East TN Medical News September 2015

Dr. David Suhrbier

PAGE 2

PHYSICIAN SPOTLIGHT

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By CINDy SANDERS

According to statistics from the Centers for Dis-ease Control and Preven-tion, one in 68 children falls somewhere on the au-tism spectrum.

The fastest-growing developmental disorder in the United States, autism spectrum disorder (ASD) is almost fi ve times more common in boys (1 in 42) than girls (1 in 189). Addi-tionally, the CDC estimates it costs at least $17,000 more per year to care for a child with autism, including extra expenditures for healthcare, education and ASD-related therapy.

While there is still no cure for ASD, research has shown early intervention can have a signifi cant impact on a child’s development and ability to more fully interact with peers at school. It’s at this in-

tersection of education and healthcare where Educa-tional Services of America (ESA) offers resources to help these children thrive.

Headquartered in Nashville, Tenn., the com-pany currently provides services in 27 states. “We serve about 17,000 kids a day, and they have a very wide variety of disabilities,” explained ESA President and CEO Mark Claypool, who founded the company in 1999. “We work primar-ily with public school sys-tems,” he said, noting the

company partners with about 250 different systems. He added ESA also works directly with some state governments and insurance car-riers.

“Providing quality services to children and young adults who (CONTINUED ON PAGE 4)

At the Intersection of Education and Healthcare

MGMA Releases Latest Provider Compensation Data

By CINDy SANDERS

In late July, the Medical Group Management Association (MGMA) released fi ndings from the 2015 Provider Compensation Survey Report, an annual analysis of compensation and pro-ductivity data illustrating market characteristics across specialties and organizational settings.

“MGMA has been collecting data on medical group management since 1926,” noted Todd B. Evenson, chief operating offi cer of the national organization for healthcare adminis-tration and medical practice management. “For the last 25 years, we’ve also been specializing in the space of physician compensation and non-physician compensation.”

Based on 2014 data, this year’s survey found physicians reported salary increases over the past year with primary care physician increases outpacing those of specialists (3.56 percent increase vs. 2.39 percent, respectively). Specialists, however, still report a higher median compensation at $411,852 compared to a median compensation of $241,273 for pri-

(CONTINUED ON PAGE 4)

FOCUS TOPICS PEDIATRICS REIMBURSEMENT

East Tennessee Children’s Hospital Pediatric Gastroenterology, Hepatology & Nutrition Services

GI for Kids, PLLC865-546-3998 | www.giforkids.com

In late July, the Medical Group Management Association (MGMA) released fi ndings from the 2015 Provider Compensation Survey Report, an annual analysis of compensation and pro-


ON ROUNDS

Tennessee’s Hep C EpidemicRecent TDH Advisory Draws Attention to Disease, New Treatments

This summer, the Tennessee Department of Health (TDH) issued a public health advisory in the wake of a nationwide increase in the rate of Hepatitis C infection ... 3

Enjoying East TennesseeTake A Walk On The Tweetsie Trail There’s something special about September and the promise of a change in seasons. As I pen this month’s column, I am listening to one of my favorite musicians, James Taylor, and his “September Grass” from October Road ... 5

2 > SEPTEMBER 2015 e a s t t n m e d i c a l n e w s . c o m

By JOE MORRIS

As early as third grade, Dr. David Suhrbier knew that he wanted to practice medicine. His focus on neurology is help-ing lots of third graders, and children of all ages, lead more normal lives as they strug-gle with epilepsy.

“I always wanted to work in pediatrics, but after starting out in in early in my ca-reer, I took a rather circuitous route getting back here again,” said Dr. Suhrbier, who is Chief of Pediatric Neurology at the Chil-dren’s Hospital at Erlanger.

A “born and bred” Chicagoan, Dr. Suhrbier received both his Bachelor’s and Master’s degrees in Biology at the Uni-versity of Illinois in Champaign-Urbana, and then attended medial School at the Chicago College of Osteopathic Medicine. A stint in the U.S. Army Medical Corps followed, where he completed an intern-ship in internal medicine at Brooke Army Medical Center. He then moved to Walter Reed National Military Medical Center for a residency in adult neurology and a fellow-ship in pediatric neurology.

“I had been fascinated by neurology even before medical school, but then I re-

alized that it would be a great use of my osteopathic training,” he said. “Neurology really does require a whole-patient ap-proach because you are practicing medi-cine, but also laying on hands. You’ve got to touch the patient, provide a good physi-cal exam, to see what’s going on in the ner-

vous system.”After 10 years of private practice in

Florida, he saw his new position as an op-portunity to put into place some method-ologies he’d developed on a larger scale. When asked, he’ll rattle off a list of short- and long-term goals for Erlanger with no problem at all.

“I want to have a pediatric residency teaching program, and even a pediatric neurology fellowship training program,” he said. “I want to expand what we’re doing with sleep medicine, which I had been working on in private practice, as well. We have great opportunities here.”

As the parent of a child with Asperg-er’s Syndrome, he knows the frustration of sometimes not being able to find a proper range of care services. So, just as he ex-plores opportunities for his son, he wants to make sure that parents who need help with their children’s neurological issues are able to secure assistance in their own com-munity.

“One of the things we’re developing now is ambulatory EEG monitoring, which allows children to remain at home and get some video monitoring done,” Suhrbier explained. “If we have it here, then they

don’t have to go to Nashville or Atlanta to have that done. We’re also working on sleep medicine by creating a sleep lab at the Baroness campus, and also using the sleep equipment at Erlanger North for our population.”

That’s quite a lot since April 13, when he began seeing patients, but Suhrbier is eager to do so much more.

“The next step would be for me to get an additional physician, and then reopen our epilepsy monitoring unit,” he said. “That exists, but we need to enhance the staff in order to bring a real, comprehen-sive epilepsy service to this area. We have the ability to do routine EEGs, and I want to expand that to ambulatory EEGs and even overnight EEGs in some cases. We’re working on the funding for these phases, and I look forward to the day when we’ve created a full epilepsy clinic where we can offer all the services that these patients re-quire.”

That’s where the residency and fel-lowship programs will come in handy be-cause they’ll allow him to attract and retain the talented physicians needed to reach as many patients as possible.

PhysicianSpotlight

Planning The Work, Working The PlanPediatric neurologist David Suhrbier lays the groundwork for a wide range of services.


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By CINDy SANDERS

This summer, the Tennessee Depart-ment of Health (TDH) issued a public health advisory in the wake of a nation-wide increase in the rate of Hepatitis C in-fection. The alert called for Tennesseans to learn more about the life-threatening disease and to consider being tested for chronic Hep C infection.

A Centers for Disease Control and Prevention report issued in May showed Hepatitis C as the most common blood-borne infection in the United States with approximately 3 million people living with Hep C. While the increase in disease is na-tionwide, the largest increases have been in the Appalachian region. The rate of acute Hepatitis C cases in Tennessee has more than tripled in the last seven years.

When announcing the public health advisory, TDH Commissioner John Dreyzehner, MD, MPH, said, “In addi-tion to reported cases of acute Hepatitis C, it is estimated that more than 100,000 Tennesseans may be living with chronic Hepatitis C and not know it.”

Tim Jones, MD, who has served as the state epidemiologist since 2007, noted, “The state of Tennessee is number four in the country for the amount of Hepatitis C that we see. We have three times the na-

tional average of rates of disease.” Look-ing at the map of Tennessee, Jones said there are a particularly high number of cases along the eastern border and northeastern part of the state.

The good news, Jones added, is that along with increased rates of disease are improved treatment options. “One of the reasons it’s getting more attention now is that there are better treatments available, and they are relatively new to

the market.”In the past, he continued, the treat-

ment regimen was difficult, not terribly effective and included a lot of side effects for many individuals. “Now there are much more rapid and effective treatments so there is more enthusiasm for getting people tested and into treatment,” said Jones, who has been with the TDH for 18 years and previously worked for the CDC. “You can now treat it in 12 weeks … and these drugs cure it.”

However, he continued, the problem is the cost of the three-month regimen, with a price tag coming in at $60,000-

$90,000. He added it’s an issue public health officials, providers and insurers are all struggling to address. Time, he contin-ued, could provide at least a partial solu-tion. “It’s likely as more medications come on the market, and there are several in the pipeline, those costs will be driven down.”

And, Jones pointed out, the slow pro-gression of the disease gives those infected time to get into appropriate care. “About 20 percent of people will get rid of it on their own. For the other 80 percent, the disease progresses very slowly. If people catch it early, it can take 20-30 years be-fore getting to the end stages,” he said.

Although price is an issue, another consideration is the cost not to treat. “As (Hepatitis C) progresses, it can lead to fibrosis of your liver up to liver failure. It’s the number one cause for liver trans-plants,” Jones noted. He added, Hep C is also the main cause for cirrhosis of the liver. If the disease progresses to one of these conditions, the price of caring for individuals with Hep C could far outstrip the cost of the drugs to cure it.

A blood-borne pathogen, Jones said the nation’s blood supply up until the late ‘80s/early ‘90s helped spread the disease. Today, however, the biggest risk factor is IV drug use.

Tennessee’s Hep C EpidemicRecent TDH Advisory Draws Attention to Disease, New Treatments


Dr. Tim Jones


need them is more important to us than who pays the bill,” Claypool stated.

While ESA, which has about 3,000 employees nationwide, has been in busi-ness for more than 15 years, Claypool said many of the programs being used have been around much longer with mea-surable results. The company has grown significantly through acquisitions and mergers, including the purchase three years ago of South Carolina-based Early Autism Project, Inc. (EAP).

“We had been working with older kids through school systems for a long time, but we wanted to identify a strong provider in the early in-tervention space,” Clay-pool explained. “Autism is a very dynamic dis-ability, and the sooner you can intervene, the greater the impact on the child’s life.”

With EAP, he noted, “We acquired this really strong regional brand and put tremendous resources behind them.” Today, EAP reaches four times the number of children and continues to expand with additional clinics coming online at a rapid pace. Currently, there are clinics and/or in-home services being provided in 11 states including Arkansas, Florida, Georgia, Kentucky, South Caro-lina and Tennessee in the Southeast.

“We’re growing very rapidly,” Clay-pool said. “In fact, we’re in the process of opening 15 new autism clinics in the next year.”

Applied BehaviorAt the heart of the program is the use

of Applied Behavioral Analysis (ABA). “We know the evidence supports ABA as the most effective treatment, by far,” said Claypool. “It enhances positive behaviors and diminishes negative behaviors.”

According to the Center for Autism and Related Disorders, the effectiveness of this evidence-based therapy has been well documented over the past 40 years. ABA utilizes the principles of learning theory to craft interventions designed to measurably improve ‘socially significant behaviors,’ which include reading, academics, social skills, communication, and adaptive liv-ing skills including self-care, toileting, un-derstanding time and money, and honing work skills.

“The same model of behavioral ther-apy is applied to all of our children across the board but will vary in its intensity,” Claypool explained of addressing individ-ual needs depending on where a child falls on the spectrum.

Finding a way to help these children is critical considering the number of chil-dren diagnosed with ASD. “If we don’t do this, the cost will be staggering. These young people will not be able to transition to adulthood and lead normal adult lives,” Claypool pointed out.

With ABA therapy, however, he said the team has seen some remarkable out-comes. “There is no one type of child with autism. There are IQs all over the board, but many do have high IQs and need to have their potential unlocked,” he continued.

That was certainly true for one South Carolina mom. Told it would be best to

find her son a residential program because he would never function on his own, she took matters into her own hands and be-came the co-founder of the Early Autism Project. Today, that son is working on his master’s degree at the University of South Carolina and speaks eight languages.

While certainly not every child with autism will perform at that level, Claypool said all children deserve the chance to reach their own potential.

The Intersection of Healthcare & Education

Realizing that ability, however, can be more difficult in some states than in others.

Claypool explained Part C of the In-dividuals with Disabilities Education Act requires public school systems to identify preschool children with special needs. However, he added, “It’s very, very loose how to do that. Frankly, it’s not followed through on very often. That issue really drove parents who had children with au-tism to find another way to have their chil-dren identified, diagnosed and treated.”

Of importance, he continued, is the understanding that special education, as it is constructed, is built on civil rights law. “That’s important because it was built on a minimum set of services defined as ‘free and appropriate.’

“But that’s not enough for parents,” Claypool said. “They want progress, and they want to know their child is going to get the very best treatments.” Therefore, he continued, “More and more, they are looking to healthcare rather than educa-tion systems to bridge the gap.”

According to the Autism Health In-surance Project, 39 states plus the District of Columbia have now enacted autism insurance mandates, meaning all fully funded, state-regulated insurance plans must provide the benefits specified by law. While the specifics vary from state-to-state, each of the mandates requires insur-ers to provide ABA to young children with autism. Self-funded (employer-sponsored) plans, however, are not legally required to offer autism benefits even in states that have mandates.

As of May 2015, Alabama, Idaho, North Dakota, Oklahoma, Tennessee and Wyoming had no autism insurance mandate. Ohio, Hawaii, Mississippi and North Carolina were in process of en-acting a mandate, and Utah had passed legislation, but it won’t go into effect until 2016. Additionally, the federal govern-ment has recently told all states their Med-icaid programs must offer ABA therapy for children under 21, but only a handful of states have put this directive into action at this point.

At the Intersection of Education and Healthcare, continued from page 1

For More Info & ReferralsFor more information on autism and other programming by Educational

Services of America, go online to esa-education.com. For more information or to refer a child with autism to EAP, go to earlyautismproject.com.

Mark Claypool

mary care physicians.The 2015 benchmarking report in-

cluded information on nearly 70,000 providers across the United States. In ad-dition to geographic diversity, Evenson said the data was representative of both large and small practices, various owner-ship structures including hospital-based providers, and more than 170 specialties.

Evenson said the collected data is im-portant for a number of reasons, not the least of which is that physicians are being recruited on a national level. To remain competitive, he noted, it’s important to look at the compensation methodologies being used by colleagues in various parts of the country.

While primary care physicians en-joyed a 3.5 percent increase in median compensation between 2013 and 2014, the figures are even more interesting when taking a slightly longer view. Evenson noted physicians in this space have seen a 9.2 percent increase in compensation since 2012.

“Will primary care physicians be compensated at the same levels as special-ists? Not likely,” Evenson said. However, he continued, “They will continue to play an integral role as care models evolve. Pri-mary care physicians are truly the lynch-pin of the new practice model as we move from fee-for-service to fee-for-value.”

Evenson added, “There’s a particular demand for primary care physicians … both because they are the backbone of the referral system and key to a value-based system.”

The latest MGMA survey also showed a continuing shift towards newer models of care. “Historically, it was normal to see 100 percent of compensation plans be productivity based,” explained Evenson. “In 2012, 50 percent of respondents said they were on a 100 percent productivity based compensation plan. In 2013, it was 39 percent; and actually this year, it was 25 percent of respondents.” As he noted, that’s a 25 percent decline in that metric over the past three years.

Evenson said the current data high-lights the gradual shift toward rewarding practitioners for improved operational efficiencies, enhanced quality and access to care. While the direct link to quality is still relatively small, it is growing. Just a few years ago, only 3.4 percent of physi-cian compensation was tied to quality metrics. “Now we’re seeing as high as 10 or 11 percent,” he said. “That value over volume concept that physicians seem to be embracing is really beginning to pay off for them.”

He added, “The behaviors they are trying to promote are tied to that triple aim (of healthcare) … reducing the per

capita cost of healthcare, improving the health of populations, and improving the patient experience of care.”

Evenson said those in the behavioral health sector are also seeing improved compensation as their work complements that of primary care providers in manag-ing a population’s health.

The industry is really recognizing a need to look to behavioral health services to better deliver quality care. The likeli-hood that someone dealing with a chronic health condition is also dealing with a behavioral health issue is high,” Evenson pointed out.

Recognition of that link has been evident in the MGMA compensation sur-vey over the last few years. “Since 2009, there has been a 21.9 percent increase in compensation for psychiatrists. Now, their median compensation is $244,796,” Even-son said, noting that now puts psychiatrists roughly equivalent to their primary care counterparts.

Economic forces of supply and de-mand are another issue factoring into phy-sician compensation. A predicted shortage of physician providers in both primary and specialty care could fuel higher compensa-tion rates down the road. Referencing a March 2015 report from the Association of American Medical Colleges (AAMC), Evenson noted the analysis projected a

shortfall of between 46,000 and 90,000 physicians by 2025.

In addition to compensation figures, Evenson said MGMA’s annual report also collects information regarding total charges, collections, encounters, RVUs (relative value unit), productivity, benefits, demographics, organizational types, and regional differences all the way down to a state level.

He said drilling down in the data al-lows those in healthcare to dissect the in-formation in myriad ways, and added it’s critical to learn from one another to adopt best practices that address the triple aim.

“You can take these benchmarks and truly understand what opportunities you have for efficiencies and for providing bet-ter care by understanding your colleagues’ activities in the industry,” Evenson con-cluded.

For more information on the 2015 Provider Compensation Survey Report, go online to mgma.com. Detailed data is available for purchase in two formats – electronically through MGMA DataD-ive™ or by ordering printed reports.

Compensation and the many other market forces impacting healthcare man-agement will be explored in depth at MG-MA’s annual conference scheduled for Oct. 11-14 in Nashville, Tenn.

MGMA Releases Latest Provider Compensation Data, continued from page 1


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The new model of healthcare reform places emphasis on the outcome, quality of care, and cost of patient care. In following of these new health care reform goals, endoscopy in children will prevent costly and otherwise unnecessary treatments by establishing a precise, rapid, diagnostic and thera-peutic tool that will decrease hospital utilization, emergency room visits, and invasive surgeries.

An esophagogastroduodenoscopy (EGD) is the most frequent procedure performed in children. Major indications for EGD’s include: dysphagia, odynophagia, unexplained vomiting, abdominal, or chest pain. Endoscopic evaluation is required to differentiate diagnoses of Eosinophilic Esophagitis (EoE), esophagitis, Barrett’s Esophagus, H. pylori gastritis, allergic gastritis, ulcer disease, achalasia, tra-cheoesophageal fi stulae, esophageal strictures, versus extraintestinal causes. A 24 hour pH probe can be placed under endoscopic guidance to evaluate for GERD. Tissue biopsy from the duodenum can evaluate for carbohydrate malabsorption, celiac disease, autoimmune enteropathy, allergic en-teropathy, infection, or Crohn’s Disease. An EGD can also determine the precise diagnosis, location and severity of hemorrhage, the risk of re-bleeding, and the complications of intervention. Foreign body ingestion (batteries, coins, small objects, toys, chemicals) causes severe mu-cosal injury which can be identifi ed and possibly therapeutically removed from the patient. Placement of PEG and GJ tubes have been one of the most frequent endoscopic interventions performed. These are usually placed in patients with underlying disorders, including gastroparesis, neurodevelopmental disorders, cere-bral palsy, intellectual delay. EGD surveillance is indicated for certain patients with family histories of polyposis syndromes, cancers, and Barrett’s esophagus. ERCP (Endoscopic Retrograde Cholangiopancreatogram) is increasingly used to assess the biliary tree and remove any gallbladder sludge/stones or block-ages. Endoscopic Ultrasound (EUS), although emerging, cannot only evaluate organs more precisely, but can also be used to assess the layers of intestinal walls, blood fl ow through blood vessels, and

obtain a fi ne needle aspirate of any suspicious masses.

Skill and experience have advanced to the point that both diagnostic and therapeutic colonoscopy are now routinely performed by pediatric gastroenterologists. The indications for colonoscopy in children include: lower GI hemorrhage to search for common causes of bleeding in children include anal fi ssures, colitis, benign juvenile polyps, IBD, and colitis; chronic diarrhea; medication abuse (com-monly laxatives), which presents as melanosis coli; cancer surveillance of polyposis syndromes and ulcerative colitis; polyposis syndromes for possible polypectomy; reduction of volvulus to decompress the colon; dilation of colonic strictures with balloon catheter dilation; and removal of foreign bodies. A total colonoscopy is also indicated to differentiate Crohn’s Disease from Ulcerative Colitis.

The power of colonoscopy rests with the simultaneous ability to visually inspect the entire length of the colon and distal ileum, take biopsies for histological analysis, and intervene therapeutically by applying hemostasis, removing polyps or foreign bodies, dilating strictures, or decompressing obstructed bowel.

Complications are infrequent with endoscopies, but include: infection, hemorrhage, perforation, duodenal hematoma, cardiac or respiratory decompensation, serosal lacerations from endoscope trauma, or death.

There are few absolute contraindications for an endoscopy in a child. They include, but are not limited to: fever (infection), cardiovascular instability, respiratory instability, neurologic instability, suspected bowel perforation, suspected ischemic colitis, inadequate procedure preparation, or coagulopathy.

A comprehensive team approach to patient care is offered by our skilled physicians and professionals in our practice. Our practice has access to a state of the art endoscopy suite. In addition to upper and lower endoscopy, we also use capsule en-doscopy, which evaluates the entire gastrointestinal tract, including the small bowel which cannot be visualized via the EGD or colonoscopy.

Please visit our website www.giforkids.com. It has extensive re-sources available including, Celi-Act, Bee Fit 4 Kids, Transitions: Be-

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GI for Kids, PLLCwww.giforkids.com (865) 546-3998

By LEIGH ANNE W. HOOVER

There’s something special about September and the promise of a change in seasons. As I pen this month’s column, I am listening to one of my favorite musi-cians, James Taylor, and his “September Grass” from October Road. This song truly captures the essence and longing to get outside…

“Well, the sun’s not so hot In the sky today And you know I can see Summertime slipping away.”

In our beautiful mountains of East Tennessee, we are approaching one of our most gorgeous seasons. It’s when things begin to change and beckon us outside again to enjoy the fleeting passage and entry into one of God’s most beautiful dis-plays of color. What better way to experience it all than taking a walk, hike or bike ride on the Tweetsie Trail?

First opened in 2014, the Tweetsie Trail has just recently been completed. It is now recognized as the largest rails-to-trails project in the state of Tennessee.

According to Tweetsie Trail Task-force Chairperson, Dan Schumaier, PhD, CCC-A, the City of Johnson City, Tenn., actually purchased an old rail line con-necting Johnson City and Elizabethton.

“It took a number of years, but Johnson City did buy the old rail

line,” explained Schumaier. “It’s actually ‘railbanked,’

and what that means is should the railroad ever decide they have to put something down to Eliza-bethton, it would revert

back to them.”

According to the AmericanTrails.org website, “railbanking” is preserving of inactive rail lines through interim con-version to trail usage. Chances are very rare an abandoned rail line would ever be needed again. However, this process saves its usage and prevents breaking up or im-peding line access.

Once a preliminary study was done on the possibility of the hiking trail con-version, it was estimated the cost would be approximately 5.8 million to com-plete a trail connecting Johnson City and Elizabethton. However, Schumaier along with committee member Grant Sum-

mers, President of Summers-Taylor, Inc., construction company in Elizabethton, walked the old rail line and decided that was an exorbitant amount of money, and the trail could be completed for much less.

To expedite the project, the two rec-ommended not taking state and federal dollars. The Tweestie Trail Taskforce agreed and began a fundraising effort for the quality of life endeavor.

“We all agreed to involve the commu-nity to build the trail,” explained Schuma-ier. “It’s joining two great cities, Johnson City and Elizabethton, so we enlisted the businesses, government and people to build the trail.”

Rather than the estimated three phases, 7.3 miles of the 10-mile trail was completed within the first year. The nearly unbelievable fact is, with its completion of the remaining 2.7 miles this month on Labor Day, the entire 10 miles, connect-ing Johnson City and Elizabethton, will have been done without state or federal funding.

Of course, the City of Johnson City owns the property and will take care of it through maintenance, along with Eliza-bethton and Carter County. However, the taskforce recently formed a 501(c) 3, entitled the Tweetsie Trail Conservancy,

Enjoying East TennesseeTake A Walk On The Tweetsie Trail



“There are pretty negative connota-tions when a disease is associated with IV drug use, but even one indiscretion de-cades ago can lead to these problems years later,” he pointed out.

Ideally, Jones said the following peo-ple should be tested:

• All baby boomers (anyone born 1945-1965),

• Anyone who has ever injected drugs (even once),

• Anyone who received a blood trans-fusion or organ transplant before 1992,

• Any healthcare worker who might have had a needle stick injury,

• Anyone who has gotten an illegal tattoo or unsanitary piercing (from an unlicensed provider),

• Anyone with HIV or AIDS,• Those with abnormal liver tests or

other liver disease, and • Anyone on dialysis.While healthcare providers might be

able to rule out some of the risk factors for their patients, Jones said the only way to really determine if an individual should be tested is to broach the topic and ask ques-tions.

Of course, he continued, the best defense is a good offense … namely pre-vention. With no vaccine for the disease, efforts to avoid exposure are the best weapon in stopping the spread of Hep C. Don’t share needles is the key message, and that includes the ‘diabetes curious’ … the person who wants to see what their blood sugar is so they try out a diabetic friend’s testing equipment.

“Don’t share needles … period,” Jones stated firmly.

Additional information for healthcare providers and patients is available through the Tennessee Department of Health website. Go to tn.gov/health/article/health-advisories for Hepatitis C statistics, answers to frequently asked questions, and prevention messages. There is also a direct link to the information from our website at EastTNMedicalNews.com.

Tennessee’s Hep C Epidemic, continued from page 1

Liver Damage in Hep C Significantly Underestimated, Underreported

The number of Hepatitis C patients suffering from advanced liver damage may be grossly underestimated and underdiagnosed, according to a new study led by researchers at Henry Ford Health System and the Centers for Disease Control and Prevention.

The findings, which were published in The American Journal of Gastroenterology (110, 1169-1177, August 2015), were the result of a study of nearly 10,000 patients suffering from Hepatitis C.

“Knowledge of the prevalence of liver damage will help decision making regarding screening for the effects of Hepatitis C, when to start anti-viral therapy, and the need for follow-up counseling,” said lead researcher Stuart Gordon, MD, director of Hepatology at Henry Ford Hospital in Deroit.

The Chronic Hepatitis Cohort Study is an analysis of records from a large, geographically and racially diverse group of 9,783 patients receiving care at four large U.S. health systems. The records analyzed by researchers indicated evidence of cirrhosis in 29 percent, or 2,788, of the Hepatitis C patients included in the study. Surprisingly, however, 1,727 of those 2,788 patients, or 62 percent, had no formal documentation in their medical records that they had cirrhosis.

Gordon said the results suggest cirrhosis may be underdiagnosed in a large segment of the population. Clinicians, he continued, typically rely on liver biopsies to diagnose cirrhosis, but in the Hepatitis C patients studied, only 661 patients were diagnosed with cirrhosis through a liver biopsy.

“Our results suggest a fourfold higher prevalence of cirrhosis than is indicated by biopsy alone,” said Gordon.The researchers discovered highly likely signs of liver damage by calculating the patients’ liver enzymes, platelet counts

and age in a previously validated test called a FIB-4 score.“It’s an underappreciated, easily obtained, and widely available test done through lab work that can point out there’s a

problem,” noted Gordon. “It’s a simple test not routinely used by clinicians. A lot of patients in our study had cirrhosis and probably didn’t know they had cirrhosis. In addition, electronic medical record reports may not be a reliable indicator of just how many Hepatitis C patients may be suffering from cirrhosis.”

The results of such testing and reporting could have wide impact on the treatment of those with Hepatitis C, which is now curable in many cases with oral antivirals.

“People with Hepatitis C need to find out the severity of their underlying liver disease because they may not realize that they have cirrhosis,” said Gordon. “Obviously, treatment can slow down the progression.”

Dr. Stuart Gordon

“A huge challenge we have is just cre-ating the services here because there is a strong need,” Suhrbier said. “You’ve got a two-hour ride for most pediatric neurol-ogy services. This means we’ve got a large population of children who aren’t getting the treatment they need, because they and their families are unable to travel.”

That’s a situation he’s seen before, he says, and has always worked to rectify.

“Wherever I’ve been during my ca-reer as a pediatric neurologist, I’ve always seen more people needing my skills and not enough people to provide them,” he said. “So I’ve learned over time that if we want a great program, we have to build it ourselves. That’s how I got into sleep medi-cine. There was no mechanism to give sleep studies to children where I was practicing in Florida — there were only three or four places in the whole state. The circum-stances were not going to change unless I changed them, and so I built a sleep lab.”

That meant connecting with experts, including a founding member of the Ameri-can Academy of Sleep Medicine, and being tutored until he could pass the board exam. Now his previous program is doing about 700 sleep studies a year.

“That’s why I think we can have our clinic, and a neurophysiology lab, here in the next three years,” he said. “I hope that we can even develop a ketogenic diet pro-gram, and so provide a wide range of care for even the most intractable cases.”

These days, he’s working on putting together an epilepsy fellowship and has begun recruiting, which also falls into his two, three- and five-year plans.

“I’m doing a lot of administrative work, but I also saw 100 new patients my first month,” he said. “That shows me how great he need is. We’ve gotten wait times down from three months to six weeks, and that’s a great start. I’ve also carved out some protected time very week so that I can work patients in. I have what I call the ‘Bat-phone,’ a number that pediatricians have, and they know if they call me on that line I’ll work that kid in. That’s going to result in fewer ER visits, and less hospitalization, and in the global scheme of things that will improve healthcare for these kids right now while we’re working to get everything else in place.”

Planning The Work, continued from page 2to ensure upkeep and allow tax-deductable donations.

Comprised of a crushed stone, which is considered better for running, the Tweetsie Trail traverses 10 miles with sponsored bridges, benches and evolving historical signage all along the trail.

“For tourism, this has been a real boon,” said Schumaier. “As a matter of fact, I was on the trail the other day and a lady said, ‘Who would have ever thought I would walk from Elizabethton to Johnson City?’ People are doing that routinely now.”

Many upcoming events are planned for the Tweetsie Trail, including races, dog walks, bird watching, photography tours and more, which will be planned by the Tweetsie Trail Committee.

As an eagle scout himself, Schumaier remains very involved in scouting and ex-cited about possibilities the trail offers for boy scouts. In addition to a special hiking patch, scouts will experience three histori-cal places, including Tipton-Haynes State Historic Site, Sabine Hill and Sycamore Shoals State Historic Park.

“The trail has also become an his-toric trail for the boy scouts,” explained Schumaier. “There aren’t a whole lot of historic trails for the boy scouts. So, scouts from all over will be walking this trail. They will come in and camp at Tip-

ton-Haynes, and then they’ll walk from Tipton-Haynes to the trail, on a spur we have going from there, all the way down to Sycamore Shoals. And at both places, they will have a history lesson.”

Users can easily gauge how far they have traversed the 10-mile trail. Mile markers, including tenths of a mile, are noted throughout the trail on recycled railroad ties.

As envisioned, the trail is truly a com-bination of a pastoral/urban trail com-bining two cities, and it is certainly being enjoyed and utilized by citizens of all ages. Schumaier leads with a passion and at-tests The Tweetsie Trail will continue to grow as other historical enhancements are added and continued improvements are made.

“We’ve done it for less than $800,000,” added Schumaier. “I think we’re a group of people that when we want to do something, we want to do it!”

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

Take A Walk, continued from page 5

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Keep your fi nger on the pulse of East TN’s healthcare industry.

The following article is the fi rst in a three-part series, which will edu-cate you about emerging issues in cybersecurity and recommend ways to protect your practice.

The widespread digitization of patient information has brought benefi ts, among them the portabil-ity of patient information, the rise of paperless offi ces, and the advent of real-time digital consultation about patient care. Despite these advancements, digitization has also created new threats to patient pri-vacy. A single careless staff mem-ber can now place large amounts of patient information at risk with the stroke of a single key. As a number of high-profi le data breach cases demon-strate, malicious attacks from outside your organization can compromise virtually all of your organization’s sensi-tive data.

So, in the unfortunate event that your organization has a cybersecurity breach, what is the potential for litiga-tion?

No Private Right of Action Under HIPAA

Even if you can’t remember what HIPAA stands for, you probably under-stand the basic principle of the “Privacy Rule.” The Health Insurance Portabil-ity and Accountability Act (“HIPAA”) requires healthcare providers, nurses, staff, and their business associates to protect patient information from unauthorized disclosure. Failure to fol-low the Privacy Rule, even unintention-ally, can expose you and your practice to government penalties, which can include signifi cant fi nes and criminal prosecution.

HIPAA does not provide the basis for a private right of action, which means that only the government can initiate proceedings under HIPAA. Pri-vate citizens cannot fi le lawsuits under HIPAA. However, an increasing number of patients have found ways around this general prohibition, and as data breaches and unauthorized disclosures continue to rise, the trend is likely to continue. Some of the more common ways your practice may be exposed to liability are discussed below.

Other Actions Involving Patient Privacy

The most common cause of ac-tion, which is rooted in HIPAA, is a claim for negligence or negligence per se. Under this theory, a patient must prove that the defendant breached a duty, which caused the patient’s dam-ages. Here, a patient argues that his or her protected health information has

been negligently compromised by the provider. Because the provider had a duty to follow HIPAA’s Privacy Rule – and arguably breached that duty – the patient claims that he or she is entitled to damages. Ironically, the patient will sometimes use the provider’s own federally-required HIPAA notifi cation letter as evidence of the breach.

Despite the strong argument that HIPAA preempts (or prohibits) this type of lawsuit, ten states have allowed, or at least noted, the practice. In Novem-ber 2014, for example, the Connecticut Supreme Court held that HIPAA can establish a healthcare provider’s duty in a state-court negligence case (1). And similarly, though not outright endorsing HIPAA-based suits, the United States District Court for the Middle District of Tennessee has held that HIPAA does not entirely preempt Tennessee state law (2).

Another cause of action that fre-quently arises in this context is invasion of privacy. In Tennessee, a claim for invasion of privacy can take one of four forms, including, one, unreasonable intrusion into the seclusion of another; two, appropriation of another’s name or likeness; three, unreasonable public disclosure of another’s private life; or, four, publicity that unreasonably places another in a “false light” to the public. Generally, patients asserting this claim must prove that the unauthorized disclosure was such that the health care provider should have realized it would be offensive to persons of ordinary sensibilities. This is a high standard to meet, but given the heightened profi le of patient data cases in recent years, this theory is also on the rise.

A third type of lawsuit that can grow out of the unauthorized disclo-sure of patient information is breach of contract. These claims require the plaintiff to prove, one, the existence of an enforceable contract, two, a breach of that contract, and, three, damages as a result. These cases largely turn

on whether a contract existed, and often, the patient will rely on the health care provider’s disclosure of its HIPAA policy to provide a basis for a breach of contract claim. A patient may also argue that the contract was implied in the physician-patient relationship

and, therefore, required confi -dentiality.

The news is not all bad. In any patient privacy case,

plaintiffs often have a hard time proving their damages. For example, in this age of digital media, information fl owing from a breach is

often lost in a vast sea of data on the internet or elsewhere, going unnoticed by anyone. Unless the patient in a case like that can prove that the breach ac-tually caused damages – for example, that someone actually saw or used the data - the defendant may be entitled to dismissal of the lawsuit or judgment in its favor.

ConclusionNo single plan or program can

reduce your risk of litigation to zero,

but careful consideration can help reduce the likelihood of unauthorized disclosures. Knowing the dangers is an important fi rst step, but you should also focus on establishing and enforc-ing HIPAA compliance and training programs within your organization. In parts II and III of this series, you will learn more about those issues, includ-ing information about HIPAA settle-ments and the various types of insur-ance products aimed at cybersecurity issues.

Notes(1) Byrne v. Avery Ctr. for Obstetrics & Gynecol-

ogy, P.C., 102 A.3d 32 (Conn. 2014). (2) Harmon v. Maury Co. Tenn., No. 1:05 CV

0026, 2005 WL 2333697 (M.D. Tenn. Aug. 31, 2005).

Kelly Street is an attorney with London Amburn, a law fi rm based in Knoxville, Tennessee, which represents providers in the area of healthcare law, including regulatory, compliance, HIPAA, malpractice and nursing home defense, employment, mergers and acquisitions, corporate and business matters. For more information, visit www.londonamburn.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

LegalMattersBY KELLY STREET, LONDON & AMBURN, P.C.

Cybersecurity And Patient PrivacyTheories Of Liability (Part I of III)


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The AMA Steps Up with STEPS ForwardAmbitious New Initiative Offers Physicians Strategies to Revitalize Medical Practices and Improve Patient Care

By LyNNE JETER

Editor’s Note: This article is part of a Medical News exclusive series, “Who’s Tend-ing Our Doctors?” to focus on ways the industry can help alleviate physician stress and allow phy-sicians to return to the joy of practicing medicine.

Several years ago, Christine A. Sin-sky, MD, FACP, made two signifi cant time-saving changes to her practice life that allowed her to leave work sooner and have more time for family and personal interests.

The fi rst: taking a streamlined approach to prescription manage-ment.

Second: taking pro-active planned care mea-sures with patients via previsit laboratory tests.

“Just making a single change – pre-scription management – decreased phone calls to the practice by 50 percent. It saved 30 minutes of doctor time and 60 minutes of nursing time per doctor per day,” said

Sinsky, an internist and partner in Medical Associates Clinic, a multispecialty group practice with sites in Iowa, Wisconsin and Illinois.

Sinsky is also the point per-son at the American Medical Association (AMA) for an am-bitious new initiative offering physicians strategies to revitalize their medical practices and im-prove patient care. The practice changes she references are found in the initial 16 modules avail-able online – free for AMA and non-AMA members – via www.STEPSforward.org.

“If you can follow one or two recommendations and go home earlier by reengineering the way you do your work, that’s a win-win all around,” said Sinsky.

The AMA took action to improve the lives of practicing physicians after a recent RAND survey showed the satisfac-tion physicians derive from their work is quickly eroding as time continues to be taken away from direct patient care be-

cause of grueling, bureaucratic obstacles. “Research shows that rates of overall

burnout among U.S. physicians approach 40 percent,” said AMA CEO James L. Madara, MD. “That’s why the AMA is taking a hands-on approach to meeting their day-to-day con-cerns through the new online series, AMA Steps Forward.”

Broadly, the 16 modules address four key areas: practice effi ciency and patient care, patient health, physician health, and tech-nology and innovation.

Specifi cally, the modules cover these topics:

• Conducting effective team meetings• Creating strong team culture• Electronic health record (EHR)

implementation• EHR software selection and pur-

chase• Expanding rooming and discharge

protocols• Improving blood pressure control• Improving physician resiliency• Medication adherence• Panel management• Preventing physician burnout• Preventing type 2 diabetes in at-risk

patients• Pre-visit laboratory testing• Pre-visit planning• Starting lean healthcare• Synchronized prescription renewal• Team documentationEach module requires only snippets of

time to study either online or printed in PDF format for a more traditional approach to learning. Live events provide yet another learning option. To earn AMA PRA Cat-egory 1 Credit™, participants must view the module content in its entirety, success-fully complete the quiz answering four of fi ve questions correctly, and complete the

evaluation. Modules include

steps for implementa-tion, case studies and downloadable videos, tools and resources.

“Within 30 minutes, physicians will know how to take the next step in their practices to work smarter, not harder,” said Sinsky.

For example, the module on effective team meetings begins with a 10-step process:• Identify the team.• Meet routinely and “on the clock.”

• Agree on ground rules.• Set a consistent meeting agenda.• Rotate meeting roles.• Solve problems as a group.• Record action steps, owners and

due dates.• Practice good meeting skills.• Have fun!• Celebrate success.Under ground rules, helpful hints in-

clude starting and ending each meeting on time, being fully present in the moment, staying on topic, focusing on the issue and not the individual, stepping up or back as needed, and giving thanks to the staff for their time. To stay on topic and maintain ef-fi ciency during the dedicated meeting time, it’s suggested that: “if the discussion wan-ders, the chair or other member can say, ‘Let’s take that offl ine,’ or ‘that sounds like an issue to put in the “parking lot” to talk about at another meeting.’ If the discussion strays, there may not be time at the end of the meeting for all the items on the agenda.”

In October, 10 modules will be added to the website. By the end of 2016, the AMA plans to have up to 50 modules available online.

Concurrently with the rollout, the AMA and the Medical Group Manage-ment Association (MGMA) issued a prac-tice innovation challenge, seeking more high-value, easy-to-adopt, and transfor-mative medical practice solutions. Pro-posals were submitted through Sept. 1; the best solutions were eligible for one of several $10,000 prizes, in addition to hav-ing the ideas developed into future STEPS Forward modules. Winners will be an-nounced at MGMA’s annual conference Oct. 11-14 in Nashville, Tenn.

“We issued the innovation challenge to tap into the creative energy that we know is present among physicians,” said Sinsky. “The goal is to help physicians take better care of themselves and their practices so they can, in turn, take better care of their patients.”

W H O ’ S T E N D I N G O U R D O C T O R S ?

Dr. Christine Sinsky

Dr. James L. Madara


The Literary ExaminerBY TERRI SCHLICHENMEYER

In One End and Out the Otherby Dr. Mike Goldsmith, illustrated by Richard Watson; c.2014, Red Shed; $12.99 / $16.95 Canada, 14 pages

In the book In One End and Out the Other

by Dr. Mike Goldsmith, illustrated by Richard Watson, 5 to 7 year old children fi nd out what happens after they can use the potty by themselves.

Let’s say you’re hungry and Mom hands you an apple. Just like gasoline in a car, food is fuel for your body and the fi rst step in making that fuel is the spit in your mouth that helps “mush up the food.”

Once you’ve fi nished a bite of your apple and swallowed, the “gloopy” mix-ture goes down your esophagus and, ten seconds later, it enters your stom-ach where it becomes something called “chyme.” Your stomach works the chyme, then sends it to your small intestines where nutrients are absorbed and, about seven hours later, it enters your large intestines, where water is removed. After another day or so, digestion is complete and you’ll be ready to fl ush what’s left down the toilet. Did you know that you’ll spend “at least” three months of your life sitting on the potty?

But once you push the fl usher… then what?

Everything you fl ush goes down a long pipe, through your house, under the ground, and into a sewer pipe. There, it mixes with water and things that other people have fl ushed; the water moves it all below the streets into the sewage treat-ment plant where it gets dumped through screens into chambers and becomes sludge.

Then, says Dr. Goldsmith, “germs break down the sludge in the same way your body breaks down food.”

At some sewage plants, sludge gets dried and becomes food for plants, while “dirty water” is cleaned with “good bac-teria” that makes it safe to put back into rivers or to use on lawns and fi elds. Other sewage plants do different things with the waste they receive, but it’s all treated so it’s safe and won’t hurt people or animals.

You thought you could breathe a sigh of relief once Potty Training was over, but then your child began asking questions that you couldn’t quite answer. That’s when you need “In One End and Out the Other.”

With a mix of words kids feel comfort-able using, and real technical and medical terms, Dr. Mike Goldsmith explains what happens from mouth to months later, not only for humans but for plants and ani-mals as well. This information – and the trivial bits that accompany it – is helped along by illustrations by Richard Watson, both in the main part of the book and in the fun-to-fi nd fl aps that give kids even more knowledge about the everyday func-

tion of their bodies and their cities.Even though I’m well beyond the

target age of this book, I learned a lot from it and I think your kids undoubtedly will, too. If you’re looking for answers to stICKY questions, In One End and Out the Other is fl ush with facts.

Simple Lessons for a Better Lifeby Charles E. Dodgen; c.2015, Prometheus Books; $18.00 / $19.00 Canada, 288 pages

Getting your news these days is a nerve-wracking thing.

Yes, you’re happy to note cat videos, new babies, and neighbors having fun. But who likes to see word of war, destruction, accidents, or death? Yes, life means having both – but at this point,

you feel as though there should be some sort of balance. Seek it in Simple Lessons for a Better Life by Charles E. Dodgen.

Things sure have changed since you were a kid.

That’s a common sentiment. People have probably been uttering it since two years after time began – but today, how do we “not exist in a perpetual state of fear and misery?” Dodgen, a clinical psychia-trist, answers that question with what he found in a nursing home.

As we age, and especially when we reach Senior Status, we become “dispos-sessed of the material features that de-fi ned… identities.” Dodgen says that’s the “original identity theft,” and while there’s no alternative to this loss, we can learn to cope with it. Everyone endures suffer-ing and pain to some degree, but there is a way to separate the two, for instance. “Pain in life is inevitable,” but a good sup-port system can help overcome it to the point of toleration. If that support system is you, resist the need to “do something about it” and just comfort. Simple love

and companionship work wonders; reach for it, and

give it.Recognize

that depres-sion lasts longer than demoral-ization; to ease

the latter, positive reminders of the past are sometimes all you need. Try

to remember that, though it’s certainly no fun, “loss allows for personal growth.” Un-

derstand that phantom pain can come from missing people, too, but

activity helps and “a… gaping hole can be fi lled with new experiences.” Keep in mind that you are your best health plan, and you can improve your own attitude and experiences, love your body, and bal-ance your mind. And fi nally, remember that there’s pain in life but what matters is what you do about it.

War, racial tensions, fi nancial prob-lems, dead lions, the list of woes all de-pends on where you sit. “Simple Lessons for a Better Life” may be able to help you relax about things – or it may not.

As self-help books go, this one is unique: by examining the emotions of those who’ve lost a lot (home, partner, in-dependence, health) and have moved to a nursing home, author Charles E. Dodgen shows how richer lives can come from ad-versity. Yes, it sounds simplistic (and there are pages where it defi nitely is), but what Dodgen says consistently makes sense on at least some level. Though it may take a bit of between-the-lines reading, that’s particularly true when his advice encom-passes the needs of caregivers, elders, and their children.

This is not a book of wisdom, so much as it’s a book of inspiration that needs to be savored and pondered to get the best from it. If you’re dealing with adversity or just watching too much news, Simple Lessons for a Better Life may be just the thing.

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

©2010. Paid for by the United States Army. All rights reserved.

The new experience you’ll gain as a member of the Army Reserve will help you remember why you became a physician. By practicing in your community and serving when needed, you could receive $250,000 in student loan repayment and $75,000 in Special Pay. You’ll feel an increased sense of pride when you care for our Soldiers and their Families.

THE STRENGTH TO HEAL and rediscover my passion for medicine.

To learn more about the U.S. Army Reserve health care team, visit healthcare.goarmy.com/mednewsor call 615-874-5002.

for a Better Lifeby Charles E. Dodgen;

Books; $18.00 / $19.00

Getting your news

accidents, or death? Yes, life means having both – but at this point,

and companionship work wonders;

ization; to ease the latter, positive reminders of the past are sometimes all you need. Try

to remember that, though it’s certainly no fun, “loss allows for personal growth.” Un-

derstand that phantom pain can come from missing people, too, but

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Priority Ambulance Hires Debbie Stone As National Director Of Human Resources

KNOXVILLE – Priority Ambulance has hired Debbie Stone as director of human resources to oversee all recruiting, hiring and benefits management throughout the company’s national network.

Stone has nearly a decade of expe-rience in human resources and legal and regulatory oversight with emergency medical services companies. Stone will apply her expertise in developing human resources policies and procedures for startup ambulance companies, mergers and acquisitions to Priority Ambulance’s rapidly growing national footprint. In ad-dition to human resources experience, Stone has managed state, vehicle, phar-macy and Medicare/Medicaid licensure and inspection processes that will help as Priority Ambulance expands into new ter-ritory.

Prior to Stone’s work in EMS, she worked as a paralegal at several law prac-tices. Stone holds a paralegal degree from Barkley College in Los Angeles.

Stone volunteers with the Multiple Sclerosis Foundation and attends retreats that support individuals living with the dis-ease. She is a member of the Society for Human Resource Management (SHRM), the world’s largest human resources membership organization. She has three grown sons.

Stone will be based at Priority Ambu-lance’s headquarters in Knoxville, Tenn., and will serve Priority’s national ambu-lance network in Tennessee, Alabama, New York, Pennsylvania, Arizona and In-diana.

Dr. Sean M. DeLair Joins Tennova’s Medical Staff

KNOXVILLE – Tennova Healthcare welcomes Sean M. DeLair, M.D., urologist, to his new medical practice at Tennova Urology – La-Follette. Dr. DeLair is ac-cepting new patients at his office at 905 East Central Avenue, Suite 102, LaFol-lette.

DeLair is dedicated to the diagnosis and treatment of geni-tourinary conditions. He specializes in the surgical treatment of kidney, pros-tate, bladder and testicular cancers. He is also experienced in vasectomy as well as treating patients with kidney stones and urinary incontinence. Same-day appoint-ments are available. For more information, call 1-855-TENNOVA (836-6682).

DeLair earned his medical degree from the Medical College of Virginia in Richmond, VA, where he also completed an internship and residency. He com-pleted an additional residency at UC Davis Medical Center in Sacramento, CA. Dr. DeLair is board certified in urology.

Dr. Brittany Stofko Joins Tennova’s Medical Staff

KNOXVILLE – Tennova Healthcare recently welcomed Brittany Stofko, D.O., obstetrician and gynecologist, to her new medical practice at Women’s Health Spe-cialists. She is accepting new patients at her office at 939 Emerald Avenue, Suite 806, Knoxville. Dr. Stofko has joined the practice of Leonard Brabson, M.D., and his team of certified nurse midwives and a nurse practitioner.

Stofko is experienced in caring for teens and women of all ages who are maintaining wellness, embracing moth-erhood or making life transitions. She specializes in the full range of obstetrical and gynecological services. Same-day ap-pointments are available. Stofko earned her medical degree from Philadelphia College of Osteopathic Medicine in Phila-delphia, PA. She completed a residency at Albert Einstein Medical Center, also in Philadelphia. She is board certified in ob-stetrics and gynecology.

Her special interests and experience include obstetrics care and management; breastfeeding support including lactation consultation; adolescent and general gy-necology; contraceptive management; and menopause treatment including hor-mone replacement therapy. .

Dr. William Skakun Joins Tennova’s Medical Staff

KNOXVILLE – Tennova Healthcare welcomes William Skakun, D.O., orthope-dic surgeon, to its medical staff.

Skakun is experienced in a wide range of general orthopedic procedures and techniques. He spe-cializes in hip, knee and shoulder arthroplasty as well as the full spectrum of surgical and nonsurgical fracture management. Same-week appointments are available.

Skakun earned his medical degree from NOVA Southeastern University in Fort Lauderdale, FL. He completed an or-thopedic surgery residency at Ohio Uni-versity, Heritage College of Osteopathic Medicine and Mercy St. Vincent Medical Center in Toledo, OH. He will perform surgical procedures at Lakeway Regional Hospital.

Summit Rheumatology Associates Welcomes Dr. Michael Watterson

The region’s leading primary care organization continues to expand with the addition of a new rheu-matologist. Michael Wat-terson, MD, is now seeing patients at Rheumatology Associates of East Tennes-see, located at 324 Park 40 North Boulevard.

Prior to joining Sum-mit, Dr. Watterson was with University of Tennessee Rheumatology Associates at UT Medical Center and practiced for 10

years with Arthritis Specialists of Nash-ville. He also served as an independent contractor with Southeastern Emergency Physicians and a general internist with Co-lumbia Regional Medical Center.

Watterson earned his medical degree from East Carolina University of Medicine and completed his residency and fellow-ship at Vanderbilt University Medical Cen-ter. He is certified by the American Board of Internal Medicine with a subspecialty in rheumatology and is a member of the American College of Rheumatology.

Helen Ross McNabb Center Introduces New Leadership Role To Support Integrated Health Care Model

KNOXVILLE – The Helen Ross McNabb Center is proud to announce the promotion of Dr. Kel-lye Hudson to director of nursing.

As its first director of nursing, Hudson will work to introduce an integrated health care approach to the Helen Ross McNabb Center’s Knox County outpatient mental health services, as well as oversee clinical staff, research and education for future expansion. Hudson has been with the Center since August 2009, and she will continue to provide direct services to cli-ents in addition to her new responsibili-ties. Hudson completed her bachelor’s in nursing, master’s in nursing and doctorate in nursing from the University of Tennes-see, Knoxville.

In recent years, Tennessee legislation has made it possible for community men-tal health centers to hire primary care phy-sicians and has opened the door for the Helen Ross McNabb Center to explore integrated health care models. This new initiative will allow individuals living with serious mental illness, who statistically face an increased risk of having chronic medical conditions, to be better served with a well-rounded team of medical spe-cialists. Hudson will lead the Center’s ini-tiative to an integrated care model.

The University Of Tennessee Medical Center Physician Elected

KNOXVILLE — At the recent 20th Congress of the International Society of Aerosols in Medicine (ISAM), Rajiv Dhand, MD, Chair of Medicine and Associate Dean for Clinical Affairs for the UT Gradu-ate School of Medicine, was elected to a two-year term as president from 2017-2019. Dhand, a pul-monologist and critical care physician at UT Medical Center, cur-rently serves as a board member to ISAM, and he will continue in that role until he takes over his new responsibilities in 2017. Dhand joined ISAM in 1995 and has been a board member for the past four years. The organization, founded in 1970 to fur-


East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2015 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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GrandRounds

Dr. Sean M. DeLair

Dr. William Skakun

Dr. Michael Watterson

Dr. Kellye Hudson

Dr. Rajiv Dhand

continued on page 11


GrandRounds

ther research in medicine including health effects of inhaled aerosols and pulmonary drug delivery, has over 300 members from countries all over the world, including North and South America, Europe, Asia and Australia.

During the congress, Dhand also released the ISAM Textbook of Aerosol Medicine. He is the editor-in-chief of the multi-author electronic textbook, which is a comprehensive resource for all aspects of aerosol therapy.

Dhand has special expertise in aero-solized therapies.

Covenant Health Welcomes Thomas Wannenburg, MD

KNOXVILLE— Covenant Health wel-comes Thomas Wannenburg, MD, to the active medical staff at Parkwest Medical Center. Dr. Wannenburg is board certified in cardiology and clinical cardiac electrophys-iology.

Wannenburg has clini-cal expertise in the diag-nosis and management of cardiac rhythm disorders, radiofrequency ablation of cardiac arrhythmias, management of dis-orders of cardiac conduction, as well as implantation and management of cardiac rhythm devices.

After residency at Johns Hopkins Bayview Medical Center in Baltimore, Maryland, Dr. Wannenberg was offered a fellowship in cardiology at Wake Forest University School of Medicine in Winston-Salem, North Carolina, and then a second fellowship at the university in electrophysi-ology.

He obtained his medical degree from the University of Stellenbosch in Tyger-berg, Cape Province, South Africa. At the University of Florida College of Medicine in Jacksonville, Dr. Wannenburg recently served as an associate professor teaching cardiology. He was also an assistant pro-gram director for the electrophysiology fellowship program.

Wannenburg has taught cardiology at Wake Forest, and has contributed to articles in numerous medical journals and books, also working as an editorial consul-tant on projects for the American Journal of Physiology and the Journal of Cardio-vascular Research, among others.

Covenant Health Welcomes Brian Kwitkin, MD

KNOXVILLE –Covenant Health wel-comes Brian Kwitkin, MD, to Crossville Medical Group and to the active medical staff at Cumberland Medical Cen-ter. Dr. Kwitkin is a general surgeon whose clinical expertise is in gastrointes-tinal, abdominal, and lapa-roscopic procedures.

Kwitkin is a graduate of Ross Univer-sity School of Medicine in Dominica, West Indies. He served a general surgery intern-ship at the University of Miami/Jackson Memorial Medical Center in Miami, Flor-

ida, following a residency there.He also had a general surgery resi-

dency at Cooper University Hospital in Camden, New Jersey. Dr. Kwitkin is a member of the American College of Sur-geons and the Society of American Gas-trointestinal and Endoscopic Surgeons.

Covenant Health Welcomes Jon Simpson, MD

KNOXVILLE – Covenant Health wel-comes Jon Simpson, MD, of Cumberland Orthopedics to the active medical staff at

Cumberland Medical Cen-ter in Crossville. Dr. Simp-son is board certified in orthopaedic surgery, with clinical expertise in total joint replacement, sports medicine, fracture care, arthroscopic surgery, and musculoskeletal injuries.

A native of McHenry County, Illinois, Dr. Simpson is a graduate of Loyola Uni-versity Stritch School of Medicine in Chi-cago. Dr. Simpson also gained experience

from an orthopaedic surgery residency at Medical College of Georgia, Augusta, and served as chief resident there.

Simpson is a member of the American Academy of Orthopaedic Surgery, Ameri-can Medical Association, Southern Medi-cal Association, Southern Orthopaedic Association, Tennessee Medical Associa-tion, and the Cumberland County Medical Society.

Dr. Thomas Wannenburg

Dr. Brian Kwitkin

Dr. Jon Simpson

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East TN Medical News September 2015