More Head for the Hills

Here’s a few new session descriptions for the upcoming Head for the Hills event:

Curbside Consults, Bob Franko

Embedding behaviorists into primary care has many benefits in both clinical and financial outcomes, but to achieve those outcomes is often harder than it looks. Cherokee Health Systems (Knoxville, TN) offers a mature integrated practice that has nearly 40 years of development to its credit, today serving over 65,000 patients in 56 clinical locations across 15 counties in east Tennessee.  We will describe the clinical model and define the key roles, as well as talk about the specific billing and coding challenges related to an integrated practice. “Curbside consults,” “warm handoffs,” and team meetings are terms associated with integrated care, but are widely misunderstood by both providers and payers. We’ll define these practices and how to discuss them with payers.

Nutrition Economy in a Food Oasis, Kelley Pearson

Living on a tight budget means careful consideration of food choices. Chef Kelley Pearson discusses how a family of two adults and five kids at the poverty line shops local and eats mostly good stuff. Kelley also runs a restaurant that serves non-processed foods, and has “fought the good fight” on what patrons will and won’t pay to eat. Listen to her witty, wise, and informative discussion of the difference between “medical advice” and “plausible lifestyles” in SW VA. Extra Q&A time has been scheduled so you can get insights from someone who has been there, done that.


Click here for the main event page and here for additional session descriptions.

Head for the Hills!

What’s on the schedule for the 2015 event?  Check out these great presentations:

Anxious Kids – A Primary Care Approach- Meds & More: C. Allen Musil, MD

A discussion of the 3 classes of medication commonly prescribed to treat childhood anxiety, appropriate reasons to initiate medication in an anxious child, common side effects of SSRI treatment in children.  Will include things a primary care provider can do when interacting with school systems, when treating a child/adolescent with school refusal second to anxiety.

WIC Works:  Jessica Arney, MS, RD, LD

Overview of the WIC program including the immediate benefits of nutrition education, counseling, supplemental foods and breastfeeding support.  I will also talk about the long term positive health outcomes associated with participation in the program.  I will be able to discuss the differences between WIC and SNAP and answer any questions about the program.

Opioid Abuse and Overdose: Recognition and Management: Sarah T. Melton, PharmD, BCPP, BCACP, CGP, FASCP & S. Hughes Melton, MD, MBA, FAAFP, DABAM

REVIVE! is a program of the Commonwealth of Virginia which makes naloxone available to lay rescuers to reverse opioid overdoses. A collaborative effort with the Virginia Department of Behavioral Health and Developmental Services (DBHDS) taking the lead, the project includes the Virginia Department of Health, the Virginia Department of Health Professions, recovery community organizations such as the McShin Foundation, OneCare of Southwest Virginia, the Substance Abuse and Addiction Recovery Alliance of Virginia (SAARA), and other stakeholders.

Cheap Meds:  Melody Counts, MD

Medical schools often teach us the best medications for a given medical condition without much regard for the cost to the patient.  In the real world, prescription medication cost can be a huge barrier to uninsured or underinsured patients.  This presentation will review the various resources for discounted and free prescription medications, as well as the reasons why a practice would want to invest time in utilizing them.

ADHD: What’s new? Roger Hofford, MD

This session will review some of the new information published, review the current treatments, present a treatment algorithm, and review recent Virginia and North Carolina Medicaid data plus CDC data.  Dr. Hofford recently chaired a work group of the Virginia Department of Medical Assistance Services Managed Care Physician Liaison Committee created by the Governor and the General Assembly in 2013.

Visit the main Head for the Hills page for registration and lodging information.

More session descriptions are posted here.

Check out that map!

JMH inaugural residency class dinner

Opening slide for Johnston Memorial Hospital’s Inaugural Residency class  dinner presentation



Double-click for a full-screen version.

So what’s on that map?  These are the Family Medicine, Internal Medicine and Pediatric residencies in Virginia (blue = MD, red = DO).   The counties are color coded by their County Health Status ranking.  Very light colors are the best rankings, dark green – the opposite.

Here’s the full list of the residency slots depicted on the map:

  1. Wellmont FM (DeBusk)
  2. MSHA Norton Community Hospital FM
  3. MSHA Johnston Memorial Hospital FM and IM
  4. HCA Lewis Gale Hospital – Montgomery FM
  5. HCA Lewis Gale Hospital – Montgomery IM
  6. OMNEE Carilion Clinic IM
  7. OMNEE Carilion Clinic FM
  8. VCOM Carilion Clinic FM with Pediatrics
  9. VCOM Danville Regional Medical Center IM
  10. VCOM Danville Regional Medical Center FM
  11. Centra Health FM
  12. UVA FM with Pediatrics
  13. UVA IM
  14. Bon Secours FM Rural VCU (St Francis)
  15. UP KYCOM Shenandoah Valley FM (Front Royal)
  16. VCU Shenandoah Valley FM
  17. VCU Chippenham and Johnston-Willis Hospitals Chesterfield FM
  18. VCU IM
  19. VCU Falls Church FM with Pediatrics
  20. Inova Fairfax Hospital IM with Pediatrics
  21. National Capital Consortium Ft Belvoir Hospital FM
  22. OMNEE Riverside Regional Medical Center FM
  23. VCU Riverside FM
  24. Eastern Virginia Medical School Portsmouth FM
  25. Naval Medical Center of Portsmouth IM with Pediatrics
  26. Eastern Virginia Medical School Ghent FM
  27. Eastern Virginia Medical School IM with Pediatrics

Do you have comments on the implications of this map? Do you know of other residency programs that should be included? Let us know!


GMEC logo

Why the wait?

What makes a general practice doctor good?  Or even great?  Sometimes, it’s how long you have to sit in the waiting room.

One Appalachian doctor was recently asked why an appointment for 2:40 wasn’t seen until after 3:00.  Her fantastic response outlines the realities for many physicians.  A test result came back positive for cancer – advanced cancer.  One patient can’t afford medication. Another’s spouse died.  All in a single day.

“One reason we are late: we take time.” 

Great doctors don’t see their patients as data on a chart.  They see real human beings with unique problems that can often only be addressed by their primary care provider.

Visit the Rapha Family Wellness site to review the full article.

Hands On!

Active learning vs. lecture:  What works best?  According to a recent review of students in STEM classes, those with hand-on lessons have higher test scores , while those in traditional lecture classes were more likely to fail.  As one article notes –

We know that learning is harder from the sidelines. If deep understanding is the objective, then the learner had best get out there and play the game. 

So how does that apply to medical education?  Students who are in a rural track at medical schools and students who have a preceptor in a rural region are able to interact with patients sooner – and learn more.

For example, at the Quillen College of Medicine, medical students can start working directly with patients as early as August in their first year by volunteering at the College’s free clinics.  Whereas students in urban programs may not have any patient interaction until well into their second year.

Click here for more on the new active learning research.

Finding Research Data Sources

The Rural Resident Research Symposium held at UVA-Wise in April included a presentation on Finding Research Data Sources for Populations in Rural Virginia.” by Susan Meacham.

The presentation strove to answer the question; Where do I find data on rural populations to answer hypothesis driven research questions?     It then addressed the following objectives:

  • Identify primary and secondary sources of data
  • Recognize the procedures needed to obtain approvals to use personal record information in research
  • Locate common sources of county, district and state level data for rural populations

The examples provided in the presentation were based on a study the Edward Via College of Osteopathic Medicine is conducting on the chronic health conditions in Central Appalachia.  It strives to determine not only what is “going wrong” in coal country, but what is going right.

View the presentation.



Graduate Medical Education – Part 2

Last week, we started a discussion on, the 22nd report from the Council on Graduate Medical Education, titled; “The Role of Graduate Medical Education in the New Health Care Paradigm

Let’s look at one of the recommendations in the report (p. 14):

Recommendation 1: GME training should be expanded in ambulatory and community sites to reflect the current and evolving practice of medicine.

Rationale: As the proportion of health care delivered in ambulatory sites increases, the percentage of GME training that occurs external to inpatient units in ambulatory sites needs to be expanded to prepare graduating physicians for medical practice. GME trainees must be provided with educational experiences in practice environments where new competencies are utilized.

Consider the practice environment of Southwest Virginia –  Rural communities, high percentage of persons who are uninsured/underinsured, high percentage of persons with comorbidities, limited access to behavioral health and specialty care.

GME is responsible for upholding a social contract with the public it serves.  A physician in this area must be able to do multiple things and needs a broad scope of training.  Southwest Virginia is a great training area for those who want to do many things very well, not the same thing over and over.

We want to hear from you!  What do YOU think could be done to make sure physicians trained in Southwest Virginia are “provided with educational experiences in practice environments where new competencies are utilized.” ?