east tn medical news january 2014

Kristan Ahler, MD

PAGE 3

PHYSICIAN SPOTLIGHT

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HEALTHCARE LEADER: Michael SuttonHome is where the healthcare is, or at least in Michael Sutton’s case. Newly appointed vice president of fi nance of Memorial Health System, Sutton has always called Chattanooga home ... 5

ENJOYING EAST TENNESSEE:Departure – Spartina 449 – Daufuskie Island If a mermaid’s siren song can lure one away, then it’s the perfect logo for a line of purses and accessories named Spartina 449 and the topic for a departure themed column ... 7

(CONTINUED ON PAGE 5)

By CINDy SANDERS

As the clock ran down on 2013, a number of deductions healthcare providers have come to depended upon to lessen their tax burden expired. Last year also saw an increase in federal tax rates, including higher taxes on investment income and capital gains. This combination has accountants nationwide bracing for a widespread outbreak of severe sticker shock come April 15.

Tom McGuinness, CPA, CVA, of Reimer, McGuinness & Associates, PC in Houston said his fi rm has run tax scenarios for high net worth individuals for more than a year. “We’re doing this as a service to prepare you for the blow … but the blow is coming,” he stated. For one client whose income hit the $2 million mark, there was a six-fi gure difference in taxes owed. “Looking at 2012 actual income data, the tax differential was 22 percent,” McGuinness said of the $860,000 that would be owed for 2013 as compared to $706,000 for 2012. “It is real money.”

He added that many of the changes in 2013 and 2014 will hit healthcare professionals and providers both

Changes to Tax Code Impact the Bottom Line at Work and Home


For generations, the Southerland family have lived and died in the tiny town of Wash-burn, Tennessee. The rural community, nestled in the Clinch Valley, has barely over 2,500 residents. There’s no police station or even a red light. The closest city, Rutledge, is over Clinch Mountain, some 15 miles away.

“It’s very rural country,” said Karen Cullom. “My mother’s family, the Southerlands, have probably been in Washburn over a hundred years. Going back from my mother, Pauline Southerland, her mother, and mother before them.”

Karen also raised her daughter, Laken Bailey, in Washburn. The Southerland women are close knit and share many family traits and traditions. However, one family tradition the women have fought to break is the cycle of obesity.

Food and family go hand-in-hand, especially in the south. Families share meals and pass along favorite recipes. Unfortunately, they often pass along unhealthy ways of cooking and eating.

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ClinicallySpeakingBY JONATHAN H. RAY, MD, FACS, FASMBS

Bariatric Surgery Helps Family Break Tradition of Obesity

Since bariatric surgery, the Southerland family has adopted healthier ways of cooking and living. Pauline (seated), Laken (left), and Karen have lost more than a total of 200 pounds.

2 > JANUARY 2014 e a s t t n m e d i c a l n e w s . c o m

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“Regions is always there when I have questions. My relationship with my Regions banker is personal and I have her on my speed dial.”

What started as a single location has grown to three with a full-time staff of 17 employees. These days, the Miami Dermatology Center utilizes a wide range of Regions banking tools, from Business Analyzed Checking and Treasury Management to loans and lines of credit.Dr. Leal-Khouri plans to expand parking at her Coral Gables location, and Regions is part of those plans too. To learn more about the Miami Dermatology Center and how Regions can assist your business, visit regions.com/success.

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PhysicianSpotlight

By JOE MORRIS

Many students arrive at medical school with the dream of becoming a gifted surgeon, and Kristan Ahler, MD, was no different. Like many others, she soon found out that her talents lay in other areas of medicine. In Ahler’s case, that was pathology.

“I originally thought about neurosurgery, and then once I got to school, I became interested in general surgery,” recalled Ahler, who received her medical de-gree from Mount Sinai School of Medicine after receiving a Bach-elor’s in biology from Brandeis University. “So I began my resi-dency training, and there was a position at the University of Ten-nessee Medical Center. The first year was great — I loved taking care of patients and working in the operating room. Then came the sec-ond year, and I was allowed to actually operate. I was very nervous, and I have always been kind of a klutz, so I realized pretty quickly that I was not the best per-son to do surgery.”

She’d already done a lot of course-work in pathology, and there were several aspects about it that appealed to her as she cast about for a new direction.

“I could be near the operating room and work with surgeons, but not be doing the same thing they were,” she explained. “And once I started, I realized that this was indeed the best field for me. It’s better suited for my personality because I really like working on puzzles and problem solv-ing.”

After finishing her residency (includ-ing time as Chief Resident) at UT Medical Center, she became the Chief of Pathol-ogy and Laboratory Services at Roane Medical Center, where she is a one-doc-tor practice and heads up a small staff to handle lab and pathology services.

All her skills at independent thinking were quickly called into play, as running a small department in a smaller hospital, even one operating out of a new facility such as Roane Medical Center, is not without its challenges. For example, a reg-ular day entails supervising lab testing and making sure all resources are well utilized, but also getting out in front of practitio-ners to make sure they avail themselves of the full range of pathology services.

“I have to promote the lab, and that means getting more involved with the sur-geons than I might be if I were at a bigger hospital or practice,” she said. “I’m not just back here doing microscope work. I’m on a lot of committees and want to make sure that everyone knows what we can do because I am committed to this hospital,

and to our patient care.”

In the main, that means producing re-sults and doing so very quickly, but Ahler says she and her staff are up to the challenge.

“Most of my time is spent dealing with the specimens that come from surgery and doctors’ offices,” Ahler said. “We ex-amine them and dissect them if necessary. We don’t do any autopsies here, so really it’s just about telling the doctors what

we’ve found so they can figure out what to do next. That’s the nice thing about pathology: we help both the doctors and the patients, and so I play a multiple role here at the hospital.”

That’s not likely to change, as healthcare reform continues to affect how hospitals and doctors operate, she adds.

“I think that all of us, in-cluding pathologists, are going to have a much bigger role mov-ing forwards,” Ahler said. “We have to do more with the same amounts of money. Doctors want to order more tests, or patients want them done, so we have to be more efficient. Lab directors can help shepherd that along. We know what the best uses of the lab, and of the tests, are. We can get involved on the front end, get everyone to wait for the results of one test before doing another one.”

Working in a smaller facility plays into her favor in this regard.

“At some large hospitals, doctors don’t even know who the pathologist is,” she said. “Here, I am as intricately involved as I need to be. That’s also something our organization, the College of American Pathologists, is really starting to promote. Know your

doctors, and that will help both in terms of assisting patients and managing re-sources.”

As a pay-for-performance model be-

comes the norm, she sees doctors want-ing to get more tests done to narrow their treatment options more quickly, so bal-ance will be key.

“People don’t like the idea of some-one looking over their shoulder, but we all went into medicine to provide great care, and that means being efficient but also not wasting time. What has to happen is we must communicate with each other bet-ter,” she said.

In addition to working with existing staff, Ahler is on staff as a clinical instruc-tor at UT Medical Center’s pathology department, and students from various disciplines, as well as new staff, frequently visit her lab. That, in turn, renews her de-sire for one specific capital improvement.

“I really want to get a multiheaded microscope in here,” Ahler said. “We don’t even have a two-headed one, so two people can look at a slide simultaneously. I really want one of those, so we can do even more teaching.”

She’d also like to get to more confer-ences, she said, because the field of pathol-ogy continues to develop and she says she wants to share her successes with young doctors, especially women, who may be giving it a look.

“If you like solving puzzles, if you’re never tired of trying to figure out the an-swer, then this is good for you,” she said. “There are a lot of women in this field because it allows for the time to have children because you’re not working a surgeon’s schedule. I’m on call, of course, but I’m my own boss, and that’s a good place to be.”

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Being Prepared for Life’s Transitions: Separation and Divorce

BY WILLIAM M. MORRIS, CDFA, CERTIFIED DIVORCE FINANCIAL ANALYST, UBS FINANCIAL SERVICES INC.

In addition to the emotional impact, separation and divorce can have a financial impact when assets, debt, and other financial connections need to be divided. The negative financial impact that separation and divorce can have has been written about extensively, and as with any major life transition, preparation is key. This article will discuss a few key issues that can have a large financial impact on both parties.

Maintaining financial security for all involved should be the focus. States often have laws regarding separation of property; however, failure to understand your state’s divorce law could also potentially impact the division of retirement plans, alimony, and child support. Following are some of the critical financial issues you and your spouse will need to consider during separation and divorce.

Dividing assets: In common law states, all property acquired by you or your spouse from marriage onward is subject to division. The intention is that property will be distributed equitably, but not necessarily equally.

A court will consider the length of the marriage, earnings potential, responsibilities for children, debt, and tax consequences in dividing assets.

However, in the nine community property states (Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, and Wisconsin), almost all assets are divided equally. Assets acquired before marriage, gifts to an individual spouse, and individual inheritances are not subject to division in both common law and community property states.

Marital debt: In common law states, in general, you are responsible for your individual debt and any debt in jointly held accounts and are not responsible for the individual debt of your spouse. However, in community property states, you will be responsible for half of all debt in jointly held accounts and potentially half of your spouse’s individual debt. You will be accountable for half of your spouse’s individual debt so long as that debt is for the “general benefit” of the marriage.

Retirement accounts: Funds accumulated over the course of a marriage are subject to applicable common land community property laws and may be subject to division during a divorce. If your employee benefit or pension plan is subject to ERISA (Employee Retirement Income Security Act), you will need to obtain a court order called a Qualified Domestic Relations Order (QDRO) and provide it to your spouse’s plan sponsor before distributions are completed to your spouse. The QDRO directs the plan sponsor to pay to your spouse all or a portion of the participant’s plan benefits, subject to the terms of the Plan.

Individual retirement accounts (IRAs) are subject to the Internal Revenue Code rules for transfers incident to divorce which does not require a QDRO, but does require a decree issued by a court in order to transfer assets between the IRAs of the spouses. The transfer incident to divorce rules can be applied before a divorce is finalized as long as there is a court order regarding separate

maintenance and the division of the IRA.

In addition to dividing retirement funds, do not forget to update your beneficiary designations. Although a number of states have enacted statutes that automatically revoke beneficiary designations of an IRA upon divorce, some states have ruled that an ex-spouse is entitled to the IRA where the beneficiary designation is not updated. To avoid this scenario, discuss with your financial advisor or company’s benefits department to update your beneficiary designations upon divorce.

Having legal and financial advisors on your side is important to help educate you on your choices, advocate for your best interests, and protect your financial future for years to come.

This article has been written and provided by UBS Financial Services Inc. for use by its Financial Advisors. Neither UBS Financial Services Inc. nor any of its employees provide legal or tax advice. You should consult with your personal legal or tax advisor regarding your personal circumstances. For more information, please visit our website at www.ubs.com/workingwithus.

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

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Charismatic, Compelling, Charming—Chee-Yun

featuring Chee-Yun, ViolinSaturday, February 8, 7:30 p.m.

sponsored by Ralph and Deborah Van Brocklin Mary B. Martin Auditorium at Seeger Chapel, Milligan College

Violinist Chee-Yun’s flawless tech-nique and compelling artistry have enraptured audiences on five conti-nents. Deeply passionate about her art, Chee-Yun continues to carve a unique place for herself in the ever-evolving world of classical music. Chee-Yun’s first public performance

at age 8 took place in her native Seoul after she won the Grand Prize of the Korean Times Competition. At 13, she came to the United States and was invited to perform with the New York Phil-harmonic. Two years later, she appeared as soloist with the New York String Orchestra. In 1989, she won the Young Concert Artist’s international competition, and a year later became the recipient of the prestigious Avery Fisher Career Grant. In addition to her ac-tive performance and recording schedule, Chee-Yun gives master classes around the world and has held several teaching posts at notable music schools and universities.

Evening ProgramLudwig Beethoven: Overture to “Egmont”

Wolfgang Amadeus Mozart: Symphony No. 40 in G minorJohannes Brahms: Concerto for Violin in D Major


“Good country cooking with lots of butter and lard,” ex-plained Karen. “My Granny couldn’t fix green beans without adding a spoonful of lard. That’s what we ate.”

And with a diet that included lots of fat, sugar, and salt, Karen, her mother Pauline, and daugh-ter Laken, packed on the pounds. The turn-ing point came when Karen needed knee surgery at age 39.

“The doctor said to have the knee replacement, I had to lose a lot of weight first,” said Karen. “He recommended bar-iatric surgery.”

Karen attended one of our Foothills Weight Loss Specialists’ surgical seminars and started the process of becoming a bar-iatric surgery patient. I performed a gastric bypass on her in February of 2010. In this procedure, the small intestine is rerouted to a smaller stomach pouch, thereby limiting the amount of food a person can eat and reducing calorie absorption.

The surgery was life-changing for Karen. “My quality of life was better. I lost over 100 pounds and could breathe better, and had more endurance,” said Karen. “Just walking across the parking lot or up the stairs, my knees felt better.”

Karen wanted the same success for her mother and daughter. “My Mom was my support person, and I encouraged her to do the surgery. I knew it could also help Laken. She was so young, and I think she was scared to acknowledge she had a weight problem.”

Twenty-year-old Laken was reluctant about the procedure. “I had been over-weight my whole life and gained more after I had a baby,” said Laken. “I was scared to do surgery, but I saw how much it helped my Mom.”

Laken and her Grandmother, Pauline, attended a seminar at Foothills Weight Loss Specialists to learn more about bariatric surgery.

“I wanted to get off my cholesterol and blood pressure medicine,” said Pauline. “Laken and I decided to do the surgery process together.”

Grandmother and granddaughter be-came teammates, with Karen cheering them on. Laken underwent gastric-bypass in De-cember of 2011 and Pauline had the same procedure a month later. Adjusting to the surgery and a new way of eating wasn’t easy.

“I had my surgery right before Christ-mas, and it was terrible lying there drinking protein shakes, while everyone ate casse-roles and cake,” remembered Laken.

But, as the weight came off, Laken, her mother, and grandmother encouraged each other to exercise and to stick to their healthier diets. “We realized we all did best when we fix and eat our food together,” said Laken.

Foothills Weight Loss Specialists’ dietician taught the women new ways to cook.

“We learned how to fix food better,” said Karen. “We get fresh vegetables from our gar-den. Instead of frying with lots of butter or lard, now things are steamed or

baked.”And, the women eat differently. “I

can’t eat ice cream at night anymore,” said Pauline. “I carry little 100 calorie snacks with me and avoid the foods I can’t eat.”

At a follow-up visit at our office in Au-gust, Laken had lost 60 pounds and Pauline nearly 50 pounds. Both enjoy being able to move more easily with their new, lighter bodies.

“At Myrtle Beach, I parked and walked six blocks to play putt-putt with my great-grandson,” smiled Pauline.

And Laken is determined that a healthy lifestyle, not obesity, is the family tradition she passes on to her young son.

Jonathan H. Ray, MD, FACS, FASMBS, is a bariatric surgeon for Foothills Weight Loss Specialists, a division of Premier Surgical Associates. Ray is board certified by the American Board of Surgery. He is a fellow of the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery. He is a member of the Society of American Gastrointestinal and Endoscopic Surgeons. For more information, visit http://www.foothillsweightloss.com.

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HealthcareLeader

Michael SuttonBy BRIDGET

GARLAND

Home is where the healthcare is, or at least in Michael Sutton’s case. Newly appointed vice president of finance of Memorial Health System, Sutton has always called Chattanooga home and discovered soon after starting his career in accounting that his niche might be in healthcare. Sutton earned a Bachelor of Science in Accounting from the Univer-sity of Tennessee at Chattanooga in 1993, and five years later, an MBA as well. As Sutton pointed out, most graduates with an accounting degree typically go into public accounting, which he did for about three years, but after talking with a friend about the need for local Medicare audi-tors, Sutton’s interest was piqued.

His first job in healthcare as a Medi-

care auditor lead him to his next position as the director of reimbursement for a health management company, which in turn introduced him to Memo-rial.

Since joining Memo-rial in 2000, Sutton has worn many hats, beginning as manager in the office of

accounting and reimbursement and then director of costs and reimbursements. While his various positions have mostly centered around numbers and finance, Sutton has also overseen process improve-ment and lean implementation.

As executive director of revenue cycles, which he served as for nearly five years, Sutton created new system effi-ciencies and cost savings, a notable ac-complishment in the healthcare industry. This past August, he was promoted to vice president of finance, bringing with him his

valued service history with Memorial. When asked to identify his biggest

challenge, Sutton noted that it is also what makes his job enjoyable: change.

“One of the things I do enjoy is that healthcare is always evolving–and evolv-ing rapidly over the next few months. And over the next four or five years to come, the payment system—how hospitals have traditionally been paid—will be chang-ing,” Sutton explained. “So although that is the part I do like about my job, that’s also the biggest headache, that it’s ever changing. You have to always be adaptive to change and be willing to move forward with healthcare reform, healthcare pay-ment change, or to move into some type of accountability care organization, what-ever healthcare is moving toward.”

As Sutton remarked, healthcare is currently moving in a different direction, as it has to move away from the traditional fee-for-service type of model to “more of a model where both the community and the

hospital and the patient take responsibility for their health,” he said.

Sutton believes that Memorial is well-positioned for embracing the changes that are coming. “The good thing about Memorial is that it’s part of the Catho-lic Health Initiative, which is a much larger organization. It does have a lot of resources to help move the organization forward, in that respect, so it isn’t just us here locally, but both of us, with Catho-lic Health Initiative being able to look at the scope of healthcare changes from East Coast to West Coast.”

And while some people in healthcare may not feel very optimistic about the fu-ture of healthcare, Sutton has maintained a positive outlook. “It’s a dynamic time in healthcare, an exciting time,” he said. “You can either look at it as a glass half empty or a glass half full, and I like to look at it as half full.”

Outside of his career, Sutton stays busy at home, as he and his wife of 15 years, Becky, have two daughters, Harper, 14, and Maggie, 11.

“Life can be a balancing act,” mused Sutton, “between all of the activities the girls are in, from basketball, to volleyball, to soccer, to travel volleyball. When I do have time for myself, I enjoy golf; I can just get away from everything. It’s good stress relief when you deal with numbers all day.”

Bariatric Surgery Helps Family, continued from page 1

Before Gastric Bypass surgery: (from left) Pauline Southerland, daughter Karen Collom and granddaughter Laken Bailey.


By HEATHER RIPLEy

A public relations crisis can occur when your business becomes the target of unwanted negative attention. This can be due to a questionable statement from an executive, a problem with a product, negative comments about your business on social media, or many other potentially damaging events.

A good example of an on-going public relations crisis is the adverse publicity surround-ing the Affordable Care Act. I doubt there is anyone left in America who hasn’t heard about the Affordable Care Act website debacle. Newspaper headlines, magazine articles, Facebook, Twitter, and news websites announce new prob-lems with the ACA website, it seems, on a daily basis.

Add to that President Obama’s “misstatement” that all Americans can keep their existing insur-ance plans if they like, only to backtrack later, admitting that what he said was not entirely true. There was a media frenzy about this factual error, and it was an em-barrassing moment for President Obama.

Many Americans were disappointed to find that they could not, in fact, keep their existing insurance.

While Obama is still being dogged by his misstatement, the government took a huge hit from the media and the public for the problems that are still plaguing the website. However, even when the

blame was eventually placed on the contractor who produced the website, the public finger-pointing is continuing.

The lesson from all of this is: when there is a PR nightmare for one busi-ness, associated business partners can get tangled up in the mess, too. A business-to-business (B2B) PR crisis can affect more than just the businesses involved and could

trickle down to the consumer level if not addressed and neutralized

using a pre-planned and cross-platform PR crisis strategy.

Think of the govern-ment as your business and

the ACA website contrac-tor as a B2B partner. Could the

government’s communications specialists have done a better job in

avoiding this whole PR fiasco in the first place? Absolutely. The facts could

have been validated more thoroughly, timelines could have been verified and checked more carefully and the reputation of the website developer could have been investigated with

more diligence than it appears it was.

In addition, there should have been a PR crisis plan of ac-tion with a flowchart detailing

a step-by-step process to “manage” a potentially damaging PR disaster like this. Who to call, what to do next, how to respond, and where and, well, you get the idea. Because I have created and im-plemented B2B crisis strategies for many businesses facing PR disasters (or potential disasters) I highly recommend businesses engage a reputable public relations agency

experienced in crisis management.Or, you can take steps to avoid a PR

crisis in the first place by following these suggestions:

Make sure your team members responsible for checking facts double- and triple-check everything that is said, printed, or published via all media outlets, even private business documents or meet-ings. In today’s social world, one simple misstatement or error can go viral in liter-ally minutes.

If you, your brand, or your spokes-person makes a mistake, own up to it as quickly as possible on as many appropriate channels as possible. Before sending out a press release or posting to Twitter or Face-book, make sure the message is the same. Some brands that have made big mistakes have put statements on the first page of their website to make sure the brand’s or executive’s message is loud and clear.

Stay on message throughout the cri-sis. Don’t let media try to move the con-versation away from the issue at hand through “crisis creep.” This is easiest to accomplish with one specific spokesper-son - either a media-trained executive, a designated spokesperson, or a reputable public relations agency - so that managing

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By LEIGH ANNE W. HOOVER

If a mermaid’s siren song can lure one away, then it’s the perfect logo for a line of purses and accessories named Spartina 449 and the topic for a departure themed column. Featured in ev-erything from Southern Living, Good Housekeeping, Oprah’s “O”, People and many, many other publications, the color-ful line of women’s accessories, which benefits the Daufuskie Is-land, South Carolina, Historical Foundation, can take you away from the dreary doldrums of January.

Named for many of the dusty roads of Daufuskie Island, landmarks, and island notables, the now infamous line of wom-en’s accessories can be spotted in boutiques and specialty stores worldwide. Owning a classic purse or Spartina accessory can take your mind on vacation to the barrier island, which lies between Hilton Head Island, South Caro-lina, and Savannah, Georgia, and is accessible only by boat.

For the past two years, this January “Departure” column has featured memo-ries of Daufuskie. Last year, I interviewed artisan Chase Allen of the Iron Fish Gal-lery, and ironically, one of the very first photo shoots for Spartina was actually on the front porch of the Iron Fish.

The “brain child” of Kay Stanley and husband Curt Seymour, Spartina was launched in 2009 after the couple sold their K &Company scrapbook busi-ness and moved permanently from Kan-sas City, Missouri, to South Carolina. Although the business actually operates out of an office on Hilton Head, inspira-tion for the Spartina line certainly origi-nates on Daufuskie, and it has made a “big splash” in the fashion industry.

Spartina is the name of the marsh grass that grows on the island. It makes me smile to see the recognizable mermaid logo and the tag about the Daufuskie Is-land Historical Foundation, which is a nonprofit 501(c) 3 organization estab-lished to preserve the island’s history and cultural heritage, affixed on each and every piece in the line.

“Since we started, every pattern has been named after a story, or a landmark, person or place that is on Daufuskie,” ex-plained Spartina Cofounder Kay Stanley. “That is because I love the island, and I think there’s so much there to tell about the island. It’s a neat way to get the retail-ers that we sell to as well knowledgeable about Daufuskie. In turn, they can share these stories with the consumers…”

The Spartina creative team, along with Stanley, meets and selects the names and the island stories that will be shared

with each new product. She says one of her main resources is the book “An Is-land Named Daufuskie” by the late Billie Burns, often referred to as “the mother” of Daufuskie.

Burns lived on Daufuskie for over 50 years and served as the school bus driver and postmaster. She was also instrumental in the Daufuskie Island Historical Foun-dation, and, in 2004, the museum was dedicated and named in her honor.

Her book took over 20 years to com-pile and was originally published in 1991. It captures island history and antidotes,

which are now forever pre-served for future genera-tions. In the book’s preface, Burns credits God’s inspira-tion to fulfilling the project.

“I never met her, and I wish I had,” said Stanley. “It [the book] sits on my confer-ence table, and we refer to it all the time.

Made from French linen and leather, Spartina launches nine different pat-terns a year. Names such as Maggioni (the infamous oys-ter family behind Daufuski without the “e”) Oysters; Calibogue, which is the body of water around the island;

Yemassee Trail, from the early Native American inhabitants; and iconic island names like Ms. Billie, Sallie Ann, and my favorite, Callahan, which is named for New York Times bestselling author and friend, Patti Callahan Henry, grace the colorful pattern designs.

Each pattern name has significance to the island, and each gives a little clue to the story of Daufuskie.

“We’ve shot all of our location shots on Daufuskie Island since we started the company,” said Stanley. “We just did a pattern called the Strachan, and we have

the model with the bag, and you can see the Strachan Mansion behind it in the photograph.”

According to Stanley, Spartina is growing and is now sold in 1,500 stores

worldwide, including Japan and Australia. The line is also available in the Baha-mas, the Caribbean, and aboard cruise ships.

Each Spartina product shares the mermaid and also a little something about Daufuskie.

In addition to hand-bags, which are available

in numerous shapes and sizes, the line also includes accessories, scarves, jewelry, resort wear, and more products available in color-ful, island influenced featured patterns.

Stanley is truly enamored with the history of Daufuskie, and through Spar-tina, she continues to share its allure with the world.

“I just love that island,” explained Stanley. “I do. There are just so many stories.”

For additional information about Spartina, visit https://www.spartina449.com/

Also visit the Iron Fish Gallery online at http://www.ironfishart.com/ and the Daufuskie Island Historical Foundation at http://www.daufuskieislandhistorical-foundation.org/

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].

Enjoying East TennesseeDeparture – Spartina 449 – Daufuskie Island

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as businesses and as indi-viduals. McGuinness said at the beginning of 2013, Congress was upset about the fi scal cliff and proud of themselves for ‘fi xing’ it. However, he contin-ued, as 2013 tax bills come due, “It’s going to be the taxpayers turn to be mad because they are going to see how the fi scal cliff was avoided.”

Key Business ChangesBenefi cial depreciation options take

a big hit in 2014. Changes to expensing qualifi ed purchases, bonus depreciation, qualifi ed leasehold improvements and a new IRS capitalization policy are all an-ticipated to impact many in the healthcare space.

“Congress did not extend the fa-vorable 179 deduction, which allows a taxpayer to expense im-mediately the cost of an otherwise capitalizable asset,” said Scott Tomi-chek, JD, CPA, senior tax manager for Carter Lankford CPAs PC, lo-cated in Tennessee. “The 2013 Section 179 deduc-tion was $500,000 for purchases up to $2 million and is set to be reduced to $25,000 for purchases up to $200,000 in 2014.”

Accelerated depreciation, which has been heavily used by healthcare providers and facilities to make equipment purchases more affordable on the front end was an-other incentive that expired at the end of 2013. Tomichek noted that on the pur-chase of capitalizable assets in 2013, a tax-payer was allowed to deduct 50 percent of that asset in the year of purchase and then depreciate the remainder. The accelerated 50 percent goes away in 2014 and reverts to the regular rules of a more even-based depreciation schedule without Congressio-nal intervention.

Another change is in the life of quali-fi ed leasehold improvements, which are defi ned as any improvement to an interior part of a building that is nonresidential property. “Qualifi ed leasehold improve-ments were able to be depreciated using a 15-year life and included in the previous Section 179 and bonus depreciation cal-culation in 2013,” Tomichek explained. In 2014, those improvements return to a 39-year depreciable life, which means the expenditures are depreciated at a much smaller annual amount over nearly four decades and no longer qualify for the other depreciation benefi ts.

Tomichek said the new IRS capi-

talization policy that went into effect on Jan. 1 is a bit of ying to the yang of losing the other deductions. “The most impor-tant part of the rule is the de minimis safe harbors that apply to not only improve-ments but to certain tangible property purchased,” he said. “The de minimis safe harbor allows a taxpayer to deduct pur-chases under a certain threshold. For tax-payers with audited fi nancial statements, the threshold is $5,000 per invoice or per item as substantiated by invoice. For those without audited fi nancial statements, the threshold is $500.” He noted that previ-ously, these qualifi ed items had to be de-preciated but now can be expensed, which is a tax benefi t. However, he added, “To qualify, the taxpayer must have a written accounting policy in place at the beginning of the tax year.”

Doug Funke, CPA, a partner with Honkamp Kroeger & Co. PC, a Mid-west regional CPA fi rm headquartered in Iowa, noted a number of other general 2014 tax changes could impact medical practices and hospitals. One example is the tran-sit benefit allowance. “The amount of transit fringe benefi ts that employers can provide to employees on a pre-tax basis for using public transportation and van pooling will drop from $245 per month in 2013 to $130 per month for 2014.”

He said dozens of other extenders, or tax incentives, including the work oppor-tunity tax credit for hiring targeted indi-viduals and the research tax credit, as well as various energy credits, expired at the end of 2013. A list of expired provisions is available through the Joint Commission on Taxation at www.jct.gov.

For exempt organizations, which in-cludes many hospitals, Funke said the IRS is focusing on compliance, using informa-tion reported on Form 990. “Indicators of potential noncompliance that they have identifi ed include the following relation-ships:

• Large fundraising revenues and small fundraising expenses,

• Large fundraising revenues and small charitable program services expense,

• Large unrelated business income but no income taxes due on the unrelated business income,

• Large total compensation to offi cers, directors, trustees and key employees and small annual gross receipts.”

Funke added, “An accurate Form 990 generally decreases the likelihood of being selected for examination.”

Also pertaining to some employers, Funke said, “The June 2013 U.S. Supreme

Court decision related to the Defense of Marriage Act recognizing same-sex mar-riages affects employers in states where same sex marriage is recognized. Em-ployer-provided healthcare coverage for same-sex spouses get the same tax-favored treatment.” He added the IRS announced two special administrative procedures for employers to make claims of refunds or ad-justments to employment taxes for certain benefi ts paid to same-sex spouses during 2013.

This Time It’s PersonalMuch has been written about the

higher tax brackets and rates, but Mc-Guinness said a lot of people will still be surprised at the cumulative effect.

“The top tax rate went from 35 to 39.6 percent and that happens starting at $450,000 married fi ling jointly or $400,000 for single fi lers,” he explained.

However, McGuinness continued, that’s just one of six tax changes that will impact high income taxpayers. A 5 per-cent increase (from 15 percent to 20 per-cent) in capital gains and dividends tax has also been instituted for those at the same income levels as the highest tax bracket. For individuals starting at $200,000 and married fi ling jointly at $250,000, the Af-fordable Care Act added a 0.9 percent additional FICA tax on wages and a 3.8 percent Medicare tax on investment in-come.

“The rules regarding the 3.8 percent investment income are more complicated than you might think,” he explained in a recent blog for physicians. “You do not include income from S Corporations or a trade or business in which you are actively involved … but do include interest, divi-dends, annuities, royalties, rents and net gain from the disposition of non-business property.”

When looking at the combination of the increased investment income and capi-tal gains taxes, McGuinness said, “What was being taxed at 15 percent is very pos-sibly going to be taxed at 23.8 percent.”

Additionally in 2014, the sales tax de-duction goes away … and for single wage earners beginning at $250,000 and mar-ried fi ling jointly at $300,000, itemized deductions and personal exemptions are being phased out.

“If you’re taking a deduction away from me, that’s a tax increase,” McGuin-ness said of the bottom line for taxpayers. He added the itemized deduction phase-out could be quite costly, particularly to those who give large amounts to charity and have signifi cant home mortgage in-terest they were used to deducting. “The personal exemption is equal to $3,900 (in 2013) per exemption you claim, and all exemptions are lowered by 2 percent for each $2,500 of income above the numbers ($250,000 single, $300,000 married fi ling jointly),” he explained. “The larger your family, the larger the tax increase.”

McGuinness noted there is a grow-ing feeling of frustration. At the same time many of his physician clients are paying signifi cantly more in taxes, reimburse-ments are shrinking. The net result is peo-

ple are having to work much harder simply to make the same money.

McGuinness said individuals should have already asked their tax advisors to provide estimates of what their 2013 tax burden will look like. If that hasn’t hap-pened, he suggests doing it now to prepare for April 15, 2014. Quoting one of his col-leagues, he said, “It’s not going to be pretty in a lot of cases … but better than fi nd-ing out on April 10 that you need to either drain your savings or take out a loan to pay your tax bill.”

End Notes & DisclaimerThe experts who contributed infor-

mation to this article are members of the National CPA Health Care Advisors As-sociation. Headquartered in Nashville, HCAA is a nationwide network of CPA fi rms devoted to serving the healthcare industry and educating its members about the ever-changing fi nancial and regula-tory landscape impacting the industry. The fi nancial professionals stressed the importance of consulting a tax specialist to ensure advice is specifi cally tailored to your unique business or personal situation to minimize the tax burden while fully com-plying with state and federal mandates.

Additionally, the information in this article was provided prior to the end of 2013. It is possible that some of the ex-piring tax incentives could be extended through legislative action. However, the consensus opinion was that Congress is un-likely to reinstate all … or even very many … of the sunsetting extenders.

Tom McGuinness

Scott Tomichek

Doug Funke

Changes to Tax Code Impact the Bottom Line at Work and Home, continued from page 1

the message never leaves your control.Reach out to the groups and orga-

nizations your business works with too. While having an amicable relationship with media is key to diffusing a crisis, reaching out to your business friends and business affi liations through social chan-nels and other means is just as important. You need these important infl uencers to be on your side and help promote your message as well.

Be vigilant on social platforms and in the media. If you do not have a dedicated staffer to monitor and manage your on-line and business reputation, you need to choose a trustworthy employee to be your eyes and ears on all social platforms, re-view sites, and in the media. Or, hire an experienced PR or reputation manage-ment fi rm to monitor your reputation as soon as possible.

No matter how big or small your B2B fi rm is, you are susceptible to a PR or rep-utation assault at any time. Today, prepa-ration is essential and cannot be pushed aside for a “someday” scenario.

Heather Ripley is the president and founder of Ripley PR, a national public relations agency specializing in Healthcare IT. For more information, visit www.ripleypr.com or email hripley@ripleypr.

Having a PR Crisis Plan,continued from page 6

EAST TN MEDICAL NEWS

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Band-Aid for a Broken Leg by Damien Brown; c.2013, Allen & Unwin; $25.95 / $28.50 Canada, 345 pages

You hope you’ve gotten the healthcare coverage that works best for you and your family.

But what if there was no option, or that healthcare was days away, dis-pensed in a tent with little technology? In the book Band-Aid for a Broken Leg by Damien Brown, you’ll read about one doctor’s experiences, literally in the field.

Growing up in relative affluence, Damien Brown only had the barest no-tion of hardship until he was in his 20s. By then, he’d lived on several different continents, had seen the effects of mis-ery and poverty, and had decided that he “wanted to help. Or at least try, in some capacity.”

So, following graduation from med school in Australia, he signed on with Médecins Sans Frontiéres (MSF) and was sent to Mavinga, Angola, on Africa’s southwest side. It would be his home for six months.

Dubbed The Edge of the World by Portuguese colonists, Mavinga was little more than a collection of dusty buildings and tents surrounded by land mines. Brown’s job was to relieve the doctor whose stint was up but, never having been in charge of a hospital before, he was terrified.

It didn’t go well at first.Brown didn’t speak Portuguese, and

the language barrier gave his staff extra reason to complain about Novo Doctor. The illnesses he saw were things he’d only ever read about before. Patient treat-ment was hampered by lack of x-rays, ox-ygen machines, and modern testing; and a near-primitive surgery suite with hand-operated equipment. Improvisation was common, sanitariness was often an issue and, between adrenaline-rush emergen-cies, there was incredible boredom.

Six months. That’s all Brown signed on for and he counted the days – until he suddenly realized that things were better. His colleagues had become friends and his time in Mavinga was up too soon. From there, he “slid finally into Melbourne” and a hospital with modern equipment.

But the difference was “a glaring, uncomfortable reminder of the dispari-ties…” and Brown missed Africa.

“By mid-year,” he says, “I’m trawling the aid-worker websites…”

You might think for a minute that Band-Aid for a Broken Leg would be like those commercials you see on TV, filled with misery meant to touch your heart.

And you’d be wrong.Oh, there’s heart-touching here,

yes. Author Damien Brown doesn’t miss a chance to share the mind-boggling things he saw, but we’re also privy to the goodness, too. That makes this book a nice balance between suffering that will make you very thankful for what you’ve got, and grace and forbearance that will make you smile.

This is the kind of book that will open your conscience – and maybe your wallet. It’s jaw-dropping and humorous, both. And if you’d love a story about a life you may never lead in a place you may never visit, Band-Aid for a Broken Leg is a good choice.

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.

Knoxville MGMA Monthly MeetingDate: 3rd Thursday of each month

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

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

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

Registration is required. Visit www.kamgma.com.

Chattanooga MGMA Monthly MeetingDate: 2nd Wednesday of each month

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

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

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

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

3RD THURSDAY 2ND WEDNESDAY

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

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

GrandRounds8th Annual Cardiovascular Summit Highlights Latest Advancements

KINGSPORT—Join the Wellmont CVA Heart Institute to learn about the lat-est advancements in cardiovascular care at the 8th Annual Cardiovascular Summit set for Saturday, February 1, 2014, beginning at 7:30 a.m. The summit will be held at the MeadowView Conference Resort and Con-vention Center. To register, visit etsu.edu/cme or call 423-439-8027.

Who should attend: Physicians, physi-cian assistants, nurse practitioners, medical residents, RNs, and other health professionals.

Cost: Wellmont Health System em-ployees, $40, Full-time students, $40, Other providers, $50

Siskin Hospital for Physical Rehabilitation Honored with Healthcare Marketing and Public Relations Awards

CHATTANOOGA — Siskin Hospital was recently honored at the Tennessee Society for Healthcare Marketing and Public Rela-tions’ Annual PRISM Awards Competition.

Hospitals and healthcare systems across Tennessee entered the competition, which recognizes outstanding achieve-

ments in healthcare marketing and public relations throughout the state. An awards ceremony was held at the Opryland Confer-ence Center in Nashville.

Siskin Hospital received a high-honor PRISM Award in the Overall Advertising Campaign Category for the “Because of Siskin Hospital, I CAN…” campaign, as well as another high-honor PRISM Award for the “Because of Siskin Hospital, I CAN…” billboards in the Billboard Campaign Cat-egory. Additionally, Siskin Hospital’s newly-designed website, www.SiskinRehab.org, received a high-honor PRISM Award in the Website Category.

The “Because of Siskin Hospital, I CAN…” campaign features Siskin Hospital patients who have remarkable recovery sto-ries of hope to share. From a young mother recovering from a stroke and getting mar-ried, to an individual with an amputation who went back to work as a skilled cabinet maker, the “I CAN” campaign captures

what Siskin Hospital patients can do after recovering from a life-altering accident, ill-ness or disability. The campaign is featured in a variety of media outlets, including print, billboard, web-based, posters, t-shirts, bumper stickers, bus ads, and more.

Siskin Hospital’s recently-launched website has been entirely redesigned, in-cluding a complete overhaul of all com-ponents and features. Siskin Hospital part-nered with Papercut Interactive to develop and build the website. The site map was reconfigured for user-friendly navigation in order to provide better dissemination of information. The website offers techno-logically advanced features including vid-eos, blog posts, online forms, social media plugs, and other interactive, engaging op-tions. The site also features a customized search option, photo galleries, online do-nation capabilities, and is responsive, mak-ing it adaptable for viewing on a variety of mobile devices.

Henry Family Donates $104,000 to Memorial FoundationCHATTANOOGA–The family of Danette Henry recently presented a check to the Me-

morial Health Care System Foundation for $20,546. The funds were raised during the 6th An-nual Danette Henry Memori-al Golf Tournament. To date, the Henry family has donated more than $104,000.

Danette battled ovar-ian cancer for five and a half years, losing her battle in January 2008. After her death, the family wanted to help other cancer patients and their families, rather than just focusing on the loss of Danette.

In 2012, the Danette Henry Family Waiting Oasis opened in Memorial’s Jo-seph H. and Alice E. Dav-enport Outpatient Infusion Center. The Oasis provides families and friends of cancer patients a comfortable, calming environment to relax while patients receive infusion therapy.

The annual tournament is held in Cleveland, Tennessee, to raise money for the fund and increase awareness of ovarian cancer. Additionally, those wanting to advance Memo-rial’s treatment of all types of cancer may make contributions to the Danette Henry Ovarian Cancer Fund.

For information about giving opportunities at Memorial, visit www.memorial.org/foun-dation.

Charles Portera, M.D.; Terry Henry, husband; Mina Trinos, infusion center manager; Jenni Giannourakis, daughter; Delores Haynie, sister; and Elvie Smith, nursing director


Elaine Clark Joins Decosimo’s Healthcare Services Practice

CHATTANOOGA — Decosimo, a leading regional accounting and business advisory firm, announces the addition of Elaine Clark to the firm’s Healthcare Services practice as a business development executive.

Clark comes to De-cosimo with healthcare in-dustry experience working for more than seven years with Pfizer, Inc. as a healthcare representative covering the state of Ten-nessee. She brings with her established

business relationships with long-term care facilities and hospitals, as well as private practice physicians and their office man-agement teams. She is a member of the Tennessee, Georgia and Alabama chap-ters of HFMA and participates as a cor-porate member with the Nashville Health Care Council.

Clark is a graduate of Vanderbilt University where she earned a Bachelor of Science degree with concentrations in Human and Organizational Develop-ment and Corporate Strategy. She stays involved with Vanderbilt University volun-teering as an alumni interviewer with the admissions office.


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

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Name: Tom Conkle

Position: Support Service Rep, Mountain States Health Alliance

At a Glance: Since 2004, Tom Conkle has been running the roads, but not aimlessly. Conkle’s position as a Support Service Rep with the outreach portion of the Johnson City Medical Center lab keeps him behind the wheel as he picks up and delivers collected specimens at physician offices and hospitals in the Tri Cities area.

His job may not be one that is readily recognized in the healthcare industry, but that’s not to underestimate its importance in quality patient care. “We have to know the proper temperature for maintaining the specimens so that their integrity isn’t compromised during transport,” explained Conkle. “And we have to deliver the results to the test facility in a timely fashion, so patients and physicians can get accurate results back, and the proper treatment can be ordered.”

Although Conkle hasn’t always worked in healthcare—he worked in the airline industry for 35 years previously—he says his job is one that is a good fit for him.

“I like the interaction with the clients I deal with. I’ve had a long line of customer service background before I started this job,” he said. “I think customer service is more or less ingrained, and it’s common sense about how you want to treat people. I look forward to opportunities to exceed expectations of what the clients expect.”

Fortunately for the clients for whom the lab serves, Conkle’s dedication to excellence ensures physicians deliver the best care possible.

Children’s Hospital Named One of Nation’s Top Hospitals by the Leapfrog Group

KNOXVILLE—The Leapfrog Group an-nounced its list of Top Hospitals, including East Tennessee Children’s Hospital, at its an-nual meeting in Washington, DC. The group highlighted the diversity of hospitals repre-sented nationwide.

Children’s Hospital is honored for set-ting the highest standards in safety and quality. Top Hospitals have lower infection rates, higher survival rates for high-risk pro-cedures, decreased length of stay and fewer readmissions.

A complete list of 2013 Leapfrog Top Hospitals and the survey results for all par-ticipating hospitals are posted on www.leapfroggroup.org/TopHospitals

Maryville, Tennessee based Molecular Pathology Laboratory Network, Inc. (MPLN) Acquires the First FDA Approved High-Throughput DNA Sequencing Analyzer

MARYVILLE – Molecular Pathol-ogy Laboratory Network, Inc. (MPLN) an-nounced that it has acquired the Illumina MiSeqDx™, currently the only next gener-ation sequencing system approved by the US Food and Drug Administration (FDA). MPLN will be the first laboratory in the country to own the FDA approved version of this revolutionary technology, and will leverage the system for the expansion of testing across all of its clinical laboratories including its clinical trials group Geneuity Clinical Research Services.

This exciting new technology is ca-pable of screening numerous gene tar-gets simultaneously at a fraction of today’s costs and does so with phenomenally high throughput. MPLN, a molecular refer-ence laboratory specializing in Oncology, Women’s Health, and clinical research ser-vices, will utilize the Illumina MiSeqDx™ to offer physicians greater access to clini-cally actionable data at the gene level, and ultimately the facilitation of better patient outcomes.


LOOK OUT! Our 2014 Season

begins January 31st!

DON’T CRY FOR ME, MARGARET MITCHELL

MAN OF LA MANCHA

I DO, I DO, I DO

THE DRYAD: AN APPALACHIAN TALE

EDUCATING RITA

THE WIZARD OF OZ

WELCOME BACK TO IVY GAP

HOLLYWOOD CONFIDENTIAL

A FACILITY FOR LIVING

RING OF FIRE: THE STORY OF JOHNNY CASH

THE WHIPPING MAN

MY FAIR LADY

WASH, RINSE, SPIN DRY

THE CRUCIBLE

THE STARVING

A MODERN CHRISTMAS CAROL

HOLIDAY MEMORIES

… one of the many highly trained surgeons and specialists available in to you in our heart care family.

Dr. Steven Hopkins, Vascular SurgeonJohnson City Medical Center

1-855-655-5111For more information about Mountain States Heart Care, call toll-free

east tn medical news january 2014

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