tri cities medical news february 2015

FOCUS ON CARDIOLOGYSPONSORED BY WELLMONT CVA

Dr. Mark Aziz

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Legal Matters: Healthcare Mergers and Acquisitions: Considerations for the Year Ahead For several years, there has been a consistent and growing trend toward mergers and acquisitions in the healthcare sector of the economy ... 3

HEALTHCARE LEADER: Elaine Arnold, Regional Director for Wellmont CVA Heart Institute During our lifetimes, in our personal lives, careers, and even in our interior journeys, we travel many roads. These roads end up taking us to unimagined destinations—sometimes to destinations that are much more diffi cult and far less glamourous than what we’d aspired ... 5

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By JOE MORRIS

The pool of patients ineligible for life-saving cardiac surgery continues to shrink, thanks to new technology allowing for percutaneous mitral valve repair.

The surgery, which is now available at the Well-mont CVA Heart Institute, is performed using the MitraClip repair system. It allows degraded valves to be repaired without invasive open-heart surgery, which means a group formerly excluded from this kind of repair now can benefi t, says Dr. Rahul Sakhuja.

“For an array of valve problems, cardiac sur-gery used to be the only option,” Sakhuja said. “Valves degenerate over time as people age, and they either get stuck or fl ap back and forth. Whether it’s stuck or leaky, it’s a problem, and we had to perform open-heart surgery to make the repair.”However, cracking the chest open, stopping the heart, putting the patient on cardiopulmonary bypass equipment and repairing or replacing a valve was far beyond what many el-derly or severely ill patients would be able to survive. That subset

of patients was “essentially left to die,” Sakhuja ex-plained, because there’s really no medicine-based treatment for valve failure.

“We really had no options until percutaneous devices were approved for aortic valve repair,” he

said. “We could open the chest, and then through an IV or catheter line fi x the valve on that side of the

heart. We at Holston Valley were one of the fi rst hand-fuls of hospitals in Tennessee to perform aortic valve work.”

The vast majority of those patients have stuck valves, and Dr. Sakhuja and the rest of the cardiac team have been waiting eagerly for a similar technology for the mitral valve, which usually isn’t closing prop-erly. The MitraClip allows for a trans catheter approach, and so is much easier on patients.

“A cardiac tram does this through a groin catheter while the patient is under general an-esthesia,” Sakhuja explained. “They are guided by trans-esophageal echocardiography, which is

basically an ultrasound of the heart. They look at where the valve is leaking, and puncture one side of the heart to get across to the

(CONTINUED ON PAGE 8)

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Opening doorsMitral valve repair gives new lease on life to cardiac patients

By AMANDA SHELL JENNINGS

Less than a year after beginning operations in March 2014, Priority Ambulance has grown to more than 500 employees with approximately 100 ambulances across four states. It’s the only national ambulance com-pany headquartered in East Tennessee.

Early in the process, emergency medical services entrepreneur and Priority Ambulance CEO Bryan Gib-son set an aggressive expansion strategy with a mix of acquisitions and cold startups to create a multistate network of companies. Gibson has more than 30 years of experience in acquiring and managing operations in the EMS industry. He founded several successful ambulance companies and served as chief operating offi cer for one of the largest ambulance companies in the country before starting Priority, which is headquartered in Knoxville.

When any company undergoes a merger or acquisition, a cohesive mission statement and strategy for transferring corporate culture is vital. In a recent interview, Gibson offered insight on preserving a company’s

Ambulance company keeps community in focus during expansion

(CONTINUED ON PAGE 8)Bryan Gibson

2 > FEBRUARY 2015 e a s t t n m e d i c a l n e w s . c o m

By JENNIFER CULP

Long-held passion for the heart has led Dr. Mark Aziz half-way around the world, from his birthplace in Egypt, to Kingsport, Tennessee. His journey was not inspired by a madcap flight of ro-mantic fancy, however, but a literal fascination with the human heart and its workings.

“I just fell in love with cardiol-ogy as a specialty! I found myself thirsty for more knowledge about it, found myself spending extra hours beyond my official training requirements taking care of pa-tients and doing medical research. So it was not a difficult decision, it was a very easy decision, and I really knew what I wanted in my career early,” he said.

Born into a family full of doc-tors, Aziz was surrounded by medi-cal professionals throughout his early life. “My father is an ear, nose, and throat surgeon; my mother is an ophthal-mologist. Other family members are den-tists and pharmacists,” he explained. His parents modeled a work ethic and attitude that would influence the course of his life, demonstrating that the field of medicine offered an opportunity not only to work in an intellectually stimulating environment, but also to improve lives.

“Growing up, my parents were a great inspiration to me to become a physician. I saw how it could be used as a profession to help others,” he said. “What interested me in medicine is that you actually have the opportunity to work and serve at the same time. I saw them doing that.”

Aziz completed medical school at Tanta University in Tanta, Egypt. After earning his diploma in 2002, he made his way to Indianapolis, Indiana, where he had spent time during rotations, to fur-ther his studies at the Krannert Institute of Cardiology at Indiana University. Aziz completed his internal medicine residency at Indiana University, and in 2008 be-came a Cardiology Fellow at the Kran-nert Institute, succeeding onward to Chief Cardiology Fellow and Interventional Cardiology Fellow in the following years. Then, in 2012, he was honored to be se-lected as Fellow of the VIVA (Vascular Interventional Advances), giving him the opportunity to undergo a one-year Ad-

vanced Endovascular Fellowship Program at the Fogarty Institute for Innovation in California. Only one interventional cardiology fel-low in the United States is selected for this prestigious position each year to train in vascular interven-tions and structural heart interven-tions. This experience allowed Aziz to undergo advanced training in cutting-edge cardiovascular devices and procedures, including trans-catheter aortic valve implantation.

Azizs hold multiple board cer-tifications in various specialties, in-cluding internal medicine, vascular medicine, endovascular medicine, interventional cardiology, cardio-vascular disease, nuclear cardiol-ogy, and echocardiography.

During his training in Califor-nia, Aziz met VIVA member Dr. Chris Metzger, who he described as “one of the pioneers in the field of interventional cardiology and

endovascular intervention,” and learned of the Wellmont CVA Heart Institute in Kingsport. Eventually the group ap-proached him with an offer to interview for a position working at the Institute, and Aziz officially joined the group in June 2014.

“The rest is history! I fell in love with the job, my wife and I fell in love with the area, and here we are,” he explained. “It’s just a dream job for an interventional cardiologist.” Aziz’s work focuses largely on innovative procedures to treat patients who are—for various reasons, such as high-risk comorbidities or previous open-heart surgery—not good candidates for traditional open-heart surgery. With his

training in trans-catheter aortic valve re-placement and expertise in treating vascu-lar blockages in blood vessels throughout the body, “from head to toe,” as he put it, Aziz brings a wealth of knowledge and en-thusiasm to his work at the Heart Institute.

Aziz’s passion for his job is evident in conversation, but his voice warmed par-ticularly when he spoke of the woman who shares his own heart in a more figurative sense. “I’m married to my beautiful wife, Monica, who is the greatest blessing in my life,” he said proudly. The couple has en-joyed settling into their new home and dis-covering what East Tennessee has to offer. “We love being part of this community; we fit right in. We enjoy teaching Sunday School at church, and biking. This area of the country offers an excellent opportunity to practice that, for sure! We don’t have kids yet, but one of the reasons we moved here was to start our family and raise kids in this beautiful area of the country,” he said.

More immediately, Aziz remains fo-cused on serving patients in the area and helping people suffering from endovascu-lar and structural heart problems regain the highest possible quality of life. When asked about his professional goals, Aziz of-fered a two-fold answer: “to help as many patients as I can in this area,” and “profes-sionally, to grow as a physician in as many respects as I can.”

The attitude of service instilled through his parents, who visit from Egypt as often as possible, is still clearly apparent in Aziz’s approach to his work. “This is the best part of medicine, in my opinion, that the separation between job and ser-vice is not very distinct,” Aziz said. “It’s very satisfying.”

PhysicianSpotlight

Mark Aziz

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e a s t t n m e d i c a l n e w s . c o m FEBRUARY 2015 > 3

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Evening ProgramFranz Schubert: Ballet music from “Rosamunde”

Ludwig van Beethoven: Symphony No. 9

For several years, there has been a consistent and growing trend toward mergers and acquisitions in the healthcare sector of the economy. More and more, private physician practices are being acquired by hospitals, health systems, and even other physician groups. Whether a merger or acquisition is right for your practice depends on a host of factors. Every potential deal is different and carries its own unique set of advantages and disadvantages. Nevertheless, there are a number of common issues that should be considered as you evaluate whether to make a deal.

What are the main drivers of healthcare mergers and acquisitions?

In last month’s “Ten Hot Button Legal Issues to Watch in 2015” article, the authors predicted that the healthcare sector “could expect to see an increase in various forms of organizational and clinical integration this year.” The main drivers of this trend were continuing payment pressures to reduce operating expenses and maximize operational efficiencies, the need to grow market share and diversify service offerings, and requirements of federal and state health reform initiatives to achieve higher-quality patient outcomes.

Similarly, 84% of respondents to the recent KPMG 2015 M&A Outlook Survey (1) predicted increased merger and acquisition activity in the healthcare sector in the coming year. Seventy-four percent of healthcare sector respondents said that the industry response to the Affordable Care Act would be the most significant driver for deal activity in 2015. Other important drivers cited by survey respondents were consolidation of core businesses/competition (45%) and the need for consumer growth (26%). According to the survey, the most challenging issues confronting potential deal makers will include regulatory/political issues, the ability to identify suitable targets, and valuation disparities between buyers and sellers (all at 42%).

What factors should physician practices consider with respect to mergers and acquisitions?

There is no simple answer to whether a particular merger or acquisition proposal is right for your practice. However, a practice should consider several factors in making its decision. The advantages of selling the practice to a hospital or another group are not limited to the proceeds received from the sale. Physicians directly employed by a hospital are likely to have fewer responsibilities and less time devoted to administrative, non-medical duties that come along with running a practice. Instead of negotiating

with insurers or dealing with billing and collections issues, physicians employed by a hospital may feel that they can focus better on the practice of medicine. On the other hand, however, becoming a hospital employee may also translate into a significant reduction in independence in your practice. Decisions ranging from paid time off policies and benefits, to the hiring and firing of staff, to the location and future development of the practice are likely to be placed with hospital management, not the physicians.

Beyond the threshold considerations of whether to sell the practice, private practice owners should also carefully consider the specific terms of the proposed acquisition. In addition to the purchase price itself, practice owners should consider the terms and conditions for obtaining the purchase price. The full purchase price may be paid at closing, but in some transactions, only a portion of the purchase price is paid at closing with the remaining amount paid over time and often with some strings attached. Practice owners should also be aware of other obligations often placed on sellers, such as indemnity for pre-closing liabilities, and the cost of malpractice insurance tail coverage.

In addition to the terms of the purchase agreement, practice owners should also carefully consider the terms of their employment arrangements post-closing. As with any physician employment contract, terms such as compensation and duties (especially in a new setting) should be considered. However, it is equally important to focus on any provisions related to term and termination of the employment agreement and any non-compete restrictions, which may become critical if the new relationship does not work out as initially anticipated. It should also be noted that in addition to any non-compete provision under an employment agreement, a physician may also be subject to a further non-compete restriction related specifically to the sale of the practice.

The above examples are but a few of the issues physicians should carefully consider with respect to the merger or acquisition of their practice. Whether a proposed merger or acquisition is advisable will depend on these and other factors involved in your particular circumstances.

Ian P. Hennessey is with London & Amburn, P.C. His practice focuses primarily on health law. He may be contacted at [email protected]. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

Notes

1. A copy of the KPMG 2015 M&A Outlook Survey Report may be downloaded at http://www.kpmgsurvey-ma.com/pdf/298400_NSS_M&A_OutlookSurvey2015v14_WEB.pdf

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Healthcare Mergers and Acquisitions: Considerations

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By LEIGH ANNE W. HOOVER

Family ski photos still line the stair-way to our basement den. Each evokes vivid memories of when our children were younger and we enjoyed winter ski trips to-gether. One year, we even used the photo as our family Christmas card.

Today, we do not ski together as often. Our son has moved on to more advanced snowboarding and enjoys the sport with friends, while my husband and I still have the longer “outdated” skis. However, they do have pop out bindings and brakes, and it is my understanding, if equipped with brakes, they are still allowed on the slopes. Regardless, skiing is part of our family memories.

The best part about living in East Tennessee in the winter is accessible, fam-ily atmosphere skiing, and February offers the perfect opportunity at Appalachian Ski Mountain.

Known as the Boone, North Caro-lina, area’s fi rst ski resort, Appalachian Ski Mountain (ASM), with its “old-world, Eu-ropean Alpine atmosphere and Bavarian style ski lodge,” originally opened in 1962 as Blowing Rock Ski Lodge.

Today, ASM is celebrating its 53rd anniversary year. With 12 slopes and three terrain parks, the original dream of the late M.E. Thalheimer lives own as an amazing business boost to the High Country and is family owned and operated by the Moretz family.

“Being the fi rst [ski resort] in the High Country was obviously pretty historic,” explained ASM Marketing Director and Terrain Park Director, Drew Stanley. “I’ve heard stories where before the ski area ex-isted, there was maybe one or two restau-rants and lodging facilities that operated during the winter in Blowing Rock, the nearest town, and now there’s dozens. So

that kind of shows how much they’ve built the business for winter tourism in the area.”

For ASM, the business truly focused on appealing to families. From Southern hos-pitality to clean-shaven, friendly employees, ASM puts service as a top priority for guests.

“Our main focus is providing the best product we possibly can, the most consistent snow conditions, the best coverage in a fam-ily friendly atmosphere,” said Stanley. “It still exudes from every department of this business to this day.”

For busy families looking for a winter escape, time is crucial, and it is not always feasible to travel out West. Travel delays also impede on actual slope time. Some-times, it’s nice to just head over to the North Carolina High Country.

“We see a measure of that, and we have lately with the economy and the re-cession a few years ago and being slow to come back,” explained Stanley. “We see a lot of people who might otherwise take that huge, expensive long west trip and maybe just take a weekend up in the mountains in the High Country, and it’s a really nice thing to have in the area… It’s an Alpine

environment right next door.”From February 13th-16th, ASP will

celebrate Valentine’s Family Weekend with a host of activities. Even though it’s also a holiday weekend for many, their new “fl ex” ticket offers skiing on your own family’s time schedule. ASM is the only NC resort offering the fl ex ticket option, and, accord-ing to the resort, this has eliminated many of the crowd woes.

With the ASM fl ex ticket, there’s no rush to be fi rst on the slopes to ski within certain regulated time parameters. In order to appeal to those on vacation, the newly in-stated fl ex ticket allows participants to select their own 8-hour ski window.

“Your session starts when you get to the mountain,” said Stanley. “So, no mat-ter when you purchase your [fl ex] ticket, it’s good for a full eight hours.”

According to Stanley, personal atten-tion is also always given to snowmaking and grooming to provide a consistent product as often as possible for an optimal ski experi-ence.

“It might not be the 4,000 vertical feet you can ski in Colorado or British Colum-

bia, but you can make several laps and still have an amazing day on the hill – no matter beginner through ad-

vanced,” said Stanley.At ASM, families will fi nd the only

Burton Progression Park south of West Virginia to introduce ski and board partici-pants to freestyle terrain. With manmade snow-covered features shaped into jumps, rollers, transitions, rails, boxes, and wall rides, which are low to the ground, partici-pants can learn with low risk.

“I kind of describe it as a skate park on the snow,” said Stanley. “It’s geared to get-ting the feeling and developing solid funda-mentals.”

At ASM, there is also a French-Swiss Ski College, which is the oldest ski school in the Southeast, located right on the premises. With a proven three lesson philosophy tem-plate, individuals can develop a skill for life.

“We want to shape that fi rst visit to where it’s a positive experience, and it gets them motivated to continue,” explained Stanley. “It’s a really great form of rec-reation. It’s an activity you can do in the winter…that’s healthy and a good outdoor activity.”

Visitors can also rent everything needed to enjoy the sport of snow skiing and boarding at Alpine Ski Shop, which is an extensive head-to-toe outfi tter right on the slopes. Participants can also rent the newer shaped or the park performance skis.

For non-skiers, there’s also ice-skating, a full cafeteria with healthy food options, and a 200-foot base observation deck at the lodge offering views of almost every slope.

Yes, the “family photo” still exists. In fact, on the Valentine’s Family Day Week-end, Joshua Easterling Photography is offer-ing a free family (digital copy) photo.

Night sessions, which are usually less crowded, are also offered on Friday and Saturday nights during weekends in Feb-ruary and on Sunday during the holiday weekend. It’s called “Midnight Blast Week-ends,” and ASM features the only late night skiing option in the High Country, where participants can ski from 5:00 until mid-night.

At midnight on Saturday, February 14th, weather permitting, a special high-light will also include a spectacular fi re-works display from the renowned Zambelli Fireworks.

“It’s really nice to be able to ski late night,” said Stanley. “Everything goes dark, and the slopes light up!”

For additional information about Ap-palachian Ski Mountain, visit www.apps-kimtn.com

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

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Elaine Arnold, Regional Director for Wellmont CVA Heart Institute

By JOHN SEWELL

During our life-times, in our personal lives, careers, and even in our interior journeys, we travel many roads. These roads end up tak-ing us to unimagined destinations—sometimes to destinations that are much more difficult and far less glamourous than what we’d aspired. In the best case scenarios, with experience, wisdom and the 20/20 vision of hindsight, we’re able to see how all of life’s winding paths in-termesh to create the people we become.

Elaine Arnold, Regional Director for the Wellmont CVA Heart Institute, is one of the lucky few whose life’s motion has ceaselessly moved forward. Through 35 years of healthcare service, Arnold has consistently moved up the proverbial totem pole, her career arc all the while leading to the best place of all, home. For Arnold, serving her community is perhaps the greatest reward.

Arnold began her career as a nurse at Wellmont’s Holston Valley Medical Center in 1980. From these inauspicious beginnings, her career as a cardiovascular administrator began to take shape. Her interaction with cardiologists at Holston Valley led to a management job in a pri-vately run group cardiology practice that was then called Cardiovascular Associates (since abbreviated to CVA).

“I met some cardiologists there [at Holston Valley], and I worked with them closely every day,” said Arnold. “And at that time, individual practices were doing their own testing. So when CVA decided to open its own diagnostic testing lab, they asked me to come onboard. It was a fan-tastic opportunity to have some autonomy and be involved from the ground level in writing policies.”

So, Arnold went from being a nurse at a Wellmont hospital to a management position for a private physicians’ group. But as fate would have it, CVA merged with Wellmont Health System to form the Wellmont CVA Heart Institute.

“I was with CVA until the merger with Wellmont, and that kind of brought me full circle,” said Arnold. “I began with Wellmont and now I’m back with Well-mont again. It’s really been neat the way it all worked out.”

As a healthcare leader, Arnold’s re-sponsibilities have continually increased.

Wellmont CVA Heart Institute has two offices in Tennessee (a headquar-ters in Kingsport and an office in Rogersville) and two more in Virginia (Norton and Pennington Gap). Presently, Arnold manages at least 100 em-ployees.

“I’m responsible for the day-to-day operations of the facility in my re-gion,” said Arnold. “Like any manager, I’m also re-sponsible for budgets and

making sure that we handle our resources properly.”

Arnold says that her job is something of a balancing act in that she must keep the patients happy and deliver the highest quality treatment regimen—all in a cost-efficient manner.

“My job is to make sure that every-thing runs smoothly and that our patients are satisfied,” said Arnold. We always make sure that the patients have the best experience that we can possibly give them. We are very much customer service ori-ented. So if there are issues, I get involved.

“The customer service is the part of the job I enjoy the most, but sometimes it’s also the hardest part of the job,” Ar-nold continued. “With other businesses, when you think of customer service, the approach is ‘the customer is always right.’ But in healthcare, we want to do what’s best, most beneficial, and safest. And sometimes the patients don’t see eye-to-eye with us. At those times, it’s my job to convince the patients to have lab work done, or have procedures, or to take cer-tain medicines, or do certain activities. I have to give the patients a rationale for their treatments—to convince them of why we do what we do and that it’s all done with their benefit in mind.

“The biggest challenge is cost con-tainment,” Arnold continued. “We want to maintain high quality care while con-taining the cost. We have to make a lot of measurements and reports. Our patients and the government expect us to allocate our resources most effectively.”

Needless to say, that’s a tough and de-manding job. Still, Arnold finds time for a rich and rewarding family and personal life. Arnold is married with two daugh-ters, both in college: older daughter Adria is studying at Middle Tennessee State University, while the younger Annabella is enrolled at East Tennessee State Uni-


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Medical professionals from around the world routinely gather in the Tri-Cities to learn from the best – the Wellmont CVA Heart Institute’s renowned vascular team.

Creating a virtual classroomRecently, Dr. Chris Metzger was selected as one of seven physicians worldwide to perform live cases for the Vascular Interventional Advances conference, broadcasting his expertise to more than 2,500 health care professionals attending the conference and online.Th e vascular team has also performed live cases for New Cardiovascular Horizons, the nation’s largest medical meeting on peripheral artery disease; Complex Cardiovascular Catheter Th erapeutics: Advanced Endovascular Coronary Intervention Global Summit; and the Amputation Prevention Symposium.

Leading the best and brightestTh e heart institute’s Cardiovascular University provides the latest and best techniques for treating peripheral artery disease.

Cardiology fellows from some of the world’s leading institutions, including Harvard Medical School, advance their skill sets through Cardiovascular University’s high-volume, hands-on training.

Finding the next great medical advancementsRecognized as one of the leading research teams in the country, our vascular experts serve as lead investigators in national and international research trials designed to advance the diagnosis and treatment of complex vascular conditions. Th is allows us to bring an average of 450 patients innovative treatments as quickly as possible. Th e Wellmont CVA Heart Institute is a consistent top enroller for many landmark studies, such as drug-coated balloons for peripheral interventions, endarterectomy for treatment of coronary artery disease and bioabsorbable drug-eluting stents.

For more information about our vascular services or to refer a patient, please call 423-230-5682.

The Wellmont CVA Heart Institute leads the way for vascular care.

Wellmont Physician Connection

Vascular expertise with Wellmont CVA Heart Institute quality Our interventional cardiologists and vascular surgeons are specially trained and experienced in a full array of treatment options, including medical therapy as well as surgical and minimally invasive endovascular approaches.

Our vascular team provides quality and compassion in its treatment of:

• Abdominal aortic aneurysm • Atherosclerosis • Carotid artery disease • Claudication • Critical limb ischemia • Deep vein thrombosis • Gangrene• Peripheral artery disease • Pulmonary embolism • Renal artery disease• Mesenteric insuffi ciency• Th oracic aortic aneurysm • Th rombosis • Ulcers • Venous Disease

And our physicians provide a wide range of therapeutic services – from minimally invasive procedures such as angioplasty, stents, and embolization to surgical treatments like bypass grafts, carotid endarterectomy and aneurysm repair.

We’re circulating our expertise.


Th e heart institute s Cardiovascular Ubest techniques for treating peripherag p

University provides the latest and For more information about our vascular seor to refer a patient, please call 423-230-56

University provides theal artery disease.

a

b

c

a. Wellmont CVA Heart Institute provides vascular services at Wellmont Health System hospitals.

b. Dr. Rahul Sakhuja discusses a vascular procedure with his patient.

c. Community members watch a broadcast of Dr. Metzger performing live cases for a national conference.

wellmont.org/MyHeart /Wellmont @WellmontHealthWellmont CVA Heart Institute vascular physicians Chris Metzger, MD, FACC; Rahul Sakhuja, MD, FACC; Mark Aziz, MD, FACC; Jeff Kappa, MD, FACS


Medical professionals from around the world routinely gather in the Tri-Cities to learn from the best – the Wellmont CVA Heart Institute’s renowned vascular team.

Creating a virtual classroomRecently, Dr. Chris Metzger was selected as one of seven physicians worldwide to perform live cases for the Vascular Interventional Advances conference, broadcasting his expertise to more than 2,500 health care professionals attending the conference and online.Th e vascular team has also performed live cases for New Cardiovascular Horizons, the nation’s largest medical meeting on peripheral artery disease; Complex Cardiovascular Catheter Th erapeutics: Advanced Endovascular Coronary Intervention Global Summit; and the Amputation Prevention Symposium.

Leading the best and brightestTh e heart institute’s Cardiovascular University provides the latest and best techniques for treating peripheral artery disease.

Cardiology fellows from some of the world’s leading institutions, including Harvard Medical School, advance their skill sets through Cardiovascular University’s high-volume, hands-on training.

Finding the next great medical advancementsRecognized as one of the leading research teams in the country, our vascular experts serve as lead investigators in national and international research trials designed to advance the diagnosis and treatment of complex vascular conditions. Th is allows us to bring an average of 450 patients innovative treatments as quickly as possible. Th e Wellmont CVA Heart Institute is a consistent top enroller for many landmark studies, such as drug-coated balloons for peripheral interventions, endarterectomy for treatment of coronary artery disease and bioabsorbable drug-eluting stents.

For more information about our vascular services or to refer a patient, please call 423-230-5682.

The Wellmont CVA Heart Institute leads the way for vascular care.


Vascular expertise with Wellmont CVA Heart Institute quality Our interventional cardiologists and vascular surgeons are specially trained and experienced in a full array of treatment options, including medical therapy as well as surgical and minimally invasive endovascular approaches.

Our vascular team provides quality and compassion in its treatment of:

• Abdominal aortic aneurysm • Atherosclerosis • Carotid artery disease • Claudication • Critical limb ischemia • Deep vein thrombosis • Gangrene• Peripheral artery disease • Pulmonary embolism • Renal artery disease• Mesenteric insuffi ciency• Th oracic aortic aneurysm • Th rombosis • Ulcers • Venous Disease

And our physicians provide a wide range of therapeutic services – from minimally invasive procedures such as angioplasty, stents, and embolization to surgical treatments like bypass grafts, carotid endarterectomy and aneurysm repair.

We’re circulating our expertise.


Th e heart institute s Cardiovascular Ubest techniques for treating peripherag p

University provides the latest and For more information about our vascular seor to refer a patient, please call 423-230-56

University provides theal artery disease.

a

b

c

a. Wellmont CVA Heart Institute provides vascular services at Wellmont Health System hospitals.

b. Dr. Rahul Sakhuja discusses a vascular procedure with his patient.

c. Community members watch a broadcast of Dr. Metzger performing live cases for a national conference.

wellmont.org/MyHeart /Wellmont @WellmontHealthWellmont CVA Heart Institute vascular physicians Chris Metzger, MD, FACC; Rahul Sakhuja, MD, FACC; Mark Aziz, MD, FACC; Jeff Kappa, MD, FACS


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

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

JOHNSON CITY MGMA MONTHLY MEETING

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

Location: Summit Leadership Foundation3104 Hanover Rd.

Johnson City

KINGSPORT MGMA MONTHLY MEETING

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

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

Second Floor, Kingsport

2ND THURSDAY 3RD THURSDAY

valve. Then they put a small clip onto the valve so that it’s not flapping back and forth.”

Because the heart is still beating, the team can then look at ultrasound images to see if the clip is performing as needed. If not, it can be repositioned, or more clips can be added. This goes on until the valve is functioning normally, and the recovery time for patients is usually just two or three days, a vast improvement over open-heart recuperation windows.

Having the procedure available in the Tri-Cities area also means that pa-tients won’t have to travel several hours for treatment, Sakhuja added.

“We’ve already got a waiting list, and are getting referrals from doctors within a four-hour radius,” he said. “We’ve had a great deal of success in our trans cath-eter program for aortic valve repair, and this is going to be just as much of a game-changer as well. We’re going to be the only center in the area to have this, and so I expect we’re going to be very busy.”

Above and beyond that, however, is

the basic fact that this surgery will liter-ally save lives that just a couple of years ago would be lost. And for that reason, Sakhuja says he and his colleagues will not just be talking up the new procedure, but valve repair in general, to area physicians.

“I think it’s a real testament to our success,” he said. “Our cardiac surgeons, interventional cardiologists, and cardiac imagers have worked hard to make our

program successful; they are an experi-enced team. But now we can help people with leaky valves that before had no op-tions. But we want to do more than just help the high-risk patients; about five per-cent of people with malfunctioning valves die every year because they are not aware of the problem, or are not aware of this procedure. Often they are given medicine, which helps for a short time, but it’s not going to save their lives. We’re excited because now we can get in there and fix both types of valves, and so we’re educat-ing providers about all the options that are available for their patients.”

In the end, he says, “We have devel-oped a very comprehensive program to deal with structural heart disease. I hope soon we’ll see devices to prevent people from throwing clots if they have atrial fi-brillation, which is another big problem. But for now, we’re seeing a major advance in helping high-risk people we couldn’t help before, and so I think the future for less invasive operations and treatments continues to be very bright.”

Opening doors, continued from page 1

unique identity during an acquisition while creating a unified corporate culture.

How did you develop your expansion strategy?

One of the unique aspects of operat-ing an ambulance company is the inher-ent, deep connection to the community. An ambulance company is more than just a business. Just like a hospital, we have a public mandate to protect community health and safety. To be able to do the job successfully, an ambulance company has to be integrated into the fabric of the com-munity.

At Priority Ambulance, our corporate motto is: “Our community. Our prior-ity.” No matter where we locate, we seek to provide the best service and support for

that community. That means having state-of-the-art ambulances, hiring and training the best EMTs and paramedics and, just as importantly, supporting community causes, events, and health initiatives. After estab-lishing a solid foundation and clear com-pany mission, we began acquiring medical transport services in new markets with an emphasis on companies who already shared our vision for community support and excellent patient care.

Our first acquisition, Kunkel Am-bulance in New York, is a family-owned business that has served the Mohawk Val-ley area for 75 years. Kunkel Ambulance has a longtime connection and rapport in the community, and we would have lost decades of community trust and equity by changing the name. Instead, we capitalized

on that relationship with the community by keeping the Kunkel name and the trusted leadership team intact.

We followed the same model with two recent acquisitions, both family-owned companies with decades of investment in their communities. Seals Ambulance has been in the Central Indiana community for 50 years and conducts 45,000 trans-ports annually in the region. Trans Am Ambulance in Olean, New York, has been owned by the Reisner family for more than 30 years. In both cases, we updated the overall look of the companies to align with our corporate brand, but left the leadership teams and established names in place.

What were the main challenges that you faced when expanding into

new markets and how did you meet those challenges?

I believe the biggest challenge in ex-panding into any market is making sure you have the right people at the helm, whether it’s a cold startup or an acquisition. Part of our strategy is looking for acquisi-tion and merger opportunities that already closely match with our company’s mission and culture.

East Tennessee was our first opera-tion with a cold startup under the Prior-ity Ambulance name. Our first step was to assemble established leaders in the East Tennessee market. Our regional leadership team has more than 400 combined years of experience in managing ambulance op-erations in East Tennessee. Rob Webb, the vice president of Tennessee operations, has been appointed by the governor for three terms on the Tennessee Emergency Medical Services Board and has deep ties in the Blount County community. He was elected to two terms on the Blount County school board. Our director of operations in Knox and Loudon counties, Dennis Rowe, is president-elect of the National Associa-tion of Emergency Medical Technicians (NAEMT), the industry’s largest profes-sional association, which helps shape issues and reform across the country.

We invest in our people because we know that’s what makes our company great. When you hire managers with local experience, you’re not starting from scratch. The relationships in the commu-nity are an integral foundation on which to build a successful ambulance company.

What are your ongoing plans for expansion?

Priority Ambulance is actively seeking expansion opportunities through acquisi-tion and startup operations in communities in East Tennessee and across the country.

At the beginning of 2015, Priority Ambulance earned its first countywide exclusive emergency contract in the East Tennessee region with Loudon County. We have additional vehicles and resources at our nonemergency operations in Knox and Blount counties, and we are prepared to fill any community need for emergency medical transport.

Additionally, we just submitted an ap-plication with the Arizona Department of Health Services for a certificate of neces-sity to operate an ambulance service in the Phoenix area. We have established a local office there with managers experienced in Arizona ambulance operations. We are in talks with several other ambulance com-panies to acquire and connect them to our national ambulance network in 2015.

Our mission at Priority Ambulance is to raise the standard of clinical pa-tient care across the country and enrich the communities we serve through high-quality emergency medical care, proactive public health education and investment in local causes and events that matter to resi-dents. As we expand through startups or acquisition, we seek companies that share our vision, and we will support them with the freedom and resources to serve their communities.

Ambulance company keeps community in focus during expansion, continued from page 1


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The Literary ExaminerBY TERRI SCHLICHENMEYER

Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner by Judy Melinek, MD, and T.J. Mitchell; c.2014, Scribner; $25.00 / $29.99 Canada, 258 pages

You may have an aptitude for num-bers. You might be a master at chess, mul-titasking, organizing, or people skills. Your real talents could be hidden, or maybe the whole world knows how good you are.

Author Judy Melinek, MD, loved doing surgery, but it had its drawbacks. And besides, as you’ll see in Working Stiff (with T.J. Mitchell), her real in-terest lay just this side of six feet under…

From the time she was very small, Judy Melinek’s father shared with her a fascination with the human body. He was a doctor; Melinek dreamed of becoming a doctor, too, and making him proud, but she “never got the chance.” He commit-ted suicide when she was just thirteen.

Still, she forged ahead and, upon graduation from UCLA medical school, she decided to become a surgeon. That specialty turned out to be a bad fi t for Me-linek, so she resigned from her residency position and turned instead to a medical branch that also intrigued her: forensic pathology.

Forensic pathologists, she says, in-vestigate “sudden, unexpected, or violent deaths by visiting the scene, reviewing medical records, and performing an au-topsy,” while gathering evidence for pos-sible legal reasons. You learn a lot about the human body when you’re a forensic pathologist and if “you knew how much hardware some of your fellow citizens are toting around in their knickers, you might see the world as a stranger… place.”

Forensic pathology only barely re-sembles what you see on TV. “Everyone thinks ‘murder’ when you say you work as a medical examiner,” she says, “but ho-micides are rare.” Still, in her career, she discovered evidence of them.

She also investigated overdoses and mis-doses, though “alcohol is the deadli-est drug.” She helped police solve a crime in which a driver swore he didn’t hit-and-run. She gave comfort to the loved ones of the deceased she autopsied, and she learned why you want to brew coffee when investigating a long-dead body.

And on September 11, 2001, she got a call to help investigate “the largest mass murder in United States history.”

Visit your local library or bookstore and you’ll fi nd a very long, long shelf of books by medical examiners. Working Stiff is one of the better ones.

Part of the reason for that, I think,

is what you won’t see in this book: the author doesn’t write about celebrities’ deaths. Her work was performed on regular people who likely would’ve lived long, anony-mous lives but who died under cir-

cumstances that needed investigation. The other appeal here is what you

will see: interesting stories of crime, death, the human body, and the ways they might intersect. Melinek (with T.J. Mitchell) is perfectly willing to share sto-ries of that intersection, which is exactly

why I loved this book.

The Teenage Brain by Frances E. Jensen, M.D. with Amy Ellis Nutt; c.2015, Harper; $27.99 / $32.99 Canada, 384 pages

A stranger

has moved into your house.

You’re not sure what to do about it. He raids your fridge, takes command of your television, hogs the bathroom, and leaves a mess everywhere. Sometimes, she cries for no apparent reason and other times, she erects a wall of silence.

Thing is, you knew this stranger once… then (s)he became a teenager. But read The Teenage Brain by Frances E. Jensen, MD, with Amy Ellis Nutt, and you’ll welcome this familiar new-comer.

“What were you thinking?”If you’re the parent of a teen, those

four words probably exit your lips at least once a day. Teenagers are widely known for their impulsivity, mood swings, and ir-rationality – but why is that so?

Blame it on what’s between their ears, says Dr. Frances Jensen.

Teenagers surely look like adults. Their physical bodies can do everything adult bodies can do, but their brains are

in a particular state of fl ux with vulnera-bilities, strengths and weaknesses that are unique to this period of life. Teens are a “work in progress,” and what happens in their lives during this time really does mat-ter.

Take, for instance, the fabled teen hormone issue. The truth is that teen hor-mone levels aren’t much different than that of their slightly older counterparts; the contrast is in how teen brains react to those hormones. Furthermore, connec-tions aren’t fi nished establishing in teen-age noggins, so certain brain-parts may have trouble communicating and thought

processes could be differently-based – which explains reckless behavior, emotionality, and difficulty with concentration. Stress (and what high schooler isn’t stressed?) only exacer-bates the situation.

The good news is that teenage brains are suited for learning, if the right amount of sleep at the right time is included in the plan. Parents should be vigilant about addictive substances (including electronics), since they have a unique effect on teen brains. Also, despite that gender equality is a hot topic, boys and girls really do differ in their domes.

To help smooth this child-to-adult transition, be proactive in your teen’s life.

Don’t be afraid to embarrass him with your vigilance. Be tolerant of her mistakes and choose your battles wisely. Remem-ber: this, too, shall pass.

Does this largely sound like common sense parenting?

Yes, I thought so, too, but The Teenage Brain does hold some surprises.

Authors Frances E. Jensen, MD, and Amy Ellis Nutt offer the usual informa-tion that veteran parents probably already know or sense, but I was glad to see that they also touch upon subjects that many parenting books miss. Chapters on vari-ous kinds of substance abuse, eating disor-ders, mental health, electronic media, and sports concussions mix nicely with gentle advice that always bears repeating; add in results from scientifi c research and you’ve got a readable guide that you’ll appreciate if you’ve got a twelve-to-twenty-four-year-old around.

Astute readers may have a number of questions left unanswered but most, I think, will fi nd this book to be very help-ful. For every parent, guardian, or teacher, The Teenage Brain proves that your adoles-cent isn’t so strange after all.

Terri Schlichenmeyer has been reading since she was 3 years old, and she never goes anywhere without a book. She lives on a hill in Wisconsin with two dogs and 11,000 books.

bates the situation.

brains are suited for learning, if the right amount of sleep at the right time is included in the plan. Parents should be vigilant about addictive substances (including electronics), since they have a unique effect on teen brains. Also, despite

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

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

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

visit www.jcsymphony.com

The Texas TenorsJohn Hagen, Marcus Collins, JC Fisher

Saturday, March 21, 7:30 p.m.sponsored by James Martin

Mary B. Martin Auditorium at Seeger Chapel, Milligan College

Since their whirlwind debut four years ago on NBC’s America’s Got Talent, The Texas Tenors have performed over 600 concerts including collaborations with some of the most prestigious sympho-nies and performing arts centers around the globe. From Alabama to Puccini, John Hagen, Marcus Collins, and JC Fisher bring their unique blend of Country, Classi-cal, and Broadway to the stage with breathtaking vocals, humor and a touch of cowboy charm. Whether it

be stage, television, recording or multi-media projects, The Texas Tenors never forget their roots. They are proud that these “three friends with a dream” remain self produced and managed with a commitment to quality, family entertainment for all ages.


Chandraiah joins ETSU psychiatry department, Quillen ETSU Physicians

JOHNSON CITY – Dr. Shambhavi Chandraiah recently joined the Depart-ment of Psychiatry and Behavioral Sciences at East Tennessee State Uni-versity’s Quillen College of Medicine and Quillen ETSU Physicians.

She comes to ETSU from the University of Mississippi Medical Center where she served as an associate professor of psy-chiatry. There, she also served as the di-rector and an adult psychiatrist for the Adult Outpatient Psychiatry Clinic.

Chandraiah, who began her new role late last year, is a professor in the College of Medicine’s Department of Psychiatry and Behavioral Sciences as well as director of Outpatient Services and the associate residency training di-rector. She will be seeing adult patients as a provider and supervising psychiatry residents’ clinics at Quillen ETSU Physi-cians.

She received her bachelor of medi-cal science (biochemistry focus) and doctor of medicine degrees from the Memorial University of Newfoundland, St. Johns, Newfoundland, Canada.

Her professional training includes a rotating internship at St. Joseph’s Hos-pital University of Toronto Hospitals in Toronto, Canada; psychiatry residency at the Clark Institute of Psychiatry at Univer-sity of Toronto Hospitals and completed at the Medical College of Virginia in Richmond, Va.; and a consultation/liai-son psychiatry fellowship at the Medical College of Virginia. She is board certified in psychiatry.

She has worked previously in aca-demic and administrative positions at the Medical College of Virginia, Rich-mond and Ann Arbor Veterans Adminis-tration Medical Centers, University of Al-abama at Birmingham, and St. Louis Uni-versity, as well as in private practice. Her primary interests are in women’s mental health and mood and anxiety disorders.

The Department of Psychiatry and Behavioral Sciences is located on the Veterans Affairs Medical Center campus. For more information, visit www.etsu-physicians.com.

Roy Joins Wellmont Medical Associates Pulmonology & Sleep

KINGSPORT – Dr. Thomas Roy, a veteran healthcare leader with long ties to the region, has joined Wellmont Med-ical Associates Pulmonology & Sleep.

A medical doctor, Dr. Roy will see patients in the practice’s offices at 111 W. Stone Drive, Suite 100, in Kingsport and 2428 Knob Creek Road, Suite 201, in Johnson City.

He said he is excited to become part of Wellmont Medical Associates, and his

addition ensures the caliber of care lung patients receive from this physician-led, professionally managed organization re-mains high.

Since 2011, Dr. Roy served as pro-gram director of the pulmonary and criti-cal care medicine fellowship program at East Tennessee State University’s James H. Quillen College of Medicine. He practiced with the medical school for 20 years.

With a career spanning more than 30 years in patient care and research, Dr. Roy has experience and interest in treat-ing patients with chronic ailments, such as asthma, black lung and scarred lung tissue, as well as lung cancer.

A graduate of the University of Lou-isville School of Medicine, Dr. Roy served a fellowship in respiratory medicine at University of Louisville Medical Center.

Dr. Roy is also board-certified by the American Board of Internal Medi-cine Critical Care, and he is a diplomate of the National Board of Medical Ex-aminers, the American Board of Family Practice, the American Board of Internal Medicine, the American Board of Inter-nal Medicine Pulmonary Medicine and the American Board of Internal Medicine Critical Care. Dr. Roy is also a fellow of the American College of Physicians and the American College of Critical Care.

ETSU physician accepted into national scholarship program

JOHNSON CITY – Dr. Dawn Tuell, an associate professor and residency program director in the Department of Pediatrics at East Tennessee State University’s Quillen Col-lege of Medicine, has been accepted into the Educational Scholarship Program of the Academic Pediatric Association (APA).

The mission of the program is to as-sist pediatric educators in developing themselves as productive, advancing and fulfilled faculty members and to in-crease the quality, status and visibility of pediatric educators in academia.

The curriculum includes didactic sessions, self-directed learning activities, development of an educator portfolio and a mentored project. Scholars are ex-pected to complete the full curriculum, including projects, over three to four years.

Tuell is one of just 24 pediatric edu-cators to be accepted into the program’s most recent cohort.

“Dr. Tuell is very gifted as a pediat-ric educator and this program will help increase her effectiveness and contribu-tion to medical education,” said Dr. Da-vid Wood, chair of the Pediatrics Depart-ment at Quillen and chief medical officer at Niswonger Children’s Hospital. “She has extraordinary potential as a medical educator.”

The APA Educational Scholars Pro-

gram was created in 2006. Sixty-three scholars have graduated with a Certifi-cate of Excellence in Educational Schol-arship. The program currently has an ad-ditional 41 active scholars.

Lorio appointed by American Medical AssociationThe Spine Health Foundation (SHF) Announces 2015-2016 Board of Directors and National Advisors

TRI-CITIES – SHF Spokesperson, Dr. Morgan Lorio accepts appointment by the AMA to represent ISASS in the capacity of CPT Advisor. “Dr. Lorio con-tinues to make a powerful impact raising awareness and advocating on behalf of spine patients for SHF. We are enthusi-astic about this appointment and know that he represent physicians and hospi-tals in areas vital to the future of spine care and spine patients, stated Carol Conduff, SHF Founder. ”

The Spine Health Foundation, Inc. (SHF) announces appointments of direc-tors for the 2015 – 2016 term; “Our Board of Directors offers a diverse amount of professional strengths, which will be in-valuable as we work toward growing the organization, this next term. These ap-pointments reflect our continued com-mitment to finding the right leaders dedicated to strengthening our organi-zation.” stated, Barb Street, SHF Board President.

Newly appointed board members include:

Christopher Abla, Financial Advisor; Ron Banton, Medtronic; Benjamin Bless-ing, VP of NFI Corporation; Melissa Cle-mens, Financial Advisor for Wells Fargo; Yvonne Sanders of Sanders and Sanders Agency; Randy Sharrow, CFO of Holston Medical Group;

Newly appointed National Develop-ment and Research Advisors:

John Nichols, President of Disability Resource Group; Laura O’Dea, S-I Bone; Dr. Jeffrey Snodgrass, Chair of Occupa-tional Therapy at Milligan

Second Term Directors:Dr. Michael Boggan; Wes Burle-

son, Burwil Construction; Dan Cates, WJHL-TV 11; Suzy Cloyd, Emeritus Rock Springs, A Brookdale Community; Carol Conduff, Spine Health Foundation; Bar-bara Street J.A Street & Associates

Foundation Advisors:Dr. Stephen Owens; David Miller, At-

torney; Betty Jessee, CPAFounded in October 2010, the SHF

has provided access to more than 450 procedures and resources including 20 spine surgeries. Additionally, the SHF provides other vital resources such as ac-cess to mental health and education to help the whole person.

GrandRounds

More Grand Rounds Online


Dr. Shambhavi Chandraiah


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Subscriptions: One year $48 • Two years $78Dr. Dawn Tuell


Name: Sharon Cole

Position: Database Coordinator for Quality, Bristol Regional Medical Center

At-A-Glance: Making a chart’s facts and figures come alive is Sharon Cole’s special talent, and the result a more efficient hospital, better care, and happier patients.

In the ever-changing world of healthcare, there is one constant: registries. Through these national databases, a hospital’s various service lines are measured against those at other facilities to see who’s doing well, and who could stand to improve.

Keeping track of a facility’s many moving parts for database submission is no easy task. Everything from medication dosages to treatment times must be pulled from charts and flowed into the database, and accuracy is crucial. Luckily for Bristol Regional Medical Center’s cardiac care team, Sharon Cole is not only good at her job, she’s fearless about getting the information she needs — and then acting on the results.

“We belong to several different cardiac registries, and between them they cover all of our cardiac care services, from surgery to heart-attack treatment and care,” said Cole, who has been with BRMC since 1985. “My responsibility is looking at every patient who comes through our system and making sure all the data is accurate. Then we harvest that data and put it into the different databases and send that out. We abstract everything out of that chart that we can find, and then we see how we compare regionally and nationally.”

BRMC’s broad array of cardiac and cardiovascular services do very well in these nose-to-nose lineups, winning a shelf full of awards for the speed and success of care. That makes all the data mining more than worthwhile for Cole, who began her healthcare career as a radiologic technologist and never really saw herself as a forensic data analyst.

“When I came here, I was given the job to start building our cardiac department,” she said. “Since then, I’ve done about everything in the cath lab I could do, and around 2000, I filled in for the nurse who input all the data. I loved taking the ‘big picture’ view of how it all works, and so when she left, I applied for the job.”

In the ensuing years, Cole has moved beyond just entering the data, and works with physicians and other team members to explore what the numbers mean, and how they affect day-to-day operations.

“In 2002, we started with a rough spreadsheet for STEMI patients; we’d never really tracked them before,” she recalled. “It really was just for keeping up with how long everything took. And then we started evaluating our door-to-bed program, and breaking down all of the various services and surgeries we provide here. Putting all that data together helped me learn about all the things that we do here, but it also helped us because we could see where we might be falling short, or where we were doing a really outstanding job.”

“Whether it’s times for treatment, or how much medication is being given, or comparing patients on one medication vs. another — or none at all — we continue to learn,” Cole said. “Every day I come in here and look for something new to be coming down the pike. We’ve come a long way with this department, and I am very proud of it. I have the best doctors in the world to work with, and we respect each other. If I see something in my numbers that I don’t understand, I call them in and we go over it. We all are continually collaborating, and that’s why we continue to improve our care, and why our patients do so well.”

GrandRounds

versity. Fittingly, Arnold’s husband is a respiratory therapist and the couple met at Holston Valley. Arnold is a music lover who plays classical guitar.

And then there are the cats.“I’m a cat lover and I have eight of

them,” said Arnold, laughing. “So I’m the crazy cat lady that can be seen driving around town with eight little cat stickers on the back of my windshield.”

While Arnold has certainly gone through several transitions and redefined herself and her job several times over, her ever-advancing career trajectory has led her back to a home base at the Holston Valley Medical Center—and that’s just fine. After all, what could be more reward-ing than knowing what you do has a real impact for the most important people in life, friends, and family?

“I’m from this area, have always lived here, and plan to retire here,” Arnold ex-plained. “So I’m very much invested in the success our healthcare system. I mean, I’ve been here all these years and I’m a consumer as well! Wellmont serves my family and my neighbors and friends.

“I see the impact on my family and my neighbors daily,” enthused Arnold. “I get to see the patients actually get better. They come in having an event that could change their life for the worst—or even end it. And with an intervention, they start getting better immediately.

“Cardiology is just an amazing field with new things on the horizon every day. And when I’m out and about, my friends and neighbors will tell me how we’ve helped them. That’s a great feeling.”

Elaine Arnold, continued from page 5

Dr. Stacey McKenzie

McKenzie to bring expertise in infectious diseases to JCCHC

JOHNSON CITY – Dr. Stacey McKen-zie has joined the staff at the Johnson City Community Health Center, a facility oper-ated by East Tennessee State University’s College of Nursing, to offer infectious diseases care for patients of the clinic.

McKenzie, a Kingsport native, comes to the JC-CHC after returning to the area earlier this year from Kentucky, where she was part of Lexington Infectious Dis-eases Consultants, a 10-physician infec-tious diseases private practice providing outpatient care as well as consultation to all the area community hospitals.

McKenzie, who is board-certified in internal medicine and infectious diseas-es, earned her doctor of medicine from Vanderbilt School of Medicine in Nashville in 1985. She also completed her internal medicine residency at Vanderbilt as well as a fellowship in infectious diseases. She was on the faculty at Vanderbilt, the Uni-versity of Cincinnati and Medical University of South Carolina before entering private practice in 2002.

FOCUS ON CARDIOLOGYSPONSORED BY WELLMONT CVA

Name: Sharon Cole

Position: Database Coordinator for Quality, Bristol Regional Medical Center

At-A-Glance: Making a chart’s facts and figures come alive is Sharon Cole’s special talent, and the result a more efficient hospital, better care, and happier patients.

In the ever-changing world of healthcare, there is one constant: registries. Through these national databases, a hospital’s various service lines are measured against those at other facilities to see who’s doing well, and who could stand to improve.

Keeping track of a facility’s many moving parts for database submission is no easy task. Everything from medication dosages to treatment times must be pulled from charts and flowed into the database, and accuracy is crucial. Luckily for Bristol Regional Medical Center’s cardiac care team, Sharon Cole is not only good at her job, she’s fearless about getting the information she needs — and then acting on the results.

“We belong to several different cardiac registries, and between them they cover all of our cardiac care services, from surgery to heart-attack treatment and care,” said Cole, who has been with BRMC since 1985. “My responsibility is looking at every patient who comes through our system and making sure all the data is accurate. Then we harvest that data and put it into the different databases and send that out. We abstract everything out of that chart that we can find, and then we see how we compare regionally and nationally.”

BRMC’s broad array of cardiac and cardiovascular services do very well in these nose-to-nose lineups, winning a shelf full of awards for the speed and success of care. That makes all the data mining more than worthwhile for Cole, who began her healthcare career as a radiologic technologist and never really saw herself as a forensic data analyst.

“When I came here, I was given the job to start building our cardiac department,” she said. “Since then, I’ve done about everything in the cath lab I could do, and around 2000, I filled in for the nurse who input all the data. I loved taking the ‘big picture’ view of how it all works, and so when she left, I applied for the job.”

In the ensuing years, Cole has moved beyond just entering the data, and works with physicians and other team members to explore what the numbers mean, and how they affect day-to-day operations.

“In 2002, we started with a rough spreadsheet for STEMI patients; we’d never really tracked them before,” she recalled. “It really was just for keeping up with how long everything took. And then we started evaluating our door-to-bed program, and breaking down all of the various services and surgeries we provide here. Putting all that data together helped me learn about all the things that we do here, but it also helped us because we could see where we might be falling short, or where we were doing a really outstanding job.”

“Whether it’s times for treatment, or how much medication is being given, or comparing patients on one medication vs. another — or none at all — we continue to learn,” Cole said. “Every day I come in here and look for something new to be coming down the pike. We’ve come a long way with this department, and I am very proud of it. I have the best doctors in the world to work with, and we respect each other. If I see something in my numbers that I don’t understand, I call them in and we go over it. We all are continually collaborating, and that’s why we continue to improve our care, and why our patients do so well.”

HealthcareServiceSnapshot

By Vipul R. Brahmbhatt, MD

When it comes to cardiac rhythm care, Mountain States Health Alliance and Johnson City Medical Center’s Electrophysiology Laboratory are committed to providing state of the art treatment to patients in our region – helping to improve overall health and quality of life.

As we celebrate Heart Month, it is a good time to review advancements in cardiac rhythm care. Technology is changing faster than ever, making once difficult surgeries now shorter and less invasive, while providing faster recovery time for our patients. Of particular interest is atrial fibrillation ablation, a procedure that tackles a common heart problem of a rapid irregular heartbeat originating in the atrial, or upper, chambers of the heart.

Atrial fibrillation is associated with significant cardiac morbidity and increased risk of stroke. Symptoms often include palpitations and fatigue. The disease is progressive, starting from the paroxysmal stage, where episodes are short and self-

terminating, to the persistent stage, where symptoms are continuous. Treatment in the early stage increases the overall chance of maintaining sinus rhythm with a less extensive ablation procedure. Results of initial clinical trials are quite impressive and atrial fibrillation ablation is now offered as a first line treatment for a selected group of patients with paroxysmal atrial fibrillation.

Atrial fibrillation ablation procedures are now applicable to a wide variety of patients with the improvements we have seen in ablation tools and mapping techniques. These procedures are performed by inserting a catheter through the groin and reaching the right atrium. From there, we go through the atrial septum to the left atrium and identify the pulmonary veins, which are the most common site of origin of atrial fibrillation. The goal of the majority of these procedures is to electrically isolate these pulmonary veins from the left atrium and ablate the surrounding left atrial tissue. At Johnson City Medical Center, we perform these procedures in conjunction with our Anesthesia Team, making it safer and more

comfortable for our patients. Over the last decade, there has

been significant debate and discussion about different approaches for management of atrial fibrillation, but recent recommendations highlight the importance of maintaining a normal cardiac rhythm for the overall wellbeing of our patients. Our goal at Mountain States Medical Group and Mountain States Health Alliance is to provide the highest quality cardiac rhythm care with success comparable to the top institutions in our country. Offering atrial fibrillation ablation, with the expertise and advanced technology, makes this possible for patients in our region.

310 North State of Franklin Road, Suite 400 • Johnson City, TN, 37604 • Phone: 423-979-6000www.mymsmg.net

Physician to Physician

Atrial Fibrillation Ablation: Complex Cardiac Procedure

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Dr. Vipul Brahmbhatt, who practices with Mountain States Medical Group Cardiology in Johnson City and Elizabethton, has special interests in cardiac catheterization, implantable cardioverter-defibrillators, pacemakers, cardiac arrhythmias, clinical electrophysiology, and complex ablation procedures. He attended B.J. Medical Col-lege in India and completed his residency and fellowship in internal medicine and cardiovascular disease at the ETSU James H. Quillen College of Medicine in Johnson City, TN. His fellowship in clinical cardiac electrophysiology was completed at the Aurora Sinai Medical Center in Milwaukee, WI. He is certified by the American Board of Internal Medicine in both Cardiovas-cular Disease and Electrophysiology.

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