East Tn Medical News October 2014

Beth Casady, DO, FAAFP

PAGE 2

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LEGAL MATTERS: Profi t and Loss: The Top Ten Things Providers Need to KnowPart VI: Audit Letter Review – Overpayment or Over You?Private insurance companies issue a variety of notices, reports, and letters to providers with contracts to offer healthcare services to their members. In the ordinary course of business, a provider would receive Explanation of Benefi ts reports, contract amendments, newsletters, and by far, the most important of all—requests for medical records ... 12

CLINICALLY SPEAKING: DIZZINESS……WHAT NEXT?Dizziness accounts for millions of primary care and specialty physician visits per year. A recent study by Bisdroff and colleagues reported a 1-year prevalence for dizziness in the adult population to be 36-49% with increasing prevalence with advancing age ... 14

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While physicians and facilities have long had to keep up with different negotiated contract rates among payers, the reimbursement landscape has become much more varied over the last few years as a push toward pay-ment innovation has ushered in a host of reimbursement options ranging from shared savings programs to bundled payments to carrot-and-stick compensation as applied to quality and effi ciency metrics.

Rob Lazerow, practice manager for Research & Insight at The Advisory Board Company, recently analyzed some of the pay-ment changes providers are navigating as the healthcare system begins to shift away from a fee-for-service model. While the traditional payment method based on volume still makes up the majority of healthcare reimbursements, Lazerow

Reimbursement RevisitA Look at payment innovation

(CONTINUED ON PAGE 8)

By BRiDGeT GARLAnD

Colon screenings, mammograms, prostate exams—the list of recommended preventative health screening for senior adults may seem overwhelming to patients—so much so that an eye exam doesn’t make their list of priorities. Unfortunately, putting off eye exams could lead to irreversible vision loss, which translates to a loss of in-dependence for many seniors.

That’s why the American Academy of Ophthalmology recommends a baseline eye exam at age 40, even for individuals with no risk factors for eye disease. “This is similar to recommended mammograms at 40 and colon screenings at 50,” explained James W. Battle, MD, an oph-thalmologist with Johnson City Eye Clinic in Johnson City, Tenn. “And persons 65 and older need at least annual eye exams.”

RecommendationsOf course, like many other screening guidelines, eye exam rec-

ommendations vary based on the patient and his or her medical history.

“Primary care providers should begin referring their patients to an ophthalmologist even sooner

if they or the patient have concerns, if they de-velop a disease known to affect the eyes such as diabetes, if they have a family history of eye dis-

ease, especially glaucoma, or if they have not had a recent eye exam or screen-ing,” added Randal J. Rabon, MD, FACS, who also practices with Johnson City Eye Clinic.

While many eye diseases have no early warning signs, Rabon noted that “Loss of vi-sion, wavy lines, pain or red-ness are all symptoms that

PCPs should pay particular attention to.”Some senior patients with certain medical conditions are at

even greater risk for developing eye diseases.“Cataracts, macular degeneration, and glaucoma are all risks

to seniors’ vision, but these diseases are limited to the eye,” ex-plained Battle. “Of systemic diseases, diabetes is the greatest risk to vision. Annual diabetic eye exams in addition to good blood sugar control are essential to preserving vision for individuals with that disease.”


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PhysicianSpotlight

By JoHn seweLL

The “country doctor” is something of a stock character of television. In sev-eral classic shows, the rural physician is depicted (along with the Sheriff) as being atop the regional social hierarchy, a re-spected, beloved, and benevolent pres-ence. Characters such as Dr. Kate Bradley on Petticoat Junction, Doc Adams on Gunsmoke, and, of course, Dr. Quinn on Dr. Quinn, Medicine Woman have become iconic. In their respective shows, all the aforementioned doctors were more than just physicians—they also served as confi dante, confessor, and counsellor for everyone in the community. In their com-munities, these doctors wore a lot of hats, so to speak.

Spring City’s Dr. Beth Casady also wears a lot of hats in her community. For over 20 years, Casady has served as a Me-morial Health Partners affi liated Family Practitioner. She also serves as the on-site physician at the Rhea County Jail. And she is the Director of Ambulance Services for Rhea County Emergency Services. And she’s the Rhea County Medical Examiner.

Spring City may not be a metropolis, and Rhea County isn’t exactly the most populated county in Tennessee. But the county’s population of 25,000, well, that’s a lot of folks. This is to say that the relent-less Dr. Casady plays several very impor-tant roles in her community. Simply put, Casady holds a lot of big jobs.

For Casady, all these big jobs some-how morph into one big job. Sure, she’s a respected presence in Rhea County—just like the archetypal television doctors. But Casady does even more. In Rhea County, Casady is not only a wise physician, but also something of a scientist, detective,

teacher, and historian for her patients.“I’ve been a family practitioner for

a long time—over 20 years” explained Casady. “I may start with one patient, and then they bring their family. So next thing you know, I’m seeing their children and grandchildren. I get to know each pa-tient’s history, and I get to know the fam-ily’s history.”

By dealing with scores of multigener-ational families for the long term, Casady is able to cobble together a big picture—not only of health issues that a particular family might face over the years, but also of emergent patterns in the entire county.

“The big problems that I see over and over are diabetes and obesity,” said Casady. “I take it as kind of a challenge to try and educate these people about how to have a proper diet. I always try to empha-size just eating good food—the right food.”

The job as Rhea County Medical Ex-aminer is another source of information for Casady. In this role, Casady is able to piece together disparate events into a big picture of the overall health of the entire county. Granted, the Medical Examiner position is demanding, time-consuming and sometimes emotionally wrenching—all part of the job.

“As Medical Examiner, I get called for any unexpected death in the county,” explained Casady. “If it’s a homicide or a suicide or a fatal car wreck, I go.”

The Medical Examiner position en-tails long hours and inopportune timing. In other words, Casady is more or less on call at all times, 24/7.

“As medical examiner, I usually get about fi ve or six calls [unexpected deaths that require the investigation of a medi-cal examiner] per month—and you never

know when that’s going to happen. It’s usually after [business] hours. One time I had to do three calls in the same day. I couldn’t believe it!”

Casady explained that there is a lot of misinformation about what medical exam-iners actually do. Casady does not perform autopsies per se. Instead, she is the offi cial that determines whether or not there is the need to perform an autopsy. After the au-topsy is conducted by a forensic patholo-gist, then Casady reports the fi ndings of the autopsy to the bereaved families. And again, this is another moment when the big picture comes into focus.

‘If there is an autopsy, I explain to the families what is the cause of death,” said Casady. “Lots of times the death is related to diabetes and obesity. And I will say to them [the families], ‘here’s the cause of death, here’s why it happened, and here’s how to avoid having something like this happen to you.’ I know the families, their histories, and their issues.”

Casady’s practice(s) may be far from the big city, but this doesn’t mean she’s lagging behind in terms of delivering top quality service to her patients. For exam-ple, Casady’s practice has used electronic medical records (EMR) for over a decade.

“EMR is all computerized, no paper,” explained Casady. “Back when we used charts on paper, we would have to search and search through fi les to track the patients’ symptoms and test results. It’s so much faster, easier, and more effective with computers.”

Believe it or not, the inexorable Casady also fi nds time for a rich and rewarding personal life. She has two children, ages 12 and 23. The family enjoys attending country music concerts together. All the family members are in-volved in various civic, community ser-vice, and church activities. Casady herself heads a Spring City based organization called Coats for Kids. “Any child that needs a coat in Spring City, we get them a coat,” said Casady.

Sure, having all of these diffi cult and demanding jobs requires persistence, knowhow, ambition—and long, long hours. But Casady is driven by a deeply-felt commitment to serve her community. And this commitment means wearing sev-eral different hats—all day, every day, and oftentimes well into the blackest of nights.

“Sleep is highly overrated,” said Casady, laughing.

Beth Casady, DO, FAAFP

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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 profi les, 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].

EAST TN MEDICAL NEWS

By LeiGH Anne w. HooVeR

Fall in the mountains of East Tennessee is simply unri-valed. It’s one of my favorite seasons, and I love everything surrounding autumn’s arrival. From football and festivals, to the glorious pictures God paints with nature’s brilliant colors and the cool crispness of the air, it’s perfect for enjoy-ing the outdoors before winter beckons us all to come back inside.

All over East Tennessee, there are wonderful ways to enjoy this time of the year. Harvest festivals and seasonal activities abound. Oakes Farms in Corryton, Tennes-see, has captured the essence of the season with their corn maze and pumpkin patch.

“Our family has had a nursery going on 30 years now, primarily mail-order and website nursery specializing in daylilies,” explained Ken Oakes. “Back in 2000, my wife and I, and my brother-in-law, were youth group leaders, and we took a youth group trip to a corn maze down in Greenback, [Tennessee]…, and the idea came to us that we could do that.”

Collectively, the Oakes family got their heads together, and they offi cially opened their own corn maze, with hay-rides up to the “pumpkin patch,” in 2001 on their property. This 2014 season marks their 14th year of celebrating the season with family fun out on the farm.

Over the years, the concept has re-ally expanded, and even more activities have been added. On Thursdays – Sun-day through November 1st, families can unplug, get outdoors, and make a day of visiting Oakes Farm.

“I grew up on a farm, so I take it for granted,” said Oakes. “A lot of folks haven’t had the opportunity just to be out-side in the big open acreage and to ride a hay wagon. Over the years, many have made it a tradition.”

Their corn maze history is fascinat-ing, and the chosen “theme” is always a work of art. From celebrating the Lady Vols and local NASCAR hero Trevor Bayne, to partnering with Extreme Make-over Home Edition, Disney, and others, each year, the themed corn maze is some-thing truly remarkable to behold.

“We can pretty much do any design we want here, so we try and think of some-thing topical,” said Oakes. “We did the Lady Vols when they won back-to-back championships, and we did Trevor Bayne, the local fellow that won the Daytona 500 as a rookie and lives right here in the community… This year, we’re partnering with a program that the state has, “Pick

Tennessee Products,” which is encourag-ing folks to visit Tennessee farms and use Tennessee products.”

To accomplish these “amazing” corn maze works of art, the Oakes work with a designer who travels the country creating corn maze art from suggested ideas and images that refl ect beautiful aerial designs. Maze images are pictured on the website, and you can glimpse past year’s themes and creations online.

According to Oakes, the designer uses

a small scale John Deere trac-tor with a tiller behind it and a global positioning system (GPS) with the lines laid into the desired pattern.

“Basically, he’s just watching his monitor, follow-ing the lines, and tilling up the paths as he goes,” explained Oakes. “He used to do it at night when it was cooler, but now that he’s upgraded to an air-conditioned tractor, he does it during the day. He spends his whole summer driv-ing around the country cutting corn mazes.”

Corn is planted on Oakes Farm at the beginning of July. Typically, the year’s theme is

decided by June, and the corn maze has been cut by August.

Once a general admission is paid to get on the property, families can decide which activities they want to enjoy dur-ing the day. In an area better known as the “Back 40,” there is entertainment for children of all ages.

From a pedal kart track and a corn box fi lled with shelled corn, to unusual slides, a sand pit and “rat racers,” which are actually large water culverts cut into

pieces for rolling, to a petting zoo and more, family farm fun is available for everyone!

“Rat rac-ers are something

we saw at another farm, and you just get

in them and roll like a hamster,” said Oakes.

“They’re fun, and it’s not something you going to do every day.”

The shelled corn is in a big pit fi lled with corn to play in, which is similar to a ball pit, except you might have to pull corn out of your pockets when you get home!

A gift shop and concessions are also available. Oakes enjoys working the grill and visiting with friends and families he looks forward to seeing each year.

If you are daring, Oakes Farm also has a haunted attraction on a separate part of the farm in October. The “Trail of Doom,” which requires a separate ad-mission, is known as “Knoxville’s largest and longest-running haunted attraction.” Featuring three different nighttime events for one admission, it promises thrills and chills!

For additional information about planning a trip to the Corn Maze and Pumpkin Patch at Oakes Farm, be sure to visit www.oakesfarm.com

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pieces for rolling, to a petting zoo and more, family farm fun is available for everyone!

ers are something we saw at another

farm, and you just get in them and roll like a

hamster,” said Oakes. “They’re fun, and it’s not

Enjoying East TennesseeCorn Maze and Pumpkin Patch at Oakes Farm

4 > OCTOBER 2014 E A S T T N M E D I C A L N E W S . C O M

HealthcareLeader

Education, outreach & moreMarketing eye-care services requires a special approach

BY JOE MORRIS

A good marketer knows how to sell a product or service, but any of them will quickly point out the diffi culty if the mer-chandise isn’t up to snuff. Happily for her, Ginger Medlock doesn’t have that prob-lem.

As Director of Marketing for the Johnson City Eye Clinic (JCEC), Medlock has a lot of duties. She spends a great deal of time with the clinic’s doctors to fi nd out what they are working on and advances they’d like to see in the practice. She works with outside physicians, from optometrists to primary care doctors, to make sure that they are aware of all of Johnson City Eye Clinic and Surgery Center services. And she interacts with the public through infor-mational presentations, health fairs, and other outreach.

It’s a lot, but when you’re promot-ing a facility that has so many offerings, multiple audiences are the norm, not the exception.

“My role is to call attention to our products and services,” said Medlock, who joined JCEC eight years ago after work-ing with a related entity in the eye care fi eld. “We have all of the specialties cov-ered: glaucoma, medical retina, pediatrics, neuro-ophthalmology, plastics, along with cataract and other surgeries. We work

hard to make everyone aware of what we have to offer.”

Working with optometrists is no sur-prise, but primary care providers?

“People who have hypertension or diabetes often develop eye problems - we want to work with them so that those don’t become serious complications,” she explained. “There is a great deal a pri-mary care provider can see through the windows of the eyes.”

Those physician and eye care pro-vider referrals are key not only to the clin-ic’s success, but also to help it navigate a changing healthcare landscape. This also means some straight-up consumer market-

ing.“Reimbursements are diminishing,

and we do reach out to the general pub-lic,” Medlock said. “But we walk a fi ne line because we don’t want to compete with our referring eye care providers. We want patients to know what services we can provide and that we are here to work with their primary care provider.”

That’s important as changes in cov-erage options from insurance companies and Medicare come down the pike. For instance, laser-assisted cataract surgery and the implantation of premium intra-ocular lenses (which allow for better near vision as well as distance seeing) are now an option for some patients. These pro-cedures are not covered by Medicare or insurance, but the patient may elect to pay out of pocket for such services.

Getting the word out on such topics, as well as related issues such as fi nancing options, is just a part of Medlock’s busy day.

“I have a great deal on my plate any given day,” she admitted. “Sometimes I fi nd myself fl ying by the seat of my pants just because there really is no routine day on my calendar. I try to prioritize tasks to make sure the most important ones come as early in the day as possible. Sometimes things do get moved to the next day’s list.”

That includes actual physical interac-

tion with not only referring physicians, but the entire JCEC staff – physicians, techni-cians, surgery center - which she says is a must-do for her on a daily basis.

“Excellent communication is key to our practice,” Medlock said. “We have a very good intranet and other communi-cations systems in place, and our doctors have an open-door policy. Reaching out to at least one of the ten doctors within the clinic every day often inspires new market-ing ideas. I try to have a personal conver-sation with at least one of our doctors each day. They have some great promotional ideas in addition to their healthcare capa-bilities.

“In talking with Dr. [Jeffrey] Carlsen the other day, we were able to brainstorm a bit on our cosmetic and reconstructive surgery offerings,” she said. “Just that quick talk led us to come up with a strategy which will be good for that portion of the practice and will allow us to reach out to the community more with those services.

“On the patient side, we want to make sure that they know they have choices following surgery. Many of them have traveled a long way for surgery, and it is important for them to know that they can go back to their regular provider for post-operative care,” she added.

Another difference in Medlock’s ef-forts from those of a traditional marketer is that they are focused more on education versus pure selling.

“When we get in front of a group of doctors, we are really providing con-tinuing education,” she explained. “Our doctors will talk with these referring physi-cians about what’s going on in periopera-tive care, so that they know what’s coming their way after we have seen or treated one of their patients. We also show them what technology and treatments are avail-able now, and what is coming.”

But in the end, she says, it’s all about the clinic and its services, and those she can readily reel off.

“We’ve been around since 1942. At one time, Johnson City Eye Clinic was the largest ophthalmology practice between Atlanta and DC. We have fellowship- trained specialists in every area. ” Medlock said. “We have an extraordinary group of doctors, and they really care about their patients. They are humanitarians. Some of them have been around for decades, so they are seeing the great-grandchildren of original patients. That’s a great compli-ment to them, and to us.

“People travel from quite a distance to JCEC because of our integrity, as well as technology and expertise. We all really care about our patients. In fact, my big-gest weakness is that I will visit with our patients when I really need to be out in the fi eld talking to doctors!”

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By Dennis Rowe

The rollout of the Affordable Care Act and the health reform movement overall have provided the emergency medical services industry with an oppor-tunity to take an even more prominent seat at the healthcare table and expand beyond medical transportation.

As reform policies, incentives, and penalties are being implemented across the country, the initial shockwaves are being recorded at the physician and hos-pital levels. Before reform, healthcare agencies, including hospitals and EMS agencies, were structured around a fee-for-service model that compensated phy-sicians and nurses based on treatment provided or, in the case of ambulance ser-vice, payment for patient transports, re-gardless of outcome or performance. The new system that is emerging will provide financial incentives to physicians and hos-pitals who proactively prevent or control illnesses that bring patients into the medi-cal facility in the first place – and that soon will extend to EMS professionals.

Under reform models, hospitals soon will be penalized by Medicare for patients who are readmitted within 30 days for a condition they previously were treated

for at the facility, if Medicare deems the readmission to be unnecessary. To better monitor patients and reduce readmissions, hospitals must find a way to interact with discharged patients to ensure they are fol-lowing the prescribed treatment plans. That’s where the EMS industry comes in to assist.

Neither the new Accountable Care Organizations nor hospitals are struc-tured to make these types of house calls. EMTs and paramedics, however, already are trained for this line of work. Paramed-ics enter patients’ homes, evaluate their condition, and identify services needed.

They are well positioned to fit into an ex-panded role, a concept known as mobile integrated healthcare.

Soon, we should expect to see EMS professionals trained to handle at-home assessments for individuals at a high risk of admission to the emergency department, where healthcare costs are the steepest. Their goal will be to identify medical is-sues before the situation requires emer-gency care.

Paramedics will follow detailed pro-tocols to check for warning signs of com-plications and ensure medications are taken correctly. They will submit a report

to the Accountable Care Organization, physician, or hospital, which will decide appropriate action – prescribing addi-tional treatment or medication, requiring a follow-up visit to a physician, or placing the patient in contact with a counselor or case manager.

Mobile integrated healthcare will re-quire a greater level of cooperation among EMS agencies, hospitals, physicians, home healthcare providers, health departments, and other partners, as well as a centraliza-tion of patient data. Paramedics will need to access patient history on the scene to accurately assess patients in the field, and hospitals will benefit from having assess-ment logs from paramedics when patients arrive to the facility.

Several areas in the United States already have launched pilot studies of mobile integrated healthcare programs. There are different models being ex-plored, but it is clear that mobile inte-grated healthcare programs will need to be evidence-based and measurable in bet-ter patient outcomes.

In 2009, MedStar, an EMS agency in Fort Worth, Texas, began the Commu-nity Health Program, which focused on 21 individuals with a high frequency of 911

EMS Companies Can Get Ahead of the Healthcare Curve



By HeATHeR RiPLey

Headlines like this are becoming more common: “Company CEO steps down after social media fi asco.” Or, “Ex-ecutive fi red over social media gaffe.”

Every company today should have a social media policy in place to reduce its chances of becoming a negative head-line, but even with a social media policy, things can get out of hand. For healthcare practices and hospitals, upholding patient privacy and confi dentiality is of the utmost importance, and in addition to having a written policy, monitoring your social media is critical.

One of our employees recently told me about a situation that occurred with a medical practice she had worked for pre-viously. The medical practice encouraged employees to “like” company posts on a social media platform. A female employee liked one of the company posts. But, by clicking on the likes, readers could be di-rected to her social media account image. She was in a very revealing outfi t in her profi le image. Apparently, patients saw the thumbnail image, clicked on it, and were treated to an eyeful. The young lady was a front-desk practice employee who

engaged with every patient who walked in. The practice did not have a social media policy in place and lost patients due to the image and the negative attention it re-fl ected on the practice.

Other examples of social media disas-ters are easy to fi nd by searching Google. So, if you think your company or business is pretty safe from a social media debacle, you could be very wrong.

Navigating social media and creat-ing comprehensive policies are not for the novice, and hiring a social media expert or PR agency is your best bet for providing your healthcare business with the best and most complete social media policy to keep your patients’ information safe and your company name out of trouble.

If you do not have the budget, but still want a social media policy, there are many examples on the Internet to use as a basic template for your business. Here are some pointers to keep in mind before creating your social media policy.

1. Start out by defi ning what your healthcare business deems as social media

A very detailed description may not take into account emerging trends and

may leave your policy open to misinter-pretation. For example, the National Council of State Boards of Nursing (NCSBN) describes social media as “social media outlets, platforms and applications, including blogs, social networking sites, video sites, and online chat rooms and fo-rums.” A broad statement like this covers most forms of social media including ones that may be on the horizon.

2. Defi ne acceptable social media use while working

Some employees may be authorized to check your company social media ac-counts while on-duty, but the parameters need to be defi ned. If employees bring their own devices, your policy needs to address this use very specifi cally. If your employees use computers or tablets that have Internet access, the use of both kinds of equipment while on the premises need to be clarifi ed. Your guidelines for taking images while on duty with electronic de-vices needs to be written into your policy as well.

3. Defi ne acceptable social media use while off-duty

More concerning to healthcare pro-

fessionals is the use of social media by healthcare staff after hours. HIPAA de-fi nes patient privacy, and all employees in healthcare should be trained and educated on a regular basis about HIPAA regula-tions. While the majority of healthcare professionals would not disclose protected information on personal social media plat-forms, it can happen inadvertently and without intention to harm. Your policy should cover professionalism and ethics, and cover proper employee use of social media in regards to protected information even after employment terminates.

4. Defi ne disciplinary actionWhen there is a breach of HIPAA

guidelines or your own social media pol-icy, there can be real repercussions. Ac-cording to the NCSBN, improper use of social media by healthcare providers or workers may violate state and federal laws (established to protect patient privacy and confi dentiality) and may result in both civil and criminal penalties, including fi nes and possible jail time. Educate your employees about your policy and spell out what ac-tions the company will take if an employee uses social media against HIPAA or your company social media rules.

Because there are so many social media platforms available today, it be-comes even harder to draw the line be-tween work and off-duty social activity. If your company encourages its employees to post on the company social media ac-counts, how are you managing this? Can anyone post to your company accounts? Is there an employee who is responsible for monitoring posts and comments? Does your company have a policy in place to handle questionable employee posts? What is the disciplinary process for inap-propriate or unprofessional posts?

These are important areas a social media policy must address to be en-forceable. If you prefer your employees refrain from posting on your company social media accounts, do you state this in your employee handbook or social media policy? Are your employees “friends” or “followers” of your company social media accounts? If so, does your company regu-larly look at the employee pages associated with your account?

Make sure each employee compre-hends your social media policy, put it in writing, and have each employee sign the document. As another layer of protection for your business, have your legal depart-ment review it before distributing the pol-icy to employees.

Heather Ripley is the founder and CEO of Ripley PR, a national B2B public relations agency specializing in Healthcare IT. For more information, visit www.ripleypr.com or email [email protected].

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In January 2015, the University of Tennessee will welcome the inau-gural class for the Executive MBA for Healthcare Leadership program. An in-novative curriculum will transition pas-sionate healthcare professionals into change agents in the midst of healthcare reform. Unlike the physician-only Physi-cian Executive MBA program, the MBA for Healthcare Leadership program is for professionals in all healthcare arenas including nurses, pharmacists, dentists,

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said it appears the shift toward account-ability models is picking up steam … albeit slowly.

Lazerow, who is based in Washing-ton, D.C., has created a ‘Field Guide to Medicare Payment In-novation’ (advisory.com). However, he was quick to note the trans-formation isn’t limited to the Centers for Medicare & Medicaid Services. “There is a lot of pay-ment innovation happen-ing right now, and it’s happening in both the public and private sectors,” he said. Lazerow added CMS, commercial payers, state Medicaid programs and employers are all experimenting with new payment models in markets across the country.

While there is any number of subtle variations within the pilot projects, Laze-row said there are generally three big cate-gories of payment innovation being rolled out at this time — pay-for-performance initiatives, bundled payments, and shared savings reimbursement models.

Pay-For-Performance“It’s still a fee-for-service payment,

but a portion is withheld and linked to predefined metrics, including process, out-comes and patient satisfaction measures,” he said. “Medicare has a lot of experience here,” Lazerow added of the Hospital Value-Based Purchasing Program, Hos-pital Readmissions Reduction Program and hospital-acquired conditions (HAC) penalties.

Lazerow said in some cases, it could mean hospitals must invest in perfor-mance software or additional manpower to provide the necessary outcomes data … effectively making it cost more to capture the same reimbursement rate compared to the pre-pay-for-performance world. How-ever, as Lazerow pointed out, this isn’t a ‘request’ from CMS. These are manda-tory programs for all hospitals that accept Medicare prospective payments with two of the three already in place and the HAC penalties set to begin in fiscal year 2015.

“We’re seeing pay-for-performance in hospitals and physician practices,” Lazerow said, noting the reimbursement model has spread past the Medicare pop-ulation. “The challenge then becomes having different payers with different metrics.”

Even when broad categories of data collection apply to multiple payers, it isn’t uncommon for each to ask providers to drill down to different outcomes measures within the umbrella category. “As you can imagine, the reporting and compli-ance burden continues to grow,” Lazerow noted.

Bundled PaymentsLazerow said bundled payments offer

a different take on volume-driven reim-bursement by coordinating care among all providers responsible for a patient’s di-agnosis, treatment and rehabilitation and inserting a level of accountability into the group dynamic.

“In a traditional fee-for-service world, all these providers are paid individually and have no aligned incentives or mutual accountability,” he explained. Although bundled payments are still volume-based … the more you do, the more you are paid … Lazerow said the concept focuses on costs and outcomes. “A bundled pay-ment drives efficiency and quality within a discreet episode of care.”

For payers, Lazerow said the reim-bursement model creates both savings and price predictability. The sum for the bundle of care is generally less than would have been paid individually to those in-volved. On the provider side, the reim-bursement option helps drive efficiency and care coordination with a goal of hav-ing the patient receive the right care in the right setting to maximize outcomes and minimize costs.

While Medicare has a big program around bundled payments, Lazerow said this model has been adopted by the spec-trum of payers including private employ-ers. Wal-Mart, he noted, has established a bundled payment program around certain cardiac care and orthopaedic procedures. Although most current bundled payment programs are designed around specific pro-cedures such as hip replacement or cardiac bypass surgery, Lazerow noted, “We’re starting to hear more interest around medi-cal admissions, as well as the procedures.”

Shared Savings ModelsAlthough bundled payments might

be highly effective for unavoidable care, the concept doesn’t address preventive care. That’s where accountable care mod-els … also known as shared savings … step in to apply population health metrics to mitigate potentially avoidable healthcare spending. The intent with these reim-bursement models is typically to spend some in order to save more.

“The big focus right now is on shared savings models,” Lazerow pointed out. He added providers work together against a pre-set annual spending target per pa-tient. Unlike past payment experiments based on monthly capitated payments, the shared savings model combines existing fee-for-service payments with a reconcili-ation process at the end of the year. Pro-viders then share in a percentage of the savings they generate. Best practices and quality metrics are a foundational element to ensure patients aren’t denied necessary care simply to save money.

“The overall concept of the ACO is these providers are collectively account-able for the total cost and quality of care for populations of patients over time,” Lazerow stated.

From Medicare Advantage plans to self-funded employers, the focus on population health has taken root across the country. While providers also seem to

embrace the evidence-based concepts and focus on chronic disease management in-tegral to population health, the financial realities of such programs have proven problematic in some cases. Lazerow noted that of the 32 original participants in the CMS Pioneer ACO program, nearly one-third have left … with seven moving to Medicare shared savings programs, which have a lower risk profile for providers, and three dropping out altogether.

“One challenge providers are facing is that sharing 50 cents on the dollar of volumes they are destroying might end up creating a negative financial outcome for the health system,” said Lazerow. “They’re not capturing enough of the sav-ings they are generating.”

The Bottom LineLazerow noted he hears different

sentiments from different providers as to which payment innovations they prefer. Some, he added, might like to stay in the traditional fee-for-service model, but that ultimately is unlikely given payer demands for more accountability, increased savings and improved efficiency.

“Some providers right now, given their market dynamics, are in a watch and wait mode, but each year we see more and more payers and providers experimenting with accountable payment models,” Laz-erow concluded.

Reimbursement Revisit, continued from page 1

Even industry regu-lations for patients with these high-risk diseases are getting tighter. As Peter Lemkin, OD, Johnson City Eye Clinic, pointed out, “Insurance companies now mandate that all diabetic patients be screened annually for retinopathy.”

New Advances and Technologies

As these screenings increase, so does the opportunity to save vision. Many ad-vances and technologies in the Ophthal-mology specialty are improving outcomes.

“This is an exciting time for ophthal-mology in general,” said Rabon. “Early diagnosis and better drugs for glaucoma, lasers for diabetes, ex-ceptional advances in cataract surgery, injec-tions for wet macular de-generation are just some of the recent advances we’ve seen,” said Rabon.

Added Battle, “The advances in cataract surgery are exciting, particularly femtosecond laser-assisted surgery, and there are more options for addressing astigmatism now than ever before. For some patients, this can mean minimal or no dependence upon glasses for many visually demanding activities, such as driving.”

And for patients with diabetic reti-

nopathy and macular degeneration, “In-jectable medications for the treatment of these disease are significant treatment ad-vances,” said Lemkin.

Nutrition and SupplementsAlong with the recommended eye

screenings, senior adults should also be regularly questioned about their nutrition and diets. Patients should be choosing foods rich in antioxidants, like vita-mins A and C, and essen-tial omega-3 fatty acids; however, there is varying research regarding vita-mins or supplements.

“Vitamins like fish oil and flax seed oil have been shown beneficial in the treat-ment of dry eyes,” Lemkin explained. “Supplements with lutein and zeaxanthin have been shown to delay the onset and progression of macular degeneration.”

Added Rabon. “Vitamins or supple-ments have been proven to help in forms of macular degeneration, the most com-mon cause of visual loss over 65, but there is debate that all may benefit.”

As Battle pointed out, “Outside of un-usual nutritional deficiencies, the only vi-tamin combination or supplement proven to make a difference for eye health was from the Age Related Eye Disease Study and its follow-up study, AREDS 2,” said Battle. This combination has only proven to be helpful for patients with a known his-tory of age-related macular degeneration

that meet certain criteria, and it’s available over-the-counter. The AREDS 2 vitamin combination was not shown to be of any benefit to individuals without macular de-generation, even if they have a family his-tory of it. The AREDS 2 vitamin contains a very high concentration of Vitamins C, E, and zinc, as well as copper, lutein, and zeaxanthin.”

Other Reminders for Healthy Senior Eyes

Primary Care Providers can also re-mind patients that the following healthy habits benefit their eyes:

• Smoking Cessation. Smoking ex-poses the eyes to high levels of oxi-dative stress and increases the risk of developing a variety of conditions that affect eye health.

• Exercise. Exercise improves blood circulation and, in turn, improves oxygen levels to the eyes and the removal of toxins.

• Wear Sunglasses. Sunglasses block harmful ultraviolet (UV) rays.

• Screen Time. Two hours of work-ing on a computer screen causes repetitive stress in the eye muscles. The computer screen should be kept within 20”-24” of the eyes and slightly below eye level. Breaks should be taken every 15 minutes to focus on a distant object.

• Eye Injuries. Patients should seek immediate, professional medical at-tention.

An Eye on Senior Health, continued from page 1

Dr. Peter Lemkin

Dr. James W. Battle

Dr. Randal J. Rabon

Rob Lazerow


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MISSION STATEMENTThe Johnson City Eye Clinic’s mission is to

provide personalized attention, excellent

service, and unparalleled comprehensive eye

care to you, your family and our community.

We will continue to achieve this goal with

three core values. Our doctors and staff will

use innovative technological advancements

in treatment, diagnostics and prevention. We

will always provide superior education to our

patients, doctors, staff and community. We

recognize every patients’ importance.

• Cataract & Intraocular Lens Microsurgery

• Laser Assisted Cataract & Refractive Surgeries

• Age Related Macular Degeneration

• Medical and Laser Treatment of Diabetic Eye Disease

• Glaucoma Surgical and Medical Management

• Pediatric Ophthalmology

• Adult Strabismus

• Neuro-Ophthalmology

• Corneal Disease and Surgery

• LASIK

• Cosmetic Plastic & Reconstructive Surgery

• Eyelid/Eyebrow Surgery

• Botox/Dysport

• Cosmetic fi llers

• Facial Resurfacing

• Hyperpigmentation Correction

• Chemical Peels






MISSION STATEMENTThe Johnson City Eye Clinic’s mission is to

provide personalized attention, excellent

service, and unparalleled comprehensive eye

care to you, your family and our community.

We will continue to achieve this goal with

three core values. Our doctors and staff will

use innovative technological advancements

in treatment, diagnostics and prevention. We

will always provide superior education to our

patients, doctors, staff and community. We

recognize every patients’ importance.

• Cataract & Intraocular Lens Microsurgery

• Laser Assisted Cataract & Refractive Surgeries

• Age Related Macular Degeneration

• Medical and Laser Treatment of Diabetic Eye Disease

• Glaucoma Surgical and Medical Management

• Pediatric Ophthalmology

• Adult Strabismus

• Neuro-Ophthalmology

• Corneal Disease and Surgery

• LASIK

• Cosmetic Plastic & Reconstructive Surgery

• Eyelid/Eyebrow Surgery

• Botox/Dysport

• Cosmetic fi llers

• Facial Resurfacing

• Hyperpigmentation Correction

• Chemical Peels


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LegalMatters

Profi t and Loss: The Top Ten Things Providers Need to KnowPart VI: Audit Letter Review – Overpayment or Over You?

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

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

Private insurance companies issue a variety of notices, reports, and letters to providers with contracts to offer healthcare services to their members. In the ordinary course of business, a provider would receive Explanation of Benefi ts reports, contract amendments, newsletters, and by far, the most important of all—requests for medical records. Any audit or review of medical records must be handled with great care. While seemingly innocuous, these letters may signal the start of an audit that could identify an overpayment or the beginning of the end of participation in the network. Either way, an audit has the potential to devastate a medical practice, temporarily or indefi nitely.

What is an audit of paid claims?An audit of paid claims occurs

when the health plan (insurance company or other payer of health insurance benefi ts) begins a review of billing records to ensure payment was proper. Medical records are requested for the auditor to review and determine whether the service billed was supported by the appropriate documentation. Providers may receive only a request for medical records for a small number of patients. This does not necessarily limit the audit to those particular patients. The audit may be expanded to review patterns of billing errors or particular CPT Codes.

What happens if a billing error is identifi ed?

Any incorrectly billed service or service not properly supported by documentation may be classifi ed as overpayment, which the provider must refund. The payer may also begin collection activities (recoupment through withholding current payments).

This could negatively impact cash fl ow if the overpayment is substantial and the payer represents a signifi cant source of income for the practice.

How far back can they look?Under Tennessee law (1), private

payers (2) may recoup reimbursements paid during the 18 month period after the date that the payer paid the claim. (This does not include any actions related to allegations of fraud or abuse, which are not addressed in this article.) If a billing error is identifi ed as a result of a small sample audit, an expanded audit might follow. For example, if a provider receives an overpayment notifi cation related to dates of service within the last six months only, an expanded review might identify overpayments for the entire 18-month look back period.

What should I do when an overpayment notifi cation is received?

After receiving an overpayment notifi cation, providers should act quickly to determine what avenues of appeal are available if they do not agree with the audit fi ndings. The time period for fi ling an appeal may be very limited and immediate action may be required. Repayment should also be discussed. Requests for an extended repayment plan may be an option. A lump sum payment (if possible) may be preferable to the bookkeeping oversight required to monitor recoupment activity.

What is a quality review audit?A quality review audit may impact

the provider’s participation with a health plan. If termination results after a due

process review, the action is report-able to the National Practitioner Data Bank (3). An audit may focus on medical records as the provider’s documenta-tion/evidence for meeting the standard of care, compliance with policies and procedures for documentation and qual-ity of care for the patient.

A quality review audit may also begin with a request for medical records. It is absolutely critical for the provider to know what type of action may result from the review. The letter must be carefully considered, given top priority, and should be brought to the attention of management. The consequences of termination from health plan participation (insurance company network provider agreement) can be catastrophic, and with no endpoint in sight.

In most situations, a provider will be offered the opportunity to improve upon identifi ed defi ciencies and allowed a period of time to take corrective action. Providers should make every effort to obtain expert advice on how to properly address the audit concerns and move forward with a continuing relationship and contract participation. If no improvement is shown, the private payer may elect to terminate the provider’s participation contract.

What happens if my contract is terminated?

The National Practitioner Data Bank requires certain adjudicated actions or decisions, which are fi nal, to be reported. If the health plan offers a due process mechanism for appeal, the termination or other comparable action must be reported. If the provider elects not to use the due process (appeal) mechanism offered, that is immaterial to the mandatory reporting process. So long as such a process is available to the provider before the decision is made fi nal, it is, by law, a reportable event (4).

In short, know the purpose of the audit: Overpayment or Over you?

Notes1T.C.A. § 56-7-110.2The 18-month look back period applies only to private payers and not to governmental payers, such as TennCare.345 Code of Federal Regulations §60.16.445 Code of Federal Regulations §60.3 – Defi nitions - see “Other adjudicated actions or decisions”

Attorneys Diana L. Gustin 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. Gustin 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.

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To succeed in today’s market, healthcare providers must continue crafting patient-care strategies that result in both excellent quality and cost-effective outcomes.

While all clinicians and stakeholders need a seat at the table during these processes, input from physicians – be they primary care or subspecialty — is crucial. That’s why Mountain States Health Alliance has created the position of Vice President, Hospital Based Programs and Service Line Development, and named Dr. B.J. Smith to fi ll it. As a hospitalist and in other roles within Mountain States, Smith knows fi rsthand the challenges physicians face, as well as the obstacles that Mountain States as a provider must overcome in order to continue offering the best, most needed services to the communities its facilities serve.

East Tennessee Medical News: Your new role is an entirely new position for Mountain States. What, exactly, have you been tasked with achieving?

Dr. Smith: I have been with Mountain States for about six years, starting out in primary care. My training is in internal medicine, and I am board certifi ed in internal medicine and pediatrics. In 2009, I was asked to start a hospitalist group at Johnson City Medical Center, and I eventually became medical director and regional medical director there for the Mountain States Medical Group of hospitalists.

All that is to say that I’ve been on both sides, and so I come to Mountain States’ Clinical Services Division with the goal of fi nding the best way to incorporate our quality metrics and things that we have to monitor into our physician practices. I want to engage our physicians in what we’re doing, so we can all work together to improve the quality of our service lines while also achieving high performances. I think having a clinician in this role is vital because I may see things that others would not, and also see opportunities for improvement that might not be apparent to other people.

ETMN: Sometimes physicians get frustrated by what they see as too much bureaucracy within a health system. At the same time, Mountain States has to track a lot of numbers in order to report to insurance companies and government agencies. How will you strike a balance?

Dr. Smith: Mountain States uses a lot of information as a road map for our operations. Some of that comes from payors, some from Medicare, because they are going to tell us what is important to them, such as reduced readmissions. We have our own quality metrics, which usually align with theirs, but also look at many other factors. We mesh all that together, and then move forward to share that information with our physician community.

Hospital Leadership 2014

Pulling in all stakeholdersHealthcare reform means getting physician buy-in for changes

Having those community doctors engaged, as well as our own medical staff on board, is essential. All these people have to understand what kind of quality measures are important from not only the data, but also the evidence that’s out there. This is the information that is going to be key to help save the patients and everyone else in terms of costs, but also improve outcomes.

ETMN: What are some specifi cs steps you are taking now to bring these ideas from theory into practice?

Dr. Smith: One of the biggest things I am doing right now is looking at our service lines. That means fully understanding the services we have, and taking an inventory to see what is going on in all of them. What do we offer? What’s going on elsewhere in the country in that area? Are we offering everything we should? Do we need a new line, or to drop an existing one? What can we do differently, and what can we do better?

Our market is changing, and having this assessment in place will help us to not only understand what our communities want, but also be in a better position to provide those services. But most importantly, we want to make sure that we are tops in all our services — if we can’t be excellent at something, then we don’t want to be proposing or offering it.

ETMN: As you look at service lines and programs within the hospitals, what are some of the steps you’ll be taking to get that physician and staff buy-in?

Dr. Smith: There’s a bit more research to be done in the hospital programs, things like emergency medicine, anesthesia, radiology and others, compared to service lines. But as a hospitalist, I became very familiar with all of them, and so my goals will be the same. We need to know where we are on the performance scale, and how we can do better. I think once we have our medical staff and outside physicians engaged in looking at all of our work, and fully understanding the evidence-based practices that we are being held accountable for, they will really buy into what we want to do.

We work with our doctors in so many ways on a regular basis. This is just getting them even more engaged so that we can improve what we do. I want them to tell me what kinds of things they need Mountain States to be working on. There are a lot of challenges continuing to arise from healthcare reform, but if we are collaborating, we can meet those as they come. If everyone knows what everyone else is expecting and needs, that will have a signifi cant impact on what we can do for the communities we serve.

Dr. B.J. Smith

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ClinicallySpeakingBY STEVEN M. DOETTL, AU.D.

Dizziness……What Next?Dizziness accounts for millions

of primary care and specialty physi-cian visits per year. A recent study by Bisdroff and colleagues reported a 1-year prevalence for dizziness in the adult population to be 36-49% with increasing prevalence with advancing age (1). The fact of the matter is that people are dizzy…..a lot of people are dizzy. Combined with the risk of falls (a “hot-button” issue in senior health), dizziness can be directly related to increased co-morbidities and mortal-ity rates. Unfortunately, a wide variety of factors including, but not limited to, vague descriptions of symptoms, confusing verbiage (dizziness, vertigo, imbalance, giddiness, etc.), and the fact that dizziness can originate from virtu-ally any system within the body, make it exceedingly difficult to diagnose and manage.

Peripheral vestibular dysfunction is the most common cause of dizziness in the adult population. Benign Parox-ysmal Positional Vertigo (BPPV) is the most frequent diagnosis - accounting for nearly 50% of all cases of reported vertigo. Despite the prevalence of BPPV, experts are concerned that close to another 10% of seniors with BPPV are being undiagnosed (2,3).

Vestibular neuritis/labyrinthitis (sec-ond most common), Meniere’s disease, perilymph fistula, and superior canal dehiscence are all also possible causes of peripheral vestibular dysfunction. Other common medical conditions such as migraine headaches, cardiovascular anomalies, neurologic dysfunction, and traumatic brain injuries can result in sec-ondary peripheral vestibular dysfunc-tion resulting in decreased balance and

increased fall risk in elders with these problems.

Obviously the first, and most important step in treating vertigo, is a thorough medical evaluation to determine if any underlying medical conditions, specifically cardiovascular, neurologic, or otologic in nature exist. Based on the medical findings, ap-propriate medical management and referrals can be made. Increasingly, physicians require more quantitative and precise vestibular evaluations to develop an appropriate management strategy. Videonystagmography (VNG) and Rotary Chair testing (RCT) have been available for years and have long-been considered the “gold-standard” of vestibular evaluation. Unfortunately, VNG and RCT testing alone combine to assess only the horizontal semicircular canal (SCC) and only the superior por-tion of the 8th cranial nerve vestibular branch, ignoring the posterior and anterior SCCs, the inferior vestibular nerve branches, and the otolithic or-gans for each ear. While still quite valu-able, these tests given in isolation can lead to more unanswered questions or at worst, false negative findings regard-ing peripheral vestibular function.

The good news is that over the last several years, vestibular evalua-tion technology has advanced, greatly improving our ability to fully assess the peripheral vestibular structures. By adding Video Head Impulse Testing (VHIT) and Vestibular Evoked Myogenic Potentials (VEMPs) to the standard test battery, one can obtain additional im-portant information regarding the func-tion of the posterior and anterior SCCs, the inferior branch of the vestibular

nerve, and the utricle and saccule in each ear.

The VHIT is based on the manual Halmagyi Head Thrust procedure com-bining the Halmagyi procedure with video-oculography to allow for record-ing and, most importantly, detailed analysis of the vestibular-ocular reflex in relation to all 6 semicircular canals independently (4). VEMP evaluations (cervical and optical) provide an evalu-ation of saccule and utricle function using the electrophysiologic evaluation of the vestibulo-spinal and vestibulo-ocular reflexes, respectively.

The combination of VNG, RCT, VHIT and VEMP (cervical and ocular) results provide information regarding each of the 10 sensory structures of the peripheral vestibular system as well as the inferior and superior vestibular nerve branches and at a wide spectrum of stimulation speeds (Figure). Each test by itself has its strengths and weak-nesses, but the combination of tests provide the highest level of diagnostic capabilities while also allowing for inter-test comparisons for confirmation of findings. In addition, the ability to assess the vestibular structures through a wide variety of measures and tech-niques allow for a greater ability to evaluate patients incapable of tolerat-ing specific procedures.

Treatment options for peripheral vestibular pathology, once properly identified, such as vestibular rehabilita-tion, are often highly successful with minimal associated risks. Canalith repositioning treatments for BPPV have been noted to be successful after one treatment in up to 80% of cases and 96% successful following two treatment

sessions (5,6). Vestibular rehabilitation techniques such as gaze stabilization exercises, habituation exercises, and balance retraining have also been known to be successful in the treat-ment of peripheral vestibular dysfunc-tion. Early identification followed by appropriate vestibular rehabilitation significantly reduces the risk of falls and greatly increases the quality of life as soon as possible.

These advances in vestibular evalu-ation technology can, in concert with physician care, help to provide the answer to “Dizziness…….What Next?” The University of Tennessee Hear-ing and Speech Center can provide assessment and management using VNG, RCT, VHIT, cVEMP, and oVEMP. The RCT and VHIT are the only of their kind in East Tennessee. Full audiometric testing, auditory brainstem response evaluations, electrocochleography, be-havioral vestibular and balance assess-ment tools, and vestibular rehabilitation services (canalith repositioning) for those patients identified with BPPV are also available.

References1Bisdorff, A., Bosser, G., Guegeun, R., & Perris, P. (2013). The Epidemiology of vertigo, dizziness, and unsteadiness and its links to co-morbidities. Front Neurol 4(29):1-7.2Luscher, M., Theilgaard, S., & Edholm, B. (2014). Prevalence and characteristics of diagnostic groups amongst 1034 patients seen in ENT practices for dizziness. J Laryngol Otol 128(2):128-133.3Oghalai, J.S., et al. (2002). “Unrecognized benign paroxysmal positional vertigo in elderly patients.” Otolaryngol Head Neck Surg 122(5):630-4.4Macdougall HG, McGarvie LA, Halmagyi GM, Curthoys IS, & Weber KP. (2013). The Video Head Impulse Test (vHIT) detects vertical semicircular canal dysfunction. PLoS One. Apr 22;8(4):e61488. doi: 10.1371/journal.pone.0061488. Print 2013.5Gans, R.E., & Harrington-Gans, P.A. (2002). Treatment efficacy of benign paroxysmal positional vertigo (BPPV) with canalith repositioning maneuver and semont liberatory maneuver in 376 patients. Sem Hearing 23(2):129-142.6von Brevern M, et. Al. (2006). “Short-term efficacy of Epley’s manoeuvre: a double-blind randomized trial.” J Neurol Neurosurg Psychiatry. 77(8):980-982.

Steven M. Doettl, Au.D., is a Clinical Associate Professor and audiologist in the Department of Audiology and Speech Pathology at the University of Tennessee Health Science Center. He earned his Doctor of Audiology degree (Au.D.) from the University of Tennessee and completed his clinical fellowship at the University of Tennessee Medical Center. Specializing in vestibular evaluation, management, and rehabilitation, he currently coordinates the UT Hearing and Speech Center Dizziness Clinic in Knoxville, TN, engages in multiple research projects in regards to evaluation and management of patients with peripheral vestibular dysfunction, and provides instruction within the Doctor of Audiology program. For more information, contact the UT Hearing and Speech Center or email [email protected].

Bee Fit 4 Kids is a family oriented pediatric weight management program using evidenced based research to help overweight children & their families. We are now accepting insurance.

KidsFACT is a nonprofit support group created by GI for Kids, PLLC for those diagnosed with pediatric Inflammatory Bowel Disease (IBD) & their family members.

Our behavior clinicians are experienced in helping a variety of disorders.

Support group helping the Knoxville region with celiac disease & gluten intolerance. www.celi-act.comwww.giforkids.com (865) 546-3998

2100 Clinch Avenue, Suite 510 | Children's Hospital Medical Office Building | Knoxville, TN 37916

…welcomes Dr. David DeVoid, who joins the group as a Pediatric Gastroenterologist specializing in diagnosing and treating infants, children and teens with digestive, liver and nutritional problems. He graduated from the University of Maryland and received initial medical training at Baylor College of Medicine while serving in the U.S. Air Force. He completed his Pediatric Residency at Wilford Hall USAF Medical Center in San Antonio, Texas and postgraduate Fellow in Pediatric Gastroenterology at Walter Reed Army Medical Center in Washington, DC. serving in the U.S. Air Force for a total of nine years. He most recently cared for pediatric gastroenterology patients in Chattanooga, Tennessee for 16 years. His Gastroenterology interests include Irritable Bowel and Liver diseases as well as encouraging a healthy lifestyle as an important part of any treatment plan.

East Tennessee Children’s Hospital Gastroenterology and Nutrition Services

accepting new patients

GI for Kids, PLLC


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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 $10

For more information: 92-MUSIC (926-8742) or visit www.jcsymphony.com

String Theoryfeaturing Jessica Miskelly, Violin

Sponsored by Carnegie Hotel

Saturday, November 15, 7:30 p.m.Mary B. Martin Auditorium at Seeger Chapel, Milligan College

Evening ProgramEdward Elgar: Serenade for Strings

Ralph Vaughan Williams: Fantasia on a Theme by Thomas TallisVivaldi: “Spring” and “Winter” from The Four Seasons

A Chamber Music Fellow at the University of Kentucky, Jessica Miskelly has been playing the violin since she was six years old. Jessica has toured China as a solo-ist with the University of Kentucky Symphony and was concertmaster when the Symphony played at Carnegie Hall. As part of the Niles String Quartet at UK, she has been artist-in-residence at the Chapel Hill Chamber Music Workshop. She is pursuing a doctorate of

musical arts at the University of Kentucky.A pre-concert talk will be presented at 6:30 p.m.

The Literary ExaminerBY TERRI SCHLICHENMEYER

The Skeleton Crew by Deborah Halber; c.2014, Simon & Schuster; $25.00/$28.99 Canada, 240 pages

You can’t find your keys. Again.

Fortunately, you always find them because they won’t travel far without you. But, as you’ll see in the new book The Skel-eton Crew by Deborah Hal-ber, some things go missing for a lot longer…

Wilbur Riddle was a well-driller back in May of 1968 and was waiting for a job to start when he noticed a canvas sack on a stone slab just off Kentucky’s Route 25. As he got closer, he could see that something was inside, and then he could smell it. He kicked the tent-canvas bag and was shocked at what he spied.

Inside the bag was a girl, curled up and bound tight with a rectangular bit of white cloth over her shoulder. She was long dead – long enough that identifi able features were nearly gone. Without a name to attach to the body, the media dubbed her Tent Girl.

The case of “Tent Girl,” says Halber, “drew me in.”

If you’re a fan of TV detective shows, you might think that the world is littered with unidentifi ed bodies – and there are “shock-ingly large numbers of them out there,” says Halber. A survey done several years ago in-dicated “more than thirteen thousand sets” of unidentifi ed bones moldering in morgues, but one estimate places the number nearly three times higher. While “many people are unaware of the extent of the problem,” a fi erce group of folks are well-acquainted with the issue.

Lurking online under pseudonyms and handles that often belie their age and gender, these people spend hours “obsessed” with matching data for missing persons with data for unknown bodies. Often sneered at by local police (and sometimes totally ignored), this “Skeleton Crew” has single-handedly solved decades-old cold cases, given names to corpses anonymously buried, and offered closure to families of people who vanished generations ago.

They’ve solved murders in Missouri. They’ve ID’d vagrants in Vegas. They’ve closed cold cases in Canada. And in a situa-tion that launched a career, one man ascer-tained the identity of Tent Girl.

You know you’ve got a great read in your hands when, on page two, you mourn that the book will end. With a mystery-true crime-science mix of facts and detective stories, author Deborah Halber explains why this two-pronged issue exists and how modern technology and amateur sleuthing is helping lessen it. Along the way, Halber tours morgues and back-rooms, lurks near

an exhumation, and tries her hand at solv-ing one of New England’s best-known cases.

And on that one, she learns that there’s some information best left buried…

If you tend to get a little queasy, this isn’t the book for you. It’s graphic and gruesome, but oh-so-fascinating and hard to put down.

No Saints around Here: A Caregiver’s Days by Susan Allen Toth; c.2014, Univer-sity of Minnesota Press; $16.95/higher

in Canada, 215 pages

It was supposed to be paradisiacal.

You’d planned it that way, in fact: the two of you, retired, with time aplenty to travel, explore, garden, enjoy your-selves. It was sup-posed to be good - until one of you got sick and the other’s now a caregiver, a journey you never wanted or expected but… there you are. And in the new book No Saints around Here by Susan Allen Toth, you’ll see that you’re not alone.

There were fifteen years between Susan Allen Toth and her husband, James.

That’s not a lot of difference in age, re-ally. It’s certainly not enough to make any-one fret about a future full of health issues, but that’s what arrived: while in his mid-70s, James was diagnosed with Parkinson’s dis-ease.

“Parkie,” as they called it faux-casually, was initially mild; James was a little clumsy and had slight tremors, and they dealt with it. But then, his symptoms worsened: loss of memory, slowness, dementia, and Toth be-came a spousal caregiver, a member of an “ever-expanding club without borders. ”

In her quest for books on the subject, Toth discovered that few authors write “from the front lines.” Nothing, for instance, indicated that she’d have to fl oss James’s teeth. She wasn’t prepared for “absurdities” of life with an ill husband or round-the-clock strangers ministering care. She was sur-prised at friendships that fell away, and how new “webs” knit themselves in help.

She began journaling and, in her en-tries, the word “time” crops up repeatedly – mostly, because there was never enough. Not enough time for herself (although, with paid help, she was sometimes able to sneak away to their Wisconsin cabin), not enough for day-to-day chores, and not enough time with James.

“It is a terrible loss,” she said of no longer being able to “slip into his bed.” She never expected to have to know about incontinence care, “beige lies,” or nursing homes (she kept James at home until the end). Snappiness wasn’t her normal mien,

but it happened. There was a “last Christ-mas” and a pleasant surprise that accompa-nied hospice care. And, says Toth, through it all, “I did the best I could.”

Pick up No Saints around Here and you’ll notice something: holding it in your hands is like grasping a half-pound of pure ache.

The truth, beautifully and brutally in real-time, is what author Susan Allen Toth offers her readers, with entries that span the 18-months before James died. Toth writes about hands-on caretaking, but she also touches upon relief, guilt, self-care, anger, and the whole-life dwindling that comes with progressive illness. That bluntness and

raw honesty may shock some read-ers, and it may make you gasp at its audacity.

Then again, if you do, maybe this isn’t your book. Toth’s words will give comfort to newly-minted caregivers who aren’t sure what’s next, who aren’t sure what to do, who don’t know what “normal” is anymore. This is a book for those men and women, spouses and chil-

dren – and if that’s you, No Saints Around Here may be heaven-sent.

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.

It was supposed to

You’d planned it that way, in fact: the two of you, retired,

other’s now a caregiver,

with progressive illness. That bluntness and

isn’t your book. Toth’s words will give comfort to newly-minted caregivers who aren’t sure what’s next, who aren’t sure what to do, who don’t know what “normal” is anymore. This is a book for those men and women, spouses and chil-

dren – and if that’s you, No Saints Around Here may be heaven-sent.

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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.

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.

calls. Through the development of indi-vidual care plans and proactive check-ins, MedStar was able to eliminate 1,000 calls per year just from those 21 people.

Today, MedStar has become a model throughout the country of how mobile in-tegrated healthcare programs can be suc-cessful. In addition to the “EMS Loyalty” program for high system users detailed above, the company since has rolled out programs focused on “patient naviga-tion” and mobile integrated healthcare. MedStar partners with the local hospital district, JPS Health Network, to provide follow-up care to outpatients at-risk for re-admission, overnight medical observation, and monitoring to reduce hospice revoca-tion. Each of these programs that would normally require a trip to the emergency department are conducted in the patients’ homes.

Organizations getting ahead of the healthcare curve, such as MedStar, also are aligning themselves with hospitals to share both risk and potential cost savings. If a patient is not admitted to the hospital because of MedStar’s proactive manage-ment, the EMS agency receives a portion of the savings. In May 2014, an analysis of cost avoidance from these programs was tallied at nearly $1.7 million. JPS Health Network referred 1,620 calls to MedStar’s mobile integrated healthcare programs from 2012 to 2014, and MedStar received its first payment of more $790,000 as re-imbursement.

As pilot programs record success, federal and state governments are ex-ploring various payment models to make mobile integrated healthcare financially viable. Centers for Medicare & Medic-aid Services (CMS) announced last year $1 billion in innovation grants to test new healthcare payment and delivery models. The state of Minnesota passed legislation last year allowing reimbursement from state-run Medicaid to EMS organizations for preemptive treatment.

This is the future of healthcare, and the EMS industry has a small window of opportunity to fill a big need. Priority Ambulance, the only national ambulance company headquartered in East Tennes-see, is positioning itself to be ready. We are currently in the early stages of plan-ning the structure of a mobile integrated program for Loudon County, Tennessee, where we hold emergency services con-tracts with the cities of Lenoir City and Loudon. As the delivery of healthcare continues to shift, I encourage my fellow EMS professionals to prepare themselves to provide a critical service under the new model.

EMS, continued from page 5

Dennis Rowe is the director of East Tennessee operations at Priority Ambulance.

Physician Executive MBA Program (PEMBA)

Since 1998, the PEMBA program has developed 546 physician leaders from 50 states and nine countries. Ranked the No. 1 preferred MBA program for phy-sicians by Modern Healthcare Magazine for ten consecutive years, PEMBA leads physicians through a one-year program using a combination of distance educa-tion technology and on-campus residen-cies. Utilizing the same proprietary High Compression LearningSM as the Ex-ecutive MBA for Healthcare Leadership, physicians gain an incredible amount of knowledge and experience in the shortest possible time frame. Upon completing the program, physicians possess the business knowledge necessary to step into industry leadership roles.

Executive Education ProgramsBeyond traditional degree programs,

the University of Tennessee, Knoxville offers non-degree executive programs and custom courses honed specifically for healthcare professionals and patient care facilities.

Clinical staff and healthcare adminis-trators often find themselves in leadership roles for which they are not equipped. CME-certified professional development programs can provide these healthcare team members with the confidence and skills needed to feel well equipped for new leadership roles.

In addition, UT is recognized for pro-prietary simulations demonstrating how Lean tools can be used in medical settings to improve patient care quality and safety. Building off an introductory multi-day certificate program specific to a healthcare

setting, individuals and organizations alike may choose to take advanced, custom or green and black belt Lean certification courses.

For more than 40 years, the Univer-sity of Tennessee, Knoxville, College of Business Administration and its graduate and executive education programs have delivered expertise, solutions, and applied thought-leadership to thousands of organi-zations worldwide. Healthcare programs at the University of Tennessee focus on patient outcomes, streamline clinical op-erations, and maximize financial perfor-mance. The college continues to expand its reputation with medical professionals across the globe through extensive educa-tional offerings and custom solutions for healthcare organizations. For more infor-mation, contact [email protected].

Developing Leaders, continued from page 7

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

Partnerships. All area Healthcare Managers (including non-members) are invited to attend.

JOHNSON CITY MGMA MONTHLY MEETING

Date: The 2nd Thursday of Each MonthTime: 11:30 AM – 1:00 PM

Location: Summit Leadership Foundation3104 Hanover Rd.

Johnson City

KINGSPORT MGMA MONTHLY MEETING

Date: The 3rd Thursday of Each Month Time: 11:30 AM – 1:00 PM

Location: Indian Path Medical Center Conference Room, Building 2002,

Second Floor, Kingsport

2ND THURSDAY 3RD THURSDAY


Dr. Ryan L. Dabbs

Ryan L. Dabbs, MD, Joins Tennessee Orthopaedic Clinics

KNOXVILLE – Tennessee Orthopae-dic Clinics welcomes Dr. Ryan L. Dabbs to its group of 26 Board Certified and Board Eligible physi-cians and surgeons.

After finishing his un-dergraduate work at the University of Colorado in Boulder, Dabbs graduated medical school from East Tennessee State University-Quillen College of Medicine in Johnson City, Tenn. He then completed his ortho-paedic surgery residency at the Southern Illinois University School of Medicine. He received comprehensive training and has a special interest in shoulder, hip, and knee joint replacement and arthroscopy. With extensive experience in emergency care, Dabbs is highly trained to handle acute pa-tient injuries and complex fractures. Dabbs is a member of the American Academy of Orthopaedic Surgeons and the Orthopae-dic Trauma Association. His varied interests include involvement with his church, spend-ing time with his wife and daughters, and outdoor activities including camping, golf, and mountain climbing.

Tennova Healthcare OB/GYN Achieves Milestone in Women’s Health SurgeryDr. Randal Hartline performs 300th robotic-assisted surgery

KNOXVILLE – Randal Hartline, M.D., obstetrician/gynecologist, recently per-formed his 300th robotic-assisted women’s health surgery at Tennova Healthcare’s Phy-sicians Regional Medical Center.

“Congratulations to Dr. Hartline on reaching this milestone,” said Karen Metz, CEO of Physicians Regional Medical Cen-ter. “He joins the ranks of several Tennova physicians who have performed a signifi-cant number of laparoscopic and robotic-assisted procedures. For women who need gynecological surgery, this means we have experienced surgical teams and specialized equipment to treat them effectively—with-out a big incision.”

“The use of robotic technology contin-ues to grow at a rapid pace. In addition to smaller incisions, the benefits to our patients include less scarring, faster recoveries and a shorter hospital stay,” Dr. Hartline said.

“This technology makes complex sur-geries easier for both the patient and physi-cian,” he added. “A good example of this is sacrocolpopexy—the gold standard to treat severe vaginal prolapse. The open surgical technique, developed in the 1960s, required long incisions and several weeks of recovery time. Most physicians stopped performing the open procedure because the recovery was so difficult for their patients.

“Robotic technology has allowed us to perform pelvic prolapse surgery – but in a minimally invasive way – which improves the overall surgical experience and is an effec-tive treatment option for this uncomfortable condition,” Dr. Hartline said.

To date, approximately 4,000 robotic-assisted surgeries have been performed at

Tennova facilities. Both Physicians Regional Medical Center and Turkey Creek Medi-cal Center have been named Centers of Excellence in Women’s Health Surgery by the American Institute of Minimally Invasive Surgery. Earning this distinction recognizes the health system’s surgical expertise and continued commitment to offer women the latest minimally invasive procedures.

Miller Joins Parkridge Health System Medical Staff

CHATTANOOGA – Orthopaedist Benjamin Miller, MD, has joined the medi-cal staff of Parkridge Health System.

Miller earned a Bache-lor of Science degree in biol-ogy from Freed-Hardeman University and a Doctorate of Medicine from the Uni-versity of Alabama School of Medicine in Birmingham. He completed a residency in Orthopaedics at the University of Arkansas and a Sports Medicine fellowship at the Mississippi Sports Medicine and Orthopaedic Center in Jackson, Miss.

Miller is a member of the American Academy of Orthopaedic Surgeons and the Arthroscopy Association of North America. He is affiliated with Chattanooga Bone & Joint.

Chattanooga’s First Single-Site Robotic Hysterectomy Performed at Parkridge East Hospital

CHATTANOOGA – A surgical team at Parkridge East Hospital recently performed Chattanooga’s first single-site robotic hys-terectomy, a less invasive treatment option that produces minimal scarring.

“This procedure offers an excellent cosmetic outcome following gynecologic surgery, and we are very excited to be able to offer it to our patients,” said Jared Be-ment, executive director of surgical services for Parkridge Health System.

Hysterectomy removes a woman’s uter-us and is the second most common surgery for women in America, with approximately one-third of all women undergoing the operation by the age of 60. Hysterectomy is often recommended to treat serious and sometimes painful conditions such as endo-metriosis, excessive menstrual bleeding, or uterine fibroids.

During the single-site hysterectomy, a surgeon makes a single one-inch incision in the navel. The surgeon controls the surgical instruments from a console in the operating room, which displays a three-dimensional high-definition image of the patient’s anato-my. The system translates a surgeon’s hand, wrist and finger movements into more pre-cise movements of the miniaturized instru-ments inside the patient.

“We are pleased to be able to offer this new technology to women in the greater Chattanooga area,” said Ronnie Hall, asso-ciate chief nursing officer for Parkridge East Hospital. “As the first facility to offer this procedure, we are proud to demonstrate our ongoing commitment to excellent pa-

tient care and the most advanced, minimal-ly-invasive surgical options available.”

Parkridge Medical Center Acquires New BiPlane Imaging System to Help Doctors Diagnose And Treat Cardiovascular, Neurological, and Other Conditions

CHATTANOOGA – Using a versatile new digital imaging system, doctors at Parkridge Medical Center now have en-hanced capabilities to diagnose and treat a variety of disorders including diseases of the heart and blood vessels, neurovascular disorders and other conditions.

The Innova* IGS 630 is a digital flat pan-el biplane imaging system manufactured by GE Healthcare. It uses two sets of X-Ray sources, each free to move independently, which allows two sets of images to be taken. The system is helping Parkridge Medical Center’s physicians to see extremely de-tailed, real-time images of patient anatomy during procedures that require exacting precision – such as stent placement, blood vessel interventions and the minimally-inva-sive treatment of uterine fibroids.

“The Innova IGS 630 addresses one of the biggest challenges in interventional im-aging today, clearly visualizing small vessels and intricate anatomy,” said Parkridge Med-ical Center imaging director Keith Davis.

The images produced by the system

are so detailed that Parkridge Medical Cen-ter physicians are able to see clearly enough to maneuver small medical devices – such as catheters, stents, and guidewires – dur-ing vascular interventions and other clinical procedures.

The Innova IGS 630 is the latest addi-tion to GE’s family of Innova digital flat pan-el cardiovascular and interventional X-ray imaging systems. With hundreds of systems installed worldwide, many physicians rely on GE’s Innova systems to help them diagnose and treat cardiovascular disease.

CHI Memorial Rheumatology and Arthritis Associates Introduces Natalie Braggs, MD

CHATTANOOGA – Memorial Health Partners Foundation wel-comes Natalie Braggs, MD, to CHI Memorial Rheuma-tology and Arthritis Associ-ates. Braggs is a graduate of University of Tennessee School of Medicine, Mem-phis, Tenn. She completed residency at University of Tennessee, Chattanooga, and fellowship at Vanderbilt University, Nashville, Tenn. Braggs is Board Certified in Internal Medi-cine.

GrandRounds

Apply at: https://jobs.etsu.eduInquiries can be directed to: Stephen Geraci, M.D., Professor and Chairman of

Internal Medicine via Karen A. Heaton, Quillen College of Medicine, Box 70622,

Johnson City, TN 37614. Phone (423)439-6367; email: [email protected].

Academic Internal Medicine Opportunities

Quillen College of Medicine, Department of Internal Medicine at East Tennessee State University is seeking BC/BE (at time of hire) Internists to join their groups in Johnson City and Kingsport, Tennessee at the Assistant/Associate Professor level. Responsibilities include teaching residents and medical students ambulatory care in our University practices, with in-patient attending at our community partner teaching hospitals, and the opportunity for clinical research. Scholarship is an expectation of all faculty with protected time for scholarly activities. Competitive pay, comprehensive benefits package, CME allowance and relocation support provided. Women and minorities are encouraged to apply. AA/EOE

Quillen College of Medicine is a community-based medical school whose mission emphasizes primary care. Located in the beautiful mountains of northeast Tennessee, Quillen College of Medicine serves the healthcare needs of over 1 million people. The Tri-cities area boasts low crime rate, low cost of living, award-winning public school systems and no state income tax.

Dr. Benjamin Miller

Dr. Natalie Braggs


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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BlueCross Foundation Commits $1 Million to Neonatal Abstinence FightGrant funds specialty treatment unit at East Tennessee Children’s

KNOXVILLE — In response to a surge of babies being born dependent on drugs and suffering the painful symptoms of neonatal abstinence syndrome (NAS), the BlueCross BlueShield of Tennessee Health Foundation has awarded a $1 million grant for construction of a new NAS treatment unit at East Tennessee Children’s Hospital in Knoxville.

“Our experience with our members has taught us how widespread a problem NAS is in East Tennessee,” said Scott Pierce, president and CEO of BlueCare Tennessee, BlueCross’ Medicaid subsidiary. “Most of those babies wind up at East Tennessee Children’s Hospital and it’s the right thing to do to help them upgrade their facilities to deal with this problem.”

According to the Tennessee Depart-ment of Health, there were 921 NAS births in the state during 2013. The vast majority of those cases were in upper East Tennes-see, where the rate per 1,000 live births in five reporting areas averaged 36.3. The rate for the rest of the state is 3.8.

“Babies experiencing withdrawal symptoms need specialized doses of medi-cation and constant supervision,” explained Carlton Long, Children’s Hospital vice president for development and community services. “Our new NAS unit will provide private rooms and a neighborhood care de-sign. This will allow for better patient moni-toring, better staff visualization of the unit and enhanced security. Our current NAS unit will be converted back into inpatient rooms.”

East Tennessee Children’s Hospital’s staff is expert in treating NAS. The new NAS unit will, among other features, offer quiet, low-light spaces where trained volunteer cuddlers can hold and comfort the babies,

a technique that helps them rest.Construction of the NAS unit comes as

part of a $75 million expansion project be-ing undertaken at East Tennessee Children’s Hospital. Ground was broken for the expan-sion Aug. 19.

Tennova Center for Surgical Weight Loss Receives Top-Level Accreditation for Bariatric Surgery

KNOXVILLE — The Tennova Center for Surgical Weight Loss at Turkey Creek Medi-cal Center is now accredited by the Meta-bolic and Bariatric Surgery Accreditation and Quality Improvement Program (MB-SAQIP) as a Comprehensive Center with Adolescent Qualifications.

MSBAQIP was formed in 2012 when the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) combined their national bariatric surgery accreditation pro-grams into a single program to create one national standard for all bariatric surgery centers. Previously, Tennova Healthcare’s bariatric program was accredited by the ACS.

“We are pleased to be named the only bariatric surgery center in Tennessee to achieve the top level of accreditation by the MBSAQIP,” said Lance Jones, CEO of Turkey Creek Medical Center. “This demon-strates our commitment to offer the highest quality of care for weight loss surgery pa-tients.”

To earn accreditation, the hospital met essential criteria that ensure its ability to support a bariatric surgery program and measure up to the performance require-ments outlined by the MBSAQIP. The three designations offered by MBSAQIP are: Low Acuity Center, Comprehensive Center, and Comprehensive Center with Adolescent Qualifications. As a Comprehensive Center with Adolescent Qualifications, the Tennova Center for Surgical Weight loss is approved

to provide care to patients of all ages.“This accreditation is an important way

for patients to verify that their surgeon has access to all the key resources necessary for optimal care,” said Stephen G. Boyce, M.D., medical director and bariatric surgeon at the Tennova Center for Surgical Weight Loss. “This level of accreditation means we are authorized to treat the most complex bariatric patients here. We are proud to be acknowledged for excellence at our center.”

MBSAQIP accredits bariatric surgery centers in the United States and Canada that have undergone an independent, voluntary, and rigorous peer evaluation in accordance with national standards. MBSAQIP-accredit-ed centers have demonstrated compliance with these standards and successfully com-pleted an on-site visit by a trained surveyor.

LMU Caylor School of Nursing Students Receive Scholarships

HARROGATE — Three Lincoln Memo-rial University (LMU) Caylor School of Nurs-ing (CSON) students have been awarded Lynn and Georgia Blake Endowment Fund scholarships for the 2014-2015 academic year.

Jenna Satterfield of Harrogate, Tennes-see, Taylor McDonald of High Ridge, Mis-souri, and Bradley Wooten of Williamsport, Tennessee, are recipients of this year’s schol-arships. All are students in the Bachelor of Science in Nursing program. The fund was established by Dr. Lynn Blake and his wife, Georgia, to benefit LMU nursing students. A Knox County, Tennessee, native, Blake was chief of pathology services and direc-tor of laboratories at East Tennessee Baptist Hospital from 1970 until his retirement in 2000. In that year, he was appointed medi-cal director of Medic Regional Blood Center in Knoxville and served in that capacity un-til his retirement from the position in 2011. Medic is the only collector and supplier of blood and blood products for 24 regional

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GrandRounds

Name: Katie Ketchem, COA, OCS, CPO, and Ruger

Position: Operations Coordinator, Johnson City Eye Clinic

At a Glance: Although Katie Ketchem spends much of her day in clinic with patients at the Johnson City Eye Clinic, her day isn’t always complete until she sees another set of patients with her Doberman, Ruger.

As certifi ed and registered volunteers with Therapy Dogs International (TDI), Katie and Ruger make regular rounds in the Transitional Care Unit at Indian Path Hospital in Kingsport, Tenn., as well as visiting area nursing homes and a few private residences.

When they make their rounds, Katie explained that they walk through the halls and ask patients if it’s okay if Ruger pays them a visit. Patients enjoy the interaction with Ruger so much that they often ask staff members when Ruger will be visiting again.

“One of our most memorable visits was to a 102-year-old patient who the nurses explained never had visitors. When we approached his room, he motioned that it was okay to visit and lit up when Ruger came up to his bed,” she recalled. “He never talked, just interacted with Ruger, but the nurses couldn’t believe it. They said he normally spent his day just staring at the wall. They asked if Ruger could stay the night!”

Such success stories are why Katie and Ruger have volunteered their time visiting patients for the past four years. Katie signed Ruger up for TDI training when he was a little over two years old. A friend had pointed out that Ruger would be a perfect fi t for a therapy dog, at 3 feet tall and 115 pounds, he can easily reach patient beds and wheelchairs.

“Ruger’s visits help patients because he gets their mind off of being in the hospital. We never talk about why the patient is in the hospital; we only talk about Ruger and other dogs,” Katie explained. “And Ruger is so loving and caring … and always happy to see a human.”

HealthcareServiceSnapshot

hospitals, including all Knoxville hospitals. The center holds 3 to 4 blood drives each day of the work week for companies, orga-nizations and communities in its 21 county service area. Through the generosity of Dr. and Mrs. Blake, the Lynn and Georgia Blake Endowment began at Baptist Health System Foundation, which became Mercy Health Partners Foundation in 2008, and is now held at Trinity Health Foundation of East Tennessee as the successor organiza-tion to Mercy Health Partners Foundation.

Associate of Science in Nursing, Bach-elor of Science in Nursing, RN-Bachelor of Science in Nursing and Master of Science in Nursing degree programs are all avail-able through the CSON. Enrollment in the CSON has quadrupled over the last fi ve years as new programs and concentrations have been added. 2014 marks the 40th an-niversary of the CSON at LMU. For more in-formation on any program of study offered by the CSON, please call 800.325.0900 ext. 6324 or email [email protected] or [email protected].

Helen Ross McNabb Center Receives Highest Level of Accreditation

KNOXVILLE – The Commission on Accreditation of Rehabilitation Facilities (CARF) International announced that the Helen Ross McNabb Center has been ac-credited for a period of three years for its continuum of rehabilitation services includ-ing mental health care, addiction treatment and social services programs.

The Helen Ross McNabb Center was the fi rst community mental health center awarded CARF accreditation in the state of Tennessee 13 years ago. The latest accredi-tation is the sixth consecutive accreditation that the international accrediting body has awarded to the Center.

This accreditation decision represents the highest level of accreditation that can be awarded to an organization by CARF and shows the organization’s signifi cant confor-mance to the CARF standards. An organiza-tion receiving the Three-Year Accreditation has put itself through a rigorous peer review process and has demonstrated to a team of surveyors during an on-site visit that its programs and services are measurable, ac-countable and of the highest quality.

CARF International’s award letter states that the Helen Ross McNabb Center’s ser-vices, personnel and documentation clearly indicate an established pattern of practiced excellence. Not only do the Center’s pro-grams meet international standards of qual-ity, but the organization as a whole, shows a continuous commitment to improvement.

“We are extremely proud of our Cen-ter’s staff whose professionalism and com-passion made this accomplishment possi-ble,” says Jerry Vagnier, CEO and President of the Helen Ross McNabb Center. “CARF‘s

accreditation shows our community that we greatly value the quality of our services while striving to be a premier mental health agency in East Tennessee.”

Helen Ross McNabb Foundation welcomes new board members and offi cers for 2014-2015

KNOXVILLE – Houston Smelcer, Vice President of Development and Government Relations, welcomes new board members and offi cers to the foundation’s board of di-rectors.

2014-2015 Helen Ross McNabb Foun-dation board members with elected offi cers:

Mrs. Fay BaileyMrs. Sandy BertelkampMr. Patrick BirminghamMrs. Jenny Brock, SecretaryMrs. Debbie BrownMrs. Betsey Bush*Ms. Elizabeth CampbellMr. Nick ChaseMs. Jeannie Dulaney, ChairMr. Greg Gilbert, TreasurerDr. Joseph E. JohnsonMr. Bob JoyMrs. Chris KahnMr. Dale KeaslingMr. George Kershaw, Past-ChairMr. Mark KroegerMr. Jim LloydMs. Virginia LoveMr. Richard Montgomery*Mr. Davis Overton, Chair-ElectMr. Bob Petrone

Mrs. Avice ReidMr. Don Rogers*Mr. Keith SanfordMr. Andy ShaferMr. Mitch Steenrod*Mr. Jerry Vagnier, Ex-Offi cioMr. Carl Van Hoozier*Newly appointed board members

Helen Ross McNabb Center Welcomes Nurse Practitioner, Kathryn J. Nottingham to its clinical staff

KNOXVILLE – The Helen Ross McNabb Center is proud to announce the addition of nurse practitioner, Katy Nottingham to its team of providers.

Katy Nottingham is now providing care for children and youth in need of mental health services at the Helen Ross McNabb Children and Youth Center. Nottingham completed her bachelor’s degree in psy-chology from Carson-Newman College, bachelor’s degree in nursing from Belmont University and master’s of science in nursing from the University of Tennessee. Notting-ham is accepting new patients and takes most insurances.

“We are honored that Katy has joined us in our mission of improving the lives of the people we serve,” says Jerry Vagnier, Helen Ross McNabb Center President and CEO. “Nurse practitioners like Katy, help the Center’s ability to provide excellent pro-grams, as well as increase access to care.

Parent Place, a supervised visitation program, fi nds new home at the Helen Ross McNabb Center

KNOXVILLE – Parent Place, a service of Catholic Charities of East Tennessee, will soon fi nd a new home at the Helen Ross McNabb Center.

Effective Oct. 1, the Helen Ross McNabb Center will add Parent Place to its continuum of care.

Parent Place provides supervised visita-tion for children and their non-custodial par-ents, grandparents or other relatives. Fami-lies are referred to Parent Place by the court system, Department of Children’s Services, family therapists, attorneys, and various community agencies, with some families self-referring.

Catholic Charities of East Tennessee has provided the visitation service to the East Tennessee community for nearly 14 years. The program serves approximately 135 families each year.

Families served by Parent Place will now have access to additional supportive servic-es under the umbrella of one organization. The Helen Ross McNabb Center provides additional services, like family therapy, par-ent education and case management that encourages and supports healthy families in East Tennessee.

Parent Place will relocate to the Helen Ross McNabb Center’s John Tarleton Cam-pus (2455 Sutherland Avenue.)



Support Niswonger Children’s Hospital!

The toy room in the surgery center at Niswonger Children’s Hospital is full of toys ready to help cheer up young patients, thanks to funds raised by

Niswonger Children’s Hospital license plate sales.

But the hospital needs help if the program is to continue another year. When it’s time to renew your license plate, please help by

purchasing a Niswonger Children’s Hospital license plate.

www.msha.com/childrenLocated in Johnson City, Tennessee • Serving children and families of Southern Appalachia

East Tn Medical News October 2014

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