tri cities medical news july 2015

Dr. David Thompson

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Due Diligence: Preparing for an Acquisition or MergerOver the past several years, changes in the healthcare regulatory environment have generated increased interest in acquisitions and mergers among physician groups, hospitals and health systems ... 4

Homegrown HeartLocal Nurse Practitioner Has Long History Helping Kids “I’ve always wanted to work with kids,” said Wendy Taylor, DNP, CPNP, and “always knew I would go into the medical fi eld.” Born and raised in East Tennessee, or “homegrown,” as she put it, Taylor started out volunteering ... 8

By CINDy SANDERS

During a National Institutes of Health Precision Medicine workshop held in Nashville at the end of May, NIH Director Francis Collins, MD, PhD, and Sen. Lamar Alexander (R-Tenn.) discussed the steps necessary to roll out a national ef-fort to deliver highly personalized care.

The Precision Medicine Initiative (PMI) has near-term goals focused on diag-nosing and treating cancer and longer-term goals that look to expand the scope to the full continuum of health and disease. In announcing the initiative earlier this year, President Barack Obama highlighted the impact of ivacaftor – a new class of drug to target the underlying cause of cystic fi brosis that is now approved for pa-tients with 10 different mutations to the CF transmembrane conductance regulator (CFTR) gene. For those with one or more of the mutations, ivacaftor has demon-strated improvement of CFTR function and has signifi cantly extended quality and quantity of life.

Collins, a physician-geneticist who is known for his landmark discoveries in disease genes and his leadership in mapping the human genome, said the plan is to launch a million-person (or more) PMI research cohort in the next few months.

“We do expect by the fall to begin the process of implementing what we are designing right now,” Collins said. He spoke from Vanderbilt University where he was onsite for a two-day PMI workshop focused on digital health data and research

(CONTINUED ON PAGE 8)

FOCUS TOPICS PERSONALIZED MEDICINE MEDICAL SCHOOLS/CME

Rolling Out the President’s Precision Medicine InitiativeNIH’s Collins, Sen. Alexander Discuss Next Steps in Nashville

Measuring the Impact of Interprofessional EducationDo Lessons Learned Translate from the Classroom to the Clinical Setting?

By CINDy SANDERS

IPE … or interprofessional education … has become a popular buzzword among educators preparing the next generation of providers. An interprofessional, team-based curriculum has been lauded as the best way to prepare healthcare professionals to work collaboratively in a value-based system where effi ciency and quality are rewarded.

But does it work? Do the lessons learned in the classroom effectively translate into the clini-cal setting? And does this model of delivery actually have an impact on patient outcomes and the healthcare system itself?

Those were some of the questions posed by the Institute of Medicine’s Global

FOCUS ON PERSONALIZED

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Dr. Francis Collins, director of the National Institutes of Health, addresses attendees at a recent workshop on precision medicine.

PHOTO COURTESY OF VANDERBILT UNIVERSITY MEDICAL CENTER

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


By KATHY BROGGY AND CAROLYN POINTER NEIL

When Knoxville was proclaimed a Purple City in May, it signaled the commitment to make our community one of the first dementia-friendly cities in the United States.

A designated “Purple City” means community members and organiza-tions execute specific steps to help people learn about dementia and help those with dementia receive the highest level of care and safety.

Such an initiative can only succeed with the back-ing of the community, its elected officials and organizations dedicated to serving those dealing with the cognitive memory loss.

The Purple Cities Alliance initiative kicked off officially in Knoxville on May 11. The formal presentation explained the goals and efforts of the alliance and included proclamations from represen-tatives of Knoxville Mayor Madeline Rogero and Knox County Mayor Tim

Burchett. Tennessee Lady Vols Basketball Assistant Coach Kyra Elzy also shared her personal story of her family’s experience with dementia.

The need for Purple Cities is clear. More than 5 million Americans live with Alzheimer’s disease, one of the most com-mon types of dementia, and most Knox-villians know someone suffering from cognitive memory loss.

Overall, the Purple Cities Alliance is

a global network based on the vision and efforts of Norman McNamara, a resident of Torbay, Devon, England, who was diagnosed with dementia at age 50. Mc-Namara founded The Purple Angel orga-nization to encourage his hometown – and cities across the world – to gain insight and understanding about dementia and there-fore become more supportive of commu-nity members living with the disease and related conditions.

The movement started by one man gained mo-mentum across Europe and spread to Asia, Australia and the United States. Knoxville now intends to serve as a model for other communities across the country.

We believe Knoxville is the perfect place to start in the United States. When the idea was suggested for our city, volunteers and organi-zations immediately came together to make it happen. On the day the alliance was announced, Henley Bridge was lit up with purple lights to signal Knoxville’s commit-ment.

Also on the day of the alliance announcement, Patrick Wade, director of The Pat Summitt Foundation, said: We’ve all felt the impact of this dis-ease, whether through Pat Summitt’s story or an experience with a family member. We’re working to treat, prevent, cure and ultimately eradicate this disease, but for millions of people living with it, we can make a difference today.”

The Purple Cities Alliance is led in

Knoxville to be a Beacon of Purple for Dementia Awareness

Carolyn Pointer Neil, right, announces the launch of the Purple Cities Alliance, a formal effort to make Knoxville one of the first dementia-friendly cities in the United States, while other alliance members and supporters look on at the kickoff event in Market Square on May 11. Pictured from left: Dava Snyder of The Courtyards Senior Living; Russ Jensen of the City of Knoxville; Patrick Wade of The Pat Summitt Foundation; Gwyn Earl of Trinity Care Senior Living; Dr. John Dougherty of the University of Tennessee Medical Center; Dr. Monica Crane of the University of Tennessee Medical Center; and Kathy Broggy of The Courtyards Senior Living.

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By JOHN SEWELL

The doctor/patient relation-ship is certainly an intimate bond. Sure, providing the best medical care is topmost on any physician’s to-do list. But any physician who serves a particular segment of the population in a certain place for the long term also becomes some-thing of a sociologist. Interacting with families and analyzing their ailments, lifestyles, and proclivi-ties for an extended period is in its way a kind of ethnographic re-search where the physician’s role might be termed that of a partici-pant/observer.

Internal Medicine Specialist Dr. David Thompson is just such a participant/observer. With a 26-year career in the Tri-Cities area, Thompson has played a key role in the lives of many of the area’s fami-lies by serving not only as a skilled medical practitioner—but as a confidante and ally.

“I’m unique in that I’ve been here for 26 years, and I’ve gotten to see these families over the long term, which is really an honor,” said Thompson. “Sometimes I treat people that are at the lowest points of their lives when they’re at their sickest. I see people who have really just escaped death. So I get to know those people and see them go through those low periods into better periods.

“Now I’m treating some people whose parents I was treating 25 years ago,” Thompson continued. “The conti-nuity of care with these families is really amazing. I get to know these people, and over time they become very good friends on a certain level.”

Thompson’s career involves a num-ber of responsibilities that oftentimes overstep the discipline of medicine. The tireless doctor was recently appointed as

Chief Administrative Medical Officer of Wellmont Medical Associates, a physi-cian-led, professionally managed organi-zation. The appointment entails a host of new challenges for Thompson, who cer-tainly seems up to the task.

“It’s a totally new experience for me,” enthused Thompson. “I just took over the position on June 1st, so we’re still in a tran-sition phase.

“Wellmont Medical Associates is set up under what we call a dyad partnership model,” Thompson continued. “It’s loosely set up in a way where we have a team of physician/leaders working with profes-sional administrators. We have five dyad partnerships that meet on a weekly basis.

“It’s going to be more slightly admin-istrative work than I’m used to doing—and a slight reduction of my clinical work. But in the new position, I’ll still be firmly grounded in my work as a clinical physi-cian. I think that’s very important to the success of these dyad partnerships—to

have clinical physicians who also serve administratively.”

Although Thompson is in-deed taking on a handful of new tasks in the new job, he will con-tinue to maintain the long-term relationships with his patients that have proven so important over time. By serving the health-care needs of several area families for over a quarter of a century, Thompson has become an astute observer of ‘big picture’ trends af-fecting the overall health of the area.

“I’m an internal medicine specialist that actually focuses on diabetic care,” explained Thompson. “An internist would be a specialist who works on adult medicine—in particular the man-agement of chronic diseases such as diabetes, hypertension, heart

disease, and chronic lung disease. I pre-dominately provide care for lots of older adults. I have a lot of elderly patients.

“I think that as our population con-tinues to age, we’re seeing some conditions that we didn’t see before,” Thompson continued. “These days, I’m seeing a lot more patients with liver disease. And you know, at one time if someone had cirrhosis of the liver, the assumption was that they were a long-time, heavy drinker. But now I’m seeing many older adults whose cir-rhosis is due to fatty liver disease. Over all, the obesity problem is the cause of this. Cirrhosis is definitely on the rise for the older population and the national statistics will support this, too. As a nation, we’re living longer, and we’re becoming more obese, so we’re seeing some different kinds of illnesses associated with this.”

Simply put, Thompson is a consum-mate achiever. His career accomplish-ments include establishing a diabetes clinic near Kingsport, a new diabetes facil-

ity in Abingdon, Virginia, and setting up a Patient-Centered Medical Home model that specializes in maintaining relation-ships with patients once they have been discharged from the hospital.

“Patient-Centered Medical Home is a concept where we treat the patient as a whole individual,” Thompson explained. “We coordinate the care to make sure that the patients go to physicians that serve their preventive care needs.

“Really, what’s most important with this model is communication,” Thomp-son continued. “We want to be sure that the patients have clear instructions about their medications, and we do our best to educate the patients about their conditions and how to treat them. This communica-tion helps to reduce the readmission rate for the patients, and, of course, that’s the goal.”

Obviously, Thompson is putting in a lot of hours on the job. So one might as-sume that the physician is all work and no play. To the contrary, Thompson assures me that’s not the case.

“It may look like I work all the time, and I do have a lot of responsibilities,” said Thompson, laughing. “But it’s impor-tant to have balance—and I always try to maintain something of a balance.”

Thompson’s leisure time activities include cooking, gardening, and volun-teering for the Appalachian Sustainable Development organization in Bristol. And skiing—lots of skiing.

“I seem to handle that work/life bal-ance thing pretty well by just keeping my routine,” explained Thompson. “You know, I’m a driven individual. I’ve always worked hard. And I enjoy playing hard at times as well. I will work into the night, then get on a plane to Colorado and be on the slopes the following morning—and then get back on the plane that afternoon to be back at work the next morning. That’s what I mean by ‘work hard, play hard.’”

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Over the past sev-eral years, changes in the healthcare regulatory en-vironment have generated increased interest in acqui-sitions and mergers among physician groups, hospitals and health systems. While the purchase and sale of physician practices require consideration of a host of factors, such as analysis of the offer, terms of the ac-quisition and the structure of the transaction itself, the due diligence process represents a common feature of almost every merger or acquisition.

Due diligence is the process through which the parties to an acquisi-tion or merger conduct an extensive in-vestigation of the entity to be acquired. This process is needed to achieve a complete understanding of the opera-tional features and liabilities of each party involved in the transaction prior to finalizing the deal.

The due diligence process is both complicated and expansive, particu-larly in highly regulated fields such as healthcare. If conducted properly, due

diligence provides the parties to a trans-action with a thorough understanding of each party’s operations and liabilities or, alternatively, uncovers issues that need to be addressed in order for the acquisi-tion to close.

Due diligence possesses common features across most types of acquisi-tions and mergers. For a practice group considering such a transaction, these features afford the opportunity to pre-pare, even before an acquisition partner is identified.

The Due Diligence Process: Typically, the initial due diligence

request will arrive at ap-proximately the same time as the transaction’s letter of intent. The request should be accompanied by an ap-propriate confidentiality and non-disclosure agreement, which is designed to protect the disclosed information and establish the process for return or destruction of deliv-erables in the event the deal fails to close.

Often, the exchange of documents and information

that make up the due diligence process will be well underway by the time the first draft of the acquisition agreement arrives, and may continue up to the execution of the final agreement.

The following is an overview of due diligence request categories and a listing of potential deliverables that are associated with each:

Corporate/Company Records. Charter documents (with amendments), bylaws and agreements among the own-ers, including any shareholder agree-ments or restrictions on the transfer of ownership.

Financial Records. Current finan-cial statements, audited financials for previous years, tax returns, audit or determination letters from the taxing authority, description(s) and supporting document(s) for any indebtedness.

Assets. A listing of all real, tangible and intangible property of the practice, including furniture, fixtures, equipment and inventory; a description of intan-gible property, including licenses and contracts for information technology and software.

Contracts. Copies of all material contracts, including provider and man-aged care contracts, professional ser-vices agreements, supply agreements, physician employment agreements and leases; and a description of any oral agreements.

Regulatory Issues. Governmental approvals or permits required to oper-ate the practice, including approvals related to federal payer programs; docu-mentation and explanation regarding any investigations by any governmental authority, both past and present, includ-ing the resolution of the investigation; and credentialing/licensing information.

Employment/Human Resources. Listing of current employees and their respective job descriptions and dates of hire; compensation information, along with employee bonuses, benefits and any pending employee claims, along with the status of each claim; and cop-ies of employment agreements, along with any current employee handbook or policy manual.

Information Systems and Tech-nology. Inventory listing of all server hardware, as well as system software overview, along with operational soft-

ware and license agreements; documen-tation regarding automated file transfer or data interfaces in place with external clients, along with electronic billing, col-lections, EMR and scheduling software.

Insurance. Copies of all insurance policies, along with detailed claims history and a listing of pending claims (including malpractice insurance, work-ers’ compensation insurance, directors’ and officers’ insurance, and any other general liability insurance or casualty policies on which the practice entity or its physicians are listed as the insured).

Environmental. Any information regarding compliance with applicable and environmental laws, as well as environmental reports and documenta-tion regarding any permits or pending violations.

Legal and Litigation. Listing of all material litigation and claims, pending or threatened, against the practice or to which the practice is currently a party; description and copy of all material judgments, settlement agreements, and any demand letters or correspondence related to these matters, or any govern-mental inquiries or allegations.

How Does Due Diligence Become

a Part of the Transaction?A party’s thoroughness, organiza-

tion and responsiveness in its disclosure of due diligence information may set the tone for the remainder of the acquisi-tion process. The inability to locate and identify important information regarding its practice may also lead to uneasiness on the part of a potential purchaser. Ultimately, the due diligence responses will provide a basis for the negotiation of the acquisition agreement, and will likely result in revisions to the representations and warranties made by the parties as a part of the acquisition agreement.

Due diligence information may also impact how long the representations and warranties in the transaction docu-ments will be binding after the acquisi-tion. In addition, the information could determine how long (and what amount of) contingency funds may need to be held in escrow post-closing.

Start Early – Be PreparedIf an acquisition or merger may be

on the horizon for your practice, review-ing and organizing the documentation and information that are likely needed in the due diligence process will be time well spent. Seeking the assistance of financial and legal advisors with experi-ence in these matters could provide the opportunity to address acquisition-related issues even before an offer is on the table.

Scott T. Powers is a Partner with the law firm of Hunter, Smith & Davis, LLP. He is chair of the corporate practice group. Mr. Powers’ legal focus is on corporate transactional work, including mergers and acquisitions, banking and healthcare.

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Due Diligence: Preparing for an Acquisition or Merger


By Joe Morris

Hospitals and physicians’ offices are in the business of help-ing sick people get better. But “business” is the operative word, and with treating the sick comes billing to insurance companies and individuals for services rendered. That some-times can lead to collection action, and that’s something that healthcare providers do not enjoy, and that they’re not particularly well suited to undertake.

This is the space that Peachtree Acceptance has stepped into. The Asheville, N.C.-based company has spun off from an existing call center in the consumer-sales industry, and is working with healthcare providers (even veterinarians) of all sizes to provide support in all aspects of debt collection, says David Reed, vice president of business development.

“We can provide services for a hospital, physicians’ group, surgery center, or any other provider in the medical-services area,” Reed explained. “We can take over debt collection for them just for overdue bills, or we can come in as soon as the service is rendered and provide ‘early outs,’ or billing services from the outset. In each of those cases, we charge a percentage of the amount collected, and they get the rest.”

Peachtree Acceptance also can buy old debt from its clients, so that they can write it off their books and their taxes. Medical debt is usually sold after its 180 days old, however, Reed said so often it makes sense to have Peachtree come in earlier in the process in hopes of getting the situation resolved to in a way that benefits both parties.

In fact, making sure that the debtor, as well as the medical provider, is well taken care of is what sets Peachtree Accep-tance apart. Stories of being hounded by debt collectors abound for a reason, and so the company is working hard to create a much friendlier and acces-sible approach.

“We’re very nice to people,” he said. “Our customer-service professionals really do want to work with that person to take care of the debt. They’re not just going to call and demand full payment, right then and there. We don’t talk down to people. We educate them about what their options are, and explain how all the billing has worked because often they think they’ve paid everything and aren’t sure why they’ve wound up in a col-lection situation.”

As an example, he points out a simple x-ray procedure. The patient gets a bill from the hospital, or surgery center, for the procedure and pays it. But what he or she may not real-ize is that there’s a separate charge for a radiologist to read the x-ray, and that may come through later. If the patient just tosses the bill away thinking it’s already been paid, he or she will go into default.

“A lot of this is because insurance and medical bills are con-fusing,” Reed said. “We want to explain what’s going on so that the person we’re working with understands their situa-tion.”

In addition, a Peachtree representative also will use propri-etary software and a comprehensive website to help debtors pay their bills, or create a payment plan, online. Giving the individual control over the process is a strong differentiator for Peachtree in the collection world, Reed said.

“They can go online, create that account, and set up a plan that works for them,” he said. “If it’s $30 a month, then that’s what they set up. If it’s not a big amount, then they can take care of the whole thing at once. Our main goal is to give them options, so they feel like they are in charge of setting the account, rather than being pushed into a plan.”

As the healthcare industry continues to evolve under the Affordable Care Act and other changes, care providers have less and less time to spend on back-office issues such as collections. What Peachtree Acceptance can do is relieve them of that burden, but do so in a way that’s kind and caring, and continues the excellent service that the patient has been receiving. In a world where there’s more medical

choice than ever, that’s important.

“These entities want their patients, their customers, handled in a professional

manner,” Reed said. “They’re understandably nervous about signing a contract with someone who’s not going to treat those patients well, and get them all

upset. When that happens, those people go somewhere else for their care. We are an extension of

that provider, and we talk to these people as though they are our

patients. We want to resolve the issue so that they aren’t worried about it any more, and so they continue to seek their care from our clients.”

Debt Collection ReimaginedConsumer-friendly approach yields better results for providers

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Youhanna Al-Tawil, MDMedical Director

KidsFACT (Kids Fighting Against Crohn’s and Colitis Together) is a non-profi t group created by GI for Kids to provide support and improve quality of life for children su� ering from pe-diatric infl ammatory bowel disease (IBD). In

addition to its primary purpose as a family-focused support group, KidsFACT raises funds to further edu-cation and research initiatives on Crohn’s disease and ulcerative colitis. Each year proceeds from a benefi t hosted by the program send a KidsFACT kid to en-joy the summer at CCFA Camp Oasis in Nashville and provide a scholarship for one KidsFACT high school senior preparing to enter college. Recently, KidsFACT launched “The Poop Scoop,” a newsletter dedicated to informing IBD patients and their families about the lat-est medical, dietary, and psychological advances relat-ed to the disease. Celi-ACT is another support group for celiac disease and gluten intolerance organized by one of GI for Kids’ dietitians. In keeping with its com-mitment to education, the practice sponsors a vendor fair to teach a� ected individuals and their families how to purchase and prepare gluten-free food and make healthy dietary choices. Gastrointestinal disorders in children have a se-rious impact on physical and emotional wellbeing. Also, some psychological illnesses adversely a� ect the gas-trointestinal system. Transitions Behavior Health Center for Kids, located within GI for Kids, addresses stress and

pain management related to gastrointestinal issues from a behavioral context. Therapists in the program are experienced in helping patients dealing with IBD, celiac disease, irritable bowel syndrome, and food al-lergies, along with eating disorders, depression, and anxiety. Transitions’ therapists work with patients and families to provide support and be-havioral modifi cation for issues related both to gastrointestinal diseases and general behavioral issues. Obesity is a serious problem in children, a� ecting all aspects of health. Bee Fit 4 Kids is a multidisciplinary weight management program that helps overweight children and their families improve exercise and eating habits. With one-on-one programs tailored specifi cally to each child, GI for Kids’ registered dietitians and nurse practitioners work with each patient to make healthy, active lifestyle changes. “I try to make us a one-stop o� ce, where we can take care of everything!” Al-Tawil said. “I only hire people who have a passion for helping children. We have a team that can really respond to disease with expert, well-managed programs.” Al-Tawil is working to establish even more programs to help kids with chronic constipation and support chil-dren who have liver diseases. He is also interested in doing even more in future to help patients su� ering from food allergies. Many food allergies caused by additives and preservatives in food are di� cult to confi rm through clinical testing and complicated to isolate and address. A multi-disciplinary group like GI for Kids is well-suited to tackling the challenge: “You really have to take a team approach to work with these patients,” Al-Tawil explained. GI for Kids is a� liated with East Tennessee Children’s Hospital and serves children from all surrounding areas. The Children’s Hospital’s endoscopy suite, one of few in the U.S. devoted to pediatric patients, is named in honor of Dr. Al-Tawil in recognition of his dedicated e� orts to provide excellent healthcare for area children. GI for Kids’ comfortable infusion department is outfi tted to make Remicade infusions and Humira treatments as pleasant an experience as possible. Patients requiring in-patient care are personally attended by GI for Kids’ inpatient nurse prac-titioner for the duration of their hospital stay. If you are interested in learning more about GI for Kids’ pro-grams, patient support groups, and community events, or if you would like to make a referral, please visit their website at www.giforkids.com or phone the o� ce at (865) 546-3998.

said medical director Youhanna Al-Tawil, MD, speaking

about his team at GI for Kids, PLLC. “If you do some-

thing because you really have a passion for it, I believe

you can make a di erence.” Al-Tawil’s enthusiasm is in-

fectious and obviously shared by the other members of

his group. Boasting board-certifi ed pediatric gastroen-

terologists, nurse practitioners, behavioral health clini-

cians, registered dietitians, a physician assistant and a

research coordinator, GI for Kids is sta ed with a team

of experts who combine their e orts to combat pedi-

atric gastrointestinal distress and disease on all fronts.

Recognizing how gastrointestinal problems a ect all ar-

eas of a child’s life, the team takes care to consider the

nutritional, emotional, social, and psychological needs

of each patient. To this end, GI for Kids features a num-

ber of programs to help kids lead happy, healthy lives.

“It’s all about passion,”


By JENNIFER CULP

“I’ve always wanted to work with kids,” said Wendy Taylor, DNP, CPNP, and “always knew I would go into the medi-cal field.” Born and raised in East Tennes-see, or “homegrown,” as she put it, Taylor started out volunteering at East Tennessee Children’s Hospital as a sophomore in col-lege. Several degrees later, she continues to help sick children in East Tennessee as inpatient nurse practitioner for GI for Kids, PLLC.

Taylor’s volunteering experience sparked an interest in nursing, and she earned a Bachelor of Science to pursue the occupation from Tennessee Wesleyan in 2004. She immediately applied to graduate school upon completing her undergraduate degree, and after postponing her entrance to work for a year, went on to earn a Master of Science in Nursing from Vanderbilt Uni-versity in 2006 and a Doctorate of Nursing Practice from the University of Alabama in 2010. While working toward her doctor-ate, she did a capstone project on obesity in young children. By monitoring kids’ weight trends between birth and two years of age and then comparing the data to their positions on the growth curve at their kin-dergarten checkups, Taylor learned some interesting things: that the children’s birth weight had no impact on obesity, and that many parents skipped well-child checkups at ages three and four, after the children had received required immunizations at two. Skipping check-ups between ages two and five appeared to be linked to obesity in the kindergarten-aged children, indicating that regular follow-up and education are important factors in avoiding early obesity.

Taylor has a long history with GI for Kids. “Dr. Al-Tawil was my first employer—I worked with him for about three years when I graduated from nurse practitioner school,” she explained. After an eighteen month period in which she departed to work in general pediatrics, Taylor missed the specialty of pediatric gas-troenterology and her co-workers at GI for

Kids. “I enjoy the physicians, nurses, and staff we have here at GI for Kids; it’s just a really awesome group of people,” she said. Additionally, “I enjoy the patient popula-tion. We have patients who have chronic medical problems, so we can establish long-term relationships with them, but most of our kids do really well, so there’s a lot more positive than negative in my job. You kind of get the best of both worlds,” she added. Over the course of her time with GI for Kids, Taylor has seen the practice grow and thrive. “When I first started working for Dr. Al-Tawil, we didn’t have any dieti-tians, we didn’t have any psychologists, we didn’t have any ancillary staff. I think they have definitely impacted how we’re able to care for our patients. So many things go to-gether: there’s medical, there’s nutritional, and then there’s an emotional/psychologi-cal aspect to care, so being able to provide all those services in one central location where the providers can communicate on a regular basis is definitely positive,” she said.

Taylor is the nurse practitioner for GI for Kids’ inpatient population, and she personally cares for all of the practice’s pa-tients who are admitted to the hospital. In her role, Taylor treats kids from birth to 21 years of age suffering from problems rang-ing from Crohn’s disease, ulcerative colitis, severe gastroesophageal reflux disease, fail-ure to thrive, liver illnesses, pancreatitis, to general or undiagnosed abdominal pain,

and consults on patients admitted to the hospital pediatric service in addition to car-ing for all patients admitted to GI for Kids’ service. “Basically, if the child is in the hos-pital and we’re involved, then…it’s me!” she explained. “I work with all of the other subspecialists with the pediatric team, pro-viding the daily care for the patients who are in the hospital.” Taylor enjoys the variety of the work and the bonds she forms with her patients and their families. “Any time one person in a family is sick, whether it be a child or an adult, it affects every family member. So, especially in pediatrics while the child is our patient, there’s a lot of in-volvement with the parents as well. You’re there to educate them, to support them, to comfort them,” she said. “You really inter-act with the whole entire family.”

Taylor and her husband live in Loudon, Tennessee, with their eight-year-old daughter and three-year-old son. They enjoy boating in the summer, but are currently a little short on time to enjoy other hobbies, “especially when the kids start school!” she laughed. “You think that when they’re infants and tod-dlers that’s when your life is crazy, but it’s so not true! The older they get, the crazier it gets.” Taylor also stays pretty busy with her kids at work. Some days there may be fifteen patients to see, sometimes five, but given the variety of issues she treats, “the number of patients never dictates the workload,” she said. “You can never tell!”

The benefits of Taylor’s work, how-ever, always outweigh the busy schedule. “My favorite thing about being in the hos-pital is that it gives me a unique opportu-nity to bond with some of our families,” she said. “I feel personally privileged that these families allow us to share in some of the big-gest moments in life with their kids. I think, for me, that’s what makes it more enticing to work with kids than adults. There are so many things—you get to watch them grow up!—that you’re kind of like a proud parent too when they graduate from high school, or win an award. You’re just invested with that family, and it’s nice to be a part of that.”

HealthcareLeader

Homegrown HeartLocal Nurse Practitioner Has Long History Helping Kids

cohort design.In order to deliver individually tailored

approaches to prevention and risk assess-ment, health maintenance, diagnosis and treatment, Collins said it was critical to build a large evidence base encompassing gender, race, ethnic, age and geographic variances. By sharing genomic informa-tion from participants, along with impor-tant clinical data from electronic health records and lifestyle and environmental information from mobile health devices and applications, researchers hope to bet-ter understand how genomic variations, in concert with other factors, impact the de-velopment and progression of disease.

Some participants will have their en-

tire genome mapped, which has become much more cost effective over the past de-cade. Collins, who was director of the Na-tional Human Genome Research Institute when human DNA sequencing was com-pleted in April 2003, noted that first map cost about $400 million. Today, the price is about $2,000.

Collins said the hope is that individuals already enrolled in several large research cohorts like those with Kaiser Permanente, Mayo Clinic, Geisinger and the Veterans Administration might give permission to roll their data into this national effort. In addition to ‘stitching together’ some of the existing cohorts, Collins noted, “We will also have to find ways to fill gaps and invite

highly motivated people who want to take part to come join.”

The goal is for patients at a fam-ily practitioner’s office in a small town to be able to participate as easily as those at major academic centers or large health sys-tems. However, Collins stressed, having an electronic health record would be crucial to participation. Even with EHRs, Collins admitted interoperability and data sharing could be an issue.

Alexander, who has been a vocal critic of the current EHR program, said prob-lems ranging from excessive documentation to disrupted workflow to interoperability issues have electronic health records “in a ditch, nationally.”

Alexander, who is the Senate health committee chair, and Patty Murray (D-Wash.) recently announced a bipartisan work group to pinpoint ways to improve EHRs. “The goal of this working group is to identify the five or six things we can do to help make the failed promise of electronic health records something that physicians and providers look forward to instead of something they endure,” Alexander said in announcing the new committee at the end of April.

That work, he noted in Nashville, would be critical to the success of personal-ized medicine. While there is a long road from the $215 million included in the presi-dent’s proposed fiscal 2016 budget for PMI and congressional approval, Alexander did say this was an area where bipartisan sup-port exists. ”Precision medicine – tailoring treatments and cures to individuals – has the potential to affect and improve the life of every American,” he said.

Another concern addressed by Alex-ander and Collins was the impact … in terms of time and cost … of creating new therapies tailored to smaller numbers of people.

“I’m working with Sen. Patty Murray, the committee’s top Democrat, to examine how we can get safe, cutting-edge drugs, medical devices, and treatments from the discovery process through the regulatory process into medicine cabinets and into doctors’ offices more quickly,” Alexander said. He added work groups currently are looking at ways to lower costs and shorten timeframes while maintaining safety. “We hope to have that legislation ready by the first of next year,” Alexander said.

Collins noted precision medicine might actually help get more drugs on the market. “The era of blockbusters may no longer be one that is going to apply as we understand more and more differences be-tween people,” he said.

“But look at it the other way,” he continued, “The failure rate in develop-ing a new therapeutic is about 99 percent.” Collins noted after spending an average of 14 years from idea through human trials, most therapeutics don’t wind up approved. “That’s why the cost of the whole pharma-ceutical industry is so high … because you have to pay for all those failures,” Collins said. “What precision medicine gives you is an opportunity, first of all, to pick the right target because we really understand at a much more detailed level what is hap-pening with diabetes or cancer or heart disease.”

He added researchers not only start with more evidence before embarking on developing new therapeutic agents, but they also have the ability to pick groups that fit the target profile. A drug crafted to impact a specific mutated gene would not be tested in patients without that genomic profile. “”That means you can run a clini-cal trial that is much smaller, and therefore much cheaper … and you also will have a much higher likelihood of success.”

Collins pointed out such a drug used in a broad trial, as is often the case now, might look like a massive failure because it only worked 10 percent of the time. However, he added, if only tested in the 10 percent of pa-tients that fit the target profile, that ‘failure’ suddenly becomes a roaring success.

Rolling Out the President’s Precision Medicine Initiative, continued from page 1

FOCUS ON PERSONALIZED MEDICINESPONSORED BY GI FOR KIDS


Forum on Innovation in Health Professions Educa-tion. In late April, a six-member committee, chaired by Malcolm Cox, MD, pub-lished their findings in the IOM report “Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Out-comes.”

The short answer to a long list of questions is that while the empirical evidence suggests this is a desirable way to train future provid-ers, there simply isn’t enough scientific research to validate that opinion.

Asking the QuestionCox, who is an adjunct

professor of Medicine at the University of Pennsylvania Perelman School of Medi-cine and the former Chief Academic Af-filiations Officer of the U.S. Department of Veterans Affairs, noted IPE became a common topic of discussion and debate among members of the Global Forum.

“One of the things that came up early on was that health professions edu-cation was ‘faith-based’ when it came to outcomes … that is we believed, without much data, that interprofessional educa-tion would be helpful, if not essential, to producing the kind of clinical workforce that the U.S. and world need in the fu-ture,” he said.

Cox noted a common sentiment among many educators is ‘the era of the Lone Ranger’ is over. He added, “I think that’s true … no one doubts that. More-over, no one doubts that the U.S. health system is rapidly moving in that direc-tion.” And in fact, Cox pointed out, data exists showing teams can provide safer, more effective, efficient care … but that isn’t the same as proving the best route to get there.

“How do we prepare health profes-sionals to hit the ground running when they reach the clinical workforce so they are ready to work in teams rather than as individuals?” he asked. “What we discov-ered is that while teams are known to be effective, how to create great teams is un-clear,” Cox continued.

No ‘I’ in Team“The leaders of healthcare systems

are not pleased with the graduates we are sending them,” Cox stated. While these new professionals might be well versed in disease recognition and the medical sci-ences, they aren’t well trained in working together, noted the physician-educator, who previously served as dean for Medi-cal Education at Harvard Medical School

Even when professionals from multi-ple disciplines are grouped together, Cox said it’s often more a matter proximity than actual teamwork. “Team leadership should be expertise- and situation-based rather than hierarchically based,” he pointed out. “Physicians are still giving orders and nurses are taking orders, which

is fine if the physician has the most knowl-edge on a subject, but there are times when the nurse or physical therapist or pharmacist should lead. The most effec-tive team is where the expertise of profes-sionals overlap so that the whole is greater than the sum of the parts.”

While a lot of emphasis is placed on leadership, Cox said the concept of ‘fol-lowership’ is equally important. “Physi-cians are great leaders but poor followers … I’m allowed to say this because I’m one of them,” he added with a chuckle.

In his experience, he added, “The only way you can really learn to work to-gether as a team … is to work together as a team.”

IPE & OutcomesCox said the committee studied the

available research and literature for both the intermediate and final outcomes of IPE. The intermediate outcomes side of the equation is tied to learning outcomes and whether or not students understood, gained knowledge and developed new skills. “There’s pretty good information

that interprofessional education begins to pro-mote collaborative be-havior within students,” he said.

“But,” he contin-ued, “we haven’t taken it to the final endpoint, which is do those learn-ing outcomes lead to enhanced patient health and health system out-comes?” Cox said, “The conclusion was there is no data that links the learning outcomes to health and system out-comes … that’s where the gap is.”

While this commit-tee was focused specifi-cally on measuring IPE,

Cox said he personally believes that all health education innovations should be held to the same evidence-based standard. “We keep changing the way we educate, and there’s little solid data that any of these changes lead to measurable changes in health or system outcomes,” he said. “Belief is one thing, but data is another.”

Filling the GapCox pointed out IOM studies are

not geared to go beyond the question at hand … in this case, a question of mea-surement. However, the report included recommendations on how to move for-ward to produce more data to assess the real world outcomes of IPE on patients, populations and healthcare systems.

The committee highlighted four areas that should be addressed in order to truly evaluate the impact of IPE on collabora-tive practice – 1) more closely align the ed-ucation and healthcare delivery systems, 2) develop a conceptual framework for measuring the impact of IPE (see graphic), 3) strengthen the evidence base for linking IPE to health and system outcomes, and 4)

better link IPE with changes in collabora-tive behavior. Furthermore, the commit-tee made two recommendations:

Interprofessional stakeholders, funders and policymakers should com-mit resources to a coordinated series of well-designed studies of the association between interprofessional education and collaborative behavior, including team-work and performance in practice. These studies should be focused on developing broad consensus on how to measure in-terprofessional collaboration effectively across a range of learning environments, patient populations and practice settings.

Health professions educators and ac-ademic and health system leaders should adopt a mixed-methods research ap-proach for evaluating the impact of IPE on health and system outcomes. When possible, such studies should include an economic analysis and be carried out by teams of experts that include educational evaluators, health services researchers, and economists, along with educators and others engaged in IPE.

Cox said the first recommendation is focused on collaborative learning out-comes. The second, which he said is “the real crème de la crème” of the report, looks at linking IPE to health and system outcomes by using ‘mixed methods’ … in-corporating both qualitative and quantita-tive research designs. “We need to know the how and why, as well as the what,” he stated, adding that without the quali-tative piece, it’s difficult to generalize the quantitative results and apply findings to the larger population.

Measuring the Impact of Interprofessional Education, continued from page 1

For More Info

To access the full report, go online to iom.edu/Reports/2015/Impact-of-IPE.aspx.


Treadway Finds Helping Kids Achieve Nutritional Goals RewardingName: Ashley Treadway

Position: Dietitian

At a Glance: Treadway, MS, RD, LDN, typically sees seven to eight patients a day at GI for Kids, PLLC, creating and managing dietary plans for kids dealing with issues ranging from celiac disease, inflammatory bowel disease, obesity, to food allergies, as well as those who require enteral feeding. “Every diet is individualized. There’s no one-size-fits-all diet,” Treadway said. “Every patient is very individualized, from babies that are extremely premature to 19 years old!”

Although she always loved food and enjoyed cooking, Treadway, who earned her B.S. in Dietetics and M.S. in Clinical Nutrition from East Tennessee State University, was originally interested in working with a geriatric population, but fell hard for pediatrics after encountering Dr. Al-Tawil and GI for Kids. “At this point in my life, I can’t imagine doing anything else, especially now that I have a 10-month-old, which sort of puts things into a different perspective,” she said. “One thing about being an outpatient dietitian is that I can build a rapport with my patients. I see them for multiple visits, depending on what their needs are. I have patients I’ve seen for eight years, and watched them grow up. It’s rewarding; you really get attached to these families and love them like they’re your own kids. It’s rewarding, knowing that I’m going to see the patients again and make a difference, and set achievable goals with them.”

Treadway manages enteral feeding for the practice, making sure children who must be fed through a tube or alternative feeding method meet their nutritional requirements. When it comes to children who need dietary management for weight loss or food allergies, Treadway employs a positive approach. “I don’t even like to use the word ‘diet,’ because it’s really a lifestyle change,” she explained. Along with Callie Juban, her fellow dietitian at GI for Kids, Treadway leads the KidsFACT support group for children and families living with pediatric inflammatory bowel disease. “I’m very passionate about being on the board of KidsFACT,” she said.

Treadway singled out Juban for praise: “Callie and I work very closely together, and she is wonderful. I couldn’t do my job without her, so I definitely want to give her props,” she added. She has similarly positive words for the entire GI for Kids team: “It’s a group effort to provide each child with the best care and to achieve the best outcome.”

When Treadway isn’t working to help children reap the benefits of better nutrition, you can find her outdoors. She enjoys gardening, spending time on the lake, walking her dog, and spending time with her baby and her husband of two years. “If it’s not raining, I’m outside!” she said. “I just enjoy being with my family.”

HealthcareServiceSnapshotBy JENNIFER CULP

FOCUS ON PERSONALIZED MEDICINESPONSORED BY GI FOR KIDS


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Knoxville by a team of volunteers, prac-titioners and community leaders, and the advisory board includes representatives from Alzheimer’s Tennessee, Courtyards Senior Living, Alzheimer’s Association Eastern Tennessee Chapter, Elder Ad-vocates, Knoxville Senior Directory, The Pat Summitt Foundation and Trinity Hills Senior Living. Other participating orga-nizations include Senior Citizens Home Assistance Service, East Tennessee Per-sonal Care Service, Amedisys Hospice, Senior Financial Group, WVLT-TV and the East Tennessee Area Agency on Aging and Disability.

The alliance provides dementia edu-cation and training resources to commu-nity members and organizations. To date, more than 40 organizations and busi-nesses have joined the alliance, including Covenant Health, Tennova Healthcare and The University of Tennessee Medical Center.

Author and advocate Gary LeBlanc of Florida created an initiative to bring dementia awareness to hospitals. He sug-gested that a small purple angel be added to admission wristbands to alert staff to the possibility that the patient could be con-fused and/or have memory issues. This program now is in the planning stages of all three hospital systems in Knoxville.

Alliance members will educate busi-

nesses and organizations by providing free training and decals for their windows to signal that the staff is dementia-aware. Those dealing with cognitive memory loss can get disoriented and act out of char-acter.

For example, a man went to the gro-cery store, picked up a loaf of bread and carried it outside without payment. The store manager accused him of stealing. This man would never steal anything; he simply forgot to pay. This incident was upsetting to all involved but would have been easier had the manager been trained to recognize the difference between a thief and a person with dementia.

Any organization or company that is interested in receiving more information and signing up as a community partner for the Purple Cities Alliance should visit www.purplecities.org.

Our goal is for all Knoxville and Knox County citizens and organizations to join us in the journey toward making Knoxville a Purple City. We have an op-portunity to stand up for our loved ones, friends and neighbors by making our city a safe, welcoming and supportive place to live. And we can set the example for cities across the country to do the same.

We hope other communities will fol-low our lead and become Purple Cities, too.

Knoxville to be a Beacon of Purple, continued from page 2

Mission Statement: The Purple Cities Alliance has begun the journey toward making Knoxville one of the first Dementia Friendly Cities (“Purple City”) in the U.S. and will serve as a model for other communities across the country.

In a Purple City, community members and organizations execute specific steps to learn about dementia and help those with dementia feel safer and better cared for in our community. The Purple Cities Alliance is a team of local volunteers, practitioners, and community leaders leading this initiative. The Purple Cities Alliance provides dementia education and training resources that enable community members and organizations to become more dementia friendly.

The Purple Cities Alliance is encouraging all Knoxville and Knox County citizens and organizations to join us in the journey toward making Knoxville a Purple City. Together, we will make Knoxville one of the first Purple Cities in the U.S. and serve as a model for other communities across the country.


GrandRounds

ETSU’s Family Medicine Clinics Receive National Recognition For Patient-Centered Care

JOHNSON CITY – East Tennessee State University’s three family medicine clinics, operated by the Quillen College of Medicine, have received national rec-ognition for their efforts as patient-cen-tered medical homes. The facilities are located in Johnson City, Kingsport and Bristol, Tenn.

The National Committee for Quality Assurance (NCQA), a non-profit organiza-tion dedicated to improving health care quality, recently certified all three fam-ily medicine residency clinics as Level 3 NCQA Patient Centered Medical Homes, the highest level attainable.

The patient-centered medical home is a way of organizing primary care that emphasizes care coordination and com-munication to transform primary care into a team-based approach among health-care providers that remains focused on quality and safety.

The certification recognizes a facility’s efforts to become more patient centered. Previously, the trio of ETSU facilities were certified at a Level 1.

Franko credited Lori Francis, clinical services coordinator; Dr. Doug Rose, the previous director of clinical services for the department; and Dr. Patricia Conner, associate program director at Bristol Fam-ily Medicine, with leading the years-long effort to earn top NCQA recognition.

Bristol Regional, Holston Valley Team With Physician To Send Ultrasound Machines To Ugandan District

BRISTOL – A collaborative effort between Holston Valley Medical Center and Bristol Regional Medical Center will empower caregivers in two locations in Uganda to have improved technology to provide the care patients need.

Bristol Regional is donating two ul-trasound machines it was planning to re-place to clinics in this African country. The idea was borne from an inquiry by Cory Siffring, MD, a trauma surgeon at Holston Valley who travels to the continent for mission work, and a partnership between the presidents of the two hospitals.

Now, the number of ultrasound ma-chines in the Kotido District will increase from one, which is housed in a private clinic, to three. One of the two clinics that will receive an ultrasound is run by the An-glican Church, and the other is operated by the Ugandan government. That is still a limited number considering this district in Northern Uganda has a population of about 237,000.

The two ultrasound machines will soon be on their way to Uganda now that the replacements have been installed. At-tebery said the plan is to connect with the clinics in Uganda via Skype so Wellmont representatives can see the devices in-stalled there.

Hancock County Hospital Named One of Top 20 Critical Access Hospitals In Nation For Patient Satisfaction

SNEEDVILLE – Hancock County Hos-pital’s commitment to deliver high-quality care that meets the needs of patients has achieved special recognition from the Na-tional Rural Health Association.

The nonprofit organization recently designated Hancock County to receive a best practice designation for patient sat-isfaction. Hancock County was one of 20 critical access hospitals in the country, and the only one in Tennessee and Virginia, to earn this elite position.

The rural health association part-nered with iVantage Health Analytics, which reviewed data submitted to the Centers for Medicare & Medicaid Servic-es to determine the top 20 critical access hospitals in the United States for patient satisfaction. The information provided to the federal government came from pa-tient satisfaction survey information Han-cock County patients completed after they had visited the hospital.

Hancock County recently celebrated its 10th anniversary with a community cel-ebration and recognition of staff mem-bers who have worked at the hospital since the beginning.

The recognition for patient satisfac-tion is the second time in recent years the rural health association has honored Han-

cock County. In 2012, it selected Hancock County as one of the top 20 overall critical access hospitals overall in the country.

National Publication Picks Alice Pope One of 150 Hospital And Health System Chief Financial Officers To Know

KINGSPORT – Alice Pope, who has provided exemplary stewardship of Well-mont Health System’s finances during her 15 years with the organization, has been selected among the elite in her profes-sion by a national publication.

Becker’s Hospital Review recently named Pope one of the 150 Hospital and Health System CFOs to Know for 2015. She was the only CFO in the region who was selected to this prestigious list.

Pope has served as Wellmont’s ex-ecutive vice president and CFO for three years and oversees about $800 million in annual revenue. One of her primary achievements has been to restructure Wellmont’s debt to lower the health sys-tem’s interest rate to about 3 percent, which has reduced interest expense by $2 million annually. The health system has also revamped its revenue cycle opera-tion using the Epic electronic health re-cord platform.

For the complete list of those who were named, please visit www.becker-shospitalreview.com.

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By Joe Morris

Usually when you hear about someone with serious eye issues, the thinking is that it’s an adult. However, children can also have complicated vision conditions, and for those in and around Knoxville, Dr. Chris O’Brien and the team at the Center for Sight are ready to help.

Dr. O’Brien has been with the Center for Sight almost a year, and is one of the few pediatric ophthalmologists practicing in the state, or even the Southeast. Now children with eye alignment issues and a host of other problems no longer have to travel out of town, or even the state, for treatment. Along with Drs. Kenneth Raulston, Jr. and Stephen Franklin, he also sees adults for those same issues, as well as cataracts, strabismus, glaucoma, diabetes-related issues, and many more.

“Pediatric ophthalmology is definitely underserved here, and we are working to make sure that people know all that we can offer for children as well as adults,” Dr. O’Brien said. “There are only about 900 practicing pediatric ophthalmologists in the United States, and they tend to congregate in the larger cities. It’s a very special skill set, for very special patients, and I am very glad to be offering my services, along with those of our entire team, to the East Tennessee community.”

A Knoxville native, Dr. O’Brien is a graduate of the economics program at Washington University in St. Louis, and is the only graduate to ever concurrently receive MD, MBA, and MPH degrees from Tulane University. He was chief resident during his residency in ophthalmology at New York Medical College, and also completed further, specialized training in pediatric ophthalmology and strabismus at the University of California – San Diego’s Shiley Eye Center, as well as at the Naval Medical Center San Diego. Following a stint in private practice on the West Coast, he returned to Tennessee last year.

As for choosing to focus on children’s eye care, Dr. O’Brien said first he was drawn to the complexity of eye medicine, and then to the further difficulties of pediatric patients.

“I liked the physics and light aspects of ophthalmology,” he explained. “During my surgical rotation, I got tired of taking out appendixes and went next door to look at what was going on with eye

surgery. I found I really liked looking through the microscope, the microsurgical aspect of this work, and then seeing how dramatic the results can be. Plus, I love that I can be someone’s general doctor for eye health, and then also be their specialist if they need surgery or some other intervention. Often in medicine we see a patient for non-surgical care, then send them to someone else for a treatment, then get them back. This lets me take care of them longitudinally as well as vertically.”

Working with children gives him special challenges because their eye care involves planning for future growth and physical changes. The rewards are many, he said, but a chief one is knowing that a small change at a young age can dramatically affect that child’s life from that day onward.

“I am excited by the opportunity to help a young person see better. It is something that can dramatically impact the course of their life,” Dr. O’Brien said. “Get their vision straightened out and they can drive a car, play sports, or do whatever they want to do for the next 80 years.”

Children can also develop cataracts, retinal disease, or other abnormalities, so he is able to treat them alongside adults patients that he and other physicians see every day.

“Frequently, there are issues because a child is born prematurely, so I have gone into hospitals and clinics to see infants,” Dr. O’Brien said. “Often we have been the third or fourth stop for children, or adults, with eye issues. Their cases are very challenging, and we really like being able to help them. It can be tough, but it’s worth it when the adults are able to see well again. And the kids? They bounce up like nothing ever happened.”

Best of all, he adds, the Center for Sight has become adept at dealing with all patients, regardless of age, quickly and efficiently.

“It’s a great team, where excellence is the norm,” Dr. O’Brien said. “We provide a patient experience that’s fun for kids, and calming for adults, while also providing the top levels of surgical and nonsurgical care. We have a lot to offer the community, and we are always glad to step up and meet the challenges people of any age have when it comes to their sight.”

A Simple VisionCenter for Sight’s pediatric ophthalmologist helps kids see clearly

Dr. Chris O’Brien

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www.CenterForSightPC.com

tri cities medical news july 2015

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