Tennessee Medicine Magazine Demo

HOD Actions &Resolutions

-page 21

Annual Awards-page 29

TMA Leadership-page 41

J U N E 2 0 0 8VOL . 1 01 , NO . 6

Member NewsPages : 53 -60

TennesseeMedicineJO U R N A L O F T H E TE N N E S S E E ME D I C A L A S S O C I AT I O N

2007-2008TMA ANNUAL REPORT& RESOURCE GUIDE

RENEW,RESTORE,

REBUILD

Signed, Sealed and Delivered!Gov Signs TMA MLR Bill

The Road to Reform- Page 35

TennesseeMedicineJO U R N A L O F T H E TE N N E S S E E ME D I C A L A S S O C I AT I O N

ContentsVolume 101 , Numb e r 6 ~ J u n e 2 0 0 8

VISIT US AT WWW.MEDWIRE.ORG

Office of Publication2301 21st Avenue SouthPO Box 120909Nashville, TN 37212-0909Phone: (615) 385-2100; Fax (615) 312-1908e-mail: [email protected]

EditorDavid G. Gerkin, MD

Editor EmeritusJohn B. Thomison, MD

PresidentRobert D. Kirkpatrick, MD

Chief Executive OfficerDonald H. Alexander

Sr. Vice PresidentRuss Miller

Managing EditorBrenda Williams

Editorial BoardLoren Crown, MDGreg Phelps, MDDeborah German, MDRonald Johnson, MDKarl Misulis, MDBradley Smith, MDJonathan Sowell, MDJim Talmage, MDRobert D. Kirkpatrick, MD

Advertising RepresentativeBeth McDaniels – (615) 385-2100 ore-mail: [email protected]

Graphic DesignAaron Grayum / Tinymusicbox Design

Tennessee MedicineJournal of the Tennessee Medical Association(ISSN 1088-6222)

Published monthly under the direction of the Board ofTrustees for and by members of the Tennessee MedicalAssociation, a nonprofit organization with a definite membershipfor scientific and educational purposes.

Devoted to the interests of the medical profession ofTennessee. This Association is not responsible for the authenticityof opinion or statements made by authors or in communicationssubmitted to Tennessee Medicine for publication. The author orcommunicant shall be held entirely responsible. Advertisers mustconform to the policies and regulations established by the Boardof Trustees of the Tennessee Medical Association.

Subscriptions (nonmembers) $30 per year for US, $36 forCanada and foreign. Single copy $2.50. Payment of TennesseeMedical Association membership dues includes the subscriptionprice of Tennessee Medicine.

Copyright 2008, Tennessee Medical Association. All materialsubject to this copyright appearing in Tennessee Medicine may bephotocopied for noncommercial scientific or educational use only.

Periodicals postage paid at Nashville, TN, and at additionalmailing offices.

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

In Canada: Station A, PO Box 54, Windsor, Ontario N9A 6J5

PRESIDENT’S COMMENTS5 President’s Introduction: Dr. J. Mack Worthington7 President’s Introduction: Dr. Robert D. Kirkpatrick8 TMA Mission Statement9 TMA Annual Report

ABSTRACT OF TMA’S 173RD ANNUAL MEETING21 House of Delegates Final Actions List22 House of Delegates Proceedings

ANNUAL AWARD PRESENTATIONS29 2008 Outstanding Physician Awards31 2008 Distinguished Service Award32 2008 Community Service Awards

SPECIAL FEATURE35 The Road to Reform

TMA RESOURCE GUIDE41 TMA Leadership45 TMA Committees49 Component Society Presidents51 TMA Membership Application

TMA MEMBER NEWS53 Save Medicare Access: Urge Congress to Pass S. 2785; 53 TMA Acts on

Quality Ratings, Doctor Shortage, the Uninsured at 173rd AnnualMeeting; 54 TN Doctors Urged to Take Part in National Primary CareSurvey; 54 Health Insurer Transparency an Ongoing Issue; 54 Payout toDoctors Pending in BCBS Settlement; 56 TMA Photo Gallery;57 MedTenn Photo Gallery; 58 FDA Alert: Heparin Recall for AllProvider Types; 58 Sports Physical Rules Change for 2008-2009;58 “Big Insurance” Lawsuit Compliance Dispute Leads to CIGNAPayment Policy Change; 59 IMPACT Capitol Hill Club; 60 Member Notes

FOR THE RECORD61 New Members61 In Memoriam61 Correction46 Advertisers in this Issue; Instructions for Authors

5

This past year has been a year of growth for me and for the TMA. It has been a uniqueopportunity to serve and represent physicians from all over Tennessee. I have met somewonderful people during this time who have dedicated their lives to serving their patients

and the profession of medicine. … I have done my best but there is still a lot to be done.

… One of the highlights this past year was the passage of laws to restrict smoking. Tennesseebecame the first tobacco state to ban smoking in public places. TMA should now stronglysupport prevention aimed at young people to keep them from smoking.

… It is intuitively obvious that we need people in the Tennessee Legislature who are knowledge-able about our issues and represent the best interests of our patients. I am encouraged thatmore of our members are interested in running for office. We all should take every opportuni-ty to educate our representatives and support efforts to improve health care for our citizens.

… It is imperative that the TMA show value to its members. I believe the value is already thereand we must demonstrate that to physicians who are not TMA members. The TMA must con-tinue to have the satisfaction of our members as a top priority, as well as the developmentof new programs aimed at our membership.

… We have accomplished a great deal this year and we should learn from any missteps to buildon the future of medicine for a stronger profession dedicated to the care of our patients.

… Thanks for your kindness and support this year. I am grateful for our members, the TMA staff,the staff and faculty at UT Family Practice, and my family. Congratulations to Dr. RobertKirkpatrick, our new president. I look forward to working with him this next year.

2007-2008 TMA President Dr. J. Mack Worthington,from his report to the TMA House of Delegates, April 2008.

Renew, Restore, Rebuild2007-2008 TMA Annual Report

7

As TMA’s new president, there are a few priority “bills” we should tend to. My first “bill”deals with immigration reform, undocumented workers and the need for border security.“Immigration reform for undocumented workers” for me means get your papers in order –

if you want to be a doctor, go to medical school. The border security issue is up to us. If the MDsdon’t plan, the MBAs will. That’s the border security issue. We have to control the borders, we haveto get involved. My second “bill” is a right to choice. My “right to choice” says that you and I andevery one of our patients have the right to choose their health plan, their hospital, their physician.That’s the choice that matters in this country. That’s the choice that we need to be about.

… We need to hold the leaders of this organization responsible. When you’re walking aroundand look at our leaders; look for an IMPACT button, or look for a Capitol Hill button. Thatmeans they’ve not only been leaders but they’ve been willing to put their money where theirmouth is.

… Finally, to our seasoned doctors in the organization, I call on you to renew, restore andrebuild TMA. To our young folks, I want you to imagine a future for TMA that we can’t. Iwant you to bring us innovation. I want you to redesign and reform your TMA. It won’t alwaysbe our TMA; it will be your TMA.

2008-2009 TMA President Dr. Robert Kirkpatrick,from his inaugural speech, April 19, 2008.

Renew, Restore, Rebuild2007-2008 TMA Annual Report

8

Mission StatementThe mission of the Tennessee Medical Association is to protect the health interestsof patients and enhance the effectiveness of physicians throughout the state bydefining 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;• Open communications between the medical profession and the public, fostering

a better understanding of the capacities of medical practice.

TENNESSEEMEDICAL

ASSOCIATION

9

2 0 0 7 - 2 0 0 8 T M A A N N U A L R E P O R T

RENEW,RESTORE,

REBUILDPoised on the edge of a new era, the Tennessee Medical Associationis moving in a new direction to celebrate and accommodate thechanges in medicine, patient care and physician practice.

In 2007-2008, the TMA saw some of its biggest successes and chal-lenges. After seven years of effort, it finally won a partial but clearvictory on the medical liability front with the passage of a compro-mise MLR bill. The measure was seen as a “step in the right direc-tion,” with firm resolve to stay the course and continue the fight toimprove the liability climate for doctors and patients.

The TMA tackled issues such as the role of physician supervision inretail health clinics, pay for performance, physician quality ratingand network tiering, and changes in TennCare. The TMA collaborat-ed nationally on issues such as the Medicare/SGR dilemma and “biginsurance” settlements. It achieved current goals and addressed newones for its Tennessee Prescription Safety Program, and continuedsewing seeds for the future with its Physician Leadership Collegeprogram. In a crucial election year, it also launched efforts to beefup its political presence and to help members ramp up their politi-cal knowledge and involvement.

Finally, the TMA revived and began to build on efforts to reengi-neer the Association to serve as a stronger voice for physicians

in Tennessee and better serve its members. The work has justbegun to ensure a healthy, vital organization in the future.

The Future of TMA

At a July 2007 meeting, TMA Trustees began a “process of

introspection” aimed at addressing the continued decline in

organized medicine membership and the TMA’s need to adapt

to the changing med-

ical environment to

better serve its mem-

bers. The BOT revived

the work of the 2000

Futures Task Force;

the new Futures II

Workgroup began its

mission to analyze

the Association’s

challenges and recommend new structure, new focus and new

services. With the help of a consultant from LBMC Planning

Services, the Workgroup began a search for a new “value propo-

sition” for the TMA, and based on a survey of member priori-

ties, identified five areas to focus on: 1) cost savings; 2) prac-

tice management; 3) personal and professional development;

4) representation and advocacy; and 5) connectivity and

communications.

The Workgroup gave a pre-

liminary report to the TMA

House of Delegates in April

2008, with its first full

report containing a three-to-

five year strategic plan due

in July, but members advise

that the work to revamp the

state’s largest physician

organization to keep in step

with the future is just beginning.

Medical Liability Reform

A year ago, passage of any MLR legislation seemed remote in

Tennessee after a compromise measure passed in the Senate but

was stopped cold by TMA in the House because trial lawyers want-

ed to revise the locality rule.

Persistence paid off and the TMA

finally celebrated victory in April

2008 with the passage of the compro-

mise bill, thanks to efforts of bill spon-

sors, physicians and their spouses who

actively worked for passage, and a newly-coop-

erative House Judiciary Committee. The new law

creates a notification and certification process aimed

at eliminating meritless

lawsuits before they

make it to court.

Acknowledging that

political success often

comes in increments,

TMA leaders see it as a

step in the right direc-

tion” and pledge to stay

on the path to win

sweeping changes in

Tennessee’s medical lia-

bility climate. (See “The Road to Reform” p. 35)

Medicare/SGR

Armed with the

results of an AMA

survey of Medicare

providers, the fight

began anew in 2007

to avert a more than

10-percent cut in

physician payments

for the program. The

TMA joined with the

AMA and other state

medical associations

nationwide and suc-

ceeded in winning a

six-month delay. TMA

leaders went to bat

10

“We’re trying to look at what wedo and make sure it’s as efficientand effective as it can be to meetthe needs of the next generationof physicians.”– Dr. Michael Minch2007-2008 BOT Chair

“This is a crucial step on the con-tinuing road to comprehensivereform. We understand that toachieve significant changes tolaw, you sometimes have toaccept incremental steps leadingin the right direction.”– Dr. Robert Kirkpatrick2008-2009 President

These are just a few highlights from the TMA’s accomplishments, actions and activities over the past year.

TMA leaders joined their colleagues from acrossthe nation in March to lobby for a bill to saveMedicare access.

again at the AMA

National Advocacy

Conference in March

2008 to urge Congress

to not only vote

against the cuts sched-

uled for July 1, but to

fix the flawed sustain-

able growth rate (SGR)

formula the payments

are calculated on. The

TMA issued a Call to

Action for its members

to contact their repre-

sentatives in Washington, DC, to urge support of the Save

Medicare Act of 2008 (S. 2785). The measure would retain cur-

rent payment levels for the remainder of this year and enact a

1.8 percent

increase for 2009,

helping physicians

and their patients

while giving

Congress enough

time to address the

flawed formula.

More recently, the

TMA has worked

with Legislative

Committee Chair Dr.

Newton Allen, Jr.,

to develop flyers

for doctors and

patients on the

Medicare cuts/SGR

issue.

Tennessee PrescriptionSafety Program

With a pledge to curb Tennessee’s prescription drug habit, the

TMA created the Tennessee Foundation for Quality Patient

Healthcare in 2005 and was

awarded nearly a half-million

dollars in funding from the

Physicians Foundation for

Health Systems Excellence

(PFHSE) the following year to

launch the Tennessee

Prescription Safety Program

(PSP). Two years later, the

PSP is the only accredited

source for proper prescribing

CME in the state, offering

both live and online seminars to help doctors statewide satisfy a

licensing requirement with the Board of Medical Examiners. Since

inception, more than 3,000 Tennessee prescribers have taken the

course. A quarterly newsletter and PSP Resource Center are in

development to continually promote the educational offerings to

prescribers statewide.

The PSP also moved forward on

a technology phase, launching a

pilot project in Monroe County,

where the medical community is dealing with one of the state’s

highest levels of prescription drug abuse. The card-swipe pro-

gram – the first of its kind in the nation – offers a promising

way to help physicians and pharmacists keep better track of

Schedule II prescriptions and reduce “doctor shopping” by drug

seekers. The project is on target to begin in early summer.

As its final element, the PSP will

spend the next year building part-

nerships between doctors and other

prescribers and law enforcement;

PSP officials are firming up plans for

a statewide summit between the

two groups later in 2008 with an

emphasis on a coordinated effort to

tackle the Rx drug abuse problem.

11

“By far the biggest issue facingmedicine at the national level isthe continued struggle forMedicare reimbursement tophysicians. This struggle will con-tinue as long as Congress refusesto act responsibly, allowingphysicians’ overhead expenseincreases several times the rateof reimbursement each year.”– Dr. Chris Fleming, AMA Delegation Chair

and Dr. David Gerkin, Vice-Chair

“The Monroe County medicalcommunity is excited about thelaunch of the program and havinga solution to the prescription drugabuse problem in their county.”– Dr. Robert Kirkpatrick

TFQPH Chair

The TMA prepared flyers to helpphysicians explain the Medicare payment

crisis to their patients.

TMA and TBI officials met withMonroe County prescribers in Decemberto explain a pilot program to track

Schedule II prescriptions.

P4P, Quality Ratings

The quest for measuring and improving healthcare quality

picked up steam in 2007-2008, with the TMA spending much of

its time and resources to keeping track of multiple efforts, chal-

lenges and developments both public and private. With the

belief that doctors can and should continually improve their

quality of care, the TMA devoted itself to making sure that any

pay for performance, trans-

parency or quality

rating/tiering programs

affecting Tennessee doc-

tors and patients were well

thought-out and used

accurate measures and pro-

tocols to assess and por-

tray quality.

Foremost, the TMA Insurance Issues Committee played a big

role in winning a delay in BlueCross BlueShield of Tennessee’s

(BCBST) Consumer Transparency Initiative, until problems in

the plan discovered by physicians were resolved. Likewise, the

committee kept tabs on similar efforts by Cigna and United

Healthcare of Tennessee (UCT). Committee members also under-

went training on P4P initiatives, presenting their findings at

TMA Town Hall meetings in October 2007 and February 2008;

inspired a TMA request asking state officials for an investiga-

tion of insurers similar to that launched by the New York State

Attorney General; and won passage of a House of Delegates res-

olution to launch a statewide public education and relations

marketing campaign in the coming year to educate patients

about P4P concerns and let it be known the TMA supports equi-

table, workable ratings solutions.

Town Hall Meetings

The TMA Board of Trustees maintained its commitment to

bring the Association closer to its members across the state.

Regional Town Hall meetings, begun in 2006, continued over

the past year in tandem with quarterly BOT sessions. Town Hall

topics included “A Disaster in the Making: Medical Workforce

Shortages,” held in Memphis on July 20; “P4P and Quality

Ratings” in Knoxville on October 19; and “Pay for Performance:

How Your ‘Report Card’ Will Affect Your Practice” at the February

21 meeting in Cookeville. Town Hall participation continues to

rise and the BOT pledges to continue this regional outreach as

a way to keep in touch with the concerns and issues of mem-

bers across the state.

Insurance Issues

As always, one of its vital advocacy activities over the past

year was to keep tabs on insurance company developments; the

TMA accomplished this through its Legal and Government Affairs

divisions, as well as the Insurance Issues Committee. In addi-

tion to P4P and quality rating and tiering initiatives, the

Association stayed on top of details of the “big insurance” set-

tlements, advising members of new and expiring set-

tlements and

their impact on

patient care and

billing. To date,

monetary pay-

ments to

Tennessee physi-

cians from the Aetna, CIGNA, Humana, HealthNet and Wellpoint

settlements have totaled more than $825,000. Most important-

ly, the settlements have helped change some of the health plans’

business practices and even the playing field for physicians.

12

“P4P / Insurance rating and tier-ing programs have been the pri-mary focus of the committee’swork this year.”– Dr. Jerome Thompson

Insurance Issues Committee Chair

TMA Town Hall meetings over the past year covered critical topics of interest,including this February session on Pay for Performance in Cookeville.

The TMA also proposed

and tracked a number

of insurance-related

bills in the General

Assembly. The TMA

won passage of its

legislation to extend

the medical mal-practice reporting

law to help illus-

trate the prolifera-

tion of malpractice

lawsuits, and sup-

ported ambulato-

ry surgical center

efforts to require insurers to

use a standard contract with standard provisions and defini-

tions; that measure won important converts this year but

lacked votes in key committees. The TMA also won passage of

bills to end undue delays in insurance credentialing and to

ensure physicians’ rights to review and comment on insur-

ance plan ratings and performance reviews before they are pub-

licized to enrollees.

In a major effort to convince State Labor and Workforce

Development officials that physician reimbursement was not

preventing workers’ compensation premiums from dropping

(despite new laws aimed at lowering the cost), the TMA joined

with the Tennessee Orthopaedic Society (TOS) to conduct a sur-

vey of orthopedic and neurosurgery practices across Tennessee.

Findings showed that ortho and neurosurgery payments in

workers’ comp cases had indeed lowered significantly, forcing

state officials to look elsewhere to figure out why the new laws

were not having an impact.

An early warning sign of problems with Medicare on-site con-tract reviewers sparked a series of articles in Tennessee

Medicine, leading to a special issue on healthcare fraud in

December 2007. A series of articles and TMA Member Alerts

helped the Association present a fair picture of onsite reviews

and advise members of their legal rights during the process.

Physician LeadershipCollege

The future of organized medicine depends on the critical

development of new leadership, and the TMA has continued its

investment in grooming

new physician leaders

through the Physician

Leadership College.

Nominated by component

and specialty societies,

medical professional and

other health organiza-

tions, the inaugural class

of 15 doctors was

announced in April 2007. Candidates underwent a year’s worth

of training in the core aptitudes – collaboration and influence

in the medical environment; decision making and conflict res-

olution; lead-

ership and

communica-

tion; and leg-

islative advo-

cacy – culmi-

nating in their graduation ceremony at the 2008 House of

Delegates session in April. During the same meeting, the TMA

unveiled 12 new candidates for the PLC Class of 2009.

13

“This may well be one of the bestprograms the TMA has done toensure the future success of thisorganization.”– Dr. J. Mack Worthington

2007-2008 President

Members of the inaugural Physician Leadership College class (above)graduated from the year-long program and a new class of 12 was

presented during the TMA annual meeting in April.

Retail Clinics/Physician Oversight

In December 2007, TMA

Trustees began to take a

look at the burgeoning

retail health clinic industry

and its presence in

Tennessee; of concern was

the impact on supervisory

physicians and patient care.

The BOT resolved to notify

members of current require-

ments for physician over-

sight, keep track of physician complaints or concerns about the

care received in retail clinics, and continue discussions with

salient groups

involved in

developing and

regulating these

types of health-

care outlets.

The TMA devel-

oped an online

“Supervising Physician Kit” as a resource, offering current reg-

ulations and responsibilities for overseeing physician assistants

and nurse practitioners; office compliance checklists; links to

TMA Law Guide topics and resources, and an Oversight

Infraction Reporting Form to help TMA Legal staffers keep track

of arising problems.

The TMA has

received and

reviewed proto-

cols from two

retail clinic com-

panies serving

Tennessee and

continues to

commun ica t e

with those companies as well as the Tennessee Nurses

Association and the Tennessee Academy of Physician Assistants.

IMPACT

Declining contributions and participation in the political

arm of the TMA spurred a decision by the Board of Independent

Medicine’s Political Action Committee – Tennessee (IMPACT) to

inject new life

into the organ-

ization. At a

time when

other PACs are

experiencing

increases in

contributions,

IMPACT has

seen signifi-

cant decreases.

Over the past

year, IMPACT

collected just

$201,855, compared with more than $281,000 in the previous

year; membership dropped from 969 in 2006 to 719 in 2007.

Currently, IMPACT ranks well behind its biggest opponents.

The IMPACT Board hired a fundraising consultant recommended by

the AMA. The consultant analyzed the PAC and presented a com-

prehensive strategic plan for becoming the dominant PAC in

Tennessee by the year 2010. The new plan calls for raising

$500,000 a year by 2012,

with a membership goal of

over 1,500. The Board also

approved three new fund-

ing levels, including a

$100 contribution level for

physicians who have not

participated in the PAC in

the past. Another step in

revitalizing its efforts is

the creation of a new elec-

tronic newsletter to deliver insider information on the political

process and IMPACT happenings.

14

“We recognize that currentTennessee law was developedprior to retail clinics and we seekto propose regulations and/orlaws that make these clinics safeand effective.”– Dr. Michael Minch

2007-2008 BOT Chair

“IMPACT Board members areenthusiastic about the possibili-ties of growing organized medi-cine’s PAC so that we are an evenstronger force in future races andin legislative issues.”– Dr. Ken Moore

IMPACT Chair

IMPACT Capitol Hill Club member Dr. Newton Allen ofNashville peruses the list of new CHC members recruited

during the TMA annual meeting.

IMPACT board members have committed to new personal efforts

and involvement, including peer-to-peer fundraising, but

Chairman Dr. Ken Moore emphasized that TMA members must

respond positively to the initiative in order to achieve the

goals. Decision time has come, according to IMPACT leaders,

and change is mandatory if organized medicine is to be a major

player in state political races.

Electronic Medicine

One of the ways medicine is changing is electronic connec-

tivity, and over the past year the TMA bolstered efforts to keep

members informed about the fast-paced changeover in technol-

ogy. Regular member alerts and e-mails, as well as articles

online and in Tennessee Medicine, kept physicians apace with

deadlines, resources and bulletins on the transition to electron-

ic filing of Medicare and TennCare claims and the required use

of the new National Provider Identifier (NPI).

In March 2008, the TMA worked with the state’s eHealth

Advisory Council to announce some $10 million in Tennessee

Physician Connectivity Grants to facilitate the adoption of

Electronic Medical Records (EMRs) and ePrescribing in eligible

physician practices, as well as the availability of special pur-

chasing opportunities for broadband access, even for practices

that do not quality for the grants. The Association is currently

developing an online eHealth Resource page for members, with

a goal to provide the latest updates in eHealth information,

certified EMR vendors, and links to helpful organizations and

other resources.

The TMA also served as a portal for news about the Health Care

Notification Network (HCNN), an electronic network delivering

drug safety alerts directly to U.S. physicians via e-mail and the

Internet. A collaborative effort by the iHealth Alliance and

other healthcare agencies, professional and industry organiza-

tions, the HCNN was launched in late March; the TMA notified

members via e-mail, on its Web site and in Tennessee Medicine.

TennCare

As the recognized collective voice of Tennessee physicians,

the TMA continued its diligence in monitoring new develop-

ments in TennCare and advocating on behalf of its members

who care for these patients.

The TMA kept participating members abreast of the continued

transition to two new TennCare managed care organizations in

Middle Tennessee, advising them of reimbursement, communi-

cation and patient care issues. Members were also advised of a

new law in 2007 addressing TennCare “doctor shoppers” –

patients going from doctor to doctor seeking prescription drugs

for abuse or resale – making it a felony for patients not to tell

their prescribers about similar controlled substances prescribed

or filled in the previous 30 days.

The Association’s biggest impact on TennCare came in January

2008, when it presented results of a TMA member survey show-

ing physicians’ perceptions of and experiences with the program

and its MCOs had not changed and in many cases, had wors-

ened, despite efforts to improve TennCare. The results were pre-

sented by TMA Director of Governmental Affairs Gary Zelizer to

the legislature’s TennCare Oversight Committee. Zelizer advised

the panel that it and Governor Bredesen would do well to heed

the survey results, particularly those related to the MCO transi-

tion in Middle Tennessee, and use them to their advantage

when initiating similar changes for West and East Tennessee.

15

Results of the TMA TennCare Survey were presented to theJoint TennCare Oversight Committee in January.

Leadership

The TMA sailed through 2007-2008 under the able leadership

of Dr. J. Mack Worthington of Chattanooga, whose priorities

included public health benefits of Tennessee’s new SmokeFree

Workplace laws and efforts to prevent and stop smoking among

children and teenagers; the passage of medical liability reform;

and a permanent solution to the recurring Medicare payment

cuts. The mantle of leadership was passed from Dr. Worthington

to Dr. Robert Kirkpatrick of Memphis during the TMA 173rd

Annual Meeting in Nashville on April 19. Also installed were Dr.

Richard DePersio of Knoxville as president-elect; Dr. Don

Ellenburg as BOT chairman; and six new board members.

MedTenn 2008 saw a big change in House of Delegates proce-

dures; the policy-making body of the Tennessee Medical

Association met in a historic one-day session, illustrating the

continuing challenges and changes the Association is making

to adapt to a new practice environment for its members.

MedTenn also featured The Medicine Ball, a new semi-formal

event celebrating the dignitaries of healthcare. This year’s

theme was “The Best of Broadway,” featuring tunes from some

of Broadway’s most beloved theatrical productions.

Membership

Total TMA membership was up slightly in 2007-2008, but

declines in dues revenue led to some Association “soul search-

ing” over the past year.

Membership totals at the end of the 2007 dues billing year

stood at 7,505, with 4,330 in the dues-paying category, a loss

of 97 paying members. Concerns about membership retention

led to a Membership Summit in November. TMA Trustees select-

ed a group of physicians, including those on the TMA

Membership Committee, to review current data, identify barri-

ers and problem areas at the state level and within local med-

ical societies, and make recommendations for a more effective

membership plan. Results were shared with the Futures II

Workgroup, currently charged with a “ground up” reevaluation of

the TMA. The TMA also tightened up its communications and

meetings with component medical societies, and addressed mem-

bership issues in areas of the state with inactive societies, lead-

ing to HOD action to allow direct membership for those doctors.

In an effort to better understand why physicians leave the TMA,

the Association also conducted a survey of over 400 previous

members. Results led to the development of a five-pronged plan:

1) Outreach to members to better promote the accomplishments

and services of TMA; 2) Outreach to potential members, includ-

ing more visibility in doctors’ lounges, specialty and local med-

ical societies and hospital staffs; 3) Promote the TMA heritage,

including its 130-year history, value

to Tennessee medicine

and health care; 4) Public

promotion urging patients

to make sure their doctor

is a member of the TMA;

and 5) Developing alterna-

tive memberships with

varying dues and services.

Stemming from that plan

was the development of a

marketing campaign centered

around the phrase, “Join us

16

Outgoing TMA President Dr. J. Mack Worthington bestows the PresidentialMedal upon incoming President Dr. Robert Kirkpatrick.

today … Make a difference tomorrow.” The campaign was con-

ducted from November thru March, utilizing electronic and print

mail marketing pieces targeting non-member physicians. Print ads

appeared in Medical News publications in Memphis, Nashville and

East Tennessee, as well as online; and in other regional publica-

tions and in Tennessee Medicine. A Membership Outreach team

was developed to focus on personal interaction with and recruit-

ment of new members, as well as personal contact with current

members. In March and April, radio ads with the slogan “The

Tennessee Medical Association: Is Your Doctor a Member?” ran in

Memphis as a pilot project for future recruitment campaigns.

Notables

Other TMA efforts of note in 2007-2008:

• PITCH 2008 – More than 100 physicians, spouses and prac-

tice managers came from the state’s three Grand Divisions

to lobby their legislators and represent the face of “good

medicine” on Capitol Hill. Rather than converging at the

State Capitol every Tuesday, this year’s PITCH effort was

concentrated into three regional dates: February 26 -

Middle TN; March 18 - West TN; and April 8 - East TN.

• Non-Compete Law – Beginning in November 2007, the TMA

launched a wholehearted effort to educate members on

Tennessee’s new physician non-compete law, which over-

turned the Udom decision. A series of articles ran in

Tennessee Medicine; the TMA also hosted one of its new

Learn@Lunch audio seminars on the topic in late December.

• TMGMA/TMA Salary Survey – A statewide medical office

staff salary survey hosted by both groups was promoted to

members and their practices; information will be used to

help managers prepare budgets and manage staff.

• New Benefits & Services – Several new member benefits were

introduced in the past year; the most notable was member dis-

counts for tamper-resistant prescription pads, required for all

TennCare prescriptions effective April l, 2008. Other services

included reduced-cost medical equipment maintenance and

service, deep practice discounts with the TMA Power Buying

Program, and unveiling a revamped Medwire.org Web site with

a better look and ease of functionality.

• Seminars –The TMA’s 27th annual Insurance Workshops were

held statewide from August through October 2007. Other

seminars included 2008 Coding Seminars, held statewide

throughout February 2008, and a new series of Learn@Lunch

audio seminars, to be held quarterly on various topics.

• TMA Alcohol Ad campaign – In August 2007, the TMA

joined an AMA campaign urging NCAA schools to ban alco-

hol advertising from their sports programs. A letter cam-

paign by the TMA AMA delegation targeted 21 colleges in

Tennessee and so far has garnered commitments from 11

colleges and the South Atlantic Conference. The campaign

continues, targeting some of the state’s largest universities.

17

West TN PITCH attendees gathered in the hallways of LegislativePlaza during one of three regional dates to press medicine’s

agenda on Capitol Hill.

Finances

A balanced budget had been projected for 2007 with rev-

enues and expenditures projected at $3,134,037.84. The actu-

al revenue was $3,439,965.00 and actual expenses were

$3,224,191.00, resulting in $215,774 excess revenues over

budgeted expenses. This excess amount was budgeted to be

added to the TMA’s reserves.

The TMA experienced revenues in excess of expenses for 2007, and

this was in excess of the projected budget by $266,270. Several

different factors contributed to this, one of which was the fact

that TMA exceeded budget investment revenue for the year.

The TMA is using the consulting and managing services of Mr.

Don Raber, president, Alderbaran Financial Inc., for both the

reserve and the general operation funds. Through the efforts of

our Investment Committee chaired by Subhi D. Ali, MD, we

experienced an 11.41 percent increase in the value of our

Reserve Investments in 2007. The Reserve Investments balance

as of December 31, 2007, was $2,459,597.47. All investments

were made within the parameters of the TMA’s Investment

Policy (Revised July 22, 2007). Of note is the fact that TMA has

contributed in excess of $1,000,000 over the past seven-year

period for revenues exceeding expenses.

18

2007 Estimated Income$3,134,037.84

2007 Estimated Expenses$3,134,037.84

19

Number Title Action

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

2008 House of Delegates Resolution Actions

BLA 01-08 Representation of Direct Members at TMA House of Delegates Adopted

BLA 02-08 Membership by Physicians from Medical Societies Considered to be Dormant Adopted

BLA 03-08 Deletion of Lie Over Requirement in Order to Amend the TMA Bylaws Lying Over for Action at the 2009 Sessionof the House of Delegates

Res. No. 01-08 Reaffirmation of Resolution No. 9-01 -Reaffirmation of Resolution No. 27-94Emergency Care of Managed Care Organization Patients Adopted by Unanimous Consent

Res. No. 03-08 Publicity Campaign Regarding Insurance Company Ratings of Physicians Adopted as Amended

Res. No. 05-08 The Approaching Physician Shortage Crisis Adopted as Amended

Res. No. 06-08 Extending Dependent Health Benefits for Young Adults Adopted

Res. No. 07-08 Member Education on Medicare Recovery Audit Contractors Adopted as Amended

Res. No. 08-08 Immunization of Tennessee Children Adopted as Amended

Res. No. 09-08 Repeal of Provisions of the Tennessee Uniform Accident and Sickness Policy Provision Law (UPPL) Adopted as Amended

Res. No. 11-08 Tennessee Medical Association (TMA) Committee Members Serving as Ex-Officio Delegates Referred to the Board of Trusteesto the TMA House of Delegates for Consideration and Recommendation

Res. No. 13-08 The Tennessee Medical Association House of Delegates Annual Meeting Referred to the Board of Trustees

Emergency Res. No. 14-08 WIC Formula Substitution Adopted

SUNSET RESOLUTIONS

R 3-01 Reaffirmation and Modification of Res. No. 7-94 – Mandatory AM Admissions

Sub R 6-01 Reaffirmation of Res. No. 14-94 - Extension of Countersignature Requirement for Verbal Orders in Long-Term Care Facilities

R 7-01 Reaffirmation of Res. NO. 22-94 – Medical Malpractice Defendants Before State Board of Medical Examiners

R 8-01 Reaffirmation of Res. No. 24-94 – Medical Practice Mini-Internships for TMA Staff

R 10-01 TMA Future Governance

Sub R 11-01 TMA Nominating Committee Structure

R 13-01 Expansion of TMA Board of Trustees

R 16-01 Annual Medical Symposium

R 24-01 IPA Resource Program

R 25-01 Legislation Limiting Damages Awarded Pursuant to Birth-Related Injuries

SUNSET/PERMANENT POLICY RESOLUTIONS

R 1-01 Reaffirmation of Res. No. 2-94 - Mandatory Auto Safety Belt Usage

R 2-01 Reaffirmation of Res. No. 5-94 - Potentially Unethical Contracts

R 4-01 Reaffirmation of Res. No. 8-94 – Reentry Assistance Needed by Physicians Health Program

R 21-01 Conflict of Interest Statement

R 22-01 Member Access to TMA Board of Trustees

22

HOUSE OF DELEGATES PROCEEDINGS

TENNESSEE MEDICINE / JUNE 2008

sidered by the House of Delegates to have chroni-cally been out of compliance with the terms oftheir charter or with the terms of these Bylaws maybe revoked or designated as “dormant” upon voteof the House of Delegates. Dormant status meansthat the component society’s charter remains onfile with TMA, but for all representative purposes,the component society is non-functioning andtherefore cannot exercise the rights and privilegesconveyed to active component societies, includingthe right to collect dues, elect officers, or elect rep-resentatives to the TMA House of Delegates.Members from component societies deemed bythe House of Delegates to be “dormant” mayremain active TMA members by joining the associ-ation directly. Component societies designated asdormant will be reviewed annually by the House ofDelegates and such society may petition the Houseof Delegates at any time to have its “dormant” sta-tus lifted. No component society shall be designat-ed as dormant for more than five (5) consecutiveyears. If the House of Delegates deems a compo-nent society “dormant” for four consecutive years,such charter shall be automatically revoked by theHouse of Delegates at the end of the fifth year in theabsence of a compelling petition to have the “dor-mant” status lifted. This provision does not pre-clude the House of Delegates from revoking thedormant society’s charter at any time during itsfive-year dormant period; and be it further

RESOLVED, That Bylaw Chapter I, B. Sec. 9, beamended by insertion as follows:

Sec. 10. A physician may hold membership in thatcomponent society most convenient for him or herto attend, on permission of the society in whosejurisdiction the physician principally practices andthat of the society he or she seeks to join, and withconsent of the councilor of that district. If a physi-cian lives and practices in a county that does nothave a chartered component society, or is not a

Final Actions of the Tennessee MedicalAssociation House of Delegates

A p r i l 1 9 , 2 0 0 8

The 173rd annual meeting of the Tennessee Medical Association (MedTenn 2008) was conducted in Nashville, Tennessee, April 18-20, at the Nashville AirportMarriott Hotel. The House of Delegates held a one-day session on Saturday, April 19. Stuart M. Polly, MD, Memphis, presided as speaker of the House, with RichardJ. DePersio, MD, Knoxville, again serving as vice-speaker. Douglas J. Springer, MD, chairman of the Credentials Committee, announced there were 129 delegates inattendance for the opening session of the House, which officially represented a quorum. The abstracted minutes of the last regular session of the House of Delegates,published in the June 2007 issue of Tennessee Medicine, were accepted by unanimous vote of the House.

BYLAW AMENDMENTSThe following bylaw amendments wereadopted by the 2008 House of Delegates.

BYLAW AMENDMENT NO. 1-08

REPRESENTATION OF DIRECT MEMBERS ATTMA HOUSE OF DELEGATES

David G. Gerkin, MD, ChairmanCommittee on the Constitution and Bylaws

RESOLVED, That Bylaw Chapter III, Section 3, beamended by deletion as follows:

Sec. 3. Each component society shall be entitled tosend to the House of Delegates each year one del-egate for every fifty active, veteran, and intern andresident members, and one for every fractionthereof, based upon the number of such membersin the component society in good standing as ofDecember 1 of the year preceding the meeting ofthe House. Each component society shall also beentitled to send one student delegate from itsmembership to the House for each medical schoolin its territorial jurisdiction. Each component soci-ety holding a charter from the Association, whichhas made its annual report and paid its assessmentas provided in the Constitution and Bylaws, shallbe entitled to at least one delegate. No delegatefrom any chartered component society shall beentitled to be seated in the House of Delegatesunless the component society which he or she rep-resents has complied with the requirements of theAssociation by submitting the report to the coun-cilor of the district in which the component socie-ty is located. Each delegate of a component socie-ty shall be a proxy representing all of the compo-nent society’s members, except as to matters upon

which a referendum is held as provided in ArticleIV of the Constitution, and the meeting of theHouse of Delegates shall constitute the annualmeeting of the members of the Association inaccordance with the requirements of the law of thestate of Tennessee relating to general welfare cor-porations.

RESOLVED, That Bylaw Chapter III, Section 4, beamended by deletion and insertion as follows:

Sec. 4. The members of the association who havejoined directly pursuant to TMA Bylaw Chapter I,section B.2, shall be entitled to send to the Houseof Delegates each year one delegate for every fiftyactive, veteran, and intern and resident memberswho have joined TMA by direct membership andare otherwise in good standing as of December 1of the year preceding the meeting of the House.Such delegate(s) shall be nominated by theStatewide Nominating Committee and elected onan at-large basis by the direct members of TMAduring the annual TMA physician leadership elec-tions; and be it further

ADOPTED_______________________________


MEMBERSHIP BY PHYSICIANS FROM MEDICALSOCIETIES CONSIDERED TO BE DORMANT


RESOLVED, That a new Bylaw Chapter I, B. Sec. 3,be inserted as follows:

Sec. 3. Chartered medical societies which, uponrecommendation of the Judicial Council, are con-

RESOLUTIONSThe following resolutions were adopted bythe 2008 House of Delegates.

RESOLUTION NO. 1-08

EMERGENCY CARE OF MANAGED CAREORGANIZATION PATIENTSREAFFIRMATION OF RESOLUTION NO. 9-01REAFFIRMATION OF RESOLUTION NO. 27-94

F. Michael Minch, MD, ChairmanTMA Board of Trustees

RESOLVED, That the Tennessee MedicalAssociation confer with the Tennessee HospitalAssociation in an effort to jointly resolve the diffi-culties encountered when patients need emergencycare but the hospitals and physicians who providethat treatment are not under contract with thepatient's insurer; and be it further

RESOLVED, That the Tennessee MedicalAssociation urge the Tennessee Department ofCommerce and Insurance to issue appropriateregulations, or, if unsuccessful, pursue passage oflegislation, to establish a uniform definition of“emergency care” that would include those health-care services provided to evaluate and treat med-ical conditions of recent onset and severity thatwould lead a prudent lay person possessing anaverage knowledge of medicine and health tobelieve that urgent and/or unscheduled medicalcare is required and to compensate any non-con-tract physician or hospital that provides neededemergency care at a level commensurate withcommunity standards.

ADOPTED BY UNANIMOUS CONSENT

_______________________________

RESOLUTION NO. 3-08

INSURANCE COMPANY RATINGS OFPHYSICIANS

Jerome W. Thompson, MD, ChairmanInsurance Issues Committee


DELETION OF LIE-OVER REQUIREMENT INORDER TO AMEND THE TENNESSEE MEDICALASSOCIATION BYLAWS


RESOLVED, That Bylaw Chapter XI be amended bydeletion as follows:

In order to amend the Bylaws of this Association, atwo-thirds majority of the members of the House ofDelegates present and voting shall be necessary.Any bylaw may be suspended during the pendingmeeting by unanimous consent.

WILL LIE OVER AND BE CONSIDEREDAT THE 2009 HOUSE OF DELEGATES

part of one, or if a physician lives and practices ina county containing a component society designat-ed as dormant, then he or she may join theAssociation directly. When more than ten physi-cians from a county belong to the Associationdirectly, then that group of physicians, may applyfor a charter with the Association to form a com-ponent society pursuant to the procedures out-lined in this Constitution and Bylaws.

RESOLVED, That Bylaw Chapter VI, A. Sec. 2, beamended by insertion as follows:

Sec. 2. The Judicial Council shall have the power tocensure, suspend, expel, or to take such other dis-ciplinary action with respect to members, mem-bers serving as officers of this Association, or com-ponent societies as in the exercise of its discretionit may deem proper under the circumstances. TheJudicial Council may recommend that the House ofDelegates place a component society on dormantstatus pursuant to Bylaw Chapter I, Section B.3.

ADOPTED

23



Board of Trustees (BOT) Chair Dr. Mike Minch leads the House of Delegates through apresentation on the work of the Futures II Workgroup.

24



RESOLUTION NO. 5-08

THE APPROACHING PHYSICIAN SHORTAGE CRISIS

Mark A. Brzezienski, MD, DelegateChattanooga-Hamilton County Medical Society

RESOLVED, The Tennessee Medical Associationand organized medicine must sound a clarion calland enlighten policy makers as to the loomingdoctor shortage; and be it further

RESOLVED, The Tennessee Medical Association willwork toward expanding residency positions andmedical schools; and be it further

RESOLVED, The Tennessee Medical Association willseek to invigorate our young people’s interest inmedicine as a career with effective mentoring pro-grams; and be it further

RESOLVED, The Tennessee Medical Association willpartner with public and private concerns regard-ing a solution to the enormous individual financialburden of medical education; and be it further

RESOLVED, The Tennessee Medical Association willadopt a posture that graduate medical education(GME) must be expanded and Medicare caps onGME must be lifted; and be it further

RESOLVED, The Tennessee Medical Association willseek to build a statewide and national consensusregarding the future physician shortage crisis andexercise its responsibility to our state and countryto ensure that an adequate supply of physicianswill be available for our next generation

ADOPTED AS AMENDED

patients through ratings/tiering based onflawed data,

• stress that use by employers or patients of asingle health plan's physician rating/tieringreport may not provide adequate qualityinformation about a particular physicianbecause it may leave out quality informationthat could be obtained from government pay-ers, other commercial health plans, otherphysicians, or other reliable sources.

• encourage employers and patients todemand fair and accurate ratings (by inde-pendent organizations) that consider a widersample of patients

• alert employers and patients of the need tobe aware that some purported quality meas-ures may be affected by factors outside thecontrol of physicians such as patient compli-ance with their doctor's recommendations,contraindications for performing a particularquality measure, and services performed ona patient by another physician.

• Inform patients that when choosing a physi-cian, they should not use health plan physi-cian ratings/tiering alone but also considerother factors such as their trust in theirphysician

RESOLVED, The Tennessee Medical Associationshall encourage its members to participate in theclinically based quality and cost reporting initia-tives being undertaken by their respective profes-sional societies.

ADOPTED AS AMENDED

RESOLVED, That TMA’s official position regardinghealth plan physician rating and tiering initiativesis that such initiatives based or weighted primarilyon claims data is a flawed methodology and is mis-leading to the public; and be it further

RESOLVED, The Tennessee Medical Associationshall encourage the Tennessee Commissioner ofCommerce and Insurance and the TennesseeAttorney General to investigate the accuracy andvalidity of administrative claims-based physician rat-ing and tiering systems utilized by health insurerslicensed in the State of Tennessee; and be it further.

RESOLVED, The Tennessee Medical Associationshall pursue an amendment to T.C.A. §56-32-230(e) requiring that,

1. Tennessee health insurers shall certify andreport the accuracy and validity of any physi-cian rating and tiering data before it is pub-lished.

2. Any cost and administrative burden associat-ed with an insurer’s physician rating systemand the certification of its accuracy shall bethe sole responsibility of the insurer.

3. Any contract provision request a physician tosubmit clinical and quality data to a healthplan shall be adequately reimbursed.; andbe it further

RESOLVED, Tennessee Medical Association imme-diately convene an ad hoc task force to report tothe Board of Trustees Executive Committee in Junea plan to:

• develop an advertising campaign to educateemployers and the public that TMA does notoppose fair and accurate physicianrating/tiering initiatives, and present bal-anced information regarding the limitedinformation available to employers and

Members of the BOT Executive Committee listen to debate during the House of Delegates session.

RESOLVED, That the Tennessee Medical Associationencourage and support legislative initiatives to sim-plify the tedious appeals process available to physi-cians and that physicians be able to recover a por-tion of their legal expenses proportional to theamount of the alleged improper payments that areoverturned on appeal; and be it further

RESOLVED That the Tennessee MedicalAssociation encourage and support legislative ini-tiatives to prevent contingencies fees paid to recov-ery audit contractors from being based on a per-centage of alleged “improve” Medicare paymentsto providers; and be it further

RESOLVED, That a copy of this resolution be sent tothe American Medical Association (AMA) throughour Tennessee Medical Association delegation tothe AMA.

ADOPTED AS AMENDED

_______________________________

RESOLUTION NO. 8-08

IMMUNIZATION OF TENNESSEE CHILDREN

Charles White, Jr., ChairmanPublic Health Committee

RESOLVED, That the Tennessee MedicalAssociation (1) support the Tennessee Departmentof Health (TDOH) goal of immunizing 90% ofTennessee’s children; (2) work closely with theTennessee Chapter, American Academy ofPediatrics (AAP) and the Tennessee Academy ofFamily Physicians (TAFP) on efforts to reach thisgoal; and be it further

RESOLUTION NO. 7-08

MEMBER EDUCATION ON MEDICARE RECOVERYAUDIT CONTRACTORS

Robert Kerlan, MD, DelegateThe Memphis Medical Society

RESOLVED, That TennesseeMedical Association continueto educate its members regard-ing their rights during ProgramSafeguard Contractor surveysand Recovery Audit Contractoraudits; and be it further

RESOLVED, That TennesseeMedical Association legal staffcompile a reference list oflawyers with experience inprosecuting appeals ofProgram Safeguard Contractorand Recovery Audit Contractoraudits to be made available toTMA members; and be it further

RESOLUTION NO. 6-08

EXTENDING DEPENDENT HEALTH BENEFITSFOR YOUNG ADULTS

Peter C. Rawlings, MD, DelegateChattanooga-Hamilton County Medical Society

RESOLVED, That the Tennessee MedicalAssociation supports the extension of existingdependent health insurance benefits to individualsup to age 25, regardless of student status; and be itfurther

RESOLVED, That the Tennessee MedicalAssociation encourages Tennessee to amend TCA56-7-2302 to provide the extension of existingdependent health insurance benefits to individualsup to age 25, regardless of student status; and be itfurther

RESOLVED, That a copy of this resolution shall besent to state legislative leaders across the countryand in the Congress.

ADOPTED25



AMA Board Chair Dr. Edward Langston updates the HOD on national advocacy issues,including the continuing battle over Medicare physician payment cuts.

Dr. Christopher Young of Signal Mountain takes themicrophone during HOD discussion.

26


allowed to serve as ex-officio delegates to theHouse of Delegates if they so choose.

REFERRED TO THE BOARD OF TRUSTEESFOR CONSIDERATION AND RECOMMEN-DATION

_______________________________

RESOLUTION NO. 13-08

THE TENNESSEE MEDICAL ASSOCIATIONANNUAL MEETING

Mark A. Brzezienski, MD, DelegateChattanooga-Hamilton County Medical Society

RESOLVED, That the Tennessee Medical AssociationBoard of Trustees schedule the Annual meeting andHouse of Delegates to be held in the summer orearly fall in future years (as soon as permitted byexisting hotel contracts) so policy developed by theHouse of Delegates can respond to issues thatemerged during the General Assembly and can be

RESOLVED, That the Tennessee MedicalAssociation seek the repeal of relevant provisionsof the Uniform Accident and Sickness PolicyProvision Law (UPPL) which prevent reimburse-ment for medical services for alcohol and narcot-ic-related injuries if such repeal is recommendedin the Comptroller’s 2008 report.

ADOPTED AS AMENDED

_______________________________


TMA COMMITTEE MEMBERS SERVING AS EX-OFFICIO DELEGATES TO THE TMA HOUSE OFDELEGATES

Edward W. Capparelli, MD, DelegateKnoxville Academy of Medicine

RESOLVED, That members of the TennesseeMedical Association (TMA) who serve on TMABoard of Trustees appointed committees be

RESOLVED, That the Tennessee MedicalAssociation (1) encourage and support legislativeinitiatives to assure funding of vaccines by all pri-vate insurance companies or by the Vaccine forChildren program for those who meet their guide-lines. This funding should cover all vaccines rec-ommended by the Advisory Committee onImmunization Practices (ACIP) for all children inTennessee 19 years of age or younger; (2) encour-age physicians to improve the level of immuniza-tions in their practice area.

ADOPTED AS AMENDED

_______________________________

RESOLUTION NO. 9-08

REPEAL OF PROVISIONS OF THE TENNESSEEUNIFORM ACCIDENT AND SICKNESS POLICYPROVISION LAW (UPPL)

Colleen M. Schmitt, MD, DelegateChattanooga-Hamilton County Medical Society

President-elect Dr. Richard DePersio (L) presents a plaque to outgoing HOD Speaker Dr. Stuart Polly.


based on a full understanding of the actual workcompleted in that year’s General Assembly.

REFERRED TO THE BOARD OF TRUSTEES


WIC FORMULA SUBSTITUTION

O. Ward Swarner, MD, DelegateGreene County Medical Society

RESOLVED,That your Tennessee MedicalAssociation strongly advocate for easier criteriaand an easier process to obtain alternative formu-las for Women, Infants and Children programinfants who exhibit complications warranting aformula substitution

ADOPTED

27



TMA delegates considered a roster of 15 resolutions dealing with topics such as quality ratings, a physician shortage, emergency care,insurance coverage and child immunization.

Former TMA presidents were reunited during their traditional annual meeting breakfast.(L-R): Drs. Subi Ali, Fred Ralston, Howard Salyer, Charles White, Sr., Clarence Sanders,John Ingram, III, Phyllis Miller, James “Ted” Galyon, John Dorian; (seated) Drs. J. KelleyAvery and Nat Hyder, Jr.

ANNUAL AWARD PRESENTATIONS

Nominated by the Chattanooga-Hamilton County Medical Society

(CHCMS), Mitchell Mutter, MD, is receiving the award for his longtime lead-

ership in organized medicine and his humanitarian aid work in Haiti.

“Dr. Mutter is indeed a true paragon of the medical profession who

embodies all the very best in principles and practice for which physicians

strive and, in this instance, achieve,” said former CHCMS President Peter

Rawlings, MD.

Dr. Mutter has served numerous leadership roles in medicine and organ-

ized medicine. He is a former president of the CHCMS and served on its board

of directors, and has been a longtime delegate to the TMA House of Delegates

as well as chairman of an HOD Reference Committee. He is the current presi-

dent of the Medical Foundation of Chattanooga, was the inaugural chairman

and board member of the Tennessee Physicians Quality Verification

Organization, LLC, and is a current member of the Tennessee Board of Medical

Examiners, serving as vice president in 2006 and president in 2007. He recent-

ly completed a three-year term as chief of staff at Erlanger Medical Center, and

is a previous chair of the Department of Medicine at St. Mary’s Medical Center.

In 2001, Dr. Mutter’s longtime commitment to medical missions in Haiti

led him to create and incorporate the Children’s Nutrition Program of Haiti, a

faith-based non-profit organization committed to improving the health and

development of Haitian children. CNP provides health and nutrition education

for mothers; offers health care, including mobile medical clinics, vaccination

and critical care programs, and rehabilitation for severely malnourished chil-

dren; and works with other organizations on safe well water programs.

His work led to being named the 2001 recipient of the American Medical

Association’s prestigious Nathan Davis International Award in medicine and

public health. In 2007, he received the Tennessee Hospital Association’s

Medical Staff Meritorious Service Award.

In Chattanooga, Dr. Mutter also gives selflessly to Project Access as a vol-

unteer physician and recruiter, and chairs the foundation that oversees the

program; he also volunteers for other mission projects for needy patients.

A former University of Tennessee Volunteers football team offensive lineman,

Dr. Mutter still serves as an associate clinical professor in the UT College of

Medicine’s Department of Medicine in Knoxville and Chattanooga.

Edward W. Reed, MD, was nominated by The Memphis Medical Society

(MMS) as a “great humanitarian ... who has had a tremendous impact on

medicine in Memphis/Shelby County,” according to MMS Past–President

Valerie K. Arnold, MD.

After completing college and medical school in Nashville, Dr. Reed moved

to Memphis in 1964 and became the first African-American board-certified

Outstanding Physician Award:Drs. Mutter, Reed, WilloughbyThe Outstanding Physician Award is presented annually by the TMA House of Delegates to member physicians who have made their personalmark on the profession of medicine in Tennessee and on those they have worked with and known during their illustrious medical careers.

DR. MUTTER RECOGNIZED FOR LEADERSHIP AND HUMANITARIAN AID

Dr. Mitch Mutter gives his acceptance comments during theAwards ceremony held during TMA’s 173rd Annual Meeting inNashville.

TENNESSEE MEDICINE / JUNE 2008 29

2008 TMA Annual Awards

DR. REED HONORED AS GREAT HUMANITARIAN

30



general surgeon to practice in the city; he was also the first African-American

physician to serve on the faculty of UT College of Medicine and have staff privi-

leges at Baptist Memorial Hospital – Memphis.

In 1981, Dr. Reed was a founding member of the Shelby County Health Care

Corporation, a private board overseeing operations of the Regional Medical

Center (The MED); he served several years as chairman of the board for The

MED. He has also served on boards and committees for several organizations

including the University of Tennessee; his alma mater, Meharry Medical College;

St. Jude’s Children’s Research Hospital, and St. Joseph Hospital, prior to its acqui-

sition by Saint Francis Hospital; the Tennessee Division of the American Cancer

Society; and the National Board of Directors of the American Cancer Society.

Dr. Reed has been honored numerous times for his medical and humani-

tarian achievements, including the National Conference of Christians and Jews

(NCCJ, now National Conference of Community and Justice) Humanitarian

Award (1995) and the NCCJ Community Service Award in Medicine (1990);

Bluff City Medical Society’s Physician of the Year Award (1980, 1987); the Alpha

Phi Alpha Fraternity First Humanitarian Award (1990); the Kiwanis Club of

Memphis Outstanding Senior Citizen (1994); and the Leadership Memphis

Citizen-at-Large (1995), among others.

Currently retired, Dr. Reed recently served as senior vice president and

medical director for Omni Care Health Plan of Tennessee until 2007.

Dr. Edward Reed of Memphis addresses the crowd after receivinghis Outstanding Physician Award.

A lifetime of advocacy on behalf of patients and his fellow physicians led

the Williamson County Medical Society (WCMS) to nominate Joseph L.

Willoughby, MD, for the TMA Outstanding Physician of 2008 award.

“Anyone who knows Dr. Willoughby is certain of the fact that he was born

to be a physician and should be held up as a role model to us all,” said WCMS

President Sam Bastian, MD.

Actively involved in the TMA and his local society, Dr. Willoughby has

served on numerous levels including president of the WCMS, and has been a

delegate to the TMA House of Delegates since 1962 and a member of the TMA

Rural Health and Long Term Care committees. In the early 1970s, Dr.

Willoughby was instrumental in the founding of the State Volunteer Mutual

Insurance Company, Inc. (SVMIC), to help solve a statewide medical liability

insurance crisis affecting Tennessee physicians. He served on the SVMIC board

for 25 years and chaired several committees.

A family practitioner dedicated to the most vulnerable populations, Dr.

Willoughby has worked tirelessly to care for and protect elderly patients as chair-

man of the Health Facilities Life Safety Task Force, a member of the Health Facilities

Board and the Tennessee Nursing Home Administrators Board, and president of

the Harpeth Terrace Convalescent Center and the Claiborne and Hughes

Convalescent Center. He is a past chief of staff at Williamson County Hospital and

currently on staff at Williamson Medical Center, Harpeth Terrace Convalescent

Center, Claiborne and Hughes Convalescent Center, and NHC, Franklin.

In his community, Dr. Willoughby has served as a member of the

Williamson County Health Board, a co-founder of Harpeth Academy, founding

president of the Carnton Club and the Carnton Association (Carnton

Plantation), member of the Heritage Foundation of Franklin and past-president

and member of the Franklin Noon Rotary Club, and on the local board of direc-

tors for Williamson County Bank, Sovran Bank, NationsBank and Bank of

America. In 1978, he was named the Review Appeal Man of the Year. �

DR. WILLOUGHBY CHOSEN FOR PATIENT AND PHYSICIAN ADVOCACY

Dr. Willoughby (L) is presented his award by TMA Speaker of theHouse of Delegates Dr. Stuart Polly.

DR. GROBMYER CHOSEN FOR IMPACT ONHEALTHCARE QUALITY

Albert J. Grobmyer, III, MD, was nominated by The Memphis Medical

Society (MMS) for his “tremendous impact” on healthcare quality, according

to former MMS President Valerie Arnold, MD. “Throughout his distinguished

career, Dr. Grobmyer has developed numerous quality initiatives and has been

affiliated with a host of quality-focused organizations,” she said.

From 2001-2007, Dr. Grobmyer served as chief executive officer of the

QSource Center for Healthcare Quality. Qsource, a non-profit healthcare con-

sulting firm, serves as the Medicare Quality Improvement Organization (QIO)

for Tennessee, providing a wide range of quality improvement services to

healthcare organizations and providers across the state. Currently, he serves as

medical director of TennCare External Quality Review for QSource.

His commitment to healthcare quality also includes service with the

American College of Medical Quality, American Society for Quality, Tennessee

Improving Patient Safety Committee, the TennCare Bureau Medical Necessity

Committee, and the Mid-South Healthcare Alliance.

A past-president of The Memphis Medical Society, Dr. Grobmyer served

over 12 years on the TMA House of Delegates. He has been a clinical assistant

professor in the UT Family Medicine residency program for over 25 years and

continues to serve the College of Medicine as a member of the Undergraduate

Medical Education Committee. He is a former president of Saint Francis

Hospital – Memphis, the Memphis Surgical Society, and the UT College of

Medicine Alumni Council.

PROJECT ACCESS INVOLVEMENT LEADSTO AWARD FOR DR. PUCKETT

Walter Puckett, MD, was nominated for the Distinguished Service Award

by the Chattanooga-Hamilton County Medical Society (CHCMS) for his leader-

ship and involvement with Project Access, a program to provide healthcare

services to low-income uninsured residents of Hamilton County.

He has served as the volunteer medical director of the Hamilton County

Project Access Community Health Initiative since its inception in April 2003.

Nearly five years later, the program has coordinated nearly $25 million in free

healthcare to needy patients in the county. He has served on the Project Access

Operations Council, which develops program policy and operational proce-

dures for the initiative, and recently worked with staff to create a new

Orthopedic Clinic for Project Access and Volunteers in Medicine patients.

Outside of Project Access, Dr. Puckett volunteers regularly for community

health fairs, conducts health screenings in various settings, and makes himself

available to help those in need.

Currently the director of Cardiac Education and chief of Cardiology at

31



Distinguished Service Award:Drs. Grobmyer, PuckettThe Distinguished Service Award has been presented annually since 1963 by the TMA Board of Trustees to exemplary members of the Associationfor their notable achievements during the last calendar year. Recipients are physician members who deserve recognition of outstanding serviceor contribution to the advancement of medical science, or to this Association, or to the public welfare, whether of a civic or scientific nature.

Dr. Grobmyer (L) receives his Distinguished Service Award fromTMA Board Chair Dr. Mike Minch.

(Continued on page 33)

32



SMOKEFREE TENNESSEE GARNERS AWARDFOR GOV. BREDESEN

Nominated by The Memphis Medical Society (MMS), the Honorable Phil

Bredesen was chosen for his diligent efforts to pass the “Non-Smokers

Protection Act,” which outlawed smoking in most workplaces across

Tennessee. “This landmark legislation promises to positively impact the health

of Tennesseans for generations to come,” said former MMS President Valerie

Arnold, MD.

The measure, signed by the governor on June 11, 2007, became effective

October 1, 2007, and promises to positively impact the health of Tennesseans

for generations to come by protecting them from secondhand smoke. The new

law is parallel with the mission of the TMA and its component medical soci-

eties to promote the health and healthcare of citizens throughout Tennessee.

“Governor Bredesen worked tirelessly with the State House and Senate to

reach a compromise,” said Dr. Arnold. “Governor Bredesen, along with our state

legislators, realized and understood how the long-term ramifications of smoking

adversely impact not only smokers, but non-smokers forced to inhale their sec-

ondhand smoke,” she added, praising Gov. Bredesen for shepherding Tennessee

to become one of the first tobacco states to sign on to the nationwide trend.

RAMSEY HONORED FOR STEP ONE PROGRAM

Hamilton County Mayor Claude Ramsey was nominated for this

award by the Chattanooga-Hamilton County Medical Society (CHCMS) for

spearheading the Step ONE Initiative in Hamilton County.

Step ONE (Optimize with Nutrition and Exercise) is a county-wide effort to

address obesity among adults and children by promoting physical fitness, good

eating practices and healthy lifestyles. The program is a partnership between

the Mayor, the Hamilton County Regional Health Council and the Chattanooga-

Hamilton County Health Department. Some of the Step ONE strategies include

educational programs for children in public schools, including “Fruit Fridays,”

the development of “walkable routes” to schools, and the appointment of a

Community Service Award:Bredesen, Ramsey, CapshawElementaryThe TMA Community Service Award annually recognizes persons or organizations outside the medical profession who contribute significantlyto the advancement of public health in their respective communities.

Tennessee’s Chief Medical Officer Dr. Veronica Gunn accepts theTMA Community Service Award from Dr. Minch on behalf of Gov.Bredesen.

Mayor Ramsey thanks the crowd after receiving his CommunityService Award.

33



school health programs coordinator. Other initiatives include making neigh-

borhoods more exercise friendly, the development of an EatSmart Restaurant

program and efforts to implement Step ONE recommendations among families

in their homes – the last two initiatives are being funded by a three-year

“Healthy Starts” grant from the Junior League of Chattanooga.

“Since its earliest days, County Mayor Ramsey has taken a deep and per-

sonal interest in the initiative,” said former CHCMS President Peter Rawlings,

MD, adding Mayor Ramsey personally became a role model for the program by

dieting and increasing his physical activity. “Mayor Ramsey has remained

actively involved, serving as a public spokesperson, mobilizing county govern-

ment to address the Step ONE goals and Objectives,” he said.

Mayor Ramsey’s leadership and commitment has been a key component of

the Step ONE Initiative’s success, according to the CHCMS. “With very little

funding but a lot of willpower and community mobilization effort, County

Mayor Ramsey, the Hamilton County Health Department, and the Regional

Health Council are creating a profound shift in the actions and attitudes of

Hamilton County residents,” said Dr. Rawlings.

CAPSHAW RECOGNIZED FOR STUDENTHEALTH INITIATIVES

Capshaw Elementary School in Cookeville was chosen as the third

recipient for the TMA Community Service Award for its significant contribution

to improving the health of its young students.

Nominated by the Putnam County Medical Society (PCMS), Capshaw

Elementary has placed an emphasis on healthy food choices and the impor-

tance of exercise through educational initiatives in both the classroom and the

cafeteria, including units on the Food Pyramid, Healthy Habits, and the STARS

Selection Program, to teach students to make healthy food choices.

The school sponsors a host of student and family physical activities, including

the Walking Works for School program, Walk Across Tennessee, an annual Festival

of Movement, the American Heart Association’s “Jump Rope for Heart” fundraiser,

and the Cougar Run. Capshaw’s outstanding efforts recently earned the gold award

in the U.S. Department of Agriculture’s Healthier U.S. School Challenge – one of just

22 schools in the country and the only one in Tennessee to win the award.

“Recognizing that healthy children are better learners and good eating

habits start early, the school involves administrators, teachers, nutritionists,

cafeteria staff, parents, a physical education specialist, nurse and guidance

counselor to teach healthy food choices an the importance of exercise,” stated

PCMS President-elect James Batson, MD. �

Capshaw Principal Kim Wright (center) and PhysicalEducation Instructor Nancy Lewis accept the CommunityService Award from Dr. Minch.

Erlanger Health System, Dr. Puckett has been recognized several times for his

outstanding teaching ability; he was named Erlanger Health System’s Outstanding

Teacher in 1981, 2001, and 2006; he also received the Augustus McCravey

Award for Lifetime of Excellence in Medical Education in 2001.

“At a time when many people might be thinking about retirement, Walter

Puckett has continued to care for those most in need, to educate and motivate a

new generation of physicians, and to ensure that hundreds of those who have

health issues but lack insurance receive quality care,” said former CHCMS

President Peter Rawlings, MD. �

Dr. Minch presents Dr. Puckett with his award atthe Annual Awards Luncheon.

(Continued from page 31)

PROJECT ACCESS INVOLVEMENT LEADS TO AWARD FORDR. PUCKETT

35TENNESSEE MEDICINE / JUNE 2008

January 2001 – Gov. Phil Bredesen and Tennessee CongressmanVan Hilleary debate medical liability reform at TMA LeadershipSummit.

March 2002 – Tennessee Medicine Editor Dr. David Gerkin pens aheartfelt call for medical liability reform in an editorial called “TheContinuing Crisis.”

June 2002 – AMA releases a 50-state analysis and declares medicalliability issue has reached a crisis point in 12 stateswith more than 30 others showing problem signs,including Tennessee.

February 2003 – The TMA proposes its firstMalpractice Liability Reform bill (SB605/HB1441)establishing a $250,000 cap on non-economic dam-ages, periodic payments for high awards, sliding contin-gency fees for attorneys, and a collateral source ruleallowing awards to be decreased if money comes fromother sources, such as Social Security or insurance, inthe same case.

April 2003 – Tennessee Medicine declares Tennessee is not yet a“crisis state” but is headed for a crisis if legislation is not passed.

August/September 2003 – TMA and State Volunteer MutualInsurance Company (SVMIC) leaders testify before the GeneralAssembly’s Joint Subcommittee on Tort Reform about the need formedical liability reform.

October 15, 2003 – TMA Legislative Committee sets a priority tocontinue the push for MICRA-style tort reform legislation in 2004.

December 2003 – The TMA develops a Campaign Action Kit to help

Tennessee doctors explain the MLR crisis to patients and the public.

January 2004 – The TMA launches a grassroots campaign; physi-cian leaders begin meeting with newspaper editorial boards aroundthe state to make their case for reform.

March 2004 – A preliminary report by the Legislature’s Tort ReformStudy Committee acknowledges an increase in malpractice insurancepremiums, recommends a formal study group be created to gather

more data.

April 2004 – Tort Reform Study Committee issues finalreport recommends gathering more data on claims andsettlements, and proposes legislation to address vicari-ous liability and restrictions on ex parte physician con-tact.

July 2004 – TMA-commissioned Prince MarketResearch survey shows 72% of Tennesseans believedoctor services are impacted by the cost of medical lia-bility insurance; 94% say the blame lies to “some or a

great” extent on threats of a lawsuit; 57% say medical liability reformis a bigger issue than it was two years ago.

August 2004 – TMA leaders begin the “Reform Road Show,” visitingallied medical organizations to gather support for a comprehensivepush for liability reform. Plans underway for the TMA Town HallMeeting on Medical Liability Reform in January 2005. A LegislativeCommittee survey of 5,000 TMA members shows tort reform remainstheir top priority.

October 2004 – TMA President John Ingram uses bylaws privilegeto call for a special meeting of the House of Delegates to follow theTMA Town Hall Meeting on MLR.

The Tennessee Medical Association’s long history with medical liability issues dates back to 1975, when the TMA helped avert a malpracticeinsurance crisis with the formation of a doctor-owned mutual insurance company.

More than three decades later, doctors were once again fighting steep premiums caused partly by escalating malpractice awards and consideredthemselves lucky if they had never been sued. By 2002, the TMA was calling for tort reform and for the next six years, returned to the GeneralAssembly again and again to try to accomplish its mission. This year, the TMA finally won passage of a compromise measure establishing a notifi-cation and certification process that would help eliminate meritless cases before they go to court.

While celebrating its first major, hard-fought victory, TMA leaders also realize this is just the first step toward meaningful reform that will help bothphysicians and their patients by preserving access to care for the future. The following is a brief look back at the long road to our first MLR victo-ry in Tennessee in over 30 years.

The Road to Reform

The TMA’s first medicalliability reformcampaign logo.

36 TENNESSEE MEDICINE / JUNE 2008

January 2005 – Special issue of Tennessee Medicine promotesupcoming TMA Town Hall Meeting on medical liability reform.

January 21, 2005 – Some600 physicians from acrossTennessee gather inNashville for the seminalTMA Town Hall Meeting:“Making Reform a Reality.”Special HOD session resultsin resolution establishingMLR as a TMA priority, urg-ing physician support and$1,000 contribution fromevery Tennessee doctor.

February 22, 2005 – TMA and specialtysociety leaders meet with U.S. Senate MajorityLeader Dr. Bill Frist on the chances of passingnational medical liability reform.

March 10, 2005 – MLR Debate Televised inNashville; Dr. Newton Allen, Jr., debates med-ical liability environment with Randy Kinnardof the Tennessee Trial Lawyers Association.

April 27, 2005 – TMA MLR bill rolled to2006 due to a rules technicality; TMA officialscelebrate success with the sign-up of morethan 30 co-sponsors.

July 2005 – BOT appoints MLR Steering Committee to oversee allMLR activities; sets fundraising goals for TMA Component MedicalSocieties to help reach $1 million MLR Campaign goal. TMA beginswork to assemble MLR Coalition, a cohesive group of specialty, alliedhealthcare professional, industry and patient groups committed toachieving medical liability reform.

November 2005 – Web survey finds 78% of TMA members practic-ing “defensive” medicine because of liability concerns; 72% reportingshortages of high-risk specialties and difficulty recruiting doctors;47% halting some risky procedures, with another 50% likely to do soand 41% considering early retirement.

November 7, 2005 – At the urging of The Memphis Medical Societyand the TMA, the Shelby County Commission passes a resolution call-ing for lawmakers to support “common sense” liability reform in theupcoming session.

January 10, 2006 – Tennessee ranks in the bottom 25 percent ofNational Report Card on the State of Emergency Medicine, due to afailing grade in its medical liability climate.

February 2006 – TMAunveils new MLR CampaignWeb site, www.mlrnow.org.

February 14, 2006 –AMA/TMA joint news con-ference held in Nashvilleannounces Tennessee hasbeen declared an AMAMLR “Crisis State.”

March 2006 – TMA MLRCampaign unveils a new look, new urgencywith “Medical Liability: REFORM Now or PayLater!” theme. In conjunction with theNational Federation of IndependentBusiness (NFIB), an MLR radio ad cam-paign is launched in Nashville and in target-ed east Tennessee communities representedby key legislators.

May 17, 2006 – House version of MLR failsby one vote in subcommittee. After defeat inSenate subcommittee, TMA is surprisedwhen Senate version is revived briefly as anamendment to Gov. Bredesen’s CoverTennessee proposal; amendment fails.

THE ROAD TO REFORM

A statewide Town Hall meeting in January 2005 birthed theTMA medical liability reform campaign.

The TMA held focus groups in late 2005 to hone its MLR message to the public.

The MLR campaign was bolstered by the pas-sage of a favorable resolution by the ShelbyCounty Commission in November 2005.

THE ROAD TO REFORM

June 2006 – TMA MLR cam-paign is featured in Spring issue ofTennessee’s Businessmagazine.

June 2006 – MLR Coalitionbegins identifying MLR-friendlylegislators and initiating plans tosupport those campaigns infall elections.

June 15, 2006 – TMA sendshealth-related issues survey outto 268 State House and Senatecandidates; as a follow-up, TMA

sends an “MLR Primer” to explain the medical liability reform issueto would-be lawmakers.

June 2006 – NewMLR print, radio and television ads run during pri-mary elections in Cookeville/Putnam County, Lebanon, Murfreesboroand other key legislative districts.

October 2006 – MLR media campaign with “Your Life May Dependon It” theme rolls out with television, radio and print ads in commu-nities with key election contests.

November 16, 2007 –TN Commerce &Insurance report to theGeneral Assembly con-firms rising malpracticejury awards and numberof meritless lawsuits inTN in 2004 and 2005;used as supporting databy the TMA.

January 2007 – AMAawards $100,000grant to TMA MLRefforts. MLR Campaigninitates new strate-

gies, including a patient petition drive, physician-to-patient direct mail campaign, enhanced media relations and patient-to-legislator hotlines in physician offices.

January 9, 2007 – New Lt. Governor, Sen. Ron Ramsey(R-Blountville), is elected; vows to push tort reform as part of hislegislative agenda.

April 2007 – TN Senate unanimously approves compromise versionof MLR bill but behind-the-scenes politics yields anunacceptable version on theHouse side. TMA and MLRCoalition launch grassrootseffort leading to rejection ofthe House amendment,sending the bill back toJudiciary Committee untilnext session.

August 22, 2007 – TMALegislative Committeediscusses tactical changesneeded to achieve compre-hensive medical liabilityreform.


A new look and message for theMLR campaign was unveiled in

February 2006.

Flanked by TMA leaders, AMA President Dr. J. Edward Hill, Jr. (center) declared Tennessee an MLR“Crisis State” at a February 2006 news conference.

THE ROAD TO REFORM

October 2007 – BOT votes to seek House vote on compromise MLRbill that won Senate approval the previous session, with plans to seekadditional changes in later sessions.

January 2008 – The TMA continues its course to seek approval ofcompromise MLR bill, along with renewal of malpractice reportinglaw that could supply more important data to support comprehensivereform in the future.

April 29, 2008 – Victory at last! TN House overwhelmingly approvescompromise MLR bill; Senate concurs. Bill signed by Gov. Bredesenon May 15, to take effect October 1, 2008. �


The TMA celebrated victory in April 2008 after the Housepassed its MLR bill and the Senate concurred.

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Tennessee Medicine.

41

TMA LeadershipTMA RESOURCE GUIDE

Executive CommitteeRobert Kirkpatrick, MD, President1301 Primacy Pkwy, Memphis 38119-0213(901) 448-0230

Donald Ellenburg, MD, Chairman2121 Highland Ave, Knoxville 37916-1111(865) 525-2640

Robert Kerlan, MD, Vice-Chairman 6005 Park Ave, Ste 200, Memphis 38119-5212(901) 761-2100

Nancy Barbarito, MD, Secretary-Treasurer1 Professional Park Dr, Ste 21, Johnson City 37604-6589 (423) 928-5111

Richard DePersio, MD, President-elect1515 Saint Mary St, Ste 200, Knoxville 37917-4514(865) 521-8050

J. Mack Worthington, MD, Immediate Past-President1100 E 3rd St, Chattanooga 37403-2201(423) 778-2957 Outgoing BOT Chair Dr. Michael Minch welcomes his

successor, incoming Chair Dr. Don Ellenburg.

BOARD OF TRUSTEES

Board MembersNewton Allen, Jr., MD4230 Harding Pike, Ste 400, Nashville 37205-4900(615) 297-2700

Valerie Arnold, MD 711 Jefferson Ave, Rm 178, Memphis 38105-5003(901) 448-5944

Samuel Bastian, MD2339 Hillsboro Rd, Franklin 37069-6225(615) 791-9300

James Batson, MD345 W Broad St, Cookeville 38501-2331(931) 528-1485

Britton Bishop, MD230 Associates Blvd, Alcoa 37701-1943(865) 273-1555

Richard Briggs, MD101 E Blount Ave Ste 800, Knoxville 37920-1669(865) 632-5900

Steven Dickerson, MDPO Box 159087, Nashville 37215-9087(615) 824-2014

Charles Eckstein, MD2801 Charlotte Ave, Nashville 37209-4035(615) 250-9200

Charles Goodman, Jr., MD320 E Main St, Murfreesboro 37130-3827(615) 896-5772

John Hale, MD, HOD Vice-Speaker1020 E Reelfoot Ave, Union City 38261-6051(731) 885-5131

Gary Kimzey, MD1755 Kirby Pkwy Ste 330, Memphis 38120-4398(901) 725-5846

Keith Lovelady, MD180 N Washington St Ste 300, Tullahoma 37388(931) 455-1511

Fredric Mishkin, MD135 W Ravine Rd, Ste 3-A, Kingsport 37660-3847(423) 246-6777

Omar Mohamed, MD, Resident & Fellow Section 135 N Pauline St Fl 6, Memphis 38105-4619(901) 448-2400

Bennett Pafford, Medical Student Section410 Lamont St, Johnson City 37604-6116(404) 202-8435

Wiley Robinson, MD, HOD Speaker6263 Poplar Ave Ste 1052, Memphis 38119-4736(901) 761-6157

Scott Sadler, MD, Young Physician Section 250 Boswell St, Lexington 38351-1566(731) 968-2006

Richard Sharpe, MDPO Box 70, Athens, TN 37371-0070(423) 745-6575

Bob Vegors, MD616 W Forest Ave, Jackson 38301-3966(731) 422-0344

Charles White, Jr., MD250 Boswell St, Lexington 38351-1566 (731) 968-2006

Christopher Young, MD975 E 3rd St, Chattanooga 37403-2103 (423) 778-7608

Special AdvisersDarlene Vickers, PresidentTMA Alliance2227 Breakwater Dr, Knoxville 37922-5678(865) 675-2890

Randy Wilmore, CMPETN Medical Group Management Association1050 N James Campbell Blvd, Ste 200,Columbia 38401-2690(931) 388-4276

Victor Braren, MD, ChairmanTN Council on Medical Specialty Societies329 21st Ave N, Ste 2, Nashville 37203-1855(615) 321-0481

TMA RESOURCE GUIDE

Members of the AMA Delegation meet during MedTenn 2008 in April.

AMERICAN MEDICAL ASSOCIATION DELEGATION

TMA SECTIONS

DelegatesChris Fleming. MD, Germantown,ChairmanDavid Gerkin, MD, Knoxville, Vice-ChairmanDonald Franklin, MD, ChattanoogaLee Morisy, MD, MemphisBarrett Rosen, MD, NashvilleCharles White, Sr., MD, Lexington

AlternatesSubhi Ali, MD, WaverlyLandon Combs, MD, BlountvilleRichard DePersio, MD, KnoxvilleJohn Ingram, III, MD, AlcoaRobert Kirkpatrick, MD, GermantownB. W. Ruffner, MD, Signal Mountain

TMA YOUNG PHYSICIAN SECTIONGoverning CouncilScott Sadler, MD, Lexington, ChairmanLandon Combs, MD, Blountville, Vice-ChairmanJames Batson, MD, Cookeville, Secretary-Treasurer

TMA HOD DelegatesStaci Van Winkle, MD, Memphis (1)Scott M. Sadler, MD, Lexington (2)Jeffrey Suppinger, MD, Franklin (3)Michel McDonald, MD, Nashville (4)James Batson, MD, Cookeville (5)Elizabeth Culler, MD, Chattanooga (6)Greg Mancini, MD, Knoxville (7)Landon Combs, MD, Blountville (8)

AMA DelegatesGeorge “Trey” Lee, III, MD, NashvilleJames Batson, MD, Cookeville

TMA RESIDENT & FELLOW SECTIONGoverning CouncilOmar Mohamed, MD, Memphis (UTHSC), ChairRegan Williams, MD, Memphis (UTHSC), Chair-electNari Heshmati, MD, Nashville (VUSM), Secretary/Treasurer

TMA HOD DelegateOmar Mohamed, MD, Memphis (UTHSC)

AMA DelegatesNari Heshmati, MD, Nashville (VUSM)Omar Mohamed, MD, Memphis (UTHSC)

TMA MEDICAL STUDENT SECTIONGoverning CouncilAriel Alexandroni, Mountain Home (QCOM), ChairmanCassandra Bradby, Nashville (Meharry), Vice-ChairNadia Sabri, Johnson City (QCOM)Rachel Wolfe, Johnson City (QCOM)Cassandra Bradby, Nashville (Meharry)Takita Brown, Nashville (Meharry)T. Amerson Pegram, Memphis (UTHSC)Kaartiga Sivanesan, Nashville (VUSM)

AMA DelegatesT. Amerson Pegram, Memphis (UTHSC)Adam Wright, Memphis (UTHSC)Takita Brown, Nashville (Meharry)

42

TMA RESOURCE GUIDE

IMPACT Chair Dr. Ken Moore outlines a new strategic plan to strengthen the PAC’s political muscle.

BOARD OF DIRECTORSKenneth Moore, MD, Franklin, Chairman (Dist. 4)Bart Bradley, MD, Bristol (Dist. 1)John Ingram, III, MD, Alcoa (Dist. 2)Mark Brzezienski, MD, Chattanooga (Dist. 3)Michael Minch, MD, Nashville (Dist. 5)Kenneth Holbert, MD, FACEP, Smyrna (Dist. 6)Robert Kirkpatrick, MD, Germantown (Dist. 7)Kirk Stone, MD, Union City (Dist. 8)Jeffery Warren, MD, Memphis (Dist. 9)James Batson, MD, Cookeville, Young Physician SectionChad Conatser, MD, Smyrna, Resident & Fellow SectionGeorganna Rosel, Johnson City, Medical Student SectionBarbara Trautman, Germantown, TMA AllianceGary Zelizer, Executive Director, Assistant Secretary/Treasurer

INDEPENDENT MEDICINE'S POLITICAL ACTION COMMITTEE - TENNESSEE (IMPACT)

43

TN FOUNDATION FOR QUALITY PATIENTHEALTHCARE (TFQPH) BOARD OF DIRECTORSSubhi Ali, MD, WaverlyNewton Allen, Jr., MD, NashvilleJohn Ingram, III, MD, AlcoaRobert Kirkpatrick, MD, MemphisMichael McAdoo, MD, MilanBronn Rayne, MD, CookevilleBarrett Rosen, MD, NashvilleDon Alexander, TMA CEO

TN MEDICAL EDUCATION FUND (TMEF)BOARD OF DIRECTORSRobert Bowers, MD, Chattanooga, ChairmanRobert Kerlan, MD, FACP, Memphis, Vice-ChairmanBob Vegors, MD, Jackson, Secretary-TreasurerMaysoon Ali, MD, WaverlySubhi Ali, MD, Waverly, Special AdvisorJohn Ingram, III, MD, Alcoa, Special AdvisorGeorge R. Lee, III, MD, NashvilleSam Williams, III, MD, Winter Harbor, ME, Special AdvisorMarcia Young, Murfreesboro, TMA AllianceBrent Atkinson, TMA Staff Liaison

SPECIAL BOARDS & COMMITTEES

TMA JUDICIAL COUNCIL Eric Fox, MD, Cookeville, Chairman (5)Samuel Bastian, MD, Franklin, Secretary-Treasurer (3)Lee Berkenstock, MD, Memphis (1)Walter Fletcher, MD, Lexington (2)Allen Lloyd, MD, Tullahoma (3)Russell Leftwich, MD, Nashville (4)Melvin Twiest, MD, Signal Mountain (6)George Smith, MD, Oak Ridge (7)David Freemon, MD, Johnson City (8)Yarnell Beatty, TMA Staff Liaison

MEDICAL LIABILITY REFORM (MLR)STEERING COMMITTEEMichael Minch, MD, Nashville, ChairmanNewton Allen, Jr., MD, NashvilleLeonard Brabson, Sr., MD, KnoxvilleCharles Handorf, MD, MemphisGary Kimzey, MD, GermantownMichael McAdoo, MD, MilanWarren McPherson, MD, MurfreesboroFredric Mishkin, MD, KingsportJohn Proctor, MD, MBA, FACEP, BrentwoodMark Thomas, MD, MaryvilleRandy Wilmore, CMPE, ColumbiaJ. Mack Worthington, MD, ChattanoogaGary Zelizer, TMA Staff Liaison

TENNESSEE MEDICINE EDITORIAL BOARDDavid Gerkin, MD, Knoxville, EditorJohn Thomison, MD, Nashville, Editor EmeritusLoren Crown, MD, CovingtonDeborah German, MD, NashvilleRonald Johnson, MD, MemphisRobert Kirkpatrick, MD, GermantownKarl Misulis, MD, JacksonGregory Phelps, MD, KnoxvilleBradley Smith, MD, NashvilleJonathan Sowell, MD, KnoxvilleJim Talmage, MD, Cookeville

THESE ARE MEMBERS OF TMA’S STANDING COMMITTEES FOR 2008-2009

TMA RESOURCE GUIDE

COMMUNITY & PROFESSIONAL RELATIONS Russell Leftwich, MD, Nashville, ChairmanLee Carter, MD, HuntingdonDeborah Christiansen, MD, KnoxvilleJames Ensor, Jr., MD, MemphisBarbara Kimbrough, MD, Johnson CityRichard Lane, MD, FranklinPhilip Pollock, MD, ChattanoogaRuss Miller, CAE, TMA Staff Liaison

CONSTITUTION & BYLAWSDavid Gerkin, MD, Knoxville, ChairmanJohn Bond, MD, NashvilleDavid Garriott, MD, KingsportTed Gaylon, MD, MemphisAlbert Grobmyer, III, MD, MemphisVincent Viscomi, MD, ChattanoogaCharles White, Sr., MD, LexingtonYarnell Beatty, JD, TMA Staff Liaison

INSURANCE ISSUES Jerome Thompson, MD, Memphis, Chairman James Bailey, Jr., MD, MemphisBritton Bishop, MD, AlcoaEdward Capparelli, MD, Oak RidgeLinda Clendening, NashvilleRichard Duszak, Jr., MD, MemphisEric Fox, MD, CookevilleWilliam Harb, MD, NashvilleWilliam Legier, DicksonCharles Leonard, MD, TalbottPhyllis Miller, MD, HixsonLee Morisy, MD, MemphisB. W. Ruffner, Jr., MD, Signal MountainWard Swarner, MD, ChuckeyJulie Griffin, TMA Staff Liaison

TMA Committees

COMMUNITY & PROFESSIONAL RELATIONS COMMITTEE ACTIVITIESOVER THE PAST YEAR INCLUDED:• Conducting an outside audit of TMA communications; results will be utilized

in the Futures II Workgroup to form recommendations to improve the overall effectiveness of Association communications efforts.

• Overseeing the modification and reorganization of the TMA Web site, in aneffort to help reduce clutter, help members find information faster and seethe most important items, and to drive membership.

• Directing a host of media relations activities, including news releases and letters to the editor on topics such as medical liability reform, Medicarephysician payment cuts, insurance rating and tiering, physician supervision ofextenders and retail clinic safety concerns, and a campaign to get Tennesseeuniversities to ban alcohol advertising from their sports programs.

• Investigating the feasibility of video and audio conferencing; the panel foundvideo conferencing was cost-prohibitive but initiated a number of audioconferences and seminars for member education.

Interested in joining this committee? E-mail Russ Miller at [email protected].

CONSTITUTION & BYLAWS COMMITTEE ACTIVITY FOR 2007-2008:• Recommended a bylaw amendment to allow representation and avoid

disenfranchisement of direct members in the House of Delegates.• Recommended a bylaw amendment creating a “dormant” classification for

non-functioning component medical societies.• Proposed a change in bylaw language deleting the required one-day “lie-

over” for proposed bylaw amendments, since the HOD now conducts business in a single-day session.

• Reviewed a bylaw amendment request to make TMA committee members ex-officio members of the HOD, and referred it to the Futures II Workgroupfor consideration.

Interested in joining this committee? E-mail Yarnell Beatty at [email protected]

2007-2008 INSURANCE ISSUES COMMITTEE ACTIVITIES: • Developed a P4P/Insurance Rating and Tiering presentation and trained its

members to bring the presentation to local medical society and hospitalstaff meetings; worked with the AMA on a P4P educational campaign, anddeveloped and co-branded flyers for distribution to TMA members.

• Regular contact with United HealthCare, Cigna and BlueCross BlueShield ofTennessee regarding insurance hassles, P4P and physician rating programs;helped secure a delay in launch of BCBST’s Consumer TransparencyProgram in Tennessee.

• Sent a letter to Cigna asking the insurer to abide by the New York settlement inTennessee, and to the State Attorney General and Commerce & InsuranceCommissioner asking for a similar investigation of health insurer practices; Cignaresponded with a commitment to follow the precepts of the New York settlement.

• Passed an HOD resolution to fund a TMA media campaign on P4P.Interested in joining this committee? E-mail Julie Griffin at [email protected].

45

LEGISLATIONNewton Allen, Jr., MD, Nashville, ChairmanGail Brabson, Knoxville, TMA AllianceBart Bradley, MD, BristolJohn Hale, MD, Union CityGary Kimzey, MD, GermantownKenneth Moore, MD, FranklinBronn Rayne, MD, CookevilleWilliam Rowe, Sr., MD, ChattanoogaIris Snider, MD, AthensCharles White, Jr., MD, LexingtonDavid Gerkin, MD, Knoxville, Ex-OfficioGary Zelizer, TMA Staff Liaison

MEMBERSHIPDouglas Springer, MD, Kingsport, ChairmanNewton Allen, Jr., MD, NashvilleJohn “Denny” Crabtree, Jr., MD, TullahomaDonald Ellenburg, MD, KnoxvilleCharles Fitch, MD, ClarksvilleMack Land, MD, MemphisRobert Miller, III, MD, GermantownPhyllis Franklin, TMA Staff Liaison

PRACTICE MANAGEMENT & QUALITYJoseph “Pete” Kelley, Jr., MD,

Chattanooga, ChairmanLeonard Brabson, Sr., MD, KnoxvilleGeorge Flinn, Jr., MD, MemphisBenjamin Johnson, Jr., MD, Nashville James Powell, MD, Franklin Wiley Robinson, MD, Memphis Colleen Schmitt, MD, ChattanoogaGeorge Woodbury, Jr., MD, CordovaYarnell Beatty, JD, TMA Staff Liaison

TMA RESOURCE GUIDE

TMA’S LEGISLATIVE COMMITTEE KEPT TABS ON MEDICINE’S AGENDA OVER THE PASTYEAR, INCLUDING:• Passage of a medical liability reform bill to require certification of medical malpractice lawsuits, to

help weed out meritless cases before they go to court.• Filing and lobbying for extending the medical malpractice reporting law, which is aimed at gathering

data to support further MLR efforts.• Winning liability protection for volunteer providers and a 90-day window for insurance plans to

complete physician credentialing and halt further delays.• Strong and visible support for the Smokefree Workplace law, tobacco tax increase and funding of

smoking prevention, education and cessation programs.• Passage of a measure that gives physicians access to an insurer’s rating methodology and data, and a

30-day period to contest or correct inaccurate data before it is published on a Web site.• Successful opposition to bills that would expand the scope of practice of a number of allied health

care providers.Interested in joining this committee? E-mail Gary Zelizer at [email protected].

OVER THE PAST YEAR, MEMBERSHIP COMMITTEE ACTIVITIES INCLUDED:• A survey of cancelled TMA members to gather helpful feedback; survey results were shared with

the Futures II Workgroup and incorporated into new marketing efforts. • New marketing strategies to get the TMA in front of its members and in touch with nonmembers

through contact with local medical societies, new services and educational offerings, and advertising through direct mail, publications and radio.

• Participation in a Membership Summit in November 2007 to analyze current membership data,identify barriers and issues at state and local levels, and strategize change and identify steps to improve membership. Findings and recommendations were shared with the Futures IIWorkgroup.

Interested in joining this committee? E-mail Phyllis Franklin at [email protected].

ACTIVITIES FOR THE PRACTICE MANAGEMENT & QUALITY COMMITTEE OVER THEPAST YEAR:• Facilitated a delay of tamper-resistent prescription pad requirements by CMS to give members time

to prepare; recommended a full-blown campaign to notify members, leading to a vendor agree-ment offering member discounts on compliant RX pads.

• Reviewed and recommended against a TMA partnership with DocSite, a new e-health product chosen by the Physicians Foundation for Health Systems Innovations for solo and small physicianpractices, until a full EHR product is available.

• Represented on the Governor’s ePrescribing subcommittee; committee facilitated the disseminationof information about ePrescribing grants to the TMA membership.

• Recommended that the TMA observe and comment on new protocols, standing orders and call centers on the rehospitalization of home health patients by QSource and the Tennessee HospitalAssociation’s Home Health Quality Initiative.

Interested in joining this committee? E-mail Yarnell Beatty at [email protected].

46

PUBLIC HEALTH Charles White, Jr., MD, Lexington, ChairmanPatrick Andre, MD, MilanEdward Capparelli, MD, Oak RidgeBennett Pafford, MPH, Johnson CityStuart Polly, MD, MemphisKirk Stone, MD, Union CityTara Sturdivant, MD, KnoxvilleJulie Griffin, TMA Staff Liaison

TMA RESOURCE GUIDE

THE PUBLIC HEALTH COMMITTEE ADDRESSED A NUMBER OF IMPORTANTISSUES IN 2007-2008: • Supported TMA legislative efforts to pass the statewide SmokeFree Workplace law, a 42-

cent-per-pack cigarette tax and a $10 million appropriation for tobacco cessation, pre-vention and education programs.

• Reviewed and recommended significant changes to past TMA policy on infectious diseaseand immunization, leading to HOD Resolution 8-08 to urge insurance and federal fund-ing for child immunization in Tennessee.

• Reviewed proposed legislation to curb increased drug use by prenatal mothers; the com-mittee supported the effort but found appropriate data to support the effort is currentlylacking and suggested the primary effort should be to collect valid data on the preva-lence of the problem.

Interested in joining this committee? E-mail Julie Griffin at [email protected].

47

T h e 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 w i s h e s t o t h a n k i t s C o r p o r a t e Pa r t n e r s :

TMA RESOURCE GUIDE

Component Medical Society PresidentsBedford County Medical Society William L. Russell, MD841 Union St, Ste 103, Shelbyville 37160-2611(931) 685-0987

Benton-Humphreys County Medical Society

George Mathai, MD224 Long St, New Johnsonville 37185-0368(931) 535-3734

Blount County Medical SocietyBritton Bishop, MD230 Associates Blvd, Alcoa 37701-1943(865) 273-1555

Bradley County Medical SocietyDennis Thompson, DO2850 Westside Dr NW, Ste D, Cleveland37312-3505(423) 472-1511

Campbell County Medical SocietyNone reported

Carter County Medical SocietyRobert Walter, MD1505 W Elk Ave, Ste 2, Elizabethton37643-2848(423) 543-1261

Chattanooga-Hamilton County Medical Society

Vincent Viscomi, MD2525 Desales Ave, Ste W-461, Chattanooga37404-1161(423) 495-7378

Cocke County Medical SocietyNone reported

Coffee County Medical SocietyBen Cottrell, MD711 NW Atlantic St, Tullahoma 37388-3562(931) 455-3445

Consolidated Medical Assembly of West Tennessee

Edmund Palmer, Jr., MD294 Summar Dr, Jackson 38301-3915(731) 423-1932

Cumberland County Medical SocietyNone reported

DeKalb County Medical SocietyMelvin Blevins, MDPO Box 667, Smithville 37166-0667(615) 597-4049

Dickson County Medical SocietyNone reported

Franklin County Medical SocietyMark Wert, MD185 Hospital Rd, Winchester 37398-2404(931) 967-8152

Giles County Medical SocietyNone reported

Greene County Medical SocietyJohn Boys, MD1420 Tusculum Blvd, Greeneville 37745-4279 (423) 787-5040

Hawkins County Medical SocietyNone reported

Henry County Medical SocietyNone reported

Knoxville Academy of MedicineDeborah Christiansen, MD2201 W Clinch Ave, Knoxville 37916-2203 (865) 525-0228

Lakeway Medical SocietyErnesto Mejia, MD500 McFarland St, Ste B, Morristown37814-3992(423) 587-3630

Lawrence County Medical SocietyMicky Busby, MD317 W Gaines St, Lawrenceburg 38464-3604 (931) 762-9665

Lincoln County Medical SocietyLarry Barnes, MDPO Box 1039, Fayetteville 37334-1039(931) 433-9900

Loudon County Medical SocietyCalvin Robert Schaerer, MD616 Ward Ave, Loudon 37774-1323(865) 458-5666

Maury County Medical SocietyJeffrey Adams, MD1050 N James Campbell Blvd, Ste 200,Columbia 38401-2690(931) 388-4276

McMinn County Medical SocietyRichard Sharpe, MDPO Box 70, Athens 37371-0070 (423) 745-6575

The Memphis Medical SocietyKeith Anderson, MD7460 Wolf River Blvd, Germantown38138-1760(901) 763-0200

Monroe County Medical SocietyNone reported

Montgomery County Medical SocietyCharles Fitch, MD1731 Memorial Dr, Ste 100, Clarksville37043-4543(931) 552-6830

Nashville Academy of MedicineMichael Zanolli, MD4230 Harding Pike, Ste 609E, Nashville37205-2013 (615) 222-3442

Northwest Tennessee Academy of Medicine

James Shore, MD117 Kennedy Dr, Martin 38237-3309(731) 587-9511

Overton County Medical SocietyNone reported

Putnam County Medical SocietyJames Batson, MD345 W Broad St, Cookeville 38501-2331(931) 528-1485

Roane-Anderson County Medical Society

George Smith, MD800 Oak Ridge Tpke, Ste A200, Oak Ridge37830-6927 (865) 483-2299

Robertson County Medical SocietyJonathan Kroser, MD320 Northcrest Dr, Springfield 37172-3963(615) 384-8211

Scott County Medical SocietyTrent Cross, MD460 Industrial Ln, Oneida 37841-6294 (423) 569-8064

Sevier County Medical SocietyNo current president

Smith County Medical SocietyRichard West, MD133 Hospital Dr, Ste 600, Carthage 37030-4006 (615) 735-2200

Stones River Academy of MedicineDavid Beaird, MD1004 N Highland Ave, Murfreesboro37130-2454(615) 867-8040

Sullivan County Medical SocietyEdwin McElroy, Jr., MD111 W Stone Dr Ste 300, Kingsport37660-6029(423) 224-3150

Sumner County Medical SocietyNone reported

Tipton County Medical SocietySamuel Johnson, MDPO Box 507, Covington 38019-0507 (901) 475-4752

Warren County Medical SocietySuneetha Nuthalapaty, MD1589 Sparta St, Ste 104, McMinnville37110-1392(931) 815-1616

Washington-Unicoi-Johnson County Medical Association

Paul Benson, MD1009 N State of Franklin Rd, Johnson City37604-3693(423) 929-7546

White County Medical SocietyNone reported

Williamson County Medical SocietySamuel Bastian, MD2339 Hillsboro Rd, Franklin 37069-6225(615) 791-9300

Wilson County Medical SocietyNo current president

49

53

Member News

Member News

Visit www.medwire.org for the latest TMA news, information and opportunities!

On July 1, Medicare will slash physician pay-ments 10.6 percent. Time is running out.Physicians and patients alike are urged to calltheir members of Congress and let them knowhow important the Save Medicare Act of 2008(S. 2785) is for seniors and their doctors.

This legislation would prevent the 10.6 per-cent cut in Medicare physician paymentsplanned for July 1, retain current payment levelsfor the remainder of this year and enact a 1.8percent increase for 2009. Physicians andpatients can call the AMA Grassroots Hotline at(800) 833-6354 to be connected to their mem-bers of Congress and urge them to co-sponsorand pass S. 2785.

Visit www.ama-assn.org/ama/pub/catego-ry/14332.html to download the AMA’s MedicarePhysician Payment Action Kit.

Urge patients to visit www.patientsactionnet-work.org to learn more about the Medicare pay-ment cuts and how they may affect their health-care. For more information, log on to www.med-wire.org. �

The Tennessee Medical Association House of Delegates (HOD) took actionon a number of healthcare quality, public health, and insurance-related issuesduring TMA’s 173rd Annual Meeting in Nashville on April 19.

Top actions by the TMA’s policy-making body included a vote to promoteclinically-based and outcomes-derived quality reporting initiatives while opposingphysician rating and tiering systems based mainly on administrative claims. TheHOD also approved resolutions aimed at helping Tennessee avert a looming doc-tor shortage, reducing the uninsured population by extending parents’ healthbenefits for their young adult children, and addressing vaccines, WIC formula sub-stitutions, and insurance coverage for emergency care of intoxicated patients.

Resolutions of InterestPhysician representatives from across Tennessee met in Nashville April 19

to create and debate policy on a variety of healthcare issues facing Tennesseedoctors and their patients. From the slate of 15 resolutions, delegates dis-cussed a variety of concerns; final actions taken by the HOD included:

Quality Rating ProgramsDenouncing administrative claims-based physician rating and tiering pro-

grams as inaccurate and misleading, TMA members voted to support clinically-based initiatives undertaken by specialty societies, while seeking to educate

TMA Acts onQuality Ratings,Doctor Shortage,the Uninsuredat 173rdAnnual Meeting

continued on page 55

SAVE MEDICAREACCESS: URGECONGRESS TOPASS S. 2785

Chattanooga-Hamilton CountyMedical Society Delegate Dr. ColleenSchmitt introduces a resolution at the2008 House of Delegates session.

54 Member News

Member News

Several provisions in the national Blue Cross and Blue Shield(BCBS) Association settlement took effect April 21, after a finalorder was filed by the federal court in Miami.

The development brings eligible physicians one step closerto the $128 million payout and allows the AMA to commenceenforcement of the national BCBS settlement as an additionalsignatory medical society. The AMA joins 27 other participatingmedical societies that are able to provide direct assistance tophysicians when a BCBS plan or subsidiary has failed to honorits commitments under the settlement.

The final order comes almost a year after 23 BCBS planssettled a class action lawsuit brought by 90,000 physicians

Payout to Doctors Pending in BCBS Settlement

TN Doctors Urged toTake Part in NationalPrimary Care Survey

The TMA is working to get Tennessee to join the movementtoward health insurer transparency. With initiatives beginning onthe national level and new state laws in Colorado, Indiana andOhio, efforts are underway to require more disclosure by healthinsurance companies about their contracts with physicians.

On a state level, the TMA expressed strong support for and wasintegral in helping draft amendatory language to the HealthInsurance Contracting Reform bill, (SB 3429/HB 3214), sponsoredby State Senator Tim Burchett (R-Knoxville) and Rep. Curt Cobb (D-Shelbyville). As amended, the bill would:

• Require a summary disclosure for each healthcare contract; • Require each insurance company to maintain a Web site

which will allow providers to make a pre-determination ofpayment;

• Set up a fair process where providers may appeal claimsdenials or inappropriate discounts to the Commissioner of theDepartment of Commerce and Insurance; and

• Address one aspect of the “Silent PPO” issue – the repricers oraggregators.

The bill was heavily opposed by the insurance industry and morerecently and surprisingly by the Bredesen administration, so spon-sors have decided to regroup and will be working with stakeholdersover the summer on provisions that can be passed next year. �

Health Insurer Transparencyan Ongoing Issue

What is the state of primary care practice in Americatoday? Can primary care physicians continue to providepatient care in the face of rising costs, reimbursement cutsand pervasive government regulations? What do primarycare doctors themselves have to say about the direction ofmedical practice in America?

The Physicians’ Foundation for Health SystemsExcellence (PFHSE), a not-for-profit group composed ofmedical societies and physician leaders created with fundsfrom the “big insurance” lawsuit settlements, is seekinganswers to these questions in one of most ambitious physi-cian surveys ever attempted. Beginning in May 2008, PFHSEsent out over 300,000 surveys to primary care physiciansand selected medical specialists throughout the country.

“We have heard from the pundits about the state ofmedical care in the United States,” notes Louis Goodman,PhD, president of PFHSE and executive vice president ofthe Texas Medical Association. “It’s time we heard whatphysicians have to say.”

The survey asks primary care physicians about the stateof their practices and whether or not they can maintainpatient care services in light of regulatory and financial bur-dens. The key question posed by the survey is can doctorscan meet the needs of patients under current practice con-ditions? If the survey indicates that medical practice itself isin jeopardy, that urgent message needs to be heard by pol-icy makers and the public, according to PFHSE officials.

Physicians in Tennessee and around the country arebeing urged to participate when the survey arrives in theirmailbox. “This is a critical chance for doctors to have theirvoices heard,” said Tim Norbeck, executive director ofPFHSE and longtime former executive director of theConnecticut State Medical Society. “The more physicianswho participate, the more persuasive their voices will be.”

For additional information, access www.physiciansfoun-dation.org or contact Phillip Miller at 469-524-1420, [email protected]. �

continued on page 59

Member News

55Member News

employers and Tennessee patients about thepitfalls of current claims-based rating systemsby health insurance companies in the state.TMA will also call for investigations by theTennessee Commissioner of Commerce &Insurance and the State Attorney Generalinto the accuracy and validity of health insur-ers’ claims-based rating and tiering systems;and seek legislation to require insurers to cer-tify the accuracy of their rating/tiering databefore it is published, and to carry the fullcost and administrative burdens of their rat-ing/tiering initiatives.

“We’re concerned about the quality ofcare patients receive and welcome newmethods to provide patients with moreinformation from the people who providecare. Doctors aren’t afraid to be rated ontheir quality of care; however, we feel it’simperative we are evaluated fairly using clin-ical and patient interaction data, not justpayment information derived from insur-ance companies,” stated newly-installedTMA President Robert D. Kirkpatrick, MD.

Physician ShortageA looming shortage of physicians pre-

dicted for as early as 2010, particularly inprimary care and rural areas of Tennessee,prompted a vote to alert and enlighten statepolicy makers about the coming crisis, workto expand residency positions and medicalschools, and support several initiatives toensure an adequate supply of physicians isavailable for the next generation of patients.The TMA officially adopted a posture toexpand graduate medical education (GME)programs and lift Medicare caps on GME.

“Our country faces a tremendous num-ber of challenges in dealing with the BabyBoom population in general. We are criticallyconcerned that we are not prepared to han-dle the demands of this generation in ourcurrent healthcare system,” said Dr.Kirkpatrick. “Even if we dedicated all our cur-rent resources to just that group of patients,it would leave grossly undermanned to carefor everyone else. It’s not too late to addressthe issue but we have to get more qualifiedcaregivers interested in a career in medicine.”

Insurance CoverageSeveral resolutions were adopted address-

ing various issues about insurance coverage.The HOD voted to urge Tennessee to join 19other states in reducing the ranks of uninsuredyoung adults by extending their parents’health benefits to cover them past the tradi-tional cutoff of age 19 through the age of 25.Another resolution directed TMA, if recom-mended by a State Comptroller’s report inDecember 2008, to seek the repeal of provi-sions of Tennessee’s Uniform Accident andSickness Policy Prevention Law (UPPL) thatprevent insurers from reimbursing for medicalservices for alcohol- and narcotics-relatedinjuries. Those provisions indirectly discouragedrug and alcohol testing of emergencypatients. HOD members also reaffirmed a pre-vious resolution to seek state action that wouldhelp resolve coverage disputes arising fromemergency care of patients treated by a hospi-tal or doctor not in their approved network.

Child HealthTMA members considered two resolutions

dealing with child health. They adopted one tosupport legislation to require funding for childimmunizations in Tennessee, either throughprivate insurance companies or the VaccinesFor Children (VFC) program. They also votedto strongly advocate for an easier way toobtain alternative formulas through theWomen, Infants and Children (WIC) programfor infants unable to use the current formula.

Other ActionsThe TMA House of Delegates acted on

a number of other resolutions:• Defeated a proposal to require a ban

on alcohol and tobacco sales in retailestablishments that also have healthcare clinics (Res. No. 2-08);

• Rejected a proposal to eliminate thepeer review process at the local orcounty medical society level andsend physician complaints directly tothe Tennessee Board of MedicalExaminers (Res. No. 12-08);

• Permanently adopted as policy previ-ous resolutions to:

° Admonish members not to signpotentially unethical contracts or failto disclose financial interests thatconflict with the best interests of theirpatients;

° Encourage physicians not to seekexemption of mandatory seatbeltsexcept when safety is outweighed byappropriateness of the restraint forphysically handicapped patients; and

° Continue supporting the work of thePhysicians Health Program and aid inthe reentry of physicians who havebeen through PHP programs.

For complete text of final resolutions, visitwww.medwire.org/medtenn. �

TMA Acts on Quality Ratings, Doctor Shortage, the Uninsured at 173rd Annual Meetingcontinued from page 53

HOD Installs TMA Leadership atAnnual Meeting:• Dr. Robert Kirkpatrick, a family

medicine/occupational medicinespecialist from Memphis, will serveas the Association’s 153rd president.

• Dr. Richard DePersio, a Knoxvilleotolaryngologist, will serve as president-elect for 2008-09.

• Dr. Donald Ellenberg, an allergistfrom Knoxville, will serve as chair-man of the TMA Board of Trustees.

• Dr. Robert Kerlan, a Memphis gastroenterologist, will serve as BOT vice-chairman.

New members selected to serve three-year terms on the TMA Board of Trustees are:• Dr. Valerie Arnold, Memphis;

psychiatrist• Dr. Richard Briggs, Knoxville;

cardiovascular/thoracic surgeon• Dr. Steven Dickerson,

Hendersonville; anesthesiologist• Dr. Charles Eckstein, Nashville;

urologist • Dr. Gary Kimzey, Memphis;

anesthesiologist• Dr. Keith Lovelady, Tullahoma;

pulmonary/critical care specialist

56 Member News

Member News

Dr. Scott Morris (2nd from L), founder of theChurch Health Center in Memphis, receivedthe prestigious AMA Pride in the ProfessionAward, bestowed by the AMA Foundation dur-ing the National Advocacy Conference inWashington, DC, on March 31. Dr. Morris andwife Mary pose with (L-R) Memphis MedicalSociety (MMS) President Dr. Keith Anderson,TMA President Dr. Robert Kirkpatrick, MMSExecutive Director Michael Cates, CAE, andAMA Delegation Chair Dr. Chris Fleming.

Dr. John Freeman, of Memphis, examines apatient’s vision in Ometepec, Mexico, on amedical mission trip in March, sponsored bythe World Cataract Foundation. Founded byhis father, Dr. Jerre Freeman, the WCF hasbeen fighting blindness in underserved coun-tries around the world since 1978. The Drs.Freeman and fellow Memphis ophthalmologistDr. Chris Fleming were among six physicianswho participated; the team, aided by Mexicancolleagues, screened 500 patients and per-formed 186 surgical procedures.

T M A P H O T O G A L L E R Y

Dr. George Woodbury, Jr., (L) is pictured with Trey Pegram, M1 and local AMAStudent President at the University ofTennessee Health Science Center in Memphisfollowing a “Pizza & Politics” lunch meetingin April. Dr. Woodbury hosted the event onbehalf of The Memphis Medical Society, urg-ing student involvement on a variety of topics, including medical liability reform, the Medicare/SGR crisis and scope of practice issues.

Member News

57Member News

PLC candidate Dr. Jeffrey Fenyves (L) poses with Dr. GeorgeTesterman at the MedTenn 2008 Welcome Reception.

State Representatives Beth Harwell (center) and Gary Odom(2nd from R) were featured guests at the IMPACT CapitolHill Club Reception.

MedTenn 2008 culminated in an inaugural evening event, The Medicine Ball: The Best ofBroadway. Attendees were treatedto a dinner show featuring songsfrom some of Broadway’s mostpopular hit musicals.

TMA President Dr. J. Mack Worthington enjoys a moment in the spotlightduring The Medicine Ball.

TMA President-elect Dr. RichardDePersio and wife Missy.

M E D T E N N P H O T O G A L L E R Y

58 Member News

Member News

Sports Physical RulesChange for 2008-2009

Beginning with the 2008-2009 school year, rising sev-enth and ninth grade student athletes will be required tohave a complete health maintenance exam (also known asa well-child check or EPSDT screen) prior to sports partici-pation. For these two grades, the required clearance formmust show the student athlete has had the required healthmaintenance exam/EPSDT screen, in addition to statingthe student is cleared for participation in sports.

Traditional sports physicals, appropriate for clearingathletes for sports participation, typically do not addressthe behavioral, emotional, and psychosocial topics coveredduring a comprehensive health maintenance exam. Giventhe number of chronic health problems rooted in child-hood, it is important to tackle these problems early and ayearly exam provides a venue to address these areas.

The required clearance form may be downloaded from the Tennessee Medical Association(www.medwire.org/Legal, click on “Sports PhysicalInformation” under “Forms” – member login required),from the Tennessee Department of Health(http://health.state.tn.us/sportsphysical/index.htm), or fromthe Web sites of the TN Chapter of the American Academyof Pediatrics (www.tnaap.org), the TN Academy of FamilyPhysicians (www.tnafp.org), or the TN Primary CareAssociation (www.tnpca.org).

For a list of provider FAQs, log on towww.medwire.org/pdf/legal/Sports_Px_FAQs.pdf. �

Please help FDA spread the word about recalls of injectableheparin products and heparin flush solutions that may be contami-nated with oversulfated chondroitin sulfate (OSCS). Affectedheparin products have been found in medical care facilities in onestate since the recall announcement. Although product recallinstructions were widely distributed, they may not have been fullyacted upon at all sites where heparin is used. There have been manyreports of deaths associated with allergic or hypotensive symptomsafter heparin administration (see FDA link atwww.fda.gov/cder/drug/infopage/heparin/adverse_events.htm).

The FDA asks health professionals and facilities to please reviewand examine all drug/device storage areas, including emergencykits, dialysis units and automated drug storage cabinets to ensurethat all recalled heparin products have been removed and are nolonger available for patient use. In addition, FDA would like toinform health professionals about other types of medical devicesthat contain, or are coated with, heparin. To read this update, andto learn how to report these problems to FDA, please go to:www.fda.gov/cdrh/safety/heparin-healthcare-update.html.

Please report to FDA adverse reactions associated with thesedevices, as well as any reactions associated with heparin or heparinflush solutions. If you have questions or would like more informa-tion about this request, please contact the Division of DrugInformation at 301-796-3400. �

FDA Alert: Heparin Recallfor All Provider Types

Effective May 1, 2008, CIGNA beganpaying physicians who bill CPT® 96110(developmental screening) with anEvaluation and Management Codeappended with a modifier 25. This wel-come payment change came as a resultof compliance disputes filed by severalpediatricians under the SettlementAgreement reached between severalstate and county medical associations,

including the TMA, and CIGNA in theRICO/managed care litigation. Thephysicians and medical societies arguedthat the Settlement Agreement requiredCIGNA to pay this code combination.Although the settlement has ended,CIGNA has agreed to make this paymentchange for the future.

Settlement agreements with Aetna,HealthNet, Humana, WellPoint, and the

Blue Cross/Blue Shield Associationremain in effect. For more informationabout physicians’ rights under the settle-ment agreements and/or if you believeany of these companies is violating thesettlement terms, contact the TMA LegalDepartment at [email protected] go to www.hmosettlements.com. �

“Big Insurance” Lawsuit Compliance Dispute Leadsto CIGNA Payment Policy Change

Member News

59Member News

Capitol Hill ClubThe IMPACT Board of Trustees recognizes the following

IMPACT donors who have become Capitol Hill Club mem-bers in the past month. We greatly appreciate all IMPACTcontributors for their help in assuring that candidates sup-portive of organized medicine receive generous financialsupport from IMPACT. To join IMPACT or the Capitol HillClub, please contact Marcia Sorrell at 800-659-1862 orsend e-mail to [email protected].

Newton Allen, Jr., MD, NashvilleValarie Arnold, MD, MemphisLee Berkenstock, MD, MemphisJohn Binhlam, MD, NashvilleBritton Bishop, MD, AlcoaRichard Briggs, MD, KnoxvilleStuart Caplan, MD, NashvilleJohn Culclasure, MD, NashvilleWalter Fletcher, MD, LexingtonEric Fox, MD, CookevilleDonald Franklin, Jr., MD, ChattanoogaJoey Hensley, MD, HohenwaldRobert Herring, Jr., MD, BrentwoodThomas Higgins, MD, KnoxvilleJohn Ingram, III, MD, AlcoaBenjamin Johnson, Jr., MD, NashvilleGary Kimzey, MD, GermantownRobert Kirkpatrick, MD, GermantownGary Lovelady, MD, ManchesterSusan Lowry, MD, MartinRobert McClure, MD, ColumbiaWilliam McKissick, MD, KnoxvilleJames Powell, MD, FranklinAvinash Reddy, MD, JacksonScott Sadler, MD, LexingtonRichard Sharpe, MD, AthensDavid Steed, JD, NashvilleRaymond Walker, MD, MemphisJeffrey Warren, MD, MemphisCharles White, Jr., MD, LexingtonCharles White, Sr., MD, LexingtonCharles Womack, MD, CookevilleGeorge Woodbury, Jr., MD, Memphis�

Payout to Doctors Pending in BCBSSettlementcontinued from page 54

against the BCBS Association and more than 30affiliated plans and subsidiaries. The settlementsare designed to curb contentious business prac-tices that have long frustrated physicians andjeopardized the delivery of quality patient care. Ifa BCBS plan chooses not to uphold its end of thebargain, physicians have a free, simple enforce-ment process that can resolve the matter.

There are special provisions in the settlementsthat are specific to particular states. Visitwww.ama-assn.org/go/settlements to access theAMA’s online interactive map, which lists theBCBS plans and subsidiaries that have settled, thestate-specific provisions of the agreement andthe dates the various provisions take effect. Formore information, log on to www.hmosettle-ments.com/pages/bluecross.html. �

60 Member News

Member News

Howard A. Burris, III, MD, of

Nashville, was in Washington, DC, in

May to testify in a Congressional brief-

ing on quality care for cancer patients.

A medical oncologist with the Sarah

Cannon Research Institute, Dr. Burris

was among expert witnesses speaking

at the hearing sponsored by the

National Coalition for Cancer Survivorship (NCCS). The briefing

was held in support of the Comprehensive Cancer Care

Improvement Act, which includes proposals to advance a sys-

tem of integrated cancer care and improved communication

between patients and their health care teams regarding treat-

ment options and follow-up care.

Julie Dunn, MD, of Johnson City, has

been selected by the American College

of Surgeons (ACS) and the American

Association for the Surgery of Trauma

(AAST) to receive the Health Policy

Scholarship. Dr. Dunn will participate

in a health policy leadership and man-

agement program at Brandeis

University and become a health policy adviser for ACS and

AAST. An associate professor of surgery at East Tennessee State

University’s James H. Quillen College of Medicine, Dr. Dunn has

been an active leader in strengthening trauma care services in

Tennessee. She is currently the director of trauma at Mountain

States Health Alliance, is a member of the ACS’ Tennessee

Committee on Trauma, and chairs the Trauma Care Advisory

Council for Tennessee.

Wahid T. Hanna, MD, of Knoxville,

recently received a Recognition of

Contribution Award for his outstand-

ing, worldwide contributions to the

field of hemophilia in Cairo, Egypt. He

was presented the award by the World

Federation of Hemophilia, Egyptian

Society of Hemophilia and the

Egyptian Ministry of Health. Dr. Hanna is currently serving as

professor of medicine and chief of hematology/oncology at the

University of Tennessee Graduate School of Medicine, and is

director of UT Medical Center’s East Tennessee Comprehensive

Hemophilia Center. He has been involved in hematology/oncol-

ogy research and the diagnosis and treatment of these diseases

for 37 years.

Paul E. Stanton, Jr., MD, has

announced his intention to retire as

president of East Tennessee State

University by March 1, 2009. Citing

health concerns, Dr. Stanton said his

retirement would allow “renewal and

new blood, new vision, new enthusi-

asm.” A former dean of ETSU’s Quillen

College of Medicine and vice president for health affairs, Dr.

Stanton is a vascular surgeon and previously served as director

of the Division of Peripheral Vascular Surgery for the Veterans

Administration Medical Center at Mountain Home and ETSU’s

College of Medicine. �

Are you a member of TMA who has been recognized for an honor, award, election, appointment, or other noteworthy achievement? Send items for consideration to Member Notes, Tennessee Medicine, 2301 21st Ave. South, PO Box 120909, Nashville, TN, 37212; fax 615-312-1908; [email protected]. High resolution (300 dpi) digital (.tif or .eps) or hard copy photos welcome.

MEMBER NOTES


NEW MEMBERS

IN MEMORIUM

Tennessee Medicine takes this opportunity to welcome these new members to the Tennessee Medical Association

BLOUNT COUNTY MEDICAL SOCIETYTroy Allen Trondson, MD, Shreveport

KNOXVILLE ACADEMY OF MEDICINERandall Curnow, Jr., MD, Knoxville

THE MEMPHIS MEDICAL SOCIETYShelly Laine Bryant Thannum, MD, Collierville Rushelle Jones Cyrus, MD, Memphis Philip G. Mintz, MD, Memphis Keith Bennett Owen, MD, Bartlett Robert Louis Yates, MD, Memphis

MONROE COUNTY MEDICAL SOCIETYChristopher Scott Bowman, MD, Sweetwater

OVERTON COUNTY MEDICAL SOCIETYBarton Matthew Clements, MD, Livingston

PUTNAM COUNTY MEDICAL SOCIETYStephen G. Gelfand, MD, Cookeville

SULLIVAN COUNTY MEDICAL SOCIETYWilliam Henry Bestermann, Jr., MD, Kingsport

Paul D. Richards, MD, age 94. Died April 3, 2008. Graduateof Bowman Gray School of Medicine at Wake Forest University.Member of Knoxville Academy of Medicine.

Lamb Bolton Myhr, Sr., MD, age 91. Died April 19, 2008.Graduate of Vanderbilt University School of Medicine. Memberof Consolidated Medical Assembly of West Tennessee.

James Peyton Lester, MD, age 83. Died April 24, 2008.Graduate of University of Tennessee Center for Health Science.Member of Nashville Academy of Medicine.

Thomas V. Stanley, MD, age 78. Died April 28, 2008.Graduate of University of Tennessee Center for Health Science.Member of The Memphis Medical Society.

Philip J. Hinton, MD, age 63. Died May 4, 2008. Graduateof Medical College of Wisconsin. Member of Washington-Unicoi-Johnson County Medical Society.

Noel C. Hunt, MD, age 70. Died May 14, 2008. Graduate ofVanderbilt University School of Medicine. Member ofChattanooga-Hamilton County Medical Society.

CORRECTIONOne of the MRI images in the article “Rhabdomyolysis in a Patient with West Nile Encephalitis and Flaccid Paralysis,”published in the April issue of Tennesee Medicine (Vol. 101,No. 4, p. 46), was a duplicate. The image for Figure 3 shouldhave been the one shown to the right. Tennessee Medicineregrets the error.

Figure 3. T2 weighted MRI after three weeks showingresolution of bilateral edema of the basal ganglia andthalamus.

LIST OF ADVERTISERS

Career Opportunity Advertising ..........................................62

DoctorsManagement, LLC ..................................................40

LBMC ..................................................................................20

Shared Health ......................................................................4

Shell Capital Management......................................................6

State Volunteer Mutual Insurance Company ........................64

Tennessee Medical Foundation ..........................................50

The TMA Association Insurance Agency, Inc. ..............28, 63

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

INSTRUCTIONS 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 identify one author ascorrespondent and should include his complete address, phone, and e-mail. Manuscripts, aswell as legends, tables, and references, must be typewritten, double-spaced on 8-1/2 x 11 in.white paper. Pages should be numbered. Along with the typed manuscripts, submit an IBM-compatible 3-1/2" high-density diskette containing the manuscript. The transmittal lettershould identify the format used. Another option is you may send the manuscript via e-mail [email protected]. If there are photos, e-mail them in TIF or PDF format along withthe 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 conditionof acceptance, shall execute a conveyance transferring copyright ownership of such materialto Tennessee Medicine. No contribution will be published unless such a conveyance is made.References – References should be limited to 10 for all papers. All references must be citedin the text in numerically consecutive order, not alphabetically. Personal communications andunpublished data should be included only within the text. The following data should be typedon a separate sheet at the end of the paper: names of first three authors followed by et al, com-plete title of article cited, name of journal abbreviated according to Index Medicus, volumenumber, first and last pages, and year of publication. Example: Olsen JH, Boice JE, SeersholmN, et al: Cancer in parents of children with cancer. N Engl J Med 333:1594-1599, 1995.Illustrated Material – Illustrations should accompany the e-mailed article in a TIF or PDFformat. If you are mailing the article and diskette, the illustrations should be 5 x 7 in. glossyphotos, identified on the back with the author's name, the figure number, and the word "top,"and must be accompanied by descriptive legends typed at the end of the paper. Tables shouldbe typed on separate sheets, be numbered, and have adequately descriptive titles. Each illus-tration and table must be cited in numerically consecutive order in the text. Materials takenfrom other sources must be accompanied by a written statement from both the author andpublisher giving Tennessee Medicine permission to reproduce them. Photos of identifiablepatients should be accompanied by a signed release.Reprints – Order forms with a table covering costs will be sent to the correspondent authorbefore publication.

CAREER OPPORTUNITY ADVERTISINGListings for Career Opportunities are sold as follows: $35 for the first 50 words($25 for TMA members), 25 cents for each additional word. Count as one word allsingle words, two initials of a name, single numbers, groups of numbers, hyphen-ated words, and abbreviations. Advertisers may utilize a box number for confiden-tiality, if desired, in care of Tennessee Medicine, PO Box 120909, Nashville, TN37212-0909. Use of this box in an ad will add eight words to the total count.

All orders must be submitted in writing by the 25th of the 2nd month preceding thedesired month of publication, and will be subject to approval. No phone orders willbe accepted. Payment must accompany order. Each listing will be removed after itsfirst publication unless otherwise instructed.

Mail your ad with payment to Beth McDaniels at Tennessee Medicine, PO Box120909, Nashville, TN 37212-0909 exactly as it should appear or e-mail your ad [email protected] and send your check with a hard copy to her attention.

PHYSICIANS WANTEDFull-time and part-time opportunities available for family prac-tice, internist, and geriatricians. We are focused on caring forpatients in nursing homes and assisted living facilities. Nursinghome medical directorships are also available. The openingsinclude flexible hours with excellent pay and benefits. All patientcare with no paperwork or administrative duties. To learn more,please call Jeanne Thomas at 866-662-4560, ext. 311 or [email protected].


Documents

Tennessee Medicine Magazine Demo