Tri Cities Medical News Nov 2013

Mansoor Tanwir, MD

PAGE 3

PHYSICIAN SPOTLIGHT

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LEGAL MATTERS: WHAT? ME WORRY? Physician Reporting Obligations Under the Tennessee Healthcare Consumer Right-To Know ActRecently, the Tennessee Board of Medical Licensure and other healthcare related boards around the state have been cracking down on failure of physicians or other providers to report payments made as a result of malpractice actions ... 7

CLINICALLY SPEAKING: Something to celebrate: Bariatric surgery leads to healthier lives

In December, my partner, Dr. Jonathan Ray, and I have the opportunity to take part in something special – the Foothills Weight Loss Specialists and Blount Memorial Weight Management Center fashion show ... 8

(CONTINUED ON PAGE 6)

By CINDy SANDERS

To see something in a different light often requires a shift in perspective. David A. Williams, CPA, MPH, FHFMA, leader of healthcare reimbursement and advisory services for HORNE

LLP, believes this certainly holds true for practices and facilities facing ever-increasing budget pressures.

Glass Half EmptyWilliams, a partner in HORNE’s Ridgeland, Miss. offi ce, noted for many health-

care providers, any incremental increase in revenue is eaten up by rising costs — from increased wages to higher prices for supplies to hikes in rent and utilities.

He pointed out that for hospitals, the largest revenue stream is for inpatient stays, and the largest single payer is Medicare, which can represent from the low 40s to the high 60s in terms of percentage of patients. “There has been a mar-

Gaining Perspective on the Reimbursement Landscape: Glass Half Empty … or Half Full


By CINDy SANDERS

What if a simple blood test could provide information that your patient had a signifi cantly elevated risk of developing diabetes within the next decade? What might that mean from the standpoint of early intervention and prevention? While it’s much too soon for this type of clinical application, researchers at the Vanderbilt Heart and Vascular Institute (VHVI) and Mas-sachusetts General Hospital have identifi ed a novel biomarker that lends itself to such intriguing questions.

Led by Thomas J. Wang, MD, director of the Division of Cardiovascular Medicine at Vanderbilt and physician-in-chief for VHVI, the team recently published results of their discovery of elevated 2-aminoadipic acid (2-AAA) as a precursor to diabetes in The Journal of Clinical Investigation. Tapping into the rich data source of the Framingham Heart Study,

Early Warning System: Researchers Identify Diabetes Risk Biomarker

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PhysicianSpotlight

By BRIDGET GARLAND

The practice of medicine has always been familiar to Man-soor Tanwir, MD; in fact, he was inspired to become a physi-cian from watching his father, a primary care physician and gen-eral internist. “I liked seeing the way he took care of people and the way people respected him,” shared Tanwir, an endocrinolo-gist who recently started prac-ticing with Wellmont Medical Associates. “Being a physician gives you the opportunity to get on a personal level with people and help them, I feel, more than any other profession.”

Tanwir’s decision to go into medicine lead him to Aga Khan University in Karachi, Pakistan, where he received his medical de-gree and then on to a residency in internal medicine and a fellow-ship in endocrinology, diabetes, and metabolism at University of Pitts-burgh Medical Center. He is board-certi-fied in internal medicine by the American Board of Internal Medicine.

Tanwir decided to study endocrinol-ogy namely, he explained, because of the diversity of the disease processes he sees in patients. “Endocrinology is a very diverse specialty,” Tanwir said. “Diabetes itself is a very diverse illness, but other than diabetes, there are so many glands in the body, so there can be numerous hormonal disorders. And for me personally, I would never want to focus on just a small area of medicine.

“The other reason is that with the physiology of endocrinology, everything functions on a feedback loop, and it’s very easy and intuitive to understand once you have a good grasp of hormone function,” he said. “That really appealed to me be-cause I can explain things as very explicit. That’s very important to me.”

After completing his fellowship, Tan-wir interviewed at several places, but join-ing Wellmont seemed to be the best fit for him for a couple of reasons. For one, Tanwir wanted to live near his family. “I am really close to my family, and I have a brother in Blacksburg and a sister in North Carolina, both are now within driv-ing distance,” he shared.

The other reason Tanwir choose Wellmont was the opportunity to make a difference in the community. “Everywhere else I interviewed, the specialty was simply expanding, but here, there is a tremendous need. People have to drive long distances to see an endocrinologist. Here I can really make a difference, and that’s professionally satisfying,” Tanwir enthused.

Moving into an area with such need, while at the same time seeing great ad-vancements in endocrinology, has Tan-wir excited about this opportunity. “There has been an explosion of different ways

you can manage diabetes, with different types of thera-pies, which makes the spe-cialty complex, but at the same time, helps patients,” he said. “And there have been lots of advancements in pharmacol-ogy, which means a lot of new medicines are coming out. At the same time, lots of advance-ment in insulin delivery have been developed, for example, insulin pumps and glucose sensing technology.”

Along with these new developments, Tanwir noted that the research being done in pancreatic regeneration therapy using stem cells or ex-isting insulin-producing cells is very promising. “My research project during fellowship was basically to establish a good supply of cells using existing cells or stem cells which make insulin. That’s the other front

that is advancing rapidly, and I keep a very close eye on the literature about its advancement.”

Tanwir has already taken advantage of the patient resources Wellmont offers through its Diabetes Centers. “We work very closely with the Diabetes Centers, often making referrals to them because it’s an excellent service and staffed with very experienced and trained diabetes educa-tors and dieticians,” Tanwir noted. “It’s a great resource that I am utilizing and will continue to utilize even more as we develop our relationship.”

The Diabetes Center resource aligns well with Tanwir’s philosophy of care, which is grounded in behavioral modifica-tion for the management of diabetes and obesity. “I have a very patient-centric ap-proach when it comes to weight loss and lifestyle modification,” he explained. “I try to give advice that helps my patients with lifestyle modification because my empha-

sis is a lot more on lifestyle modification, as much or more than pharmacological or drug-based therapies,” he said. “I am a strong believer in a patient-centric ap-proach in which any change must come from within the person rather than a phy-sician instructing him or her on what to do. So I spend a lot of time with patients, especially diabetes patients, to develop that inside them.”

And Tanwir doesn’t just assume that his approach works all the time; he’s keep-ing track of his patients very carefully. “I am very keen to look at how the approach really changes behavior in patients. I do keep track of it, which is interesting—in a way, it’s my own research project going on,” he mused. “Behavioral modification is really tough, but behavioral psychology is part of my specialty, and I tend to focus on it. It may be kind of overlooked in modern medicine, but I feel it is very important.”

In additional to diabetes, Tanwir sees adult patients for thyroid disorders, hormone imbalances, metabolic diseases, high cholesterol, high blood pressure, os-teoporosis and vitamin D deficiency, and lipid abnormalities associated with heart disease.

Tanwir’s wife, Rabeeya Nusrat, MD, has also joined Wellmont Medical Asso-ciates as an internal medicine physician. The couple, along with Dr. David Hens-ley, a family medicine physician, are see-ing patients in the same office. Tanwir and Nusrat met while in the same medical school class, and they now have a nine-month-old daughter.

When they aren’t busy in clinic, Tan-wir says that he and his wife both enjoy being outdoors. “We love the mountains, and we like to trek and hike. We also love being in the water, like kayaking, but that’s on hold right now until our daughter is a bit older,” he shared. “On the weekends, we are outside doing things, which is an-other reason this area attracted us. The Smoky Mountains are close by, and we just visited Asheville this past weekend.”

Mansoor Tanwir, MD

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HealthcareLeader

Phoning it inCall center director oversees growing source of effi ciency and revenue

By JOE MORRIS

When he arrived at Mountain State Health Alliance in 1999, Rick Newman was very much a stranger in a strange land. An engineer, he wasn’t overly familiar with the world of healthcare, and he didn’t have any clinical background to help him in that regard. What he did have, however, was a successful approach to systems and processes, and between that and a well-run call center program, he was able to hit the ground running.

“I inherited a phenomenal program, and had the backing of everyone from the CEO on down,” said Newman, who is Di-rector of MSHA’s Medical Call Center. “I’d sent 20 years working at companies such as Texas Instruments and Siemens, and in that had done a lot of process au-tomation projects. I had to understand customers in different businesses, and learn how to streamline and improve their busi-ness operations. And even though I knew nothing about healthcare call centers when I arrived, or this industry, I realized that it was going through what manufacturing and other business had gone through years ago: There was a growing competition, and they had to change quickly.”

He took a “customer fi rst” approach to the call center operations, telling staff that “we earn the right to serve a customer tomorrow by the way we serve that cus-tomer today.” Over the next decade, he turned the center into not just an effi cient and profi table part of the overall MHSA operation, but also one that helped other departments integrate more seamlessly with one another.

“When I came, the center was doing a couple of programs,” Newman recalled.

“We had the NurseLink program, which was similar to what call centers everywhere were doing. This is a community triage line that provides health information, physician referrals, class registration, and things like that. The challenge I was given was to de-fi ne the return on investment for the center because it was coming under fi re. Many people saw call centers as just an expensive marketing tool, and the thinking was, can we afford it?”

That question was answered by his examination and subsequent overhaul of MDLink, the MSHA center’s other pro-gram at the time. A patient-transfer sys-tem, it was logging 850 patient transfers a year. This “diamond in the rough” was smoothed by Newman and his staff, and now generates 1,200 patient transfers a month.

“Once I discovered what that program

was, and how valuable it was to physicians and patients for providing effective trans-fers, I realized that we had an opportunity not only to generate more revenue and a better margin, but we could also grow our market share,” he said. “That turned out to be the return on investment for the call cen-ter — making it more of a patient transfer center, while also keeping NurseLink and then seeing how we could add more value.”

MDLink began to see 20 percent to 30 percent growth per year around the early 2000s, and programs such as Wings Air Rescue that provide emergency transfer added to MHSA’s, and the call center’s, capabilities.

“With Wings, we can quickly and ef-fi ciently transfer patients by having a com-mon 800 line,” Newman said. “We were doing cardiac patients so quickly we often had them at the hospital before the treating team was there. We have made that very effective.”

Other services that have been imple-mented and improved by the call center staff include working to implement the area’s fi rst medical home systems, as well as disease management systems for chronic heart failure patients.

“These people were readmitting often, and they are dealing with a disease that you can’t cure,” Newman said. “We put to-gether a nursing arm, and worked with the hospitals, to create a management program that had phenomenal results. We were able to help reduce readmission by 69 percent for those patients.”

And in 2005, the call center became involved in a discharging-patient callback project, which now works to reduce read-missions and improve patient satisfaction

MSHA Medical Call Center

Opened: 1992

Operates 24/7

Calls to Date: 3,400,000 NurseLink:

30,000 community nurse calls annually

16 business clients

15,800 class registration calls per year MDLink:

Opened 1995

91,000 patient transfers to date.

10 percent of all MSHA admissions

13,000 transfers in 2012

Services: Hospital Transfers, MD consultations, MD Offi ce transfers, General purpose MD hot line for any physician requesting help accessing MSHA system. Wings Air Rescue:

Team of EMTs supports 4 Wings bases and helicopters receiving fl ight requests and coordinating all fl ight operations between Wings pilots and crew, EMS personnel on the ground and/or hospital personnel.

This team participates in all drills and safety programs.

Wings fl ight operations is also the Regional Medical Communications Center for Region 1 for TN Emergency Medical Management.

Wings fl ew 1,375 patients last year. Technology:

The call center includes about $2M in technology: 32 workstation call center plus helicopter fl ight center, 10+ computer servers, I3 phone system, Clinical Solutions triage software, Central Logic transfer software, Wings radios, servers and various software packages, backup power system.

Awards:

2003 – 2004: Disease Management Innovation Award

2005: Gold Award for Call Center



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By BRIDGET GARLAND

It happens all too often. A law enforcement offi cer pulls over

a vehicle, suspicious that the driver is im-paired, but rather than being under the infl uence of alcohol or drugs, the driver is having a glycemic event.

It’s no surprise that police offi cers would make such a mistake because all of the signs and symptoms of a hyper- or hypo- event mimic those of substance im-pairment.

Recognizing a need to help law en-forcement offi cers identify diabetic drivers, Wellmont Health System, in collaboration with Mountain States Health Alliance, began an initiative in November 2009 to provide Diabetes Alert window stickers to persons on the road or in an accident that may be having a diabetic emergency.

“Anyone who has diabetes, and es-pecially Type 1, is subject to a hyper- or hypo- event, … and law enforcement is seeing this almost daily,” shared Jim Perkins, System Di-rector of the Wellmont Diabetes Centers. “It happens all the time, and people get put in jail and then sue the police de-

partment. The thought that law enforce-ment should have a heads up, that it might be something else, created this program.

“One of things that law enforcement wanted, though, was to make sure that ev-eryone who has a sticker truly has diabe-tes,” he said. This assurance is provided to offi cers through a prescription sheet that must accompany the sticker. Only patients who are given an order from their physician or a diabetes representative can receive the sticker.

Another request from law enforce-ment which the program has imple-mented is the distribution of pocket cards to offi cers so that they can identify the signs and symptoms of a diabetic event. “Every patrol offi cer in the state has ac-cess to them,” said Perkins. “Initially, we listed the signs and symptoms and went to the Kingsport Police Department to ask which ones mimicked impaired driving. ‘Each and every one of them’ was the re-sponse we got.”

The cards not only help the offi cers identify the signs and symptoms of a gly-cemic event, but also list treatment options for the offi cer to follow until EMS arrives.

“In most cases, EMS will come right away, but we do offer a 2-hour, POST-accredited program for training of law enforcement on diabetes,” Perkins ex-

plained. “Diabetes is so prevalent, though, that some places already teach diabetes awareness.”

Since implementing the program in the Tri Cities, interest and participation in the program has grown statewide, pres-ently totaling 27 hospitals across the state.

“As part of the State Diabetes Advisory Counsel, I meet every quarter with them and I report what we are doing here in the Tri Cities,” Perkins said. “When I brought up the sticker program, it was liked so much that it was implemented into the state plan. We received grant money to take it across the state.”

The statewide distributed stickers look almost identical, except for the par-ticipating hospital’s logo, allowing the

Keeping Tennessee Roads SafeDiabetes Alert Sticker Assists Diabetic Drivers, Law Enforcement Offi cers

Hypoglycemia (Low Blood Sugar) less than 70 mg/dL on meter.

Offi cer Observed Signs/Symptoms Include: Shaky, Blurry Vision, Nervous or Upset, Fast Heartbeat, Sweaty, Dizzy or Confused, Anxious, Hungry, Headache, Weak or Tired (Sleepy)

If possible, have person to do blood sugar check.

Treatment (Choose One): • 3 to 4 glucose tablets • 3 to 5 hard candies (chewed quickly) • 4 ounces of fruit juice • ½ can (6 ounces) regular soda pop • 7 Life Savers (chewed quickly)

Wait 15 minutes and recheck blood sugar, if still below 70 mg/dL treat again.

Hyperglycemic Event (Diabetic Ketoacidosis – DKA) can occur with blood glucose levels as low as 250 mg/dL.

Offi cer Observed Signs/Symptoms Include: Strong Fruity Breath Odor (similar to alcoholic breath); Confusion; Rapid, Deep Breathing; Drowsiness; Flushed, Hot, Dry Skin; Diffi culty Waking Up; Blurry Vision; Vomiting; Abdominal Pain

If possible, have person do a blood sugar check.

Treatment: CALL EMS

(CONTINUED ON PAGE 6)Jim Perkins


which is now following its third generation of participants, the Wang research team studied blood samples gathered more than a decade ago from 188 individuals who ultimately developed type 2 diabetes and 188 who did not develop diabetes.

Using these blood samples, the in-vestigators were able to compare levels of metabolites to see if there were any differ-

ences between the group that went on to develop diabetes and the group who did not. Wang noted newer technology now makes it possible to profile hundreds of metabolites at one time.

“One of the things that really lit up when we looked at the people who devel-oped diabetes was 2-aminoadipic acid,” he said. “Having elevated levels of 2-AAA

predicted risk above and beyond their blood sugar at baseline, their body weight, or other characteristics that put them at risk.” Wang added there doesn’t appear to be a specific threshold of risk at this point … the higher the levels of 2-AAA, the higher the risk of developing diabetes. In fact, those in the top quartile of 2-AAA concentrations had up to a fourfold risk of developing diabetes during the 12-year follow-up period compared to those in the lowest quartile.

Interestingly, the researchers found 2-AAA might not be just a passive marker. As part of the same study, the team con-ducted mouse model testing and discov-ered giving 2-AAA to the mice actually altered the way the animals metabolized glucose.

“It suggests the molecules might be playing a direct role in how the body pro-cesses glucose rather than being an inno-cent bystander in the process,” Wang said. He added that elevated levels of 2-AAA don’t necessarily mean the molecule is bad for the body. Instead, it could be a defense mechanism where the body is producing higher levels to fight risk from another, as yet unknown, source.

Figuring out the metabolite’s exact role in the functioning of pancreatic cells is one area for future research. If, indeed, 2-AAA turns out to be a defense mecha-nism to stave off diabetes, the good news is that the metabolite could be given to humans in the form of nutritional supple-ments. On the other hand, if 2-AAA turns out to be harmful to the body’s glucose regulation system, further research could reveal methods to lower the metabolite’s presence.

Wang was quick to say the next step

is to conduct additional research to mea-sure 2-AAA in other human populations outside of the Framingham study through both retrospective and prospective stud-ies. More in depth animal model studies are also in the pipeline. “A lot of the effort will be focused on trying to understand the biologic effect of 2-AAA in developing dia-betes,” he said of the work going forward.

However, Wang said the current re-search results at least raise the possibility that somewhere in the future knowing how high a person’s circulating 2-AAA levels are could impact clinical practice by allowing providers to adopt a more ag-gressive intervention posture among those at highest risk, whether that be through exercise, weight loss or pharmacologic measures. It is conceivable that 2-AAA might be the type of red flag for diabetes that high cholesterol is for heart disease.

“Understanding why diabetes occurs and how it might be prevented is a very intense area of investigation because of the serious consequences of having the disease,” Wang said. “Down the road, this might be one part of the armamen-tarium of tests that could be considered. If this were proven useful in further studies and could be used clinically, it would be an easy test to administer.”

As for the impact of the findings right now, Wang added, “In 2013, it highlights a specific pathway that might be related to diabetes risk that we previously didn’t know about.”

Considering the prevalence of type 2 diabetes and growing obesity epidemic in the United States, that is an important lead for researchers working to develop strategies to interrupt the disease progres-sion and stop risk from becoming a reality.

Early Warning System: Researchers Identify Diabetes Risk, continued from page 1

organization to promote their individual program. Any patient with diabetes can participate by calling the Diabetes Center for that particular health system or hos-pital. In West Tennessee, participating organizations include McKenzie Medical Center, Bruceton Clinic, Dresden Specialty Clinic, Jackson Madi-son County General Hospital, LeBonheur Children’s Hospital, Methodist Health-care – University Hos-pital, and Methodist LeBonheur Healthcare – Germantown Hospital; In Middle Tennessee, Baptist Diabetes Center, Macon County General Hospital, MTMC Diabetes Cen-ter, Gateway Medical Center, and Stones River Hospital; In East Tennessee, Well-ness Place at Methodist Medical Center (MMC), Fort Sanders Diabetes Center (FSDC), Erlanger Health System, and Chattanooga Lifestyle Center; In North-east Tennessee, Holston Valley Medical Center-Diabetes Treatment Center, Bris-tol Regional Medical Center-Diabetes Treatment Center, Wellmont Urgent

Care, Hawkins County Memorial Hos-pital, Takoma Regional Hospital, and Mountain States Health Alliance: Health Resource Center in the Mall at Johnson City.

For providers wanting to find out more about the program,

they can visit the website mydiabetesalert.com or locally, call in King-sport (423) 224-3575 or in Bristol (423) 844-2950.

Perkins empha-sized the benefits of the

program. “Physicians re-alize this is a real problem,

but the people who really un-derstand how much the program is

helping are the law enforcement people out on the street. These events happen all the time,” said Perkins. “I talked to one officer who had recently pulled over six people with the sticker, and they all were having glycemic problems. The police department sees it every day….And it doesn’t stop in the home or in the work-place. Every sticker we distribute identifies another driver driving with diabetes who may need help one day.”

Keeping Tennessee, continued from page 5

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LegalMatters

WHAT? ME WORRY? Physician Reporting Obligations Under the Tennessee Healthcare Consumer Right-To Know Act

BY JASON H. LONG

Recently, the Tennessee Board of Medical Licensure and other healthcare related boards around the state have been cracking down on failure of physicians or other providers to report payments made as a result of malpractice actions. Many physicians have been caught by surprise regarding their duties, in particular under the Tennessee Healthcare Consumer Right-to-Know Act, with respect to their reporting obligations. Often, a physician assumes that once a malpractice matter is resolved, either through litigation or settlement, his or her duties are over and it is time to move on. However, that is not always the case. Following are important questions to which every Tennessee provider should know the answer.

Q. Who is required to maintain a profi le with the Department of Health pursuant to the Tennessee Healthcare Consumer Right-to-Know Act?

A. The list is long and specifi c, but comprehensive. According to the Tennessee Healthcare Consumer Right-to-Know Act, the following individuals must establish a profi le with the Department of Health:

Physicians, osteopathic physicians, chiropractors, dentists, podiatrists, optometrists, dietitians, nutritionists, physician assistants, respiratory care practitioners, pharmacists, audiologists, speech pathology therapists, certifi ed nurse practitioners, registered nurse anesthetists, social workers, psychologists, professional counselors, marital and family therapists, clinical pastoral therapists, massage therapists, medical laboratory personnel, alcohol and drug abuse counselors, occupational therapists, physical therapists, dispensing opticians, electrologists, veterinarians, and nursing home administrators.

Q. Once I have a profi le established, do I ever need to revisit it?

A. Yes. The statute requires that providers update their profi le with the Department of Health within 30 days of any information changing event. For example, a change of practice or address would warrant an update. That notifi cation should be in writing to the Department of Health.

Q. If I am involved in litigation and there is a settlement, isn’t it enough that I am reported to the National Practitioner Data Bank?

A. No. The reporting requirements of the National Practitioner Data Bank (NPDB) and the Tennessee Department of Health pursuant to the Tennessee Healthcare Consumer Right-to-Know Act fall under separate and distinct statutory schemes and require independent reporting.

The NPDB is a confi dential clearinghouse created by Congress with the goal of improving healthcare quality and reducing fraud and abuse. Access to the database is generally limited to hospitals, other healthcare entities and professional societies with formal peer review, state medical and dental boards and healthcare practitioners performing a self-query. Typically, where a settlement or

judgment in a medical malpractice action against a provider has occurred, the provider’s insurance carrier will report the matter to the NPDB.

The Tennessee Healthcare Consumer Right-to-Know Act is a state statutory scheme. It requires reporting of all court judgments or arbitration awards where a payment is made to a complaining party. In addition, any settlements of healthcare liability claims in which a payment is made to a complaining party must be reported as well. There are statutory thresholds which defi ne a reportable event. Providers are only required to report where the judgment, arbitration award, or settlement is in excess of: $75,000 for physicians, $50,000 for chiropractors, $25,000 for dentists, and $10,000 for all others.

Q. Isn’t it my attorney or insurer’s responsibility to make sure that a report is made?

A. No. The statute makes clear that it is the provider’s responsibility to update their profi le with the Department and is silent as to whether anyone can make that report on their behalf. Hopefully, a provider’s attorney will counsel them regarding the need to update the provider’s

profi le at the conclusion of the case and assist in that regard. However, the responsibility lies upon the physician’s shoulder to assure that has occurred.

Q. How long do I have to make a report?

A. Updates must be made within thirty (30) days of a reportable event (settlement or judgment).

Q. What are the penalties for failure to report?

A. Failure to report can result in a Board complaint and disciplinary action.

It is essential, at the conclusion of any malpractice litigation, whether by judgment, arbitration, settlement, or otherwise, that a provider assess whether he or she is obligated to report any action to the Tennessee Department of Health. Failure to do so may result in a new and frustrating set of obstacles for the provider down the road.

Jason H. Long is an attorney practicing at London & Amburn, P.C. The focus of Mr. Long’s practice is medical malpractice defense, long-term care, general civil litigation, healthcare regulatory compliance, and appellate practice. He chairs the fi rm’s Civil Trial Practice. For more information, you may contact Mr. Long by visiting www.londonamburn.com.


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ClinicallySpeakingBY MARK A. COLQUITT, MD, FACS, FASMBS

Something to celebrate: Bariatric surgery leads to healthier livesIn December, my

partner, Dr. Jonathan Ray, and I have the opportunity to take part in something special – the Foothills Weight Loss Specialists and Blount Memorial Weight Management Center fashion show featuring bariatric surgery patients. The annual event provides an opportunity for participants to show off a bit – walk the catwalk and talk about what a difference their weight loss has made in their health and lifestyles.

This year’s celebration will mark the 11th annual fashion show. How has the event reached the 10-year mark and beyond? The secret to its success is simple, really.

First, it is remarkable to see the models’ change in appearance and to consider the amount of weight lost. Seeing patients with their former “fat” clothes or viewing before and after photos is always stunning. The 26 patients who participated in the 2012

fashion show represented a combined weight loss of 2,600 pounds. To put it in perspective, Ferrari is pioneering its next hybrid supercar, expected to come in at just under 2,500 pounds.

Second, the patient testimonials are compelling. The positive energy

and gratitude are palpable in the air as participants share stories of newfound confi dence, improved health, and the ability to wear fashionable clothes.

Often emotional and uplifting, testimonials also do a good job of conveying the signifi cant benefi ts of having surgery. Below are a few examples from past events:

Carson Lynn lost 250 pounds in 18 months following

his gastric bypass and said the surgery saved his life. “I was on oxygen, had high blood pressure, and my heart was out of rhythm. If I hadn’t had the surgery, I’d probably be in the ground tonight.”

“I didn’t realize how tired I was,” said patient Tami Hargis. “Now I’m ready to go every day!” Hargis lost 114 pounds following her gastric band procedure.

“I was taking three shots of insulin a day. Now I’m taking none,” said patient Larry Webb, who lost 125 pounds following surgery.

James Lawson lost 215 pounds in 15 months following his surgery. “I went from taking 17 pills a day to nothing. My diabetes is gone. This is the best thing you can ever do, and it can save your life,” said Lawson.

Diana Parton lost 66 pounds from August through December. “I came back from the hospital and got off my diabetes medicine, which I had to take twice a day. I took a handful of pills every morning, and now I only take three.”

While the fashion show is a “feel good” event that provides an excellent congratulatory platform for patients who have lost tremendous amounts of weight, Dr. Ray and I hope that it can also be an impetus for change.

Each year, among the crowd of patients, friends and family members are individuals trying to decide if bariatric surgery is right for them. The fashion show affords these individuals the opportunity to hear real stories from real people and see what is possible if they are willing to commit to change.

And, while far too many people still consider bariatric surgery a purely cosmetic procedure, its health

benefi ts are far too signifi cant to ignore. Consider the statistics for the 26 models from 2012 (see chart).

The link between bariatric surgery and resolution of diabetes is further confi rmed by STAMPEDE, a study published in the March 26, 2012, issue of the New England Journal of Medicine. The study concluded that bariatric surgery resulted in better glucose control than medical therapy in severely obese patients with Type 2 diabetes. The results of the study were signifi cant. At two years, diabetes remission had occurred in no patients in the medical therapy group versus 75 percent in the gastric-bypass group and 95 percent in the biliopancreatic diversion group. The results also showed that remission was independent of weight loss, suggesting that the positive outcomes are a result of metabolic changes achieved through surgery.

Do you have morbidly obese patients who have repeatedly failed at all efforts to lose weight? If they seem truly ready for and committed to change, I encourage you to consider recommending bariatric surgery. I’d love to see them on the catwalk in a year or two.

Mark A. Colquitt, MD, FACS, FASMBS, is Director of Metabolic and Bariatric Surgery at Blount Memorial Hospital in Maryville, Tenn., and is a bariatric surgeon with Foothills Weight Loss Specialists, a division of Premier Surgical Associates. Colquitt is board certifi ed by the American Board of Surgery. He is a fellow of the American College of Surgeons and of the American Society of Metabolic and Bariatric Surgery and is a member of the Society of American Gastrointestinal and Endoscopic Surgeons. For more information, visit http://www.foothillsweightloss.com.

Comorbidity Of 26 bariatric surgery patients, number to reach resolution of chronic health condition

Sleep apnea 6

Depression 2

Anxiety 1

Joint Pain 12

Hypertension 8

GERD (Gastroesophageal

refl ux disease) 7

Diabetes 8

High Cholesterol 5

Polysistic Ovarian Syndrome 1

Congestive Heart Failure 1

Foothills Weight Loss Specialists surgeon Dr. Mark Colquitt, right, praised the success of patient/models during the 10th Annual Bariatric Fashion Show in December 2012. With him is Blount Memorial Weight Management Center’s bariatric coordinator Dana Bradley, who is also a patient who lost 100 pounds within 10 months of her laparoscopic sleeve gastrectomy.


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By CINDy SANDERS

Established in 1938, the Tennessee Hospital Association has adopted the ta-gline “reinventing tomorrow’s healthcare every day for 75 years” as an ongoing theme for 2013.

Over the years, the staff of the THA might have had many days … often stretching into many months … to help members prepare for and implement change. However, in the face of industry-wide transformation, being nimble enough to reinvent the hospital’s role in healthcare delivery on a daily … if not hourly … basis has become the norm. Helping its mem-bership navigate the challenges that come with sweeping reform was central to the programming at the THA Annual Meet-ing, held Oct. 31-Nov. 1 at Gaylord Opry-land Resort and Convention Center.

“I’ve always said healthcare moves glacially, but we’re getting up to lighten-ing speed now,” THA President Craig Becker said with a rueful laugh. “It has been a tough road to hoe right now for our members.” Yet, Becker continued, he ulti-mately views the transformation process as ‘constructive deconstruction.’

Going into 2014, he continued, “Our number one issue is the Affordable Care Act and trying to get people enrolled …

not only the ones that are eligible through the fed-eral exchange but to try to convince the governor and Legislature to expand TennCare to include the poorest of the poor.”

Becker added there are approximately 500,000 Tennesseans who should be eli-gible for enrollment through the federal exchange. However, there are another 400,000 currently left out of coverage opportunities unless Gov. Haslam and the Centers for Medicare and Medicaid Services can come to an agreement about expanding TennCare rolls, and the Ten-nessee Legislature approves the plan.

“We’re having a hard time getting the Legislature to separate this from Obam-acare,” Becker said. However, he noted negotiations with CMS are ongoing, which he said was an encouraging sign.

“We’ve got $5.4 billion worth of cuts over 10 years under the Affordable Care Act,” Becker pointed out. Those cuts were more palatable when hospitals thought Medicaid rolls would be expanded. When the individual mandate was upheld but not the Medicaid expansion, anticipated coverage for large chunks of the popula-tion evaporated.

“I’m really concerned about my rural hospitals. They don’t have the reserves some of the bigger hospitals do,” Becker said. However, he added no facility is im-mune to the looming financial stressors. Addressing the key point of coverage for the 400,000 left out, Becker stated, “If we don’t get it, some of our hospitals cannot make it. I guarantee that.”

Three hospitals have recently shut down operations in Tennessee. While two in West Tennessee probably had more to do with the number of facilities in comparison to the population, one in East Tennessee simply couldn’t make it in healthcare’s new financial reality. Scott County residents now have to go else-where for care. “The hospital was strug-gling. When the (ACA) cuts came, it was the death nail for them,” Becker said.

The Tennessee Hospital Association is also focused on the Tennessee Payment Reform Initiative, which is initially slated to be rolled out for the TennCare and state employee populations. Tennessee has received a CMS grant to transform the state’s healthcare payment system. While details are still being ironed out, the governor’s vision is to incentivize ‘quarter-backs’ (typically physicians) to provide the highest quality, least costly care. As part of that plan, the quarterbacks would receive

a bonus for sending patients to facilities with the best quality and lowest prices.

However, Becker said there are con-cerns arising from geographic location and from skewed price comparisons. He pointed out large academic medical cen-ters with high-cost service lines including trauma centers and burn units and other unusual expenses such as graduate medi-cal education cannot fairly be compared to community hospitals without those same factors. In areas with only one nearby hos-pital, referring patients to a facility farther away that has a better cost structure might not be feasible … or desirable … depend-ing on the urgency of the situation.

Becker noted, “Seventy-five percent of physicians admit to one hospital only so I’m not sure it makes a lot of sense. I’m not sure that this will change physician admitting patterns.” However, he contin-ued, the general consensus is that the plan will move forward so THA staff is prepar-ing for implementation while addressing their issues with government and provider stakeholders in an effort to design a work-able plan.

Despite any reservations about the plan’s mechanics, Becker applauded the general concept of shared information. “I think the more transparent and the more

Tennessee Hospital AssociationReinventing Tomorrow’s Healthcare Every Day for 75 Years


Craig Becker


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].

‘‘We have to make sure that patient care

is foremost. ’’

By LEIGH ANNE W. HOOVER

Just over the mountains in Ashe-ville, North Carolina, visitors to Bilt-more Estate can truly step back in time, and there is no better time to visit than during the holidays. The ex-perience is outstanding any time of the year, but dressed up for the holidays, Biltmore is simply spectacular.

My late mother, Corrie M. Whit-lock’s, life’s work was beautification. As a past president of the Garden Club of South Carolina, South Atlan-tic Regional Director for the National Garden Club, landscape critic, master flower show judge, master gardener, and the list goes on and on, my mother would have loved being able to inter-view Cathy Barnhardt, floral displays manager and holiday décor expert for the Biltmore Estate. She would have enjoyed Barnhardt and been truly fasci-nated with her gift.

Beautification was Mama’s gift, and everything she touched through her service in South Carolina and elsewhere was sim-ply magnificent. In fact, once in an inter-view prior to Mama’s passing, I remember explaining this to a journalist.

“If there’s a garden club in heaven, she will be in it. If not, she will organize one and make us all join!”

Barnhardt shares this same gift, and her talents have been featured on Today, CBS This Morning, HGTV, and in many national magazines. With a Bachelor of Science degree in ornamental horticulture and landscape design and a minor in art his-tory from the University of Tennessee, the woman is amazing!

“My degree from UT is horticulture and landscape design, so when I came to Biltmore, I was hired to work in the green-house,” explained Barnhardt.

After a year of managing the green-house, Barnhardt was faced with a chal-

lenge. She was asked whether she wanted to stay in the greenhouse or move full time to the estate house, arranging flowers and “doing Christmas.” According to Barn-hardt, prior to her arrival and agreeing to take on the monumental assignment, Christmas at Biltmore had been done on a much smaller scale.

For over 36 years, Barnhardt’s talents have been on display at the grandest show house in the world. During Christmas, her expertise truly takes center stage.

“When I was at UT, I also loved his-tory, and I loved art,” continued Barnhardt. “I think that when you combine a love of flowers, design, history, and art, Biltmore’s my perfect job, and that’s why I have been here for 36 years.”

Growing up just beyond Biltmore’s gates in Kenilworth, Barnhardt always knew that she wanted to come back to the mountains of western North Carolina to work at Biltmore, one of the reasons she feels this is her “perfect job.”

Although she decorates her own home,

Barnhardt attests the Cape Cod style home is nothing like decorating the estate. How-ever, she does incorporate a theme in her home, too.

Years ago, Barnhardt’s daughter sepa-rated their personal ornaments by color, and this has helped her alternate colors like her team does at Biltmore. In fact, sorting by theme and color is a tip Barnhardt al-ways gives others for their homes.

Christmas begins early at Biltmore, and the annual “umbrella” themes are de-cided years in advance. Teams, including marketing, events, museum services, and horticulture, gather to map out themes for upcoming years. Barnhardt says they con-sider events both past and current to decide on the overall, umbrella theme.

Dressed in its holiday best, the estate, known as “America’s largest home,” of-ficially ushers in the season on November 2, 2013. For a 250 room chateau, it is only befitting that the holiday décor remains through January 12, 2014, and this year’s theme is “The Nature of Christmas.”

According to history, George Vander-bilt actually opened Biltmore House to family and friends for the very first time on Christmas Eve in 1895. Over the years, it has remained a truly festive and special time of celebration for the estate.

This year, the large banquet hall, which exhibits the infamous 35-foot tall decorated Fraser fir from Newland, North Carolina, will be in a whimsical fashion celebrating children and the festive spirit of Christmas.

“We want the Christmas tree to be fresh throughout the season. We want the guests that come in December to enjoy it just as much as those who come during the first week of November,” explained Barnhardt.

In order to ensure this, two signature trees are used in the banquet hall. The “great switch” of the 35-foot tree occurs on December 11th this year. Barnhardt explained the switch begins at 4:00 in the morning with laundry bins on wheels for storing 500 ornaments, 500 lights, and 500 gift boxes for redecorating.

“500 is our number,” said Barnhardt.”And, the reason is in some old, old periodicals, there is reference to 500 gifts, and that just seemed like a good number for the banquet hall. We have descriptions of that 35-foot tree, electric lights, ornaments that were hung on the tree, evergreen gar-lands, holly berries, and shining green leaves that tell us a little about what the decorations might have looked like here, but a lot of it is also our interpre-tation. We are inspired by what was here.”

With essentially every employee, and some on reserve, the holiday tran-sition occurs.

The tree is dismantled with a chainsaw in sections onto tarps, which are draped across the banquet room floor. According to modern-day tradi-tion, the engineers even hide a used

light bulb ornament somewhere on the tree.“Guests love seeing the process,” said

Barnhardt. “Each year, we pick out two trees. The first tree usually is a little slimmer. The second tree is a little bigger, and the reason is we can change that first tree out quickly and put that bigger tree in through-out Christmas.”

According to Barnhardt, these trees are grown specifically for the estate at a tree farm in Avery County. After they are re-moved, they are ground into mulch, which is later used in the gardens. The first tree raising day has become an annual tradition for many.

Beginning in November, visitors to Biltmore can come early in the season to obtain all kinds of ideas that can be used in their own homes.

“We love to get feedback from guests when they ask, ‘How did you do that? I want to do that at my house,’” said Barn-hardt. “It will be fun to see what the main interest is this year because last year, it was two little topiary trees that were on the breakfast room table made out of kumquats and oranges.”

Barnhardt notes that even though themes are changed, to always add a little something different and to keep everyone inspired, her decorators are “masters at re-purposing” and reusing items. Once they are too worn, items are denoted to Habitat for Humanity for their retail shop.

“We have a lot of freedom in deciding decorations based on the historical frame-work,” said Barnhardt. “And, I think we’ve been able to do that successfully through the years.”

For additional information about holi-day happenings, visit www.biltmore.com .

Enjoying East TennesseeBiltmore Estate - Deck the Halls!

Phoning it in, continued from page 4by following up on such basic needs as follow-up appointments and prescription fulfillment.

Next up is a pilot project that works with the area’s uninsured population to attempt to get those people to be more proactive about their healthcare, and to see their primary care physician before treatable conditions become acute. It’s an ever-changing list of programs and needs, but Newman says he is able to rise to the challenge thanks to a staff that never stops working and adapting to today’s healthcare climate.

“I have the greatest team, clinical and non-clinical folks,” he said. “I am here for service management, here to serve them. They have the passion, not just for cus-tomer service, but also for really taking care of patients. That is what makes them so effective.”

And that is key, as reimbursement rates and other financial concerns mean leaner, more patient-centered operations than ever before.

“Call centers now have to be actively involved in patient care and patient deliv-ery,” he said. “We were one of the first ones to be on that cutting edge, and we continue to innovate. I want to find a way that we can continue to be at the forefront of high-quality healthcare delivery, and with all the changes coming now, we are ideally situ-ated. We have spent a lot of time teaming up with our patient centers, our medical home operation, our physician groups, and our accountable care organization. We are the central point of access, and so whether it’s through the telephone or through texts, social media, or other points of access, we are making sure we are ready to take care of the current generation and the next one.”


By BRAD LIFFORD

Dr. Jeffrey O. Carlsen has demonstrated that he doesn’t mind traveling thousands of miles to bring the best in eye care to patients in other parts of the world. Carlsen went far afield earlier this year to deliver eye care – he saw patients on a medical mission trip to a small town in Guatemala – but he doesn’t want his patients to have to travel far to re-ceive care. When he can bring very specialized eye care to children close to home, it gives him a particular sense of fulfillment.

In the case of those who have pediat-ric cataracts, although there is only a small population locally, it is one that Carlsen and his colleagues do feel a sense of commitment to, nonetheless.

“Everyone will develop cataracts as we grow older, as part of the normal aging process,” Carlsen said, “but pediatric cataracts are congenital; they are hereditary. You’re not talking a large number of cases here – it might be a dozen a year. But they still need our help, and it’s a service we feel like we should pro-vide to the community.”

Fortunately, with the recent purchase of a highly specialized surgical device at Niswonger Children’s Hospital, Carlsen and the pediatric care team at Johnson City Eye Clinic are able to offer pediatric cataract surgeries locally; he had his first cases in September.

“We really needed this,” Carlsen said, “because kids who did need this procedure were required to travel to Nashville or Knoxville.

“Traveling for eye care takes a toll on the children and their families because for kids who have cataract surgery, it’s a lifelong commitment to regular eye care and a particularly big commitment during that first year or so. That first year could mean six to ten trips to Nashville for check-ups. That’s a lot on a child and the child’s family.”

The physicians of Johnson City Eye offer a wide scope of services in their clinic in Med Tech Park, as well as a surgery center that is a compo-nent of delivering comprehensive care that includes the treatment of glaucoma, macular degeneration, pediatric ophthalmology, retinal disease, and cosmetic and reconstructive surgeries. In the coming weeks, patients will also see availability of a new facet at the Johnson City Eye Surgery Cen-ter: femtosecond laser surgery for cataracts. Carlsen said installation of this new, cutting-edge device could happen around the beginning of 2014. Unlike traditional cataract procedures performed with a surgical blade, a femtosecond laser uses tightly focused laser energy to allow for incredibly precise incisions. “It’s exciting, and I think we will be the first in the region

to offer femtosecond cataract surgery,” Carlsen said. “It’ll be appropriate for many patients, especially those with astigmatism.”

The surgery center in Med Tech Park en-ables patients to undergo same-day procedures in a facility that has earned the status as an Ac-creditation Association for Ambulatory Health Care, Inc., a distinction that is awarded only after a center has shown it meets the highest standards of quality care.

In addition to practicing pediatric and gen-eral ophthalmology, Carlsen’s clinical interests include cosmetic and reconstructive plastic surgery, as well as strabismus surgery. He com-pleted fellowships in pediatric ophthalmology and strabismus, as well as an ophthalmic plastic and facial surgery fellowship.

Carlsen is one of eight physicians who serve a wide spectrum of the ophthalmic needs not only of Tennesseans but also of patients in Virginia, North Carolina, and Kentucky, with a heritage of excellence that spans more than 70 years. In addition to Carlsen, the medical staff currently includes Drs. John C. Johnson Jr., Michael F. Shahbazi, Amy B. Young, Alan N.

McCartt, James W. Battle, Randal J. Rabon, Calvin L. Miller, and Peter Lemkin, a doctor of optometry. Dr. Carlsen is also very pleased to announce that Bristol native, Dr. Jennifer L. Oakley, a glaucoma specialist, will be joining the practice next month.

More than 100 healthcare professionals make up the team at Johnson City Eye Clinic. Another feature of the practice, located adjacent to the clinic, is Cosmetic Laser Skin Care, an extension of the physicians’ interest in plastic surgery for upper and lower eyelids and full face laser resurfacing, plastic, cosmetic, and reconstructive surgeries. In addition to the cosmetic surgeries and services available there – which includes Botox Cosmetic, Juvederm, and Restalyn, the skin care clinic offers a large variety of day spa services.

InSights

Johnson City Eye Clinic & Johnson City Eye Surgery Center110 Med Tech Park • Johnson City, TN 37604

225 Medical Park Drive, BristolPhone: (423) 929-2111 • Fax: (423) 929-0497

Email: [email protected]

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

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

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

visit www.jcsymphony.com

Winter Wonderlandfeaturing City Youth Ballet of Johnson City

Saturday, December 14, 7:30 p.m.Mary B. Martin Auditorium at Seeger Chapel, Milligan College

sponsored byFerguson Enterprises and Roadrunner Markets

The City Youth Ballet is a chartered, not-for-profit per-formance organization offering an extensive repertoire of classical and contemporary ballet performances for the general public and school groups throughout the year. The CYB provides high quality performances of classi-cal ballets and contemporary and lesser known ballets. Original, commissioned works are also part of the CYB’s repertoire. Under the direction of Susan Pace-White, the City Youth Ballet will join the Johnson City Symphony Orchestra in performance of excerpts from Pytor Illych Tchaikovsky’s “Nutcracker Suite.” The program will also include holiday-related music from Gabriel Pierne, Wolf-gang Amadeus Mozart, Anatol Liadov, Irving Berlin, Georges Bizet, Frederick Delius, and Leroy Anderson.

ket basket update, but for the last couple of years, it’s been less than 2 percent,” he said.

Williams noted the government puts in the full market basket update but then begins reducing the rate by looking at ad-justments tied to value-based purchasing, readmission rates and acquired conditions, in addition to other factors. “Normally you’re seeing very minimal increases. It’s caused a flattening of revenue per patient,” he said. Then, Williams continued, after payment increases are netted out, “Medi-care is subject to a 2 percent reduction to fulfill the sequestration order.”

He added that Medicaid, which typi-cally covers anywhere from 5-15 percent of patients … or higher depending on loca-tion and a hospital’s safety net status, is not currently subjected to sequestration. Yet, he said, hospitals are faced with mounting concerns about Medicaid expansion, un-compensated care, and cuts to dispropor-tionate share hospital payments.

For hospitals in states that didn’t opt to expand Medicaid rolls, administrators are worried about rising levels of uncom-pensated care for those that fall into the gap in the Affordable Care Act between traditional Medicaid eligibility and qualify-ing for federal subsidies on the healthcare exchange. Even for providers who are in states that did expand Medicaid, Williams said uncertainty still exists about how reim-bursement will actually net out.

Traditionally, Medicaid has reim-bursed providers at a set match rate for di-rect patient services and a 50 percent rate for the administrative portion of the epi-sode of care. Although the ACA Medicaid expansion plan covers 100 percent of pa-tient services for three years and then rolls down incrementally to 90 percent over sub-sequent years, the administrative match re-mains at 50 percent so the state does incur additional cost by expanding rolls. Addi-tionally, Williams said certain provisions of the ACA require mandatory changes for states regardless of expansion, includ-ing: welcome mat population or those who were eligible for Medicaid but had not en-rolled previously, foster children expansion to age 26, expanded eligibility for children, primary care physician fee increase, and health insurer fee. In Mississippi, a non-expansion state, the estimated amount of the mandatory changes is between a $272 - $436 million increase in spending. With this amount of growth, the state is not ex-pected to increase the reimbursement rate for a full episode of care.

Medicare DSH payments also are causing administrators to lose sleep at night. Initially, the ACA plan called for a 75 percent reduction in Medicare DSH payments. However, Williams said part of the final regulation that went into effect Oct. 1 of this year moderated that number a bit by moving to an empirical DSH pay-ment for uncompensated costs … a com-plex, calculated cut that softens the blow some by looking at a hospital’s relative share of Medicaid inpatient utilization as a proxy for uncompensated patients.

Williams said that for one hospital in the Mississippi Delta, the original Medi-care DSH reduction would have meant a loss of $5.6 million. “But,” he continued, “because of the additional payment to fund the uncompensated cost, it was actually a

reduction of $2 million.” While that is still a significant loss, “It could have been worse,” Williams noted.

Still, he continued, “You’re faced with the fact your revenue isn’t growing as fast as your expenses. It’s very concerning to most every healthcare organization around.”

Glass Half FullSo if revenue isn’t going up, the logi-

cal place to increase margins is to decrease costs. Yet, healthcare providers want to make sure they provide the best care possi-ble without sacrificing a patient’s well being simply to save a few dollars.

“A lot of people equate higher quality with higher cost, but that’s not necessar-ily true,” Williams pointed out. In fact, he said, doing the right thing in the right way is often significantly more cost efficient.

“A major cost in providing care to pa-tients is variation in the clinical process of care,” Williams said. He added it is easy to find real world examples of this type of vari-ation where one hospital’s cost for an aver-age hip replacement is $45,000, yet another one might have an average cost of $22,000. “What’s the disconnect?” he asked of the two cost scenarios. “A lack of standardiza-tion of using evidence-based protocols,” he answered.

By using data available through elec-tronic health records coupled with a part-nership with technology company Health Catalyst, Williams said HORNE is able to mine the available information to look at clinical pathways and search out deviation from standard protocols that adds to the cost of care. He was quick to add that the technology doesn’t seek to stop physicians from exercising their medical judgment but does highlight where there are outliers when it comes to following clinical proto-cols. “Best practices and evidence-based medicine say that these are the best proto-cols out there,” he pointed out.

Following those protocols not only saves money, but also should optimize qual-ity. With increased transparency, payers and patients will have access to information re-garding those positive outcomes and lower costs, which could ultimately drive volume.

A Foot in Both BoatsAdministrators and chief financial offi-

cers are caught between the fee-for-service and value-based payment worlds right now. Williams said they are trying to keep their heads above water in the current payment system … and now reimbursement experts want them to shift their focus to population management. Although making the move is understandably frustrating, Williams be-lieves it is also the best option to ultimately improve the bottom line.

“There has to be a change in culture from what it’s been in the past,” he noted. “We tell them, ‘Let’s prepare for it by being the most efficient, effective deliverer of care and eliminating patient waste.’ That puts you in a competitive advantage over those providers that have a higher cost structure.”

It is a different mindset, Williams con-tinued, to stop attacking reimbursement from the top and instead improve revenue by cutting costs. “If you deliver high qual-ity at a lower cost, then your margins are going to be greater. We see opportunities,” he concluded.

Gaining Perspective, continued from page 1


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By HEATHER RIpLEy

What strategies and tactics does your healthcare business use to promote its products or services to other businesses?

The usual, right? A mix of print ad-vertising, email marketing, social media posts and promotions, online ads and pay-per-click, press release distribution, web-site promotion, white papers and reports and, well, you get the picture. Or maybe you want to, but you don’t have the time or staff to manage all the above.

All of those marketing tactics depend on content. And, all that “content” takes time and effort to research, write, and pro-duce. The fact is, creating and distributing your content is probably taking a lot more time than you thought it would. When you hear the term “content marketing,” it not only means getting the content you write to the correct targets in a consistent manner, it means writing it correctly, too.

In my industry, healthcare public re-lations and marketing, content is not only “king,” it’s everything. And according to the recent B2B Content Marketing Report authored by Holger Schulze, manager of the B2B Technology Marketing Commu-nity on LinkedIn, more than 82 percent of the business respondents plan to increase

their content production next year. This means the trend toward businesses be-coming, in essence, their own publishers is not far off the mark.

One of the challenges for healthcare businesses in the coming year will be in finding a definitive way to answer the question: “Where is that content going to come from?” In the past, content came from various sources: your website, your marketing department (if your business had one), staffers who could write well, CEOs, other executives, freelance writers, or even staff members’ friends and family.

These sources may have been ad-equate in the past, but as more and more B2B companies plan on adopting some form of content marketing for the future, depending on staffers who are not trained or experienced in content marketing can end up costing your business more than you think. A content marketing plan is something businesses are going to need. And not just any plan, one that includes integrating content across multiple chan-nels and platforms for branding, continu-ity, purpose, identity, promotion, and for Internet search rankings (SEO).

Last year one of the biggest problems businesses had was creating engaging content, and that is still a major problem

going forward. According to the LinkedIn survey, the content challenges for B2B marketing in 2014 will be:

• Finding the staff time/bandwidth to create content (55 percent)

• Creating engaging content (49 per-cent)

• Producing enough varied content to capture interest across multiple channels (39 percent)

The key to good content though is not in the quantity, rather, it’s in the quality, and that’s where some businesses feel they lack the needed expertise to really engage and inform their audiences. It’s no secret that telling a compelling story is one of the most effective ways to create interest, but not every business is able to (or even wants to) employ a staff of experienced content marketers to write stories. And across multiple channels with the neces-sary keywords and search engine optimi-zation techniques tailored to each channel of communication.

Creating a cohesive and directed content marketing plan is even more chal-lenging when you consider the increas-ing number of channels content needs to fill. According to Marketing Profs and the Content Marketing Institute’s recent B2B Marketing Content report for 2013,

“B2B marketers are spending more, using more tactics, and distributing their con-tent on more social networks than they have in years past. Unfortunately, there is also more uncertainty. B2B market-ers are more uncertain whether they are using various content marketing tactics effectively.”

Rather than create an in-house pub-lishing department to handle the content needs of your B2B organization, firms of-fering content marketing services to this industry can be a worthwhile alternative. Before you make a decision on how to handle your B2B content marketing efforts, consider your staff’s time, your businesses’ ability to hire and manage content mar-keting staff, and how you will determine whether the return on investment (ROI) of your marketing efforts is successful or not. I think about it this way: content may be king but ROI is the master of the universe. Until you know which efforts are successful and why, it’s almost impossible to chart your future content marketing path.

Putting Content to Work for your Healthcare Business

Heather Ripley is the president and founder of Ripley PR, a business-to-business (B2B) public relations agency specializing in Healthcare IT. For more information, visit www.ripleypr.com or email [email protected].


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Knocking on Heaven’s Door: The Path to a Better Way of Death

by Katy Butler; c.2013, Scribner; $25.00 / $28.99 Canada, 322 pages

Indeed, the worst part about making a decision can be the regret that’s pos-sible at the end of the choice. And in the new book Knocking on Heaven’s Door by Katy Butler, a seemingly no-brainer decision tears a family apart.

Jeff Butler cheated death many times.

As a child, he narrowly missed dying in a car accident. In World War II, he lost an arm, but not his life. And in Novem-ber 2001, at age 79, he suffered a stroke that nearly killed him. A year later, he re-ceived a pacemaker.

And that, says his daughter Katy, kept him alive but didn’t “prevent his slide into dementia, incontinence, near-muteness, misery, and helplessness.”

Jeff and his wife Val were forward thinkers. He was a college professor. She was a perfectionist with fierce drive. They had been “in control of their lives, and they did not expect to lose control of their deaths.”

But that’s exactly what happened: as Jeff’s health continued to decline, his abilities dwindled and his cognizance weakened – all of which he was aware. He indicated dismay at his diminished life and said that he’d “unfortunately” lived too long.

On the other side of the country, Katy Butler worried. She’d always been closer to her father than to her mother, but arguments and old hurts continued

to sting. Still, she flew home to Connecti-cut to help because she was, after all, their daughter – statistically, the one who bore the brunt of parenting a parent.

But as Jeff’s dementia worsened, so did Val’s tolerance and her health. She was “stoic,” but impatient, snappish, and exhausted, and only accepted outside help when she became overwhelmed. Butler says she knew her mother “clout-ed” her father, and shouted at him in frustrated anger.

By this time, Butler was convinced that the pacemaker her father had wasn’t the medical miracle it was meant to be. And she learned that pacemakers could be turned off…

So much went through my mind as I read this beautiful, emotionally brutal book.

With sorrow, grace, and growing exasperation, author Katy Butler writes of her father’s long, messy death; her mother’s quiet, dignified passing; and the parallel story of how modern medi-cine, drug companies, and government rules promoted the former.

That’s a lot of hard reading, made gentler with Butler’s Buddhist values and serenity. And yet, it’s not easy to avoid outrage as she points out the unfairness of aging, the cruelty of physical decline, and the knowledge that those – and the surety of caretaking – are somewhat in-evitable for many Baby Boomers today.

This is a stunning book, truthful and its dignified, and it could be a conversa-tion-starter. If there’s a need for that in your family – or if you only want to know what could await you – then read Knock-ing on Heaven’s Door.

One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine

by Brendan Reilly, MD; c.2013, Atria Books; $28.00 / $32.00 Canada, 464 pages

In the new book One Doctor by Brendan Reilly, MD, you’ll see that moth-eaten testing methods may beat modern.

“New York doctors don’t work week-ends.”

That’s what one of Brendan Reilly’s patients claimed, surprised to see Reilly at her bedside on an early Saturday morning at New York’s Presbyterian Hos-pital. He was there because he believes that the doctor who “knows you best” is the one who should assume the majority of the caregiving. That’s not the way most medical centers work these days, but it’s the way he prefers to practice medicine.

For Reilly, doing things the old-fash-ioned way is often better than technol-ogy, when making a proper diagnosis. Machines, he points out, can miss the smallest of symptoms: a non-dilated pu-pil, an errant reflex, a hidden blood clot, rare bacteria that mimics something else.

“Diagnosing disease,” he says, “has something to do with patterns.” Good doctors – “grandmasters,” he calls them – know how to recognize those patterns without “wasteful, redundant, or ineffec-tive” medical intercession. Such recogni-tion, near-intuition, and the ability to deal with a day when “doctoring feels like pin-ball” are talents he cultivates in his resi-dents and students.

Even so, there are times when a doctor is stumped by a medical mystery that requires rapt attention and sleuthing skills. That’s when it’s mandatory to listen to a patient, the patients’ ailing body, and one’s own subconscious, as well as medi-cal knowledge new and old. Such myster-ies may result in instinctual reaction, and a cure. Other times, they might end with the surety that it’s time to stop.

And on that, says Reilly, doctors “know about regret. But we don’t talk about it. Ever.”

Broken up into thirds, One Doctor is a mixed (medical) bag.

Author Brendan Reilly, M.D. starts his book in the wee hours of a typical on-ser-vice day in a busy New York hospital, and we’re treated to a whirlwind of intriguing medical cases, AHA! moments, and solu-tions worthy of a Sherlockian novel. The end of that long day, and the cases of his own parents, are where Reilly wraps up.

I would have been more enthusiastic about this book, had that been the sum of it.

No, instead, the middle third here is taken up by the story of a couple that Reilly knew some 30 years ago, the care of which still resonates in his career. That was interesting at first, but I thought it be-came overly long.

And yet, I did enjoy this book, over-all, and I think lovers of medical dramas will, too. If that’s you, and you’re maybe willing to skip bits that lose your interest, then One Doctor tests out well.

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.

information you get in the hands of our physicians and hospitals, the better off we are,” he said.

While the immediate future brings many challenges, Becker said the message of the annual meeting was a hopeful one. “This is the constructive destruction of the health system as we knew it. It will be very different going forward.”

As for the THA’s role in helping hospitals shift to population manage-ment models, Becker succinctly noted, “It’s coming, and we’re here to help you do it.” He continued, “We’ve really put an increased emphasis on quality. We’ve put an increased emphasis on education and on sharing best practices and process improvement data. Our data is all geared toward giving transparent information to our members so they understand how they stack up against others.”

He added the THA has also been hands-on in helping hospitals help their patients. In a move unique among hospi-tal associations, Becker said, “We actually took $3 million out of reserves and put it aside for grants for hospitals to enroll peo-ple in the exchange.”

He continued, “We touch 350,000 uninsured people every year in our emergency rooms.” Becker noted iden-tifying those who qualify for the federal exchanges and getting them covered is a win/win for families and facilities. Hos-pitals have until the end of November to apply for the grants.

“We’re excited to have a good oppor-tunity to give back to our members and hopefully help our hospitals get ahead of the curve in signing people up,” he said.

Despite the obvious pain points that come with transformational change, Becker and his staff are keeping an eye on the prize. “We’ll have a far better health-care system once we get to the other side,” he concluded.

Tennessee Hospital, continued from page 9


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For East TN Medical News advertising information please contact:Cindy DeVane: [email protected] or 423.426.1142

Sharon Dobbins: [email protected] or 865.599.0510

Stay on top of local, regional,and national medical news with

EAST TN MEDICAL NEWS IN 2014.

MONTH CLINICAL FOCUS BUSINESS FOCUS

January Public Health Financial/Tax PlanningFebruary Cardiology Mergers & AcquisitionsMarch Stroke Healthcare Design/ConstructionApril Diabetes/Wound Care ICD-10May Women’s Health Health Information TechnologyJune Rural Health Practice ManagementJuly Pediatrics Health ExchangesAugust Ortho/Sports Med. Physician/Hospital AllianceSeptember Oncology Medicare/MedicaidOctober Senior Health ReimbursementNovember Radiology/Imaging Health Education

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

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

JOHNSON CITY MGMA MONTHLY MEETING

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

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

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

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Make plans to attend the Kingsport MGMA holiday party on December 19th!

Frontier Health Nets American Graphic Design Award

JOHNSON CITY — Frontier Health received an Award of Excellence from Graphic Design USA in their annual 2013 American Graphic Design Awards for Frontier Health’s 2012 annual report, “Re-covery, Success & Independence.”

Only 15 percent of the more than 8,000 entries were recognized for their excellence. The American Graphic De-sign Award is the original and flagship competition of Graphic Design USA, New York. For five decades, it has sponsored design competitions that spotlight areas of excellence and opportunity for creative professionals. It’s open to advertising agencies, graphic design firms, corpora-tions, associations, government, universi-ties, publishers and more.

Graphic Design USA honors out-standing new work across all media: print and collateral, advertising and sales promotion, packaging and point-of-pur-chase, internet and interactive design, broadcast and motion graphics, corpo-rate identity and logos, internet and inter-active design, and broadcast and motion graphics.

Appalachian Christian Village Announces Purchase of New Resident Transport Bus

JOHNSON CITY – Appalachian Christian Village (ACV), one of the first established Continuing Care Retirement Communities in East Tennessee, an-nounced that it has purchased a new bus to help transport its residents to and from ACV and the outside community. The bus includes accommodations for six ACV wheelchair residents.

The six-passenger wheelchair acces-sible Ford/Starcraft Allstar bus is expect-ed to arrive at ACV within the next two months. The bus also includes 12 fold-

away seats.“We are highly anticipating its ar-

rival,” said Angie Gibson, ACV Director of Sales. “We are especially pleased that we can now provide our wheelchair residents an opportunity to go out on van rides and visit local restaurants and other Johnson City community landmarks.”

Gibson noted that a portion of the new bus purchase was funded by the generous response of ACV’s donors in its Spring Appeal 2012 letter, a yard sale that ACV held at Pine Oaks in October 2012, and a Silent Auction fundraiser that the community held in December 2012.

Bulawa Joins Internal Medicine Practice at TMA

GREENEVILLE – Dr. Erick Bulawa, who is board-certified in both internal medicine and pediatrics, has joined Takoma Medi-cal Associates (TMA).

Bulawa is working in the internal medicine prac-tice with Dr. Candi Over-holt, Dr. Katherine Gray, and nurse practitioner Lori Grabner. His office is located on the sec-ond floor of the TMA building at 438 E. Vann Road.

Bulawa graduated from medical school at SUNY Health Science Center at Syracus, N.Y. He completed a com-bined residency in internal medicine and pediatrics, followed by a chief residency program in pediatrics at Albany Medical Center Children’s Hospital. Bulawa has more than 18 years of experience work-ing in internal medicine and pediatrics. He specializes in diabetes, obesity, and complex medical conditions.

Bulawa lives in Greeneville with his wife and four children. They enjoy golfing and attend Notre Dame Catholic Church.

Raudat joins MSMG Cardiovascular/Thoracic Surgery

JOHNSON CITY – Cardiovascu-lar and thoracic surgeon Charles Wil-liam Raudat, DO, FACS, FCP, has joined Mountain States Medical Group Car-diovascular/Thoracic Sur-gery in Johnson City. He was most recently with a multi-specialty practice in the southern tier of New York where he practiced as a cardiovascular and thoracic surgeon and was chairman of vascular surgery and program director of the general surgery residency.

Raudat received his medical degree from Philadelphia College of Osteopathic Medicine in Philadelphia. He completed his residency at Fairview General Hospi-tal in Cleveland, Ohio, and a fellowship at University of Missouri Hospitals and Clin-ics in Columbia, Mo.

Raudat’s primary cardiac surgery in-terest is aortic valvular disease. He also specializes in thoracic oncology, diseases of the chest and esophageal pathology and has extensive experience in vascular surgery, including peripheral artery dis-ease, carotid arteries and endovascular management of aortic aneurysms.

He is board certified by the American Board of Thoracic Surgery and the Ameri-can Board of Surgery, and is a member of the American College of Surgeons, the American College of Chest Physicians, the American Medical Association and the Society of Thoracic Surgeons.

He will practice with Cardiovascu-lar/Thoracic Surgeons at 310 N. State of Franklin Road, Suite 101 in Johnson City.

Blackwelder installed as president of American Academy of Family Physicians

JOHNSON CITY – Dr. Reid Black-welder, a professor of Family Medicine at East Tennessee State University’s James H. Quillen College of Medicine, has been installed as president of the American Academy of Family Physicians (AAFP).

Blackwelder, who is director of the Medical Student Education Division for the ETSU Department of Family Medi-cine, won election last year to a three-year term by the AAFP Congress of Delegates, and he served the previous year as presi-dent-elect. As president, Blackwelder will advocate on behalf of 110,600 physicians and medical students who are members of the AAFP, in an effort to inspire posi-tive change in the U.S. health care system. The AAFP installed new officers last week at its annual conference in San Diego.

A member of the university faculty since 1992, Blackwelder has long been a respected family physician at ETSU’s Fam-ily Physicians of Kingsport, and his dedica-tion to education at the Quillen College of Medicine has led to several teaching awards from colleagues, students, and medical residents.

A graduate of the Emory University School of Medicine, Blackwelder is widely recognized for his expertise on comple-mentary medicine and patient-centered medicine. His commitment to family medicine was formed early in his career, when he served in the National Health Service Corps for many years as the only physician in a small Georgia town of 1,400 residents.

Wilson Joins Wellmont Medical Associates as Family Medicine Physician with Passion for Wellness

BRISTOL, Va. – Dr. Rachel Wilson has joined Wellmont Medical Associates as a family medicine physician, bringing a passion to trav-el with her patients on the lifelong wellness road.

Wilson, an osteopath-ic physician, sees patients of all ages at 410 Stage-coach Road off Exit 7 of Interstate 81. In delivering high-quality care, she also provides pa-tients an extra measure of convenience by taking care of them until 7 p.m. on Tuesdays and Thursdays.

Wilson graduated from East Ten-nessee State University with a Bachelor’s degree in biology. She completed medi-cal school at the Edward Via College of Osteopathic Medicine in Blacksburg, Va. and a residency at ETSU’s James H. Quil-len College of Medicine in the ETSU Fam-ily Physicians practice in Bristol, Tenn.

Wilson is a member of the American Academy of Family Physicians, the Ameri-can Osteopathic Association, the Chris-tian Medical and Dental Associations and the American Medical Association.

GrandRounds

Dr. Erick Bulawa

Dr. Charles William Raudat

Dr. Rachel Wilson


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Surgeon Creates Fund to Promote Community Safety as Holston Valley’s Level I Trauma Center Turns 25 Years

KINGSPORT—Holston Valley Medi-cal Center’s legacy of delivering high-quality trauma care and life-changing community outreach will continue to grow with a significant endowment from one of its surgeons that will promote a higher quality of life in the region.

To celebrate Holston Valley’s 25th anniversary as a Level I trauma center, Dr. George Testerman, one of the hospi-tal’s stellar trauma surgeons, has created a fund with Wellmont Foundation. This generous contribution from a highly re-spected physician, who has served at the trauma center since its inception, will be used for injury prevention and research initiatives.

Among the ways the George M. Testerman, MD, Injury Prevention Fund will help is the purchase of improved safety equip-ment for local high school sports teams, safety class-es for senior citizens, and more training for teenage drivers. Holston Valley’s trauma outreach team also plans to expand its role in the local pre-scription drug abuse battle.

Testerman joined representatives of Holston Valley’s administration and staff, as well as local emergency medical servic-es agencies, at a ceremony on Thursday, Oct. 10, to highlight his gift and the an-niversary. The event began with a demon-stration flight by WellmontOne Air Trans-port that illustrated the quality of care the trauma team renders every day.

Holston Valley’s strong interest in safety was also evident in its collaboration with the Kingsport Area Safety Council to secure Sullivan County’s designation in 2012 as a Safe Community by the Na-tional Safety Council. Sullivan County is the only county in Tennessee to earn this distinction through the Safe Communi-ties of America program.

Todd Norris, Wellmont Health Sys-tem’s senior vice president for system advancement and the foundation’s presi-dent, said Testerman’s contribution is a testament to the way communities are strengthened when they partner with their local health system.

Tim Attebery Named Interim President of Holston Valley Medical Center, Takes over Dec. 1st

KINGSPORT – Tim Attebery, who has provided stellar administrative lead-ership for the nationally recognized Wellmont CVA Heart Institute, has been named interim president of Holston Valley Medical Center.

Attebery is replacing Virginia Frank, who is retir-ing after serving as the hospital’s presi-

dent the last three years, effective Dec. 1. A committee has been formed to search for a permanent replacement to oversee Wellmont Health System’s largest hospital.

Since 2007, Attebery has served as administrative leader of the heart institute and the former Cardiovascular Associates practice and is currently Wellmont’s vice president of cardiovascular services.

During the interim period, oversight of the heart institute and Wellmont’s car-diovascular program will be handled by the remaining administrative, manage-

ment, and clinical leadership. That in-cludes Dr. Jerry Blackwell, the heart insti-tute’s president, and Dr. Herb Ladley, who will serve as vice president of cardiovascu-lar services.

Attebery oversees strategic develop-ment and the operational and financial performance of Wellmont’s innovative and frequently honored cardiovascular program, including its ambulatory, outpa-tient, and hospital-based operations. His 27-year healthcare career has included a variety of physician practice and hospital

leadership roles in administration and consulting in Indiana, Missouri, South Carolina, and Tennessee.

Now, Attebery will use his impressive skill set to lead Kingsport’s flagship hos-pital. He said it will be important to work with Holston Valley’s board of directors, medical staff, management, co-workers and community leaders to maintain the outstanding reputation and long-stand-ing tradition of superior quality, compas-sionate care, and patient service at the hospital.

GrandRounds

Dr. George M. Testeman

Tim Attebery


Nusrat will practice with her husband – Dr. Mansoor Tanwir, a Wellmont Medi-cal Associates endocrinologist – and Dr. David Hensley, a Wellmont Medical Asso-ciates family medicine physician. All three physicians are medical doctors.

In establishing a practice, Nusrat follows in the footsteps of her parents, a grandfather, and many siblings.

Nusrat was intrigued by the way the body worked and was amazed by the pro-cess of healing. She watched her parents assess a patient to determine the ailment and then prescribe a medication that im-proved his or her health.

Having earned her medical degree from Aga Khan University in Karachi, Paki-stan, Nusrat completed her residency in internal medicine and a fellowship in ne-phrology, with a renal transplant focus, at University of Pittsburgh Medical Center. She is certified with the American Board of Internal Medicine and eligible for cer-tification from the American Society of Nephrology.

HMG welcomes primary care provider Emily Campbell, MD

KINGSPORT, TN – Holston Medical Group (HMG) welcomes primary care provider Emily Campbell, MD, to HMG Internal Medicine and Pe-diatrics at Sapling Grove (240 Medical Park Blvd., Suite 3600, Bristol, TN 37620). She will be joining HMG primary care provid-ers Mary McCormick, MD, Rick Whiles, MD, and Can-dyce R. Poteet, FNP.

Additionally, Campbell will be serv-ing on the HMG sports medicine team providing care for the new HMG Sports Injury Clinic, Kingsport.

Board certified by the American Board of Family Medicine, Campbell re-ceived her doctorate of medicine from East Tennessee State University, Johnson City, followed by the completion of an internship and residency with the ETSU Department of Family Medicine, Bristol. Campbell’s advanced training includes a sports medicine fellowship with Wake Forest Baptist Health, Winston-Salem, NC. She has also earned a certificate of added qualification in sports medicine.

Additionally, Campbell’s education includes a bachelor of science degree in biology from Wofford College, Spartan-burg, SC, and a master’s of science in ex-ercise science from George Washington University, Washington, DC.

The recipient of numerous awards and academic honors, Campbell is a member of the American Academy of Family Physicians, the Tennessee Acad-emy of Family Physicians, the American Medical Society for Sports Medicine, and the American College of Sports Medi-cine.

Wellmont CVA Heart Institute Receives Bridges to Excellence Award from National Organization

KINGSPORT – The Wellmont CVA Heart Institute has earned another na-tional honor for its leadership in the de-livery of high-quality cardiovascular care in Northeast Tennessee and Southwest Virginia

The heart institute, which operates 15 offices in the region and provides care at Wellmont Health System hospitals, has received the Bridges to Excellence award from the Health Care Incentives Improve-ment Institute. The award recognizes cardiology practices that are committed to continuous quality improvement and safe, effective, patient-centered care.

The heart institute is the only entity

in the region and one of only 23 in the na-tion to have received the Bridges to Ex-cellence Cardiology Practice Recognition.

Nusrat Joins Wellmont Medical Associates as Internist, Church Hill Office

CHURCH HILL – Coming from a long line of physicians in her family, Dr. Ra-beeya Nusrat was a natural fit to enter the medical pro-fession.

Now, Nusrat, an inter-nist, is bringing her skills to the Tri-Cities area, where she will help adults achieve optimal health. She has joined Wellmont Medical Associates and will operate a primary care practice at the Church Hill office, 115 Garland Ave.

GrandRounds

Dr. Rabeeya Nusrat

Name: Steve Shaffer

Position:Volunteer, J.D. and Lorraine Nicewonder Cancer Center in Bristol and the Bristol Regional Medical Center Emergency Department

At a Glance: January will mark three years that Steve Shaffer has been volunteering at the J.D. and Lorraine Nicewonder Cancer Center, as well as at the Emergency Department at Bristol Regional Medical Center. Every Monday and Wednesday, Shaffer devotes his time to helping patients at these facilities who may not have anyone else to accompany them to their visit. While patients at both facilities range in age, for Shaffer, his decision to volunteer came out of his love for one particular group. “I guess I’ve always had a soft spot for older folks; I like to sit down and talk about past experiences,” he said. “Some of them who have no one else come in by themselves, so I really like to socialize with them and try to understand what they are going through because we might go through the same thing one day. I like to give them as much of my time as I can.”

Shaffer starts his shift by preparing snacks, coffee, and other refreshments, and then makes his rounds to ensure that everyone feels at ease, that breakfast and dinner orders have been put in, and that the patients are tolerating their meals, as some persons cannot tolerate food while receiving chemotherapy.

“I really care for them, and sometimes you get attached to them. The other volunteers and I realize that the patients are coming in to get better, but the therapy has to work on them first,” he shared. “Patients can get to a point where they are down, depressed, and just want somebody, even hunger for somebody, to sit down with them and just listen to what they are saying. I pride myself on being a good listener.”

Shaffer says that for him, all the reward or recognition that he needs comes from the very satisfying feeling that he has helped someone get through their troubling time because “they are in a lot of pain, and I love them all. On Wednesdays and Mondays, that’s what I get up for,” he said. “I guess you can say that I crave that interaction, too.”

Of course, Shaffer says he couldn’t do what he does without the support of the other volunteers. “We have a great group of volunteers,” he said. “They care, and they try so hard. There are days they come in and don’t feel so good, but they still give all they can, and we just make each other laugh.”


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Seasons’ OB/GYN Jeffrey A. McQueary, MD, FACOG, receives board certification in female pelvic medicine and reconstructive surgery

BRISTOL, TN – Women’s health spe-cialist Jeffrey A. McQueary, MD, FACOG, of Seasons at Bristol (320 Bristol West Blvd., Bdg. 1 – Suite 2B, Bristol, TN 37620) is now one of only two ob/gyns in the region to achieve board certification in female pelvic medicine and reconstructive surgery. McQueary passed the board on June 21, 2013.

Known by his colleagues and pa-tients as an accomplished women’s health surgeon who often introduces leading-edge surgical techniques to the region, McQueary’s additional board certification will allow Seasons to expand its current offerings for reconstructive pelvic surgery.

Board certified by the American Board of Obstetrics & Gynecology, Mc-Queary received his doctorate of medi-cine from Loma Linda University School of Medicine in Loma Linda, Calif., and completed his residency at the Medical College of Virginia in Richmond, Va. Ad-ditionally, McQueary earned a bachelor of science degree from Pacific Union Col-lege in Angwin, Calif.

McQueary’s special interests in-clude urinary incontinence and pelvic prolapsed. He is also very experienced in minimally invasive da Vinci robotic surgery, with over 150 procedures per-formed.

Seasons at Bristol is a division of Holston Medical Group.

For more information, visit www.sea-sonsforyou.com.

HMG welcomes Fatemeh Yamani, MD, MPH, to HMG Urgent Care

KINGSPORT – Holston Medical Group (HMG) welcomes Fatemeh Ya-mani, MD, MPH, to HMG Urgent Care. Yamani will be serving at both HMG Ur-gent Care at Sapling Grove and HMG Ur-gent Care at Medical Plaza .

Board certified by the Educational Commission for Foreign Medical Gradu-ates (ECFMG), Yamani received her doc-torate of medicine from Tehran University in Iran. After operating her own practice in Azna, Iran, and being recognized by the Social Security Organization as “Best Doctor” in the Azna Clinic two years in a row, Yamani came back to Tehran to con-tinue her work in private practice.

Following a number of years in pri-vate practice, Yamani returned to the United States to further her education and work in clinical research. She received a Master of Public Heath degree from the University of California, Los Angeles, Cal., and completed her residency at East Ten-nessee State University Family Medicine in Kingsport, Tenn. Yamani is now a United States Citizen and brings years of experi-ence as a physician to HMG Urgent Care.

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GrandRounds

Dr. Jeffrey A. McQueary

Hope is close to home.

www.msha.com/cancer

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

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

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

Hope is close to home.

www.msha.com/cancer

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

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

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

Documents

Tri Cities Medical News Nov 2013