TNMED.ORG Volume 109, Number 1 + Quarter 1, 2016

VOL. 109, NO. 1 | QUARTER 1, 2016 Gives Retirement Guidance Dr. Jackson Buttterworth Dr. JacksonButtterworth What willbeour legacy? Dr. JohnW.Hale Jr. TMA Voter Guide TNMED.ORG Volume 109, Number 1 + Quarter 1, 2016

Tennessee Medicine: Journal of the Tennessee Medical Association (ISSN 10886222) is published Quarterly by the Tennessee Medical Association, 2301 21st Ave S., Nashville, TN 37212. Tennessee Medical Association is a nonprofit organization with a definite membership for scientific and educational CONTENTS purposes, devoted to the interests of the medical profession of Tennessee. This Association is not responsible for the authenticity of opinion or statements made by authors or in communications submitted to Tennessee Medicine for publication. The author or communicant shall be held entirely responsible. Cover Story Advertisers must conform to the policies and regulations established by the Board of Trustees of the Tennessee Medical Association. Subscriptions 19 Collaborative Care: Teamwork Between (nonmembers) $30 per year for US, $36 for Canada and foreign. Single copy Providers Leads to Better Patient Care $5.00. Payment of Tennessee Medical Association membership dues includes the subscription price of Tennessee Medicine. Periodicals postage paid at Nashville, TN and at additional mailing offices.

POSTMASTER: Send address changes to Tennessee Medicine, 2301 21st Ave STAT S., Nashville, TN 37212. In Canada: Station A, P.O. Box 54, Windsor, Ontario, 5 ICD-10 N94 6J5. ______

Copyright 2015, Tennessee Medical Association. All material subject to this copyright appearing in Tennessee Medicine may be photocopied for President’s Comments noncommercial scientific or educational use only 7 What Will be Our Legacy—John W. Hale Jr., MD ______

PRESIDENT Editorials John W. Hale Jr., MD 9 CEO’s Note: Resolutions for a New Year—Russ Miller 11 Editorial: The Growing Culture of Hostile Dependency CHIEF EXECUTIVE OFFICER Towards Doctors—David G. Gerkin, MD Russ Miller, CAE ______EDITORS David G. Gerkin, MD Ask TMA Dave Chaney 13 Why Would I Receive a Second Contract from an Insurer? MANAGING EDITOR ______Katie Brandenburg

EDITORIAL BOARD Member News James Ferguson, MD 15 Physician Spotlight: Dr. Jackson Butterworth Gives Karl Misulis, MD Retirement Guidance Greg Phelps, MD 16 IMPACT Donors Bradley Smith, MD ______Jonathan Sowell, MD Andy Walker, MD Voter Guide ADVERTISING REPRESENTATIVE 22 Instructions Michael Hurst – 615.385.2100 President-Elect Candidates or [email protected] 23 24 Trustee Candidates GRAPHIC DESIGN 25 Judicial Council Candidates The Gray Umbrella, LLC ______Special Feature 27 Physicians May See Increased Liability in Hospital EHR Contracts – Katie Dageforde, JD ______For The Record 31 New Members 32 In Memoriam TNMED.ORG 34 Advertisers in This Issue; Instructions for Authors

A QUICK LOOKSTATSTAT AT THE ISSUES IMPACTING HEALTHCARE IN TENNESSEE

DIFFERENCES BETWEEN ICD-1O ICD-9 AND ICD-10 CODES 80,000 Beginning Oct. 1, 2015, the Centers for Medicare

& Medicaid Services required ICD-10 codes for all 70,000 healthcare transactions. TMA for the past several years has provided education and resources to help members 60,000 prepare for the transition.

50,000 The United States has been using ICD-9-CM since 1979. 40,000 In 2015, TMA hosted five ICD-training coding camps across the state. 949 people registered to take part in 30,000 the workshops last year.

20,000 A total of 10.1% of total claims processed were denied during the first month of using new codes 10,000 (Oct. 1-Oct. 27). The historic baseline for denials is 10%, according to CMS. 0

2% of claims were rejected because of incomplete or ICD-9-CM ICD-10 CODE SETS invalid information Oct. 1-27, on par with the historic baseline. Procedure Diagnosis Codes Codes

NEW CODES USHERED IN WITH ICD-10 INCLUDE: W55.21: Bitten by a Cow | Z63.1: Problems in Relationship with In-Laws | Y92.253: Injury at the Opera W56.22: Struck by Orca | V91.07: Burn Due to Water Skis on Fire | V97.33: Sucked into Jet Engine V95.40: Unspecified Spacecraft Accident Injuring Occupant

FOR ICD-10 RESOURCES FROM TMA, GO TO WWW.TNMED.ORG/ICD-10

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877.226.9091 | jttconnect.com PRESIDENT’S COMMENTS

WHAT WILL BE OUR LEGACY? By John W. Hale Jr., MD | President

Most people have heard of the Nobel Prize. I would surmise a faster, easier and less expensive track for individuals to be able that most readers of this poor editorial have also heard of Alfred to legally practice medicine. Nobel, the benefactor of the prize. Nobel and his name are now If you think that hypothetical scenario sounds bad, it will famous for the propagation of peace, but that was not always get worse if it becomes reality. And once something is done it is the case. Nobel was an inventor who was concerned about nearly impossible to undo. the use of nitroglycerin at construction sites. It was useful in We need to push Tennessee’s healthcare providers toward blasting rock and thus relieving men of the burdensome and more collaboration, not less, by updating the structure that time-consuming method of breaking rocks by hand, but it was was originally intended when valuable extender roles were first extremely dangerous and led to many deaths. His invention of created to support an efficient, integrated model of care. TMA’s the process of stabilizing this chemical created dynamite, which physician-led, team-based approach to healthcare bill will do this is still used today and is the standard by which all explosives are and much more. Mmeasured. This discovery made him wealthy and famous. It will not be easy. We will be in for a fight with those who Nobel probably thought at that time that he could live wish to practice medicine without the supervision and education his life in comfort, until an erroneous report of his death. A that is warranted. It is important to note that not all APNs want newspaper, upon hearing of his brother’s death, thought it this, and I have talked to physician assistants and CRNAs who was Nobel and published his obituary. Instead of praising his support what we are doing. But there is a very vocal group that achievements, it accused him of being the deliverer of a horrible is advocating change. They are well financed (another reason to weapon and the creator of destruction and sorrow. He was so contribute to IMPACT, TMA’s political action committee) and shocked and concerned about what his legacy would become they will make an argument about access to care. that he bequeathed his entire fortune to the Nobel prizes. I invite and encourage everyone to read our white paper on Physician extenders were created to increase access to care this issue on the TMA website. It explains it much better and for patients and allow the physician to devote his or her time to with more detail than a single editorial allows. more complex cases. The classification of the complexity of the We have all complained about the changes we have seen in case was determined by the physician and was understood by all this arena, but now is the opportunity to act. Get active in the those involved. If ever there was a question about what work was political process. Contact the TMA office to give them your name to be assigned to the physician extender, the physician made the and office address in order to establish which legislators represent final determination. Since the doctor was the employer, his or you and how to contact them. Record anecdotes of problems her authority was unquestioned. you have encountered with APRNs, physician extenders and This situation worked well initially, and in some areas the others in your practice setting. Poor patient outcomes cost the relationship between physicians and extenders continues to state money and the legislature does not want that. Even if function in much the same way as originally designed. But you don’t want to get directly involved in the political process, the practice of medicine has changed dramatically in the past contribute what you can to IMPACT. Contributions help open several years, and in some practice settings these interprofessional many doors. relationships have been distorted. Greed and apathy have laid A philosopher once said bad things happen when good waste to the structure that was originally intended. Both parties people see wrong and do nothing. – physician and extender – are to blame. What will be our legacy? + While the majority of situations are proper and benefit patients, there is an effort to completely change the landscape Share your thoughts with Dr. Hale at [email protected]. by giving advanced practice nurses “full practice authority,” a euphemism for independent practice, free of physician supervision. It appears to me, based on editorials in Tennessee’s major news outlets, that the state’s nursing schools are advocating

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Subject to credit & other restrictions CEO’S NOTE

RESOLUTIONS FOR A NEW YEAR By Russ Miller | CEO

With every New Year comes a new set of challenges both means by which to communicate regularly than we have ever for our physicians and for TMA. The single, most critical factor had. To improve communications with members, TMA is to TMA’s ability to achieve its priorities for the physicians and initiating a campaign in 2016 to collect more accurate contact patients of Tennessee is our ability to rally all physicians together information from our members. In recent years, TMA has also in a shared vision and purpose. redesigned its website and ramped up efforts to communicate Our ability to remain a leader in healthcare policy with members through email and social media, which many of development and shape the future of patient care in our state our members use daily. is directly proportional to the percentage of physicians we unify TMA strives to remain relevant and top of mind to in a single voice. What makes this increasingly difficult is the physicians in the state by focusing our time, energy and resources changing work environment of our members. Not many years on issues and projects that are universally desirable for physicians ago, the vast majority of physicians were in private practice. regardless of practice modality, locale, gender or employment WCurrent statistics show that we are rapidly approaching the 50 status. One of the areas of concern that is emerging rapidly and percent threshold for employed physicians in Tennessee. causing much anxiety is the use of clinical data reporting for This also presents another challenge. Often the person or reimbursement. This year, TMA is working on plans to aggregate organization paying member dues may not perceive the direct and analyze clinical information on physicians and patients benefits. While TMA is the physicians’ organization, more throughout Tennessee. This is no easy task, but we believe it frequently the decision about paying dues is falling to a practice necessary to better position physicians as the informational CEO or a hospital CFO. authority on how care is delivered in our state and how to As we have toured the state in the past year to meet with improve the overall health of Tennessee. various medical groups and to speak to medical students and Another project we plan to introduce is a value-added service residents, it was abundantly clear that physician employment is for members to help them better control annual expenditures on not just a passing trend, but the way physicians will approach health insurance for physicians, their dependents and employees. the business aspects of medicine for the foreseeable future. These are just two examples of universally shared challenges When questioned about their plans for the future, students and facing Tennessee physicians and medical practices. residents almost universally said, “I want to finish my training I’m often asked, “What is it that TMA does and why should and find a job.” I join?” I usually answer that TMA is the only organization with TMA always strives to meet the needs of its members, and the size, clout, reputation, experience and know-how to take it is becoming increasingly challenging when physicians in on issues that are too big for any single physician, practice or private practice and employed physicians have different wants specialty to handle alone. Our work in 2016 will prove this once and needs. A survey conducted by another state similar in size again, just as we have proven with numerous other issues in years to Tennessee asking about the top five issues facing physicians past. today found that the No. 1 issue for independent physicians But let me reiterate that our future ability to bring resolutions was decreasing reimbursement (employed physicians ranked this to the challenges facing Tennessee physicians every day hinges fourth), while employed physicians say their top issue is time on your ability to get your peers to join for the betterment of the spent on electronic medical records (independents ranked this profession and for the patients you all serve.+ fifth). However, all agreed state and federal regulatory hassles are a firm No. 2. Share your thoughts with Mr. Miller at [email protected]. Another challenge to aligning physicians – be they employed or in private practice, small practice or large multispecialty, academic or corporate medicine – is regular communications. Direct colleagues interested in In our meetings across the state, it was universally acknowledged joining TMA to tnmed.org/join that communicating with physicians is more difficult today than at any point in the past. That seems ironic as we all have more

TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org 9

EDITORIAL

THE GROWING CULTURE OF HOSTILE DEPENDENCY TOWARDS DOCTORS David G. Gerkin, MD | Editor

Several years ago I came across the term hostile dependency. I perceive themselves to be. thought it was an unusual type of dependency adjective, but when What gives patients that perception is related to today’s market- I heard it recently to refer to a type of a detrimental relationship based medicine. Even though patients are aware of the impact between patients and doctors, my attention was heightened. both government and private health plans have on their access to Somehow, with what training I had in psychiatry as a medical care, and as angry as they may be about these entities, the doctors student and with having read the basic psychiatric articles for are the nearest target. Patients follow the media blitz on medical primary doctors, I assumed that phrase must have been fairly errors, misdiagnosis rates, prolonged waiting times, inability to fill new. I was certainly wrong about that. Using my usual source the prescriptions written by their doctors, the cost of medications, for information, Wikipedia, I found the following definition or unnecessary testing and lastly, the perception of the doctor is rude, characteristics: “Hostile-dependent relationships are characterized when in fact, he is merely struggling with the burdens of practice in by either one sided, or a mutual atmosphere of hostility and this hectic arena. Saggression between the partners, which are endured due to the So the patient is angry, and the doctor descends into a spiral dependence of the partners involved (Aldrich, 1966). Since the of “burnout” and loss of sense of personal accomplishment. The members of the relationship are dependent on one another, these forced duality of being a doctor and a businessperson has created characteristics can express themselves in complementary ways. For this terrible dilemma. Sometimes as much as half a day is spent example, between spouses where one is a sadist and the other a doing clerical and business tasks most doctors think diminish masochist, however, many other forms are possible, for instance, as their ability to provide the care in which they trained. Also, a abusive spousal relationships or in parental relationships with their current dichotomy exists. If you ask doctors whether they would dependent children (both young, teen and adult children) and other recommend the profession to others, most would be unwilling to circumstances of dependency. Many members of hostile-dependent do so. However, applications for medical school in the last two years relationships remain together, despite the conflict between one have exceeded expectations. It certainly demonstrates that, even another.” with all the problems, the profession is admired and valued. How did this relationship between patients and doctors What is the solution? First, many feel that some of the impersonal gradually change to today’s perception of a negative relationship? things creating these issues could be changed by a change in political As expected, for many years doctors were held in high esteem party or leadership. Perhaps some elements could be affected, but as a profession. Gradually that esteem began to fade, but most they are not likely to be significant. Some even feel a change in patients still proclaimed “I still like my doctor.” The “I still like my the type of practice would be a solution, and that has given rise doctor” element of the relationship is the thing that is deteriorating to the practice modality of concierge medicine. As attractive as it in the current arena of culture change. The obligatory or needed might appear, most patients are not ready for that type of practice relationship for both the patient and his or her physician forces this or cannot afford it. Rick Lippin, MD in his essay, “My New Adult “hostile dependency relationship.” Relationships with My Patients” says, “My approach with my Why is this happening? For the doctor, it is a struggle between patients has evolved over 35 years of medical practice. The excesses the reason most choose the profession and the increasing impact of of paternalism in my practice of medicine have been replaced by a things that affect that motivation in a disturbing way. Many people much more rewarding adult-to-adult relationship with my patients. believe many doctors went into medicine for economic gain. Of Not shaking my finger at them or scolding them as ‘children’ has course, that is an attribute of credit for a long education time and helped them and me more than you can imagine.” I have often the struggle to achieve relevant training, but certainly not the main heard the statement “He is an excellent doctor but does not like to reason. Studies show taking care of others is the primary cause. be questioned.” I am not sure how most doctors would feel about Much of the problem today is triggered by the patient’s this, but this is Lippin’s opinion. narcissistic rage towards the doctor who he needs but no longer feels As you can see, I have little to offer regarding the solution, and represents his best interest. This is engendered by multiple things in most of my reading on the subject also fails in that aspect. I suppose today’s healthcare arena forcing doctors to have the appearance of that I, like most physicians today, will continue to contrast the past the business model of “providers” not the “professionals” doctors “Golden Years” – the ones marked with dedication, commitment (Continued on p. 13) TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org 11

ASK TMA

WHY WOULD I RECEIVE A SECOND CONTRACT FROM AN INSURER?

I recently received a new single provider agreement from Cigna, but I’m already contracted with Cigna through my group. Do you know why I received this contract?

Based on contacts from member physicians, these new bureau does not have jurisdiction to address Qcommercial provider agreements contain language tying whether or not the plan can include an “all the individual contract to the insurance plan’s workers’ products clause” in its agreement. These all compensation network. If a physician signs the contract, he or products clauses require participation in she agrees to participate in the plan’s workers’ compensation both the plan’s commercial and workers’ network and accept its reimbursement, which is typically less compensation products. than the state medical fee schedule. At least one plan (Cigna)& If you discover that you have a signed would not take this language out of its agreement, and another contract with an all products clause and (Trinity) agreed to take it out of its amended fee schedule but are now participating in the insurer’s workers’ compensation not its state base agreement. network, then you need a full understandingA of Tennessee’s law Recently, a few practices submitted redacted Cigna and regulating workers’ compensation silent PPOs. Multiplan contracts to the TMA legal department for review. Silent PPOs are a scheme by insurance companies to keep the To determine whether or not your practice is impacted, look at full and fair reimbursement from a physician practice. Tennessee the following sections in your Cigna and Multiplan participation Code Annotated § 50-6-215 addresses workers’ compensation agreements: silent PPOs. To see a full discussion of the Tennessee Workers’ Compensation Silent PPO law, review the workers’ comp and 1. Cigna: Section 2.1 of the Base Agreement, section I of silent PPOs section of TMA’s online Law Guide at tnmed.org. Exhibit C and page 2 section IV-1 The Law Guide Directory can be found in the Legal section under 2. Multiplan: Page 3, section IV 4.1 Member Resources. The online Law Guide includes several topics addressing workers’ compensation issues and laws in Tennessee. Robert Snyder, MD, Medical Director of the Bureau of If you have any questions, please contact the TMA Legal Workers’ Compensation for Tennessee, has indicated that the Department at [email protected]. +

DISCLAIMER: The discussion of this issue should not be construed as legal advice or representation by the TMA. It does not constitute an attorney-client relationship between you or any TMA employee. This unwarranted material is provided only for informational purposes. Should you require legal advice or representation, you should contact your personal attorney.

TMA members can “Ask TMA” by email: [email protected] or by phone: 800.659.1862. Questions and comments will be answered personally and may appear anonymously in reprint for the benefit of our members.

THE GROWING CULTURE OF HOSTILE DEPENDENCY TOWARDS DOCTORS (Continued from p. 11) and fulfillment – against challenges the profession faces today. I think If you have any suggestions or thoughts, please write a letter to even with all the bitter things physicians are facing, we still have the the editor. They can be sent to [email protected]. It is best profession in the world in caring for patients, and I continue to my reason for writing this to stimulate that response.+ believe using that enforcement and value helps us face the onslaught of today’s hostile environment. TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org 13

MEMBER NEWS

Visit tnmed.org for the latest TMA news, information and opportunities! PHYSICIAN SPOTLIGHT DR. JACKSON BUTTERWORTH GIVES RETIREMENT GUIDANCE

Jackson Butterworth Jr., first draft of the guide. In September, it was endorsed by the MD, of Bristol said hearing Tennessee Board of Medical Examiners. concerns from doctors nearing Dr. Butterworth came to the vice president of medical affairs retirement age when he served as position after retiring in 2004 from his urology practice. He said vice president of medical affairs he received questions from many of his colleagues about the at Bristol Regional Medical retirement process. Center alerted him to a need for “Some were very unhappy with what they knew about it and more retirement guidance among how to proceed,” Dr. Butterworth said. his colleagues. To help other doctors understand the distinction between The experience inspired him retiring a practice and a medical license, the retirement guide to work with TMA to create a discusses various licenses – separate from a full medical license Jackson Butterworth Jr., MD new resource for retiring TMA – that allow a physician to do things such as work at a clinic or members. participate in medical mission trips. “It came from talking with different doctors and hearing Dr. Butterworth said that, for physicians, a medical career some of their concerns,” he said. becomes an integral part of their lives, influencing their place in “A Guide to Physician Retirement and Closing a Medical the community. Practice,” launched in September. It is available at tnmed.org “Surrendering that is an emotional decision,” he said. under the law guide section or at tnmed.org/retiring. Retired physicians can still be a resource for the medical The retirement guide includes guidance on the types of community, Dr. Butterworth said. licenses a retired physician can choose to maintain, a checklist for During his time at Bristol Regional Medical Center, the closing a practice and rules for disposing of controlled substances. hospital hosted a luncheon twice a year for retired doctors. It is a joint resource from TMA and the State Volunteer “I viewed them as ambassadors for our hospital in the Mutual Insurance Company. Dr. Butterworth wrote the community,” he said. +

The Retiring Physician Manual can be found at www.tnmed.org in the Law Guide Directory under Member Resources.

AMA HONORS CATES STAFFER HONORED The American Medical FOR DECADE OF SERVICE presented its Association The TMA Board 2015 Medical Executive of Trustees Lifetime Achievement Award to recognized Michael Cates, CAE, executive Region 8 Manager vice president of the Memphis Pam Slemp Medical Society, during the AMA for ten years of Interim Meeting in Atlanta in service during its November. November meeting Cates has led the Memphis Mike Cates, CAE in Nashville. Medical Society staff since 1985. + Before that, he spent ten years with the North Carolina TMA Region 8 Manager Pam Slemp, left, is congratulated by Medical Society and the Mecklenburg County Medical Society Dr. Michel McDonald, chair of the TMA Board of Trustees. in Charlotte, N.C. + TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org 15 MEMBER NEWS

CROWN RETIRES Don’t give up the fight. We need your support to FROM BOARD continue making a difference and ensuring friends of medicine are in the CAPITOL HILL CLUB Tennessee General Assembly.

THANK YOU TO OUR IMPACT DONORS

2015 CORPORATE DONORS Robert M. Maughon, MD Advanced Diagnostic Imaging PC Michael A. McAdoo, MD Anesthesiology Consultants Exchange PC Scott W. McCall, MD Chattanooga Neurosurgery and Spine Robert Wallace McClure, MD FHG Core Physicians Michel Alice McDonald, MD The Jackson Clinic Fredric Ronald Mishkin, MD Loren Crown, MD, FACEP Maury County Medical Society Brent Robert Moody, MD, FACP, FAAD Mid Tennessee Bone and Joint Clinic PC Kofi W. Nuako, MD Loren Crown, MD, Nephrology Associates PC Edmund T. Palmer Jr., MD, FACP recently retired FACEP, Southern Oncology Inc. Rodney A. Poling, MD from the Tennessee Medicine Tennessee Interventional James E. Powell, MD Editorial Board after serving and Imaging Associates F. Bronn Rayne, MD on the board for 14 years. University Surgical Associates Wiley Thomas Robinson, MD, FHM “I have learned much Perry Clyde Rothrock III, MD from my co-editors and even 2015 CAPITOL HILL CLUB Wayne T. Scott, MD more from my corresponding MEMBERS Nita W. Shumaker, MD colleagues concerning Yasmine Subhi Ali, MD Jane Meredith Siegel, MD practice, policies, and Maysoon Shocair Ali, MD, FACP Douglas John Springer, MD, FACP, FACG politics,” Crown said. “This Subhi Dawud Suboh Ali, MD William Kirk Stone, MD George Milum Testerman, MD publication allows rural- Newton Perkins Allen Jr., MD Keith Gregory Anderson, MD Bob Vegors, MD, FACP based practitioners like me, Rebekah Crump Austin, MD John J. Warner, MD far from the halls of academia Samuel Ray Bastian, MD, FACP, FAAP Charles W. White Jr., MD and the seats of legislation, James Howard Batson, MD William Turney Williams, MD to remain in touch and to Leonard Allison Brabson Sr., MD George R. Woodbury Jr., MD achieve input.” + Richard M. Briggs, MD Christopher E. Young, MD Tommy J. Campbell, MD Cathy Marie Chapman, MD 2015 SUSTAINING MEMBERS Barton A. Chase III, MD Vijaya L. Appareddy, MD Dewayne P. Darby, MD Joseph R. Armstrong, MD Richard J. DePersio, MD, FACS Michael E. Bearb, MD Robert Marshall Dimick, MD Eric W. Berg III, MD Scott C. Dulebohn, MD Berta M. Bergia, MD James K. Ensor Jr., MD, FACP Stanley L. Bise, MD Tamara P. Folz, MD John E. Blake III, MD Eric G. Fox, MD Mark William Bookout, MD Timothy Lee Gardner, MD Glenn H. Booth Jr., MD, FACP David George Gerkin, MD Sandra J. Boxell, MD Paul W. Gorman, MD Gail M. Brabson Mark E. Green, MD M. Bart Bradley, MD John W. Hale Jr., MD Michael Wayne Brueggeman, MD James E. Jolley II, MD Gary A. Brunvoll, DO Robert Ashley Kerlan, MD, FACP Jeffrey William Bunning, MD James D. King, MD Patrick H. Burkhart, MD Ronald H. Kirkland, MD, MBA John Boustany Buttross, MD Kenya Kozawa, MD John Bright Cage, MD Jeffrey P. Lawrence, MD Paul B. Cardali, MD George R. Lee III, MD, MS T. Mark Carter, MD Adele Maurer Lewis, MD Marian L. Chamberlin, MD 16 TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org MEMBER NEWS

Elijah Grady Cline Jr., MD Richard Geoffrey Lane, MD, FACP Tedford Steve Taylor, MD Donald Alexander Cole, MD Brandon D. Lee, MD Gregory Bryan Terry, MD Sabrina Lee Collins, MD Charles Edwin Leonard, MD Christopher Charles Thacker, MD Jeffrey Wade Cook, MD James Peter Little, MD Pitchar Theerathorn, MD Daniel F. Coonce, MD Penny B. Lynch, MD Steven Michael Thomas, MD Scott A. Copeland, MD Ben B. Mahan, MD Leslie Mooney Treece, MD John D. Crabtree Jr., MD Richard O. Manning, MD Sue Vegors John W. Culclasure, MD Christopher D. Marshall, MD K. Dawn Vincent, MD Natalie Marie Curcio, MD, MPH H. Lynn Massingale, MD, FACEP Andy Walker, MD Patrick Matthew Curlee, MD Byron C. May, MD Meeca Walker, MD Carolee Marie Cutler Peck, MD Mary Katherine McDonald, MD Jeffery Steven Warren, MD Brian J. Daley, MD Edward Melton McIntire, MD W. Bedford Waters, MD Charlotte A. DeFlumere, MD David Earl McKee, MD Ralph E. Wesley, MD Dennis H. Duck, MD, FACP Alvin Henry Meyer Jr., MD Jerald Wayne White, MD Ms. Heidi Dulebohn Keith A. Micetich, MD Sean Patrick White, MD Steven G. Flatt, MD Jami L. Miller, MD, FACP Lane Edward Williams, MD Tony A. Freeman, MD Thomas P. Miller, MD Mark Anthony Williams, MD, PhD Charles S. Fulk, MD F. Michael Minch, MD Phillip A. Wines, MD Paige Clifton Furrow, MD Donald A. Moore Jr., MD George B. Winton, MD Thomas L. Gautsch, MD Pamela Denise Murray, MD Mary Katherine Gingrass, MD John Henry Nading, MD 2016 CORPORATE DONORS Mark S. Goldfarb, MD Robert Hiram Nichols Jr., MD The Jackson Clinic Richard S. Greene, MD R. Michael Nollner, MD Heritage Medical Associates PC Erich Bryan Groo Jr., MD Patrick O’Brien, MD David Nelson Gwaltney, MD Thomas James O’Donnell, MD 2016 CAPITOL HILL CLUB Curtis James Hagenau, MD Grant Douglas Ordiway, DO MEMBERS Eric Harman, MD Jaykrishna S. Patel, MD Newton Perkins Allen Jr., MD Joe Mark Harris, MD Steve Leroy Peterson, MD Tommy J. Campbell, MD Randal G. Hartline, MD Edward Andrew Peterson, MD Barton A. Chase III, MD Danielle Hinton Hassel, MD Janet G. Pickstock, MD Dewayne P. Darby, MD Melinda J. Haws, MD David A. Rankine, MD Steven Reid Dickerson, MD James William Haynes, MD Susan P. Raschal, DO Tamara P. Folz, MD George J. Heard Jr., MD Charles W. Reynolds, MD Eric G. Fox, MD George Alan Hill, MD James W. Richardson Jr., MD Charles Russell Handorf, MD David Harvey Horowitz, MD James P. Richmond Jr., MD William Joseph Harb, MD John R. Hovious III, MD Grant Thomas Rohman, MD Ronald H. Kirkland, MD, MBA Stephen P. Humphrey, MD Jack M. Rowland, MD Kenya Kozawa, MD William Dean Jameson, MD Chester Allan Ruleman Jr., MD James C. Loden, MD Kenneth O. Jobson, MD Richard T. Rutherford, MD Shauna Lorenzo-Rivero, MD Clifford Quentin Johnson Jr., MD Sunil Sarvaria, MD Michael A. McAdoo, MD John C. Johnson, MD Benjamin Samuel Scharfstein Jr., MD John David McCarley, MD Ronald Jackson Johnson, MD Grover F. Schleifer III, MD William J.L. Newton, DO Austin Jones III, MD Jennifer Bess Schuberth, MD Kofi W. Nuako, MD Someswara Reddy Karri, MD Richard L. Schultz, MD Jeffrey Patton, MD Albert A. Kattine, MD John Douglas Scott, MD Julie Maria Pena, MD Scott H. Keith, MD David G. Sexton, MD F. Bronn Rayne, MD Haresh H. Khatri, MD Corydon W. Siffring, MD Perry Clyde Rothrock III, MD Anthony D. Khim, MD Eric K. Smith, MD Douglas John Springer, MD, FACP, Gary W. Kimzey, MD Stanley L. Smith, MD FACG James Duval Koonce, MD Christopher S. St. Charles, MD John J. Warner, MD Joseph G. Krick, MD John R. Staley Jr., MD Charles W. White Jr., MD Sylvia Lynne Krueger, MD Janet F. Stastny, DO William Turney Williams, MD Sarbjeet Singh Kumar, MD Rebecca J Taylor, MD Michael D. Zanolli, MD

$1,000 Capitol Hill Club Member / $300 Sustaining Member / $250 Non-Physician Capitol Hill Club Member $100 Spouse or Practice Manager Member / $50 Retired Physician

To join IMPACT or to make a corporate donation contact Kelley Mathis at 615.460.1672, or [email protected]. Please make your check out to IMPACT and send to 2301 21st Avenue S. Nashville, TN 37212. + TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org 17

Ronald Kirkland, MD, MBA practice, he said. knows firsthand that team-based Dr. Kirkland said he values nurse practitioners and realizes healthcare works. the necessity of having them to provide care. In his practice at The Jackson “They are absolutely necessary,” he said. “They are very well Clinic, Kirkland worked in a team trained. They are essential.” of three physicians and one nurse Patients should realistically expect them, however, to be able practitioner. He recently retired. to collaborate with well-trained physicians. That nurse practitioner essentially always had a physician accessible to call on for assistance, but she Read about TMA’s vision performed a wide range of tasks and for physician-led, team-based procedures for which her training healthcare delivery in Tennessee Ronald Kirkland, MD, MBA and about 35 years of healthcare in the association’s latest white experience prepared her, he said. “This is absolutely the best circumstance for patients paper at tnmed.org/teambasedcare. because she is typically more accessible than the physicians,” Dr. Kirkland said. This year, the Tennessee Medical Association will continue its BENEFITS OF COLLABORATION efforts to see a team-based healthcare model put into action across Evidence suggests that collaborative care models lead to the state as it pushes for passage of the Tennessee Healthcare lower costs and better healthcare outcomes. In a 2012 look at the Improvement Act. The legislation creates a blueprint for a Patient-Centered Medical Home model of care, the American physician-led, patient-centered, team-based healthcare delivery Academy of Family Physicians found promising results from model. The bill would change the relationship between physicians PCMH models. and advanced practice nurses from supervisory to collaborative. In a Patient-Centered Medical Home, each patient has The bill is one of TMA’s top legislative priorities in the a trained personal physician to handle complex diagnoses and second year of the 109th General Assembly. comprehensive care. That physician leads a team of healthcare It is being offered as an alternative to a nurse independent professionals who are responsible for ongoing patient care. practice bill that would allow nurses to diagnose, treat and First-year results from a BlueCross BlueShield test of the prescribe drugs without a physician to consult or review charts. PCMH model found that nearly 60 percent of eligible PCMH “In order to have a more workable, practical and patient- groups recorded lower than expected healthcare costs. centered solution to the problem, TMA came up with the BCBS Michigan’s PCMH project helped save $310 million Tennessee Healthcare Improvement Act,” Dr. Kirkland said. during its first five years and resulted in fewer admissions, Dr. Kirkland said the Tennessee Healthcare Improvement readmissions and emergency department visits. Act is an important one as the healthcare field changes rapidly. A similar pattern has taken shape internationally. A study “First and foremost, it’s important for patients,” he said. “The of 11 industrialized countries showed that adults with complex vast majority of patients want to be taken care of by a physician care needs reported better coordinated care, fewer medical errors when they are sick. That’s practically universal, and this bill helps and test duplications, better relationships with their doctors and to make that happen.” greater satisfaction with care under the medical home model, A 2013 survey by TMA showed that 92 percent of according to a 2012 report from the Patient-Centered Primary Tennesseans believe physicians should have the primary Care Collaborative. responsibility for leading and coordinating care and 97 percent In Tennessee, MissionPoint Health Partners (Saint Thomas of respondents feel that doctors and nurses need to work together Health’s Accountable Care Organization) reported that it saved in a coordinated manner to provide care. $9 million in its first year of operation and earned half of that back A system of coordination between doctors and mid-level through the Medicare Shared Savings Program. ACOs are another providers could lead to better care. method of creating a coordinated network of payers and providers. “In effect, we’ve been operating under a system for 12 or 13 years that has become distorted,” Kirkland said. HEALTHCARE COSTS Having a nurse practitioner on staff helps provide both same- One argument sometimes made in favor of independent day access to care and high-quality medical care to patients in his practice for nurse practitioners is that it would help curb rising TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org 19 healthcare costs. But a drop in the cost of some office visits, for Physicians are simply more prepared for and more qualified instance, doesn’t tell the whole story. to handle complex diagnoses and treatment in part because A 2015 report from the RAND Corporation entitled “The of the intense academic training they endure. While a family Impact of Full Practice Authority for Nurse Practitioners and physician will spend 11 years on undergraduate, post-graduate Other Advanced Practice Registered Nurses in Ohio” notes that, and residency training, a nurse practitioner spends from five while the cost of well-child visits could drop by 6 percent if Ohio and a half to seven years getting the required degrees to practice, approved independent practice for advance practice nurses, total according to a report from the Primary Care Coalition. A family spending on office visits increased by 4.3 percent in states where physician will spend 20,700 hours to 21,700 hours to complete nurses have such authority. training while a doctorate of nursing practice will spend 2,800 to A study published in the journal Effective Clinical Practice 5,350 hours to complete training. in 1999 showed that resource utilization for patients assigned to Physicians also receive more clinical training than nurse nurse practitioners was higher for a number of measures than for practitioners, according to the Primary Care Coalition. At the those assigned to resident or attending physicians. In that study, point of certification, a new nurse practitioner will have acquired patients assigned to nurse practitioners saw more specialty visits between 500 and 1,500 hours of clinical training while a new and hospital admissions and had more expensive ultrasonography, family physician has acquired more than 15,000 hours of clinical computed tomography and magnetic resonance imaging studies training. than patients assigned to attending physicians. Nurse practitioners account for more than 20 percent of all OTHER PRIORITIES prescribed pain medications in Tennessee and a majority of the Though a critical part of TMA’s 2016 legislative goals, the Top 50 controlled substance providers in Tennessee’s Controlled Tennessee Healthcare Improvement Act is one among a slate of Substance Monitoring Database. bills TMA will work to see passed during the session. Though in recent years Tennessee has made great strides Another top priority is the Healthcare Provider Stability Act, in battling against prescription drug abuse, it’s important to which would limit how often insurance companies can change fee continue that momentum. schedules and payment policies/methodologies. The legislation would become the first of its kind in the nation, if approved. REACH OF CARE Currently, insurance companies can make essentially Access to safe, affordable and quality healthcare, especially in whatever changes they want to fee schedules and payment rural areas, is one reason that collaboration among providers is policies, leaving physicians with the no-win choice of accepting increasingly important. diminished payment or leaving the network, Dr. Kirkland said. Some argue that nurse independent practice would mean that “It’s very unfair, not just to providers and hospitals, but also midlevel providers would provide care in those underserved rural to patients,” he said. areas, but the impact for rural areas is not yet clear. TMA will also support a bill this year to put a constitutional A 2012 study funded by the American Nurses Association amendment on the ballot clarifying that the General Assembly found that only three states in the U.S. had the same or more has authority to set caps on noneconomic damages for doctors rural nurse practitioners than urban nurse practitioners. and other businesses. In Tennessee, the county with the best ratio of population to Caps have been in place for several years, but have been provider for nurse practitioners is also one of the most populous. challenged by several recent court cases. Dr. Kirkland said that Davidson County has a nurse practitioner ratio of 486:1 and a tort reform has been a positive for the state. population of more than 600,000. In contrast, Moore County, “It makes Tennessee a more attractive state for business, and with a population of 6,362, has just one nurse practitioner, it is a great economic boost to have the current law on the books,” according to the American Medical Association Health he said. Workforce Mapper. It will be an even greater advantage to have the constitutional A report from the Primary Care Coalition looked at amendment in place, Dr. Kirkland said. the distribution of nurse practitioners in states with nurse Other legislative priorities for TMA in the legislative session independent practice and those requiring collaboration between include: physicians and nurse practitioners and found similar distribution • In-Office Physician Dispensing patterns for both types of states. This legislation would establish rules for in-office dispensing of medicine to make sure the ability isn’t abused. EDUCATIONAL ADVANTAGE • Workers’ Compensation Silent PPOs When Tennessee’s current system of oversight for advance This legislation would set up penalties for insurance practice nurses was set up, the idea was that physicians would companies that don’t comply with regulations for workers’ be in close contact with them, and they would work under compensation silent PPOs. + established protocols. But that model has become distorted, Dr. Kirkland said. Follow Grassroots Manager Rebecca Lofty on Twitter “That model, over the years, ceased to work and nurse @tnmedonthehill or see tnmed.org/legislative for updates on practitioners were seeing more and more complex patients,” the TMA’s legislative efforts during the session. he said. The requirements for doctors to sign off on the work of midlevel providers also became onerous, Dr. Kirkland said, adding that many in the medical community are concerned that advanced practice nurses are ill-equipped to care for patients in very complex medical cases.

20 TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org

ELECTIONS

It’s election season! Use this voter guide to review nominees Voter’s before casting your ballot. All voting materials are available GUIDE online at tnmed.org/elections.

TMA ELECTIONS Cast YOUR VOTE

• Voting will be open Feb. 1-Feb. 29, 2016.2O16• All ballots will include space for write-in votes.

• All active and veteran members as of Dec. 31, 2015 will be • All ballots must be cast by 5:00 pm CST on Monday, Feb. 29, eligible to vote in the election. 2016 in order to be counted.

• All votes must be cast online. • If a runoff election is needed, it will take place March 21-28.

• Every member with an email address in the TMA system will receive an electronic notice with his or her TMA member number, All ballots must be cast online by 5:00 pm CST verification of voting region and a link to the election ballot. on Monday, February 29, or they will not be counted. • Members without active email addresses on file with TMA can access the ballot at tnmed.org/elections.

• No login will be required to vote, but a TMA member number and For more information, contact Audrey Smith region number will be required. at [email protected] or 615.460.1665.

TMA Election Center – tnmed.org/elections

Voting Opens: Feb. 1, 2016 Voting Closes: 5pm, CST on Monday Feb. 29, 2016 All ballots must be cast by the deadline to be counted.

22 TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org ELECTIONS

2016 TMA ELECTION NOMINEES

PRESIDENT-ELECT: BOARD OF TRUSTEES : JUDICIAL COUNCIL : Matthew Mancini, MD, Knoxville Region 2: Kirk Stone, MD, Union City Region 1: Paul Klimo Jr., MD, MPH, Nita Wall Shumaker, MD, Chattanooga Region 4: Rodney Lewis, MD, Nashville Germantown Region 5: James H. Batson, MD, Cookeville Region 3: Omar Hamada, MD, Brentwood Region 7: Elise C. Denneny, MD, Knoxville Region 5: James C. Gray, MD, Cookeville Region 7: Richard Briggs, MD, Knoxville

MEET THE CANDIDATES

PRESIDENT-ELECT: Serves as head of the Tennessee Medical Association for the year following the election. Responsibilities include serving as official spokesperson with media, government officials and other entities. The president-elect will serve one year as president-elect, one year as president and one year as immediate past president.

Nominee: Matthew Mancini, MD Nominee: Nita Wall Shumaker, MD City: Knoxville City: Hixson CMS: Knoxville Academy of Medicine CMS: Chattanooga-Hamilton County Specialty: General Surgery Medical Society Medical School: Mercer University School of Medicine Specialty: Pediatrics Email: [email protected] Medical School: East Carolina University School of Medicine I am proud to be a member of the Tennessee Medical Association because Email: [email protected] I believe in its mission and what the organization achieves for physicians and their patients. Practicing general surgery for 20 years and seeing As TMA trustee, medical society past-president and former tertiary hospital the progress on tort reform, Tennessee has become a great place to chief of staff and trustee, I know that physician unity is vital to protect the practice medicine. We must always continue to work on areas that need practice of medicine and provide the best patient care. If elected, I will address improvement to ensure that Tennessee remains a great state in which to the rules and regulations that govern our work. I will oppose efforts to hold practice! To that end, I have had the privilege to serve on the TMA Board physicians responsible for patient behavior – pitting us against our sickest in the capacity of both board chair and trustee. I currently am a member and weakest patients – and work to pilot a path to less expensive and more of the TMA Membership Committee, lending my support to membership integrated patient care. I will use my strong communication skills, including growth in addition to participating on the CME Advisory Committee, a use of social media, to help us relate to and communicate with many of our group dedicated to developing quality educational programs for the patients and younger physicians who primarily use social media in our rapidly membership. changing world. I truly believe that together we are stronger.

TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org 23 ELECTIONS

TMA BOARD OF TRUSTEES: The TMA Board of Trustees determines the policy and details of management of the association between meetings of the TMA House of Delegates. Trustees carry out the directives given by the House. They serve two-year terms.

REGION 2 REGION 4 Nominee: Kirk Stone, MD Nominee: Rodney Lewis, MD City: Union City City: Nashville CMS: The Northwest Tennessee Academy CMS: Nashville Academy of Medicine of Medicine Specialty: Internal Medicine Specialty: Family Medicine Medical School: University of Virginia School of Medicine Medical School: University of Mississippi Email: [email protected] Email: [email protected] A native of Kingsport, I have practiced as a primary care internist at Heritage I have been a member of the TMA for more than 20 years and have served Medical Associates in Nashville since 2008. I am honored to receive this as a delegate to the House of Delegates for almost 20 years. In my years nomination from the Nashville Academy of Medicine and look forward to in TMA I have served on the Judicial Council, as a chairman of the young helping the Tennessee Medical Association serve the interests of all patients physicians section, on the Public Health Committee (on which I still serve) and physicians in Tennessee. Currently, I divide my time between my and on the IMPACT Board, as well as serving a previous term on the busy practice and my even busier wife, Adele, and our three children, Callie, Board of Trustees. I also served as president of my local TMA chapter Quin and Preston. (Northwest Tennessee Academy of Medicine) for approximately three years. I realize how important our efforts as a group are to our practice of medicine and to our patients and I am therefore eager to serve as a member of the board again.

REGION 5 REGION 7 Nominee: James H. Batson, MD, FAAP Nominee: Elise Denneny, MD City: Cookeville City: Knoxville CMS: Putnam County Medical Society CMS: Knoxville Academy of Medicine Specialty: Pediatrics Specialty: Otolaryngology and Surgery, Medical School: East Tennessee State University, Facial Plastic James H. Quillen College of Medicine Medical School: Rush Medical College Email: [email protected] Email: [email protected]

I am a General Pediatrician in Cookeville and I am seeking re-election Born and trained in Chicago, I have practiced otolaryngology - head and to represent the Upper Cumberland Region 5 at the TMA Board of Trustees. neck surgery - in Knoxville for most of my career, both at private and I have two tours of trustee experience within the last decade and have been teaching hospitals. With a belief in giving back to the medical profession, an active TMA member since starting practice in 1999. Presently, I am I have chaired numerous hospital committees including serving as the vice-chairman of the board and hope to continue next year as chairman. Chief of Surgery at East Tennessee Baptist Hospital. I have been a member My local medical society (Putnam County) has had some success in the of TMA and the Knoxville Academy of Medicine (KAM) since 1989. I am fight against neonatal abstinence syndrome by aggressively lobbying the a Past President of KAM and presently serve on the KAM Foundation Board. Tennessee legislature to repeal the Intractable Pain Act that was partly Additionally, I am the Chair of the KAM Legislative Committee as well to blame for the severe increase over the last 15 years. We also are excited as the Physician Chair of the Knox County Drug Task Force. For TMA, about our efforts to consolidate medical society activities within our region I currently Chair the TMA Professional Relations Committee and have served to support ongoing growth and engagement among our colleagues. for several years on the TMA Legislative Committee. These activities have I appreciate your vote. prepared me to understand many issues that TMA will face in the next few years. I hope to wisely represent Region 7 as trustee to the Tennessee Medical Association Board.

24 TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org ELECTIONS

TMA JUDICIAL COUNCIL: The Judicial Council meets annually, or more often if necessary, to investigate alleged improper conduct and oversee formal disciplinary action against members or component medical societies. Councilors also assist component medical societies in maintaining viability in the region. Each region has one councilor serving on the Judicial Council. Councilors serve two-year terms.

REGION 1 REGION 3 Nominee: Paul Klimo Jr., MD, MPH Nominee: Omar Hamada, MD, MBA City: Germantown City: Brentwood CMS: The Memphis Medical Society CMS: Williamson County Medical Society Specialty: Surgery, Neurological Specialty: Obstetrics and Gynecology Medical School: Medical College of Wisconsin Medical School: University of Tennessee Center for Email: [email protected] Health Science Email: [email protected]

I am happy to have been nominated to serve as Judicial Representative representing Region 3. We are in a difficult period with healthcare in flux and instability. I will enthusiastically represent our region to advance the interests of all physicians and the patients we serve. I have extensive leadership, policy, business and executive experience in military, academic, private practice and corporate venues. I have an MD from UT, an MBA from Vanderbilt and am Board Certified in OB/GYN and in Family Medicine. I am a 14-year combat veteran of the US Army Special Forces, (ABN). I look forward to serving you in this capacity.

REGION 5 REGION 7 Nominee: James C. Gray, MD Nominee: Richard Briggs, MD City: Cookeville City: Knoxville CMS: Putnam County Medical Society CMS: Knoxville Academy of Medicine Specialty: Obstetrics and Gynecology Specialty: Cardiovascular Surgery, Thoracic Surgery Medical School: Medical College of Georgia Medical School: University of Kentucky College of Medicine Email: [email protected] Email: [email protected]

I practiced Obstetrics and Gynecology in a private practice setting in Dr. Richard Briggs attended high school in Chamonix, France before Cookeville for 24 years. My practice associates and I recognized the value receiving his B.S. degree from Transylvania University in Lexington, KY. He of TMA component medical society membership. We sponsored first graduated from the University of Kentucky College of Medicine in 1978 with year membership for all physicians we recruited. Today, employers are Highest Honors and immediately entered active military service with the increasingly non-physicians and, although medical society membership is U.S. Army. He served in combat with the 1st Armored Division in Operation Desert Storm, where he was awarded the Bronze Star. With more than 30 offered as a potential benefit of employment, it has not been encouraged. years of active and reserve military service, Colonel Briggs also served in I would like to explore a regional component medical society model. Korea, Central and South America, and in Egypt during the Somalia crisis. I believe this would offer members in counties with struggling medical Following the attacks on September 11, 2001, Colonel Briggs volunteered societies an opportunity to engage with other physicians in their region to return to active duty for service in Afghanistan. In 2005-2006, he deployed to promote Quality, Safe and Effective medical care. Physician employers to the Green Zone in Baghdad as the Senior Trauma Surgeon at the main and the community will benefit when the employed physician takes a U.S. Army Combat Support Hospital in Iraq, commonly known as “Baghdad leadership role in their local component medical society. I look forward to ER.” Colonel Briggs has commanded U.S. Army Reserve units in Nashville, working with the Judicial Council to give every physician in every county an Chattanooga and Johnson City. opportunity to belong to a viable component medical society. Dr. Briggs practices cardiothoracic surgery at Tennova Physicians Regional Medical Center in Knoxville and has held academic appointments at the University of Texas-San Antonio, the University of Louisville and the University of Tennessee-Knoxville. He has served seven years on the Board of Trustees of the Tennessee Medical Association and is a past president of the Knoxville Academy of Medicine. Dr. Briggs was elected to the Tennessee State Senate from Knox County in 2014 after sitting on the Knox County Board of Commissioners for seven years. He is the Vice Chairman of the Senate State and Local Government Committee and the Senate Health Committee. TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org 25

SPECIAL FEATURE

PHYSICIANS MAY SEE INCREASED LIABILITY IN HOSPITAL EHR CONTRACTS By Katie Dageforde, JD

Most physicians understand the importance of the information is keyed. There may also be legitimate reasons thoroughly reading any contract that they may be asked that a user may choose to disclose purposefully his or her ID to sign, especially as it relates to their practice of medicine. But or password, such as if the user allows his or her nurse to enter do they do it? information with the user’s ID. Failing to read and understand contract provisions can have This particular provision does not allow for any of these a detrimental impact on a physician down the road. scenarios. It should include the term “knowingly” so that the Recently, the TMA Legal Department reviewed a troubling user acknowledges he or she should not knowingly divulge the provision in an EHR Access and Confidentiality Agreement that ID information. Otherwise, the user is liable even if he or she has a member was required to sign as part of the re-credentialing no control over how the password or ID was obtained by another process with a Tennessee hospital. The provision states that party. the EHR user may not divulge his or her user identification The second part of the provision is especially concerning. Mor password in any way. It also places liability on the user for It states that any inappropriate disclosure of EHR will make damages, including monetary damages, for the inappropriate the user responsible to the hospital for damages, including disclosure of an EHR, regardless of whether the disclosure is monetary damages, but it does not define what an “inappropriate made by someone else using his or her password or ID. This one disclosure” might be. It does not limit liability if a person other provision in a hospital’s EHR contract could potentially place a than the user accesses the EHR without user permission. It higher liability on the physician than one would typically expect appears to be a no-fault penalty against the user for a breach no to assume. matter what or who else may have caused the information to be While it is standard for these types of agreements to prohibit disclosed. the user from divulging his or her password or ID to any other At this time, the TMA Legal Department is not aware of any person or entity, this specific provision does not distinguish other hospitals that have incorporated similar language in their between potential scenarios that may be out of the user’s control. EHR agreements. However, that does not mean they are not out There are endless ways in which IDs and passwords could be there. TMA urges all physicians to review carefully any EHR discovered by someone else. They can be divulged accidently confidentiality or access agreements they may be required to sign through the negligence of the user. to ensure they are fully aware of their liability exposure. + More troubling, an ID or password could be divulged through no fault of the user, such as if the information is Ms. Dageforde is assistant general counsel for TMA. Contact her at hacked or another staff person looks over the user’s shoulder as [email protected] or 615.460.1647.

TENNESSEE MEDICINE’S SCIENTIFIC JOURNAL HAS MOVED ONLINE.

Read the latest research and case reports from Tennessee Medicine’s e-Journal online at ejournal.tnmed.org/home. You can also submit your own work for inclusion in the e-Journal on the website.

In our latest issue: $3,000 for $1.05: Short Changed?

Meena Sunil, MD, and Gary Malakoff, MD, FACP, report on the case of a woman who swallowed coins totaling $1.05. The extraction of those coins through an esophagogastroduodenoscopy cost about $3,000.

TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org 27

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sheakley.com FOR THE RECORD

NEW MEMBERS CHATTANOOGA-HAMILTON Judith R. Lee-Sigler, MD, Memphis Beverly B. Thomas, MD, Cookeville COUNTY MEDICAL SOCIETY Nicholas R. Leonardi, DO, Memphis Lori A. Thomas, DO, Cookeville Marie L. Beasley, DO, Chattanooga Yehoshua C. Levine, MD, Memphis Lanny J. Turkewitz, MD, FAAN, Cookeville Stephan M. Becker, MD, Chattanooga John T. Morris, MD, Memphis Michael P. Zelig, MD, Cookeville Stephen L. E. Bresson, MD, Chattanooga Daniel L. Magro Jr., MD, Collierville Steven C. Cogswell, MD, Chattanooga James K. Patterson, MD, Memphis SEVIER COUNTY MEDICAL George R. Dixson, MD, Chattanooga Jan H. Petri, MD, Memphis SOCIETY Elizabeth D. Ferluga, MD, Chattanooga Daniel K. Powell, MD, Memphis Laura M. Schnegg, MD, Sevierville Jason Kilmer, DO, Chattanooga Kenneth R. Robertson, MD, Memphis Elizabeth D. Mabry, MD, Chattanooga David Shibata, MD, Memphis TMA DIRECT MEMBERS Harish Manyam, MD, Chattanooga James C. Varner, MD, Memphis Stephanie C. L. Slocum, MD, Gallatin Eric N. McCartt, MD, Chattanooga Kyle R. Stephens, DO, Paris Stephen C. Miller, DO, Ooltewah NASHVILLE ACADEMY Peter R. Sabatini, MD, Chattanooga OF MEDICINE WASHINGTON-UNICOI- Andrew W. Smith, MD, Pikeville Tyler W. Barrett, MD, FACEP, Nashville JOHNSON COUNTY MEDICAL Jason R. Spangler, DO, Chattanooga David E. Bentley, MD, Nashville ASSOCIATION Roger R. Dmochowski, MD, Nashville Howard E. Herrell, MD, Johnson City CONSOLIDATED MEDICAL Matthew A. Leavitt, MD, Nashville ASSEMBLY OF WEST TENNESSEE WILLIAMSON COUNTY MEDICAL Davidson C. Curwen, MD, Jackson PUTNAM COUNTY MEDICAL SOCIETY William S. Ragon Jr., MD, Jackson SOCIETY Sheron J. Langston, MD, Franklin Pierce C. Alexander, MD, Knoxville KNOXVILLE ACADEMY Phillip Bertram, MD, MACP, Cookeville *Does not include student or resident members. OF MEDICINE Zaid A. Brifkani, MD, Cookeville Jose A. Cardenas, MD, Powell Gerald T. Chapman, MD, Cookeville Jane R. Conley, MD, Knoxville James W. Davis, MD, Cookeville Katherine K. Dabbs, MD, Athens Chiranjeevi Gadiparthi, MD, Cookeville Nicole A. Kissane-Lee, MD, Knoxville Randy A. Gaw, MD, Cookeville Karthik R. Krishnan, MD, Knoxville Sidney L. Gilbert, DO, Cookeville Ellen R. Liuzza, MD, Knoxville Apryl M. P. Hall, MD, Cookeville Jeffrey L. Schlactus, MD, Knoxville Bernadette S. Hee, MD, Cookeville Jaideep Sood, MD, Knoxville David J. Henson, MD, Cookeville Ronak B. Jani, MD, Cookeville MCMINN COUNTY MEDICAL Ron L. Johnson, MD, Cookeville SOCIETY Hemamalini Karpurapu, MD, Cookeville Katherine R. Hall, MD, Athens Rohini Kasturi, MD, Cookeville Hima B. Kona, MD, Cookeville THE MEMPHIS MEDICAL SOCIETY Venumadhav Kotla, MD, Cookeville Khalid Abdel-Latif Al Sherbini, MD, Memphis Guillermo A. Mantilla, MD, Knoxville Chinelo N. Animalu, MD, Germantown Crystal D. Martin, MD, Cookeville Debashis Biswas, MD, Memphis Dalia G. Miller, MD, Cookeville James R. Bradley, MD, Memphis Ashim Mushtaq, MD, Cookeville Reshma R. Brahmbhatt, MD, Memphis Jason S. Nolan, MD, Cookeville Claiborne A. Christian, MD, Memphis Cedric M. Palmer Jr., MD, Cookeville Donald S. Euler Jr., MD, Memphis Mark A. Pierce, MD, Cookeville Ian T. Gaillard, MD, Memphis Vijay A. R. Rupanagudi, MD, Cookeville Timothy A. Head, DO, Germantown Algis P. Sidrys, MD, Cookeville Ryan A. Helmick, MD, Memphis Rebekah L. Sprouse, MD, Cookeville David P. Jones, MD, Memphis Hunter A. Stenzel, DO, Cookeville Kelly Kempe, MD, Memphis Suneel K. Tammana, MD, Cookeville

TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org 31 FOR THE RECORD

IN MEMORIAM Edmond L. Alley, MD, age 86. Died Charles H. Householder, MD, age 98. Jeno I. Sebes, MD, age 80. Died November 2, 2015. Graduate of the Died September 25, 2015. Graduate of the December 14, 2015. Graduate of University University of Tennessee Center for Health University of Tennessee Center for Health of Tennessee Center for Health Science. Science. Member of the Sullivan County Science. Member of The Memphis Medical Member of The Memphis Medical Society. Medical Society. Society. John R. Sellars, MD, age 72. Died Ernest L. Cashion, MD, age 91. Died Nat E. Hyder Jr., MD, age 86. Died September 16, 2015. Graduate of the November 28, 2015. Graduate of the October 15, 2015. Graduate of the University of Tennessee Center for Health University of Arkansas School of Medicine. University of Tennessee Center for Health Science. Member of The Memphis Medical Member of The Memphis Medical Society. Science. Member of the Washington-Unicoi- Society. Johnson County Medical Association. Colin C. D. Clarendon, MD, age Thomas J. White III, MD, age 75. Died 80. Died September 30, 2015. Graduate Kenneth M. Kressenberg, MD, age 93. November 27, 2015. Graduate of the of Johns Hopkins University School of Died September 30, 2015. Graduate of the University of Tennessee Center for Health Medicine. Member of The Memphis University of Tennessee Center for Health Science. Member of The Memphis Medical Medical Society. Science. Member of the Nashville Academy Society. of Medicine. Hugh Francis Jr., MD, age 85. Died William J. Whitehead, MD, age 80. September 29, 2015. Graduate of the William R. Lee, MD, age 89. Died August Died December 14, 2015. Graduate of the University of Tennessee Center for Health 29, 2015. Graduate of Baylor College of University of Tennessee Center for Health Science. Member of The Memphis Medical Medicine. Member of the Bradley County Science. Member of The Memphis Medical Society. Medical Society. Society.

James R. Gay, MD, age 101. Died July Allen D. Lewis, MD, FAAD, age 76. 20, 2015. Graduate of Johns Hopkins Died November 15, 2015. Graduate of University School of Medicine. Member of Emory University School of Medicine. The Memphis Medical Society. Member of the Chattanooga-Hamilton County Medical Society. Robert L. Harrington, MD, age 80. Died October 23, 2015. Graduate of Herbert T. McCall, MD, age 85. the University of Tennessee Center for Died October 22, 2015. Graduate of the Health Science. Member of the Northwest University of Tennessee Center for Health Tennessee Academy of Medicine. Science. Member of the Nashville Academy of Medicine. Basil T. Harter, MD, age 90. Died September 15, 2015. Graduate of Johns Bruce P’Pool Jr., MD, age 82. Died Hopkins University School of Medicine. October 5, 2015. Graduate of the University Member of the Sullivan County Medical of Tennessee Center for Health Science. Society. Member of the Nashville Academy of Medicine. Charles B. Harvey, MD, age 87. Died August 22, 2015. Graduate of the University Lenor De Sa Ribeiro, MD, age 96. of Tennessee Center for Health Science. Died November 27, 2015. Graduate of the Member of Coffee County Medical Society. Universidade Federal Fluminense. Member of the Nashville Academy of Medicine. Daniel R. Hightower, MD, age 76. Died November 23, 2015. Graduate of Vanderbilt Nathaniel D. Robinson Jr., MD, age University School of Medicine. Member of 74. Died August 30, 2015. Graduate of the Nashville Academy of Medicine. Facolta Medical e Chirurgia dell Univeristy Bologn. Member of the Nashville Academy of Medicine. 32 TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org TENNESSEE DRUG CARD CAN HELP RETIREES WITH PRESCRIPTION COSTS

more and more baby boomers hit the retirement size of this donut hole but it did not eliminate it all together. age of 65, many things need to be evaluated. One According to EBRI’s report, by 2020 those enrolled in of the major decisions a person should make Medicare will pay 25% of both name brand and generic whenA enterings his or her senior years is selecting medical prescription drugs when they are in the donut hole. In the coverage options. For those approaching age 65, taking the future you could end up paying a greater percentage due time to review the types of coverage available and weighing to the financial restraints of Medicare and penny pinching the overall financial impact of those options will help you efforts of employment-based retiree health programs. and your spouse plan as you move into the next stage of your life. Many costs that arise during retirement are due to When planning for retirement, out-of-pocket medical unexpected medical procedures and high-price prescriptions. expenses should be put into a budget. Prescription costs alone can set some people back quite a bit. According to Some in or approaching their Medicare years are under the EBRI’s findings based on median drug prices, if a man misconception that Medicare is going to cover all medical retired at age 65 in 2014 he “would need $64,000 in savings expenses, but unfortunately that is not true. Medicare and a woman would need $83,000 if each had a goal of does not cover all medical costs, and the out-of-pocket having a 50% chance of having enough money saved to expenses for medical care can still have a sticker shock cover health expenses in retirement.” The savings total for effect. According to the Employee Benefit Research Institute’s women is higher due to their longer life expectancy. October 2014 Executive Summary, “In 2011 Medicare covered 62% of the cost of healthcare services for Medicare The Tennessee Medical Association would like to remind beneficiaries 65 and older, while out-of-pocket spending members about the Tennessee Drug Card, a free prescription accounted for 13%, and private insurance covered 15%. assistance program available to all residents with no age or Medicare was never designed to cover expenses in full.” income requirements. Although many routine medications may be covered by Medicare, it is always worth shopping One part of Medicare that is often responsible for large out- around to see if there is a better rate through a program like of-pocket costs is prescriptions, especially when people fall in this. When an individual falls in the donut hole, he or she the donut hole. The Patient Protection and Affordable Care can use this program to help offset the cost of high-price Act of 2010 (PPACA) includes provisions to minimize the prescriptions.

Go to TennesseeDrugCard.com to print a free card or check the price of your medication using the Tennessee Drug Card. For questions call 1.888.987.0688 or email [email protected]. INSTRUCTIONS Smart. Tough. Creative. FOR AUTHORS Manuscript Preparation – Electronic manuscripts HEALTH CARE LITIGATION should be submitted to the Editor, David G. Gerkin, MD, via email at katie.brandenburg@ tnmed.org. A cover letter should identify one author as correspondent and should include his/her complete address, phone, and e-mail. Manuscripts, as well as legends, tables, and references, must be typed, double-spaced on 8-1/2 x 11 in. white paper/ Word document. Pages should be numbered. The transmittal letter should identify the format used. If there are photos, e-mail them separately in TIF, JPG or PDF format along with the article; photos and illustrations must be high resolution files, at least 300 dpi.

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34 TENNESSEE MEDICINE | Quarter 1, 2016 | tnmed.org