Kamilia F. Kozlowski, MD

PAGE 3

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HEALTHCARE LEADER: Dennis VonderfechtPerhaps the best decision Dennis Vonderfecht, president and CEO of Mountain States Health Alliance (MSHA), ever made took place years ago when he decided majoring in music likely would not serve him well fi nancially ... 6

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(CONTINUED ON PAGE 6)

By CINDy SANDERS

If being quite specifi c while leaving plenty of room for interpretation was an art form, the Centers for Medicare and Medicaid Services surely would have achieved

‘master class’ status by now. The two-midnight rule, the recent compliance man-date that went into effect on Oct. 1, is an example of this dichotomy and has left physicians and hospital administrators scrambling to understand what it means for patients … and the bottom line.

Boiled down, the new rule sets “two midnights” as a benchmark for in-patient admission, but there are exceptions. Meant to clarify the difference between appropriate observation status and inpatient admission, the IPPS fi nal rule caused enough confusion that CMS offered a three-month amnesty period, which is set to expire at the end of 2013. During this last quarter of the year,

hospitals will not face fi nancial penalties even if deemed out of compliance with the rule.

Instead, the federal agency has used this time period for a “probe and edu-cate” program where Medicare Audit Contractors (MACs) have focused reviews

Two-Night MinimumObservation, Inpatient & the Two-Midnight Rule

(CONTINUED ON PAGE 8)

By CINDy SANDERS

Whether in the context of discussing defensive medicine or the latest diagnostic technology, there seems to be a pervasive belief that increasing overutilization of medical imaging is a key driver of healthcare spending. Yet, those within the fi eld point to recent studies that fi nd a fl aw in that line of thinking … within the Medicare population, utilization rates are actually in decline.

A study conducted by the Harvey L. Neiman Health Policy Institute and published this summer in the Journal of the American College of Radiology found the number of physician visits by patients age 65 or older that resulted in an imaging exam has consistently trended downward over the past decade from 12.8 percent in 2003 to 10.6 per-cent in 2011. Using Medical Expenditure Panel Survey (MEPS) data in addition to Medicare claims data, the researchers also said that annual spending on imaging for the senior population grew from $294 per enrollee in 2003 to $418 per enrollee by 2006 but had declined to $390 per enrollee by 2011.

Richard Duszak, Jr., MD, FACR, chief medi-cal offi cer and senior research fellow at the Nei-man Health Policy Institute, which is part of the research arm of the American College of Radi-

Medical Imaging UtilizationThe trend might surprise you

FOCUS TOPICS IMAGING AUDIT/COMPLIANCE

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

Since joining Mountain States Health

Alliance (MSHA) on November 1st,

Unicoi County Memorial Hospital

(UCMH), located in Erwin, Tenn., has been

delivering patient-centered care a little bit

differently...with the surety of a healthy

future.

UCMH administrator Tracy Byers, who

assumed his position two months ago,

said the acquisition has provided a much-

needed stability. “Knowing that the hospital

here is healthy and stable is important; no

patient wants to get their healthcare, or no

physician wants to commit to a hospital,

where the hospital is rumored to close,” he

said. “Now that the future is stable, no one

has to wonder if the hospital is going to be

open in six months.”

Becoming the 14th hospital in the MSHA

organization, UCMH provides valuable

services to the community, without which,

patients would have to drive miles to receive

care. As a full-service hospital, UCMH

offers basic hospital services, as well as

physical therapy, a sleep lab, occupational

health services, and respiratory therapy,

to name just a few.

“We pretty much have

all of the basics you

would expect from a

community hospital,”

explained Byers. “We

have all the basic imaging

equipment—x-ray, CT

scan, MRI, ultrasound—

you would have at other facilities, and we

have a full service lab, a 24/7 emergency

department, and operating rooms that have

the capabilities of any community-based

hospital.”

As part of the acquisition plan, MSHA has

committed to building a new hospital in the

area in the next five years, so eventually, the

current building will be replaced with a new

state-of-the-art facility. Until that project is

complete, however, UCMH will be acquiring

some new equipment, including a new

64-slice CT scanner within the next four or

five months that will replace the current one.

“We have made some important

promises to the people of Unicoi County

with respect to their hospital,” said Dennis

Vonderfecht, president and CEO of MSHA.

“Now it is time for us to fulfill those

promises. We are so grateful for the support

we’ve seen from the community and the

relationships we’ve built throughout this

acquisition process, and we’re excited about

what the future holds for Unicoi County

Memorial Hospital.”

“Some of things Mountain States will

help us with immediately are things that

patients may not recognize right away, for

instance, our Wi-Fi capability will improve,”

shared Byers. “And a lot of what Mountain

States will do is make this building last the

next four years so that we can continue to

see patients in a good facility before the new

one is built.”

Selection of an architect for the new

facility is planned for late 2014, and

construction is expected to begin in 2015.

Tentatively planned to open in 2017, the

replacement hospital will be located on

Temple Hill Road off Exit 40 in Erwin.

One benefit to physicians, Byers pointed

out, is the available office space. “We

have an office building for physicians who

want to come here, perhaps to get out of

a larger, more competitive environment.

They can come here and practice, be more

independent, if you will, and provide the

community with services related to their

specific specialty.

“From a patient standpoint, they don’t

have to drive all the way to Johnson City,

Bristol, or Kingsport to get their care; they

can do it here,” said Byers. “I think for both

physicians and the community, knowing that

we are open and the future is stable, gives

them that little extra reassurance that the

hospital is definitely going to be here and is

getting better.

“We will have the things Mountain

States offers, rather than continue to

struggle as an independent hospital. Our

country’s healthcare system seems to be

getting more and more challenging all

the time, but being part of a big system is

definitely beneficial.”

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

All source data for this article has been provided by

A Healthy Future, A Healthy CommunityUnicoi County Memorial Joins Mountains States Health Alliance

Patient-Centered Practices

Tracy Byers

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

PhysicianSpotlight

Suspend for a moment all you’ve heard about the suspected secrets our gov-ernment and insurance companies keep re-garding the cost of healthcare and consider another secret patients may not be hearing from their doctors. Perhaps unintentional, but advocates for state breast density laws often refer to a woman’s breast density as one of the “best kept secrets” in our coun-try’s healthcare system.

Knoxville radiologist Kamilia F. Kozlowski, MD, agrees, and three years ago started working towards getting a bill passed in Tennessee that would require physicians to inform their patients if their screening mammogram reveals a dense mammographic pattern.

Up through the 1990s, there were no regulations regarding the results of a mam-mogram. Mammography facilities would send results to the patients’ physicians, but whether or not the results made it to the patients is hard to determine, especially if the paper was misfiled or left on an over-whelmed physician’s desk. Recognizing the problem, in 1997, the FDA pushed for the Mammography Quality Standards Act (MQSA), which made it a requirement that the patient get a letter in the mail saying one of two things: the findings are negative, or there is a questionable finding that needs further follow up with a doctor. “It does not require that a woman be advised about the mammographic density of her breast,” explained Kozlowski, “That is important medical information for a patient to know if she has had a screening mammogram.”

As Kozlowski explained, approxi-mately 50 percent of women, when look-ing at their mammogram, have more fatty tissue than glandular tissue, or more gray than white on the mammogram image. In this patient population, the mammography is good at picking up breast cancers; how-ever, the other 50 percent of patients have more white than gray, or more glandular tissue than fatty tissue. “So finding a mass or nodule or something even smaller is like trying to find a penny in a glass of milk, as compared to a woman who has a fatty breast with lots of gray on the imagine; it’s like finding a penny in a glass of water,” Kozlowski said.

Mammography for women with lots of glandular tissue (i.e., a dense mammo-graphic pattern) can miss 40 to 50 percent of breast cancers. According to the Na-tional Institute of Health, breast density is recognized as one of the strongest risk factors associated with the development of breast cancer, even stronger than having two first degree relatives with the disease. And even for women who have followed the rules and have had their recommended mammogram, even religiously, a few weeks or months after their mammogram, they

might feel a lump or see their doctor for their yearly breast examination who feels a lump. If it’s discovered the patient has breast cancer, she wonders why the mam-mogram didn’t find her breast cancer. “What’s wrong? Why wasn’t the cancer found on my mammogram?” she may ask. “Because you have dense breast tissue.” “Why wasn’t I told that?” “Because we don’t have to.”

This same scenario happened to Nancy M. Cappello in Connecticut, Ex-ecutive Director and Founder of Are You Dense, Inc., an organization borne out of her own tragedy of an advanced stage breast cancer diagnosis in 2004, although she had had yearly “normal” reports for more than a decade.

Cappello began advocating in 2007

for a law to be passed in Connecticut re-quiring that women be informed about their dense mammographic pattern. Her efforts have gone a long way to help pa-tients; many states have taken her lead. However, although screening mammo-grams are covered by insurance, screening ultrasounds are not. There is no screening code for them. “Women have to pay out of pocket, and a lot of places won’t do them,” said Kozlowski. “Some of the radiologic lit-erature says that it’s not cost effective and it takes too much time to do, that there are too many false positive.”

Even the American College of Radiol-ogy (ACOR) has never pushed to have a screening code for breast ultrasound, Ko-zlowski pointed out, although other studies have shown it to be beneficial and increase the yield of breast cancers that are mammo-graphically occult. “Because of the govern-ment’s Deficit Reduction Act, the American College of Radiology was told that if they get a screening code for breast ultrasound, in order to stay fiscally neutral, reimburse-ment would be reduced on some of the other high-end imaging studies like MRIs and CTs of other parts of the body, and they were unwilling to do that,” she said. “So the American College of Radiology or any other group had no impetus to push for it.”

Kozlowski’s practice, along with a lot of other private practices and facilities, un-derstand the predicament and perform the ultrasound regardless. “We have a code for dense breast tissue, so we bill it as a diag-nostic code, even though we don’t get re-imbursed much from it,” she said. “But, I

have done breast ultrasound screening for 30 years; I have educated my patients about dense breasts, and I tell them why I need to do it. Most of the cancers that have been proven by ultrasound are under a centime-ter, and if you can find it when it’s that small, it has a very good prognosis and, most of the time, negative lymph nodes as well.”

Although financial burden is always a hindrance toward quality patient care, Ko-zlowski’s biggest concern about dense breast tissue is the lack of knowledge about it. So three years ago, Kozlowski started trying to pave the way to pass a breast density in-formation bill in Tennessee. Together with Representatives Dennis Powers from LaFol-lette and Becky Massey from Knoxville who have supported the bill, Kozlowski spent the first year fighting with the Tennessee Radio-logic Society and the Tennessee Medical As-sociation to try to pass it, but on June 4th of this year, the bill was signed into law by Governor Haslam. “Similar battles have been fought across the country, we were the 6th state to pass the law, and there are now 16 states that have passed it,” she said. The Breast Cancer Prevention Act goes into ef-fect January 2014 and requires that all women who have a screening mammogram be informed if it’s discovered they have a dense mammographic pattern. “They must be told that [they have a dense mammao-graphic pattern] and that they should talk to their physician about other ancillary means of examining the breast, and then it’s the woman’s choice to do it,” she said “But at least she’s informed because holding back

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LegalMatters

Physician Employment Agreements: Common Issues

BY IAN P. HENNESSEY, ESQ.

As an attorney focusing on healthcare law, matters involving physician employment agreements are a frequent source of questions from employers and physician employees alike. Contrary to common belief, there is no single “standard” or “correct” form of physician employment agreement. Most employers have their own unique way of doing things, whether they happen to be a large hospital network, a small independent practice, or something in between. Nevertheless, there are several common issues in most physician employment agreements that deserve special attention from both the employer and the physician employee.

Compensation ProvisionsFor obvious reasons,

compensation provisions often receive the most attention in a physician employment agreement. There is no single way to structure physician compensation. In fact, there are several common compensation structures, including traditional base salary, RVU-based productivity,

“eat-what-you-kill” models, and various combinations of these and other models. No matter what kind of compensation model is used, it is important that the parties clearly understand the compensation structure, including any potentially negative scenarios that may arise. For example, an “eat-what-you-kill” model will often allocate certain expenses to the physician employee (shared and individual) that may create an account deficit, while a RVU-based model may include a provision under which compensation may be reduced if the physician employee does not reach his/her RVU target. The best time to decide what is “fair” to both parties is before the contract is executed and any dispute concerning money has had a chance to arise.

Professional Liability InsuranceProfessional liability insurance

is a key provision in any physician employment agreement. Typically, the agreement will state which party is responsible for the obtaining professional liability insurance during the term of the agreement and the

amount of coverage to be provided. Even more important, however, is how a physician employment agreement addresses coverage following termination of the agreement (e.g., tail coverage). Although the employment relationship may be over, there is still potential for a malpractice lawsuit to be filed related to events that occurred prior to termination. It is critical for both parties to agree in advance who will be responsible for the cost of coverage and what remedies are available if the party responsible for obtaining such coverage fails to do so. If a lawsuit is filed, neither party will want to find itself under circumstances in which there is no professional liability coverage for the claim.

Non-Compete ProvisionsNon-compete provisions are fairly

common in physician employment agreements. Under Tennessee law, non-compete provisions in physician employment agreements are enforceable if the restriction is for two years or less and the geographical area of the restriction is the greater of a ten-mile radius from the physician’s primary practice site or the county in which the primary practice is located (1). Depending on the circumstances, a physician may be restricted from practicing at any facility at which the physician provided services during the term of the employment agreement. If the non-compete provision does not comply with the applicable Tennessee physician non-compete statute, then it may not be enforceable following termination of the contract.

Non-Solicitation ProvisionsThough not as prevalent as non-

compete provisions, non-solicitation provisions are another important provision in a physician employment agreement. Unlike a non-compete provision, a non-solicitation provision prohibits the physician from soliciting the employer’s patients. Non-solicitation provisions are not subject to the same statutory regulation as non-compete provisions. However, it should be noted that general advertisements are not typically considered “solicitation” under Tennessee law.

TerminationThe termination provisions of a

physician employment agreement are of critical importance to both the employer and the physician employee. There are typically two categories for termination of an employment agreement: termination “for cause” and termination “without cause.” Termination “for cause” means termination for a certain reason, such as breach of the agreement or certain acts by the employee or, in some cases, the employer. Typically, termination for breach of the agreement will not occur until the breaching party has been allowed an opportunity the cure the breach. On the other hand, certain breaches of the agreement (e.g., loss of the physician’s license or conviction of a felony, or an employer’s bankruptcy or insolvency) may lead to immediate termination.

As its name suggests, termination “without cause” means that there is no specific reason for the termination other than that one of the parties has chosen to end the contract. There is usually a notice period for termination without cause, typically ranging anywhere from 30 days to 180 days. Employment agreements that automatically renew at the end of their term may also contain a provision establishing a notice period for non-renewal of the agreement.

ConclusionThe topics in this article are

common issues in most physician employment agreements, but by no means the only issues. In each individual circumstance, there will be different priorities and points of emphasis related to the physician employment agreement. However, regardless of the issue, it is important that the parties discuss any questions or issues they may have before executing the contract. Although there may never be a “perfect” contract for either party, it is best when neither party faces any unnecessary or unpleasant surprises after the employment relationship has begun. As the old adage says, an ounce of prevention is worth a pound of cure.

Notes

1. If the employing entity is a hospital, the duration of the restriction can be longer (though not to exceed five years) if it is determined by written mutual agreement that the extended period is necessary to comply with federal statutes, rules, regulations or IRS revenue rulings or private letters. See T.C.A. §63-6-204

Ian P. Hennessey is with London & Amburn, P.C. His practice focuses primarily on health law. He may be contacted at ihennessey@latlaw.com. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

REPRINTS: Want a reprint of a Medical News article to frame? A PDF to enhance your marketing materials? Email subscribe@medicalnewsinc.com for information.

e a s t t n m e d i c a l n e w s . c o m DECEMBER 2013 > 5

HealthcareLeader

Dennis VonderfechtBy BRIDGET GARLAND

Perhaps the best decision Dennis Vonderfecht, president and CEO of Mountain States Health Alliance (MSHA), ever made took place years ago when he decided majoring in music likely would not serve him well financially. “I started in college as a music major, vocal music, as I sing, but I decided shortly after I started that unless you are a top-notch performer, it’s going to be difficult making a living off of music, and I really didn’t have that much interest in teaching.”

As a young man, Vonderfecht prob-ably didn’t realize the magnitude of that foresight, but looking back at his long, suc-cessful career in hospital administration, he, as well as the multitude of people who have been served by MSHA, are grateful he took the path he did.

His interest in medicine prompted Vonderfecht to switch his major to pre-med, but even after being accepted to medi-cal school, he still didn’t feel he had found his niche. After finishing a degree in busi-ness administration, and as circumstances prompted him, Vonderfecht, on the advice of a guidance counselor, looked into the field of hospital administration, which com-bined his interest in business and healthcare. He applied to three different schools with accredited Master’s degree programs, got accepted to all three, but ended up going to the University of Missouri in Columbia, where he and his wife spent two years.

After finishing his degree, Vonder-fecht worked for Humana (when it was a hospital company) for eight years and left there to work in the not-for-profit sector in Kansas City, Missouri, where he served as regional vice president over nine hospitals and nursing homes for approximately four years. He moved to Johnson City in 1990 to accept the position of president and CEO of Johnson City Medical Center (JCMC). In 1998, JCMC acquired six hospitals from Columbia HCA, forming Mountain States Health Alliance.

Although he still enjoys singing, most of his time is spent at the helm of the MSHA organization, helping guide it through the many storms the healthcare in-dustry has faced over the past few decades. And Vonderfecht feels good about the place where MSHA is anchored, as he prepares to retire on December 31st.

“We have a very good strategic plan in place that will guide MSHA well over the next few years. It will be challenging times, there’s no doubt about that, but we’ve had them before,” he said. “Through good strat-egy-setting and implementing those strate-gies, we’ve been able to come through those tough times. In fact, we are going through them now, with the cuts in reimbursements and the governors of two states opting not to expand the Medicaid programs.

“We are hoping, however, to get insur-ance coverage for people who don’t have insurance, so that they can access the sys-

tem in an earlier age of their illness rather than waiting to go to the emergency depart-ment at an advanced stage. It’s challenging, no doubt, but our strategic plan is very fo-cused in on this transformation we are going through, and we think it has the ingredients for success for coming through at the end of this transformation in a good state.”

Part of that strategic plan has been the development of Integrated Solutions Health Network (ISHN), comprised of area physicians, whether they are employed by MSHA, in private practice, or are uni-versity physicians. “Integrated Solutions Health Network allows us to work together to best care for patients under a popula-tion health management model,” explained Vonderfecht. “It benefits the patients and also benefits the physicians and our organi-zation financially from being able to share in savings associated with high quality care and cost savings from keeping patients out of high-cost care settings.”

As he pointed out, almost all the ar-ea’s physicians are involved with ISHN in some capacity, whether through con-tracting with insurance companies, under MSHA’s Medicare Advantage Plan, or through MSHA’s participation in the Medi-care Shared Savings Program. “I see that [physician participation in ISHN] as a real model of integration for our system that al-lows physicians to stay independent, to be a part of the university, or whatever they want, and still be a part of the greater good for what we are trying to do in the commu-nity,” he said.

“I just think there are a lot of oppor-tunities for us in the future, using evidence-based care guidelines to develop care models which allow us to work together as a team to benefit the patient, working around the triple aim—improving outcomes, improv-ing the patient’s experience, and reducing costs at the same time,” he added.

Vonderfecht says he hasn’t fully for-mulated his retirement plan, but he has determined that it will include spending time with his family, while also doing some traveling. Having a big heart for animals, Vonderfecht also plans to spend more time on his miniature donkey farm, Appalachian Homestead. A unique interest, Vonderfecht explained that he grew up showing quarter horses and kept horses until about twelve years ago. “I had two really well-trained horses but was running out of time to keep the riding up on them so that I could show

them. I sold them and went a couple of years without anything in the pastures,” he shared. “One day my wife mentioned we needed something in the pastures, so we looked at goats and llamas and other creatures of various kinds but settled on the donkeys.”

One of the favorites on the farm is Henry, who after losing a leg, now has a prosthetic that helps him get around. “We change his sleeve on his leg every day, and he just lays his head on your shoulder while you do it. He’s so sweet,” he shared.

Vonderfecht doesn’t want to abandon healthcare in retirement. He plans to stay involved. “I might teach part time, which I have already been doing for the College

of Healthcare Executives about four times a year. I may also do some consulting work around governance and performance improvement, those are two areas I feel I have some ex-pertise in that I might be able to share with others,” he said. “Beyond that, I may serve on some boards, but I don’t want to be tied down; I want time to explore some other inter-ests I have. I want to do some mission work with my church, which I haven’t had the oppor-tunity to do, and I’d like to sing,

so I may want to get involved with some singing groups.”

Wherever retirement may lead him, one thing is certain: his legacy will always be felt in Johnson City and the Tri-Cities area. “Our incoming CEO has mentioned a number of times that we are well-positioned because we’ve had consistent leadership, a comprehensive strategy that has carried us up to this point, and a terrific board of directors who has supported Dennis’s lead-ership,” said Teresa Hicks, MSHA’s Com-munications Manager. “We’re positioned to continue to be strong, and that’s some-thing we are appreciative of. We are really sad to see Dennis go, but we are grateful that he has left us with that legacy.”

6 > DECEMBER 2013 e a s t t n m e d i c a l n e w s . c o m

ology, noted a major concern for those in the profession is that outdated informa-tion could be used to inform healthcare policy with a direct impact on patients and providers. “We’re in an interesting time where there is immense scrutiny on our health delivery system,” he said. “We really need good, credible information driving policy decisions.”

Duszak, a board-certifi ed radiologist, noted that at some point the mantra that imaging utilization was continually spiral-ing upward “didn’t match what we in the trenches saw.” He added imaging studies were rapidly growing until 2006, “Then it plateaued and has, in fact, declined.” Duszak added he isn’t suggesting imaging utilization shouldn’t continue to be moni-tored but that similar scrutiny should ac-crue to other Medicare service lines that are now growing at a faster rate.

“Like any tool … like any technology … like any discipline, how good imaging is — how useful it is — really depends upon how it is utilized. I think there are some appropriate areas where we can reduce in-judicious use of imaging, but,” he stressed, “we should not be throwing the baby out with the bathwater in the process.”

The medical discipline has already taken a number of fi nancial hits. The Defi cit Reduction Act of 2005 signifi cantly decreased fi nancial reimbursement for di-agnostic imaging. Sequestration, bundled payments and other changes to reimburse-ment models and formulas also threaten to further erode the fi nancial viability of

the fi eld. In this most recent research, the study’s authors wrote, “A failure to un-derstand changes in utilization that may accompany these potential payment re-ductions could ultimately produce adverse effects on patient care regardless of whether the intended cost containment goals are re-alized.”

Duszak pointed out the fi eld of radiol-ogy has seen incredible technological and diagnostic advancements that have helped physicians accurately pinpoint health issues and improve outcomes. He said the down-stream effect must also be considered when determining appropriate imaging utiliza-tion levels.

He said looking solely at the front-end savings is a bit like only watching the fi rst part of a movie without regard to how the story ends. “The hero did great. He saved money … but what happens in the next scene? Did that money really get saved, or are there other unforeseen costs as a result of the hero’s actions in scene one?” Duszak questioned.

It’s a topic Duszak explored in a brief he authored for the Neiman Health Policy Institute last fall. “Lawmakers, regulators and medical professionals are making med-ical imaging policy decisions without fully understanding or examining their down-stream effects, which may include an in-crease in hospital stays, associated costs and other adverse events,” he wrote. “We need to examine imaging, as it relates to a pa-tient’s overall continuum of care, to ensure that decision-makers don’t create imaging

cost reduction policies which paradoxically raise overall costs, create barriers to care and ultimately harm patients.”

Getting a better handle on the bearing imaging has on the overall cost of care is an area where Duszak said more research is critically needed. What impact does im-aging play in catching cancers early when treatment is most effective? Did skipping a diagnostic study result in a patient staying extra days in the hospital while providers

tried to determine the source of illness? “We need more research in this space to answer these questions defi nitively,” he said.

Ultimately, Duszak said, everyone’s goals should align — fi nd out where imag-ing is most benefi cial and push for more of it … determine where it isn’t as helpful and push for less. “We need to continue a so-phisticated analysis to determine appropri-ate usage,” he concluded.

Medical Imaging Utilization, continued from page 1

medical information is against the Hippo-cratic oath.”

Kozlowski’s passion for her patients is obvious, and her expertise in breast imag-ing has proven valuable in getting the bill passed. With 32 years of breast imaging experience, her practice, the Knoxville Comprehensive Breast Center, was the fi rst breast imaging center in Knoxville, opened in May 1983, and she introduced fi lm screen mammography to the area when others were using older techniques that re-quired a higher dose of radiation. But for Kozlowski, her victory simply boils down to one thing: “Women need to be told they have dense breasts and know what they can do to help themselves to make sure they are well evaluated,” she said. “Early detection is critical.”

Go to www.areyoudense.org for cur-rent information about the law and the states that have already passed the law.

Knoxville Physician, continued from page 3

Five facts about dense breast tissue

Breast density is a well-established predictor of breast cancer risk.

95% of women do not know their breast density.

Breast density is a greater risk factor than having two fi rst degree relatives with breast cancer.

Less than one in 10 women learn about their dense breast tissue from their doctors.

Additional screening tests to mammography for women with dense breast tissue will increase detection by up to 100%. (From areyoudense.org)

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By LEIGH ANNE W. HOOVER

Last month, we ventured over the mountains to rediscover Biltmore Estate and “deck the halls” for the holidays. As my husband, Brad, and I discovered, Biltmore has grown to encompass so much. There’s something new every time you visit, and one column just did not do it justice. So, for December, we are going to take another look at this historic jewel.

If you are looking for a way to expe-rience the beauty and essence of the holi-days, make the trip over to Asheville, North Carolina, and visit Biltmore. Just as George Vanderbilt welcomed visitors to his exqui-site home on Christmas Eve, you, too, can glimpse how it might have felt.

“Our mission is preservation of the es-tate,” explained Biltmore Public Relations Manager Marissa Jamison “Everything that we do is meant to preserve the estate’s legacy and to showcase it to our guests as the Vanderbilts would have intended.”

Because George Vanderbilt selected Christmas as the season to debut his new home to friends and family, the season has remained very special. One holiday high-light is the Candlelight Christmas Evening Tours, which are offered through Decem-ber 31st.

Although Biltmore House did have electricity and was considered technologi-cally advanced, candles were still some-times used.

“While George Vanderbilt himself preferred newly fashionable electric lights, we do know from our records that his mother, Louisa, sometimes insisted on hav-ing real candles on the Christmas trees,” said Jamison. “So, we have taken inspi-ration from that story in our decorations throughout the house during our candle-light tours.”

Local choirs, small musical ensembles and soloists stationed throughout the home, bring the sounds of the season to life.

“We celebrate the Christmas season at Biltmore in a way that is very unique to the house, rooted in tradition and in the way that this family would have entertained their guests for the holidays,” said Jamison.

Although audio for Biltmore tours has recently been updated and is definitely worth the add-on cost to your admission ticket, this feature is not available during the candlelight tours.

The minute guests arrive, luminaries are lining the driveway, and the majestic 55-foot Norway spruce is bedecked in Christ-mas lights to welcome visitors to “America’s largest private home.” With dimly lit light-ing, fires burning in the fireplaces, candles, music, and the wafting smells of evergreen, it’s a very special ambience for the season’s self- guided evening tours.

“It’s a peaceful and different way to see the house that leaves you in the holi-day spirit,” added Jamison. “Guests come to see décor like outdoor luminary displays, Christmas trees of grand proportions and for Gilded Age grandeur inside the house.”

Since the Biltmore Winery and Antler Hill Village are also included in your ad-mission to the estate, my recommendation would be to enjoy this area first on the eve-ning of a candlelight tour visit. Check the winery hours because it closes before Bilt-more House. You will want to enjoy a wine tasting and possibly make an advanced, early dinner reservation at either Cedric’s Tavern, known for its estate brewed ales, or the Bistro, which has a French influence, and reservations are strongly encouraged.

Deerpark Restaurant or the, lunch-only, Stable Cafe are a couple of other din-ing possibilities on the estate. And there is also a fine dining restaurant located in the Inn at Biltmore.

The Biltmore Winery opened in 1985, and it is touted as the most visited winery in the country. Award-winning wines are produced annually, and each year, there is always a special Biltmore Christmas wine.

When we visited the tasting room, Jeff Rayl explained that this year’s Christmas wine is the perfect complement to a holi-day dinner. With a light golden color and a rose petal, lychee, and honeysuckle nose, the taste is a perfect balance of sweetness and acidity with a hint of apricot, citrus, and spice. As always, it’s sure to compli-

ment any holiday dinner.“Our wine makers blend a commemo-

rative wine every year for our Christmas wine,” explained Jamison. “It’s usu-ally a sweet or semi-sweet wine, which tends to pair well with the rich holiday offerings.”

Beautifully packaged with a unique, festive label, the Bilt-more Christmas wine has even become collectible. This year’s label design contest winner is Perry Winkler, an artist from DuBois, Pennsylvania.

According to Jamison, the Biltmore portfolio of wines typically includes around 40 different wines.

“Because of the vol-ume of people that we see come through the winery, we are often accommodating people for their first visit to a winery all the way up to afi-cionados…, and we are unique in this way. So, we have designed our portfolio to really offer something for everyone,” said Jamison.

Since it can be difficult to grow grapes in the North Carolina climate, Biltmore

does source grapes from other regions like California to maintain the high volume with the best quality grapes. However, some wines are made with North Carolina grapes, and chardonnay is a grape that grows very well on the estate.

“We buy more grapes from North Carolina vineyards than any other winery in the state,” explained Jamison. “We have a lot of partnerships with other vineyards in the state, and we also supply research and help with grape growing technologies in the state.”

Visitors can purchase wine to “take a taste of Biltmore home” or find selections in nearly 30 states throughout the country.

Before leaving Antler Hill Village, be sure to also visit the recently opened ex-hibit about the Biltmore legacy titled “The

Vanderbilts at Home and Abroad.” “The ‘Legacy’ exhibit is a

deep-dive behind the history of the Vanderbilts and gives you more

of that personal story,” explained Jamison. “With this exhibit, you get

to go into deeper detail about spe-cific aspects of their lives like George

Vanderbilt’s travels that inspired his collections.”

Come early enough to also enjoy the infamous gardens, greenhouses and so

much more at Biltmore this holiday sea-son. To plan your trip visit www.biltmore.com, and for additional information about the Biltmore Winery, go directly to http://www.biltmore.com/wine/visit-the-winery.

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.

Enjoying East TennesseeBiltmore Estate - Candlelight Tours, Winery and Antler Hill Village

8 > DECEMBER 2013 e a s t t n m e d i c a l n e w s . c o m

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.

on claims that are for stays of less than “two midnights” after admission and have of-fered feedback and education to providers about compliance and missteps. During this period, the Recovery Audit Contractors (RACs) have not conducted medical neces-sity reviews. At year’s end, CMS has said it will assess the findings to see if additional guidance is needed.

Brian Contos, executive director over-seeing the clinical research and insights pro-grams at The Advisory Board Company, recently spoke with Medical News to shed a little light on the confusing and contro-versial rule.

The Backstory“There are probably two storylines be-

hind why they have implemented the two-midnight rule,” Contos said of CMS. “On the one hand, they’re instituting this policy to address concerns surrounding extended observation stays.” He continued, “I think the other reason is the simple fact that there are a tremendous number of very short stay inpatient admissions.”

Looking to the first motivating factor, Contos said, “Between 2006 and 2011, there was a dramatic increase in observa-tion stays … a 65 percent increase.” In addi-tion, he continued, there was a 176 percent increase for those kept in observation for an extended period — 48 hours or longer. As for the second issue, Contos said, “Of the roughly 15 million Medicare admissions in 2012, about 2 million of those were admit-ted with a one-day stay.”

Since the cost to Medicare is far greater under Part A than under Part B (outpatient or observation status), the federal payer has a vested interest in how patients are classi-fied, but CMS made it clear the goal is nei-ther to keep patients in observation limbo when inpatient admission is warranted nor to pay Part A rates when services could be rendered in a more cost effective manner.

Contos said, “From CMS’ perspec-tive, there’s a yin and yang here … we don’t want a really long observation period nor do we want to pay for these really short in-patient stays.” He said it’s all about finding

equilibrium.Going forward, one-night inpatient

stays will probably serve as a red flag for auditors to dig deeper to ascertain whether Part A reimbursement was appropriate. While two midnights is the benchmark for inpatient status, there certainly are excep-tions. First and foremost, any procedure that appears on the inpatient-only list is ex-empt from the rule. Second, there are other conceivable situations where a patient could have reasonably been expected to meet the benchmark but only stayed one night, in-cluding self-discharge against medical ad-vice, death, or transfer. However, Cantos stressed the documentation must clearly show that the physician admitted the indi-vidual to inpatient status with an anticipa-tion that the patient’s condition warranted a stay of at least two midnights.

In addition to the marked increase in observation cases, Cantos said the issue of post-acute care was another catalyst for the rule. For Medicare to pick up the tab for a stay in a skilled nursing facility or rehab unit, a patient has to stay in the acute care facility for three days, and observation days don’t count. Pressure has been mount-ing on CMS … both by patient advocacy groups and through legal challenges … to ‘do something.’ A report based on Medi-care data from 2012 and released this July by the Office of Inspector General found there were more than 600,000 hospital stays last year that lasted at least three nights but didn’t qualify for inpatient payment … which means those stays would not have satisfied the three-day rule if needed.

Contos noted, “I would say the three-day rule is universally hated. Hospitals and advocacy groups want time in observation to count if a patient ultimately is admitted.” While CMS did not opt for that route, the two-midnight rule could be seen as a step toward ensuring a more timely determina-tion of whether or not a patient should be admitted.

The Problem for Hospitals“It’s a judgment call at the end of the

day,” Contos said of whether or not a physi-

cian admits a patient. Therein lies part of the problem for

hospitals … the two-midnight rule is specific in that it is a judgment call and simultane-ously very loose because, by its very nature, a judgment has many shades of gray, which could leave the soundness of the decision open to interpretation … perhaps by an auditor.

Although CMS actually expects about 400,000 observation cases to become inpa-tient and 360,000 inpatient cases to move out, many hospitals don’t believe the rule will help the bottom line. First, the inpa-tient payment rate is being adjusted down slightly to achieve budget neutrality. The other concern is that for some hospitals, the number of inpatients gained from extended observation will be considerably less than the number lost from shorter stays, which will negatively impact margins that are al-ready extremely tight.

“I don’t think we can assume what happens in one hospital will happen in all. It will be institution by institution. Every hospital is going to look differently,” Cantos said.

Certain service lines will probably be disproportionately impacted. For example, about one-third of hypertension cases and approximately 40 percent of Medicare chest pain cases result in a one-day admis-sion. Presumably, those patients will wind up as observation patients in the future. Cantos encouraged hospital administrators to work closely with their analytics team to get a better sense of the anticipated effect of the rule on their specific hospital.

Exacerbating the financial concern is the increased out-of-pocket burden on patients. Moving from Part A inpatient to Part B observation status typically means the patient will shoulder more of the costs, adding strain to the collection process and potentially increasing the hospital’s bad debt ratio.

So what is to keep a hospital from skewing the numbers in their favor … keep-ing short stays longer and admitting more observation patients? Cantos said some hos-pitals certainly might opt to roll the dice, but

there are inherent risks in this plan.First, demanding a patient be admit-

ted contrary to a doctor’s medical opinion is never optimal. “Physician judgment should really be held almost sacred,” Cantos said. “There is nothing more disruptive to hospi-tal/physician relationships than for a hospi-tal administrator to tell a physician how to assess or judge a particular patient’s care.”

Cantos continued, “This is something that starts with a physician’s medical judg-ment, and I don’t think most hospitals want to dictatorially stipulate how physicians must practice.”

The second risk is that a hospital could ultimately wind up taking an even bigger hit to the bottom line. Although CMS offers a rebilling process to move claims incorrectly filed as Part A to Part B, hospitals only have one year to do so. By the time an auditor comes in to review inpatient claims, there is a good chance many would be past the one-year mark. In those cases, a claim deemed inappropriate by the auditor wouldn’t be eligible for rebilling. Instead, the hospital would be liable to CMS for the full amount of those claims plus any fines.

Prepping for Post-AmnestyWith the grace period granted by

CMS rapidly coming to an end, Cantos of-fered four observations about steps hospital administrators could take to optimize com-pliance.

First, there should be an emphasis on physician education. “You don’t want to dictate, but you do want to make sure ev-eryone understands the rule and documen-tation requirements,” Cantos said.

In the eyes of CMS, he added, ‘admit’ and ‘admit to inpatient care’ are different. No one wants to lose out on reimbursement because of incorrect terminology. Hospitals also don’t want to present RAC auditors with widely divergent case documentation. “As a hospital, you do want to try to estab-lish some norms here so it’s not a total crap-shoot if audited,” Cantos said. “If you’re all over the map, it becomes really difficult to right-size your program.”

The second recommendation is for hospitals to look at the processes in place to assess and reassess observation cases. “There’s a timing element,” Cantos pointed out. While it’s critically important to docu-ment how, when and why a decision was made to admit to inpatient status, it’s also important to expedite that process. “It’s something every hospital is going to have to push on — timely decision-making,” he said.

Cantos said hospitals also should re-view their internal auditing process. “Like-wise, you want to develop a self-review process to identify cases that were inappro-priately admitted so you can rebill under Part B within the one-year filing window,” he noted.

The fourth item is to make sure that in addition to educating staff about the two-midnight rule, hospitals also remember to explain it to patients. “It’s very important the patients understand that just being in a bed in a hospital doesn’t mean you are ad-mitted. Patients pay more out-of-pocket for Part B so they must understand the nuances about payment for inpatient and observa-tion,” Cantos stated.

Two-Night Minimum, continued from page 1

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

DysphagiaBy Clarisa E. CuEvas, MD

Dysphagia is defined as difficulty in swallowing. It is a symptom that can be due to a defect in the mouth, oropharynx, or esophagus. It can also be the result of a motor disorder or mechanical obstruction.

To determine the area of defect, we must evaluate all stages of swallowing. It all begins with suckling. The lips must be able to form a tight seal as the tongue is displaced posteriorly. The glottis closes to guard the airway, and the soft palate rises to close the nasopharynx as the cricopharyngeal muscles relax. The food then passes to the back of the pharynx. Solids require coordinated actions requiring appropriate jaw movements and teeth alignment. Salivary secretions lubricate the food as it passes through the mouth into the pharynx and then the esophagus.

Abnormalities in any phase can interrupt successful swallowing. It is abnormalities of the muscles involved in the ingestion process, their innervations, strength or coordination causing intermittent dysphagia in infants and children. Cerebral palsy, Arnold-Chiari malformation, myelomeningocele, congenial myotonic dystrophy, and other myopathies, as well as cricopharyngeal achalasis, can present as dysphagia.

Esophageal disease is a common cause of swallow dysfunction. Sudden dysphagia in the younger child should be evaluated immediately and a foreign body should be ruled out. Eosinophilic esophagitis often presents as a swallow dysfunction and feeding refusal with or without chocking. Candida pharyngitis or esophagitis can cause difficulty in swallowing. Gastroesophagel reflux with esophagitis or ulcerations can result in chocking and difficulty with both liquid and solid bolus. Idiopathic achalasia often presents with difficulty in swallowing liquids and solids. A history of tacheoesophageal atresia or fistulae suggests stricture formation and a motility problem.

The clinical presentation varies. In the younger child, it often presents with respiratory signs and symptoms combined with feeding refusal. The older child can have fits of coughing, nighttime drooling, and refusal of their favorite foods. A chocking

episode with food bezoar impaction is the most common presentation in the adolescent patient.

Careful examination of oral, pharyngeal, laryngeal, and esophageal anatomy and function are important during the evaluation of children with dysphagia. Three basic approaches are utilized:

Radiographic studies: (a) upper gastrointestinal series will help identify anatomic or structural abnormalities such as strictures, vascular anomalies of the esophagus, fistulae and masses. Images of the coordination of movement of bolus through the oropharynx and esophagus can help identify motility dysfunction, chalasia or achalasia; (b) modified barium swallow with a speech or occupational therapist can identify oropharyngeal dysfunction.

Direct visualization with a fiberoptic endoscope will help in both the identification of the problem and in removal of a bezoar, foreign body, or therapeutics with botulin toxin or pneumatic dilation for achalasia.

Motility studies are indicated for the evaluation of esophageal peristalsis. A 24- hour study can help when GERD is suspected.

The therapeutic modalities vary depending on the cause for the dysphagia. At our GI for Kids clinic, we coordinate care with speech therapy and occupational therapy in the case of oropharyngeal problems. Recommendations for treatment of both achalasia (Botox/dilatations) and chalasia (H2 antagonist/PPIs) are given. Treatment and follow-up are provided so as to prevent recurrence of the problem particularly in the case of Eosinophilic esophagitis. Inhalers, PPIs, and esophageal dilation are needed throughout the year. While dysphagia requires a complex evaluation, in most cases we have complete resolution of the medical problem.

GiforKids, PLLC is a pediatric gastroenterology specialty clinic located at East Tennessee Children’s Hospital staffed with dedicated providers offering comprehensive care to patients and their families.

Clarisa E. Cuevas, MD, is a board-certified pediatric gastroenterologist with GI for Kids, PLLC, in Knoxville, Tenn.

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Virus Hunt: The Search for the Origin of HIVby Dorothy H. Crawford; c.2013, Oxford University Press; $27.95 U.S. and Canada, 244 pages

In the new book

Virus Hunt by Dorothy H. Crawford, you’ll see how scientists discovered the roots of HIV.

In 1981, doctors in California be-gan noticing “rare infections… and an unusually aggressive tumor” in certain patients. Soon, the same was reported in New York , Florida , and elsewhere around the country. By 1982, the disease was called AIDS.

The risk of catching AIDS seemed at first to be limited to sexually-active gay men, particularly those with multiple partners. Within weeks, heroin users and hemophiliacs were added to the at-risk group, then doctors discovered that in-fected mothers could pass it to their chil-dren. “Fear of AIDS” became “a disease in its own right.”

By 1984, the “causative virus was identified [as human immunodeficiency virus]… and shortly thereafter the ge-nome was sequenced…”

But where did HIV come from?Soon after the first description of

AIDS was released in 1981, Boston re-searchers noticed that their captive macaque population was affected with something that sounded similar. Four years later, scientists at that research fa-cility isolated a simian immunodeficiency virus (SIV) which had spread and mutated as animals were “unwittingly” shipped around to other facilities.

That led to the discovery that some SIVs are “closely related” to certain strains of HIV and share “between 62 and 87 percent” of their genetic sequences. It didn’t take much to see how the virus mutated, or how it leaped from animal to human, possibly via Africa’s sooty mang-abey monkeys (a “natural host of the vi-rus”), which were sometimes hunted for food.

But the question of where HIV came from needs to go back even further than 1981. A man from Memphis was report-ed with what doctors would consider to be typical AIDS symptoms in 1952. SIVs were discovered in Icelandic sheep in 1949. Scientists, in fact, believe that SIVs are “ancient parasites” and that HIV has been “circulating in the African popula-tion since near the start of the 20th cen-tury.”

At the beginning of this book, au-thor Dorothy H. Crawford indicates that the search for the beginnings of HIV is somewhat like a mystery. She’s absolute-ly correct. It is, but you need a Sherlock-ian PhD to understand it all.

That’s not to say that Virus Hunt is a bad book – that’s not the case at all. What readers will want to know, howev-er, is that it’s very academic and heavily steeped in genetics, epidemiology, and laboratory-level research. That’s great for anyone employed in those fields. For the layperson, this mystery’s not unreadable but it’s as far from relaxing entertainment as you’ll ever get.

Death, American Styleby Lawrence R. Samuel; c.2013, Rowman & Littlefield; $40.00 / $44.50 Canada, 189 pages

Does your death frighten you, or are you intrigued? Curious or repelled? Your attitude may come from the outlook surrounding you, as you’ll see in Death, American Style by Lawrence R. Samuel.

In the years immediately following World War I, Americans were reeling. Not only was there a “sheer volume of people” dead from battle, but the 1918 influenza epidemic also claimed many victims. Americans thought hard about death and reached for spiritualists, who purported to communicate with the newly deceased.

By the 1930s, researchers had an inkling that maybe death wasn’t “neces-sary.” Alas, according to one nurse of the era, people continued to expire and they all “died the same, more or less…”

In the years prior to World War II, although there were marked increases in death by automobile and by home ac-cidents, dying was “a relatively normal, even innocent affair.” During the war, however, parents suddenly realized that they’d “better be prepared to explain death to their children.” Death on “such a massive scale… was itself frightening and potentially scarring to children.”

Post-war modern medicine benefit-ted by the increasing acceptance of au-topsies, the advancement of medical pro-cedures and medicines, and the growing notion that death could be reversed. The timing was fortuitous, at least for research studies: more people died in hospitals than at home in the 1950s.

For some, though, being surround-ed by machines didn’t sound like a good way to go, so the notion of natural death began to take hold in the mid-1960s.

And yet, we just can’t get over our squeamishness: death has been, alter-nately through the past four decades, a taboo subject, a class subject, reason for “deeply philosophical examination,” and “a principal theme in American pop culture.” Today, we’re able to cautiously discuss death, though many “continue to resist their mortality.”

In his introduction, author Lawrence R. Samuel indicates that his intention with this book was not to look at the death industry, but rather at the attitude Americans have towards death itself.

He accomplishes that in Death, American Style… just not all that well.

Perhaps it’s the length of this book: the “cultural history of dying” is a vast subject; much bigger than the small page count allows here, which leads to an irritating lack of depth. It doesn’t help that Samuel’s first chapter sometimes reads like an overgeneralized synopsis of a dime-store novel, or that some subjects seemed to be brushed aside or are to-tally missing in the narrative.

To the good, there are nuggets of fascination in this book, but they’re pret-ty scattered and might not be enough to satisfy a truly curious mind.

theLiteraryExaminerBY TERRI SCHLICHENMEYER

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

10 > DECEMBER 2013 e a s t t n m e d i c a l n e w s . c o m

(CONTINUED ON PAGE 15)

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GrandRounds

Alexander Joins University Surgeons Associates

KNOXVILLE - University Surgeons As-sociates is pleased to welcome Dr. Mariah Alexander to their medi-cal staff. She completed medical school at the Uni-versity of Alabama School of Medicine in 2007 and completed her residency in general surgery at the Uni-versity of Tennessee Medi-cal Center in Knoxville in 2012. Her experience includes minimally invasive techniques for general, endo-crine, and bariatric surgery. Comments Dr. Alexander, “I have co-authored two book chapters on laparoscopic hernia repair, and I am very excited about Uni-versity Surgeons Associates’ new Hernia Center.”

Parkridge Medical Center Inc. Earns “Top Performer on Key Quality Measures®” Recognition from The Joint Commission

CHATTANOOGA – Parkridge Medi-cal Center Inc. today was recognized as a Top Performer on Key Quality Measures® by The Joint Commission, the leading ac-creditor of health care organizations in America.

The hospital system earned top rat-ings from the Joint Commission for a demonstrated commitment to achieving positive patient outcomes using evidence-based treatment. Parkridge received the Top Performer distinction for heart attack, heart failure, pneumonia, surgical care, and inpatient psychiatric care. The ratings are based on an aggregation of account-ability measure data reported to The Joint Commission during

In addition to being included in the release of The Joint Commission’s “Im-proving America’s Hospitals” annual re-port, Parkridge Medical Center Inc. will be recognized on The Joint Commission’s Quality Check website (www.qualitycheck.org). The Top Performer program will be featured in the December issues of The Joint Commission Perspectives and The Source.

BlueCare Tennessee Medical Director Donates Award Money to Fund Mental Health First Aid Training

CHATTANOOGA – BlueCare Ten-nessee has announced that its Behavioral Health Medical Director, Dr. Kelly Askins, has donated his award for winning second place in the 2013 National Council for Be-havioral Health’s Welcome Back Award in Psychiatry to the Tennessee Mental Health Consumers’ Association. The money will be used to help fund Mental Health First Aid training programs offered through the organization.

Mental Health First Aid is a ground-breaking public education certification course that helps participants identify, un-derstand, and respond to signs of mental illnesses and substance use disorders.

The National Council chose Dr. Askins from a national field of psychiatrists primarily due to his work contributing to the Recovery Care Management (RCM) model of clinical intervention that utilizes a team approach to behavioral health

treatment. The non-profit organization established the Welcome Back Awards in 1998 with Lilly pharmaceutical company to fight the stigma associated with depres-sion and to promote the understanding that it is a treatable condition.

The National Council has advocated Mental Health First Aid training for hu-man services and social workers; employ-ers; college and university staff; families of people with mental illnesses and ad-dictions; law enforcement; and the gen-eral public. Since 2008, more than 100,000 individuals nationally have received the training.

Charles “Ed” McBride Named Vice President of Clinical Services for Summit Medical Group

KNOXVILLE - Dr. Charles “Ed” Mc-Bride has been promoted to Vice Presi-dent of Clinical Services for Summit Medical Group, the region’s leading pri-mary care organization. McBride is responsible for overseeing quality, patient experience, care coordina-tion, health education and physician engagement. He will also oversee Summit’s Regional Medi-cal Directors, who will act as liaisons with primary care physicians, furthering physi-cian engagement and representing the needs of practice sites.

McBride came to Summit in 2010 as Associate Medical Director of Clinical In-formatics. Since March 2012 he has served as Summit’s Medical Director of Quality and Informatics. Working in collaboration with other departments, McBride success-fully implemented Electronic Health Re-cord (EHR) organization-wide.

Prior to joining Summit, he was a Prin-cipal Physician Leader with Holston Medi-cal Group and a site Medical Director with Floyd Healthcare Management in Geor-gia. He is a board-certified family medi-cine physician, graduating from the Medi-cal University of South Carolina and com-pleting his residency in family medicine at the Carilion Health System in Virginia. McBride recently completed his MBA from the Isenberg School of Management at the University of Massachusetts and is a Certified Physician Executive.

Two Physicians Join Statcare, Summit’s Hospitalist Services Division

KNOXVILLE - Summit Medical Group, the region’s leading primary care organi-zation, welcomes Dr. Amish Patel and Dr. Richard Scott Gallian to Statcare Hospital-ist Services.

Patel is a graduate of the Univer-sity of Alabama, College of Community Health Services where he also completed his residency and internship. He is a mem-ber of the American Academy of Family Physicians. Patel completed research at Vanderbilt University in the Department of Cardiovascular Medicine.

Gallian is a graduate of Louisiana State University in Shreveport. He is board-certified in internal medicine and is a mem-ber of the American College of Physicians.

Lattimore Black Morgan & Cain Young Professionals’ Program Takes Two Top Honors

KNOXVILLE - Lattimore Black Mor-gan & Cain, PC, is proud to announce that the LBMC Young Professionals’ Pro-gram, dedicated to the professional and personal growth of LBMC young profes-sionals, won the 2013 prestigious Leading Edge Alliance Young Professionals award at the International LEA conference in San Francisco and the Young Profession-als of Knoxville (YPK) first Inaugural Impact Award. This firm has a Young Professional (YP) program to address the needs of pro-fessionals in all its offices who are within their first seven years of their careers.

Getting involved in a nonprofit board helps the YP develop early on their net-working skills in a low pressure environ-ment. Many times, there is a wide range of people involved on these boards, so it is also a wonderful networking opportunity as they get to know people in the commu-nity. Some of the various non-profit board placements throughout the State of Ten-nessee include:

• Mental Health Associate of Middle TN – Education/Program Committee Member

• Nurses for Newborns of TN – Board Member

• Juvenile Diabetes Research Foun-dation – Board Member

• Books from Birth of Middle TN (Vanderbilt Children’s Hospital) – Board Member

• Dream Catchers of TN – Board Member

• Girls on the Run – Vice Treasurer • Mental Health America – Finance

Committee Member • Mental Health America of Middle

TN – Young Ambassador • Project Cure – Board Member

Fort Sanders Regional Attains Highest Recognition for Efforts to Improve Elderly Care

KNOXVILLE – Fort Sanders Regional Medical Center has achieved “Exemplar” status for its NICHE (Nurses Improving Care for Healthsystem Elders) program. NICHE is the premier designation indicat-ing a hospital’s commitment to excellence in the care of patients 65-years-and-older. The “Exemplar” status recognizes Fort Sanders Regional’s ongoing dedication to geriatric care and progressive implemen-tation and quality of system-wide inter-ventions and initiatives that demonstrate organizational commitment to the care of older adults.

The status — the highest of four possible program levels — was assigned following a rigorous self-evaluation of the current state and future goals of the NICHE program at Fort Sanders Regional. The requirements include implementation of the NICHE Geriatric Resource Nurse (GRN) model and evidence-based pro-tocols on all applicable units, including specialty units; implementation of aging-sensitive policies; inclusion of the input of patient, families and community-based providers in planning and implementation of NICHE initiatives; and assuming region-al and national leadership roles.

Dr. Mariah Alexander

Dr. Charles McBride

e a s t t n m e d i c a l n e w s . c o m DECEMBER 2013 > 11

Name: Glenda Beene

Position: Volunteer, Battlefield Imaging and Fuller Cancer Center

At a Glance: Hutcheson Medical Center recently named Glenda Beene as the hospital’s Auxiliary Volunteer of the Month for October. Bonner has volunteered at the hospital’s Battlefield Imaging and Fuller Cancer Center for seven years.

Beene said that helping others gives her the most satisfaction. As a volunteer, Beene does a variety of tasks, including bringing patients back from the lobby, answering the phones, and transporting items to the lab. “When a patient first comes to the Cancer Center, I tour the patients and give them an informational video. I like the relationship that I have with patients, and I enjoy working with the employees. I miss them when I am not here,” shared Beene.

Chareen Humble, Manager of Volunteer Services at Hutcheson, said that Beene is someone upon whom others can always depend. “Glenda always helps out where possible and is a great volunteer. I wish we had 200 more volunteers just like her.”

GrandRounds

(front row from left to right): Chareen Humble, Manager of Hutcheson Volunteer Services; Debby Kelly, Director of Fuller Cancer Center; Glenda Beene, October Volunteer of the Month; Angela Helmes, Administrative Assistant, and Roger Forgey, President and CEO.

MagMutual Launches Patient Safety Institute

ATLANTA – MagMutual Insurance Company, the Southeast’s foremost medi-cal professional liability insurer, today an-nounced the establishment of the Mag-Mutual Patient Safety Institute. Underscor-ing its commitment to improving quality across care delivery settings, MagMutual’s $50 million investment offers physicians a wide range of resources and practical tools that facilitate the adoption of best practices to improve safety and decrease exposure to risk.

The MagMutual Patient Safety Insti-tute will systematically compile a database of information from more than 18,000 phy-sician policyholders and compare those findings with those from other national databases. This data will enable the In-stitute to craft continuing medical educa-tion from evidence-based research and offer MagMutual policyholders access to insights and successes achieved by their peers and leaders in the field of patient safety. The Institute will also assist policy-holders with self-assessments based on root-cause taxonomy.

Future plans for the Institute include a state-of-the-art simulation lab that will model patient safety best practices in an advanced, simulated real-life environ-ment. Completion of the lab is anticipated in 2014.

Mental health foundation welcomes new board members and officers from across East Tennessee

KNOXVILLE - The Helen Ross McNabb Foundation welcomes new board members and officers from across East Tennessee to the foundation’s board of directors.

New Helen Ross Foundation board members include Mrs. Debbie Brown, Raymond James; Mr. Bob Joy, Colgate Palmolive – Retired; Mr. Mark Kroeger, Scripps Network; Mr. Jim Lloyd, CPA, Per-ishing Yoakley & Associates; Ms. Virginia Love, Baker Donelson; Mr. Keith Sanford, First Tennessee

Newly appointed officers are Mr. George Kershaw, Chair, D&K Manage-ment; Ms. Jeannie Dulaney, Chair-Elect, Lattimore Black Morgan & Cain; Mr. Greg Gilbert, Treasurer, Lattimore Black Morgan & Cain; Mrs. Jenny Brock, Secretary; Nick Chase, Past-Chair, Egerton, McAfee, Ar-mistead & Davis

UnitedHealthcare Launches Neighborhood Connections to Help Tennessee’s Most At-Risk Residents Get Healthier

KNOXVILLE – UnitedHealthcare has launched Neighborhood Connection-sTM, a comprehensive health and com-munity service support program for at-risk TennCare members.

As part of the program, UnitedHealth-care will open health assistance centers in Knoxville, Memphis and Nashville and hire 12 care coordinators to support local resi-dents in accessing much-needed health care and community services.

Neighborhood Connections is a per-sonalized health support program to help people who are most at-risk for serious health complications. The model of care involves a “feet on the street” approach

through Connections Coordinators who visit members at their homes to help get them the health treatments and commu-nity resources they need to live healthier lives. People eligible for Medicaid in Ten-nessee who have unmanaged chronic or complex health conditions – as deter-mined by multiple gaps in care, frequent emergency room visits and other health indicators – are eligible to participate in this unique one-on-one support program.

Connections Coordinators come di-rectly from local neighborhoods to bring a greater level of understanding of the communities and the unique issues their residents might have. They work closely with UnitedHealthcare’s physical and behavioral health providers, including members’ physicians and community care organizations to identify people who are at-risk, may not have permanent housing, or have unmanaged chronic or complex conditions.

Coordinators will work with members to set health and self-management goals, and create health, emotional and social support plans. They will follow up with regular visits to address any challenges and offer support and advocacy while em-powering members to continue on their path to better health.

Unlike traditional case management programs, this clinical care model takes a “whole person” approach to care, as-sessing all aspects of each individual’s life – including current health status, religious and cultural beliefs, living conditions, be-havioral health concerns, and financial status – to create unique care and support plans.

One of the goals of Neighborhood Connections is to remove barriers that of-ten prevent people from getting needed care.

Hope is close to home.

www.msha.com/cancer

We know you want the best cancer care as close to home as possible. That’s why Mountain States Cancer Care is here for you with locations throughout Northeast Tennessee and Southwest Virginia. However, if you need a more advanced level of care that is not available at your community hospital, that’s no problem. Advanced cancer care services are available through our cancer care network. Our physicians at Mountain States Medical Group will make sure you get the care you need at the most convenient location possible.

No matter where you are in your fight against cancer – whether you’ve been recently diagnosed, are recovering from surgery, in the middle of radiation treatment or five years out – we are here for you and your cancer care needs.

Our Cancer Care Network:• Indian Path Medical Center• Johnson City Medical Center• Johnston Memorial Hospital• Smyth County Community Hospital• Sycamore Shoals Hospital

Hope is close to home.

www.msha.com/cancer

We know you want the best cancer care as close to home as possible. That’s why Mountain States Cancer Care is here for you with locations throughout Northeast Tennessee and Southwest Virginia. However, if you need a more advanced level of care that is not available at your community hospital, that’s no problem. Advanced cancer care services are available through our cancer care network. Our physicians at Mountain States Medical Group will make sure you get the care you need at the most convenient location possible.

No matter where you are in your fight against cancer – whether you’ve been recently diagnosed, are recovering from surgery, in the middle of radiation treatment or five years out – we are here for you and your cancer care needs.

Our Cancer Care Network:• Indian Path Medical Center• Johnson City Medical Center• Johnston Memorial Hospital• Smyth County Community Hospital• Sycamore Shoals Hospital