Clay Runnels, MD, FACEP

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HEALTHCARE LEADER: Earl Wilson, MD“If you build it, they will come” may not have been words whispered to Earl Wilson, MD, like they were to Kevin Costner in the movie Field of Dreams but the words couldn’t be more applicable to Wilson’s visionary leadership ... 6

Enjoying East TennesseeWomen’s Basketball Hall of Fame As a banker, my husband, Brad, was a member of the Tennessee Bankers Association (TBA) –Young Division. ... 7

By AMANDA SHELL

As the healthcare industry seeks to eliminate waste and add effi ciency to facilities, Building Information Modeling (BIM) helps accomplish those objectives before the fi rst shovel even hits the dirt.

BIM is a three-dimensional, digital model produced during the design and construction of a facility. The model is created and maintained by all members of the project team – ideally including the owner, builder, architect, engineers, consultants, and specialty contractors.

As a shared information database, BIM is an interac-tive blueprint with the capacity to shape a facility from the ground up and the inside out, fl oor by fl oor and system by system. The technology is especially useful in healthcare

Building Information Modeling: The future of healthcare construction

(CONTINUED ON PAGE 8)

FOCUS TOPICS STROKE HEALTHCARE DESIGN/CONSTRUCTION

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A New View on Clinical Stroke ResearchNIH Hopes to Revolutionize Process through National Network

(CONTINUED ON PAGE 8)

By CINDY SANDERS

Everyone wants to build a better mousetrap … but building it over and over again isn’t very effi cient. Find-ing a way to keep the ‘mousetrap’ infrastructure in place while adding new features based on a collective body of knowledge is fundamentally the basis of the new Na-tional Institutes of Health Stroke Trials Network.

Funded and managed by the National Institute of Neurological Disorders and Stroke (NINDS), NIH StrokeNet is focused on the three prongs of stroke re-search — prevention, treatment and recovery. The new structure utilizes a network of academic medical centers across the country working with nearby satellite facilities to coordinate and streamline stroke research by central-izing approval and review, while creating a comprehen-sive data-sharing system. The network also is expected to lessen the time required to set up clinical trials since

Building Information Modeling (BIM) is especially useful for health care construction because of the signifi cant amount of mechanical, electrical and plumbing infrastructure required in health care facilities. Beyond cost and time savings during construction, the building model is helpful as owners plan future renovations and retrofi ts.

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

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“Regions is always there when I have questions. My relationship with my Regions banker is personal and I have her on my speed dial.”

What started as a single location has grown to three with a full-time staff of 17 employees. These days, the Miami Dermatology Center utilizes a wide range of Regions banking tools, from Business Analyzed Checking and Treasury Management to loans and lines of credit.Dr. Leal-Khouri plans to expand parking at her Coral Gables location, and Regions is part of those plans too. To learn more about the Miami Dermatology Center and how Regions can assist your business, visit regions.com/success.

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PhysicianSpotlight

By BRIDGET GARLAND

It’s a logical conclusion for most patients—when there’s an emergency, go to the Emer-gency Department. Likewise, when healthcare’s facing a cri-sis, who best to make decisions but someone who specializes in emergencies. That’s one of the approaches Mountain States Health Alliance (MSHA) seems to have taken with the appoint-ment of Clay Runnels, MD, to the position of Chief Medical Officer of Washington County facilities. As CMO, Runnels is responsible for medical staff issues including quality im-provement for five facilities in Washington County, including Johnson City Medical Center, Franklin Woods Community Hospital, Niswonger Children’s Hospital, Woodridge Hospital, and Quil-len Rehabilitation Hospital. And at a time when healthcare seems to be ever evolv-ing, Runnels must stay prepared to keep up.

For Runnels, however, staying abreast about the different facets of healthcare is perfectly suited for him, as being knowl-edgeable about a wide array of topics is one of the reasons he choose Emergency Medicine as his specialty. “I liked emer-gency medicine because my vision of what

a physician was, was someone who helped patients out on their worst day and knew a little bit about everything, so emergency medicine fit that mindset of the physician I wanted to be,” he explained. “I enjoy being there to help, and enjoy studying broad subject matter.”

Originally from Beaumont, Texas, Runnels didn’t decide on medicine as a career until he was an undergrad at Texas A&M University, where he received a Bachelor’s degree in Microbiology. The

summer following his sophomore year, Runnels worked in a hos-pital and after experiencing the patient care there, he knew what he wanted to do. “Two things that I have always enjoyed are working with people and study-ing sciences and math,” he said. “Medicine seemed a good mar-riage of the two.” Runnels went on to attend the University of Texas Southwestern Medical School at Dallas, graduating in 1997, and then completed his residency in Emergency Medi-cine at the Texas A&M College of Medicine and Scott & White Memorial Hospital.

“One of the things that made me feel good about emer-gency medicine is that it has always been a safety net for pa-tients. Whenever someone has a real emergency, we have always

been there for them, but even when some-one has nowhere else to turn for care, the Emergency Department has also been that safety net, no matter what commu-nity you are in across the country. I don’t think that has ever changed,” he shared. “As for the challenges to Emergency Medicine, they seem to be the same chal-lenges the rest of healthcare is seeing right now: declining reimbursements and the changes related to healthcare reform.”

These challenges are part of what

Runnels has to tackle as CMO, but he ap-proaches them well equipped, after having received his MBA from Milligan College in 2006. “That’s really when I became interested in administrative work like I’m doing now,” he said. “I’m really excited about the role I’m in now. Although we have a lot of challenges in healthcare, we also have a lot of opportunities to improve, and I’m excited about focusing on the im-provements to healthcare in general.”

One of the main areas for improve-ment that Runnels and his team are addressing right now is efficiency. “As reimbursements are changing and as healthcare is changing, we are going to have to get much more efficient with healthcare,” he said. “We are going to have to work on length of stay, provid-ing high quality care in the most effi-cient manner in order to move patients through the system and get them back home as quickly as possible.”

Runnels is no stranger to challenges, especially as it applies to life outside of healthcare. He and his wife Emily, who have been married for 20 years, have five children: ages 14, 12, 10, 7, and 3. Even with such a large, busy household, Run-nels still finds time to coach a sports team, either baseball or soccer, depending on the season. “There’s a competition be-tween the kids to see whose team I’ll coach this year,” he shared. “Baseball season is almost upon us, and I’ll coach my son’s baseball team this year.”

Clay Runnels, MD, FACEP

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John Pizzarelli, the world-renowned jazz guitarist and singer, was called “Hip with a wink” by Town & Country, “madly creative” by the Los Angeles Times and “the genial genius of the guitar” by The Toronto Star. After his recent smash success with the Boston Pops, he was hailed by the Boston Globe for “reinvigorat-ing the Great American Songbook and re-popularizing jazz.” And the Seattle Times called him “a tour de

force” and “a rare entertainer of the old school.” Using perform-ers like Nat “King” Cole, Frank Sinatra and Joao Gilberto and the songs of composers from Richard Rodgers, George Gershwin to James Taylor, Antonio Carlos Jobim, and Lennon & McCartney as touchstones, John Pizzarelli has established himself as one of the prime interpreters of the Great American Songbook and beyond, bringing to his work the cool jazz flavor of his brilliant guitar play-ing and singing.

Getting Started with ICD-10 Implementation

BY JENNY HARVEY, CODING CONSULTANT, LATTIMORE, BLACK, MORGAN & CAIN, PC (LBMC)

ICD-10 represents a radical change in the way medical coding will be conducted, using nearly five times as many codes as ICD-9. The enhanced specificity of the codes will add greater detail to documentation in the patient record than we currently have with ICD-9, resulting in more precise billing. Symptoms, illnesses, and procedures now have more detailed descriptions, requiring providers to make considerable changes in the way they handle coding and billing processes. Coders, physicians, billers, and other staff will need training to acquire new skills to use the coding system successfully.

By October 1, 2014, all health organizations must be ready to incorporate ICD-10 into their revenue cycle processes, having made all the required technological and workflow updates and provided sufficient training to physicians and administrative staff. ICD-10 implementation projects and plans should be already well under way at

this time; however, multiple surveys show that many organizations have not formulated a plan and began implementation efforts. Becker recently reported that 75% of physicians and associated groups have yet to address the transition. Further, it is estimated that coder and physician/provider productivity will decrease by 50% initially but rise back to approximately 85% after the initial nine-month implementation period.

Poor planning can mean greatly reduced or no revenue coming in for dates of services on October 1, 2014 and thereafter. For HIPAA-covered entities, transition to ICD-10 is not an option. Without ICD-10, providers will experience delayed payments or even non-payment; increased rejected, denied or pending claims; reduced cash flows; and, ultimately, lost revenues. Payments to providers cannot be made without the proper ICD-10 coding.

Claims for all services and hospital inpatient procedures performed on or

after October 1, 2014, must use ICD-10 diagnosis and inpatient procedure codes. (This does not apply to CPT coding for outpatient procedures.) Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. It is important to note, however, that claims for services and inpatient procedures provided before the compliance date of October 1, 2014, must use ICD-9 codes.

A smooth transition to ICD-10 requires careful planning. A successful implementation plan should include performing an impact assessment to determine the people, processes, and technologies affected by ICD-10 implementation. It is imperative that you communicate with your vendors, payers, clearinghouses, and billing agency to determine their implementation plans. When communicating with software vendors, you will need to ask if there will be a cost involved in upgrading to ICD-10. This is also a good time to ask if they will allow sending test claims before the go-live date.

Communicate with payers, regarding how ICD-10 may affect provider contracts. Due to the increased specificity of the ICD-10 codes, payers may modify the terms of their contracts for billing. Payers may require coding of illnesses and procedures to the highest level of specificity. They may alter their payment schedules or reimburse differently for higher acuity codes vs. lesser detailed codes. It is critical to understand your payers’ payment schedules and billing requirements using the appropriate ICD-10 codes. In addition to reimbursement, the change to a higher level of detail found in ICD-10 codes may affect payers’ medical review, auditing, and coverage determinations. Learning of any changes by your payers early on will be valuable in analyzing how the changes will affect the processing of claims.

Identify potential changes to workflow and business processes using information gathered during the Impact Assessment. Areas

where changes to existing processes may be needed include clinical documentation, updating encounter forms and pre-authorization forms, quality and infectious disease reporting, claims submission, and writing orders and referrals.

Using the completed Impact Assessment, evaluate staff training needs by identifying what level of education and subjects are needed for each set of staff members. Training is a critical step for ensuring that staff is knowledgeable about the ICD-10 code set and is prepared for using the new codes. Different staff within your organization will require different levels of training based on their interaction with the diagnosis codes. Training should focus on learning the ICD-10 code set and any workflow changes. Clinical staff will need to learn about ICD-10 to understand how their documentation will affect the ability to code and bill accurately. Coding staff will need the most training to learn how to use the new code set and correctly capture the diagnosis using ICD-10.

Conduct test transactions using ICD-10 codes with payers and clearinghouses. The final step before going “live” with the ICD-10 codes will be to complete testing with your trading partners. The testing will involve sending ICD-10 codes in test transactions through the channels you use today, such as to the clearinghouses or payers.

The implementation plan should include budgeting for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training. When budgeting, it is important to take into account that any new processes takes time to learn and could result in a slower turn-around time during the revenue cycle process. It is recommended that entities take out a line of credit to cover expenses during this learning curve.

Jenny Harvey, a member of the American Academy of Professional Coders (AAPC), the American Health Information Management Association (AHIMA), and the National Association for Healthcare Quality (NAHQ), has over 20 years of extensive experience in the healthcare field. During her career, Harvey has worked in the fields of inpatient and outpatient hospital coding, physician coding/billing, payer services, and pharmacy services. Her experience includes implementing education for physicians and other providers, regulatory and payer compliance, fee schedule analysis, and billing review for compliant reimbursement. Harvey has taught CPT coding and medical terminology at Roane State Community College.

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ClinicallySpeakingBY MARK A. COLQUITT, MD, FACS, FASMBS

New Guidelines Give Physicians Roadmap for Obesity TreatmentThe November 2013 release of

new guidelines for the management of overweight and obese patients by the American College of Cardiology, the American Heart Associates, and the Obesity Society is a significant step for-ward in fighting America’s obesity epi-demic. The recommendations not only give primary care physicians, many who may not be trained in obesity diagnosis and treatment, a “roadmap” for help-ing their patients, but the joint effort also marks the first time a nonsurgical society has included bariatric surgery consultation in the disease manage-ment model for obesity.

The guidelines urge primary health providers to measure patients’ body mass index (BMI) at least annually and identify those who may be at high risk of heart attack, stroke, or other dis-eases because of their excess weight. Physicians are encouraged to develop individual weight loss plans for patients who are overweight (with a BMI of 25 or more) or obese (BMI of 30 or higher).

Individual weight loss plans may in-clude lifestyle and behavioral programs that feature a reduced calorie diet, ex-ercise, and counseling.

For morbidly obese patients (BMI over 40 or BMI of 35 with comorbid-ity), the offer to refer the individual to an experienced bariatric surgeon for consultation and evaluation is sug-gested as an adjunct to the compre-hensive lifestyle intervention.

This recommendation may help dispel misconceptions some physi-cians have long held about the merit and safety of bariatric surgery. The new guidelines note that bariatric sur-gery “leads to improvements in both weight-related outcomes and many obesity-related comorbid conditions. The benefit-to-risk ratio may be favor-able in appropriately selected patients at high risk for obesity-related morbid-ity and mortality.” While the new guide-lines are an important step in giving primary care physicians a tool to help patients win the war on obesity, there is still much room for improvement. At-titudes towards obesity are still slow to change. More education is needed to help the public, and even physicians, recognize that obesity is a chronic con-dition that requires lifetime treatment.

It may ultimately be up to patients to arm themselves with information, such as these new guidelines, and de-mand that their healthcare provider better partner with them in managing their weight and their long-term health.

Mark A. Colquitt, MD, FACS, FASMBS, is Director of Metabolic and Bariatric Surgery at Blount Memorial Hospital in Maryville, Tennessee, and is a bariatric surgeon with Foothills Weight Loss Specialists, a division of Premier Surgical Associates. Colquitt is board certified by the American Board of Surgery. He is a fellow of the American College of Surgeons and of the American Society of Metabolic and Bariatric Surgery and is a member of the Society of American Gastrointestinal and Endoscopic Surgeons. For more information, visit www.foothillsweightloss.com.

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By HEATHER RIPLEy

Let’s face it, it’s hard enough to do business these days with all the competition, especially in healthcare IT and associated health care services, so a website should be one of your business’ most effective tools for garnering and converting leads (customers).

As a B2B public relations professional and CEO of Ripley PR in East Tennes-see, I counsel healthcare clients and create and implement PR strategies on everything from how to start a social media campaign to how to create dynamic website content to creating media buzz about a product, service, or business. Making sure you are top-of-mind in all these areas is critical to staying a step ahead of your competition.

The key to this might be simpler than you thought. There is a prime spot of real estate on most business websites that is ei-ther underutilized or not used at all. It’s your “news” page.

Different businesses call these pages different things (news, media, newsroom, in the news, etc.), but the important thing to remember is that this page can be a huge asset to your business or it can be a very sad reflection that nothing is going on worth talk-ing about. And many businesses don’t even realize how forlorn these pages look to media and potential clients or businesses partners.

An additional reason to spiff up your news page is that reporters and other media generally go to that page to find out the lat-est about your company. The likelihood that they will write about your business is much greater if you have easy-to-find im-ages, stories, previous press releases and statistics that are accessible with as little “digging” as possible.

So, I have some suggestions that will help rev up your image on your website so you can be proud to direct media, potential clients, and business partners to your web-site news page for a glimpse at your business

in its best possible light.Having a news page is the first step, but

once you have one, it’s not a page that you can just let “sit.” Recent surveys conducted by online press release giant, PR Newswire, have shown that reporters are taking on more and more work that used to be done by other staffers, so having the information they need right at their fingertips is essential.

And, even the best websites aren’t of-fering what reporters need. According to a report by PRESSfeed, only 39 percent of all company news pages had an image gallery when it was a top request from reporters and while 82 percent of reporters feel videos with embed codes are essential, only 37 per-cent of website news pages provide these.

Most agree, you must update your news page regularly and often. Here are a few important points to consider before adding material to your news page:

• Have staff bios with images (or links from the news page to the bios) on your page so media and website users can “see” the staff.

• Have your social media platform but-tons front and center (Facebook, Twitter, LinkedIn, YouTube, Instagram, Pinterest, Google+ and any you are active on).

• Have a contact us form and an email opt-in form placed prominently on the page.

• Highlight your media contact in a box or with shading so media can spot it easily if they have questions.

• Add a link to your FAQs page from your news page as well, the fewer clicks a reporter has to make, the better.

• Place your best current videos and embed codes on this page, and keep it up-dated.

• In the news release portion of the page, place the latest one first and offer a news re-lease archive function so that reporters and users can easily find a release by date.

• Include an image gallery on your news page if you can; as more news staff are let go, there are fewer and fewer photogra-phers to go out and shoot stills for a story. Your good-quality images can make a huge difference in getting a story published.

One last thing, if you can’t implement these suggestions yourself, consider hiring a professional PR or online marketing com-pany with references and testimonials from past and current clients. Even if you just up-date your news page ,you will be surprised with the results.

Heather Ripley is the president and founder of Ripley PR, a national public relations agency specializing in health care IT. For more information, visit www.ripleypr.com or email  hripley@ripleypr.com.

Your Company’s News Page Can Help or Hurt Your Bottom Line

6 > MARCH 2014 e a s t t n m e d i c a l n e w s . c o m

HealthcareLeader

Earl Wilson, MDBy BRIDGET GARLAND

“If you build it, they will come” may not have been words whispered to Earl Wilson, MD, like they were to Kevin Costner in the movie Field of Dreams, but the words couldn’t be more applicable to Wilson’s visionary leadership. Wilson, a neurologist and the medi-cal director of the Bristol Regional Medical Center’s Primary Stroke Center, lead the initiative to establish the center over a decade ago. In February, the Center earned the Get With The Guide-lines® Stroke Gold Plus Quality Achievement Award from the American Heart Association. The award spot-lights the center’s adherence to treatment guidelines and quality measures to enhance quality of care.

The second to be es-tablished in Tennessee and the third to be established in Virginia, the Primary Stroke Center was a grassroots ef-fort for everyone involved.

“When we started, it was really difficult because there were no rural stroke centers that we could use as a reference to try to develop it; we were sort of breaking new ground,” said Wilson. “There was no algorithm or set way to do it, so we had to feel our own way along.”

As Wilson explained, the initiative to establish the Primary Stroke Center was fueled by the fact that there was a new treatment developed in the late 90s

called tPA, a clot buster medication that works well, but only if given within three hours. And after being administered, a neurologist and potentially a neurosur-geon are needed to assist in the patient’s care. Rural, smaller hospitals like Lone-some Pine in Big Stone Gap, Va., and Buchanan General in Grundy, Va., aren’t big enough to have a full-time neurologist and neurosurgeon, so the Primary Stroke

Center can coordinate with them to provide care to pa-tients having a stroke.

“The most rewarding thing about the whole process was that every hospital, every administrator, every nurse coordinator, all the ER doc-tors, everybody we worked with were working for the same purpose: they wanted care for their community,” Wilson said. “We got noth-ing but help and cooperation from everybody. Things then fell into place.”

Of course, Wilson’s leadership was instrumental to the success of the project and continues to be an asset to the center. According to Greg Neal, Bristol Regional Medical Center’s president, “Dr. Wilson has been stead-fast in his commitment to establish and elevate our high-quality stroke program, which is focused on restor-ing our patients to health as quickly as possible. His exper-tise and leadership have been instrumental in enabling the Primary Stroke Center to produce excellent patient

outcomes and achieve consistent recogni-tion from national organizations. He has served our hospital and the region with distinction, and we are proud to have him on our medical staff.”

For Wilson, service to community is one of the things he enjoys most about his job. Originally from Tazwell, Va., and having lived in Bristol, Va., for several years, Wilson wanted to return home after

finishing his education so that he could give back to his community.

When he first started medical school, he planned on becoming a family practi-tioner, but during the later part of medical school, that plan quickly changed.

“I spent a month during the first part of my 4th year of medical school with a neurologist. I like the field because you see young people and older people, babies on up to the elderly. And you see diseases that are scary and you see diseases that are bothersome, like migraines, that you can make a difference in. We also see people for long periods of time, that you develop a relationship with, like MS and epilepsy,” he recalled. “I was just enamored by the field, and by the time I was through, I was changing my application to residency and wound up going into neurology.”

Fortunately, his expertise has been a tremendous asset to the region, an area he pointed out is known as the “stroke belt.” A combination of factors, including a high Celtic population, a high incidence of obe-sity and tobacco use, and a culture resis-tant to preventative health visits, especially among male patients, increases the inci-dence of stroke in the patient population.

“Each community has patients who have strokes, no surprise, but a hospital has to be ready for taking care of strokes because stroke is a disease that requires that you take care of it immediately,” Wil-son said. “The problem is that you only have about three hours to act. The brain is damaged within a few minutes of having the event and irreversible by four hours. We have a disease that requires that you act fast and in addition to that, we have a region that is problematic for doing things about it.”

Education, according to Wilson, would go a long way in helping improve stroke outcomes. “Patients tend to delay coming to the hospital as long as pos-sible, hoping their symptoms will just go away, but patients don’t understand that you have a limited time to take care of a stroke,” he said. “I think the one thing physicians in our area could do is be aware that, first of all, there is tPA, that it is an effective treatment, and that there is a time frame we have to stick with, a very limited-time frame. Getting to the hospital within three hours and getting treatment can be the difference between having a lifelong neurological deficit and having the potential for it to be gone completely.”

Added Wilson, “If doctors can com-municate that to their patients, that would be a great service to the area and to the patients.”

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By LEIGH ANNE W. HOOVER

As a banker, my husband, Brad, was a member of the Ten-nessee Bankers Association (TBA) –Y0ung Division. During the late 80s, we attended the annual con-ventions, and I always enjoyed the spouses’ programs. Retired banker R.B. Summitt II served as president of TBA Young Division in 1985, and it was through these meetings that I was first intro-duced to his then wife, Pat Head Summitt, the illustrious head coach of the Tennessee Lady Vols.

During “March Madness,” when basketball is everywhere and on every channel, I am reminded of those TBA years. Nearsighted-ness never served me well in the sport of basketball. Even though I took off my glasses and tried to play, the closest I ever got to actu-ally experiencing being part of an organized basketball team was the church league in middle school. However, even I knew of Coach Summitt’s reputation and was in awe to be able to actually hear her speak.

Pat Head Summitt served as head coach of the Lady Vols from 1974 until 2012, when she announced her retirement due to early onset dementia-Alzheimer’s disease. Today, Summitt still serves as head coach emeritus for the team.

In addition to many, many, many prestigious titles, accolades, and awards, Summitt’s coaching legacy is also honored in the Women’s Basketball Hall of Fame (WBHF) in Knoxville, Tennessee, and she is a member of the founding class of 1999 when the facility opened.

In fact, the WBHF has the official letter from the University of Tennessee, which is dated 1974, requesting Summitt teach and serve as a volunteer girls’ bas-ketball coach.

Housed beneath the “world’s largest basketball,” among memorabilia from its many legendary icons, visitors to the non-profit museum can experience the history of women’s involvement in the sport. The Knoxville WBHF is the only facility in the world that honors all levels of the women’s sport, which makes it quite unique.

“We like to celebrate the athletes that are currently playing and not only honor the greats but the ones who are actually playing now,” explained Director of Op-erations and Technology Josh Sullivan.

From a huge map marking high school champion teams from across the country, to jerseys hanging in the “Ring of Honor,” visitors can glimpse names of the finest in the sport from both high school and col-lege. Professional athletes, Olympians,

and specialty women’s bas-ketball teams, like the infa-

mous All American Red Heads, are all honored with their stories. It is amazing that this entertaining, educational trea-sure is located in East Tennessee. Accord-ing to Sullivan, the WBHF was originally supposed to be built in Jackson, Tennes-see, because the NAIA tournaments were hosted there.

“Unfortunately, they could not raise the funds [in Jackson] to actually get the building built. So, Pat Summitt and Gloria Ray, two of our Hall of Fame inductees, spearheaded the effort to get the money raised and have the Hall built here in Knoxville,” said Sullivan.

In keeping with the mission state-ment, “Honor the Past, Celebrate the Present, and Promote the Future,” inter-active exhibits also allow a unique chance to learn and even envision yourself as part of the game.

“Even if people do not know a lot about women’s basketball, we want them to come in and be able to interact with the information and the history to make it more appealing,” explained Sullivan. “When people get engaged, they seem to have a better time and they actually learn a lot more.”

Some of the interactive exhibits in-clude a huddle formation where you can select a coach, stand among statues with your feet in a marked place, and hear taped segments from coaches during ac-

tual timeouts of real games. You can also hear the “locker room strategies” from championship coaches and feel part of the team in the Modern Locker Room at the WBHF.

“We want you to feel a part of women’s basketball,” said Sullivan. “That way, you learn more and get an idea of how far women’s basketball has come over the years, and we make you a fan of women’s basketball even if you might not have been before you came.” When Brad and I visited, I was immediately struck by the beauty of the bronze statue, “The Eastman,” which is per-manently displayed in the rotunda and represents the mis-sion statement. Three different women are representative of the past, present, and future areas of basketball. Annual induct-ees into the WBHF are given a smaller replica.

I was also astounded by the variety of early outfits/uniforms worn by women players. There is even an animatronic version of the “mother of women’s bas-ketball,” Senda Berenson.

While we may talk of the varying lengths of men’s shorts over the years, women originally played in floor length dresses.

“We put that uniform timeline in a couple of years ago…, and it was so inter-esting to go through pictures. They had wool bloomers and dresses and the high stockings, and they had to cover their arms. I couldn’t even imagine playing in something like that,” stated Sullivan.

According to Sullivan the roles of women players in the game have also changed much more over the years than for men. For example, it used to be viewed as unhealthy on the female body for women to play full court. At one time, the game was divided three ways.

“Most people don’t know that when the court was divided into three portions, guards, centers and forwards played only what the name implies,” explained Sulli-van. “The women used the terms literally because they couldn’t run up and down the court.”

This history is explained in “Hoop-ful of Hope,” which is a brief video about women’s involvement in the game. Shown at regular intervals in the State Farm Tip-Off Theater, the video also acclimates visi-tors to the museum.

With plenty of court space on the lower level and a large party room, the WBHF can be rented for birthday parties and corporate events. Upstairs, there is a panoramic view of Downtown Knoxville, which makes it a popular evening venue for weddings and receptions.

Actual Hall of Fame members are

selected from players, coaches, and con-tributors to the sport.

“As a player, you have to be retired for five years,” explained Sullivan. “As a coach, you have to have at least 20 years of experience, and for referees and con-tributors, you have to have at least 10 years of experience.

Although some classes have been larger, since 2003, the WBHF inducts six new members annually.

“You get six new inductees, and they’ve come from all different parts of the world,” said Sullivan. “To hear the stories of them playing basketball or coaching basketball and growing up is just so inter-esting. And to hear that rich heritage of where these people came from and how women’s basketball has helped them and shaped their lives and how they’re now giving back to women’s basketball, it’s just very interesting.”

For additional information on the Women’s Basketball Hall of Fame, visit www.wbhof.com.

Enjoying East TennesseeWomen’s Basketball Hall of Fame

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

8 > MARCH 2014 e a s t t n m e d i c a l n e w s . c o m

the infrastructure will already be in place, thereby making research more efficient and less costly.

Scott Janis, PhD, program director in the Office of Clinical Research at NINDS and the scientific direc-tor for NIH StrokeNet, explained, “We identi-fied 25 geographically distributed regional cen-ters and identified over 200 hospitals that will be part of the network. Many are primary stroke centers, but many are community hospi-tals aligned with the regional stroke par-ticipant.”

The 25 lead sites were chosen based on a demonstration of past experience in stroke research and recruitment, in-cluding the ability to enroll underrepre-sented populations. Each center has been granted five-year funding with $200,000 in research costs and $50,000 for training stroke clinical researchers per year over the first three years. The completion of milestones will drive additional funding. The University of Cincinnati has been named the national clinical coordinating center.

With the new structure in place, Janis said it should be possible to more rapidly add studies to the pipeline. NIH StrokeNet also creates a central institu-tional review board and has a built-in master trial agreement to further expedite launching new trials.

Janis also noted the network calls on a truly intraprofessional team of providers and researchers — from first responders and emergency room physicians to the specialists caring for patients acutely all the way through to ambulatory rehabili-tative therapists. By having a coordinated team across the continuum of care, includ-ing pediatric specialists in the 25 regional centers, the hope is that stroke patients will be rapidly identified and more easily followed throughout their journey.

“This network fosters communication in a collaborative way,” he said. “We can’t control when someone has a stroke, but we can control our ability to identify them for a potential study.”

Previously, the model for stroke clini-cal trials happened in a stand-alone man-ner. A large team, often over multiple centers across the country, had to be as-sembled, and the infrastructure set up for each trial. Then, once completed, the en-tire team had to be disassembled only to start the process all over again for the next study. The cumbersome method led to de-lays in patient recruitment and repeated costs to initialize new projects. Sometimes those delays caused a stroke trial to go much longer than initially anticipated, costing millions of dollars more than the original estimate.

“That effort in building and tearing down, building and tearing down, doesn’t efficiently allow us to ask the questions to move the science forward,” Janis said. Drug research to control stroke risk fac-tors has improved to the point that Janis said sometimes the medicine had moved

on by the time a stroke trial that had un-dergone delays managed to wind down. “You really want to get to answers more rapidly,” he noted.

Janis said the tipping point to change the way stroke research occurred across the country came about in a couple of dif-ferent ways. First, stroke experts identified key research priorities during a NINDS strategic planning meeting two years ago and stressed the need for an orchestrated effort. Second, Janis said NINDS al-ready had honed their ability to manage a coordinated effort through SPOTRIAS (Specialized Programs of Translational Research in Acute Stroke).

“The idea behind the network is to

take what we already know how to do and do it in a more efficient way,” Janis said.

NINDS has a long history of oversee-ing successful stroke clinical trials, includ-ing the first treatment for acute stroke, announced in 1995. Although sometimes slow, research translated from bench to bedside still has been so successful that mortality rates from stroke have declined significantly over the past decade. While still a leading cause of disability, stroke re-cently moved from the third leading cause of death in the United States to the fourth.

Janis noted funding still would be available to researchers outside the net-work when appropriate. However, he added, the goal would be to collaborate

with the network and to coordinate tri-als through the new mechanisms now in place.

“We want to be able to use this in-frastructure we’re investing in to be our frontline sites for stroke trials,” he stated.

In the Southeast, lead research sites include Emory University School of Medicine in Atlanta, Medical University of South Carolina in Charleston, Miller School of Medicine at the University of Miami, and Vanderbilt University Medi-cal Center in Nashville. Providers and researchers can learn more about the net-work and clinical trials through the new website at nihstrokenet.org.

A New View on Clinical Stroke Research, continued from page 1

projects because of the ex-tensive mechanical, electri-cal, and plumbing (MEP) infrastructure required. Builders of healthcare fa-cilities are asked to fit much more MEP infrastructure into the same amount of space as a commercial build-ing, requiring increased planning—a perfect applica-tion of the BIM process.

“For nearly 15 years, our firm has used Lean Con-struction processes to maxi-mize efficiency and minimize waste,” Messer Construction Co. Vice President Andy Lorenz said. “BIM is an important tool in the Lean process. Creating three-dimensional, vir-tual models make it possible to identify potential problems before they reach the jobsite to ensure we only build once, sav-ing significant effort and resources.”

BIM is also invaluable during reno-vation and retrofit projects. It also allows prefabrication to occur offsite for quicker installation and decreased interruptions to the daily processes of a currently operat-ing hospital or medical facility.

Lorenz noted that in East Tennessee, Messer was one of the early adopters of this relatively new technology. As an ex-ample of a successful project, Lorenz cited the 2009 construction of the Knoxville Orthopaedic Surgical Center.

“We were very pleased with how smoothly and efficiently the process worked,” said Glenn Sumner, CEO of OrthoTennessee, the parent company of Knoxville Orthopaedic Clinic (KOC). “BIM helped diminish the possibility of system conflicts and minimized change orders. Messer’s innovative construction techniques ultimately saved us time and money and allowed us to begin seeing pa-tients in our new facility quickly.”

The $8 million KOC project included a two-story, 32,500-square-foot facility with four operating rooms, a procedure room, corporate offices, and shell space for additional operating rooms. Messer completed the project early and returned significant savings to the owner, despite a month of weather delays.

“Studies show that 30 percent of the waste generated in construction is the result of miscommunication or poor in-formation,” said Andy Burg, Messer’s ex-ecutive director of operations technology services. “By using BIM, this waste can be avoided, and the project team can focus on building, rather than addressing issues as they arise.”

Burg noted three major benefits of BIM for healthcare owners:

Space management. Data available through BIM helps facility managers more accurately quantify areas to be used for re-search funding and in Medicare and Med-icaid reimbursements.

Asset management. BIM supports facility managers’ oversight of ongoing building operations and maintenance. For example, it helps them quickly determine things as simple as the type of light bulb used in each light fixture or how much carpeting is required for a particular floor of the building, which is very helpful for budget forecasting.

Energy analysis. Energy audits are helpful, but they typically only provide historical data. BIM makes it easy for fa-cilities to compare how the building was designed to operate versus how the build-ing is actually being used, helping owners determine if or why the facility is not op-erating as planned.

Messer has been using BIM across the country since 2006. A study by McGraw-Hill shows that Messer was among about 17 percent of construction companies using BIM in 2007. By 2012, the national BIM

adoption increased to 71 percent – and that was dur-ing a significant economic recession. BIM is becoming the accepted practice in the construction industry, and Messer has helped lead the charge.

In addition to its East Tennessee portfolio, Messer and its in-house Virtual Construction Group have used BIM in major health-care projects across its cor-porate footprint. Messer is currently building a 446,500-square-foot, $200

million Clinical Sciences Building for Cin-cinnati Children’s Hospital Medical Cen-ter. The entire team, including the owner, construction manager, architects, engineers and subcontractors, are using BIM to col-laborate closely on the project. BIM was used to develop an energy model that re-sulted in the owner saving $126,260 in util-ity bills annually. High performance glass, fritting, vertical and horizontal sun shades, Aircuity system, LED lighting, increased R-value roof insulation and energy efficient chillers were evaluated.

Following the building’s completion in mid-2015, Cincinnati Children’s will also benefit from the BIM model by using it as an ongoing database for all building updates, remodeling and maintenance needs, thus serving as a permanent digital record for the facility.

Messer also recently completed an $130 million medical office building and parking structure at Pikeville Medical Center in Kentucky. The construction was located immediately adjacent to the main hospital and Cancer Center en-trances. Using BIM to assemble pieces offsite and to evaluate vehicle and pedes-trian traffic flow allowed the hospital to minimize disruptions to ongoing opera-tions through all phases of construction.

“BIM is not only changing the way healthcare providers build their facilities, it is helping owners better manage their facilities once complete,” Burg said. “BIM is the future of healthcare construction.” For more information, visit http://www.messer.com.

Building Information Modeling, continued from page 1

Messer Construction Co. built the $8 million Knoxville Orthopaedic Surgical Center using Building Information Modeling (BIM). The use of BIM helped Messer complete the building early despite one month in weather delays and saved the owner significant money.

Dr. Scott Janis

e a s t t n m e d i c a l n e w s . c o m

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

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(CONTINUED ON PAGE 12)

LegalMatters

Still a Legislative Focus for 2014BY ERIN B. WILLIAMS, LONDON & AMBURN, P.C.

The past three years have seen substantial changes in the laws affecting controlled substance prescribing and pain management clinics in Tennessee. In 2011, the General Assembly enacted Public Chapter 340, which requires any practice meeting the definition of a “pain management clinic” to apply for certification from the Tennessee Department of Health to operate the clinic. This certification must be renewed every two years. In 2012, Tennessee enacted the Tennessee Prescription Safety Act, requiring practitioners to register in and check the Controlled Substance Monitoring Database (“CSMD”). Then, in 2013, the Addison Sharp Prescription Regulatory Act broadened the definition of “pain management clinic” and tightened penalties for operating an “uncertified pain management clinic.” Data provided by the State indicates that efforts to enforce these laws have increased and, based upon the new legislative bills introduced in January, it appears 2014 will hold yet more changes to the laws regulating

controlled substance prescribing and pain management clinics in Tennessee.

Increase in Enforcement and Investigations

The Controlled Substance Database Advisory Committee (“Committee”) was established as part of the Tennessee Prescription Safety Act of 2012. The purpose of the Committee is to maintain and operate the CSMD. Specifically, the Committee has a duty to use the CSMD to identify unusual patterns of prescribing controlled substances. If the Committee determines that a prescriber has an unusually high pattern of prescribing controlled substances that cannot be explained by other factors (such as the particular specialty, patient-type, or location of the practice), then the Committee may refer the prescriber to his or her licensure board for further investigation.

To that end, the Office of Investigations of the Tennessee Health Related Boards has added five new investigative positions, the

stated purpose of which was to “help pain management and excessive prescribing complaints and survey investigations” (1). Practitioners should be aware that any request for records or any other inquiry received from the investigative unit of the Health Related Boards or the Department of Health may have stemmed from information contained on the CSMD, and practitioners should timely respond to and treat seriously such investigation.

Additionally, 2013 legislation now requires the Department of Health to identify the top 50 prescribers of controlled substances in the state by July 31 of each year. The Department of Health will contact each of the top 50 prescribers and, if applicable, the prescriber’s supervising physician, both of whom must respond within 15 business days. Of the top 50 prescribers contacted in 2013, the Committee determined that 10 provided appropriate responses and the cases were closed, 38 provided inadequate responses or did not respond, and 2 were added to the active investigations (2). The licensure

type of the top 50 prescribers also varied: 16% were physician assistants, 26% were medical doctors, and 58% were advanced practice nurses (3). The practitioner’s licensure board may take disciplinary action against any of those who failed to respond or failed to do so in a timely manner.

2014 Legislative BillsThe new legislative bills

introduced in January 2014 demonstrate the General Assembly’s continued focus on enacting and modifying the laws related to controlled substance prescribing and pain management clinics. Senate Bill 1663 (HB 1512) would make more changes to the regulation of prescription drugs, including the prohibition of dispensing by medical practitioners. Another bill, Senate Bill 2000 (HB 1939), would further expand the definition of “pain management clinic” to capture even more practice types. Perhaps most significant to healthcare practitioners, Senate Bill 1630 (HB 1426) would authorize

10 > MARCH 2014 e a s t t n m e d i c a l n e w s . c o m

By CINDy SANDERS

Last year, members of the 108th Regular Session of the Tennessee Legisla-ture voted unanimously to extend the life of the Health Services and Development Agency through June 30, 2017. This action en-sured the state’s certifi cate of need (CON) program would continue, uninter-rupted, into its 44th year.

History of Tennessee’s Program

Melanie M. Hill, exec-utive director for the Ten-nessee HSDA, noted the state has relied on a CON program to drive the orderly creation and expansion of health facilities and services since 1973, a year prior to a federal mandate for such programs. In Tennessee, the Health Facilities Commis-sion administered the CON program until

2002 and was the predecessor to the cur-rent agency. Hill joined the Health Facili-ties Commission in 1998 and was named to the director’s post in 2001. The follow-ing year, the Tennessee Legislature passed the Health Services and Planning Act of 2002, which created HSDA.

“Our sole responsibil-ity is the certifi cate of need program and related activi-ties,” Hill said, adding that includes providing technical assistance and collecting data on certain medical equip-ment including MRIs, PET scanners, CT scanners and linear accelerators, among others. “There is a require-ment in the statute that the equipment be registered with the agency and that owners report usage data annually.”

After establ ishing CON programs nationwide through the 1974 National Health Planning and Re-sources Development Act,

the law was repealed in 1987, eliminating federal funding assistance for state plan-ning offi ces. However, CON programs remain in place across much of the coun-try. “There are 36 states plus the District of Columbia that have certifi cate of need programs,” Hill stated. She added each

state is different with some having more stringent requirements than others.

According to the American Health Planning Association’s website, there are 30 coverage areas for which state pro-grams might choose to require a CON. On one end of the spectrum, Vermont re-quires an application be made for all 30 of those options from acute hospital beds and air ambulances to medical offi ce buildings and ultrasound. On the opposite end of the spectrum, Ohio requires an approved CON only when adding skilled nursing/long-term care beds for projects exceed-ing $2 million in cost. With 20 service and equipment areas covered by CON regula-tions, Tennessee falls a little right of the middle.

Application TrendsThe economy and uncertainty over

the Affordable Care Act have impacted the number of CON applications being fi led in the state. Hill said, “We used to average 100-120 applications annually.” Now, she continued, “We’re probably looking more in the range of fi ve full ap-plications a month.”

She added, “In 2008, we dropped from 121 applications to 56 in 2009.”

After rebounding slightly to 62 CON applications in 2012, the number dipped down to 51 last year.

Gaining Approval for a CON

At the heart of the approval process is the need to meet three criteria:

• Answering a healthcare need,• Proving a plan is economically fea-

sible, and• Showing how the plan contributes

to the orderly development of adequate and effective healthcare facilities and ser-vices.

Actually, Hill noted, “Most applica-tions are approved. It’s a fairly strenuous process so you really have to have your information together by the time you fi le.”

Prior to fi ling an application, Hill said her agency could provide technical assis-tance to help navigate the process, impor-tant background information regarding utilization for those considering adding equipment or services, and insight into needs outlined in the state health plan.

Although applications are assessed against the state health plan, which out-lines the numbers that would indicate a community might need to add a facility or service line, Hill was quick to add there are valid reasons to override those num-bers … or lack thereof. “That’s why it is guidance and not set in stone,” she said of the health plan. Hill added, “I hope we’re never strictly ‘just numbers.’ There are certainly circumstances in each commu-

Building or Expanding Health Facilities in Tennessee? There’s an ‘App’ for ThatA Look at the State’s CON Program

FacilitiesThreshold: A modifi cation, expansion or renovation in excess of $5 million for a hospital or $2 million for other healthcare facilities.

• Hospital

• Nursing Home

• Recuperation Center

• Ambulatory Surgery Center

• Mental Health Hospital

• Intellectual Disability Institutional Habilitation Facility

• Home Care Organization (Home Health & Hospice)

• Outpatient Diagnostic Center

• Rehabilitation Facility

• Residential Hospice

• Nonresidential Substitution-based Treatment Center for Opiate Addiction

• Birthing Center

Addition of Services• Burn Unit

• NICU

• Open Heart Surgery

• Positron Emission Tomography

• Swing Beds

• Home Health

• Psychiatric (Inpatient)

• Rehabilitation (Inpatient)

• Hospital-based Alcohol & Drug Treatment (for adolescents under a program of care exceeding 28 days)

• Extracorporeal Lithotripsy

• MRI

• Cardiac Catheterization

• Linear Accelerator

• Hospice

• Opiate Addiction Treatment (provided through a facility licensed as a nonresidential substitution-based treatment center)

ActionsIn addition to the cost triggers listed under facilities, the following actions also require CON approval. Go online for details.

• Change to the bed makeup of a healthcare institution.

• Change in location or replacement of existing or certifi ed facilities providing healthcare services, major medical equipment, or healthcare institutions.

• Change of parent offi ce of a home health or hospice agency from one county to another county.

• Acquisition of major medical equipment with a cost in excess of $2 million.

• Discontinuation of obstetrics.

• Closure of any hospital that has been designated a critical access hospital or the elimination of any services for which a certifi cate of need is required in those hospitals.

What Requires a CON?As outlined by Tennessee code, certain facilities, services and actions trigger the need for an approved certifi cate of need before proceeding. Visit Tennessee.gov/hsda for more information.

Prior Approval or Notifi cation

Additionally, there are some actions that require individuals to notify or seek prior approval from the Tennessee HSDA even though a formal CON is not required. Details are available on the HSDA website.

(CONTINUED ON PAGE 13)

e a s t t n m e d i c a l n e w s . c o m MARCH 2014 > 11

The physicians of Johnson City Eye Clinic and Surgery Center are the first in the area to offer bladeless laser cataract removal procedure to their patients. The LensX® laser offers revolutionary technology for a truly cus-tomized cataract treatment for patients traveling from a five state area.

The LenSx® laser improves the way modern cataract surgery is per-formed. It is 100% customized for each unique eye. Until recently, cataract surgery required the use of a manual surgical blade to open the eye and capsule supporting the diseased lens. New bladeless laser technology provides a more advanced manner by which to perform several steps of the procedure. Johnson City Eye Clinic’s adoption of this technology is a testament to their dedication to offering the most advanced technology as an option for patients in the community.

The Femtosecond laser signifies a bold leap forward in cataract surgery by bringing image-guided computer precision to cataract surgeons. The system performs surgery according to surgeon preferences, using focused laser pulses to create incisions. Surgeons utilizing this new technology will be able to create more predictable openings that carry through subse-quent steps of cataract surgery.

This “blade-free” laser approach to cataract surgery allows the surgeon to improve the predictability of the procedure, with increased precision, ac-curacy, and faster healing time. Laser cataract surgery is the most accurate and gentle way to remove a diseased lens. With LenSx®, surgeons can now create consistent incisions that are up to ten times more precise than the manual portions of the cataract surgical procedure. The procedure takes

about 15 minutes.Customized for each unique eye, laser cataract surgery performs

advanced astigmatism treatments to ensure the very best visual result. The precision and customization of the LenSx® laser is also perfectly suited to patients seeking an improved visual outcome through a specialty lens implant, like the ReStor® or Toric® lens implants. Patients have had the option of choosing these specialty lenses for several years; lenses that help to improve vision at distance and at near. When used in conjunction with LenSx®, these lenses may mean a great deal more freedom from glasses after cataract surgery.

Johnson City Eye Clinic and Surgery Center is committed to providing patients with innovative technology, education, and treatment options.

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12 > MARCH 2014 e a s t t n m e d i c a l n e w s . c o m

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: Quillen ETSU Physicians Clinical Education Building, 325 N. State of Franklin 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

The Death Class: A True Story About Life

by Erika Hayasaki; c.2014, Simon & Schuster;$25.00 / $28.99 Canada, 265 pages

Tragedies always make you think about your own mortal-ity.

Someday, yes, you’re going to die. But as you’ll see in The Death Class: A True Story About Life by Erika Hayasaki, you need to learn to live first.

As a journalist for several larger newspapers, Erika Hayasaki had seen plenty of death. She was at Virginia Tech after the shootings a few years back. She’d seen corpses, interviewed survi-vors, she’d even been close friends with a victim of domestic violence. And it be-gan to bother her – a lot.

“I had become a journalist to try to explain… the world and its stories,” she says. “But death’s mercilessness and meaning, I could not figure out…” So when she heard about a college course taught by a popular, well-loved teacher in New Jersey, Hayasaki begged to be allowed to sit in on the class.

Dr. Norma Bowe agreed – but Haya-saki couldn’t be just a journalist in the back row. She had to participate.

So Hayasaki spent a semester fol-lowing The Death Class to morgues and autopsies. She visited a funeral home where the “sacred” happened. She took “field trips” to prisons, visited hospices, examined her own mortality, and, as the one-semester project turned into a sev-eral-years-long friendship, Hayasaki got to know Bowe and her students.

She learned that Bowe, who is a con-summate caregiver, wasn’t just a teacher. Formerly a nurse, she was a mentor, ad-vice-dispenser, calm presence, and ad-

vocate, seemingly always on the lookout for opportunities to make a difference. Bowe taught in prisons, redecorated hospices, supported a homeless girls’ shelter, and helped found an organiza-tion that fosters change. She taught that life is good, especially if you can make it better for someone else.

Above all, she encouraged her stu-dents (old and new) to call her anytime, and she came flying when they needed her. She was there for them – and vice versa, when tragedy struck too close to home.

Though it has a title that might make you think it would be dark, depressing, or even a little bit maudlin, The Death Class really is anything but.

A journalism background is appar-ent in author Erika Hayasaki’s writing, which is excellent: Hayasaki has a way of winnowing out the facts, the interest-ing stuff, small details, and tiny secrets that make us want to know more. That immerses us so well into the story of the class, students, and the professor that it’s almost easy to forget we’re reading. We become part of what’s happening, com-plete with triumphs, gasps, and stirring inspiration.

This book is fascinating, a true plea-sure to read, and I think that if you want something that puts life’s purpose into perspective, this is it.

The AIDS Generation: Stories of Survival and Resilience

by Perry N.Halkitis; c/2014, Oxford University Press; $49.95 / $54.95 Canada, 249 pages

Some of the best experiences you had last year were with your friends.

When you think back about the highlights, you remember dancing to-gether, eating together, late-night bull sessions, parties, travels, and idle man-watching. Those shared experiences are the glue that forever hold your friendship together.

Or maybe, like the men in The Aids Generation by Perry N. Halkitis, your bond is that you’re survivors.

The history of AIDS is vast and can’t be told without the stories of the people lost to the disease and the ones they left behind. Of the latter, says Halkitis, “… all the gay men of my generation, infected or not, are long-term survivors...”

Those are the men who came of age in the 1980s when “the promise for sexual freedom and sexual expression existed…” They are the men who, in the prime of their lives and when they should’ve been the picture of health, watched their friends and lovers die and who were told, upon their own AIDS di-agnosis, that they, too, would probably be dead within two years.

But, of course, that wasn’t neces-sarily true. This book, the culmination of a large-scale project on gay men who have lived with AIDS for decades, pulls together 15 survivors who were “still alive to tell their stories as middle-aged men.”

Some of them don’t remember when they learned of their diagnosis, while some remember the day clearly. Regardless, all exhibited “the pause,” as Halkitis calls the stress reaction to re-membering that time.

Some of the fifteen knew, deep-down, that they’d been infected; one said it would’ve been “a miracle… not to be positive.” For others, it came as a surprise. Some got sick, while others waited for illness that never really came. All are “resilient,” says Halkitis, and are now surprised and amazed to experi-ence the kind of normal health issues that men in middle-age endure.

“I’ve been at the worst of this vi-rus,” one of the men told Halkitis, “and now I’m in the golden years of this virus. This virus has taken me halfway around the world, and I’m still here.”

At first blush, The AIDS Genera-tion may seem like it’s more academic than not. That assessment is true; there is plenty for academics in this book, but casual readers will find something here, too.

As one of the “AIDS Generation,” author Perry N. Halkitis knew, specifical-ly, which questions to ask of his subjects in order to get the memories and emo-tions he pulled from them. That ques-tioning leads to a fresh sense of heart-ache in the telling of tales, and a distant theme of horror that bubbles with anger and ends with a general awe for life and an appealing sense of triumph. Despite linguistic stumbles that might’ve been better off edited out, that makes them compellingly readable.

theLiteraryExaminerBY TERRI SCHLICHENMEYER

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.

certain healthcare providers to place a copy of the patient’s CSMD report in the patient’s medical records. Such a change would be significant, as currently placing a copy of the report in the patient’s medical records is prohibited by laws protecting the confidentiality of the information contained in the CSMD and puts practitioners who do so at risk for penalties.

While none of the 2014 bills have been passed by either the House or Senate as of the editorial deadline of this article, it will certainly be important to monitor their progression throughout the legislative process. If the last three years are any indication, it is safe to say that 2014 will see still more changes to controlled substance prescribing laws that healthcare practitioners will have to incorporate into their practices.1. Controlled Substance Monitoring Database Advisory Committee Meeting Minutes (8-21-12), available at https://health.state.tn.us.

2. Controlled Substance Monitoring Database Advisory Committee Meeting Minutes (10-8-13), available at https://health.state.tn.us.

3. Ibid.

Erin B. Williams is an attorney practicing at London & Amburn, P.C. Her practice includes medical malpractice defense and health law issues, including board investigation defense and regulatory compliance. For more information on the CSMD or other health law matters, you may contact Ms. Williams at (865) 637-0203 or visit www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

Still a Legislative Focus, continued from page 9

e a s t t n m e d i c a l n e w s . c o m MARCH 2014 > 13

Knoxville MGMA Monthly MeetingDate: 3rd Thursday of each month

Time: 11:30 AM until 1:00 PMLocation: Bearden Banquet Hall, 5806 Kingston Pike,

Knoxville, TN 37919Lunch is $10 for regular members.

Come learn and network with peers at our monthly meetings. Topics are available on the website.

Registration is required. Visit www.kamgma.com.

Chattanooga MGMA Monthly MeetingDate: 2nd Wednesday of each month

Time: 11:30 AMLocation: The monthly meetings are held in Meeting Room A of the Diagnostic Center building, Parkridge Medical Center, 2205

McCallie Avenue, Chattanooga, TN 37404 Lunch is provided at no cost for members, and there is currently no cost to a visitor who is the guest of a current member. Each member is limited to one unpaid guest per meeting, additional guests will be $20 per guest. All guests must be confi rmed on

the Friday prior to the meeting.RSVP to Irene Gruter, e-mail: irene@chattmedsoc.org or call

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

3RD THURSDAY 2ND WEDNESDAY

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

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

HMG’s Nichole Skirvin Earns Award from 2013 US Clinical Researcher of the Year

KINGSPORT – Holston Medical Group (HMG) Clinical Research Process Special-ist Nichole Skirvin has been awarded Pharma Silver in the Study Nurse/Clinical Re-search Coordinator category for the 2013 US Clinical Re-searcher of the Year compe-tition.

The US Clinical Re-searcher of the Year competition tests pro-fessional skills through a program of compe-tency-based exercises devised and judged by a panel of senior industry experts in Clini-

cal Research. Nichole plays a vital role in the success

of the Clinical Research studies at Holston Medical Group. As a Research Process Spe-cialist, her duties include business develop-ment, quality assurance monitoring, infor-mation technology, training support, and study coordinating. Holston Medical Group Clinical Research (HMG CR) has been im-pacting lives through the conduct of clinical studies since 1996. With six locations across the Tri-Cities, HMG CR has conducted over 740 phase I-IV pediatric and adult clinical trials with its physician investigators having extensive experience in many disease states and conditions.

To learn more about HMG Clinical Re-

search, please visit www.holstonmedical-group.com.

Mungara Joins Wellmont CVA Heart Institute as Cardiothoracic and Vascular Surgeon in Bristol

BRISTOL – Dr. Charan Mungara, a cardiothoracic and vascular surgeon, has brought his impressive skill set to Bristol Regional Medi-cal Center as one of the new physicians at the Wellmont CVA Heart Institute.

Mungara specializes in surgery for various heart and lung diseases, but he is also trained to treat all forms of vascular disease. He will primarily work with Drs. Bill Messerschmidt and Marcus Wil-liams to continue the tradition of excellence at Bristol Regional. All three physicians are medical doctors.

A second-generation physician, Dr. Mungara follows in the footsteps of his fa-ther, who took care of patients around the globe while he worked for the World Health Organization. His sister is also a practicing physician.

Mungara graduated from The Univer-sity of Mysore in Karnataka, India, with a bachelor’s degree in medicine and surgery. He completed general surgery residencies at Carraway Methodist Medical Center in Birmingham, Ala., and University of Wiscon-sin Hospital and Clinics in Madison.

He finished his training with fellowships in cardiothoracic surgery at the University of Wisconsin and cardiothoracic and vascular surgery at Indiana University Health Arnett Hospital. He is certified by the Thoracic Board of Surgery.

Mungara said his passion as a physician has always been to work on hearts and lungs, and he focuses on performing minimally in-vasive procedures whenever possible. When patients undergo a less invasive procedure, they experience less pain, go home more quickly and return to their normal activities faster.

Wellmont Selects Presidents for Holston Valley, Bristol Regional and Community Hospital Division

KINGSPORT – Three stellar executives with vast experience in healthcare have been selected to serve as the presidents of Wellmont Health System’s two largest hospitals and the commu-nity hospital division.

Tim Attebery was serv-ing as interim president for Holston Valley Medical Center, and Greg Neal was serving in the same position for Bristol Regional Medi-cal Center. Fred Pelle was interim president for the community hospital division, which consists of Mountain View Regional Medical Cen-ter, Lonesome Pine Hospital, Hawkins County Memo-rial Hospital and Hancock County Hospital.

Attebery has a 27-year healthcare career with a vari-ety of physician practice and hospital leadership roles. Now, he takes the helm of Holston Valley, which U.S. News & World Report named in 2013 as one of the top three hospitals in Tennessee and high performing in 11 services, including cardiol-ogy and cancer.

Neal brings more than 20 years of ex-perience with Wellmont to the helm of Bris-tol Regional and previously served as the hospital’s chief operating officer. He was the president of the community hospital division when he became interim president of Bristol Regional.

Pelle, a 30-year healthcare veteran, was serving as chief operating officer of Moun-tain View Regional, Lonesome Pine, Hawkins County Memorial and Hancock County when he was selected as interim president.

nity that are unique to that community.”For example, she said population

figures alone might not warrant the ad-dition of a second MRI in a community. However, she continued, if the owner of the current MRI doesn’t accept many insurance plans, or doesn’t participate in TennCare, or has excessive wait times for appointments, then circumstances could demonstrate a need for a second MRI op-erator in that area.

Hill added the monthly CON meet-ings are open and transparent … and highly participatory. She said those for and against an application are welcome to come to the meeting and are given an opportu-nity to speak. She added that when an ap-plication is controversial, her team has even held town hall meetings to allow residents to voice concerns. She noted this extra step isn’t requested very often, though.

Ultimately, an 11-member board decides the fate of a CON application. There are three consumer appointees — one each from the speaker of the house, governor and lieutenant governor. Three more board members are state officials with the comptroller, commissioner for Commerce and Insurance and the di-rector of TennCare each designating an appointee. The remaining five board members are chosen by the governor with one each being selected to represent home health, surgery centers, nursing homes, hospitals and physicians. While the related associations often provide a list of possible appointees, the selection is at the gover-nor’s discretion.

The Big PictureAlthough various groups have looked

to limit or abolish the CON process, particularly during years when HSDA is under sunset review, there are many staunch supporters of the system. The Tennessee Hospital Association listed keeping the CON program running in its current format among its top legislative priorities last year.

“In Tennessee, we’ve had a CON program for 40 years. It’s a very stable process, and it’s one the healthcare indus-try understands,” Hill said. “I think it’s a growth management tool, and also it’s a

cost savings tool.” Hill said perhaps one of the most im-

portant functions of her agency is to help ensure quality programming is available in Tennessee. The impact of the CON process on cardiovascular surgery out-comes has been the focus of a number of studies. Hill said, “A 2002 report from the University of Iowa College of Medicine showed states without CON programs for open heart surgery had a 21 percent higher mortality rate.”

Similarly, she continued, when the Pennsylvania CON law expired, the state saw an influx of open heart surgery pro-grams … quickly growing from 35 to 62. “They saw morbidity and mortality increase,” Hill said. “Any time you see that dramatic growth, you are decreasing volume for surgeons.” Less volume … less experience, she pointed out.

Hill concluded, “You still have people who say the CON process is anti-competi-tive, but it’s really not … it provides a level playing field.”

Building or Expanding, continued from page 10

GrandRounds

Nicole Skirvin

Dr. Charan Mungara

Tim Atteberry

Greg Neal

Fred Pelle

14 > MARCH 2014 e a s t t n m e d i c a l n e w s . c o m

Jaber Joins Wellmont CVA Heart Institute

KINGSPORT – Dr. Raffat Jaber, a high-caliber vascular and endovascular surgeon who completed training at one of the premier hospitals in his field, has joined the Wellmont CVA Heart Insti-tute.

A medical doctor, Jaber will see patients at The Heart Center, 2050 Meadowview Parkway, and perform a variety of noninva-sive and minimally invasive procedures, as well as traditional surgeries, at Holston Val-ley Medical Center. He will improve the lives of patients with conditions such as carotid artery disease, aortic abdominal aneurysms and peripheral artery disease.

Jaber obtained his medical degree from Kuban State Medical Academy in Kras-nodar, Russia. He finished a general surgery residency at University of New Mexico Hos-pital in Albuquerque and internal medicine and surgery residencies at Loma Linda Uni-versity Medical Center in Loma Linda, Calif.

He then embarked on two fellowships – vascular and endovascular surgery at Har-bor-UCLA Medical Center in Torrance, Ca-lif., and advanced endovascular surgery at the Arizona Heart Hospital in Phoenix. Both of these were high-volume hospitals, and Arizona Heart is considered one of the elite endovascular training facilities in the United States.

Jaber was also pleased to learn Well-mont Health System has a robust wound care program, including the use of hyperba-rics at Holston Valley, Bristol Regional Medi-cal Center and Lonesome Pine Hospital. He said that is essential for vascular patients, many of whom have nonhealing wounds

CrestPoint Health has become the fastest growing Medicare Advantage Plan in the Region

JOHNSON CITY - Locally owned and operated CrestPoint Health, which is based in Johnson City, has seen rapid growth in Medicare Advantage membership over the past year, thanks to community members who value the benefits that a local plan can

bring. CrestPoint created its plans based on the region’s needs, and to give people in the community an option close to home. 

Enrollment figures just released from the Centers for Medicare & Medicaid Ser-vices show that CrestPoint had an overall increase of 644 percent when it came to new member enrollments for Medicare Ad-vantage plans from August 2013 to January 2014.

CrestPoint Health was created to serve the health needs of the thousands of Moun-tain States Health Alliance caregivers - who themselves provide health care to the com-munity - and their families.  CrestPoint has been so successful at meeting those needs, that it now serves its employees’ parents and neighbors with the Medicare Advan-tage program.

CrestPoint offers Medicare Advantage plans in Carter, Greene, Hancock, Hawkins, Johnson, Sullivan, Washington and Unicoi counties in Tennessee.

 HMG welcomes Puckett to Occupational Medicine

KINGSPORT - In conjunction with se-lection of Dr. Samuel Breeding as incoming Chief Medical Officer/Medi-cal Director, Holston Medical Group (HMG) welcomes Ter-ry Puckett, MD, FACOEM, back to HMG Occupational Medicine at Medical Plaza, Suite 1J, 105 West Stone Drive, Kingsport, Tenn.

Having previously served as Chief Operating Officer and oc-cupational medicine physician with HMG, Puckett returns with extensive healthcare and leadership experience. Following his prior experience with HMG, Puckett be-came the Director of Occupational Health Services with Mountain Home Veterans Af-fairs Medical Center.

Board Certified by the American Board of Preventive Medicine, Puckett has served in numerous medical capacities with the military, including Deputy Chief of the Navy Medical Corps, senior military physician with the DoD Center for Education and Research in Patient Safety, and senior aerospace med-icine specialist for the US Navy and Marine Corps.

Puckett received a Bachelor of Science degree from William Jennings Bryan Col-lege in Dayton, Tenn., and his medical doc-torate degree from the University of Tennes-see College of Medicine in Memphis, Tenn. His post graduate experience includes a concentration in family medicine at Na-val Hospital Charleston in Charleston, S.C. Puckett earned his master of public health degree in healthcare systems management from Tulane University in New Orleans, LA.

Puckett’s residency was in aerospace medicine with the Naval Operational Medi-cine Institute in Pensacola, FL. He is a fellow of the American College of Occupational Medicine and Environmental Medicine.

Both physicians are certified as medical examiners with the Department of Transpor-tation and are certified Medical Review Of-ficers.

GrandRounds

Dr. Raffat Jaber

Dr. Terry Puckett

(CONTINUED ON PAGE 15)

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Mountain States Foundation; Andy Dietrich, Champion co-owner; Joe Herman; Pat Holtsclaw, Mountain States Foundation president; Tim Copenhaver, Champion co-owner.

Spirit Gala Raffle winner to donate winnings back to good causesJOHNSON CITY – Mountain City’s Joe Herman was the lucky $25,000 winner of Mountain

States Foundation’s Spirit Gala Raffle – and then he promptly went about giving it all away.Herman, president and owner of Danny Herman Trucking, won his choice of one of three

new cars or $25,000 in cash, provided by Champion Chevrolet Cadillac, and he chose the mon-ey. Then Herman said he would donate it to the Johnson County Community Hospital Foundation – which is part of Mountain States Foundation – as well as to four oth-er organizations in the Mountain City area.

“When I bought three of the raffle tickets, I said a little prayer. I said, ‘If I win it, I’ll donate it.’ So you don’t go back on something like that,” he said.

The raffle was part of Moun-tain States Foundation’s Spirit Gala, which is raising money to outfit the new Radiation Oncology Center at Johnson City Medical Center (JCMC), including purchase of a new linear accelerator that pro-vides extremely precise radiation treatment. The Spirit Gala, Raffle and Prelude events, all held in January, netted more than $200,000. The Foundation’s fundrais-ing goal is $7 million for the Radiation Oncology Center and the total is at about $4.8 million.

Tickets for the raffle were sold at $50 apiece. The prize choices were any one of a 2014 Cadillac SRX, a 2014 Chevrolet Impala, a 2014 Chevrolet truck or the $25,000 cash. This marked the seventh year Champion Chevrolet Cadillac has offered the grand prize for the raffle, and over those years the dealership has given away $75,000 and four new cars.

Along with the Johnson County Community Hospital Foundation, the causes Herman will donate to are:

• Johnson County Community Foundation• St. Anthony Catholic Church in Mountain City for their food pantry• Summit Leadership Foundation in Johnson City• Fellowship of Christian AthletesHerman said he’s bought tickets to the Spirit Gala Raffle for the last several years. His busi-

ness gives to various good causes every year. But this was the first time Joe has personally won anything so substantial.

“I just had the lucky number on a football board for a couple of quarters in the Super Bowl ,” he said, laughing, “and after winning the raffle, my friends said, ‘You oughta play the lottery!’”

The raffle drawing was held Jan. 26 in Johnson City at The Millennium Centre. Herman was at home in Mountain City with his wife and youngest son at the time, so Holtsclaw quickly called to give him the news.

On Thursday at the check presentation at Champion Chevrolet Cadillac, Herman shrugged off any praise for himself, saying he was nothing special – “I’m just Joe.”

e a s t t n m e d i c a l n e w s . c o m MARCH 2014 > 15

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Blevins Joins Wellmont Medical Associates Physical Therapy

ABINGDON, Va.  – Barret Blevins has joined Wellmont Medical Associates Physi-cal Therapy, contributing to the comprehensive, high-quality care available from  Wellmont Health Sys-tem at Exit 19 off Interstate 81.

From postoperative re-habilitation to sports medi-cine, Blevins provides a range of physical therapy services in his practice, which is lo-cated at 24530 Falcon Place Blvd. Suite 203. He comes to the practice with several years of experience and extensive knowledge of the region, having been born at Bristol Me-morial Hospital and raised in the Abingdon area.

This background and his familiarity with Wellmont and its reputation of improving patients’ lives led him to choose Wellmont Medical Associates.

Blevins obtained a Bachelor’s degree in physical education from Emory & Henry Col-lege and a doctor of Physical Therapy de-gree from Virginia Commonwealth Univer-sity. When he began treating patients, one of his many skills helped him considerably.

Blevins is a member of the American Physical Therapy Association and the Na-tional Athletic Training Association. He is also a volunteer athletic trainer for Washing-ton County schools.

Frontier Health Announces Spanish Links on Web Site Get Help Pages

JOHNSON CITY - Frontier Health just added Spanish translation Get Help (Con-siga Ayuda) pages for the behavioral health care organization’s web site. The Get Help pages link individuals with potential needs to key Frontier Health services.

The Get Help menu tailors potential needs by service area including Crisis Re-sponse (Respondiendo a Crisis), Suicide Pre-vention (Prevención Suicida), Children and Teens in Crisis (Niños y Adolecentes en Cri-sis), Runaways (Menores que Huyen de sus Hogares), Domestic Violence (Violencia Do-mestica), Mental Illness (Salud Mental), Drug and Alcohol Addiction (Adicción a Droga y Alcohol), Developmental Disabilities (In-capacidad de Desarrollo), Deaf or Hard of Hearing (Sordo(a) o Incapacidad Auditiva), and Psychological Testing (Evaluaciones Psi-cológicas).

The content for the site, www.frontier-health.org, is written so that family members or friends of those who many need help can find the care they need. Crisis informa-tion is available throughout the site. Frontier Health’s interactive site also features simple navigation, eye-catching graphics and links to online resources for advocacy, informa-tion and support including self-screening tests for depression, bipolar disorder and alcohol or drug addiction. The service guide navigation offers many ways to identify ser-vices and facilities that are offered in North-east Tennessee and Southwest Virginia.

Ayers Foundation donates $1 million to JCMC radiation oncology campaign

KINGSPORT – At a recent event to hon-or retiring MSHA CEO Dennis Vonderfecht, the biggest award of the evening went to the area’s cancer patients – a $1 million donation to Mountain States Foundation’s radiation oncology campaign, given in Vonderfecht’s name by Unicoi County philanthropists Jim and Janet Ayers.

“Jim and I are pleased to announce that we will make a $1 million contribution in your honor and in recognition of your retire-

ment and your legacy, and for what you’ve done for Mountain States and the new can-cer center,” Janet Ayers said to Vonderfecht during the celebration, which took place at MeadowView Conference Resort & Conven-tion Center Jan. 9.

The Mountain States Foundation is in the midst of a major capital campaign to fund the new radiation oncology center at Johnson City Medical Center. The new cen-ter will provide state-of-the-art cancer-fight-ing technology as well as improved efficiency that will make scheduling and appointments more convenient for patients. To complete

the project, the Mountain States Foundation needed to raise a total of $7 million.

Jim Ayers is the sole shareholder of FirstBank, the largest independently owned bank in Tennessee. He created The Ayers Foundation in 1999, whose mission is to improve the quality of life for the people of Tennessee with a special emphasis on Deca-tur, Henderson, Perry and Unicoi counties.

The Ayers have a strong connection to their home counties and a desire to give back to the communities in which they live and work.

GrandRounds

Berret Blevins

… one of the many highly trained surgeons and specialists available to you in our heart care family.

Dr. Steven Hopkins, Vascular SurgeonJohnson City Medical Center

1-855-655-5111For more information about Mountain States Heart Care, call toll-free