tri cities medical news october 2014

Dr. Harold Dillon

PAGE 2

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

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

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

Reimbursement RevisitA Look at payment innovation

(CONTINUED ON PAGE 8)

By BRiDGeT GARLAnD

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

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

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

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

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

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

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

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

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

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

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


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PhysicianSpotlight

By Joe MoRRis

It takes a special combina-tion of skills to be a fi ghter pilot, not the least of which is having spectacular eyesight. So in a way, it’s not a total surprise that Dr. Harold Dillon wound up as an ophthalmologist. Still, it wasn’t a direct path from the cockpit to be-coming Chief of Surgery Service at James A. Quillen Medical Cen-ter in Mountain Home.

“I graduated from college with a degree in biology and psychology from East Tennessee State University (ETSU), but soon after I did that and met my wife, I went into the U.S. Air Force as a fi ghter pilot,” Dillon recalled. “I aspired to medical school when I was young, but also wanted to fl y. I knew that I could fl y when I was younger, but not as I got older, so I got that out of the way fi rst.”

He took F-4E Phantom IIs and F-4G Wild Weasel aircraft into the skies over Germany, and also served as a T-38 instructor pilot at Vance Air Force Base in Oklahoma during his military ca-reer. At the same time, he also was ap-plying for medical school and eventually returned to ETSU to study medicine, and then it was back to the Air Force for the Pilot Physician Program, which allowed him to fl y from the front seat and also provide fl ight medicine.

“I did a deployment to Saudi Arabia around that time, fl ying Operation South-ern Watch missions, and about that time got interested in ophthalmology,” he said. “I was particularly interested in what was going on around refractive surgery, and how that was going to impact the military

— especially aviators.”At the time, most pilot physicians

went into aerospace medicine, which Dil-lon said is a fi ne idea, but he felt that the Air Force needed someone who really un-derstood its needs. The right people agreed with him, so he became ophthalmology resident at Wilford Hall Medical Center in San Antonio, and then was at Langley Air Force Base for fi ve years. While there, he became the Chief of Human Systems Integration, which meant working to see how humans could be best integrated into new equipment and planes.

After all that, he opted for private practice in South Carolina. It didn’t last long.

“That was 2005, and I’d been in the

service for more than 23 years, so I thought I was ready to go,” Dil-lon said. “I went to South Carolina and opened a private practice, but it just wasn’t a good fi t for me. I needed to get back to veterans, so I relied on my contacts here to come back, which I did in 2008.”

Since coming to Quillen, he has worked in ophthalmology as well as serving as Laser Safety Offi ce, Chief of Surgical Subspe-cialties, and Physician Utiliza-tion Management Advisor. He’s also working as a Clinical Assis-tant Professor of Surgery. Most recently, he was named Chief of Surgery Service.

“It feels a bit odd to be an ophthalmologist and also chief of surgery service, but it’s worked out pretty well,” he noted. “Most of the people who work for me and with me know me pretty well, and I’m able to divide my time be-tween administration three days

a week, half a day of surgery, and then a full day of clinic work. Our chief of staff is adamant about my keeping my hand in, not just because it keeps me up to speed medically, but also makes sure that I am using the same systems everybody else is using. Plus, I really want to stay grounded with the people here, and I can’t do that if I’m not down in the trenches with them.”

Practicing medicine within the Vet-erans Administration brings its own chal-lenges, some of which mean that he and his surgeons don’t always have access to the absolute newest equipment. He’s quick to point out that what they work with is top-notch, but sometimes private practice will just get the newer technology a little bit faster.

One advancement he’s eager to see is new artifi cial lenses that allow the recipi-ent to have improved vision both close up and at a distance.

“Those lenses are out there, but they’re not quite perfected,” he said. “The person who perfects them is going to do very well because a lot of baby boomers are getting cataracts, and if you can give them their near and distance vi-sion back, pretty much all of them are going to want to participate in that!”Improvements in laser treatments, as well as advances in dealing with macular de-generation, also give him a great deal of optimism for the future of his profession. The trick will be making sure that he’s got the practitioners, and the room, to keep up with demand.

“The VA doesn’t skimp on buying equipment, and our outcomes are excep-tionally good,” he said. “We just don’t have enough physicians to provide service as quickly as we need to. It takes a long time to hire someone — with orthopae-dic surgeons, it can be almost two years to bring one on board full time. We also need to upgrade our building so that we can do more specialty and subspecialty work. There are a lot of impressive things going on with robotics, for example, and we want to be on top of that.”

More providers, more space, adding to the workday due to rising patient load … it’s all part of the challenge, but Dillon says he is eager to meet it.

“We want to offer a broader spec-trum of care, and increase the complexity of some procedures,” he said. “There are a lot of things we do very well here, it’s just a matter of sorting out the strategy to expand, and then putting that plan into place so that everyone who needs us has access.”

Top-fl ight physicianAll eyes are on ophthalmologist Dr. Harold Dillon, which is fi ne by him

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

By LeiGH Anne w. HooVeR

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

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

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

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

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

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

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

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

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

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

According to Oakes, the designer uses

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

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

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

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

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

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

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

“Rat rac-ers are something

we saw at another farm, and you just get

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

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

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

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

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

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

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

ers are something we saw at another

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

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

Enjoying East TennesseeCorn Maze and Pumpkin Patch at Oakes Farm

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

HealthcareLeader

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

BY JOE MORRIS

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

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

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

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

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

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

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

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

ing.“Reimbursements are diminishing,

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

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

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

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

That includes actual physical interac-

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

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

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

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

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

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

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

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

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

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By Dennis Rowe

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

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

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

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

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

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

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

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

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

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

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

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

EMS Companies Can Get Ahead of the Healthcare Curve



By HeATHeR RiPLey

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

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

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

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

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

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

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

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

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

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

2. Defi ne acceptable social media use while working

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

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

More concerning to healthcare pro-

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

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

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

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

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

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

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

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Healthcare in the United States is facing unprecedented pressures requiring industry leaders to navigate legislation and meet the demands of changes required by new healthcare laws. This evolution de-mands professionals be as skilled on the business side of the industry as they are at a patient’s bedside, requiring skills far beyond formal medical education.

The University of Tennessee, Knox-ville, College of Business Administration is helping healthcare professionals around the world learn to thrive in the business environment through a collection of in-novative education programs designed specifically for healthcare.

Executive MBA for Healthcare Leadership

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

physical therapists, physician assistants, administrators, quality engineers, and those involved in research and develop-ment.

The 11-month program combines distance learning with four residency periods: three one-week sessions at the University of Tennessee campus and a one-week healthcare policy immersion trip to Washington D.C. One of the pro-gram cornerstones is the residency in our

nation’s capital. Through a partnership with the Washington Campus, a non-profit association, students will gain “real time” perspective on healthcare through meetings with government insiders, legis-lators, and officials.

“The healthcare leadership program is for individuals wanting more than just an ‘MBA’ designation after their name,” stated Kate Atchley, Executive Director of Executive-Level MBAs. “Students will be

forced to think differently about their or-ganization and the overall industry, com-pleting the program with a renewed sense of empowerment to positively transform healthcare in their com-munities.”

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

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

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

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

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

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

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

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

Bundled PaymentsLazerow said bundled payments offer

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

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

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

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

Shared Savings ModelsAlthough bundled payments might

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

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

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

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

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

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

The Bottom LineLazerow noted he hears different

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

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

Reimbursement Revisit, continued from page 1

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

New Advances and Technologies

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

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

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

And for patients with diabetic reti-

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

Nutrition and SupplementsAlong with the recommended eye

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

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

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

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

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

Other Reminders for Healthy Senior Eyes

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

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

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

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

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

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

An Eye on Senior Health, continued from page 1

Dr. Peter Lemkin

Dr. James W. Battle

Dr. Randal J. Rabon

Rob Lazerow


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MISSION STATEMENTThe Johnson City Eye Clinic’s mission is to

provide personalized attention, excellent

service, and unparalleled comprehensive eye

care to you, your family and our community.

We will continue to achieve this goal with

three core values. Our doctors and staff will

use innovative technological advancements

in treatment, diagnostics and prevention. We

will always provide superior education to our

patients, doctors, staff and community. We

recognize every patients’ importance.

• Cataract & Intraocular Lens Microsurgery

• Laser Assisted Cataract & Refractive Surgeries

• Age Related Macular Degeneration

• Medical and Laser Treatment of Diabetic Eye Disease

• Glaucoma Surgical and Medical Management

• Pediatric Ophthalmology

• Adult Strabismus

• Neuro-Ophthalmology

• Corneal Disease and Surgery

• LASIK

• Cosmetic Plastic & Reconstructive Surgery

• Eyelid/Eyebrow Surgery

• Botox/Dysport

• Cosmetic fi llers

• Facial Resurfacing

• Hyperpigmentation Correction

• Chemical Peels






MISSION STATEMENTThe Johnson City Eye Clinic’s mission is to

provide personalized attention, excellent

service, and unparalleled comprehensive eye

care to you, your family and our community.

We will continue to achieve this goal with

three core values. Our doctors and staff will

use innovative technological advancements

in treatment, diagnostics and prevention. We

will always provide superior education to our

patients, doctors, staff and community. We

recognize every patients’ importance.

• Cataract & Intraocular Lens Microsurgery

• Laser Assisted Cataract & Refractive Surgeries

• Age Related Macular Degeneration

• Medical and Laser Treatment of Diabetic Eye Disease

• Glaucoma Surgical and Medical Management

• Pediatric Ophthalmology

• Adult Strabismus

• Neuro-Ophthalmology

• Corneal Disease and Surgery

• LASIK

• Cosmetic Plastic & Reconstructive Surgery

• Eyelid/Eyebrow Surgery

• Botox/Dysport

• Cosmetic fi llers

• Facial Resurfacing

• Hyperpigmentation Correction

• Chemical Peels


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LegalMatters

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

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

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

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

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

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

What happens if a billing error is identifi ed?

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

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

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

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

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

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

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

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

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

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

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

What happens if my contract is terminated?

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

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

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

Attorneys Diana L. Gustin and Erin B. Williams focus their practice on healthcare compliance and regulatory matters. For more information on any health law or compliance matters, you may contact Ms. Gustin or Ms. Williams at (865) 637-0203 or visit www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

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

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

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

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

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

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

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

Hospital Leadership 2014

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

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

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

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

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

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

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

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

Dr. B.J. Smith

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ClinicallySpeakingBY STEVEN M. DOETTL, AU.D.

Dizziness……What Next?Dizziness accounts for millions

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

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

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

increased fall risk in elders with these problems.

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

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

nerve, and the utricle and saccule in each ear.

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

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

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

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

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

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

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

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

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

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

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

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

East Tennessee Children’s Hospital Gastroenterology and Nutrition Services

accepting new patients

GI for Kids, PLLC


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

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

Tickets: $35; Seniors (65+) $30; Students $10

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

String Theoryfeaturing Jessica Miskelly, Violin

Sponsored by Carnegie Hotel

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

Evening ProgramEdward Elgar: Serenade for Strings

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

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

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

The Literary ExaminerBY TERRI SCHLICHENMEYER

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

You can’t find your keys. Again.

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

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

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

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

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

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

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

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

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

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

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

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

in Canada, 215 pages

It was supposed to be paradisiacal.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It was supposed to

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

other’s now a caregiver,

with progressive illness. That bluntness and

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

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

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Knoxville MGMA Monthly MeetingDate: 3rd Thursday of each month

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

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

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

Registration is required. Visit www.kamgma.com.

Chattanooga MGMA Monthly MeetingDate: 2nd Wednesday of each month

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

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

the Friday prior to the meeting.RSVP to Irene Gruter, e-mail: [email protected] or call

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

3RD THURSDAY 2ND WEDNESDAY

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

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

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

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

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

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

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

EMS, continued from page 5

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

Physician Executive MBA Program (PEMBA)

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

Executive Education ProgramsBeyond traditional degree programs,

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

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

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

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

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

Developing Leaders, continued from page 7

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

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

JOHNSON CITY MGMA MONTHLY MEETING

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

Location: Summit Leadership Foundation3104 Hanover Rd.

Johnson City

KINGSPORT MGMA MONTHLY MEETING

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

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

Second Floor, Kingsport

2ND THURSDAY 3RD THURSDAY


GrandRounds

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

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

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

Academic Internal Medicine Opportunities

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

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

Anderson Compounding Pharmacy Staff Members Receive Training at U.S. Pharmacopeial Convention

BRISTOL — Two Anderson Com-pounding Pharmacy staff members recently participated in the Global Education and Training Program hosted by the U.S. Phar-macopeial Convention (USP) in Rockville, Maryland.

Microbiologist Chad Trent, Ander-son’s director of sterile preparations, and Tanya Gragg, a certified pharmacy techni-cian who supervises Anderson’s laboratory operations, attended programs in July that addressed the USP’s standards for sterile and non-sterile compounding guidelines, known as USP standards <797> and <795>, respectively.

USP is a nonprofit organization that sets scientific standards designed to im-prove the quality of medicines. USP <797> standards set requirements for preparing, testing, and verifying sterile compounded medications, while the USP <795> stan-dards establish similar requirements for non-sterile compounds. These standards help compounding practitioners adhere to widely acknowledged, scientifically sound procedures and practices, and facilitate the delivery of consistent and good-quality compounded medicines to patients.

Compliance with the USP standards is considered necessary for quality com-pounding. Twenty-nine states require phar-macies to comply with USP <797> stan-dards.

“It is important for compounding phar-macists to understand and comply with the guidelines set forth by the U.S. Pharmaco-peial Convention,” says Cleve Anderson, DPh, owner and chief pharmacist of Ander-son Compounding Pharmacy.

Anderson Compounding Pharmacy re-cently added Ultra High Performance Liquid Chromatography (UHPLC) verification on select formulations, a benefit provided by a limited number of pharmacies throughout the United States. UHPLC verification as-sesses the potency of ingredients in a medi-cation. Anderson Compounding Pharmacy is the only compounding pharmacy in the state of Tennessee to own and operate the UHPLC on a daily basis.

Additionally, earlier this year, Ander-son became the only compounding phar-macy in Tennessee to earn both the Phar-macy Compounding Accreditation Board’s (PCAB®) Seal of Accreditation and the Healthcare Quality Association on Accredi-tation’s (HQAA) Seal of Accreditation. An-derson’s designation as a PCAB-accredited pharmacy demonstrates that the pharmacy meets the highest quality and safety stan-dards in its profession. Anderson is only the sixth compounding pharmacy in the state of Tennessee to earn this distinctive accredita-tion.

Chris Spencer Named Wellmont’s Vice President of Revenue Cycle

KINGSPORT – Chris Spencer, who has helped Wellmont Health System success-fully launch its electronic health record and ensure programs are in place for people to find insurance, has been promoted to vice president of revenue cycle.

Spencer served as executive director

of revenue cycle since he joined Wellmont in 2013 un-til he was recently elevated to his new position. He has responsibility for about 250 co-workers and oversees all hospital billing, professional billing, patient responsibility billing, pre-service and patient access de-partments.

The revenue cycle incorporates all business functions that occur outside of clinical care. The money this area generates enables Wellmont to purchase life-saving equipment, meet payroll and maintain its physical plant.

Spencer played an important role in the startup of the Epic electronic health record. During the initial launch with Well-mont Medical Associates, he reached out to front-line staff and provided education and assurance. When all Wellmont hospitals went live in March, Spencer helped ensure one of Wellmont’s larger hospitals achieved its goals in record time.

He said he chose to work at Wellmont to seek additional professional opportuni-ties and was attracted to working with the Epic product.

Before joining Wellmont, Spencer was director of revenue cycle and financial plan-ning for CamdenClark Medical Center in Parkersburg, West Virginia.

Takoma Regional’s Joanie Scott Receives National Certification As Diabetes Educator

GREENEVILLE – Joanie Scott, a di-etitian at Takoma Regional Hospital, has earned national certification as a diabetes educator.

Scott graduated from Murray State University in Murray, Ky., with a bachelor’s degree in nutrition. She also received a mas-ter of medical science degree from Emory University in Atlanta.

Scott teaches Takoma’s physician-re-ferred classes for people with diabetes and their family members. Co-teachers include Louisa Hammer, a registered nurse who also is a certified diabetes educator, and dietitian Dawn Wright. Classes are offered twice a month, with 3-month and 12-month follow-up sessions included free in the pro-gram.

In addition, Takoma offers a monthly diabetes support group that meets the sec-ond Monday of each month from 11 a.m.-noon in the Everett and Carolyn Coolidge Volunteer Conference Center at the hospi-tal.

“Our team is dedicated to providing a comprehensive plan of diabetes care,” Scott said. “We work closely with our pa-tients to teach them how to self-manage their disease.”

Trimble named CEO of Mountain States’ regional operations in Washington CountySystem taps clinical leader with nursing and extensive leadership background

JOHNSON CITY – Melody Trimble has been named CEO of the Washington Coun-ty operations of Mountain States Health Alli-ance, health system officials announced this week. In her role, Trimble will serve as CEO of Johnson City Medical Center and its sub-

sidiaries and will also have oversight for all Washington County operations.

Trimble comes to Mountain States having served in various healthcare leadership roles for more than 20 years. Starting her career as a nurse, and work-ing in various nursing positions up to her service as a chief nursing officer, Trimble was then tapped to lead hospital organizations in multiple states as a chief executive offi-cer. Most recently, she served as president of an operating group of hospitals consist-ing of 35 hospitals and multiple physician practices and surgery centers in Washing-ton, Texas, Oklahoma, Alabama, Arkansas, Mississippi, South Carolina, North Carolina, Georgia, and Pennsylvania, representing more than $3 billion in annual revenue.

Trimble was selected through a search process that involved leaders of Mountain States working collaboratively with the phy-sician leadership and volunteer members of the community board for Washington County. The decision to recruit Trimble was heavily supported by the medical staff lead-ership after they interviewed several highly qualified candidates from across the nation.

Trimble earned a master of nursing degree at the University of Kentucky and a bachelor of science in nursing at East-ern Kentucky University. She holds Best on Board certification and is a fellow of the American College of Health Care Execu-

tives. She and her husband, Mike, have two grown daughters, Mary and Michaela, as well as three beloved grandchildren who live in Knoxville, Tenn.

Johnston Memorial Hospital introduces life-saving interventional heart care to Southwest VirginiaA highly experienced team of doctors and staff bring the only 24/7 advanced heart program to Southwest Virginia

ABINGDON, Va. – In a move that will save lives and improve the healthcare for everyone in Southwest Virginia, Johnston Memorial Hospital has implemented a new interventional cardiology program, allowing highly experienced doctors to not just di-agnose but also to treat patients for urgent heart problems.

This life-saving service is available 24 hours a day.

When a patient is experiencing chest pain, it may be a heart attack – a condition where blood flow to the heart has been se-verely impaired. Fast treatment is essential in order to minimize damage to the heart, and likely makes the difference between life and death for a patient.

The American College of Cardiology and the American Heart Association agree that the time between a patient’s arrival at a hospital to the time he or she receives percutaneous coronary intervention (PCI)– a procedure that opens blocked arteries

Chris Spencer Melody Trimble

(continued on page 18)


GrandRounds

(continued on page 19)

and restores blood flow to the heart muscle – should be 90 minutes or less in order to minimize damage to the patient’s heart. With the new services in place, Johnston Memorial has been able to achieve a treat-ment time from door to intervention of 20 to 30 minutes – well exceeding hospital indus-try standards for high quality.

The interventional heart care services at Johnston Memorial are in operation 24 hours a day, 7 days a week, meaning highly trained specialists are available any time of the day or night, including weekends.

In addition to saving lives, this new ser-vice establishes Johnston Memorial Hospital as a full service referral center for advanced cardiac disease, and as a part of Mountain States Health Alliance, the region’s largest health system, makes available the full com-plement of services patients need.

The hospital has assembled a team of highly trained and experienced cardiolo-gists and staff members to provide these expanded services. Leading the way are Dr. John Patterson, Dr. Eduardo Balcells, and Dr. Gregory Miller. Bringing nearly five decades of experience to Johnston Memorial, these doctors have experience diagnosing and treating a high volume of complex, high-risk cardiovascular disease. These doctors also have extensive experience in research.

Team members at Johnston Memorial have been working with Emergency Medi-cal Services (EMS) providers to train them on identifying heart attack symptoms and initiating on the spot diagnostics (electro-cardiogram) procedures and stabilization before the patient even arrives at the hos-pital. Johnston Memorial will be notified, and while the patient is in transport, the catheterization lab at the hospital will be activated and ready for the patient’s arrival.

Mountain States honored as Economic Ambassador by WCEDC

JOHNSON CITY – Mountain States Health Alliance has been recognized as an Economic Ambassador by the Washington County Economic Development Council. The award was announced at the WCEDC Annual Meeting, held at the Millennium Centre.

The honor is bestowed upon people or organizations that have made outstand-ing contributions to the economic develop-ment of Washington County, Tenn., and the Tri-Cities region.

Mountain States’ impact is a result of being the area’s largest employer, with more than 8,000 jobs in the region and an estimat-ed regional impact of about $1.3 billion for the Tri-Cities and $680 million in Washing-ton County alone, said Mitch Miller, CEO for the WCEDC.

In choosing Mountain States for the award, the WCEDC recognized the five Washington County facilities for their acco-lades, noting Franklin Woods Community Hospital as the first LEED-certified “green” hospital in the state; Niswonger Children’s Hospital as the region’s only children’s hos-pital and home for one of only six St. Jude Research Hospital Affiliate Clinics; and Mountain States’ flagship hospital, Johnson City Medical Center, as one of six Level 1 Trauma Centers in Tennessee.

Also noted were two major partner-

ships recently announced in Washington County that are expected to create 100 new jobs. A contract was signed with Health-South Corporation to allow HealthSouth to take over management of MSHA’s Quil-len Rehabilitation Hospital and expand to include additional rehabilitation beds. A second agreement was made through a let-ter of intent with Signature HealthCARE to build a new assisted living and skilled nurs-ing facility at the site of the former of North Side Hospital, an estimated $16 million in-vestment that will be complete within two years.

Miller also noted Mountain States has been a leader in developing the Med-Tech Regional Business Park, a 130-acre mixed-use medical and technology-oriented de-velopment with 22 individual building sites valued at over $100 million. Among its facili-ties are Franklin Woods, The Wellness Cen-ter, and MSHA’s corporate headquarters.

The Economic Ambassador Award was one of four honors given out at the awards banquet. The other three were:

Community Champion Award – Tweet-sie Trail Task Force

Commercial Project of the Year – Tu-pelo Honey Cafe in downtown Johnson City

Industry/Office Project of the Year – NN Inc., for expanding their company and bringing their corporate headquarters to the SunTrust Bank Building in Johnson City

For more information on the awards, visit www.thewcedc.com.

Hamilton, O’Hare take new roles at Mountain States Health Alliance

JOHNSON CITY — Taylor Hamilton has been named Vice President of Market-ing for Mountain States Health Alliance. She comes to Mountain States from Physicians Regional Healthcare System in Naples, Fla., where she currently serves as the regional director of marketing and communications. Hamilton brings 10 years of experience in health care marketing, communications and operations, and is also co-founder of a young biotechnology company focusing on the commercialization of newly FDA ap-proved nano-tech medical devices. In addi-tion to her experience in hospital marketing and operations, Hamilton has been involved with three different start-up companies, and brings a combination of team building, stra-tegic planning and business development to the organization.

Hamilton holds a bachelor of commu-nications from the University of Florida and a master’s in biotechnology enterprise from Johns Hopkins University. Taylor is the vice president for the Cancer Alliance of Naples, a nonprofit organization that offers services and programs for individuals and loved ones that have been diagnosed with cancer. She also serves as vice chair for the Collier County Injury Prevention Coalition, whose mission is to prevent injury, disability, and death through advocacy, education, legisla-tion and partnerships.

Hamilton is replacing Shane O’Hare, who was recently named Corporate Direc-tor of the Value Optimization System (VOS) at Mountain States Health Alliance. VOS is Mountain States’ initiative, using nationally respected Lean principles, to ensure high quality, efficiency and patient satisfaction in

all healthcare activities. In his role, O’Hare will be responsible for guiding and facilitat-ing team-member-led VOS activities that use ideas from front line workers to solve problems in everyday processes.

O’Hare previously served as Corporate Director of Marketing and Communications for Mountain States, a role he has held since 2008. Prior to that, he served as Laboratory Outreach Business Manager for the health system. O’Hare graduated from Rensselaer Polytechnic Institute in 1995 with a bach-elor’s degree in theoretical mathematics and earned a master’s degree in business administration from East Tennessee State University in 1999. He lives in Erwin with his wife and three children and is a member of the Erwin Kiwanis Club.

Quillen student James Johnston named 2014 Tillman Military Scholar

JOHNSON CITY – As a 37-year-old fa-ther of three, James Johnston is hardly your typical second-year medical student. Throw in his seven deployments to Afghanistan and Iraq between 2002 to 2012 – in between which he spent seven years getting his bachelor’s degree by taking night classes – and he’s anything but the average student enrolled at East Tennessee State University’s Quillen College of Medicine.

“I was a few years out from having enough time in to retire from the Army,” Johnston said. “I walked away with 17-18 years of service to come to medical school.”

Johnston said he always knew he want-ed to work in the medical field, but wasn’t sure what exactly he wanted to do. It was his wartime experiences, one in particular, that led him to the decision to become an actual doctor.

“One of my buddies was killed in 2005 and I had to work on him,” said Johnston, who served as a Special Forces medic dur-ing his time overseas. “That was kind of one of those parts of my life – that was a linchpin in my decision to become a doctor.”

But the loss of a good friend also made it hard for Johnston to walk away from mili-tary life and his role in the Special Forces.

Instead of leaving, Johnston began attending night school in between his de-ployments and military training. It took him seven years to get his bachelor’s degree in health sciences.

Last year, he was accepted into the Quillen College of Medicine and began his first year as a medical student.

Johnston, who is leaning toward be-coming an emergency room doctor, re-cently was named a 2014 Tillman Military Scholar. He is one of just 58 individuals in the country to receive the honor this year from the Pat Tillman Foundation.

The scholarship program was created in 2008 to honor the memory of Pat Tillman, an NFL football player who put his career on hold to serve in the military. Tillman was killed in 2004 while serving in Afghanistan.

“If you look at Pat Tillman’s life, he was a role model in sports, in service. He was a husband, a friend,” Johnston said. “People daydream every day about having what he had, and he gave it all up just to go be a guy on the ground in the war. It comes down to selfless service and putting a common goal


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GrandRounds

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

Position: Operations Coordinator, Johnson City Eye Clinic

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

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

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

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

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

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

HealthcareServiceSnapshot



above personal wants and needs.”The scholarship program recognizes

the service, leadership and academic excel-lence of U.S. service members, veterans and military spouses. More than 7,500 people applied for the scholarship this year.

Johnston is the second Quillen student to receive the honor. In 2010, Mario Soto, who graduated in 2013 from the medical school, also was named a Tillman Military Scholar.

In addition to fi nancial support, the scholarship program welcomes recipients to an annual Pat Tillman Leadership Summit, bringing together Tillman Military Scholars with industry, non-profi t and community leaders for three days of keynote addresses, panel discussions and workshops focused on collaborative impact and service for communities and the country.

ETSU professor featured in national magazine article about tanning

JOHNSON CITY – Dr. Joel Hillhouse, director of East Tennessee State University’s Skin Cancer Prevention Laboratory, recently was featured in an article published by a na-tional magazine.

Olga Khazan, a staff writer for The At-lantic, a publication that focuses on a vari-ety of news-based topics including cultural trends, interviewed Hillhouse in August for the article titled, “The End of Tanning?”

In it, Hillhouse talks about the “cultural shift” toward a better understanding of the dangers related to tanning. “Fifteen years ago, you would not have seen an article in Seventeen or Cosmopolitan about the dangers of indoor tanning, but now it’s very common,” he states in the article.

Hillhouse further discusses the need to focus anti-tanning campaigns on how tan-ning can disfi gure a person’s skin overtime. He also talks about his research success in pointing younger woman toward websites that promote clothing and jewelry styles that go with natural skin tones.

The article was published online on Aug. 25. To read the article in its entirety, visit http://www.theatlantic.com/health/ar-chive/2014/08/the-end-of-tanning/378872/.

Hillhouse is the associate dean for re-search and a professor in the ETSU College of Public Health. He has been doing work in prevention science for more than 20 years and is widely considered the nation’s fore-most researcher on indoor tanning.

ETSU researcher receives $422,000 grant to study treatment, prevention of fungal infection

JOHNSON CITY – At best, a yeast infection is uncomfortable. At worst, it is deadly.

Now, Dr. Mike Kruppa, an assistant professor in the Department of Biomedical Sciences and member of the recently estab-lished Center for Infl ammation, Infectious Disease and Immunity at East Tennessee State University’s Quillen College of Medi-cine, is working to fi nd ways to prevent such infections.

Perhaps more concerning, though, is the danger such infections post to individu-als who are already very sick. Since critically ill patients often have a weakened immune

system, they are susceptible to a secondary infection caused by the fungus Candida al-bicans, Kruppa explained.

Kruppa recently received approxi-mately $422,000 in grant funding from the National Institutes of Health to conduct re-search over the next three years to better understand the interplay between Candida albicans and the normal fl ora in a human be-ing’s ecosystem.

Kruppa will examine several genes of Candida albicans that have been identifi ed to play a role in the communication of the yeast fungus with various bacteria. His aim, he said, is to essentially “short circuit” the communication pathways between the fun-gus and bacteria to prevent Candida albi-cans from transitioning from a yeast form to a fi lamentous form.

Kruppa is hopeful his research will identify novel compounds that could result in the creation of better drugs to treat yeast infections, or in some cases, prevent them altogether.

Gatton College of Pharmacy group takes home national award

JOHNSON CITY – Approximately 100 of East Tennessee State University’s Bill Gat-ton College of Pharmacy students are cele-brating a national victory after their chapter of the Kappa Psi organization was named the “Most Improved Chapter” in the coun-try.

Kappa Psi is the oldest and largest pro-fessional pharmacy fraternity.

In early August, the ETSU chapter earned the “Most Improved Chapter” award for the district, which is made up of 18 different chapters. Less than two weeks later, it was named the national winner, beating out the top chapter from each of the other 10 districts located throughout the United States.

The competition is based off a rubric that measures the amount and extent of the chapter’s community service, philanthropy and scholarship involvement. The chapter’s participation and leadership in regional, state and national profession activities is also measured.

Members of the ETSU chapter have worked with philanthropic events including the American Cancer Society’s Relay For Life, the Salvation Army’s Angel Tree pro-gram and a Veterans Association benefi t. They have also hosted service events includ-ing medical awareness classes and breast cancer awareness activities.

Johnson City Community Health Center receives $250,000 for mammography services

JOHNSON CITY – A grant awarded this week by the U.S. Department of Health and Human Services will help East Tennes-see State University provide more health-care services to the people of the region.

Offi cials with the Johnson City Com-munity Health Center, an ETSU nurse-man-aged clinic serving the homeless, migrant workers, those in public housing, school children and hundreds of other residents

of Northeast Tennessee, learned that the facility will get $250,000 from the Health Re-sources and Services Administration (HRSA) to expand services to include mammogra-phy screening.

“Quality monitoring has identifi ed that less than 50 percent of women referred by the community health center have kept their appointment,” said Silas Tolan, executive di-rector of ETSU’s community health centers. “Currently, the women served at the JCCHC have to travel to another site for this service and often face travel, language and other barriers. Having mammography services at the clinic provides service for the patients at a single point of care.”

Through the grant, part of the JCCHC will be renovated and transformed into a digital mammography screening room. The grant will also allow the clinic to purchase patient portal software that will integrate with the facility’s electronic medical record system.

Additionally, self-management, care management, meeting complex medical needs and e-prescribing will be enhanced by patients being able to have access to update their medical record, medication list and other medical-related information, To-lan noted.

The JCCHC was one of 147 health cen-ters across the nation to receive funding this week through the Affordable Care Act fund-ing for patient-centered medical homes. It is the only facility in the state of Tennessee to get the funding.

Support Niswonger Children’s Hospital!

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

Niswonger Children’s Hospital license plate sales.

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

purchasing a Niswonger Children’s Hospital license plate.

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

tri cities medical news october 2014

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