since time began, humans have wondered if there’s “more to the story.”

Lately, science has tried to answer that with a “Theory of Everything.” The problem is that that doesn’t settle pro-found questions on the meaning of exis-tence. We can look to religion, but that may not have an answer, either.

Instead, says Alexander, “The key to understanding this world... is to remember the place above and beyond, where we really came from.” Heaven, he believes, is what makes us human and, without it, “life makes no sense.” Furthermore, when we become open to the “larger world be-hind the one we see around us every day,” we will fi nd the “Gifts of Heaven.”

The Gift of Meaning, for instance, is something that “people are starving for,” but that is already inherent in life. Part of understanding it lies in understanding that coincidences are not coincidental, but may be messages from beyond.

The Gift of Vision allows us to see how we’re connected with one another and with every living thing. The Gift of Belonging helps us know that we are where we need to be, and that “higher worlds” surround us. The Gift of Strength teaches that we will someday be much more than we are today. The Gift of Hope tells us that we “must not forget that [this world] is not all there is.”

Imagine yourself standing at the edge of the Grand Canyon, looking down.

What you’d see is not quite how deep “The Map of Heaven” is.

Using ancient philoso-phy, modern psychology and medicine, science, etymology, letters from readers, several different religious tenets, and a big dose of New Age, author Eben Alexander, MD, attempts to put the Afterlife in context for us on Earth.

This expounding on his previous book (“Proof of Heaven”) is provocative, but also quite disorienting. Alexander bounces from one discipline to another so quickly (sometimes in the same sentence) and so often without context that I gen-

erally had a very hard time following his thoughts before he ca-

reened to the next idea. It could be argued,

I suppose, that this im-parts a sort of excitement to what’s said here, and the meaning behind the

meaning of life. That could be so, but just know that The Map of Heaven is as deep as they come, and it may cause your brain to recalculate.

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.

By HEATHER RIPLEy

According to Pew Research, the way Americans view healthcare is now driven heavily by the internet. Seventy-two per-cent of U.S. internet users say they have looked for health information online within a year, and 52 percent of smart-phone users say they regularly research healthcare information on their phones.

With the growing trend of online healthcare consultation, physicians can no longer just get by with a simple landing page. As 2014 comes to a close, it is a wise

business decision to evaluate your medi-cal practice’s website and determine if any changes need to be made in order to keep up with the future of healthcare trends.

When reviewing your website, make sure it meets these key points:

Responsive on all platforms: Single website layouts can be detrimental to any business’s growth, but the repercus-sions can be even more serious on health-care providers. As mobile device users increase, a physician’s website should have the ability to transition from mobile, tablet, and desktop versions automati-

cally. People’s search habits are different depending on the device and having op-tions such as “Request Appointment,” “Contact Us,” or “Emergency” fi rst on a mobile device layout might not be a bad idea.

Interactive: From the popularity of WebMD came a trend of patients who self-diagnose. While this can be empower-ing for members of the public, it can be-come frustrating for dedicated physicians. Having interactive tools that encourage patients to make appointments for check-ups or call urgent care numbers can lessen

the doubt often associated with symptom checkers and strengthen your doctor-pa-tient relationships.

Holds a unique voice: Is the only thing separating your website from the local competition’s a street address? For Primary Care Physicians especially, add-ing a unique voice such as a blog to your website can showcase a dose of personality and position your practice as the friendly experts. This might just be enough to sway patients your way.

Minimalist Design: Having a fl ashy website is nice for fl amboyant com-panies but can be harmful for healthcare providers. By implementing what’s called Flat Design, your website can strip down the visuals and concentrate on what’s important - the content. Use clear back-grounds, fl at colors, and crisp fonts but be careful as there is a difference in Flat De-sign and boring.

In just the past few years, website design has advanced greatly and with the ever increasing technology spectrum, keeping up with consumer demands is something all professionals should be aware of. For physicians, having a good website that is friendly, professional, invit-ing, and useful on all devices is paramount for success in this modern world. It’s what can make your practice stand out from the rest.

How Web Design Will Alter the Future of Healthcare

Heather Ripley is the founder and CEO of Ripley PR, a national public relations agency specializing in healthcare. For more information, visit www.ripleypr.com or email [email protected].


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.

PUBLISHED BY:SouthComm, Inc.

CHIEF EXECUTIVE OFFICERChris Ferrell

ASSOCIATE PUBLISHERSharon Dobbins

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EDITORBridget Garland

[email protected]

CREATIVE DIRECTOR Susan Graham

[email protected]

GRAPHIC DESIGNERSKaty Barrett-Alley, Amy GomoljakJames Osborne, Christie Passarello

CONTRIBUTING WRITERSSharon Fitzgerald,

Cindy Sanders, Lynne Jeter, Terri Schlichenmeyer,

Bridget Garland, Leigh Anne W. Hoover, Joe Morris, John Sewell

[email protected]

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changes should be mailed to:

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SOUTHCOMMChief Executive Officer Chris FerrellChief Financial Officer Patrick Min

Chief Marketing Officer Susan TorregrossaChief Technology Officer Matt Locke

Chief Operating Officer/Group Publisher Eric Norwood

Director of Digital Sales & Marketing David WalkerController Todd Patton

Creative Director Heather PierceDirector of Content /

Online Development Patrick Rains

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.

Registration is required. Visit www.kamgma.com.

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

the Friday prior to the meeting.RSVP to Irene Gruter, e-mail: [email protected] or call

622.2872. For more information, visit www.cmgma.net.

3RD THURSDAY 2ND WEDNESDAY

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

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

CME Program offered as Joint Sponsorship between LMU-DCOM & The University of New England College of Osteopathic Medicine

Program Title: Best Practices in Clini-cal Teaching: A Panel Presentation

Date: November 6, 2014Time: 6:00 pm – 8:00 pmLocation: Kingsport Chamber of Com-

merceCost: Free with dinner providedCME: 2.0 AMA PRA Category 1

Credit(s)TM and 2.0 University of New Eng-land contact hours for non-physicians has been approved. 2.0 hours of AOA Category 1-A CME credit is pending.

Program Description: Clinical settings offer rich environments for teaching oppor-tunities. Evidence-based teaching methods and instructional strategies provide value to the educational experience and improve teaching and learning for the preceptor and student and ultimately, patient care out-comes.

This CME activity uses a panel of clini-cal teaching experts to present discussion topics on precepting in a busy practice, pro-moting student learning, and the art of pre-cepting to improve teaching and learning at rotation sites in consideration of practice time constraints.

To register: http://dcomcme.lmunet.edu/best-practices-clinical-teaching-panel-presentation-live-2014

LMU-DCOM and ORAU Online CME Program “Increasing Patient Safety” Available Through December 30, 2014 Program Available Online at Minimal Charge

HARROGATE—Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) in Harrogate, Tenn., in partnership with Oak Ridge Associated Universities (ORAU) radiation emergency medicine physicians and experts has creat-ed an online Continuing Medical Education (CME) program entitled “Increasing Patient Safety: Recognition and Management of Acute Local Radiation Injury (LRI).”

The online CME program was re-

leased in December 2013 and will be available through the end of this year. The two-hour online program addresses acute local radiation injuries, providing a deeper understanding of the subject mat-ter through the study of current publica-tions, addressing related case study issues and with a panel discussion highlighting subjects of concern for osteopathic physi-cians. Primary care physicians will usually be the first health care providers to see the conditions that result from accidental or malevolent overexposure to ionizing radiation. This online CME delivers educa-tion and training curricula to address the time and resource constraints of the busy practitioner who traditionally does not have the time or resources to engage in disaster medicine CME offerings.

The faculty includes: Dr. Doran M. Christensen, ORAU associate director/staff physician; Dr. Ronald E. Goans, ORAU se-nior scientific/medical advisor; Dr. Carol J. Iddins, ORAU staff physician; and Dr. Mi-chael Seaman, assistant professor of family medicine and emergency medicine at LMU-DCOM.

Registration cost is $40 and is avail-able online at https://www.docmeonline.com/. The program is best viewed through a computer internet browser, such as Chrome or Internet Explorer. It is recommended that participants view the online program on a computer with an operating system of Windows 7 or higher. The program is not optimized for viewing on a mobile device. Two hours of Category 1-A AOA credit will be available to current AOA members. The program is made possible by a grant from the American Osteopathic Association.

AMA’s New Fact Sheet for Physicians Aims to Help Ensure Patients Continue to Have Access to Medically Necessary Treatment Under New DEA Rule

WASHINGTON – The American Medi-cal Association (AMA) has released a new fact sheet to assist physicians in complying with new federal regulations on prescribing hydrocodone and help avoid disruptions in patient care. The rule, effective October 6,

2014, reschedules hydrocodone combina-tion products (HCPs) into Controlled Sub-stance Schedule II. Millions of patients will be impacted by this new rule from the Drug Enforcement Administration (DEA), and the new resource will help physicians under-stand the rule and avoid interruptions in ac-cess to medically necessary HCPs for their patients.

Prescriptions for HCPs issued before October 6 that have authorized refills can be dispensed in accordance with current DEA rules for refilling, partial filling, trans-ferring, and central filling of Schedule III-V controlled substances until April 8, 2015. However, due to state laws and limitations on some pharmacy and insurance processes - some health insurers and pharmacies may deny requests for refills on or after October 6. To help ensure continuity of care for pa-tients and reduce confusion, the AMA is en-couraging prescribers to act now to provide new hard copy or electronic prescriptions for patients, rather than depending on ex-isting refills.

In addition to providing helpful re-sources like these to physicians, AMA in-tends to continue its advocacy efforts for a multi-pronged approach to address pre-scription drug abuse and diversion.

For more information, please visit www.ama-assn.org.

Tennessee Cancer Specialists Welcomes Dr. Sudarshan Doddabele to Group

KNOXVILLE—Tennessee Cancer Spe-cialists welcomes Sudarshan Doddabele, MD, to their practice. Doddabele complet-ed his medical degree at Karnatak Medi-cal College, an internship and residency in internal medicine at East Tennessee State University, and a fellowship in hematology at Baylor College of Medicine. He is board certified in medical oncology, hematology, and internal medicine, and has been prac-ticing since 2000.

Doddabele is returning to the East Ten-nessee area after 7 years. He had a previous-ly thriving practice in the Morristown, Tenn., area, and most recently was in Sioux City, IA.


More Grand Rounds Online


GrandRounds

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Renowned Neuroscientists at UT Medical Center to Lead Researcher Team in Studying the Brain

KNOXVILLE—Two of the world’s most renowned neuroscientists are now based at The University of Tennessee Medical Cen-ter and will lead a collaborative team of re-searchers in the Knoxville region to advance research studies of the brain.

Dr. Helen A. Baghdoyan and Dr. Ralph Lydic, a married couple and research team who were recruited to Knoxville from the University of Michigan, are charged to build a nationally recognized neuroscience re-search program in the UT Medical Center’s Department of Anesthesiology through fur-ther enhancing interaction, collaboration and exchange between UT’s main campus, Oak Ridge National Laboratory, UT Medical Center, and the medical center’s Cole Neu-roscience Center.

The Chattanooga Heart Institute Welcomes Vinay Madan, MD

CHATTANOOGA–The Chattanooga Heart Institute at Memorial welcomes Vi-nay Madan, MD. Madan is board certified cardiovascu-lar diseases and specializes in interventional cardiology. He completed fellowships in cardiovascular disease and interventional cardiol-ogy at New York University Langone Medical Center.

Madan completed his internship and residency in internal medicine at Barnes-Jewish Hospital at Washington University School of Medicine. He is a graduate of the University of Alabama at Birmingham School of Medicine and holds a degree in biochemistry from Rhodes College in Mem-phis, TN.

Hutcheson Votes to Resume Labor & Delivery Services Hospital Will Once Again Be “The Place Where Babies Come From”

FORT OGLETHORPE, Ga. –Citing overwhelming demand from physicians and the community to once again offer ma-ternity services, the Board of Directors for Hutcheson Medical Center voted today to resume the hospital’s Labor, Delivery, and inpatient pediatric services by the end of the calendar year.

In preparation for reopening the ser-vice, Hutcheson has remodeled the Labor and Delivery unit to compete with other area birthing facilities. “Today, it’s not enough to provide excellent quality medical care. Mothers and families want an aesthetically pleasing environment with modern ameni-ties in which to give birth, and our new wing offers just that,” stated Sandra Siniard, Vice President of Patient Care at Hutcheson.

Darrell Weldon, MD, an OB/Gyn physi-cian who has delivered over three genera-tions of babies at Hutcheson and serves as Chairman of the hospital’s Authority Board, says he is very excited about Labor and De-livery reopening. “Many families want to deliver their baby at Hutcheson because of the level of service excellence they have

experienced in the past. The hospital has made substantial renovations to the Labor and Delivery center and I believe patients will be pleasantly surprised and impressed with the facility.”

Generous Gift to the UT Center for Advanced Medical Simulation Helps Keep Medical Clinicians Prepared

KNOXVILLE—The University of Ten-nessee Medical Center and the UT Gradu-ate School of Medicine recognized the generous gift of $300,000 to the UT Cen-ter for Advanced Medical Simulation from Mike West and Back Porch Vista Capital

Management. The unveiling of the plaque occurred on the anniversary of the Front Street Baptist Church bus accident. It provided the occasion to show how the Simulation Center is utilized for medical education throughout the region.

When rapid and accurate assess-ment, along with the ability to resuscitate and stabilize is required, skills needed to manage critically injured patients must be instinctive. Such instincts are acquired through training and dedicated practice which is facilitated at the UT Center for Advanced Medical Simulation.

The UT Center for Advanced Medi-

cal Simulation, located on the UT Medi-cal Center campus, is the place where physicians, nurses, pharmacists and many other clinical staff - locally, regionally, na-tionally and even internationally - perfect their skills in not only treating and caring for critically injured patients, but for all pa-tients. At the simulation center, new tech-niques are taught and practiced, surger-ies are rehearsed, and medical teams use hands-on and realistic exercises of various life threatening scenarios in order to be prepared for whatever may occur.

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 November 2014

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Transcript of East TN Medical News November 2014