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THE RIGHT PRESCRIPTION FOR A BETTER PRACTICE.

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PresidentChristopher E. Young, MD

Chief Executive OfficerRuss Miller, CAE

Office of Publication2301 21st Avenue SouthPO Box 120909Nashville, TN 37212-0909Phone: (615) 385-2100 Fax (615) [email protected]

EditorDavid G. Gerkin, MD

Managing EditorBrenda Williams

Editorial BoardLoren Crown, MDJames Ferguson, MDKarl Misulis, MDGreg Phelps, MD

Bradley Smith, MDJonathan Sowell, MDJim Talmage, MDAndy Walker, MD

Tennessee MedicineJournal of the Tennessee Medical Association(ISSN 1088-6222)Published monthly under the direction of the Board ofTrustees for members of the Tennessee Medical Association, a nonprofit organization with a definitemembership for scientific and educational purposes,devoted to the interests of the medical profession ofTennessee.

This Association is not responsible for the authen-ticity of opinion or statements made by authors or in

communications submitted to Tennessee Medicinefor publication. The author or communicant shall beheld entirely responsible. Advertisers must conform to the policies and regulations established by theBoard of Trustees of the Tennessee Medical Association.

Subscriptions (nonmembers) $30 per year for US,$36 for Canada and foreign. Single copy $2.50. Payment of Tennessee Medical Association member-ship dues includes the subscription price of Tennessee Medicine.

Copyright 2013, Tennessee Medical Association. Allmaterial subject to this copyright appearing in Tennessee Medicine may be photocopied for noncom-mercial scientific or educational use only.

Periodicals postage paid at Nashville, TN, and atadditional mailing offices.

POSTMASTER: Send address changes to:Tennesssee MedicinePO Box 120909, Nashville, TN 37212-0909

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Advertising Representative: Michael Hurst – (615) 385-2100 or [email protected] Graphic Design: Aaron & Michelle Grayum / www.thegrayumbrella.com

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are of the highest quality available. Don't

take them for granted. Read their adver-

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your advertisers.

Volume 106, Number 6 + June/July 2013

4 Tennessee Medicine + www.tnmed.org + JUNE/JULY 2013

DOCTORS PROTECT,HEAL, CARE,INSPIRE, ENCOURAGE,AND TRANSFORMPATIENTS’ LIVESThe TMAEmpowers,Advocates,and ImprovesTheir Abilityto Do All Of Those Things

ANNUAL REPORT 2012-2013

5Tennessee Medicine + www.tnmed.org + JUNE/JULY 2013

ANNUAL REPORT 2012-2013


7 Mission Statement

9 Thank You, And A Challenge

10 Empowering Physicians

16 Protecting Patients

20 Guardians Of Medicine

28 Leadership In Action

32 Recognizing Excellence

42 Financial Overview

45 Member News

63 IMPACT 2013

65 Membership Application

69 For The Record

70 Advertisers; Instructions


The Tennessee Medical Association is a professional organization for doctors dedicated to protecting the health inter-ests of patients and enhancing the effec-tiveness of physicians throughout thestate by defining and promoting:

+ Quality, safe and effective medical care;

+ Public policy to protect the sanctity of the physician-patient

relationship, improve access to and the affordability of quality

medical services;

+ Ethics and competence in medical education and practice; and

+ Open communication between the medical profession and the

public, fostering a better understanding of the capacities of

medical practice.

Wiley Robinson, MD, FHMTMA President, 2012-2013

Christopher E. Young, MDTMA President, 2013-2014


When I considered how things would change when I advanced from beingpresident of the Tennessee Medical Association to becoming immediate past-president, I was reminded of the speech given by General Douglas McArthurto a joint session of Congress in 1951. In that speech he referenced a popularbarracks ballad that had a refrain proclaiming, “Old soldiers never die, theyjust fade away.” What I found out was that past TMA presidents fade some,but not away.

I will remain involved with our association by serving on the Execu-tive Committee and the Physician Services Committee, and I was also electedat the annual meeting to serve as one of the TMA delegates to the AMA. Ad-ditionally, I do not consider myself old!

I am very grateful to the TMA membership for the opportunity tohave served as your 158th president. We were successfully able to transitionfrom our CEO of 30 years Mr. Donald Alexander to the very capable Mr. RussMiller. We began implementation of our strategic plan that Mr. Miller has beeninstrumental in building for several years. We increased membership and weincreased donations to IMPACT. We made several structural changes to ourBoard of Trustees, improved our working relationship with the TMA Alliance,

and implemented changes in our accounting and financemethods to insure the financial health of our association. Wedealt with prescription drug issues and obesity in our State.We improved our advocacy for specialty societies in Ten-nessee and began our work on a collaborative team approachto healthcare delivery. We supported the election of severalphysicians to the state and federal government and we aidedon your behalf a successful legislative session this year. Webegan educating our members about ICD-10 and about a newway to electronically communicate about our patients. Wealso met directly with insurance companies about specificconcerns our members had with their products. Finally, weconvened a special committee to look at the structure andfunction of our organization to see if we could make this 183-year-old organization work more effectively and efficiently.

None of this could have been possible without thehard work and dedication of your Board of Trustees, TMAStanding Committees, and the TMA staff. While space doesnot allow me to name them all, you can find who is doing theheavy lifting for organized medicine in Tennessee by visitingthe TMA website at tnmed.org.

When I first took office last year, I issued a challengeto the delegation at our annual meeting. I re-issued that chal-lenge at the annual meeting last month. I am now issuing thesame challenge to you, the members of the TMA. I ask thatyou perform three tasks.

First, find one physician in Tennessee who is cur-rently not a member of TMA and ask them to join. In addi-tion to working with the Membership Committee, I waspersonally successful in getting over 20 physicians to join theTMA this past year by simply asking them to join.

Second, donate to our political action committee,IMPACT. Make that donation at least the equivalent of theamount you spent on a meal the last time you ate out. I ampersonally a member of the donation level Capitol Hill Clubbecause I eat out frequently.

Finally, become involved in organized medicine onthe local, state, or federal level. No one will represent yourprofessional interests or the interests of your patients betterthan you will. Your employers, hospitals, insurance compa-nies, and the government all have competing interests whichare often at odds with what is best for your patients or yourpractice. The more physicians are involved, the more likely weare to protect and advance our profession.

It has been an honor and a privilege to serve as yourpresident and it will be a challenge to serve as immediate pastpresident of the TMA, but it is a challenge that I accept withgratitude. Remember, as that popular doctor’s lounge jingleproclaims, “Past presidents never fade away, they just join an-other committee.”

Wiley T. Robinson, MD, FHMImmediate Past-President

Dr. Robinson gives his farewellmessage in April before inaugurating his successor, Dr. Chris Young, as TMA president.


Physicians learn about Tennessee’s Controlled Substance

Monitoring Database during a MedTenn 2013

CME session led by Dr. Micah Cost of the

Tennessee Pharmacists Association.


Medicine has undergone a journey of change sincethe first practitioner administered the first healingpotion to an ailing soul. Physicians continue to seechange everywhere — in their patients, practicemodels, payment, tools, education, preparation,standards and requirements.They have also realized they need help to foresee, navigate and even influence the change. That is what the Tennessee Medical Association does best: advocate for and empower physicians to respond to the times and be the best they can be.

In 2012-2013, the TMA was out on every possible frontline of change, working to come alongside doctors as a part-ner and advocate. Some of our top accomplishments and activities over the past year include:

MEDICARE PAYMENT TRANSITIONThe TMA joined state and national medical societies in aunited call for dropping the flawed payment system basedon the Sustainable Growth Rate (SGR), and posing core el-ements of a more reasonable and better-functioningMedicare program. The Association continues to promotean SGR replacement formula, and works with TennesseeCongressman Phil Roe, MD, and the American Medical As-sociation to oppose a health reform provision that createdan independent review board -- that is not representativeof physicians or answerable to Congress -- to set Medicarepayment rates and rules.

ICD-10 TRANSITIONAlong with informing members of pending deadlines, ad-vocacy efforts by medicine and delays by CMS, the TMAbegan preparing physicians and medical staff early for thechangeover from ICD-9 to the more complex ICD-10 diag-nostic coding system. After a successful Phase I educationseries focusing on an overview of the changes, your asso-ciation launched the ICD-10 Roadshow statewide in May2013 as a follow-up CEU class on the new system’s impacton physician documentation. Implementation resourcesand tools are available to members on the TMA’s ICD-10web resource page, including discounts on ongoing webi-nars, an ICD-10 Transition Toolkit and customized code con-version software, while individual assistance is availablethrough TMA Practice Solutions.

HIPAA LAWSWork continued to keep members apprised of changes inHIPAA privacy laws, through development of a new HIPAAcompliance training course as well as a resource websitewith links to HIPAA-related online classes and webinars,compliance tools and checklists. With the release of theHIPAA Omnibus Final Rule, TMA Legal experts offered ananalysis of the rule’s impact on physician practice and theassociation co-sponsored a webinar giving an overview ofthe rule and strategies for compliance. “Ask TMA” blogposts and articles addressed various aspects of the lawover the past year and will continue to do so.

AFFORDABLE CARE ACTThe TMA remained ever-vigilant to inform and educatemembers about the impact of health reform. The Septem-ber 2012 issue of Tennessee Medicine included analysis ofthe U.S. Supreme Court decision, the TMA’s response tothe decision, an outline of changes for doctors and pa-tients, and articles representing various physician view-points. A Health System Reform series was launched in theJournal in 2012 and 2013 on various aspects of the reformlaw impacting medical practice. Likewise for the ACA “Sun-shine Act” regarding pharmaceutical gifts and payments tophysicians - the TMA Legal Department completed ananalysis for members in April 2013 on their rights and re-sponsibilities under the law. The TMA will continue to mon-itor and report on ACA developments impacting physicians


and patients including delivery of care, reimbursement, re-ferral and network adequacies, practice models, coveragemandates, incentives, anti-fraud efforts, and more.

MEDICAID EXPANSIONSpecific attention has been paid to the expansion of Ten-nCare under the ACA. As Gov. Bill Haslam weighed the prosand cons and input of various stakeholders, the TMA twicesurveyed members over the past year to see if there was

consensus; both times it found physicians were split nearlydown the middle on expansion of the Medicaid programin Tennessee. Following the Governor’s decision not to takefederal dollars to expand the program for now, the TMAHouse of Delegates debated its own position during its ses-sion at MedTenn 2013. After lengthy discussion, delegatesultimately approved a resolution supporting increased ac-cess to care, either through a three-year trial of the Gov-ernor’s own “Tennessee plan” or through direct expansionof TennCare.

HEALTH INSURANCE EXCHANGESWhile the TMA supported a state-run health insurance ex-change, Gov. Haslam’s decision not to do so was under-stood by Association leaders, given the lack of guidanceand firm objectives from the federal government andunanswered questions. The TMA issued a statement tothat effect following his announcement in January 2013.Your Association continues to monitor the impact of im-plementation of a federally-operated exchange and advisemembers accordingly.

CONTROLLED SUBSTANCE MONITORINGDATABASEThe TMA’s vigilance led to creation of an online prescrip-tion monitoring database in 2002; over the past year Ten-nessee’s dependence on prescription drugs led to a newlaw mandating a prescriber check of the database beforeissuing or dispensing new opiate or benzodiazepine pre-scriptions. Issues arising with the system’s technologicalcapabilities, as well as finer points of the law impactingdaily medical practice, were taken by the TMA to statehealth officials in the months preceding and following the

law’s implementation in April 2013. Advocacy continues byyour association to further smooth use of the database forprescribers.

SCOPE OF PRACTICE BATTLESDue to changes in leadership and the climate on Capitol Hill,a number of expected scope of practice bills from nurses,psychologists and physical therapists did not materializeduring the 2013 legislative session. Optometrists undertook

a bid to remove eye lesions using injectable anesthetics but,thanks to the TMA and the Tennessee Academy of Oph-thalmology, lost that bid. Nurses did, however, begin dis-cussions about the need to expand primary care services tomeet the needs of expanded care under health reform bybroadening the capabilities of mid-level providers. To ad-dress this issue, the TMA commissioned a survey, partiallyfunded through a grant from the American Medical Associ-ation, demonstrating that Tennesseans clearly believe in theneed for a strong physician-led team to provide healthcareservices in the future. Over the course of the year, the TMAwill continue to increase awareness among our membersand educate the public that takes a team to deliver greathealth care, a team of dedicated professionals and special-ists, a a team with a well-trained physician in the lead.

AETNA LAWSUIT SETTLEMENTLongtime involvement in class-action lawsuits againstmajor insurers yielded rewards for TMA members again,with the announcement of a $120 million settlement withAetna in late 2012. The case over the insurer’s use of theflawed INGENIX database to determine “usual and cus-tomary rates” led to provider and patient payments. Thecase was the second major class-action settlement be-tween Aetna and the TMA in a decade, and was the directresult of advocacy by the TMA, the AMA and other medicalassociations.

E-HEALTH INITIATIVESOver the past year, implementation of federal standardsfor meaningful use of electronic health records has rampedup; the Association has worked to keep members apprisedof deadlines and incentive requirements via alerts, articles,

“In nothing do men more nearly approach the gods, than in giving health to men.” — Marcus Tullius Cicero


webinars and teleconferences, and has been a conduit forlearning opportunities through CMS and its various part-nerships. Over the past year the Association continued pro-motion of its “AdoptEHR” video series, created incooperation with tnREC (Tennessee’s Regional ExtensionCenter), showcasing physician practice benefits, experi-ences and lessons learned during EHR adoption. The TMAhas also kept an eye on a number of projects related tohealth information exchange and continues to monitor thedevelopment of pilot projects and emerging technologieslike Direct Project and Vital Connect. Members with spe-cific questions have, as always, been able to receive per-sonal assistance through TMA Practice Solutions.

PHYSICIANS IN LEADERSHIPThanks in part to the contributions of physicians to IMPACT(Independent Medicine’s Political Action Committee-Ten-nessee), three TMA members won election to the State Sen-ate -- Dr. Joey Hensley, Dr. Mark Green and Dr. Steve Dickerson-- along with nine other Senate candidates supported by med-icine. In the State House, 50 of the 54 candidates supportedby IMPACT won their races. At the national level, physicians

supported the re-election of TMA member Dr. Phil Roe toCongress. In the non-political arena, the TMA graduated an-other successful class of scholars from its Physician Leader-ship College; to date 70 physicians have completed theyear-long leadership training course, many of them going onto take leadership posts within the association, in hospitals orother medical organizations, and in their communities.

INSURANCE VICTORIESThe TMA kept a diligent eye on developments affectingphysician payment by insurers. The incidence of “lost” dol-lars through insurance claims held up by hassles and bu-reaucratic red tape led to the creation of the new TMAInsurance Recovery Program in November 2012, offeringfree assistance for members up to $5,000 and for all Ca-haba GBA issues, and fee-based assistance for non-mem-bers. TMA class-action lawsuits yielded still more benefitto members, including a BCBS settlement benefiting cardi-ologists. Members were alerted to numerous deadlines

and required transitions to electronic payment by both fed-eral and private payers; a questionable contract amend-ment from HealthSpring was clarified due to TMAinvolvement; Volunteer State Health Plan’s shift to QuestDiagnostic Labs was monitored and modified through TMAadvocacy; alerts on TennCare and Medicare paymentchanges were sent regularly; and the Association is stillquestioning Cigna on a decision to exclude some physiciansfrom networks in West Tennessee.

CHANGING PRACTICE ENVIRONMENTChange is manifested increasingly in new medical practicemodels, many as a direct result of health reform. Account-able Care Organizations (ACOs) and Patient-Centered Med-ical Homes (PCMHs) are springing up across the state. TheTMA has focused several publications and resources onthese new models of care as well as career trends for physi-cians themselves; legal staff has devoted numerous arti-cles, Law Guide analysis and resources to the formationand operation of ACOs under ACA rules. Noting the rise ofmergers and employed physicians, the TMA undertook afocus group study to evaluate their needs and launched a

LinkedIn group, Tennessee Employed Physicians, in April2013 as a forum for discussion and communication, and asa resource for these doctors.

MEMBERSHIP TRENDSA number of efforts are underway to meet new mem-bership needs, including the rising trend of employedphysicians. A focus group project surveyed employedphysicians in Tennessee’s major markets to learn whatbenefits and services they would find most valuable.Overall recruitment and retention efforts continue tofocus on the value of belonging to the TMA. Special mail-ings, letters, group practice and resident member out-reach, exhibits and meeting presence, practice visits, anduse of web-based invitations to join continued with somesuccess. Overall membership is up but there is concernabout the number of physicians who do not renew eachyear; the problem is under evaluation for new ways to re-tain these valuable members.

“Unless physicians stand together to fight threats and injustices, our practices cannot remain viable

in the future.” — Samuel Wilson


CONTINUING MEDICAL EDUCATIONOverwhelming response to the TMA’s online and in-personsessions and workshops has led the Association to bolsterits CME and other educational offerings over the past year.Its web-based portal offers a robust mix of courses avail-able to members at their convenience. Traveling seminars

and those offered at MedTenn 2013 were well-received,partly due to the TMA obtaining earned credits for bothphysicians and medical staff. The TMA is working to becomean established accrediting organization for CME, which willfurther increase the quality of education offered and thevalue of the Association to its members in the future.

SPECIALTY COLLABORATIONWith a strategic plan objective to improve and maintain re-lations with medical specialty organizations, the TMA metwith five specialty group representatives in August 2012.Discussions centered around common issues, mutual goalsand obstacles and future plans for collaboration; top issues

addressed included mutual concerns about the medical li-censing board and scope of practice encroachment. TheTMA will continue to identify areas for cooperation movingforward. Efforts are also underway to have a jointstatewide convention with specialty societies in 2014 andto grow the meeting in subsequent years.

MEMBER SERVICESOver the next year, members will see the new rollout ofproducts and services from TMA Physician Services, Inc.Recently relocated from Chattanooga to TMA headquar-ters in Nashville, the program has undergone an extensiveprocess to update the offerings to include services ourmembers need, want and actually use. The goal is to pro-vide physicians with savings they cannot get anywhere elseand that will ultimately more than pay for the cost of mem-bership. Best of all, patronizing the association turns rev-enue back into the work of the association, which helpsthe TMA advocate even more effectively for physicians.

“Only those who regard healing as the ultimate goal of their efforts can, therefore,

be designated as physicians.” — Rudolf Virchow

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MemberRenewal_FullAd2013_Layout 1 12/20/12 4:28 PM Page 1


Tennessee Health Commissioner Dr. John Dreyzehner

hosts a MedTenn CME session on Tennessee’s prescription

drug abuse problem and the resulting explosion of newborns

with Neonatal Abstinence Syndrome.

17

Without the patient, there would be no physician. When 47 doctors gathered in 1830 to organize the Medical Society of Tennessee, their first thought was for the health,safety and welfare of Tennesseans. One-hundred-eighty-three years later, the TMA remains dedicated to protecting thehealth interests of patients.

Some of our most important activities on behalf of patients this past year include:

PRESCRIPTION DRUG DEPENDENCEHaving adopted prescription drug abuse and misuse as itssignature public health issue in 2010, the TMA stayed thecourse with continued efforts to seek funding for a com-prehensive, statewide public awareness and provider edu-cation campaign. It joined hands with the TennesseeDepartment of Health to begin the process of creatingtreatment guidelines for prescribing addictive medications,forming an opioid prescribing committee to advise thestate and participating in a series of seminars aimed atbringing stakeholders together. TMA support helped winpassage of restrictions on the prescribing of Schedule II, IIIand IV controlled substances by nurse practitioners andphysician assistants and mandatory identification of thetop 50 prescribers of controlled substances in the state anda requirement that those prescribers justify their prescrib-ing habits. Collaboration with state, professional and alliedstakeholders remains critical to the goal of reducing thenumber of pills issued per capita in Tennessee.

PRESCRIPTION SAFETY ACTThe TMA worked with the Public Safety Committee, com-prised of law enforcement and district attorneys in thestate, to ensure that new regulations on registered painclinics were appropriate and changes that prohibit the dis-pensing of more than a 30-day supply of opioids or benzo-diazepines and new required continuing education onproper prescribing of controlled substances were reason-able and did not overburden physicians for little benefit.The bill was amended to the TMA’s satisfaction and takeseffect in October.

NEONATAL ABSTINENCE SYNDROME“SAFE HARBOR” ACTWith an explosion in the number of newborns with drugdependence, the TMA took action, passing legislation to

protect addicted pregnant women from punitive action ifthey adhere to drug and prenatal treatment throughoutthe pregnancy, and place them first in line for funded sub-stance abuse treatment. The measure also provides civilimmunity for healthcare providers involved in their care.

YOUTH CONCUSSION POLICIESRising concern about the long-term and yet unknown ef-fects of concussions led to passage of a TMA-initiated billon the issue. Working collaboratively with the TennesseeChapter of the American Academy of Pediatrics and otherstakeholders, the measure requires school and communityathletic organizations to adopt guidelines and policies andmeet annual standards, and sets the rules for removal andreturn of youth athletes who show signs or symptoms of aconcussion.

EXPANDED ACCESS TO CAREDespite member sentiment on both sides and robust de-bate of the issue, the TMA House of Delegates in April af-firmed the Association’s commitment to improving accessto medical care by passing a policy resolution in favor ofexpanded access in Tennessee. The policy supports twomeans, either through a mixed public-private solution asoffered by Gov. Bill Haslam or through direct expansion ofTennCare, the state’s Medicaid program.

CHOOSING WISELYWith the awarding of a grant sought by The Memphis Med-ical Society and the TMA, the national campaign to reduceunnecessary medical tests and procedures has come to Ten-nessee. Both societies will promote activities, resources andevents related to the “Top Five” lists developed by each spe-cialty of tests and procedures that both doctors and pa-tients should question. The primary goal is to providebetter, less wasteful and less expensive care to patients.

Tennessee Medicine + www.tnmed.org + JUNE/JULY 2013

FUNGAL MENINGITIS OUTBREAKYour Association was at its best during the outbreak of fun-gal meningitis in Tennessee in mid-2012. TMA leadersworked hand-in-hand with state officials and other stake-holders to alert members to vital information about theoutbreak, affected facilities, tainted lots of spinal steroidsand new reporting requirements, and to contact facilitiesthat may have been affected by the recall. In the wake ofthe crisis, the TMA has weighed in on and monitored re-

sulting legislation at both the state and federal levels toprevent such an outbreak in the future, to ensure themeasures are an appropriate response without posingundue burden on healthcare providers.

AFTER-HOURS CARE “DUMPING”Acting on a growing problem with daytime, rural, walk-inand urgent care clinics, the TMA Board of Trustees adoptednew policy in October 2012 aimed at discouraging the“dumping” of non-emergency after-hours care of patientson physicians and emergency departments. The concernwas over the inconvenience and possible harm to patientswho cannot reach clinic personnel after hours and are di-rected to the ER, as well as the unfair transfer of care toproviders who are not familiar with the patient. The Boardurged Tennessee physicians working in non-traditional en-vironments to either acknowledge and follow-through ona formal physician/patient relationship by providing after-hours care, or inform patients that they are not their full-time physicians.

HORMONE REPLACEMENT THERAPYAfter passing legislation requiring medical examination andfull disclosure before patients could undergo hormone re-placement therapy in HRT facilities, the TMA again steppedforward to address patient safety concerns at these facili-ties in late 2012. The Association issued a statement sup-porting a state attorney general investigation ofquestionable medical practices at a specific hormone re-placement therapy clinic. Stating that it was making nojudgment in the specific case, the TMA said members hadreported concerns about a lack of appropriate training andoversight of non-physicians at these types of clinics. The

Association said it supported efforts to ensure quality ofcare and strong disciplinary action against any physicianwho does not uphold these high standards.

MATERNAL MORTALITY REVIEWTMA delegates voted in April to support the establishmentof a maternal mortality review process in Tennessee that ispeer-review protected and HIPAA compliant. The Ten-nessee Department of Health would operate the program

to review maternal deaths and make recommendations forsystem changes to improve healthcare services to women.

OBESITY & LIFESTYLE ISSUESTennesseans are tipping the scales like never before andthe healthcare community must come together. The TMAhas a history of promoting and supporting healthy lifestylesamong Tennessee citizens and this past year united withstate health officials on several fronts. The TMA partici-pated in an Obesity Forum in mid-2012, and released anissue brief calling for “cohesive collaboration” among allstakeholders and supporting a mixture of initiatives andfull funding of current legislation to ensure healthy com-munities, healthy schools and healthy homes. Dialoguecontinues between the TMA and the Tennessee Depart-ment of Health on ways to work together toward this goal.

MENTAL HEALTH TREATMENTHigh-profile media coverage of mentally-ill patients whohave carried out deadly threats sparked a national con-versation on the lack of resources for mental health treat-ment and screening. The TMA responded, inviting NationalMedical Association and Tennessee Psychiatric AssociationPresident Dr. Rahn Bailey to give a CME presentation onthe mental health crisis in Tennessee. TMA House of Dele-gates adopted policy in April to support efforts to win morestate or federal funding for mental health screening andtreatment in Tennessee.

MOTORCYCLE HELMET LAWAlthough supporters came closer this year, the TMA andallied organizations were able to fend off another attemptto change Tennessee’s life-saving motorcycle helmet law.

“Let the young know they will never find a more interesting, more instructive book

than the patient himself.” — Giorgio Baglivi


The legislation, delayed until 2014, would have exemptedriders meeting certain age, safety and insurance criteriafrom wearing a helmet.

TRANSPARENCY FOR PATIENT CHARGESBecause the rising cost of healthcare is an ever-constantconcern, the TMA House of Delegates in April adopted newpolicy supporting the public posting of patient out-of-pocket costs for prescription drugs and hospital charges.

PUBLIC HEALTH ACHIEVEMENTSThe TMA values efforts to further the health of Ten-nesseans and over the past year has sought to promotethose efforts among its members. Individual TMA mem-bers who have made valued contributions to public healthprograms or initiatives have been honored as TMA Quar-terly Public Health Champions. The Association has alsobegun discussions with the Tennessee Public Health Asso-ciation on a joint annual award to recognize outstandingpublic health work in Tennessee.

“Patients don’t care how much you know until they know how much you care.” — Unknown


TMA delegates stand for a special vote count

on a resolution in favor of expanded access to health care

during the House of Delegates session in April.

The resolution passed by a majority following heavy debate.



NUMBER

BLA 1-13Res. No. 1-13

Res. No. 2-13

Res. No. 3-13

Res. No. 4-13

Res. No. 5-13Res. No. 6-13Res. No. 7-13Sub. Res. No. 7-13Res. No. 8-13Res. No. 9-13Res. No. 10-13Res. No. 11-13Res. No. 12-13Res. No. 13-13Res. No. 14-13Res. No. 15-13Res. No. 16-13Res. No. 17-13Res. No. 18-13

Res. No 2-6

Res. No. 3-6

Res. No. 4-06

Res. No. 5-06

Res. No. 6-06

Res. No. 12-06

Res. No. 15-06Res. No. 27-06Res. No. 34-06

TITLE

Affiliate MembershipMandatory Acceptance of Assignment for InsuranceReaffirmation of Res. Nos. 1-92 and 1-99Indigent Care ActivityReaffirmation of Res. Nos. 22-92 and 10-99Hospitals Charging for Physician ApplicationsReaffirmation of Res. No. 17-99Independent Medical Expert Testimony in Medical Liability CasesReaffirmation of Res. No. 30-06Inclusion of Cosmetic Surgery in the State Medical Practice Act (MPA)Delegation of Cosmetic Surgical Procedures TMA Support of Medicaid Expansion in Tennessee Medicaid ExpansionFirearm Sales and Mental Health ScreeningTMA Support of Medicaid Expansion in Tennessee Expanding Access to CareMaternal Mortality ReviewRebuilding TN Medical Association’s Grassroots NetworkIn Defense of Medical Education and Physician InvolvementPrescription Drug Transparency in TennesseeTransparency of Hospital Charges in Tennessee Gay MarriageMedicaid ExpansionTMA Elections

Ban of “Promotional Drinking” Reaffirmation of Res. Nos. 4-92 and 2-99 Opposition to Boxing as a Sport Reaffirmation of Res. Nos. 5-92 and 3-99 Tax on Professional Medical Services Reaffirmation of Res. Nos. 9-92 and 5-99 Control of Over-The-Counter Diet Pills Reaffirmation of Res. Nos. 12-92 and 7-99 Tobacco Use on Tennessee School System Property Reaffirmation of Res. Nos. 14-92 and 8-99Lung Disease Education Reaffirmation of Res. No. 24-99 Code of Conduct for Physicians Expert Testimony Emergency Resolutions Cessation of Use of the Term “Provider”

FINAL ACTION

Not AdoptedAdopted by Unanimous Consent

Adopted by Unanimous Consent



AdoptedAdoptedReplaced by Sub. Res. No. 7-13Adopted as AmendedAdopted as AmendedReplaced by Sub. Res. No. 7-13Replaced by Sub. Res. No. 7-13Adopted as AmendedAdopted Adopted as AmendedAdopted as AmendedAdopted as AmendedWithdrawnReplaced by Sub. Res. No. 7-13Referred to BOT







Adopted by Unanimous ConsentAdopted by Unanimous ConsentAdopted by Unanimous Consent

T E N N E S S E E M E D I C A L A S S O C I A T I O N

2013 House of Delegates Resolution Actions

SUNSET /PERMANENT POLICY


Res. No. 7-06

Res. No. 9-06

Res. No. 10-06

Res. No. 13-06

Res. No. 17-06

Res. No. 22-06Res. No. 25-06Res. No. 26-06Res. No. 28-06Res. No. 32-06Res. No. 35-06Res. No. 36-06

Insurance Company Provider Terminations Reaffirmation of Sub. Res. Nos. 17-92 and 9-99West Tennessee Disaster Preparedness Reaffirmation of Res. Nos. 28-92 and 11-99 Continuity of Care for TennCare Patients Reaffirmation of Res. No. 15-99 AMA Membership Reaffirmation of Res. No. 16-99 Georgia Physician Membership in The Chattanooga-Hamilton County Medical Society without Membership in TMATennCare Formulary Complaint State Funding for Uncompensated Care to Unassigned TennCare Disenrollees Medical Liability Reform Support of House Bill 3833, Senate Bill 3665 Aggravated Rape of a Child TennCare Pharmacy Benefit OverrideFunding for Tennessee Medical Association Physician Leadership College Tobacco Industry Lawsuit Settlement Reaffirmation of Sub. Res. No. 22-99

SUNSET RESOLUTIONS






Adopted by Unanimous ConsentAdopted by Unanimous ConsentAdopted by Unanimous ConsentAdopted by Unanimous ConsentAdopted by Unanimous ConsentAdopted by Unanimous ConsentAdopted by Unanimous Consent

The 178th Annual Meeting of the Tennessee Medical Association, MedTenn 2013, was conducted in Franklin, TN, April 5-7, at the Franklin Marriott Cool Springs hotel. The House of Delegates held a two-day session on Saturday, April 6, andSunday, April 7. John W. Hale, MD, Union City, presided as speaker of the House, with Jane M. Siegel, MD, Nashville, serv-ing as vice-speaker. Edward W. Capparelli, MD, Oak Ridge, chairman of the Credentials Committee, announced there were116 delegates in attendance for the opening session of the House on Saturday, which officially represented a quorum;there were 107 delegates in attendance for the Sunday session, representing a quorum.

The abstracted minutes of the last regular session of the House of Delegates, published in the June/July 2012 issue of Tennessee Medicine, were accepted by unanimous vote of the House.

Final Actions of the Tennessee Medical Association House of Delegates

April 5-7, 2013

BYLAW AMENDMENTThe following bylaw amendmentwas acted on by the 2013 House ofDelegates.

BYLAW AMENDMENT NO. 1-13

AFFILIATE MEMBERSHIPRobert W. Herring, Jr., MD, Delegate Nashville Academy of Medicine

RESOLVED, That Bylaw Chapter I.A, beamended by deletion and insertion as follows:

Sec. 1. This Association shall be composed

of active, associate, veteran, special, hon-orary, intern and resident, and student, andaffiliate members.

Sec. 9. An affiliate member is a non-votingmember. An affiliate member is defined asa nurse practitioner or physician assistantwhose supervising physician is a memberin good standing with the Tennessee Med-ical Association, a chief operating officer,chief executive officer, or practice man-


ager/administrator of a medical practice inwhich a majority of the physicians in theirpractice are members in good standing ofthe Tennessee Medical Association.

Sec. 9. 10 Wherever the term physician isused in the Bylaws, the following definitionshall apply: A physician is a person who,having been regularly admitted to a med-ical school duly recognized in the country inwhich it is located, has successfully com-pleted the prescribed course of studies inmedicine or osteopathy, and has acquiredthe requisite qualifications to be legally li-censed, under Title 63, Chapters 6 or 9 ofthe Tennessee Code Annotated, or a similarstatute of another state, to practice medi-cine or osteopathy.

Sec. 10 11. No person who is under sen-tence of suspension or expulsion from anycomponent society of this Association orwhose name has been dropped from its rollof members shall be entitled to any of therights or benefits of this Association, or bepermitted to take part in any of its proceed-ings until such time as he or she has beenrelieved of such disability.

Sec.11 12. From this point forward, themembership-at-large shall be defined asactive, associate, veteran, special, internand resident, elected student representa-tives and affiliate to the Tennessee MedicalAssociation House of Delegates from eachof the four medical schools and the MedicalStudent Section.

RESOLVED, That Bylaw Chapter II, Section5, be amended by deletion and insertion asfollows:

Sec. 5. All active, associate, veteran, spe-cial, intern and resident, student, and hon-orary and affiliate members and invitedguests shall be privileged to attend allmeetings of the Association.

RESOLVED, That Bylaw Chapter V, Section1, be amended by deletion and insertion asfollows:

Sec. 1. The annual dues shall be deter-mined by the House of Delegates and shall

be levied per capita on the active mem-bers, and intern and resident members,and affiliate members of the charteredcomponent societies. No dues shall bepaid by veteran, special, associate, resi-dent/fellow student, or honorary members.The annual dues shall be payable on orbefore January 1 of the year for which theyare levied. Members whose dues are notreported to the Tennessee Medical Associ-ation by March 31 shall be considereddelinquent. The secretary of each compo-nent society shall collect and forward tothe Association the dues for its membersexcept for those members billed directlyby or for the Association. Any memberwho is delinquent at the end of the yearmay be assessed a reinstatement fee atthe discretion of the Board of Trustees, inaddition to the regular dues, when reap-plying for membership in a subsequentyear. Every dues-paying member of theAssociation shall receive the Journal with-out cost.

NOT ADOPTED................................................................

RESOLUTIONSThe following resolutions wereacted on by the 2013 House of Delegates.

RESOLUTION NO. 1-13

MANDATORY ACCEPTANCE OFASSIGNMENT FOR INSURANCE REAFFIRMATION OF RESOLU-TION NOS. 1-92 AND 1-99

Keith G. Anderson, MD, Chairman TMA Board of Trustees

RESOLVED, That the Tennessee Medical As-sociation oppose the principle of mandatoryacceptance of assignment as a requirementfor reimbursement for the care of patientswho are recipients of Medicare benefits; andbe it further

RESOLVED, That the Tennessee MedicalAssociation vigorously oppose any future

effort to include mandatory acceptance ofassignment as a condition for reimburse-ment from any government or privatesource.

ADOPTED BY UNANIMOUS CONSENT .................................................................

RESOLUTION NO. 2-13

INDIGENT CARE ACTIVITYREAFFIRMATION OF RESOLU-TION NOS. 22-92 AND 10-99


RESOLVED, That the Tennessee Medical As-sociation (TMA) through the Board ofTrustees continue to encourage its membersvia its local component societies to providefree care and reduced cost services to theindigent and that the TMA act as a resourcefor the development and enhancement ofsuch activities.


RESOLUTION NO. 3-13

HOSPITALS CHARGING FORPHYSICIAN APPLICATIONSREAFFIRMATION OF RESOLUTION NO. 17-99


RESOLVED, That application fees associ-ated with hospital staff membership bedecided by the medical staff; and be itfurther

RESOLVED, That any monies raised by ap-plication fees associated with hospital staffmembership be used for the collective goodof the medical staff and do not offset thehospital’s administrative costs.



RESOLUTION NO. 4-13

INDEPENDENT MEDICAL EXPERTTESTIMONY IN MEDICAL LIA-BILITY CASESREAFFIRMATION OF RESOLUTION NO. 30�06


RESOLVED, That the Tennessee Medical As-sociation encourage the use of independentmedical experts to advise a judge when thejudge does not fully understand the medicalissues involved in the case; and be it further

RESOLVED, That the Tennessee Medical As-sociation will, when requested, provide sug-gestions for medical experts to advise ajudge, taking into account their knowledgeof the medical facts in the case, and tak-ing care to avoid conflicts of interest suchas personal, legal, or financial relation-ships; and be it further

RESOLVED, That the Tennessee Medical As-sociation will support the position that anycosts associated with obtaining independ-ent medical testimony to advise a judgewhen the judge does not fully understandthe medical issues involved in the case betaxed to the participants in the same man-ner as other court costs.

ADOPTED BY UNANIMOUS CONSENT

.................................................................

RESOLUTION NO. 5-13

INCLUSION OF COSMETIC SUR-GERY IN THE STATE MEDICALPRACTICE ACT (MPA)

Steven Bengelsdorf, MD, DelegateNashville Academy of Medicine

RESOLVED, That the Tennessee Medical As-sociation support actions to expand the defi-nition of the practice of medicine in the Stateof Tennessee to specifically include within itany surgical procedure performed for cos-metic or aesthetic purposes; and be it further

RESOLVED, That the Legislative Committeeof the Tennessee Medical Association makethe inclusion of cosmetic surgery in the Ten-nessee Medical Practice Act, a priority itemfor legislative action in 2013.

ADOPTED.................................................................

RESOLUTION NO. 6-13

DELEGATION OF COSMETICSURGICAL PROCEDURES

Steven Bengelsdorf, MD, DelegateNashville Academy of Medicine

RESOLVED, That the Tennessee Medical As-sociation support efforts to prevent unli-censed and unsupervised cosmetic surgicalprocedures through legislative action andenforcement by the Board of Medical Exam-iners; and be it further

RESOLVED, That the legislative committeeof the Tennessee Medical Association makethe delegation of cosmetic surgical proce-dures without adequate physician supervi-sion outside of a medical environment apriority item for legislative action in 2013.

ADOPTED.................................................................

RESOLUTION NO. 7-13

TMA SUPPORT OF MEDICAIDEXPANSION IN TENNESSEE

David E. McKee MD, DelegateNashville Academy of Medicine

RESOLVED, That the Tennessee Medical As-sociation support efforts to ensure the ex-pansion of Medicaid in Tennessee under theAffordable Care Act.

REPLACED BY SUBSTITUTE RES. NO. 7-13.................................................................

SUBSTITUTE RESOLUTION NO. 7-13

EXPANDING ACCESS TO CARE

David E. McKee MD, DelegateNashville Academy of Medicine

Jerome Thompson, MD, DelegateThe Memphis Medical Society

Robert W. Herring, Jr., MD, DelegateNashville Academy of Medicine

John D. McCarley, MD, DelegateChattanooga-Hamilton County Medical Society

RESOLVED, That the Tennessee Medical As-sociation support access to affordable health-care for all Tennesseans; and be it further

RESOLVED, That the Tennessee Medical Asso-ciation supports a trial for three years to ex-pand access to care by using Medicaidexpansion funds either to subsidize uninsuredresidents to purchase health insurance throughthe Federal Insurance Exchanges or through di-rect Medicaid Expansion; and be it further

RESOLVED, That the Tennessee Medical As-sociation insists that benefits to residentsreceived via health insurance purchasedthrough federal exchanges, be at a mini-mum at least comparable to Medicaid/Ten-nCare benefits; and be it further

RESOLVED, That the Tennessee Medical As-sociation will make itself fully available tothe Governor and the state legislature to ad-vocate for healthcare coverage in Tennessee.

ADOPTED AS AMENDED.................................................................

RESOLUTION NO. 8-13

MENTAL HEALTH SCREENING

Edmund T. Palmer, Jr., MD, DelegateConsolidated Medical Assembly of West Tennessee

RESOLVED, That the Tennessee Medical As-sociation support efforts for more state andFederal money for mental health screeningand treatment in community hospitals andpublic health clinics.

ADOPTED.................................................................


RESOLUTION NO. 9-13

TMA SUPPORT OF MEDICAIDEXPANSION IN TENNESSEE

Jerome Thompson, MD, DelegateThe Memphis Medical Society

RESOLVED, That the Tennessee Medical As-sociation endorse Medicaid Expansion inTennessee; and be it further

RESOLVED, That the Tennessee Medical As-sociation make itself available to the Gov-ernor and State Legislature to advocate forMedicaid Expansion in Tennessee; and be itfurther

RESOLVED, That the Tennessee Medical As-sociation develop a communications strat-egy to inform the membership and thepublic on the importance of Medicaid Ex-pansion to the state of Tennessee.


RESOLUTION NO. 10-13

EXPANDING ACCESS TO CARE

John D. McCarley, MD, DelegateChattanooga-Hamilton County Medical Society

RESOLVED, That the Tennessee Medical As-sociation support access to affordablehealth care for all Tennesseans; and be itfurther

RESOLVED, The Tennessee Medical Associ-ation supports the state of Tennessee’s ef-forts to expand access to care by usingfederal expansion funds to allow uninsuredresidents to purchase health insurancethrough the federal insurance exchange;and be it further

RESOLVED, The Tennessee Medical Associa-tion supports approaching this trial expan-sion for an initial period of three years, witha review at the end of that time; and be itfurther

RESOLVED, That the Tennessee Medical As-sociation work with the administration toreduce bureaucratic and administrativebarriers and encumbrances in the Medicaidprogram.



MATERNAL MORTALITY REVIEW

Phyllis E. Miller, MD, DelegateChattanooga-Hamilton County Medical Society

RESOLVED,That the Tennessee Medical As-sociation support the establishment of apeer review protected and HIPAA compliantmaternal mortality review process under theauspices of the Tennessee Department ofHealth to review maternal deaths in Ten-nessee and make recommendations for sys-tem changes to improve health careservices for women in this state.



REBUILDING TENNESSEE MED-ICAL ASSOCIATION’S GRASS-ROOTS NETWORK

Robert M. Dimick, MDTMA Legislative Committee

RESOLVED, That each component medical so-ciety is requested to hold at least one meet-ing per year with their local legislativedelegation to discuss issues important tophysicians and our patients; and be it further

RESOLVED, That each component medicalsociety work to identify at least two physi-cians per legislator who will serve as a keycontact and resource to that legislator sothat when important issues arise, each leg-islator will have constituent physicians act-ing as liaisons they know and trust to talk toabout issues critical to organized medicine.The names of the liaisons shall be sharedwith the Tennessee Medical Association so

they can keep these individuals informed asissues arise; and be it further

RESOLVED, That the Tennessee Medical As-sociation legislative staff be available toparticipate in meetings and calls with com-ponent medical societies to assist in com-munications with their local legislativedelegation; and be it further

RESOLVED, That the Tennessee Medical As-sociation legislative staff report back to thisbody at the next meeting of this House on thegrassroots activities of each component med-ical society as set forth in this resolution.

ADOPTED.................................................................


IN DEFENSE OF MEDICAL EDU-CATION AND PHYSICIAN IN-VOLVEMENT

O. Lee Berkenstock, MD, DelegateThe Memphis Medical Society

RESOLVED, The Tennessee Medical Associa-tion, through its American Medical Associa-tion (AMA) delegation, petition the AMA towork with the Centers for Medicare and Med-icaid Services and other federal authoritiesto remove the onerous language stating,“Any contribution and participation of a bill-able service must be performed in the pres-ence of a teaching physician or resident...”and “...the teaching physician may not referto your documentation of physical examina-tion findings or medical decision making inhis personal note”; and be it further

RESOLVED, That Tennessee Medical Associ-ation, through its American Medical Asso-ciation (AMA) delegation, petition the AMAfor a more suitable alternative that recog-nizes more accurate documentation of carewhile allowing the profession of medicine toresume educating its future colleagues in amore cost effective and efficient manner.




PRESCRIPTION DRUG TRANS-PARENCY IN TENNESSEE

Thomas C. Gettelfinger, MD, DelegateThe Memphis Medical Society

RESOLVED, That the Tennessee Medical As-sociation work with insurors and pharma-cies in Tennessee to mandate that whatpatients pay for name brand medicationand that of any generic equivalent be madeavailable on the health insuror and phar-macy organizations website.



TRANSPARENCY OF HOSPITALCHARGES IN TENNESSEE

Thomas C. Gettelfinger, MD, DelegateThe Memphis Medical Society

RESOLVED, That the Tennessee Medical As-sociation work with the health insurors andhospitals in Tennessee to draft legislationthat would require insurors and hospitals toelectronically post what patients pay out ofpocket for hospital benefits, (“charge mas-ter”) the benefit paid by the patient’s insur-

ance, the benefit payable by Medicare andTennCare in an easily comparable format.



MEDICAID EXPANSION


RESOLVED, That the Tennessee Medical As-sociation support the proposed Medicaid Ex-pansion to those with incomes between100% and 133% of poverty; and be it further

RESOLVED, That the Tennessee Medical As-sociation express by letters to the Governor,Speaker of the House, the Speaker of theSenate support of Medicaid Expansion inTennessee no later than the first Friday afterthis 2013 meeting of the House of Delegates; and be it further

RESOLVED, That the Tennessee Medical As-sociation prepare a press release to themajor newspapers in Tennessee, such asthe Nashville Tennessean, the MemphisCommercial-Appeal, the Knoxville NewsSentinel, the Chattanooga Times Free Press,and others as determined by the Board ofTrustees, no later than the first Friday after

this 2013 meeting of the House of Delegatesits support of Medicaid Expansion in Ten-nessee; and be it further

RESOLVED, That the Tennessee Medical As-sociation Board of Trustees take any actionneeded to adequately express the impor-tance of Medicaid Expansion to patientswith marginal income.



TMA ELECTIONS


RESOLVED, That the Tennessee Medical As-sociation (TMA) House of Delegates elect theofficers of the TMA including the TMA pres-ident, president-elect, and secretary-trea-surer, in a manner similar to the AmericanMedical Association. The TMA Board ofTrustees may add officers to this list as ap-propriate.

REFERRED TO THE TMA BOARD OFTRUSTEES

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TMA-Insurance_FullAd2013_Layout 1 5/22/13 12:50 PM Page 1

TMA Board of Trustees members hear budget presentations

during a quarterly meeting in October 2012.



TMA Resource Guide

BOARD OF TRUSTEESKeith Anderson, MD, Germantown, Chair*Bob Vegors, MD, Jackson, Vice-Chair*Christopher Young, MD, Signal Mountain, President*

Wiley Robinson, MD, FHM, Memphis, Immediate Past-President*

Douglas Springer, MD, FACP FACG,Kingsport, President-Elect*Pete Powell, MD, Franklin, Secretary-Treasurer*

Richard Briggs, MD, KnoxvilleHeidi Dulebohn, Johnson City, AdvisorEric Fox, MD, CookevilleTimothy Gardner, MD, Johnson CityJohn Hale, Jr., MD, Union City, Speaker, House of Delegates

Danielle Hassel, MD, Collierville, Young Physician Section

M. Usman Khan, MD, Memphis, Resident & Fellow Section

Michel McDonald, MD, NashvilleWill Pitt, Maryville, AdvisorSamuel Riney, Memphis, Medical Student SectionNita Shumaker, MD, HixsonRuss Miller, CAE, TMA Staff Liaison

*Executive Committee

BOT contact information is available at tnmed.org/directory; member login required.

JUDICIAL COUNCILEugene Ryan, MD, Chattanooga, ChairEdward Capparelli, MD, JacksboroOmar Hamada, MD, Brentwood

Pushpendra Jain, MD, CookevillePaul Klimo, Jr., MD, MPH, MemphisSusan Lowry, MD, MartinFredric Mishkin, MD, KingsportRon Overfield, MD, NashvilleYarnell Beatty, JD, TMA Staff Liaison

CONSTITUTION & BYLAWSCOMMITTEEDavid Gerkin, MD, Knoxville, ChairDanielle Hassel, MD, ColliervilleScott Jay, MD, GreenevilleRobert Miller, III, MD, GermantownVincent Viscomi, MD, HixsonCharles White, Sr., MD, LexingtonRobin Williams, MD, NashvilleYarnell Beatty, JD, TMA Staff Liaison

IMPACT COMMITTEE(INDEPENDENT MEDICINE’S POLITICAL ACTION COMMITTEE-TENNESSEE)Newton Allen, Jr., MD, Nashville, ChairLeonard Brabson, Sr., MD, Knoxville David Crabtree, Johnson City Kenneth Holbert, MD, FACEP, Smyrna Lee Hunter, Jr., MD, Columbia Yuvraj Kalra, MD, Nashville George “Trey” Lee, III, MD, MS, Nashville Perry Rothrock, III, MD, Cordova Kirk Stone, MD, Union City Sue Vegors, Jackson Turney Williams, MD, KnoxvilleChristopher Young, MD, Signal Mountain Gary Zelizer, TMA Staff Liaison

INSURANCE ISSUES COMMITTEEB W. Ruffner, Jr., MD, Signal Mountain, ChairEdward Capparelli, MD, Jacksboro

Collin Cherry, MD, ChattanoogaEric Fox, MD, CookevillePaul Klimo, Jr., MD, MPH, MemphisCharles Leonard, MD, TalbottSharon Piper, MD, NashvilleMichael Raybeck, MD, ChattanoogaJane Siegel, MD, NashvilleIris Snider, MD, AthensFrederick Yarid, MD, MorristownPhyllis Franklin, TMA Staff Liaison

LEGISLATIVE COMMITTEEJohn Hale, Jr., MD, Union City, ChairDavid Armstrong, MD, Chattanooga Marcie Barr, Tullahoma, AdvisorSam Bastian, MD, FranklinElise Denneny, MD, Knoxville Robert Dimick, MD, Hermitage James Ensor, Jr., MD, FACP, Germantown Robert McClure, MD, Columbia Kathryn Potts, Chattanooga Bronn Rayne, MD, Cookeville Tedford Taylor, MD, Johnson City Gary Zelizer, TMA Staff Liaison

MEMBERSHIP COMMITTEEJerome Thompson, MD, Memphis, ChairKeith Anderson, MD, Germantown, TMA Board Liaison

Rodney Lewis, MD, Nashville Matthew Mancini, MD, Knoxville Erin Rohman, MD, Cookeville Nita Shumaker, MD, Hixson Christopher Tanner, TMA Staff Liaison

PUBLIC HEALTH COMMITTEEStuart Polly, MD, FACP, Memphis, ChairYasmine Ali, MD, Nashville Valerie Arnold, MD, Memphis


Lee Berkenstock, MD, Memphis Barry Jarnagin, MD, Franklin Benjamin Johnson, Jr., MD, Nashville Adele Lewis, MD, Nashville Pete Powell, MD, Franklin Kirk Stone, MD, Union City Bob Vegors, MD, FACP, Jackson, TMA Board Liaison

Lorrie Villeneuve, Johnson City, AdvisorPamela Slemp, Johnson City, TMA Staff Liaison

Brenda Williams, TMA Staff Liaison

PRACTICE MANAGEMENT & QUALITY COMMITTEEBenjamin Johnson, Jr., MD, Nashville, ChairJeffrey Jump, MD, Chattanooga Fredric Mishkin, MD, Kingsport Pete Powell, MD, Franklin Perry Rothrock, III, MD, Cordova Yarnell Beatty, JD, TMA Staff LiaisonAngela Madden, CHC, TMA Staff Liaison

PROFESSIONAL RELATIONSCOMMITTEERonald Kirkland, MD, Jackson, ChairDaniel Boyd, MD, Germantown Elise Denneny, MD, Knoxville James Haynes, MD, Ooltewah Barbara Kimbrough, MD, Johnson City Michel McDonald, MD, Nashville Samantha McLerran, MD, LivingstonNita Shumaker, MD, Hixson

Bobo Tanner, MD, Nashville Ashley Cates, TMA Staff Liaison

PHYSICIAN LEADERSHIPCOLLEGE STEERINGCOMMITTEEJohn Ingram, III, MD, Alcoa, ChairSamuel Bastian, MD, FranklinMichael Cates, CAE, MemphisJeffrey Fenyves, MD, KingsportGeorge “Trey” Lee, III, MD, MS, NashvillePhyllis Miller, MD, HixsonAshley Cates, TMA Staff Liaison

TENNESSEE MEDICINE EDITORIAL BOARDDavid Gerkin, MD, Knoxville, ChairLoren Crown, MD, FACEP, CovingtonJames Ferguson, MD, FACP, KnoxvilleKarl Misulis, MD, JacksonGregory Phelps, MD, MPH, MAHCM, Knoxville

Bradley Smith, MD, NashvilleJonathan Sowell, MD, KnoxvilleJames Talmage, MD, CookevilleAndy Walker, MD, NashvilleBrenda Williams, TMA Staff Liaison

TENNESSEE MEDICAL EDUCATION FUND BOARDRobert Kerlan, MD, FACP, Memphis, ChairMaysoon Ali, MD, FACP, WaverlySubhi Ali, MD, WaverlyRobert Bowers, MD, ChattanoogaJohn Ingram, III, MD, AlcoaGeorge “Trey” Lee, III, MD, MS, NashvilleNicole Schlechter, MD, NashvilleBob Vegors, MD, JacksonSam Williams, III, MD, Winter Harbor, ME, Special Advisor

Brent Atkinson, TMA Staff Liaison

YOUNG PHYSICIAN SECTIONDanielle Hassell, MD, Collierville, ChairJennifer Headrick, MD, Knoxville, Vice-Chair/AMA Alternate Delegate

Natalie Scott, MD, Greeneville, AMA Delegate

RESIDENT & FELLOW SECTIONFrederick Clayton, III, MD, Johnson City,Chair/Secretary/AMA Alternate DelegateHeena Khalid, MD, Memphis, Vice-Chair/AMA Delegate

M. Usman Khan, MD, Memphis, Trustee (BOT)/AMA Delegate

MEDICAL STUDENT SECTIONSamuel Riney, Memphis, UTHSC, Trustee (BOT)

Bedford County Medical SocietyTrent Cross, MD, PresidentMaxwell Huff, MD, Secretary

Benton-Humphreys County Medical Society Charles Heffington, Jr., MD, President Subhi Ali, MD, Secretary

Blount County Medical Society Nathan Schrock, MD, PresidentKimberly Weaver, Executive Director

Bradley County Medical SocietyJason Dunn, MD, President

Carter County Medical Society Scott Caudle, MD, PresidentJohn Green, MD, SecretaryPamela Slemp, TMA Staff Liaison

Chattanooga-Hamilton CountyMedical Society Mark Anderson, MD, FACP, PresidentWayne Scott, MD, Secretary Rae Bond, Executive Director

Coffee County Medical Society Brett Ferrell, MD, PresidentKeith Lovelady, MD, Secretary

Consolidated Medical Assemblyof West TennesseeKarl Rhea, Jr., MD, PresidentFielding Randolph, MD, Secretary

Cumberland County Medical SocietyJohn Milligan, MD, President

Component Medical Society Leadership

(Cont...)


DeKalb County Medical SocietyMelvin Blevins, MD, President/Secretary

Franklin County Medical Society Thomas Smith, MD, President

Greene County Medical SocietyScott Jay, MD, PresidentMichael Hartsell, MD, SecretaryPamela Slemp, TMA Staff Liaison

Knoxville Academy of Medicine Elise Denneny, MD, PresidentJeffrey Broussard, MD, SecretaryKimberly Weaver, Executive Director

Lakeway Medical Society John McGraw, Sr., MD, PresidentCharles Leonard, MD, SecretaryPamela Slemp, TMA Staff Liaison

Lincoln County Medical SocietyFred Ralston, Jr., MD, MACP, Secretary

Maury County Medical SocietyRodney Poling, MD, PresidentCharles Bramlett, Jr., MD, Secretary

The Memphis Medical Society Charles Larkin, MD, PresidentMelanie Woodall, MD, SecretaryMichael Cates, CAE Executive Director

Monroe County Medical Society Kenya Kozawa, MD, PresidentHasmukh Kanabar, MD, Secretary

Montgomery County Medical Society Charles Fitch, MD, PresidentRobert Kasper, MD, SecretaryWilma Cooley, TMA Staff Liaison

Nashville Academy of MedicineSteven Graham, MD, President Nicole Schlechter, MD, PhD, SecretaryKasey Anderson, Executive Director

Northwest Tennessee Academyof MedicineJames Shore, MD, President/Secretary

Overton County Medical Society Samantha McLerran, MD, SecretaryFern Savage, Staff Liaison

Putnam County Medical SocietyJohn Nichols, MD, PresidentDonald Tansil, MD, Secretary

Roane-Anderson County Medical SocietyEdward Capparelli, MD, PresidentKimberly Weaver, Executive Director

Robertson County Medical SocietyJonathan Kroser, MD, FACS, PresidentKeith Goldberg, MD, Secretary

Scott County Medical SocietyTrent Cross, MD, PresidentMaxwell Huff, MD, Secretary

Sevier County Medical Society Ammar Razzak, MD, FACP, President

Stones River Academy of Medicine David Beaird, MD, PresidentKerri Woodberry, MD, SecretaryWilma Cooley, TMA Staff Liaison

Sullivan County Medical Society Herbert Ladley, MD, PresidentJames Kneff, Jr., MD, FACEP, SecretaryPamela Slemp, TMA Staff Liaison

Tipton County Medical SocietySamuel Johnson, MD, PresidentRobert Lazar, MD, Secretary

Washington-Unicoi-JohnsonCounty Medical Society Paul Gorman, MD, PresidentFrederick Clayton, III, MD, SecretaryPamela Slemp, TMA Staff Liaison

Williamson County Medical Society Elliot Himmelfarb, MD, SecretaryWilma Cooley, TMA Staff Liaison

Wilson County Medical Society Wayne Wells, MD, PresidentDwayne Lett, MD, SecretaryJennifer Jessie, Staff Liaison

CMS contact information is available atwww.tnmed.org/directory; member loginrequired.


Dr. Caine was posthumously honored with the TMA Outstanding Physician Award.

Before his death on October 23, 2012, Dr. Caine had practiced internal medi-cine and hematology in Chattanooga since 1969. He was chief of the Hema-tology Service at the University of Tennessee College of Medicine- Chattanooga(UTCOMC) and chief of staff of Erlanger Hospital from 1989-1991. He servedas attending physician at Erlanger and clinical professor of medicine at the UT-COMC. While undergoing cancer treatment last fall, Dr. Caine continued hisactive schedule of patient care and teaching, up until the day before his death.

He twice received the Outstanding Teacher Award from UTCOMC; he also wonthe 2000 American College of Physicians National Volunteer Teacher of theYear Award and the appellation “Laureate in Medicine;” the 2001 Robert L.Summitt Award for Leadership in Medical Education from the University ofTennessee; the 2009 Baroness Erlanger Foundation Distinguished PhysicianAward; and the 2010 Augustus McCravey Award for a Lifetime of Excellence inMedical Education. Dr. Caine served as program director for MKSAP ReviewCourses from 1979 until his death.

He was a member of the American Society of Hematology, American MedicalAssociation, a Diplomate of the American Board of Internal Medicine, and wasactive in the TMA as a longtime member and former chairman of the Contin-uing Medical Education Committee. Dr. Caine was also a volunteer physicianwith Hamilton County Project Access.

Winston P. Caine, MD, FACP

Dr. Caine received a posthumous Outstanding Physician Award; his family, including widow Priscilla (2nd from right), was on hand for the honor.

BOUTSTANDING PHYSICIAN AW

ARD

“Dr. Caine’s devotion to hispatients and their careinspired his pursuit of

medical knowledge, andhe loved to teach and

impart this knowledge tocountless medical students,

interns and residentsfor whom he became

a role model.” — Dr. John McCarley

Chattanooga-Hamilton County Medical Society


Dr. Higgs was honored for his “stellar” career in medicine as well as his second career involunteerism following his retirement from practice. His leadership in medicine and or-ganized medicine and his community activism were emphasized in the nomination letterfrom Consolidated Medical Assembly of West Tennessee.

A former president of both Consolidated Medical Assembly and the Tennessee chapterof the American Academy of Pediatrics, Dr. Higgs was a longtime partner in The JacksonClinic, practicing in the Department of Pediatrics. He is a former clinical instructor in theUniversity of Tennessee Department of Family Practice and served on the medical staffat Jackson-Madison County General Hospital. After serving as a captain in the U.S. AirForce, in 1960-62 he served as director of Pediatrics at the Frank T. Tobey Memorial Chil-dren’s Hospital, a precursor to St. Jude’s Children’s Research Hospital in Memphis.

A Diplomate of the American Board of Pediatrics, he also served as editor of the Ten-nessee Pediatric Society newsletter and during practice, also volunteered with the Head-start program and with Madison County Health Department clinics. After retirement fromThe Jackson Clinic in 1997, Dr. Higgs continued volunteering with Madison County clin-ics and began serving a as a volunteer physician for Hospice of West Tennessee Health-care. He has served as a board member and mentor with Youth Town of Jackson.

“I can think of no finerphysician in our

community to be considered for

this award.” — Robert D. Vegors, MD, FACP Consolidated Medical Assembly

of West Tennessee


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OUTSTANDING PHYSICIAN AWARDPresented annually by the TMA House of Delegates to member physicians who have made their

own personal mark on the profession of medicine in Tennessee and on those whom they have

worked with and known during their illustrious medical careers.B

Dr. Bobby Higgs addresses the crowd after receiving his TMA Outstanding Physician Award.

Bobby Clark Higgs, MD


Dr. Lamb was nominated by the Nashville Acad-emy of Medicine for his 40 years of service toNashville patients as an orthopaedic surgeon andhis simultaneous service to his community andhis profession.

He is lauded for co-founding the Faith FamilyMedical Clinic in Nashville with Dr. David Gaw.The clinic has served over 20,000 low-income,uninsured Nashvillians since 2001 and Dr. Lambremains an active volunteer specialist and boardmember. He is a board member and for the past20 years a monthly volunteer with the NashvilleRescue Mission, and a former chairman of theNashville Chapter of the Arthritis Foundation, re-ceiving that organization’s Volunteer Distin-guished Service Award in 1999. His career andvolunteer contributions led to his receiving aHealth Care Heroes Lifetime Achievement Awardfrom the Nashville Business Journal in 2012.

Dr. Lamb filled numerous leadership roles in theAcademy including on various committees, aschairman of the board, as president in 1998 andas a delegate to the TMA. Other active member-ships include the AMA, Nashville Surgical Soci-ety, Nashville Orthopedic Society, AmericanAcademy of Orthopedic Surgeons, American Col-lege of Surgeons and the InternationalArthroscopy Association.

“Dr. Lamb has exemplifiedthe characteristics of an

outstanding physician throughout his career.

He has been dedicated to his profession, his family, and our community.”

— Dr. Michel McDonald Nashville Academy of Medicine

John W. Lamb, Sr., MD

Following the April ceremony, Dr. Lamb poses with his TMA award.


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RAC Audits . . .are you the next target?Unfortunately, physicians are a soft targetwhen it comes to a RAC audit investigation.

That's why The TMA Insurance Agency offers an insuranceprogram to combat the financial damage that can be caused byRAC audits. Our program pays for the investigation costs andshadow audits, as well as fines and penalties resulting from theprocess. As RAC audits continue to increase, your facility is atgreater risk for a review and potential fines.

Why not be prepared and take a proactive step to protect yourpractice and reputation? Contact us today to learn more aboutthis specialized program!

THE TMA ASSOCIATIONINSURANCE AGENCY, INC.Exclusive Insurance Plan Administratorfor the Tennessee Medical Association

[email protected]

800.347.1109


Dr. Dugdale was nominated by The Memphis MedicalSociety for her significant contribution to public healthand the field of blood disorders over the past year.

A leader in the field of blood clotting since joining theUniversity of Tennessee Health Science Center(UTHSC) in 1962, Dr. Dugdale has worked tirelessly formore than fifty years taking care of patients with rareblood disorders. She is a former professor in theUTHSC Department of Medicine (Hematology) andwas appointed professor emeritus in 2009. In 1986she served as president of the now-closed UT-BowldHospital in Memphis.

For over 30 years, Dr. Dugdale has held a contractfrom the Tennessee Department of Public Health for

the provision of hemophilia diagnostic, treatment, re-ferral and counseling service for state-approved pa-tients. She also holds a contract with the University ofNorth Carolina as part of an NIH grant in the study ofadult hemophilia.

Her numerous honors include UTHSC’s Gene Stoller-man Outstanding Faculty Teaching award, the Distin-guished Service Award from The Regional MedicalCenter at Memphis, the 2011 Healthcare Heroes Life-time Achievement Award from the Memphis BusinessJournal, the Humanitarian Award from the Memphischapter of the National Hemophilia Foundation, andthe Special Award for the Commitment to the Im-provement of Hemophilia Care in West Tennessee.

“It is with great pride that The Memphis Medical Societynominates Marion Dugdale,MD, for the DistinguishedService Award.” — Dr. Robert Miller The Memphis Medical Society

Marion Dugdale, MD

BDISTINGUISHED SERVICE AW

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DISTINGUISHED SERVICE AWARDPresented annually since 1963 by the TMA Board of Trustees to exemplary members of the associ-

ation for their notable achievements during the past year. Recipients are physician members who

deserve recognition of outstanding service or contribution to the advancement of medical science,

or to this Association, or to the public welfare, whether of a civic or scientific nature. B

TMA Board of Trustees Chairman Dr. Keith Andersonpresents the TMA award to Dr. Dugdale.


A TMA president in 2010-2011, Dr. Ruffner washonored for his work as an advocate for qualityhealth care in Tennessee and for the professionof medicine.

In the past year he served in a number of lead-ership roles including as the TMA representativeto the AMA Physicians Consortium for Perform-ance Improvement (PCPI). PCPI is a national,physician-led program dedicated to enhancingquality and patient safety. He also representedTennessee in the AMA Council on Senior Physi-cians and as an alternate delegate to AMA. Dr.Ruffner served as treasurer and a member of theBoard HIP-TN (Health Information Project-Ten-nessee) as it laid important groundwork for Ten-nessee’s ongoing efforts to foster the adoptionand use of electronic health records. In 2012 Dr.Ruffner assisted with the “wind-down” of the or-ganization as the state of Tennessee decided tomove in a new direction to facilitate secure elec-tronic communication of medical information.He also served in as a consultant for the Centerfor Medical Technology Policy and to the Blue-Cross BlueShield of America Technology Evalua-tion Center.

He served on the Hamilton County Project Ac-cess Operations Council, which oversees day-to-day policy for the charity health care initiative.Dr. Ruffner is an active member of the Chat-tanooga-Hamilton County Medical Society Boardof Directors and provided strong leadership forthe 2012 Doctors’ Day on the Hill and other Gov-ernmental Affairs Committee activities. He is arecognized and respected leader on health carepolicy issues. In 2012, Dr. Ruffner also chairedthe Baroness Erlanger Foundation, which pro-vides support for the Erlanger Health System inHamilton County.

“We think it is extremely noteworthy that Dr. Ruffner has devoted his time and talents topromote quality health care in

Tennessee and has worked tirelessly to be a staunch advocate

for the profession of medicine.” — Dr. John McCarley

Chattanooga-Hamilton County Medical Society

B W. Ruffner, Jr., MD, FACP

Dr. Ruffner poses with his 2013 TMA Distinguished Service Award.

BDISTINGUISHED SERVICE AW

ARD


Greater Memphis Greenline was nominated by The Memphis Med-ical Society for positive impact on the health of Shelby County citi-zens, GMGI advocates and organizes for a network of integratedhiking and biking trails, greenways and bicycle lanes throughoutMemphis and Shelby County. Its efforts have led to paved trails useddaily by hundreds for recreation promoting healthy lifestyles and en-hanced quality of life.

Getting a paved trail took great effort. Targeting an abandoned CSXline passing through Shelby Farms, GMGI led a seven-year effort,which culminated with the 2010 opening of the seven-mile ShelbyFarms Greenline.

Public experience with the Greenline created great synergy for otherefforts. Now the network connects Germantown with the Bing-hampton area. Memphis created 54 miles of bike lanes. GMGI hasspawned efforts to connect the Greenline with Overton Park and toconnect downtown Memphis to Arkansas with a bikeway across theMississippi River. Shelby Farms is expanding the Greenline to Cor-dova. GMGI leads the effort to pave an old rail spur in North Mem-phis, crucial to connecting Overton Park with downtown Memphiswhile providing safe recreation in a chronically underserved area.

Greater Memphis Greenline, Inc.(GMGI)

COMMUNITY SERVICE AWARDThe TMA annually recognizes persons or organizations outside the medical profession who

contribute significantly to the advancement of public health in their respective communities.B

BCOMMUNITY SERVICE AW

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Greenline President Nancy Ream accepts the TMA Community Service Award for improvingthe health of Shelby County citizens with hiking and biking trails and greenways.


Hamilton County Project Access was nominated bythe Chattanooga-Hamilton County Medical Society(CHCMS) for its work to provide medical services tothe low-income, uninsured residents of HamiltonCounty and the greater Chattanooga area. It isspecifically cited for creating unprecedented coop-eration among diverse health partners, and for itsassistance and technical support to Project Accessprograms in Knoxville and the Tri-Cities area.

Managed by the Medical Foundation of Chat-tanooga, it was the first Project Access initiative inthe State of Tennessee. Since its beginning in April2004, Hamilton County Project Access has coordi-nated more than $100 million in documentedhealthcare services from physicians, health centers,laboratories, hospitals, rehabilitation and physicaltherapy facilities, and other partners. The servicesare provided at no charge to qualifying patients –those with incomes below 150-percent of povertywith no other access to health care.

“This is at the heart of our missionas physicians.”

— Dr. John McCarley Chattanooga-Hamilton County

Medical Society

Hamilton County Project Access

Medical Foundation of Chattanooga Vice President Dr. Peter Rawlings accepts the TMA Community Service Award for Hamilton County Project Access.


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Dr. Self is president and CEO of the Baptist Heal-ing Trust, a private grant-making foundation sup-porting the work of nonprofit organizations inMiddle Tennessee that provide health servicesto vulnerable and underserved populations. Asits leader, she is cited for her passionate advo-cacy on behalf of each organization funded bythe trust.

She is credited for leading and expanding theTrust’s “Caring for the Caregiver” program, de-signed to strengthen and address the emotional,mental and spiritual needs of caregivers andmedical professionals. Quarterly retreats forphysicians and monthly retreats for non-physi-cian caregivers have become a vital part of thatprogram.

A physical therapist and home health profes-sional, she previously served in various leader-ship roles in rehabilitations services at BaptistHospital and as a director of organizational andleadership development and vice president oforganizational learning at St. Thomas HealthServices before first working with Baptist HealthTrust as consultant in 2005. She became seniorvice president of the Trust in 2007 and wasmade CEO in 2010.

“She is keenly interested in leadership development and

organizational culture change, and develops a ‘coaching’

relationship with many leadersamong the agencies with whom

the Trust is involved.” — Dr. Michel McDonald

Nashville Academy of Medicine

Catherine Self, PT, PhD

TMA Community Service Award winner Catherine Self accepts the congratulations of Dr. Anderson.


2012 Estimated Income: $3,380,250

A balanced budget had been projected for 2012 with revenuesand expenditures projected at $3,356.250. Actual revenue was$3,142,116 and actual expenses were $3,486,116, resulting in$344,000 expenses over revenue.

Through the efforts of our Investment Committee, chaired bySubhi Ali, MD, we experienced a 10.37-percent increase in thevalue of our Reserve Investments in 2012. The Reserve Invest-ments balance as of December 31, 2012, was $1,775,385.73. Thebenchmark set forth by the TMA Investment Policy is that thefund exceeds the S&P 500 by two percent. For 2012, the S&P 500

increased at a rate of 16.00 percent; therefore, the TMA’s ReserveInvestments fell short of their benchmark by 5.63 percent for2012. All investments were made within the parameters of theTMA’s Investment Policy (revised July 18, 2010). Of note is the factthat the TMA has contributed in excess of $1,000,000 over thepast 11-year period for revenues exceeding expenses.

To view a full copy of the 2012 TMA audit conducted by the firmof Bellenfant & Miles, PLLC, certified public accountants, pleasemake an appointment with TMA Director of Finance Brent Atkin-son at 800-659-1862 or [email protected].


2012 Estimated Income: $3,380,250 2012 Estimated Expenses: $3,380,250

Member NewsVisit www.tnmed.org for the latest TMA news, information and opportunities!

The 108th General Assembly was gaveled into session on January 8 withRepublican supermajorities in both the Senate and the House. Lt. Gov.Ron Ramsey and Speaker Beth Harwell were easily re-elected to leadthe State Senate and State House, respectively. Returning memberswelcomed eight freshmen Senators and 23 freshmen Representatives.Of particular note were the three new physician members of the StateSenate (and TMA members): Dr. Joey Hensley of Hohenwald, who leftthe House to run a successful Senate campaign; Dr. Steve Dickerson ofNashville; and Dr. Mark Green of Clarksville. All three physicians wereawarded plum committee assignments on Health, Commerce, Judiciary,Finance and Education.

A new rule offered by the House Speaker and adopted by the HouseRules Committee limited each member to 15 bills to sponsor; as such,only 1,365 bills were filed in the House that had companion bills in theSenate, a far cry from the normal 2,000+ usually filed each year. Giventhe composition of the Senate Health and Welfare Committee, whichgreatly favors the medical community, the session may be known morefor what was not filed than what was introduced. After a number ofyears of laying the groundwork and working with a grant from the

Robert Wood Johnson Foundation, thenursing community did not bring legis-lation on independent practice, as hasbeen done in a number of other states.Psychologists chose not to introduce a bill that would permit them toprescribe psychotropic drugs, the first time in memory. Optometrists,who had been hinting about expanding their scope of practice to per-mit them to perform laser and other surgeries, came instead with a billto permit them to use injectable anesthetics to remove eyelid growths;they are now permitted to do the same but only under topical anes-thetic. Despite the paucity of scope bills, there was some discussion,prompted by the Tennessee Nurses Association (TNA), about the lackof primary care physicians in the state and the need to address thatissue by broadening other providers’ ability to provide medical serv-ices to Tennesseans newly insured under the Patient Protection andAffordable Care Act. The TNA continues to voice concern about nursepractitioners being able to practice to the fullest extent and ultimately

Notable Issues of the 2013 General AssemblyTMA Wins with NAS Safe Harbor, Youth Concussion; Blocks Helmet Law Repeal, Optometrist Scope Bills

(Continued on page 59)

Physicians should have received letters in May from TennCareMCOs outlining how they will receive the new payment increase forMedicaid primary care providers, and should read everything care-fully and respond by July 15. The information in the letters will af-fect the next steps they are required to take to receive payment.

The Tennessee Medical Association previously alerted mem-bers to the January 1 increase, and met recently with the TennCareBureau to discuss final plans for getting those increased paymentsto Tennessee providers.

WATCH FOR LETTERSBureau officials reported that all three TennCare MCOs sent letters

to physicians on May 3, 2013, explaining the process to receivethese payments. Physicians have until July 15 to send in the attes-tation forms in order to receive retroactive payments back to Janu-ary 1, 2013, dates of service.

Each TennCare MCO sent out two different types of letters:

1. Physicians may receive an MCO letter stating they have al-ready qualified to receive the increased payments. De-pending on the MCO’s ability to systematically access theircredentialing information, they may be able to search for

Alert: Letters Sent On Tenncare Primary Care Rate Increase


By Gary ZelizerTMA Government Affairs Director



Member News


Physician practices should check the state's Controlled Substance Mon-itoring Database (CSMD) monthly to ensure record accuracy and to de-tect any unauthorized use of a physician's DEA license.

That from the TMA Legal Department, which seeks to be a physi-cian advocate on legal and regulatory issues, including prescribinglaws. The Tennessee Medical Association continues to keep membersinformed, work behind the scenes to seek adjustments, and give feed-back to state officials on issues that arise with the state’s prescribingdatabase.

IMPORTANT INFOThe CSMD Committee encourages all prescribers to run a PractitionerReport monthly and review it for unauthorized use of a physician’s DEAlicense or for erroneous information.

Unauthorized UseAlert local law enforcement if you find a physician’s DEA number hasbeen used without his or her permission. Be advised the law regardingprosecution of unauthorized use of a DEA license will change on July 1.Currently, the individual who allegedly uses a DEA license illegally mustbe prosecuted in the location where the prescription was filled; effec-tive in July, the venue may be either the county where the offense iscommitted or the county where the physician practices or resides, re-gardless of whether the defendant was ever in that county. This newlaw also allows for additional charges against the defendant, includingidentity theft and prescription drug fraud (see details in our Law Guidetopic on Controlled Substances, Section VIII-E, available atwww.tnmed.org/lawguide). Until then, if a DEA license is used illegallyoutside the county of the physician’s practice, local law enforcementshould forward the report to the appropriate jurisdiction and the re-porting physician may receive a call to verify the information.

Erroneous InformationContact the filling pharmacy as soon as possible if a physician discov-ers a mistake in the information in his or her Practitioner Report. A dis-cussion with the pharmacist to correct the mistake will hopefully clearup the error. If the pharmacy chooses not to correct it, call the Board ofPharmacy or email it the pharmacy’s information; the board will get intouch with the pharmacy to have it corrected. Contact Terry Grinder, theboard’s interim director, at 615-253-1306 or [email protected].

For more information or assistance, contact the TMA Legal Depart-ment at 800-659-1862. +

Prescribing Database:Important Things to Know

Due to TennCare budget cuts, obstetrical practices in Tennesseeare beginning to receive either recoupment demands or letters no-tifying them of “adjustments” to their reimbursement claims. Theactions by the TennCare Bureau come as a result of a seven-per-cent reduction in reimbursement rates for cesarean and vaginaldeliveries, retroactive to July 1, 2012.

The TMA Insurance Recovery Program has received calls frommembers about the rate reduction. The Tennessee Medical Asso-ciation provides insurance advocacy for members, as well as guid-ance and assistance on health insurance billing and paymentproblems.

BACKGROUNDIn 2012, the TennCare budget required managed care organiza-tions (MCOs) to implement a new policy regarding Cesarean andVaginal Delivery Reimbursement as follows:

• to increase vaginal delivery rates by up to 17 percent.• to pay the same rate for Cesarean and vaginal deliveries

effective July 1, 2011.

However, the 2013 Budged passed by the General Assembly in-cluded a seven-percent reduction, effective July 1, 2012, resultingin possible claims adjustments.

For more information, or help with insurance issues, contactthe TMA Insurance Recovery Program at 800-659-1862 or [email protected]. +

TennCare ImplementsOB Delivery Rate Reduction

Member News

47Tennessee Medicine + www.tnmed.org + JUNE/JULY 2012 47Tennessee Medicine + www.tnmed.org + JUNE/JULY 2013

The Tennessee Medical Association is mourning the loss of three for-mer presidents within a month. Charles Edward Allen, MD, of JohnsonCity, died April 17; John Brown Thomison, Sr., MD, of Nashville, diedon April 21; and Robert D. Kirkpatrick, MD, of Germantown, died onApril 26.

“We are extremely sad to be missing these leaders of medicine.Each of these men has made historic contributions to health care, toorganized medicine and specifically to our Association,” said TMAChief Executive Officer Russ Miller.

Dr. Allen served as TMA president in 1992. “His dedication to med-ical education and organized medicine are unparalleled,” said Miller.After serving as a U.S. Army captain, he joined The Medical Group ofJohnson City in 1962, where he practiced until retirement in 2001. Analumnus of the University of Tennessee College of Medicine in Memphis,

Dr. Allen recognized the critical need for more physicians in rural EastTennessee; he rallied support and led a 14-year effort to create what isnow Quillen College of Medicine at East Tennessee State University.For his work, he received the Governor’s Outstanding TennesseanAward, the TMA Distinguished Service Award, the ETSU Alumni Asso-ciation, and the Tennessee Hospital Association’s Membership ServiceAward. In 1985, the Charles E. Allen Annual Distinguished Lectureshipin Medicine was established at the medical school, and a building onthe VA campus in Johnson City is named in his honor. His numerousleadership roles within the AMA included longtime delegate, commit-tee member, director of the Accreditation Council on Graduate MedicalEducation, and trustee for the Educational Commission for ForeignMedical Graduates. He was a member of the Washington-Unicoi-John-son County Medical Society.

The longtime, beloved editor of the Journal of the Tennessee Med-ical Association, Dr. Thomison also served as TMA president in 1988.Graduating from Vanderbilt University Medical School with his MD in1944, Dr. Thomison taught pathology and infectious disease at Van-derbilt where he developed diagnostic standards for clinical cervicalcytology. He went on to co-found Associated Pathologists and Interna-tional Clinical Laboratories and served as pathologist at CentennialMedical Center. Along with president and editor/editor emeritus of theJournal, Dr. Thomison served the TMA as an AMA delegate, was the


With the October 1, 2014, ICD-10 transition deadline approaching, you maybe wondering how to code a claim you are submitting in October 2014 fora service provided in September 2014. The answer: even if you submit yourclaim on or after the ICD-10 deadline, if the date of service was before theOctober 1, 2014, deadline, you will use ICD-9 to code the diagnosis.

WHEN TO SWITCH?For dates of service on or after the October 1, 2014, deadline, you will useICD-10. You may not be able to use ICD-9 and ICD-10 codes on the sameclaim based on your payers' instructions. This may mean splitting servicesthat would typically be captured on one claim into two claims: one claimwith ICD-9 diagnosis codes for services provided before October 1, 2014,and another claim with ICD-10 diagnosis codes for services provided on orafter October 1, 2014.

Some trading partners may request that ICD-9 and ICD-10 codes besubmitted on the same claim when dates of service span the compliance

date. Trading partner agreements will determine the need for split claims.Here is an example of a split claim: A patient has an appointment on

September 27, 2014, and is diagnosed with bronchitis. He returns for a fol-low-up appointment on October 3, 2014. In this case, a practice will sub-mit a claim with an ICD-9 diagnosis code for the first visit and another claimwith an ICD-10 diagnosis code for the follow-up visit.

KEEP UP TO DATEMake sure your systems, third-party vendors, billing services and clearinghouses can handle both ICD-9 and ICD-10 codes in the months following October 1, 2014. Visit the TMA ICD-10 web page atwww.tnmed.org/ICD-10 for resources, tools and upcoming seminars. Youcan also visit the CMS ICD-10 website at www.cms.gov/Medicare/Cod-ing/ICD10/index.html?redirect=/ICD10. Contact TMA Practice Solutions at800-659-1862 with any questions.+

ICD-10 Transition: Dates of Service Question?

Dr. KirkpatrickDr. ThomisonDr. Allen

Loss of Three Former Presidents Deeply Felt


Member News


MEDTENN 2013 PHOTO GALLERY

Dr. Nancy Chase of Memphis pro-vides the traditional bagpipe reelto open the 2013 House of Dele-gates session.

Incoming President Dr. Chris Young (left)presents outgoing President Dr. WileyRobinson with his presidential gavel duringinauguration ceremonies.

Members of TMA Region 8 hold a caucus meeting to discuss resolutions before the final House of Delegates session.

Russ Miller gives his first addressas TMA chief executive officer tothe House of Delegates.

3

Member News


TMA former presidents gathered again this year for their traditional portrait. (L-R): Drs. Wiley Robinson, Charles White, Sr., David Gerkin, Robert Bowers, Richard DePersio, John Ingram, John Dorian, Michael McAdoo, Subhi Ali, Mack Worthington,Chris Fleming, Barrett Rosen, Michael Minch, B W. Ruffner and Ted Galyon.


Dr. John Hale proudly shows off his Capitol Hill Club ribbon during a visit to the IMPACT booth.

TMA Resident & Fellow Section Poster Competition winnerDr. Gregory Nieckula poses in front of his winning entry.He is an internal medicine resident at the University ofTennessee College of Medicine-Chattanooga.



Member News


Drs. Robin Williams of Nashville, Danielle Hassel of Germantown and Adele Lewis of Nashville enjoy the opening MedTenn reception.

Guests dance to the R&B sounds of the Scat Springs Bandduring the Saturday night inauguration reception.

XMC Middle Tennessee General Manager Doug Lackey presents Jan Headrick with NCAA Final Four tickets, won in aMedTenn drawing.

Dr. Sidney Moragne of Jackson (left) and Lorrie Villeneuve ofJohnson City were the winners of iPad minis given away byMedTenn sponsor EVault.

3

Member News


Helpful new tools to smooth out the transition to ICD-are now available on the TMA website:a transition toolkit and special software, priced at a discount for TMA members only.

This toolkit is designed as a vir-tual ICD-10 consultant, providingcomprehensive tools and guid-ance to physician practices man-aging their own ICD-10 Transition.It is suitable for any size practiceand specialty. This interactive,user-friendly program will guideyou from the planning phases

through implementation, saving all of your information and progress, and populating it to re-lated projects so analysis can be instantly performed. Editing capabilities make it customiz-able to every practice.

THIS COMPREHENSIVE WEB-BASED APPLICATION INCLUDES:• Organization and key stakeholder surveys• Project planning and assessment tools• Project charter, communication and training

plans• Documentation chart reviews• Budgets and budget impact assessments• Post-transition guidance, revenue tracking

and analysis• Conversion tools for your top diagnosis codes• Five-part video series describing each phase

Cost: $399 + $35 per provider

YOU'LL LOVE HOW THE TOOLKIT:• Helps determine strategic direction• Assists in determining implementation costs• Facilitates budget management and

progress tracking• Creates and maintains your ICD-10 timelines• Manages staff participation and accounta-

bility• Assigns tasks, follow up and roles for your

entire organization• Tracks internal and external readiness

preparations• Helps plan training and educational materials• Sets up and manages the entire process

SEE HOW EASILY YOU CAN:• Convert superbills and EHR problem lists• Print custom documentation training tools• Jump start your ICD-10 training process• Engage and motivate providers and staff• Save hours of time converting codes

WEB-BASED• Access from anywhere using any com-

puter that has an internet connection.Also works on mobile devices and tablets.

• Subscription based - Renewed annually.

DOWNLOAD• Single seat license, good for installation

on one PC (not compatible with Mac). • No ongoing subscription costs or update

fees. • One-time cost.

New ICD-10 Tools for Members

Physicians who have been asked to sign anew insurance contract related to the im-plementation of a health insurance ex-change (HIX) are being asked to share thecontract with the Tennessee Medical As-sociation and the American Medical Asso-ciation. The contract will become part ofan AMA database of contract examples, toaid in advocacy efforts during implemen-tation of these exchanges under the Af-fordable Care Act.

Please email the de-identified con-tract examples or questions [email protected] or fax to 615-312-1907.Please redact all individual physician andinsurer information and make sure thatthe disclosure of it does not violate theterms of the agreement(s) with an insurer.You or your practice will not be identifiedand de-identified contract provisions maybe used in AMA advocacy efforts.

NEW CONTRACTSIn preparation for a federally-operatedexchange in Tennessee, insurers may betaking steps to ensure an adequatephysician network and this may requirea new agreement between a physicianand an insurance plan.

The AMA has received reports of unfaircontracting, transparency and other issuesinvolving insurers. The database will helpidentify trends and other issues and aid theAMA and TMA in notifying physicians of po-tentially unfair practices. In addition to a li-brary of contracts, the AMA will developresources that will likely include Web andprint-based presentations, model legisla-tion to combat unfair practices, and otherresources as needed.

For more information, contact the TMALegal Department at 800-659-1862. +

AMA AskingDocs to ShareHIX Contracts

Cost: $129

For more information on both of these resources, visit www.cpticdpros.com/tnmed/. +


Member News


PERSONALOfficial Title/Position: Medical director, Ten-nessee Comprehensive Pain Center; associ-ate clinical professor of Anesthesiology,Vanderbilt University School of Medicine(part-time).Company/Years: 22 years at Vanderbilt / twomonths at TCPC.Practice Interests/Specialties: Anesthesiol-ogy and pain medicine.Most Important Accomplishment: Seventrips to the Philippines with Operation Smileteams to deliver anesthesia services for cleftpalate and burn surgeries.Family: Married to Willa-Jean Johnson for 37years; four sons and four grandchildren.Something Not Widely Known About You: I enjoy golf, deep sea fishing, reptiles, tropicalfish.Currently Reading: Contributions of VariousStructures in Chronic Low Back Pain, byManchikanti, et al.

COMMITTEEYears as Chair: Three years.Why Agreed to Step into Leadership Role: The Physician Lead-ership College was a great inspiration to get involved with or-ganized medicine. Goals and Philosophy as Committee Chair: To build a teamof physicians committed to ensuring that Tennessee physi-cians have the best opportunity to create a practice environ-ment that is fulfilling to them and edifying to our patients. Theemphasis is to facilitate access to methods of developing a flexible, robust medical practice thatcan adapt to our changing healthcare environment and still bring the best that medicine has tooffer to our patients.Most Important Accomplishments of Your Committee: Our current project to improve the educa-tional mission of the TMA.Importance of the TMA and This Committee: The TMA must be the voice of Tennessee physiciansas we address the critical issues that impact our ability to deliver the highest quality of care to ourpatients. One of the most important issues in healthcare delivery must be the quality of the physi-cian as well as the practice environment created. Our committee studies various practice manage-ment strategies and practice instruments and makes recommendations to the TMA board regardingthe feasibility, practicality and risk potential to our physicians. In addition, the committee is planningto upgrade the educational mission of the TMA to better equip our physicians with relevant, cost-effective educational venues that meet their educational and professional needs. +

Interested in serving on a TMA Committee? Visit http://tnmed.org/TMA_committees/ or email [email protected].

MEET

1997 recipient of the TMA Outstanding Physician Award. Additionalleadership and presidency roles in medicine are too numerous tomention. He was also editor and editor emeritus for the SouthernMedical Association Journal. “He directly influenced the spirit andthoughts of Tennessee physicians through his editorials for so manyyears,” said Miller. “The mark he left on Tennessee medicine is perma-nent, respected and will always be remembered.”

Dr. Kirkpatrick held the TMA presidency from 2008-2009 and wasa longtime member of the TMA House of Delegates, Board of Trusteesand numerous committees, delegate to the AMA, and chaired the Ten-nessee Foundation for Quality Patient Healthcare. He received theTMA Distinguished Service Award in 2010. A family medicine/occupa-

tional medicine specialist, he also served as president and boardmember for the Tennessee College of Occupational and EnvironmentalMedicine, president of The Memphis Medical Society, and board mem-ber and delegate for the Tennessee Academy of Family Physicians.Until his death, Dr. Kirkpatrick was serving as medical director withthe State of Tennessee Workers’ Compensation Division. He was chairof the Department of Family Medicine at St. Francis Hospital, andmedical director at several clinics and companies. Dr. Kirkpatrick re-ceived his MD from the University of Tennessee Health Science Center.

“‘Dr. K’ has been a integral part of TMA leadership for more thantwo decades and his friendship, support, and love for organized medi-cine will be greatly missed,” said Miller. +

LOSS OF THREE FORMER PRESIDENTS DEEPLY FELT(Continued from page 47)

Practice Management & Quality Committee Chairman Dr. Benjamin Johnson

Member News


East Tennessee State University James H. Quillen College of MedicineMeagan Aiken, Grnvll Hosp Sys/U SC, Ped Jason Barter, GA Hlth Sci U, Em MedAshley Blevins, U Lousvll SOM-KY, OB/GYN Frederick Bossert, UTCOMC, OB/GYN Kiana Brooks, ETSU QCOM, OB/GYN Bradley Broyles, UTCOMC, Em Med William Buselmeier, Self Reg Hlthcr-SC, Fam Med David Carver, UTHSC, Surg - Ortho Angela Cowart, Sinai Hosp-Balt-MD, OB/GYN Dane Daley, Med U SC, Surg - Ortho James Fisher, Walter Reed Natl Mil Med Ctr, TransLeslie Fitzgerald, ETSU QCOM, Int Med Jason Fogleman, UTCOMC, Surg - Ortho Robert Gibson, U FL COM-Shands Hosp, Int Med Julia Haston, Med U SC, Ped David Henley, Womack Army Med Ctr, Fam MedRobie Hensley, ETSU QCOM, Fam Med/Bristol Sarah Hockaday, Navy Med Ctr Prtsmth, Em MedJennifer Laird, Mem Hlth /U Med Ctr-GA, OB/GYN Audrey Marsidi, U CT SOM, OB/GYN Elisabeth McGaw, VA Cmnwlth U Hlth Sys, OB/GYN Niva Misra, U TN SOM-Knox, Int Med Lauren Moore, U VA, Psych Sara Negrotto, Mayo Sch Grad Med Ed-MN, Int Med

Avery Nolen, OH ST U Med Ctr, Urban Track, Fam Med Andrew Parsons, U VA, Int Med Amit Patel, Tulane U SOM-LA, Oto Ron Pearson, U TN SOM-Knox, Trans /Rad; Rad-Diag Jamie Perry, U TN SOM-Knox, OB/GYN Andrew Pierce, U FL COM-Shands Hosp, Psych Andrew Press, Vidant Med Ctr/East Crlna U-NC, Em Med Erin Preston, New Hanover Reg Med Ctr-NC , OB/GYN Jessica Pugh, ETSU QCOM, OB/GYN Justin Quinn, Palmetto Hlth Rchlnd-SC, Fam Med William Rasberry, UT/Bapt Hosp-Nash, Int MedJames Reagan, Marshall U SOM-WV, Surg-OrthoRebecca Red, Grand Rapids Med Ed Prtnrs-MI, OB/GYNIan Ross, Barnes-Jewish Hosp-MO, Int MedChristine Smith, Med U SC, PedMichael Snyder, Navy Med Ctr Prtsmth, Int MedKalpana Suresh, Christiana Care Hlth Svcs-DE, Surg-GenJessica Tate, FL St U COM, PedMegan Varvoutis, Mem Hlth-U Med Ctr-GA, OB/GYNSamuel Webb, U TX Sthwstrn Med Sch-Dall, OB/GYNJocelyn Wilson, Baylor Med Ctr-Garland-TX, Fam Med

Meharry Medical CollegeJanelle Anderson, Loma Linda U, Int MedLakeisha Chism, No MS Med Ctr, Fam MedIdoreyin Montague, Johns Hopkins Hosp, Int Med/PedEarl Stewart, Jr., Rhode Island Hosp-Brown U, Int Med

ETSU Quillen College of Medicine Grad Brad Boyles and wife Lisa pose with their proud son during Match Day festivities. Dr. Broyles is headed to an

emergency medicine residency in Chattanooga.

Match Day at TN Medical SchoolsTHE TMA IS HONORED TO RECOGNIZE ITS STUDENT MEMBERS ON THEIRGRADUATION AND CELEBRATE THEIR MATCHES FOR RESIDENCY TRAINING.

Smiling Meharry grad Idoreyin Montague points to her Match Day residency location: Johns Hopkins Hospital in Baltimore. Photo: Emanuel Roland


Member News


University of Tennessee Health Science CenterAllen Alana, UTHSC, PedJacqueline Angel, UTHSC, Trans Year/ U AL Med Ctr-Birm, Rad-DiagMallory Baker, U Lousvll SOM-KY, Med-PedMatthew Barnes, UTHSC, Int MedTaylor Barnett, Scripps Clin/Green Hosp-CA, Int MedChristopher Bates, UTHSC, Rad-DiagJessica Baumann, U AZ Affil Hosp, PathDavis Berry, UTHSC, Surg-PrelimSneha Bhat, U TN Grad SOM-Knox, Gen SurgAleksandr Birg, U IL COM-Chcgo, Int MedMatthew Broyles, U AL Med Ctr-Birm, AnesthJessica Burke, Rush U Med Ctr-IL, Int MedAmie Cahill, UTHSC, PedCarla Cash, U TX Sthwstrn Med Sch-Dallas, Em MedTimothy Chen, CA Pacific Med Ctr, Int MedAmy Cheng, Emory U SOM-GA, PedBrian Cohen, RI Hosp/Brown U, Ortho SurgSara Connaughton, UTCOMC, Em MedAnne Craddock, UTHSC, Med-PedJennifer Crawford, UTHSC, PedPaul Crook, VA Cmmnwlth U Hlth Sys, Ortho SurgDarren Cullinan, Barnes-Jewish Hosp-MO, Gen SurgJessica Cummings, UTHSC, PsychBlake Curtis, UTHSC, Rad-DiagJohn Daniels U NE SOM-Reno, Fam MedRebecca Empting, UTHSC, Surg-PrelimEmily Escue, U Chcgo Med Ctr-IL, Int MedCharles Fraga, UTHSC, Med-PedKeerthi Gadiparthi, UTHSC, Int MedJoseph Gooch, UTHSC, Fam Med

Jennifer Gordon, UTHSC, Gen SurgWilliam Gordon, UTHSC, Neurol SurgDerrick Green, WV U SOM, PathMollie Gross, Bay St Med Ctr-MA, PedMustafa Haddad, UTHSC, Surg-Prelim/ Mayo Sch

Grad Med Edc-MN, Rad-DiagJustin Hallock, UTHSC, Ortho SurgDustin Hamilton, U KY Med Ctr, Ortho SurgShawn Hamm, UTHSC, Fam MedAndrew Han, UTHSC, Int MedFelicia Hare, UTHSC, Int MedBenjamin Harper, U TN Grad SOM-Knox, AnesthAndrew Harris, RI Hosp/Brown U, Ortho SurgMark Heckle, UTHSC, Int MedGlendon Hyde, UTCOMC, Gen SurgRissa Ivens, VUMC-TN, PsychNickalus Khan, UTHSC, Neurol SurgAnderson Kuo, U TX HSC-San Ant, Integ Diag Rad/PhDRobert Lane, UTHSC, Int MedNathan Littlejohn, U AK-Lttl Rck, Surg-Prelim; UrolTravis Littleton, UTHSC, Ortho SurgJoseph Marino, Mem Hosp-IN, Fam MedMatthew Marker, Hartf Hosp-CT, PsychBrandon McElroy, Med U SC, Int Med

Cathryn McGill, UTCOMC, Gen SurgJoseph Merriman, U UT Affil Hosp, Int MedMallory Mulroy, U Lousvll SOM-KY, PsychCayce Nawaf, UTHSC, Med-PrelimCherechi Ogwo, UTHSC, Int MedMatthew Pagni, UTHSC, Med-Prelim/ Wk Forst Bapt Med Ctr-NC, Rad-DiagBhumin Patel, UTHSC, Med-Prelim/ Bapt Mem Hosp-TN, Rad-DiagNamrata Patel, Case Wstrn/U Hosps Case Med Ctr, Med-PedCarter Pelham, UTCOMC, Trans/ Bapt Mem Hosp-TN, Rad-DiagHashani Perkins, USF, Surg-PrelimMatthew Petty, Chld Mercy Hosp-UMKC-MO, PedKaicee Ponds, Med U SC, PedJason Porter, UTHSC, Int MedJohn Prenshaw, U TN Grad SOM-Knox, Trans/ U VA, OphthalAniket Rali, Case Wstrn/U Hosps Case Med Ctr, Int MedAdam Ross, UTHSC, Fam MedEvan Shelby, U NC Hosp, Int MedAh Shin, U KS SOM-Wich, Fam MedMary Shuster, UTHSC, DermLauren Simpson, Med U SC, PedShruti Singh, Loyola U Med Ctr-IL, Int MedJace Smith, Marshall U SOM-WV, Ortho SurgNathan Smith, U TN Grad SOM-Knox, Int MedRoss Smith, WV U SOM, Ortho SurgValerie Stine, UTHSC, Trans/ Wake Forest Bapt Med Ctr-NC, Rad-DiagHolbrook Stoecklein, U UT Affil Hosp, Em MedMeshell Stokes, UTCOMC, OB/GYNEthan Stranch, UTHSC, Gen SurgNathan Summers, Case Wstrn/U Hosps Case Med Ctr, Int MedTsegayesus Temtem, UTHSC, PedWilliam Tidwell, U TN Grad SOM-Knox, Trans/ U Lousvll SOM-KY, Derm

UTHSC grads crowd around to receive their Match Day envelopes. Photo: University of Tennessee Health Science Center

Member News


Andrea Ward, UTCOMC, TransNicholas Watson, St Louis U SOM-MO, Em MedKristin Wheeler, Barnes-Jewish Hosp-MO, OB/GYNJennifer Winbigler, U TN Grad SOM-Knox, Int MedTaylor Wright, U TN Grad SOM-Knox, Fam Med

Vanderbilt University School of MedicineSuzanne Alfano, Nrthwstrn McGaw/Chld Mem Hosp, Ped/Bapt Hlth Sys,

TransNatalie Ausborn, Mem Sloan-Kettering, Rad OncBrian Barnett, MA Gen Hosp, PsychJoshua Bilsborrow, Yale-Nw Hvn Hosp, Int MedEdem Binka, U MD Med Ctr, PedMarissa Blanco, UPMC Med Ed Pgm, PedSarah Bourne, Clvnd Clin Fndn, Neurol SurgKatharine Burns, Advoc Chrst Med Ctr, Em MedMichael Casner, UCLA Med Ctr, Em MedTyffany Chen, USC/LA Co Med Ctr Pgm, Int MedAnkeet Choxi, JXN Mem Hosp, AnesthApril Christensen, VUMC, Int MedKathleen Collins, U TX Sthwstrn Med Sch-Dallas, PedJessica Cornett, St. Mary’s Hosp, Fam MedStephanie Couch, Med Coll GA, Em MedJennifer Dang, Baylor COM, OtoBenjamin Deschner, Nrthwstrn McGaw/Nrthwstrn Mem Hosp/VA,

Gen SurgStacey Doran, U Hosp, Gen SurgAnna Fahy, U WA Affl Hosp, Int MedDavid Friedlander, Harvard Med Sch/Brig Wmns, Surg-Prelim; UrolErin Fulchiero, U CO Sch Med, Int Med

Nicholas Giacalone, Brig Wmns Hosp, Med-Prelim; Rad Onc/St. John Hosp,Trans

Everett Gu, U MI Hosp-Ann Arbr, Rad, DiagAmanda Harris, VUMC, Int MedLaila Hassam-Malani, U NM Sch Med, Neurol Surg

Emory Hsu, Emory U Sch Med, Int MedStephanie Hsu, VUMC, PedTendeukai Hungwe, IN U Sch Med, Em MedElliott Kim, VUMC, Ortho Surg/Method Hosp, TransKatrina Korhonen, Hosp U PA, Rad-DiagRyan Lang, Johns Hopk Hosp, Int Med/U TN/Bapt

Hosp, Med-PrelimNeal Langdon, VUMC, Rad-DiagAlana Lewis, Duke U Med Ctr, Int MedDennis Lockney, U FL COM-Shands Hosp, Neurol SurgNeil Manus, Albert Einstein Med Ctr, Em MedAllison Martin, U VA, Gen SurgDaniel McClure, Crlnas Med Ctr, Ortho SurgPuneet Mishra, VUMC, Med-PrelimDavid Moore, VUMC, Surg-Prelim; UrolRishi Naik, VUMC, Int MedJill Neely, U AL Med Ctr, Int Med/VUMC, Med-PrelimKathleen Nemer, Barnes-Jewish Hosp, DermNatalie Nesmith, VUMC, Int MedKathy Niu, U MA Med Sch, Psych-NeUrolBaldeep Pabla, U Chcgo Med Ctr, Int MedRavi Patel, VUMC, Gen SurgMichael Pelster, Nrthwstrn McGaw/Nrthwstrn Mem

Hosp/VA, Med-Prelim; DermLaura Peterson, U WA Affl Hosp, Path/VUMC,

Med-PrelimNatalia Plotnikova, Tufts Med Ctr, DermMeera Reddy, VUMC, Int MedApril Seay, Duke U Med Ctr, PsychTina Shah, Nrthwstrn McGaw/Nrthwstrn Mem Hosp/VA, AnesthCraig Sheedy, VUMC, Em Med/North Shore-Long Isl Jewish Hlth Sys,

Med-PrelimGrace Shih, USC, OphthalLakshmi Sivarajan, Nrthwstrn McGaw/Nrthwstrn Mem Hosp/VA,

Int Med/Tripler Army Med Ctr, TransMichael Stockin, Walter Reed Army Med Ctr, AnesthWilliam Sullivan, VUMC, Med-PedBrittany Taylor, Cinc Chld Hosp Med Ctr, PedLaura Tortora, North Shore-Long Isl Jewish Hlth Sys, Em MedThuy Tran, Yale-Nw Hvn Hosp, Int Med; Physic Scient/David Grant Med Ctr,

Gen SurgColby Uptegraft, USAF Sch Aerosp Med, Aerosp MedFrancys Verdial Argueta, U WA Affl Hosp, Gen SurgDanielle Wright, Meharry/Metro Gen Hosp, OB/GYNJesse Wright, VUMC, Gen SurgVictoria Wurster, Cinc Chld Hosp Med Ctr, PedZachary Yoneda, VUMC, Int MedLi Zhou, Barnes-Jewish Hosp, Int Med+

Victoria Wurster reacts after learning she and her fiancé Fernando Ovalle are headed to Cincinnati. Photo: Ann Rayner/VUSM


Member News


Vijaya L. Appareddy, MD, of Chattanooga, was among Bush admin-istration alumni and volunteers invited to commemorate the com-pletion of the George W. Bush Presidential Center on April 25 inDallas, TX. Distinguished guests included President Barack Obamaand Mrs. Michelle Obama, President George H.W. Bush and Mrs. Bar-bara Bush, President Bill Clinton and former Secretary of StateHillary Clinton, and President Jimmy Carter and Mrs. Rosalyn Carter.Dr. Appareddy served as vice chair of the President’s Committee onIntellectual Disabilities from 2002-2006. Certified by the AmericanBoard of Psychiatry and Neurology, she practices with Tri-State Psy-chiatric Services in Chattanooga. She is a member of the TennesseePsychiatric Association and the Chattanooga-Hamilton County Med-ical Society.

Karen A. Rhea, MD, of Nashville, has beennamed a Life Fellow of the American PsychiatricAssociation. Board-certified in child and ado-lescent psychiatry, psychiatry, and pediatrics,she is an associate clinical professor of psychi-atry at Vanderbilt University School of Medicineand chief medical officer of Centerstone, pro-viding community-based mental health and ad-diction services. Dr. Rhea is a member of theTennessee Psychiatric Association and theWilliamson County Medical Society.

Jon H. Robertson, MD, FAANS, FACS, has beennamed the 2013 Harvey Cushing Medalist, the

highest honor bestowed by the American Association of Neurologi-cal Surgeons (AANS). His award was presented during the AANS 81st

Annual Scientific meeting in New Orleans in April/May. Dr. Robert-son has been a neurosurgeon at the Semmes-Murphy Neurologicand Spine Institute in Memphis for 33 years; he is also a formerchairman of the University of Tennessee Center for Health Sciences’Department of Neurosurgery. A past president of the AANS, Dr.Robertson’s volunteer service also includes presidencies for theNorth American Skull Base Society and the Society of UniversityNeurosurgeons, a term on the American Board of Neurological Sur-geons’ Board of Directors, and directorships at the Semmes-MurphyInstitute and the Medical Education and Research Institute. He is amember of The Memphis Medical Society.

Joseph T. Santoso, MD, FACOG, of Memphis, hasbeen awarded the 2013 Excellence in TeachingAward by Student Government Association's Ex-ecutive Council (SGAEC) at the University of Ten-nessee Health Science Center (UTHSC). Theawards were presented to one faculty memberfrom each of UTHSC’s six colleges; winners arechosen by students most directly impacted by

faculty efforts. Dr. Santoso was recognized for his dedication toprovide medical students with the best possible training. A gyneco-logic oncologist with The West Clinic, Dr. Santoso is also a professorof Obstetrics and Gynecology at UTHSC. He is a member of The Mem-phis Medical Society.

Brad Somer, MD, and ToddTillmanns, MD, both withThe West Clinic in Mem-phis, created and recentlyled the inaugural Ride toConquer Cancer Race, ben-efiting Mid-South cancerpatients. The May 5th eventwas hosted by a cancer

center partnership between the University of Tennessee Health Sci-ence Center, The West Clinic and Methodist Healthcare. All fundsraised will support the Comprehensive Cancer Center, a partnershipof The West Clinic, Methodist Healthcare and the University of Ten-nessee Health Science Center. Dr. Somer is an oncologist/hematol-ogist and Dr. Tillmanns is a gynecologic oncologist. Both aremembers of The Memphis Medical Society.

M E M B E R N O T E S

Dr. Appareddy poses with husband Ramesh at the dedication of the Bush Presidential Center.

Dr. Somer Dr. Tillmanns

Member News


Michael D. Zanolli, MD, of Nashville,has been elected to the Board of Di-rectors for the Federation of StateMedical Boards (FSMB). Currentlyserving as president of the TennesseeBoard of Medical Examiners, Dr.Zanolli is a former TMA Board ofTrustees member and a current TMA

delegate from the Nashville Academy of Medicine. Heserves as associate clinical professor of Medicine at Van-derbilt University Medical Center.

John W. Zirkle, MD, of Jefferson City, has received the 2013Jefferson County Citizenship Award from the Senior Citi-zens Home Assistance Service. He was honored for hisoutstanding medical career and service to the community,including as a volunteer physician at Jefferson Rural Clinic,on the community board of FSG Bank, and a member ofthe Quality of Life Team of Building a Better Future, Jef-ferson County. Dr. Zirkle served as longtime medical di-

rector of Jefferson County Nursing Home in Jefferson City before retiring in2011; he previously was a private internal medicine physician at TennesseeValley Medical Group. He is a member of Lakeway Medical Society. +

Are you a member of the TMA who has been recognized for an honor, award, election, appointment, or other noteworthy achievement? Send itemsfor consideration to Member Notes, Tennessee Medicine, 2301 21st Ave. South, PO Box 120909, Nashville, TN, 37212; fax 615-312-1908; e-mailbrenda.williams@ tnmed.org. High resolution (300 dpi) digital (.jpg, .tif or .eps) or hard copy photos required.

M E M B E R N O T E S

participating physicians and identify those who are board-certi-fied within the required specialties, in which case the physicianwill not have to fill out the attestation form. However, if the physi-cian plans to attest that he accept professtional responsibility forhis or her mid-level provider(s), then he or she will be required tofill out the entire attestation form attached to the letter, even ifthey were “pre-approved.” If you want to attest on behalf of amid-level provider(s), go to each of the MCO websites that youcontract with and/or bill and print the form, complete and returnto each MCO as needed.

2. If the MCOs could not electronically access the necessary cre-dentialing information to determine certain providers as board-certified in the required specialties, then physicians will receivea letter that will include the required attestation form askingthem to fill out the entire form and mail it back to the MCO. Thephysician would also need to attest to any mid-level providers.Please note this letter has also been mailed to out-of networkphysicians within the required specialties for whom the MCOshave paid claims within the last 12 months.

Any physician (in-network or out-of-network) who attests to an MCOand/or has been determined qualified by an MCO will not have to take

action with the TennCare Bureau to receive the increased rates on theirTennCare Crossover Claims. MCOs will provide the required informationto TennCare for qualified providers. If you are a provider who does notbill or contract with any TennCare MCO but you bill TennCare forcrossover payments, you will need to go to the TennCare website andcomplete the form, print, sign and return it (preferably by fax) to Tenn-Care.

ATTESTATION FORMSThe attestation forms can be found on all three MCO websites and onthe TennCare website. The forms are identical but physicians must fillout attestation forms for each individual MCO with whom they are con-tracted or bill. Physicians are asked not to print and fill out the formsuntil they have received letters from the MCOs, as it could flood the sys-tem. If you have not yet received a letter and think you qualify, youshould go ahead and obtain forms from the MCO websites.

The TMA Legal Department will continue to keep members updatedon this topic. Please contact us with any questions or concerns you mayhave at 800-659-1862. +

ALERT: LETTERS SENT ON TENNCARE PRIMARY CARE INCREASE(Continued from page 45)

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NOTABLE ISSUES OF THE 2013 GENERAL ASSEMBLY(Continued from page 45)

will be bringing legislation for independent practice.The overprescribing and diversion of controlled substances continues to receive much atten-

tion from legislators, who will look at any option to address the scourge that currently plaguesthe state. The TMA has remained vigilant in attempting to forestall implementation of any provi-sions that only add time and cost to legitimate providers and patients without adequately ad-dressing the proverbial “pill mills” that continue to operate in the state.

The TMA’s legislative package was, by design, limited, in anticipation that we would be spend-ing an inordinate amount of time on the defense. The two most important bills in the package –establishing a safe harbor for a prenatal patient who complies with both her prenatal care anddrug treatment and a youth athlete concussion program – were passed and enacted into law.Legislation encompassing two AMA Model Acts that address the operations of coordinated careorganizations was discussed with key legislators and stakeholders at the beginning of session.Given direction from the Legislative Committee to determine the interest in pursuing such legis-lation, the bills were not filed in 2013 with the understanding the stakeholders would work on theissues over the summer. Proposed budget amendments seeking new state funds for growth ofmedical schools in the state, and for expansion of substance abuse treatment funds, were han-dled differently but had the same outcome: with little interest expressed in pursuing new fund-ing by the medical schools, the decision was made to concentrate efforts on securing new fundsfor substance abuse treatment, especially given passage of the Safe Harbor Act. Unfortunately,the Finance Committees chose to spend limited, unobligated state funds elsewhere, despite ef-forts by the TMA and partners to urge expanded services to persons with substance abuse prob-lems in Tennessee.

Due to the potential of an unexpected windfall from the Master Settlement Account (tobaccosettlement), the Legislature appropriated an amount of $37.9 million, contingent on receipt of theadditional funds. The state intends to invest this one-time contribution in a five-year Health andWellness Initiative to improve the health of Tennesseans through changes in lifestyle behaviors.

Here is a list of the legislative bills the TMA was active on in the 2013 session:

• Safe Harbor Act of 2013: SB459 Yager/HB277Dunn*STATUS: Signed by the Governor on May 14

• Concussion policies for youth athletic pro-grams: SB882 Tracy/ HB867 Sexton*STATUS: Enacted as Public Chapter 148

• Prescribing restriction for nurse practitioners,physician assistants: SB529 McNally/ HB49Shepard*STATUS: Signed by the Governor on May 14

• Optometrists practicing in a retail store: SB220Overbey/ HB555 DennisSTATUS: Assigned to General Subcommittee inSenate Health and Welfare Committee

• Pain clinics and controlled substances pre-scription changes: SB676 Yager/ HB1264 DunnSTATUS: Awaits Governor’s signature

• Helmet exemption for certain motorcycle oper-ators: SB548 Bell/ HB44 SextonSTATUS: Deferred in House Finance Subcom-mittee to first calendar of 2014; placed GeneralSubcommittee of Senate Finance

• Workers’ compensation changes: SB200 Nor-ris/ HB194 McCormickSTATUS: Enacted as Public Chapter 289

*TMA legislation

Legislative Highlights

2013 TMA LEGISLATIVE PACKAGESafe Harbor Act of 2013 - SB459/HB277 Sponsors: Sen. Ken Yager / Rep. Bill Dunn STATUS: Signed by the Governor on May 14Effective Date: Retroactive to May 14, 2013Description: Creates the Safe Harbor Act of 2013. Establishes pregnantwomen referred to drug addiction treatment that receives public funding tobe a priority user of available treatment. Prohibits certain treatment cen-ters from refusing treatment solely because the person is pregnant. Ob-stetrical providers are encouraged to refer pregnant women who aremisusing or abusing prescription drugs to seek drug addiction treatment.So long as the patient adheres to prenatal care and drug therapy during theterm of the pregnancy, DCS is prohibited from petitioning for the newborn'sprotection solely because of the patient’s use of prescription drugs for non-medical purposes during the her pregnancy. Provides civil immunity for in-volved healthcare providers.

Concussion policies for youth athletic programs - SB882/HB867Sponsors: Sen. Jim Tracy / Rep. Cameron Sexton STATUS: Enacted as Public Chapter 148Effective Date: January 1, 2014Description: Requires schools and community-based youth athletic organ-izations to adopt guidelines and policies concerning the nature, risk andsymptoms of concussion and head injury. Requires coaches to complete anannual concussion recognition and head injury safety program. Requiresthe creation of a concussion and head injury information sheet. Establishesprocedures for the immediate removal of any youth athlete who showssigns and symptoms of concussion and permits the athlete’s return-to-playonly by a physician or neuropsychologist trained in concussions.

Prescribing restriction for nurse practitioners, physician assistants -SB529/HB49Sponsors: Sen. Randy McNally / Rep. David Shepard STATUS:House and Senate passed; signed by the Governor on May 14

Effective Date: July 1, 2013Description: Prohibits a nurse practitioner or physician assistant from pre-scribing schedules II, III, and IV controlled substances unless such pre-scription is specifically authorized by the formulary or approved afterconsultation with the supervising physician. Establishes a nurse practitioneror physician assistant may only prescribe or issue a schedule II or III opioidat the initiation of treatment for a maximum 30-day non-refillable course oftreatment unless specifically approved after consultation with the super-vising physician. Requires the Commissioner of Health at least annually toidentify and send correspondence to the 50 top prescribers of controlledsubstances requesting the prescriber (and the supervising physician if theprescriber is a mid-level practitioner) to justify the elevated use of controlledsubstances. Failure to either respond or to respond with a legitimate ex-planation would subject the prescriber (and supervising physician) to po-tential disciplinary action.

Immunity for voluntary healthcare providers - SB1201/HB938Sponsors: Sen. Steven Dickerson / Rep. Roger Kane STATUS: Enacted as Public Chapter 235Effective Date: July 1, 2013Description:Provides good faith immunity for healthcare providers servingat certain programs and authorizes collection of certain charges for volun-tary provision of health care services when forwarded to the sponsoring or-ganization.

State defense of an expert witness - SB1210/HB1060Sponsors: Sen. Steven Dickerson / Rep. David Shepard STATUS: Enacted as Public Chapter 212Effective Date: April 23, 2013Description: Redefines “state employee” to include any expert witness whotestifies on behalf of the Department of Health in certain proceedings for thepurpose of permitting the Attorney General to provide legal representationor reasonable compensation for counsel to the expert witness.

LEGAL REFORMDoctrine of joint and several liability - civil actions - SB56/HB1099 Sponsors: Sen. Brian K. Kelsey / Rep. Jeremy Durham TMA Position: WatchSTATUS: Signed by the Governor on April 29Effective Date: July 1, 2013Description: Requires the doctrine of joint and several liability to not be ap-plied in civil actions governed by comparative fault. Requires a defendantto only be held liable for that defendant's attributed fault as determined bythe court. Retains the doctrine of joint and several liability in certain civilconspiracy cases.

Written expert testimony in health care liability action - SB274/HB1058Sponsors: Sen. Brian K. Kelsey / Rep. Jeremy Durham TMA Position: SupportSTATUS: Failed in Senate Judiciary Committee: 3-4-1Description: Requires experts in healthcare liability action to provide testi-mony or written statement when the opposing party prevails on the basisof the failure of the party to offer any competent expert testimony.

Medical malpractice resulting from emergency care - SB475/HB272Sponsors: Sen. Mark Green / Rep. Glen Casada TMA Position: SupportSTATUS: Taken off Notice in House Civil Justice SubcommitteeDescription: Limits emergency healthcare provider malpractice liability tocases that arise in a hospital emergency department and certain other med-ical situations. Sets claimant's burden of proof in healthcare liability ac-tions. Creates a rebuttable presumption of negligence under certaincircumstances.

INSURANCEPoint of Service Option - SB805/HB400Sponsors: Sen. Ferrell Haile / Rep. Ryan HaynesTMA Position: Watch

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Flat Fee ITStrategic IT Planning

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Hardware & Software Upgrades

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STATUS: Enacted as Public Chapter 92Effective Date: April 8, 2013, for contracts signed after this dateDescription: Changes the number of full-time employees an employer musthave from 25 to 100 or less before an employer may reject a contract’s pointof service option.

Co-payment restrictions for seeing certain health providers -SB726/HB859Sponsors: Sen. Bo Watson / Rep. Jeremy Durham TMA Position: WatchSTATUS: Deferred in House Insurance and Banking Subcommittee to sum-mer studyDescription: Prohibits any health insurance entity from imposing any co-payment or coinsurance amount for services rendered during an office visitto a chiropractic physician or a physical or occupational therapist which isgreater than the copayment or coinsurance amount imposed for servicesrendered during an office visit to a primary care physician.

Health care provider diagnostic radiology test payment required -SB888/HB556Sponsors: Sen. Joey Hensley / Rep. Eric Watson TMA Position: SupportSTATUS: Assigned to General Subcommittee in the Senate Description: Requires a healthcare provider to be paid when a health insureror radiology benefits manager which is contracted to provide utilization re-view services for the health insurer has approved a diagnostic radiology test,unless there was fraud on the part of the provider in procuring the authori-zation.

Utilization review of preauthorizations for healthcare services -SB1142/HB926Sponsors: Sen. Mark Green / Rep. Glen Casada TMA Position: SupportSTATUS:Action deferred in House Insurance and Banking Committee to firstcalendar of 2014Description: Establishes and revises requirements involving utilization re-view of preauthorizations for healthcare services. Provides that if no inde-pendently developed evidence-based standards exist for a particularhealthcare item, treatment, test, or imaging procedure, the utilization reviewagent cannot deny coverage based solely on the grounds that it does notmeet an evidence-based standard. Requires medical directors to be licensedin Tennessee.

Credentialing application before a health insurance entity - SB1173/HB699Sponsors: Sen. Rusty Crowe / Rep. Andy Holt TMA Position: SupportSTATUS: Failed in Senate Commerce: 2-4-3Description: Establishes a process for reimbursing physicians for servicesrendered during the period the physician’s credentialing application is pend-ing before a health insurance entity.

PRACTICERetaining medical records - SB103/HB1081Sponsors: Sen. Becky Duncan Massey / Rep. Ryan Williams TMA Position: Watch STATUS: Enacted as Public Chapter 113 Effective Date: April 12, 2013Description: Requires mammography records to be retained for 10 years fol-lowing the patient’s discharge from a hospital or death. Requires the Boardof Medical Examiners to promulgate rules and regulations pertaining to theretention of mammography records.

Checking of controlled substance database in overdose cases -SB221/HB482Sponsors: Sen. Charlotte Burks / Rep. Ryan Williams TMA Position: WatchSTATUS: Action deferred on the House Floor to first calendar of 2014Description: Requires a physician in an emergency department to check thecontrolled substances database to determine if a patient who has overdosedhas been prescribed a prescription for the same substance on which the pa-tient overdosed. Requires the physician to report the overdose to the pre-scriber of the controlled substance and to the Board of Medical Examiners ifthe physician determines that the patient has been prescribed the controlledsubstance.

Assault against a health care provider - SB412/HB306Sponsors: Sen. Mark Green / Rep. JoAnne Favors TMA Position: SupportSTATUS: Signed by the Governor on May 13Effective Date: July 1, 2013Description: Adds healthcare provider to the list of persons where, if an as-sault or an aggravated assault is committed while acting in the discharge ofthe provider's duty, the maximum fine is increased to $5,000 and $15,000 re-spectively.

Ultrasound prior to an abortion - SB632/HB984 Sponsors: Sen. Jim Tracy / Rep. Rick Womick

TMA Position: WatchSTATUS:Never placed on calendarDescription: Requires a medical professional not more than 72 hours and notless than 24 hours prior to the performance of an abortion to perform an ul-trasound, display the ultrasound images in a manner that the pregnantwoman may view them, verbally offer the woman a printed copy of the ul-trasound image, and make audible, when present, the live, real-time heartauscultation.

Requires information on dense breast tissue to be sent to patients -SB745/HB532Sponsors: Sen. Becky Duncan Massey / Rep. Dennis Powers TMA Position: Watch as amendedSTATUS: Signed by the Governor on May 14Effective Date: January 1, 2014Description: If a physician determines, after a mammogram is performed,that a patient has dense breasts or extremely dense breasts, based on thebreast imaging report and data system established by the American Collegeof Radiology, the facility where the mammogram was performed must pro-vide notice to the patient about the potential risks of the condition. Failureto comply does not create or impose any liability.

Reporting of a patient who makes an actual threat of bodily harm -SB789/HB645Sponsors: Sen. Ferrell Haile / Rep. William G. Lamberth TMA Position: WatchSTATUS: Enacted as Public Chapter 300Effective Date: July 1, 2013Description:Requires mental health professionals to report any patient whomakes an actual threat of bodily harm against a reasonably identifiable vic-tim or victims to local law enforcement who shall then report such patient toNational Instant Criminal Background Check System (NICS) for purposes ofprohibiting the purchase of a firearm when a background check is conducted.

Enacts the "Tennessee Health Care Pricing Act" - SB1114/HB908Sponsors: Sen. James F. Kyle, Jr. / Rep. Bo Mitchell TMA Position: OpposeSTATUS:Never placed on calendarDescription: Requires healthcare providers to develop a pricing list, postthat pricing list on its website, and provide notice of a price change. Providesthat a healthcare provider cannot charge an amount that is different thanthe amount listed. Requires a physician to develop and enforce written poli-cies for billing of health care services and supplies. Establishes the writtenpolicies standards.

SCOPE OF PRACTICEOptometrists practicing in a retail store - SB220/HB555Sponsors: Sen. Doug Overbey / Rep. Vance Dennis TMA Position: Oppose as amendedSTATUS: Assigned to General Subcommittee in Senate Health and WelfareCommitteeDescription: The amendment to this caption would permit optometrists touse a local anesthetic to remove an eyelid lesion.

Replaces current universal do not resuscitate order statute - SB257/HB1019Sponsors: Sen. Rusty Crowe / Rep. Cameron Sexton TMA Position: WatchSTATUS: Enacted as Public Chapter 254Effective Date: July 1, 2013Description: Replaces current do not resuscitate order with a new provisionauthorizing physician orders for scope of treatment (POST). Defines POSTas written orders on an approved form that specifies, in the event of cardiacor respiratory arrest, whether cardiopulmonary resuscitation should orshould not be attempted and specifies other medical interventions that areto be provided or withheld. Authorizes nurse practitioners, clinical nurse spe-cialists or physician assistants to issue a POST under certain circumstances.

Functions performed by alcohol and drug abuse counselors -SB424/HB355Sponsors: Sen. Rusty Crowe / Rep. Bob Ramsey TMA Position: WatchSTATUS: Enacted as Public Chapter 190Effective Date: July 1, 2013Description: Clarifies that the competencies in which licensed alcohol anddrug abuse counselors may engage include clinical evaluation, treatmentplanning, referrals, service coordination, counseling, client, family, and com-munity education, documentation, and professional and ethical responsi-bilities.

Recommendations to the commissioner of health for cosmetic procedures(caption bill) - SB635/HB602Sponsors: Sen. Jim Tracy / Rep. Mike Sparks TMA Position: WatchSTATUS:Never placed on calendarDescription: Requires the Board for Licensing Health Care Facilities andBoard of Medical Examiners to prepare a report to the commissioner ofhealth concerning the need for regulation of outpatient cosmetic procedures.

Also requires the boards to make appropriate recommendations for licens-ing and other appropriate responses to protect the public. Requires the Com-missioner of Health to review the reports and make recommendations to theHouse Health Committee and the Senate Health and Welfare Committee.

EDUCATION

Proof of immunization against meningococcal disease - SB93/HB288Sponsors: Sen. Lowe Finney / Rep. Craig Fitzhugh TMA Position: SupportSTATUS: Enacted as Public Chapter 114Effective Date: July 1, 2013Description: Requires certain, new incoming students at any public institu-tion of higher learning who live in on-campus housing to provide adequateproof of immunization against meningococcal disease.

Epinephrine auto-injectors - SB1146/HB866Sponsors: Sen. Mark Green / Rep. Cameron Sexton TMA Position: SupportSTATUS: Enacted as Public Chapter 294Effective Date: Effective April 29, 2013Description:Permits a school to maintain in at least two (2) unlocked, securelocations, epinephrine auto-injectors so that epinephrine may be adminis-tered to any student believed to be having a life-threatening allergic or ana-phylactic reaction. A physician is authorized to prescribe epinephrineauto-injectors in the name of a Local Education Association (LEA) or non-public school to be maintained for use in treating an allergic reaction in theevent a student’s personal epinephrine auto-injector is not available or thestudent is having a reaction for the first time. Except for intentional disre-gard for safety, the physician who issued the prescription or standing pro-tocol is provided immunity.

PHARMACYCompounding pharmacies - SB582/HB317Sponsors: Sen. Ferrell Haile / Rep. David Shepard TMA Position: WatchSTATUS: Enacted as Public Chapter 266Effective Date: April 25, 2013Description: Expands the definition of compounding by permitting, whenthe product is not commercially available, its use in a prescribing practi-tioner’s office for administration to the prescribing practitioner’s patient, foruse in a health care facility for administration to a patient receiving treat-ment or services provided in that facility or for use by emergency medicalservices for administration to a patient or patients receiving services underauthorized medical control. Establishes new regulations for out-of-statecompounding pharmacies. Requires pharmacies engaged in sterile com-pounding to comply with relevant United States Pharmacopeia (USP) guide-lines. Except for hospital-based pharmacies, pharmacies engaging in sterilecompounding must report, on a quarterly basis, to the Board of Pharmacythe quantity of sterile compounded products dispensed.

Pain clinics and controlled substances prescription changes -SB676/HB1264Sponsors: Sen. Ken Yager / Rep. Bill Dunn TMA Position: Watch as amendedSTATUS: Awaits Governor’s signatureEffective Date: October 1, 2013Description: Requires the Department of Health to establish treatmentguidelines for prescribing of opioids, benzodiazepines, barbiturates andcarisoprodol, and to instruct the prescribing boards to determine how theguidelines should be used. Clarifies that a provider is not required to checkthe CSMD on in-patients. After July 1, 2014, certain licensees will be requiredto include two hours of continuing education on issues involved with pre-scribing of controlled substances, to include the treatment guidelines, aspart of the licensee’s two-year continuing education requirement. Limits dis-pensing (but not prescribing) of opioids and benzodiazepines to a 30-daysupply. Requires patients at registered pain clinics to have valid identifica-tion. Eliminates acceptance of a money order for payment of services at aregistered pain clinic. Adds a provision that would permit a healthcare ex-tender to check the Controlled Substance Monitoring Database on behalf ofmultiple prescribers if approved by the authorizing prescriber who approvedregistration of the extender.

Pain management clinics cannot dispense controlled substances -SB705/HB868Sponsors: Sen. Randy McNally / Rep. Cameron Sexton TMA Position: WatchSTATUS: Signed by the Governor on May 13Effective Date: July 1, 2013Description: Prohibits pain manage clinics from dispensing controlled sub-stances with the exception of no more than a three-day course of a sched-ule IV or V sample.

Tamper-resistant prescriptions - SB963/HB319Sponsors: Sen. Randy McNally / Rep. David Shepard TMA Position: SupportSTATUS: Enacted as Public Chapter 74

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Effective Date: April 1, 2013Description: Revises current requirements to permit practitioners who writeor print prescriptions to include use of technology that results in a tamper-resistant prescription.

Restriction on products with methamphetamine precursors -SB984/HB368Sponsors: Sen. Randy McNally / Rep. David B. Hawk TMA Position: OpposeSTATUS:Action deferred in House Criminal Justice Subcommittee to first cal-endar of 2014Description: Establishes that any material, compound, mixture or prepara-tion which contains any quantity of ephedrine or pseudoephedrine is aSchedule III controlled substance. Prohibits any products that contain anyimmediate methamphetamine precursor from being dispensed by anyoneother than a licensed pharmacy upon presentment of a valid prescription. Ex-empts immediate methamphetamine precursors if they are not in a form thatcan be used in the manufacturing of methamphetamine, including productsin the form of gel capsules and liquid preparations.

PUBLIC HEALTHUsage of motor vehicle safety belts as evidence in court - SB119/HB414Sponsors: Sen. Bill Ketron / Rep. Tony Shipley TMA Position: SupportSTATUS:Passed the House; assigned to General Subcommittee in the SenateDescription: Permits the failure to wear a safety belt as admissible evidencein a civil action.

Helmet exemption for certain motorcycle operators - SB548/HB44Sponsors: Sen. Mike Bell / Rep. Cameron Sexton TMA Position: OpposeSTATUS:Deferred in House Finance Subcommittee to first calendar of 2014;placed General Subcommittee of Senate Finance Description: Permits motorcycle operators to ride a motorcycle without ahelmet if they have completed a Department of Safety-approved motorcyclesafety education course, been legally operating a motorcycle for at least twoyears, are at least 25 years of age, and have a minimum of $25,000 of liabilityinsurance and medical insurance coverage each.

Instruction in infant cardiopulmonary resuscitation for parents -SB665/HB611Sponsors: Sen. Dolores R. Gresham / Rep. Jeremy Faison TMA Position: WatchSTATUS: Enacted as Public Chapter 197Effective Date: July 1, 2013Description: Requires hospitals, birthing centers, healthcare facilities, physi-cians, nurse practitioners, physician assistants or other healthcare practi-tioners who provide medical care to newborns, as well as obstetricians whoprovide routine care for prenatal patients, to make available information andinstruction concerning the appropriate use and techniques of infant car-diopulmonary resuscitation (CPR) to at least one (1) parent. Providers arenot required to offer certified CPR classes. Immunity is provided.

Increases penalties for not wearing a safety belt - SB847/HB613Sponsors: Sen. Bill Ketron / Rep. Tony Shipley TMA Position: SupportSTATUS: Failed in House Transportation CommitteeDescription: Raises the fine in lieu of court appearance for any violation ofthe safety belt law from $10.00 to $50.00 for the first violation and from$20.00 to $75.00 for second and subsequent violations. Creates a $75.00fine in lieu of court appearance for violation of the safety belt law if the per-son is between 16 and 17 years of age. Allocates revenues from increasedfines to the Tennessee Court Appointed Special Advocates for Children, Ex-change Club Family Centers, and to the Division of Vocational Rehabilitationto assist eligible individuals with disabilities who have been seriously in-jured in motor vehicle accidents.

Illegally taking a narcotic drug while pregnant - SB1391/HB1295Sponsors: Sen. Reggie Tate / Rep. Terri Lynn Weaver TMA Position: Oppose as filedSTATUS: Passed by House Criminal Justice Committee; Sent to SummerStudy by Senate Judiciary CommitteeDescription: Provides that a mother can be prosecuted for an assaultive of-fense or homicide if she illegally takes a narcotic drug while pregnant and thechild is born addicted or dies because of the drug.

WORKERS’ COMPENSATION

Workers’ compensation changes - SB200/HB194Sponsors: Sen. Mark S. Norris / Rep. Gerald McCormick TMA Position: WatchSTATUS: Signed by the Governor on April 29Effective Date: July 1, 2014Description: Redefines an injury to mean an injury by accident, mental injury,occupational disease or cumulative trauma conditions arising primarily outof and in the course of employment. Makes changes in the Workers’ Com-pensation program including revision of medical panels and the develop-ment of treatment guidelines, which are presumed for UR purposes to beappropriate if the medical provider is following them. Impairment ratings willbe determined by the treating physician to be assigned as a percentage ofthe body as a whole and not consider complaints of pain in calculating thedegree of impairment, notwithstanding allowances for pain provided by theapplicable edition of the AMA Guides. Provides the Division with the au-thority to waive the caps on the medical fee schedule when necessary to as-sure an injured worker receives appropriate medical care. Rules are to beadopted regarding the electronic submission and processing of medical billsby healthcare providers. Insurance carriers will be required to accept med-ical bills submitted electronically.

Removes some medical conditions under the workers' compensation law- SB616/HB327Sponsors: Sen. Ken Yager / Rep. Charles Curtiss TMA Position: OpposeSTATUS:Assigned to General Subcommittee in Senate Commerce; Taken offnotice in Consumer and Human Resources Subcommittee

Description: Excludes myocardial infarctions, arrhythmias, strokes, or anydisease of the heart or brain from the definition of injury and personal injuryunder Workers’ Compensation Law. Establishes that diseases of the heart,neurovascular system, brain and hypertension are not considered occupa-tional diseases under Workers’ Compensation Law.

Providing of impairment ratings for mental injuries - SB1364/HB1102Sponsors: Sen. Reginald Tate / Rep. Gary Odom TMA Position: WatchSTATUS:Never placed on calendarDescription: Authorizes psychologists licensed in this state to provide im-pairment ratings for a mental injury claimed by an employee.

TENNCAREAnnual Coverage Assessment Act of 2013 - SB441/HB544Sponsors: Sen. Doug Overbey / Rep. Michael Harrison TMA Position: SupportSTATUS: Enacted as Public Chapter 250Effective Date: July 1, 2013Description: Establishes process for annual coverage assessments to be ap-plied on covered hospitals. Requires such assessment to not be used to re-duce or eliminate state funding to the Tenncare program. Establishesprocedure to impose and collect the assessment. Specifies the amount of theassessment.

Prohibits Medicaid expansion under new federal health care law -SB804/HB937Sponsors: Sen. Brian K. Kelsey / Rep. Jeremy Durham TMA Position: WatchSTATUS:Action deferred in House Insurance and Banking Subcommittee to2014Description: Prohibits the state from establishing, facilitating, implement-ing, or participating in any new expansion of the Medicaid program, pur-suant to the Patient Protection and Affordable Care Act.

REGULATORYRemoves medical imaging equipment from certificate of need -SB290/HB854Sponsors: Sen. Mark Green / Rep. Cameron Sexton TMA Position: SupportSTATUS: Taken off notice in House Health SubcommitteeDescription: Removes the requirement to have a certificate of need for mag-netic resonance imaging and positron emission tomography. Redefinesmajor medical major equipment to not include any medical imaging equip-ment, including but not limited to, magnetic resonance imaging, computedtomography, and positron emission tomography equipment.

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Tennessee Medicine + www.tnmed.org + JUNE/JULY 20126464 Tennessee Medicine + www.tnmed.org + JUNE/JULY 2013

IN MEMORIAM

ROBERT COLEMAN, MD, age 96. Died April 13, 2013. Graduate of Uni-versity of Louisville School of Medicine. Direct member of the TMA.

NATHAN P. HORNER, MD, age 95. Died April 21, 2013. Graduate of Uni-versity of Tennessee Health Science Center. Member of Greene CountyMedical Society.

CHARLES G. PEAGLER, MD, age 85. Graduate of Medical College ofGeorgia. Member of Knoxville Academy of Medicine.

BOLESLAUS FALINSKI, MD, age 56. Died May 3, 2013. Graduate of Loy-ola University Stritch School of Medicine. Member of Chattanooga-Hamilton County Medical Society.

In an article about the TMA’s new president, Dr. Christopher Young (Tennessee Medicine, Vol. 106, No. 5, p. 5), the wrong name was used in the pro-file box. It should have read, “Dr. Young – At a Glance.”

Tennessee Medicine regrets the error.

CORRECTION

NEW MEMBERS

CHATTANOOGA-HAMILTON COUNTY MEDICAL SOCIETYDavid W. Adcock, MD, Chattanooga John D. Hammond, MD, Chattanooga Dennis C. Matzkin, MD, Chattanooga J. Enrique Ordonez, MD, Soddy Daisy Michael F. Osborne, MD, Chattanooga Vonda K. Ware, MD, Ringgold John D. Watson, MD, FACEP, Chattanooga

KNOXVILLE ACADEMY OF MEDICINE Julianna Lindsey, MD, Knoxville Jeffery A. Ollis, II, MD, Knoxville

LAKEWAY MEDICAL SOCIETY Hong I. Tjoa, MD, Jefferson City

THE MEMPHIS MEDICAL SOCIETY Ali Akbar, MD, Memphis Sarada Alla, MD, Memphis Tricia S. Alleyne, MD, Memphis Mario E. Briceno-Medina, MD, Memphis Argun D. Can, MD, Memphis Ana P. Carasusan, MD, Memphis

Andres Carrion, MD, Memphis Joel Dennhardt, MD, Memphis Sanjeevani V. Deolapure, MD, Memphis Erin K. Dooley, MD, Memphis Cailin M. Frank, MD, Memphis Haley Mimms Fuller, MD, Memphis Kristen M. Fuller, MD, Memphis Lisa E. Goldman, MD, Tucson Deepthi Hoskoppal, MD, Memphis Jayna M. Kelly, MD, Memphis Yasser M. Khorchid, MD, Madison Heights Esther E. Kim, MD, Memphis Rayanne C. Lee, MD, Memphis Timothy M. Lonergan, MD, Memphis Richard B. Lou, MD, Memphis Emily G. Mai, MD, Memphis Jon G. McCowan, MD, Memphis Christian C. Patrick, MD, Memphis Marina Santa Cruz, MD, Memphis Matthew D. Strain, MD, Memphis Poojitha Valasareddy, MD, Memphis Meredith W. Wagner, MD, Germantown Abigail S. Yandell, MD, Memphis Yu Zhao, MD, Cordova

NASHVILLE ACADEMY OF MEDICINE James A. Bookman, MD, Nashville Jesse M. Ehrenfeld, MD, Nashville Mr. DeAngelo A. Harris, Nashville Michael L. Hasty, MD, Nashville Ms. Ebone Ingram, Nashville Ms. Tesniem Shinawi, Murfreesboro

PUTNAM COUNTY MEDICAL SOCIETY Don E. Asberry, MD, Cookeville

TMA DIRECT Mr. Anthony R. Mattox, Memphis

WASHINGTON-UNICOI-JOHNSON COUNTYMEDICAL ASSOCIATION Robert M. Harris, MD, Johnson City

WILLIAMSON COUNTY MEDICAL SOCIETY Elizabeth W. Bailes, MD, Franklin Ronald C. Cate, MD, Nashville Starling C. Evins, MD, Franklin


BlueCross/BlueShield of Tennessee............................8

Doctors Management, Inc. ..........................................3

Guidant Partners ......................................................58

State Volunteer Mutual Insurance Company ............72

Tennessee Medical Foundation ................................68

The TMA Association Insurance Agency, Inc. ....36, 71

TMA Insurance Recovery Program............................62

TMA Insurance Workshops ........................................27

TMA Legal Services ....................................................44

TMA Member Renewal................................................15

TMA Online CME ........................................................67

TMA Physician Services, Inc. ......................................2

XMC, Inc. ....................................................................35

LIST OF ADVERTISERSINSTRUCTIONS FOR AUTHORSManuscript Preparation – Manuscripts should be submitted to the Editor, David G.Gerkin, MD, 2301 21st Avenue South, Nashville, TN 37212. A cover letter should identifyone author as correspondent and should include his complete address, phone, and e-mail.Manuscripts, as well as legends, tables, and references, must be typewritten, double-spacedon 8-1/2 x 11 in. white paper. Pages should be numbered. Along with the typed manu-scripts, submit an IBM-compatible 3-1/2 high-density diskette containing the manuscript.The transmittal letter should identify the format used. Another option is you may send themanuscript via e-mail to [email protected]. If there are photos, e-mail themin TIF or PDF format along with the article.Responsibility – The author is responsible for all statements made in his work. Acceptedmanuscripts become the permanent property of Tennessee Medicine.Copyright – Authors submitting manuscripts or other material for publication, as a con-dition of acceptance, shall execute a conveyance transferring copyright ownership of suchmaterial to Tennessee Medicine. No contribution will be published unless such a con-veyance is made.References – References should be limited to 10 for all papers. All references must becited in the text in numerically consecutive order, not alphabetically. Personal communi-cations and unpublished data should be included only within the text. The following datashould be typed on a separate sheet at the end of the paper: names of first three authorsfollowed by et al, complete title of article cited, name of journal abbreviated according toIndex Medicus, volume number, first and last pages, and year of publication. Example:Olsen JH, Boice JE, Seersholm N, et al: Cancer in parents of children with cancer. N EnglJ Med 333:1594-1599, 1995.Illustrated Material – Illustrations should accompany the e-mailed article in a TIF orPDF format. If you are mailing the article and diskette, the illustrations should be 5 x 7 in.glossy photos, identified on the back with the authors name, the figure number, and theword top, and must be accompanied by descriptive legends typed at the end of the paper.Tables should be typed on separate sheets, be numbered, and have adequately descriptivetitles. Each illustration and table must be cited in numerically consecutive order in the text.Materials taken from other sources must be accompanied by a written statement from boththe author and publisher giving Tennessee Medicine permission to reproduce them. Pho-tos of identifiable patients should be accompanied by a signed release.Reprints – Order forms with a table covering costs will be sent to the correspondent au-thor before publication.

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CAREER OPPORTUNITY ADVERTISING

Career opportunity advertising is available for all TMA members.

Please return this page, with ad text typed and double-spaced, for all

career opportunity advertising. Send to:

Michael Hurst

Tennessee Medicine

2301 21st Avenue South, P.O. Box 120909

Nashville, Tennessee 37212-0909

Phone: (615) 385-2100 Fax: (615) 312-1900

Rates are $100 for the first 50 words and then 25 cents for each additional

individual word. Count as one word all single words, two initials of a name,

single numbers, groups of numbers, hyphenated words, and abbreviations.

Advertisers may utilize a box number for confidentiality, if desired,

in care of Tennessee Medicine, P.O. Box 120909, Nashville, TN 37212-

0909. Using this box in an ad will add eight (8) words to the total count.

The deadline is the 15th of the month proceeding the desired first

month of publication, and will be subject to approval. Each listing will be

removed after its first publication unless otherwise instructed.

Please type your ad exactly as it should appear or e-mail your ad to

Michael Hurst at [email protected] and send your check with a

hard copy to his attention. You may call in with credit card information for

payment, if needed.

Tennessee Medicine + www.tnmed.org + JUNE/JULY 201370 Tennessee Medicine + www.tnmed.org + JUNE/JULY 2013

SERVICE . . . QUALITY . . . COMMITMENTSERVICE always comes first . . . you deserve it . . . and we will provide it.

QUALITY is important to us. We represent many excellent insurance carriers, all with anemphasis on financial strength, longevity, credibility and value.

Our COMMITMENT to TMA members remains undeniable. If there’s a better way — wewant to tell you about it.

As the exclusive insurance plan administrator for the Tennessee Medical Association since1985, we have a proven track record of our ability to serve, the quality of our products andour commitment to TMA members. We know things are tough out there and we’re here tohelp. Give us a chance to show you our commitment — give us a call today.

Chattanooga 800.347.1109 l Nashville 866.625.0630 l Jackson 888.981.6888 l Memphis [email protected] l TMAinsurance.com

INDIVIDUAL PLANS l EMPLOYEE BENEFITS l PROPERTY & CASUALTY

THE TMA ASSOCIATIONINSURANCE AGENCY, INC.

Exclusive Insurance Plan Administrator for the Tennessee Medical Association

I don’t justhave insurance.

I own the company.

Medical Professional Liability Insurance

Mutual Interests. Mutually Insured.

Hugh Francis III, MD

“Like me, you’ve probably noticed some professional liability insurance carriers recently offering physicians what seem to belower rates. But when I took a closer look at what they had to offer, I realized they simply couldn’t match SVMIC in terms ofvalue and service. And SVMIC gives me the peace of mind that comes when you’re covered by a company with a stellar recordof over thirty years of service and the financial stability of an “A” rating or better since 1984. At SVMIC, I know it’s not justone person I rely on… there are 165 professionals who work for me. And, since SVMIC is owned by you, me, and over 14,000other physicians across the Southeast, we know our best interests will always come first.”

General and Vascular Surgery

MEMPHIS SURGERY ASSOCIATESMEMPHIS, TN

Contact David Willman, Amy Brown or Deborah Hudson at [email protected] or 1-800-342-2239. www.svmic.comSVMIC is exclusively endorsed by the Tennessee Medical Association and its component societies.

Follow us on Twitter @svmic

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