tri cities medical news april 2014

Joseph M. Gunn, MD

PAGE 3

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HEALTHCARE LEADER: Dawn D. Tipton, RN, BSNHer experiences have taken her all over the world, but for Dawn Tipton, Director of Nursing for three practices within State of Franklin Healthcare Associates (SoFHA), serving the patients of the Tri Cities and surrounding areas is where she wants to be ... 7

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By CINDy SANDERS

What is the best way to get … and keep … diabetic patients actively engaged in the lifelong self-management of their condition?

The individual or institution that comes up with a defi nitive answer to that question will surely be re-membered in the history books in the same manner as Jonas Salk. After all, diabetes is a pervasive condition of epidemic proportions in much of the world. Accord-ing to the latest statistics from the National Institutes of Health, 25.8 million Americans have diabetes … roughly 8.3 percent of the nation’s population. Additionally, it is estimated another 79 million American adults have prediabetes, putting them at high risk for developing the condition without active intervention to stop the progres-sion toward disease.

Keenly aware of the toll diabetes takes on the body, healthcare

providers routinely talk to patients about the threat of co-morbid conditions ranging from heart disease, stroke and kidney disease to blindness and amputation. Yet, there continues to be a disconnect from what a patient seem-ingly hears and understands in the offi ce and what actu-ally transpires on a daily basis.

“We talk about diabetes all day long with patients, but they have to go about their business of living with the disease,” noted Elizabeth S. Halprin, MD, associate direc-tor of Adult Diabetes at Joslin Diabetes Center, an affi liate of Harvard Medical School.

A recent study conducted by Joslin researchers looked at obstacles present among patients with poorly controlled diabetes. Halprin, a board certifi ed endocri-

nologist and instructor at Harvard Medical School, said the rea-sons for poor management vary hugely and are specifi c to individuals

Addressing Obstacles on the Road to Diabetes Control

(CONTINUED ON PAGE 10)

FOCUS TOPICS DIABETES/WOUND CARE ICD-10

With the Deadline Fast Approaching, AMA Continues to Campaign Against ICD-10 Implementation

By CINDy SANDERS

The fi rst rule of marketing is to make sure you have a clear message. For the American Medical Association leadership, their position on the impending ICD-10 conversion could not be more straightforward … they want to see it stopped.

AMA President Ardis Dee Hoven, MD, pointed to a number of issues that have members worried about the health of their practices … and ultimately their patients. Concerns range from cost of im-plementation and software availability to worries over disruption in pay and a siphoning of resources away from other transforma-tive changes that improve healthcare delivery.

In a Feb. 12 letter to Kathleen Sebelius, secretary for the U.S. Department of Health and Human Services (HHS), the AMA ac-knowledges the position they have taken is at odds with some of their industry colleagues. Yet, AMA offi cials believe the timing of such a massive undertaking is ill advised and could prove disastrous for physi-cians.

(CONTINUED ON PAGE 6

Dr. Elizabeth S. Halprin

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PhysicianSpotlight

By BRIDGET GARLAND

For those who know him, Dr. Joseph M. Gunn’s tendency to bleed orange would come as no surprise. Originally from Mem-phis, Tenn., Gunn, who practices with Southeast-ern Retina Associates, received a good portion of his education on each of the University of Ten-nessee campuses. Gunn knew from a very early age that he wanted to study medicine, but it wasn’t until college that he decided it was people that he wanted to take care of instead of animals.

“I still love animals, and tease about going back to school to be a veterinary ophthalmologist, but I guess I’m a little old for that now,” Gunn laughed. “I feel lucky that I knew early on what I wanted to do, and pretty much knew how I needed to get there. I was fortunate to figure that out early on.”

After double majoring in biology and zoology at the UT-Knoxville campus, Gunn headed back home to west Tennes-see for medical school at the University of Tennessee Center for the Health Sciences in Memphis. After graduating in 1985, he came right back to the other end of the state for his ophthalmology residency at the UT-Chattanooga campus.

His interest in ophthalmology was also something he developed early on, namely out of personal experience. “I started wearing glasses when I was 15, after I didn’t get to take the written test for my driver’s permit because I failed the vision test,” he recalled.

“A moment that really stands out to me is the day I got my glasses, and I was driving up our street with my mom. We passed a huge oak tree, and I said to her, ‘Wow, I can see the leaves on that tree now.’ I thought my mom was going to start crying,” he recalled.

His fellowship training in retina and

vitreous was completed in Chicago at the Illinois Eye and Ear Infirmary, after which he went to Florida to practice and then to Charlotte, N.C., for seven years.

Gunn started working in the Tri Cities in January 1997, when he joined Southeastern Retina Associates.

A quick look at Gunn’s CV reveals his keen interest in academic work and clinical research, and he said his group has been very fortunate to be included in their speciality’s major clinical trials. “We were one of the centers nationally included in the Submacular Surgery Trials and that really helped us be included in the other clinical trials,” he said. “These studies help keep us on the cutting edge of things.”

Although Gunn sees patients for reti-nal detachment and other retinal macular diseases, one area of interest for Gunn is diabetes, primarily because of the large number of patients he sees with diabetes and macular degeneration. “So many people in this area are affected by diabe-tes,” said Gunn. “Some of the medicines that we are using treat both conditions. We might use slightly different doses or a slightly different timing regime, but some of the medicines used to treat diabetes were spun off of medicines used to treat macular degeneration.

“We are getting better results now, but not because we are doing a better job—we’ve always done the best job we

can—but the visual results for our patients have gotten better as our treatments have gotten better,” he shared. “It’s really nice to be able to either stabilize a patient’s vision or make it better. Previously, the only way to treat patients with macular degeneration was to use the laser. We could treat the leaks, but the patient’s vi-sion didn’t get better. We did the best we could at the time, but some of the treat-ments we are developing are making us better at what we do.”

As Gunn explained, diabetes in gen-eral is a chronic disease and very frus-trating for patients because it changes everything that they do, especially for those with type 1 who have had it from a very young age.

“Denial is probably a big factor in younger patients,” Gunn said. “But with the better treatments available, there is a good chance they can completely avoid developing retinopathy.”

A good illustration Gunn shared was the outcomes of a brother and sister seen in clinic who both had type 1 diabetes. The brother completely neglected his dis-ease and hadn’t seen an eye doctor until he was 18. Even though the clinic was aggressive in taking care of him, he went downhill quickly, and by the time he was 20, he was completely blind in both eyes. His younger sister, on the other hand, learned from her brother’s example, kept

her A1C under control, and had no reti-nopathy.

“Over time, the longer you live with it, the higher the chances of developing leakage in the center of the retina. If pa-tients can control their sugars, they do a lot better over time,” Gunn explained. “In the past, most diabetic patients didn’t live long enough to develop retina problems, but the retina specialty has really taken off because of greater demand as a result of the better treatments for blood sugar con-trol. I tell my patients to be aggressive with managing their sugars, and they won’t have to come see me quite as often.”

Gunn and three other providers see patients in Kingsport, Bristol, Johnson City, and Abingdon, covering the Tri Cit-ies region for Southeastern Retina Associ-ates, with offices also located throughout East Tennessee and north Georgia.

Since moving to the Tri Cities, Gunn and his wife Julie have been active com-munity members. Julie owns a business and is past president of Junior League in Kingsport. She also has been on the YMCA board and the Second Harvest Food Bank board. Gunn serves on the board of directors for two local surgery centers and Indian Path Hospital. A 2012 graduate of Dobyns-Bennett High School, their son Conner played baseball there and is now a sophomore at Amherst Col-lege, where he also plays baseball.

Joseph M. Gunn, MD

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The question these days is, “How can we reform healthcare quickly and effi ciently?” There’s no one magic-bullet answer, but for some good working ideas, ask a nurse.

That’s what Mountain States Health Alliance does when it turns to Candace Jennings, Senior Vice President of Tennessee Operations for Mountain States Health Alliance (MSHA). Before assuming her current position, Jennings was Senior Vice President and CEO for Washington County operations, and holds a Bachelor’s degree in nursing and Master’s degree in health services administration from the University of Alabama-Birmingham.

Having watched MSHA continue to evolve and excel from vantage points at the bedside and the boardroom, Jennings lays out the future — and says all goals are attainable with smart decision making and hard work.

East Tennessee Medical News: Hospitals and healthcare providers are being told to innovate, or risk being left behind. Does that just mean signing onto an EMR system, or is it much more?

Candace Jennings: We think of two kinds of innovation in healthcare now; one is around technology, and the other is around totally new ways of healthcare delivery.

Retail pharmacies are becoming healthcare companies. They are changing the way that patients get primary care for things like immunizations or the sniffl es. That’s innovative. We haven’t thought of Walgreens as a competitor, but they and many others are getting into healthcare.

At MSHA, we launched our fi rst patient portal in April. Patients are taking an active role, and we are meeting them when it comes to delivering better care.

All this innovation is very disruptive to the current state, but it’s really important to getting us to a position where we are giving healthcare at a much reduced cost, but doing a better job on preventative medicine and maintenance care, not just sick care.

ETMN: With that in mind, how is MSHA sorting through its “to do” list when it comes to setting goals and operating within the reality of capital budgets?

CJ: We are working to become much more knowledgeable about telemedicine, for one. We have a telemedicine service at Johnson County Community Hospital, in consultation with ETSU. Now we can do consults at Johnson County using a robotic cart, and that is a very inexpensive technology compared to what we have spent on other information systems in healthcare. We also are working in conjunction with Vanderbilt University Medical Center to roll out a different way that our physicians can consult with a Vandy doctor via telemedicine. There, we’ll be using iPads in the emergency department to assess whether or not a patient is having a stroke, and what the next steps should be.

We can’t afford to have specialists at all four of our rural hospitals, but now those patients don’t have to be transferred to a bigger

Hospital Leadership 2014

Planning aheadJennings says MHSA’s multiyear focus on innovation is paying off

hospital because we’ll have access to those physicians by way of telemedicine. That’s going to be important in a few years because we already have a shortage of physicians in the specialties, and that’s going to worsen as current doctors retire and are not replenished. The Affordable Care Act is only going to increase demand for physicians, and so we see telemedicine as a very effective way to provide that care.

ETMN: Whether its innovation or effi ciency, it comes down to smart management of resources. How is MSHA going to leverage its strengths over the next few years?

CJ: We recently completed our strategic planning meetings in all our hospitals, as well as with our medical communities, to talk about exactly how we are going to do that. We have had a plan in place for a ten-year period, but now we’re getting to a much more granular level in terms of the next 12 to 24 months.

We have pillars, or areas of concentration, around things like fi nance, service excellence and quality, and we’ve now added innovation to that. We are focusing on innovation in all our operations, and trying to see how that can integrate technology and other tools to deliver healthcare in a different way.

We’ve also invested a lot of time and energy in developing patient-centered medical homes in our physician practices. They’ve been in place a year or more in some areas, and those along with the new patient portal really do provide a gateway to do a lot more in terms of population health management. We want to prevent our patients from getting diseases early on, and also help manage their chronic conditions much better.

We want to be the destination of choice. Sure, patients can go to the drug store for basic treatments now, but those facilities can’t do what we do. A physician in their medical home has a full knowledge of what that patients’ healthcare needs are — not just that episode. That physician can access a record and history, see meds and be able to do a faster and better job of thinking about the patient holistically rather than just treating a symptom and an episode.

Our board has charted the right course. We’re three years into that ten-year plan, and we are very well positioned to weather the storms that are occurring right now. A lot of things are taking business out of the hospital, and if the cost of healthcare is lower, then the reimbursement is, too. But we are convinced that lowering those costs is the right thing to do, and not every hospital has that vision, or is ready to do that.

Everything that’s happening now, we saw coming. We have crafted a vision for the next few years and have everything in place, including our own provider-sponsored health plan and insurance company, to let us be very creative and innovative for what’s coming up. We are ready, and so we won’t miss any opportunities. We are moving into this new era of healthcare in a very positive way.

Candace Jennings

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LegalMatters

Profit and Loss – The Top Ten Health Law Issues Medical Providers Need to Know

BY ERIN B. WILLIAMS, LONDON & AMBURN, P.C.

Health care providers are monitored for quality of healthcare, billing for services, documentation requirements, and professional and ethical behavior. The financial consequences resulting from an issue related to any one of these could result in a loss of profits, or worse, a major loss of revenue for a provider’s practice. To help the healthcare community be more prepared for what lies ahead, this article will be the first in a new series which further explores each of the topics below.

Office of Inspector General Work Plan for 2014

The U.S. Department of Health and Human Services Office of Inspector General’s mission is to protect the integrity of the HHS programs and the health and welfare of the beneficiaries of those programs. In Fiscal Year 2013, OIG reported expected recoveries of over $5.8 billion and exclusions of 3,214 individuals and entities from participation in Federal healthcare programs; 960 criminal actions against individuals or entities; 472 civil actions and administrative recoveries from self-disclosed matters. The OIG 2014 Work Plan outlines the current focus areas and this upcoming article will highlight the areas of concern related to a physician’s practice.

Private Insurance Audits and Recovery

Provider participation agreements with private insurance companies are governed by contractual terms and obligations. Appeal provisions may be limited based upon the disparity in bargaining power between the parties. This upcoming article will examine considerations for dealing with audits of claims.

Private Insurance Network Participation

Provider participation with private insurance company networks is also governed by federal and state law provisions related to reporting requirements and the National Practitioner Data Bank. Certain termination situations may result in reports to the National Practitioner Data Bank. Negotiations, corrective action, appeal and review provisions will be discussed in this upcoming article.

Health Insurance Portability and Accountability Act (HIPAA)

Privacy and security for individuals’ individually identifiable

protected health information (“PHI”) is more than an ethical responsibility. PHI is protected by a complex system of federal regulations which continue to evolve and the penalties can be severe. Enforcement activities and compliance programs will be addressed in this upcoming article.

60 Days to Report and Refund Identified Overpayments

As part of the federal government’s efforts to capture overpayments, the Accountable Care Act created the duty to report and refund identified overpayments. The time frame for making the refund is short, and the consequences for failing to report and refund are harsh. Retained overpayments may be classified as False Claims, triggering the civil monetary penalties in addition to the actual overpayment. Self-reporting and refunding overpayments will be discussed in this upcoming article.

Medicare Audits and Extrapolation of Error Rate Findings

In 2003, the Medicare Modernization Act was signed into law and included a provision for the Limitation on Use of Extrapolation in Medicare audits. Extrapolation allows Medicare to review a small sample of claims and then create a very large overpayment based upon the error rate. Permitting the Secretary of Health and Human Services to use extrapolation to calculate an overpayment when the provider has no history of billing problems may put unsuspecting providers out of business. In this upcoming article, we will review the Medicare audit and appeal process and how extrapolation can result in an overpayment in the millions.

Controlled Substance Prescribing and Pain Management Laws

Pain management and controlled substance prescribing laws have been a focus of the Tennessee legislature over the past few years. This upcoming article will discuss violations of the controlled substance prescribing and pain management laws, as well as monetary and other penalties for failure to comply.

Medical Board Investigations A multitude of issues can serve

as the impetus for investigation by the Health Related Boards: patient complaints, reports of settlements, criminal arrests, etc. The defense

of such investigations, which are sometimes but not always covered by insurance, can significantly impact the provider’s practice, as can the potential penalties, including licensure suspension or revocation. This upcoming article will focus on defense of board investigations potential penalties affecting a physician’s profits or, even worse, ability to continue the practice of medicine.

Stark Law Violations The “Stark” law prohibits referrals

for designated health services for Medicare and Medicaid patients if the physician (or an immediate family member) has a financial relationship with that entity (1). Stark law violations and penalties will be the focus of this upcoming article. While there are exceptions to the prohibition, there are also substantial penalties for violations. Repayment of all services provided during the period of noncompliance can make an innocent mistake extremely costly, depending upon the length of time the error went

undetected. This upcoming article will review CMS’s authority to settle these cases, as well as specific self-disclosure protocol for reporting and resolving these matters.

Medicare Audits and Appeals Medicare audit overpayments

are due to be repaid within 30 days of the Demand Letter sent to the provider. While the time table for action is expedited, there are ways to preclude collection which can protect the practice’s cash flow for several months. Protecting the practice during the appeal process will be further addressed in this upcoming article.

Notes1. 42 USC 1395nn.

Attorney Erin B. Williams focuses her practice on healthcare compliance and regulatory matters, including each of those topics mentioned in this article. For more information on any health law matters, you may contact 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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“The challenge here is disruption — it’s a disruptive process that delivers no direct benefit to patient care,” Hoven as-serted.

Many Codes Equals Much Room for Error

ICD-10 — the International Classi-fication of Diseases, 10th Edition — was endorsed by the World Health Organiza-tion (WHO) in May 1990 and put into use by member states beginning in 1994. It is the tool used to capture mortality and morbidity data, track disease outbreaks, highlight research needs, and provide a general snapshot of health among nations and populations.

There are two parts to the system in the United States. Clinical Modification (CM) is used for diagnosis coding in all healthcare settings. The Procedure Cod-ing System (PCS) is for inpatient settings only. According to the Centers for Medi-care and Medicaid Services (CMS), any-one covered by HIPAA… not just those who submit Medicare and Medicaid claims … must convert to ICD-10 by the Oct. 1, 2014 deadline.

“You’ve got to have an ICD-10 code for the disease signs and symptoms, ab-normal findings, complaints, circum-stances and external causes of injury or disease,” noted Hoven. “The problem is the granularity of the ICD-10 codes,” she continued.

Hoven said ICD-9-CM encompassed

between 13,000 to 14,000 codes compared to ICD-10’s 68,000 options. “It’s about a five-fold increase,” she pointed out.

She was quick to add the inflated num-ber of codes in ICD-10 wasn’t set by the WHO but instead is a product of U.S. modifica-tions to the system. In addition to the CM codes, the PCS portion has 72,000 codes. Other countries have significantly fewer options. Canada, Germany and Austra-lia all have less than 20,000 codes in their ICD-10 set, and Canada uses ICD-10 for inpatients only.

“There’s something like nine codes for parrot bites,” Hoven said of the U.S. system. The vast number of choices, she fears, makes the potential for error enor-mous.

Financial ConcernsSince ICD-10 accuracy is tied to

reimbursement, physicians across the country are worried about the financial stability of their practices if payments are denied, delayed or otherwise disrupted.

“If it’s not correct, Medicare won’t pay you … no one will pay you,” Hoven noted. She added patients might be the ones who ultimately pay the highest price in terms of access to care if some practices simply cannot weather the financial storm.

“This is why the American Medical Association has been so adamant in trying to get ICD-10 repealed.”

Not getting paid is a very real con-cern. Hoven pointed to the results of a pilot study released last year by the Healthcare Information & Management Systems Society (HIMSS) and the Work-group for Electronic Data Exchange (WEDI) that showed experienced coders had an average accuracy rate of about 63 percent when converting diagnoses to the ICD-10 coding system.

Conducted in 12 waves, each test series consisted of a number of different cases. While 63 percent accuracy was the overall result, individual figures varied widely within each wave. For example, in wave 6, ‘acute bronchiolitis due to RSV’ was accurately coded only 38 percent of the time. On the plus side, coding for “de-viated nasal septum” had a 100 percent accuracy rating in wave 7.

Another financial issue recently came to light when the AMA initiated an up-dated cost study, which found the price tag for ICD-10 implementation was dra-matically higher than previous estimates.

“We were basically operating on 2008 figures, and when we saw these new numbers, it was even worse,” Hoven said. In fact, the 2014 figures found that in some cases implementation costs would be nearly three times what had been pre-dicted six years earlier. Nachimson Ad-visors conducted both the original 2008 study and updated 2014 version.

In 2008, the average predicted cost to implement ICD-10 was:

• $83,290 for a small practice,

• $285,195 for a medium practice, and

• $2.7 million for a large practice.The new cost estimates feature a

range for each practice size based on variable factors including specialty, ven-dor and software. The updated study pre-dicted implementation costs would be:

• $56,639-$226,105 for a small prac-tice,

• $213,364-$824,735 for a medium practice, and

• $2 million to just over $8 million for a large practice.

Two-thirds of physician practices are projected to fall into the upper ranges of the current cost estimates, which include training, assessment and testing, produc-tivity loss, process remediation, payment disruption and vendor/software up-grades. Data also has shown vendors are lagging behind in software development, making it difficult for practices to install and conduct appropriate pre-launch test-ing and to institute workflow changes if needed.

“The markedly higher implementa-tion costs for ICD-10 place a crushing burden on physicians, straining vital re-sources needed to invest in new health-care delivery models and well-developed technology that promotes care coordina-tion with real value to patients,” Hoven said.

Balancing the Pluses and Minuses

ICD-10 certainly has many propo-nents who point to the benefit of hav-ing increased information through the detailed coding system to enhance data analysis, public health surveillance and research initiatives.

It isn’t an argument that sits particu-larly well with Hoven. “But at the end of the day is it going to improve patient care?” she questioned. “The answer is no.”

Those in favor of ICD-10 insist that’s exactly what the new system will do by providing greater opportunity for evidence-based practice and clinical de-cision support. The argument has even been made that the switch ultimately will lessen the burden on providers be-cause they won’t be required to provide as much detailed clinical documentation since the codes are already so specific.

Hoven stressed physicians are strongly supportive of changing the way healthcare is delivered in terms of imple-menting evidence-based protocols, work-ing collaboratively and adopting new models like the patient-centered medical home. However, according to Hoven, too many new administrative and regu-latory requirements that do little to im-prove outcomes have been thrust upon physicians to a point where it has become overwhelming.

“Over the last seven to eight years, the changes have been tumultuous in practices.” Hoven said.

On the way to implementing changes that improve patient care, she noted phy-sicians have been met time and again with

administrative and financial hurdles man-dated by CMS including new require-ments for the physician quality reporting system (PQRS), value-based payment modifier program, and meaningful use.

Despite a national call for adminis-trative simplification, Hoven pointed out, “Nothing seems to get simplified. It gets more complicated. The problem when you start dealing with rules at the federal level is it further complicates everything. It doesn’t improve healthcare, and it doesn’t improve health outcomes.”

What AMA Hopes to Achieve

In February, AMA launched a #StopICD-10 Twitter campaign in sup-port of the organization’s continuing ef-fort to urge HHS to make good on its commitment to improve the regulatory climate for physicians. However, after a number of delays, Hoven knows CMS officials have been adamant the ICD-10 implementation deadline will not move again. Oct. 1 is coming … ready or not.

Hoven said she was delighted by the announcement in mid-February that CMS would conduct end-to-end test-ing for select providers. AMA, along with other industry groups including the Medical Group Management Associa-tion, have pushed hard for such testing. Hoven said the AMA believes end-to-end testing is essential to ensuring there won’t be massive disruptions in claims and pay-ment processing. She noted it was critical that practices of different sizes and spe-cialties be included in the test and called upon CMS to start as soon as possible considering the short window between now and Oct. 1.

“If we see this end-to-end testing is a disaster, our hope is that they will, in fact, delay implementation until a) they can figure out how to fix it, or b) replace it with something else that is more work-able,” she said.

Hoven added if ICD-10 goes into ef-fect as planned, she would advocate for policy changes to protect physician prac-tices such as a two-year implementation period where there would not be payment denials around coding issues.

The Bottom Line“ICD-10 is an unfunded mandate,”

Hoven reiterated, adding it’s also one that comes with a high price tag at a time when physicians already are struggling to stay on top of other costly federal man-dates.

“Adopting ICD-10, while it may provide benefits to others in the health-care system, is unlikely to improve the care physicians provide their patients and takes valuable resources away from implementing delivery reforms and health information technology,” she concluded.

And One Final NoteWhile the debate rages on over ICD-

10, it should be noted work on develop-ing ICD-11 has already begun and is expected to be ready for WHO approval in 2017.

With the Deadline Fast Approaching, AMA Continues, continued from page 1

Dr. Ardis Dee Hoven


HealthcareLeader

Dawn D. Tipton, RN, BSNBy BRIDGET GARLAND

Her experiences have taken her all over the world, but for Dawn Tipton, Di-rector of Nursing for three practices within State of Franklin Healthcare Associates (SoFHA), serving the patients of the Tri Cities and surrounding areas is where she wants to be. In fact, Tipton’s travels, as she explained, opened her eyes and helped shape her perspective on how healthcare is delivered in the Appalachian region.

Originally from Knoxville, Tipton moved to Johnson City to attend East Ten-nessee State University (ETSU), where she received her Bachelor’s in Nursing. After graduation, she started working on the Med-Surg floor at Johnson City Medical Center, but at the time, didn’t have a spe-cific direction in mind for her career. While in the process of talking to a missions orga-nization about opportunities with them, a medical evacuation had Tipton bound for Ethiopia, where she worked for 14 months as a rural health nurse. Along with an Aus-tralian midwife, the two ran a clinic serving a remote tribe there.

“I fell in love with nursing all over again,” she said. “Although clinically, pe-diatrics was my passion, I really enjoyed rural health. We saw all ages, from birth to geriatrics.”

And for a nurse fairly new in her ca-reer, Tipton ended up getting a crash course in rural medicine when the midwife had to be flown out for a medical emer-gency. Tipton was left to run the clinic by herself for five months.

“It matured me,” she explained. “And the experience opened my eyes to the ac-cessibility of healthcare we have in the U.S., compared to Ethiopia.

“The people in the tribe were in a sense between a rock and a hard place,” she continued. “They have a government

system and a private system. The govern-ment system access wasn’t there for them, and the private care was too expensive. And insurance wasn’t available for the tribe.”

As Tipton explained, the tribe used a bartering system, so she would often hear offers such as asking to trade a cow for an-tibiotics, or a chicken for medicine, or even the offer to make something in exchange for medical supplies and equipment.

“I worked with a NGO (non-govern-ment organization), so we had a flat rate. Medical services were free, and we only charged for medicines or medical sup-plies,” she said. “When I finished serving there, I wanted to come back to work in a rural area.

“I really wanted to help patients and make sure they truly understood their dis-ease. I wanted to be somewhere that I could invest time in the patient,” she said. “They did more for me than I ever did for them.”

When she returned home, she took a position at East Tennessee Children’s Hos-pital in Pediatric Oncology. She loved it and decided to go back to school to earn her Master’s. For a while, she was driving back and forth from Johnson City to Knox-ville, working in one place and attending school at ETSU. She eventually met her husband, Jonathan, a Johnson City native,

and life veered in a slightly different direc-tion.

“I decided to take a break and let my husband focus on his career,” she said. “I also wanted to try working on the adminis-trative side of nursing. When this position opened up, I applied, and it has been a great fit.”

Tipton has been working at SoFHA for three years now, overseeing approxi-mately 54 nurses and phlebotomists for First Choice Family Practice, First Choice Internal Medicine, and Johnson City In-ternal Medicine. The couple also has a nineteen-month old daughter, Makenzie.

Tipton’s initial responsibilities at SoFHA included scheduling and oversight of day-to-day activities, but soon, she was challenged to develop a way to track how the clinics were serving and monitoring their patients, and, ultimately, ensure that patients did not fall through the cracks.

“The nurses and providers are great here,” she enthused. “The physicians are very forward thinking. When they see a need, they analyze it and try to meet that need. Dr. Moulton had the idea to moni-tor one of our largest populations, diabetes. About 11% of the population in this area is diabetic, and diabetes can lead to other diseases, such as eye problems, circulatory


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Enjoying East TennesseeKeeper Kids – Tennessee Aquarium

Leigh Anne W. Hoover is a native of South Carolina and a graduate of Clemson University. She has worked for over 25 years in the media with published articles encompassing personality and home profiles, arts and entertainment reviews, medical topics, and weekend escape pieces. Hoover currently serves as immediate president of the Literacy Council of Kingsport. Contact her at [email protected].

By LEIGH ANNE W. HOOVER

Did you know penguins are very picky eaters, and even a misshapen fish will cause them to turn up their beaks? Or, did you know a starfish is actually not a fish at all, and scientists call it a sea star?

These are just a few of the topics I enjoyed learning about during a backstage visit of the Ocean Journey at the Tennes-see Aquarium in Chattanooga. I love visiting aquariums and learning something new with every visit.

Spring break offers the per-fect time to take your family. In fact, the Tennessee Aquarium’s “Keeper Kids” program is some-thing very special for children ages six and up, and it will be offered through April 20, 2014, on a first come, first served basis with the price of admission.

Participants will be able to choose two of 16 different behind the scenes Keeper Kids activities happening daily at the Aquarium. Each program lasts 15 – 20 minutes, and whether it’s exploring the Ocean Journey with hands-on activities as I did, or going behind the scenes with River Journey experiences, your children will enjoy a fun, learning encounter.

In fact, one of the best things about visiting the Tennessee Aquarium is being able to glimpse animal behavior up close and personal—especially with the Keeper Kids experience.

“It’s [Keeper Kids] an opportunity for families to explore the aquarium in a different way,” explained Senior Market-ing & Communications Manager, Ten-

nessee Aquarium and IMAX Theater, Thom Benson. “It’s to have fun but keep that learning curve going during spring break.”

According to Benson, the Keeper Kids experience also allows inter-action with the many scientists, naturalists and veterinarians. For older teens, it is an opportunity to explore science as a pos-sible future career.

“To have the opportunity to go be-hind the scenes and see what it takes to care for the animals and maintain the ex-hibits and do a world-class job with the animal care is really something special,” said Benson. “It can strictly just be a lot

of fun, or it could be something that leads to something bigger and

longer term.”An advantage of Ten-

nessee Aquarium membership is visiting multiple days and doing

many of the Keeper Kids programs dur-ing the week while in Chattanooga.

Whether it’s observing and learning about the penguins from the overlook above their habitat, or viewing the new arrivals in the quarantine area, where animals are first introduced to the facility, participants will experience a whole new way of exploring and getting up close to the animals and fish on exhibit.

“Rivers of the World is a lot of fun

because you get to go behind the scenes and feed some of the fish,” explained Benson. “Up in the Delta Swamp, that feeding process is pretty cool because the aviculturist has trained the birds to come down on the posts and get mealworms… within a couple of feet of you. For people who are photographers and like native songbirds, that’s really a cool opportunity.”

To enjoy multiple Keeper Kids experiences tailored to children’s’ individual interests, Benson encourages parents to go one-on-one with children. Larger audiences will be also accommodated with additional special events in the auditorium.

“They’re [Keeper Kids] all a lot of fun, and we get a really big positive response from peo-ple who do the activities,” said Benson. “In fact, our staff really enjoys facilitating the programs

because it’s another way to directly engage our visitors.”

In addition to the Keepers Kids pro-grams, the Tennessee Aquarium will also be running the River Gorge Explorer on the Williams Island Family Adventure Cruise through April 17th with special Spring Break ticket pricing. Participants will hear about Civil War history and view wildlife and rookeries with onboard natu-ralists. It’s not unusual to spot an osprey nest, blue heron, and even a bald eagle from the observation deck. There’s also an onboard scavenger hunt!

The best way to get the most out of your Spring Break is to plan your expe-rience by consulting the website Keeper Kids: http://tnaqua.org/SpringBreak.aspx . Additionally, check the boat and the IMAX® 3D Theater schedules on the website: http://www.tnaqua.org/Home.aspx. Visitors can also use the new Ten-nessee Aquarium app, which contains conservation and keypad games to extend the experience, for event schedules.

Benson added that the great experts on staff at the Tennessee Aquarium truly love sharing their experience and knowl-edge.

“They’re very passionate about what they do,” explained Benson. “When kids get extra excited about learning about sea turtle or sharks, our biologists really love that!”

e a s t t n m e d i c a l n e w s . c o m APRIL 2014 > 9e a s t t n m e d i c a l n e w s . c o m

easttnmedicalnews.com

The third step from the bottom squeaks when you tread on it – which is something you tried to remember when you snuck in after curfew.

There’s a light switch near the door that does nothing, and never did. One of the kitchen drawers has a tendency to stick. And someone, sometime, put a strip of wallpaper on upside down.

Yes, the house you grew up in has its peccadilloes, but your mother loves it there and she wants to stay. In Living Safely, Aging Well by Dorothy A. Drago, MPH, you’ll learn how to ensure that she does.

You probably don’t need to be re-minded that, as we age, our bodies change. Bones get fragile, eyesight dims, hearing can fade, balance can go out of whack. These things are annoying when you’re younger but can lead to devastating injuries for an elder.

But mere awareness puts you on the advantage. Says Drago, “When you antic-ipate the possibility of an injury, you can attempt to prevent it.”

Take, for instance, falls.According to nearly all sources, falls

are “the primary injury mechanism for the aging population.” But merely knowing the risk for falls won’t prevent them; you need to know why people fall. Clothing mishaps, problems with furniture, slippery fl oors, and other environmental reasons can be dealt with individually or with pro-fessional help; poor balance, medications and other physical issues can be brought to the attention of a doctor. It can also be reassuring to teach someone how to get up if they tumble.

But though falls may be fi rst on your mind, there are other things to consider when making a home as safe as possible. Kitchens and bathrooms can be literal

hotspots, and there are ways to minimize the risk of burns and scalds. M e d i c a t i o n mix-ups can lead to poisoning, which can be easily monitored. The risk of choking – the “third leading cause of home injury death among those over the age of 76…” - can be minimized. And good health deci-sions can be made through health literacy and by asking your doctor to be an ally.

You want to keep Mom or Dad inde-pendent a little longer, whether it’s in their home or yours. Either way, Living Safely, Aging Well can give you the tools to do it.

We’ve all seen TV commercials about falling, and while author Dorothy A. Drago, MPH, has a huge chapter on that aspect of home safety, I was pleased to see

a bigger picture: Drago also digs deeper and of-

fers solutions to other is-sues that don’t normally

come to mind. Boomers will be relieved to know that that

includes the hard stuff, like giving up dangerous-but-be-

loved possessions and furniture, giving up a bit of autonomy, and giving up the driver’s license.

Specifi cally, because of those I-never-thought-of-that issues, I think anyone who’s over age 50 needs this book on their shelf. If you’re concerned about safety for a loved one or want to maintain indepen-dence yourself, Living Safely, Aging Well will give you the steps you need.

Terri Schlichenmeyer. Terri is a professional book reviewer who has been reading since she was 3 years old and she never goes anywhere without a book.

The Literary ExaminerBY TERRI SCHLICHENMEYER

hotspots, and there are ways to minimize the

lead to poisoning, which can be easily monitored. The risk of choking

a bigger picture: Drago also digs deeper and of-

fers solutions to other is-sues that don’t normally

come to mind. Boomers will be relieved to know that that

includes the hard stuff, like giving up dangerous-but-be-

loved possessions and furniture,

Living Safely, Aging Wellby Dorothy A. Drago, MPH; c.2013, Johns Hopkins University Press; $16.95 / higher in Canada, 204 pages

The UHS Board of Directors wish to congratulate the following physicians who completed

Physician Leadership AcademyThe University of Tennessee Medical Center

Supported by UT Graduate School of Medicine, The University of Tennessee Medical Center Medical Staff and UT College of Business.

The University of Tennessee Medical Center has established the advancement of the Physician Leadership Academy as one of our highest priorities. The Physician Leadership Academy is an intense year long formal education program provided by the Executive Education Program of the University of Tennessee College of Business Administration.

Mark E. Anderson, MDNeonatology

Larry Kilgore, MDGynecologicOncology

Amy Barger-Stevens, MDFamily Medicine

TreyLa Charité, MDHospitalist

J. KirkBass, MDNeonatology

J. RussellLangdon, MDAnesthesiology

RobertCraft, MDAnesthesiology

MelissaPhillips, MDGeneral Surgery

RaymondDieter, III, MDCardiothoracicSurgery

RamanujanSamavedy, MDGastroenterology

LisaDuncan, MDPathology

JamesShamiyeh, MDPulmonology

KeithGray, MDSurgical Oncology

MichaelWalsh, MDNeurosurgery

Jano Janoyan, DOHospitalist

WesleyWhite, MDUrology


and their own personal circumstances. Are there financial issues that make office visits cost prohibitive? What about transportation or geographic barriers that make it difficult to get to an appointment? Perhaps an indi-vidual is working multiple jobs or caring for everyone else in the family with little time left over to address their own needs.

Halprin said the study also revealed some interesting perceptions about the healthcare system and providers. “They find the whole healthcare system imper-sonal,” she said of the study participants. “They think we’re not listening and that we suggest things that aren’t practical.”

To a physician, telling a patient to ‘in-crease physical activity’ seems like a highly appropriate, straightforward step toward bet-ter diabetes management. To a patient who struggles financially, a gym membership is out of the question and strolling through an unsafe neighborhood could be more danger-ous to their health than the disease, itself.

“Diabetes is a very time consuming dis-ease to have, but it’s also a very time con-suming disease to treat,” Halprin pointed out. “The healthcare system doesn’t always permit the time for exploring and looking at each person’s individual needs.”

To address that, Joslin is investigating the addition of care coordinators to work with high-risk patients. The coordinator be-comes the point person who initiates a fol-low-up call after an appointment to see if the patient understood recommendations and to make sure prescriptions are being filled. The coordinator might also reach out to remind

the patient when it is time for their diabetic eye or foot exam. This is the individual who is more likely to know about medication assis-tance programs, area outlets for safe activity, and other resources to overcome obstacles.

Although the concept isn’t novel in healthcare, it is one that has been difficult to fund under the current payment system. Changes in reimbursement models, such as the patient-centered medical home, make it more feasible to add a care coordinator to the team approach that Halprin used at Joslin. In addition to the physician, the team includes a nurse practitioner, nutritionist, exercise physiologist, registered nurse, psy-chiatrist and diabetes educator. Through a joint project with Beth Israel Deaconess Medical Center, Joslin has launched the Diabetes Practice Liaison Program to share collaborative strategies with primary care providers and their office staff in the region.

Just as one provider doesn’t hold all the answers, it’s unlikely one approach will meet everyone’s needs.

Halprin pointed to another study among Joslin’s older patients that had en-couraging outcomes. “A highly structured education program with specific tasks and cognitive behavior strategies resulted in bet-ter A1c control, which was maintained for at least a year,” she noted of the interven-tion that worked well with older patients up to age 75. However, she continued, that program didn’t show the same promise among middle-aged patients.

Race and ethnicity are also important variables in how information is received,

perceived and acted upon. Joslin has ini-tiatives for Asian, African-American and Latino patients that take into account social and cultural traditions. Considering the risk of diagnosed diabetes in comparison to non-Hispanic whites is 18 percent higher among Asian Americans, 66 percent higher among Latinos, and 77 percent higher among non-Hispanic blacks, reaching these specific populations in a meaningful way is critical.

Halprin, a member of Joslin’s Latino Diabetes Initiative, noted there is a support group that meets regularly at the diabetes center to knit and chat. A staff psychologist joins the group to guide conversation and answer questions.

“They bring food so that’s an oppor-tunity to discuss what is a good choice or a not-so-good choice,” Halprin said. “Nu-trition is a huge part of diabetes care, but it’s also a huge part of the Latino culture,” she noted, adding nutritionists on staff try to make suggestions that are culturally ap-pealing or that revamp traditional meals to lighten the carbohydrate load.

Additionally, education classes are con-ducted in Spanish and materials have been translated. Providers with the Latino pro-gram also are piloting group medical visits with four-eight participants. All of these ef-forts combine to make the healthcare clinic less intimidating and more welcoming of natural conversation and questions about living with diabetes.

In fact, Joslin hosts a number of pro-grams in a group setting including DO IT, a four-day intensive outpatient program de-

signed for those who have gotten off track with their self-management; Why WAIT, a combined weight reduction and manage-ment program with a focus on nutrition, physical activity and behavioral support; and interactive games like CarbChallenge where participants test their knowledge of carbohydrate containing foods.

“Diabetes can be a very isolating con-dition,” Halprin said. “It’s good for people to be in a group and know other people are struggling with similar issues.”

What’s good for patients is also good for providers. Halprin’s colleague, Rob-ert Gabbay, MD, the chief medical officer for Joslin Diabetes Center, is slated to give the keynote speech at The American Journal of Managed Care annual meeting. “Patient-Centered Diabetic Care: Putting Theory into Practice” is the 2014 theme of the April 10-11 conference in Princeton, N.J.

“Our meeting will occur as the first waves of newly insured consumers are ac-cessing the healthcare system, including many who will learn for the first time they have diabetes or other cardiometabolic conditions,” said Brian Haug, president of AJMC. “This is an important time for healthcare professionals to be engaged with leaders in this field.”

By working collaboratively, utilizing diverse technologies and education offer-ings, and leveraging the theories embedded in new reimbursement models, the hope is patients and providers will work together to overcome the obstacles to effective diabetes self-management.

Addressing Obstacles on the Road to Diabetes Control, continued from page 1

Non-Alcoholic Steatohepatitis and Obesity

GI for Kids, PLLC

BY DIANA MOYA, MD

Obesity and Non-alcoholic steatohepatitis (NASH) are fascinating entities becoming more frequent in our practice. During the past two decades, there has been a dramatic increase in obesity in children and adolescents in the United States. Data from the CDC estimates that childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years, and approximates 17% (12.5 million). Parental obesity is one of the main risk factors for the development of pediatric obesity. Obese adolescents have a 50 to 77% risk of becoming obese adults with an increase to approximately 80% given 1 obese parent.

Obesity during childhood carries devastating consequences including hypertension, dyslipidemia, non-alcoholic fatty liver disease (NAFLD), insulin resistance, diabetes mellitus and metabolic syndrome. Children are at greater risk for bone and joint problems, sleep apnea, precocious puberty, polycystic ovary syndrome and social and psychological problems such as poor self-esteem and bullying.

Many families, surprisingly enough, report being unaware that their child is overweight or obese. This unawareness limits interventions in a timely fashion. As physicians and medical care providers, we must warn families for any concerns about overweight and obesity at any age. Body fat is measured by Body Mass Index (BMI) based on height and weight. BMI curves are calculated from the 5th to the 95th percentile and by consensus children and adolescents are overweight or obese if the BMI exceeds the 85th or 95th percentiles respectively.

Obesity can be multifactorial involving genetic and environmental factors. In overweight and obese children, excess fat accumulates when total energy intake exceeds total energy expenditure. Other factors include genetic syndromes, hormonal disorders, and medications.

NAFLD occurs more frequent in obese children. NAFLD is a spectrum of diseases ranging from simple steatosis to cirrhosis. Non-alcoholic steatohepatitis (NASH) is the severe form of NAFLD and is characterized by steatosis, hepatocyte injury and cell death, infl ammation and collagen deposition or fi brosis of the liver. The pathogenesis of NASH is not fully understood, although metabolic derangements related to obesity, insulin resistance and oxidative stress is well known factors involved. The development of NASH is likely a “two hit” process. Fat accumulation in the hepatocytes is the suggested “fi rst hit”. The “second hit” is related mainly to oxidative stress, and additionally mitochondrial dysfunction, pro-infl ammatory cytokines, and adipokines that leads to the production of reactive oxygen species.

Most obese children with NASH are asymptomatic. Few patients may complain about fatigue and upper abdominal discomfort. Although the only fi nding on physical exam may be a BMI above the 85th or 95th percentiles, other fi ndings may indicate organic etiologies

of obesity. Short stature may suggest hypothyroidism, hormonal abnormalities or genetic syndrome such as Prader-Willi syndrome. Constipation or intolerance to cold may indicate hypothyroidism. Polyuria and polydipsia may suggest diabetes. Acanthosis nigricans suggests insulin resistance. Symptoms of jaundice, ascites, edema or hepatosplenomegaly may be signs of advance liver disease related to cirrhosis due to progressive NASH.

Laboratory evaluation may be challenging as no single test is used to diagnose NASH. Helpful tests includes liver function tests, gamma-glutamyl transpeptidase, fasting insulin and glucose levels, fasting lipid panel, thyroid panel and iron studies. Occasionally more specialized tests are used to rule out other causes of elevated liver enzymes such as autoimmune or infectious hepatitis, Wilson’s disease or hemocromatosis.

Abdominal ultrasound is a helpful, simple and noninvasive way to diagnose hepatic steatosis and evaluate for portal hypertension or gallbladder disease. In patients with NASH, the liver is hyperechogenic or bright and steatosis is usually detected when more than 30% of liver has fatty changes. Other diagnostic studies also available are abdominal computed tomography and magnetic resonance. Invasive tests such as a liver biopsy should be considered in patients with suspected NASH to assess the extent of liver damage and fi brosis, defi ne the prognosis and exclude other unsuspected causes of liver disease.

No specifi c treatment is available for (NASH). Lifestyle modifi cation including weight loss, dietary changes, and exercise activity are the most important measures to slow the progression of the disease and reverse hepatic steatosis. According to the AASLD guidelines, 2-3% of weight loss generally reduces hepatic steatosis, but up to 10% weight loss may be needed to improve necroinfl ammation.

Recommendations for pharmacological therapies such as metformin, statins, ursodeoxycolic acid, thiazolidinediones, omega-3 fatty acids and vitamin E in children are limited and therefore not recommended for this population.

Some complications associated with NASH may include cirrhosis and its complications: variceal bleeding, ascites, encephalopathy, and liver failure. The prognosis in NASH depends on the histologic stage at presentation. The rate of progression worsens if more than one liver disease is present (alcoholic liver disease or chronic viral hepatitis).

At GI for Kids, we offer a weight management program, Bee Fit 4 Kids, for overweight and obese children and teenagers. Bee Fit comprises

group and individual counseling sessions with two Registered Dietitians to discuss healthy dietary habits, an Exercise Specialist to improve physical activity habits, and a Psychologist assessing

behavior modifi cation to ensure a successful weight loss journey. Our Gastroenterologists and Nurse Practitioners also participate in this program.www.giforkids.com (865) 546-3998

bleeding, ascites, encephalopathy, and liver failure. The prognosis in NASH depends on the histologic stage at presentation. The rate of progression worsens if more than one liver disease is present (alcoholic liver disease or chronic viral hepatitis).

At GI for Kids, we offer a weight management program, Bee Fit 4 Kids, for overweight and obese children and teenagers. Bee Fit comprises

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Although one in every 20 Americans over the age of 50 has peripheral arterial disease (PAD), less than a third of patients present with typical symptoms. Primary care providers may easily identify the common symptoms of lower extremity arterial diseases, primarily claudication (leg pain on walking or exertion), but patients with PAD also present with leg pain at rest, pain in the buttock or hip, unhealed ulcers and wounds, gangrenous feet or legs, discoloration of the feet or legs, cold or pale feet, burning, numbness, and leg fatigue . The American Heart Association and the American College of Cardiology recommend screening asymptomatic patients 50 years and older with a history of smoking or diabetes. Risk factors of PAD include smoking, diabetes, high cholesterol , hypertension, physical inactivity, and overweight/obesity.

An ABI (ankle-brachial index) is used in office to screen at-risk patients. The risk factors of patients who have an abnormal ABI should be aggressively controlled with medication and by changing their lifestyles. Smoking must stop, and diabetes, high cholesterol and high blood pressure need to be controlled.

Along with controlling risk factors of PAD and lifestyle modification, patients diagnosed with PAD should be on aspirin therapy for prevention of heart attack and stroke, and prescribed cilostazol for help in controlling symptoms (with the exception of patients with congestive heart failure). At the same time, all these patients should undergo a supervised exercise program. If after three months of medical treatment and supervised exercise, symptoms have not improved, patients should undergo an MRI, duplex ultrasound, or an abdominal aortogram with selective lower extremity angiogram to determine the exact location and percentage of blockage. Angioplasty and/or stenting or atherectomy is often indicated to open narrowed or blocked arteries.

A significant number of patients have uncontrolled blood pressure, even with optimal doses of multiple medication. Those patients and patients with accelerated or malignant hypertension; deteriorating kidney function; and flash pulmonary edema should undergo evaluation for renal artery stenosis as a cause. Renal duplex ultrasound is the initial screening method and renal angiogram is the gold standard for evaluation of renal artery stenosis. Renal artery stenting or angioplasty is indicated for resistant or malignant hypertension; deteriorating kidney function; and flash pulmonary edema.

Primary care providers can refer their patients for evaluation and management of lower extremity PAD and renal artery stenosis. Early identification and treatment of those patients significantly improve a patient’s quality of life , symptom relief, and prevent future adverse cardiovascular events.

Dr. Timir Paul practices with Quillen ETSU physicians and is skilled in the evaluation and treatment of peripheral vascular diseases. He performs angioplasty and stenting in renal, iliac, femoral, and popliteal arteries, as well as tibial and peroneal arteries.Dr. Paul earned his MD from the University of Dhaka, Dhaka Medical College, Dhaka, Bangladesh; MPH in Cardiovascular Epidemiology from the School of Public Health and Tropical Medicine, Tulane University, New Orleans, La; and a PhD in Cardiovascular Epidemiology, Tulane University, School of Public Health and Tropical Medicine, New Orleans, La.He completed his residency in internal medicine with the Department of Internal Medicine at the Quillen College of Medicine in Johnson City, Tenn. He completed his fellowship in cardiology at Oschner Clinic, New Orleans, La. He finished his interventional cardiology fellowship at University of North Carolina at Chapel Hill, Chapel Hill, N.C.

Quillen Heart

Talk Your Patients

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By TIMIR K. PAUL, MD, PhD, MPH, FACC

329 North State of Franklin RoadJohnson City, TN 37604

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Nationally, healthcare providers list patient education as one of the most important

aspects of quality patient care, yet patient education is one of the most difficult quality initiatives to achieve. That’s why the Mountain States Health Alliance (MSHA) Health Resources Center (HRC) is such a valuable community resource. The HRC offers easily accessible health information, health classes, and health screenings for individuals throughout the Tri Cities. Open Monday through Saturday from 8 a.m. to 6 p.m., the Health Resources Center has two locations, at the Kingsport Town Center (formerly Fort Henry Mall) and the Mall at Johnson City. The Center also offers blood pressure checks and weight checks, with an RN on staff during all business hours. Individual nutritional counseling is available with a registered dietician who is certified in diabetes education (CDE).

In addition to health classes and screenings, the HRC hosts monthly support groups, offers cooking demonstrations, and exercise programs, such as yoga, Zumba Lite, dance fitness, and fitness training.

“We try to mix it up and have something for everyone,” said Laurel McKinney, RN, manager of the HRC. “The biggest advantage of the HRC to patients and the community is the help we offer for keeping people healthy, prevention of disease, and teaching optimal health. We want the community to understand, and stay healthy.”

Although the HRC offers a wide range of resources and education on many diseases and conditions, a big focus of the HRC is on diabetes, since a large percentage of the community population has been diagnosed with diabetes or is at risk for developing it. Currently, the Johnson City location offers on the spot Hemoglobin A1Cs, an important test for diabetics, which reveals a longer-term picture of blood sugar levels either for diabetics or for individuals who have had a fasting blood sugar that’s a little high. An RN goes over the results with the patient and instructs them on what the results can indicate. Lab work for diabetes as well as other disease screenings is typically cheaper than the co-pay on an individual’s insurance plan, and no doctor’s order is required.

Any person can use the HRC’s resources, no matter his or her healthcare provider or insurance carrier, and with most services offered free of charge or for a minimal cost, healthcare providers will find that the HRC can be a valuable resource to their patients.

“Our disease management classes are a great resource for physicians to use for patient education and disease management,” said McKinney. “We want to help keep patients healthy if they have been diagnosed with a disease, or who might be headed in that direction, to help keep them out of the hospital.

“Examples of our classes would be ‘Lowering Your Cholesterol’ or ‘Dash to Better Blood Pressure.’ We offer COPD classes, managing congestive heart failure, medication safety, smoking cessation, stress management, or even preparation for a joint replacement,” McKinney explained. “So when patients are diagnosed or discharged from the hospital, this is the perfect fit for them to come learn more about their disease and stay as healthy as they can be with their disease state. These are classes that we offer every single month. Our focus is on healthy living, preventative care, and disease management.”

A monthly calendar of events is available for both HRC locations and is sent out via email and postal mail, listing class and screening schedules. The HRC also makes the schedule available on the MSHA website, and highlighted events are posted on MSHA’s Facebook page, in the Johnson City Press, and in the Kingsport Times. The HRC also works with television stations WJHL and WKPT to announce screening and class schedules.

Physicians can call and register their patients if preferred or patients can sign up themselves. Although classes are typically free

or low cost, registration is required because of class size limitations and scheduling considerations. Classes often fill up.

Although the staff teaches disease management classes themselves, guest speakers are utilized—and needed—at both locations for Healthy Living

classes. Physicians can book classes to teach at the HRC, and both locations are very accommodating for a variety

of teaching methods. Most class sessions are scheduled for

an hour, with 40-45 minutes allowed for instruction, and 15 minutes for questions and answers.

“We would love to have physicians come speak. Classes can be as formal or as casual as the speaker desires,” said McKinney. “We have laptops, projectors, and other equipment for presentations or

speakers can pull up chairs and simply lead a discussion. We remind our speakers that most of the attendees are members of the general public, so a very simplified version of the topic is appreciated.”

For those who are interested in teaching a class, a call to the center is all that is required. Classes are planned at least a month in advanced, and the HRC checks credentials for those who have never presented before. Alternative therapy topics are welcomed, as long as the subject matter does not discourage MSHA protocols and practices.

The HRC also offers outreach programs to the community, making presentations for civic groups and schools, such as the Hope House Center for Women, the Johnson City Farmer’s Market, the Kingsport Funfest, or the No Boundaries Couch to 5K program.

Other services that can be scheduled are one-on-one education for diet and nutrition, weight management and reduction, or infant and child feeding, to name a few.

“We are here for the community, for help with understanding illness or disease, and a place for the community to come in and ask questions,” McKinney emphasized.

For more information, or to contact the Health Resources Center, call 423-915-5200, in Johnson City, or 423-857-7981 in Kingsport.

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

All source data for this article has been provided by

Health Resources Center Helps Community Understand and Stay Healthy

Patient Centered Practices

Laurel

McKinney, RN

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Diabetes Alert Sticker Program Enhances Community Safety, Earns NASCAR Nationwide Series Driver’s Support

BRISTOL – Imagine seeing a car weav-ing in and out of its lane and eventually running off the side of the road.

It might seem like a clear case of someone driving under the influence, but officers and health officials who have wit-nessed this type of incident recognize something else might be at play. The driver might have diabetes and be experiencing a complication with the disease that is im-pacting his or her ability to drive properly.

Representatives of Bristol Motor Speedway, Wellmont Health System, Lilly Diabetes and the American Diabetes Asso-ciation have joined NASCAR Nationwide series driver Ryan Reed, who is living with type 1 diabetes, to call attention to this is-sue. They held a news conference on Fri-day, March 14, at the World’s Fastest Half Mile to tout the value of the Diabetes Alert sticker.

The event was held the day before the flag drops on the inaugural Drive to Stop Diabetes 300 presented by Lilly Diabetes at the speedway.

Wellmont developed the Diabetes Alert sticker, which is placed on a rear win-dow and helps officers know they need to check whether the driver is having dif-ficulties with diabetes instead of driving impaired. The health system has partnered with law enforcement officers locally and across the state to raise awareness that such a scenario might be in play.

“If you have never seen the symptoms of a high or low blood-sugar episode in a person with diabetes, you would probably assume the individual is driving under the influence of drugs or alcohol,” said Jim Perkins, director of Wellmont Diabetes Treatment Centers. “The Diabetes Alert

sticker is a great way to help law enforce-ment identify individuals who might be prone to such an event.”

The American Diabetes Association advises in addition to alerting law enforce-ment that a driver may have diabetes, it is important for law enforcement officers to receive training on diabetes in order to re-spond appropriately to diabetes emergen-cies. The association works to educate law enforcement agencies about diabetes and has developed several training resources, including an educational video and accom-panying poster, and diabetes information cards and diabetes medical alert wallet cards that can be kept in a person’s vehicle.

Perkins commended police depart-ments and sheriff’s departments across the state for recognizing this potential medical issue.

Multiple organizations put a lot of thought into this program, and appropriate safeguards were established to ensure Dia-betes Alert stickers were provided to those people who needed them, Perkins said.

Stickers are available at 27 locations throughout Tennessee, which include four Wellmont hospitals and Wellmont Urgent Care in Johnson City, but require a pre-scription from a physician.

Reed, who was diagnosed with type 1 diabetes when he was 17, has collaborated with the American Diabetes Association on the Drive to Stop DiabetesSM initiative and is the driver of the No. 16 Drive to Stop Dia-betesSM presented by Lilly Diabetes Ford Mustang in the NASCAR Nationwide se-ries. He appreciates Wellmont and police agencies working together to establish and grow the sticker program. Reed has to take precautions to control his diabetes on and off the track and knows the potential health problems when something is amiss.

Lilly Diabetes learned about the stick-er program after deciding to sponsor the race. Lilly recognizes that the program is an

excellent initiative that equally addresses the health needs of drivers and the need to ensure roads stay safe for all motorists.

Locally, Sullivan County ranks in the top five in most diabetes categories in the state.

For more information about the stick-ers, please call Wellmont Diabetes Treat-ment Centers at 423-224-3575 or visit www.mydiabetesalert.com.

To access the American Diabetes As-sociation’s law enforcement training ma-terials, please visit www.diabetes.org/po-licevideos.

Hobson Selected as Hospital’s Chief Operating Officer

BRISTOL – Brian Hobson, a leader with a track record of success, has been selected as Bristol Regional Medical Center’s chief op-erating officer.

Hobson has served the hospital in multiple roles for 25 years, including the last several months as interim chief operating officer. Greg Neal, the hospital’s president, said Hobson has excelled and earned removal of his interim status.

Hobson rose through the ranks during his initial 24-year career at the hospital. He was a respiratory therapist, oversaw pul-monary diagnostics and directed the pul-monary and neurophysiology departments and the medical emergency team. He also was responsible for Bristol Regional’s wound care services.

His success in these roles resulted in a promotion in 2011 to finance director at Hawkins County Memorial Hospital and Hancock County Hospital and, later, addi-tional duties for Wellmont Health System as vice president of finance and operations for the community hospital division. Neal

problems, and stroke. I was asked to look at our clinical processes for these patients and explore ways to improve them.”

Tipton’s commission lead to the estab-lishment of the group’s diabetic clinic. A list of patients is generated quarterly who have been diagnosed with diabetes and have HgbA1C of 8 or greater. The list is used to develop a tracking mechanism for each individual patient, and it is one nurse’s sole responsibility to manage.

For each patient, standard treatment protocols are applied, such as determin-ing his or her HgbA1C, last microalbu-min, last eye exam, etc. If the labs are out of range or haven’t been recorded in the chart in the recommended timeframe, the clinic communicates with the patient and either schedules the patient to have the labs drawn or to see a provider. The nurse then follows up with the patient to report im-provements or to identify barriers that may be preventing improvements.

“Does the patient understand their disease? Do they have transportation to the clinic? Have they recently had changes in their insurance or a loss of a job? Is their medication affordable for them?” explained Tipton. “We ask these type of questions, and continue to follow the pa-tient indefinitely. We run the lists quarterly to capture patients with a new diagnosis or out of range hemoglobin A1C.”

“We have seen a drastic decrease in the hemoglobin A1C values since starting the clinic, and many were lowered by as little as one point, or even below eight. We found that following up with the patient, not hassling them, but expressing concern, really helps. Some are even depressed and just need a listening ear,” she said.

Although Tipton explained that the program aligns with their Patient Centered Medical Home, which focuses on track-ing chronic disease states, and their ACO, the providers in her clinics are quick to ask what they can do.

“They are invested in their patients, and they know their patients,” she ex-plained. “They ask us how to use this data to serve in the clinic itself, and not just as an administrative program.”

This dedication to patient care is one of the many reasons Tipton says she loves her job, “I work with a great team here,” she said. “The nurses and providers I work with are wonderful. We have a good time at work and are able to take each other seri-ous and take care of our patients.”

Tipton says she also enjoys having a bird’s eye view of the clinic, yet still hav-ing the ability to look closer at processes, develop them, and help the patients by facilitating improvements to the care they receive.

“I really enjoy developing programs that serve the patients. As part of our work on quality initiatives, we will soon start a hypertensive clinic, and we are looking at developing a lipid program as well,” she said. “We want to have processes and pro-grams in place that serve the patients in our area.”

Healthcare Leader, continued from page 7

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Brian Hobson

(continued on page 14)


supervised him in these positions and saw firsthand Hobson’s leadership and team-work.

Hobson holds a Bachelor’s degree from King University and multiple certifica-tions and registrations. He is a member of the American Association for Respiratory Care and serves as chairman of the Adviso-ry Committee for Respiratory Care at East Tennessee State University.

Appalachian Christian Village Celebrates 5th Annual Employee Service Awards Johnson City natives recognized for their 25 years of dedication and service

JOHNSON CITY - Appalachian Christian Village (ACV), one of the first established Continuing Care Retirement Communities (CCRC) in East Tennessee, recently held its 5th Annual Employee Ser-vice Award Ceremony to honor the com-mitment and loyalty of its long-standing employees. Among those were 25 year veterans Ramona Hopson, Juanita Dooley and Susan Taylor.

“We are honored to have an extreme-ly dedicated and caring staff,” states Tom Sexton, CEO of Appalachian Christian Vil-lage. “Our experienced group of profes-sionals assist Appalachian Christian Village daily in fulfilling its mission statement, ex-ceeding the expectations of the residents, and going above and beyond to help and mentor their fellow employees.”

One of 12 children, Juanita Dooley be-

gan her career in May 1988 as a Nursing Assistant.Upon completing the Certified Nursing Assistant classes offered by ACV at that time, she has served as one of the community’s Health Care Center C.N.A.s for 25 years. In addition to providing care to the community’s residents, Dooley also mentors new employees and supports the management team in completing addi-tional tasks when necessary. Prior to join-ing ACV, she worked in the manufacturing industry. She currently resides in Johnson City with her husband, Doug, three chil-dren and six grandchildren.

Similar to Dooley, Ramona Hopson began her career in July 1988 as a Nurs-ing Assistant, and enrolled in the Certified Nursing Assistant classes offered by ACV. Upon completing the classes, she served as a C.N.A. for 20 years in the communi-ty’s Health Care Center. In 2008, Hopson graduated from Tennessee College of Ap-plied Technology in Elizabethton, Tenn. as a Practical Nurse Graduate. After passing the state board exam, she was promoted to the Licensed Practical Nurse position. In addition to providing care for the commu-nity’s residents, Hopson serves as a mentor to student nurses from the Tennessee Col-lege of Applied Technology and provides them with hands-on experience. She cur-rently resides in Johnson City with her three children and grandson. Hopson also enjoys participating in kickball and bowling.

Hat collector, Susan Taylor joined Ap-palachian Christian Village in August 1988 as an Administrative Assistant. Throughout

her 25 year career with the community, she has held various positions within the Ac-counting Department such as Accounts Receivable and Client Account Specialist. She currently holds the position of Staff Accountant and is responsible for the se-nior living community’s trust and resident billing. Taylor is a graduate of Lamar High School in Jonesborogh, Tenn. and studied at Steed College in Johnson City, Tenn. She currently resides in Johnson City with her husband, Jeff, and has a son, daughter-in-law and granddaughter.

During the Employee Service Award presentation, the ladies received a certifi-cate, pin and Seiko watch to commemorate their 25 years of service and dedication to the community. Additionally, Appalachian Christian Village honored employees who had completed 2 to 15 years with the se-nior living community.

Those recognized were: 15 year vet-erans Annie Simerly of Jonesborough and Tom Sexton of Blountville; Myra Paessler and Nikki Roberts of Johnson City and Sherri Humphrey of Bluff City have served 10 years;and 5 year veterans Diane Parkes, Patricia Radford and Teresa Lane of John-son City, Sheila Morelock and Betty Smith of Kingsport, Aaron Keller and Laura Hughes of Elizabethton, Rachel Brumfield and Gay Penix of Piney Flats, Loretta Peters of Watauga, Lorie Massey of Limestone, and Sandy Hall of Jonesborough. Employ-ees completing their second year of ser-vice included

•Jonathan Keller, Elizabethton •Vickie Bowen, Kingsport •Steven Evans, Gate City, VA •Christina Neal, Johnson City •David Sentell, Johnson City •Dorothy Holsclaw, Elizabethton •Margaret Phillips, Gray •Melinda Pierce, Elizabethton •Michael Cross, Johnson City •Denise Dunn, Johnson City •Tabitha Luster, Rogersville •Janet Swift, Johnson City •Connie Adkins, Elizabethton •Elizabeth Souder, Elizabethton •John Miller, Hampton •Ruby Greene, Johnson City •Amber Hass, Johnson City •Sarah Shelton, Greeneville •Angela Clark, Johnson City •Erin Donovan, Johnson City •Sandra Greene, Elizabethton •Tammy Price, Jonesborough •Judy Ward, Johnson City

Additionally, James “Tread” West, Nikki Roberts and Judy Ward of Johnson City; Debbie Gibson of Kingsport; Rachel Brumfield of Piney Flats; and Katherine Nidiffer of Limestone were awarded Ap-palachian Christian Village’s Making A Dif-ference Award. This peer-nominated award recognizes employees at ACV who exem-plify teamwork and maintains a positive work attitude.

For more information about Appala-chian Christian Village, please visit www.christianvillage.org/info or call 877-302-8720.

BlueCross Links Members with Pharmacists for Improved Medication ManagementFree program aims to improve quality of care for Medicare Advantage enrollees

CHATTANOOGA — Helping mem-bers with multiple health conditions effec-tively manage medications is the goal of a new Medication Therapy Management program (MTM) offered through BlueCross BlueShield of Tennessee’s Medicare Ad-vantage plans. The program links members with local pharmacists who provide a com-prehensive program to ensure safe and effective use of medication in accordance with standards set forth by the Centers for Medicare & Medicaid Services.

BlueCross’ program, delivered through OutcomesMTM, provides one-on-one medication management to high-risk members − those with three or more chronic health conditions requiring mul-tiple medications. Key to the program is an annual comprehensive medication review to detect and resolve any issues with the patient’s prescription and over-the-counter medications. As part of the review, the pa-tient receives private consultation on exist-ing regimen, a medication action plan and a personalized drug list.

The MTM program also provides timely alerts to specially trained pharma-cists when the patient starts a medication with high risk of causing side effects. Ad-ditionally, patients who have difficulty with taking their medications on time receive special counseling to help them manage their drug treatments.

Adults ages 65 and older make more than 177,000 emergency department visits each year for adverse medication interac-tions. They are also seven times more likely to be hospitalized after the emergency visit than other age groups, according to the Centers for Disease Control and Preven-tion (CDC).

OutcomesMTM provides regular up-dates to pharmacists letting them know when a member starts a new medication and needs education and follow-up. Phar-macists confer with the member or his/her doctor to resolve issues found with the member’s medication. Additionally, phar-macists will also confer with the member on over-the-counter medicines for minor ailments.

Pharmacists who participate in the OutcomesMTM program complete spe-cial training to provide medication man-agement services to BlueCross’ members. The program is a free benefit covered in BlueCross’ Medicare Advantage plans.

Niswonger Children’s Hospital Radiothon raises $140,000 to benefit its youngest patients

JOHNSON CITY – The 2014 Nis-wonger Children’s Hospital Radiothon was a big success March 3-4, raising more than $140,000. The money will benefit

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Takoma’s Lewis Named Certified Physician ExecutiveGREENEVILLE – Dr. Daniel Lewis, a family medicine physician with Takoma Medical As-

sociates and chief medical officer at Takoma Regional Hospital, has been designated a certi-fied physician executive (CPE).

He is one of only 2,000 physicians with this designation, out of the estimated 850,000 physicians in the United States. Dr. Lewis received the designation by the Certifying Commission in Medical Manage-ment for his superior levels of management education, leadership skills and stature as a physician.

Lewis completed 125 hours of vigor-ous coursework by the American College of Physician Executives, on topics including management, health law, finance, and com-munication.

Lewis, a board-certified family medi-cine physician, received his medical de-gree from East Tennessee State University’s James H. Quillen School of Medicine with a curriculum focus on rural health. He was recognized by the Tennessee Academy of Family Physicians as the “Outstanding Stu-dent in Family Medicine” award during his senior year of medical school.

Lewis completed a family medicine residency at Self Regional Healthcare in Greenwood, S.C., where he was recognized as South Carolina Academy of Family Physicians’ Outstanding Resident of the Year. He also received the prestigious AAFP/Bristol-Myers Squibb Award for Excellence in Graduate Medical Education as a second-year resident physician – an award only given to 20 resident physicians across the United States each year.

Lewis also completed a primary care sports medicine fellowship at Wake Forest Univer-sity, and received a certificate of added qualification in sports medicine.

He is married with five children, and serves on the board of directors for the Boys & Girls Club of Greeneville and Greene County. He also volunteers as a sideline physician for sport-ing events at area high schools, as well as at Tusculum College. (continued on page 15)


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the children’s hospital through the Moun-tain States Foundation and be used to purchase specialized Neonatal Intensive Care Unit beds, which cost about $35,000 apiece.

“This event was all about the equip-ment needs for the smallest of our pa-tients, those who are in the NICU,” said Mountain States Foundation President Pat Holtsclaw. “Our thanks to the community as they gave from their hearts!”

“That $140,000 surpasses last year’s total by about $15,000, and it equates to four of those NICU beds the hospital can buy,” said Don Raines, 2014 Radiothon Chair. “We really appreciate all the great help we got out of our ‘phone comman-dos’ and all the time and effort our volun-teers put into this, and I want to thank all our sponsors and donors for stepping up and helping the young patients in our re-gion, because that’s what this is all about.”

The radiothon was broadcast live from the lobby of Niswonger Children’s Hospi-tal on Holston Valley Broadcasting stations 98.5 WTFM, Classic Hits 102.7 WVEK, 95.9 The Hog, FM94! WMEV, and ESPN Radio. Fundraising began several months ago and culminated with the radiothon. Cor-porate sponsors; local organizations like schools, churches and clubs; and families and individuals pitched in to help the ra-diothon reach their goal.

“It was a wonderful event,” said Ste-ven Godbold, CEO of Niswonger Chil-dren’s Hospital. “I want to thank the com-munity for their support and thank every-one who participated. This means a lot to our hospital and to the children and fami-lies who depend on us.”

Although the on-air portion of the ra-diothon has ended, donations can still be made online at www.mshafoundation.org/radiothon.

Sword Promoted to Director of Case Management at Holston Valley Medical Center

KINGSPORT – Sharon Sword, an in-novative nursing professional for 27 years at Holston Valley Medical Center, has been promoted to serve as the hospital’s di-rector of case management.

Sword, who was serving as interim director, now pro-vides leadership and vision to the case management department, with objectives of reducing length of stay, coordinating care and fa-cilitating transitions to post-acute settings. She will also manage the department’s dai-ly operations, including the budget.

During her career, Sword has excelled in various levels of nursing, including the medical-surgical and step down units. She also served as a charge nurse for many years.

For the last eight years, she has worked in case management, the last four of which have been in leadership.

Sword graduated from East Tennes-

see State University with an Associate’s degree in nursing and a Bachelor’s degree in health education, with an emphasis in patient education.

Indian Path Medical Center celebrates 40 years of serving the community

KINGSPORT – Indian Path Medical Center (IPMC) is celebrating 40 years of service to the community, having treated its first patients on March 1, 1974.

Over those four decades the hospital has become an integral part of Kingsport and the surrounding area, helping to heal thousands of people and save countless lives. While IPMC has continued to expand and enhance its services, equipment and facilities, it hasn’t outgrown its roots as a community hospital with a patient-friendly atmosphere.

To celebrate the anniversary, the hospital put together a week of activities, including a Kingsport Chamber of Com-merce breakfast; “A Closer Look” seg-ment on WKPT-TV 19; a 40th Anniversary Commemorative Video; a ribbon-cutting and proclamation ceremony followed by a Founding Physician/40-Year Team Mem-ber Luncheon; and an IPMC Team Member 40th Anniversary Celebration on.

As you’d imagine, the hospital has seen dramatic changes as healthcare and technology have evolved, but the team members at IPMC are proud of their com-mitment to providing great patient-cen-tered care.

IPMC was called Indian Path Hospital when it opened its doors in 1974, with the first two patients being treated on March 1. It began as part of Hospital Corporation of American (HCA) – which in 1994 joined with Columbia to form Columbia/HCA – before becoming part of Mountain States Health Alliance (MSHA) in 1998.

A huge crowd was on hand for the hospital’s grand opening on Feb. 24, 1974. They braved rain and the nation’s gas cri-sis to see the ceremony and enjoy a tour of the facility. When it opened, Indian Path offered some of the best technology and finest treatment available at the time.

According to a story in the very first edition of the hospital’s “Pathfinder” news-letter (then called simply “The Bulletin”): “Patients’ rooms are equipped with elec-trically-controlled beds, color televisions, radios, individual baths, piped-in oxygen, nurse-call set-ups, and individual ther-mostats for room temperature controls. Hallways and rooms (excepting isolation rooms) are carpeted to keep noise to a minimum. The medical staff is made up of some 50 area physicians who, for the most part, are on the staffs of other local hospi-tals.”

Richard Welch was the hospital’s first administrator. In a letter to employees shortly after the opening, he thanked them for making opening day a success as well as “for the tremendous performance you

Sharon Sword

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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.

have shown in the initial weeks of ‘giving birth’ to a new hospital.”

There are eight employees and sever-al physicians who have been at Indian Path since the beginning. IPMC original team members include: Judy Powers, Betty Bell, Barbara Knight, Wanda Britt, Marie Linger-felt, Jane Jones, Tommy Davis and Glen Lewis.

Three of them – Lingerfelt, Davis and Jones – still work in the IPMC Laboratory, a department they helped start basically from the ground up.

Change continues at IPMC, and one of the biggest boosts was joining MSHA. Since then, Indian Path has enhanced and expanded many departments and services.

The seven-story facility, located at 2000 Brookside Drive just off Highway 93 (N. John B. Dennis Highway), has grown to in-clude 178 operating beds and offers an ar-ray of services, including an Interventional Cardiology program, a Joint Replacement & Spine Center, a Cancer Center, Surgery, a Family Birth Center, 24-hour emergency department, Comprehensive Diagnostic Imaging, and a Sleep Disorders Lab.

Wexford House Receives Awards for Customer Satisfaction, Prevention of Hospital Readmissions

KINGSPORT – Wexford House, a com-prehensive skilled nursing facility that re-cently joined Wellmont Health System, has earned two awards from a national organi-zation that focuses on enhancing quality.

The 174-bed facility received the Em-bracing Quality Awards during the Ameri-can Health Care Association and the Na-tional Center for Assisted Living’s sixth an-nual quality symposium. The awards came from Providigm, a Denver-based company that creates quality improvement solutions for health care.

Wexford House was recognized in two categories – exceptional customer satisfac-tion ratings and a low risk-adjusted rate of hospital readmissions.

Wexford House, located at 2421 N. John B. Dennis Highway, provides respira-tory services, hospice, skilled nursing care and short-term stays. Other care includes inpatient and outpatient physical therapy, speech therapy and occupational therapy.

To qualify for the quality awards, Wex-ford House needed to achieve Quality As-surance and Performance Improvement Accreditation from Providigm. The facility recently received that accreditation, which reflected Wexford House’s continuous as-sessment of residents’ quality of life. Spe-cific topics that are addressed include pain, dignity, respect for resident choice and quality of care matters, such as staffing, in-fections and rehabilitation.

Wexford House joined Wellmont in December, enhancing the continuum of care for the region’s patients.

“This recognition of Wexford House is a perfect illustration why this facility was an

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New Wellmont Cancer Institute Facility in Johnson City Maximizes Comfort, Promotes Healing for Patients JOHNSON CITY – Soothing colors, gorgeous photos and abundant natural light will enhance the healing experience for patients as the

Wellmont Cancer Institute reinforces its high quality of care in its newest facilityThe cancer institute is moving its Johnson City physician office and infusion service to 378 Marketplace Blvd., Suite 10. Scheduled to open

March 24, the new facility is located next to Wellmont Urgent Care and Northern Tool behind Fuddruckers and continues the superior care the cancer institute has delivered in the community.

Patients diagnosed with all types of cancer and other blood disorders have been seen by medical oncologists from Wellmont Medical As-sociates Oncology & Hematology and received infusion since January 2013 at 302 Wesley St., Suite 3. This was a temporary home that enabled the cancer institute to treat patients in Johnson City as it prepared to move to a permanent location.

The cancer institute celebrated the upcoming opening with a ribbon-cutting ceremony and tours Wednesday, March 5. Attendees saw six exams rooms, eight infusion bays, the nurse’s station, multiple work areas for clinicians and staff and other amenities.

Among the services available to patients will be chemotherapy, hydrations and injections.In addition to increased natural light, photos and artwork, the new location will feature infusion chairs that provide the comfort patients

need while offering heat and massage capabilities that benefit them greatly. Patients will have ease of access, with parking right outside the front door.The primary health professionals at the new location are Drs. Jamal Maatouk and Fadi Abu-Shahin, who are both medical doctors with

Wellmont Medical Associates Oncology & Hematology, and nurse practitioner Myra Blankenship. Dr. Paul Kramer, a medical doctor and a gynecologic oncologist with Wellmont Medical Associates Women’s Cancer Services, will see patients there once a week.

Patients will also be able to connect to varied other caregivers, including social workers, dieticians, the only licensed genetic counselor in Northeast Tennessee, clinical trials personnel and oncology nurse navigators.

The cancer institute has also incorporated into the facility a small retail store, called the Wishing Well Shoppe, which will help patients with the side effects of cancer and lift their spirits. Among the broad spectrum of items patients can select are skin and mouth products, clothes and jewelry.

This relocation consolidates the cancer’s institute’s Johnson City services, which also include the Wellmont Breast Center, on the Wellmont Outpatient Campus. The breast center, which provides mammograms, opened in 2012 at 316 Marketplace Blvd., and will continue to provide this screening test there.

Other care available at the outpatient center is the Wellmont Medical Associates family medicine practices of Drs. Bob Connell and Rita Plemmons and the Wellmont Medical Associates Pulmonology & Sleep practice of Dr. Mark Emery. All of these physicians are medical doctors and located in the same building as the breast center.

On the other side of State of Franklin Road, located at 2124 Knob Creek Road, are the Wellmont CVA Heart Institute and the Wellmont Medical Associates Women’s Health practice of Dr. Peter Earl, an obstetrician and gynecologist who is also a medical doctor.

Cancer survivor Donna Ferguson and representatives of Wellmont Health System, the Wellmont Cancer Institute, Wellmont Medical Associates, the City of Johnson City and the Chamber of Commerce serving Johnson City, Jonesborough and Washington County cut the ribbon on the new Wellmont Cancer Institute facility on Marketplace Boulevard.



By Andrew S. Rhinehart, MD, FACP, CDE, BC-ADM, CDTC

As we transition from our old fee-for-service model of healthcare to a more quality and value-based reimbursement system, diabetes is taking center stage. As the quintessential chronic disease state, we must put in place systems and processes to help our patients succeed in this new environment. I envision a 4-pronged approach to achieve the outcomes and quality care that our patients with diabetes deserve. It is essential that we:

• Develop an outpatient care model that helps make our primary care providers and patient centered medical homes successful.

• Strengthen our specialty care in the region for those individuals with difficult to manage disease states.

• Devise inpatient management strategies that achieve the glycemic control necessary to limit the excess morbidity and mortality related to poor glycemic control.

• Bolster our transitions of care between these different areas; primary care, specialty care, and hospital care.

However, with that being said, the best way to make this 4-pronged approach successful is to provide caregivers, providers, and people with diabetes the proper diabetes self-management education; thus, certified diabetes educators are the keystone of this care model.

Outpatient Diabetes CareAs we develop and grow our patient

centered medical homes across the region, we must provide these medical homes with the resources, both electronic and human, to successfully manage a large population of people with diabetes. Unfortunately, as providers, we have been historically poorly trained in managing a population of patients. However, population health management is the key to success as we move forward in this new healthcare system. We need to be able to identify, engage, and communicate successfully with our patients who are struggling with their diabetes care.

Without the proper technology in place, the identification of these patients, which is essential, will be almost impossible. We must

have electronic health records that allow us to mine the data and identify those patients who are missing appointments, not achieving A1c, blood pressure, or lipid targets, frequently visiting the emergency room, requiring recurrent hospitalizations, not refilling their medications, and who are missing their specialty appointments with the eye doctor, the podiatrist, and the like. Ergo, without a robust electronic health record with a population health management overlay in place, this endeavor will not be successful.

We must also have the human resources in place to engage these patients once they are identified. This includes care coordinators, clinical pharmacists, dietitians, nurse educators, and providers. Our struggling patients may require frequent communications, at times, possibly daily, as we work to keep these individuals out of the hospital and emergency rooms. But this requires manpower and technology. We need to meet patients where they are by discovering the best way to communicate with that individual. Is it through text message, e-mail, phone calls, telehealth visits, or the mail? We can use technology to our advantage as we move forward in population health management. Pay me now or pay me more later. We must invest in the electronic and human resources now to make this care model successful in the future.

Specialty Diabetes CareAs most of us are very well aware, the

paucity of specialty care in our region makes it challenging to get those difficult patients seen in a timely manner. Therefore, it’s essential that we work to recruit specialists to our area, discuss with our local residency programs to consider adding endocrinology and diabetology fellowships that may help with future staffing, and identify interested primary care providers to potentially train them in the specialty of diabetology.

Inpatient Glycemic ControlIt is vital that we work together with

the hospitalist teams and other admitting physicians to improve glycemic control of our patients to prevent readmissions, morbidity and mortality, postoperative surgical infections, and the need for post-hospital skilled nursing care. This is best accomplished though a

multidisciplinary team-based approach. This team will need to develop basal bolus insulin order sets, educate and engage the nursing staff, and energize the medical staff in regards to the importance and implementation of inpatient glycemic control.

Transitions of CareWe need to work together and develop

systems where patients are transitioned between all these different facets of care in a more timely, well informed, and seamless manner. Technology can help us here as well as care coordinators, diabetes educators, and better and more efficient communication between providers.

Diabetes EducationDiabetes self-management education is

essential for all patients with diabetes and is truly the cornerstone of diabetes management. People with diabetes have so much to manage on a daily basis, including the proper use of a glucose meter; medication adherence; proper use of injectables; decision-making in regards to food intake and exercise; the proper treatment of acute complications of diabetes, including hyper and hypoglycemia; and the daily struggle of balancing all of this along with work, school, family, and friends. It is critical that our patients receive proper education not only in specialty care, but also in primary care and hospital settings. Diabetes education has been proven to improve medication adherence and clinical outcomes and is vital when changes are made in medication regimens and during transitions of care. Therefore, certified diabetes educators are the most essential part of this chronic care model. Our patients with diabetes, as with all of our patients, deserve the best possible care and this new model of healthcare may provide us an opportunity to improve their care as we focus more on outcomes and quality.

Andrew S. Rhinehart, MD, FACP, CDE, BC-ADM, CDTC, is the program director for the Mountain States Medical Group Diabetes Wound Care Center in Abingdon, Va. A certified diabetologist, Rhinehart completed medical school at the University of Maryland School of Medicine. He finished his residency at East Tennessee State University’s Quillen College of Medicine. He is board certified by the American Board of Internal Medicine Specialities in Internal Medicine.

MSMG Diabetes Wound Care • 16000 Johnston Memorial Drive, Suite 313 • Abingdon, VA, 24211 • Phone: 276-258-3780 • Fax: 276-258-3776

Physician to Physician

Diabetes Care in our New Healthcare System

Proudly practicing at Johnston Memorial Hospital.

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excellent match for Wellmont,” said Tracey Moffatt, the health system’s chief operat-ing officer. “Both organizations have been relentless in their pursuit of clinical excel-lence and enhanced operational measures. This integration has resulted in an ele-vated level of quality that will benefit the residents of Wexford House, our hospitals and the communities we are privileged to serve.”

For more information, please visit www.wellmont.org and www.wexford-house.org.

TMA Annual Convention April 24-27 in Franklin

The Tennessee Medical Association will hold its Annual Convention on April 24-27 in Franklin. MedTenn 2014 features four days of exclusive medical education, professional networking and entertainment events. Physicians, practice managers, nurses and other healthcare professionals from all medical specialties in Tennessee are encouraged to attend and take up to 16.75 hours of CME or 10 hours of CEU courses at a fraction of the typical cost. You do not have to be a TMA member to at-tend.

Featured courses include:•ICD-10ImplementationStrategies•PrescribingGuidelinesforPainMan-

agement & Patient Safety• Health Reform, Government Initia-

tives & EHR Performance• Emerging Payment & Employment

ModelsRegister at www.tnmed.org/medtenn

2014.

Bristol Regional Volunteers Enhance Hospital Experience with $80,000 Donation

BRISTOL – Bristol Regional Medical Center’s volunteer auxiliary recently bol-

stered the hospital’s delivery of patient-centered care with a donation of $80,000.

This donation will enhance Bristol Re-gional’s Healing Environment philosophy, which encompasses a number of projects developed by co-workers to improve the experience for patients, their families and staff members while they are in the hospi-tal.

Every year, the auxiliary makes finan-cial donations that have helped Bristol Regional deliver superior health care with compassion. In previous years, the hospi-tal has used the substantial funds from the auxiliary to purchase vein finders and up-grade its short stay surgery area.

Volunteers of all ages are welcome to join the hospital’s auxiliary. To learn more about opportunities at Bristol Regional, please contact the volunteer services de-partment at 423-844-2831.

MSHA partners with the Tenn. Department of Health to reduce sleep-related infant deaths

JOHNSON CITY – Twenty percent of all infant deaths in Tennessee are due to unsafe sleep practices. In an effort to save lives, the Family Birth Centers at Mountain States Health Alliance (MSHA) have part-nered with the Tennessee Department of Health (TDH) to reduce infant mortality by promoting the ABCs of safe sleep for in-fants: Infants should sleep Alone, on their Back and in a Crib.

Studies have shown that when parents go home, they put their babies to sleep the same way they see their baby positioned in the hospital. But at home, babies do not have the same monitoring and supervision as in the hospital.

This is why Niswonger Children’s Hos-pital, Johnson City Medical Center and Franklin Woods Community Hospital in Johnson City and Indian Path Medical Cen-

ter in Kingsport have implemented a safe-sleep policy for all infants in the hospital. Team members who care for infants will re-ceive annual training that includes educa-tion on best practices for a safe sleep, and how to educate new parents on placing ba-bies to sleep when they go home.

Although Sudden Infant Death Syn-drome (SIDS) has decreased in Tennessee, preventable sleep-related deaths are on the rise. A primary cause of sleep-related infant death is suffocation, which can hap-pen with an adult rolls over on an infant or when an infant is smothered by pillows or blankets. Out of 1,000 babies born in Ten-nessee in 2012, seven did not reach their first birthday due to sleep-related deaths.

Safe sleep practices can prevent sleep-related deaths. MSHA Family Birth Centers promote the American Academy of Pediatrics recommendations that infants should:

•Alwaysbeplacedontheirbackstosleep;

•Sleepaloneinacriborbassinet,al-though the crib or bassinet can be in the same room as an adult caregiver;

• Not have bumper pads, blankets,stuffed animals, toys or pets in their cribs;

•Sleeponafirmcribmattresswiththemattress covered only by a fitted sheet.

MSHA is committed to the health and safety of all patients and is proud to partner with the Tennessee Department of Health in this effort to reduce infant deaths.

For more information on sleep-related deaths, visit the TDH website at http://safesleep.tn.gov.


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5 reasons to get the Niswonger Children’s Hospital mobile app:

The Niswonger Children’s Hospital app is available at Google Play Store or the iPhone App Store. Get yours today!

1. It’s FREE and interactive for both adults and kids!2. Learn about our physicians and services.3. Get up-to-date information and health tips for kids, teens, and parents.4. Enjoy daily devotionals and a photo gallery.5. Receive exclusive mobile alerts specific to children’s health care.

www.msha.com/children

Located in Johnson City, Tennessee • Serving children and families of Southern Appalachia

Home of the St. Jude Tri-Cities Affiliate Clinic • Affiliated with Cincinnati Children’s Hospital Medical Center

tri cities medical news april 2014

Documents

adult diabetes

diabetes control

toll diabetes

controlled diabetes

joslin diabetes center

diabetic patients

heart disease

kidney disease