East TN Medical News Sept 2013

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Dr. Homero Rivas II

PAGE 3

PHYSICIAN SPOTLIGHT

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HEALTHCARE LEADER: Alex StockdaleFor Alex Stockdale, a career in healthcare has meant focusing on the small things, but also being able to look at a much, much bigger picture ... 4

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

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

Special Advertising Patient Centered Practices ... 13

FOCUS TOPICS ONCOLOGY TRANSPARENCY

Jolie Sparks National BRCA1 ConversationWellmont certifi ed genetic counselor provides answers

By StACy FENtRESS

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

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

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

(CONTINUED ON PAGE 14)

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

FOCUS ON ONCOLOGY

SPONSORED BY WELLMONT

HEALTH SYSTEM

By CINDy SANDERS

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

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

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

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


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

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

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

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PhysicianSpotlight

By JENNIFER CULP

Dr. Homero Rivas II has a deep apprecia-tion for the importance of spinal health and pain management. At age 19, Rivas—who was extraordinarily physically active in his youth, participating in sports ranging from soccer to windsurfing to mountain climb-ing—suffered a terrible accident that could have killed him. Instead, it set him on a new course in life.

Intending to study aerospace engi-neering and become a Naval pilot, Rivas attended the Naval Academy after gradu-ating from high school. “Unfortunately, in my second year at the Academy, I had a very serious accident where I fell about four floors and spent August 26 of 1990 to July 3 of 1991 in the hospital,” he summarized the incident succinctly.

On late-night weekend security watch, Rivas fell through the space in the middle of a winding stairwell to land in a concrete basement. He woke up in an intensive care unit in Baltimore on the following Monday morning with no memory of the accident. He suffered dreadful injuries, including—among others—a shattered pelvis, fractured vertebrae, a broken left hip and broken right ribs, dislocated right shoulder, and fractured right wrist. Due to osteomyelitis resulting from infection of the screws placed in his left hip, surgeons eventually fused the hip, rather than attempt to perform a hip replacement. Rivas was discharged from the Navy due to the severity of his injuries,

and the recovery process was long and difficult.

“I had to use a cane just to get around up until probably the fall of ‘93. It took a good solid three years after that to get back to normal—well, as normal as you can be,” he explained. “Unfortunately, the first fracture of L4 dam-aged the spinal cord, so there was damage to

the nerves going to the bowel and bladder, as well as the right leg. I still have a lot of residual weakness in the right leg and a lot of atrophy because of that nerve damage, along with some minor nerve damage to the bowel and bladder.”

Fused vertebrae also affected his move-ment. In 1992, the hip fusion had to be redone, putting Rivas back in a body cast for another three months of that year and delaying his return to college, and normal life, still further.

In spite of his numerous injuries and grueling years of rehabilitation, Rivas didn’t let the accident keep him down. “I remem-ber telling myself, ‘If I never set foot in a hospital again for the rest of my life, I’ll be happy,’” he said.

Starting over, he went back to college and earned a degree in Mechanical Engi-neering from the University of Texas in Austin, Texas. Researching the design of hip implants gave him a better understand-

ing of their shortcomings and the reasons his treatment team chose fusion as the best option in his own case, leading to his in-terest in attending medical school, with a particular focus on physical medicine and rehabilitation. The accident also indirectly led to another of Rivas’ enduring interests: scuba diving.

“At that time, I was still getting around with a cane. I was looking for something I could do to be active that would take some weight off of my back and my hip, and div-ing was sort of a natural thing to try,” he said. Nearly 20 years and many more dive certifications later, he still takes trips to dive with some of the friends he made while earn-ing his initial open water dive certification.

Rivas’ expertise in non-surgical spine care and scuba diving both come into play in his brand-new practice, Chattanooga Spine & Body. The practice approaches the treatment of back pain, neck pain, and re-lated spinal conditions through conservative management, utilizing physical therapy, medication, and injections, and also offers non-surgical treatments for musculoskeletal pain. A member of the Referral Physician Network for the Divers Alert Network with recognized training in hyperbaric medicine and diving medicine, Rivas also offers pre-dive physical examinations for those who need clearance prior to taking a SCUBA class or diving.

Chattanooga Spine & Body is a cash-only practice, which Rivas believes will allow freedom to provide the best possible treatment options for patients, while keep-

ing prices fair and affordable. Over the course of his career, Rivas became frus-trated over past experiences in which pa-tients were denied coverage for beneficial treatments by their insurers and suffered reduced quality of life as a result. Rather than relying on insurance companies to determine which treatments are medically necessary or have resulted in sufficient im-provement to warrant further treatment, the cash-only model allows the physician and patient to determine the appropriate course of action for each patient’s individual circumstances.

Outside of work, Rivas stays very ac-tive. He most often dives in caves, rather than open water, visiting the Florida Pan-handle and north central Florida to cave dive. After years of cave diving, he devel-oped an interest in dry caving, leading him to spend a good deal of time in one cave or another. This led to further interests in photography and videography. “People al-ways ask me, ‘Why do you dive? Why do you cave? Why do you cave dive?’” he said, “so now I can show them photographs or video to show them what I see underwater, or underground, to see why I do it.” Inter-ested parties might get the chance to hear Rivas, too; he is also a didgeridoo player with over 10 years experience, and even plays in caves!

Rivas refused to allow tragedy and physical injury to limit the scope of his life, and in his work at Chattanooga Spine & Body, he hopes to help others overcome pain in order to live their lives to the fullest.

Dr. Homero Rivas II

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HealthcareLeader

Broader perspectiveHealthcare exec helps practices analyze, improve operations

By JOE MORRIS

For Alex Stockdale, a career in healthcare has meant focusing on the small things, but also being able to look at a much, much big-ger picture.

As the owner of Next Level Strategy Solutions, based out of Knoxville and Charlotte, NC, Stockdale works with healthcare providers, pharmaceutical compa-nies, and other healthcare-related entities to help them fi nd effective administrative solutions for their practices, as well as navigate tech-nology upgrades and the many other components of the Affordable Care Act.

But as a longtime administra-tor for medical groups, he also has years of experience working within just one organization on the minu-tiae that can mean the difference between a successful practice and one that struggles no matter how healthy its patient volume.

“With my own company, I help them with the day-to-day operations sometimes, but also with much larger strategic deci-sions, such as hiring a COO,” Stockdale said. “My role is to guide them through any area where they are having issues, or might need some outside perspective.”Becoming a healthcare-business expert wasn’t on his radar when he got a market-ing degree from the University of Tennes-see, but through some social connections, he found himself working for an Oak Ridge-based physician who had just got-ten into the then-new ultrasound technol-

ogy in a big way, and needed some help promoting its various attributes.

“This was a technology that was just as good for a veinogram or arterio-gram, and it didn’t involve the invasive procedures and the risk,” Stockdale re-called. “He had the machine, which had cost several hundred thousand dol-lars, and didn’t really have much be-yond that. A friend connected us, and I worked with him to create a marketing plan and other details for what was then a new entity, the diagnostic center.”Stockdale eventually returned to school at Tennessee Tech for a Master’s degree in fi nance, but also helped his initial client

build a vascular surgery practice. Once that was up and running, he opted to tie into a small group of specialty ophthalmologists and help build another enterprise from its starting point.

“Over time, we grew that group from about 12 people to more than 200, and at the time, they were the largest retina group in the country,” he said. “But when I left them, I had really been think-ing about becoming my own boss, and taking what I’d been doing and building my own company around it.”

His goal, both then and now, is to allow physicians to separate their practices into two tracks: patient focus and business side. By doing so, they can give each the time and attention it needs to make the whole operation run successfully, Stock-dale said.

“They often are at cross pur-poses; if they do the business part cor-rectly, they sometimes will let the patient side get behind, and if they are only pa-tient focused, and doing all the right things there, it’s easy to let the business side get behind,” he said. “The two really work hand in hand, and when everything gets the proper attention, they will have a suc-cessful business and also be doing a better job helping patients. It’s really a lot like engineering, when the job is to fi gure out the best way to get a desired outcome.”Decisions that must be made can include how to approach the market, which means everything from fi guring out the geographic area to be served all the way

down to specifi c products and services, as well as plans for potential growth.

“If they are making decisions that benefi t the patients, the fi nancial side will usually take care of itself,” Stockdale said. “But a lot of times, I am able to bring in some knowledge of best practices that they may not have. I can take a snapshot of the company, then look at the industry’s best practices, and fi nally compare the two. Quickly, we can see that some areas need more attention than others.”

He also makes sure to listen to the physicians involved, as they will have specifi c ideas about what they want to ac-complish, and some very clear priorities in that regard. Those also will drive the prac-tice, and must be folded into any forward-thinking business plan.

It all sounds fairly straightforward, but in a healthcare climate that’s chang-ing daily, and with multiple large-scale un-knowns still looming as the Affordable Care Act is fully deployed in the coming months, the challenges are still fairly robust.

“We’re in an environment of de-creasing fees, so every practice is hav-ing to learn how to do more with less,” Stockdale said. “How do you make your processes more effi cient? Margins are shrinking, there are more governmental regulations and dictates on everything from electronic medical records to privacy issues, but the bottom line is that all this must be handled while doing a better and more effi cient job taking care of patients.”To that end, he says, the goal will be to stay on top of any and all innovations, from technology to drug therapies, in order to keep practices viable.

“I think that the really progressive practices who are tackling these issues now are going to be very well positioned for success in the future. They are implement-ing new technologies, they are shoring up their geographic and physician coverages, and that means they are working through their efficiency challenges. Physicians and practices have proven over the last 20 years that they can work in an environ-ment of declining fees and reforms, and always fi gure out a better way to deliver care. Their outcomes prove that. We’re in another realignment period now, but I am very optimistic about how the smart practices will survive the changes.”

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LegalMatters

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

BY DIANA L. GUSTIN, ESQ.

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

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

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

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

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

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

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

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

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

When does an investigation become a compliance review?

If the investigation indicates there

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

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

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

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

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

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

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

Who should have compliance policies and procedures?

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

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

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

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

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

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

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

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

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

visit www.jcsymphony.com

Opening Night: Tragedy to Triumph

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

Mary B. Martin Auditorium at Seeger Chapel, Milligan College

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

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

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

Jean Sibelius: Symphony No. 2 in D Major, Op. 43EAST TN MEDICAL NEWS


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

2013 THA ANNUAL MEETING

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

Infertility in 2013Infertility is not a rare

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

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

Common CausesThe most common cause of fe-

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

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

Disturbing TrendsSeveral disturbing trends are

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

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

Cost ConsiderationsMost patients are treated at any

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

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

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

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


By LEIGH ANNE W. HOOVER

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

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

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

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

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

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

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

“My mother took pride in the appear-

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Register online at EastTNMedicalNews.com

to receive the new digital edition of Medical News

optimized for your tablet or smartphone!

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


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

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

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

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

The Back StoryChampioned by Sen. Chuck Grassley

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

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

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

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

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

What is a Transfer of Value?

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

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

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

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

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

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

Disputing a ReportSo what happens if your name ap-

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

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

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

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

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

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

TimelineData accumulation for 2013 has al-

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

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

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

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

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

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

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

12 Key Exemptions to the Reporting Rule

Certifi ed and accredited CME.

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

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

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

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

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

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

Discounts including rebates.

In kind items for use in providing charity care.

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

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

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

Tom Baker

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

Dr. John Dreyzehner

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

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

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

Introducing Trilogy – our new power for fi ghting cancer

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

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

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

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

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

Advanced robotic technology with CyberKnife

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

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

• Our radiation oncology technology in Kingsport, Bristol and Norton

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

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

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

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

Strength for today and hope for tomorrow

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

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

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

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

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

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

pit the most comfortable experi

Advanced robottechnology with

radiosual Meddful nayberKn

otic ares to tu

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

hensive scope of services

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

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

technology wCyberKnife

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


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

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

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

Introducing Trilogy – our new power for fi ghting cancer

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

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

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

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

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

Advanced robotic technology with CyberKnife

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

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

• Our radiation oncology technology in Kingsport, Bristol and Norton

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

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

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

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

Strength for today and hope for tomorrow

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

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

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

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

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

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

pit the most comfortable experi

Advanced robottechnology with

radiosual Meddful nayberKn

otic ares to tu

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

hensive scope of services

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

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

technology wCyberKnife

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


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

Healthcare and Transparency

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

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

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

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

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

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

Businesses Using Transparency

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

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

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

Transparency and TrustOne of the cornerstones of Zappos’

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

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

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

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

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

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Cancer care has

long been a service

that hospitals have

provided, but, until recently,

featuring hospital cancer

services was unheard of.

Perhaps an attempt at “if

you don’t see it, it doesn’t

exist,” nationwide, cancer

programs were tucked away

in hospital corners. But

according to Kyle Colvett, MD,

a radiation oncologist and the

Medical Director for Oncology

Services at Mountain States

Health Alliance (MSHA), that

pessimistic attitude toward

cancer care is no longer the case.

Colvett has been working in Oncology

Services at MSHA since 1995. “Over the years

that I’ve been here, our volume has grown

tremendously—about five times the size, but our

current facility opened in 1988, and it was not

designed to accommodate

anywhere near the volume

we have presently,” he

explained. “Our current

facility is not only small,

but it wasn’t designed in

a patient-friendly manner.

It has almost an industrial

feel, with exposed concrete

and no natural light. Besides the fact that our

volumes have grown, we have been frustrated

that we don’t have the best environment for

patient care.”

Over the decades, MSHA’s oncology service

line has improved its technology tremendously,

seeing results that others are seeing nationwide:

cancer is being treated successfully with very few

side effects. Understandably, though, when the

facility doesn’t match the technology or high-

tech workflows, delivering the best cancer care

can be tough.

“Times have changed, though,” Colvett said.

“A new building is being constructed adjacent

to Johnson City Medical Center, the upper level

of which will house new operating rooms, the

lower level, adjacent to our current department,

provides a great opportunity for us to expand

out and add space for oncology. In the process,

we are adding a more pleasant, patient-oriented

environment.”

Some of the patient-centered features of the

new oncology facility include a new, separate

parking lot, dedicated to oncology patients;

a weather-protected entrance; lots of natural

light, as well as two fireplaces; a waiting room

designed with alcoves to respect patient privacy;

and a separate waiting room for children.

“One unique thing about our specialty is

that we take care of everybody, from infants to

people that are 100,” shared Colvett. “Children

have different interests and needs, so the area

has video games and other kid-centric activities,

a different décor, and an entrance to separate

exam rooms.”

Beyond the waiting areas, Colvett pointed

out that new dressing rooms are being added,

designed much like the locker room at a health

club. Each patient can have a locker, adjacent to

a private changing room, with a private entrance

to the treatment area.

Patients and staff are scheduled to begin

using the facility in September, but a full roll

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

expected in 12 to 18 months.

“Budgets are difficult

in our current healthcare

environment, so the Mountain

States Foundation took this

new facility on as a focus of

interest,” said Colvett. “They

have been a tremendous friend

to us.”

Pat Holtsclaw, president

of the Mountain States

Foundation, explained that

although cancer mortality rates

have dropped, the prevalence

rate is higher, making it difficult

for the current facility to serve

the increased volume. “This

new facility will accommodate

patients throughout our service area and will

give us the opportunity to transform the patient

environment for care and

the capacity for care,” she

explained.

“We are in the process

of acquiring new technology

that runs into millions of

dollars, so we are delighted

to have Clarinda Jeanes

serving as Chair of the

Radiation Oncology Capital Campaign and

Dr. Jim Gibson as Honorary Chair to lead this

effort. They have been long-term supporters

of the Foundation and Mountain States Health

Alliance,” added Holtsclaw.

“Very few people have not been touched by

cancer,” Holtsclaw said, “so the new radiation

oncology facility will not only serve the patient’s

needs, but will also make a difference in the

community by improving the area’s cancer care.”

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

All source data for this article has been provided by

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

Patient-Centered Practices

Dr. Kyle Colvett

Pat Holtsclaw


Jenny Harvey

Knoxville MGMA SAVE THE DATE!

Date: Thursday, September 19thLocation: Downtown Marriott,

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

information for the current trends and changes in the industry.

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

Chattanooga MGMA Monthly MeetingDate: 2nd Wednesday of each month

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

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

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

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

3RD THURSDAY 2ND WEDNESDAY

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

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

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

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

Who should have genetic testing?

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

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

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

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

• Personal history of breast cancer at age 50 or younger

• Personal or family history of male breast cancer

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

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

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

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

Getting genetic testingPatients interested in genetic testing

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

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

The actual genetic test requires only a blood sample.

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

Addressing patient concerns about genetic testing

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

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

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

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

Paying for genetic testingAnother concern patients may have

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

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

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

After genetic testing – Being a ‘Previvor’

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

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

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

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

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

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

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

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

Jolie Sparks National BRCA1 Conversation, continued from page 1

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

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

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

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

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

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

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

In Case of Emergency, continued from page 9


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Up: How Positive Outlook Can Transform Our Health and Aging

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

Let’s look on the bright side.

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

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

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

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

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

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

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

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

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

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

theLiteraryExaminerBY TERRI SCHLICHENMEYER

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

The Possibility Dogs

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

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

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

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

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

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

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

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

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

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

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

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


Turkey Creek Medical Center First in Area to Perform Partial Knee Replacement Surgery Offering Lifetime Implant Warranty

KNOXVILLE—Turkey Creek Medi-cal Center, located in Knoxville, became one of the first hospitals in Tennessee to perform a partial knee replacement sur-gery utilizing the Signature™ Personal-ized Patient Care System. The system complements the Oxford® Partial Knee by providing surgeons with a technique to use instrument guides specifically tai-lored to the patient’s anatomy.

Gregory Hoover, MD, orthopedic surgeon, performed the surgery using the Oxford® Partial Knee with Signa-ture™ technology and is the only knee replacement system with a Lifetime Im-plant Replacement Warranty in the Unit-ed States. Biomet, an orthopedics com-pany and manufacturer of the Oxford® Partial Knee, is offering the warranty

With the Signature™ Personalized Patient Care System, surgeons are able to utilize a magnetic resonance imaging (MRI) scan to create a three-dimension-al joint reconstruction. The scans help create personalized femoral and tibial positioning guides for patients, en-abling surgeons to plan a partial knee replacement. They also have access to enhanced detail and precision for im-plant position and alignment before surgery.

Another benefit is that with the Lifetime Implant Replacement War-ranty, Biomet will cover the cost of re-placement implants for patients who received the Oxford® Partial Knee with Signature™ technology on or after September 10, 2012 in the event they require knee revision surgery. Biomet’s warranty specifically covers the cost of the replacement implant.

Parkridge Medical Center Names New Clinical Coordinator for Pelvic Floor Center

CHATTANOOGA– Wendy Hollo-way, RN, has been named the new clini-cal coordinator of the Pelvic Floor Cen-ter at Parkridge Medical Center.

Holloway holds a degree in Nurs-ing from Jacksonville State University. Before coming to Parkridge Medical Center, she worked in the Emergency Department at DeKalb Regional Medi-cal Center in Ft. Payne, Ala.

Patterson Named Executive Director of CONTACT Care Line

OAK RIDGE– CONTACT Care Line, a crisis line that has provided a listen-ing ear to East Tennesseans for 40 years, has named Deborah Patterson as its new executive director.

Patterson is a University of Tennes-see alumna with experience in a variety of social service settings and a master’s degree in business administration. She takes the reins at CONTACT as the Oak Ridge-based organization works to build a Knoxville presence and expand services to 24 hours a day, seven days a week.

CONTACT fields some 10,000 calls per year from East Tennesseans needing a listening ear, referral to community re-sources, or crisis intervention. The agen-cy also makes reassurance calls to home-bound individuals and provides training in active listening skills in “The Art of Lis-tening,” a class open to the public.

Patterson earned a Bachelor’s de-gree majoring in art and psychology as well as her MBA from UT. She also earned a Master’s in social service administration from the University of Chicago. In addi-tion to her work with NASW, Patterson has held a variety of social service posi-tions in Knoxville and Chicago.

LeConte Sports Medicine and Four Sevier County High Schools Receive Safe Sports School Award

SEVIERVILLE—Gatlinburg-Pittman, Pigeon Forge, Seymour and Sevier County High Schools, in conjunction with LeConte Sports Medicine, have all been selected as the recipients of the National Athletic Trainers’ Associa-tion (NATA) Safe Sports School Award for their Secondary School Athletics. The award champions safety and rec-ognizes secondary schools that provide safe environments for student athletes. The award reinforces the importance of providing the best level of care, injury prevention, and treatment.

Since 2001 LeConte Sports Medi-cine has provided Certified Athletic Trainers, medically-licensed healthcare providers, to cover all sports at Sevier County’s four high schools. LeConte Sports Medicine coordinates the ath-letic healthcare for students, provid-ing comprehensive on-site services for Gatlinburg-Pittman, Pigeon Forge, Sey-mour and Sevier County High Schools.

For more information about NATA or the award please visit: www.athletic-trainers.org.

Erlanger Health System welcomes new physician to Academic Urologists

CHATTANOOGA–Anand Shridha-rani, MD, has joined Erlanger Health System as the newest member of Academic Urologists at Erlanger.

Shridharani special-izes in diagnosing and offering state-of-the-art treatments for disorders of male reproduction, male hypogonadism, erectile dysfunction and Peyronie’s dis-ease.

Shridharani received a medical degree at the University of Massachu-setts Medical School. He completed a preliminary internship in urology and general surgery at the University of Lou-isville and a urology residency program at the Medical College of Wisconsin in Milwaukee. He also received advanced fellowship training in Andrology and Erectile Dysfunction from the Medical College of Wisconsin.

Laura Findeiss Joins University Radiology, UTMC

KNOXVILLE—University Radiol-ogy and The University of Tennessee Medical Center and Graduate School of Medicine are pleased to welcome Laura K. Find-eiss to the practice as Chairman of the Depart-ment of Radiology and as a clinical Interventional Radiologist. Dr. Findeiss comes to UTMC from the University of California at Irvine Medical Center where she was Division Chief of Vascular and Interven-tional Radiology and also served as the co-director of UCI’s Ablative Oncology Center. Dr. Findeiss entered Diagnostic Radiology residency at Virginia Mason Medical Center in Seattle and gradu-ated in 2004. She followed this with a Vascular and Interventional Radiology fellowship at the University of Washing-ton Medical Center, completed in 2005. Prior to her position in California, Dr. Findeiss also practiced in the Vascular Center of Excellence at Charleston Area Medical Center in West Virginia and as the Chief of Vascular and Interventional Radiology at the University of Utah in Salt Lake City.

In 2012, Findeiss was named one of “America’s Top Doctors” for Southern California by Castle Connolly Medical Ltd for her expertise in treating Aortic Aneurysm, Peripheral Vascular Disease and Vascular Malformation. Dr. Findeiss lectures nationally on a range of Vascu-lar/Endovascular topics, image-guided treatment of vascular anomalies, and minimally invasive cancer interventions, including tumor ablation. Dr. Findeiss holds national leadership roles as a member of the Executive Council of the Society of Interventional Radiology, and as a member of the SIR Founda-tion Board of Directors. She also par-ticipates as a member of the Leader-ship Committee of the American Heart Association’s Cardiovascular Radiology and Intervention Council.

Besides certifications in Diagnostic Radiology and Vascular and Interven-tional Radiology, Findeiss is certified by the American Board of Vascular Medi-cine in Endovascular Medicine and is a Registered Physician in Vascular Inter-pretation. She has been honored as a Fellow in the Society of Interventional Radiology (FSIR), as well as obtaining Fellow status in the American Heart As-sociation.

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

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

JOHNSON CITY MGMA MONTHLY MEETING

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

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

Johnson City

KINGSPORT MGMA MONTHLY MEETING

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

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

Second Floor, Kingsport

2ND THURSDAY 3RD THURSDAY

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

GrandRounds

Dr. Laura K. Findeiss

Dr. Anand Shridharani


Caylor Schoo l o f Nurs ing

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Information Sessions atLMU-Cedar Blu�

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

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Peninsula Welcomes Liquete to Psychiatric Staff

KNOXVILLE—Dr. Maria Theresa Liquete joins Peninsula, a division of Parkwest Medical Center, as a staff psy-chiatrist. Liquete will work with patients in the Peninsula Outpatient Clinics in Blount and Sevier counties.

Liquete has eight years of experi-ence in the field of clinical psychiatry. She comes to Peninsula from Wellmont Health System, where she worked in the inpatient psychiatric unit at Ridgeview Pavilion in Bristol, Va.

Liquete holds a Bachelor’s degree in biology from Saint Louis University and a doctor of medicine degree from Saint Louis University College of Medi-cine in Baguio City, Philippines. She completed her residency at East Ten-nessee State University in Johnson City, Tenn.

Hamm Joins Psychiatric Staff at Peninsula

KNOXVILLE—Dr. Robert Hamm has joined Peninsula, a di-vision of Parkwest Medi-cal Center, as a staff psy-chiatrist. Hamm will work with adult and adolescent patients at Peninsula Out-patient Clinics in Knox-ville and Loudon, and will

occasionally see patients at Peninsula Hospital.

Hamm comes to Peninsula from Life Management Center of Northwest Florida where he served in both the inpatient Crisis Stabilization Unit and the outpatient clinic. Prior to this role, he worked as a volunteer physician and professor in Dominica, West In-dies, teaching problem-based learning and introduction to clinical medicine to medical students.

Hamm holds undergraduate de-grees in biology and psychology from the University at Buffalo and a doctor of medicine degree from Ross University School of Medicine in Dominica, West Indies. He served his residency in psy-chiatry at East Tennessee State Univer-sity in Johnson City, Tenn.

Heather Jett Promoted to Director of Patient Care Services at Peninsula Hospital

KNOXVILLE–Heather Jett, nurse manager of the cardiac unit at Parkwest Medical Center, has been selected to serve as direc-tor of patient services at Peninsula Hospital. In this role, she will direct day-to-day operations while reporting to Liz Clary, VP of Behavioral Medicine.

She will work closely with the dedicated team members at Peninsula to provide excellent care to clients and throughout the organization.

Jett has 13 years of nursing expe-rience at Parkwest Medical Center, be-ginning as a nurse extern in 2000. She became a clinical nurse educator and nurse manager of the cardiac, pulmo-nary and renal care unit in 2004.

Jett holds a Master’s degree in Health Service Administration from the University of St. Francis and an Associ-ate’s degree in Nursing from Roane State Community College. She is cur-rently pursuing her Bachelor’s degree in Nursing from The University of Tennes-see, Knoxville. Jett is also a member of the Tennessee Nurses Association.

Suzanne Miller Promoted to Director of Patient Care Services at Parkwest Medical Center

KNOXVILLE–Parkwest Medical Center has announced the promotion of Suzanne Miller to direc-tor of patient care servic-es. Miller will oversee the management of clinical services for several areas at Parkwest. Additionally she will continue to work with the Senior Leader-

ship Team and staff to promote high quality patient care throughout the or-ganization.

Miller has more than 27 years of nursing experience, with 15-plus of those at Parkwest.

She holds an MBA from Lincoln Memorial University and a Nursing degree from Sinclair College. She is a member of the first Covenant Nursing Leadership Series class, a program cre-ated in partnership with The University of Tennessee’s College of Business Ad-ministration and College of Nursing to develop world class nursing leadership.

UT Professor Marian Roman Honored for Psychiatric Care

KNOXVILLE—Marian Roman, an associate professor of nursing at the University of Tennessee, Knoxville, has been hon-ored for her work in aid-ing the mentally ill in the Knoxville community.

She is the recipient of the 2013 Award for Inno-vation from the American Psychiatric Nursing Association (APNA). The APNA Annual Awards recognize nurses who exemplify excellence across the spectrum of psychiatric-mental health nursing practice, education, leadership, research and innovation.

GrandRounds

Dr. Robert Hamm

Heather Jett Suzanne Miller

Marian Roman



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

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GRAPHIC DESIGNERSKaty Barrett-Alley

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GrandRounds

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

Position: Oncology Clinical Nurse Specialist for Wellmont Cancer Institute

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

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

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

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

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

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

Summit Welcomes Ben Huff to Deane Hill Location

KNOXVILLE—Summit Medical Group, the region’s leading primary care organization, adds a new primary care physi-cian to its Deane Hill lo-cation, 7211 Wellington Drive, Knoxville.

Huff is a family prac-tice physician specializ-ing in pediatric, adoles-cent, geriatric, and adult care. He is a graduate of The University of Tennes-see Health Science Center at Memphis and completed his residency in family medicine at the University of Tennessee Graduate School of Medicine.

He is board-certifi ed in family med-icine and is a member of the American Association of Family Physicians, the Tennessee Association of Family Physi-cians and the American Board of Family Medicine. A native of Scott County, Ten-nessee, Huff resides in Rockford.

Parkridge Medical Group Battlefi eld Welcomes Nurse Practitioner Robin T. Jones

CHATTANOOGA – Parkridge Med-ical Group Battlefi eld is pleased to an-nounce the addition of nurse practitioner Robin T. Jones to the practice.

Jones has over 30 years of nursing expe-rience. She holds a di-ploma in Nursing from Fort Sanders School of Nursing, a Bachelor’s degree in Nurs-ing from the University of Tennessee, and a Master’s degree in Nursing from the University of Tennessee. Jones joins Dr. Tiku Bhutwala, Dr. David Bosshardt, Dr. William Horton, Dr. Terri Jones, and Lisa Brooks, DNP at the Ringgold, Ga. offi ce.

Mothers and Infants Sober Together (M.I.S.T.) services expand in East TN

OAK RIDGE—The state of Tennes-see has made reducing neonatal absti-nence syndrome (drug exposed infants) a priority and has established a report-ing system to help track the problem. Mothers and Infants Sober Together (M.I.S.T.) is a program that works with pregnant women who are addicted to drugs before and after delivery, and with their babies that are born with neonatal abstinence syndrome (NAS) or substance exposed infants.

M.I.S.T. began in 2009 when Rid-geview Behavioral Health Services was awarded a grant to support and serve drug exposed infants and their fami-lies in Roane and Anderson counties. However, the new M.I.S.T program in Campbell County is unique and innova-tive in that it utilizes an approach which integrates health care and behavioral health care.

The Campbell County M.I.S.T. pro-gram was offi cially launched on July 11,

FOCUS ON ONCOLOGY

SPONSORED BY WELLMONT

HEALTH SYSTEM

Jim McDaniel Named as Hutcheson Volunteer of the Month FORT OGLETHORPE—Jim McDaniel has been named as the hospital’s Volun-

teer of the Month for August. McDaniel has volunteered in Hutcheson’s Emergency Department for four years.

McDaniel vol-unteers in 12 hour shifts, mostly dur-ing weekends, when emergency room volumes are typically higher.

As Volunteer of the Month, McDan-iel received a basket with gift certifi cates and gift items from The Hutch Gift Shop. He was awarded use of the Volunteer of the Month parking space and his name will be added to the recognition plaque by the hospital’s information desk.

(from left to right): Chareen Humble, manager of Hutcheson Volunteer Services; Roger Forgey, President and CEO; Jim McDaniel, Volunteer of the Month; and Jennifer Daniel, Director of ED and ICU.

Dr. Ben Huff

Robin T. Jones


I don’t just have insurance.

I own the company.

Medical Professional Liability Insurance

Mutual Interests. Mutually Insured.

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

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

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

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

Follow us on Twitter @SVMIC www.svmic.com

at Indian Mountain State Park in Jellico. Scott Pierce, BlueCare Tennessee presi-dent and C.E.O.; Cheryl McClatchey, manager of Behavioral Health Programs for BlueCare; Geogy Thomas, M.D., med-ical director of Dayspring Family Health Center; Erik Wangsness, C.E.O. of Jellico Community Hospital; Brian Buuck, C.O.O. of Ridgeview and David R. Reagan, M.D., chief medical officer for the Tennessee Department of Health, pledged their sup-port to improve the lives of families in the area, one mom and one baby at a time.

M.I.S.T services are being made avail-able to mothers-to-be in Campbell Coun-ty through a two-year, $290,000 grant from the BlueCross BlueShield of Tennes-see Health Foundation. Ridgeview part-ners with Dayspring Family Health Center, Jellico Community Hospital and BlueC-are Tennessee to work with mothers who demonstrate a desire and commitment to staying drug free and providing a safe and stable home for their babies.

The Ridgeview team consists of Pro-gram Manager Michelle Jones, a master’s level therapist and three case managers that conduct substance abuse and men-tal health assessments and work with the parents and their infant intensively for ap-proximately six months. Staff also works closely with hospitals, primary care physi-cians, pediatricians, foster parents, DCS, juvenile court judges and family members.

For information about M.I.S.T. or oth-er Ridgeview programs, visit the website at www.ridgevw.com.

Announcing the 2013 Take Steps Chattanooga Event

CHATTANOOGA—On October 19th, 2013 the Crohn’s & Colitis Founda-tion’s Tennessee Chapter will hold the 3rd annual Take Steps for Crohn’s & Coli-tis fundraising walk and celebration at Coolidge Park. Take Steps is the nation’s largest event dedicated to finding a cure for digestive diseases that affects over 1.4 million Americans, including 30,000 Ten-nesseans.

Take Steps is a family-friendly walk and fundraising event, celebrating our strides towards a future free from Crohn’s disease and ulcerative colitis- collectively known as Inflammatory Bowel Diseases (IBD). Participants are encouraged to form teams of friends, family members and co-workers to walk together and en-joy this meaningful event. Monies raised will continue to fund CCFA mission-crit-ical research, support and educational programs for patients, as well as Camp Oasis, a summer camp for children bat-tling IBD. Attendees will enjoy a one-mile walk through Coolidge Park, music provided Paul Hadfield and The Tucker Hollow Band, food, fundraising incentives and more. Young ones will have a blast in our Kid’s Corral, featuring fun activities for kids of all age. The event will also feature Mission Moments to spread awareness about IBD, featuring local Honored He-roes, 6 year old Kenny Smith and 18 year old Jerica Davis.

East Tennessee Kidney Foundation Names 2013-2014 Board

KNOXVILLE—The East Tennessee Kidney Foundation recently named its 2013-2014 board of directors.

“I’m delighted to continue working with such a committed group of commu-nity leaders and volunteers,” said WATE-TV 6’s Sarah Burton, who was reappointed as East Tennessee Kidney Foundation president.Other board members include board secretary Edith “Dickie” Kaserman; board treasurer Charles “Wes” Carruthers

Jr. of Downey Oil/KenJo Markets; Sharon Azevedo; Shashi Dhingra of Realty Ex-ecutives Associates; Danielle Faulkner of Fresenius Medical Care; Terry Gillingham of South Central Media; Dianne Hagey of Knoxville Dialysis Center; Brent Han-nah of UT Medical Center; Vandaly Jef-fers of Dialysis Clinic Inc.; Curtis McGinnis of Cedar Springs Christian Stores; Amy Pangelinan of Pinnacle Financial Partners; Richard Pangelinan of Tennessee Ap-praisal Group; and Steve Winfree of Visit Knoxville.

Advisory board members include

Katrina Atchley Arbogast of Lewis, King, Krieg & Waldrop PC; Stephanie Burgett of Nephrology Associates; Brian Carlin of McKesson Medical-Surgical; Dr. Os-car Grandas of UT Medical Center; Da-vid Hammontree of A&W Office Supply and Design; Craig Horsley of AAA East Tennessee; Chanda Hurst of Qsource; Mark Moon of Cherokee Country Club; Ronald Sherrill of Care Max Home Med-ical; Dr. Denise Rivers of Nephrology Associates; Dr. Paul Serrell of Nephrol-ogy Associates; and Dr. Urath Suresh of Nephrology Associates.

GrandRounds

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East TN Medical News Sept 2013