Tri Cities December 2013

Roderick Biosca, MD

PAGE 3

PHYSICIAN SPOTLIGHT

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HEALTHCARE LEADER: Dennis VonderfechtPerhaps the best decision Dennis Vonderfecht, president and CEO of Mountain States Health Alliance (MSHA), ever made took place years ago when he decided majoring in music likely would not serve him well fi nancially ... 6

ENJOYING EAST TENNESSEE:Biltmore Estate - Candlelight Tours, Winery and Antler Hill Village Last month, we ventured over the mountains to rediscover Biltmore Estate and “deck the halls” for the holidays.... 7

SPECIAL ADVERTISING:Patient Centered Practices ... 2Dysphagia ... 9

(CONTINUED ON PAGE 6)

By CINDy SANDERS

If being quite specifi c while leaving plenty of room for interpretation was an art form, the Centers for Medicare and Medicaid Services surely would have achieved

‘master class’ status by now. The two-midnight rule, the recent compliance man-date that went into effect on Oct. 1, is an example of this dichotomy and has left physicians and hospital administrators scrambling to understand what it means for patients … and the bottom line.

Boiled down, the new rule sets “two midnights” as a benchmark for in-patient admission, but there are exceptions. Meant to clarify the difference between appropriate observation status and inpatient admission, the IPPS fi nal rule caused enough confusion that CMS offered a three-month amnesty period, which is set to expire at the end of 2013. During this last quarter of the year,

hospitals will not face fi nancial penalties even if deemed out of compliance with the rule.

Instead, the federal agency has used this time period for a “probe and edu-cate” program where Medicare Audit Contractors (MACs) have focused reviews

Two-Night MinimumObservation, Inpatient & the Two-Midnight Rule

(CONTINUED ON PAGE 8)

By CINDy SANDERS

Whether in the context of discussing defensive medicine or the latest diagnostic technology, there seems to be a per-vasive belief that increasing overutilization of medical imaging is a key driver of healthcare spending. Yet, those within the fi eld point to recent studies that fi nd a fl aw in that line of thinking … within the Medicare popula-tion, utilization rates are actually in decline.

A study conducted by the Harvey L. Neiman Health Policy Institute and published this summer in the Journal of the American College of Radiology found the number of physician visits by patients age 65 or older that resulted in an imaging exam has consistently trended downward over the past decade from 12.8 percent in 2003 to 10.6 percent in 2011. Using Medical Expenditure Panel Survey (MEPS) data in addition to Medicare claims data, the researchers also said that annual spend-ing on imaging for the senior population grew from $294 per enrollee in 2003 to $418 per en-rollee by 2006 but had declined to $390 per en-rollee by 2011.

Richard Duszak, Jr., MD, FACR, chief medi-cal offi cer and senior research fellow at the Nei-man Health Policy Institute, which is part of the

Medical Imaging UtilizationThe trend might surprise you

FOCUS TOPICS IMAGING AUDIT/COMPLIANCE

To promote your business or practice in this high profi le spot, contact Cindy DeVane at Tri Cities Medical News.

[email protected] • 423.426.1142

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

Since joining Mountain States Health

Alliance (MSHA) on November 1st,

Unicoi County Memorial Hospital

(UCMH), located in Erwin, Tenn., has been

delivering patient-centered care a little bit

differently...with the surety of a healthy

future.

UCMH administrator Tracy Byers, who

assumed his position two months ago,

said the acquisition has provided a much-

needed stability. “Knowing that the hospital

here is healthy and stable is important; no

patient wants to get their healthcare, or no

physician wants to commit to a hospital,

where the hospital is rumored to close,” he

said. “Now that the future is stable, no one

has to wonder if the hospital is going to be

open in six months.”

Becoming the 14th hospital in the MSHA

organization, UCMH provides valuable

services to the community, without which,

patients would have to drive miles to receive

care. As a full-service hospital, UCMH

offers basic hospital services, as well as

physical therapy, a sleep lab, occupational

health services, and respiratory therapy,

to name just a few.

“We pretty much have

all of the basics you

would expect from a

community hospital,”

explained Byers. “We

have all the basic imaging

equipment—x-ray, CT

scan, MRI, ultrasound—

you would have at other facilities, and we

have a full service lab, a 24/7 emergency

department, and operating rooms that have

the capabilities of any community-based

hospital.”

As part of the acquisition plan, MSHA has

committed to building a new hospital in the

area in the next five years, so eventually, the

current building will be replaced with a new

state-of-the-art facility. Until that project is

complete, however, UCMH will be acquiring

some new equipment, including a new

64-slice CT scanner within the next four or

five months that will replace the current one.

“We have made some important

promises to the people of Unicoi County

with respect to their hospital,” said Dennis

Vonderfecht, president and CEO of MSHA.

“Now it is time for us to fulfill those

promises. We are so grateful for the support

we’ve seen from the community and the

relationships we’ve built throughout this

acquisition process, and we’re excited about

what the future holds for Unicoi County

Memorial Hospital.”

“Some of things Mountain States will

help us with immediately are things that

patients may not recognize right away, for

instance, our Wi-Fi capability will improve,”

shared Byers. “And a lot of what Mountain

States will do is make this building last the

next four years so that we can continue to

see patients in a good facility before the new

one is built.”

Selection of an architect for the new

facility is planned for late 2014, and

construction is expected to begin in 2015.

Tentatively planned to open in 2017, the

replacement hospital will be located on

Temple Hill Road off Exit 40 in Erwin.

One benefit to physicians, Byers pointed

out, is the available office space. “We

have an office building for physicians who

want to come here, perhaps to get out of

a larger, more competitive environment.

They can come here and practice, be more

independent, if you will, and provide the

community with services related to their

specific specialty.

“From a patient standpoint, they don’t

have to drive all the way to Johnson City,

Bristol, or Kingsport to get their care; they

can do it here,” said Byers. “I think for both

physicians and the community, knowing that

we are open and the future is stable, gives

them that little extra reassurance that the

hospital is definitely going to be here and is

getting better.

“We will have the things Mountain

States offers, rather than continue to

struggle as an independent hospital. Our

country’s healthcare system seems to be

getting more and more challenging all

the time, but being part of a big system is

definitely beneficial.”

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

All source data for this article has been provided by

A Healthy Future, A Healthy CommunityUnicoi County Memorial Joins Mountains States Health Alliance

Patient-Centered Practices

Tracy Byers

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

PhysicianSpotlight

By BRIDGET GARLAND

Now serving the patients of southwest Virginia, Roderick Biosca, MD, a physi-cian with Abingdon Radiology Services, decided to return close to home to use his training and skills as a fellowship-trained radiologist. Biosca grew up in Johnson City, Tenn., graduating from Science Hill High School in 1993. He left the northeast Tennessee area on a soccer scholarship to Lafayette College in Pennsylvania and finished his undergraduate education at Wofford College in Spartanburg, S.C. He returned for medical school at East Ten-nessee State University’s James H. Quillen College of Medicine, and after finishing an internship in internal medicine, moved to Birmingham, Ala., to complete his radiology residency at the University of Alabama, Birmingham, from 2006-2010. He stayed an additional year to complete a musculoskeletal radiology fellowship at the University of Alabama and St. Vin-cent’s Hospital in Birmingham, where he gained a lot of valuable experience work-ing at the same facility where Dr. James Andrews, a premier sports medicine/orthopedic surgeon, holds clinic. Known for his work with many professional ath-letes across the country, Andrews’ clinic gave Biosca practice working with unique musculoskeletal cases. “He revolutionized the Tommy John Surgery, a procedure used on professional pitchers with injured elbow ligaments,” he explained.

After completing his training, Biosca accepted his current position with Abing-don Radiology Services, which, at the time, only provided radiology services for Johnston Memorial Hospital in Abing-don, but since 2011, has grown to provide services for all Mountain States Health

Alliance hospitals in southwest Virginia, including Russell County Medical Center in Lebanon, Smyth County Community Hospital in Marion, and Norton Commu-nity Hospital.

Becoming a physician was a natural career choice for Biosca. Growing up, he had watched his father provide care as a veterinarian in Johnson City, and with a proclivity for math and science—more so than the Humanities or English—he had planned to become a veterinarian or phy-sician. Once he got to college and had a chance to look closer at both fields, he de-cided medicine might be a good route to take. “My mother also had breast cancer when I was a junior in college and that

probably steered my decision as well,” he said. “That was 20 years ago, and she’s very healthy today.”

While in medical school, Biosca en-joyed his more hands-on rotations in orthopaedics and surgery, performing procedures, for instance, and figured he would end up choosing orthopaedics as his specialty. But at the invitation of a family friend over one Christmas Break, Biosca spent time with the radiologist and it really interested him. “Observing what she did, it made me think about what I’d like to do,” he said. “I thought radiology would be a good choice for me because I like being involved in multiple things, and it would also give me the opportunity to

do some procedures, which was appeal-ing.”

As Biosca pointed out, radiology is unique in medicine in that it has really propelled the move toward less invasive-ness in surgery and medicine. “You still have to be able to see in order to do any-thing, and the tools that radiology pro-vides gives us the knowledge we need to be on the frontline of most of the new ad-vances and breakthroughs that are occur-ring in the evaluation of disease processes and procedures,” he said. “Instead of a surgical biopsy of lesions of the lung, we do the biopsy under CT guidance with a needle. We can do so many things now with an image and a needle. It’s rare today for someone with a mass in their liver or a mass in their chest or a mass in their ab-domen to go to surgery first. They go to radiology first to determine the diagnosis.

“Surgery and oncology end up plan-ning treatment off of the information we provide them. We do most of staging for cancers now from just the imaging, whether it’s from a CT scan, from PET CT scan, from MRI, or even radiograph and ultrasound,” he enthused.

Biosca and his wife Hannah live in the Abingdon/Bristol area. Hannah, who is also from Johnson City and graduated from Science Hill, attended Milligan Col-lege, where she received her nursing de-gree in 2005. While living in Birmingham, Hannah worked as a nurse at a private hospital, running the OR there, but now stays home with their two children, ages 4 and 2. The couple is expecting a third child in June.

Although Biosca stays busy with fam-ily and career, when he does find time for recreation, he enjoys golf, snow skiing, and fly fishing.

Roderick Biosca, MD

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LegalMatters

Physician Employment Agreements: Common Issues

BY IAN P. HENNESSEY, ESQ.

As an attorney focusing on healthcare law, matters involving physician employment agreements are a frequent source of questions from employers and physician employees alike. Contrary to common belief, there is no single “standard” or “correct” form of physician employment agreement. Most employers have their own unique way of doing things, whether they happen to be a large hospital network, a small independent practice, or something in between. Nevertheless, there are several common issues in most physician employment agreements that deserve special attention from both the employer and the physician employee.

Compensation ProvisionsFor obvious reasons,

compensation provisions often receive the most attention in a physician employment agreement. There is no single way to structure physician compensation. In fact, there are several common compensation structures, including traditional base salary, RVU-based productivity,

“eat-what-you-kill” models, and various combinations of these and other models. No matter what kind of compensation model is used, it is important that the parties clearly understand the compensation structure, including any potentially negative scenarios that may arise. For example, an “eat-what-you-kill” model will often allocate certain expenses to the physician employee (shared and individual) that may create an account deficit, while a RVU-based model may include a provision under which compensation may be reduced if the physician employee does not reach his/her RVU target. The best time to decide what is “fair” to both parties is before the contract is executed and any dispute concerning money has had a chance to arise.

Professional Liability InsuranceProfessional liability insurance

is a key provision in any physician employment agreement. Typically, the agreement will state which party is responsible for the obtaining professional liability insurance during the term of the agreement and the

amount of coverage to be provided. Even more important, however, is how a physician employment agreement addresses coverage following termination of the agreement (e.g., tail coverage). Although the employment relationship may be over, there is still potential for a malpractice lawsuit to be filed related to events that occurred prior to termination. It is critical for both parties to agree in advance who will be responsible for the cost of coverage and what remedies are available if the party responsible for obtaining such coverage fails to do so. If a lawsuit is filed, neither party will want to find itself under circumstances in which there is no professional liability coverage for the claim.

Non-Compete ProvisionsNon-compete provisions are fairly

common in physician employment agreements. Under Tennessee law, non-compete provisions in physician employment agreements are enforceable if the restriction is for two years or less and the geographical area of the restriction is the greater of a ten-mile radius from the physician’s primary practice site or the county in which the primary practice is located (1). Depending on the circumstances, a physician may be restricted from practicing at any facility at which the physician provided services during the term of the employment agreement. If the non-compete provision does not comply with the applicable Tennessee physician non-compete statute, then it may not be enforceable following termination of the contract.

Non-Solicitation ProvisionsThough not as prevalent as non-

compete provisions, non-solicitation provisions are another important provision in a physician employment agreement. Unlike a non-compete provision, a non-solicitation provision prohibits the physician from soliciting the employer’s patients. Non-solicitation provisions are not subject to the same statutory regulation as non-compete provisions. However, it should be noted that general advertisements are not typically considered “solicitation” under Tennessee law.

TerminationThe termination provisions of a

physician employment agreement are of critical importance to both the employer and the physician employee. There are typically two categories for termination of an employment agreement: termination “for cause” and termination “without cause.” Termination “for cause” means termination for a certain reason, such as breach of the agreement or certain acts by the employee or, in some cases, the employer. Typically, termination for breach of the agreement will not occur until the breaching party has been allowed an opportunity the cure the breach. On the other hand, certain breaches of the agreement (e.g., loss of the physician’s license or conviction of a felony, or an employer’s bankruptcy or insolvency) may lead to immediate termination.

As its name suggests, termination “without cause” means that there is no specific reason for the termination other than that one of the parties has chosen to end the contract. There is usually a notice period for termination without cause, typically ranging anywhere from 30 days to 180 days. Employment agreements that automatically renew at the end of their term may also contain a provision establishing a notice period for non-renewal of the agreement.

ConclusionThe topics in this article are

common issues in most physician employment agreements, but by no means the only issues. In each individual circumstance, there will be different priorities and points of emphasis related to the physician employment agreement. However, regardless of the issue, it is important that the parties discuss any questions or issues they may have before executing the contract. Although there may never be a “perfect” contract for either party, it is best when neither party faces any unnecessary or unpleasant surprises after the employment relationship has begun. As the old adage says, an ounce of prevention is worth a pound of cure.

Notes

1. If the employing entity is a hospital, the duration of the restriction can be longer (though not to exceed five years) if it is determined by written mutual agreement that the extended period is necessary to comply with federal statutes, rules, regulations or IRS revenue rulings or private letters. See T.C.A. §63-6-204

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

REPRINTS: Want a reprint of a Medical News article to frame? A PDF to enhance your marketing materials? Email [email protected] for information.

e a s t t n m e d i c a l n e w s . c o m DECEMBER 2013 > 5

HealthcareLeader

Dennis VonderfechtBy BRIDGET GARLAND

Perhaps the best decision Dennis Vonderfecht, president and CEO of Mountain States Health Alliance (MSHA), ever made took place years ago when he decided majoring in music likely would not serve him well financially. “I started in college as a music major, vocal music, as I sing, but I decided shortly after I started that unless you are a top-notch performer, it’s going to be difficult making a living off of music, and I really didn’t have that much interest in teaching.”

As a young man, Vonderfecht prob-ably didn’t realize the magnitude of that foresight, but looking back at his long, suc-cessful career in hospital administration, he, as well as the multitude of people who have been served by MSHA, are grateful he took the path he did.

His interest in medicine prompted Vonderfecht to switch his major to pre-med, but even after being accepted to medi-cal school, he still didn’t feel he had found his niche. After finishing a degree in busi-ness administration, and as circumstances prompted him, Vonderfecht, on the advice of a guidance counselor, looked into the field of hospital administration, which com-bined his interest in business and healthcare. He applied to three different schools with accredited Master’s degree programs, got accepted to all three, but ended up going to the University of Missouri in Columbia, where he and his wife spent two years.

After finishing his degree, Vonder-fecht worked for Humana (when it was a hospital company) for eight years and left there to work in the not-for-profit sector in Kansas City, Missouri, where he served as regional vice president over nine hospitals and nursing homes for approximately four years. He moved to Johnson City in 1990 to accept the position of president and CEO of Johnson City Medical Center (JCMC). In 1998, JCMC acquired six hospitals from Columbia HCA, forming Mountain States Health Alliance.

Although he still enjoys singing, most of his time is spent at the helm of the MSHA organization, helping guide it through the many storms the healthcare in-dustry has faced over the past few decades. And Vonderfecht feels good about the place where MSHA is anchored, as he prepares to retire on December 31st.

“We have a very good strategic plan in place that will guide MSHA well over the next few years. It will be challenging times, there’s no doubt about that, but we’ve had them before,” he said. “Through good strat-egy-setting and implementing those strate-gies, we’ve been able to come through those tough times. In fact, we are going through them now, with the cuts in reimbursements and the governors of two states opting not to expand the Medicaid programs.

“We are hoping, however, to get insur-ance coverage for people who don’t have insurance, so that they can access the sys-

tem in an earlier age of their illness rather than waiting to go to the emergency depart-ment at an advanced stage. It’s challenging, no doubt, but our strategic plan is very fo-cused in on this transformation we are going through, and we think it has the ingredients for success for coming through at the end of this transformation in a good state.”

Part of that strategic plan has been the development of Integrated Solutions Health Network (ISHN), comprised of area physicians, whether they are employed by MSHA, in private practice, or are uni-versity physicians. “Integrated Solutions Health Network allows us to work together to best care for patients under a popula-tion health management model,” explained Vonderfecht. “It benefits the patients and also benefits the physicians and our organi-zation financially from being able to share in savings associated with high quality care and cost savings from keeping patients out of high-cost care settings.”

As he pointed out, almost all the ar-ea’s physicians are involved with ISHN in some capacity, whether through con-tracting with insurance companies, under MSHA’s Medicare Advantage Plan, or through MSHA’s participation in the Medi-care Shared Savings Program. “I see that [physician participation in ISHN] as a real model of integration for our system that al-lows physicians to stay independent, to be a part of the university, or whatever they want, and still be a part of the greater good for what we are trying to do in the commu-nity,” he said.

“I just think there are a lot of oppor-tunities for us in the future, using evidence-based care guidelines to develop care models which allow us to work together as a team to benefit the patient, working around the triple aim—improving outcomes, improv-ing the patient’s experience, and reducing costs at the same time,” he added.

Vonderfecht says he hasn’t fully for-mulated his retirement plan, but he has determined that it will include spending time with his family, while also doing some traveling. Having a big heart for animals, Vonderfecht also plans to spend more time on his miniature donkey farm, Appalachian Homestead. A unique interest, Vonderfecht explained that he grew up showing quarter horses and kept horses until about twelve years ago. “I had two really well-trained horses but was running out of time to keep the riding up on them so that I could show

them. I sold them and went a couple of years without anything in the pastures,” he shared. “One day my wife mentioned we needed something in the pastures, so we looked at goats and llamas and other creatures of various kinds but settled on the donkeys.”

One of the favorites on the farm is Henry, who after losing a leg, now has a prosthetic that helps him get around. “We change his sleeve on his leg every day, and he just lays his head on your shoulder while you do it. He’s so sweet,” he shared.

Vonderfecht doesn’t want to abandon healthcare in retirement. He plans to stay involved. “I might teach part time, which I have already been doing for the College

of Healthcare Executives about four times a year. I may also do some consulting work around governance and performance improvement, those are two areas I feel I have some ex-pertise in that I might be able to share with others,” he said. “Beyond that, I may serve on some boards, but I don’t want to be tied down; I want time to explore some other inter-ests I have. I want to do some mission work with my church, which I haven’t had the oppor-tunity to do, and I’d like to sing,

so I may want to get involved with some singing groups.”

Wherever retirement may lead him, one thing is certain: his legacy will always be felt in Johnson City and the Tri-Cities area. “Our incoming CEO has mentioned a number of times that we are well-positioned because we’ve had consistent leadership, a comprehensive strategy that has carried us up to this point, and a terrific board of directors who has supported Dennis’s lead-ership,” said Teresa Hicks, MSHA’s Com-munications Manager. “We’re positioned to continue to be strong, and that’s some-thing we are appreciative of. We are really sad to see Dennis go, but we are grateful that he has left us with that legacy.”

6 > DECEMBER 2013 e a s t t n m e d i c a l n e w s . c o m

research arm of the American College of Radiology, noted a major concern for those in the profession is that outdated information could be used to inform healthcare policy with a direct impact on patients and providers. “We’re in an inter-esting time where there is immense scrutiny on our health delivery sys-tem,” he said. “We really need good, credible in-formation driving policy decisions.”

Duszak, a board-certified radiologist, noted that at some point the mantra that imaging utilization was continually spiraling upward “didn’t match what we in the trenches saw.” He added imaging studies were rapidly grow-ing until 2006, “Then it plateaued and has, in fact, declined.” Duszak added he isn’t suggesting imaging utilization shouldn’t continue to be monitored but that similar scrutiny should accrue to other Medicare service lines that are now growing at a faster rate.

“Like any tool … like any technology … like any discipline, how good imaging is — how useful it is — really depends upon how it is utilized. I think there are some appropriate areas where we can re-duce injudicious use of imaging, but,” he stressed, “we should not be throwing the baby out with the bathwater in the pro-cess.”

The medical discipline has already taken a number of financial hits. The Def-icit Reduction Act of 2005 significantly decreased financial reimbursement for di-agnostic imaging. Sequestration, bundled payments and other changes to reimburse-ment models and formulas also threaten to further erode the financial viability of the field. In this most recent research, the study’s authors wrote, “A failure to understand changes in utilization that may accompany these potential payment reductions could ultimately produce ad-verse effects on patient care regardless of whether the intended cost containment goals are realized.”

Duszak pointed out the field of ra-diology has seen incredible technological and diagnostic advancements that have helped physicians accurately pinpoint health issues and improve outcomes. He said the downstream effect must also be considered when determining appropriate imaging utilization levels.

He said looking solely at the front-end savings is a bit like only watching the first part of a movie without regard to how the story ends. “The hero did great. He saved money … but what happens in the next scene? Did that money really get saved, or are there other unforeseen costs as a re-sult of the hero’s actions in scene one?” Duszak questioned.

It’s a topic Duszak explored in a brief he authored for the Neiman Health Policy Institute last fall. “Lawmakers, regulators

and medical professionals are making medical imaging policy decisions without fully understanding or examining their downstream effects, which may include an increase in hospital stays, associated costs and other adverse events,” he wrote. “We need to examine imaging, as it relates to a patient’s overall continuum of care, to ensure that decision-makers don’t create imaging cost reduction policies which par-adoxically raise overall costs, create barri-ers to care and ultimately harm patients.”

Getting a better handle on the bear-ing imaging has on the overall cost of care is an area where Duszak said more research is critically needed. What impact does imaging play in catching cancers early when treatment is most effective? Did skipping a diagnostic study result in a patient staying extra days in the hospi-tal while providers tried to determine the source of illness? “We need more research in this space to answer these questions de-finitively,” he said.

Ultimately, Duszak said, everyone’s goals should align — find out where im-aging is most beneficial and push for more of it … determine where it isn’t as helpful and push for less. “We need to continue a sophisticated analysis to determine ap-propriate usage,” he concluded.

Medical Imaging Utilization, continued from page 1

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By LEIGH ANNE W. HOOVER

Last month, we ventured over the mountains to rediscover Biltmore Estate and “deck the halls” for the holidays. As my husband, Brad, and I discovered, Biltmore has grown to encompass so much. There’s something new every time you visit, and one column just did not do it justice. So, for December, we are going to take another look at this historic jewel.

If you are looking for a way to expe-rience the beauty and essence of the holi-days, make the trip over to Asheville, North Carolina, and visit Biltmore. Just as George Vanderbilt welcomed visitors to his exqui-site home on Christmas Eve, you, too, can glimpse how it might have felt.

“Our mission is preservation of the es-tate,” explained Biltmore Public Relations Manager Marissa Jamison “Everything that we do is meant to preserve the estate’s legacy and to showcase it to our guests as the Vanderbilts would have intended.”

Because George Vanderbilt selected Christmas as the season to debut his new home to friends and family, the season has remained very special. One holiday high-light is the Candlelight Christmas Evening Tours, which are offered through Decem-ber 31st.

Although Biltmore House did have electricity and was considered technologi-cally advanced, candles were still some-times used.

“While George Vanderbilt himself preferred newly fashionable electric lights, we do know from our records that his mother, Louisa, sometimes insisted on hav-ing real candles on the Christmas trees,” said Jamison. “So, we have taken inspi-ration from that story in our decorations throughout the house during our candle-light tours.”

Local choirs, small musical ensembles and soloists stationed throughout the home, bring the sounds of the season to life.

“We celebrate the Christmas season at Biltmore in a way that is very unique to the house, rooted in tradition and in the way that this family would have entertained their guests for the holidays,” said Jamison.

Although audio for Biltmore tours has recently been updated and is definitely worth the add-on cost to your admission ticket, this feature is not available during the candlelight tours.

The minute guests arrive, luminaries are lining the driveway, and the majestic 55-foot Norway spruce is bedecked in Christ-mas lights to welcome visitors to “America’s largest private home.” With dimly lit light-ing, fires burning in the fireplaces, candles, music, and the wafting smells of evergreen, it’s a very special ambience for the season’s self- guided evening tours.

“It’s a peaceful and different way to see the house that leaves you in the holi-day spirit,” added Jamison. “Guests come to see décor like outdoor luminary displays, Christmas trees of grand proportions and for Gilded Age grandeur inside the house.”

Since the Biltmore Winery and Antler Hill Village are also included in your ad-mission to the estate, my recommendation would be to enjoy this area first on the eve-ning of a candlelight tour visit. Check the winery hours because it closes before Bilt-more House. You will want to enjoy a wine tasting and possibly make an advanced, early dinner reservation at either Cedric’s Tavern, known for its estate brewed ales, or the Bistro, which has a French influence, and reservations are strongly encouraged.

Deerpark Restaurant or the, lunch-only, Stable Cafe are a couple of other din-ing possibilities on the estate. And there is also a fine dining restaurant located in the Inn at Biltmore.

The Biltmore Winery opened in 1985, and it is touted as the most visited winery in the country. Award-winning wines are produced annually, and each year, there is always a special Biltmore Christmas wine.

When we visited the tasting room, Jeff Rayl explained that this year’s Christmas wine is the perfect complement to a holi-day dinner. With a light golden color and a rose petal, lychee, and honeysuckle nose, the taste is a perfect balance of sweetness and acidity with a hint of apricot, citrus, and spice. As always, it’s sure to compli-

ment any holiday dinner.“Our wine makers blend a commemo-

rative wine every year for our Christmas wine,” explained Jamison. “It’s usu-ally a sweet or semi-sweet wine, which tends to pair well with the rich holiday offerings.”

Beautifully packaged with a unique, festive label, the Bilt-more Christmas wine has even become collectible. This year’s label design contest winner is Perry Winkler, an artist from DuBois, Pennsylvania.

According to Jamison, the Biltmore portfolio of wines typically includes around 40 different wines.

“Because of the vol-ume of people that we see come through the winery, we are often accommodating people for their first visit to a winery all the way up to afi-cionados…, and we are unique in this way. So, we have designed our portfolio to really offer something for everyone,” said Jamison.

Since it can be difficult to grow grapes in the North Carolina climate, Biltmore

does source grapes from other regions like California to maintain the high volume with the best quality grapes. However, some wines are made with North Carolina grapes, and chardonnay is a grape that grows very well on the estate.

“We buy more grapes from North Carolina vineyards than any other winery in the state,” explained Jamison. “We have a lot of partnerships with other vineyards in the state, and we also supply research and help with grape growing technologies in the state.”

Visitors can purchase wine to “take a taste of Biltmore home” or find selections in nearly 30 states throughout the country.

Before leaving Antler Hill Village, be sure to also visit the recently opened ex-hibit about the Biltmore legacy titled “The

Vanderbilts at Home and Abroad.” “The ‘Legacy’ exhibit is a

deep-dive behind the history of the Vanderbilts and gives you more

of that personal story,” explained Jamison. “With this exhibit, you get

to go into deeper detail about spe-cific aspects of their lives like George

Vanderbilt’s travels that inspired his collections.”

Come early enough to also enjoy the infamous gardens, greenhouses and so

much more at Biltmore this holiday sea-son. To plan your trip visit www.biltmore.com, and for additional information about the Biltmore Winery, go directly to http://www.biltmore.com/wine/visit-the-winery.

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

Enjoying East TennesseeBiltmore Estate - Candlelight Tours, Winery and Antler Hill Village

8 > DECEMBER 2013 e a s t t n m e d i c a l n e w s . c o m

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

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

JOHNSON CITY MGMA MONTHLY MEETING

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

Location: Quillen ETSU Physicians Clinical Education Building,

325 N. State of Franklin Rd., Johnson City

KINGSPORT MGMA MONTHLY MEETING

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

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

Second Floor, Kingsport

2ND THURSDAY 3RD THURSDAY

There will be no December meeting for the Johnson City MGMA members.

on claims that are for stays of less than “two midnights” after admission and have of-fered feedback and education to providers about compliance and missteps. During this period, the Recovery Audit Contractors (RACs) have not conducted medical neces-sity reviews. At year’s end, CMS has said it will assess the findings to see if additional guidance is needed.

Brian Contos, executive director over-seeing the clinical research and insights pro-grams at The Advisory Board Company, recently spoke with Medical News to shed a little light on the confusing and contro-versial rule.

The Backstory“There are probably two storylines be-

hind why they have implemented the two-midnight rule,” Contos said of CMS. “On the one hand, they’re instituting this policy to address concerns surrounding extended observation stays.” He continued, “I think the other reason is the simple fact that there are a tremendous number of very short stay inpatient admissions.”

Looking to the first motivating factor, Contos said, “Between 2006 and 2011, there was a dramatic increase in observa-tion stays … a 65 percent increase.” In addi-tion, he continued, there was a 176 percent increase for those kept in observation for an extended period — 48 hours or longer. As for the second issue, Contos said, “Of the roughly 15 million Medicare admissions in 2012, about 2 million of those were admit-ted with a one-day stay.”

Since the cost to Medicare is far greater under Part A than under Part B (outpatient or observation status), the federal payer has a vested interest in how patients are classi-fied, but CMS made it clear the goal is nei-ther to keep patients in observation limbo when inpatient admission is warranted nor to pay Part A rates when services could be rendered in a more cost effective manner.

Contos said, “From CMS’ perspec-tive, there’s a yin and yang here … we don’t want a really long observation period nor do we want to pay for these really short in-patient stays.” He said it’s all about finding

equilibrium.Going forward, one-night inpatient

stays will probably serve as a red flag for auditors to dig deeper to ascertain whether Part A reimbursement was appropriate. While two midnights is the benchmark for inpatient status, there certainly are excep-tions. First and foremost, any procedure that appears on the inpatient-only list is ex-empt from the rule. Second, there are other conceivable situations where a patient could have reasonably been expected to meet the benchmark but only stayed one night, in-cluding self-discharge against medical ad-vice, death, or transfer. However, Cantos stressed the documentation must clearly show that the physician admitted the indi-vidual to inpatient status with an anticipa-tion that the patient’s condition warranted a stay of at least two midnights.

In addition to the marked increase in observation cases, Cantos said the issue of post-acute care was another catalyst for the rule. For Medicare to pick up the tab for a stay in a skilled nursing facility or rehab unit, a patient has to stay in the acute care facility for three days, and observation days don’t count. Pressure has been mount-ing on CMS … both by patient advocacy groups and through legal challenges … to ‘do something.’ A report based on Medi-care data from 2012 and released this July by the Office of Inspector General found there were more than 600,000 hospital stays last year that lasted at least three nights but didn’t qualify for inpatient payment … which means those stays would not have satisfied the three-day rule if needed.

Contos noted, “I would say the three-day rule is universally hated. Hospitals and advocacy groups want time in observation to count if a patient ultimately is admitted.” While CMS did not opt for that route, the two-midnight rule could be seen as a step toward ensuring a more timely determina-tion of whether or not a patient should be admitted.

The Problem for Hospitals“It’s a judgment call at the end of the

day,” Contos said of whether or not a physi-

cian admits a patient. Therein lies part of the problem for

hospitals … the two-midnight rule is specific in that it is a judgment call and simultane-ously very loose because, by its very nature, a judgment has many shades of gray, which could leave the soundness of the decision open to interpretation … perhaps by an auditor.

Although CMS actually expects about 400,000 observation cases to become inpa-tient and 360,000 inpatient cases to move out, many hospitals don’t believe the rule will help the bottom line. First, the inpa-tient payment rate is being adjusted down slightly to achieve budget neutrality. The other concern is that for some hospitals, the number of inpatients gained from extended observation will be considerably less than the number lost from shorter stays, which will negatively impact margins that are al-ready extremely tight.

“I don’t think we can assume what happens in one hospital will happen in all. It will be institution by institution. Every hospital is going to look differently,” Cantos said.

Certain service lines will probably be disproportionately impacted. For example, about one-third of hypertension cases and approximately 40 percent of Medicare chest pain cases result in a one-day admis-sion. Presumably, those patients will wind up as observation patients in the future. Cantos encouraged hospital administrators to work closely with their analytics team to get a better sense of the anticipated effect of the rule on their specific hospital.

Exacerbating the financial concern is the increased out-of-pocket burden on patients. Moving from Part A inpatient to Part B observation status typically means the patient will shoulder more of the costs, adding strain to the collection process and potentially increasing the hospital’s bad debt ratio.

So what is to keep a hospital from skewing the numbers in their favor … keep-ing short stays longer and admitting more observation patients? Cantos said some hos-pitals certainly might opt to roll the dice, but

there are inherent risks in this plan.First, demanding a patient be admit-

ted contrary to a doctor’s medical opinion is never optimal. “Physician judgment should really be held almost sacred,” Cantos said. “There is nothing more disruptive to hospi-tal/physician relationships than for a hospi-tal administrator to tell a physician how to assess or judge a particular patient’s care.”

Cantos continued, “This is something that starts with a physician’s medical judg-ment, and I don’t think most hospitals want to dictatorially stipulate how physicians must practice.”

The second risk is that a hospital could ultimately wind up taking an even bigger hit to the bottom line. Although CMS offers a rebilling process to move claims incorrectly filed as Part A to Part B, hospitals only have one year to do so. By the time an auditor comes in to review inpatient claims, there is a good chance many would be past the one-year mark. In those cases, a claim deemed inappropriate by the auditor wouldn’t be eligible for rebilling. Instead, the hospital would be liable to CMS for the full amount of those claims plus any fines.

Prepping for Post-AmnestyWith the grace period granted by

CMS rapidly coming to an end, Cantos of-fered four observations about steps hospital administrators could take to optimize com-pliance.

First, there should be an emphasis on physician education. “You don’t want to dictate, but you do want to make sure ev-eryone understands the rule and documen-tation requirements,” Cantos said.

In the eyes of CMS, he added, ‘admit’ and ‘admit to inpatient care’ are different. No one wants to lose out on reimbursement because of incorrect terminology. Hospitals also don’t want to present RAC auditors with widely divergent case documentation. “As a hospital, you do want to try to estab-lish some norms here so it’s not a total crap-shoot if audited,” Cantos said. “If you’re all over the map, it becomes really difficult to right-size your program.”

The second recommendation is for hospitals to look at the processes in place to assess and reassess observation cases. “There’s a timing element,” Cantos pointed out. While it’s critically important to docu-ment how, when and why a decision was made to admit to inpatient status, it’s also important to expedite that process. “It’s something every hospital is going to have to push on — timely decision-making,” he said.

Cantos said hospitals also should re-view their internal auditing process. “Like-wise, you want to develop a self-review process to identify cases that were inappro-priately admitted so you can rebill under Part B within the one-year filing window,” he noted.

The fourth item is to make sure that in addition to educating staff about the two-midnight rule, hospitals also remember to explain it to patients. “It’s very important the patients understand that just being in a bed in a hospital doesn’t mean you are ad-mitted. Patients pay more out-of-pocket for Part B so they must understand the nuances about payment for inpatient and observa-tion,” Cantos stated.

Two-Night Minimum, continued from page 1

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

DysphagiaBy Clarisa E. CuEvas, MD

Dysphagia is defined as difficulty in swallowing. It is a symptom that can be due to a defect in the mouth, oropharynx, or esophagus. It can also be the result of a motor disorder or mechanical obstruction.

To determine the area of defect, we must evaluate all stages of swallowing. It all begins with suckling. The lips must be able to form a tight seal as the tongue is displaced posteriorly. The glottis closes to guard the airway, and the soft palate rises to close the nasopharynx as the cricopharyngeal muscles relax. The food then passes to the back of the pharynx. Solids require coordinated actions requiring appropriate jaw movements and teeth alignment. Salivary secretions lubricate the food as it passes through the mouth into the pharynx and then the esophagus.

Abnormalities in any phase can interrupt successful swallowing. It is abnormalities of the muscles involved in the ingestion process, their innervations, strength or coordination causing intermittent dysphagia in infants and children. Cerebral palsy, Arnold-Chiari malformation, myelomeningocele, congenial myotonic dystrophy, and other myopathies, as well as cricopharyngeal achalasis, can present as dysphagia.

Esophageal disease is a common cause of swallow dysfunction. Sudden dysphagia in the younger child should be evaluated immediately and a foreign body should be ruled out. Eosinophilic esophagitis often presents as a swallow dysfunction and feeding refusal with or without chocking. Candida pharyngitis or esophagitis can cause difficulty in swallowing. Gastroesophagel reflux with esophagitis or ulcerations can result in chocking and difficulty with both liquid and solid bolus. Idiopathic achalasia often presents with difficulty in swallowing liquids and solids. A history of tacheoesophageal atresia or fistulae suggests stricture formation and a motility problem.

The clinical presentation varies. In the younger child, it often presents with respiratory signs and symptoms combined with feeding refusal. The older child can have fits of coughing, nighttime drooling, and refusal of their favorite foods. A chocking

episode with food bezoar impaction is the most common presentation in the adolescent patient.

Careful examination of oral, pharyngeal, laryngeal, and esophageal anatomy and function are important during the evaluation of children with dysphagia. Three basic approaches are utilized:

Radiographic studies: (a) upper gastrointestinal series will help identify anatomic or structural abnormalities such as strictures, vascular anomalies of the esophagus, fistulae and masses. Images of the coordination of movement of bolus through the oropharynx and esophagus can help identify motility dysfunction, chalasia or achalasia; (b) modified barium swallow with a speech or occupational therapist can identify oropharyngeal dysfunction.

Direct visualization with a fiberoptic endoscope will help in both the identification of the problem and in removal of a bezoar, foreign body, or therapeutics with botulin toxin or pneumatic dilation for achalasia.

Motility studies are indicated for the evaluation of esophageal peristalsis. A 24- hour study can help when GERD is suspected.

The therapeutic modalities vary depending on the cause for the dysphagia. At our GI for Kids clinic, we coordinate care with speech therapy and occupational therapy in the case of oropharyngeal problems. Recommendations for treatment of both achalasia (Botox/dilatations) and chalasia (H2 antagonist/PPIs) are given. Treatment and follow-up are provided so as to prevent recurrence of the problem particularly in the case of Eosinophilic esophagitis. Inhalers, PPIs, and esophageal dilation are needed throughout the year. While dysphagia requires a complex evaluation, in most cases we have complete resolution of the medical problem.

GiforKids, PLLC is a pediatric gastroenterology specialty clinic located at East Tennessee Children’s Hospital staffed with dedicated providers offering comprehensive care to patients and their families.

Clarisa E. Cuevas, MD, is a board-certified pediatric gastroenterologist with GI for Kids, PLLC, in Knoxville, Tenn.

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GI for Kids, PLLCwww.giforkids.com (865) 546-3998

Virus Hunt: The Search for the Origin of HIVby Dorothy H. Crawford; c.2013, Oxford University Press; $27.95 U.S. and Canada, 244 pages

In the new book

Virus Hunt by Dorothy H. Crawford, you’ll see how scientists discovered the roots of HIV.

In 1981, doctors in California be-gan noticing “rare infections… and an unusually aggressive tumor” in certain patients. Soon, the same was reported in New York , Florida , and elsewhere around the country. By 1982, the disease was called AIDS.

The risk of catching AIDS seemed at first to be limited to sexually-active gay men, particularly those with multiple partners. Within weeks, heroin users and hemophiliacs were added to the at-risk group, then doctors discovered that in-fected mothers could pass it to their chil-dren. “Fear of AIDS” became “a disease in its own right.”

By 1984, the “causative virus was identified [as human immunodeficiency virus]… and shortly thereafter the ge-nome was sequenced…”

But where did HIV come from?Soon after the first description of

AIDS was released in 1981, Boston re-searchers noticed that their captive macaque population was affected with something that sounded similar. Four years later, scientists at that research fa-cility isolated a simian immunodeficiency virus (SIV) which had spread and mutated as animals were “unwittingly” shipped around to other facilities.

That led to the discovery that some SIVs are “closely related” to certain strains of HIV and share “between 62 and 87 percent” of their genetic sequences. It didn’t take much to see how the virus mutated, or how it leaped from animal to human, possibly via Africa’s sooty mang-abey monkeys (a “natural host of the vi-rus”), which were sometimes hunted for food.

But the question of where HIV came from needs to go back even further than 1981. A man from Memphis was report-ed with what doctors would consider to be typical AIDS symptoms in 1952. SIVs were discovered in Icelandic sheep in 1949. Scientists, in fact, believe that SIVs are “ancient parasites” and that HIV has been “circulating in the African popula-tion since near the start of the 20th cen-tury.”

At the beginning of this book, au-thor Dorothy H. Crawford indicates that the search for the beginnings of HIV is somewhat like a mystery. She’s absolute-ly correct. It is, but you need a Sherlock-ian PhD to understand it all.

That’s not to say that Virus Hunt is a bad book – that’s not the case at all. What readers will want to know, howev-er, is that it’s very academic and heavily steeped in genetics, epidemiology, and laboratory-level research. That’s great for anyone employed in those fields. For the layperson, this mystery’s not unreadable but it’s as far from relaxing entertainment as you’ll ever get.

Death, American Styleby Lawrence R. Samuel; c.2013, Rowman & Littlefield; $40.00 / $44.50 Canada, 189 pages

Does your death frighten you, or are you intrigued? Curious or repelled? Your attitude may come from the outlook surrounding you, as you’ll see in Death, American Style by Lawrence R. Samuel.

In the years immediately following World War I, Americans were reeling. Not only was there a “sheer volume of people” dead from battle, but the 1918 influenza epidemic also claimed many victims. Americans thought hard about death and reached for spiritualists, who purported to communicate with the newly deceased.

By the 1930s, researchers had an inkling that maybe death wasn’t “neces-sary.” Alas, according to one nurse of the era, people continued to expire and they all “died the same, more or less…”

In the years prior to World War II, although there were marked increases in death by automobile and by home ac-cidents, dying was “a relatively normal, even innocent affair.” During the war, however, parents suddenly realized that they’d “better be prepared to explain death to their children.” Death on “such a massive scale… was itself frightening and potentially scarring to children.”

Post-war modern medicine benefit-ted by the increasing acceptance of au-topsies, the advancement of medical pro-cedures and medicines, and the growing notion that death could be reversed. The timing was fortuitous, at least for research studies: more people died in hospitals than at home in the 1950s.

For some, though, being surround-ed by machines didn’t sound like a good way to go, so the notion of natural death began to take hold in the mid-1960s.

And yet, we just can’t get over our squeamishness: death has been, alter-nately through the past four decades, a taboo subject, a class subject, reason for “deeply philosophical examination,” and “a principal theme in American pop culture.” Today, we’re able to cautiously discuss death, though many “continue to resist their mortality.”

In his introduction, author Lawrence R. Samuel indicates that his intention with this book was not to look at the death industry, but rather at the attitude Americans have towards death itself.

He accomplishes that in Death, American Style… just not all that well.

Perhaps it’s the length of this book: the “cultural history of dying” is a vast subject; much bigger than the small page count allows here, which leads to an irritating lack of depth. It doesn’t help that Samuel’s first chapter sometimes reads like an overgeneralized synopsis of a dime-store novel, or that some subjects seemed to be brushed aside or are to-tally missing in the narrative.

To the good, there are nuggets of fascination in this book, but they’re pret-ty scattered and might not be enough to satisfy a truly curious mind.

theLiteraryExaminerBY TERRI SCHLICHENMEYER

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

10 > DECEMBER 2013 e a s t t n m e d i c a l n e w s . c o m

GrandRounds

Coopwood Installed as Tennessee Hospital Association (THA) Chairman, Medley Chair-Elect

NASHVILLE - Reginald Coopwood, MD, president and CEO, Regional Medi-cal Center at Memphis, was installed as chairman of the Tennessee Hospital As-sociation’s board of directors during the association’s recent annual meeting in Nashville.

Mark Medley, president and CEO, hospital operations, Capella Healthcare, Franklin, was elected chairman-elect of the board. He will become chairman dur-ing the 2014 annual meeting in Nashville.

Joe Landsman, president and CEO, University of Tennessee Medical Center, Knoxville, became immediate past chair-man. He also will serve as speaker of the House of Delegates in 2014.

District representatives on the THA board of directors are David Archer, CEO, Memphis market, Saint Francis Hospital, Memphis district; Thomas Gee, CEO, Henry County Medical Center, Paris, west district; Mike Garfield, CEO, HMA/Ten-nova Healthcare, middle district; Alan Watson, CEO, Maury Regional Healthcare System, Columbia, south middle district; James Hobson, president and CEO, Me-morial Health Care System, Chattanooga district; Keith Goodwin, president and CEO, East Tennessee Children’s Hospital, Knoxville district; Scott Bowman, admin-istrator, Sweetwater Hospital Association, mid-east district; and Candace Jennings, senior vice president, Tennessee opera-tions, Mountain States Health Alliance,

Johnson City, northeast district. At-large members of the board are

Bobby Arnold, president and CEO, West Tennessee Healthcare, Jackson; David Posch, CEO, Vanderbilt University Hospi-tals, Nashville; Denny DeNarvaez, presi-dent and CEO, Wellmont Health System, Kingsport; Jeff Seraphine, president, Del-ta Division, LifePoint Hospitals, Inc., Brent-wood; Mike Schatzlein, MD, president and CEO, Saint Thomas Health, Nashville; and Anthony Spezia, president and CEO, Covenant Health, Knoxville.

Other board appointments include Thelma Traut, board chair, Baptist Me-morial Hospital-Huntingdon, and Jeffrey Woodside, MD, board member, Hardin Medical Center, Savannah; representing hospital trustees; Scott Tongate, CEO, Lauderdale Community Hospital, Rip-ley, representing the THA Small or Rural Constituency Section; and THA President Craig Becker.

Paul Korth, CEO and CFO, Cookeville Regional Medical Center, will represent the THA Council on Government Affairs; Morris Seligman, MD, senior vice presi-dent/CMO, Mountain States Health Al-liance, Johnson City, and chairman, THA CMO Society, will serve as the physician representative; Charles Howorth, execu-tive director, Tennessee Business Round-table, Nashville, will serve as the business representative; Chuck Whitfield, presi-dent and CEO, Laughlin Memorial Hos-pital, Greeneville, will serve as the THA Solutions Group board representative; Jason Boyd, interim CEO, Metro Hospi-tal Authority, Nashville, and chair of the THA Council on Diversity, will serve as the

diversity representative; Christine Brad-ley, assistant vice chancellor, government relations, Vanderbilt University Hospitals, Nashville, will serve as the Tennessee Ru-ral Partnership representative; and Robert Gordon, retired executive vice president and chief administrative officer, Baptist Memorial Health Care Corporation, Mem-phis, has been selected to serve as an emeritus board member.

Jason Little, executive vice president and chief operating officer, Baptist Memo-rial Health Care Corporation, Memphis; and Stephen Corbeil, president, HCA Tri-Star Health System, Brentwood, will serve as Tennessee’s delegates to the American Hospital Association (AHA). Kevin Spie-gel, president and CEO, Erlanger Health System, Chattanooga, will serve as an AHA alternate delegate.

Tennessee’s Health eShare Direct Project Reaches Milestone 1,000th Participant

NASHVILLE – Direct Technology has been adopted by 1,000 healthcare profes-sionals across Tennessee thanks to Health eShare, a statewide initiative through the Office of eHealth Initiatives (OeHI) to im-plement Direct secure email technology.

In an intensive, four-month effort, Health eShare’s Direct Project team, com-prised of OeHI and Qsource, has been working across the state to assist a wide range of individuals and facilities deliver-ing healthcare. Healthcare professionals already participating include physicians, nurse practitioners, physician assistants, social workers, medical assistants, admin-istrators, and others. Many different types of healthcare organizations are represent-ed such as hospitals, long-term care facili-ties, hospice organizations and rehabilita-tion facilities.

Health eShare’s objective is to maxi-mize the efficiency and interoperability of secure messaging through broad adop-tion of Direct across all healthcare set-tings. “Essentially, we focus on identifying healthcare provider ‘connectors’ within the community and then putting them in touch with their patient referral partners to create a more effective communica-tion vehicle for sharing important clinical information regarding their patients,” said Dawn FitzGerald, CEO of Qsource. “As a result, Tennessee healthcare professionals are recognizing Direct’s value in obtaining patient information more timely and effi-ciently, which helps them provide the best care possible.”

According to Health eShare, Direct Technology provides improved care co-ordination by allowing providers and their staffs to securely send and receive patient information while also helping healthcare providers meet federal standards. Health-care providers can achieve Meaningful Use Stage 2, a requirement that must be met by 2015 under the American Recovery and Rehabilitation Act (ARRA) of 2009, by offering secure electronic data exchange from one healthcare setting to another, such as from hospital discharge to follow up care with their primary care doctor.

An incentive program is available for early adopters to help offset the cost of signing up for a Direct account. Those interested in learning more about Direct should visit www.HealtheShareTN.com or call Qsource at (866) 514-8595.

(CONTINUED ON PAGE 15)

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Sue Lindenbusch, senior vice president of the Wellmont Cancer Institute, highlights how Trilogy and TrueBeam will help change the landscape in the delivery of advanced radiotherapy treatment for some of the most complex cancers.

Wellmont Cancer Institute Demonstrates Leadership with Addition of trilogy, Plan for Truebeam

KINGSPORT – New technology at Holston Valley Medical Center and Bristol Regional Medical Center is exhibiting the Wellmont Cancer Institute’s leadership in the delivery of su-perior and cutting-edge oncology care.

The cancer institute recently enhanced its radiation oncology program at Holston Valley’s Christine LaGuardia Phillips Cancer Center with the installation of Trilogy. This linear accelerator is already in use. Plus, The J.D. and Lorraine Nice-wonder Cancer Center at Bristol Regional will bolster its offerings with the planned acquisition of the TrueBeam system for radiation oncology patients.

These additions are helping Drs. Byron May, Scott Coen and John Fincher, who are members of the cancer institute’s radiation oncology team, change the landscape in the delivery of advanced radiotherapy treatment for some of the most complex cancers. The three physicians are medi-cal doctors who are certified by the American Board of Radiology.

Leaders of the cancer institute and Wellmont Health System, as well as oncology care provid-ers, celebrated Trilogy and TrueBeam during a news conference at Holston Valley on Monday, Nov. 11. Attendees were able to see a demonstration of Trilogy in action after the event.

Trilogy and TrueBeam further advance the cancer institute’s ability to treat some of the most complex cancers in areas such as the head, neck, lung, prostate, liver and breast. These pieces of technology will improve outcomes by delivering radiation with pinpoint accuracy and provide increased comfort for the patient while minimizing the risk to healthy tissue.

TrueBeam is another step in accelerating the cancer institute’s regional strength in ste-reotactic radiosurgery that has been delivered since 2004 through CyberKnife. Trilogy will continue to showcase the cancer institute’s stellar delivery of stereotactic body radiation ther-apy. Together, Trilogy and TrueBeam empower the cancer institute to continue treating all forms of cancer and a broad spectrum of patients.

In addition to the exciting developments at Bristol Regional and Holston Valley, the can-cer institute in recent months secured an On-Board Imager for the radiation oncology pro-gram at the Southwest Virginia Cancer Center in Norton.

Further information about the cancer institute is available at www.wellmont.org.

e a s t t n m e d i c a l n e w s . c o m DECEMBER 2013 > 11

Name: Glenda Beene

Position: Volunteer, Battlefield Imaging and Fuller Cancer Center

At a Glance: Hutcheson Medical Center recently named Glenda Beene as the hospital’s Auxiliary Volunteer of the Month for October. Bonner has volunteered at the hospital’s Battlefield Imaging and Fuller Cancer Center for seven years.

Beene said that helping others gives her the most satisfaction. As a volunteer, Beene does a variety of tasks, including bringing patients back from the lobby, answering the phones, and transporting items to the lab. “When a patient first comes to the Cancer Center, I tour the patients and give them an informational video. I like the relationship that I have with patients, and I enjoy working with the employees. I miss them when I am not here,” shared Beene.

Chareen Humble, Manager of Volunteer Services at Hutcheson, said that Beene is someone upon whom others can always depend. “Glenda always helps out where possible and is a great volunteer. I wish we had 200 more volunteers just like her.”

GrandRounds

(front row from left to right): Chareen Humble, Manager of Hutcheson Volunteer Services; Debby Kelly, Director of Fuller Cancer Center; Glenda Beene, October Volunteer of the Month; Angela Helmes, Administrative Assistant, and Roger Forgey, President and CEO.

Oakley Joins Johnson City Eye Clinic

JOHNSON CITY - Jennifer Powell Oakley, MD and Glaucoma Specialist has joined the Physicians and Staff of Johnson City Eye Clinic and Surgery Center. A Bristol, Tenn., native, Oakley graduat-ed from Tennessee High School. She holds a B.A. from the University of Ten-nessee and received her medical degree from the Quillen College Medicine, East Tennessee State Universi-ty. Oakley completed her ophthalmology residency at the University of Mississippi Medical Center and concluded a glau-coma fellowship at the University of South Florida. Oakley is board-certified by the American Academy of Ophthalmology and a member of the Christian Medical and Dental Association, the Association for Research and Vision in Ophthalmology and the Mississippi Academy of Eye Physi-cians and Surgeons. Oakley will be seeing patients in the Johnson City Eye Clinic’s Johnson City and Bristol locations.

Foster Children Volunteer Support for Others Facing Crisis

JOHNSON CITY — Foster children and teens in Lee, Wise and Scott Coun-ties were quick to volunteer when they heard staff for VALUES Foster Care were creating the VALUES Backpack Program to help kids just like them placed through local Department of Social Service agen-cies.

VALUES staff and the youth in foster care are requesting donations of new or gently used backpacks, stuffed animals, books, blankets, and new or unused school supplies for the Backpack Program. The donated items will be combined with new pajamas, school, and other supplies and given to children as they enter foster care even in the middle of the night or on a holiday.

• Backpacks, duffel bags or overnight bags are needed. Blankets should be small enough to fit in a backpack or tote bag.

• Books for all ages are needed, in-cluding chapter books, coloring books, activity pads and series books.

• New or very gently used stuffed ani-mals are important for all ages of children facing a crisis.

Either drop off items at the VALUES office at Addington Hall in Duffield, or call 888-443-1804 for other options. Of-fice hours are 8 a.m. to 5 p.m. Monday through Friday.

THA Honors Wellmont Physician, Board Member for Meritorious Service

KINGSPORT – A compassionate Wellmont Health System physician dedi-cated to helping patients without financial means and a committed board member with a lengthy record of advancing the re-gion’s health have been honored by the Tennessee Hospital Association.

Dr. Joe Smiddy, a pulmonologist with Wellmont Medical Associates Pulmonol-ogy & Sleep, and R. David Crockett Sr., a longtime member of Bristol Regional Medical Center’s board of directors, re-cently received the Meritorious Service

Award. The hospital association celebrat-ed their achievements during the organi-zation’s 75th annual meeting in Nashville.

Smiddy, a medical doctor, was recognized for his community service, which includes his volun-teer leadership with Re-mote Area Medical® clinic and the Health Wagon and his work with patients at Lonesome Pine Hospital and other Wellmont facilities.

Crockett was commended for his dedicated service as a member of Bristol Regional’s and Wellmont’s board of direc-tors. He has served three times as chair-man of Bristol Regional’s board and one time as chairman of Wellmont’s board.

Smiddy was a driving force behind the first Tri-Cities RAM clinic, held in 2010 at Bristol Motor Speedway. That passion has continued with his support of the sec-ond and third clinics as well.

He has also worked year-round with the Health Wagon to provide primary and preventive care to the area, as well as education on the dangers of smoking and other tobacco use. He also travels with an army of volunteers and family to foreign countries, most notably with his Body and Soul of Belize program, for which he serves as medical director.

Crockett’s service to the health sys-tem began in 1976 when he joined Bristol Memorial Hospital’s board of directors. During his tenure on that board, he has provided valuable guidance, enhanced by his deep connections with the community, as medical services have expanded. Each time, Crockett encouraged physicians and hospital administrators to work col-laboratively to ensure patients in Bristol Regional’s service area continue to receive outstanding healthcare.

Dr. Jennifer Powell Oakley

Dr. Joe Smiddy

Hope is close to home.

www.msha.com/cancer

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

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

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

Hope is close to home.

www.msha.com/cancer

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

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

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