Troy F. Kimsey, MD, FACS

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

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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 KIMBERLy O’NEAL WILSON

Troy Kimsey, MD, FACS, keeps a handmade blue “prayer pillow” on a shelf in his new offi ce at Premier Surgical As-sociates’ offi ce at Fort Sanders Regional in Knoxville. The pillow was given to him by the sewing group of a former pa-tient who passed away.

“It’s a reminder of why I’m here,” explained Kimsey.

Kimsey, a surgical oncolo-gist, joined Premier Surgical in August. Coming to Premier and East Tennessee is another step on his medical and spiritual journey. Much of Kimsey’s ca-reer has been led by seeking a path that allows him to minister through medicine.

A spiritual awakening dur-ing his first year of medical school led Kimsey to reconsider being a physician and contem-plate becoming a pastor. Kim-sey said prayer and conversations with several youth ministers convinced him he was already on the right path.

“I saw that there were many oppor-tunities to serve through medicine,” re-membered Kimsey. “God made it clear that He had me in medicine for a rea-son.”

Kimsey, who grew up in Athens,

Georgia, said before his religious conver-sion, he didn’t have a solid plan for his life or career.

“I went to medical school by de-fault,” confessed Kimsey. Hailing from a long line of dentists, with his father, two grandfathers, and three uncles all practic-ing dentistry, Kimsey said he naturally considered going into the medical fi eld,

but wasn’t interested in becoming a dentist.

Kimsey entered the Medical College of Georgia, and although he enjoyed studying medicine, he said he was personally fl oundering.

“At the time, I was completely living for myself,” remembered Kimsey. “And then, God inter-vened.”

Kimsey recalled how every- thing changed after he surrendered his life to God. “I began to real-ize that my opinions and desires weren’t my driving force anymore. I began to seek God for what He wanted me to do through medi-cine.”

Kimsey met his wife, Bethany, while doing Pathology research at the Medical College of Georgia. “I defi nitely think God used the expe-rience in Pathology in a lot of great ways,” explained Kimsey, “but I felt God was leading me into pa-tient care.”

After practicing family medi-cine for a year, Kimsey entered a

surgery residency. “I let God choose a path for me that I wouldn’t necessarily have gone down,” said Kimsey, “but, it was confi rmed for my wife and me that surgery is where I needed to be.”

Kimsey underwent a fi ve-year general surgery residency and a year of surgical oncology research in Augusta, Georgia, before completing a surgical oncology

fellowship at Memorial Sloan-Kettering Cancer Center in New York.

He returned to Southwest Georgia to spend six years practicing broad-based general surgical oncology. There he served as the Director of Surgical Oncol-ogy and helped with the continued devel-opment of the Phoebe Cancer Center, a community-based regional facility.

“I really do see surgical oncology as a ministry. I treat my patients like I’m treating one of my family members,” said Kimsey. “Meeting people diagnosed with cancer and walking with them during this particular part of their journey can be es-pecially rewarding.”

Now Kimsey’s journey has led him, his wife, and seven children to a new home and practice in East Tennessee. In August, he joined Premier Surgical Asso-ciates’ offi ce at Fort Sanders Regional in Knoxville.

“We’d been praying whether we’d be in Southwest Georgia long term and this opportunity arose,” explained Kim-sey. “I’m one who likes a lot of details and certainty, but, in this case, I feel God is guiding me by His peace.”

Kimsey is excited about meeting and treating new patients in Knoxville, but admits the decision to relocate was a leap of faith. “God brought us here to East Tennessee,” said Kimsey. “I’m looking forward to seeing what He has in store for me and my family here.” It’s another step in the journey.

Premier Surgical Associates Surgical Oncologist Troy F. Kimsey, MD, FACSBlending Medicine & Ministry

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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 hoover@chartertn.net.

4 > SEPTEMBER 2014 e a s t t n m e d i c a l n e w s . c o m

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

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

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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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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)

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

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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e a s t t n m e d i c a l n e w s . c o m SEPTEMBER 2014 > 9

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

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

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

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

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

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

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

“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

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Janice Lea, MDEmory University

Brad Rovin, MDOhio State University

Laura Mulloy, DOGeorgia Health Science

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Richard Glassock, MDUniversity of California at

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Tom Devlin, MDErlanger Health System

David MerrittLeavitt Partners

Arthur Wheeler, MDVanderbilt University

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Juan Velez, MDMedical University of

South Carolina

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

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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Knoxville MGMA Monthly MeetingDate: 3rd Thursday of each month

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

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

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

Registration is required. Visit www.kamgma.com.

Chattanooga MGMA Monthly MeetingDate: 2nd Wednesday of each month

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

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

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

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

3RD THURSDAY 2ND WEDNESDAY

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

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

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.

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

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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

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GrandRoundsUT Professor Awarded Highly Competitive Robert Wood Johnson Foundation Fellowship

KNOXVILLE—Tami Wyatt, associate professor and director of graduate stud-ies in the College of Nursing at the Uni-versity of Tennessee, Knoxville, has been named one of 20 Robert Wood Johnson Foundation executive nurse fellows for 2014.

Wyatt joins a select group of nurses from across the country chosen to partici-pate in the fi nal cohort of this world-class three-year leadership development pro-gram which is enhancing the effective-ness of nurse leaders working to improve the United States healthcare system.

Wyatt’s expertise aligns with her professional roles as chair of Educational Technology and Simulation and co-direc-tor of the Health Information Technology and Simulation Lab at the College of Nursing, and co-owner and President of Academic Technology Innovations. Wy-att has received grants from the National Institutes of Health, the National Science Foundation and private corporations for her work related to technology improv-ing consumer and professional health education. She is a scholar of the Harvard Macy Institute and mobile health train-ing institute of the National Institutes of Health. Wyatt also will be inducted as a fellow in the American Academy of Nurs-ing in October 2014.

16 > SEPTEMBER 2014 e a s t t n m e d i c a l n e w s . c o m

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GrandRounds

Three Qsource Employees Appointed to 2014 TNCPE Board of Examiners

NASHVILLE — Three Qsource em-ployees have been appointed by the Board of Directors of the Tennessee Center for Performance Excel-lence (TNCPE) to the 2014 TNCPE Board of Exam-iners. Appointees are Alyssa Chase, Population & Community Manager; Stacy Dorris, Quality Im-provement Specialist; and Alex Babakus, Quality Management Coordina-tor. Qsource is a Tennes-see-based healthcare quality improvement and information technology consultancy.

Each year, the TNCPE award program recognizes local, regional, and state-wide organizations that demonstrate excellence in business operations and results.

Examiners are responsible for re-viewing and evaluating organizations that apply for the TNCPE Award. The Board of Examiners comprises experts from all sectors of the regional economy, including health care, service, nonprofit,

manufacturing, education and govern-ment. All members of the Board of Exam-iners must complete extensive training in the Baldrige Criteria for Performance Excellence. Examiners take the skills and expertise developed during training and the assessment process back to their own jobs, benefiting and improving their own organizations in the process.

TNCPE Board of Examiners contrib-utes more than 10,000 hours of volunteer service each year to organizations across Tennessee.

New Multi-State Consortia - atom Alliance, Set to Ignite Powerful Change in Tennessee’s Healthcare Quality Improvement Effort

NASHVILLE – Far-reaching collabo-rations and rapid, widespread changes in our nation’s reform of healthcare will soon hit home here in Tennessee, where a multi-state alliance, composed of three healthcare quality improvement consul-tancy organizations have joined forces to win a 5-year, 4-state Quality Innovation Network (QIN)/Quality Improvement Or-ganization (QIO) contract from the Cen-ters for Medicare & Medicaid Services (CMS). Under provisions of the new con-tract, atom Alliance will work to improve healthcare quality for Medicare patients and their families in Alabama, Kentucky, Mississippi, and Tennessee.

New Alliance for Healthcare Quality Improvement

Organizational members of atom Alliance include AQAF (Alabama), IQH (Mississippi) and Qsource (Tennessee and Kentucky). Qsource will serve as the nonprofit alliance’s prime organizational contractor to CMS, with sub-contracts in place for AQAF and IQH to carry out the work in their respective states. Each atom Alliance member has operated in-dependently for more than 30 years as a leader in their state’s healthcare quality improvement efforts.

The newly restructured QIN-QIO contract is part of an unprecedented overhaul of CMS’s Quality Improvement Organization (QIO) program and aligns with the goals of the National Quality Strategy’s (NQS) three broad aims to bet-ter care, better health, and lower costs through improvement. Under the new structure, atom Alliance will work with healthcare providers and communities on multiple, data-driven quality initiatives to improve patient safety, reduce harm and improve clinical care. Through its work, the Alliance will support CMS in its efforts to improve and promote healthcare qual-ity across the entire four-state area to en-sure the right care is provided to health-care patients, at the right time, every time.

Key Areas of Focus The atom Alliance will focus on sev-

eral key initiatives during the next five years, with an

emphasis on the entire region’s ru-ral health needs, according to Qsource Chief Executive Officer, Dawn FitzGerald.

“At a high level, our work with health-care providers will focus on the preven-tion and treatment of chronic disease, such as improving cardiac health and reducing disparities in both cardiac and diabetes treatment and care,” FitzGerald said. “We also will use our collective, very specialized expertise to improve preven-tion coordination across the atom Alli-ance by working with providers to imple-ment and understand the analytics and information available through healthcare information technologies,” she said.

Patient safety initiatives remain among the key topics for atom Alliance’s work over the next five years, including working with hospitals to reduce health-care associated infections and helping nursing homes reduce the use of antipsy-chotic medications and improve mobility by reducing incidents of falls-related inju-ries and restraint use.

While improving patient experienc-es and health outcomes will be a primary focus for atom Alliance, reducing health-care costs remains high on CMS’s agen-da. With the consortia’s new endeavor also comes a relatively newer effort to assist providers with improving care by

Alysssa Chase

Stacy Dorris

Alex Babakus

(continued on page 17)

e a s t t n m e d i c a l n e w s . c o m SEPTEMBER 2014 > 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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GrandRoundslowering healthcare costs through value-based purchasing programs, in addition to the continuation of successful patient-centered initiatives, such as reducing costs through improvements in care tran-sitions.

Jeffrey Howard, Chairman of the Board of Directors for Qsource, says he’s glad to see Qsource’s footprint expand with atom Alliance into a coordinated effort in healthcare improvement across multiple states. “The focus of the health-care landscape is changing,” Howard stated. “The highest priorities are no lon-ger cutting reimbursement and manage utilization but improving quality through improved outcomes. Atom Alliance will cover a broad range of the most impor-tant Medicare quality initiatives, which will have a tremendous impact on our state’s beneficiaries. Our work will continue to involve local, collaborative efforts with community stakeholders, providers and healthcare trade organizations through-out Tennessee but with a much larger footprint for these collaborations which provides efficiencies of scale across the board and access to resources that we’ve never had. I’m happy to say it’s a win for Qsource, but more importantly, it’s a win for Tennessee’s healthcare consumers,” Howard said.

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18 > SEPTEMBER 2014 e a s t t n m e d i c a l n e w s . c o m

GrandRounds

(CONTINUED ON PAGE 15)

East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2014 Medical News Commu-nications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore uncondition-ally assigned to Medical News for publication and copyright purposes.

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Chief Marketing Officer Susan TorregrossaChief Technology Officer Matt Locke

Chief Operating Officer/Group Publisher Eric Norwood

Director of Digital Sales & Marketing David WalkerController Todd Patton

Creative Director Heather PierceDirector of Content /

Online Development Patrick RainsJohn

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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.

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 will oversee all business op-erations, mission related activity and fun-draising campaigns for East Tennessee. She is a graduate of the University of Ten-nessee at Chattanooga and will continue to reside in Chattanooga, Tenn., with her husband and daughter.

UT Introduces MBA For Healthcare Leadership

KNOXVILLE – The University of Tennessee, Knoxville, is introducing a one-year Executive MBA in Healthcare Leadership program for healthcare pro-fessionals. The inaugural class begins January 2015.

Led by student requests, the pro-gram is a fusion of the College of Busi-ness Administration’s Physician Execu-tive MBA program and its non-degree

executive development programming. The Physician Executive MBA program has been ranked the No. 1 preferred MBA program exclusively for physicians by Modern Healthcare/Modern Physician magazine for more than ten years, and the non-degree executive development programming has improved patient out-comes and organizational efficiencies within healthcare enterprises worldwide.

Unlike the physicians-only Physician Executive MBA program, the Executive MBA in Healthcare Leadership program is for professionals in all healthcare are-nas, including nurses, pharmacists, den-tists, physical therapists, physician as-sistants, those involved in research and development, among others.

Kate Atchley, executive director of executive-level MBAs, said the program connects business acumen and transfor-mational leadership with the issues and challenges facing today’s healthcare in-dustry, giving healthcare professionals the tools and knowledge they need to make an impact on the healthcare industry.

The curriculum combines periodic distance learning sessions with four resi-dency periods: three one-week sessions UT and a one-week healthcare policy immersion trip in Washington, D.C. The immersion trip serves as the program’s cornerstone where students get to inter-act with government insiders, legislators, and officials involved in healthcare.

Students will also complete an Or-ganizational Action Project, which inte-grates classwork with issues at their cur-rent organization. Bruce Behn, associate dean of graduate and executive educa-tion, believes the Organizational Action Project is not only a great hands-on ex-perience, but it also offers students a re-turn on their investment.

The program also develops each student’s leadership skills through course content and a 360-degree analysis of each student’s personal leadership strengths and opportunities.

For more information about the Ex-ecutive MBA in Healthcare Leadership program, visit http://HealthcareEMBA.utk.edu.

Erlanger appoints Phillip E. Jackson as new VP for health system

CHATTANOOGA – Phillip E. Jack-son, DSL, FACHE, has been appointed Erlanger’s new Vice Presi-dent (VP) and Chief Ex-ecutive Officer (CEO) for Erlanger East and North Hospitals.

Jackson will assume his new position with Er-langer on September 1, 2014. Erlanger’s new health system VP is currently an execu-tive with Davita HealthCare Partners, a Fortune 500 company which operates 2,100 outpatient dialysis centers world-wide. Jackson comes to Erlanger from Memphis, Tennessee, where he serves as Regional Operations Director for 20 outpatient dialysis centers, five joint ven-tures, and five home programs.

Jackson is board-certified in health-care management and is a Fellow of the American College of Healthcare Ex-ecutives. He obtained a MSM in Finance from the Naval Postgraduate School in Monterey, California. He also earned a Doctorate of Strategic Leadership from Regent University in Virginia Beach, Vir-ginia. Jackson has 27 years of healthcare management experience working for the military health system, higher education, and for-profit health care.

Prior to his Regional Operations Di-rector position, he served as Health Care Management Degree Program Chair for Baptist College of Health Sciences in Memphis. Jackson served honorably for 30 years in the United States Navy as an Administrator, Chief Administrative Offi-cer, Senior Human Resources Executive, and Vice President in hospitals world-wide. In addition, his professional experi-ences span several years as a corporate financial manager and senior program/budget analyst for Navy Medicine and Department of Defense (Health Affairs).

As a lifelong learner, Jackson has re-mained active in higher education as an advisory board member, lead faculty for Ohio University MHA Program, and ad-junct faculty for the University of Arkan-sas MSOM Program.

Phillip E. Jackson

e a s t t n m e d i c a l n e w s . c o m SEPTEMBER 2014 > 19

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Tennessee Surgical Quality Collaborative Saves 533 Lives and $75 Million in Three YearsProgram helps Tennessee hospitals improve quality, reduce surgical complications

CHATTANOOGA – A unique collab-orative of Tennessee surgeons, hospitals, and insurers, established in 2008 to share data, compare results, and improve out-comes, reported impressive results to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) National Conference in New York City.

Ten hospitals in the Tennessee Sur-gical Quality Collaborative (TSQC) have reduced surgical complications by 19.7 percent since 2009, resulting in at least 533 lives saved and $75.2 million in re-duced costs.

“It’s rare for three major stakeholders in healthcare—hospitals, surgeons, and insurers—to work together on measur-ing and improving the quality of surgical care in hospitals, but that’s exactly what the collaborative has accomplished,” ex-plained Joseph B. Cofer, MD, FACS, of University Surgical Associates, and one of the authors of the study. “We also discov-ered that Tennessee hospitals have not only improved care, but sustained those improvements over time.”

Between 2009 and 2012, ten TSQC hospitals collected clinical, 30-day out-comes data on more than 55,000 surgical procedures, and researchers examined rates of 17 types of surgical complica-tions. In 2012 another eleven Tennessee hospitals joined the TSQC.

Compared with complication rates in 2009, the 21 hospitals in the TSQC achieved 19.7 percent fewer postopera-tive occurrences, and the postoperative mortality rate dropped 31.5 percent. Hospitals prevented an estimated 3.75 deaths per 1,000 surgical procedures and avoided $75.2 million in excess costs. The collaborative saw improvements in 13 of the 17 types of complications, and nine improved significantly, including surgical site infections, pneumonia, and urinary tract infections.

A study published in the Journal of the American College of Surgeons in 2012 showed the initial 10 TSQC mem-bers reduced complication rates and saved more than $8 million in excess costs from 2009 to 2010. This new study shows TSQC hospitals continued to im-prove in the years after the program was launched.

The hospital collaborative is a part-nership of the Tennessee Chapter of the American College of Surgeons and the Tennessee Hospital Association’s (THA) Center for Patient Safety, with support from Blue Cross Blue Shield’s Tennessee

Health Foundation.Study authors include lead author,

Brian Daley, MD, MBA, FACS; Joseph B. Cofer, MD, FACS; William C. Gibson, MD, FACS; Scott A. Copeland, MD, FACS; Chris Clarke, RN; William Cecil, MBA; and Barbara J. Martin, RN, MBA, CCRN.

Participating hospitals in the Tennes-see Surgical Quality Initiative include:

• Saint Thomas Midtown Hospital (formerly Baptist Hospital)

• Baptist Memorial Hospital - Memphis

• Claiborne County Hospital

• Cookeville Regional Medical Center - Cookeville

• Cumberland Medical Center• Erlanger Health System -

Chattanooga• Ft. Sanders Regional Medical

Center• Henry County Medical Center• Jackson Madison Co General

Hospital• Maury Regional Medical Center• Memorial Health Care System• Methodist University Hospital -

Memphis

• NorthCrest Medical Center• Parkwest Medical Center –

Knoxville• Regional One Health - Memphis• Saint Francis Hospital - Memphis• Saint Thomas West Hospital• Summit Medical Center• University of Tennessee Medical

Center -Knoxville• Vanderbilt University Medical

Center- Nashville• Wellmont Bristol Regional

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