tri cities medical news sept 2014

Fadi Abu-Shahin, MD

PAGE 2

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Enjoying East TennesseeNiswonger Performing Arts Center My husband and I recently celebrated our 30th wedding anniversary. As college sweethearts at Clemson University, my now “clean shaven,” banker husband, Brad, used to look a lot like Grammy-winner singer/songwriter Kenny Loggins ... 3

HEALTHCARE LEADER: Cathy GottCathy Gott, Director of Radiation Oncology for Wellmont Cancer Institute, is one of those rare people whose career trajectory has followed a linear path with no digressions ... 8

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By CINDy SANDERS

Which region of the country has the fewest states that opted to expand Medicaid, the highest rate of un-insured nonelderly adults, leads the nation in chronic conditions such as obesity and diabetes, and fi nds the majority of its states have poverty levels above the na-tional average? No surprises here … it’s the South.

Jessica Stephens, a senior policy analyst with the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, has been instrumental in working on several KFF projects this year assessing coverage

and care in Southern states, along with opportunities and challenges the region faces to provide increased health-care access and equity. Stephens, who received both her undergraduate degree and master’s in Health Policy and Administration from Yale, is also part of the Disparities Policy Project for KFF.

In looking at expansion decisions by region, Ste-phens noted KFF uses the U.S. Census Bureau defi ni-tion of the South, which includes 16 states – stretching westward to Texas and northward to Delaware – plus the District of Columbia.

Southern ExposureThe Medicaid expansion haves … and mostly have nots … in the South

(CONTINUED ON PAGE 12)

A Gift Back to the Community Wellmont Health System’s Clinical Trials move research forward, help save lives

By JOHN SEWELL

At one time, being diagnosed with the unspeakable “C-word,” cancer, was basically a death sentence. But with an ever-expanding menu of drugs and treatments, cancer pa-tients are fi nding the odds some-what tilted in their favor. Today, the survival rate for cancer is 60-70%. Granted, this is all a matter of how far the cancer has progressed when diagnosed and which cancer it is.

Clinical trials are crucial for spurring cancer research forward and saving lives. And Wellmont Medical System’s clinical trials are on par with the best hospitals in the nation. As such, Wellmont’s clinical trials participants are able to undergo world-class treatment without traveling hundreds of miles to other hospital systems. And with a glut of new drugs and treatment options, perspectives toward cancer are changing.

“It’s not that we’re curing the disease, but we’re keeping the

people alive for longer periods,” said Sue Prill, MD, practic-ing oncologist and director of Wellmont’s Leonard Family Comprehensive Breast Center. “Our goal is to get it [cancer] to where we can treat it as a chronic disease instead of a

terminal disease.“Control is the real issue,”

Prill continued. “There’s noth-ing wrong with having a stable disease—if you can keep it under control, that is.”

With around 200 clinical trials participants per year, Well-mont’s staff is pushing cancer

research forward. Wellmont’s present trial research is, for the most part, focused on fi ne-tuning already established treatments and drug regimens.

“Generally, we look at treatments that we already know are work-ing,” explained Prill. “Usually, our biggest task is to get the right com-binations and to prove that these combinations work to the FDA.”

Gathering that proof, however, is a long and arduous process. (CONTINUED ON PAGE 15)

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PhysicianSpotlight

By BRIDGET GARLAND

Although he’s practic-

ing medicine far from his

hometown in Jordan, Fadi

Abu-Shahin, MD, a medical

oncologist and hematologist

with Wellmont Cancer In-

stitute since 2012, is fulfilling

his childhood aspiration.

As a child, he noticed

the special status physicians

received and how well re-

spected they were in his

country. “I liked that idea

[to become a physician] as a

child, and being able to help

people; it was also an abil-

ity to do something no one

else could,” Abu-Shahin re-

called.

Knowing that medical

school would immediately follow high

school, Abu-Shahin worked hard to earn

high marks and perform well on the gen-

eral exam before graduation, as only the

very top scores advance. He was accepted

into the University of Jordan School of

Medicine, where he spent the next six

years completing his pre-clinical and clini-

cal coursework. He spent the next year

in hands-on training at Al-Salt Hospital

in Jordan.

“In medical school, you rotate

through all the departments, and you

begin to get a feeling for the fit that is

best for you,” he explained. “Typically,

your personality determines it. I have two

brothers and a sister with different per-

sonalities, and we all went into different

fields.”

During his transitional year resident

training, he worked in oncology at the

prestigious King Hussein Cancer Cen-

ter in Jordan. All of his preceptors were

American trained and boarded, had

come back to Jordan, and had opened the

center. “I liked the variation, the men-

tal processing, and the clinical judgment

required for the specialty,” Abu-Shahin

said. “And after working with that popu-

lation, in that center, I knew that was what

I wanted to do.”

He applied to multiple places in the

United States for residency, but

he was very attracted to the pro-

gram at East Tennessee State

University’s Quillen College of

Medicine. In 2006, he started his

three-year internal medicine resi-

dency and continued for a fourth

year as chief resident. Immedi-

ately following, he started his on-

cology fellowship. He received the

school’s Thomas Ronald Award

for Excellence in the care of

cancer patients, and he is board-

certified in internal medicine and

medical oncology.

When questioned about the

common perception that working

with cancer patients is depressing,

Abu-Shahin is quick to correct

that misconception. “It is tough,

but at the same time, it’s very re-

warding. A lot of people we cure,

and more than half are close to achieving

a cure,” he explained. “We offer a lot of

help and support, even if the patient isn’t

cancer free. We help them feel better and

help them get their disease under control.”

To explain further, Abu-Shahin used

an analogy that some cancers are like dia-

betes. “We don’t have a cure for diabetes,

but there are good medications and life-

style modifications that can keep it under

control,” he said. “Even if the cancer can

be kept in check like a chronic disease,

that’s rewarding.

“Oncologist also develop a close re-

lationship with their patients. Patients be-

come part of the family. They begin to call

you first, even before their primary care

physicians because you get so involved

with them,” he said.

Another highlight that Abu-Shahin

points out about his specialty is the nu-

merous advancements that are being

made in oncology. “Even since I have fin-

ished school, many medications are new,

and many new technologies have been de-

veloped,” he explained. “I am constantly

learning.”

And Abu-Shahin couldn’t be more

excited about the opportunity to work

with the Wellmont Cancer Institute. “I

love working with this group—I love it,”

he enthused. “Not every group is this ho-

mogeneous, but this group is perfect. We

have seven physicians, and I love them

all. They are knowledgeable, caring for

patients, and easy to work with. The staff

in general and the administration are also

very good and provide everything we

need.”

While in medical school, Abu-Shahin

met his wife Rowan Abu-Zeitoon, MD,

who works as a hospitalist at Wellmont’s

Holston Valley Medical Center in King-

sport. They graduated in the same year

and came to Tennessee together. The cou-

ple now have two girls, Kenda, who is 6

years old, and Naya, who is 2½ years old.

Abu-Shahin spends most of his free

doing things with his children, dedicating

the time to family activities. He also enjoys

sports, namely soccer, because he grew up

watching it. He plays a game with friends

on occasion and is excited that his daugh-

ter has joined a soccer team this year.

Fadi Abu-Shahin, MD

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By LEIGH ANNE W. HOOVER

My husband and I recently celebrated our 30th wedding anniversary. As college sweethearts at Clemson University, my now “clean shaven,” banker husband, Brad, used to look a lot like Grammy-win-ner singer/songwriter Kenny Loggins. In fact, with longer hair, a beard, and flannel shirts, one of my brothers even told me Brad was a “Kenny” look alike.

As a journalist, I knew if I ever had the opportunity to interview Kenny Log-gins, Brad would have to be there, and he was! In 2007, I was granted a one-on-one interview with Kenny Loggins for a fea-ture titled “Enduring Lure of Loggins,” which was published in Marquee Maga-zine. Since then, of course, I have re-mained a fan and was thrilled to discover he will be performing on October 28th at the Niswonger Performing Arts Center (NPAC) in Greenev-ille, Tennessee.

Is it just me, or have you noticed the wonderful lineup of performers at NPAC for the 2014-15 sea-son. Chances are, if you are reading this article, you may have already enjoyed a few, and there are many, many more to come.

Turns out, this is the 10th year anni-versary for the venue. Adjacent to Green-eville High School, what was originally going to be a part of a remodeling effort turned into a 1,152 seat state-of-the-art venue when Scott M. Niswonger, as a member of the high school building com-mittee, decided to do something more im-pressive in Greeneville, Tennessee.

Through a collaborative effort, which partnered the city of Greeneville, Green-eville City School Board of Directors, and the generous, approximately $6.2 million private funding of Scott M. Niswonger, the $7 million state-of-the-art NPAC opened in 2004 and has benefitted the en-tire region.

“The facility adjoins Greeneville High School, and it is used as their pri-mary auditorium,” explained Executive Director Tom Bullard. “But, it is not ac-tually a school facility.”

According to Bullard, NPAC oper-ates as a separate nonprofit entity and leases from the school system. In turn, the school utilizes the facilities for perfor-mances.

It would appear to be a delicate bal-ance, but through Managing Director, Angie Wilson, NPAC makes the coordi-nation appear effortless.

“We actually have a great relationship with the school, and we now have their cal-

endar at least a year in advance,” explained Bullard. “We are able to plug-in their dates and then build around it with ours.”

Surrounded by mahogany, which was imported from Africa and acoustic tiles from China, the facility is one of the very best, and there is not a bad seat in the house.

In fact, the fa-cility is an intimate 1,152 seat venue that offers performers and patrons a more per-sonal concert experi-ence.

In January 2013, the NPAC govern-ing board brought on Bullard and his com-

pany, Creative Entertainment Manage-ment Group, and exciting performances

are definitely happening. Fulfilling the mission of perpetuating and enhancing the performing arts for the region, Bullard is excited about everything at NPAC.

The 2014-2015 10th Anniversary line-up is fabulous, and there should be one or more performances that will certainly ap-peal to everyone’s taste in entertainment.

“Overall, the quality of the perfor-mances has improved, by far, and the quantity of performances has greatly in-creased,” said Bullard. “The diversity of the performances, where we’ll have jazz one night, country the next and 70s an-other, is a wide variety of entertainment. We’re also specializing in family program-ming... and international performances.”

According to Bullard, there are now matinee performances for family-oriented performances. With international acts, including the Russian Ballet, Argentina Tango Dancers, and National Acrobats from China, many countries are also rep-resented.

Bullard attests the NPAC is fortu-

nate to have philanthropists like the Nis-wongers involved, and it is most rewarding to see his dream of what the facility could be actually being fulfilled.

“When you see what they do as far as the Niswonger Foundation, the Nis-wonger Children’s Hospital, all the mon-ies that are given back to schools in East Tennessee, the philanthropy is amazing, and they are just a great group of persons to work for,” said Bullard.

Under Bullard’s leadership, the NPAC has been a boon for the economy and continually attracts visitors from across the Southeast.

“Last year, our demographics showed over 75 percent of the persons attending shows here had never been to the facility before,” said Bullard. “That was very im-pressive. We actually doubled the average attendance in one year.”

Although Kenny Loggins has been touring extensively as part of the trio, Blue Sky Riders, Bullard was able to coordinate a Loggins only exclusive performance, which is set for October 28th at NPAC, and you will not want to miss it. Trust me, as the king of movie soundtracks from the 80s, this crooner can still go into the fal-setto and belt out the ballads. Loggins is definitely “Alright” by me!

For additional information regarding all of the upcoming exciting performances and events at NPAC, and to purchase tickets, be sure to visit http://www.npac-greeneville.com/home.aspx

Enjoying East TennesseeNiswonger Performing Arts Center

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].


Online Event

Calendar

By CINDy SANDERS

Tennessee became one of the first states in the nation to face litigation over its Medicaid practices in the post-reform era when three advocacy groups filed suit on behalf of clients they say have waited far beyond the legal limit for a determination of TennCare eligibility.

The Southern Poverty Law Center, Tennessee Justice Center and National Health Law Program filed suit on July 23 in the U.S. District Court for the Middle Dis-trict of Tennessee. Darin Gordon, Larry B. Martin, and Raquel Hatter, PhD, in their respective official capacities as director of the Bureau of TennCare, commissioner of the Tennessee Department of Finance and Administration and commissioner of the Tennessee Department of Human Services have been named as defendants.

In a conference call with statewide media representatives, lawyers for the plaintiffs alleged the state was playing poli-tics by adopting policies that have deprived vulnerable citizens of healthcare coverage for which they are eligible and kept others, who might or might not ultimately be eli-gible, hanging in limbo with no determina-

tion date in sight. The attorneys said the Centers for Medicare and Medicaid Ser-vices have long required eligibility decisions be made within 45 days of an individual filing an application. However two of the plaintiffs, each facing a health crisis, had al-ready waited more than 140 days without receiving any determination.

“No one wants to be here today,” said Michele Johnson, co-founder and executive director of the Tennessee Justice Center

(TJC). “The state of Tennessee has failed its citizens. The results have been unimagi-nable and unacceptable.”

Sam Brooke, a senior staff attorney at the Southern Poverty Law Center, stated, “We have filed a federal lawsuit today, Wilson v. Gordon, because Tennessee is frankly playing politics with the lives of their citizens.”

He added that Tennessee has made it more difficult than any other state in the

nation to enroll in its Medicaid program. “They’re throwing a monkey wrench into their own Medicaid program so the can demonize the federal government. People in dire need of medical care are being sac-rificed,” Brooke said.

He noted the 45-day requirement for determining eligibility isn’t a new rule, nor is the requirement that calls for a hearing if a denial or no determination is made. “What is new is Tennessee’s decision to ig-nore both these requirements,” he asserted. The attorneys said failure to render a deci-sion or to offer a channel to settle a dispute violates an applicant’s right to due process.

The group added they have been meeting with TennCare officials for sev-eral months to address a variety of issues, several of which were outlined in a sternly worded mitigation letter from CMS to TennCare in late June accusing the state of failing to meet six of seven critical success factors required by federal healthcare law. “To their credit,” said Brooke, “they have addressed some of the other issues but have drawn a line in the sand on this.”

Johnson said the backlog stems from a decision to end in-person assistance for

Tennessee Facing Litigation Over Medicaid PracticesDelays in TennCare Determinations at Heart of Lawsuit

(CONTINUED ON PAGE 14)

(L-R) Attorneys Michele Johnson and Sam Brooke are joined by Melissa Wilson and Ricky Reynolds in announcing the lawsuit against TennCare. Wilson and Reynold’s wife April are two of the plaintiffs who have waited more than five months without receiving any word on their enrollment applications.

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By LyNNE JETER

“Uncertainty prevails” was a com-mon theme in the recently released Jackson Healthcare study on the Af-fordable Care Act’s (ACA) impact on physicians and practices.

“We found that a significantly larger number of phy-sicians desire to be employees (versus inde-pendent contractors) in the post-ACA world,” said Sheri Sorrell, man-ager of market research for Jackson Healthcare, a national healthcare recruitment fi rm based near Atlanta. “They know a salary is constant, even when reimbursements decline. Plus, they know someone else will navigate the complexities of the ACA.”

Jackson Healthcare’s “Physician Practice Trends 2014,” a national study with nearly 2,000 physicians representing all 50 states and medical-surgical specialties, revealed some rap-idly changing statistics that are shaping physicians’ decisions to ink an employ-ment deal with a hospital or healthcare

system. The happiness factor. Physicians

whose income decreased in the last year are more likely to be age 45 to 64, own their medical practice, work more than eight hours a day, be dissatisfi ed with their career, and discourage young people from entering the medical fi eld. Because of the ACA roll-out, they say they’ve lost patients, and remaining patients often delay treatments because of higher out-of-pocket costs.

The “never-known-indepen-dence” physicians. Satisfi ed physi-cians are more likely to be between the ages of 25 and 44, work eight hours a day, be employed, have chosen employ-ment for lifestyle reasons, and have a greater number of patients with private insurance. “Younger physicians are most likely to have never been in private prac-tice,” noted Sorrell. “They started out employed and remain employed.”

The impact of higher deduct-ibles. As a result of higher deductibles resulting from effects of the ACA law, patients are seeking routine care less frequently and postponing certain pro-cedures. The trend attributed to 12 percent of physicians’ responses to the most prevalent effects the rollout of the ACA has had on their practices. The higher deductible has made insurance the equivalent of self-pay. “In reality,” one physician wrote, “patients don’t have insurance until they’ve met their deduct-

ibles.”The insurance cancellation

aspect. Insurance policy cancellations led to 23 percent of physicians saying they’ve lost patients since the ACA im-plementation; another 15 percent lost patients because their practice could no longer accept their insurance plans.

Quality of life and fi nancial reasons are only a part of the reason why older physicians, especially primary care pro-viders (PCPs), are approaching hospi-tals, with the keys to their practice in hand.

“The majority of acquisitions are ini-tiated by physicians,” emphasized Sorrell. “It’s not necessarily the hospitals going after the practices. It’s the practice physi-cians knocking on the hospital door.”

Fortunately, practice acquisitions are mutually benefi cial for practice phy-sicians and hospitals and health systems, the latter of which are welcoming the op-portunity to buy PCP practices as they’re forming and growing Accountable Care Organizations (ACOs).

The answer to which party has the upper hand depends on the geographic location of the practice.

“They’re hedging their bets,” added Sorrell. “They’ve done the math. They know what they need to keep up with the ACA compliance. They see it’s too much to deal with. They realize they’re better off accepting a salary, putting in their eight hours a day, and going home.”

Despite the awkward position of practice physicians approaching hospi-tals and health systems about a deal, they have a considerable amount of leverage, especially in larger metropolitan areas, Sorrell pointed out.

“They’re offering the practice on their terms,” she explained, “and can say, ‘if you don’t take it, I’m going down the street to offer it to your competitor.’”

A striking study statistic as a positive benefi t to physicians of selling their prac-tice: The number of physicians taking call dropped from 77 percent in 2012 to 55 percent in 2014.

“Basically, it’s a result of employ-ment,” Sorrell said. “It’s interesting be-cause physicians, especially older doctors, tend to complain a little bit about the work ethic of younger folks, who want to work eight hours a day and not take call. Those same physicians are making a shift in that percentage by at least limiting on-call time in their contracts.”

Sorrell said study statistics align with broader trends seen in other Jackson Healthcare and industry research.

“We’ve been tracking the trend to-ward employment in various ways, with studies on physician practice acquisitions, why physicians decided to sell their prac-tice, or why they want to get out of private practice,” she said. “We’ve also been tak-ing a look at what happens when physi-cians become employed. These are trends we’ll continue to watch.”

Shifting Toward EmploymentMore PCPs are becoming hospital employees, according to ACA impact study on physicians and their practices

Sheri Sorrell


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LegalMatters

Profit and Loss: The Top Ten Things Providers Need to KnowPart V: Refunding Overpayments – 60 Days and Shades of Grey

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

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

It sounds so simple: Identify an overpayment and send it back. The Patient Protection and Affordable Care Act (“ACA”) mandates refund of governmental healthcare funds within 60 days after identification (or the due date of the corresponding cost report for those providers who file cost reports) (1). This section of the Act was created to enhance Medicare and Medicaid Program integrity provisions. Failure to refund on a timely basis makes the retention of the money a “reverse false claim.” This framework requires providers to perform an in-depth analysis to address the shades of grey involved in the refund process.

How did the overpayment happen?

Before a Provider can decide what

to do about an overpayment, the facts and circumstances that resulted in the overpayment must be examined. Was the overpayment the result of an innocent mistake, wrongful conduct, or a billing question? Some CPT code descriptions have an inherent aspect of interpretation. For example, Evaluation and Management (E/M) services require decision-making, whereas billing for a flu injection is relatively simple.

In Medicare audits, claims are sometimes down-coded by reviewers. The difference between the reimbursement rate billed and rate allowed is considered an overpayment. Repayment is required, but generally no penalty is associated with this type of overpayment.

However, a pattern of consistent up-coding may be characterized as fraudulent billing. In July 2013, the Office of Inspector General (OIG) reported a settlement with a regional medical center in California that allegedly violated the Civil Monetary Penalties law. The OIG described

the submitted claims as upcoded by a physician “who had engaged in a pattern or practice of coding at a higher level that he knew or should have known would result in a greater payment than the code applicable to the services he was providing.”

Where do you report?The statute gives a list of places for

reporting and refunding: the Secretary of Health and Human Services, the State, an intermediary, a carrier, a contractor. On February 16, 2012, the Department of Health and Human Services, Centers for Medicare and Medicaid Services, proposed rules for the Medicare Program: Reporting and Returning Overpayments (2). To date, these rules have not been finalized. Review of the discussion, background, and scope of the proposed rules may provide clarification to help providers decide how to handle overpayment situations. Examples of reasons for the overpayment noted in the proposed rule include incorrect service date; duplicate payment; incorrect CPT code; insufficient documentation; and lack of medical necessity. Reference is also made to the voluntary refund process described in Chapter 4 of the Medicare Financial Management Manual, noting the existing procedures for the voluntary refund process. The report must also include an explanation of how the error was discovered; a description of the corrective action; the reason for the refund; whether the provider or supplier is under a corporate integrity agreement with the OIG; the time frame and total amount of the refund; and identifying information related to the provider, the payment, etc. Reporting directly to the payer of the funds and making a refund directly to that payer would be appropriate only if the overpayment was not caused by a violation of federal criminal, civil, or administrative law for which civil monetary penalties are authorized.

When do civil monetary penalties apply?

Review of the federal regulations which address civil monetary penalties will give providers some guidance about the overpayment. Unfortunately, this is another area where ambiguity exists because knowledge of an overpayment is considered actual or constructive (3). The basis for civil money penalties allows the OIG of the Department of Health and Human Services to impose a penalty if it determines a claim was “knowingly” made. Knowing is defined as “when

the person knew, or should have known, a claim was not provided, including a claim that is part of a pattern or practice of claims based on codes that the person knows or should know will result in greater payment” (4).

What are the potential penalties?If the overpayment is identified

and not reported and refunded by the 61st day, the claim may be classified as an “obligation” and violation of The False Claims Act, subjecting the provider to treble damages (or, $5,500 - $11,000 per false claim) (5). If the overpayment is reported to the OIG through the Self-Disclosure Protocol, a minimum multiplier of 1.5 times the single damages is the general practice. In other words, if you self-report an overpayment of $1,000 to the OIG, you could expect to pay $1,500 to settle the matter. (OIG applies this multiplier to the amount paid by Federal healthcare programs, not the amount claimed.)

The date of identification of the overpayment is yet another grey area subject to interpretation. The proposed rules state that a person may receive information concerning a potential overpayment which then creates an obligation to make a reasonable inquiry. The text goes on to warn that failure to make that inquiry “with all deliberate speed” could result in the provider “knowingly retaining an overpayment” because it acted in reckless disregard or deliberate ignorance of whether it received such an overpayment (6).

Ultimately, the facts of the case will determine how a provider should deal with an overpayment. In the example in which a provider billed a patient for two flu shots instead of one, a refund to the payer should solve the problem. Beyond that scenario, the analysis into the facts and the law will require providers to decide how to appropriately navigate the shades of grey in refunding overpayments.

Notes:1Patient Protection and Affordable Care Act, Pub. L. No. 111-149, Section 6402(d) Reporting and Returning Overpayments.2Federal Register Volume 77, No. 32, page 9179, Thursday Feb. 16, 2012342 CFR Part 1003 Civil Money Penalties, Assessments and Exclusions442 CFR 1003.102 5False Claims Act, 31 U.S.C. §§ 3729 – 37336Federal Register, volume 77, No. 32, page 9182, Thursday Feb. 16, 2012

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


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Greg GilbertShatita Daniels Brooke ThurmanStacy SchuettlerAndrew McDonaldJenny Harvey

Meet Some of the Faces Behind Our Healthcare Experience.

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Katie Graham 862.862.3020 (direct) / [email protected] Senior – Healthcare Consulting

Katie, a healthcare senior, works directly with medical practices to enhance the overall levels of efficiency and profitability. With ten years of experience, she has extensive experience in operational and revenue cycle assessments, EMR/PM consulting, fee schedule analysis and needs assessments. Katie is active in Healthcare Information and Management Systems Society (HIMSS) and Knoxville Area Medical Group Management Association (KAMGMA), and enjoys biking, listening to local music and spending time with her family. She appreciates the outdoors and is often outside playing with her two dogs.

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Where Great Companies Come to Grow.

The Literary ExaminerBY TERRI SCHLICHENMEYER

Shocked: Adventures in Bringing Back the Recently Dead by David Casarett, MD; c.2014, Current; $27.95 / $32.95 Canada, 260 pages

Even in the worst kind of shoot-out, the Hero always manages to nail the bad guy, who clutches his chest, falls without hitting his head, gasps, and flutters his eye-lids before shutting them. Fingers go limp, cue the credits.

Television aside, you know that death isn’t that neat. It’s messy and chaotic, and in the new book Shocked: Adventures in Bringing Back the Recently Dead by David Casarett, MD, you’ll see that that’s a very good thing.

Back when he was in medical school, David Casarett had a patient he’ll never forget: the man he calls “Joe” had a “mas-sive heart attack” and died, but the resus-citation team brought him back to life. Joe didn’t fare well – Casarett questioned his own quickness in calling code - and, be-

cause this happened some time after a two-year-old had famously been successfully resuscitated after dying, Casarett wondered why the outcomes weren’t the same.

Now, as a hospice doctor, Casarett knows why: lifesaving technology “can’t make [a patient] young and healthy. Nei-ther can it cure the other maladies that come with age.” That doesn’t stop medi-cal science from trying to re-start the life of someone who’s died – but where is the edge of the envelope being pushed?

CPR and mouth-to-mouth resuscita-tion go back decades, if not centuries. Also back then, tying a body to a horse and jog-ging around a park was a recommended method of revival. That worked, as Casa-rett learned, but it was only a “partial suc-cess.” Other methods included blowing smoke into a victim’s orifices (volunteers? anyone?) and immersion in warm water.

Much of this, of course, has to do with a person’s heart, as Casarett learned on a tour of a monster-sized plastic organ. But it also depends on the methods of revival, as he saw in a high-tech dummy in a state-of-the-art training ER. It has to do with the way someone has died, their mitochondria, how quickly (or if) the body was chilled, economics, and the proximity of lifesaving equipment.

But any way you look at it, technologi-

cal advances mean that “death isn’t what it used to be.”

So you say that expiration is no laugh-ing matter? It is when you’re reading Shocked. This book could turn any spectre of death into the Grin Reaper.

With a keenly-honed sense of true cu-riosity and a killer wit, author David Casa-rett gamely goes from mortuary to museum and back, to look deeply at how “dead” is maybe not really dead these days. In doing so, he melds old-school myth with modern technology to see why lives are saved (or not), and his irreverent comments and hi-larious observances give the title of his book a wicked double meaning.

Constructive Wallowing by Tina Gilbertson; c.2014, Viva Editions; $15.95 / $19.95 Canada, 256 pages

You were this close to getting what you wanted.

That big sale, the raise, the promo-tion, all within your grasp. The acquisition, the job, the deal of a lifetime: almost yours,

until everything fell through.That’s life, right? Buck up and suck it

up. Move on… but how, when you can’t get over it? You’re miserable, so read the book Constructive Wallowing by Tina Gilbertson, and learn that feeling sorry for yourself may be the right thing to do.

We all have our disappointments. It’s a part of being human, just as it is to say “Look on the bright side!” or “It could’ve been worse!” The truth is, though, that chirpy sentiments and Think Positive post-ers only make you feel lousier. What’s more, if you follow those words, you’ll cut yourself off from understanding and you quash the chance to get rid of those bad feelings.

The point, says Gilbertson, is that “how we deal with our feelings has an im-pact on how quickly we’re able to bounce back from setbacks large and small.” The trick, she says, is not to change your emo-tions or suppress them, since stuffing them down puts them in an “escalation cycle.” Instead, acknowledge them, allow yourself to feel them, then let them run their course.

“You can’t wallow unless you ALLOW,” says Gilbertson, and wallowing constructively means being kind to yourself while you’re allowing feelings to surface.

Doing so seems so difficult, but there are steps to help you.

Have a conversation with yourself, and (CONTINUED ON PAGE 14)


Date night at Barter is love’s kick starter.

Make your date Sing-Shakespeare

“If music be the food of love, play on.”

HealthcareLeader

Cathy GottBy JOHN SEWELL

Cathy Gott, Director of Radiation Oncology for Wellmont Cancer Insti-tute, is one of those rare people whose career trajectory has followed a linear path with no digressions. In other words, Gott always knew she wanted to work in radiation therapy. Her job is not just a ca-reer—it’s a calling. And right now, she’s precisely where she wants to be.

“I had two significant events that led me down the path that I had chosen,” ex-plained Gott. “When I was 13, I sustained a foot injury—shot in the foot. So I spent a month in the hospital at Holston Val-ley. While I was there, I was always fasci-nated whenever they took x-rays. Then, my mother developed cancer and battled it for 12 years. So I was around the ra-diation therapists that treated her. I was always interested in x-rays and knew that was exactly what I wanted to do.”

And that’s exactly what she did. After receiving an Associate’s Degree in radiol-ogy from East Tennessee State University, Watt signed on as a Staff Radiologist at Wellmont’s Kingsport Hospital in 1984. For the next 14 years, Gott ascended through the ranks in a number of radiol-ogy positions at Wellmont. Then, in 1998, she had an epiphany.

“I was doing some management work at Holston Valley,” explained Gott. “And I realized that if I was going to do man-agement, I had to get some business sense.

So I earned a BA in business, and then an MBA, with a healthcare focus.”

With these degrees, Gott acquired all the tools she needed to proceed toward her present career destination. As director of oncology, Gott juggles a host of respon-sibilities with élan. Her tasks include (but are not limited to) setting up a multi-tiered system of patient services, arranging clini-cal trials, accounting, human resources, and the most important job of all—work-ing to make sure patients at the Wellmont Cancer Institute receive top-notch care.

“I want to be there for all the pa-tients in real time, all the time,” said Gott.

“It’s hard sometimes. Our patients have so many needs. Cancer is such a devas-tating disease. And it seems to get harder and harder to provide top quality care as the state of healthcare continues in the path it’s on. Basically, we just try to help people. And that’s where our patient as-sistance program comes in.”

Patients enrolled in the Wellmont Cancer Institute have access to a breadth of professionals to help guide them through the perilous journey that is can-cer. Above and beyond physicians and techs, Wellmont also provides dieticians, social workers, and a genetic counsellor.

“The genetic counseling is something that is a rarity in Tennessee, and we’re really proud to offer that,” said Gott. “Everyone on the team has focused their abilities to best serve cancer patients. And, of course, I think we have the greatest phy-sicians. My father has cancer right now, and I do not hesitate to bring him here.”

Gott is particularly enthusiastic about two new acquisitions called linear accel-erators. Simply put, linear accelerators are high powered x-ray machines used in ra-diation therapy for cancer patients.

“The linear accelerators are the lat-est and greatest technologies,” explained Gott. “We have a long legacy of high tech acquisitions; we’ve had Cyberknife for over 10 years now. And the linear accel-erators are going to help us continue on with that legacy. We’re ecstatic to have them. Both of the machines are great. So

now we have the full arsenal of treatment for any eventuality.”

Wellmont is also in the process of in-stalling a new device called the Truebeam, which will be available for patients in the fall of 2014. Finally, the Cancer Institute will be offer a new infusion center in its Bristol location, which is slated to open in winter 2015.

“The incidence of cancer is on the in-crease, and we’re doing everything we can to keep up with the pace,” said Gott. “One million people get cancer every year. But cancer is not a death warrant anymore. Right now, about 64 percent of the people who have been diagnosed with cancer in the last five years are survivors, and that’s so exciting. That’s why I like being in on-cology so much.”

Technological innovations are cer-tainly a crucial necessity—especially for dealing with a complex disease like can-cer. And, of course, it’s pivotally impor-tant to continually restructure and evolve staff configurations and integrations with other facilities. But, ultimately, maintain-ing close working relationships and inter-action with patients and their families is the “glue” that holds complex organiza-tions like the Wellmont Cancer Institute together.

“The team we have together right now is absolutely the best—the surgeons, physicians, radiation oncologists, nurses, techs, everyone,” enthused Gott. “My job to make the process as smooth as pos-sible for the patients that go through our program. And that involves business and management skills. It’s an awesome job—trying to put all those parts together. But in the final analysis, that kind of takes a backseat to caring for the patients.

“There is nothing else I’d ever want to do than to care for patients,” Gott con-tinued. “I can’t imagine doing anything else.

“The thing about oncology is, people either love doing it—or they respect the people that are able to do it. And I think that our team is people that love doing it. They know just how important and worth-while the job really is.”


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Fax – (615) [email protected]


By JOE MORRIS

Providing the latest technology and treatment options is

vital in today’s competitive healthcare environment, but doing so in an environment that’s also warm, caring, and focused on the patient is a major differentiator as well.

Nowhere is that fusion of high-tech and personal more visible – and more appreciated — than in oncology service lines. That’s why Johnson City Medical Center (JCMC) is pleased to have been named one of America’s “100 Hospitals and Health Systems with Great Oncology Programs” by Becker’s Hospital Review, as well as one of Tennessee’s Top 10 Hospitals by US News and World Report.

While the US News list cited multiple reasons for the inclusion, Becker’s honed in on patient care, cancer outcomes, and research as reasons JCMC made the list. That’s no surprise to Tony Benton, interim CEO of Mountain States Health Alliance’s Washington County, Tenn. hospitals, who said that cancer care is one of many areas that MSHA and its hospitals are focusing on — with excellent results.

“If you see the list of 100 hospitals that Beckers selected, it’s a very esteemed list,” Benton said, noting that JCMC is keeping company with the likes of Vanderbilt University Medical Center, St. Jude Children’s Research Hospital, and the University of Tennessee Medical Center here in Tennessee, and national notables such as the Cleveland Clinic, Johns Hopkins Kimmel Cancer Center, and the Cincinnati Children’s Hospital.

“The credit goes to the group of physicians and clinical staff we have, who do a phenomenal job of delivering care to our patients,” Benton added. “They are so dedicated to their practice, and as anyone touched by cancer knows, it’s a life-changing, emotional time. It takes very unique people to

be able to work and flourish in that care area, and I’m proud we have such a great team. The experience they bring is amazing, and it’s very nice to get this kind of external recognition. It just validates a lot of things we’ve been on a long journey to try to provide.”

For JCMC and other Mountain States hospitals, a patient-centered approach means looking at the mental and emotional state of a patient, as well as his or her physical condition, Benton said, and then including family members in the care plan. It also means incorporating proactive care plans during hospitalization that can extend outward from the hospital once the patient has returned home.

“Part of what makes our oncology program great is the navigator program that helps patients guide their way through,” he said. “We have nurse navigators who help them make sense of all the different appointments they have, and the different treatments. It’s very helpful to patients, families and caregivers to have that support. The navigator is someone who, because of his or her expertise, can see the big picture and help weave it all together for the patient. He or she is a real partner.”

In the future, Benton said the navigator model will likely grow into other service lines such as stroke care and cardiology because they also are high-touch when it comes to patient-caregiver interaction.

“What we’ve been working toward in terms of healthcare reform and the changes hospitals are undergoing is the ability to look beyond our walls,” he explained. “Having a

navigator program in place allows us to extend beyond our walls, and make sure that the full continuum of care means more than just the period when the patient is hospitalized.”

To that end, he pointed out JCMC’s new clinic to treat those with congestive heart failure. It serves as a midway point between hospital and home, so that those patients can do a better job of managing their own care, as well as helping their care providers do the same.

“When those people do well, they don’t come back to the ER or wind up back in the hospital,” Benton said. “We want to take our patients further and help them improve while they are away from us. We think this model will have a lot of other applications, all of which will benefit our community.”

Going forward, he noted, the patient-provider interaction is “only going to be expanded and made more efficient. One of the things most exciting to me about getting the kind of recognition we are seeing now is that so many good things are still yet to come. We have two new state-of-the-art linear accelerators coming to our area, and they are going to allow us to do some procedures that haven’t been available around here.

“Mountain States and all our hospitals are on a journey when it comes to treating our patients and providing that patient-centered care environment,” Benton continued. “We have the technology and the treatments, but it really starts with our people. They are our foundation to be successful, and they are crucial when it comes to keeping the focus on the patient. Our people really are the most important part of our care.”

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

All source data for this article has been provided by

Nationally recognized excellenceOncology care just one aspect of Mountain States’ patient-centered approach

Patient Centered Practices

Tony Benton

PAID ADVERTISEMENT


Our multidisciplinary team’s combined expertise helps determine the best possible treatment options for every patient.

To beat cancer, you want a team of experts on your – and your patients’ – side. You want a team that brings the latest in evidence-based medicine and the most advanced technologies to help en-sure the best outcome for each case. Th at’s what you’ll fi nd at the Wellmont Cancer Institute.

Introducing TrueBeamSTx with BrainLab – the latest in radiotherapy and radiosurgeryBuilding on a decade of expertise in robotic radiosurgery, we’re expanding the suite of in-novative services available to your patients with TrueBeam STx and BrainLab. Located at Bris-tol Regional Medical Center’s J.D. and Lorraine Nicewonder Cancer Center, this non-invasive technology represents the state-of-the-art in ste-reotactic radiotherapy and radiosurgery systems.

It is faster and more powerful than ever, giving clinicians the ability to navigate the complexities of cancer care with confi dence, including challenging brain, spine, lung, liver and prostate cases.

TrueBeam’s sophisticated technology synchro-nizes imaging, patient positioning, motion management, beam shaping and dose delivery. Designed to treat a moving target with unprec-edented speed and accuracy, TrueBeam targets tumors as the patient continues to breathe, helping deliver treatments up to 50 percent faster than more traditional methods. Th is means less time for patients on the table and more time living life.

Th e addition of BrainLab, the only one of its kind within a 200-mile radius, signifi cantly enhances the treatment options available to you, especially for hard-to-reach tumors of the brain and spine. BrainLab’s image-guided software displays a 3d reconstruction of abnormal tissue. Using that reconstruction, we tailor the shape of the radiation beam to conform to the lesion, providing a level of pinpoint accuracy not possible before. Th is also minimizes radiation exposure to surrounding healthy tissue.

Robotics expertise you can rely onIn 2004, Wellmont Health System became the region’s fi rst provider – and one of the fi rst sites in the country – to use specialized radiotherapy in cancer treatment. And we’ve been performing stereotactic radiosurgery with Cyberknife at Bristol Regional ever since.

Providing specialized care backed by cut-ting-edge research and innovative clinical trials has paved the way for the next generation of technology. In 2013, Wellmont announced the arrival of the Trilogy linear accelerator at Holston Valley Medical Center. Trilogy provides a new level of power, precision and versatility to better equip Wellmont to treat more complex cases. TrueBeam marks the continuation of this tradition.

The technology and team you can trust to help win the fi ght against cancer.Wellmont Cancer Institute

Wellmont Physician Connection

A team-based approach to careAt the Wellmont Cancer Institute, we provide a multidisciplinary approach to care. Medical, radiation and surgical oncologists, specialty surgeons, radiologists and pathologists come together to create the plan of care specialized for the individual patient. Other caregivers, including a certifi ed genetic counselor, nurse navigators, registered dietitians and social workers, round out the team to ensure we’re meeting all of the patient’s needs.

During our tumor conferences, the team dis-cusses each patient’s medical history, imaging studies and other records. Th ey also follow national treatment guidelines and consider clinical trials that might be benefi cial – all to ensure we’re providing the most comprehen-sive treatment available.

Cancer care with compassionNo one should ever fi ght cancer alone. Th at’s why the Wellmont Cancer Institute features a special group of oncology nurses known as patient navigators who work closely with pa-tients and their families to guide them through the journey.

For patients facing fi nancial hardship during their treatment, the patient assistance fund, supported through annual fundraisers, is there to help with medications, utilities and other necessities during their treatment. Wishing Well Shoppes located in the cancer institute’s Kingsport and Johnson City locations donate 10 percent of their proceeds to benefi t the patient assistance fund.

ise helps for every patient.

te-ms.

Using that reconstruction, we tailor the shape of the radiation beam to conform to the lesion, providing a level of pinpoint accuracy not possible before. Th is also minimizes radiation exposure to surrounding healthy tissueexposure to surrounding healthy tissue.

cases. TrueBeam marks the continuation of this tradition.

For patietheir treasupportedto help wnecessitieWell ShoKingspor10 percenpatient as

Lois Jinks and daughter, Beth Jinks, were thankful to have LaCosta Brown, nurse navigator, to guide them both through their cancer treatments.

wellmont.org/hope /Wellmont @WellmontHealth

Located at the Wellmont Cancer Institute in Kingsport and Johnson City.

Wishing Well Shoppes support the Wellmont Cancer Institute’s patient assistance fund.

For the region’s most advanced, comprehensive cancer care services, turn to the Wellmont Cancer Institute. For more information, call Holston Valley Medical Center at 423-224-5500 or Bristol Regional Medical Center at 423-844-2360. Or visit wellmont.org/hope.

Matthew Wood, MD, neurosurgeon, John Fincher, MD, radiation oncologist


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].

Our multidisciplinary team’s combined expertise helps determine the best possible treatment options for every patient.

To beat cancer, you want a team of experts on your – and your patients’ – side. You want a team that brings the latest in evidence-based medicine and the most advanced technologies to help en-sure the best outcome for each case. Th at’s what you’ll fi nd at the Wellmont Cancer Institute.

Introducing TrueBeamSTx with BrainLab – the latest in radiotherapy and radiosurgeryBuilding on a decade of expertise in robotic radiosurgery, we’re expanding the suite of in-novative services available to your patients with TrueBeam STx and BrainLab. Located at Bris-tol Regional Medical Center’s J.D. and Lorraine Nicewonder Cancer Center, this non-invasive technology represents the state-of-the-art in ste-reotactic radiotherapy and radiosurgery systems.

It is faster and more powerful than ever, giving clinicians the ability to navigate the complexities of cancer care with confi dence, including challenging brain, spine, lung, liver and prostate cases.

TrueBeam’s sophisticated technology synchro-nizes imaging, patient positioning, motion management, beam shaping and dose delivery. Designed to treat a moving target with unprec-edented speed and accuracy, TrueBeam targets tumors as the patient continues to breathe, helping deliver treatments up to 50 percent faster than more traditional methods. Th is means less time for patients on the table and more time living life.

Th e addition of BrainLab, the only one of its kind within a 200-mile radius, signifi cantly enhances the treatment options available to you, especially for hard-to-reach tumors of the brain and spine. BrainLab’s image-guided software displays a 3d reconstruction of abnormal tissue. Using that reconstruction, we tailor the shape of the radiation beam to conform to the lesion, providing a level of pinpoint accuracy not possible before. Th is also minimizes radiation exposure to surrounding healthy tissue.

Robotics expertise you can rely onIn 2004, Wellmont Health System became the region’s fi rst provider – and one of the fi rst sites in the country – to use specialized radiotherapy in cancer treatment. And we’ve been performing stereotactic radiosurgery with Cyberknife at Bristol Regional ever since.

Providing specialized care backed by cut-ting-edge research and innovative clinical trials has paved the way for the next generation of technology. In 2013, Wellmont announced the arrival of the Trilogy linear accelerator at Holston Valley Medical Center. Trilogy provides a new level of power, precision and versatility to better equip Wellmont to treat more complex cases. TrueBeam marks the continuation of this tradition.

The technology and team you can trust to help win the fi ght against cancer.Wellmont Cancer Institute

Wellmont Physician Connection

A team-based approach to careAt the Wellmont Cancer Institute, we provide a multidisciplinary approach to care. Medical, radiation and surgical oncologists, specialty surgeons, radiologists and pathologists come together to create the plan of care specialized for the individual patient. Other caregivers, including a certifi ed genetic counselor, nurse navigators, registered dietitians and social workers, round out the team to ensure we’re meeting all of the patient’s needs.

During our tumor conferences, the team dis-cusses each patient’s medical history, imaging studies and other records. Th ey also follow national treatment guidelines and consider clinical trials that might be benefi cial – all to ensure we’re providing the most comprehen-sive treatment available.

Cancer care with compassionNo one should ever fi ght cancer alone. Th at’s why the Wellmont Cancer Institute features a special group of oncology nurses known as patient navigators who work closely with pa-tients and their families to guide them through the journey.

For patients facing fi nancial hardship during their treatment, the patient assistance fund, supported through annual fundraisers, is there to help with medications, utilities and other necessities during their treatment. Wishing Well Shoppes located in the cancer institute’s Kingsport and Johnson City locations donate 10 percent of their proceeds to benefi t the patient assistance fund.

ise helps for every patient.

te-ms.

Using that reconstruction, we tailor the shape of the radiation beam to conform to the lesion, providing a level of pinpoint accuracy not possible before. Th is also minimizes radiation exposure to surrounding healthy tissueexposure to surrounding healthy tissue.

cases. TrueBeam marks the continuation of this tradition.

For patietheir treasupportedto help wnecessitieWell ShoKingspor10 percenpatient as

Lois Jinks and daughter, Beth Jinks, were thankful to have LaCosta Brown, nurse navigator, to guide them both through their cancer treatments.

wellmont.org/hope /Wellmont @WellmontHealth

Located at the Wellmont Cancer Institute in Kingsport and Johnson City.

Wishing Well Shoppes support the Wellmont Cancer Institute’s patient assistance fund.

For the region’s most advanced, comprehensive cancer care services, turn to the Wellmont Cancer Institute. For more information, call Holston Valley Medical Center at 423-224-5500 or Bristol Regional Medical Center at 423-844-2360. Or visit wellmont.org/hope.

Matthew Wood, MD, neurosurgeon, John Fincher, MD, radiation oncologist


“Six states including D.C. have imple-mented the Medicaid expansion,” Stephens said, listing Delaware, Maryland, the Dis-trict of Columbia, Arkansas, Kentucky and West Virginia. “They’ve all taken slightly different approaches,” she noted. “Arkan-sas, in particular, has adopted a private op-tion where they are using Medicaid funds to assist newly eligible adults pay for pri-vate coverage through the marketplace,” Stephens added of a waiver granted by the Centers for Medicare & Medicaid Services to allow the state to provide premium as-sistance.

Nationally, Stephens continued, 26 states plus the District of Columbia have implemented Medicaid expansion, which means nearly half of the U.S. states elect-ing not to expand at this time are located in the South – 11 of the remaining 24. “In the West and Northeast, the majority of states have (expanded). In the Midwest, a larger number are not, but it’s still more than in the South.”

The reasons for not implementing ex-pansion are multifactorial. Stephens said that in addition to general political opposi-tion to the Affordable Care Act in many Southern states, there is also a concern over the sustainability of maintaining expanded Medicaid rolls even though the phased down match rate of 90 percent is still much higher than the general Medicaid popula-tion. And, she continued, “There are con-cerns over the Medicaid program overall … how it’s run in general.”

On the flip side, though, there is

mounting concern over what the decision to not expand means for a large number of people. Stephens said more than a third of the nation’s population, 37 percent, live in the South, and the region is also home to 4 of 10 people of color. “The expansion was important, in part, because it was going to expand Medicaid to adults who were his-torically excluded from the program,” she said.

A very large percent of those who make too much for traditional Medicaid but not enough to qualify for federal sub-sidies reside in the South. “Overall in the South, there are 3.8 million people who fall into this gap, and nationally, there are 4.8 million … so nearly 80 percent of all those who fall into the gap nationally are in the South,” Stephens stated.

She added people are often surprised to fi nd out just how little a family could make in order to qualify for traditional Medicaid. Citing median levels, she noted, “For a family of three – one adult and two children – that family cannot earn more than approximately $12,000 a year for the parent to be eligible.” Stephens continued, “Non-disabled, childless adults remain in-eligible regardless of how much they earn.” Without expansion, she said, Medicaid eli-gibility for adults remains very limited.

Additionally, Stephens noted the deci-sion not to expand Medicaid also further exacerbates healthcare disparities with people of color being disproportionately impacted by the choice. “Six in 10 blacks who would have been eligible for Medic-

aid in the South, about 1.2 million people, are not because they fall into the coverage gap.”

Among states that did expand cov-erage, Stephens said reports are coming in that those states have been able to im-prove the effi ciency and function of their Medicaid programs by taking advantage of a number of ACA provisions. “We can tell the Affordable Care Act and the Med-icaid expansion has important potential to change delivery,” she said. “It also has the potential to reduce disparities in access to coverage and care by race and ethnic-ity and also by geography if the Southern states would expand.”

Even without expansion, though, Ste-phens said outreach and consumer assis-tance is critically important to chip away at the 21 million in the region still lacking any type of coverage. About 48 percent of the South’s uninsured currently qualify for existing programs.

“Of the 21 million uninsured in the South, we have 7 percent who are Med-icaid-eligible adults, 11 percent who are Medicaid- or CHIP-eligible children, 30 percent who are eligible to obtain tax cred-its to purchase private coverage through the marketplace, 18 percent who are in the coverage gap, 21 percent who are ineligible for fi nancial assistance who have incomes above the tax credit limit or an offer of em-ployer-sponsored coverage, and 13 percent who are ineligible due to their immigration status,” Stephens outlined.

Ultimately, improving health out-

comes will largely depend on the creation of dependable channels to access care … whether through the expansion of Medic-aid, implementation of other solutions to address the needs of the uninsured, or a combination of both.

Southern Exposure, continued from page 1

State Current Medicaid Expansion Decision

Alabama No

Arkansas Yes

Delaware Yes

District of Columbia Yes

Florida No

Georgia No

Kentucky Yes

Louisiana No

Maryland Yes

Mississippi No

North Carolina No

Oklahoma No

South Carolina No

Tennessee No

Texas No

Virginia No

West Virginia Yes

Internal MedIcIne Update15 AMA/CME Credits will be provided

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A Medical Education meeting with practical Internal Medicine topics from dozens of locally and nationally renowned speakers

• anemia• C. difficile• chronic disease mgmt.• diabetes• diabetic neuropathy• echocardiography• hematuria

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• neuro ICU for stroke• psychopharmacology• pulmonary embolism• stroke pathophysiology• stroke prevention• thrombosis management and more!

And 20 more healthcare experts!Come to Chattanooga, TN!

The Chattanoogan Hotel Chattanooga, TNOctober 1-4, 2014

Accreditation: The University of Tennessee College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. AMA Credit Designation: The University of Tennessee College of Medicine designates this live activity for a maximum of 15 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Phil BredesenFormer Governor

Janice Lea, MDEmory University

Brad Rovin, MDOhio State University

Laura Mulloy, DOGeorgia Health Science

Medical Center

Richard Glassock, MDUniversity of California at

Los Angeles

Tom Devlin, MDErlanger Health System

David MerrittLeavitt Partners

Arthur Wheeler, MDVanderbilt University

George Bakris, MDUniversity of Chicago

Juan Velez, MDMedical University of

South Carolina

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By SEAN P. WHITE, MD, FACOG

In 1928, the Greek pathologist Georgios Papanikolaou first described a noninvasive technique of collecting cells from the vaginal tract and smearing them on a slide for microscopic evaluation and detection of precancerous and cancerous cervical cells. This “Pap” test was not widely implemented for cervical cancer screening for a couple of decades after this introduction. Remarkably, however, the incidence of cervical cancer has decreased by 50% since the widespread implementation of the Pap smear, as well as newer technologies.

The goals of cervical cancer screening are identification and treatment of true cervical cancer precursors. CIN 3 is a definite cervical cancer precursor, which peaks between the ages of 25 and 30 years, and progression to cancer usually takes at least a decade longer. Because of the moderate cancer risk associated with CIN2, it is the consensus threshold for treatment in the U.S. There will be an estimated 12,360 new cervical cancer cases in the U.S. in 2014. Cervical cancer is much more common in third world countries, which do not have adequate screening or HPV vaccination.

Since Dr. Papanikolaou’s introduc-tion of the Pap screen, there have been numerous advances which improve the ability to detect cervical cancer and its precursors. Automated screening machines were developed to augment cytologic interpretation of Pap smears. Liquid-based cytology subsequently evolved to decrease obscuring mucous, blood, and debris. Another improvement in sensitivity of cervical cancer screening has been the addi-tion of high risk HPV testing.

These recent advances in cervical cancer screening prompted the American Cancer Society (ACS), US Preventive Services Task Force (USPSTF), and the American College of Obstetrics and Gynecology (ACOG) to recommend changes in screening for cervical cancer .The new guidelines vary by patient age, and healthcare providers must change

screening frequency for age-appropriate management. In 2009, ACOG recommended avoidance of screening anybody under 21 years of age regardless of age of sexual debut or number of partners. It was determined that most young women have an effective immune response that clears HPV infection. Less than 0.1% of cervical cancer cases occur in this age group.

The new 2012 ACOG guidelines recommend that women aged 21-29 undergo cytology screening every 3 years. Co-testing with HPV assay is not recommended in this age group. Women aged 30-65 should undergo co-testing with cytology and HPV every 5 years. Cytology testing alone every 3 years in this age group is an acceptable, but not preferable, alternative. (Clinical trials have demonstrated that cytology and HPV co-testing has increased sensitivity for detecting CIN3 and cancer compared to cytology alone.) The aforementioned testing intervals should be followed even with ASCUS results, as long as HPV is negative.

Women 30-65 year olds who have a negative Pap and positive HPV result get high risk HPV 16/18 testing. If HPV 16/18 is negative, patients should have repeat co-testing in 12 months. If HPV 16/18 is positive, colposcopic evaluation should be performed.

The new guidelines also recommend cessation of cervical cancer screening at the age of 65. Women aged 65 and older should not be screened if they meet the following criteria: 1) no history of CIN 2 or greater in the past 20 years, 2) negative screening with 2 consecutive cytology and HPV co-testing or 3 consecutive negative cytology alone screenings within the last 10 years (with a recent test within the last 5 years), 3) no personal HIV history or history of immunocompromised condition, and 4) no previous DES exposure.

There are too many possibilities to cover all of the likely scenarios of cervical cancer screening in this article, but the above guidelines are the basic recommendations for screening with normal test results. They

are a marked deviation from the previous recommendation of annual pap smears. One can refer to ACOG Practice Bulletin number 140, December 2013, for flow charts and greater elaboration of the new guidelines on the management of various abnormal results. There is also a mobile app from ASCCP (American Society for Colposcopy and Cervical Pathology) at http://www.asccp.org/Guidelines to simplify applying the guidelines in practice.

As physicians and patients adopt these new guidelines with extended intervals of up to five years between Pap screenings, it could be problematic making sure that women get regular preventative examinations and cervical cancer screening. In the old interval testing, there was a big buffer if a patient missed one yearly exam. If a five year cervical cancer screen is missed, this could possibly lead to very long gaps in screening intervals. In the US, 10-20% of cervical cancers occur in women who have not had a pap in the preceding five years.

Patients will need to be educated on the importance of continued regular physician visits for family planning, STD screening, and other gynecologic concerns. The extended interval between cervical cancer screenings will require providers to be more diligent in tracking when the next cytologic testing is due. It will be more difficult, even with electronic records, to keep track of and send patient reminders of when the next cytologic testing is due since the intervals vary with patient age. These increased intervals, however, should save the system money and prevent unnecessary testing and treatment.

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

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

JOHNSON CITY MGMA MONTHLY MEETING

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

Location: Summit Leadership Foundation3104 Hanover Rd.

Johnson City

KINGSPORT MGMA MONTHLY MEETING

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

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

Second Floor, Kingsport

2ND THURSDAY 3RD THURSDAY

residents trying to apply for TennCare. Tapping into federal funds, Tennessee has invested $35 million in an upgraded com-puter system that will hopefully alleviate the situation. However, Johnson said 100 people in county offices who served as in-person resources for applicants were laid off

before seeing if the computer system func-tioned properly … it didn’t.

Now, TennCare officials seem unable to offer a timeline as to when the system will be operational. Instead all applications for TennCare are being funneled through the federal marketplace website, healthcare.gov, which Johnson said was neither set up for nor intended to process and deter-mine eligibility for TennCare’s 27 unique categories.

Jane Perkins, legal director for the Na-tional Health Law Program, noted, “It is clear Tennessee is a national outlier. We are monitoring enrollment in other states, and at this point, Tennessee is among the worst … if not the worst … offenders.” She added, “This is the first case that has been filed to challenge a state’s failure to process applications in a timely manner.”

The phones have continued to ring at

the TJC as individuals share stories of their battles with red tape and radio silence from anyone who could make a determination on their status. “We’ve gotten about 160 calls in the last six weeks about this issue,” Johnson said last month. “We’d never got-ten a call before Jan. 1 from someone who was waiting 45 days.”

While there were 11 plaintiffs in the original filing, the attorneys have asked the court to certify the suit as a class action. They are also seeking emergency help for those stuck in limbo. Johnson said they are asking for a court injunction requiring a de-cision be made within 72 hours after it has been brought to the attention of TennCare officials that an individual has waited more than 45 days for an eligibility determina-tion.

“On August 14, the state responded and filed a motion to dismiss the whole

case,” Johnson continued. “They said we should have sued the federal government.” She added the state’s take on the situation seemed to be that the enrollment delays were tied to failings with the federal mar-ketplace and healthcare.gov site coupled with the ongoing problems with the state’s new computer system. However, Johnson noted every other state has managed to get its computer system working except Ten-nessee. Other states also offer in-person assistance to help individuals navigate a complex system. Johnson reiterated the federal online marketplace “was never meant to be the only door to obtain state coverage.”

A hearing on the requests by both the plaintiffs and defendants was set for Aug. 29. In the meantime, costs and frustrations continue to mount.

“Charity care clinics often require, rightfully so, some kind of proof that you’ve been denied coverage, but these folks can’t get that because they can’t get any answer,” said Johnson. “Tell them yes. Tell them no. But tell them something.”

Tennessee Facing Litigation Over Medicaid Practices, continued from page 4

Go Online for UpdatesAn important hearing regarding this case was scheduled for Aug. 29, which fell after our print deadline for the September issue. Please go online to NashvilleMedicalNews.com for updates regarding the lawsuit.

figure out why you’re experiencing bad feelings. Don’t be afraid to get everything out into the open; there is no wrong answer here. Learn the 11 Reasons why you want to wallow in your emotions, then use The T-R-U-T-H Technique to bring the bad feelings forward. “Feel your pain. Let it go where it wants to go with you,” and don’t try to force anything. Have a good cry if you need to, and remember that when bad feelings have “run their natural course… they’ll go away on their own.”

Sounds a little new-agey, doesn’t it? I thought so, too – but then again, if you’ve ever talked yourself out of a bad mood, then you’ll know that it’s hard to argue with what’s inside Constructive Wallowing.

By advocating what is basically a deep examination and acceptance of emotions, author and counselor Tina Gilbertson of-fers readers a few handy tools to help get rid of those feelings that seem to hang around like an overstayed guest in the back bedroom. Some of the methods are given in step-by-step fashion while others, though moderately repetitive, advocate more of an overall, big-picture helping hand. And if readers still struggle with emotions they’d rather not have, Gilbertson finishes her book with advice on finding a therapist to help.

Yes, what’s here may be somewhat alternative, but when the remains of a dis-appointment just won’t let go, Constructive Wallowing seemed to me to be worth a try. And if that’s what you need in a book, keep this close.

The Literary Examiner,

continued from page 7

Terri Schlichenmeyer. Terri is a professional book reviewer who has been reading since she was 3 years old and she never goes anywhere without a book.


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Prill said that it usually takes around 10-12 years from a project’s inception in clinical trials to FDA approval. All of this is some-what belabored by bureaucratic hurdles and a constant grappling for funding from corporate and non-profi t organizations.

“I think the key is that there are new drugs emerging for every cancer every day,” enthused Prill. “It’s just exploding. Today, there is not a disease state where we’re not looking at something. It’s just an amazing time to be an on-cologist.”

Wellmont’s clinical trials team’s work is fur-ther complicated by the ever-extending nuances associated with cancer, an infi nitely complex and evolving disease. Wellmont’s team is not only looking for new drugs to combat cancers—but also to searching for new ways to help patients manage pain and cope with the side effects of their treatments.

“People just assume that if you have cancer, then you should get in a trial. But that’s not exactly how it works,” said Teresa Bailey, Wellmont’s Manager of Ancillary Services. “There are criteria. Of course, we want to make new treatments avail-able to patients. But there’s also the matter of most effectively testing drugs and treat-ments. Sometimes the patients’ illnesses don’t match the studies—and that’s the hard part.”

“That’s really the most challenging thing I do—fi nding trials to fi t each patient,” Bailey continued. “Recently our funding has been cut, and it’s frustrating when we can’t help each and every patient. Because honestly, I’ve rarely ever had a patient that says no [to participating in a clinical trial]. They want to have a legacy. If there’s any way they can help other people with the dis-ease, they’ll do it.”

Bailey explains that all clinical re-search must be meticulously documented for legal purposes and, more importantly, as a safeguard for clinical trials volunteers. Each case must go through Wellmont’s Institutional Review Board (IRB), which is specially structured to deal with each case as promptly and expeditiously as possible.

To streamline its processes, Wellmont’s IRB is structured as a single, all-inclusive body for all its hospitals. Bailey says that Wellmont’s IRB panel includes physicians, legal professionals, and representatives from the hospital and pharmaceutical industries among its ranks. The IRB’s task is to ensure that clinical trial volunteers are made aware of the risks and potential side effects prior to the trials. The IRB also holds monthly meetings to assess any issues that might arise in treatment.

“It’s nice that we have people [on Well-mont’s IRB] from both the national and community levels,” said Bailey. “It’s really a very smooth process and our goal is to make sure that the patients are safe.”

For Bailey, the most satisfying part of

the job is her ongoing relationships with patients. Oftentimes, these relationships in-clude follow-up calls that extend far beyond the patient’s treatment regimen.

“I see patients out and about some-times, and I’m never quite sure whether I should talk to them or not—because sometimes people don’t recognize me out of pocket,” said Bailey. “So I was shopping one day and I saw a lady who asked me if I worked for Wellmont. I said, ‘ yes, that’s me.’

“She said, ‘I want to tell you some-thing—I just love it when you call me every year to check on me.’ And I said, ‘well, I just love it every year when I call you too!’

“That’s really what matters, helping people,” Bailey continued. “And what we do in the clinical trials is certainly not a money-maker. It’s a gift back to the com-munity.”

A Gift Back to the Community, continued from page 1

Dr. Sue Prill

Online Event Calendar

To submit or view local events visit the East TN Medical News website and click on the calendar icon on the right hand sidebar.

easttnmedicalnews.com

GrandRoundsEd Roop Named Chairman for Mountain View Regional, Lonesome Pine Boards New Board Members Named in Wellmont’s Community Hospital Division

KINGSPORT – Ed Roop, vice presi-dent of Farmers and Miners Bank in Wise, Virginia, has been named chairman of the combined board for Mountain View Regional Medical Center and Lonesome Pine Hospital.

A longtime board member, Roop succeeds Skip Skinner, whose term ex-pired. Skinner will continue to serve on this board and the Wellmont Health Sys-tem board.

In addition to the transition in chair-man from Skinner to Roop, new mem-bers have joined those who will continue their service on the boards of directors for Wellmont’s community hospitals.

Dr. Kevin Allred, Danny Lambert, Dr. James Raj and John Schoolcraft have joined the combined board for Mountain View Regional and Lonesome Pine.

The other new board member in the community hospital division is Dr. Mihir Patel.

Several members have rotated off hospital boards in the community hospi-tal division. They are Drs. Chris Basham and Michael Vacco, M. Blake Wilson Jr. and Martha Spurlock from the Lonesome Pine and Mountain View board, Dr. Jose Velasco from the Hawkins County Memo-rial board and Nikki Reed from the Han-cock County Hospital board. Drs. Basham and Vacco are medical doctors.


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GrandRounds

Franklin Woods Community Hospital earns recognition for safety, quality

JOHNSON CITY - Since it opened four years ago, Franklin Woods Com-munity Hospital has garnered plenty of recognition for meeting high quality standards and earning high patient sat-isfaction ratings.

The hospital recently made the grade again in some distinguished areas, earning the distinction of being a final-ist for the QUEST Award for High-value Healthcare. Meanwhile, Franklin Woods Pharmacy Services was awarded the Sylvia Moss Brown Award of Excellence because of its work to improve patient safety by creating Safety Watch Advisory Teams (SWAT).

The QUEST Award, given by Pre-mier, Inc., measures six areas: Harm, mor-tality, readmissions, costs, patient experi-ence, and evidence-based care. Franklin Woods was one of only 37 hospitals na-tionwide to receive finalist recognition by achieving top performance in five of those six areas.

Three other Mountain States Health Alliance hospitals earned recognition from Premier as QUEST to-performing hospitals. Sycamore Shoals Hospital and Smyth County Community Hospi-tal achieved top performance in all six areas, while Indian Path Medical Center received recognition as a finalist.

Franklin Woods was also recognized in 2013 as a QUEST Top Performer, and in 2012 as a QUEST finalist.

The Sylvia Moss Brown Award of Ex-cellence is a risk management award giv-en by the American Excess Insurance Ex-change (AEIX). The Franklin Woods Phar-macy Department created the “SWAT” teams to help reduce errors involving high-alert medications, and was awarded $10,000 for leading a best-practice initia-tive and showing improved patient safety and reduced liability.

AEIX is an alliance of sophisticated health care systems that own and man-age their excess professional and gen-eral liability insurance program. AEIX was built by industry leaders to promote best practices, reduce risk, and share in the fi-nancial rewards of the company.

American Heart Association Appoints Emily Daily Fuller Vice President of East TN

EAST TENNESSEE – The American Heart Association has appointed Emily Daily Fuller to the role of Vice President for their East Tennessee Team covering Chattanooga, Knoxville, and the Tri-Cit-ies area.

An American Heart Association col-league since 2008, Fuller most recently served as Senior Regional Director, man-aging Go Red for Women and Heart Ball campaigns in both Knoxville and Chatta-

nooga areas.Fuller is a graduate of the Univer-

sity of Tennessee at Chattanooga and will continue to reside in Chattanooga, Tenn., with her husband and daughter.

John Chiles Elected Chairman of Holston Valley’s Board of Directors, Three Others Join Panel

KINGSPORT – John Chiles, a retired trial lawyer who also conducted me-diations, has been elected chairman of Holston Valley Medical Center’s board of directors.

Chiles succeeds Char-lie Floyd, whose term re-cently expired. Floyd will continue to serve on the board as its immediate past board chairman.

The new board lead-er said he is honored to serve such an important role with King-sport’s flagship hospital.

Three new members have joined the volunteer board, which guides the hospital and provides community lead-ership. They are David Cagle, pastor of First Presbyterian Church; Norris Sneed, an Eastman Chemical Company retiree; and Roger Leonard, chairman of the Wellmont Health System board of direc-tors and a senior adviser for a national boutique investment bank.

Terry Begley, a retired Eastman vice president, has been elected vice chair-man, and Olan Jones Jr., Eastman Credit Union’s president and CEO, will serve as its secretary.

Members rotating off the board are Dr. Marvin Cameron, pastor of First Bap-tist Church; Dr. William Locke, former president of Northeast State Community College; and T. Arthur “Buddy” Scott Jr., a Kingsport lawyer with a business and es-tate planning practice who most recently served as Wellmont’s board chairman.

Bristol Regional Board Names John Vann Chairman, Adds New Members

BRISTOL – John Vann, business management consultant at The Sum-mit Companies, has been elected chair-man of Bristol Regional Medical Center’s board of directors.

Vann previously served as the execu-tive vice president for corporate develop-ment at Chiltern International Inc. He was responsible globally for supporting the company’s growth and development ef-forts through strategic relationships and acquisitions. He also oversaw marketing and business development.

Three new members have joined Bristol Regional’s board, which guides the hospital and provides community leadership. They are family medicine

John Chiles

(continued on page 17)


Name: Myra Blankenship, MSN, FNP-BC

Position: Advanced Nurse Practitioner, Wellmont Cancer Institute

At a Glance: Myra Blankenship knows all too well the rigors of a cancer diagnosis. As an advanced nurse practitioner for the Wellmont Cancer Institute in Johnson City and a cancer survivor herself, Blankenship enjoys every moment of delivering compassionate, empathetic care to the patients she serves. Although her nursing career spans over 30 years, her personal diagnosis prompted her move into oncology services.

“I enjoyed working in the emergency room and cardiology, but having been a cancer survivor myself, that experience stimulated my interest to become a nurse practitioner in oncology,” she shared. “The patients are the greatest pleasure possible. It’s very rewarding helping them as they face this challenge in their lives. I feel like we are truly helping them.”

Blankenship received her Bachelor’s degree in nursing from East Tennessee State University (ETSU) in 1974 and her Master’s degree in nursing from the University of Virginia in 1981. She returned to ETSU and earned her nurse practitioner certificate in 2007.

The only difficult part of her job, Blankenship explained, is having to deliver bad news. “When we know a patient doesn’t have long to live—that talk, about preparing to face the end—is tough,” she explained. “We get very close to our patients.”

Fortunately, with the new technologies and advances in oncology and hematology, those talks are becoming few and far between. “Many people assume my job would be depressing, but it’s not. It’s very emotional, and tugs at your heart strings, but the patients are very appreciative that we are caring for them.”

Blankenship explained that the Wellmont Cancer Institute team emphasizes the importance of two aspects of care—patient safety and patient comfort. “Our treatment regimes absolutely follow the National Comprehensive Cancer Network (NCCN) recommendations,” she said. “Our protocols and regimes are tested and follow the standard of care to the letter.

“Our approach is very patient-focused. We offer the best quality care, and we have a tremendous team. I couldn’t ask for a better place to work,” she enthused.

HealthcareServiceSnapshot

Physical Inactivity and Diet in Children

GI for Kids, PLLC

YOUHANNA S. AL-TAWIL, MD

Screen time has been on the rise when it comes to a child’s preferred daily recreation. It is estimated that children in the United States spend 25% of their waking hours watching TV, using the computer, and playing video games in their leisure time. According to the Department of Health and Human Services, physical trend data indicate that one third of adolescents are not getting the recommended levels of moderate or vigorous activity, 10% are completely inactive, and physical activity falls as they get older. It is estimated that physical activity levels decrease by 1.8% to 2.7% per year for boys 10 to 17 years of age and by 2.6% to 7.4% per year for girls 10 to 17 years of age. The American Academy of Pediatrics notes that children who watch fi ve or more hours of TV per day have four-and-a-half times greater risk of being overweight than those who watch two hours or less.

Physical activity is an important component of health and well-being for people of all ages. Children who are physically active may gain immediate and long-term positive effects, such as improved mental health status and self-esteem, increased physical fi tness, which enhances performance of daily activities, promotion of bone formation, weight maintenance, and prevention of cardiovascular risk factors. In addition, physical activity patterns established during childhood may continue into adulthood, establishing healthier choices over the entire lifespan. Health benefi ts for physically active adults include lower risks of coronary artery disease, type 2 diabetes mellitus, hypertension, hyperlipidemia, osteoporosis, certain cancers, and depressive symptoms.

Diet and physical activity are inextricably linked. Overweight and obesity result when daily energy intake is greater than daily energy expenditure over time. This concept of energy balance is crucial for successful assessment, prevention, and management of overweight and obesity in childhood and adolescence. Energy intake is a relatively easy concept, because it includes all foods and beverages consumed during the day. Energy expenditure is more complex, because it is a combination of resting metabolic rate, the thermic effects of food, and the variety of activities the individual performs during the day. Therefore, measurement of physical activity is not equivalent to measurement of total energy expenditure; rather, physical activity is one (albeit the most variable and modifi able) element of total energy expenditure.

For children and adolescents, a certain amount of positive energy balance is necessary for proper growth and development. The overall energy balance should tip in favor of slightly greater energy intake, relative to expenditure, although the percentage of total energy required for growth is small after infancy.

Clarifi cation of several terms is necessary to understand what is being measured when physical activity is being discussed. Physical activity is defi ned as any bodily movement produced by the contraction of skeletal muscles that increases energy expenditure above the basal level. Physical activity thus encompasses movement resulting from free play, structured activities such as sports, and general activities of daily living. Exercise is planned, structured, and repetitive bodily movement performed specifi cally to improve or to maintain physical fi tness. Children and adolescents often participate in planned activities during physical education classes or in structured sports activities; however, the goal is not necessarily physical fi tness. Physical fi tness is a set of attributes that people have or achieve, such as cardio respiratory fi tness, muscular strength, fl exibility, endurance, and body composition.

Children today have adopted unhealthy diet consumption, including more fast foods, sugar-sweetened drinks, and not eating breakfast. Fast food is ready-to-eat, low cost, and easy to take home and serve. Having less nutritional value, fast food is also much higher in calories.

Dietary change and increased physical activity is cornerstone to reducing the risk of children becoming overweight or obese. Behavior modifi cation is the key. In 2007, the American Academy of Pediatrics’ Recommendations for Treatment of Child and Adolescent Overweight and Obesity

include avoidance of sugar-sweetened beverages, reduced portion size, intake of 5 to 9 fruit and vegetable servings per day, 1 hour of moderate to vigorous physical activity daily, daily breakfast, maximum daily screen-time exposure of 2 hours of TV, and eating at home vs. eating at a fast food restaurant.

At GI for Kids, we offer a weight management program, Bee Fit 4 Kids, for overweight and obese children and teenagers. Bee Fit involves individual counseling sessions to discuss healthy dietary habits with Pediatric Gastroenterologists,

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and vegetable servings per day, 1 hour of moderate to vigorous physical activity daily, daily breakfast, maximum daily screen-time exposure of 2 hours of TV, and eating at home vs. eating at a fast food restaurant.

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GrandRoundsphysician Charles Bolick, MD; general surgeon Glenn Birkitt, MD; and anesthe-siologist Joseph Nounou, MD.

Ted Wood, a retired business execu-tive, has been elected vice chairman and Wayne Estes, president of The Best Park-ing Space, has been elected secretary.

Members rotating off the board are Jill Harrison, Alpha Natural Resources’ coal sales counsel; general surgeon Nel-son Gwaltney, MD; radiologist Bill John-stone, MD; and cardiothoracic surgeon Bill Messerschmidt, MD.

Page McClanahan Joins Wellmont Medical Associates in Johnson City as Nurse Practitioner

JOHNSON CITY – Page McClana-han, an experienced family nurse practi-tioner, is joining Wellmont Medical Associates’ John-son City office.

McClanahan brings 18 years of medical care to the office, which also in-cludes the practices of Dr. Rita Plemmons, a medical doctor, and Aimee Hurd, another family nurse practitioner.

Since graduating with her master’s degree in nursing from Vanderbilt Uni-versity, McClanahan has worked in sev-eral area offices, giving her extensive knowledge about patient care.


Page McClanahan


GrandRoundsJo

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

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

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

Opening Night: Cosmic Energyfeaturing Staff Sergeant Douglas Kost, Trombone

East Tennessee Children’s Choir, Jane Morison, Director

sponsored by Ferguson Enterprises and Pain Medicine AssociatesSaturday, October 11, 7:30 p.m.

Mary B. Martin Auditorium at Seeger Chapel, Milligan College

Evening ProgramZ. Randall Stroope: Homeland

Launy Grondahl: Concerto for Trombone and OrchestraGustav Holst: The Planets

Staff Sergeant Douglas Kost is a featured soloist with the United States Air Force Band of Mid-America. He performs with the Concert Band and the Hot Brass ensemble located at Scott Air Force Base, St. Clair County, Ill. Before joining the Air Force, he performed with the Glenn Miller Orchestra and the Youngstown Symphony Orchestra.

The Mountain Empire Children’s Choral Academy (MECCA) strives to enrich the lives of youth in the region

through a program of vocal music education and through the study and performance of the world’s great choral literature.

Rob Seebacher will hold a pre-concert talk at 6:30 p.m.

Wellmont Adds Three Business Leaders to Board of Directors, Selects New Officers

KINGSPORT – Two innovative busi-ness leaders and a highly respected newspaper publisher, all of whom have left indelible footprints on the region, have been appointed as members of Wellmont Health System’s board of di-rectors.

Keith Wilson, publisher of the King-sport Times-News and president of Northeast Tennessee Media Group, re-cently began his board service. He was joined by Ted Wood, who retired as pres-ident and vice chairman of The United Company after an extensive tenure as an executive in the pharmaceutical industry. The other new board member is Terry Begley, who retired as Eastman Chemical Company’s vice president of global sup-ply chain and chief procurement officer.

Begley and Wood serve as vice chairmen of the boards at Holston Val-ley Medical Center and Bristol Regional Medical Center, respectively.

The Wellmont board has also select-ed officers for the next two years – Leon-ard as chairman, Julie Bennett as vice chairwoman, Wayne Kennedy as secre-tary and Roger Mowen as treasurer.

Other board members are R. David Crockett Sr.; Nelson Gwaltney, MD; Mary Hall; Ravan Krickbaum; David Lester; T.

Arthur “Buddy” Scott Jr.; Glen “Skip” Skinner; William Smith, MD; and David Sparks, MD. Mowen, Crockett and Scott completed two-year terms as chairman, with Scott now serving as immediate past chairman.

Several board members have ro-tated off the panel. They are Jack But-terworth, MD; Marvin Cameron; Charlie Floyd; Douglas Springer, MD; and John Williams.

Mountain States Health Alliance again named a ‘Most Wired’ health system

JOHNSON CITY – Mountain States Health Alliance was recently recognized for the third year in a row by Hospitals & Health Networks magazine as a “Most Wired” hospital or health system. The honor acknowledges a high level of so-phistication throughout the system in creating and using electronic medical records.

The results were announced as part of the 16th annual Health Care’s Most Wired Survey, sponsored by H&HN. Health Forum, an American Hospital Association information company, dis-tributes, collects and analyzes the Most Wired data and develops benchmarks for measuring IT adoption for operation-al, financial, and clinical performance in healthcare delivery systems.

More than 350 hospitals and health

systems across the nation met the criteria this year. Mountain States was one of five organizations in Tennessee to be recog-nized; the others were HCA Healthcare and Vanderbilt University Medical Cen-ter, both in Nashville; IASIS Healthcare in Franklin; and Covenant Health in Knox-ville. Details of the results can be found at www.hhnmag.com.

All of Mountain States’ clinics as well as its 14 hospitals in Northeast Tennes-see and Southwest Virginia have already implemented at least the basic compo-nents of electronic medical record sys-tems, but the push for better technol-ogy and more value for patients doesn’t end there. This year Mountain States has focused on adding applications and modules that improve workflow and add value for patients and their families.

Among other recent advancements and accomplishments at Mountain States: widespread distribution of an in-tegrated nursing plan-of-care module, physician order entry in emergency de-partments including sophisticated medi-cation administration system, a patient portal, and replacement of the surgical information system.

Three Mountain States facilities earn national recognition as QUEST high-performing hospitals

JOHNSON CITY – Three Mountain States Health Alliance Hospitals have re-ceived national recognition from Premier, Inc., for delivering high-quality, cost-ef-fective healthcare.

Sycamore Shoals Hospital in Eliza-bethton, Tenn., and Smyth County Com-munity Hospital in Marion, Va., earned the highest honor by achieving top per-formance in all of the six areas measured in Premier’s QUEST collaborative. They were among only 18 hospitals nation-wide to receive the QUEST Award for High-value Healthcare.

The areas measured included harm, mortality, readmissions, costs, patient ex-perience, and evidence-based care.

Kingsport’s Indian Path Medical Center was recognized as a finalist for the award by meeting five of the six stan-dards. There were 37 hospitals in the na-tion to receive finalist recognition.

The six categories were:• Obtaining a mortality rate at least

15 percent less than expected;• Reducing the average cost of care

to less than $5,690 per discharge;• Reliably delivering all evidence-

based care measures to patients in the areas of heart attack, heart fail-ure, pneumonia and surgical care at least 95 percent of the time;

• Improving the hospital experience so that patients favorably rate their stay and would recommend the fa-cility to others at least 73 percent of the time;

• Reducing preventable harm events; and

• Obtaining a readmissions rate at least 11 percent less than expect-ed. (CONTINUED ON PAGE 15)

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Niswonger, ETSU doctors lead development of new children’s book series to encourage literacy

JOHNSON CITY –Studies show that kids whose parents read aloud to them will develop better literary proficiency. Doing this is so valuable, in fact, that the American Academy of Pediatrics recom-mends pediatricians provide children’s books to parents and counsel them on how to read aloud to their kids.

Pediatricians at East Tennessee State University and Niswonger Children’s Hos-pital are already doing just that, and have even led development of a new children’s book series to encourage literacy devel-opment and healthy behaviors during early childhood.

“As a ‘Reach Out and Read’ practice, we have been providing free children’s books to families during well child visits for several years,” said Dr. Gayatri Jais-hankar, Associate Pediatric Residency Program Director at ETSU. “In fact, by the time their children are 5, our patients have a library of at least 15 books we’ve given them. Research shows that a pedia-trician’s advice on how to use books with their child is helpful to parents, and facili-tates children’s early brain development.”

The first new book – authored by Quillen College of Medicine student Laurie Bennie and professional storytell-er Cathy Jo McMaken and illustrated by Robin Fisher and Jill Fair, designers in the ETSU Department of Biomedical Com-munications – includes ideas for play and a reading guide developed by Dr. Karen Schetzina, a general pediatrician and as-sociate professor at ETSU. It’s titled “A Rainy Day Adventure.”

Last summer, the group collected ideas for the book’s story and themes by talking with early childhood educators and parents and by conducting storytell-ing activities with children during ETSU’s Little Bucs summer camp and the John-son City Public Library’s Summer Reading Program Finale.

Schetzina and Jaishankar are proj-ect directors of ReadNPlay for a Bright Future, a coordinated initiative aimed at supporting healthy, active living among families with young children in clinical and community settings. The new book series is part of a collection of ReadNPlay tools to enhance communication about healthy behaviors between pediatricians and families during well child visits.

Starting this fall, a new regional fam-ily literacy initiative will offer monthly parenting support groups, reading activi-ties in local preschools, and community events. Key partners in the project include Niswonger Children’s Hospital, ETSU Department of Pediatrics, ETSU Clem-mer College of Education, Johnson City Schools, and local adult education pro-grams. The group is also planning to expand adult literacy and parent-child together classes in the region.

According to a new policy statement from the American Academy of Pediat-rics, two-thirds of U.S. children – and 80

percent of children in families living be-low the poverty line – do not develop reading proficiency by the third grade.

The ReadNPlay “My Baby Book” will be available as a free interactive mobile application in 2015.

U.S. News & World Report ranks JCMC as No. 8 hospital in Tennessee

JOHNSON CITY – Johnson City Medical Center (JCMC) has earned rec-ognition in U.S. News & World Report as one of the top hospitals in Tennessee.

The publication recently ranked JCMC as No. 8 in the state, the highest of any facil-ity in Northeast Tennessee.

The ratings were based on a study of various adult specialties offered at each hospital. JCMC was rated as high-per-forming in four specialties – cardiology and heart surgery, gastroenterology and GI surgery, pulmonology, and urology – and was rated among the top 10 hospitals in the state in each of 13 adult specialties.

The study’s criteria included survival rates, patient safety measures, patient volume, nurse-to-patient ratio, advanced

technologies offered and patient services being offered. It also considered patient satisfaction ratings as well as reputation among other physicians.

Tennessee has 154 hospitals across the state. The top two according to the U.S. News rankings were Vanderbilt Uni-versity Medical Center (an affiliated hospi-tal with Mountain States Health Alliance) and University of Tennessee Medical Cen-ter.

For a list of the report’s top-ranked hospitals in Tennessee, visit http://health.usnews.com/best-hospitals/area/tn.

Support Niswonger Children’s Hospital!

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

Niswonger Children’s Hospital license plate sales.

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

purchasing a Niswonger Children’s Hospital license plate.

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

tri cities medical news sept 2014

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