tri cities medical news sept 2013

John Ehrenfried, MD, FACS

PAGE 3

PHYSICIAN SPOTLIGHT

PRSRT STDU.S.POSTAGE

PAIDFRANKLIN, TN

PERMIT NO.357

PRINTED ON RECYCLED PAPER

September 2013 >> $5

ON ROUNDS

ONLINE:EASTTNMEDICALNEWS.COM

HEALTHCARE LEADER: Karla LaneSimply put, running a healthcare organization is a time-consuming, tedious process. Dealing with the nonstop deluge of documents and bureaucratic ... 4

Enjoying East Tennessee“Days Gone By” Museum of Appalachia –Norris, Tennessee

Storytelling is a gift, and it can truly make the past come alive ... 7

Special Advertising Patient Centered Practices ... 13

FOCUS TOPICS ONCOLOGY TRANSPARENCY

Jolie Sparks National BRCA1 ConversationWellmont certifi ed genetic counselor provides answers

By STACy FENTRESS

This past May, actress and director Ange-lina Jolie made news around the world when she announced she had undergone a preventive double mastectomy because she tested positive for the BRCA1 gene. Her revelation sparked conversations and renewed interest in the idea of genetic testing to determine cancer risk, and it caused women to ask themselves, “What would I do?”

For Debbie Pencarinha, a certifi ed genetic counselor with the Wellmont Cancer Institute, this isn’t a new discussion. But Pencarinha recog-nizes that Jolie’s story has brought genetic testing to the forefront.

“Angelina Jolie’s story brought a lot of edu-cation to the public and showed people that it’s okay to make big decisions to take control of your health,” Pencarinha said. “You don’t

(CONTINUED ON PAGE 14)

Debbie Pencarinha, a licensed, board certifi ed genetic counselor, provides genetic testing services at the Wellmont Cancer Institute

FOCUS ON ONCOLOGY

SPONSORED BY WELLMONT

HEALTH SYSTEM

By CINDy SANDERS

If you’ve recently enjoyed a golf outing with your friendly pharmaceutical rep or a nice dinner with a device manufacturer, that information will soon be available for all to see.

The Physician Payments Sunshine Act went into effect Aug. 1 of this year and requires applicable manufacturers to report certain interactions with physicians and teaching hospitals that are deemed to have value. ‘Applicable manufacturers’ are defi ned as pharmaceutical, device, biologic and medical supply manufacturers whose products either require a prescription to be dispensed or for which payment under federal healthcare programs is available.

“The Sunshine Act generally applies when physicians or teaching hospitals re-ceive transfers of value from applicable manufacturers, and the applicable manu-

Shining a Light on Physician, Industry RelationshipsPhysician Payments Sunshine Act Now in Effect


Director of Southwest Virginia Cancer Center

To promote your business or practice in this high profi le spot, contact Cindy DeVane at East TN Medical News.

423-426-1142 • [email protected]

2 > SEPTEMBER 2013 e a s t t n m e d i c a l n e w s . c o m

That’s why the Tennessee Hospital Association and BlueCross BlueShield of Tennessee teamed up to create the Tennessee Center for Patient Safety. This program provides ongoing training and support to eliminate infections and help keep patients across the state healthy and safe.

So everyone who provides care can provide it better. BlueCross BlueShield of Tennessee is for Tennessee. See how BlueCross is impacting your community at bcbst.com/impact

©B

lueC

ross

Blu

eShi

eld

of T

enne

ssee

, Inc

., an

Inde

pend

ent L

icen

see

of th

e B

lueC

ross

Blu

eShi

eld

Ass

ocia

tion.

We’re all on the SAME TEAM.

When it comes to PATIENT SAFETY,

A not-for-profit, Tennessee-based company.

BCBS4079_Mrr_TCPS_TnMedNews_Memphis.indd 1 6/20/13 1:20 PM

e a s t t n m e d i c a l n e w s . c o m SEPTEMBER 2013 > 3

PhysicianSpotlight

By BRIDGET GARLAND

The adage “Something good

always comes out of something bad”

can be aptly applied to the life and

career of John Ehrenfried, MD, a

surgical oncologist with Surgical

Associates of Kingsport. Although

his grandfather was diagnosed and

treated for cancer at MD Anderson

Cancer Center, Ehrenfried said that

his grandfather’s experience was

partly responsible for his decision to

become a surgical oncologist.

“As a very young child, I al-

ways thought that doctors did sur-

gery—they kind of went together for

me, but when I was in junior high,

I also heard all about my grandfa-

ther’s cancer and treatment at MD

Anderson,” he recalled. “So when

I was in medical school, on surgery rota-

tion, one of the chief residents was going

to MD Anderson to do extra training in

cancer surgery. I had no idea I could do

that, but decided then that that’s what I

was going to do.”

Ehrenfried grew up in Norfolk, Ne-

braska, and naturally pursued his medi-

cal degree at the University of Nebraska

in Omaha. Although neither of his par-

ents had careers in medicine—one was a

teacher and the other worked in the insur-

ance department of a bank—Ehrenfried

and his two brothers have a long-standing

joke about their career choices. “I have an

older brother and younger brother. My

older brother is a veterinarian, and my

younger brother works in horticulture,”

he shared, “So the joke is that my parents

had three doctors—an animal doctor, a

plant doctor, and I’m the people doctor.”

After receiving his medical degree,

he moved to Galveston, Texas, to com-

plete a surgical residency and two years

of NIH surgical research at the University

of Texas Medical Branch. From there, he

left for MD Anderson in Houston to finish

a two-year fellowship in surgical oncology.

“I always felt like surgery was so

hands-on, such direct care. You can see

a result directly,” said Ehrenfried. “And

with surgical oncology, specifically, I am

able to practice the part of surgery that in-

terested me the most, the potential to cure

someone of a life threatening disease.”

After completing his fellowship, Eh-

renfried and his wife Lorna, an

anesthesiologist who currently

practices at East Tennessee

Ambulatory Surgery Center in

Johnson City, started searching

for a place to relocate. When a

colleague from MD Anderson

turned down a position in King-

sport in order to move to Chat-

tanooga, his recommendation to

the practice was to recruit Eh-

renfried. “So while we were in

Houston, they called about an

interview,” he shared. “We were

looking for a place with four sea-

sons, rivers, mountains, lakes,

and good schools, so I said ‘yes,

I’ll come look,’ but I was think-

ing, ‘no one in my family ever

went East.’ However, I came and

looked, and here I am.”

The Ehrenfrieds have three chil-

dren—two daughters, who are students

at the University of Tennessee-Knoxville,

and a 15-year-old son, who is a student at

Dobyns-Bennett High School.

Since arriving in the area 13 years ago,

Ehrenfried has become a valued member

of the Tri-Cities medical community. Cur-

rently the only fellowship-trained surgical

oncologist in the region (the closest oth-

ers being in Knoxville), Ehrenfried helps

train East Tennessee State University resi-

dents on rotation and is actively involved

in multi-disciplinary planning conferences

for newly diagnosed cancer patients at the

Wellmont Cancer Institute.

“Case presentations are made by

members of the team—a radiologist might

present films, a pathologist will present

slides of biopsies, and there might also

be plastic surgeons, surgical oncologists,

medical oncologists, and radiation oncolo-

gists present,” Ehrenfried explained. “Ev-

eryone is there to see and hear the story,

understand the patient, give an opinion,

and come to a consensus about the best

treatment plan, without the patient hav-

ing to see each provider. The conferences

help to guide the care and make sure it’s

the most timely and appropriate care for

each individual patient.”

Also part of the Institute’s inter-mul-

tidisciplinary approach to care is making

sure that after surgery, patients are seen

by the appropriate physicians for follow-

up treatment and care, if needed, he ex-

plained. Designated as patient navigators,

these oncology nursing specialists work

with patients to ensure they get where

they need to be following surgery.

Ehrenfried is enthusiastic about the

progress being made in the treatment of

cancers, especially in the breast. “The use of

MRI and genetic testing of tumor samples

helps guide care for treatment after surgery,

such as with chemotherapy,” he said. “There

are also new medications for people with ad-

vanced disease that are showing promise. In

the breast, for example, advances are being

made that save people from having to have

a lymph node dissection.”

More information about the Well-

mont Cancer Institute’s inter-multidisci-

plinary team approach to cancer care is

available online at www.wellmont.org,

and then click on the Wellmont Cancer

Institute link.

John Ehrenfried, MD, FACS

Mortgage Rates Are Rising.Pre-qualify & lock in your rate for 75 days at mortgage.ecu.org! Offer ends October 31, 2013.

ETMedicalNewsBannerLockShop.indd 1 8/12/13 3:59 PM

FOCUS ON ONCOLOGY


HEALTH SYSTEM


HealthcareLeader

Karla LaneDirector of Southwest Virginia Cancer Center

By JohN SEwELL

Simply put, running a healthcare or-ganization is a time-consuming, tedious process. Dealing with the nonstop deluge of documents and bureaucratic tedium that is part and parcel of the administra-tive process can wear anyone down even-tually. This incessant number-crunching and form-filing can be somewhat dehu-manizing—creating a barrier between the patient and the administrator.

For Karla Lane, Director of Well-mont Cancer Institute’s Southwest Virginia Cancer Center in Norton, Vir-ginia, being an administrator is not such a cold and distanced vocation. With a background in nursing, Lane brings the warmth, conviction, and compassionate focus of a nurse to her job.

“I’m a bedside nurse and I think hav-ing that experience has helped me greatly in my management role,” said Lane. “The nurse in me is very much patient-centered. I don’t want to toot my own horn, but my process is about the whole experience. I’m not just concerned with the bureaucratic angle. I’m concerned with the patient’s physical, emotional, spiritual, and financial needs—the whole package.”

Lane began her career as an oncol-ogy nurse and slowly rose through the ranks to attain the administrative position

she’s held at the Southwest Virginia Can-cer Center for almost two years. One of Lane’s first goals in her new position was to fine tune the organization’s processes in ways that better deal with urgent human needs encountered on a day-to-day basis.

“One of the things that surprised me most when I started the job was that the patient focus was somewhat lacking,” explained Lane. “The patient assistance process was already there, of course, but it was not exactly sharpened if you will—

it was still a little bit fragmented. So I’ve been continually working to facilitate the process for the patients.

“One of the first things that we do when the patient first comes through the door is to try to ascertain exactly what their needs are, and I don’t mean just their treatment needs,” Lane continued. “Some of the patients are insured, others are uninsured, and some have other spe-cial needs. So one of the first things we do is try to figure out what copays or as-sistance that a patient needs. We also work with outside drug companies to attain as-sistance for free medication and that kind of thing. When I came here, these things were already being done—but the process wasn’t nearly as hardwired in the system as it is now.”

Lane explains that her primary chal-lenge as Director has been dealing with America’s ever-evolving and sometimes confusing insurance system.

“There are always changes these days,” said Lane, bemusedly. “It’s really a big challenge to operate as lean as you can and still offer the patients the very best healthcare available.

“I remember back when I was a nurse, I was only concerned about the treatments patients were getting,” Lane continued. “But today—and especially from an administrative point of view—you have to think about what the treat-

ment will cost, what is the overhead, etc. So with all the changes in how insurance is handled, well, these are challenging and difficult times.”

Sure, treating cancer is a daunting job. There is a lot of drama involved, and the pace is relentless. But Lane faces her job with unrelenting positivity, focusing on the ways she can best benefit patients.

“I think one of the most important things for anyone in the oncology field is to remember not to become complacent,” enthused Lane. “When you do something as serious as this for days, months, years, you can become hardened to it. So you always have to remember the fears and anxieties that a patient with this [cancer] diagnosis will have. Even though what we do may be a bit of a routine, we have to remember that it’s something new that can be really scary for the patients. Keep-ing the patients in perspective and paying attention to their feelings is absolutely cru-cial.

“A lot of times people will talk to me about my job, and they’ll say that it must be depressing,” Lane continued. “And, you know, it’s really not. I knew early on that oncology was where I wanted to be for my entire career. Oncology patients are so brave and humble, and they’re going through tough times. So it’s impor-tant for me to be able to help these people in these important times of their lives. So, I don’t go home thinking ‘this is too hard.’ This job fulfills me.”

Thankfully, life is not all seriousness for Lane. Her leisure time activities in-clude hiking, camping, and going to the lake with her son Camden, her daughter Kaegan, and her husband William.

Lane strives to continually upgrade the services at the Southwest Virginia Cancer Center, which is no small task. Among upcoming changes, the center is preparing to attain accreditation from the American College of Surgeons (ACOS).

“Right now we are fine tuning both our community outreach and research for the accreditation,” said Lane. “We’re on our way, and will be assessed early next year. That will be a feather in our cap.”

For Lane, her profession is more of a calling than a vocation. She expects to stay with Wellmont for the remainder of her career.

“I’ve always said I’ll do oncology till I retire,” said Lane. “That way I can continue to make a difference in patient’s lives.

“I think we’re all put here for a pur-pose, and oncology must be mine,” Lane continued, laughing. “I want to continue to help as an administrator or in any other way that I can. I just really look forward to all the progress we’ll see in the future, maybe even curing cancer. That would be the ultimate.”

FOCUS ON ONCOLOGY


HEALTH SYSTEM


Online Event

Calendar

To submit or view local events visit

the East Tennessee Medical News

website.

easttnmedicalnews.com

A user name and password are required

to submit an event. Under Member Options, go to

“free sign up” to register.

LegalMatters

HIPAA Five-O: Complaints, Compliance, and the Privacy Police

BY DIANA L. GUSTIN, ESQ.

As Detective Steve McGarrett would often say on the classic television show Hawaii Five-O: “Book ‘em, Danno.” Only in this case, it’s not “murder one” on the Hawaiian islands – it’s for violation of the HIPAA Privacy Rule. On January 25, 2013, the Office of Civil Rights published the Final Rule to implement modifications to HIPAA Privacy, Security, and Breach Notification rules(1). The basis for the imposition of a civil money penalty was revised to include business associates. The potential amount for a civil penalty increased to permit an assessment of the maximum of $1.5 million for identical vio-lations during a calendar year.

The penalty is based upon the facts and circumstances in a four tier system:

(i) the covered entity (or business as-sociate) did not know and by exercising reasonable diligence would not know of the violation: $100 - $50,000/violation and up to $1,500,000;

(ii) the violation was due to reason-able cause: $1,000 - $50,000/violation and up to $1,500,000;

(iii) the violation was due to willful neglect: $10,000 - $50,000/violation and up to $1,500,000;

(iv) the violation was due to willful neglect and was not corrected within 30 days of knowledge (actual or con-structive): $50,000/violation and up to $1,500,000(2).

Enforcement provisions now require a formal investigation if a complaint (and the preliminary investigation of the facts) indicates a violation was due to willful ne-glect(3). Covered entities and business as-sociates must carefully consider the sta-tus of their HIPAA compliance program. Failure to implement HIPAA policies and procedures could be construed as willful neglect and result in significant financial penalties. Protected health information (PHI) must be protected by law.

How does an investigation begin?An individual has the right to file a

complaint with the Secretary of Health and Human Services if that person be-lieves a covered entity or business associ-ate is not complying with HIPAA(4). The Secretary will investigate any complaint when a preliminary review of the facts in-dicates a possible violation due to willful neglect. The comments in the Federal Register indicate the Secretary currently conducts a preliminary review of every complaint received and proceeds with an investigation where the facts indicate a possible violation of the HIPAA Rules. (Mandatory reports for breach may also trigger a complaint and investigation.)

When does an investigation become a compliance review?

If the investigation indicates there

might be facts to support the possibility of a violation due to willful neglect, the Secretary must conduct a compliance re-view. The Secretary will conduct a com-pliance review of the covered entity or business associate to determine if there is compliance with the applicable admin-istrative simplification provisions when a preliminary review of the facts indicates a possible violation due to willful neglect(5). The Secretary also retains discretion to conduct a compliance review in any other circumstance(6).

What is “willful neglect”? The term “willful neglect” is defined

at 45 C.F.R. §160.401 to mean the con-scious, intentional failure or reckless indif-ference to the obligation to comply with HIPAA. The comments in the Proposed Rule listed examples of willful neglect as

1. disposal of a hard drive in an un-secured dumpster where the covered entity failed to implement policies and procedures to safeguard PHI during the disposal process;

2. failure to respond to an individ-ual’s request for restriction of the uses of PHI where the covered entity did not have any policies and procedures in place for consideration of the request for restriction;

3. a covered entity’s employee loses a laptop that contains unencrypted PHI and the covered entity feared for its rep-utation if the incident became public and decided not to provide the appropriate notification(7).

The facts in the above examples were described as situations where the covered entities had actual or construc-tive knowledge of the violations. It is im-portant to recognize that two examples focused upon the covered entities failure to have policies and procedures in place, which was described as “a conscious in-tent or reckless disregard” of their com-pliance obligations.

Who should have compliance policies and procedures?

Covered entities, business associ-ates, and subcontractors need to have appropriate policies and procedures in place to protect the privacy and security of individual’s medical information. The comments to the Proposed Rules note it was assumed that business associates in compliance with their contracts would have already designated personnel to be responsible for formulating the orga-nization’s privacy and security policies, performed a risk analysis, and invested in hardware and software to prevent and monitor for internal and external breach-es of protected health information(8). To emphasize the requirement, the risk of criminal and/or civil monetary penalties

was referenced as an incentive for orga-nizations to bolster their security and pri-vacy policies.

What does it all mean? The law continues to evolve through

a complex system of rules, regulations, and guidance. Keep it simple by making your patients’ privacy a priority. Update your compliance program and train your staff to stay current with the law, as well as the technology.

Disclaimer: The information contained here-in is strictly informational; it is not to be construed as legal advice.

1. 78 Federal Register 5566, January 25, 20132. See 45 C.F.R. §160.402 and §160.4043. 45 C.F.R. §160.3084. 45 C.F.R. §160.3065. 45 C.F.R. § 160.308(a)6. 45 C.F.R. § 160.308(b)7. 75 Federal Register 40879, July 14, 20108. 75 Federal Register 40909, July 14, 2010

Diana L. Gustin is an attorney practicing at London & Amburn, P.C. Her practice focuses on defense of clients responding to government and private payor reimbursement claims, healthcare compliance and regulatory matters, including HIPAA. For more information on HIPAA or other health law matters, you may contact Ms. Gustin by visiting www.londonamburn.com.

John

son

City

Sy

mph

ony

Orc

hest

ra

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

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

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

visit www.jcsymphony.com

Opening Night: Tragedy to Triumph

featuring Cherylonda Fitzgerald, CelloSaturday, October 12, 7:30 p.m.

Mary B. Martin Auditorium at Seeger Chapel, Milligan College

Cherylonda Fitzgerald is principal cellist of the Johnson City Symphony Orchestra and a member of the Asheville Symphony and the Kingsport Symphony of the Mountains. As a chamber musician, Ms. Fitzgerald performs with The Paramount Chamber Players, the Shelbridge Chamber Players, and Signature Strings. Ms. Fitzgerald has taught cello/bass and chamber music at Milligan

since 2005 and is an adjunct instructor at East Tennessee State University. She maintains a private cello studio and is director of the East Tennessee Cello Choir. She holds a bachelor’s degree in performance and music education from the University of Louisville and a master’s degree in cello performance from S.U.N.Y. at Stony Brook.

Evening ProgramAntonin Dvorak: Concerto for Cello in B minor, Op. 104

Jean Sibelius: Symphony No. 2 in D Major, Op. 43


For exhibit information, call 615-256-8240 or 800-258-9541.Print the exhibit prospectus on THA’s web site: www.tha.com.

2013 THA ANNUAL MEETING

EXHIBIT SHOWOCTOBER 30-31

GAYLORD OPRYLAND RESORT & CONVENT ION CENTER

The premiere opportunity to showcase healthcare products and services in Tennessee

Attendees Include Hospital CEOs and Department Heads, Plus Many More Healthcare Executives!

Not all the specialists are inside the medical facility.

PMC is proud to be an extension of your best practices, offering assistance is what we do best.

· Valet drivers· Shuttle service· Wheelchair/Medical device assistance· Patient services· Adherence to HIPPA guidelines· IAHSS Member 877.388.2299

www.runfastdriveslow.com

ClinicallySpeakingBY NORMAN A. ASSAD, MD, FRCS (C)

Infertility in 2013Infertility is not a rare

condition. Unfortunately, it affects one in six couples. Approximately 40% of the time the cause is related to female factors, 40% of the time male factor, and 15% of the time there may be more than one factor.

The primary consider-ation prior to starting treat-ment is to make a diagnosis and base treatment on the underlying cause of infertil-ity, rather than to perform arbitrary treatment with the hope that something will work.

Common CausesThe most common cause of fe-

male fertility are ovulation disorders. This can account for up to half of all female fertility, and many patients with anovulation have Polycystic Ovarian Syndrome. It is important to control the manifestations of this condition, for without proper diagnosis and treat-ment, these patients can frequently progress to full blown Metabolic Syn-drome with all of its catastrophic con-sequences in later life. The second most common cause of infertility in the female is Endometriosis, and, again, it is import to diagnose and treat this condition so it does not progress to later stages of the disease, which can have significant consequences on quality of life and other pain issues. The third most common factor, which accounts for only 10% of patients with infertility, are tubal factors. Many of these are secondary to endometriosis, while others are related to STD’s. Di-agnosis is important as these patients are very susceptible to tubal pregnan-cy when they occur.

For known medical conditions, these can often be diagnosed and treated using the patients insurance benefits, as many of these services are covered. The majority of insurances that we deal with also have diagnostic coverage for infertility.

Disturbing TrendsSeveral disturbing trends are

emerging in 2013. Many men are using testosterone supplements for symptoms associated with “low T,” and these medications can have a profound effect on lowering sperm count. Many women are given com-pounded substances for infertility. Many of these contain progesterone, which can have a contraceptive effect if used prior to ovulation, as they affect sperm transport. We are also seeing a decrease in ovarian reserve, particu-larly in young women. This seems to be a national trend, and no one can come up with an exact etiology. We are measuring antimullerian hormone levels, which are cycle independent

and seems to be a more accurate as-sessment of ovarian reserve than the FSH or Estradiol levels.

Cost ConsiderationsMost patients are treated at any

level of therapy, for a finite number of cycles (usually 3), as national statistics reveal a leveling off of success rates with more cycles than this. As these cycles are mostly paid for by the pa-tient, it is important not to exhaust their financial and emotional resources with therapies that have little chance of success. We increasingly recommend treatment based on outcomes, and ex-plain the cost effectiveness ratio with each level our therapy. For instance, Gonadotrophin/IUI cycles are three times as effective as Clomiphene/IUI cycles; however, the cost of the former is about triple the amount of the latter.

At Quillen ETSU Physicians, we at-tempt to do global pricing for all cash pay cycles which make it easier for pa-tients to plan therapy, with few finan-cial surprises. Our success rates are in line with national statistics and with IVF, we enjoy one of the higher rates in the State, but at cost effective prices. The latter are at the lower end of the spectrum both statewide and nation-ally, and we have endeavored to keep these prices low given the population that we serve.

The success rate of infertility treat-ments continue to improve with ad-vanced technology; however, it is im-portant to maintain the “human” side of treatment as this condition and its treatments can be very difficult for young couples.

Norman A. Assad, MD, FRCS(C) serves as Fertility Services Division Director for Quillen ETSU Physicians’ Department of Obstetrics and Gynecology. A board-certified obstetrician and gynecologist, Assad is a specialist in reproductive and menopausal medicine. He is a member of the American Society for Reproductive Technologies, the American College of Obstetricians and Gynecologists, and the American Association of Gynecologic Laparascopy. He earned his medical degree and completed residency training at The University of Western Ontario and is a Fellow of the Royal College of Obstetricians and Gynecologists of Canada. Assad has been practicing medicine in the Tri-Cities since 2002 and joined Quillen ETSU Physicians’ OB/GYN Department in January 2005, serving as an associate professor at East Tennessee State University Quillen College of Medicine. For more information or to make a referral, visit www.etsuphysicians.com/medical-services/fertility.html.


By LEIGh ANNE w. hooVER

Storytelling is a gift, and it can truly make the past come alive. For our adult children, some of their fondest memories are from family gatherings and hearing their elders share stories from the past. Whether it’s a funny tale from a grandpar-ent’s childhood or an uncle’s rendition of a family escapade, they are simply mesmer-ized by the past.

The Museum of the Appalachia founder John Rice Irwin shares this same fascination, and his “hobby” of collect-ing relics, stories, and preserving the past became his life’s work. Today, Irwin is 83-years-old and retired. However, his legacy lives own through collections show-cased in a nonprofit jewel of a museum, which is simply like no others.

Just 16 miles north of Knoxville, Mu-seum of Appalachia is situated on 65 acres of picturesque countryside complete with 36 authentic log cabin structures. The facil-ity has been featured in numerous publica-tions, including the Smithsonian, National Geographic Traveler, Southern Living, Reader’s Digest, and many others. Anyone from infamous dignitaries and celebrities to those just seeking a respite and an escape to the past has walked the grounds, and the museum has shared a story or two and a true slice of Appalachia with each one.

In fact, prior to the 1982 World’s Fair, Irwin and the late Alex Haley, Pulit-zer Prize-winning author of “Roots,” once served on the Tennessee Entertainment & Music Commission (TFEMC) together, and Irwin introduced Haley to his mu-seum. Haley fell in love with the museum and even built a house in Norris, Tennes-see, close to the property and remained close friends with Irwin and his family.

Today, Irwin’s daughter, Elaine Meyer, serves as president of the museum and continues her father’s mission of keep-ing the past alive and preserving the Ap-palachian heritage. Museum of Appalachia became a not-for-profit 501(c)(3) museum in 2003, and all proceeds support the mis-sion of “not only preserving physical arti-facts of an earlier time but also instilling in the community, regionally, nationally, and internationally, a greater knowledge and appreciation for the Appalachian history and heritage.”

“In the early days, John Rice just col-lected things –especially tools and different farm implements…that were housed in our garage,” explained Meyer. “At some point, they filled the garage to the ceiling and gravitated outside on the lawn.”

Meyer remembers people stopping by and wanting to “trade” with her father. During inclement weather, Irwin used a tarp to cover his collection to protect it from the rain. However, this was the im-petus that necessitated the first outbuilding, which was the General Bunch cabin that was obtained from the very remote New River area of Anderson County.

“My mother took pride in the appear-

ance of the house and lawn, and she did not like all of that ‘stuff’ in the yard,” explained Meyer.

So, the outbuildings grew, and one cabin led to another on the property forming an eventual museum, which was founded in 1969. From one room shanties, to a schoolhouse and many others, a virtual pioneer village has been recreated. There is even a cabin that belonged to Mark Twain’s family on the grounds.

Meyer can remember a “gas station” type bell that would ring in their house when a visitor drove up, and she, her sis-ter, or mother would meet guests and take them on guided tours.

As president of the Museum of Ap-palachia, Meyer has added vision with an increased interest in preserving her father’s vast collection. In 2007, the museum was officially adopted as a Smithsonian Institu-tion Affiliations Program.

“Growing up, the Smithsonian was just the pinnacle…, and to be a part of that is just more wonderful than I can even describe,” said Meyer. “Senator Howard Baker is a member of our board of direc-tors…, and he decided that we were worthy of being a Smithsonian affiliate.”

According to Meyer, this “worthiness” led Baker to pursue visits from the Smithso-nian. The affiliation designation recognizes the museum’s efforts to preserve, treasure, and share the past for others as a living, re-alistic snapshot of pioneer life right here in East Tennessee.

Relics too numerous to count are housed in additional museum properties, and each has its own individual story and familial connection. Documented stories and signage allow visitors to read and ap-preciate as much of the history as desired. There is even a dedicated area to the early days of medicine.

“These people had strong ethics and morals, and they were brilliant in making do with what they had,” explained Meyer. “They could build, think, and figure things out without someone telling them what to do.”

In fact, for the 34th year, October 11th-13th the museum will celebrate with the Tennessee Fall Homecoming, which began as a way to showcase the many dying crafts and pioneer activities. Today, those

same historic demonstrations continue with all of the expected sights and smells as the sounds of music also echo through the mountains.

The very best musicians from genres, including bluegrass, old-time country, Southern gospel and Americana perform throughout the weekend on five, unique stages.

“When they [visitors] get out of their cars, the first thing that they hear is the music of the area,” said Meyer. “It sets the tone for the day.”

Wagons, pulled by vintage tractors, pickup guests, and they take rides over to

the museum festival activities. In addition to the music, smells of fried apple pies, pinto beans, sassafras teas, and other spe-cialties envelop guests in the essence of days gone by.

If antiques are your interest, a “Days of the Pioneer” antique show presented by A Simple Life Magazine will take place September 13th-14th at the Museum of Appalachia. Dealers from throughout the country will showcase and sell the very best of the 18th and 19th century.

“I love the fact that people connect [through the museum], and they enjoy talking to their parents and their grandpar-ents,” said Meyer. “That oral history really brings people together and [links] gen-erations. The love of family is what brings people here, and when they leave, there is a greater appreciation of their ancestors and themselves.”

For additional information on the Mu-seum of Appalachia, visit http://www.mu-seumofappalachia.org

Enjoying East Tennessee“Days Gone By” Museum of Appalachia –Norris, Tennessee

Register online at EastTNMedicalNews.com

to receive the new digital edition of Medical News

optimized for your tablet or smartphone!

to receive the new digital edition of Medical News

optimized for your tablet or smartphone!

Now Available!

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


facturers receive actual or potential value in return,” explained Tom Baker, a shareholder in the Baker Donelson Health Law group.

Baker, who practices in the fi rm’s Atlanta of-fi ce, pointed out the man-ufacturer doesn’t actually have to receive fi nancial benefi t in exchange for the ‘value transfer,’ which can take a wide variety of forms, including donated items, payment to a physician for consulting ser-vices or expenditures for entertainment. “It’s enough that it might infl uence a phy-sician,” he noted.

“The Sunshine Act is about transpar-ency in two different fundamental ways,” he continued. “First, there is the potential interference in medical judgment in clini-cal trials required for FDA approval of drugs or medical devices. Second, there is potential interference in medical judg-ment in terms of ordering an item or ser-vice for which federal reimbursement is available.”

Baker said the policy is to shine a light on interactions that could be construed to unduly infl uence a physician or teaching hospital and to ferret out confl icts of inter-est. “It’s not saying that transfers of value are, per se, illegal but that the public has a right to know when medical judgment might be infl uenced by the value trans-fer,” he continued. Relationships between physicians and industry will now be on display for patients, auditors, personal injury lawyers and others to see when the Centers for Medicare and Medicaid Services (CMS) begins publishing the re-ported data next fall.

The Back StoryChampioned by Sen. Chuck Grassley

(R-Iowa) and Sen. Herb Kohl (D-Wis.), the impetus behind the Sunshine Act came from mounting concern over poten-tial confl icts of interest within the industry. These confl icts were highlighted by sev-eral egregious incidents involving clinical trials and devices up for FDA approval where physicians received large payments from the manufacturers of the drugs or devices being studied.

Grassley publicly described a num-ber of academic physicians taking money from the National Institutes of Health when those physician-scientists had direct fi nancial interests in their own research. Among the worst offenders, the former chairman of the Psychiatry Department at Stanford University received an NIH grant to study a drug when he owned $6 million in stock in the company seeking FDA approval. Similarly, the former chair of the Psychiatry Department at Emory failed to report hundreds of thousands of dollars from GlaxoSmithKline while re-searching the company’s drugs. Harvard also had to discipline three researchers who received almost $1 million each in outside income while heading up several NIH grants.

Outside of these fl agrant examples, the concern persists that much smaller

gifts might also infl uence medical deci-sions. Earlier this year, Pew Charitable Trust published Persuading the Prescrib-ers: Pharmaceutical Industry Market-ing and its Infl uence on Physicians and Patients, which stated the drug industry spent nearly $29 billion marketing their products in 2011 (Source: Cegedim Stra-tegic Data). Of that amount, $25 billion was spent directly marketing to physicians.

After unsuccessfully introducing the legislation in 2007, the Sunshine Act was incorporated into the Affordable Care Act. A couple of missed rulemaking dead-lines by CMS pushed the law’s effective date to Aug. 1, 2013 for the balance of this calendar year and requires annual report-ing going forward.

What is a Transfer of Value?

With 12 major exceptions (see box), any direct payment or transfer of value of $10 or more (or an aggregate of $100 or more in a calendar year) to a physician or teaching hospital must be reported. Addi-tionally, indirect transfers through an in-termediary or third party are also subject to reporting.

There are 14 main reporting cat-egories. These include consulting fees, compensation for services other than con-sulting, gifts, entertainment, food, travel, charitable contributions, education, grants, research, royalty or licensing fees, current or prospective ownership or in-vestment interest, direct compensation for serving as faculty or a speaker for a medi-cal education program, honoraria.

Under the new rules, Baker said a physician could accept a ballpoint pen or pad of sticky notes from a manufacturer without it being included in the annual re-port, but most meals, tickets, or gifts prob-ably will fall under one of the reporting categories considering the $10 threshold.

“The days of the pharmaceutical company taking a group of physicians to the Super Bowl are over … or at least it will be disclosed and expose you to the risk of Anti-Kickback statute prosecution,” Baker said. “It’s the entertainment part of it that physicians would probably like to have exposed the least,” he added.

The law also requires applicable man-ufacturers and GPOs (group purchasing organizations) to report ownership inter-ests by physicians or their immediate fam-ily members. It should be noted, however, that purchased industry stocks and mu-tual funds that are generally available to the public are not reportable. If Dr. Smith buys 50 shares of ABC Pharmaceutical stock, which is publicly traded, it doesn’t have to be reported. If a representative of ABC Pharmaceutical gives Dr. Smith stock, then it does.

Ultimately, a patient whose doctor recommends a specifi c device or drug will be able to search the CMS database to see if there is a connection between the physician and the manufacturer. “You’re going to know when your physician has a personal fi nancial interest in your health-care beyond the physician’s professional services,” Baker pointed out.

Disputing a ReportSo what happens if your name ap-

pears on a report, and you disagree with the data? Baker said CMS is going to notify physicians of all their reported re-lationships. Once access is granted to the online portal housing the consolidated re-port, a physician should have at least 45 days to challenge the data and try to re-solve the dispute with the reporting entity.

Those who cannot agree will be given an additional 15 days to come to a resolu-tion before the information is made pub-lic. If no agreement can be reached, the data will be published but fl agged as dis-puted. Physicians cumulatively have up to two years to dispute reports even after the data is published.

“While physicians aren’t required to track transfers of value, they are encour-aged to do so,” said Baker. “How in the world are you going to be able to refute a report if you don’t have evidence to the contrary.”

Baker pointed out you might not think you received an infl uential ‘gift’ from a de-vice manufacturer by grabbing a bite of lunch, but even a sandwich, tea, tip and tax is often over the $10 threshold. Short of asking to see the bill, it would be diffi cult to gauge the cost per person at the table; and without a copy of the receipt, it would be diffi cult to dispute the reported item.

“As a practical rule, doctors probably aren’t going to be good at refuting the evi-dence,” Baker said.

However, he added, CMS has cre-ated a smartphone app with a version for industry and another for physicians to make it easier to keep track of reportable transfers. “Open Payments Mobile” is available at no charge through the Apple Store and Google Play Store.

TimelineData accumulation for 2013 has al-

ready begun. Below is a timeline of up-coming key dates in the process. • Jan. 1, 2014: Anticipated launch date for CMS physician portal where doc-tors can register to receive notice when their individual consolidated report is ready for review. This portal also provides a means for physicians to contact manu-facturers and GPOs about disputes in ac-curacy. • March 31, 2014: Partial year data (August-December 2013) must be turned into CMS. • June 2014: Anticipated access to in-dividual consolidated reports from 2013. Physicians have a minimum of 45 days by law to seek corrections or modifi cations to the information by contacting manufac-turers/GPOs through the portal.September 2014: Searchable reports are published and open to the public.

Be Prepared“The act itself is vexing,” said Baker.

Adding to the frustrations, he continued, is that CMS is interpreting the Sunshine Act very broadly.

“The applicable manufacturers are not going to take any chances,” Baker continued. He noted, those who acciden-

tally fail to disclose required data will face penalties of not less than $1,000 and not greater than $10,000 per incident up to a cap of $150,000 annually. Those who knowingly withhold reportable informa-tion face penalties between $10,000 and $100,000 for each value transfer with an annual cap of $1 million.

“Physicians need to know other peo-ple are going to be talking about them,” concluded Baker. “One would hope everything reported is within the legal boundaries … but if you are testing those boundaries, you better stop.”

Shining a Light on Physician, Industry Relationships, continued from page 1

12 Key Exemptions to the Reporting Rule

Certifi ed and accredited CME.

Buffet meals, snacks, coffee breaks that are provided by a manufacturer at a large-scale conference or event when the items are generally available to all attendees.

Product samples that are not intended for sale and are for patient use.

Educational materials that directly benefi t patients or are intended for patient use.

The loan of a medical device for evaluation during a short-term trial period (not to exceed 90 days).

Items or services provided under a contractual warranty in the purchase or lease agreement for a device.

The transfer of any item of value to a physician when that physician is a patient and not acting in his or her professional capacity.

Discounts including rebates.

In kind items for use in providing charity care.

A dividend or other profi t distribution from, or ownership or investment in, a publicly traded stock or mutual fund.

Transfer of value to a physician if the transfer is payment solely for the services of the physician with respect to a civil or criminal action or an administrative proceeding.

A transfer of anything with a value of less than $10 unless the aggregate amount transferred to, requested by, or designated on behalf of the physician exceeds $100 in the calendar year.

Tom Baker

e a s t t n m e d i c a l n e w s . c o m JANUARY 2013 > 9

Dr. John Dreyzehner

Accounting - consulting - HR - tecHnology

KNOXVILLE | NASHVILLE | CHATTANOOGA

ph: 865.691.9000 | www.lbmc.com

Shatita DanielsGreg Gilbert 862.862.6500 (direct) / [email protected] Partner – Tax Services & Managing Partner of Knoxville Office

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

LBMC has assembled a uniquely

experienced team of over

40 healthcare professionals

that clearly differentiate us

from other service providers

– all with deep financial

experience as well as practical

experience working in

the field of healthcare.

Meet Some of the Faces Behind Our Healthcare Experience.

Katie Graham Brooke ThurmanStacy SchuettlerAndrew McDonaldJenny Harvey

By CINDy SANDERS

Between immunizations, primary care services, licensure and regulation of health facilities, analyzing health statistics and launching preventive care initiatives, it’s easy to think of the Tennessee Depart-ment of Health as more ‘Clark Kent’ than “Superman.’ Yet, as the recent multi-state fun-gal meningitis outbreak clearly reminded us, ad-dressing emergency situ-ations is a key part of the TDH’s core function.

In fact, the depart-ment was primarily established to combat life-threatening outbreaks of cholera, yellow fever and other deadly diseases in the late 1880s. Preventing or stopping pub-lic health threats remains a top priority. Sometimes those threats warrant local, state or national attention, but often the TDH staff quietly goes about that part of their workday without much fanfare.

“Our mission is to protect, promote and improve the health and well-being of Tennesseans. The emergency prepared-ness aspect is all about protecting the pop-ulation,” noted TDH Commissioner John Dreyzehner, MD, MPH.

The types of emergencies range from natural or manmade disasters to addressing or preventing communicable and infectious diseases to investigating outbreaks. “We take an all hazards ap-proach,” explained Dreyzehner. “We never know when the next event will be … but we know it’s coming.”

With the State Public Health Labo-ratory in Nashville and additional labs in east and west Tennessee, the TDH has ap-proximately 130 staff members who per-form close to 1.5 million lab tests annually. Not only do the labs have the ability to run a broad spectrum of health assays, the staff also is called upon to analyze substances of concern, such as an unidentified powder, that might come to the attention of law en-forcement officials. “This occurs more fre-quently than people realize,” Dreyzehner noted.

While biohazards are a small part of the overall lab workload, the state labs also play an integral role in analyzing en-vironmental samples, conducting newborn screening panels, and identifying West Nile and other arboviral diseases. Equally important is the state’s work in preparing for threats that haven’t yet arrived.

“Right now we have spent a good bit of time and resources on MERS-CoV — Middle East respiratory syndrome corona-

virus — and H7N9, a new strain of flu,” Dreyzehner said. “I hasten to add that neither of those have come to our shores.”

Being ready, however, has set Tennes-see apart. When H1N1 did strike America several years ago, the State Public Health Lab was on the forefront of running tests. At one point, Tennessee was doing testing for other states that didn’t yet have the ca-pacity to analyze incoming samples.

Since health threats come from many different arenas, it’s difficult to anticipate every scenario. “A key lesson is we never know where the next hazard is going to come from. We have spent a lot of time creating the infrastructure, relationships, tools, and capacity to respond to any haz-ard,” explained Dreyzehner.

That was made abundantly clear in the recent issues with preservative-free methylprednisolone acetate (MPA). He noted that in the fungal meningitis out-break, the TDH relied heavily on the relationships and partnerships that were put in place well in advance of the crisis to effectively work with victims and to com-municate information both internally and externally.

“We were able to use some existing capacities in some very innovative and novel ways to great success,” Dreyzehner said. One example, he noted, was using

preparedness software developed for an-other purpose to track patients who had been exposed to the tainted MPA.

The team also relied on their capac-ity to collect and analyze data to predict the most effective treatment protocols and to identify those at risk. As Dreyzehner pointed out, going into this crisis there was virtually no literature on the particular type of fungus involved in the meningitis outbreak. “We were dealing with a situa-tion that no one had ever encountered be-fore.” Calling on relationships with federal agencies, national experts, and academic centers, Dreyzehner said the team quickly gathered and disseminated information to local provider resources across Tennes-see — including public health nurses and county public health staff — who have regularly reached out to inform and up-date those impacted by the tainted MPA.

Dreyzehner was quick to add this work is ongoing. “More than 13,500 peo-ple were affected by this … ranging from disconcerting to catastrophic,” he said. “This is still affecting more than 700 peo-ple around the country — 749 cases have currently been identified, and 63 people unfortunately lost their lives.

The need for a rapid and accurate information loop has spurred the state to

In Case of EmergencyTennessee Department of Health’s Role in Protecting the Population



diseased tissues. Th e cancer is pinpointed by CyberKnife’s image-guided technology – similar to that used by the military to target cruise missiles.Because the ra-diation is delivered with submillimeter accuracy, tumors and other abnormalities receive a concentrated dose of radiation, but the impact on surrounding healthy tissue is minimized. Th e CyberKnife allows physicians to treat tu-mors throughout the body and central nervous system – including tumors that once would have been inoperable. Treatment is completely non-invasive, requires no anesthesia and is usually completed on an outpatient basis.

Comprehensive services – in the heart of the Tri-Cities and beyond

For patients in Southwest Virginia, the Wellmont Cancer Institute’s cancer center in Norton provides more than 7,000 square feet of dedicated radiation oncology space in a luxurious, lodge-like setting.At the Southwest Virginia Cancer Center, we provide high-quality services, including inten-sity-modulated radiation therapy and image-guided radiation therapy.With our telemedicine capabilities, our oncologists can conference and collaborate with physicians across our system – without having to take time away from patients to drive long distances. And if further services are needed, patients at the South-west Virginia Cancer Center have seamless access to the services and caregivers at Holston Valley and Bristol Regional.

Introducing Trilogy – our new power for fi ghting cancer

Our radiation oncologists use the Trilogy’s high-powered X-ray beam to destroy tumors and cancers. Its other benefi ts include:

• A high dose rate for shorter, faster treat-ments – and lower radiation exposure

• Finely detailed, real-time ct images, which allow us to situate patients accurately and quickly

• Adjustable radiation beams, so we can ac-count for breathing movements

Trilogy is so precise, we’re able to deliver highly concentrated doses of radiation directly to tumors – sparing healthy tissue to a previously unimaginable extent.Its fl exible range of motion means we can treat any area of the body. And its unique design al-lows us to treat patients from any angle, making it the most comfortable experience possible.

Advanced robotic technology with CyberKnife

When the CyberKnife radiosurgery system ar-rived at Bristol Regional Medical Center, it was one of only a handful nationwide. And now, it’s still the only CyberKnife off ered in our region.CyberKnife uses its robotic arms to precisely direct the radiation doses to tumors and other

No matter where you are in Northeast Tennessee or South-west Virginia, your patients have access to some of the re-gion’s most compre-hensive cancer care, including:

• Our radiation oncology technology in Kingsport, Bristol and Norton

• An accredited breast center in Johnson City, as well as comprehensive breast centers in Kingsport and Bristol

• Targeted therapy, chemotherapy and other infusion and injection services in Kingsport, Bristol, Johnson City and Norton

• Th e region’s only board-certifi ed genetic counselor in Kingsport, Bristol, Johnson City and Norton

• Clinical trials in Kingsport, Bristol, Johnson City and Norton

Strength for today and hope for tomorrow

Above all, we believe treatment should be-gin – and end – with hope. Because where there is hope, there is the strength to fi ght and the optimism to survive. With hope as its fo-cus, the Wellmont Cancer Institute is commit-ted to helping patients have the chance to live out their dreams long after cancer is only a distant memory.

Give your patients every advantage in the fi ght against cancer.Trust the Wellmont Cancer Institute for the region’s state-of-the-art radiation oncology care.

To refer a patient, please call 1-855-878-8550. Or visit wellmont.org to learn more about the Wellmont Cancer Institute.

You’ve always depended on the Wellmont Cancer Institute to provide compassionate, highly skilled cancer care – including the region’s most robust radiation oncology services.

Since 2004, we’ve off ered the CyberKnife radiosurgery system, which has helped make an enormous diff erence in our patients’ lives. And more recently, we were proud to announce the arrival of the Trilogy linear accelerator at Holston Valley Medical Center.With these two systems, as well as the radiation oncology capabilities at our Southwest Virginia Cancer Center in Norton, Va., the Wellmont Cancer Institute is providing your patients the most comprehensive scope of services in the region.

Drs. Scott Coen, md, Byron May, md, and John Fincher, md

pit the most comfortable experi

Advanced robottechnology with

radiosual Meddful nayberKn

otic ares to tu

l as the radiation oncology capabilities at our Southwest Virginia the Wellmont Cancer Institute is providing your patients the most

hensive scope of services

oen, md, Byron May, , md, cher, md

ellmont Cancer Institute is providing your patients the s in the region.

technology wCyberKnife

When the CyberKnife rrived at Bristol Regionait was one of only a hannow, it’s still the only Cyour region.CyberKnife uses its robodirect the radiation dose


Bee Fit 4 Kids is a family oriented pediatric weight management program using evidenced based research to help overweight children & their families. We are now accepting insurance.

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

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

Allergy 4 Food is a resource that allows you to shop for nutritional supplements without the frustration of driving all over town. www.allergy4food.com

Support group helping the Knoxville region with celiac disease & gluten intolerance. www.celi-act.com

East Tennessee Children’s Hospital Gastroenterology and Nutrition Services

is East Tennessee’s premier pediatric gastroenterology group. We are staffed with four of the area’s fi nest board certifi ed pediatric gastroenterologists, in addition to three nurse practitioners, two behavior health clinicians, three registered dieticians, one physicians assistant, and a research coordinator. We serve all of east Tennessee and the surrounding areas.

www.giforkids.com

(865) 546-3998

ACCEPTING NEW PATIENTS

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

By hEAThER RIpLEy

You have probably seen the word “transparency” used in newspaper head-lines, on network and cable TV news shows, on website stories, blogs, Facebook and Twitter, to name a few communication platforms. Transparency is the latest buzz-word businesses, and especially healthcare businesses, will need to think about as they look for new and more effective ways to communicate openly with their audiences - both in business-to-business and business-to-consumer relationships.

Healthcare and Transparency

Not surprisingly, transparency in the healthcare industry is at the top of the list, and not just with consumers. It’s something

the healthcare industry as a whole is talking about. As an example, at the recent 2013 America’s Health Insurance Plans Institute (AHIP) event, the topic of healthcare trans-parency increased 400 percent in Twitter conversations during and after the event. Google the phrase “healthcare industry transparency” and you’ll likely find there are more than two million search returns in approximately .26 seconds.

The healthcare industry is being urged to adopt more transparency from within the medical community as well. For example, the American Medical Association recently issued a recommendation requesting in-surers to provide physicians and their staff with better tools to determine a patient’s treatment cost prior to treatment. It’s pretty clear, healthcare businesses will be under more scrutiny than ever before, and becom-

ing more transparent will be a necessity, not a choice.

But creating a culture and corporate identity that employs transparency is no easy task, and many business owners have tried to adopt some form of corporate trans-parency on their own with various degrees of success. Some have decided it is too much trouble or not worth it.

I have consulted with many businesses, creating marketing strategies that maintain integrity and security while embracing a culture of openness and honesty. For those businesses that have a hard time determin-ing what transparency means for them, engaging a professional with social, public relations, reputation management and crisis communications experience can be a huge help.

Businesses Using Transparency

A recent article on INC.com high-lighted transparency in business, noting that transparency for businesses also means being more transparent with employees, not just business partners or clients. Some busi-nesses are going so far as to share salaries – including CEO salaries—with employ-ees. Some feel this transparency makes for a more unified team.

Other business-to-business firms are making their financials more available to their business partners and vendors in a twist that they hope will allow them to ob-tain more or better credit. If they reveal how good their numbers are, their suppliers, vendors, clients and business partners might be more willing to use that information to give businesses with good, solid financials better financial arrangements. This is only useful if your business is financially stable.

An example of a business that worked transparency into its business model with great success is Zappos. Already well-known for its great customer service, Zap-pos wanted to include employees, vendors and its partners in its culture. In a surprising move, the Zappos executive team decided to televise the company’s annual meetings for all to see. They also started a blog called “Zappos Insights” so they could communi-cate directly with their employees, customers and other businesses about the Zappos cul-ture. The blog offers ways other businesses can learn from Zappos’ experiences through webinars, training, coaching and more.

Transparency and TrustOne of the cornerstones of Zappos’

company culture is trust. Zappos manager Robert Richman’s thoughts on transparency mirror the company mandate, “The quickest way to trust is through transparency.”

In the healthcare business especially, there is more to transparency than just being more open about your business. Trust is a big issue in the healthcare industry, and creating a corporate culture of trust - both internally and externally - can be a make-it or break-it business decision, particularly in today’s business climate.

Price Waterhouse Cooper’s website re-cently featured an article titled, “Trust but verify: From transparency to competitive advantage,” addressing the ways businesses can employ transparency to gain trust. But it also stresses a point I strongly agree with:

“While transparency is an all-impor-tant first step in building trust, it is not the entire solution. Without credibility, trans-parency remains an unverified promise.”

Don’t let the idea of transparency in your business keep you up at night. When you are honest, open and willing to com-municate often and listen to your vendors, partners, stakeholders and employees, your business will be more successful. It’s not a matter of if transparency is coming, it’s a matter of when. Will you be ready?

Transparency in Healthcare What does it Mean to You?

O� er Expires in 30 days.Includes exam, cleaning and x-rays. New Patients Only.

A Proud Member of the Dental Practice Group of Tennessee.D0150, D0330, D0272, D0210, D1110, D0140, D0220, D0230, D9972

Contact us today!

Make an appointment instantly on our website!

(865) 223-6183 6502B Chapman Highway

Knoxville, TN 37920

h� p://www.demandforce.com/b/Dogwood-Family-Dentistry

Affiliated with Dental PartnersAffiliated with Dental Partners

Dogwood Family DentistryAffiliated with Dental PartnersAffiliated with Dental Partners

Dogwood Family DentistryDogwood Family Dentistry

$59 NEW PATIENTSPECIAL

We LOVE to see you SMILE!

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


Cancer care has

long been a service

that hospitals have

provided, but, until recently,

featuring hospital cancer

services was unheard of.

Perhaps an attempt at “if

you don’t see it, it doesn’t

exist,” nationwide, cancer

programs were tucked away

in hospital corners. But

according to Kyle Colvett, MD,

a radiation oncologist and the

Medical Director for Oncology

Services at Mountain States

Health Alliance (MSHA), that

pessimistic attitude toward

cancer care is no longer the case.

Colvett has been working in Oncology

Services at MSHA since 1995. “Over the years

that I’ve been here, our volume has grown

tremendously—about five times the size, but our

current facility opened in 1988, and it was not

designed to accommodate

anywhere near the volume

we have presently,” he

explained. “Our current

facility is not only small,

but it wasn’t designed in

a patient-friendly manner.

It has almost an industrial

feel, with exposed concrete

and no natural light. Besides the fact that our

volumes have grown, we have been frustrated

that we don’t have the best environment for

patient care.”

Over the decades, MSHA’s oncology service

line has improved its technology tremendously,

seeing results that others are seeing nationwide:

cancer is being treated successfully with very few

side effects. Understandably, though, when the

facility doesn’t match the technology or high-

tech workflows, delivering the best cancer care

can be tough.

“Times have changed, though,” Colvett said.

“A new building is being constructed adjacent

to Johnson City Medical Center, the upper level

of which will house new operating rooms, the

lower level, adjacent to our current department,

provides a great opportunity for us to expand

out and add space for oncology. In the process,

we are adding a more pleasant, patient-oriented

environment.”

Some of the patient-centered features of the

new oncology facility include a new, separate

parking lot, dedicated to oncology patients;

a weather-protected entrance; lots of natural

light, as well as two fireplaces; a waiting room

designed with alcoves to respect patient privacy;

and a separate waiting room for children.

“One unique thing about our specialty is

that we take care of everybody, from infants to

people that are 100,” shared Colvett. “Children

have different interests and needs, so the area

has video games and other kid-centric activities,

a different décor, and an entrance to separate

exam rooms.”

Beyond the waiting areas, Colvett pointed

out that new dressing rooms are being added,

designed much like the locker room at a health

club. Each patient can have a locker, adjacent to

a private changing room, with a private entrance

to the treatment area.

Patients and staff are scheduled to begin

using the facility in September, but a full roll

out, utilizing all of the program’s technology, is

expected in 12 to 18 months.

“Budgets are difficult

in our current healthcare

environment, so the Mountain

States Foundation took this

new facility on as a focus of

interest,” said Colvett. “They

have been a tremendous friend

to us.”

Pat Holtsclaw, president

of the Mountain States

Foundation, explained that

although cancer mortality rates

have dropped, the prevalence

rate is higher, making it difficult

for the current facility to serve

the increased volume. “This

new facility will accommodate

patients throughout our service area and will

give us the opportunity to transform the patient

environment for care and

the capacity for care,” she

explained.

“We are in the process

of acquiring new technology

that runs into millions of

dollars, so we are delighted

to have Clarinda Jeanes

serving as Chair of the

Radiation Oncology Capital Campaign and

Dr. Jim Gibson as Honorary Chair to lead this

effort. They have been long-term supporters

of the Foundation and Mountain States Health

Alliance,” added Holtsclaw.

“Very few people have not been touched by

cancer,” Holtsclaw said, “so the new radiation

oncology facility will not only serve the patient’s

needs, but will also make a difference in the

community by improving the area’s cancer care.”

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

All source data for this article has been provided by

New Oncology Facility at Johnson City Medical Center will improve Environment of Care, Capacity of Care for Tri-Cities Community

Patient-Centered Practices

Dr. Kyle Colvett

Pat Holtsclaw


Jenny Harvey

Knoxville MGMA SAVE THE DATE!

Date: Thursday, September 19thLocation: Downtown Marriott,

Knoxville, TN 37919Get the latest in healthcare updates, must-have

information for the current trends and changes in the industry.

For more information or to register, visit www.kamgma.com

Chattanooga MGMA Monthly MeetingDate: 2nd Wednesday of each month

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

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

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

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

3RD THURSDAY 2ND WEDNESDAY

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

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

have to wait until cancer happens.” When Jolie came forward, some peo-

ple assumed that genetic testing for can-cer was only available to the wealthy. But genetic testing is available for women and men with particular family risk.

Who should have genetic testing?

“If you have at least one relative who was diagnosed with breast cancer under the age of 50, you need to consider test-ing,” Pencarinha said. “But it is best – if possible – to test the relative that had can-cer first.”

Pencarinha says it is also important to consider your own age. “Some younger women, under the age of 20, say they wish they had waited to get the test,” she said. “They feel like there’s nothing they can do until they reach 25. But if you have relatives who were diagnosed with cancer in their 20s and you carry the gene, you could start getting scans earlier.”

Also – men can carry breast can-cer genes as well, so testing isn’t only for women. “Men are often hesitant to do genetic testing, but men with the BRCA gene have a 7% risk of breast cancer and a 20% risk of prostate cancer, and the risk is higher in some families,” Pencarinha said.

While there are no standard criteria for recommending or referring someone for BRCA1 or BRCA2 mutation testing, some generally agreed upon guidelines include:

• Personal history of breast cancer at age 50 or younger

• Personal or family history of male breast cancer

• Personal history of ovarian cancer• A parent, sibling, child, grandpar-

ent, grandchild, uncle, aunt, nephew, niece, or first cousin diagnosed with breast cancer at age 45 or younger

• A mother, sister, daughter, grand-mother, granddaughter, aunt, niece, or first cousin diagnosed with ovarian cancer

• A family history of both breast and ovarian cancers on the same side of the family

Getting genetic testingPatients interested in genetic testing

should first talk to their physician about their family history and risk factors. Pen-carinha – and most other genetic counsel-ors across the country – only see patients that have been referred by their physi-cians. Once the patient has been referred, their genetic counseling can begin.

“When you come to a genetic coun-seling appointment, we will first talk about why you want genetic testing,” Pencarinha said. “Then we will talk about your medi-cal history. We’ll talk about family history going back three generations. We will talk about the pros and cons of genetic testing and how much it will cost. I will answer questions about insurance and address any concerns about insurance discrimina-tion.”

The actual genetic test requires only a blood sample.

“Most patients are surprised at how easy the process of genetic testing is,” Pencarinha said. “There can be anxiety related to waiting for the results of the test, but I have found that patients gener-ally anticipate a higher risk than they actu-ally end up having. Plus, once they know if they have the gene or not, they can take action to prevent cancer.”

Addressing patient concerns about genetic testing

Pencarinha sees patients with a va-riety of concerns, ranging from fear of knowing they have an increased risk of cancer to fear of insurance or employer discrimination if they are found to have the BRCA1 or BRCA2 genes.

For patients worried about insurer or employer discrimination if they test posi-tive, she educates about the Genetic In-formation Nondiscrimination Act (GINA) of 2008. The law was passed to protect individuals from medical insurance and employer discrimination.

“Patients and their physicians were worried they could lose their medical in-

surance or that their employers would know if they tested positive for the BRCA1 or BRCA2 gene,” Pencarinha said. “Dis-crimination based on genetic testing was never a widespread problem, but the fear kept people from coming in for genetic testing.”

Paying for genetic testingAnother concern patients may have

about genetic testing is the cost. According to the National Cancer Institute, the cost for BRCA1 and BRCA2 mutation testing usually ranges from several hundred to several thousand dollars.

Some insurance plans will pay for testing, and there are also grants from organizations such as Susan G. Komen for the Cure to help with the expenses of genetic testing. The Wellmont Cancer In-stitute has a Komen grant for women with no or low insurance coverage.

“Most insurance will cover genetic testing with appropriate family history,” Pencarinha said. “Medicare will cover ge-netic testing only if you’ve had cancer.”

After genetic testing – Being a ‘Previvor’

“We call people who test positive and take steps to prevent cancer previvors,” Pencarinha said. “They survive cancer by never getting it in the first place.”

Previvors have a variety of options. While surgeries such as preventive mas-tectomy and removal of fallopian tubes and ovaries are an option, many previvors prefer to do regular screenings, to modify their behavior to reduce risk of cancer, or to take medications or participate in clini-cal trials in hopes of reducing their risk of developing cancer.

“Younger women who learn they have the gene generally opt to do screen-ings, with mammograms and MRIs start-ing at age 25,” Pencarinha said. “They will alternate these tests every six months. By screening regularly, we can catch can-cer early and treat it.”

Another important thing for previ-vors to remember: “Testing positive for

the BRCA1 or BRCA2 gene doesn’t mean you have cancer – and it doesn’t mean you will have cancer,” Pencarinha said.

Research studies and clinical trials “In our practice, we work with pa-

tients to connect them with the research studies and trials that may be beneficial to them, and we also encourage patients to do their own research as well,” Pen-carinha said.

When looking into research stud-ies and clinical trials, and in deciding to have genetic testing in the first place, Pen-carinha sums up why very simply: “Hav-ing knowledge is empowering.”

Jolie Sparks National BRCA1 Conversation, continued from page 1

enhance communication tools. “We need to be able to push our information to our healthcare partners and receive informa-tion from them in a more real time and co-operative space,” explained Dreyzehner. To that end, he said Tennessee is creat-ing the Health Joint Information Center, which is a concept derived from the Na-tional Incidence Management System.

“In order to provide the best informa-tion to the public and media partners, we create a place where partners and entities can pool information to make sure we are providing the right answers in a rapid fashion.”

Ultimately, it all comes down to building a scalable infrastructure, and a big part of that infrastructure comes from creating and maintaining relationships. “An emergency is the last place you want to be meeting people for the first time,” Dreyzehner pointed out wryly.

The smooth interaction between local providers, the TDH staff, and federal of-ficials during the meningitis outbreak un-derscored just how important it was to have previously developed relationships in place when it came time to act. “Just like community health providers and cen-ters are our eyes and ears, the state health departments are the eyes and ears for the CDC,” Dreyzehner said.

“We in public health rely on a variety of surveillance tools to detect concerns and to protect health,” he continued, adding the TDH relies on local healthcare person-nel, hospitals and health departments to draw attention to concerns. “We’re always thinking of the continuum of reporting,” Dreyzehner continued. The first call, he added, should be to the local health depart-ment to report the incident. “They are cer-tainly able to escalate that rapidly if there is a need,” he said, adding each department has a medical director and direct access to the state’s subject matter experts.

Dreyzehner said the best defense to protect against or respond to public health threats is working together.

“To the healthcare community, we appreciate you … we depend on you … and we will make every effort to keep you informed and work with you to protect life and health before, during and after an event.”

In Case of Emergency, continued from page 9


The cytogenetic laboratory and information resource of choice for physicians who demand accurate, timely, and state of the art cytogenetic diagnostic services for their patients.

Where advanced cytogenetic technology meets old-fashioned service

Genetics Associates Inc. is CAP accredited, CLIA and State of Tennessee Licensed.

Our professional staff includes four American Board of Medical Genetics (ABMG) certifi ed directors.

• Chromosome Analysis

• Polymerase Chain Reaction (PCR)

• Fluorescence In Situ Hybridization (Fish)

• Array Comparative Genomic Hybridization (Microarray)

1916 Patterson Street, Suite 400 • Nashville, TN 37203(615) 327-4532 • 1-800-331-GENE (4363)

www.geneticsassociates.com

Up: How Positive Outlook Can Transform Our Health and Aging

by Hilary Tindle, MD, MPH.; c.2013, Hudson Street Press; $25.95 / $27.50 Canada, 277 pages

Let’s look on the bright side.

You’ve probably heard that sentiment several hundred times in your life; so much, perhaps, that it’s basically meaningless to you by now. Honestly, can turning a frown upside down really make a difference?

In the new book Up: How Positive Outlook Can Transform Our Health and Aging by Hilary Tindle, M.D., M.P.H., you’ll see how a positive attitude can make every year a better one.

According to Hilary Tindle, attitude has “the potential to influence every facet of our health.” Doctors, for instance, have long known that positive patients are more likely to follow medical instructions, “seize opportunities,” and avoid sabotaging their own healing. In short, upbeat patients are easier to treat – which leads to less illness and longer lives.

Research further shows that quickness to anger can predict your likelihood for heart disease. That, and a snarly attitude, can also “predict… risk factors that are known to cause… major illnesses of aging” such as high blood pressure and diabe-tes. These factors, which can stem from a negative outlook on life, begin to manifest

themselves as early as childhood and they can add up over the years.

To counteract a lifetime of sourpuss-ness, Tindle says that change is necessary (just about everybody needs some change) and definitely possible. Learn how to man-age responses to problems, first of all. If you’re prone to descending into a “nega-tive cycle,” know how to escape it. Don’t think you have to be sunshiny all the time; there are many “faces” of optimism. Ac-knowledge your accomplishments through-out every step of life, follow “typical” doc-tor advice, get in touch with nature now and then, and stop being so self-critical.

Then, buck up. Says Tindle, “… out-look can be one of our strongest allies in the aging process.”

It would be way too trite and simplistic to say that “Up” is a book about positivity. No, author, researcher, and self-proclaimed optimist Hilary Tindle offers cutting-edge information on why it’s never too late to seize change and seek a better outlook in order to reap the rewards of contented ag-ing with fewer health issues.

Knowing that it’s not that easy, howev-er, Tindle gives readers tips on altering one’s attitude, climbing out of the doldrums, and reaching for community as a bolster. I liked this book – though I think there’s a lot here that I’ve heard before – and I liked that its advice is mixed with real evidence.

Curmudgeons, crabs, and grumps be-ware: this book could change your outlook and, says the author, every little bit helps. So smile once in awhile and grab Up… be-cause if you do, the sky’s the limit.

theLiteraryExaminerBY TERRI SCHLICHENMEYER

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

The Possibility Dogs

by Susannah Charleson; c.2013, Houghton Mifflin Harcourt; $27.00 / $33.95 Canada, 260 pages

Your dog has a one-track mind, one thing at a time. So wouldn’t you be sur-prised at what else he can do? In the new book The Possibility Dogs by Susannah Charleson, you’ll see your dog’s hidden potential.

As the human half of a Search-and-Rescue team, Susannah Charleson knows what it takes to teach a dog an important task. Using the innate talents and per-sonality of her golden retriever, Puzzle, Charleson taught her girl to find lost or injured people.

So when Charle-son met a man with a “psych dog” (a ser-vice dog for someone suffering psychiatric disorders), she was intrigued. Most ev-erybody knows about guide dogs and hear-ing-assistance dogs, but what kind of ca-nine Einstein would it take to help a person whose disabilities weren’t quite as visible?

With the encouragement of her extended pool of contacts, Charleson decided to find out. She already had a houseful (two cats, Puzzle, and a small herd of Pomeranians), but she began to search for the perfect-personality puppy – which arrived unexpectedly when a neighbor who knew about Charleson’s love of dogs hastily dropped off an ema-ciated, terribly sick, half-starved puppy at her Dallas-area doorstep.

Could this little guy be like Haska, who helps her person withstand PTSD?

Would he be like Merlin, who assisted both father and son to overcome disabili-ties? Could the puppy be like Annie, who gives a teacher control over OCD; or like Juice Box, who helped his partner deal with depression and social problems? Could the puppy she named Jake Piper someday assist with loneliness, fear, ill-ness, or isolation?

Or would he be just a dog – cher-ished, pampered, and special only in the eyes of his human?

Charleson wasn’t sure if the little guy would be trainable, or even if he’d live. One thing was sure, though: she was go-ing to give him every possible chance…

Take a look at the cover of this book. Who could resist a face like that, huh? Not author Susannah Charleson, and in this wonderful book, you’ll meet that boy, and others – but don’t think that the po-tential in The Possibility Dogs is only ca-nine.

Through interviews and personal ex-periences, Charleson shows how these highly trained (though very intuitive) dogs can make an amazing difference in the lives of people who might have oth-erwise had to suffer at home, in silence. Those stories will touch your heart, and they might spur you to think about find-ing your own dog to raise or help. To that end, Charleson offers subtle advice with her addicting tales.

This slice-of-life is about dogs that nobody initially wanted – but if you’re a pet-lover or are interested in service dogs, you’ll definitely want this book, so fetch The Possibility Dogs. It’s a story you’ll like very well.


Rebekah English Named Northeast Regional Director

NASHVILLE–Rebekah English, RN, MPH, has been appointed the new di-rector of the Tennessee Department of Health’s Northeast Region. She as-sumes the role after serving as assistant regional director for the TDH Northeast Region since 2010.

English will provide leadership for all administrative, clinical, non-clinical and medical services within the TDH Northeast Region. In her new role, she will oversee management of county health departments in Carter, Greene, Hancock, Hawkins, Johnson, Unicoi and Washington Counties. Located in John-son City, the Northeast Regional Office is also responsible for providing guid-ance within the region in areas of com-munity emergency preparedness, com-municable and environmental disease control, health education and outreach.

English holds a Master of Public Health degree and a Bachelor of Sci-ence in Nursing degree from East Ten-nessee State University. She succeeds Fred Adams, who retired in June after 45 years of service with TDH.

English brings extensive expertise and public health experience to her new position as regional director. Before serving as assistant regional director for the TDH Northeast Region, she served as county health director for the Greene County Health Department. English also served as coordinator of the Breast and Cervical Program and later as Maternal and Child Health director while working as a public health nurse in the Northeast Regional Office. Prior to joining TDH as a public health nurse, English worked as a nurse with a home health agency.

English is a member of the Tennes-see Public Health Association and the East Tennessee State University College of Public Health Leading Voices Advi-sory Committee. She also serves as a board member with Frontier Health.

Franklin Woods One of Four Hospitals Honored for Commitment to Quality

SAN DIEGO – Four U.S. hospitals were recognized for their leadership and innovation in quality improvement and safety. The 2013 American Hospital Association-McKesson Quest for Quali-ty Prize was awarded to Beth Israel Dea-coness Medical Center in Boston, which will receive $75,000. Franklin Woods Community Hospital in Johnson City, Tenn. was honored as a finalist and will receive $12,500. St. Mary’s Hospital in Centralia, Ill. and Vidant Medical Center in Greenville, N.C. received the Citation of Merit.

The American Hospital Association-McKesson Quest for Quality Prize is presented annually to honor leadership and innovation in quality improvement and safety. The prize is supported by a grant from the McKesson Corporation. This year’s awardees were recognized on July 25 at the Health Forum and American Hospital Association Leader-ship Summit in San Diego.

Franklin Woods Community Hos-pital serves Johnson City as well as the surrounding rural areas. As a new hos-pital, it has been strategically designed to provide patient-centered, high qual-ity care. By impressively aligning their goals from a strategic level to an opera-tional and personal level, the hospital truly involves staff in quality and process improvement.

Tracy Byers to join Unicoi County Memorial Hospital as Administrator

ERWIN – Tracy Byers has been se-lected to serve as the administrator for Unicoi County Memorial Hospital (UCMH). The hospital, which is cur-rently under a management agreement with Mountain States Health Alliance (MSHA), is in the process of joining

MSHA, pending approval of the acqui-sition by the Unicoi County Commission and the Tennessee Attorney General. The UCMH Board of Control and Erwin Town Council have already approved the sale.

Byers will begin working with in-terim CEO Jete Edmisson on Sept. 9, and Edmisson will remain at UCMH until Sept. 30.

Byers comes to UCMH from Great Plains Regional Medical Center in Elk City, Ok., where he serves as Chief Operating Officer. He has also served as Chief Operating Officer for Harton Regional Medical Center in Tullaho-ma, Tenn.; Chief Executive Officer for Muhlenberg Community Hospital in Greenville, Ky.; and Assistant Adminis-trator and Long-Term Care Administra-tor for Hugh Chatham Memorial Hospi-tal in Elkin, NC.

In addition to operating long-term care facilities, Byers has overseen mul-tiple capital construction projects, en-hanced hospital operations through the recruitment of new physicians, and improved patient satisfaction using the nationally-recognized Studer Program.

He earned a Master of Healthcare Administration degree at the University of North Carolina, Chapel Hill, a Mas-ter’s degree in clinical psychology from the University of Louisville, and a Bach-elor’s degree in psychology from David Lipscomb University.

East Tennessee retirement community deploys the MIMI mobile health monitoring solution

CHARLOTTESVILLE, Va. — Status Solutions today announced that Ap-palachian Christian Village, one of the first established Continuing Care Re-tirement Communities in East Tennes-see, has introduced the Motion into Meaningful Information (MIMI) mobile

health monitoring solution to residents in its Personal Care Plus program. This real-time, nonintrusive system provides health alerts to family members and community staff to proactively monitor residents’ health care needs.

Powered by AFrame Digital, MIMI tracks vitals and daily activities via a wristwatch device to create personal-ized care models and trend reports. If a change in any baseline occurs, a notifi-cation automatically goes to caregivers to assist them in determining if modi-fications to a resident’s health care are needed.

Appalachian Christian Village’s Per-sonal Care Plus program is comprised of Independent Living residents who need some health care assistance. With MIMI’s implementation, the senior liv-ing community will log blood pressure, capture sleeping patterns, and track glucose levels. MIMI also is being inte-grated with Status Solutions’ Situational Awareness and Response Assistant (SARA) to provide fall-detection alerts. SARA has been used for automated alerting and response management across Appalachian Christian Village’s spectrum of care since January 2008.

ETSU pharmacy, dietetic students collaborate on diabetes education classes

JOHNSON CITY – Students and faculty from East Tennessee State Uni-versity’s Bill Gatton College of Pharma-cy and the College of Clinical and Reha-bilitative Health Sciences is holding an interprofessional series of diabetes ed-ucation classes for the general public.

ETSU student pharmacists and graduate students in the ETSU dietetic internship program collaborate on the classes, which are held at Johnson City Community Health Center (JCCHC). Af-ter organizing an initial series of classes earlier this year, the Gatton College of Pharmacy decided to move diabetes education efforts to JCCHC and invite members of the ETSU nutrition and foods program to contribute their ex-pertise.

All classes are held from 6-7 p.m. one Tuesday of each month, and each focuses on a different topic that will provide useful information for those who have diabetes or know someone who does. Topics and dates include “Advanced Carbohydrate Counting” on Sept 17; “Glucose Monitoring 101” on Oct. 22; and “Sweet Tips for Healthy Holiday Eating” on Nov. 19.

Located behind Woodridge Hospi-tal at 2151 Century Lane, JCCHC is man-aged by the ETSU College of Nursing in partnership with the College of Clinical and Rehabilitative Health Sciences.

Admission is free. For questions or more information, send e-mails to [email protected].

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

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

JOHNSON CITY MGMA MONTHLY MEETING

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

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

Johnson City

KINGSPORT MGMA MONTHLY MEETING

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

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

Second Floor, Kingsport

2ND THURSDAY 3RD THURSDAY

Save the Date: Don’t miss the September meeting, comedian Matt Fore will be performing.

GrandRounds


Caylor Schoo l o f Nurs ing

Want to advance your nursing career?

Information Sessions atLMU-Cedar Blu�

October 3 and November 4 from 3 p.m. to 7 p.m.

1-800-325-0900 ext. 6324for more information

www.LMUnet.edu

Mountain States Health Alliance announces new CEOAlan Levine to bring health policy, operations experience

JOHNSON CITY – Mountain States Health Alliance (MSHA) officials an-nounced that Alan Levine has been named by the Board of Directors to serve as President and Chief Executive Officer effective January 6, 2014. Levine will succeed Dennis Vonderfecht upon his retirement at the end of 2013.

Levine, 46, will join MSHA after more than 20 years in hospital opera-tions and in public service. Having led large, complex, multi-hospital orga-nizations as well as leading two state health systems as the senior regulator and health policy advisor to two Gover-nors, Levine is uniquely qualified to lead MSHA through the challenges and op-portunities that lie ahead for the health care system.

Prior to his current role as Group President overseeing the operations of more than 40 hospitals and their af-filiated services for Health Management Associates, Levine served as Secretary of the Louisiana Department of Health and Hospitals and Senior Health Pol-icy Advisor to Governor Bobby Jindal, where he oversaw the state’s Medicaid program and led the state’s healthcare system through two major hurricanes,

the pandemic flu, the Deepwater Ho-rizon oil spill, major health care reform and the restructuring of the state’s charity hospital system. In partnership with the Attorney General of Louisiana, Levine also led a major and success-ful effort to crack down on fraud in the Medicaid program.

Prior to his service in Louisiana, and prior to his service as President of one of the nation’s largest not-for-profit public hospital systems, Levine served as Deputy Chief of Staff and Senior Health Policy Advisor to Florida Gover-nor Jeb Bush before being appointed by Governor Bush to serve as Secretary of Florida’s Agency for Health Care Ad-ministration, the state’s regulatory and Health Policy agency with a budget of more than $17 billion. In addition to overseeing one of the nation’s largest Medicaid programs, Levine led Florida’s health care system through eight ma-jor hurricanes making landfall, sought and received federal and legislative approval for the most sweeping Medic-aid reforms in the nation, and was one of the first health secretaries in the na-tion to publish hospital cost and quality outcomes for consumers. His efforts to crack down on fraud and abuse in the Medicaid program led to recognition for his Agency by Florida TaxWatch.

Beth Bulawa Joins TMA’s Surgery Team

GREENEVILLE – Dr. Beth Bulawa has joined the surgery team at Takoma Medical Associates. She specializes in general, breast and laparoscopic surgery.

Bulawa, who is board certified, has joined Dr. Robert Bridges at the sur-gery practice located on the second floor of the TMA building at 438 E. Vann Road.

Bulawa received her medical de-gree from Downstate Medical Center in Brooklyn, N.Y., and completed her gen-eral surgery residency and her general surgery chief residency at Albany Medi-cal Center, also in New York.

Local Residents Show Up to Support Historic Cancer Research Study

Tri Cities, TN - Over 475 people throughout Northeast Tennessee and Southwest Virginia are now part of Can-cer Prevention Study-3 (CPS-3), a his-toric study into what causes – and what could possibly prevent – cancer. The 20-30 year study, which is open to individu-als between the ages of 30-65 who have not been diagnosed with cancer, will look at genetic, lifestyle and environ-

mental factors that may cause or pre-vent cancer. The previous Cancer Pre-vention Studies by the American Cancer Society resulted in discovering the link between smoking and lung cancer and certain lifestyle factors associated with increased cancer risks.

During August 6-9, participants enrolled in CPS-3 at one of five sites throughout Northeast Tennessee and Southwest Virginia thanks to a partner-ship with Wellmont Cancer Institute and YWCA of Bristol. To enroll in the study, individuals were asked to read and sign an informed consent form; complete a comprehensive survey packet that asks for information on lifestyle, behavioral, and other factors related to his/her health; had a waist circumference mea-sured; and gave a small blood sample. The Society will now send periodic follow-up surveys to update enrollee information and annual newsletters with study updates and results. Periodic follow-up surveys of various lengths are expected to be sent every few years to enrollees.

The voluntary, long-term commit-ment by participants is what will pro-duce benefits for decades to come. For more information about CPS-3, visit cancer.org/cps3.

GrandRounds

Suzanne Miller



East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Commu-nications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore uncondition-ally assigned to Medical News for publication and copyright purposes.

easttnmedicalnews.com

Become a fan on Facebook, and Follow us on

Twitter@EastTNMedNews

SOUTHCOMMChief Executive Offi cer Chris FerrellChief Financial Offi cer Patrick Min

Chief Marketing Offi cer Susan TorregrossaChief Technology Offi cer Matt Locke

Business Manager Eric NorwoodDirector of Digital Sales & Marketing David Walker

Controller Todd PattonCreative Director Heather Pierce

Director of Content / Online Development Patrick Rains

GrandRounds

Name: Kathy Visneski, APN, AOCN, APHN-BC

Position: Oncology Clinical Nurse Specialist for Wellmont Cancer Institute

At a Glance: An employee with the Wellmont Cancer Institute since 1982, Kathy Visneski teases that she’s “their girl Friday” because “I do whatever needs to be done.” Over the years, Visneski has served in many different capacities, including educator, facilitator, and caregiver. She teaches the Institute’s chemotherapy course to nurses, as well as oncology education for staff members. She also navigates inpatient oncology patients, making sure that when they go home, “all the things that need to happen are happening,” she explained.

Of all of her different responsibilities, Visneski said her favorite job is facilitating the cancer support group Survive and Thrive, which she has been doing every year for 26 years. “I get so much more out of it than I give,” she enthused. “I have learned so much from them about surviving. It changes your whole life when you work in cancer care.”

Visneski shared that the notion cancer care is a depressing thing is false. “I don’t know if that it’s only nice people get cancer or that they get nice once they get it, but I have the most awesome patients. They appreciate everyone who helps them.”

Her dedication to her patients has been nationally recognized. In 2009, Visneski received the Lane Adams Quality of Life Award from The American Cancer Society, a prestigious award given each year to health professionals who provide consistently excellent and skilled care to cancer patients.

Sometimes the care Visneski gives is given unexpectedly. As she explained, just a few weeks ago, she sat at her desk with tears rolling down her face over the fact her hairdresser of 30 years had abruptly retired. “Then a patient knocks on my door, who had just had a PET scan, and the results were not good. He would have to change his chemo, start radiation, and I felt ashamed to tell him why I was upset,” she recalled. “He walked around my desk, patted me on the shoulder, and assured me that it would be okay. It took me two seconds to think ‘Who cares if she retired?’

“And, even more, it made him feel better that in his bad place, he could help me! They put your life in perspective for you very quickly.”

VCU names Dr. Wilsie Bishop to list of ‘120 Visionary Leaders’

JOHNSON CITY – The Virgin-ia Commonwealth University (VCU) School of Nursing recently published a list of “120 Visionary Leaders” who are alumni or faculty from its School of Nursing, and that list includes Dr. Wilsie Bishop, vice president for Health Affairs and chief operating offi cer for East Ten-nessee State University.

VCU identifi ed 120 visionary leaders to commemorate the 120th anniversary of its nursing school. Bishop earned a bachelor’s degree in nursing from VCU in 1970 and a Master’s degree in 1978. She later graduated from the University of Southern California with graduate degrees in education and public admin-istration, as well as the doctor of public administration degree.

A member of the ETSU faculty for

over 30 years, Bishop has a long history in executive academic leadership that echoes from her time as a VCU student, when she held offi ces in the National Student Nurses Association at the local, state and national levels.

Bishop became dean of what was then known as ETSU’s College of Public and Allied Health in 1994. Later, as vice president for Health Affairs, she was in-strumental in the growth process that resulted in the college evolving into two independent entities, the College of Public Health and the College of Clini-cal and Rehabilitative Health Sciences.

A native of Appomattox, Va., Bish-op has been ETSU’s chief operating offi cer since 2004. As the leader of the university’s Health Affairs division, she has guided ETSU to the establishment of an Academic Health Sciences Center that, with colleges of medicine, nurs-

FOCUS ON ONCOLOGY


HEALTH SYSTEM

ing, pharmacy, public health, and clini-cal and rehabilitative health sciences, is among the most diverse in the nation in terms of academic programming.

Bishop is one of only 11 academic leaders in the nation and the only one in Tennessee who serve as board mem-bers for the Association of Academic Health Centers.

Seven More Physicians Enroll in Wellmont Osteopathic Family Medicine Residency in Southwest Virginia

BIG STONE GAP, Va.– Another group of medical residents is reinforc-ing Wellmont Health System’s commit-ment to develop highly skilled physi-cians and increase access to primary care in Southwest Virginia.

Seven physicians who have enrolled in the osteopathic family medicine resi-dency program created by Wellmont re-cently participated in a white-coat cer-emony at Lonesome Pine Country Club.

They are the third class to have joined this innovative program that is bolstering the level and quality of care for patients in this region. The program now has about 20 residents and is near-ing the maximum of 24 Wellmont has been approved to enroll.

The new residents and their medi-cal school are Dr. David Bhola, Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, Fla.; Dr. Menalin Ganal, Touro Univer-sity College of Osteopathic Medicine, Vallejo, Calif.; Dr. Zehra Hussain, Uni-versity of North Texas Health Science Center, Fort Worth; Dr. Dwayne Likens, University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, Ky.; Dr. Veronica Robinson, A.T. Still Univer-sity School of Osteopathic Medicine, Mesa, Ariz.; Dr. Joshua Yeary, Lincoln Memorial University-DeBusk College of Osteopathic Medicine, who previously worked as a lab technician at Hancock County Hospital in Tennessee; Dr. An-thony Yount, LMU-DCOM, who previ-ously worked as an emergency depart-ment nurse at Hancock County.

As they complete their residency, these seven physicians will deliver com-passionate care at Mountain View Re-gional Medical Center, Lonesome Pine Hospital and Lee Regional Medical Center in Virginia. They will also receive some of their specialty rotation training at Holston Valley Medical Center and Bristol Regional Medical Center in Ten-nessee.

In addition, these physicians will im-prove patients’ lives by treating them at the Wellmont Osteopathic Family Med-icine Residency Clinic at 295 Wharton Lane, Norton.

PUBLISHED BY:SouthComm, Inc.

CHIEF EXECUTIVE OFFICERChris Ferrell

PUBLISHERJackson Vahaly

[email protected]

ASSOCIATE PUBLISHERCindy DeVane

[email protected]

EDITORBridget Garland

[email protected]

CREATIVE DIRECTOR Susan Graham

[email protected]

GRAPHIC DESIGNERSKaty Barrett-Alley

Amy GomoljakChristie Passarello

CONTRIBUTING WRITERSSharon Fitzgerald, Cindy Sanders, Lynne Jeter, Terri Schlichenmeyer,

Bridget Garland, Leigh Anne W. Hoover, Rick Jelovsek, Brad Lifford,

Joe Morris

ACCOUNTANTKim Stangenberg

[email protected]

[email protected]

——All editorial submissions and press

releases should be emailed to: [email protected]

——Subscription requests or address

changes should be mailed to:

Medical News, Inc.210 12th Ave S. • Suite 100

Nashville, TN 37203615.244.7989 • (FAX) 615.244.8578

or e-mailed to: [email protected]

Subscriptions: One year $48 • Two years $78


I don’t just have insurance.

I own the company.

Medical Professional Liability Insurance

Mutual Interests. Mutually Insured.

“ Like me, you’ve probably noticed some professional liability insurance providers recently offering physicians what seem to be lower rates. But when I took a closer look at what they had to offer, I realized they simply couldn’t match SVMIC in terms of value and service. And SVMIC gives me the peace of mind that comes when you’re covered by a company with more than 35 years of service and the financial stability of an “A” (Excellent) rating. At SVMIC, I know it’s not just one person I rely on...there are 165 professionals who work for me. That’s because SVMIC is owned by you, me, and over 14,000 other physicians across the Southeast. So we know our best interests will always come first.”

Gary E. Meredith, M.D.Pediatric Diagnostic Associates

Chattanooga, TNPediatrics

Contact Randy Meador or Susan Decareaux at [email protected] or 1-800-342-2239.

SVMIC is endorsed exclusively by the Tennessee Medical Association and its component societies.

Follow us on Twitter @SVMIC www.svmic.com

Neal Carter Joins Wellmont CVA Heart Institute as Cardiothoracic and Vascular Surgeon

KINGSPORT – Dr. Neal Carter, a cardiothoracic and vascular surgeon who was trained at the world-renowned Texas Heart Institute, has joined the Wellmont CVA Heart Institute.

Carter will deliver ex-pert care to patients at The Heart Center, 2050 Meadowview Parkway, and perform cases at Holston Valley Medical Center, which has repeatedly been recognized for its stellar cardiovascular care.

Carter received a Bachelor’s degree in international studies from Brigham Young University in Provo, Utah, before embarking on his medical career. He graduated from Des Moines Univer-sity College of Osteopathic Medicine in Iowa and then completed a general surgery residency at St. Elizabeth Health Center in Youngstown, Ohio.

His most recent training was a fel-lowship in cardiothoracic surgery at the Texas Heart Institute at the Baylor Col-lege of Medicine in Houston. That insti-tute is internationally recognized for its premier cardiothoracic program.

Carter is trained in advanced pro-cedures to treat heart, lung and vascu-lar disease. Carter is certified with the American Board of Surgery. He was a resident member of the American Col-lege of Surgeons and the American Col-lege of Cardiology. He also served as a clinical instructor in surgery at North-eastern Ohio Universities College of Medicine in Rootstown.

TN Health Comm. John Dreyzehner is TMA Public Health Champion

NASHVILLE—Tennessee Health Commissioner John J. Dreyzehner, MD, MPH, FACOEM, of Nashville, has been named a TMA Quarterly Public Health Champion for 2013. The honor recog-nizes TMA member physicians for their outstanding public health contributions across the state of Tennessee.

Dreyzehner is being recognized for over 20 years of service and leader-ship in clinical and public health at the federal, state and local levels, most recently as an advocate for a healthier Tennessee as state health commission-er. Dreyzehner has been instrumental in tackling a variety of public health issues, particularly the Volunteer State’s pre-scription drug abuse problem and its consequences. Working with the Ten-nessee Medical Association and other stakeholders, he helped pass new laws aimed at monitoring controlled sub-stance prescriptions and stemming the prevalence of Neonatal Abstinence Syn-drome.

A former district director for Virgin-ia’s Cumberland Plateau Health District

and acting district director with the Vir-ginia Department of Health, Dreyzehner serves as an adjunct faculty member at East Tennessee State University’s Col-lege of Public Health, visiting assistant professor in Public Health Sciences for the University of Virginia, and is found-ing faculty for the Healthy Appalachia Institute at University of Virginia‐Wise.

Board certified by the American Board of Preventive Medicine in Occupa-tional and Environmental Medicine, he is a Fellow of the American College of Oc-cupational and Environmental Medicine

and a Diplomate of the National Board of Medical Examiners. Along with the TMA, his other professional associations include the American Medical Associa-tion (AMA), and the Association of State and Territorial Health Officials (ASTHO).

Dreyzehner began his medical ser-vice in 1989 as a U.S. Air Force flight sur-geon. Following honorable discharge as a major, he spent several years practic-ing occupational medicine, joining the Virginia Department of Health in 2002. He also concurrently practiced addic-tion medicine for several years while

working on substance abuse prevention in his public health role. He joined Ten-nessee Governor Bill Haslam’s cabinet as Commissioner of Health in Septem-ber 2011.

He graduated from the University of Illinois at Champaign‐Urbana Magna Cum Laude with a Bachelor of Science in psychology. He received his Doctor of Medicine degree from the University of Illinois at Chicago, and earned his Mas-ter of Public Health at the University of Utah, where he also completed his resi-dency in Occupational Medicine.

GrandRounds

Dr. Neal Carter

The NEW APP has landed!• Personalize your health profile.

• See up-to-date ER wait times.

• Find your closest First Assist Urgent Care location.

• See distances to ERs and urgent care locations.

• Check out our services and catch up on our latest social media posts.

The MSHA mobile app - available at your app store.Download your app today! It’s free!

www.msha.com Android iPhone

tri cities medical news sept 2013

Documents

genetic counselor

applicable manufacturers

tennessee storytelling

tennessee center

genetic testing services

idea of genetic testing

debbie pencarinha

wellmont cancer institutefocus