Bringing Medicine Together
From April 24-27, physicians from across the state gathered in Middle Tennessee to discuss issues impacting medicine, attend targeted educational courses, vote on key policy resolutions, install new officers, network with colleagues, and support Alzheimer’s awareness during MedTenn 2014.
The annual convention of the Tennessee Medical Association featured more than 20 speakers and 20 sessions over four days. TMA President Russ Miller said the theme of ‘bringing medicine together’ speaks to the association’s focus on collaborative practice and communication around patient-centered care.
“We feel it’s very important to continue to advocate for doctors and patients to bring everyone together,” he said, adding the annual conference has become more of a true medical convention with a ‘big tent’ feel that includes other medical specialty societies. The multi-specialty meeting included coordinated events, education and activities with Cumberland Pediatric Foundation, Tennessee Academy of Ophthalmology, Tennessee Association for Long-Term Care Physicians, Tennessee Chapter of the American Academy of Pediatrics, Tennessee Chapter of the American College of Surgeons, Tennessee Geriatrics Society and Tennessee Psychiatric Association.
The four-day conference included hot topics impacting patients and providers in Tennessee. Featured courses included ICD-10 implementation strategies, proper prescribing, workers compensation law changes, personalized medicine, depression secondary to critical illness, health reform, Medicaid expansion, and emerging payment and employment models.
Miller noted TMA is keenly focused on the changing paradigm of payment for episodes of care. He added the change from volume to value isn’t threatening to physicians but is concerning in terms of how quality is counted and measured. “Doctors are always about quality and comparative data,” he stressed, adding it is important that decisions are based on clinical data and not just on claims data.
The TMA is keeping a close eye on innovation grants tied to TennCare with the recognition that payment reform will ultimately expand to commercial payers, as well. “We realize the success of these pilots is directly in the hands of the physicians doing the work,” Miller said. “We’ve got to get it right at the onset. If we need to take a little extra time to make sure what we measure matters, it will benefit the patient and profession.”
From a public health standpoint, Miller said, “There are a couple of issues that need resolution in short order.” One, he continued, is Tennessee’s prescription drug problem. “I think we’ve got awareness at a high level,” he said of past efforts to draw notice to the problem. “Now, our attention is more focused on providing solutions to the misuse and abuse of prescription drugs.”
TMA has been closely involved in crafting continuing medical education seminars tied to prescription drugs and opioid use in the state. The latest CME iteration (see related article) was launched during MedTenn ’14 in response to recent legislative requirements pertaining to controlled drug prescribing and licensure renewal. The two-hour course also will be presented around the state in the coming weeks.
Another public health issue on the front burner is the expansion of Medicaid in Tennessee. “As doctors in Tennessee, TMA believes it’s the right thing to do at the end of the day. It’s documented that people with access to healthcare and health insurance lead longer, healthier, more productive lives,” Miller said. He continued, “Healthcare supports expansion … politics has to figure out how to pay for it. Our position comes from what’s right for patients, but we’re going to continue to work with legislators to find a solution we can all live with.”
In addition to tackling the serious business of medicine, attendees also got to have a little fun and give back at the same time. Miller noted TMA opted to forego the traditional banquet following the presidential gavel exchange in favor of a fundraiser this year benefitting the Pat Summitt Foundation, which provides grant funding in the fight against Alzheimer’s disease. Miller said physicians generously give of their time and resources throughout the year. The TMA team thought it was highly appropriate to support that spirit by giving back as an organization to a medical issue impacting millions of families across the country.
Prescribing Guidelines for Pain Management & Patient Safety
The fourth in a series of continuing medical education seminars tied to prescription drug use and abuse, the 2014 course fulfills a new legislative requirement that medical doctors and osteopathic physicians take an approved two-hour class in controlled drug prescribing in order to renew their medical licenses in 2015.
“Since 2007, the health-related boards have required physicians to have one hour of CME in proper prescribing. Beginning this year, they now require physicians to have two hours of CME,” explained Roland Gray, MD, FAAP, FASAM, medical director for the Tennessee Medical Foundation.
Gray has has been instrumental in crafting and presenting all four TMA-affiliated workshops since the educational series was launched in 2007, shortly after the Controlled Substance Monitoring Database went live in Tennessee. The original course was designed to educate prescribers about the growing prescription addiction problem nationally and in Tennessee. The second workshop, Are You Smarter than a Drug Seeker, offered tricks and tips to identify doctor shoppers, scams and problem patients. The third in the series — Epidemic: Prescribers’ Response to Tennessee’s Rx Drug Abuse Crisis — debuted in 2012 and focused on how the problem has evolved over the past two decades, the proper use and responsible management of pain clinics, and the importance of educating patients about the medications being prescribed.
The 2014 edition hones in on new guidelines crafted by a state advisory panel that were released earlier this year and can be accessed on the Department of Health website (health.state.tn.us/providers.htm). Gray, who was part of the guidelines steering committee, said with the exception of cancer pain, there really haven’t been clinical guidelines for chronic pain on a national or state level. “We wanted to come up with guidelines to stem the tide of the complications of overuse and misuse of opioids in Tennessee,” he said. Gray continued, “We recognize these medications have a legitimate place in medicine, and we wanted those with chronic pain syndromes to be able to continue to be treated.”
He added highlights of the two-hour course feature a summary of the new guidelines including steps to take prior to initiating opioid therapy, an update on the Controlled Substance Monitoring Database and details about the requirements to be a pain management specialist in Tennessee. Starting July 1, 2016, he continued, to run a pain clinic or work in one as a pain specialist, the guidelines call for the provider to be certified by the American Board of Pain Management or be fellowship trained in pain management.
“Right now, we have over 90,000 Tennesseans on really high dose opioids,” Gray said, adding a provider with specialized training should see those in need of such high dosages. He stressed, however, the new guidelines don’t apply to hospice care, emergency room care, or acute pain management. “We wanted to make sure primary care providers and family physicians would continue to be able to care for the more common forms of chronic pain in their offices,” he added of the guidelines for prescribing 100 milligram morphine equivalent daily dose (MEDD) or less.
Gray said the course also includes information on changes in opiate warnings and schedules. With neonatal abstinence syndrome (NAS) creating heartbreaking problems for infants, the Food & Drug Administration has added a black box warning for the use of long-acting or extended release opiates during pregnancy. “And for hydrocodone, which is the most prescribed drug in Tennessee, the FDA is in the process of changing it from a Schedule III drug to a Schedule II drug … that comes with a lot more regulations,” he said.
In addition to the CME session held during MedTenn 2014, the course will be presented in Memphis on May 6, Nashville on May 7, and Knoxville on May 8. The prescribing workshop also can be presented live by request at local and regional medical society meetings or taken on demand as part of TMA’s web-based training. For more information or to request a presentation, contact Angie Madden at angie.madden@tnmed.org.
TMA Installs Volunteer Leadership
The pomp and ceremony surrounding the presidential succession of the Tennessee Medical Association is always a highlight of the annual meeting. This year was certainly no exception as the gavel passed from Chris Young, MD, to Doug Springer, MD, who was installed as TMA’s 160th president with John Hale, MD, stepping into the president-elect position.
President:
Douglas J. Springer, MD, FACP, FACG, is a gastroenterologist from Kingsport. Originally from Canada, he moved to Tennessee in 1978 as part of a young physicians’ program to move doctors to underserved areas of the state. Now a naturalized U.S. citizen, Springer has practiced his specialty for 35 years in Upper East Tennessee.
A Fellow of the American College of Physicians and American College of Gastroenterology, Springer has been actively involved in several professional medical associations and is a past president of the Sullivan County Medical Society and past chair of TMA’s membership committee. He also has held professional service positions including reviewer for examinations for the American Board of Internal Medicine and chairman for the Department of Medicine at Indian Path Medical Center and Holston Valley Medical Center.
Springer received his medical degree from the University of Calgary, Alberta, where he also completed his residency in Internal Medicine. He then undertook a fellowship in Gastroenterology at Queen’s University in Kingston, Ontario, Canada. He is board certified in both Internal Medicine and Gastroenterology.
President-Elect:
John W. Hale, Jr., MD, is a family medicine practitioner in Union City, Tenn. Hale has been actively involved with the TMA since his student affiliation while at East Tennessee State University (ETSU). A three-time member of the TMA Board of Trustees, Hale has served in the House of Delegates (HOD) for 22 years. Immediately prior to his new position, Hale completed terms as speaker of the HOD and chair of TMA’s legislative committee. He is a past chair of the young physicians group and past AMA delegate in that role. Additionally, Hale has served as a past president and secretary of the Northwest Tennessee Academy of Medicine and is a past iMPACT board member.
Hale earned his medical degree from ETSU’s Quillen College of Medicine and completed his residency at Jackson-Madison County Hospital.
Immediate Past President:
Christopher E. Young, MD, an anesthesiologist at Erlanger Medical Center in Chattanooga, just finished his role as 159th TMA president. Young has also served the TMA in a variety of other capacities including stints on the organization’s Board of Trustees, House of Delegates, and finance committee. Young sits on the Chattanooga-Hamilton County Medical Society Board of Directors and is a current legislative committee member and past president of the Tennessee Society of Anesthesiologists. On a national level, he also is a past member of the American Society of Anesthesiologists House of Delegates and served as a state director from 2007-2012. Internationally, Young led one of the first orthopaedic surgical teams into Port-au-Prince following the Haiti Earthquake in 2010 and has participated in surgical mission trips to Mexico, Peru, Panama and Haiti for more than two decades.
He earned his medical degree at Georgetown University. Subsequent training included internship at ETSU’s Quillen College of Medicine and residency at SUNY Health Science Center in Syracuse, NY.
The Economic Impact of Tennessee Physicians
A report released last month by the America Medical Association in conjunction with state medical societies underscores the enormous influence physicians have on national and state economies.
Looking at approximately 720,000 physicians in the United States primarily engaged in patient care (as opposed to physicians focused on research and teaching), the study found physicians create healthy communities in ways that extend far beyond the delivery of medical care. Nationally, patient care physicians contributed $1.6 trillion in economic activity and supported 10 million jobs in 2012.
"Physicians carry tremendous responsibility as skilled healers, trusted confidants and patient advocates, but their positive impact isn't confined to the exam room," said AMA President Ardis Dee Hoven, MD. "The new AMA study illustrates that physicians are strong economic drivers that are woven into their local communities by the jobs, commerce and taxes they generate." She added those dollars support schools, housing, transportation and other public services in local communities.
In Tennessee, patient care physicians support more than 143,000 jobs and more than $11.7 billion in wages and benefits. Additionally, those physicians contribute to a total of $618.8 million in local and state tax revenues and generate $20.1 billion in economic activity for Tennessee. On average, each physician supported 10.21 jobs with an average of more than $834,000 in total wages and benefits, contributed more than $44,000 in local and state tax revenues, and generated more than $1.4 million in direct and indirect economic output.