tri cities medical news august 2014

Paul Jett, MD, MBA

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Emerging & Reemerging Infectious DiseasesChikungunya and new strains of infl uenza are among a list of emerging infectious diseases that have grabbed recent headlines, but reemerging diseases including measles and pertussis are also causing epidemiologists concern across the nation ... 6

Taking Your Breath Away How Do Cities Fare In The Latest Annual Asthma Report? ... 7

HEALTHCARE LEADER: Linda Snodgrass“I have been in the healthcare industry for 24 years, and I’ve enjoyed every step of the way, but I absolutely love Urgent Care!” said Linda Snodgrass, Practice Administrator for First Assist Urgent Care of Mountain States Medical Group ... 8

By CINDy SANDERS

There’s no question healthcare delivery is in the middle of a transformational period highlighted by un-precedented consolidation. While there are a number of factors impacting alignment decisions, Paul Keckley, PhD, boiled the equation down to its simplest terms, “Economics drives behavior.”

Keckley, managing director for Navigant’s Center for Healthcare Research & Policy Analysis, said physi-cians are having to assess their practices in light of a new reality that requires effi ciency, effectiveness and contracting clout to survive.

“If you’re of a view that the economics favors you being inde-pendent for the rest of your practice, you go that route,” he stated.

However, the noted healthcare expert who has pub-lished three books and more than 250 articles on the industry and health reform, said that practice model is becoming increasingly rare.

For many, Keckley said practice decisions take a step-wise progression. Option A fi nds two small prac-tices within a specialty banding together. Option B brings multiple specialties together to form a large group. Option C has physicians or practices joining forces with a hospital or payer under some type of em-ployment, joint venture, or managed services organiza-tion (MSO) agreement.

“I think most doctors are past Option A. I think most doctors realize circling the wagons around a single specialty isn’t realistic,”

Partnering in a New Paradigm

(CONTINUED ON PAGE 15)

NASS Takes a Proactive Approach to Evidence-Based Coverage Decisions

By CINDy SANDERS

In an effort to improve patient access to appropriate, evidence-based care, the North American Spine Society (NASS) recently released detailed policy recommenda-tions for coverage of 13 common spine care treatments, procedures and diagnostics.

The fi rst-of-their-kind reference documents outline when it is … and when it is not … appropriate to utilize each of the options based on an extensive review of cur-rent literature by a multidisciplinary team of experts.

William Watters, MD, president of NASS, said, “Maintaining patient access to high-quality, evidence-based and ethical spine care is the single most important part of NASS’ mission. It is our hope that payers, spine specialists and their patients will use these evidence-based coverage recommendations as a reference to advocate for appropriate care for patients.”

Watters added the society was uniquely positioned to take the lead on such an ex-tensive project because of the multispecialty nature of the organization, which includes the expertise of surgeons and allied health professionals. “We cover the full spectrum of spine care,” he noted.

Watters, who is a board certifi ed orthopaedic surgeon in private practice at the Bone & Joint Clinic of Houston and a clinical associate professor at both the Uni-versity of Texas Medical Branch in Galveston and Baylor College of Medicine, said


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

PhysicianSpotlight

By BRIDGET GARLAND

Sports isn’t the only arena where a well-trained, talented team scores a win. When health-care is managed with a team ap-proach, patients win big. That multidisciplinary concept is what initially attracted Paul Jett, MD, a board-certified physiatrist (a spe-cialist in Physical Medicine and Rehabilitation), to his specialty in medical school.

“You work in a team en-vironment,” he explained “It’s interdisciplinary, with multiple team members; it’s a whole care approach.

“As a medical student, I liked the variety that was available with Physical Medicine and Rehab, and I enjoyed the musculoskeletal aspect of the specialty. It’s sort of two specialties in one if you think about it,” he explained. “You have the rehabilitative aspects of it treating catastrophic injuries, brain and spinal cord injuries, strokes, a host of traumas; and then you have the physical medicine aspects, such as musculoskeletal care, spine management, back pain, pro-cedures, education, and medical manage-ment.

Jett recalled that even as a young child, he wanted to be a doctor and wanted to help people, and that desire seemed to dovetail magically when he discovered his scientific aptitude in high school. He went on to attend the Univer-sity of Kentucky, where he majored in bi-ology, and then attended medical school at the University of Louisville School of

Medicine. His internship and residency were completed at the Charlotte Institute of Rehabilitation in North Carolina. Jett is one of only about 10,000 physiatrists in the country. In addition to his board certification in physical medicine and re-habilitation, he is board-certified by the American Board of Independent Medical Examiners and the American Board of Pain Medicine. He is also board-eligible in sports medicine.

After finishing his education in Char-lotte in 2005, Jett and his wife Jeannine, a speech therapist, moved to Morristown, Tennessee, affording him the opportunity to practice closer to family.

One part of his education that Jett felt was lacking was the business aspect of medicine. That knowl-edge gap and the recent changes to healthcare, including the Affordable Care Act, prompted him to pursue an MBA from the University of Tennessee in Knoxville.

Jett admits that the year-long program was a difficult challenge, but well worth his time and effort. “I’m always wanting to learn more, and with the healthcare model evolving and changing, the Physi-cian Executive MBA made sense,” he said. “I worked with 50 other physicians, who I met with one week a quarter for intensive training and during Saturday classes. The pro-gram included both individual and group projects studying the business side of medicine that I was never exposed to before. It was extremely hard to balance it with my practice and family, but it was a tremendous opportunity.”

Near the completion of his degree, Jett was prompted to look at a career change. Having been affiliated with the Wellmont Health System in Rogersville, Tennessee, while directing a spine clinic at Hawkins County Memorial, Jett ap-proached Wellmont about the possibility of partnering in care.

“I wanted to develop a practice working with Wellmont, with a lot of dif-ferent teams, focusing on the nonsurgical management of back pain, nonopioid and conservative pain management, rehabili-tation for stroke, spine care, even Botox for migraines,” he shared. “Wellmont was open to helping me build a program,

and since then, I’ve joined the controlled substance advisory committee, which is working toward a standardized approach in pain management across the organiza-tion.”

Added Jett, “It has also been nice to see Wellmont’s Physician Leadership at work with the administrative team that is in place. The physician leadership is a nice model and it has been a great experi-ence thus far.”

Jett currently provides comprehen-sive care at two locations: full time at Wellmont Medical Associates Spine & Re-habilitation, at 121 E. Ravine Road, Suite 200, in Kingsport, and part time at 401 Scenic Drive, next to Hawkins County Memorial Hospital in Rogersville.

The practice has recently experienced a lot of growth, adding a new nurse prac-titioner, with plans to add a second one soon; and in early fall, the practice plans to move to another location at Sheridan Square in Kingsport.

“I’m excited about working with Wellmont and area physicians,” Jett said. “I’m excited to bring my skill set to the table for patients who need long-term management outcomes, especially for those individuals who have been strug-gling with back pain or other musculoskel-etal complications.”

Jett and his wife have two daugh-ters, nine-year-old Polly, and six-year-old Essie. They enjoy art, music, and swim-ming, as well as taking care of their family pets, a bulldog, two shitzus, a bird, and even a guinea pig.

Apart from spending time with his family, Jett enjoys Crossfit training, trav-eling, and supporting the University of Kentucky Wildcats.

Paul Jett, MD, MBA

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LegalMatters

Profit and Loss: The Top Ten Things Providers Need to KnowPart IV: The Stark Reality –Your Physician Group may not be a “Group Practice”

BY PATTI T. COTTEN, LONDON & AMBURN, P.C.

This article is the fourth installment in a series which explores the top ten health law issues and their potential financial consequences on a provider’s practice.

The “Stark Law” is the healthcare

industry’s common name for the federal law which prohibits physicians from making referrals of certain “designated health services” (DHS) payable by Medicare to an entity with which the the physician (or an immediate family member of the physician) has a financial relationship (1). “Stark” is often correctly cited by healthcare providers with a basic understanding that there is something inherently wrong with financially rewarding a physician for referring DHS to outside entities such as hospitals, laboratories, and other diagnostic facility. But, what many physicians do not realize is that the Stark law may directly impact the

compensation arrangements inside their own group practices.

How do the Stark laws/regulations apply to a physician group practice?

Any group practice which performs its own DHS (e.g., radiology services, laboratory and pathology services, physical therapy services, etc.) for Medicare patients must be concerned about compliance with the Stark law. When a group physician orders an x-ray on one of his/her Medicare patients and that x-ray is performed by the group’s rad tech on the group’s radiology equipment, then that physician has made a Stark “self-referral” to an entity with which he has a financial arrangement (i.e., his/her own group). To be Stark-compliant, that referral has to fall within an enumerated exception to Stark’s self-referral prohibition.

Isn’t there a Stark “group

practice” exception? The Stark “in-office ancillary

services” exception (the “IOAS exception”) allows a physician to refer within his/her own group practice, so long as each element of the IOAS exception is fulfilled. Contrary to popular belief, there is no “group practice” exception under Stark. However, in order to apply the IOAS exception to the ancillary services performed by the group, the practice must meet Stark’s definition of a “group practice.”

Our group of physicians has been practicing together for 15 years. How could we not qualify as a “group practice” under the Stark law?

If asked to define a “group practice,” most physicians would cite the traditional business model. Under common perceptions, “XYZ Medical Group, PLLC” (which might have 4 physician members, 2 physician employees, plus a couple of mid-level practitioners, practicing in the same office and billing under the same group name) surely qualifies under Stark as a “group practice,” right? Well, it depends.

Other than shared office space, equipment, personnel, and billing numbers, what other factors determine whether a group qualifies as a Stark “group practice”?

Many physicians who routinely order lab work or x-rays performed by their own group practice do not realize that the group’s compensation model will determine whether or not that Stark “referral” falls within the IOAS exception. Yet, for a group to be considered a “group practice” under the Stark law (so that it may qualify for the IOAS exception), its must ensure that its allocations of overhead and expenses and its calculation of physician compensation, productivity bonuses and profit-sharing are “not determined in any manner which is directly related to the volume or value of referrals” (2).

Why does Congress care how my group allocates its overhead expenses?

Actually, Congress does not

really care how a group allocates its expenses, but it does require that overhead expenses be “distributed in accordance with methods previously determined.” So, the group must determine, in advance, how it is going to allocate expenses. The allocation may be changed any number of times so long as it is applied prospectively, but the group may not wait until those expenses are incurred and then take into account each physician’s volume of DHS referrals when allocating those expenses.

May a group physician be compensated for ordering DHS?

Yes, but only indirectly. Stark says that a group may pay its physicians using methods that either recognize their “hands on” productivity or allocates to them a share of overall profits derived from DHS performed by others in the group. Whether a profit or productivity approach is selected, the key is that the physician’s allocation may not be determined in a manner that is directly related to the physician’s volume or value of DHS referrals.

So, our group must split all

ancillary revenues equally?That’s only one Stark-compliant

compensation methodology – and it may be highly unsatisfactory, especially when the group’s physicians have significantly varying use of the group’s ancillary services. Moreover, it is a common misconception that all ancillary revenues of the group practice have to be allocated in the same way. The Stark law only applies to Medicare DHS revenues, so revenues derived from ancillary services billed to commercial payers may be allocated directly to the ordering physician.

If the group focuses on productivity, then it might pay bonuses based on total patient encounters or relative value units (“RVU”). Or, it might look at physician referral patterns for non-DHS revenues and allocate the DHS revenues along those same patterns under a profit-sharing arrangement. While the Stark regulations actually enumerate three approved compensation methods


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Many healthcare IT businesses create white papers in hopes of gaining more in-terest in their products, processes or data. And, hopefully, getting more business leads and attention as a result. The best white papers are factual and informative, rather than promotional or pushy, and a well-written, authoritative white paper can elevate your business in the eyes of your peers, other businesses and potential cli-ents by presenting an image of expertise and knowledge.

Sometimes white paper development is overlooked by businesses in the health-care industry, misjudged as a verbose and boring document no one really reads. However, I have found that white papers written in an educational and practical style can be effective and powerful mar-keting tools. In a recent blog by content marketing expert Lee Oden, he listed the top content marketing tools from the up-dated 100+ B2B Content Marketing Sta-tistics report. Out of all the various content strategies used by the businesses studied, white papers made the top ten, coming in at number nine on the list.

While a white paper may not be as “sexy” as a fl ashy, glossy advertisement, businesses can benefi t from a great white paper in many ways:

Your peers will think of your business

as an authorityA white paper need not be a lengthy,

100-page tome, but it does need to be fac-tual, offer useful information, and appeal to the audience your business is trying to reach. Presenting useful research or re-vealing a solution to a common business problem will make your readers and peers look to you as the expert in your industry.

You can collect email addresses from individuals downloading your paper

This is probably one of the main ad-vantages to offering a free white paper to your target audience. If you ask for an email address before allowing your white paper to be viewed in its entirety, you have an easy way to follow up with potential cus-tomers who have already shown an interest in your business. You can also use this as a way to track the white paper’s success.

By offering case studies, you elevate your business without selling it

People love a good case study, and a white paper is the ideal medium to high-light your best ones without too much horn-tooting. Just like reviews on TripAd-visor, the case studies in your white papers promote your product with real user infor-mation, not sales talk. Your white papers will be more successful without overt plug-ging, and your audience will come back to read your other papers.

You can repurpose your white papers for multiple platforms

White papers can be great content marketing tools for social posts, blog posts, press releases, website teasers, articles, and as information pieces for media. Use the information in your white papers on other platforms to help build an audi-ence and gain more traction. By sharing and promoting your valuable information via social, you can create additional buzz and funnel readers directly to your white paper.

When creating a white paper for your healthcare business, always keep in mind your audience. What can your white paper offer that will help your audience or solve a problem? Try to offer statistics and diagrams to create visual interest. And remember not to be too technical, unless your paper is specifi cally geared to expert IT professionals or engineers. If you do not have writers on staff, professional writers or agencies who employ seasoned writers can develop a structure and style for your white papers, while targeting your audi-ence for maximum impact.

There are also free tools and resources online where you can investigate the proper steps needed to write a successful white paper.

Heather Ripley is the founder and CEO of Ripley PR, a national B2B public relations agency specializing in Healthcare IT. For more information, visit www.ripleypr.com or email [email protected].

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By CINDy SANDERS

Chikungunya and new strains of influenza are among a list of emerging infectious diseases that have grabbed recent headlines, but reemerging diseases including measles and pertussis are also causing epidemiologists concern across the nation.

“There are newly emerging diseases and reemerging diseases … and both are disturb-ing,” stated Tim Jones, MD, state epidemiolo-gist for the Tennessee Department of Health (TDH). Jones, whose past experience includes working in the Centers for Disease Control and Prevention’s Epidemic Intelligence Ser-vices, recently provided insight into the old and new. He also shared his thoughts on why we’re seeing a resurgence of some diseases, such as polio, that the medical community thought would be a distant memory at this point in history.

“Internationally, we had hoped that polio would be eradicated by the turn of the century, but here we are in 2014 with it expanding into additional countries,” he said.

Jones, who is the immediate past president of the Council of State and Ter-

ritorial Epidemiologists, noted the spread of new diseases and return of some of the older ones is multifactorial with global mobility and increasing refusals to be vac-cinated contributing to the problem.

Emerging Infectious Disease“The majority of these new diseases

are what we call zoonotic. As the name suggests, they are diseases that have jumped from the animal world into hu-mans,” Jones explained, adding exam-ples include SARS, West Nile Virus and H1N1.

The most recent mosquito-borne dis-ease to make its way to the United States is chikungunya. “We just started seeing it in the last few months,” Jones noted of the disease’s migration primarily from the Ca-ribbean where there have been large out-breaks. “Our first cases in Tennessee were in May. We’d never seen it before. As of today, there are 37 suspected cases, and all of them are people who have recently returned from the Caribbean.”

Jones added, “This new one, chikun-gunya, luckily does not have a reservoir out in the wild.” He explained the viral disease doesn’t live in birds or other ani-mals and only transmits between mosqui-tos and humans. “For me to get it, the mosquito would have to bite an infected person and then me. So far we haven’t seen any jump from infected travelers

to someone local, but that’s what we’re afraid of.”

(Editor’s Note: At the time of the interview in early July, there had not been any cases of chikun-gunya originating in the United States. However, the CDC has since confirmed the first cases of the virus being locally acquired. The virus is transmit-ted through two species of mosquitoes, Aedes ae-gypti and Aedes albopictus, which are found in a number of regions across the country including the Southeast.)

Primary symptoms include joint pain and fever. Although there is no vaccine, Jones noted, “It’s rarely fatal, but it makes you feel terrible for about a week, and 10 to 15 percent of people will have very bad arthralgias for up to a year.”

Dengue is another mosquito-borne virus that epidemiologists are closely mon-itoring. “Generally, it’s pretty endemic in the Caribbean and South and Cen-tral America, but it seems to be moving north,” Jones said. “As these vector-borne diseases move into new areas, it raises con-cerns as to whether it could be related to climate change.”

With no vaccine or treatment, den-gue is a leading cause of illness and death in the tropics and subtropics and is caused by any of four related viruses transmitted by mosquitos. “Unfortunately, dengue you can get more than once, and if you get it a second time, it’s usually much more severe,” Jones said, adding it’s nickname is ‘breakbone fever’ because the intense joint and muscle pain can cause those with den-gue to have contortions.

The first 2014 human case of yet an-other mosquito-borne disease, West Nile Virus, was confirmed in Tennessee in late June. WNV has been present in the state since 2001.

The common thread with all three of these viruses is that there is no vaccine so prevention remains the best way to con-tain the spread of the virus. The TDH lists a number of recommendations on their website for individuals to prevent mos-quito bites including the use of insect re-pellants and elimination of standing water near homes.

Reemerging DiseasesAlthough ‘officially’ eradicated from

the United States in 2000, measles is still present in other regions of the world and has begun to reappear in this country. In fact, the CDC recently announced they have confirmed more cases of measles in the United States so far in 2014 than in any other year in the past two decades.

This spring, the TDH identified the first case of measles in the state in three years. As with most cases now seen in this country, the virus was traced to an inter-national traveler and then spread to those who weren’t immune to the disease.

“We had one person who returned from overseas from an area that was hav-ing an outbreak, and we ended up hav-ing five people infected before we got it under control,” Jones said. Transmittable through the air, he added, “Measles is very serious and really, really easy to spread.”

Although the state has a very high rate of compliance for the measles vaccine, Jones pointed out that the vaccine was re-ally only recommended for those born after 1957 since many older citizens were exposed to measles in childhood. A two-part vaccine, Jones said the state probably only has 2-3 percent of the population that isn’t fully immunized.

Pertussis, or whooping cough, is an-other disease spreading throughout the country. Although Jones said Tennessee has only had light activity with 100-200 cases per year, other parts of the country have been much more heavily affected. “There are some states in the Midwest and now California that have had many hundreds and thousands.”

The problem, Jones continued is a combination of under-immunization and the fact that it isn’t a perfect vac-cine. Because of some concern about the immunization wearing off, a booster is now recommended. “In the last couple of years, we began recommending all adults that haven’t had this new Tdap (tetanus, diphtheria and acellular pertussis) vaccine get a dose no matter when the last time they had a tetanus shot,” Jones said.

In Tennessee, the continuing concern over tuberculosis comes with some good news and some bad news. “For the first time this year, Tennessee is below the na-tional average, which is exciting … but as the numbers go down, the complexity of each case is going up,” Jones said.

He added, “While we’re having a real impact on domestic TB, now nationally the majority of TB cases are in the foreign-born population. We’re seeing much more imported TB.”

Although contagious, Jones said it takes close, prolonged contact rather than casual proximity to spread the disease. In the absence of a good vaccine for TB, test-ing becomes important … particularly for healthcare workers.

A major issue with reemerging dis-eases is a lack of recognition by healthcare providers since they are so rare. “There are very few physicians in the U.S. who have ever seen a true case of measles,” Jones said. “Likewise for TB … most physicians are never going to have seen a real case, and that makes it challenging.” He added, “With TB, for example, we’re increasingly seeing people who went to a healthcare professional and were treated for bronchitis, smoker’s cough, etc. We’ve got to keep these diseases in the back of our minds as possibilities.”

Jones said education and awareness are key to catching infectious diseases early. The CDC has extensive information on both emerging and reemerging public health threats. Likewise, the TDH pro-vides resources and local updates about diseases present in Tennessee. For more information, go online to cdc.gov and to the TDH section on communicable and environmental diseases and emergency preparedness (CEDS) at health.state.tn.us/ceds.

Emerging & Reemerging Infectious Diseases

Dr. Tim Jones


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Jenny, a member of the American Academy of Professional Coders (AAPC), the American Health Information Management Association (AHIMA), and the National Association for Healthcare Quality (NAHQ), has over 20 years of extensive experience in the healthcare field. During her career, Jenny has worked in the fields of inpatient and outpatient hospital coding, physician coding/billing, payer services, and pharmacy services. Her education for physicians and other providers, regulatory and payer compliance, fee schedule analysis, and billing review for compliant reimbursement. Jenny has taught CPT coding and medical terminology at Roane State Community College. She is a music nut, loves discovering small indie artists before they become a big deal, going to see live music and is an avid collector of vinyl (record albums) over 2,000 and counting. She also enjoys spending time outdoors with her husband and dogs on their property in Ozone, TN.

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By LyNNE JETER

A thriving city rich in history, perched on the brow of the picturesque James River, has once again captured the uncov-eted title as the most challenging place to live with asthma.

For the second consecutive year, and four of the last fi ve years, Richmond, Va., took the title perch, with worse than aver-age ratings for prevalence factors (crude death rate for asthma), risk factors (annual pollen score, poverty rate, the uninsured, and public smoking laws), and medical factors (emergency room visits for asthma).

Medical News markets located across the South and Midwest were represented in “Asthma Capitals 2014,” the 11th an-nual research project released by the Asthma & Allergy Foundation of America (AAFA). Boston Scientifi c Corporation (NYSE: BSX) sponsored this year’s report.

Medical News market rankings, with 2013 rankings in parentheses:

No. 2: Memphis, Tenn. (3)No. 6: Chattanooga, Tenn. (2)No. 22: New Orleans, La. (24)No. 26: St. Louis, Mo. (55)No. 27: Little Rock, Ark. (31)No. 38: Nashville, Tenn. (32)No. 41: Knoxville, Tenn. (10)No. 42: Jackson, Miss. (47)

No. 48: Birmingham, Ala. (23)No. 49: Orlando, Fla. (62)No. 50: Tampa, Fla. (57)No. 55: Lakeland, Fla. (60)No. 64: Daytona Beach, Fla. (76)No. 65: Baton Rouge, La. (79)No. 75: Sarasota, Fla. (87)No. 81: Raleigh, NC (91)No. 87: Charlotte, NC (86)Most Metropolitan Statistical Areas

(MSAs) in Medical News markets im-proved over 2013, collectively dropping 45 spots. The St. Louis market showed the least improvement, moving up 29 spots among the most challenging places to live with asthma. The most improved MSAs for easier asthma living: Knox-ville, Tenn., sliding down 31 spots, fol-lowed closely by Birmingham, Ala., which dropped 25 spots.

MethodologyAnalytical data from the 100 most-

populated MSAs in the United States de-termined the ranking system. Researchers and medical specialists focused on three primary areas – prevalence, risk, and medical factors – that include 13 unique factors, with non-equal weights applied to each data set in individual factor groups. Total scores were calculated as a compos-ite of all factors, refl ecting each factor’s

relative impact on exposure to asthma triggers, quality of life, costs and access to care.

Prevalence factors included the predicted population with asthma, self-reported population with asthma, and re-corded death rates for adults and children from asthma. Risk factors included com-prehensive annual pollen measurements, average length of peak pollen seasons, out-door air quality, poverty and uninsured rates, state school inhaler access laws, and smoke-free public laws.

Medical factors included ER visits for asthma, rescue medication use, controller medication use, and the number per pa-

tient of board-certifi ed adult and pediatric allergists and immunologists, and pulmo-nologists.

ER visits represent a signifi cant chunk of asthma care-related costs.

“Many ER visits are from people with severe asthma, but not all of them,” said Mario Castro, MD, professor of medicine and pediatrics at Washington University School of Medicine in St. Louis, discuss-ing the average of more than 2,300 visits to ERs for asthma in each U.S. city, with one in four admitted to a hospital. “Many people with less severe asthma show up to the ER, too. But much of this is avoidable with new treatments for severe patients and better prevention and care for those with less severe disease.”

Making StridesEarlier this year, the Supreme Court

upheld the U.S. Environmental Protection Agency’s (EPA) Cross-State Air Pollution Rule, which aims to reduce the amount of pollution drift from certain states into oth-ers, prompting health issues for residents in those states. The Supreme Court also noted the rule is an effective way to con-trol emissions, and melds with the EPA’s mission under the Clean Air Act.

The AAFA is collaborating with state

Taking Your Breath Away How do cities fare in the latest annual asthma report?

The national burden of 25 million Americans with asthma costs more than $50 billion annually in healthcare expenses, missed school and work days, and deaths. Yet, asthma rates have continued to climb since the late 1980s across age, gender and racial lines, now affecting nearly 10 percent of the U.S. population.



HealthcareLeader

Linda SnodgrassBy JENNIFER CULP

“I have been in the healthcare indus-try for 24 years, and I’ve enjoyed every step of the way, but I absolutely love Ur-gent Care!” said Linda Snodgrass, Prac-tice Administrator for First Assist Urgent Care of Mountain States Medical Group. “Patient service is my passion,” she con-tinued, “and at First Assist, I have the op-portunity to meet patients from all over the region, help meet their healthcare needs, and hopefully make a positive dif-ference in their lives.”

The roots of Snodgrass’s career ex-tend back to her childhood in Salisbury, North Carolina. Her mother worked as a nurse at the VA Medical Center in Salis-bury, and watching her work to care for patients and improve their lives made Snodgrass interested in pursuing a health-care career of her own. “My first job in healthcare was a summer position as a patient service representative in a local radiological office in Salisbury,” Snod-grass remembered. “I fell in love with the elderly patients I helped there, so I felt that I was definitely on the right career path.”

Snodgrass’s ambition led her to enroll at East Tennessee State University, which she chose for its Healthcare Administra-tion program. While working to earn her degree, she spent evenings and weekends as a medical transcriptionist in the Radi-ology Department of Takoma Hospital in Greenville, Tennessee, and later as a med-ical transcriptionist and office assistant in the Occupational Medicine Department of the same hospital. Upon earning her Bachelor’s degree in Healthcare Admin-istration, Snodgrass took on a full-time position as a medical transcriptionist for Medical Center OB/GYN in Johnson City. “That position was a blessing for me

because it allowed me to work full time to support myself and attend graduate school at night. The physicians and office manager there were very supportive of my school schedule and career goals, which made completing graduate school much easier for me. Even though many of them have now retired, I will be forever thankful for their support,” she said.

After completing her Master’s degree in Public Health in 1997, Snodgrass ex-panded the scope of her responsibilities, becoming the practice manager for John-son City OB/GYN Associates. In 2004, she took a position as practice administra-tor at the Center for Integrative Medicine, where she developed her skills and expe-rience until moving to her current job at

First Assist Urgent Care in 2007.“I am currently responsible for the

First Assist Urgent Care/MedWorks Occupational Medicine service line for Mountain States Medical Group, which consists of eight clinics, 47 providers, and 87 team members located in Tennessee and Virginia,” she explained. “Much of my time is spent on day-to-day opera-tions, traveling from site to site. I may be in Jonesborough in the morning, Colonial Heights after lunch, and Abingdon in the afternoon!”

Navigating the healthcare industry, as Snodgrass pointed out, can be a con-fusing experience for the layperson, who may not know where to go or who to call in order to find appropriate care for their medical problems. At First Assist, provid-ers and staff work not only to address pa-tients’ immediate needs, but also to help them secure establishment with primary care providers, pediatricians, and special-ists. First Assist is open 364 days a year, on weekends and evenings, as well as holi-days for the convenience of patients suf-fering from non-life threatening injuries and illnesses. The practice offers on-site x-rays and lab services for convenience of patients, as well as sports and school physi-cals and occupational medicine services at each of its eight locations. Snodgrass is personally invested in providing the best possible experience for each and every patient; her phone number is listed on the practice’s website for patients who have any questions or concerns about seeking care at any of First Assist’s locations. In addition to treating patients’ physical ail-ments, the First Assist team makes a pri-ority of engaging with and improving the local community.

“The First Assist team members, pro-viders, and I enjoy community outreach,

and make it a priority to get out into the community and participate in numerous outreach events quarterly,” Snodgrass ex-plained. “You may see us in the clinic on Monday, at the Health Resource Center in the Johnson City Mall on Thursday, and in the First Assist First Aid Tent on the football field on Saturday! We just want to make a positive difference in the community and let our patients know that we’re here for them when they need us.”

Snodgrass and her husband Roger, a pharmaceutical specialist, recently cele-brated their 10-year wedding anniversary. The couple have two children, William (age 6) and Morgan Elizabeth (age 3). When she’s not working, Snodgrass likes to relax with reading, landscaping, and interior design.

“My husband and I love antiquing and traveling, but our favorite time of day is evening when we get to just relax and spend time outdoors with the children,” she said. Snodgrass and her family love their Elizabethton home and community. “Even though I’m not from East Tennes-see originally, it’s home now, and I can’t imagine living anywhere else,” she said. “It’s a beautiful place to live and raise a family!”

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Take good care of your money.


East Tennessee Children’s Hospital Gastroenterology and Nutrition ServicesGI for Kids, PLLC

Every Child Is Special.

www.giforkids.com (865) 546-3998

Bee Fit 4 KidsOur physicians are well aware of the obe-sity crisis in the United States, especially among children. That’s why

we have developed Bee Fit 4 Kids, a family-based, multidisciplinary pediatric weight management program. Bee Fit 4 Kids brings together a physician extender, behavioral health clinician and registered dietician to cre-ate a team for each child in the pro-gram. Working with the children, his or her parents and other family members where appropriate, the team builds rapport with the child through one-on-one meetings, and then begins to create an individualized treatment plan around nutrition, fi tness and psycho-logical concerns. How does it work? Healthy lifestyle changes at every step of every day. Weight loss doesn’t happen overnight, and good eating habits don’t form in a weekend. We work with the child to teach him or her about healthy and fun food choices, as well as starting on physical activities. The emotional side of weight loss is covered as well, so the child learns how to live healthier both physically and mentally. Bee Fit 4 Kids is for children and adolescents with a Body Mass Index, or BMI, greater than the 95th percentile, or the 85th percentile if there is an over-weight parent, medical complication or family history of specifi c health risks.

The Developmental Feeding ClinicChildren born prematurely often have diffi culty eating as they grow and develop. Partnering and collaborat-ing with Dr. Nadine Trainer at East

Tennessee Children’s Hospital, GI For Kids’ Medical Director, Dr. Youhanna Al-Tawil, working with dietician Ashley Treadway, has developed The Develop-mental Feeding Clinic of the Children’s Hospital Rehab Center to address their special needs. At its core, The Feeding Clinic focuses on the needs of children with feeding issues due to neonatal ab-stinence syndrome, premature birth, neurodevelopmental delay and sensory integration disorder.

Liver Disease Specialty TreatmentGI For Kids has launched a new liver program that will treat the entire range of liver issues, from elevated liver en-zymes to diseases such as hyperbiliru-bemia, autoimmune hepatitis, infectious hepatitis and chronic liver conditions.

Celi-ACT GI For Kids has many patients who deal with the ongoing issues

surrounding celiac disease and gluten intolerance. Our goal is not only to pro-vide medical treatment, but also care and support. Celi-ACT is a support group that gives children and their families the education and information to deal with a diagnosis of Celiac disease. From life-style changes to what to expect medi-cally, the group is there to calm fears and provide hope.

KidsFACTKidsFACT (Kids Fight-ing against Crohn’s and Colitis Together) is a nonprofi t sup-

port group founded by GI For Kids to

help those with pediatric Infl ammatory Bowel Disease, or IBD. In addition to providing information and support, KidsFACT also gives college scholar-ships to children with IBD, Crohn’s Disease and ulcerative colitis.

Transitions Behav-ioral Health ClinicAll of our work at GI For Kids is patient-centered, but that doesn’t mean just treating the physical

ailments. We also focus on the mind, because whether it’s dealing with a Crohn’s diagnosis or the emotional issues surrounding weight loss, whole-body health is key to success. Our Transitions Behavioral Health Clinic works with pediatric patients and their families as they tackle the big changes that have come their way. We offer support and behavioral modifi ca-tions, and also receive outside referrals from other pediatrics practices to treat behavioral issues both related and unre-lated to GI issues.

From intake to diagnosis and beyond, GI For Kids works with patients and their families to treat GI illnesses, weight issues, mental-health challenges and much more. We work with the en-tire East Tennessee Children’s Hospital medical family on community outreach events and educational seminars/work-shops throughout the year, because we believe an informed community is a healthy community. If you would like any information about our practice, support groups or upcoming events, please contact us at (865) 546-3998, or visit us at www.giforkids.com.

Celi-ActKnoxville area celiac patients helping each other.

www.celi-act.com Established by GI for Kids, PLLC

GI FOR KIDS DOESN’T FOLLOW THE TRENDS, IT SETS THEM.

When a child says “my tummy hurts,” it can be a lot of di� er-ent things. That’s why GI For Kids is ready to treat children with a variety of GI issues, o� ering pediatric gastrointestinal, hepatology and nutritional services.

We are an a liate of East Tennessee Children’s Hospital, and our highly trained, award-winning sta� includes four board-certifi ed pediatric gastroenterologists, three nurse practitio-ners, a physician assistant, two behavioral health clinicians, three registered dieticians and a research coordinator.

Their healthcare should be, too. At GI for Kids, that’s the way we do things all day, every day.

TREATING THE WHOLE CHILD ISN’T A CONCEPT. IT’S WHAT WE DO.At GI For Kids, we treat our patients when they come to us, but we also keep up with what’s going on outside our walls. From attending (and often presenting at) seminars and workshops to writing for medical journals, we take the advanced concepts of pediatric medicine and create programs tailored to help our patients, and their families, live better lives.

2100 Clinch Avenue, Suite 510 | Children's Hospital Medical Offi ce Building | Knoxville, TN 37916


East Tennessee Children’s Hospital Gastroenterology and Nutrition ServicesGI for Kids, PLLC

Every Child Is Special.

www.giforkids.com (865) 546-3998

Bee Fit 4 KidsOur physicians are well aware of the obe-sity crisis in the United States, especially among children. That’s why

we have developed Bee Fit 4 Kids, a family-based, multidisciplinary pediatric weight management program. Bee Fit 4 Kids brings together a physician extender, behavioral health clinician and registered dietician to cre-ate a team for each child in the pro-gram. Working with the children, his or her parents and other family members where appropriate, the team builds rapport with the child through one-on-one meetings, and then begins to create an individualized treatment plan around nutrition, fi tness and psycho-logical concerns. How does it work? Healthy lifestyle changes at every step of every day. Weight loss doesn’t happen overnight, and good eating habits don’t form in a weekend. We work with the child to teach him or her about healthy and fun food choices, as well as starting on physical activities. The emotional side of weight loss is covered as well, so the child learns how to live healthier both physically and mentally. Bee Fit 4 Kids is for children and adolescents with a Body Mass Index, or BMI, greater than the 95th percentile, or the 85th percentile if there is an over-weight parent, medical complication or family history of specifi c health risks.

The Developmental Feeding ClinicChildren born prematurely often have diffi culty eating as they grow and develop. Partnering and collaborat-ing with Dr. Nadine Trainer at East

Tennessee Children’s Hospital, GI For Kids’ Medical Director, Dr. Youhanna Al-Tawil, working with dietician Ashley Treadway, has developed The Develop-mental Feeding Clinic of the Children’s Hospital Rehab Center to address their special needs. At its core, The Feeding Clinic focuses on the needs of children with feeding issues due to neonatal ab-stinence syndrome, premature birth, neurodevelopmental delay and sensory integration disorder.

Liver Disease Specialty TreatmentGI For Kids has launched a new liver program that will treat the entire range of liver issues, from elevated liver en-zymes to diseases such as hyperbiliru-bemia, autoimmune hepatitis, infectious hepatitis and chronic liver conditions.

Celi-ACT GI For Kids has many patients who deal with the ongoing issues

surrounding celiac disease and gluten intolerance. Our goal is not only to pro-vide medical treatment, but also care and support. Celi-ACT is a support group that gives children and their families the education and information to deal with a diagnosis of Celiac disease. From life-style changes to what to expect medi-cally, the group is there to calm fears and provide hope.

KidsFACTKidsFACT (Kids Fight-ing against Crohn’s and Colitis Together) is a nonprofi t sup-

port group founded by GI For Kids to

help those with pediatric Infl ammatory Bowel Disease, or IBD. In addition to providing information and support, KidsFACT also gives college scholar-ships to children with IBD, Crohn’s Disease and ulcerative colitis.

Transitions Behav-ioral Health ClinicAll of our work at GI For Kids is patient-centered, but that doesn’t mean just treating the physical

ailments. We also focus on the mind, because whether it’s dealing with a Crohn’s diagnosis or the emotional issues surrounding weight loss, whole-body health is key to success. Our Transitions Behavioral Health Clinic works with pediatric patients and their families as they tackle the big changes that have come their way. We offer support and behavioral modifi ca-tions, and also receive outside referrals from other pediatrics practices to treat behavioral issues both related and unre-lated to GI issues.

From intake to diagnosis and beyond, GI For Kids works with patients and their families to treat GI illnesses, weight issues, mental-health challenges and much more. We work with the en-tire East Tennessee Children’s Hospital medical family on community outreach events and educational seminars/work-shops throughout the year, because we believe an informed community is a healthy community. If you would like any information about our practice, support groups or upcoming events, please contact us at (865) 546-3998, or visit us at www.giforkids.com.

Celi-ActKnoxville area celiac patients helping each other.

www.celi-act.com Established by GI for Kids, PLLC

GI FOR KIDS DOESN’T FOLLOW THE TRENDS, IT SETS THEM.

When a child says “my tummy hurts,” it can be a lot of di� er-ent things. That’s why GI For Kids is ready to treat children with a variety of GI issues, o� ering pediatric gastrointestinal, hepatology and nutritional services.

We are an a liate of East Tennessee Children’s Hospital, and our highly trained, award-winning sta� includes four board-certifi ed pediatric gastroenterologists, three nurse practitio-ners, a physician assistant, two behavioral health clinicians, three registered dieticians and a research coordinator.

Their healthcare should be, too. At GI for Kids, that’s the way we do things all day, every day.

TREATING THE WHOLE CHILD ISN’T A CONCEPT. IT’S WHAT WE DO.At GI For Kids, we treat our patients when they come to us, but we also keep up with what’s going on outside our walls. From attending (and often presenting at) seminars and workshops to writing for medical journals, we take the advanced concepts of pediatric medicine and create programs tailored to help our patients, and their families, live better lives.



EAST TN MEDICAL NEWS

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Knoxville MGMA Monthly MeetingDate: 3rd Thursday of each month

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

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

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

Registration is required. Visit www.kamgma.com.

Chattanooga MGMA Monthly MeetingDate: 2nd Wednesday of each month

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

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

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

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

3RD THURSDAY 2ND WEDNESDAY

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

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

the society already had experience weighing the evidence at the request of physicians, patients and payers. “NASS began a number of years ago be-coming involved in third party payer coverage de-cisions,” he noted. How-ever, he continued, the turnaround time was often tight and the number of studies to consider extensive.

“We decided to proactively create our own coverage decisions based on the best evidence available … and where evi-dence was lacking, based on the expertise in this group,” he explained. “We came up with what we feel is the most sound group of recommendations based on the best evidence available at this point and time.”

Watters continued, “One of the hopes that we have is that we bring a bit of uniformity to the whole process of spi-nal care.”

Christopher Kauffman, MD, health policy council director for NASS, con-curred. He said allowed treatments and diagnos-tics vary by state and by payer. These recommen-dations outline the scope and clinical indications for a therapeutic measure when a patient meets ap-propriate inclusion cri-teria. They also clearly state scenarios in which employing the measure is not indicated.

While not recommending payers re-imburse for every procedure under every circumstance might be controversial among some providers, Kauffman said, “People who understand where medicine is going with outcome measures get it. So far, the re-sponse has been overwhelmingly positive.”

He added, “People may confuse cov-erage with medical appropriateness. The two are not equal. People assume pay-

ment equals medical appropriateness. I can’t stress enough this isn’t true. Payment equals treatments where the literature has reached a certain bar of evidence.”

Kauffman, a board certifi ed ortho-paedic surgeon in practice at Premier Orthopaedics in Nashville, said, “For everything we recommend, we think the evidence does reach the bar for coverage. This is what we think should be covered by any payer.”

However, he continued, it doesn’t mean other treatments being employed don’t have therapeutic benefits. “You can’t ever throw out the art of medicine.” Yet, Kauffman noted, “If you’re falling outside the clinical guidelines, you have to expect that you’re going to do a peer-to-peer review, or it might not be a covered service.” He added the recommendations would be routinely revisited to incorporate new evidence.

In addition to the 13 coverage pol-icy recommendations published in May, Watters said NASS is already in process or planning to create documents for 14 additional diagnostic and therapeutic mo-dalities including annular repair, cervical and lumbar radiofrequency neurotomy, cervical fusion, cervical laminectomy and laminoplasty, minimally invasive lumbar fusion, SI joint fusion and injec-tions, DNA-based scoliosis test and elec-trical stimulation for bone healing, among others. “The remainder will be released within a year,” he said.

“The plan is to reassess the literature at least every two years,” he continued, emphasizing the need to stay current as new studies are published and new treat-ment options become available. “This has to be a living document.”

He added it’s a nearly impossible task to ask physicians, surgeons, nurses, therapists and other providers to wade through all the literature required to prac-tice evidence-based, contemporary medi-cine. Having the committee go through the best, most soundly crafted studies to

create each of the 5-30 page recommen-dations, which include supporting details behind the rationale and a thorough list of references, simplifi es the process for prac-titioners and their patients. “These turned out to be remarkably educational docu-ments,” Watters stated.

Both Kauffman and Watters stressed at the end of the day, the coverage rec-ommendations are an effort to ensure patients have equal access to the best pos-sible treatments.

“It’s making sure that good spine care is available for patients across the U.S.,” Kauffman concluded.

NASS Takes a Proactive Approach, continued from page 1

Dr. William Watters

Dr. Christopher Kauffman

Coverage Policy RecommendationsTo access the documents for each of the procedures listed below, go online to www.spine.org and click on the “Policy & Practice” heading.

Cervical artifi cial disk replacement

Endoscopic discectomy

Epidural cervical spinal injections

Interspinous device without fusion

Interspinous fi xation with fusion

Laser spine surgery

Lumbar artifi cial dis replacement

Lumbar discectomy

Lumbar fusion

Lumbar laminotomy

Lumbar spinal injections

Percutaneous thoracolumbar stabilization

Recombinant human bone morphogenetic protein (rhBMP-2)

each for distributing profi ts and for paying productivity bonuses, group practices may also devise their own indirect allocation method, as long has it is appropriately documented and, essentially, “makes sense.” So, while groups may not give a physician dollar-for-dollar credit for each ancillary service he/she orders, it may be able to use the Stark-sanctioned methods which virtually mirror a direct allocation.

Should our group practice really be worried about our compensation methodology?

Consider this chain of events: A group does not qualify as a “group practice” because it wrongly allocates DHS revenues based on physician referrals, but nevertheless bills the Medicare program for DHS ordered by its physicians, violating the Stark law. That means that monies received for those DHS services are actually overpayments, which the Affordable Care Act (ACA) says must be reported and refunded within sixty (60) days of their identifi cation (3). If the group does not so report and refund, then it now has retained overpayments. Under the ACA, those overpayments become “false claims” that may be prosecuted under the False Claims Act (4). Most cases under the False Claims Act are initiated by whistleblowers.

Would it not be better then for your group practice to review its compensation methodology and ensure Stark compliance than to have a disgruntled former employee convince the government to do it for you?

Patti T. Cotten is an attorney at London & Amburn, P.C. in Knoxville, Tennessee, focusing her practice on healthcare regulatory compliance matters, including Stark law. She co-chairs the fi rm’s Healthcare Compliance, Regulatory Matters, HIPAA, Peer Review, and Managed Care practice group. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.

Notes142 U.S.C. § 1395n242 C.F.R. §411.352342 U.S.C. § 18001431 U.S.C § 3729

Profi t and Loss: The Top Ten Things Providers Need to Know, continued from page 4


EAST TN MEDICAL NEWS

Whether it’s staffing, billing and collections, or help with insurance claims, Mountain Management offers a full range of services to meet the business needs of physicians wanting to improve their practices and betters serve patient needs.

Our customized strategic business and management plans and patient satisfaction programs ensure your practice is in compliance with Medicare, Medicaid, OSHA, laboratory rules, human resources, and payroll regulations. We also offer help with purchasing, medical records, education and more.

To learn more about how your practice can benefit froma relationship with Mountain Management, please call

(423) 495-6889

Do what you do best:Care for your patients.

Leave therest to us.

5425 MtnMngmnt_EastTNMedNews_HfPg_Hor_FINAL.indd 1 6/13/14 3:56 PM

The Literary ExaminerBY TERRI SCHLICHENMEYER

Getting Waisted: A Survival Guide to Being Fat in a Society That Loves Thinby Monica Parker; c.2014, HCI; $15.95 / $19.95 Canada, 278 pages

Up and down. Up and down.

You’re up and down while cleaning, work-ing, exercising, and weighing yourself – and on that note, if the latest diet doesn’t work, maybe the next one will.

Or, maybe, as you’ll see in the new book Getting Waisted by Monica Parker, it’s time to break this yo-yo string.

Born in Glasgow, Scotland, Monica Parker was six-and-a-half pounds at birth but an hour later, “I weighted sixty-two pounds.” That’s a slight exaggeration, she admits, but the point is that, for as far back

as she remembers, Parker was overweight.Her mother, whom Parker calls

Queen Elizabeth (resemblance in attitude only), was a Viennese refugee from Hit-ler’s regime who’d been forced to leave her two eldest children behind during the war. The family was reunited when Parker was a small child, but the damage had already been done: she grew up lonely, picked-on, self-conscious, and believing that her mother barely noticed her. Subconsciously thinking that being larger would mean being seen, Parker ate.

She was chubby when the family – which now included Parker’s estranged father – immigrated to Toronto. She was chunky as a teen when she learned that her size gave her “power” - but not enough to keep her from being raped. She tried to fl irt, tried to date, hoped to fi nd a boy-friend, and ended up being little more than a sidekick to her two svelte roommates as a young adult.

Men didn’t like Parker’s body. She didn’t like it, either.

Parker tried every diet that sounded workable. She starved herself, then binged; rewarded and punished herself; and almost ruined the relationship she always wanted.

And then, in one of those only-in-Holly-wood moments, Hollywood called and Parker was offered a job she dreamed of. It meant moving to Beverly Hills, though, an atmosphere that didn’t exactly nurture Parker’s body image…

Getting Waisted is a nice surprise. It’s funny in the right places, sad where sad be-longs, and supportive in a Sisterhood kind of way. However, there’s a big but…

In this memoir, author Monica Parker takes us through her personal ups and downs – a lot. Reminiscent of yo-yo diet-ing, we read about highs and lows that hap-pen repeatedly, details that start to seem like more of the same. I didn’t mind that at fi rst – or fourth, or fi fth – but I quickly lost my appetite for it. It just made the book feel padded.

But then – literally on the penultimate page – we get the nugget we’ve waited for, the raison d’être, the thing every woman needs to know. I wish it had come sooner, but angels sang when I read it and that’s good enough for me.

Watch for copious amounts of (justi-fi ed) (and charming) name-dropping when you read this book – and if you’re a mirror-avoiding, diet-trying woman who hates her

thighs-arms-stomach-chin, you should. For you, Getting Waisted is one to pick up.

Over Our Dead Bodies: Undertakers Lift the Lid by Kenneth McKenzie and Todd Harra; c.2014, Citadel Press; $15.95/$17.95 Canada, 256 pages

The End.And then

what? What happens to your mortal remains when that’s all that remains? Take a peek at Over Our Dead Bodies by Ken-neth McKenzie and Todd Harra, and you’ll get a general idea.

In your job, you basically know what to expect from day to day. Not so, if you’re an undertaker. When you care for the dead and their families, anything can happen – and McKenzie and Harra prove that well.



To learn more, visit healthcare.goarmy.com/y941 or call 1-888-550-ARMY.

Terri Schlichenmeyer. Terri is a professional book reviewer who has been reading since she was 3 years old and she never goes anywhere without a book.

Name: Jayma Jeffers-Branam

Position: Practice Manager, GI for Kids, Knoxville

At a Glance: Although Jayma Jeffers-Branam has only been with GI for Kids for 18 months, she brings more than 26 years’ worth of healthcare experience with her — and everyone benefi ts.

“I’ve worked in basic cardiology, internal medicine, pediatrics, behavioral health, OB-GYN, and even family dentistry,” Jeffers-Branam said. “But wherever I’ve been, the focus has always been on the patient. That’s very true of GI for Kids, where everything we do, all the healthcare we provide, is about working toward that.”

A native Tennessean, Jeffers-Branam spent more than 20 years in neighboring Lexington, Ken., before returning home. Her work as a practice manager has carried her to different patient demographics over the years, but she says that working in the South, and Kentucky and Tennessee in particular, have a lot of common elements.

“Our patient bases are very similar in this region, even though we may be treating women at one practice, and children at another,” she said. “The needs differ, but the patients all have a lot in common just because they are from the area around the practice.”

One thing that has changed is how practices operate, and so as a practice manager Jeffers-Branam says she has to work constantly to keep up.

“Major changes over the years always have revolved around insurance, and managing it for patients,” she said. “It’s about all the different types of coverage, and the different authorizations for a patient’s treatments. We have to be on top of all those requirements in order to give the very best care we can give. That can be a real juggling act sometimes, and very diffi cult, but the goal is always to provide the very best care for that patient, regardless of what’s going on with their insurance. We always treat the patient fi rst.”

Technology has also been a boon, especially as electronic medical records have taken hold.“It’s a great tool, and getting even better,” Jeffers-Branam said. “As a healthcare provider, you want something

that’s going to make you more effi cient in your workfl ow, but doesn’t change the way you treat patients. Having all a patient’s information at your fi ngertips is amazing.”

Parents and even children are getting into the tech arena as well, which helps create partnerships for the practice that wouldn’t have been possible before, she added.

“They are all very tech savvy, and doing research on the conditions they have and the types of questions to ask,” she said. “People want to learn what they can do at home to live a better life, and that really raises the bar for us. We have to understand not just the technology that’s coming out for our offi ce work, but also what the community is working with, and how we can work with them. Healthcare providers are defi nitely having to change with the times.”That’s not a problem at GI for Kids, Jeffers-Branam notes.“Children’s Hospital has been a staple in this area for years, and when I came home I was thrilled to get the opportunity to come to GI for Kids,” she said. “I love being affi liated with the hospital network, and the work that GI for Kids does is amazing. Dr. Al-Tawil has a incredible reputation across the country for being a pioneer in pediatric GI and nutrition treatment, and we are doing amazing things here.”

HealthcareServiceSnapshotBut fi rst – a little history.Take the label “undertaker,” for ex-

ample. It initially had to do with the un-dertaking of proper burial but some 130 years ago, the National Funeral Directors Association offi cially changed the title to “funeral director.”

Back then, funeral directors and cabi-net makers went hand-in-hand; someone had to make the coffi ns, so why not some-one with woodworking skills? The business was then passed down through the family, with many an undertaker getting his (or her) start as a child, sweeping the parking lot, pulling weeds, or helping out inside.

But getting back to the main point: “no day is the same” for a funeral direc-tor. You can’t ever prepare yourself for a “Goat” to appear on someone’s last wishes. You can’t fail to be impressed at the timing of a husband and wife who die within hours of one another. You can’t re-main unfazed by any coincidence, really, and you’ll never get over the death of your own mother, no matter how many moth-ers you’ve buried.

Still, funerals aren’t “doom and gloom and death and dying and tears and crying every day, all day.” Funny things happen – like a hearse caught in a snowstorm and a funeral rescued by a beat-up pickup. Like a jazz funeral that ended with a second chorus. Like superstitions, accidental love-matches, funeral crashers, and life stories that start with a piece of furniture and go full circle.

And speaking of life, the authors say, enjoy yours to the fullest “because you too will one day be pushing daisies.”

No pun intended, but my fi rst impres-sion of “Over Our Dead Bodies” was that it was a little stiff.

There’s quite a bit off-topic in the fi rst few pages here – extraneous info that felt like a commercial – and because of that, it seems to take awhile for authors Ken-neth McKenzie and Todd Harra to get to the body of their book. Once they do, however, we’re treated to the kinds of tales we’d normally beg to hear when we’d meet an undertaker at a cocktail party, as well as personal stories and a rambling (and quite fascinating) social history of death and fu-nerals.

But fear not: this isn’t macabre stuff; it’s funny and poignant and, as you dig in, it’s very, very addicting. Once you’ve started Over our Dead Bodies, in fact, you’ll like it to The End.

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chapters to mandate or improve on the requirement of stocking epinephrine in schools for severe allergic reactions. For example, California is considering legisla-tion to strengthen its existing epinephrine-stocking law to require schools to stock the medication and train a volunteer to administer it. Illinois is considering legis-lation to require, rather than simply allow, schools to stock epinephrine. All states in Medical News markets have epinephrine-stocking school policies in place, with the exception of North Carolina, which at press time had pending legislation.

The AAFA has banded with other national health advocacy groups to sup-port increased research funding, which in-cludes lobbying against proposed budget cuts for the National Institutes of Health, Centers for Disease Control and Preven-tion (CDC), Agency for Health Resources and Quality, and other agencies with research relevant to asthma and allergic diseases.

For example, the CDC’s National Asthma Control Program has helped decrease asthma mortality rates by more

than 45 percent since its inception in 1999.

“There are many things that we can improve now to make life better for people with asthma,” says AAFA spokes-person and asthma patient, Talisa White. “Our Asthma Capitals report helps to shed light on the asthma burden in each city, but it also provides a roadmap for improvements.”

Taking Your Breath Away, continued from page 7

Fast Facts about Asthma

Every day in the United States,

44,000 people have an asthma attack;

36,000 kids miss school due to asthma;

27,000 adults miss work due to asthma; and

9 people die from asthma.

SOURCE: AAFA.

said Keckley. “Two out of three primary care doctors have already cast their lot,” he continued of aligning with hospitals, payers or very large groups.

“Frontline specialists have already gone to bigger groups. Now they are mov-ing to the next option … most look like they’re going to hospitals,” he added of orthopedists, ENTs and OB/GYNs. As for other specialists, he said the decision to remain independent, merge or consoli-date is all over the board and is specialty dependent.

Going forward, Keckley said, “I think we’re going to end up with a very few private doctors in practice indepen-dently.” He predicts seeing a few more very large, multispecialty practices. “I think the majority end up employed in the hospitals because of these new payment mechanisms.”

In fact, he noted, “It’s been incentiv-ized for the hospitals to hire physicians.” Clinical integration, outcomes-based re-imbursement and bundled payments have created an environment where hospitals and doctors are increasingly co-depen-dent.

Although hospital administrators and clinicians have always had to work together, Keckley said this new closeness highlights areas that must be addressed to maximize effectiveness. Three key stress-ors are administrative decisions, clinical performance, and … of course … alloca-tion of money.

“There’s always going to be tension around operations,” he said of admin-istrative decisions. “Each presumes the other’s operating is simpler than it really is,” he continued of the chasm between blue suits and white coats.

With reimbursement tied to out-comes, he said physicians and hospitals face tougher decisions around strategy.

One issue is how to address physicians not practicing effectively. “The hospital suits don’t do a very good job of changing the behavior of doctors. It takes peers,” he noted.

The biggest cause of tension is ex-pected to be around allotting payments to each of the partners in a vertically inte-grated delivery system. “And then you get down to money, and that’s where it gets ugly,” Keckley stated. However, he con-tinued, too often the perception among administrators is that it’s all about the money when it comes to physicians. “If it was just about money, there are a lot of better ways to make money … and easier, by the way. Most doctors don’t go into it to be wealthy. It’s hard work. The aver-age medical career is 30 years, and it’s a hard 30 years.”

That said, he added physicians do want to be successful, have a sense of satisfaction around their career choice and be well compensated for their work. However, Keckley noted, “There’s such a difference between the way doctors think things should be and the way they are.”

Keckley said too many physicians tend to dismiss data as unreliable or be-lieve their patient is an outlier. Yet, he added, “The table stakes are you’ve got to have data. You can’t just have a bunch of opinions.” To bridge that gap, Keckley said he believes it is going to take physi-cians willing to step into the hot seat and take criticism from their colleagues as the profession adapts to new economic reali-ties.

“I think physician leadership is prob-ably going to be a theme over the next 10 years,” Keckley said. “The medical profession is well respected and well com-pensated … that doesn’t change … but how that profession plays in the delivery system is very much a work in progress.”

Partnering, continued from page 1 GrandRoundsFrontier Health Programs Net 5th Consecutive CARF Accreditation

JOHNSON CITY – CARF International announced that Frontier Health received a fi fth consecutive three-year term of accredi-tation through June 2017 for 20 program areas including crisis intervention, crisis sta-bilization, detoxifi cation, residential alcohol and drug treatment, intensive outpatient, outpatient, case management, community integration: psychosocial rehabilitation, in-tensive family-based services, out-of-home treatment and employment services.

The highest level of accreditation given refl ects Frontier Health’s substantial confor-mance to CARF standards. The not-for-prof-it was noted for exemplary conformance, “The organization has a very thorough and complete performance improvement sys-tem that begins with goals and objectives that are based on industry standards and include measure of effectiveness and effi -ciency. The written analysis of the outcomes is well organized and produced in several different formats so that is understandable by many different audiences.”

Frontier Health chooses to go through this rigorous accreditation process be-cause of their dedication to quality services that help people reach their full potential. Through the onsite review, staff and lead-ership demonstrated to a team of nine sur-veyors that programs and services are of the highest quality, measurable, and answerable to ensure excellence and accountability.

Frontier Senior Vice President appointed Chair of TDMHSAS Licensure Review Panel

JOHNSON CITY – Randall E. Jessee, PhD, Frontier Health Senior Vice President of Specialty Services, was appointed as chair of the Tennessee Department of Men-tal Health and Substance Abuse Services Licensure Review Panel.

The TDMHSAS Offi ce of Licensure, Review and Investigation is responsible for protecting Tennesseans who need mental health, developmental disability, alcohol and drug abuse, and personal support ser-vices by applying the department’s licensure rules.

The Offi ce of Licensure, Review and Investigation functions to protect the inter-est of tax-paying citizens against unlicensed service providers, unsafe environments, in-adequate education and training of person-nel, physical and mental abuse and any un-scrupulous acts deemed detrimental to the treatment and general welfare of persons with mental health/developmental disabili-ties issues, alcohol or drug abuse problems. This also includes those in need of personal support services.

Jessee continues to serve on the Ten-nessee Co-Occurring Disorder Collab-orative Steering Committee, the statewide A&D and Mental Health leadership organi-zation.


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

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

JOHNSON CITY MGMA MONTHLY MEETING

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

Location: Summit Leadership Foundation3104 Hanover Rd.

Johnson City

KINGSPORT MGMA MONTHLY MEETING

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

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

Second Floor, Kingsport

2ND THURSDAY 3RD THURSDAY

GrandRoundsLeah Balch, Susan Breeden Join TMA

GREENEVILLE – Two area women have joined Takoma Medical Associates (TMA) as nurse practitioners.

Leah Balch of New-port is working as an adult advanced nurse practitio-ner in the gastroenterol-ogy practice of Dr. Joseph Kretschmar, located on the second floor of TMA, 438 E. Vann Road.

Balch received a Mas-ter’s degree in nursing from Vanderbilt University and a Bachelor’s degree in nursing from East Tennessee State University. She completed her nurse internship at Holston Valley Medical Center in Kingsport and later worked as a registered nurse at Newport Medical Center. She is a member of the Tennessee Nurses Association and the American Nurses Association.

Susan Breeden of Johnson City has been hired as a family nurse practitioner for the cardiology practice at TMA. Breeden is working in Dr. Gregory Uhl’s office, located on the second floor of TMA.

Breeden received a Master’s degree in nursing from Lincoln Memorial Univer-sity and a bachelor’s degree in nursing from ETSU. She has worked as a registered nurse at Outpatient Cytopathology Center in Johnson City and on a cardiology unit at Mountain States Health Alliance. She is a member of the American Academy of Nurse Practitioners.

Goodwin Joining Women’s Center of Greeneville

GREENEVILLE – Dr. Jami Goodwin has joined the Women’s Center of Greeneville as an obstetrician and gynecologist.

Goodwin graduated from the Medi-cal College of Virginia in Richmond, Va.

and completed her intern-ship and residency at East Tennessee State University. She received a bachelor’s degree in neuroscience at Vanderbilt University in Nashville.

She is a member of the American Medical Association and the American Congress of Obstetricians and Gynecologists.

Goodwin is married to Dave and they have five children: Jake, Sara, Jacey, Sawyer and Dawson. She enjoys NASCAR, watch-ing college football, and traveling.

Takoma Receives QUEST Award For Quality Improvement

GREENEVILLE – Takoma Regional Hos-pital has received national recognition for quality improvement.

The hospital was recognized June 11 at Premier’s 2014 Breakthroughs Conference and Exhibition in San Antonio.

Takoma is proud to receive this recog-nition because it reinforces the hospital’s commitment to delivering exceptional pa-tient care.

Premier is a hospital performance im-provement alliance associated with the Cen-ters for Medicare and Medicaid. The group consists of more than 3,000 hospitals and 110,000 other providers across the country.

JCCHC offering healthcare services to underserved groupsArmy veteran Sue Reed named director of special populations

JOHNSON CITY – Underserved popu-lations such as migrant workers, the home-less or people living in public housing set-tings are eligible to receive care through the Johnson City Community Health Center.

Sue Reed, R.N., M.S.N., F.N.P.-B.C., a board-certified family nurse practitioner, has been appointed director of special popula-tions for the center, which is operated by

East Tennessee State University’s College of Nursing, and will oversee care for these individuals.

Reed will see homeless patients at the Johnson City Downtown Clinic Day Center, located at 202 W. Fairview Ave. She will also be available to see public housing residents at the Johnson City Public Housing Partners for Health Clinic within the Keystone Com-munity on a weekly basis as well.

Migrant workers can be seen at the JC-CHC where interpretation services are avail-able.

Reed holds an M.S.N. degree from ETSU and has worked with at-risk and un-derserved populations for nearly 20 years. She recently retired from the U.S. Army fol-lowing 26 years of service.

ETSU nurse-managed clinics ink agreement with UnitedHealthcare

JOHNSON CITY – The Johnson City Community Health Center (JCCHC) and other centers managed by the College of Nursing at East Tennessee State University have entered into an agreement with Unit-edHealthcare.

Through this new agreement, patients with UnitedHealthcare and Medicare Ad-vantage will have access to services at the center, as well as services at the Johnson City Downtown Day Center, the Keystone Community’s Partners in Health Clinic, the Mountain City Extended Hours Health Cen-ter and the Hancock County School Based Health Centers in Sneedville.

ETSU has one of the largest networks of nurse-managed clinics in the nation. The College of Nursing opened its first clinic in 1990 and today provides nearly 30,000 primary care and outreach visits to under-served patients across Northeast Tennes-see.

The JCCHC is located on Century Lane across from Johnson City Medical Center and is open Monday–Friday, 8 a.m.-8 p.m.

and 8 a.m.-noon on Saturday. Other insur-ance plans are accepted by these clinics as well. To schedule an appointment at JC-CHC call 423-926-2500. Appointments at the Hancock County clinics can be arranged by calling 423-733-2121 and 423-727-1150 for the Mountain City center.

Information about other ETSU nurse-managed clinics is available at http://www.etsu.edu/nursing/practice/sites/default.aspx.

ETSU behavioral health clinic now accepting TennCare programs

JOHNSON CITY – The Behavioral Health and Wellness Clinic (BHWC) at East Tennessee State University is now participat-ing in the Blue Care, TennCare Select and Cover Kids insurance programs.

The clinic serves as the clinical training arm of the ETSU Ph.D. program in psychol-ogy and provides individual, family and couples mental health services for children, teens and adults, in addition to a wide range of psychological assessment services.

The BHWC opened seven years ago and is managed under the auspices of the ETSU Department of Psychology. All clini-cians are doctoral students in psychology and are supervised by licensed psycholo-gists.

In addition to accepting referrals from these insurance programs, the clinic also bills on a sliding scale fee system.

The center is open Monday through Friday from 8 a.m. until 4:30 p.m. with some evening appointments. It is located on the ETSU campus, and free parking for patrons is available.

Sports celebrities raise $700,000 for Niswonger Children’s Hospital

BRISTOL, Va. -- Celebrities and sup-porters came together on Monday to raise money for a worthy cause -- and thanks to their generosity, the 2014 Niswonger Chil-dren’s Hospital Golf Classic raised about $700,000.

The tournament, played at The Virgin-ian Golf Club and organized by Mountain States Foundation, brought in a host of ce-lebrities, among them NFL greats Peyton Manning, Jason Witten and Dan Marino, NFL head coach Ken Whisenhunt of the Tennessee Titans, pro golfers Corey Pavin and Larry Mize, and college coaching leg-ends Frank Beamer from Virginia Tech, Phil Fulmer from the University of Tennes-see and Bruce Pearl, former UT basketball coach who’s the new Auburn head coach.

They gathered to support the children of the region who need specialized medical care. Niswonger Children’s Hospital, locat-ed in nearby Johnson City, Tenn., and part of Mountain States Health Alliance, serves more than 200,000 children from a 29-coun-ty region covering Northeast Tennessee and Southwest Virginia and reaching into Kentucky and North Carolina.

It offers treatment for specialized dis-eases and health problems that children might otherwise have to travel hundreds of miles to receive.

Leah Balch

Susan Breeden

Dr. Jami Goodwin


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…welcomes Dr. David DeVoid, who joins the group as a Pediatric Gastroenterologist specializing in diagnosing and treating infants, children and teens with digestive, liver and nutritional problems. He graduated from the University of Maryland and received initial medical training at Baylor College of Medicine while serving in the U.S. Air Force. He completed his Pediatric Residency at Wilford Hall USAF Medical Center in San Antonio, Texas and postgraduate Fellow in Pediatric Gastroenterology at Walter Reed Army Medical Center in Washington, DC. serving in the U.S. Air Force for a total of nine years. He most recently cared for pediatric gastroenterology patients in Chattanooga, Tennessee for 16 years. His Gastroenterology interests include Irritable Bowel and Liver diseases as well as encouraging a healthy lifestyle as an important part of any treatment plan.

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The golf tournament was part of a two-day fundraising celebration that included a benefit concert the night before the tour-nament featuring country sensations The Band Perry, who hail from Greeneville. Par-ticipants in the golf tournament got to at-tend a VIP Par-Tee, presented by CrestPoint Health, to meet the sports celebrities, and they were also treated to tickets for the ben-efit concert.

In addition to Pavin and Mize, fel-low pro golfers Joe Durant, Loren Roberts and Gene Sauers participated in this year’s tournament, as did former NFL standouts Wesley Walls, Carroll Dale, Jim Stuckey and Steve Johnson, the former New Eng-land Patriots tight end who is a commercial developer in Bristol and one of the driving forces behind the tournament.

The tournament has drawn many re-peat celebrities, including Marino and Man-ning.

“It’s an honor for me to be a part of this,” Manning said. “It’s great fellowship, great fun and also a great cause.”

JCMC surgery center earns LEED certification as green facility

JOHNSON CITY – Johnson City Medi-cal Center’s new surgery center, opened last fall, has been awarded Silver-level certifica-tion for Leadership in Energy and Environ-mental Design (LEED) from the U.S. Green Building Council.

The LEED green building certification program is the nationally accepted bench-mark for design, construction and operation of green buildings.

“As project manager, it’s very reward-ing to oversee a LEED health care construc-tion project like this that will have a long-term, positive impact,” said Jeff Clinebell, senior project manager for construction at Mountain States.

The new surgery center opened in Oc-tober 2013 as an addition to Johnson City Medical Center, located in the back next to the Heart Hospital. It offers state-of-the-art surgical technology like the Artis Zeego ro-botic imaging system and features 16 oper-ating rooms, each 30 percent larger than the old ORs. It’s more user-friendly for both pa-tients and staff than the old surgery center.

Mountain States has already opened three LEED-certified green hospitals over the last four years – Franklin Woods Com-munity Hospital in Johnson City in 2010 (LEED Silver); Johnston Memorial Hospital in Abingdon, Va., in 2011 (LEED Gold); and Smyth County Community Hospital in Mari-on, Va., in 2012 (LEED Gold).

The LEED certification process evalu-ates the construction and land develop-ment aspects of a building as well as its energy-saving features and daily opera-tions. The green aspects of the new surgery center include:

• 77 percent of the waste from the con-struction process was recycled;

• Low-VOC (volatile organic com-pound) materials were used for paint, adhesives and sealants, resulting in improved air quality;

• The central sterilization unit is equipped with steam cleaners that

make the sterilization process more energy-efficient;

• The landscaping features plants that do not require irrigation, thereby conserving water;

• A bicycle storage area is available for hospital team members;

• An automation control system keeps the HVAC system and lighting run-ning at the most energy-efficient lev-els.

Nina Tarlton Joins Wellmont Medical Associates as Family Nurse Practitioner in Rogersville

ROGERSVILLE – Nina Tarlton, an expe-rienced caregiver who has enjoyed a diverse career, has joined Wellmont Medical Asso-ciates as a family nurse practitioner in the Rogersville office.

Tarlton will bring her impressive medi-cal skills to the practices of Amanda Dove, Amy Haynes and Liliana Murillo, all of whom are medical doctors based at 405 Scenic Drive. Tarlton has worked as a nurse practi-tioner at a urology clinic in Johnson City and in family medicine and internal medicine of-fices in Virginia.

Before earning her Master’s degree in nursing from Radford University in 2005, Tarlton worked as a registered nurse for 11 years.

While Tarlton has treated a wide variety of medical conditions, she especially enjoys helping patients with complex and chronic conditions, such as type 2 diabetes and el-evated cholesterol. Tarlton said she helps her patients make wise choices for a healthy and active lifestyle, which fits well with the Wellmont LiveWell initiative.

Allie Blackwell Joins Wellmont Medical Associates as Family Nurse Practitioner in Rogersville

ROGERSVILLE – Allie Blackwell, who brings a passion for rural medicine, has joined Wellmont Medical Associates as a

family nurse practitioner in its Rogersville office.

Blackwell will build on her skill set as she practices with Drs. Amanda Dove, Amy Haynes and Liliana Murillo, all of whom are medical doctors, in the office at 405 Scenic Drive. Blackwell graduated East Tennessee State University with a bachelor’s degree in nursing before pursuing a master’s in nurs-ing from Belmont University.

Before joining Wellmont Medical Asso-ciates, Blackwell worked as a nurse practitio-ner in an allergy and asthma office and as a registered nurse. She enjoys seeing patients of all ages and considers her most impor-tant duty to be caring about patients as indi-viduals and advocating for their health.

Martha Pearson Promoted to System Director of Patient Access, Brings 14 Years Experience to Position

KINGSPORT – Martha Pearson, a well-respected veteran healthcare professional, has been promoted to system director of patient access for Wellmont Health System. Pearson brings a vast level of experience to this new role, having served as Holston Valley Medical Center’s director of patient access for seven years. In addition to that role, she has also served as a leader in the corporate admissions department.

Prior to coming to Holston Valley, Pear-son worked for six years for a hospital sys-tem in Florence, S.C.

In her systemwide role, Pearson will be responsible for coordinating leadership over all patient access and registration ser-vices. These include central scheduling, fi-nancial counseling and insurance eligibility, verification and authorization. She will part-ner with her co-workers in utilizing process improvement strategies and accomplishing system goals.

Six More Physicians Graduate from Osteopathic Family Medicine Residency Established by Wellmont

BIG STONE GAP, Va. – High-quality training from an experienced team of medi-cal professionals continues to produce well-prepared physicians to deliver the next gen-eration of patient care.

Six more osteopathic physicians are graduating from the family medicine resi-dency program created by Wellmont Health System. The program’s leaders recently held a ceremony to present them with their certif-icates and celebrate the completion of their three-year residency.

Drs. Christopher Bishop, Eric Hofmeis-ter, Lawson Hunley, Thomas Robbins and Lindsay Yorns graduated June 30, and Dr. Brian Enriquez will finish his residency in Oc-tober. Dr. Hunley served as chief resident for the last year.

One of the graduates – Dr. Robbins – will continue his medical career in the area as a hospitalist at Lonesome Pine Hospital. He is the third physician from the residency program to join Wellmont Medical Associ-ates in Southwest Virginia.

Dr. Aaron Porter has practiced as a family medicine physician in Norton for two years and recently expanded his practice to treat patients in Lonesome Pine’s wound care clinic. Dr. Addison Ward established his family medicine practice in Norton in 2013.

The residency program was formed in 2009 with the Lincoln Memorial University-DeBusk College of Osteopathic Medicine as the academic sponsor. Many residents who have been accepted into the residency program, including Dr. Robbins, received their medical degrees from LMU-DCOM.

During their residency training, these physicians see patients at the Wellmont Osteopathic Family Medicine Residency Clinic at 295 Wharton Lane in Norton. Part of their training also includes delivering care at Lonesome Pine, Mountain View Regional Medical Center, Holston Valley Medical Center and Bristol Regional Medical Center.


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Unicoi County Memorial Hospital visioning committee making preparations for new facilityERWIN – Plans for the new Unicoi County Memorial Hospital are beginning to take shape with the help of a new 10-member visioning

committee. The group, made up of Unicoi County residents and Mountain States Health Alliance team members, is tasked with creating an overall vision for the new facility and deter-mining many of the crucial details.

The committee members are as follows:• Matt Rice of Erwin Utilities, chairman• Randy Trivette, UCMH board member• Dwight Bennett, UCMH board member• Dr. Jason Colinger, Unicoi Medical Associates• Danielle Rogers, Nuclear Fuel Systems• Rick Storey, Citizen’s Bank, Mountain States board

member• Bill Alton, Mountain States VP for facilities and con-

struction management• Candace Jennings, Mountain States senior VP for re-

gional operations• Allison Rogers, Mountain States VP for strategic plan-

ning• Tracy Byers, AVP / administrator of Unicoi County Me-

morial. The committee convened to craft its vision statement for the new hospital, along with the latest timeline. Construction is expected to start

in fall of 2016, with the facility opening in early spring of 2018. The site is next to Exit 40 off I-26 on Temple Hill Road.The vision statement reads: “Our vision at Unicoi County Memorial Hospital is to create a patient- and family-centered, modern, efficient,

and financially viable facility that meets the needs of Unicoi County and surrounding areas. This will be done by listening to the needs of our community, team members, physicians, and employers.”

L-R: Allison Rogers, Matt Rice, Danielle Rogers, Dwight Bennett, Tracy Byers, Randy Trivette, Rick Storey, Bill Alton. (Not pictured: Candace Jennings, Jason Colinger)

Holston Valley’s Trauma Center Earns Level I Status from State for Three More Years

KINGSPORT – Holston Valley Medi-cal Center’s trauma center, which provides round-the-clock care for patients and ex-tensive community outreach, has been des-ignated as a Level 1 facility by the state for another three years.

The trauma center has held Level 1 status, the highest possible, for 25 years and recently earned the extension from the Board for Licensing Health Care Facilities.

Holston Valley’s trauma center is one of only six with Level I status in Tennessee and was among the first facilities when it re-ceived that state designation in 1988.

The trauma center treats patients who have experienced major trauma and po-tentially life-threatening events such as au-

tomobile and all-terrain vehicle accidents, major falls, gunshot wounds and severed or severely injured limbs.

To treat these injuries, the trauma cen-ter has a full range of specialists and equip-ment available 24 hours a day, seven days a week. It has full diagnostic radiology ser-vices, including computed tomography and StatScan scanners; subspecialty surgical care in medical fields such as neurosurgery, orthopedic surgery and urology; and con-stant access to surgery suites.

“We are here to serve the community with a broad spectrum of care and services when patients and their loved ones need us,” said Dr. Tiffany Lasky, an osteopathic physician and the trauma center’s medical director. “These incidents can produce a complex set of injuries that require expert, innovative care to resolve. We have a mul-

tidisciplinary team ready to handle these emergencies with skill, and we work seam-lessly with other departments in the hospital to achieve optimal results for our patients.”

Besides Dr. Lasky, other trauma sur-geons who deliver exceptional care at Holston Valley are Drs. Daniel Anderson, George Testerman, John Beatty and Cory Siffring, who are medical doctors. All five physicians are also traumatologists who have completed a critical care fellowship. Sharon Littleton coordinates the care team process as the trauma center’s manager.

While the multidisciplinary trauma team is ready to deliver superior care at the hospital, it is just as focused on preventing injuries. They provide a variety of initiatives aimed at educating people about practical ways to live safer lives.


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