Nashville Medical News October 2014 by FW Publishing

FOCUS TOPICS SENIOR HEALTH REIMBURSEMENT

October 2014 >> $5

Middle Tennessee’s Primary Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 2

Thomas Lavie, MD

PHOTO: TENNESSEE TITANS

ON ROUNDS

Plugging In for Peace of Mind Evermind Technology Supports Independent Living Necessity might be the mother of invention, but for Dave Gilbert, PhD, it was actually grandmother who made invention a necessity ... 10

ALS & the Ice Bucket Aftermath By MELANIE KILGORE-HILL

Three words … Ice Bucket Challenge. Never before has a cause gained such momentum or so quickly saturated social media as the awareness campaign for amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease. The viral challenge, in which participants dump a bucket of ice water on their heads or donate to the ALS Association, has been accepted by everyone from U.S. presidents to A-list celebrities, garnering a response described simply as “a miracle” by Cheri Sanders, executive director of the ALS Association’s Tennessee Chapter. “Our phone is ringing off the hook,” Sanders said in September.

“One of our strategic plan goals for this year was to create awareness for our disease. We can check that one off.” Breaking All Records The numbers are impressive. The ALS Association received 2.4 million new donors and a whopping $107.4 million between July 29 and Sept. 3, compared to $3.2 million during the same timeframe in 2013. Driven by Facebook, the challenge took off in late July thanks in great part to supporters of Pete Frates, a former Division I college baseball player diagnosed with ALS in 2012. Awareness generated by the challenge has been equally (CONTINUED ON PAGE 4) impressive.

Medicare Math Health Care Council Launches 2015 Fellows Recruitment Recruitment for the 2015 Fellows class — an annual initiative of the Nashville Health Care Council — is underway ... 15

Or How a 2.3 Percent Raise Became a 3 Percent Reduction By cINDy SANDERS

At first glance, the FY-2015 revision of the Medicare hospital inpatient prospective payment systems (IPPS) by the Centers for Medicare & Medicaid Services (CMS) appears to offer acute care hospitals a 2.3 percent rate increase beginning this month. Dig deeper, however, and it looks more likely that Tennessee hospitals will actually realize less than last fiscal year for providing the same services. “It’s death by a thousand cuts,” explained David McClure, senior vice president for Finance & Medicare at the Tennessee Hospital Association. (CONTINUED ON PAGE 14)

ONLINE: NASHVILLE MEDICAL NEWS.COM

To promote your business or practice in this high profile spot, contact Tami Pearce at Nashville Medical News. tpearce@nashvillemedicalnews.com • 615-844-9407 PRINTED ON RECYCLED PAPER

PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357

PhysicianSpotlight

Dr. Thomas Lavie Knows the Healing Power of Art By LARRY McCLAIN

Psychiatrist Thomas Lavie, MD, and abstract expressionist artist Willem de Kooning are both well acquainted with loss and new beginnings. At age 22, de Kooning left his home in the Netherlands by stowing away on a ship that took him to New York City. Lavie’s departure from his native New Orleans was even more emotionally wrenching. His home, clinic and affiliated hospitals were all destroyed by Hurricane Katrina in 2005, which led to his relocation to Nashville the following year. Like de Kooning, Lavie is a painter – and his art has helped him find the courage to start over. His figurative and abstract works span a wide variety of styles and media, including oils, acrylics, house paint, ink and mixed media collage. His paintings hang in private collections coast to coast, but his “day job” is that of psychiatrist at Centerstone’s Dede Wallace Campus in Berry Hill, where he partners with a primary care physician to meet patients’ mental and physical healthcare needs. Lavie’s life took a direct hit from Katrina. “The two hospitals where I worked never reopened,” he said, “and the clinic was outside the levee system so the water was over the roof. It was too dangerous to get into my art studio at home so I lost over 100 paintings there, plus many of the ones that hung in my house. Since then, I’ve tried to reproduce some of the lost paintings from memory, and I’ve been able to restore many of the damaged ones.”

“Judgement,” mixed media on canvas by Dr. Thomas Lavie

You can see hundreds of Lavie’s works at a website called gallerynona.com (shorthand for “New Orleans/Nashville”). The site also showcases paintings by Lavie’s colleague A.J. Friedman, MD, a neurologist whose work captures the mood of post-Katrina New Orleans. “He does a lot of paintings with trees because the city lost so many of them,” said Lavie. “The salt water killed a lot of the oak trees that had been there for decades.” On the website, Lavie notes that he was a late bloomer who didn’t start painting until after medical school. It all began

with a trip to New York’s Museum of Modern Art, where he first got to see abstract expressionist works by painters from the acclaimed New York School. Since moving to Nashville, Lavie has had two solo exhibits, including one at the Tennessee Art League. Several of his pieces also grace the walls of the Dede Wallace Campus, an integrated care clinic offering a range of behavioral and primary care services. Lavie and family chose Nashville for their new home because he had done rotations here during medical school and really

FREE

EXAM AND X-RAYS

New patients only. Offers may be combined. Offers have no cash value. Fees may be charged for copies of x-rays. Fee advertised is minimum fee only. THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS THE RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION OR TREATMENT. ADA#s: D0140, D0150, D0120, D0180, D0220, D0201, D0272, D0274, D1110, D4355, D9983. TN Lic DN# FL Lic #DN14545

OCTOBER 2014

A Proud Member of the Dental Practice Group of Tennessee D0150, D0330, D0272, D0210, D1110, D0140, D0220, D0230, D9972

liked the city. For seven years, he served as a clinician and clinical supervisor as the medical director of Vanderbilt’s Adult Psychiatric Outpatient Clinic, which also included the opportunity to teach. He still serves on the clinical faculty. It’s not surprising that Lavie feels a strong connection with people who’ve been displaced – and he’s counseled many patients who lives were disrupted by Nashville’s devastating 2010 flood. Lavie uses art as a therapeutic tool nearly every day. “I have several of my paintings in my Centerstone office, and patients almost universally respond to them. New patients think that I collect art, and when I tell them I painted what they’re seeing, they get really excited – although about half of them think I’m joking. But that leads us into a discussion about creativity. Some psychiatric patients have confidence issues and don’t always believe in themselves. I let them know how easy it is to be creative. Many of them say ‘I can’t even draw a stick figure,’ so I’ll show them something that’s just a color field. They really respond to that, and it helps them believe in their own uniqueness.” Although he’s sold many paintings, Lavie doesn’t chase commercial success. “It’s hard to make a living selling paintings,” he noted. “But I’d like to have a gallery representation some day in New Orleans.” Lavie still has four siblings and many other relatives in New Orleans, and he still roots for the LSU Tigers and pro football Saints. But he’s currently making no plans to return. “Nashville is our home now, and we’re very happy here,” he said. “Our daughter is a sophomore pre-med student at University of Tennessee in Knoxville. And honestly, it would be very hard for us to go through anything as traumatic as that again.” Like de Kooning on the docks of New York, Thomas Lavie knows that it’s important to treasure the past while welcoming what today has to offer. nashvillemedicalnews

.com

The doctors’ doctor:

Dr. Ming Wang Harvard & MIT (MD, magna cum laude); PhD (laser physics) Performed surgeries on over 4,000 doctors Dr. Ming Wang, Harvard & MIT (MD, magna cum laude); PhD (laser physics), is one of the few cataract and LASIK surgeons in the world today who holds a doctorate degree in laser physics. He has performed over 55,000 procedures, including on over 4,000 doctors (hence he has been referred to as “the doctors’ doctor”). Dr. Wang currently is the only surgeon in the state who offers 3D LASIK (age 18+), 3D Forever Young Lens surgery (age 40+) and 3D laser cataract surgery (age 60+). He has published 7 textbooks, over 100 papers including one in the world-renowned journal “Nature”, holds several U.S. patents and performed the world’s first laser-assisted artificial cornea implantation. He has received an achievement award from the American Academy of Ophthalmology, and a Lifetime Achievement Award from the American Chinese Physician Association. Dr. Wang founded a 501c(3) nonprofit charity, the Wang Foundation for Sight Restoration (www.Wangfoundation.com), which to date has helped patients from over 40 states in the U.S. and 55 countries worldwide, with all sight restoration surgeries performed free-of-charge.

Amniotic membrane is obtained after the baby’s birth

Inventions & Patents 1. LASERACT: All-laser cataract surgery U.S. patent filed.

2. Phacoplasty U.S. patent filed. 3. Amniotic membrane contact lens for photoablated corneal tissue U.S. Patent Serial No 5,932,205.

4. Amniotic membrane contact lens for injured corneal tissue U.S. Patent Serial No 6,143,315.

5. Adaptive infrared retinoscopic device for detecting ocular aberrations U.S. Utility Patent Application Serial No. 11/642,226.

6. Digital eye bank for virtual clinical trial U.S. Utility Patent Application Serial No. 11/585,522.

7. Pulsed electromagnetic field therapy for nonhealing corneal ulcer U.S.patent filed.

8. A whole-genome method of assaying in vivo DNA protein interaction and gene expression regulation U.S. patent filed

AMNIOTIC MEMBRANE CONTACT LENS

Dr. Wang’s invention U.S. patents: 5,932,205 & 6,143,315

Used by over 1,000 eye doctors to restore sight.

Wang Vision 3D Cataract & LASIK Center 615.321.8881 | WangCataractLASIK.com nashvillemedicalnews

.com

OCTOBER 2014

ALS & the Ice Bucket Aftermath, continued from page 1 “This has been a Godsend to help get the word out,” Sanders said. “Before this challenge, it was predicted that only 50 percent of the population even knew what ALS was. Every time I go anywhere now, people recognize who we are and are stepping forward with stories of friends or someone they know who has the disease. The awareness has been like a miracle for us, and we’re so grateful.”

PHOTO: TENNESSEE TITANS

weeks has given a face stiffness in their limbs similar to that of an and voice to this neuroMS patient. Symptoms often persist up to degenerative disease. a year before patients seek answers. DiagMichael Kaminski, nosis is made through a clinical exam, lab MD, of Saint Thomas studies, electric diagnosNeurology Specialists tic testing and imaging. and board member “You really have to take of ALS Association time to examine the musTennessee, estimates cular system for signs of Middle Tennessee atrophy and twitching, sees approximately 40 which are strong hints new cases annually, a toward this kind of a diDr. Michael statistic he considers agnosis,” Kaminski said. Kaminski “troubling for such a “Physicians are learning devastating disease.” that ALS is really not that uncommon, and Risk factors for ALS when there’s atrophy or twitching with Serving ALS are still largely unan absence of sensory loss, it’s a clue that Patients in Tennessee known. The averit might be a motor nerve disease rather Amyotrophic lateral age patient is over 50 than carpal tunnel or a pinched nerve in sclerosis is a progressive and male, and five to the back.” neurodegenerative disease 10 percent of cases No cure exists for ALS, although riluthat affects nerve cells in the Pictured are (L-R), Cheri Sanders, former Titans player Tim Shaw, and Megan Frazier, president are familial. While zole is often given to prolong survival for a brain and the spinal cord, of the ALS Tennessee Chapter Board of Directors speculation exists few months. Still, Kaminski is optimistic leading to cell death and loss about a link between that attention and funding provided by the of muscle control. Patients ALS and exposure Ice Bucket Challenge is a big step in the nessee, funding services like speech therapy, typically survive two to five years after to heavy metals or chemical agents, Karight direction for the relatively new disease. medical equipment and caregiver support. diagnosis. Approximately 5,600 people minski said the numbers have been too “We’ve known about the disease since the “Our services are incredible,” Sanders said. in the United States are diagnosed with small to carry out large, definitive studies. 18th century, but the first gene for ALS “When someone calls, the first thing we do ALS each year, and as many as 30,000 ALS symptoms often come on gradually wasn’t even discovered till 1993,” Kaminski is schedule a home visit to sit down with Americans may have the disease at any and present in three ways, Kaminski exsaid. “Basic research in the last five years is them and see what their needs are. We edugiven time. Sanders said ALS affects applained. The most common complaint is shedding light on what may be the underlying cate them on the disease and evaluate them proximately 425 Tennesseans, but she esthe painless wasting of a limb (a foot that mechanisms of the disease. The wonderful to see what they’ll need.” timates that only half are aware of the ALS may drop), or weakness or clumsiness in an thing about the Ice Bucket Challenge is that Association and services available to them. arm that spreads to other limbs. A quarter it infuses more money into research, which Risk Factors & Diagnosis “When someone finds out they have ALS, of patients present with swallowing difficulcan help us find a key. Even if you can’t cure The onset of patient stories in recent they have to reach out to us (for confidenties or slurred speech. Some also experience it, what if you can stop its progress?” tiality reasons), but a lot more people have been calling in recent weeks to say they’ve been diagnosed,” Sanders said. “Before this campaign, people didn’t know who to call … especially those who live in small or rural communities. This has enabled By MELANIE KILGORE-HILL us to reach out to people across the state.” The ALS Association’s Tennessee Chapter Stem Cell Research Statement from the ALS Besides an ice bucket, what does it take to manages care services staff in Nashville, Association launch a historic social media campaign? Memphis, Chattanooga, the Tri-Cities We spoke with Ashley Mixson, executive and Knoxville. Like most non-profits, the The ALS Association primarily funds adult stem cell research using stem cells director of Nashville’s Girlilla Marketing, group operates from charitable gifts, genderived from the skin cells of people with ALS (“induced pluripotent stem cells” or a tech savvy firm that specializes in digital eral or memorial donations and a handful iPS cells). These iPS cells begin as adult human skin cells but are then reprogrammed marketing. to become stem cells, which are then ready to become other cell types. This process of grants. Regional golf tournaments and “It helps if what you’re asking people to offers a powerful tool for modeling the disease process and for discovering and walks also help generate funds (see sidebar). do is easy,” Mixson said. “Everyone has ice testing new therapies. More than 85 percent of proceeds raised and a bucket. I also think that once heavy Currently, the association is funding one study using embryonic stem cells (ESC), through the state chapter stay within Tenhitters like celebrities get involved it makes and the stem cell line was established many years ago under ethical guidelines set by it hard to ignore. The Ice Bucket Challenge the National Institute of Neurological Disorders and Stroke (NINDS). This research is funded by one speciﬁc donor, who is committed to this area of research. included everyone from CEOs to musicians, The ALS Association is committed to honoring donor intent. If a donor is not actors, athletes and regular people. It was in comfortable with a type of research, he or she can stipulate that their dollars not be your Facebook feed no matter what time of invested in that particular area. day because everyone wanted to participate.” After all, who could resist watching an 86-yearold Ethel Kennedy go under the bucket? Walking for ALS And then there was Dolly Parton — ate both awareness and funds, said Mixson ing those rumors on their website (See Box). bigger-than-life personalities accepting a – an area where media campaigns often And then there’s the fleeting nature of Nashville’s annual “Walk to challenge so simple, fun and humbling that it strike out. anything viral. Remember that babbling Defeat ALS” took place Sept. 27 at Lipscomb University. Thanks crossed all age, cultural and socioeconomic There’s no question the challenge baby or costumed canine blowing up last to attention from the Ice Bucket barriers. And it was real. No glamour or was a giant win for the ALS Association. month’s news feed? They were fun, but we Challenge, registration was up over fancy camera angles. No Photoshop needed. But that success begs the question, what’s moved on. That’s the nature of social media. 25 percent compared to 2013’s “So much of what is working in 2014 is peoon the downside of becoming an overStill, for the ALS Association, the benfundraiser, said Cheri Sanders of ple talking to people,” Mixson said. “You night viral sensation? For the ALS Assoefits of the campaign will last far beyond the the ALS Association’s Tennessee can spend a ton of money and get your ciation, this included rumors of overpaid challenge’s viral shelf life. First, awareness of Chapter. October walks include product in front of people day in and day executives and massive embryonic stem the disease has dramatically increased. Secan Oct. 11 Tri-Cities Walk and out, but when a company gets on that level cell research … gossip that blew up in ond, the amount of money raised … even an Oct. 18 Memphis Walk. Golf of just directly talking to people, whether it’s minutes thanks to the immediate, in-yourif never matched in future years … should tournaments also take place each a fan or consumer, it’s less of a sales pitch face nature of social media. In response, provide a foundation for extensive research May in Nashville and Chattanooga. and more of a human interaction.” several challengers sent funds to different aimed at curing ALS or slowing the proFor more information, visit webtn.alsa.org Another unique plus for the ALS Assoorganizations. The ALS appropriately gression of the disease. Those are long-term ciation was the challenge’s ability to generand immediately responded by addressdividends for 15 minutes of fame.

ALS & the Power of Social Media

OCTOBER 2014

nashvillemedicalnews

.com

MedSolutions Selected to Participate in CMS Bundled Payments MedSolutions, a diversified healthcare cost management company based in Franklin, recently announced it has been selected to participate in the Centers for Medicare and Medicaid Services (CMS) Bundled Payments for Care Improvement Initiative (BPCI) as an awardee convener. The move allows the company to expand its current post-acute care offering and accelerate into the growing bundled payments space. The goal of the BPCI program is to deliver coordinated, high-quality, lower-cost care for Medicare beneficiaries who have experienced an inpatient admission through a period of 90 days post-discharge. As an awardee convener, MedSolutions partners with episode initiators, such as hospitals, hospital systems, and physician groups, allowing them to quickly become part of this ready-made BPCI solution and have more impact on their patients’ experiences post discharge. This solution brings MedSolutions’ existing postacute care program – which provides robust analytics support, case management, care coordination and outreach services – to beneficiaries participating in the initiative. “Inclusion in this initiative is a big step for our company’s strategic market and product diversification efforts in core areas such as post-acute care and musculoskeletal management,” said Curt Thorne, MedSolutions’ president and CEO. “It also fulfills a long-term goal for MedSolutions to form true hospital and physician partnerships that positively impact patient experiences across the acute and post-acute spectrums.” Participating partners will be able to capitalize on savings generated outside of their normal scope and prepare themselves for additional bundled payment opportunities in the future. The company is currently active as a Model 2 Convener in Phase 1 (analysis) of the BPCI, and will go live in Phase 2 (care redesign implementation) on Jan. 1, 2015.

nashvillemedicalnews

.com

Local Experts Weigh in on Hospital Reimbursement By MELANIE KILGORE-HILL

Let’s talk reimbursement. Hospitals have absorbed $121 billion of new cuts since 2010, including $2.1 billion in uncollected debts. In 2012, the American Hospital Association reported an aggregate Medicare/Medicaid loss of $56 billion in payments. The numbers are painful, especially since two-thirds of every dollar spent by hospitals goes to staff wages and benefits. Released by the AHA earlier this year, these stats sum up a few of the reasons administrators are scrambling to understand the “why’s” and “how’s” behind an industry-wide shortfall. Hit from All Sides According to the AHA, hospitals nationally are reimbursed only 86 cents for every dollar spent caring for Medicare patients and 89 cents for Medicaid patients. That adds up, especially since the two groups account for 58 percent of all care provided by hospitals. Kelly Miller, senior manager of Healthcare Consulting in the Nashville office of Lattimore, Black, Morgan and Cain (LBMC), said hospitals are in the process of transitioning from a strictly case- or volume-driven model to one that includes more quality pay-for- Kelly Miller performance measures. She also cited the move from inpatient care toward an outpatient-centered model as being another major impact on hospital revenue. For 2015, it’s predicted that overall Medicare spending on inpatients will decrease by $756 million, while outpatient spending will increase by $800 million. “That’s a huge shift, and decrease in inpatient payments reflects a mix of everything going on in the inpatient world including lower inpatient utilization,” Miller said. Fewer inpatient stays, deductions for scoring poorly on readmissions criteria and hospital acquired conditions, as well as the hospital value-based purchasing program are all contributing factors to the shrinking bottom line. Constant regulatory changes at both federal and state levels are also to blame. “Medicaid programs continue to be a concern with the new federal regulations, and everyone’s trying to figure out what works and what doesn’t,” Miller said. She noted providers are turning to firms like LBMC and other consultants for assistance with reimbursement strategies, regulatory compliance and long term strategic planning to try to stay financially viable. Healthcare’s New Payer Another change in healthcare’s reimbursement paradigm is evolution of the payer. “The biggest shift we’re seeing is the introduction of a significantly more important payer: the patient,” said Kris

Joshi, PhD, executive vice president of products at Emdeon. Headquartered in Nashville, Emdeon is among the largest intelligent financial, administrative and clinical health Dr. Kris Joshi information networks in the nation, processing more than 7 billion transactions with a claims value of $1 trillion annually. Clients include 340,000 providers, 81,000 dentists, 60,000 pharmacies, 5,000 hospitals, 600 vendors, 450 laboratories and 1,200 government and commercial payers. “Consumers are becoming a much more significant part of the reimbursement system because co-pays are going up,” Joshi said. “What used to be a small co-pay is now sometimes 20 percent of the total bill. Fundamentally that’s different than what patients in the past have seen.” Those high co-pays are, in part, a result of decisions made about plans available on the health insurance marketplace. Not surprisingly, enrollees often opt for the lowest monthly rates with the highest deductible. The patient as payer is a huge shift driving changes across the revenue cycle, from registration through billing and collections.

The Need for Transparency The solution, Joshi suggested, is transparency and explanation of costs on the front end — a beneficial model for both patients and providers. “Given the large patient liability emerging, most providers are starting to have that conversation up front with patients, which never used to happen,” Joshi said. “Patients are being told up front how much will be owed and asked how they’d like to pay for that. Those are conversations that didn’t happen before when hospitals were able to write off a $50 patient bill. Now those bill are $2,000 and can’t be written off without losing millions in revenue each month.” That’s where companies like Emdeon come in, he continued. Tools like the Patient Responsibility Estimator help consumers and physicians look up prospective cost of a treatment based on diagnosis. The next step, Joshi said, is to make billing itself convenient and transparent. Most patients receive a myriad of bills for each visit, in addition to the ‘clear-as-mud’ explanation of benefits. Overwhelmed, patients often won’t pay a dime until insurance corroborates what is actually owed. “Healthcare is so complex that no patient or physician can ever keep up with the (CONTINUED ON PAGE 6)

The cytogenetic laboratory and information resource of choice for physicians who demand accurate, timely, and state of the art cytogenetic diagnostic services for their patients.

• Chromosome Analysis • Polymerase Chain Reaction (PCR) • Fluorescence In Situ Hybridization (Fish) • Array Comparative Genomic Hybridization (Microarray) Genetics Associates Inc. is CAP accredited, CLIA and State of Tennessee Licensed. Our professional staff includes five American Board of Medical Genetics (ABMG) certified directors. 1916 Patterson Street, Suite 400 • Nashville, TN 37203 (615) 327-4532 • 1-800-331-GENE (4363)

Where advanced cytogenetic technology meets old-fashioned service www.geneticsassociates.com OCTOBER 2014

Direct Pay Business Models Changing Reimbursement Landscape By MELANIE KILGORE-HILL

Remember when medicine revolved around patient care rather than ICD codes? While the days of country docs trading chickens for childbirth are long past, the simpler practices of yesteryear are making a strong comeback thanks to a handful of practitioners committed to a ‘new,’ old model of medicine. Recently, Bernard Health and Fifth Third Bank co-hosted the Fourth Annual Healthcare Reform Seminar featuring Middle Tennessee practitioners who’ve opted out of the insurance game in favor of a direct pay or concierge model of healthcare. “Our view is that primary care fee-forservices is the wrong business model,” said Alex Tolbert, founder of Nashville-based Bernard Health. “A subscriptionbased business model is much better for the doctor and the patient, since the driver is the customer in healthcare: the paAlex Tolbert tient.” According to Tolbert, elimination of the tax benefit that

caused employers to have group health plans is pushing employers to adopt strategies that involve individual plans. Tolbert’s company, which facilitates coverage transition for employers and helps employees and individuals evaluate healthcare options, now operates seven retail stores in four cities including Nashville. The non-commissioned staff provides consultation on a range of issues from medical billing, Medicare, or COBRA advice for individuals to HSA and benefits brokerage and advice for employers. Robert Tomsett, PA, of GracePointe Healthcare in Franklin was one of the panelists at the August seminar. Tomsett’s practice is a direct pay model, offering comprehensive healthcare options for individuals and employers. GracePointe has Robert been voted ‘Best in Primary Tomsett Care’ by the Toast of Music City Readers’ Choice Awards two years running. “I saw the nonsense medicine had

SHAPE THE FUTURE OF HEALTH CARE. Earn a CERTIFICATE IN HEALTH POLICY from the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College. START HERE

› meharryhealthpolicy.org OUR PROGRAMS & EVENTS

EXECUTIVE ROUNDTABLES • HEALTH POLICY ASSOCIATES • HEALTH POLICY FELLOWS • HEALTH POLICY SCHOLARS • NATIONAL SCHOLARS’ CURRENT ISSUES IN HEALTH POLICY LECTURE SERIES • PILOT PROJECT MINI-GRANT PROGRAM • PROFESSIONAL DEVELOPMENT PROGRAM • SUMMER EXTERNSHIP PROGRAM • SUMMER INSTITUTE ON HEALTH POLICY 1005 Dr. D. B. Todd. Jr. Blvd. • Nashville, Tennessee 37208 • 615.327.6202 • hpadmissions@mmc.edu

OCTOBER 2014

Robert Tomsett (seated, second from left) joined other provider panelists at a recent healthcare reform seminar to discuss switching to a direct pay reimbursement business model.

become with the rat wheel of getting patients in and out, getting reimbursed and keeping patient load up because of the extra cost of just trying to get paid,” Tomsett said. “There was a constant whip cracking, and I was spending so little time with patients and not investing in the relationship part of medicine.” In 2011, Tomsett was offered the chance to take over an established primary care practice. “My first thought was, ‘heck no,’ but then I started researching direct pay and realized it would get me back to practicing medicine the way I feel called to do medicine,” said Tomsett, a former flight and Green Beret medic. “I wanted to have a relationship with my patients, where they trust me and I trust them.” The transition wasn’t easy. For three months, Tomsett alerted patients of the change … 75 percent left. And then there was Medicare. Government regulations allow a practitioner to opt out once a quarter, and paperwork must be submitted 30 days before the beginning of the quarter. In the interim, Tomsett couldn’t see Medicare patients unless it was for free. “I had patients in limbo for 90 days where I could not charge them so I saw them for free and made sure I took care of those who couldn’t stay,” Tomsett said. Patients soon trickled back in, however. He saw 75 his first month and took a 75 percent salary cut that first year. Three years later Tomsett is much closer to his original income thanks primarily to word-of-mouth advertising – GracePointe’s primary source of referrals. Tomsett has also invested in paid advertising, since insurance companies no longer funnel patients his way. The second biggest challenge, Tomsett said, was educating patients on the new system. “Once patients get it and understand the overall savings, they switch to a high deductible plan and save so much money,” Tomsett said. Many patients rely on health savings accounts or submit claims for the out-ofnetwork provider. Others are content to pay out-of-pocket, knowing it’s a small price for individualized, no-rush care. GracePointe’s Smart Care Plan also makes

Tomsett’s direct pay structure surprisingly affordable. While the model works well for Tomsett, he admitted it’s not for everyone. “It takes a ton of commitment, and you will work your tail off the first several years,” said Tomsett, who takes vitals, draws blood and empties trashcans on any given day. “You have to have a certain skill set, and if you’re not prepared to do all these things you shouldn’t attempt this.” But for Tomsett and his patients, it’s a winwin. “I’m enjoying practicing medicine again,” he said. “When patients come in, I’m getting their hard earned money so I need to earn their business and get back into the service mode of medicine, which is what it should be about.” Tolbert expects the direct pay model to become increasingly popular in coming years. “The long term trends are that we’ll see more and more providers like Tomsett who say the patient volume Medicare sends isn’t worth it and who chose to get out of network in favor of a subscriptionbased model,” Tolbert concluded.

Local Experts, continued from page 5 complexity of the billing process, which is the root cause for many bills not getting paid,” Joshi said. “If you want to improve economics, the first thing you need is transparency. That kind of billing innovation will be absolutely critical going forward.” Better Billing, Better Results The two experts also noted providers should offer more flexible payment options. Fortunately, improved electronic payment capabilities are making these arrangements more convenient. And while some hospitals are sophisticated enough to handle these systems alone, many more are outsourcing billing. Regardless of who handles billing, Joshi said it’s imperative to adopt a proactive approach to reimbursement. “It’s not enough to gather your bills and collectibles and tell someone, ‘Here collect on it for me.’ By then it’s too late to address the problem,” Joshi said. “You start at the beginning, and what’s needed is the capability to treat patients as consumers. They’re paying out-ofpocket and expect transparency and clarity in healthcare just as they expect in other parts of life,” he concluded. nashvillemedicalnews

.com

Take good care of your money.

THINK OF US AS SPECIALISTS FOR YOUR FINANCES.

In today’s uncertain markets, having a bank that tends to your financial health is vital. First Tennessee Medical Private Banking can help with today’s needs and tomorrow’s goals. Our Relationship Managers offer guidance and solutions tailored to medical professionals. So you can focus on your priority: your patients. To make an appointment with a Relationship Manager, please contact: Laura Folk Senior Vice President & Manager Medical Private Banking ph: 615-514-6056 email: lsfolk@ftb.com

Glenn Bradley Vice President Medical Private Banking ph: 615-514-6054 email: gmbradley@ftb.com

Adriel McCord Vice President Medical Private Banking ph: 865-971-2139 email: admccord@ftb.com

Medical Private Banking

12714_0118_FTB_10x13_4c_RateSnipe_C_V2.indd 1 nashvillemedicalnews

.com

7/18/14 4:34 PM

OCTOBER 2014

Reimbursement Revisit A Look at Payment Innovation By CINDY SANDERS

While physicians and facilities have long had to keep up with different negotiated contract rates among payers, the reimbursement landscape has become much more varied over the last few years as a push toward payment innovation has ushered in a host of reimbursement options ranging from shared savings programs to bundled payments to carrot-and-stick compensation as applied to quality and efficiency metrics. Rob Lazerow, practice manager for Research & Insight at The Advisory Board Company, recently analyzed some of the payment changes providers are navigating as the healthcare system begins to shift away from a fee-for-service model. While the traditional payment method based Rob Lazerow on volume still makes up the majority of healthcare reimbursements, Lazerow said it appears the shift toward accountability models is picking up steam … albeit slowly. Lazerow, who is based in Washington, D.C., has created a ‘Field Guide to

Medicare Payment Innovation’ (advisory. com). However, he was quick to note the transformation isn’t limited to the Centers for Medicare & Medicaid Services. “There is a lot of payment innovation happening right now, and it’s happening in both the public and private sectors,” he said. Lazerow added CMS, commercial payers, state Medicaid programs and employers are all experimenting with new payment models in markets across the country. While there is any number of subtle variations within the pilot projects, Lazerow said there are generally three big categories of payment innovation being rolled out at this time — pay-for-performance initiatives, bundled payments, and shared savings reimbursement models. Pay-For-Performance “It’s still a fee-for-service payment, but a portion is withheld and linked to predefined metrics, including process, outcomes and patient satisfaction measures,” he said. “Medicare has a lot of experience here,” Lazerow added of the Hospital Value-Based Purchasing Program, Hospital Readmissions Reduction Program and hospital-acquired conditions (HAC) penalties. Lazerow said in some cases, it could

2014 THA TECHNICAL AND EDUCATIONAL EXPOSITION November 5-6, 2014 4 Gaylord Opryland Resort and Convention Center Held during THA's Annual Meeting, the Technical and Educational Exposition is the premiere opportunity to showcase healthcare products and services in Tennessee. Interact with attendees who include CEOs, department heads and hospital executives.

For exhibit information, call 615-401-7419 or 800-258-9541. Download the exhibit prospectus at www.tha.com

OCTOBER 2014

mean hospitals must invest in performance software or additional manpower to provide the necessary outcomes data … effectively making it cost more to capture the same reimbursement rate compared to the pre-pay-for-performance world. However, as Lazerow pointed out, this isn’t a ‘request’ from CMS. These are mandatory programs for all hospitals that accept Medicare prospective payments with two of the three already in place and the HAC penalties set to begin in fiscal year 2015. “We’re seeing pay-for-performance in hospitals and physician practices,” Lazerow said, noting the reimbursement model has spread past the Medicare population. “The challenge then becomes having different payers with different metrics.” Even when broad categories of data collection apply to multiple payers, it isn’t uncommon for each to ask providers to drill down to different outcomes measures within the umbrella category. “As you can imagine, the reporting and compliance burden continues to grow,” Lazerow noted. Bundled Payments Lazerow said bundled payments offer a different take on volume-driven reimbursement by coordinating care among all providers responsible for a patient’s diagnosis, treatment and rehabilitation and inserting a level of accountability into the group dynamic. “In a traditional fee-for-service world, all these providers are paid individually and have no aligned incentives or mutual accountability,” he explained. Although bundled payments are still volume-based … the more you do, the more you are paid … Lazerow said the concept focuses on costs and outcomes. “A bundled payment drives efficiency and quality within a discreet episode of care.” For payers, Lazerow said the reimbursement model creates both savings and price predictability. The sum for the bundle of care is generally less than would have been paid individually to those involved. On the provider side, the reimbursement option helps drive efficiency and care coordination with a goal of having the patient receive the right care in the right setting to maximize outcomes and minimize costs. While Medicare has a big program around bundled payments, Lazerow said this model has been adopted by the spectrum of payers including private employers. Wal-Mart, he noted, has established a bundled payment program around certain cardiac care and orthopaedic procedures. Although most current bundled payment programs are designed around specific procedures such as hip replacement or cardiac bypass surgery, Lazerow noted, “We’re starting to hear more interest around medical admissions, as well as the procedures.”

Shared Savings Models Although bundled payments might be highly effective for unavoidable care, the concept doesn’t address preventive care. That’s where accountable care models … also known as shared savings … step in to apply population health metrics to mitigate potentially avoidable healthcare spending. The intent with these reimbursement models is typically to spend some in order to save more. “The big focus right now is on shared savings models,” Lazerow pointed out. He added providers work together against a pre-set annual spending target per patient. Unlike past payment experiments based on monthly capitated payments, the shared savings model combines existing fee-for-service payments with a reconciliation process at the end of the year. Providers then share in a percentage of the savings they generate. Best practices and quality metrics are a foundational element to ensure patients aren’t denied necessary care simply to save money. “The overall concept of the ACO is these providers are collectively accountable for the total cost and quality of care for populations of patients over time,” Lazerow stated. From Medicare Advantage plans to self-funded employers, the focus on population health has taken root across the country. While providers also seem to embrace the evidence-based concepts and focus on chronic disease management integral to population health, the financial realities of such programs have proven problematic in some cases. Lazerow noted that of the 32 original participants in the CMS Pioneer ACO program, nearly onethird have left … with seven moving to Medicare shared savings programs, which have a lower risk profile for providers, and three dropping out altogether. “One challenge providers are facing is that sharing 50 cents on the dollar of volumes they are destroying might end up creating a negative financial outcome for the health system,” said Lazerow. “They’re not capturing enough of the savings they are generating.” The Bottom Line Lazerow noted he hears different sentiments from different providers as to which payment innovations they prefer. Some, he added, might like to stay in the traditional fee-for-service model, but that ultimately is unlikely given payer demands for more accountability, increased savings and improved efficiency. “Some providers right now, given their market dynamics, are in a watch and wait mode, but each year we see more and more payers and providers experimenting with accountable payment models,” Lazerow concluded.

nashvillemedicalnews

.com

Turning Predictive Modeling into Practical Medicine By cINDy SANDERS

“Predictive modeling, on its face, has absolutely no value.” That’s a strong statement from a man who makes his living in the field, but Dan Hogan, president and CEO of Nashvillebased Medalogix, is firm in his assertion. Not surprisingly, though, there is more to his sentiment. “Telling risk does nothing if you don’t facilitate a change,” Hogan contin- Dan Hogan ued. “Where we started as analysts, we’ve become analysts and clinical behavioral consultants.” It’s that ‘and,’ he said, that makes all the difference to patients and the providers caring for them. Hogan, a former home health agency owner, founded Medalogix in 2012. “We provide predictive modeling and workflow tools to home health providers, and in a secondary market, to hospice providers,” he said. Hogan added he believes his company to be the only predictive modeling toolset specifically designed for the postacute care market. While the analytics are certainly not limited to senior care, Hogan said the sphere in which Medalogix operates means their work typically impacts older patients. For example, he noted, the average home health patient on his census is 82 years old with two chronic conditions. “Approxi-

mately 60-65 percent of the patient records we’re analyzing on a day-to-day basis are Medicare beneficiaries … 30-35 percent are private pay,” Hogan said. However, he continued, “Well over 95 percent of patients we analyze data for are Medicarequalifying in age.” Using complex algorithms, Hogan’s team is able to assess which patients are more likely to be readmitted to the hospital within 30 days or to predict patient mortality within 180 days. “On the back end of that analysis, we provide the workflow solutions that facilitate the reduction of the risk of either of these terrible outcomes,” he said. Risk, he continued, is not singular. Not only is it dependent on how sick a patient is but also on the skill sets of the clinical organization caring for that patient. Congestive heart failure is certainly a risk factor for both hospital readmission and mortality, but Hogan noted a patient’s risk of those outcomes is inherently less if they are receiving care at a center of excellence. “Not everybody is good at everything. Clinical capability really does matter,” he said. In determining risk, the company’s data scientists customize the algorithms taking into account a client’s specific concerns, patient demographics, organizational information and historical data. Again, Hogan stressed, the resulting data insights are only as valuable as the actions they inform. And those actions can and do change the trajectory of risk. Drawing from his own background as a home health agency

Vanderbilt-led Study Shows High-Dose Flu Vaccine More Effective in Seniors High-dose influenza vaccine is 24 percent more effective than the standard-dose vaccine in protecting persons ages 65 and over against influenza illness and its complications, according to a Vanderbilt-led study recently published in the New England Journal of Medicine (NEJM, Aug. 14). The multicenter study enrolled 31,989 participants from 126 research centers in the United States and Canada during the 2011-2012 and 2012-2013 influenza seasons to compare efficacy of the two dosing options. “The study was done to see if using a high-dose vaccine protected older adults better than the usual vaccine. Until this trial came out, we didn’t know if it was going to be clinically better or not … and now we know it is better,” said lead author Keipp Talbot, MD, assistant professor of Medicine at Vanderbilt, who served as coordinating investigator for the more than 100 study sites. “Older adults are the most vulnerable to influenza; they become the sickest and have the most hospitalizations,” Talbot continued. “This vaccine works better than the standard dose and hence I would tell my patients to get the high-dose vaccine every year. In the meantime, we will continue to work to find newer and better vaccines for older adults.” Known as the Fluzone High-Dose vaccine, and made by Sanofi Pasteur, the inactivated influenza vaccine contains four times the amount of antigen that is contained in the standard-dose Fluzone vaccine. “This vaccine does have some more arm soreness than the usual vaccine because it is a higher dose. \With this increased soreness comes greater protection,” said Talbot. However, researchers concluded the high-dose vaccine is safe, induces significantly higher antibody responses, and provides superior protection against laboratory-confirmed influenza illness compared to standard dose among persons over 65 years of age. Study data also indicated the high-dose vaccine might provide clinical benefit for the prevention of hospitalizations, pneumonia, cardio-respiratory conditions, non-routine medical visits, and medication use.

nashvillemedicalnews

.com

owner, Hogan recalled, “We were terribly ineffective at managing bed sores.” Trying to reduce the patient risk, he sent three nurses to a training seminar. “Within 90 days, our rate of readmission for decubitus ulcers was down to 4 percent.” Similarly, Medalogix uses data to determine optimal transference to hospice care. “At a very high probability of mathematical accuracy, we identify patients at elevated risk for mortality,” he said. That knowledge, he continued, is very powerful in the hands of experienced clinicians … and powerful for family members, as well, when it comes to making informed decisions. “Identifying a patient that is hospice appropriate earlier in that end-of-life cycle tends to result in longer life,” he pointed out. More importantly, Hogan continued, those patients also enjoy a much higher quality of living during the time they have left. While the data analysis is highly accurate, Hogan is the first to say there are always exceptions to the rule. “Intuition trumps data,” he added with a laugh … at least when that intuition comes from experienced clinicians. “There are always people we have ranked very high on risk, and the clinician will say, ‘Nope, you’re wrong on this one.’ They are usually right.”

An indomitable spirit can certainly carry a patient past mortality expectations when there is a deep desire to see a grandchild married or a great-grandbaby born. For most patients, though, predicting readmissions or mortality is extremely difficult when relying on intuition alone. “The analysis of clinical data is providing an opportunity to glimpse into the future,” Hogan said. “In healthcare, historically the quality and clinical decisionmaking largely depended on the experience and skills of good doctors and nurses. Now, Medalogix and other companies are building analytical tools providing data to support those experienced doctors and nurses, making data-driven decisions possible. “We would absolutely say medicine is both a science and an art,” he continued. “Having both the data and the artistic insight maximizes resources and is better than just one or the other.” Clearly, that message is catching on with clients as the landscape shifts to payfor-performance models. In the last year, Medalogix has increased its client base by more than three-fold and doubled staff to keep up with demand. The company recently received a $5 million cash infusion from Connecticut-based Coliseum Capital Management to help fuel this continued growth.

When it Counts. And it Always Does. • Tax Consultation & Preparation • Financial Audit & Assurance Services • Financial Analysis & Benchmarking • Accounting Services • Practice Management Consulting Services • Health Care Solutions

615.320.0225 www.CLCPAS.com 1114 17th Ave South, Nashville, TN OCTOBER 2014

Plugging In for Peace of Mind Evermind Technology Supports Independent Living By CINDY SANDERS

Necessity might be the mother of invention, but for Dave Gilbert, PhD, it was actually grandmother who made invention a necessity. “I have a 96-year-old grandmother, Lois, who lives in McMinnville, Tenn.,” explained Gilbert. She’s a ‘heels and lipstick every day’ kind of lady who cherishes her independence, he said with a chuckle. For Lois, wearing a bulky medical alert device was simply a non-starter. “She would not do it … will never do it,” Gilbert said. “We started looking for a way that would give us peace of mind and her peace of mind without being invasive or intrusive.” While Lois might live alone, she’s certainly not alone … there are more than 11 million people over the age of 65 in the United States living independently. Additionally, more than 61 million individuals with physical or intellectual disabilities also live alone. Evermind, which was formally founded in May 2012, employs cutting-edge wireless technology deployed through a simple plug receptacle to send alerts when there is a disruption in normal routine. “Evermind creates a connection to the rhythms of another’s daily life, giv-

Dr. Dave Gilbert

ing assurance that they are safe and sound whether they live next door or a thousand miles away,” said Gilbert co-founder and CEO of the company. “The product is very simple,” he continued. The system, Gilbert explained, includes three separate power sensors that are plugged into wall outlets, and then three common household items are plugged into them. “They can be anywhere in the house,” he noted, adding it’s

actually good to choose three options that are used throughout the day … for example, a coffee maker, living room television, and bedside lamp. Other items often used include a garage door opener, CPAP machine, or washing machine. However, Gilbert said the system works with any item that gets regular use. He added the company has clients who plug in curling irons, hairdryers, toaster ovens and crockpots. The sensors are able to share data, and one has Verizon wireless network capabilities to transmit information to a caregiver either by text message or email. Gilbert added Evermind customers do not have to be Verizon subscribers to use the product. “These routines, like making coffee in the mornings or watching a favorite television show before bedtime, serve as a way for loved ones to check-in and signal that everything is okay even when it is not possible to call or drop by,” he noted. Conversely, Gilbert continued, a change in normal routines could indicate a problem. Caregivers, who also have access to a web dashboard, create alerts based on activity or inactivity. “You can create custom notifications,” Gilbert explained. “You very specifically can set up notices about aggregate appliances or individual ones.”

He added a caregiver might choose to be alerted if the coffeemaker isn’t on by 7:45 in the morning or if a lamp or television is used in the middle of the night. “You can set up as many combinations of different activity and inactivity notifications as you want. It’s about learning the habits and routine of your loved one and tailoring notification rules to those habits and routines,” he said. The dashboard, he continued, is a powerful tool because it allows you to see patterns over time. “It’s a good conversation starter when you see something unusual,” he noted. One client was alerted that her autistic daughter with ADHD was watching television in the middle of the night. It only took a few questions for the mother to figure out her adult child was taking Ritalin too late in the day, which was keeping her from being able to sleep. “On the other hand, when you know everything looks normal, you can just have a happy and pleasant conversation,” Gilbert added. The affordable three-sensor system, which just became broadly available to the general public in August, costs $199 plus a monthly service fee of $29 for the data access. “There is no long-term contract,” Gilbert stressed. (CONTINUED ON PAGE 15)

Meet Some of the Faces Behind Our Healthcare Experience.

Greg Eli

Jeff McCorpin

Andrew McDonald

Lisa Nix

Sharon Powlus

Brian Tate

Art Van Buren

LBMC has assembled a uniquely experienced team of over 50 healthcare professionals that clearly differentiate us

LBMC Healthcare Services

Accounting - consulting - HR - tecHnology

NASHVILLE | KNOXVILLE | CHATTANOOGA

from other service providers – all with deep financial experience as well as practical experience working in the field of healthcare.

Meet Andrew Bissonnette 615.309.2209 (direct) / abissonnette@lbmc.com Partner - Accounting and Assurance Services As a healthcare partner in the Accounting and Assurance practice, Andrew, also a CPA, serves as the client service or technical consulting partner on a number of healthcare engagements, including for profit and not-for-profit hospitals, behavioral health providers, ASC’s, long-term care (assisted living, independent living and CCRC facilities) and home health care companies. With over 17 years of experience, Andrew is familiar with the complex financial accounting requirements that healthcare companies typically face. In his spare time, Andrew enjoys golf, traveling and spending time with his wife and three boys.

ph: 615.377.4600 | www.lbmc.com

Where Great Companies Come to Grow.

OCTOBER 2014

nashvillemedicalnews

.com

No Longer Last in Line The Changing Role of SNFs Just as the notion of what’s considered ‘old’ has changed in today’s society … think 70 is the new 50 … so too has the role and function of skilled nursing facilities. Gerald Coggin, senior vice president of Corporate Relations for National HealthCare Corporation, has witnessed transformative change in the long-term care industry during his more than four decades with NHC. With operations in 10 states, the publicly traded company based in Murfreesboro owns and/or operates 73 skilled nursing centers with 9,410 beds. NHC affiliates also operate 37 homecare programs, five residential living centers, 18 assisted Gerald Coggin living communities, plus offer additional services including long-term care pharmacies, memory care units, hospice care, and rehabilitative therapy. Coggin said the notion of a ‘nursing home’ as the last stop for seniors before they die is simply outdated. A little ironically, the industry has moved from being a residential model that looked like an old-fashioned, antiseptic medical facility … to a medical model that often looks like a well-appointed residence. As the model has changed, one of the most striking differences is in length of stay. Coggin noted that less than a decade ago, NHC’s average length of stay was 210 days. Today, the median length of stay is 26 days. In a number of facilities, such as NHC Farragut in Knoxville, Tenn., that time frame is even shorter.

Pointing Seniors in the Right Direction The Council on Aging of Greater Nashville publishes an online directory of services for seniors and their family members or caregivers. Topics range from adult day services, emergency help, food services and home care to housing options, legal matters, public services and transportation. Searchable by Middle Tennessee county, the publication is found online at directory.coamidtn.org. A printed copy of the directory is also available at no charge at all public library branches or the COA ofﬁce. In addition, the non-proﬁt organization offers a number of other resources including a guide to maintaining health, planning for end-of-life issues, updates on scams targeting seniors, and a transportation toolkit. For more information, contact: Council on Aging of Greater Nashville 95 White Bridge Road, Suite 114 Nashville, TN 37205 (615) 353-4235 councilonaging-midtn.org

nashvillemedicalnews

.com

PHOTOS COURTESY OF NHC

By cINDy SANDERS

Although NHC has adopted a medical model, the surroundings have an upscale residential feel.

“We’re serving more patients than we’ve ever served, but the length of stay is much shorter than it’s ever been,” said Coggin. “Farragut is one of those facilities that is on the cusp of a new generation of longterm care. It’s all because of the emphasis on rehabilitation.” There are a number of reasons behind this change, but Coggin said cost and reimbursement … along with a culture shift … are among the primary drivers. The Omnibus Budget Reconciliation Act of 1987 signed into law by President Ronald Reagan fundamentally changed the way nursing homes operated … and simultaneously transformed society’s expectations of them. For long-term care facilities to receive Medicare and Medicaid funding in the postOBRA world, they must provide services so that each resident might “attain and maintain her highest practicable physical, mental and psycho-social well-being.” “The emphasis was on making sure the right patient was at the right place. As a result, a new housing phenomena … assisted living … grew out of that,” Coggin explained. That ‘right patient, right place’ idea endured and changed the concept of how a skilled nursing facility could align with hospitals in an evolving post-acute care role. “So much has been driven by reimbursement,” Coggin noted. He added hospitals could only keep patients, who were progressing as expected, for so long before Medicare would stop paying the inpatient rates associated with the higher acuity level of care. Yet, Coggin continued, these patients weren’t ready to go home, either. “That’s when we saw a shift in our patients … from a few Medicare patients who needed rehab to a lot of patients needing rehab,” he said. A tiered-down system was born from these hospital reimbursement constraints. At the same time, a cultural shift was happening. Longer lifespans and medical technology improvements meant more seniors could expect to live active lifestyles far beyond retirement age … and the senior segment of the population also began to increase dramatically. According to the Social Security Administration, there were approximately 9 million Americans age 65 and over in the year 1940. By 2000, that number had jumped to almost 35 million. By 2010, that number had grown yet again to just over 40 million. Increasingly, Coggin said, skilled nurs-

ing facilities “are the recovery centers where you go to rehab.” He added with a chuckle, “It’s not unusual at all to have patients come to us for services and then get a note a month later saying, ‘Thanks for the rehab. I just finished a round of golf.’” He continued, “I’ve been in this business for 41 years, and we have clearly switched over in the last 15-20 years from a residential model to a patient care model … and it’s ramped up even greater over the last 3-5 years.” Once again, he pointed to cost and reimbursement as drivers of the most recent jump in the rehab population. Not only do many SNFs like NHC provide a full range of occupational, speech and physical therapy services at a lower daily rate than hospitals,

these post-acute facilities can also help hospitals avoid the monetary penalties associated with avoidable readmissions. Similarly, just as NHC accepts patients downstream from hospitals, the rehab facilities also look to move patients to a more appropriate care setting once therapists have maximized their time with a patient … whether that is to assisted living or hospice or a return home. In fact, Coggin said, about 80 percent of NHC’s rehab patients ultimately are discharged home. “It’s clearly a focus on transitions of care to make sure the patient receives the appropriate level of care for the appropriate amount of time and avoids unnecessary readmissions,” Coggin concluded of the new role SNFs play in the care continuum.

YOU take care of your patients.

WE can take care of YOU. Serving Nashville’s healthcare industry for more than 50 years. •

Start-up assistance

•

ICD-10 education and preparation

•

Outsourced accounting

•

Tax planning and preparation

Medicare/Medicaid cost reports and related services

•

Wealth management services

•

Coding and documentation audits

•

Litigation support

•

CDM reviews and analysis

•

Valuations

•

Due diligence, acquisitions and divestitures

•

HIPAA compliance

•

RAC appeals and risk assessments

•

Assurance services

•

Physician practice consulting

Contact: Scott Mertie Kraft Healthcare Consulting, LLC 615-782-4292 www.krafthealthcare.com Vic Alexander KraftCPAs PLLC 615-242-7351 www.kraftcpas.com For recommendations, visit www.linkedin.com/company/kraft-healthcare-consulting-llc/products.

OCTOBER 2014

IOM Report: U.S. Health System Not Designed to Meet the Needs of Patients at End of Life According to a report released Sept. 17 by the Institute of Medicine, the U.S. healthcare system is not properly designed to meet the needs of patients nearing the end of life or those of their families. The IOM report calls for major changes to the system. The 21-member Committee on Approaching Death, which wrote the report, envisioned an approach to end-of-life care that integrates traditional medical care and social services and that is high quality, affordable, and sustainable. The committee called for more advance care planning by individuals, improved training and credentialing for clinicians, and for federal and state governments and private sectors to provide incentives to patients and clinicians to dis-

cuss issues, values, preferences, and appropriate services and care. “Patients can, and should, take control of the quality of their life through their entire life, choosing how they live and how they die, and doctors should help initiate discussions with their patients about such decisions,” said Philip Pizzo, co-chair of the committee and professor of Pediatrics and Microbiology and Immunology at Stanford University. “For most people, death does not come suddenly. In- stead, dying is a result of one or more diseases that must be managed carefully and compassionately over weeks, months, or even years, through many ups and downs. It is important that the healthcare options available to individuals facing

the end of life help relieve pain and discomfort, maximize the individual’s ability to function, alleviate depression and anxiety, and ease the burdens of loved ones in a manner consistent with individual preferences and choices.” Americans express strong views about end-of-life care. In general, they prefer to die at home and want to remain in charge of decisions about their care. However, the vast majority of Americans have not engaged in an end-of-life discussion with their healthcare provider or family. A 2013 national survey of adults found that while 90 percent believe having family conversations about end-of-life wishes is important, fewer than 30 percent actually have done so. The committee proposed a model for advance care planning, which encompasses the whole process of discussing endof-life care, clarifying related values and goals, and seeing that written documents and medical orders embody patients’ preferences. For more information, go to iom. edu/endoflife.

Morning Pointe Assisted Living Announced for Franklin Last month, Chattanooga-based Independent Healthcare Properties, the developer and owner of 24 Morning Pointe facilities in ﬁve states, announced a new, $25 million assisted living community was slated for construction on 10 acres along New Highway 96 in Franklin. The 117-apartment Morning Pointe community will also feature The Lantern at Morning Pointe Alzheimer’s Center of Excellence. Built in two phases, the initial construction is anticipated to be completed next fall. Amenities will include ﬁne dining areas, life enrichment programming, and professional health and wellness services. For those with dementia, therapeutic programming developed by the Morning Pointe team including SimpleC Companion services, Cuddle Therapy and the Meaningful Day program, will be incorporated into daily activities.

In 2014 over 533 Data Breaches have occurred. According to the Identity Theft Resource Center “ITRC”, 42% of those occurred in the Healthcare Industry. This is a 27% increase over last year’s Data Breaches. You might want publicity but not like this. Call AOCC for a Free Network Security Audit.

For the month of November we are providing a free HIPAA Audit to the first 20 Offices to call and sign up. We will provide you with the following:

Toll Free: 1-866-610-7881

www.aando.net

OCTOBER 2014

Local Phone: 1-615-784-0096

aocc@aando.net

nashvillemedicalnews

.com

HealthcareEnterprise

NaviLife Health Solutions Helping Hospitals Navigate Patient Throughput NaviLife co-founders Andy Huckabay (L) and Barry Dennis previously worked together at HCA where Dennis served as administrative director and Huckabay as director of physician and outreach relations. The duo have put their respective skill sets to work with NaviLife creating throughput solutions for acute care hospitals and marketing those services to physicians and regional facilities to help patients access the appropriate level of care.

By cINDy SANDERS

EMAIL NOTIFICATIONS

Get the current online edition of Nashville Medical News delivered to your desktop.

nashvillemedical news.com nashvillemedicalnews

.com

number to coordinate care for patients who require inpatient treatment. “We direct connect the referring physician to the accepting facility,” explained Dennis. He added the NaviLife nurses could also provide access to clinical documentation from the referring provider or facility and oftentimes even write the admission orders to initiate care as soon as the patient arrives at the accepting acute care facility. “The goal is to help keep the receiving facility from having to repeat tests,” he said. “The quicker you can get patients to the level of care they need, the better their outcomes will be,” Dennis noted. “Healthcare doesn’t always deliver services expeditiously. We get tangled up in our own web sometimes, and we don’t always get the patient to the right level of services either on the front end or the back end. That’s the gap NaviLife is trying to close.” ized care, Dennis noted it isn’t unusual for nursing. Swift Admit is the company’s core While the scope of services depends an ED physician or nurse to make several solution to assess inpatient referrals, admison each individual contract, Dennis said calls to line up an accepting physician and sion and transfers. Other solutions include follow-up after discharge is a popular opfacility … and then several more to arrange Discharge Direct, Around-the-Clock Bed tion since roughly 60 percent of the volumes transportation. During the process, not only Management/After Hours Assist, and Call for client hospitals come from the Medicare is that patient waiting, but all the other paan RN. population, which now comes with financial tients in the ED also are experiencing delays Each client hospital has a unique penalties for many avoidable readmissions. while the clinical staff is busy making arphone number that is marketed within “We offer a readmission migration rangements. Instead, Dennis said, a physithe facility’s catchment area by NaviLife’s strategy. We’re calling that patient and folcian could make one call to NaviLife, which outreach team. Area physician practices, lowing that patient after they are discharged has centralized all those functions. clinics and rural hospitals are given that home to make sure they are receiving the NaviLife’s throughput resources they need,” he said. solutions are provided around Nurses typically call the the clock by registered nurses patient or a family member from the Medical Access Cenwithin 48 hours of discharge ter in Hendersonville, which to make sure post-acute care serves as a virtual extension instructions are understood, of each client hospital. “We prescriptions filled, physician require our nurses to be liappointments are set, and censed in every state in which transportation is available. If we operate,” noted Dennis. the answer is ‘no’ to any of He added, NaviLife currently those, the nurses help the paemploys a dozen nurses with tient or family find solutions. about 90 percent coming Dennis noted having from a critical care or ED patients access care at the background. most appropriate level, helpThe NaviLife nurse ing facilities avoid duplicanavigators remotely direct tive tests, and then following patients to each client hospiup with patients to ensure tal’s most appropriate healththe necessary steps are being care resources to ensure entry taken to promote optimal at the correct access point. recovery makes sense finanThey also coordinate transcially and medically for all fers, timely discharge services, Navigator Ursula Fletcher, RN, has 13 years of experience including medical/surgical and parties. It just takes a little and follow-up care, including telemetry nursing, nursing informatics, and quality assurance. She also holds a master’s in coordination and navigation referrals to physical therapy, Health Administration and is a Registered Health Information Administrator. to maximize the available rehabilitation and skilled resources. PHOTOS COURTESY OF NAVILIFE HEALTH SOLUTIONS.

Middle Tennessee can add another national headquarters to the long list of healthcare service firms that call this area home. This time it’s Hendersonville, and the homegrown start-up is NaviLife Health Solutions, LLC, which has carved out its own niche by offering virtual patient navigation solutions to hospitals across the country. Co-founded by healthcare veterans Barry Dennis, RN and Andy Huckabay last October, the company already has formalized partnerships with hospitals in Alabama, Arizona, Texas and Iowa. Additionally, negotiations are underway with facilities in five more states. While a number of large hospitals and specialty lines offer onsite navigation services, Dennis said he and Huckabay believe NaviLife is the first to offer contract navigation services to hospitals nationally. “One of the challenges faced by our healthcare system today and in the future is the increased utilization of healthcare services by the senior population,” said Dennis, who serves as the company’s CEO. “This population generally requires more healthcare resources.” Between an aging population and greater access under the Affordable Care Act, hospitals are seeing an increased demand for services while at the same time facing declining operating margins. “It’s all about throughput,” said Dennis. “The more efficient you can make the throughput, the more successful you can become.” Unfortunately, he added, hospitals are not always as efficient as they need to be in the face of new demographic and economic realities. “Traditional methods of managing access to care and directing patients to the appropriate level of care are very fragmented with a host of people responsible for those functions on any given day,” said Dennis. “There’s a lot of variability in hospital processes depending on the time of day or even the day of the week.” He continued, “When we contract with a hospital, we bring in a single process that is consistently the same 24 hours a day, seven days a week.” For a patient requiring more special-

OCTOBER 2014

Medicare Math, continued from page 1 “What CMS gives you, they find a way to take back.” McClure, who has been with THA for nearly two decades, recently spent several weeks deciphering the 500-plus pages of the IPPS final rule, which was published in the Federal Register in August in advance of going into effect Oct. 1. “The inpatient rule controls the David payment to hospitals for McClure about $2.5 billion in the state of Tennessee,” he said. “This inpatient rule continues on with the implementation of provisions in the Affordable Care Act and the American Taxpayer Relief Act of 2012.” On the plus side of the payment equation for Tennessee hospitals, he noted, “The market basket update this year was 2.3 percent. That’s about $60 million.” However, McClure continued, those ‘new’ dollars are quickly offset when looking at reductions and penalties spread out through a number of provisions in the two acts. Two automatic cuts tied to ACA reduce the market basket index by 0.5 percent and 0.2 percent respectively. The first is a reduction to offset productivity improvements assumed to have been gained through increased efficiency. The second, McClure said, is a general reduction to help pay for the Affordable Care Act that is in place through 2021. “Those two re-

ductions account for about $16 million in cuts,” he noted. “Then in the Taxpayer Relief Act, they have what’s considered a coding reduction. That’s worth about $17.5 million,” he continued. McClure said the rationale behind the 0.8 percent cut is that hospital personnel are becoming better coders. He added that’s probably true considering the number of audits and increased emphasis on coding education. However, McClure continued, the basic premise behind the rationale is flawed since billing is for services rendered … being ‘better’ at coding has no impact on the actual cost of the service provided. With these three cuts in place, more than half of the $60 million increase has already been erased. And, McClure noted, that’s just the beginning. “Probably the biggest change that will happen for hospitals in 2015 comes from the Medicare Disproportionate Share payments,” he continued. McClure explained CMS began implementing a strategy in 2014 to reduce Medicare DSH payments because enrollment in health plans and expansion of Medicaid was anticipated to increase the number of people with coverage. CMS also reworked the formula for offsetting care delivered to the uninsured. The Medicare DSH funding was split into two pools with 25 percent remaining traditional DSH and 75 percent moving to a new uncompensated care pool.

Apply at: https://jobs.etsu.edu

Monetary Penalties After all the automatic cuts, hospitals must also factor in monetary penalties associated with quality metrics. “From the quality side, there are really three metrics being considered this year — value-based purchasing, readmissions and hospital-acquired conditions,” McClure said. He added the 19 different measures being considered under value-based purchasing are anticipated to be an economic wash for hospitals in Tennessee. As for the readmissions penalty, McClure noted CMS has increased the area of focus from three in 2014 to five in 2015 with the addition of COPD and elective hip and knee implants. “The cap in the penalty also moves from 2 percent to 3 percent in 2015,” he said. The estimate is that Tennessee hospitals will probably see close to $10 million in penalties this coming year. Similarly, CMS is looking at eight different measures under hospital-acquired conditions and comparing and ranking hospitals nationally. Those in the worst quartile for HACs will see Medicare payments reduced by 1 percent. “We estimate there will probably be 17 or 18 hospitals in Tennessee (that fall in that quartile), and estimate it will reduce those hospitals’ payments by $7 million total,” he said. McClure noted that at the time he spoke to Medical News CMS had yet to publish the final data on hospitals regarding both the readmissions and HAC program but that information was anticipated to be available by Oct. 1.

Inquiries can be directed to: Stephen Geraci, M.D., Professor and Chairman of Internal Medicine via Karen A. Heaton, Quillen College of Medicine, Box 70622, Johnson City, TN 37614. Phone (423)439-6367; email: heatonka@etsu.edu.

The Bottom Line “When you get to the bottom, bottom line, we would get $25 million less than we

Academic Internal Medicine Opportunities Quillen College of Medicine, Department of Internal Medicine at East Tennessee State University is seeking BC/BE (at time of hire) Internists to join their groups in Johnson City and Kingsport, Tennessee at the Assistant/Associate Professor level. Responsibilities include teaching residents and medical students ambulatory care in our University practices, with in-patient attending at our community partner teaching hospitals, and the opportunity for clinical research. Scholarship is an expectation of all faculty with protected time for scholarly activities. Competitive pay, comprehensive benefits package, CME allowance and relocation support provided. Women and minorities are encouraged to apply. AA/EOE

Quillen College of Medicine is a community-based medical school whose mission emphasizes primary care. Located in the beautiful mountains of northeast Tennessee, Quillen College of Medicine serves the healthcare needs of over 1 million people. The Tri-cities area boasts low crime rate, low cost of living, award-winning public school systems and no state income tax.

“We’re becoming part of the minority now in states that haven’t expanded Medicaid,” McClure noted. “CMS looked at uncompensated coverage rates nationwide and made a decision about how much to cut and how to divide it nationally.” With 27 states opting to expand Medicaid, the uncompensated care pool has been significantly impacted. The net result, McClure said, is that Tennessee is really hit twice … both by not expanding coverage to a large population segment and then by receiving reduced rates for delivering care to that patient sector. “Tennessee will receive 23.8 percent less in DSH and uncompensated care pool payments,” he said. “Under all that redistribution and computations, we will receive $36 million less in Tennessee than we would have under the traditional formula of DSH payments.” He added large, urban hospitals would feel the brunt of those cuts, absorbing approximately $32.5 million of the anticipated $36 million in lost reimbursement. For those keeping up with the math, the reimbursement picture now looks like this — $60 million on the plus side for FY2015 and approximately $69.5 million in new cuts. “Then on top of that, you take away another 2 percent for sequestration,” McClure continued, noting the automatic spending cuts are currently scheduled through 2024.

OCTOBER 2014

did last year,” McClure said of expectations for FY-2015 in Tennessee. That reduction, which equals close to a 1 percent cut from FY-2014, coupled with wiping out the entire 2.3 percent increase touted for FY-2015 means area hospitals will receive about 3 percent less than anticipated this coming year. “Right now we’re in the neighborhood of receiving 92-93 percent of cost … so we’re getting paid less than cost,” McClure pointed out of net Medicare IPPS payments. So how do hospitals keep the doors open? “Hopefully CMS is correct and some of these (newly) insured will come into the hospital and help provide some cash flow and help the hospitals survive,” he said of those joining commercial plans through the federal healthcare marketplace. However, he noted, many of the newly insured are opting for high deductible plans that have a lower monthly costs. “They get federal subsidies for their premiums but not for their deductibles,” McClure continued. “Some folks are having a hard enough time paying premiums. I don’t know how they’ll pay a $5,000 or $10,000 deductible.”

AHA Reacts to Final Rule Linda Fishman, senior vice president for the American Hospital Association, released the following statement regarding the IPPS final rule: “Today’s rule will make it more difficult for hospitals to maintain their commitment to their communities. We are very disappointed that the ACA-mandated Medicare Disproportionate Share Hospital (DSH) cut is significantly higher than originally proposed. While we understand some of the reductions are due to increased coverage, it is unclear how CMS arrived at the remaining reductions. These payments provide vital support to hospitals that serve the most vulnerable patients. That’s why we continue to urge Congress to help hospitals and patients by delaying the Medicare DSH cuts for two years. While we appreciate CMS making refinements to its scoring methodology for the hospitalacquired conditions penalty program, one-fourth of hospitals will continue to be penalized regardless of their improvement in quality. Additionally, the program negatively affects those hospitals caring for older, sicker patients. We will continue to urge Congress to develop an alternative proposal that would more effectively promote hospital quality improvement. We appreciate CMS’ willingness to involve stakeholders on developing a methodology that will more accurately pay for short inpatient stays, and we will work with CMS on this important issue.”

nashvillemedicalnews

.com

Health Care Council Launches 2015 Fellows Recruitment

Plugging In, continued from page 10 While sales are currently online, he said the company is in the process of getting product in a number of durable medical equipment supply companies. Ultimately, the goal will be to ramp up production to the point where Evermind can service big box retailers, as well. Gilbert, a former college professor in communications and technology in New York, returned home to Middle Tennessee several years ago to work for Griffin Technology, a major manufacturer of iPod, iPhone and iPad accessories. He and a number of colleagues at Griffin developed the Evermind technology over time and began seeking funding for the startup in 2011. “We were accepted to the Jumpstart Foundry program in May of 2012,” he said. By the following year, Series A financing was secured. “We initially raised $1.8 million led by Tri-Star Technologies, Solidus and LaunchTN,” Gilbert said. He added his former boss, Paul Griffin, sits on the Evermind Board of Directors. The company is based in Nashville with product assembly in Tullahoma. nashvillemedicalnews

.com

Council Fellows is ably led by healthcare experts Dr. Larry Van Horn (L) and Dr. Bill Frist.

more information and to begin the application process, visit the Fellows website at healthcarecouncilfellows.com Applicants must commit to the 2015 class dates: Jan. 30, Feb. 13, Feb. 27, March 13, April 2, April 24, May 1, and May 22. Through these eight full-day sessions, the 2015 Fellows will participate in a specially designed curriculum focused on business strategies, creating value, driving industry growth and effecting change on both local and national levels. Discussions address the following critical industry issues: • Value-based health delivery systems, • State and federal healthcare policy reform, • Fundamental shifts in reimbursement systems, • Population health management, • Clinical advancements in genomics and personalized medicine, • Consumerism, • Crisis management, • Integrated delivery networks, • Disruptive innovation in technology, and • Healthcare analytics. The Annual Initiative Launched in 2013, the Fellows program began amidst historic and sweeping reform that impacted every corner of the healthcare industry. Two years later, change continues to be a centerpiece of healthcare, and the need to build a more sustainable system remains paramount. “Navigating today’s healthcare industry demands more of leaders,” said Fellows Co-Director Larry Van Horn, a leading expert in healthcare management and economics and professor at Vanderbilt University’s Owen Graduate School of Management. “Healthcare is in the middle of disruptive transformation, and leaders must drive change in their organizations in order to stay ahead of the market – a task that requires deep knowledge and commitment.”

ince its 1971 founding in Murfreesboro, NHC has grown to provide a spectrum of health care services throughout Middle

Tennessee and the U.S. Today, in our centers and our patients’ homes, we are providing a high level of quality and loving care to all our families. Visit NHCcare.com to explore our full range of services and find the NHC nearest you. To learn more about our homecare services visit MyNHChomecare.com. For information about services in your area simply call

1- 888- INFO-NHC.

Discover a new way to schedule your rehab care at

NHCPriorityReservation.com.

Recruitment for the 2015 Fellows class — an annual initiative of the Nashville Health Care Council — is underway. Now in its third year, this nationally unique program brings together senior healthcare leaders to explore strategies to meet the industry challenges of today and the future. Applications will be accepted through October 27, and the 2015 class will be announced in early December. Created in response to the unprecedented change and transformation occurring in healthcare, the Fellows initiative brings together approximately 30 senior leaders from a wide range of sectors, including provider, payer, technology, finance, population health and government. “The Fellows program is a highly valuable opportunity to learn and actively exchange ideas with the best and brightest of the healthcare industry,” said Fellows Co-Director and former U.S. Senate Majority Leader Bill Frist, MD. “It is an experience that only Nashville – with its strong foundation of healthcare leadership and exciting community of healthcare innovators and startups – can provide.” Application & Class Details All applications require information and statements of interest by the applicants, a professional bio and resume, and letters of recommendation from each applicant’s CEO and an industry leader. For

Family issues hit close to home. Thankfully, NHC is never far away.

REHABILITATIVE CARE • POST HOSPITAL CARE ASSISTED LIVING • INDEPENDENT LIVING • SKILLED NURSING HOMECARE • HOSPICE • LONG-TERM CARE INSURANCE

OCTOBER 2014

GrandRounds Oct. 11 • 7 pm • Eyeball 2014: A Concert • Massey Concert Hall, Belmont University Ming Wang, MD, PhD (on Chinese violin er-hu) Carlos Enrique, M. Mus. (composer/classical guitarist) Deidre Emerson, M. Mus. (cellist), and David Fischer, JD (Tenor soloist) perform a concert to benefit the Wang Foundation for Sight Restoration. For more information, go online to wangfoundation.com.

Nov. 9-13 • EMS World Expo • Music City Center The largest EMS-focused conference and trade show in North America returns to Nashville. The event offers more than 120 CE-certified sessions taught by leading industry experts and more than 300 exhibitors. This year’s event also features off-site tours of Vanderbilt University Medical Center, including LifeFlight operations. For more information or to register, visit EMSWorldExpo.com.

Nov. 11 • 8 am-4:30 pm • Mental Health Law Seminar • Bass Berry & Sims Office Mental Health America of Middle Tennessee (MHAMT) is hosting their annual Mental Health Law seminar, which includes lunch and 6.0 CLE/CEUs for attorneys, mediators, social workers, counselors and other professionals. For more

information, contact Tom Starling, MHAT president and CEO, at (615) 269-5355 or go online to ichope.com and click on ‘Events.’

Lung Cancer Study Reveals New Drug Combination Targets A Vanderbilt lung cancer patient’s exceptional response to different types of therapies spurred research that suggests lung cancer patients with specific gene alterations may benefit from combination therapy that targets two different cancer pathways. The study, led by Christine Lovly, MD, PhD, assistant professor of Medicine and Cancer Biology, was published in early September in Nature Medicine. The work was based on an intriguing clinical observation of a female Dr. Christine Lovly patient with advanced lung cancer who had an unexpected response to a monoclonal antibody that targets the insulin-like growth factor receptor (IGF-1R). IGF-1R helps cancer cells survive and evade anticancer therapies. Remarkably, the patient remained on the IGF-1R therapy for 17 months — far longer than any other patient on the clinical trial. The Vanderbilt researchers, led by Lovly, became interested in why this par-

Food for Thought Second Harvest, Jarrard Partner on Wellness Initiatives By CINDY SANDERS

With changing healthcare delivery models and an emphasis on population health, Second Harvest Food Bank of Middle Tennessee recognized an opportunity to reach out to the medical community to convey a message highlighting the value of food as medicine. The nonprofit organization equally recognized the need to find a partner to help strategically guide that message and create innovative programming … enter national healthcare communications and public affairs firm Jarrard Phillips Cate & Hancock, Inc. Jarrard and Second Harvest recently announced their alliance to develop collaborative models with the area’s healthcare community. Early this year, the two organizations convened a meeting of Middle Tennessee healthcare advisors and executives to discuss mutually beneficial ways to serve the community and to help provider organizations address issues such as medication adherence, disease-specific packages for the chronically ill, nutritional guidelines and wellness. “Our goal at Second Harvest is to help 16

OCTOBER 2014

the nearly 400,000 people in Middle Tennessee who don’t know where their next meal will come from,” said Jaynee Day, president and CEO of Second Harvest. “With the way healthcare is evolving, there’s a tremendous opportunity for us to take our existing healthcare relationships to the next level. We are grateful to partner with Jarrard, which is uniquely positioned to work with local healthcare organizations, to identify where their missions overlap with ours.” Second Harvest already operates a successful hospital pantry out of Saint Thomas Hickman Hospital, in addition to established food-asmedicine programs at Maury Regional Medical Center and Sumner Regional Medical Center. “We’re honored to partner with Second Harvest,” said Molly Cate, a co-founder and principal at Jarrard who has led this effort for the firm. “With the relationships and familiarity we have in the healthcare community – particularly here in Nashville, the healthcare capital of America – we’re looking forward to leveraging this partnership to help Second Harvest meet its mission in new, exciting ways.”

ticular patient’s tumor responded to the experimental therapy so dramatically. Investigators decided to test for gene mutations and found an unexpected result — the patient’s tumor was positive for an ALK gene fusion. Only about 5 percent of lung cancer patients have this gene fusion in their tumor. The patient’s dramatic and unexpected response led the team to further research the interplay between ALK and IGF-1R. The patient was enrolled in another clinical trial testing crizotinib, a drug that targets ALK rearrangements, and her cancer stopped progressing for several more months. Working in cell lines, mouse models and patient lung tumor cells, Lovly and colleagues from medical centers in the United States, Germany and Australia tested the ability of IGF-1R inhibitor therapies alone or in combination with ALK inhibitors and found the combination therapy enhanced the ability to slow down the growth of ALK+ lung cancer cells. They found similar results in cell lines from ALK+ lymphoma, a different form of cancer harboring the same tumor genetic alteration. “When used in combination, the IGF-1R inhibitor and an ALK inhibitor appear to work cooperatively to interfere with cell growth in ALK+ lung cancer cells,” Lovly said. “We need better tools to treat diseases like lung cancer that traditionally have been resistant to therapy, and increasingly, we are finding that combination therapies may be necessary to improve outcomes for our patients.”

executive search consulting firm, to help identify the next president of the historic institution. Spencer Stuart was chosen through a competitive bid process. “Meharry is a proud institution with a rich history of caring for those who are often forgotten in our society,” said Jim Williams, Chair of the search committee. “Our new president will have the important task of carrying on and continuing to grow that legacy.” The 12th president will succeed Dr. A. Cherrie Epps, who will continue to lead the organization until the new president is appointed. Meharry’s Presidential Search Committee will work with Spencer Stuart to develop a timeline and key steps toward securing a new leader within the coming months.

STMG Offers New Sinus Procedure

Abuse of prescription opioids is the number one drug problem for Tennesseans receiving publicly funded assistance for treatment services. Over the past decade, substance abuse admissions for prescription drugs like hydrocodone, oxycodone, morphine, and methadone have increased 500 percent. The situation has dramatically driven admissions to treatment facilities up— from 764 in 2001 to 3,828 admissions in 2011. “As of July 1, 2012, the number of admissions in our state for prescription drug abuse exceeded admissions for alcohol abuse for the first time in history,” said E. Douglas Varney, commissioner of the Tennessee Department of Mental Health and Substance Abuse Services. According to a 2010 National Survey on Drug Use and Health, more than 4 percent of Tennessean’s over the age of 18 and approximately 12 percent of those 18 to 25 years of age reported using pain relievers recreationally in the past year. “Many people needing substance abuse treatment are not getting the help they need,” said Varney. “And of the number of Tennesseans who could benefit from treatment, only about one person in eight actually received it.”

Saint Thomas Health recently introduced a new, minimally invasive sinuplasty as a safe and effective procedure for many patients seeking relief from uncomfortable and painful sinusitis symptoms. Matthew Speyer, MD, of Nashville ENT and Allergy Clinic, a division of Saint Thomas Medical Group (STMG), performed the successful surgery, which used a minimally invasive NuVent balloon technique, along with intraoperative navigation. “The days of painful sinus surgery may be over for millions of sufferers in the U.S. with the advent of in-office balloon sinus dilation,” Speyer said. “Patients typically use over-the-counter pain medications after surgery and are able to return to work the next day.” He noted outcomes so far have equaled traditional sinus surgery. Speyer added the minimally invasive procedure could save patients thousands of dollars by avoiding the operating room and general anesthesia. He performed the first advanced procedure at Saint Thomas Surgicare in Nashville using Medtronics’s latest sinus surgical innovation.

Meharry Medical College Hires Presidential Search Firm The Board of Trustees of Meharry Medical College recently announced it has selected Spencer Stuart, a leading global

Aegis Sciences Corporation Partners with McGavock High

In late August, officials from Aegis Sciences Corporation, McGavock High School and the Academies of Nashville gathered to celebrate the official naming of the Aegis Sciences Corporation Academy of Health Science and Law. The Aegis leadership team has been involved with the Academies of Nashville since the program’s early development. Through the partnership, Aegis already has hosted numerous job shadowing days, speakers at the school, hosted Laboratory Boot Camp and helped develop curriculum for the Academy of Heath Science and Law.

Prescription Drug Abuse Now Tops Alcohol Abuse in Tennessee

Wishes Granted The UnitedHealthcare Children’s Foundation (UHCCF) is seeking grant applications from families in need of finannashvillemedicalnews

.com

GrandRounds cial assistance to help pay for their child’s healthcare treatments, services or equipment not covered, or not fully covered, by their commercial health insurance plan. Qualifying families can receive up to $5,000 per grant with a lifetime maximum of $10,000 per child to help pay for medical services and equipment such as physical, occupational and speech therapy, counseling services, surgeries, prescriptions, wheelchairs, orthotics, eyeglasses and hearing aids. To be eligible for a grant, children must be 16 years of age or younger. Families must meet economic guidelines, reside in the United States and have a commercial health insurance plan. Grants are available for medical expenses families have incurred 60 days prior to the date of application as well as for ongoing and future medical needs. Parents or legal guardians may apply for grants at www. UHCCF.org, and there is no application deadline. In 2013, UHCCF awarded more than 1,700 medical grants, worth $5.6 million, to children and their families across the United States. BlueCross Foundation Commits $1 Million to Neonatal Abstinence In response to a surge of babies being born dependent on drugs and suffering the painful symptoms of neonatal abstinence syndrome (NAS), the BlueCross BlueShield of Tennessee Health Foundation has awarded a $1 million grant for

construction of a new NAS treatment unit at East Tennessee Children’s Hospital in Knoxville. According to the Tennessee Department of Health, there were 921 NAS births in the state during 2013. The vast majority of those cases were in upper East Tennessee, where the rate per 1,000 live births in five reporting areas averaged 36.3. The rate for the rest of the state is 3.8. MacRae Linton, MD, who directs the Vanderbilt Lipid Clinic, is principal investigator of a five-year, $11.8 million federal grant to find out why high-density lipoprotein (HDL), known as “good cholesterol,” doesn’t function properly in some cases. Generally elevated levels of HDL protect against heart attacks and atherosclerosis. However, when HDL functions inappropriately, it might actually accelerate heart disease. The grant from the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH), focuses on three disorders with elevated heart disease risk — rheumatoid arthritis, chronic kidney disease, and familial hypercholesterolemia. Linton said that while statins, which lower LDL levels, are the most effective current way to prevent heart attacks, they don’t prevent them all. HDL “dysfunction” may contribute to this “residual” risk. In fact, more heart attacks are associated with low HDL levels than with high LDL levels.

Certifications & Accreditations The Council for Accreditation of Counseling and Related Educational Programs has accredited Lipscomb University’s clinical mental health counseling master’s program, making it the second CACREP-accredited program in Nashville. Jake Morris, chair of the Department of Psychology and Counseling at Lipscomb said it is typical for first-time applicants o receive a two-year accreditation and then be required to undergo the re-accreditation process. Lipscomb was granted an eight-year accreditation on the first attempt.

NAM Names Leslie New Executive Director Last month, the board of directors of the Nashville Academy of Medicine announced the appointment of Rebecca Leslie as the organization’s new executive director. Leslie is an experienced non-profit leader and joins the Academy Rebecca Leslie from her position as vice president of talent development at the Nashville Area Chamber of Commerce, where she led the effort to ensure that the workforce met the needs of the region’s expanding economy. Notable programs and initiatives under Leslie’s supervision at the Chamber included work-

force support for relocating and expanding companies, the Nashville Emerging Leader Awards program and the WorkIT Nashville campaign, which reached 116 million people in the first year.

Reichstein Joins Tennessee Retina

Last month, Tennessee Retina welcomed David A. Reichstein, MD, to its physician staff. His specialty includes the diagnosis and management of patients with all types of ophthalmic tumors, including uveal melanoma or nevus, retinoblastoma, vitreoretinal and choroidal lymphoma, Dr. David A. Reichstein vascular tumors of the posterior segment, and choroidal metastases. After receiving his medical degree at Mount Sinai School of Medicine, he completed his internal medicine internship at St. Luke’s Roosevelt Hospital Center in New York City and a residency in ophthalmology at Vanderbilt. Reichstein then completed a clinical fellowship in ocular oncology at Wills Eye Hospital, followed by a second clinical fellowship in vitreoretinal surgery and diseases at the Medical College of Wisconsin. He is seeing patients at multiple Tennessee Retina locations, including Nashville, Hendersonville and Bowling Green.

Now, this is just what the doctor ordered.

Call 615.252.BANK (2265) to speak to one of our Private Client Bankers to learn how Avenue provides exceptional and personalized financial services to physicians and physician groups in Middle Tennessee. Locations in Cool Springs, Cummins Station, West End, and Green Hills Mobile App/Mobile Deposit • Online Banking • Any ATM Free • Concierge Banking Service EQUAL HOUSING LENDER

MEMBER FDIC

14-AVE-0037 M1rb Nashville Medical 10x6.38.indd 1

nashvillemedicalnews

.com

avenuenashville.com

9/11/14 6:41 PM

OCTOBER 2014

GrandRounds TriStar Summit Welcomes Urologist, Interventional Cardiologist TriStar Summit Medical Center recently welcomed board certified urologist M. Leon Seard, II, MD, to its medical staff. Seard received his medical degree from Loma Linda University in California followed by a general surgery residency at Wright State University Affiliated Hospitals Dr. M. Leon in Dayton, Ohio. He then Seard, II returned west to complete his urology residency at the University of Southern California in Los Angeles. He is accepting patients from his Urology Associates office in Hermitage. Interventional Cardiologist Evan Russell, MD, also recently joined the medical staff. Russell re- Dr. Even Russell ceived his medical degree

from the University of Cincinnati College of Medicine and completed his residency in internal medicine at University Hospitals Case Medical Center in Cleveland, Ohio. He then completed both his cardiology and interventional cardiology fellowships at St. Vincent Hospital in Indianapolis, Ind. Russell is board certified by the American Board of Internal Medicine in the specialties of Internal Medicine and Cardiovascular Disease. He is accepting patients at his Centennial Heart at Summit practice.

HCA Names Taylor President of Parallon Recently, HCA, which operates 165 hospitals and 115 surgery centers in 20 states and England, announced 29year company veteran Chris Taylor had been named president of Parallon, HCA’s healthcare Chris Taylor business and operational

Let’s Give Them Something to Talk About! Awards, Honors, Achievements The Tennessee Public Health Association and the Tennessee Medical Association have created a joint award to recognize individuals who demonstrate extraordinary efforts in the advancement of public health in Tennessee. The William Schaffner, MD Award is named after the chair of the Department of Preventive Medicine at Vanderbilt University. TPHA and TMA officials presented the inaugural award to Dr. Schaffner last month during TPHA’s annual awards luncheon. The two organizations will accept nominations (L-R) Dr. John J. Dreyzehner, commissioner of Tennessee Department from their members of Health; Dr. Stuart M. Polly, chair of TMA Public Health Committee; Honoree Dr. William Schaffner; and Paula Masters, president of the on an annual basis and TPHA. a selection committee will make the final decision. TPHA and TMA will honor the deserving individual during a joint ceremony each year. Several Middle Tennesseans landed on Modern Healthcare’s 2014 list of “100 Most Influential People in Healthcare.” Leading the way was Milton Johnson (#6, president & CEO of HCA), Wayne Smith (#15, chairman and CEO of Community Health Systems), Jonathan Perlin, MD (#31, president of clinical services and CMO of HCA), and Bill Carpenter (#43, chairman and CEO of LifePoint Hospitals). Thomas D. Miller, president of Division V Operations for Community Health Systems in Franklin, has been named one of eight new trustees for the American Hospital Association. On Jan. 1, 2015, he begins a three-year term on the AHA Board of Trustees, which is the policy-making body of the national association and has ultimate authority for the governance and management of its direction and finances. Debra Wilson, DPh, has been appointed to the Tennessee Board of Pharmacy for a six-year term. Wilson is president of three pharmacy service organizations with locations in Johnson City and Nashville, including Clinical Management Concepts Inc. and its subsidiaries, ProCompounding Pharmacy and Pharmacy Network Services, Inc. MissionPoint Health Partners has been selected by Becker’s Hospital Review as one of “100 Accountable Care Organizations (ACOs) To Know.” Dr. Debra Wilson Mary Harkleroad, LCSW, a geriatric social worker, has been named board chair of Mental Health America of Middle Tennessee. As Harkleroad starts her 2-year term, she is leading Mary Harkleroad the agency through a renewed strategic planning process this fall.

OCTOBER 2014

services subsidiary. Taylor has served as CFO of Parallon since 2012 and he has served as interim president of the company since November 2013. Parallon provides a range of services to more than 1,400 hospitals and 11,000 non-acute care providers. In his new role, Taylor will report directly to William B. Rutherford, executive vice president and CFO of HCA. Previously, Taylor served as CFO of HCA’s TriStar Division, comprising 17 hospitals in Tennessee, Georgia and Kentucky. He is a board member of the Nashville Chapter of the American Red Cross and United Way of Williamson County. He is also a member of several professional organizations, including the Healthcare Financial Management Association (HFMA), and the American College of Healthcare Executives (ACHE). He received his undergraduate degree in accounting from Tennessee Wesleyan College and an MBA from Belmont University.

Healthways Promotes Michela to COO Matt Michela, who has served Healthways as market executive officer for two years, has been named chief operating officer of the company. Michela will assume responsibility for Healthways’ commercial health plan, specialized health plan and employer market strategies and execution. He will also continue to oversee the company’s centralized operations functions to ensure seamless growth and execution across Healthways’ markets. Michela originally joined Healthways in 2000 as senior vice president, where he was responsible for the company’s disease management operations. From 2004 through 2013, Michela founded several companies, including CellNexus LLC, a gene and cell therapy company, 2MPLUS, Inc., a healthcare management services company, and Care Management International, Inc., a healthcare services and technology company focused on providing clinical knowledge-based solutions to reduce care and administrative costs and improve healthcare quality.

Fox Admitted to Membership at KraftCPAs On Aug. 1, Ramona E. Fox, CPA was admitted to membership at KraftCPAs PLLC. Most recently she was a member in Fox, Kolb & Associates, PLLC, and has more than 20 years of accounting experience. Prior to co-founding Fox, Kolb & Associates in 2007, Romano E. Fox she practiced with Crowe Horwath LLP and Kruse & Associates. A graduate of Lipscomb University, she practices in the firm’s entrepreneurial services group, which provides outsourced accounting, tax and consulting services, primarily for closely held, owner-operated businesses.

PUBLISHED BY: SouthComm, Inc. BUSINESS DEVELOPMENT Tami Pearce tpearce@nashvillemedicalnews.com 615.844.9407 SALES 615.844.9237 Maggie Bond, Adam Cross, Heather Cantrell, Mike Smith LOCAL EDITOR Cindy Sanders editor@nashvillemedicalnews.com NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Christie Passarello CONTRIBUTING WRITERS Lynne Jeter, Melanie Kilgore-Hill, Larry McClain, Kelly Price, Cindy Sanders CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: editor@nashvillemedicalnews.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 • Two years $78

SOUTHCOMM Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Chief Operating Officer/Group Publisher Eric Norwood Director of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Director of Content / Online Development Patrick Rains Nashville Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2014 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.        All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.

nashvillemedicalnews.com nashvillemedicalnews

.com

GrandRounds DentaQuest Names Martin Tennessee Dental Director

LifePoint Promotes Five, Announces New Advisory Board

Last month, DentaQuest, the dental benefits manager for TennCare, announced Brent Martin, DDS, has been named Tennessee dental director. In this role, Martin will oversee the provision of dental services to the approximately 750,000 Tennessee children who receive dental benefits through TennCare. Additionally, he will play an integral role in monitoring dental program integrity, quality, utilization management and utilization review, reviewing and evaluating claims and appeals and assisting with the credentialing process, site visits and provider orientations. A graduate of the University of Missouri Kansas City School of Dentistry, Martin also holds a master’s degree in healthcare economics and administration from the University of Dallas. He brings more than 40 years of dental practice and policy experience to DentaQuest, most recently serving as chief dental officer at the University of Massachusetts Medical School and dental director of Massachusetts’ Medicaid agency, MassHealth.

Brentwood-based LifePoint Hospitals® recently announced the promotion of five of its senior directors to vice president: Mike Caplenor to VP of IT&S Service Delivery and Administration; John Faust to VP of Financial and Ancillary Systems; Ed Richards to VP of Technology Services; Ron Evans to VP of Clinical Systems; and Sean Van Kerkhove to VP of Physician Services. In other news, the hospital company also announced formation of a patient and family advisory board (PFAB) to provide guidance to the company on efforts related to patient engagement and satisfaction in order to help every LifePoint hospital deliver the best possible patient experience. “A great hospital must be responsive to the community it serves,” said Rusty Holman, MD, chief medical officer and PFAB chair. “By empowering patients and family members to become involved in strategic conversations about the dynamic healthcare industry and provide insightful feedback about their experiences, we can better understand their needs and augment how we deliver safe, high quality care.”

PhyMed Expands Team Nashville-based PhyMed Healthcare Group, a physician-owned practice management company specializing in anesthesia, pain management and critical care, has recently made several personnel announcements. Ryan Dorr has been named chief information officer. He joined PhyMed in May 2013 as vice president of information technology. Previously, Dorr was assistant vice president within Information Technology Ryan Dorr at Ardent Health Services where he directed a team of 50 to help achieve meaningful use certification for the electronic health records system of seven hospitals. Chris Farley has been hired as director of operations where she is responsible for the execution of the company’s strategic plan for operations as well as the daily operating activities. Prior to joining PhyMed, Farley Chris Farley was with Saint Thomas Health where she was the division director for Outpatient Rehabilitation Services. Most recently, she was the regional manager for behavioral healthcare provider Vericare. Michelle Vaughn has been named director of revenue cycle management. She joins the company with 27 years of experience in revenue cycle management (RCM). Most recently she was senior director of RCM at SunCrest Healthcare. Vaughn is responMichelle Vaughn sible for RCM across the PhyMed organization and its subsidiaries, including Anesthesiology Medical Group. nashvillemedicalnews

.com

Capella Announces Executive Appointments Capella Healthcare recently announced the appointment of two senior executives. Troy Sybert, MD, MPH, was appointed executive vice president and CMO. Sybert came from Wellmont Health System in Kingsport, where he Dr. Troy Sybert

served as chief quality and medical information officer since 2010. Prior to that, he was CMO for University of Texas Medical Branch in Galveston for four years. Sybert earned his medical degree from University of Texas Southwestern Medical School, completing a combined internship and residency in internal medicine and general preventive medicine. He was then selected for a fellowship in hospital medicine at Mayo Clinic. He also completed a master’s degree in public health at University of Texas Medical Branch while achieving certification in Six Sigma/ Lean Thinking from the American Society for Quality. Davis W. Turner has been named vice president, associate general counsel. With more than 27 years of legal experience, Turner will provide legal support for Capella’s hospitals and the corporate office on a variety of matters. Previously, he Davis W. Turner was vice president and assistant general counsel for Vanguard Health System where he served for nine years. He has also worked as in-house counsel at Quorum Health Group, OrNda Healthcorp and HCA and was a member of both Frost Brown Todd and Waller. After completing his undergraduate studies at University of North Carolina at Chapel Hill, he earned his law degree from Vanderbilt University School of Law, where he graduated Order of the Coif. He also earned an MBA from Vanderbilt’s Owen Graduate School of Management.

Medalogix Expands with Three New Hires Medalogix, the Nashville-based healthcare technology company providing predictive modeling for the postacute market, recently announced appointments to newly created roles. Patrick Wall has joined Medalogix as director of operations. Wall previously worked at W.S. Darley & Co. where he was an outside sales representative. He also served in the Army for six years, most recently as battalion assistant operations officer for the 1st Calvary Division in Baghdad during Operation Iraqi Freedom. Wall is currently pursuing his MBA from Lipscomb University through the Yellow Ribbon Program for veterans. Wes Kennedy has joined as director of engineering and is responsible for data, systems, and application architecture and planning. He is also a key contributor to driving data vision strategy. Previously Kennedy served as a senior database developer at GHX. He graduated with an associate science degree from Cuesta College at the age of 17 and from Harding University with a bachelor’s degree at 19. Israel Ovalle has joined as product manager where he develops and executes product strategy and roadmaps for home care clients to deliver products and services focused on providing better quality of care for patients. Ovalle previously was an operations and project management consultant for Medalogix. He was also the director of operations for The Shalom Foundation, a healthcare non-profit headquartered in Guatemala.

Are Your Patients CPAP Non-Compliant? Our in-office Radiofrequency Ablation procedure can eliminate the need for a CPAP by significantly decreasing AHI level and increasing oxygen saturation level.

Sleep Apnea Institute

Breathe Easier

For results and other information, visit thesleepapneainstitute.com or call (855) 429-2557. OCTOBER 2014

BREAKTHROUGHS IN THERAPIES AND TREATMENTS FOR BLOOD CANCERS TENNESSEE ONCOLOGY’S IAN FLINN, M.D. According to the Leukemia & Lymphoma Society (LLS), one person in the United States is diagnosed with blood cancer approximately every three minutes. an estimated 156,420 people will be diagnosed with leukemia, lymphoma and myeloma in the nation this year. also, an estimated 55,350 are expected to die from the blood cancers this year alone. While the statistics are unsettling, clinical investigators are seeing a huge change, not seen in many, many years, in the way these hematologic malignancies are treated. new therapies and treatments are also creating a whole new paradigm, improving patients’ duration and quality of life. for instance, the u.s. food and Drug administration recently approved a new, exciting targeted therapy called idelalisib (Zydelig®) for patients with relapsed chronic lymphocytic leukemia (cLL), relapsed follicular b-cell non-hodgkin lymphoma (fL) and relapsed small lymphocytic lymphoma (sLL). My team at the sarah cannon research institute (scri) and tennessee oncology began working with idelalisib more than six years ago. in fact, a patient in nashville was the first in the world to be treated with the medication. idelalisib, a targeted molecule, is a daily, oral medication that replaces aggressive chemotherapy and attacks cancer cells. the side effects of the medication are moderate when compared to traditional chemotherapy. currently, patients who benefit most from the medication have received prior treatment that was not effective. however, i hope idelalisib will become the best in frontline treatment in the future. it has been very gratifying to see patients respond to the medication in a positive way that improves their lives. at scri and tennessee oncology, my team is currently working with second and third generation molecules to overcome the weaknesses found in the original drug. the LLs is an important non-profit organization that is dedicated to fighting blood cancers. i have been very involved with the non-profit organization for several years, particularly its therapy acceleration Program. the program obtains funds from various LLs events, helping clinical investigators invest in new medications and get them to patients as soon as possible. the LLs tennessee chapter is gearing up for its annual Light the night® Walk at LP field on friday, oct. 10 at 5:30 p.m. the event gathers people to honor those who have fought blood cancers, as well as to spotlight the importance of treatments and therapies for blood cancers – most importantly, finding a cure for blood cancers. fundraising teams are also formed, with every penny raised going toward research for blood cancers. tennessee oncology is a gold sponsor for this year’s event, and we have a team fundraising money, as well as walking in the event. Tennessee Oncology’s Center for Blood Cancers is committed to providing compassionate, ethical and high-quality services to adult patients. These services include: standard treatments, investigational treatment on phase 1-3 clinical research trials with the Sarah Cannon Research Institute and blood and marrow transplant services. Caring for cancer patients is a privilege.

IAn fLInn, M.D.

the obvious choice for cancer care in tennessee

1.877.TENNONC • www.tnoncology.com