east tn medical news june 2013

FOR SALE

By CINDy SANDERS

Preventing America’s seniors from falling is a national health priority both in terms of injury and cost. Yet, fall preven-tion programs have only proven to be marginally successful over the long term.

Cathleen S. Colón-Emeric, MD, MHS, and colleagues fo-cused on the gap between quality improvement (QI) protocols and sustained bedside implementation in the nursing home set-ting. An associate professor of Medicine in the Division of Ge-riatrics at Duke University School of Medicine, Colón-Emeric said previous studies found the desired improvements occurred when outside trainers and researchers stepped in to create in-terventions. The external staff addressed multiple risk factors to help lower fall rates, recurrent falls and injurious falls. How-ever, she continued, “When you try to train the existing nursing home staff to do those things, it doesn’t seem to work.”

Based on social constructivist theory, complexity science, and prior studies, the research team believed there was a di-

Tom Kim, MD

PAGE 3

PHYSICIAN SPOTLIGHT

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Healthcare Leader: James W. Hansen, MD

Meshing a medical practice with healthcare administration may not be a responsibility most physicians would relish, but for James W. Hansen, MD, his position as Chief Manager at State of Franklin Healthcare Associates (SoFHA) in Johnson City has been a rewarding experience. Hansen, an internist with SoFHA’s Johnson City Internal Medicine Associates, joined the group in 1999 and within fi ve years, he had been offered and accepted his administrative position. He heads the SoFHA board and oversees its administration ... 4

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FOCUS TOPICS SENIOR HEALTH RETIREMENT SUCCESSION PLANNING

(CONTINUED ON PAGE 8)

Selling Your Practice? Considerations for Ensuring Your Succession Plans Are Successful

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By IAN P. HENNESSEy

Succession planning in physician practices can take many forms, includ-ing options not traditionally thought of when planning to retire. While it is still common for practices to recruit younger physicians to pur-chase an ownership interest in the practice and, after some transi-tion period, eventually buy out the retiring physician, trends over the past few years show a marked decline in the number of indepen-dently practicing physicians. In fact, a recent survey conducted by Accenture

found that today only 39 percent of doctors nation-wide are on their own, which is down from 57

percent in 2000. Perhaps, consequently, there appears to be increased willingness by phy-sicians to consider selling their practice to hospitals and other healthcare organiza-tions. While there are many advantages

to selling your practice in anticipation of retirement, there are several potential

issues to consider before you sign on the dotted line.

Purchase price…but with strings attached.One perceived advantage of selling a

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

Health eShare Direct Project Delivers Promise of Secure Exchange of Patient Information to State’s Healthcare Workers, and Then Some

As the structure of Tennessee’s healthcare system takes

shape around healthcare reform legislation, providers

and patients have new opportunities to improve the

way services are coordinated, funded and delivered to

patients. Through a program called Tennessee Health

eShare Direct Project, healthcare providers and their

staffs are using a newly available, secure messaging

protocol being piloted in Memphis, Chattanooga and

Hickman County, with each community testing and

developing use cases of the platform.

The technology, known as Direct Messaging, was

developed by the federal government and is being

implemented nationwide. Direct is a protocol for secure

exchange of health information from point to point.

Direct improves workflow and increases efficiency for

healthcare providers, administrative staff and healthcare

organizations.

For those who have taken the simple step of enrolling in

the program, the advantages to their daily practices have

included workflow and efficiency improvement – and

then some. Tommy Preston is one of those individuals.

As the assistant director of the Southeast Tennessee

Area Agency on Aging and Disability, Preston knows

the inefficiency of the healthcare system better than

many of the healthcare providers he works with every

day. As a participant in the Community-based Care

Transitions Program (CCTP) in Chattanooga, Preston’s

agency is responsible for connecting its high-risk clients

discharged from hospital inpatient care settings with the

community care, rehabilitation and ancillary services they

need to recuperate, recover, and avoid costly hospital

readmissions.

Yet before enrolling in the Direct pilot, Preston’s staff,

like the overwhelming majority of healthcare providers

in Tennessee, had no means of securely sending or

receiving patient discharge information or exchanging

patient information electronically with its multiple

hospital system and healthcare provider partners.

The solution? Frequent road trips to retrieve patient

charts and discharge summaries from hospitals were

the only option. Staff hours that should have been spent

arranging home health visits, securing transportation

to dialysis centers or scheduling visits to specialty care

physicians were spent…in traffic.

But once enrolled in the project and using Direct, the

impact on Preston’s staff and the patients they serve was

immediate. Preston says his staff began receiving patient

discharge notifications and relevant information from

patients’ clinical charts almost instantaneously. As a result,

Tommy’s staff can immediately engage health coaches to

reach out to patients, usually within hours of their discharge.

Today Southeast Tennessee Area Agency on Aging and

Disability staff login to Direct from wherever they are,

identify information sent from one provider and send

referral information on to an orthopedist, confirm ICD-9

codes, transmit patient clinical information, or confirm an

address for the referral.

Direct is gaining traction in the state thanks to the increased visibility it’s receiving through Tennessee Health eShare. Access to the Direct technology is available now, and the cost of using Direct technology is more than covered by an incentive program offered by the state of Tennessee Office of eHealth Initiatives.

That’s why a growing number of healthcare providers

and eligible individuals across the state are signing up

and using Direct through Tennessee Health eShare.

Several healthcare organizations, including Erlanger

Health Systems, have also signed up. If you work in

healthcare and routinely handle patient information,

chances are you can too.

Direct secure messaging technology is being implemented and supported by Qsource, a Tennessee-based nonprofit healthcare quality improvement and information technology company, working in cooperation with the Tennessee Office of eHealth Initiatives. To learn more about how you can get started using Direct, visit the Tennessee Health eShare Direct website at http://www.healthesharetn.com/.

About the Office of eHealth: The mission of the Tennessee Office of eHealth Initiatives (OeHI) is to facilitate improvements in Tennessee’s healthcare quality, safety, transparency, efficiency, and cost effectiveness through statewide adoption and use of electronic health records (EHR) and health information exchange (HIE). OeHI received grant funding from the American Recovery and Reinvestment Act of 2009 (ARRA) to support this Direct Project and other projects to implement secure health information exchange. Through these stimulus funds, ARRA enables Tennessee the opportunity to advance the secure exchange of health information and to expand the adoption and Meaningful Use of EHRs and HIE. For more information, please visit http://www.tn.gov/ehealth/.

Client: QsourceJob No: QSO-40993Title: Chattanooga Success Story

Pub: East TN Medical NewsInsert: June 2013Size: 10"x13"

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

PhysicianSpotlight

By JOE MORRIS

If anyone can talk about the importance of making a difference wher-ever you are, it’s Dr. Yoo K. (Tom) Kim.

Kim is well known in the East Tennessee area as the operator of five free clinics, but the story of how he came to practice medi-cine, and why he’s deter-mined to provide health care to everyone, provides a fuller measure of just whom he is.

Born in North Korea, Kim escaped with his family — by troop-train rooftop in the dead of winter — to South Korea when he was six. Prior to that time, his father had been personal physician to Il Sung Kim, grandfather of the current North Korean leader. The Kim family eventually made its way to the United States, finally settling in Gary, Ind., in 1962. After high school, Kim, whose grandfather had been a Presbyterian minister, decided to continue his studies at Milligan College in Johnson City because of its Christian affiliation. He then returned to South Korea to study at Severance Medical School, and then completed a residency at St. Agnes Hospital in Baltimore. By 1979, he’d settled at the University of Tennessee Medical Center for a fellowship in hematol-ogy and oncology, specialties that eventu-ally defined the practice he opened in 1981.

But all along, he’d been considering a return to South Korea as a medical mission-ary because he desperately wanted to give back to the country that had sheltered his family. He soon realized that his services might be of more value closer to home, how-ever, and that would allow him to repay the debt he felt he owed the United States for all the opportunities he’d been given.

“I always liked to try to help poor people, and so becoming a doctor was how I thought I could best do that,” Kim said. “South Korea has become a very prosper-ous, rich country, and they didn’t really need me. Forty years ago that wasn’t the case, but they are fine now. So I started to look around and see what I could do here.” He opened his first free clinic in 1993, and a big 20th anniversary celebration is set for later this summer. He also began to forge ties with local groups so that he could find new ways to reach out and help people.

“I am paying back to the American people,” he said. “They sent the gospel to me and my family, and they helped to res-cue our people during the [Korean] war and gave us freedom. Now I work to give medical services to areas where the people can’t afford to go to the doctor.”

By 2005, the clinic had formally be-come the Free Medical Clinical of America Inc., a 501 (c) 3 organization. By 2013,

three more have opened in Briceville, Oneida, and Morgan County. In addi-tion, he helped form Clin-ics of Hope, which runs the Free Medical Clinic of Oak Ridge. To date, vol-unteer doctors and other staff at the Knoxville loca-tion, which is on Chapman Highway, have treated more than 11,500 patients and saved the county an estimated $15 million in

emergency room expenses. The clinics began to take more and

more time, however, so in 2005, he left his practice to work at the clinics full time, as they were seeing a huge uptick in numbers after the state cut back its TennCare rolls.

“I am driving about 150 miles on Wednesdays, heading to all these differ-ent places,” Dr. Kim said, and musingly, “My wife is still mad at me for giving up the practice.”

He’s still logging plenty of miles, but now he’s working on a new project: a re-treat center in the Great Smoky Mountains for people with terminal cancer.

“I want to build a hospice retreat cen-ter for poor people who have already been everywhere, had every treatment, and are still dying,” he said. “This will be for people who are still alert and able to move around, but have not had the opportunities in life to go somewhere really nice, really beautiful. It’s going to be a large venture, but if I can get a lot of people involved, it will work.”

Indeed, Kim says that thanks to his strong ties to the faith community, he’s al-ways been able to find volunteers and get financial support for his clinics. What he needs now, and in the future, is doctors.

“I have five clinics within a 100-mile radius, and right now I am supervising 30 medical students who are studying family practice in our Knoxville clinic,” he said. “I want to get them, and some young doc-tors who have graduated, out into the other clinics. I need doctors. They soon will be carrying on with all of the healthcare in the United States. No retired doctors; they’ve already put in their time and need to have their rest. We need young ones, who need the training. I tell them, ‘you need to take a break sometimes and go on a drive,’ and I have some beautiful drives for them to take!”

At day’s end, Kim says he hopes to make a difference in lives, and wants that to be his Christian witness.

“I don’t want to preach anything, but just show compassion,” he said. “I just want to set the example. I tell our volun-teers, don’t ask people about church and things like that, and just have your actions be ones that people would want to follow. If we show compassion, we are doing the right thing.”

Setting an exampleMultiple free clinics allow Dr. Tom Kim to pay back community

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By LEIGH ANNE W. HOOVER

For the ninth year, the city voted “best town ever” by Outdoor magazine will play host to the Southeastern Wilderness Medicine (SEWM) Conference June 21 – 26, 2013. Whether you are an outdoor enthusiast or a weekend warrior, earning continuing educational units is the most fun in Chattanooga.

“Chattanooga is one of the few metropolitan areas in the country where you have such im-mediate access to the outdoors,” explained Chris Moore, MD, Founder & Program Director, Southeastern Wilderness Medi-cine. “This is a great location to be able to produce this conference.”

In a world where continuing medical education (CME) credits can be obtained online, this conference offers education mixed with adventure. According to Moore, even if a physician is not particu-larly an outdoor enthusiast, the SEWM conference touts world renowned leading speakers on wilderness medicine and of-fers an opportunity to experience learning from the very best.

“This conference will open avenues

to medical topics many doctors have never even thought about,” said Moore. “It’s probably one of the most interesting and enjoyable ways to earn lots of CME credits in an interactive setting among some of the most adventurous, creative doctors out there.”

Unlike most wilderness medicine

conferences, sessions can also be selected to accommodate personal schedules and taken individually without committing to the entire event, and pricing is reflective of per day and even half-day sessions.

“People are blown away by all of the outdoor amenities this conference pro-vides, and with the summer event date, they can also bring their families. Many events and classes are available for them, too,” said Moore. “It’s one of the most en-joyable ways to earn continuing medical education that I know of!”

For additional information visit www.sewm.net

Southeastern Wilderness Medicine ConferenceCome Outdoors!


HealthcareLeader

James W. Hansen, MDBy BRIDGET GARLAND

Meshing a medical practice with healthcare administration may not be a responsibility most physicians would relish, but for James W. Han-sen, MD, his position as Chief Manager at State of Franklin Healthcare Associates (SoFHA) in Johnson City has been a rewarding experience. Hansen, an internist with SoFHA’s Johnson City Internal Medicine Associates, joined the group in 1999 and within fi ve years, he had been offered and accepted his administrative position. He heads the SoFHA board and oversees its administration.

“I enjoy decision making, even though it’s nothing I ever trained to do,” he explained. “We have a strong admin-istration at SoFHA, which is necessary when diffi cult fi nancial decisions have to be made.”

Continued Hansen, “And as a mul-tispecialty group, our board is comprised of many different viewpoints and every-

body has an equal say.” Specialties represented include Internal Medi-cine, OB/GYN, Family Practice, Pediatrics, Hos-pitalist Medicine, and Sleep Medicine

Physician owned and board managed, SoFHA, PLLC, was formed in July 1998 and currently has 90 primary care pro-viders, of which 71 are physicians. Hansen works closely with his colleague Ronald Blackmore, MD, who serves as chairman

of the board. Although Hansen never received for-

mal training in healthcare administration, he brought with him a wealth of adminis-trative experience. He grew up in Boone, Iowa, and attended the University of Iowa as an undergraduate, where he earned a Bachelor of Science degree in Chemistry. Board certifi ed by the American Board of Internal Medicine, Hansen received his medical degree from Creighton Uni-versity in Omaha, Nebraska in 1986, and continued on at Creighton for his Intern-ship and Residency in Internal Medicine.

Although his current practice is primarily general internal medicine, Hansen com-pleted a pulmonary/sleep fellowship while at Creighton and is an American College of Chest Physicians Fellow.

After fi nishing at Creighton, Hansen served in the Navy in Charleston, SC, for eight years, where he gained much of his experience in administration, as well as in-ternal medicine and critical care.

After fi nishing his service with the Navy, Hansen and his wife started con-sidering places to relocate. After talking with his friend Richard Rolen, MD, who served in the Navy with him, Hansen was “prompted to take a look” at East Tennessee, and made the move to John-son City to join Rolen in practice with Johnson City Internal Medicine Asso-ciates. His wife, Shoko Hansen, MD, also practices in Johnson City. Origi-nally from Tokyo, Japan, she met her future husband while they were interns at Creighton. “She rescues greyhounds now,” shared Hansen. “Outside of medi-cine, that’s her passion.”

As for passions, Hansen’s life-long pursuit has been medicine. “In the 6th grade, we went on a school fi eld trip to the University of Iowa Hospital. We were able to see all of the equipment, and I was

fascinated,” he recalled. “That stuck with me.”

Even before starting his residency, Hansen knew he wanted to do primary care, and while at Creighton, he decided to complete the pulmonary fellowship be-cause of the strong, high quality program there.

Throughout his career, Hansen has witnessed many technological advances in medicine, which makes him excited about the future of his profession. “We have made great advances in Alzheimer’s, dia-betes, cancers, genetic testing, hyperten-sion,” he said. “It’s so great that we can offer better treatments and quality of life, and people are living longer.”

Of course, even with the great strides healthcare has made, it is not without its challenges. “The biggest challenge is the cost,” Hansen said. “Finding a solution is a diffi cult decision, but it needs to be ad-dressed.”

FOCUS ON SENIOR HEALTH


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By JENNIFER CULP

The importance of patient-centered care is widely recognized. Treating a sick person in a holistic fashion and recogniz-ing the import of his or her individual cir-cumstances is known to improve patient outcomes and benefit healing. At Erlanger Health System and the University of Tennessee College of Medicine in Chat-tanooga, healthcare providers have coor-dinated their efforts in order to provide the best possible experience for patients in all aspects of care.

“The goal was to incorporate a system that really promotes integrated, account-able, patient-centered care,” explained Mukta Panda, MD. “We wanted to really look at patient care from a different model, rather than hav-ing a hierarchical model where the doctor’s on the top, and then the nurse, and so on. We wanted to put the patient in the center, with all the healthcare team around the patient working toward a common goal so that all patient care needs are met. So, not just looking at the physical healing of the pa-tient, but also social, emotional, spiritual healing, and all the ways we could allocate resources to make sure that patient care is seamless and continuity is maintained,” she continued.

The multidisciplinary rounding team, which meets weekly to discuss each pa-tient and holds daily huddles on the floor to ensure that all issues are addressed in a timely fashion, consists of physicians, medicine trainees, a nurse practitioner, the floor nurse manager, nurses who care for each individual patient under care, a dietician, a pharmacist, therapists (physi-cal, occupational, speech, and respiratory, as needed), a case management team (in-cluding case manager and documentation specialist), legal aid, and a chaplain. Each Wednesday morning, the physician team presents the patient from a medical stand-point and addresses any issues needing as-sistance from other disciplines, and then, in turn, the other disciplines represented in the team discuss each patient from their standpoints and address any issues they have uncovered. Following input from each member, the team collaborates to solve any outstanding problems.

This interdisciplinary team is unique not only in coordinating efforts between members of different healthcare disci-plines in order to strategize and maintain continuity of care both in and out of the hospital, but also in its inclusion of Legal Aid and pastoral care services. Legal Aid provides assistance for low-income patients who fall below the poverty line, allowing them to receive care without undue worry over financial or other legal concerns. Two chaplains offer pastoral

care, visiting patients in the hospital and their homes. “We know that spiritual healing is paramount to physical heal-ing,” Panda said, continuing, “We have a unique opportunity here, where, in the Department of Medicine, we have two chaplains on the faculty.” The availability of legal aid and pastoral care benefits pa-tients, patients’ families, and patients who have no family to rely on. The inclusion of these team members, as well as case man-agers, demonstrates a great commitment to whole-person, patient-centered care, respecting the needs of the patient, who, for example, might not have insurance or be able to afford out-of-pocket care but nonetheless finds herself in the hospital, or the family members of a patient who needs to be placed under conservatorship, or the patient who has no living family but needs counseling and comfort throughout the process of struggling with disease and treatment. The multidisciplinary team is equipped to provide for patients in ways that a single physician or provider simply could not accomplish alone.

This multidisciplinary approach to care has also proved satisfying to team members. “Our communication has im-proved; we learn from each other,” said Panda. Since the project’s inception, team members have reported increased communication, better understanding of patients’ plans of care, better subjec-tive “insight” into patients’ issues, better follow-up plans, easier navigation of so-cial, ethical, and end-of-life issues, and in-creased education on documentation and its role in reimbursement.

“There are times when we get caught in our focused tunnels of thinking, and it’s important to hear each other’s per-spectives, because we are all trying to achieve the same shared covenant, which is to make sure that we provide the best evidence-based, coordinated care for our patients,” Panda explained.

Improved communication between team members allows providers to better serve patients, and also seems to alleviate stressors on the part of team members. “As you know, healthcare providers and physi-cians probably are the worst at taking care of themselves, and I think this approach brings a mindfulness to medicine,” Panda said. “Everybody has different pressures on them, and we know that one person cannot always spend the time needed for each individual patient. What can we do to make sure that all of the patient’s needs are met? With the team, we con-tinue care once the patient is discharged from the hospital, and we see them in our

offices. We have all these resources avail-able to them; they see that the chaplains are available to meet with them, the legal aid is available to them, the case managers are available, and, of course, the physician and other team members are there, also.” Within this framework, the patient truly occupies the center of team members’ ef-forts, which not only benefits the patient but spreads the burden of care among the team members.

Panda, her colleagues in the Depart-ment of Medicine, the trainees, program director, and hospital hope to expand the multidisciplinary rounds program in the future. “We’ve had a lot of support from my own department, faculty, and residents, Erlanger, and the dean of the University of Tennessee,” Panda said. “The hospital leadership is really want-ing to make this a part of every patient care unit now. We are looking toward that, and it is moving pretty quickly. We are really excited!” Even beyond Erlanger and the University of Tennessee’s efforts, Panda envisions this type of interdisciplin-ary care spreading in the future: “We’re training our future doctors in this system, so this type of care will be carried beyond the walls of Erlanger and the University of Tennessee Chattanooga.”

Multidisciplinary Rounds put emphasis on Holistic Care

Dr. Mukta Panda

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By Kevin Gormley

Financial planning and investment management are not the same thing. The former creates a plan and the lat-ter may be a piece of that plan. Finan-cial planning involves the coordination of all or most of your financial issues—retirement planning, tax planning with tax professionals, college planning, es-tate and trust planning with attorneys, an evaluation of insurance needs, debt management, and investments.

Investment management is about – simply put – investments. Unfortunately, the financial industry has added to the confusion by describing people who work with financial products with many similar names. They may be known as financial advisors, financial consultants, wealth managers, and other various names. There are some in the industry who say they do “financial planning” –but all they are really doing is putting numbers into a software program that spits out the reasons why one should in-vest, purchase insurance, buy annuities and other products –usually from their company. Your sound future is not their

priority.My focus as a financial planner is

the financial plan and how it can help establish and clarify a family’s goals and take action with the use of ideas and well-considered, structured strategies to reach and protect those goals. Financial planning can help reinforce confidence in how one feels about their plans. It can inspire others towards action. Husbands and wives can become more comfort-able discussing financial issues with a professional third-party planner and look to the future with a greater sense of control and calm. The financial plan document may ultimately be the tan-gible product that is produced, but the intangible benefits are the key to a good financial-planning engagement.

What benefits can a financial plan produce for clients?

• Compile data into an easy-to-re-view format, taken from various sources, including 401ks, IRAs, 529 plans, loans, personal assets, insurance policies, trusts, restricted stock, stock options, and Social Security expectations.

• Motivate clients to save more, in-

vest with purpose, get estate documents in order, have appropriate insurance coverage, and manage their credit cards and other debt.

• Ensure that the fees being paid for all financial products are fair and reason-able

• Improve the decision-making pro-cess around money.

• Help minimize taxes on invest-ments based on asset allocation, asset choices, and asset location (investments should be in appropriate account types).

• Aid with decisions about the need or possibility of changing companies or careers where compensation plans are different or other major life events where financial decisions are part of the equa-tion.

• Possibly offer advice on invest-ments.

Despite all of these advantages, the real benefits of ongoing financial plan-ning include the discussion during the planning phase, evaluating and break-ing down and making sense of the num-bers in relation to the desires and needs of the family, the presentation of initial ideas and alternatives, updates on tax laws, what the investment horizon looks like, and clarifying the family’s personal goals and needs.

The most difficult financial plan to work on – the one that motivates me the most – is the one where the individual or couple is near the end of their work-ing lives. They are extremely motivated to have a plan. Their needs, wants, and wishes may not match their assets and other income streams, creating a major problem. There is an obvious shortfall. The data is rechecked and the shortfall still exists. In the follow-up meeting, the concern is shared and it can be dis-couraging. There are obvious solutions – keep working, spend less, or take more risks with investments. None of these are greeted with excitement. The worst words to hear in the financial planning process: “Are you sure that is right?”

What can be done to improve your outcomes?

• Investment assets. Save and in-vest more. Maximize returns with low-cost investments. Minimize taxes. Persist through down markets. Simple advice but hard to follow.

• Social Security. Social Security (SS) is not an entitlement. U.S. citizens pay for it and possibly pay more into it than one will ever receive. By working longer at higher income levels, one can increase benefits and if income is lower, there is no penalty. Surprisingly, many (76%) people apply for SS as soon as it is available (now age 62) and do no plan-ning around Social Security income at all. There are at least six choices from

which a married couple can choose and five (5) involve one of the spouses not taking SS at age 62. Currently, if one waits until age 70 rather than taking it at age 66 there is an annual 8% growth in the amount of the benefit. Where can anyone get 4 years of guaranteed 8% growth in the marketplace today? Of course, the health of each individual must be discussed and wealth strate-gies reviewed. Software can show the amount of money that one will get at age 62-70 and every age in between. If the spouse is eligible, they can receive their own benefits or may receive spou-sal benefits at full retirement age (rules apply). One spouse may be able to con-tinue to work and “file and suspend” –which allows the spouse to get spousal benefits. This area of financial planning is much more complex than most people believe. Get help.

• Pension. The most frequently asked question for people who are con-sidering leaving “Corporate America” is: “Should I take the pension money as an annuity payout or should I take the lump sum?” This is where a profes-sional advisor needs to be an important participant in the discussion. Review the benefits and drawbacks of either choice with the advisor. The actuarial assump-tions should be reviewed on the annuity pension. One should ask if the planner/advisor has a conflict of interest, as the lump sum may create great income for the advisor and the annuity may not. With actuarial assumptions, there can be differences between what a different company’s actuaries believe will happen in the future concerning interest rates or mortality tables. Three other key issues are health, flexibility, and the diligence and discipline of an individual to invest the money rather than spend it.

A million dollars is a lot of money when one is still working. But when one is living off of a million dollars, most data suggests that only $40,000 (known as the 4% rule) is the maximum that can be removed and keep the million dollars stable. With today’s interest- rate envi-ronment it may be even lower.

Don’t let the phrase “Can’t get there from here” happen to you. There are lim-ited options when one retires. You must know and understand those options. There are decisions that can be irrevers-ible and time is no longer on the retiree’s side to make tangible adjustments. Plan, protect, save, invest –and keep repeat-ing this. Otherwise, you may be caught in a situation of looking for directions on how to retire …. and not finding an easy path.

theBottomLine

Can’t Get There from HereThe Worst Financial Planning Scenario

Kevin Gormley, CPA, PFS, CFP(R), is a certified financial planner with Patriot Investment Management and lives in Knoxville, Tenn. He may be contacted at [email protected].

e a s t t n m e d i c a l n e w s . c o m JANUARY 2013 > 7

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Andrew works with a team of experienced healthcare professionals that possess diverse backgrounds in valuation, accounting, coding/compliance, information technology consulting, revenue cycle management and general healthcare management. During a 27-year career as either full-time administrator or consultant to a broad range of healthcare organizations, he is experienced in providing fair market value compensation opinions, practice valuation, EMR assessment, billing/coding/collection, strategic planning, human resource management, financial analysis, practice development, and general practice management services to organizations preparing to meet the challenges presented by an ever-changing healthcare environment.

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Where Great Companies Come to Grow.

By LEIGH ANNE W. HOOVER

Each year, a single rhododendron blooms outside my kitchen window in a backyard flowerbed. It’s planted beside a statue of an angel that was given to me by my sister-in-law nearly 10 years ago following my mother’s passing and stands as a reminder of her life’s work and passion for gardening.

Growing up in South Carolina, we would take family outings to the nearby mountains of North Carolina to see our azaleas’ flowering cousins, the rhododen-drons and mountain laurel. Although cer-tain varieties of rhododendrons can endure the hot, humid summers of the upstate, they tend to thrive in higher, cooler, lush environments with nutrient rich soil free of clay.

Nearly 30 years ago, when I moved to my husband’s home state of Tennessee, I was captivated by the gorgeous beauty of

the rhododendrons in flowerbeds and fas-cinated by their size. From June 15th -16th, the rhododendron is showcased in all of its glory during the annual Roan Mountain Rhododendron Festival.

Originating in 1947, the Roan Moun-tain Citizen’s Club has been conducting this festival that celebrates God’s beauty in nature and beckons visitors to Roan Moun-tain State Park. Located near the Tennes-see/ North Carolina state line, beauty

abounds, and the altitude offers a cooler calling for a summer outing on either side of the Mountain.

In fact, the festival originally included both states. Today, the North Carolina side of the Roan celebrates with the North Carolina Rhododendron Festival in Bakersville, N.C., on the same week-end, June 14th and 15th. This way, visitors can ex-perience both festivals and come to the Tennessee side on Sunday, June 16th.

Years ago, the Ten-nessee festival was actu-ally in the gardens, but it has since moved down the

mountain in the state park. In addition to a variety of vendors with specified “person-ally handcrafted” items, visitors can also enjoy onstage musical entertainment.

“This is the 66th annual Rhododen-dron Festival,” said Citizens Club Vice President Brian Tipton. “The festival is the largest event that the club puts on, and they usually try to always have it when the rho-dodendrons will be in full bloom.”

Just seven miles up the mountain,

spectators can glimpse the “world’s larg-est,” natural rhododendron gardens, atop Roan Mountain. Spanning over 600 acres, the rhododendron catawbiense (Catawba rhododendron) blankets the top of Roan Mountain in all of its glory in natural gar-dens that attract visitors from all over the world.

Sitting atop Roan Mountain, over 6,000 feet above sea level, the luxury Cloudland Hotel once attracted wealthy guests with breathtaking views to enjoy the higher altitude and offered a respite from hay fever. Although the famous hotel no longer exists, the spectacular views still pre-vail for current and future generations to experience and enjoy.

“One of the things that is amazing to me is how the rhododendron have expanded to fill the space where the old Cloudland Hotel stood back in the late 1800s and how accessible the paths are for wheelchairs and walkers,” explained Emma Ruth Shomaker, secretary of the Roan Mountain Citizens Club.

Festival activities are always the third weekend in June. However, with the higher altitude and the later blooming cycle, the colorful views usually are available through-out the remainder of the month.

“If there is a time other than during

Enjoying East TennesseeRhododendron Festival – Roan Mountain



rect link between the failure to successfully deploy fall interventions and the hierarchi-cal culture present in most skilled nursing facilities. Colón-Emeric, who also serves as associate director – clinical program for the Durham VA Geriatric Research, Edu-cation & Clinical Center (GRECC), noted the vertical command structure doesn’t foster broad-based, interdisciplinary staff interaction.

“They lack the connections with their coworkers that they need to share informa-tion and problem solve,” she said. “Nursing home staff tend to work in silos.”

Colón-Emeric continued, “Coordi-nation of a multi-factorial risk reduction program requires a great deal of commu-nication. Older adults don’t fall because of one risk factor … they fall because of five or six factors. To reduce risks, you have to intervene on all of those things.”

She added reasons for a fall might in-clude any number of factors from a long, diverse list ranging from poor vision and tripping hazards to a drop in blood pres-sure upon standing or suboptimal choice of an assistive device.

“In order to improve fall rates,” Colón-Emeric said, “the team needs to know what the resident’s behavior is like.”

However, the person with the most hands-on knowledge often isn’t the one creating that resident’s specific care plan. Colón-Emeric pointed out aides deliver the majority of care in the nursing home setting. Yet, nurse aides aren’t typically part of the decision-making process and are often expected to communicate only within the chain of command. “They are less likely to implement the care plan if they haven’t been involved in making it in the first place,” she noted.

In an article published in Implemen-tation Science last year, the research team said QI programs could not reach optimal levels of staff behavioral changes unless the context of social learning was present. The team developed the CONNECT educa-tional intervention to foster improved con-nections within and between disciplines, heighten communication flow and encour-age cognitive diversity in solving problems on behalf of residents.

The next step was to see if the ‘all hands on deck’ approach made a difference in fall rates in comparison to traditional QI initiatives that focus on an individual’s mas-tery of content and process change.

Colón-Emeric said eight nursing homes in North Carolina and Virginia

were selected with half randomized to re-ceive three months of CONNECT training followed by three months of a traditional falls QI program and the other half receiv-ing only the QI program training. The eight participants included a mix of com-munity nursing homes and VA facilities.

The CONNECT intervention in-cluded interactive in-class learning sessions, unit-based mentoring and relationship mapping. All activities were focused on helping the staff build networks and rela-tionships for problem-solving activities. “We designed the CONNECT interven-tion to show staff where their communi-cations weren’t working … where gaps existed … and to teach them some practi-cal tools to better communicate,” she ex-plained.

Post-intervention, three areas were reviewed for both the CONNECT and control groups — staff communications measures, charting, and fall rates. Colón-Emeric said to measure communication, the team used surveys before, during and after the intervention. The team also re-viewed documentation of the types of prevention interventions in the medical re-cord. Fall rates, she added, were viewed as an exploratory outcome in light of the small number of study sites.

“What we found was that the staff communication levels improved a little bit in the CONNECT group but decreased in the control facilities,” she said, adding the net result was significant. Among the CONNECT group, increased communica-tion was more pronounced in the commu-nity settings, as Colón-Emeric said the VA facilities already had high levels of commu-nication.

Charting turned out to be a non-fac-

tor. “Both groups improved a little bit and neither was significant,” she said, adding improved documentation did not correlate with decreased falls. “We don’t think the chart measures are really a good measure of what is happening at the bedside … at the site of patient care.”

As for the most important outcome — preventing falls — Colón-Emeric said the team saw the desired trajectory. “There was no change in fall rates in the control group, but the fall rate in the CONNECT facilities improved … they went down about 12 percent,” she said.

Colón-Emeric was quick to temper the significance of the outcome in light of the small number of participating study sites. However, she said the group is now in the second year of a larger trial of 24 nursing homes with 12 each in the CONNECT and control groups.

“If we see the same magnitude of ben-efit, that would be statistically significant.” She continued, “We should be finished with our last nursing homes in 2014 and have the results out shortly thereafter.”

Colón-Emeric added that if the im-proved collaboration is proven to positively impact falls QI initiatives, then it would be reasonable to apply the same tactics to other multi-factorial issues facing Ameri-ca’s growing senior population.

CONNECTing Caregivers to Prevent Patient Falls, continued from page 1

Falls Hurt Physically & Financially

According to the Centers for Disease Control & Prevention, one in every three adults age 65 and older falls each year. In this age group, falls are the leading cause of injury death and are the most common cause of nonfatal injuries and hospital admissions for trauma.

In 2010, 2.3 million nonfatal fall injuries among older adults were treated in the emergency room with more than 662,000 requiring hospitalization. The direct medical cost of these falls, adjusted for inflation, was estimated to be $30 billion.

festival weekend when someone can go to the top of the mountain to see the rhodo-dendron, traffic will be less, and travel will be faster,” explained Shomaker.

With hiking trails, fields, private camp sites and unrivaled views, Roan Mountain State Park is definitely a “must see.”

According to Tipton, on a clear Fourth of July evening, fireworks can often be seen in Johnson City, Tenn., which is 45 min-utes away in drive time.

“The Roan Mountain State Park is also one of Tennessee’s best parks,” added Tipton. “Actually, a sign we have here on the mountain says, ‘Roan Mountain State Park is the crown jewel of all Tennessee state parks.’”

The annual Rhododendron Festival serves as a fundraiser for the Roan Moun-tain Citizens Club, and all proceeds go back into the community for a college scholar-ship and beautification efforts to enhance the community and maintain its beauty.

“Once you go up on top of the moun-tain, there’s fresh, cool air where you can enjoy the weather and not burn up doing it,” explained Tipton. “There’s also usu-ally a 10 to 15 degree drop in temperature making Roan Mountain the place to go!”

For additional information, visit www.RoanMountain.com

Enjoying,continued from page 7

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].


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By AMANDA SHELL

How much will it cost to transport my mother from the nursing home to her dialysis appointment by ambulance? Dad’s home from the hospital, but they want him back for a CAT scan. What do I do if I can’t fi t his electric wheelchair into my car?

Good questions.An ambulance is more than just an

emergency vehicle. Patients often re-quire ambulance transportation in non-emergency situations as well. And those requiring specialized transportation ser-vices are most often disabled or elderly.

There are several non-emergency transport providers available in East Tennessee, and cost and coverage varies widely depending on the provider and level of care required. Before scheduling transportation, it is important to get the facts and be an informed consumer.

Does my insurance or Medicare cover non-emergency transportation?

The short answer is sometimes – if it meets a medical necessity. Typically, insurance will cover all or part of non-emergency transportation for medical treatments, outpatient procedures, or post-operative check-ups if that trans-portation assistance is determined to be a medical necessity.

According to Darlene Kitts, division marketing manager at Rural/Metro, the most important thing to know about get-ting a transport covered is to make sure the medical need for an ambulance is documented by a physician.

“It’s important that a patient has a document from their doctor proving med-ical necessity,” said Kitts. “Medicare has forms specifi cally for this. This is such an important step for qualifying for payment that we will sometimes to into physicians’ offi ces to update them on proper docu-mentation and provide information on how to code medical necessity on forms.”

Additionally, some carriers require that the ambulance service provider be in the insurance carrier preferred network. Several require pre-certifi cation, meaning the insurance carrier must be notifi ed in advance about the ambulance transport. There may also be a deductible or co-pay involved.

All or part of non-emergency trans-ports are more likely to be covered if a patient is moving from one hospital or care facility to another, particularly if the patient is moving for specialized care or long-term rehabilitation. Some carriers, excluding Medicare, will cover transport for a doctor’s visit. Medicare and others also cover wound care at an approved hospital-based clinic.

“Most reputable ambulance service providers, like Rural/Metro, will have a consumer advocate on staff that will

help customers determine eligibility re-quirements and what documentation is needed,” said Kitts. “Once we get all the information, we can usually let people know right then an estimate of costs.”

To be certain, patients and caregiv-ers are encouraged to check with their individual insurance providers for specifi c requirements and coverage, and Medicare provides information on their website, www.medicare.gov.

What type of service is best?There are a number of reasons a

patient may need professional assistance with transportation. If the patient has a wheelchair that will not fi t in a standard vehicle, has complex medical equipment

such as a ventilator or needs continual medical monitoring during transportation, an ambulance may be needed.

There are several types of ambu-lances, and it is important to get the right one – for health and safety as well as cost savings. Patients do not want to pay for more than they need.

For example, Rural/Metro has fi ve different types of ambulance transporta-tion available. The differences are based on the medical equipment on board and the qualifi cations of the personnel.

·• Wheelchair van service is ideal for patients who need an escort, assistance walking or have a wheelchair that will not fi t in a standard car. No medical care is provided.

• A Basic Life Support (BLS) ambu-lance is required when a patient requires a little more assistance, such as medi-cal monitoring, oxygen administration or oral suctioning. This ambulance has a minimum of two state-licensed emer-gency medical technicians (EMTs) and an automatic external defi brillator (AED) on board.

• An Advanced Life Support (ALS) ambulance is needed for a patient with more intensive medical needs such as EKG monitoring, advanced airway man-agement or medical administration. The ALS ambulance has and EMT as well as a paramedic and more advanced medical equipment available.

• The Critical Care ambulance is for a patient needing medication adminis-tered via pump or ventilator, and is staffed with a paramedic trained in critical care.

• A bariatric ambulance is equipped with a wider bariatric cot rated to carry patients weighing more than 300 pounds and require a wider stretcher.

Specifying the level of assistance needed when scheduling non-emergency medical transport service ensures the pa-tient will have the appropriate personnel and equipment for a safe transport. It also helps keep costs down, since most plans cover only the level of service medically necessary. It is best to check with a phy-sician to specify clearly what services are required.

What You Need to Know About Non-emergency Medical Transportation

Rural/Metro emergency medical technicians Lauren Luttrell (left) and Lindsay Wheeler transport patient Roosevelt Davis from NHC Healthcare to his dialysis treatment. In addition to being the offi cial emergency services provider for Knox County, Rural/Metro also has a staff dedicated to non-emergency transport.





A medical home is where the primary care physician leads a professional health care team that will be responsible

for the ongoing care of the patient. Patients are encouraged to self-manage their con-ditions through shared goals, education on disease states, and health coaches. The goal is to create partnerships between patients and their primary care physician. There is no additional cost to pa-tients, just a signed agreement between the prima-ry care physician/ physician extender and patient to participate.

This program is being conducted at SoFHA for patients with certain chronic disease states such as diabetes. If you are someone with a chronic dis-ease state, you may qualify for participation in this program.

Patients participating in the PCMH have available and will be provided with the following: educational tools on their specifi c disease states; receive one-on-one assistance with their care coordinator on their specifi c disease state; assistance in schedul-ing appointments and referrals; receive proactive

healthcare services; assistance in making same day “urgent” appointments with their personal physician or a member of his/her healthcare team.

Patients enrolled and participating in PCMH will have access to their personal care coordinator via e-mail and phone Monday -Friday 8:00am-5:00pm during operational business hours. The care coor-dinator will assist patients by triaging (determining medical priority) for same-day appointments with physician/physician extender. The care coordina-tor will follow-up with patients on a monthly ba-sis for any needs or assistance in areas that may help in maintaining compliance with their on-going health care plan.

Our medical team will assist patients in man-aging chronic disease states by providing educa-tion and ensuring any tests relevant to a particular disease state is performed as needed. In addition, patients will be provided with education related to preventive health screenings and any assistance with scheduling these screenings.

www.sofha.net

Vision, Experience,Understanding.

Blue Ridge Family Medicine301 Med Tech Parkway - Suite 120Johnson City, TN 37604Phone: 423-794-1800Fax: 423-794-1801

Family Physicians of Johnson City303 Med Tech Parkway - Suite 100Johnson City, TN 37604Phone: 423-282-5611Fax: 423-282-5712

FirstChoice Family Practice301 Med Tech Parkway - Suite 140Johnson City, TN 37604Phone: 423-794-5530Fax: 423-794-1824

FirstChoice Internal Medicine301 Med Tech Parkway - Suite 280Johnson City, TN 37604Phone: 423-794-5550Fax: 423-794-1829

FirstChoice Pediatrics301 Med Tech Parkway - Suite 160Johnson City, TN 37604Phone: 423-794-5560Fax: 423-794-5873

First Medical Ob/Gyn1505 W Elk Ave.Elizabethton, TN 37643Phone: 423-543-7919Fax: 423-543-5323

Johnson City Internal Medicine Associates301 Med Tech Parkway - Suite 240Johnson City, TN 37604Phone: 423-794-5520Fax: 423-282-6940

Johnson City Pediatrics301 Med Tech Parkway - Suite 180Johnson City, TN 37604Phone: 423-794-5540Fax: 423-926-3187

Pinnacle Family Medicine303 Med Tech Parkway - Suite 150Johnson City, TN 37604Phone: 423-282-8070Fax: 423-282-8550

Riverside Pediatrics1503 W Elk Ave.Elizabethton, TN 37643Phone: 423-547-9400

State of Franklin OB/GYN Specialists301 Med Tech Parkway - Suite 200Johnson City, TN 37604Phone: 423-794-1300Fax: 423-794-1398

Our Clinics

We at SoFHA want to provide you with the highest level of care possible and we feel this program will allow us to enhance your care by involving “you”, the patient, in all areas of your health care.

MORE ABOUT our services

JUST WALK IN AND WE’LL TAKE IT FROM THERE.

A consistent leader in ambulatory care in East Tennes-see, State of Franklin Walk-In Clinic in Johnson City is dedicated to providing accessible, high-quality healthcare to the community we serve. Above all else, we strive for the highest standard of excellence in compassionate patient care. We love what we do and consider it a privilege to o� er warm and welcoming care to you when you need it most – from our family to yours.

Designed with your busy lifestyle in mind, no appointment is necessary in the unfortunate event you should sustain an injury or become ill. Whether it’s a routine sports physical, an itchy case of poison ivy, or just cold or � u symptoms, our experienced providers will treat you with excellent and e� cient care so that you may be on your way and on the mend in no time.

Visit us for ambulatory injuries and illnesses seven days a week – adults and children alike. Our

family of staff is here for you Monday thru Friday from 8:00 AM to 8:00 PM and on Saturdays and Sundays

from 9:00 AM to 5:00 PM.

Unsure or just have a question? Email us at [email protected].

REST ASSURED WE ARE HERE FOR YOU.

� e SoFHA Sleep Center, which is accredited by the American Academy of Sleep Medicine, o� ers comprehen-sive testing for an array of sleep disorders. � e studies are performed in a comfortable, homelike setting using state-of-the-art equipment. Our goal is to increase awareness of the importance and potential serious consequences of untreated sleep apnea and other sleep related disorders. We can improve the lives of our patients by educating, diagnos-ing, and managing these disorders. Above all else, our primary goal is to provide quality patient care.

Tests are conducted by highly skilled, licensed sleep technologists and reviewed by sleep physicians certi� ed by the American Board of Sleep Medicine (ABSM). � e sleep technologists work with each patient to explain the procedures used in completing a sleep study. � e recording techniques are noninvasive and all electrodes are applied to the surface of the skin. During the study, the electrodes will record the amount and quality of sleep. � e data displayed will include measurements such as brain waves, heart rate, oxygen level, muscle activity, breathing pattern and various other activities throughout the study.

We take referrals from SoFHA and non-SoFHA physicians as well as self-referrals. We also accommodate vendors and DME (medical equipment companies).

Our services include: • Standard Polysomnogram (95810) • PAP Titration (95811) • Multiple Sleep Latency Test (95805) • Maintenance of Wakefulness Test (95805) • Consultation with Sleep Specialist • Follow-up with Sleep Specialist (w/o initial consultation)

Treatment options available are: • CPAP • Dental Appliance (Mild OSA) • Positional Th erapy • Behavioral Modifi cation • Medications

Some treatment options may require a referral to a specialist. � ese specialists may include a Dentist, Psychiatrist, Psychologist, Cardiologist, or an ENT (ear, nose, and throat).

Our offi ce hours are 8:00 AM – 5:00 PM with clinical hours being from 9:00 PM – 6:30 AM.

DEDICATED TO IMPROVING YOUR QUALITY OF LIFE.

Th e Physical Th erapy Department of State of Franklin Healthcare is dedicated to making a positive di� erence in the quality of life of our patients. Our mission is to provide every patient with the best possible physical therapy ser-vices in a supportive and educational atmosphere to enable him or her to achieve goals. We strive to ensure the highest quality healthcare in a positive and forward thinking environment.

Our goal is to achieve measurable results, which are proven, in an environment that permits comfort and change. We also aim for the highest level of integrity, professionalism, honesty, and delivery of individualized care to improve the quality of life in all of our patients.

We have been o� ering compassionate and highly skilled care to our patients in pursuit of their individual needs and goals since our doors opened in 2003. We welcome oppor-tunities for professional development and advanced clinical training in order to ensure that our clinical practice aligns with the changing needs of our patient population.

We treat and educate patients with medical problems and health-related conditions that interfere and/or limit their ability to move and perform functional activities in their daily lives. Proper movement and function are promoted through exercise and functional training in a “hands-on” care approach.

Common conditions we treat include: all orthopedic injuries and dysfunctions (including spine, shoulder, hip, knee, etc.), muscular strains and sprains, sports injuries, post-operative conditions, and work-related injuries and repetitive conditions.

By o� ering a variety of specialized treatment options for various populations, SoFHA Physical Th erapy Department has the ability to successfully treat all physical therapy related conditions. Most of our therapists are certi� ed in McKenzie Spine evaluation and treatment.

Visit us Monday thru Fridays from 8:00 AM to 5:00 PM.

At State of Franklin Healthcare (SOFHA), we are continually searching for ways to improve services to our patients. We are pleased to share with you our program that has been designed to provide more advanced personalized health care services. The“Patient Centered Medical Home” was developed to enhance care by enabling our patients personalized medical access provided by a care coordinator under the direction of their primary care physician.

Proud members of Qualuable Medical Professionalswww.qualuable.com

Sleep Center Walk-In ClinicPhysical Therapy


physician practice to a hospital or other healthcare organization is that the pur-chase price is paid at the time of the closing rather than in installments over time. In some transactions, however, only a portion of the purchase price is paid at closing, with the remaining amount paid over time and often with some strings attached. For in-stance, a purchase agreement may require you to continue your employment for a certain period of time after the closing to ensure a smooth transition. If you decide to retire before the end of the period, you may be required to forfeit some or all of the remaining payments of the purchase price. In addition, you may be required to indemnify the buyer against liabilities of the practice that arose prior to the transac-tion closing date. Accordingly, if you are considering selling your practice to another entity, it is important that you not only

become comfortable with the overall pur-chase price, but also with all of the terms and conditions associated with obtaining the full purchase price for the sale.

Becoming an employee.In many cases, a physician who sells

his or her practice to a hospital or other healthcare organization will be required to continue practicing as a hospital em-ployee. If you are considering such a sale as your succession plan, it is very impor-tant that you carefully review the terms of the proposed employment agreement in light of your personal retirement plans. In most cases, physicians directly employed by a hospital are likely to have fewer re-sponsibilities and less time devoted to ad-ministrative, non-medical duties that come along with running a practice. On the other hand, this transition usually comes

with a marked decrease in your indepen-dence. Decisions regarding the call sched-ule, staffing, the location of your practice, vacation, and a host of other matters will now be in the hands of hospital manage-ment. Keep in mind that these issues and others are likely to have a significant im-pact on your lifestyle in the time between the sale and your retirement.

Restrictive covenants.Not all succession planning involves

total retirement from the practice of medicine. Accordingly, before choos-ing a practice sale as a form of succes-sion planning, you should be aware of the potentially broad restrictions that can be associated with the sale of your practice. If you continue as an employee after the closing, you may be subject to a covenant not to compete as part of your employ-

ment agreement. Under Tennessee law, noncompete provisions in physician em-ployment agreements are enforceable if the restriction is for two years or less (1) and the geographical area of the restric-tion is the greater of a ten-mile radius from the physician’s primary practice site or the county in which the primary practice is lo-cated. Depending on the circumstances, a physician may be restricted from practic-ing at any facility at which the physician provided services during the term of the employment agreement. If the buyer is a hospital, however, the noncompete pro-vision must also include a clause permit-ting the physician to buy back his or her medical practice. If the medical practice is repurchased from the hospital, the non-compete provision is void.

Tennessee also permits physician noncompete agreements in conjunction with the sale of a medical practice, which are merely required to be “reasonable under the circumstances.” Moreover, there is a rebuttable presumption that such “deal noncompete” provisions are enforceable. While a healthcare orga-nization (such as a large medical group, for example) may utilize deal noncom-pete provisions, there is currently some question regarding whether a hospital is permitted to utilize deal noncompete pro-visions in conjunction with the purchase of a physician’s practice. In any event, it is possible that a hospital or other health-care organization acquiring your practice will seek to restrict your ability to provide patient care over a longer period and/or in a much wider area in which a hospital and its affiliates conduct business. In ad-dition, it could also restrict your ability to perform other activities, such as provid-ing consulting services, investing in other healthcare companies, or participating in other management activities that may “compete” with the company that pur-chases your practice. Therefore, if you are considering selling your practice as your succession plan, it is important that you evaluate any proposed restrictive cov-enants in light of your future plans.

Selling your practice to a hospital or other healthcare organization may be a simpler, more attractive alternative to re-cruiting a younger physician to purchase your practice. As you move forward with your succession plan, however, be aware of the strings attached to a practice sale and what effect they may have on your future plans.

Note: if the employing entity is a hos-pital, the duration of the restriction can be longer (though not to exceed five years) if it is determined by written mutual agree-ment that the extended period is necessary to comply with federal statutes, rules, reg-ulations or IRS revenue rulings or private letters. See T.C.A. §63-6-204.

Selling Your Practice? continued from page 1

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

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What do you look for in non-emergency transport service?

Whether scheduling transport from home or from a medical care facility, the patient has options. In order to make the best, most efficient and cost-effective deci-sion, there are several things to look for when choosing a service provider.

The first thing to consider is the level of service required. Some companies have only one type of ambulance, which may or may not meet the patient’s needs. When choosing a non-emergency medical transport service, patients should also consider the qualifica-tions of both the service and the personnel.

“It is important that patients use only licensed service providers. All non-emer-gency medical transportation providers are required to be licensed by the state of Tennessee,” said Kitts. “As the only CAAS-accredited service in East Tennes-see, Rural/Metro goes above and beyond

the state requirements for licensure.” The Commission on the Accredita-

tion of Ambulance Services (CAAS) is an independent commission that established a comprehensive series of standards for the ambulance industry determined to designate excellence in modern emer-gency medical services providers for clini-cal quality and operational efficiency.

Licensed and trained EMTs and paramedics are another important con-sideration. These professionals are trained to move patients to avoid injury and can address medical emergencies if necessary during the transport. The state of Tennes-see does not require an EMT on board for a wheelchair van transport, so patients should inquire whether the service they are scheduling has a medically trained person on board.

“Rural/Metro strives to go above and beyond minimum state requirements,”

said Kitts. “We always staff wheelchair vans with a licensed EMT. Not every provider does, but we feel it’s always im-portant to be prepared in case an emer-gency situation arises.”If a patient requires specialty equipment such as oxygen, it is important to know whether the carrier will have it on board or if the patient is expected to provide what is needed.

With so many services to choose from and details that affect cost and coverage, selecting the right non-emergency medi-cal transportation can become a compli-cated decision. The first and best decision is to consult with a doctor and insurance provider and choose an excellent and re-liable service provider, like Rural/Metro, who can provide a patient with an advo-cate. Knowing what questions to ask can help prevent delays and perhaps cancel-lations if the right level of service is not dispatched.

What You Need to Know About Non-emergency Medical Transportation, continued from page 9


By BRAD LIFFORD

When Donald L. Wells began his career at Johnson City Eye Clinic, a vi-sion problem that now affects untold millions of people was virtually unheard of.

And one thing is sure: computer vision syndrome, commonly referred to as CVS, is hardly on the decline.

“CVS is widespread,” Wells said, “and definitely growing.”

Computer vision syndrome is a problem that encompasses a set of vision symptoms that – while not caus-ing permanent damage – can cause serious discomfort and strain the eyes. The pervasiveness of high technology has enriched our productivity and work capabilities and opened up wondrous realms of entertainment, but staring at screens big and small has taken a toll.

The American Optometric Association estimates that as little as 50 per-cent and as much as 90 percent of the U.S. adult population experiences CVS.

Wells is well-versed in conditions related to the eye. A Master Optician, he began his career at Johnson City Eye in June of 1980. Johnson City Eye Clinic, located in Med Tech Park, has a tradition of eye excellence that dates to 1942.

Interestingly enough, the first digital computers were being used in the same era when Johnson City Eye got its start, but just one of those computers was the size of a room. Today, 90 percent of Americans own a personal electronic device, according to the Pew Internet and American Life Project: computer, MP3 player, videogame console, cell phone, e-book reader, or tablet computer. And that’s not to mention the video monitors that capture our gaze at work.

“Our doctors at Johnson City Eye don’t have a specific diagnosis for CVS,” Wells said, “but it’s a condition that is generally associated with sec-ondary complaints of dry eyes, eye strain, blurred vision, and headaches. Those are some of the major complaints related to the eye, and those are often associated with musculoskeletal symptoms as well, such as shoulder and neck pain.”

Wells said that our electronic devices literally hold our attention too long and often for uninterrupted duration.

“One of the main contributors to CVS is probably dry eyes,” Wells said. “When people work on their computers, they don’t blink enough, and therefore they don’t spread their tears over the cornea, the clear front part of the eye. The cornea dries out, and it causes problems that can include blurred vision and burning eyes.”

That fixation on video monitors large and small and, with computers, the related typing on a keyboard, differs from the typists of yesteryear, Wells said.

“I have wondered why the typists of pre-computer years didn’t suffer the same symptoms,” Wells said. “But their habits were different. I’ve been told that typists then moved around more – both their eyes and body. In general, they took breaks from typing; they would get up and move around and deliver a typed letter to someone or get envelopes and stuff them.

“People who work on computers have different habits. With no breaks

and no movement, they can do ev-erything electronically – receive and send e-mail, play games, buy things, read the news. You don’t have to move.”

So moving around, blinking to keep the eyes moist and limiting those rapt gazes are advisable, Wells said. Another tip: Ensure your moni-tor or device is used in the right lighting.

“Lighting can be another very important variable,” Wells said. “You should generally avoid working near windows or have too much lighting; you probably need to vary it in order to have the right lighting for you. Lighting can cause a lot of glare on monitors, too. Sometimes just tilting your screen a little can reduce glare, and you can use a non-glare screen

and also have non-glare put on your glasses if you wear them.”Wells said the simplest solution for those experiencing symptoms that

could be related to CVS is one that will benefit them regardless of whether they are actually experiencing CVS – and it that solution could offer a big return where their vision is concerned.

“The problem area,” Wells said, “is that not enough people get their eyes examined.”

Ample research backs that contention. Regular eye exams detect more serious and treatable conditions than CVS; the U.S. Centers for Disease Control estimates that 11 million Americans ages 12 and older could see better through measures that include reading glasses, contact lenses or eye surgery.

“Anyone having any eye problems should start with a good eye exam,” Wells said. “They need to make sure their vision is corrected. As we age, it becomes more likely that we’ll need to have our vision corrected. For exam-ple, people who are approaching 40 may need correction for near vision.”

Johnson City Eye Clinic provides a full spectrum of eye care and surgi-cal services for adult and pediatric patients. In addition to comprehensive eye care, Johnson City Eye physicians specialize in cataract surgeries, the treatment of glaucoma, macular degeneration, reconstructive surgeries, pediatric ophthalmology and retinal disease. The medical staff at Johnson City Eye includes Drs. Alan N. McCartt, John C. Johnson Jr.; Dr. Jeffrey O. Carlsen; Amy B. Young; James W. Battle; Randal J. Rabon; Calvin L. Miller; Michael F. Shahbazi; and Peter Lemkin, a doctor of optometry.

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]

Computer vision syndrome a widespread, growing problem


Wine 201Wines with Barbecue

Rick Jelovsek is a retired physician, a Certified Specialist of Wine, and a member of the Society of Wine Educators. He is also author of a book available from Amazon on Wine Service for Wait Staff and Wine Lovers. You may contact him with wine questions at [email protected] or visit his website at www.winetasteathome.com.

Barbecue, barbeque, or BBQ? Each means slightly different cooking to differ-ent people. We have some friends from the UK who talk about grilling meat over charcoal or a gas grill and call it barbecue. In East Tennessee, however, we just call that ‘grillin.’ Barbecue to us refers to sea-soned meat very slowly cooked over wood or wood charcoal and often finished with a glazing sauce containing vinegar and spices and varying degrees of sweetness from sugar, honey, or molasses. We admit that dry rub (spices only) barbecue exists, but for the most part, East Tennesseans favor slow cooked meats with added tangy sweet, tomato-based sauces.

I must admit that beer is often just right with barbecue, but I usually prefer wine. The only time I switch to beer is if the meat or sauce contains a fair amount of red pepper hotness. In that case, the higher amount of alcohol in wine, com-pared to beer, further dissolves the capsa-icin oil and makes the dish even “hotter”; I confess that I do not care for super hot BBQ. In Arkansas or Texas, I will grab a beer with BBQ, but in East Tennessee, the lower capsaicin hotness and dominant smoke-flavored meat with vinegary sweet and spicy sauces go extremely well with acidic wines with a touch of sweetness. Let me explain why.

Basic food, sauce, and wine pair-ing rules include acidic wines with acidic foods; low acid wines with savory foods; slight sweetness with spicy (hot) foods, fat, and salt to cut tannins; and oaky wines with roasted meats. What these pairing rules do, if you choose to follow them, is to bring the wines into balance with the foods. You may not care for acidic wines, but following acidic foods, they taste much more balanced. If you don’t like astringent tannins in wine, have that tannic wine with some fatty, salted pulled pork, and you will be amazed at the difference. If you are just grilling, oaked red wines or an oaked Chardonnay bring that smoke taste into a delicious perspective.

Over the years, I have found that some of the best wine combinations with barbecue or even just plain grilled foods include the following:

Meat: Pulled Pork Sauce: East Tennessee/Western

North Carolina, tomato/vinegary, slightly sweet sauce

Wines: Fruity, California Cabernet Sauvignon (Bogle, Don Sebastiani, Robert Hall, Black Box); Apothic Red; eastern US Chambourcin or Chancellor

Meat: Pulled Pork Sauce: East Carolina vinegary, pep-

pery sauceWines: Rosé, White Zinfandel,

Chenin Blanc, Rieslings, Pinot Gris/Gri-gio

Meat: Pulled Pork Sauce: South Carolina, mustardy

BBQ sauceWines: New Zealand Sauvignon

Blancs (Oyster Bay, Cloudy Bay, Kim Crawford)

Meat: ChickenSauce: Alabama white sauceWines: Austrian Grüner Veltliner

(GruVee)

Meat: St Louis/Kansas City style ribs

Sauce: Allspice in the sweet sauce Wines: Off dry reds (Apothic Red,

Ménage à Trois Red)

Meat: Texas Barbecue brisket Sauce: Mild hot sauce Wine: Zinfandel (Steele, Ridge,

Rosenblum) or Spanish Tempranillo wines

Meat: Grilled steaks or roasts Sauce: Salt, pepper, and butter onlyWine: Petit Sirah (Bogle, Greg Nor-

man, Foppiano); Carmenére (Concho y Toro); Bordeaux

Meat: Cedar board grilled salmon or grilled smoked salmon

Sauce: AnyWines: Oaked Chardonnays (Chal-

one, Chateau St Jean, Toasted Head,)

Meat: Barbecued chicken Sauce: Red BBQ sauceWines: Russian River Pinot Noir

(Martin Ray, Merry Edwards, Martinelli, Rodney A Strong, Siduri)

Meat: Grilled Italian or smoked sau-sages, bratwurst

Wines: Alexander Valley or Napa Valley Cabernet Sauvignon, Italian San-giovese or Chianti

Meat: Grilled hamburgers and hot dogs

Wines: Depends upon what con-diments you like: California Sauvignon Blanc (St Supery, Ledford, Bogle ) with mustard, pickles, onions; Unoaked Char-donnay (Joel Gott, Sebastiani, Simply Naked, Toad Hollow) with tomato, may-onnaise, and lettuce; California Pinot Noir (Bogle, Mark West, Mondavi Coastal, Castle Rock) with catsup; Italian Pinot Grigio (Cavit, Ecco Domani, Cupcake) with chili and slaw

I am getting hungry just writing this article. If you have not tried wines very often with barbecue, now is the time. Try it, you might like it!

What Makes a Baby

by Cory Silverberg, illustrated by Fiona Smyth; c.2013, Seven Stories Press; $16.95 U.S. & Canada, 36 pages

So your wee one knows that some-body’s going to have a baby… but you haven’t had The Talk yet. The new book What Makes a Baby by Cory Silverberg, illustrated by Fiona Smyth makes the con-versation a little bit easier.

Using ideas that are easy for smaller kids to understand, author Cory Silverberg tastefully explains how babies are con-ceived and born.

Eggs and sperm are pretty special. Inside each egg, there’s a story about the person that the egg came from. The sperm is the same way: it contains a story, too.

Not all bodies have sperm. Not all bodies have eggs. So when grown-ups want to make a baby, they use an egg from one person and a sperm from another person and they put them in a warm, safe place. That place is called a uterus, and even though it has the words “YOU” and “US” in it, not every body has one of those, either.

When an egg and a sperm get togeth-er in the uterus, they do a sort of dance, and they talk to each other and share those stories about the bodies they came from. By the time the dance is done, they’re not an egg and sperm anymore – they’re a brand-new, tiny thing that might or might not grow. If it does, it becomes a baby just like you were a long time ago.

Inside, a baby grows… and grows… and grows for about forty weeks until it’s ready to be born. Sometimes, the baby comes out on its own and sometimes a doctor decides when it’s time – but no mat-ter how it arrives, it’s a pretty big deal for the baby and for the people who were hap-py for it to arrive. And one of those people who are happy to meet the baby is you!

While the story itself is quick to read, the brightly colored illustrations by Fiona Smyth will make kids want to linger on each page. Those illustrations are, in fact, my fa-vorite part of the book because they oh-so-subtly touch upon kids and families of all kinds. That inclusion means a fresh take on an age-old story.

If your child is full of questions, make sure you’ve got this cute book around for easy answers. For curious 3-to-6-year-olds, not having What Makes a Baby is incon-ceivable.

Is Work Killing You? A Doctor’s Prescription for Treating Workplace Stress

by David Posen, MD; c.2013, House of Anansi, $18.95 US and Canada, 358 pages

Your employees have had to push a little harder than they ever had to before, and they’ve endured some layoffs, but ev-erybody seems to have adjusted. Still, you know that morale is low, and you’re think-

ing a fun group event might help.According to David Posen, MD, you’re

on the right track, but there are lots more things you can do for your employees. In his book Is Work Killing You? you’ll see how helping them will help you.

In his medical practice, David Posen sees “first-hand and up close the psycho-logical and physical damage” caused by workplace woes. Employees are stretched too thin, they’re doing more work for less money - some businesses even expect em-ployees to work through lunches, week-ends, holidays, and vacations – which often leads to headaches, forgetfulness, irritabil-ity, agitation, and depression that Posen di-rectly attributes to work-related stress.

“Workplaces are making people sick,” he says, and no one seems willing to discuss it.

As he sees it, the biggest contributors to workplace stress are volume (an increase in workload, to the point of overload), velocity (accelerated speed at which em-ployees are expected to work), and abuse (office bullies who “wreak havoc”). Other issues come into play, but these are the top three.

Though it’s a “hard sell,” Posen says studies indicate that productivity, mental clarity, and energy actually improve when work hours are reduced, face-time and meetings become optional, vacation-taking is mandatory, and employees are encour-aged to disconnect from work on a regular basis.

As an employer, you’ll also get more out of your employees if you encourage healthy habits. If it’s feasible, let them go home early when work is finished. Share the wealth – or at least make salaries more equitable. Help employees deal with of-fice politics. Know the difference between “excellent service and excessive service.” Prioritize projects wisely and discourage multitasking.

Lastly, ease up. Your employees’ health and your bottom line both depend on it.

As I was reading Is Work Killing You? there was one question that kept popping into mind: why isn’t this book taught in school?

You’ll ask yourself that, too, as you devour this common-sense, how-to, rant-slash-advice book because author and physician David Posen makes many good points for employees and business owners alike. In making those arguments, he under-scores his research by sharing dozens of an-ecdotes from his patients and others, and some of them are jaw-droppingly uncom-fortable to read. Posen doesn’t leave us hanging on those squirmy details for long, though; he offers pages and pages of ideas meant to make the business world better, do-able from dual sides of the paycheck.

This is one of those books that could potentially benefit anyone who works for a living, and I’m excited to finally see this topic tackled. I think that if a stress-free workday is what your business needs, then reading Is Work Killing You? should be your goal.

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.


CME Events in the Greater Knoxville Area

Name of activity: Medicine Grand Rounds: Ethics and Allocation of ResourcesName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of MedicineDate: June 11, 2013Times: 8-9 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Pulmonary Tumor Board SeriesName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer InstituteDate: June 13, 2013Times: 7-8 a.m.Place: University of Tennessee Medical Center Cancer Institute, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Surgery Grand RoundsName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of SurgeryDate: June 13, 2013Times: 7-8 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: John Sullivan, DDS, Memorial Endowed LectureName of CE provider/sponsor: University of Tennessee Graduate School of Medicine and Department of General DentistryDate: June 14, 2013Time: 7:30 a.m.-5:00 p.m.Place: Heart Hospital Auditorium, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AGD credits and CEUsContact: Department of General Dentistry: 865-305-9191, [email protected]

Name of activity: Pulmonary Tumor Board SeriesName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer InstituteDate: June 20, 2013Times: 7-8 a.m.Place: University of Tennessee Medical Center Cancer Institute, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Surgery Grand RoundsName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of Surgery

Date: June 20, 2013Times: 7-8 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Medicine Grand Rounds: Celiac DiseaseName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of MedicineDate: June 25, 2013Times: 8-9 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Pulmonary Tumor Board SeriesName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center Cancer InstituteDate: June 27, 2013Times: 7-8 a.m.Place: University of Tennessee

Medical Center Cancer Institute, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

Name of activity: Surgery Grand RoundsName of CME provider/sponsor: University of Tennessee Graduate School of Medicine and Department of SurgeryDate: June 27, 2013Times: 7-8 a.m.Place: Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleCredits available: Approved for AMA and AAPA credit and CEU Information: www.tennessee.edu/cme Contact: University of Tennessee Graduate School of Medicine, [email protected], 865-305-9190

East Tennessee CME Events Editor’s Note: In an effort to provide our readership with the latest professional healthcare news, East Tennessee Medical News is working with area institutions to provide this monthly listing of CME events throughout the East Tennessee region. For more information about each activity, please see the contact information provided for each event.

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.

Speakers Vary Each Month, Covering Topics Such As Meaningful Use, Compliance, Coding, Legal Considerations, and More. To assist with appropriate catering preparation, please RSVP by the Monday prior to the meeting:

Johnson City: Michael Manning @ [email protected].

Kingsport: Frances Sizemore @ [email protected] or fax to (423)224-3901.

JOHNSON CITY MGMA MONTHLY MEETING

Date: The 2nd Thursday of Each Month

Time: 11:30 AM – 1:00 PM

Location: Quillen ETSU Physicians Clinical Education Building,

325 N. State of Franklin Rd., Johnson City

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

KINGSPORT MGMA MONTHLY MEETING

Date: The 3rd Thursday of Each Month

Time: 11:30 AM – 1:00 PM

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

Second Floor, Kingsport

2ND THURSDAY 3RD THURSDAY

East TN Medical News

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GrandRoundsMemorial Hospital receives American Heart Association’s Mission: Lifeline Silver Quality Achievement Award for heart attack careAward demonstrates Memorial’s commitment to quality care for heart attack patients

CHATTANOOGA – Memorial Hos-pital has received the American Heart Association’s Mission: Lifeline® Silver Receiving Quality Achievement Award. The award recognizes Memorial’s com-mitment and success in implementing an exceptional standard of care for heart at-tack patients.

Hospitals participating in Mission: Lifeline are part of a system that makes sure STEMI patients get the correct care as quickly as possible. Mission: Lifeline fo-cuses on improving the system of care for STEMI patients as well as improving care for all heart attack patients.

The national goal is 90 minutes from the time a person comes through the door of the emergency department to the time that a patient is receiving a catheterization. Memorial far exceeds that goal with an average time of 45.9 minutes that is one of the fastest in the nation demonstrating Memorial’s high standards of performance in quick and appropriate treatment of STEMI patients to open the blocked artery. Before they’re discharged, patients are started on ag-gressive risk reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers and they receive smoking cessation counseling if needed. Hospitals must adhere to these guidelines-based measures at a set level for a designated period of time to be eli-gible for the achievement awards.

Vista Named Exclusive Radiology Provider at Jellico Community Hospital

KNOXVILLE —Vista Radiology, P.C. became the exclusive radiology services provider at Jellico Community Hospital, Jellico, Tenn., on Friday, February 1.

A 54-bed nonprofit hospital oper-ated under the direction of the Adventist Health System, the acute care facility has provided quality healthcare to the Jellico community since 1974. The new partner-ship with Vista significantly expands pa-tient services while enhancing medical technology offered by the hospital.

Jellico Community Hospital becomes Vista’s eleventh hospital in which it pro-vides radiology services, the tenth in East Tennessee. Vista Radiology President Daryl Harp, MD, said Vista “is excited to serve the people of Jellico, and we look forward to getting to know them better.”

Established over 50 years ago as Fort Sanders Radiology, Vista Radiology has 37 board-certified radiologists providing the highest levels of radiology expertise, including 24-hour teleradiology services and sub-specialized radiographic inter-pretations.

Vista Radiology also specializes in endovascular repair of aneurysms, acute stroke treatments, breast biopsy and ra-diofrequency ablation, in Knoxville and the surrounding areas. Vista’s member-ship includes fellowship trained radiolo-gists specializing in body / cross sectional imaging, MR imaging, musculoskeletal

radiology, neuro-interventional radiol-ogy, neuroradiology, cardiac imaging & thoracic radiology, cardiovascular / inter-ventional radiology, women’s imaging / breast intervention, PET & nuclear medi-cine, and pediatric radiology.

The University of Tennessee Medical Center Awarded Certification as a Comprehensive Stroke Center

KNOXVILLE — The University of Ten-nessee Medical Center has been recog-nized by The Joint Commission and the American Heart Association/American Stroke Association as meeting The Joint Commission’s standards for Disease-Spe-cific Care Comprehensive Stroke Center Certification, which means it is part of an elite group of providers focused on com-plex stroke care. Complex Stroke Centers are recognized as industry leaders and are responsible for setting the national agenda in highly-specialized stroke care.

Comprehensive Stroke Center Cer-tification recognizes those hospitals that have state-of-the-art infrastructure, staff, and training to receive and treat patients with the most complex strokes. Certifica-tion is a voluntary process and UT Medical Center underwent a rigorous onsite re-view in late March. Joint Commission ex-perts reviewed the medical center’s com-pliance with the Comprehensive Stroke Center standards and requirements in-cluding advanced imaging capabilities, 24/7 availability of specialized treatments, and staff with the unique education and competencies to care for complex stroke patients.

Comprehensive Stroke Center Cer-tification was developed in collaboration with the American Heart Association/American Stroke Association and derived from the Brain Attack Coalition’s “Recom-mendations for Comprehensive Stroke Centers,” (Stroke, 2005), and “Metrics for Measuring Quality of Care in Compre-hensive Stroke Centers,” (Stroke, 2011), and on recommendations from a multi-disciplinary advisory panel of experts in complex stroke care.

For more information on The Joint Commission and American Heart As-sociation’s Advanced Certification for Comprehensive Stroke Center visit http://www.jointcommission.org/or www.heart.org/myhospital.

In addition to Comprehensive Stroke Certification, UT Medical Center’s Stroke Center also was awarded Get with The Guidelines Gold Plus Achievement award for the third year in a row. The medical center also achieved the Target: Stroke Honor Roll. A national emphasis, led by the American Heart Association, on de-creasing “door to treatment” times for patients receiving IV t-PA has resulted in improvement in treatment times across the country.

LBMC Security & Risk Services Lynn Cagle Named Administrative Director of Nursing at Parkwest Medical Center

KNOXVILLE – Parkwest Medical Cen-ter has announced the promotion of Lynn Cagle, BSN, to administrative director of nursing. Cagle will direct day-to-day nurs-ing operations for Parkwest and oversee the directors of clinical services. Cagle will

also have primary responsibility across the continuum for compliance with regula-tory agencies including The Joint Com-mission as well as serving as a liaison for the Schools of Nursing and their Advisory Boards.

Cagle will also lead professional de-velopment and coaching for department leaders, working with the Senior Leader-ship Team and staff to promote higher quality patient care. Her promotion is ef-fective June 1, 2013.

Cagle has two decades of progres-sively responsible nursing experience, with the majority of those years at Park-west. She has served Parkwest as Direc-tor of Medicine since 2008. Prior to that, Cagle was Nurse Manager on the Park-west Cardiac Observation Unit from 2000-2008, also having served as a staff RN on the Critical Care Unit from 1998-2000.

She holds a Bachelor of Science de-gree in Nursing from the University of Ala-bama – Huntsville and a Master of Busi-ness Administration degree from Lincoln Memorial University.

Liz Clary Named Vice President of Behavioral Health at Peninsula

KNOXVILLE – Liz Clary, RN, has been promoted to the position of vice presi-dent of behavioral health for Peninsula, a division of Parkwest. Clary replaces retir-ing vice president Jeff Dice.

Clary has more than thirty years of healthcare administrative and executive experience in psychiatric and acute care. Her professional background includes operations, strategic planning, program development, fiscal management, phy-sician relations and supervision, all with a strong value system and focus on high quality patient care and staff develop-ment and support.

Clary has served Peninsula Hospital as director of patient care services since 2010.

The University of Tennessee Medical Center Earns National Accreditation from American College of Surgeons for University Bariatric Center

KNOXVILLE — University Bariatric Center at The University of Tennessee Medical Center has been accredited as a Level 2 facility under the Bariatric Surgery Center Network (BSCN) Accreditation Program of the American College of Sur-geons (ACS). The accreditation demon-strates the surgery center’s commitment to delivering the highest quality care for its bariatric surgery patients.

To earn the accreditation, University Bariatric Center met the essential criteria that ensure its ability to support a bariatric surgical care program and the institution-al performance requirements outlined by the BSCN Accreditation Standards. Ac-credited bariatric surgery centers provide both the hospital resources necessary for optimal care of morbidly obese patients and the support and resources necessary to address the entire spectrum of care and needs of bariatric patients, both pre- and postoperatively.

Bariatric Surgery Centers that are ac-credited under ACS BSCN program stan-dards are part of the Metabolic Bariatric Surgery Accreditation Quality Improve-ment Program (MBSAQIP) administered

by the American College of Surgeons. In March 2012, the ACS and the American Society of Metabolic and Bariatric Surgery (ASMBS) announced plans to combine their respective national bariatric surgery accreditation programs into a single uni-fied program to achieve one national ac-creditation standard for bariatric surgery centers. This transition is now in process.

Memorial Health Care System’s inspire magazine receives two awards for creativity and excellence in communications

CHATTANOOGA – Memorial Hos-pital’s inspire magazine has received a PLATINUM win in the Hermes Creative Awards 2013. Hermes Creative Awards is an international competition for creative professionals involved in the concept, writing and design of traditional materials and programs, and emerging technolo-gies. Platinum is the greatest distinction given in the Hermes competition. En-tries come from corporate marketing and communication departments, advertising agencies, PR firms, graphic design shops, production companies, web and digital creators and freelancers.

Memorial’s second accolade for in-spire is the Award of Distinction win in the 19th Annual Communicator Awards. The Communicator Awards is the leading in-ternational awards program recognizing big ideas in marketing and communica-tions. Founded nearly two decades ago, The Communicator Awards receives over 6,000 entries from companies and agen-cies of all sizes, making it one of the larg-est awards of its kind in the world.

To begin receiving inspire magazine, send your name and address to [email protected].

Erlanger Physicians to Provide Gastroenterology Services at Hutcheson

FORT OGLETHORPE, Ga. – Hutcheson Medical Center announced Erlanger gastroenterology specialists Arlsan Kahloon, MD, and Laurie-Anne C. Swaby, MD, will provide GI services in North Georgia. The physicians from Erlanger’s Academic Gastroenterology practice will see patients at Hutcheson’s multi-specialty practice located on the Parkway and perform GI procedures at Hutcheson’s hospital GI lab.

Kahloon earned his medical degree at The Aga Khan University in Karachi, Pakistan. He completed an internal medi-cine residency program at University of Pittsburgh Medical Center and complet-ed fellowship training in gastroenterology and hepatology from Indiana University School of Medicine in Indianapolis.

Swaby earned her medical degree from Albert Einstein College of Medi-cine of Yeshiva University in New York. She completed an internal medicine resi-dency program at Brigham & Women’s Hospital in Boston and a gastroenterol-ogy fellowship at the University of North Carolina Hospitals in Chapel Hill.

Hutcheson’s Multi-Specialty Practice is located in suite 320 at Hutcheson on the Parkway. The practice also offers in-office surgical procedures by Ih Koo Park, MD; gastroenterology by Donald Mack-ler, MD; and urology by Joseph Veys, MD.


GrandRounds

Incentive funding up to $63,750 is available for Eligible Professionals (EPs) within the Medicaid program seeking to achieve Meaningful Use of an EHR.

Through special funding, tnREC is Through special funding, tnREC is offering free or low-cost health information technology services if an EP meets the Medicaid patient volume thresholds.

We help healthcare providers take We help healthcare providers take the right steps to implement new technologies that enhance and improve the quality of care available.

Apply onlinewww.tnrec.org

This presentation and related material was prepared by tnREC, the HIT Regional Extension Center for Tennessee, under a contract with the Office of the National Coordinator for Health Information Technology (ONC), a federal agency of The Department of Health and Human Services (HHS). Contents do not necessarily reflect ONC policy. 90RC0026/01 13.TREC.04.049

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Name: Thomas Myers

Position: Emergency Response Vehicle driver, American Red Cross

At a Glance: During his more than 20 years of service as a Red Cross volunteer, Thomas Meyers has seen more human suffering than most of us, as he has looked into the eyes of literally thousands of people facing the worst day of their lives. As a result, he understands that each of the 70,000+ people the Red Cross helps every year carries a personal story.

Whenever horrific disaster scenes play out on TV and the Red Cross vans, also known as ERVs, appear delivering food to people who just lost everything, there’s someone like Thomas either behind the wheel or handing out meals. Although he delivers the basic human need of food into disaster situations, Myers gives something intangible but equally as healing. His assuring smile and calming demeanor brings comfort and hope that although the situation is bad now, it’s going to get better. For Myers, it’s about more than just driving through neighborhoods to deliver food. He knows the importance of the human touch.

This great-grandfather and Vietnam-era veteran, along with other loyal Red Cross volunteers, hit the road with the ERV: Ready, Set, Rock & Roll Tour during the month of May. It was an opportunity for the Red Cross to recruit and train new disaster volunteers to deliver emergency services and help local communities be better prepared whenever the need arises.

La Grand Joins LBMC Technologies

KNOXVILLE – LBMC Technolo-gies, LLC, the Southeast’s leading full-service technology firm and a member of the LBMC (Lattimore Black Morgan & Cain, PC) Family of Companies, is pleased to announce the recent addition of Matt La Grand to the network operations division in its Knoxville office.

Matt La Grand joins LBMC Technologies, LLC as a network systems engineer with over ten years of experience in the areas of finance, healthcare and telecommunications and technology consulting. He brings a wealth of experience in Microsoft Server, Exchange and SQL, VMWARE and CIS-CO and comes to LBMC from Advanced Network Solutions where he served as an IT Systems Engineer. Matt is also certified in Aerohive Wireless Network engineering.

Originally from Central City, Ken-tucky, Matt enjoys hunting and spend-ing time with his two boys, Noah and Jonah hiking and backpacking. He also gives back to his community in his free time as a volunteer with the Boy Scouts of America

Budayr Named 2013 LMU-DCOM Preceptor of the Year

HARROGATE – Dr. Madhi Budayr, an allopathic surgeon from Maryville, Tenn., was awarded the 2013 Preceptor of the Year award from Lincoln Memorial Uni-versity-DeBusk College of Osteopathic Medicine (LMU-DCOM). The award was announced at LMU-DCOM’s annual gradua-tion ceremony on May 11.

The Preceptor of the Year Award is presented annually to an individual who consistently provides outstanding clinical instruction to LMU-DCOM third- and fourth-year students.

The award recognizes a preceptor who displays a passion for teaching, a com-mitment to service and a dedication to the highest ethical standards.

Budayr did his residency in general surgery at Conemaugh Valley Memo-rial Hospital, Temple University program, and completed his fellowship in colon and rectal surgery at Carle Foundation Hospital in Champaign, Ill. He is board certified by the American Board of Sur-gery and the American Board of Colon Rectal Surgeons and is currently a colon/rectal surgeon at Blount Memorial Hos-pital in Maryville, Tenn.

Save the Date for StarNight 2013, featuring Wilson Phillips

CHATTANOOGA – Help Siskin Chil-dren’s Institute support children with special needs and their families. Don’t miss StarNight 2013 - one of Chatta-nooga’s most highly anticipated annual

gala events. Join us for an evening with Grammy-nominated vocal trio Wilson Phillips as they grace the stage with un-forgettable classics and pop hits.

Carnie and Wendy Wilson, daugh-ters of The Beach Boys’ founder Brian Wilson, and Chynna Phillips, daughter of The Mamas and The Papas’ John and Michelle Phillips, launched their own musical careers in 1990 as Wilson Phil-lips. Their self-titled debut album was an instant smash with the hit singles “Hold On,” “Impulsive,” and “Release Me,” driving worldwide sales past the ten mil-lion copies mark.

After taking some time to pursue a series of solo recordings and television projects, in 2004 the group released Cal-ifornia, an album of California-inspired cover songs. In 2010 the trio reunited with their original Wilson Phillips pro-ducer for their first-ever holiday album, Christmas in Harmony, which brought the group back together in full swing 20 years after their breakthrough album.

The added benefit of this gala event, other than outstanding entertain-ment? You’ll be helping raise money for a worthy cause—the children and fami-lies served by Siskin Children’s Institute.

Please join us to celebrate StarNight and be a part of a tradition that has ben-efitted countless children and families during its 51 year history.

Matt La Grand

Dr. Madhi Budayr


Parkridge Valley CEO Receives Crisis Intervention Team Partner of the Year Award

CHATTANOOGA – Parkridge Val-ley CEO Brennan Francois was recently recognized at a special ceremony as the Hamil-ton County/Chattanooga Crisis Intervention Team’s Partner of the Year.

The Partner of the Year Award is an acknowl-edgement of the exten-sive support Francois has given to the Crisis Intervention Team (CIT) program, which trains law enforce-ment personnel on the proper way to respond to individuals dealing with a mental health crisis. Francois has been involved since the beginning of the pro-gram in 2009, teaching classes for the CIT School as well as the CIT For Youth course established for School Resource Officers and College Campus Police last year.

City, county, and federal law en-forcement from across the region have participated in the 40-hour CIT program, which covers topics such as substance abuse and co-occurring disorders, legal issues and mental health law, and train-ing on assessing and requesting crisis services. Instruction, which includes lec-tures, site visits to mental health facilities, and role-playing exercises, is provided by volunteer mental health professionals and advocates as well as experienced CIT officers.

To date, over 150 officers represent-ing agencies from six counties in three states have received instruction from the Hamilton County/City of Chattanooga CIT program.

For more information about the CIT program, visit http://www.hcsheriff.gov/uniform_services/crisis_intervention.asp

For more information about Parkridge Valley Hospital, visit www.parkridgevalley.com


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MEDICAL MOVER MOMENTDerby Day

A fundraiser for the Spine Health Foundation, Derby Day, was held on May 4, 2013 at The Olde Farm.

Attendees came together to celebrate and support the mission of The Spine Health Foundation, the only non-profit organization in the nation directly impacting lives by providing disadvantaged individuals access to specialized spine care.

Guests walked the red carpet to have their picture taken as they entered the Party Barn to join the pre-derby party festivities.

A few highlights of the evening were traditional southern derby cuisine and mint juleps; a Best Derby Hats Contest; and a silent and live auction.

Annually, the Spine Health Foundation honors one individual who has gone above and beyond to help those suffering with spinal disorders or injuries. Dr. Mor-gan Lorio presented the 2013 Hope Award to Dr. David Wiles of East Tennessee Brain and Spine Center, P.C. Dr. Wiles was not present, and Dr. Timothy Fullagar accepted on his behalf.

Major sponsors included Alpha Natural Resources, Eastman Credit Union, Re-gions Bank, Depuy Synthes, Victory Orthotics & Prosthetics, Medtronic, Alphatec Spine, Integra Foundation, Bill Gatton Automotive.

Kim Nicewonder, Carol Conduff, Krista Wharton


LBMC Security & Risk Services Claims Top Prize at Cyber Readiness Challenge

KNOXVILLE, CHATTANOOGA – LBMC Security & Risk Services, a division of Lattimore Black Morgan & Cain, PC, earned 1st place in the Symantec Nash-ville Cyber Readiness Challenge held at the Franklin Marriott Cool Springs in Franklin, Tennessee. LBMC Security & Risk Services, one of LBMC’s fastest growing service lines, provides a wide range of services including penetration testing, web application assessments, and compliance services to numerous domestic and international companies and government entities.

The Symantec Cyber Readiness Challenge is a competition designed to put participants in the hacker’s shoes to understand their targets, technology, and thought processes so they can ulti-mately better protect their company or clients.

The competition took the form of a ‘capture the flag’ style cyber-attack sim-ulation, with players competing against each other in a race to discover hidden vulnerabilities within the testing environ-ment.

The LBMC participants were Lucas Gates, Stewart Fey, and Brooke Mulli-can.

Robert P. Main, President and CEO of Siskin Hospital for Physical Rehabilitation, Announces Plans for Retirement

CHATTANOOGA — Robert P. Main, President and CEO of Siskin Hospital for Physical Rehabilitation, has announced his plans for retirement effective January 31, 2014, after 26 years of service. The an-nouncement was made at the April 24, 2013 quar-terly Board of Directors meeting at Siskin Hospi-tal.

Main has served on numerous boards and committees at the local, regional, and national level, and has received countless awards and recog-nition throughout his 47-year career in healthcare. In 2011, he was named the Chamber of Commerce’s Chattanooga Area Manager of the Year. Most recently, he was awarded with the 2013 Baron-ess Erlanger Foundation’s Distinguished Community Honoree Award and the 2013 American Hospital Association’s Grassroots Champion Award.

Main is looking forward to the next phase of his life and spending more time with his family. He has been working with the Board’s Executive Committee for the past year developing a plan for the orderly transition of the leadership of Siskin Hospital. A national search firm has been retained to assist in recruit-ing Siskin Hospital’s next President and Chief Executive Officer.

Robert P. Main

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(noun) the right or opportunity to use or benefit from something

Important Information for People with BlueCross BlueShield of Tennessee Insurance Coverage

8At t e n t i o n

What does the word “access” mean to you?

www.msha.com/bcbsT

We will do everything we can to stay in-network for all plans, but we want to be sure you know your options if MSHA is dropped from the BlueCross BlueShield of Tennessee network on July 1, 2013. You may want to

consider other insurance options that would guarantee your aCCeSS to your local MSHA providers. A list of other health plans that include MSHA facilities and physicians in their networks is below.

• Aetna• BeechStreetNetwork• Stratoseformerly

CoalitionAmerica/NPPN• CoventryNational

HealthcareNetwork/ First Health

• CrestPointHealth• FortifiedProvider

Network• GatewayHealth• HumANA

• IntegratedHealthPlan(IHP)

• IntegratedSolutions HealthNetworkLLC

• magellanHealthServices• medicare• mountainStates

PreferredNetwork• multiPlanNetwork• NovaNetInc.• OneCallmedical

(Norton,VA)

• OptimaHealth• OptumHealth

Behavioral Solutions/ United Behavioral Health

• PHCSNetwork• unitedHealthcare• VirginiaHealthNetwork• VirginiamedicaidPlans• VirginiaPremier

HealthPlanInc.

access

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