FOCUS TOPICS DIABETES ICD-10
April 2014 >> $5
Middle Tennessee’s Primary Source for Professional Healthcare News
PHYSICIAN SPOTLIGHT PAGE 2
C. Lee Parmley, MD, JD
ON ROUNDS
18
T-Minus 6 and Counting Preparing for ICD-10 Lift Off Although it looked as if there would be no reprieve this time, Congress passed a delay of ‘at least one year’ for ICD-10 conversion as part of a package enacting another temporary patch to the flawed sustainable growth rate formula on Monday evening, March 31 ... 5
ROI on Healthcare Workforce Diversity Embracing Cultural Competency By CINDy SANDERS
Last month, healthcare leaders gathered in Nashville for the Council on Workforce Innovation’s symposium on trends and resources impacting healthcare workforce diversity and cultural competency in the delivery of quality healthcare. Opening the half-day summit, Cathy Childs, event co-chair and director of Human Resources for Cumberland Consulting, noted, “One thing I’ve learned in my 15 years of healthcare HR is employee engagement and cultural competency go hand-in-hand.” Organizer Jacky Akbari, board chair of the National Organization for Workforce (NOW) Diversity, welcomed Waller Chairman John Tishler, JD, to introduce the first speaker, Nashville Mayor Karl Dean. “Karl has done many wonderful things for our city,” Tishler said, “but among the best involves protecting and promoting the rich diversity (CONTINUED ON PAGE 8)
The Cleveland Clinic Approach CEO Cosgrove Shares Insights with Health Care Council Members
Delegation Makes Annual Pilgrimage to D.C. Members of Leadership Health Care, an initiative of the Nashville Health Care Council, embarked on their 12th annual trek to Washington, D.C. last month to gain insight on implementation of the Affordable Care Act and other pressing national health agenda topics ... 9
Nashville Mayor Karl Dean and Memphis Mayor A C Wharton chat after speaking at the 2014 Healthcare Diversity Forum held last month in Nashville.
By KELLy PRICE
The Nashville Health Care Council recently hosted a briefing with Delos M. (Toby) Cosgrove, MD, president and CEO of Cleveland Clinic. A sought-after speaker and noted expert on the efficient, effective delivery of care, Cosgrove shared his insights with 250 executives in attendance. William H. Frist, MD, former majority leader of the U.S. Senate and noted transplant surgeon, facilitated the program. “Much like Cleveland Clinic, Nashville is a center of experimentation and innovation,” Frist said in his introduction. “We welcome the opportunity to host Dr. Cosgrove and hear first-hand about the groundbreaking work at the Clinic.” Cosgrove, who like Frist is a cardiac surgeon, joined Cleveland Clinic in 1975 and was named chairman of the Department of Thoracic and Cardiovascular surgery in 1989. Under his leadership, Cleveland Clinic has consistently been identified as one of America’s top four hospitals by
Delos M. (Toby) Cosgrove
(CONTINUED ON PAGE 4)
(C) 2014, DONN JONES
ONLINE: NASHVILLE MEDICAL NEWS.COM
To promote your business or practice in this high profile spot, contact Tori Hughes at Nashville Medical News.
NASHVILLE
Your Primary Source for Professional Healthcare News
thughes@southcomm.com • 615-844-9410 PRINTED ON RECYCLED PAPER
PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357
PhysicianSpotlight
Parmley Takes Reins as Chief of Staff at Vanderbilt University Hospital By MELANIE KILGORE-HILL
On Feb. 17, C. Lee Parmley, MD, JD, joined the ranks of distinguished physicians who have been selected to serve as chief of staff at Vanderbilt University Hospital. Parmley, professor of Anesthesiology and chief of the Division of Anesthesiology Critical Care Medicine, first arrived at Vanderbilt in 2004. But Nashville wasn’t always on his radar. Parmley was enjoying a successful career at the University of Texas, where his roles included leading the Critical Care Fellowship Program, when a former fellow landed a job at Vanderbilt and encouraged him to visit. “Despite the fact that I wasn’t looking, I became interested in the job and the things that could be done here,” Parmley said of his inaugural trip to Nashville. “I came and saw what was going on and the camaraderie and collegiality between departments. That was very refreshing.” As chief of staff, Parmley’s new responsibilities will include oversight for inpatient discharges, inpatient surgical and intensive care volume goals, and collaborating with hospital and VUMC leadership to enhance health system operating performance. He will serve as a physician lead for developing bundled care offerings and will lead work on Vanderbilt’s Acute Episode Management
Care Model, including the inpatient operating model. Within the hospital, he will help develop and implement clinical operating policies and procedures, along with practice and productivity standards.
Learning & Leading
The son of a rural general practitioner, Parmley attended medical school
Kraft Healthcare Consulting, LLC presents:
ICD-10 Boot Camp
SAVE THE DATE
This fast-paced boot camp is designed for coders and others in health information management and compliance who are already ICD-9 proficient and need to maintain their professional credentials.
May 21, 22, 23
Two course options available for participants:
Course 1: ICD-10 CM Boot Camp (12 CEUs) Course 2: ICD-10 PCS Boot Camp (12 CEUs) Materials will be provided, and CEUs will be available. Speaker Heather Greene, MBA, RHIA, CPC, CPMA, is an AHIMA-approved ICD-10 CM/PCS trainer and vice president of compliance services with Kraft Healthcare Consulting, LLC.
This program has been approved for continuing education units (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.
2
at Loma Linda University in California through an Air Force scholarship program and was assigned to Lackland Air Force Base for his anesthesiology residency. He completed his military commitment in San Antonio and worked in private practice near Houston before taking a brief detour from medicine. The anesthesiologist pursued his law degree from South Texas College of Law in Houston and worked briefly in medical malpractice before returning to medicine. In 1991, Parmley began a Critical Care fellowship at the University of Texas Health Science Center in Houston and discovered a passion for working with critically ill patients and end-of-life and organ procurement issues. He remained on faculty at UT until moving to Nashville. A lifelong learner, Parmley continued his education in Tennessee where he earned a Master of Management in Health Care (MMHC) degree from Vanderbilt University’s Owen Graduate School of Management in 2011. He is board certified in Anesthesiology and Critical Care and is a Fellow of both the American College of Legal Medicine and American College of Critical Care Medicine.
>
APRIL 2014
Location: KraftCPAs PLLC 555 Great Circle Road Nashville, TN 37228 MetroCenter
Learn more and register at www.kraftcpas.com/ events.php.
Facing Problems, Finding Answers
Diverse professional training and early exposure to healthcare give Parmley unique insight into the evolution of medicine over the past half century. “What I do as an intensivist is so different than what my dad did in rural Colorado,” Parmley said of his now 93-year-old father. “I think about that in how much growth there has been in the understanding of human physiology, pharmacology and technology, and where we go from here.” One of the greatest changes, Parmley said, is arrival of an era where healthcare is more political than personal. “Everyone has an opinion, but healthcare reform is the law of the land; and we have to adjust what we do to provide services needed within that law,” he stated. “Many parts can be intimidating since we don’t know what the future looks like, but that’s also the part I find appealing.” One advantage of today’s industry is the stabilization of technological and pharmacological advancements, Parmley said. Reaching that equilibrium point means more attention can be paid to learning how to consistently and judiciously deliver what the population needs in a fair way. “That’s a huge job and being associated with an institution like Vanderbilt is where I think these problems will be solved,” he noted. “When I thought about it carefully, the answer was clear. We have a responsibility in healthcare, and we have many opportunities to figure out how to do this and do it right.” To that end, Parmley has devoted much of his time to helping grow Vanderbilt’s advanced practice nursing program and ensuring nurse practitioners are readily available in critical care units. He also supports the use of peer leadership to erode the silos that have divided physicians and nurses in years past, and he is committed to designing facilities and services with needs of the underserved and rural communities in mind. “It’s easy to say, ‘That’s not my problem,’ but that’s not the way my mind approaches things,” Parmley said of the challenges facing today’s healthcare leaders. “We’re at a point in history where we’ll need to reach down inside and find that courage and willingness to do things we haven’t done in the past. What I love about Vanderbilt is that it’s an institution that has that commitment … not just to what goes on within but also to people who might find their way here and what we offer, even if it’s sharing a thought process through a phone call. Our commitment is more broad than the patients on our campus,” he concluded.
nashvillemedicalnews
.com
Rules of Engagement Diabetes, Chronic Disease Prevention & Management By CINDY SANDERS
Tight schedules make it difficult for primary care providers to spend as much one-on-one time as they would like with diabetic patients or those at risk for developing the disease. Nashville, however, is home to a number of organizations with experts to help fill in the gaps and empower individuals to take control of their health. Demand for disease management professionals and health coaches is increasing as recent statistics from the Centers for Disease Control and Prevention showed the prevalence of diabetes doubled in Tennessee between 1995 and 2010. Last month, MissionPoint Health Partners received an $80,000 grant to launch a chronic disease management pilot program serving the most challenging cases of uninsured patients with diabetes in Clarksville and nearby Fort Campbell, Ky. A medically underserved area, Montgomery County has the highest ageadjusted prevalence of diagnosed diabetes in the state. In addition to coaching, the grant will be used to connect patients with social services support, health system navigation and care coordination. Wendy Wright, vice president of Clinical Integration for MissionPoint, noted the patients targeted for this grant had no other access to diabetes care except through the country health department. Health officials were concerned, she continued, because they felt they were continu- Wendy Wright ously ‘putting a bandage’ on the problem instead of being able to get to the root of the diabetes self-management issue. Using evidence-based standards of care and self-management guidelines, Wright said their model is all about problem solving … looking at how to achieve objectives in light of obstacles. “You can tell a person to quit smoking,” she pointed out. “Everyone knows that they should quit, that it isn’t good for them … but the how is a lot harder. That’s what we do … the how.” Wright continued, “We try to get to the barrier and eliminate it.” She added that while others might write off particularly challenging patients, she doesn’t believe people are willfully non-compliant. “Life gets in the way,” she stated. “It takes enormous commitment to be able to care for oneself with diabetes,” she continued, adding it impacts every aspect of a person’s life. Addressing challenges starts, she said, by employing the health-coaching model, which uses motivational interviewing to ask what an individual hopes to achieve. nashvillemedicalnews
.com
“Starting from that perspective is very different than being told what to do,” Wright pointed out. She continued, “We try to set small goals to achieve success. From small successes come even bigger successes.” Specific data measures will be followed throughout the one-year grant from the Clarksville-Montgomery County Community Health Foundation to help assess the program’s effectiveness. Wright noted a similar program in Davidson County has already resulted in promising outcomes. Nashville is also home base for international health and well-being company, Healthways, Inc., which partners with payers and employers in the quest to help individuals live healthier, happier lives as a value proposition for all parties involved. Ann Worf, senior clinical designer and family nurse practitioner, said the company has three decades of diabetes management experience. Using a clinical algorithm to assess a diabetic individual’s acuity Ann Worf level and ability to self manage, the company’s health coaches then hone in on areas of greatest need and deliver support through a telephonic program. Worf noted there are several key areas that tend to trip people up and keep them from achieving maximum management. “The area of medication adherence is one of our big areas – taking all of your medications, every day, exactly as prescribed,” Worf said. She added there are a number of reasons why someone might not follow their doctor’s orders. One such barrier, she noted, is a lack of understanding about a medication’s purpose and the health consequences of not taking it.
Financial issues are also a major concern. Worf said Healthways has social workers to help connect individuals with assistance programs, provide conversation starters to discuss costs with a provider, or even directly contact the provider at the individual’s request. Similarly, poor appointment adherence is another barrier to optimal diabetes management. “There are so many standard of care clinical guidelines that go with diabetes,” Worf said, adding regular checkups, labs, annual foot check, dilated retinal exams and blood pressure checks are just a few appointments that must be made and kept. “We send out lots of educational materials and quarterly reminders with checklists of what needs to be done when,” she noted of simple steps to make the overwhelming more manageable. Under the larger umbrella of ‘self management,’ Worf said issues range from tobacco use and poor dietary choices to physical inactivity and depression. Although Healthways doesn’t handle depression management, they do screen and refer. “We do depression screening as part of all of our calls, and
we do a larger depression screening every six months with anyone who has a chronic disease,” Worf explained. Specific programs target each of the other areas such as QuitNet for tobacco cessation or Innergy, which was developed in collaboration with Johns Hopkins to help with sustained weight loss. “The coaches for each of these programs are very specialized,” Worf said, adding health coaches are selected for programs based on their backgrounds and then given additional training and tools to address their focus area. “It’s absolutely individualized. There’s no cookie cutter here,” Worf said. “We’re going to work with the person where they are today.” She added coaches help each person set and achieve attainable goals based on their real life parameters. She continued, “You can scare anybody into doing anything for a short time … but it’s not sustainable.” Instead she continued, “Feeling good, having hope, feeling like you can have a normal life … that is sustainable.” Worf said success comes once an individual begins to own their health and make the connection between their actions and how they feel. “It’s like anything that’s good … you want more,” she concluded.
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 APRIL 2014
>
3
Could Cell Regeneration Turn the Tide on Diabetes? Vanderbilt University scientists have found evidence that the insulin-secreting beta cells of the pancreas, which are either killed or become dysfunctional in both main forms of diabetes, have the capacity to regenerate. The surprising finding, posted online recently by Cell Metabolism, suggests that by understanding how regeneration occurs, scientists one day might be able to stop or reverse the rising tide of diabetes, which currently affects more than 8 percent of the U.S. population. The study “provides clues to how we might learn what signals promote betacell regeneration in type 1 and type 2 diabetes,” said Alvin Powers, MD, the paper’s senior author and director of the Vanderbilt Diabetes Center. In the past three months, Powers and his research colleagues … in four separate papers … have reported important findings about the microenvironment of the insulin-secreting beta cells and glucagonsecreting alpha cells, which are among four types of cells clustered in the pancreatic islets. Both hormones are important in regulating blood glucose levels and ensuring that glucose is delivered to muscles and brain to be burned as fuel, and stored in the liver. Powers called the islets a “mini-organ” because they are highly vascularized and innervated, and they exist
PHOTO BY ANNE RAYNER
Vanderbilt Researchers Uncover Clues
The team studying beta-cell regeneration includes: (L-R) Dr. Chunhua Dai, Kristie Aamodt, Dr. Marcela Brissova, and Dr. Rachel Reinert.
within a specialized environment. Marcela Brissova, PhD, research assistant professor of Medicine, was first or co-first author on three of the manuscripts. Chunhua Dai, MD, research assistant professor of Medicine, and Kristie Aamodt and Rachel Reinert, PhD, students in the Vanderbilt MD/PhD program, were also among the first or co-first authors. In two papers in the journal Diabetes and one each in Development and Cell Metabolism, the researchers described four main findings about islet vascularization and innervation:
First, vascular endothelial growth factor A (VEGF-A) is important for development of the islets’ blood supply and for beta-cell proliferation. Blocking the growth factor early in development in a mouse model ultimately reduced beta-cell mass and insulin release and impaired glucose clearance from the bloodstream. Second, VEGF and other ‘signals’ released by the endothelial cells lining islet blood vessels consequently stimulated growth of islet nerves in mice that connected to the brain. “If the islets don’t become vascularized properly, they don’t become in-
nervated properly,” Brissova said. These signals also promote beta cell growth. Third, VEGF-A was not involved when the beta-cell mass increased in an obese mouse model of type 2 diabetes in response to rising glucose levels. Unlike tumors, which sprout new blood vessels as they grow, the beta-cell tissue increased its blood supply by dilating existing vessels. Finally, too much VEGF-A can lead to beta cell death. But that sets up a regenerative microenvironment involving an interaction of vascular endothelial cells and macrophages which, in turn, leads to beta cell proliferation both in mice and human islets. “That’s very, very unusual because islet cells are like neurons; once they’re dead, they don’t usually regrow,” Brissova said. “We think that the endothelial cells and macrophages which are recruited from the bone marrow create an environment that promotes the proliferation and regeneration of those beta cells.” The Vanderbilt Diabetes Research and Training Center (DRTC) is a NIHsponsored Diabetes Center that facilitates the discovery, application, and translation of scientific knowledge to improve the care of patients with diabetes. The interdisciplinary Vanderbilt DRTC involves more than 120 faculty distributed among 15 departments in 3 schools and 4 colleges at Vanderbilt and Meharry Medical College.
The Cleveland Clinic Approach, continued from page 1 U. S. News & World Report and is one of only six healthcare services organizations to be named to the “World’s Most Ethical Companies” ranking by the Ethisphere Institute. A graduate of Williams College, Cosgrove received his medical degree from the University of Virginia School of Medicine and completed his training at Massachusetts General Hospital, Boston Children’s Hospital and Brook General Hospital in London. A decorated veteran, he served as a surgeon in the U.S. Air Force. At Cleveland Clinic, Cosgrove presides over a $6 billion healthcare system that also includes eight community hospitals, 18 family health and ambulatory surgery centers, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Toronto, and the new Cleveland Clinic Abu Dhabi. Cosgrove said the Abu Dhabi facility was built “from the fiber optics up” to the most forward-thinking standards. Cosgrove has made the importance of patient-centered care and the overall patient experience a point of emphasis and has launched major wellness initiatives for patients, employees and the larger community. He was instrumental in Cleveland Clinic’s reorganization of clinical services into organ and disease-based institutes. In his remarks to the Nashville healthcare community, Cosgrove described his 4
>
APRIL 2014
system’s highly regarded model of care and discussed how the organization plans to evolve during this transformative time for the business, as well as the practice, of healthcare. He also spoke about the constant need for innovative technologies in healthcare, along with the importance of using metrics to illustrate and measure the value of services. Cosgrove pointed out, “At Cleveland Clinic we subscribe to the belief that quality care, proven by measured outcomes, leads to reduced costs and healthier patients in the long run. Encouraging our patients to become active in their own care through dialogue and transparency has allowed us to maintain a high quality standard of care while reining in expenses, ultimately allowing us to improve our delivery system.” Cosgrove’s new book, “The Cleveland Clinic Way: Lessons in Excellence from One of the World’s Leading Health Care Organizations,” explores these themes and takes an in-depth look at today’s healthcare system and processes. In the book, Cosgrove focuses on eight trends that he says are shaping medicine including the effectiveness of collaboration, the benefit of big data, the need to focus on healthcare instead of ‘sickcare,’ and the impact of empathy on patient outcomes. Senator Frist asked Cosgrove how thinking about patient care had changed in
the last 10 years, observing that the change in approach to treatment had been transformed from what was almost a guild system organized around doctors’ specialties to medical disciplines organized by disease. Cosgrove said taking a multidisciplinary approach with a focus on wellness of the mind and body allows providers to share thoughts on the best way to care for the whole patient. Innovation happens, Cosgrove said, “when people bump up against each other at the borders” where several disciplines are interacting. “This is how we bring innovations into practice by bringing together ideas,” he continued. Cosgrove added Cleveland Clinic has produced more than 600 innovative products, “with 1,500 more in the queue,” and formed more than 60 companies that are producing solutions to medical care and added capabilities. Wellness and behavioral choices impacting health are a major part of Cleveland Clinic’s focus for staff, as well as for patients and the larger community. Frist asked what steps had been taken to achieve a totally smoke-free workforce of more than 40,000 employees. Cosgrove answered that before the Clinic implemented the decision, they designed a progressive program that started with not allowing smoking in public spaces at the Clinic … then moved to free smok-
ing cessation programs … then began testing for nicotine … and then, finally, moved to not hiring anyone who smoked. Cosgrove noted, “We may have saved more lives doing that than I saved in a career as a cardiac surgeon.” Cleveland Clinic has taken a similar approach to the problem of obesity in the workforce and community. “We started with requesting that onsite McDonald’s outlets make changes in the food they served,” he said, noting that local newspapers ran headlines describing this as a “Big Mac Attack.” As part of this program, Clinic vending machines no longer include candy bars; and the system offers onsite exercise programs, free access to Weight Watchers meetings, and a partnership with the YMCA to improve the health of the community. “As a group, we have lost 43,000 pounds as a result,” Cosgrove said enthusiastically. Cleveland Clinic has made a commitment to utilizing its intellectual capital to grow its brand, successfully using technology, training, innovation and motivation to achieve its goals as a leader in providing healthcare in a changing environment and in sharing those best practices with others. Cosgrove said he believes eventually there will be standards of care across the country, and the evolution of “cookbook” medicine will be important in an economically restrained environment. nashvillemedicalnews
.com
18 T-Minus 6 and Counting Preparing for ICD-10 Lift Off
diseases on a global scale, and is laid out in a logical, orderly manner. Kraft Healthcare Consulting experts Heather Greene, MBA, RHIA, CPC, CPMA, and Scott Mertie, CHFP, FHFMA, recently sat down with Nashville Medical News to discuss ICD-10 and its implications and implementation. Greene, a member of the 2014 Women to Watch Class (see insert), is vice president of Compliance Services and Mertie is president of Kraft’s healthcare industry team.
By CINDY SANDERS
Although it looked as if there would be no reprieve this time, Congress passed a delay of ‘at least one year’ for ICD-10 conversion as part of a package enacting another temporary patch to the flawed sustainable growth rate formula on Monday evening, March 31. In addressing members of the Healthcare Information and Management Systems Society (HIMSS) in late February, Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner said, Delayed Reaction “There are no more delays, ICD-10 has been in use and the system will go live on by some countries since 1994. Oct. 1.” She then added, “It’s While World Health Organitime to move on.” zation rules call for all memEvidently it isn’t quite ber states to adopt the latest time, yet. However, the Amerversion of ICD, there really is ican Hospital Association, IT Heather Greene and Scott Mertie discuss strategies for helping clients transition to ICD-10. no way to mandate or enforce professionals, coding experts, when that might occur. Howand a number of consulever, more than 100 nations tants across the health continuum share have adopted the system, which can be find that ICD-10 coding better mirrors Tavenner’s sentiments. Those in favor clinically modified for use within a counwhat we now know about disease states, … or at least acceptance … of the move try. The United States is among the last improves the ability to research and trace
industrialized nations to make the switch. “The reason we’re so far behind is because we were so far ahead,” Greene said. She went on to explain that when ICD-9 was adopted in 1979, the United States heavily invested in technology, equipment and training. “Those advances have made it expensive to change.” Despite ICD-9 modifications and tweaks over the years, the U.S. is using a system crafted 35 years ago. As the Kraft team pointed out, it is inconceivable that any other type of business system would have been in place that long with no major update. “We’re three decades behind,” Greene said. “We’re using a nomenclature that is no longer relevant to a lot of our disease processes and understanding.” Greene added the previous implementation delay didn’t necessarily pan out as envisioned. “We’re further behind now than we were a year ago,” she stated. “Before it was delayed, we were all moving forward. There was momentum.” Once the delay from 2013 to 2014 was announced, many people put ICD-10 on the back burner. The concern is that rather than using this extra time to prepare, the same thing will happen again (CONTINUED ON PAGE 6)
Meet Some of the Faces Behind Our Healthcare Experience.
Jeremy Conner
Shatita Daniels
Meredith Douglas
Brett Kennedy
Kelly Miller
Jayme Parmakian
John Teas
LBMC has assembled a uniquely experienced team of over 40 healthcare professionals that clearly differentiate us
LBMC Healthcare Services
Accounting - consulting - HR - tecHnology
NASHVILLE | KNOXVILLE | CHATTANOOGA ph: 615.377.4600 | www.lbmc.com
from other service providers – all with deep financial experience as well as practical experience working in the field of healthcare.
Meet Brad Bonde, CPA 615.309.2434 (direct) / bbonde@lbmc.com Senior Manager – Accounting & Assurance Services Brad, a CPA, has ten years of experience providing audit and business consultation services to businesses primarily in the healthcare industry. Brad’s healthcare experience includes working with hospitals, health systems and hospital management companies, along with private equity-backed healthcare services companies across the sector. Brad also has experience working with large benefit plans and assists with technical reviews for LBMC’s audit practice. Brad is actively involved in Leadership Healthcare and the Nashville Health Care Council, serves on committees for the TSCPA and AICPA, and volunteers with High Hopes Development Center in Franklin, Tennessee. In his spare time, Brad enjoys traveling with his family and assisting with his children’s baseball teams.
Where Great Companies Come to Grow.
nashvillemedicalnews
.com
APRIL 2014
>
5
T-Minus 6 and Counting, continued from page 5 with this latest extension. “We have some clients who have been very proactive,” Mertie noted. “Others are not ready to worry about it yet.” However, he added, “You can’t avoid the inevitable. The time is now.” Eating the Elephant As the old saying goes … “How do you eat an elephant? One bite at a time.” Greene said some of the trepidation over ICD-10 understandably comes from the magnitude of the switchover and vast increase in codes. Thinking about ICD10 in toto is understandably overwhelming. However, most everyone will have parts of the ‘elephant’ left untouched. Providers, Greene pointed out, have a good idea about their general patient population and should pay particularly close attention to codes used in frequent rotation … and recognize that a significant number of the codes might never be used. For example, codes pertaining to being bit and/or hit by a sea turtle might possibly come into play in Hawaii and coastal states, but Tennessee coders are probably safe to chuckle over those and then promptly forget them. Mertie added Kraft recently completed a boot camp for a large national skilled nursing provider. When honing in on necessary codes for their senior population, Mertie pointed out, “A lot of sections were just gone … like OB/GYN, pediatric codes, etc.”
Both agreed orthopaedic practices cross many populations and would, therefore, have a steeper learning curve than some specialties. “Orthopaedics is going to be hit hard,” Greene said. “They need to be prepared.” However, she continued, “If they documented well in ICD-9, it should only be tweaking for ICD-10. I’m not a proponent of massive documentation, but I believe in clear, concise documentation … it’s key words.” She added that coding, whether in ICD-9 or ICD-10, is a challenge every day. In conducting trainings, she said, “I ask my coders, ‘When did a challenge stop you?’ … ‘Not often’ is the usual response.” Finding the Good A major plus, Greene and Mertie agreed, is that ICD-10 coding does follow a logical sequence. “Think about how many diseases have been discovered in just the last three decades,” Mertie said. He added that in trying to ‘squeeze’ new information into the existing ICD-9 structure, any pattern that existed got lost over time. “In ICD-10, there is a rhyme and a reason for placement,” Greene said of codes. “Even though it’s huge, it’s structured; and it’s logical; and it makes sense.” She added, as an example, injury codes run from head to toe. ICD-10 also has much more emphasis on laterality and has a specificity that is missing in the current system. The hope is that the ability to more fully explain a patient’s situation through coding will result in the need for
less verbiage in documentation and fewer claims heading to appeals since payers will have a clearer picture on the front end. Although she understands why providers might be frustrated with the level of specificity, Greene said there is a bigger picture that impacts research and patient care. “If I’m being attacked by a crocodile or an alligator, I don’t care which it is. But, if I’m researching the overpopulation of these animals in the Everglades, I’d want to know which animal is more aggressive and where it is attacking. From a research standpoint that information is huge,” she said. Circling back to a more common injury … falls … she pointed to how details that might initially be thought of as extraneous could actually impact patient care and prevention by statistically showing patterns to providers and payers. “If you know what room it’s in (the fall), that might make a huge difference with an aging population,” Greene said. “For example, if I find most seniors are falling in bathroom tubs, it might make more sense to pay for a $50 handrail instead of $50,000 in hip surgery and rehab.” Mertie added, “My hope is that as a population, it will help us find solutions that we couldn’t before. We would have been stretching the correlation in ICD-9 … it’s a much more direct correlation in ICD-10.” Coming Out the Other Side Like most things in life, preparation is
half the battle. Greene and Mertie said they readily recognize the concerns of providers and coders worried about denials as a result of inadvertent mistakes. However, Mertie noted, “The more time they can spend preparing for it, that’s going to make the hit on their revenue cycle much less.” Greene favors a ‘ripping the bandage off’ approach. At some point, providers and coders simply have to dive into the new process. In some ways, the U.S. has debated ICD-10 for so long that it has become healthcare’s version of the bogeyman. After training sessions are finished, Greene noted she inevitably hears comments from participants that ICD-10 wasn’t as bad as imagined. “Part of what I do is help them get rid of the fear, which hinders learning,” she explained. Still, Greene added, the new nomenclature represents a major shift and will be a bit like starting over even for experienced coders. “Be prepared for some glitches,” she counseled, adding those are to be expected no matter how long individuals have to prepare for the conversion. “One thing I advise is to make sure you have a financial plan in place to weather the (cash flow) disruption.” Greene concluded, “Any change is difficult … and this is going to be difficult. I wouldn’t want to ever say it’s all going to be rainbows and roses. It’s going to be hard work.” But, she continued, “I think when we get to the other side, we’ll find ourselves in a better situation.”
ICD-10 on the Frontlines The Coder’s Perspective By CINDY SANDERS
AMA Pushes for ICD-10 Stoppage or Delay The first rule of marketing is to make sure you have a clear message. For the American Medical Association leadership, their position on the impending ICD-10 conversion could not be more straightforward … they want to see it stopped. READ MORE AT
nashvillemedical news.com 6
>
APRIL 2014
Recently, two members of the STAT Solutions coding team received certificates of ICD-10 proficiency. After attending a weekend seminar with the local chapter of the American Academy of Professional Coders (AAPC), completing additional AAPC work online, and sitting for a two-and-a-half hour certification exam, Kathi Carney, CPC, and Donna Baker, CPC, expressed relief … and optimism. “I was a little nervous,” Baker said about tackling the switchover. “I know a lot of the ICD-9 diagnosis codes by heart.” The sheer volume of codes is what has so many intimidated, but Baker and Carney found Donna Baker the ICD-10 formulary to be logical. “Every digit and every letter means something. It does make sense and flow,” Carney said. “Once you figure out how it’s set up, it makes sense,” she added. Based on anatomy and with an emphasis on laterality, the coders noted one
ICD-9 code could easily convert into 20 or more ICD-10 codes. “The choice of codes is so much greater, physicians will need to be more in tune to their documentation,” Carney said. STAT Solutions, LLC, a wholly owned Kathi Carney subsidiary of Crosslin & Associates, offers a range of practice management services including outsourced billing and coding consulting. Despite another implementation delay, the coders said they wanted to be prepared to help clients make the eventual change. Justin Crosslin, a principal with the firm, noted practices are being slammed on all fronts with a host of sweeping changes. “Change is never easy, and the healthcare industry is so heavily regulated it makes it difficult to operate as a business while staying focused on patient care,” he said. Crosslin added it isn’t Justin surprising the AMA and Crosslin many providers are frus-
trated. “There is a lot of pushback to any real change because it is costly and disruptive in the short term.” However, he continued, he does think improved delivery and operations will be the result of all the changes occurring now. “It helps everyone … it’s just a painful process to get to that point.” Everyone seems to agree disruption and decreased productivity are going to be a way of life for a period of time whenever the conversion occurs. Baker said provider productivity is anticipated to decrease 10-20 percent due to the significant increase in queries in the ICD-10 documentation and additional time spent with patients … estimated at one to two additional minutes per appointment. Although a few minutes might not seem like a lot of time, when multiplied over a week by every documenting provider, it’s easy to see why patient volume is expected to drop. The good news, Carney said, is there are many ICD-10 resources available and local consultants to help … and now providers have extra time to seek out that help. “We’ll be ready,” Carney confidently stated of her firm’s ability to help practices navigate the learning curve. nashvillemedicalnews
.com
Getting Started with ICD-10 Implementation By JENNY HARVEY
ICD-10 represents a radical change in the way medical coding will be conducted, using nearly five times as many codes as ICD-9. The enhanced specificity of the codes will add greater detail to documentation in the patient record than we currently have with ICD-9, resulting in more precise billing. Symptoms, illnesses, and procedures will have more detailed descriptions, requiring providers to make considerable changes in the way they handle coding and billing processes. Although the deadline has shifted again, all health organizations must get ready to incorporate ICD-10 into their revenue cycle processes, having made all the required technological and workflow updates and provided sufficient training to physicians and administrative staff. ICD-10 implementation projects and plans should have been already well under way. However, multiple surveys show that many organizations have not formulated a plan and begun implementation efforts. Becker’s recently reported that 75 percent of physicians and associated groups have yet to address the transition. Further, it is estimated that coder and physician/provider productivity will decrease by 50 percent initially but rise back to approximately 85 percent after the initial nine-month im-
plementation period. For HIPAA-covered entities, transition to ICD-10 is not an option. Without ICD-10, providers will experience delayed payments or even non-payment; increased rejected, denied or pending claims; reduced cash flows; and, ultimately, lost revenues. Once the deadline arrives, claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. It is important to note, however, that claims for services and inpatient procedures provided before the compliance date must use ICD-9 codes. A smooth transition to ICD-10 requires careful planning. A successful implementation plan should include performing an impact assessment to determine the people, processes, and technologies affected by ICD-10 implementation. It is imperative that you communicate with your vendors, payers, clearinghouses, and billing agency to determine their implementation plans. When communicating with software vendors, you will need to ask if there is a cost involved in upgrading to ICD-10. This would also be a good time to ask if they will allow sending test claims before the go-live date. Communicate with payers, regarding how ICD-10 might affect provider contracts. Due to the increased specificity of the ICD-10 codes, payers might modify the terms of their contracts for billing. Payers
could require coding of illnesses and procedures to the highest level of specificity. They might alter their payment schedules or reimburse differently for higher acuity codes vs. less detailed codes. It is critical to understand your payers’ payment schedules and billing requirements. In addition to reimbursement, the change to a higher level of detail found in ICD-10 codes might affect payers’ medical review, auditing, and coverage determinations. Learning of any changes by your payers early on will be valuable in analyzing how the changes will affect the processing of claims. Identify potential changes to workflow and business processes using information gathered during the impact assessment. Areas where changes to existing processes might be needed include clinical documentation, encounter and pre-authorization forms, quality and infectious disease reporting, claims submission, and orders and referrals. Using the completed impact assessment, evaluate staff training needs by identifying what level of education and subjects are needed for each set of staff members. Different staff within your organization will require different levels of training based on their interaction with the diagnosis codes. Training should focus on learning the ICD10 code set and any workflow changes. Clinical staff will need to learn about ICD10 to understand how their documenta-
tion will affect the ability to code and bill accurately. Coding staff will need the most training to learn how to use the new code set and correctly capture the diagnosis using ICD-10. The final step before going “live” with the ICD-10 codes will be to complete testing with your trading partners by sending ICD-10 codes in test transactions through the channels you use today, such as to the clearinghouses or payers. The implementation plan should include budgeting for time and costs related to ICD-10, including expenses for system changes, resource materials, and training. When budgeting, it is important to take into account that any new process takes time to learn and could result in a slower turn-around time during the revenue cycle. It is recommended that entities take out a line of credit to cover expenses during this learning curve. Jenny Harvey is a coding consultant for Lattimore, Black, Morgan & Cain, PC. (LBMC), which has offices in Nashville, Knoxville and Chattanooga. Harvey’s experience includes implementing education for physicians and other providers, regulatory and payer compliance, fee schedule analysis, and billing review for compliant reimbursement. During her career, she has worked in coding in inpatient and outpatient setting. Harvey’s professional memberships include the American Academy of Professional Coders (AAPC), and the American Health Information Management Association (AHIMA).
Reach Middle Tennessee physicians, hospital administrators and Medical Group Management Association (MGMA) members with Nashville Medical News.
Each monthly issue of Nashville Medical News highlights a Clinical and Business focus. These focus features provide in-depth information on national topics relevant to the ever-changing healthcare sector and the business of healthcare. A local emphasis is often provided to complement the national content.
In addition to the focus features, topics covered on a regular basis include:
MONTH
CLINICAL FOCUS
BUSINESS FOCUS
May
Women’s Health
Health Information Technology
June
Rural Health
Practice Management
July
Pediatrics
Health Exchanges
August
Ortho/Sports Med.
Physician/Hospital Alliance
•
Hospital concerns
•
Practice management issues
September
Oncology
Medicare/Medicaid
•
Legislation affecting healthcare
October
Senior Health
Reimbursement
•
Healthcare law and the regulatory environment
November
Radiology/Imaging
Health Education
•
Newsworthy research developments
December
INCHARGE
nashvillemedicalnews
.com
APRIL 2014
>
7
ROI on Healthcare Workforce Diversity, continued from page 1 of our community.” He naught. Health Science Center and the city’s large added the mayor was “Diversity is the best way medical manufacturers and the recogniinstrumental in helping to make sure that our hospition that research must include different defeat an English-only tals … that all of our facilities populations. proposal in 2009. … are attuned to the needs “Diversity does matter,” Wharton Taking the stage, outside of the hospital,” he said. “Diversity does pay … not merely Dean thanked NOW said. Wharton added that to the fiscal bottom line but to the overall Diversity for keeping in Memphis … and probwelfare of your community. It is an investthe dialogue going. He ably most communities, a sigment well worth taking.” noted the time is right nificant number of hospital Also during the morning, the 2014 to have these converemployees come from neighHealthcare Innovation Awards were sations as Nashville borhoods facing these issues handed out. Tatum Hauck Allsep, founder becomes more diverse. and have valuable input to and executive director of the Music City “In fact,” he said, “by share. “They are in the best Health Alliance Foundation, was prethe year 2020, the maposition to tell the folks inside sented with the Healthcare Employer jority of Nashville’s the hospital exactly what the award. Kennard Brown, JD, MPA, PhD, population … 50.1 real world is like,” he said. FACHE, executive vice chancellor and percent … will be peoWharton also stressed the chief operations officer for the University ple of color. By 2030, critical importance of being of Tennessee Health Science Center, was that number will be 59 able to communicate across named Healthcare Educator. percent, and by 2040, ethnic and religious lines. He Following the breakfast, a panel (L-R) Terrell Smith, event organizer Jacky Akbari, Dr. Vaughn Frigon, Dr. Leslie Wisnerit will be 68 percent.” was quick to add, this doesn’t discussion was held delving deeper into Lynch, and moderator Vicki Yates posed for a picture following a lively panel discussion on He added nearly 12 mean a black patient must healthcare workforce diversity and chaldelivering culturally competent care. percent of the city’s have a black provider or a lenges to delivering culturally competent population was born Muslim patient a Muslim phycare. Moderated by Nashville Newsoutside of the U.S. “As these numbers ilsician, but it does mean providers need to he said it would be nice if society could Channel 5 Anchor Vicki Yates, the panel lustrate, the face of our city is changing be sensitive to cultural and ethnic norms hone in on an individual’s needs at a parincluded Vaughn Frigon, MD, chief medirapidly.” and not view everyone filtered solely ticular point in time without regard to recal officer for TennCare; Leslie WisnerDean remarked that when urban rethrough the lens of their own personal ligion, race, gender, wealth, or any of the Lynch, DDS, DMSc, executive director searcher Richard Florida, PhD, spoke to background or experiences. other characteristics used to make quick of BioTN Foundation; and Terrell Smith, the Nashville Chamber of Commerce last ‘Diversity,” Wharton said, “is a mind assumptions. MSN, RN, director of Patient and Famfall, he cited ‘three Ts’ that are essential to thing.” He added it’s a mistake to count “I applaud you for saying, ‘We’re ily Engagement at Vanderbilt University a city’s success … technology, talent and the number of individuals in any particugoing to step out and lead where othMedical Center. tolerance. Dean pointed to recent media lar group and think of that as diversity. “It ers dare not tread,”” he said of the day’s The summit wrapped up with a coverage touting Nashville as one of the is not a quantitative … it is a qualitative event. “This is something that’s going to luncheon highlighted by comments and country’s hottest cities. However, he said, … matter. I always say, when we view transcend the boundaries of your profesinsights from Andre Churchwell, MD, “If we’re going to continue to build on the it through the prism of numbers, all you sion,” he predicted. associate dean for Diversity Affairs at success our city is experiencing right now, have to do is look at the first four letters Wharton said that like Nashville, Vanderbilt, and luncheon keynote speaker we must continue to be a welcoming city in the word ‘numbers,’ and what does it healthcare is a huge force in the economy Robert Frist, CEO of HealthStream. that opens its doors to anyone and everyspell?” of Memphis, employing approximately Shannon Goff Kukulka, an attorney with one who wants to be here and to be part His final point spoke to the array of 85,000. St. Jude, he said, is an excellent Waller, also presented a summation of her of our growing community.” research happening in Memphis through example of “an institution that transcends white paper, “Workforce Diversity: Driver He added, it isn’t enough to simply St. Jude, the University of Tennessee all lines.” He also applauded the major for Equality of Access to Healthcare.” respect tolerance but said tolerance must hospitals in Memphis that have chosen to be actively promoted. Dean said, “We all stay in the core city when so many other know businesses that embrace diversity businesses and industries moved out, and do better in the marketplace than those he noted the acute care facilities have that don’t.” He noted the strength of the been models when it comes to inclusionhealthcare industry is inextricably linked ary business practices. to the success of Nashville as the city’s “There is so much that our hospitals largest and fastest-growing employer. and healthcare facilities do beyond the Last month, the National Business Group on Health (NBGH), a non-profit “Nashville strengthens the healthtechnical provision of healthcare. They association of nearly 400 large employers, selected Vanderbilt University care industry. The healthcare industry are our anchor institutions in so many as one of six winners of an Innovation in Reducing Health Care Disparities strengthens Nashville. And diversity ways,” Wharton said. Award. strengthens us all,” he summed up. From a clinical standpoint, he noted Taking the podium, keynote speaker the industry has moved to the broader Mary Yarbrough, MD, associate professor of Medicine and executive Memphis Mayor A C Wharton, Jr. talked definition of health as being more than director of Faculty and Staff Health and Wellness, accepted the award at a about the impact healthcare workforce dijust an absence of illness but instead an national NBGH meeting in Washington, D.C. versity has on Memphis. overall state of well-being. “Because of the In a letter announcing the award, NBGH executives noted, “Your “I can think of no better topic to representation of diverse members in our Occupational Health Clinic, Work/Life Employee Assistance Program and bring us together than celebrating diverhealthcare operations, we’re now much Health Plus programs to reduce healthcare disparities within your employee sity,” he opened. “What profession is betmore sensitive to the fact that it takes population should be commended, and we hope that you continue to expand ter positioned to talk about diversity than more than a doctor and some pills and and grow your efforts to address healthcare inequities within Vanderbilt the healthcare profession? When it comes some medicine and an X-ray machine to University’s workforce.” to healthcare, it is a universal need.” bring about health,” Wharton noted. The NBGH noted specific achievements at Vanderbilt, including a nearly Likewise, he said those who deliver He added in many cases the great10 percent increase in flu shots for African-American and Asian populations, a healthcare are in the best position to see est threat to health is environment rather 26 percent decrease in sedentariness in the African-American population, and the world from a universal viewpoint. than a heart attack. Wharton said it didn’t Walking through an Emergency Departmatter how many times healthcare proa 5 percent reduction in smoking for those employees. ment in Memphis recently, Wharton viders patched someone up or got them “Vanderbilt University is blessed with a rich diversity in its workforce,” noted one man had on a three-piece suit, stabilized, if those individuals were reYarbrough said. “The Faculty/Staff Health & Wellness program seeks to another appeared to be homeless, but turned to unhealthy, unsafe neighborengage our community by appreciating the differences inherent among both were cared for based on triage prohoods — plagued by violence, pollution, different ethnic, racial and gender groups. We strive to achieve the same high tocols. “Wouldn’t it be great if our whole absence of fresh food, or other barriers to engagement rates while acknowledging differences.” world could just operate that way every healthy living — then all the hard work day?” he asked. Continuing the analogy, of the healthcare industry really goes for
Vanderbilt Honored for Efforts to Address Health Disparities
8
>
APRIL 2014
nashvillemedicalnews
.com
Delegation Makes Annual Pilgrimage to D.C. By CINDY SANDERS
Members of Leadership Health Care, an initiative of the Nashville Health Care Council, embarked on their 12th annual trek to Washington, D.C. last month to gain insight on implementation of the Affordable Care Act and other pressing national health agenda topics. Nearly 100 of the area’s emerging industry leaders made the trip March 10-11 for two days of meetings with lawmakers, Obama administration officials, key national healthcare association leaders, and Capitol Hill staff members who are actively involved in influencing and implementing health policy. The group heard from a number of speakers regarding insurance exchange enrollment and new models of care and reimbursement. On the first day, Michael Ramlet, founder and editor of “The Morning Consult,” a digital media company, discussed the impact of the exchanges and said data released in the coming weeks would give the industry a better idea of whether or not enrollment will hit the projected goal of 7 million. The last estimates put enrollment at a little more than 4 million. However, Ramlet continued, he thinks a story not being told often or loudly enough is that 20 percent of those enrolled have not paid their premiums … so they actually don’t have coverage. Keynote speaker Dora Hughes, a former White House advisor and CMS official who is now senior policy advisor in the government strategies group of law firm Sidley Austin, said another concern are the more than 5 million who don’t have affordable access to coverage since they don’t qualify for subsidies on the exchanges and live in states, like Tennessee, without Medicaid expansion. A ‘lively’ panel discussion also focused on ACA implementation. Tom Nickels, senior vice president for Federal Relations at the American Hospital Association, said he anticipates it will take three years to get coverage … whether through Medicaid expansion or the exchanges …
Sen. Lamar Alexander and Nashville Health Care Council President Caroline Young pause for a moment during a breakfast event with lawmakers.
(Above) The Leadership Health Care delegation stops for a group shot before embarking on a full day of meetings. (R) Sen. Rand Paul (R-Ky.) shared his views on issues plaguing the healthcare system and alternative ways to address reform measures.
to the desired levels. “So I think judgment ought to be suspended at least until we get to the end of 2016,” he said. A more immediate impact of ACA, however, is expected to be felt by elected officials. Ramlet pointed to a poll that shows independent voters evenly split on which of the major parties they trust more on healthcare issues. He noted what happens in the next few months will be critical at the polls for midterm elections and beyond. John Harris, editor in chief for the non-partisan POLITICO, talked about the current climate in the nation’s capital and the possibilities of the Republican Party regaining control of the Senate. Day two centered on time with elected officials including Sen. Lamar Alexander (R-Tenn.) Corker (R-Tenn.) Rand (R-Ky.) and Cooper (D-Tenn.). After a breakfast reception, Sen. Paul said the healthcare system was broken largely because market
forces had been removed with neither the consumer nor provider actively engaged in thinking or caring about price. He said future generations would bear the brunt of the explosion in costs without meaningful reform. Cooper agreed healthcare spending must be controlled. He noted by 2040, every available tax dollar would have to go to Social Security, Medicare and Medicaid if spending growth isn’t curbed. However, he also said there has been a slowdown in that growth over the last few years for a number of reasons including efforts by the industry to improve quality and efficiency. “We’ve got to make it continue, no matter how painful it is for your individual
company or for the industry,” Cooper told the group. He also challenged those in attendance to make Nashville more of a health policy center and to search for solutions to improve the industry considering the depth and breadth of expertise in Middle Tennessee. “This is not someone else’s problem … this is not another generation’s problem,” Cooper said. “This is why you, who are currently in positions of power and influence in your companies, need to figure this out and need to have business plans that make the problem better.” Before flying out, the LHC delegation also heard from Rahul Rajkumar, MD, JD, FACP, a senior advisor to the director of the Center for Medicare and Medicaid Innovation, regarding some of the 20 payment and delivery model systems being tested across the country. He pointed to the recent decline in healthcare spending as a signal the changes being made “are beginning to bear fruit.” Ted Lomicka, LHC chairman and vice president and assistant treasurer for Community Health Systems, summed up the trip, saying, “The great thing about the delegation is that attendees get direct insight into the healthcare discussions that impact policy decisions in Washington. Delegates can take that information home and apply it to their business strategies.”
Where Have All the CEOs Gone?
1 in 5 Hospitals Saw Turnover at the Top in 2013 By CINDY SANDERS Turnover in the highest-ranking administrative spot for hospitals increased significantly last year, according to a report released March 10 by the American College of Healthcare Executives (ACHE). In 2013, hospital CEO turnover tracked at 20 percent, which is the highest rate recorded since ACHE began keeping up with the statistic more than three decades ago. CEO turnover clocked in at 17 percent in 2012 and at 16 percent the two years prior to that. In the first decade of this century, the rate fluctuated between 14-18 percent, with most years hovering between 14 and 15 percent. In 1981, the first year ACHE
nashvillemedicalnews
.com
published this data, hospitals recorded a 14 percent turnover rate. In 2013, Alaska led the way with a turnover rate of 37 percent. Other states coming in above the national average include Oklahoma, Virginia, Massachusetts and New York. Eight southeastern states, including Tennessee (24
percent), also saw higher-than-average rates. On the opposite end, 16 states plus the District of Columbia were deemed low-turnover states with Vermont and Rhode Island logging zero changes in CEO status last year. “The increase in the turnover rate may be indicative of a combination of factors, including an increased number of baby boomers seeking retirement, the emerging trend toward consolidation in our industry and the complexity and amount of change going on in healthcare today,” said Deborah J. Bowen, FACHE, CAE, president and CEO of ACHE. “The increase in the rate reinforces the need for healthcare leaders to work with their boards to ensure appropriate succession plans are in place.”
APRIL 2014
>
9
Changes & Opportunities in 2014 for Small Employers under ACA By DAVID JOFFE
The Affordable Care Act (ACA) brings about significant healthcare reform changes, as well as opportunities for small employers in 2014. Many of the reforms affect all employers who sponsor group health plans; however, the effect of some of the reforms is limited for smaller employers. Also, small employers will benefit from changes affecting tax credits and new coverage provided through the Small Business Health Options Program. 2014 Reforms For plan years beginning on or after Jan. 1, 2014, certain existing reforms will be enhanced, and new reforms will apply to most plans. Annual limits will be prohibited on essential health benefits; previously, restricted limits were allowed. Waiting periods may not exceed 90 days. Plans may also not discriminate against a healthcare provider acting within the scope of his or her license; however, this provision does not require plans or insurers to contract with “any willing provider” or prohibit varying reimbursement rates. Preexisting condition exclusions will no longer be permitted; this is true regardless of the age of the participant. Non-grandfathered plans will be required to cover costs associated with certain approved clinical trials. Insurance Changes As a related matter, new limitations on premium rate setting will apply for insurers in the small group market (generally, 2 to 50 employees). New guaranteed-availability and guaranteed-renewability rules also apply. ACA provides for an overall limitation on out-of-pocket maximums and deductible limits for non-grandfathered plans. Although these requirements apply to all group health plans, the agencies interpret the deductible limit (in 2014, $2,000 for individuals or $4,000 for other plans) as applying only to plans and insurers in the small group market. With respect to outof-pocket maximums (in 2014, $6,350 for self-only coverage and $12,700 for family coverage), although the requirement applies under ACA to all group health plans, the agencies have added a one-year safe harbor if a plan or insurer utilizes more than one service provider to administer benefits, subject to certain requirements. Tax Credit Since 2010, eligible small employers that offer health insurance coverage to their employees have been entitled to a tax credit of up to 35 percent of the nonelective (employer) contributions they make toward the premium cost (and up to 25 percent for tax-exempt eligible small employers). Some important changes become effective beginning with 2014 taxable years. First, the maximum credit amount increases from 10
>
APRIL 2014
35 percent to 50 percent of premiums paid (and from 25 percent to 35 percent for taxexempt eligible small employers). Second, the coverage must be offered through a SHOP exchange (see below). Third, the credit can be claimed for only two consecutive years beginning on or after 2014. Automatic Enrollment ACA amends the Fair Labor Standards Act to require certain large employers to enroll automatically new full-time employees in one of the employer’s health benefit plans (subject to any waiting period authorized by law) and continue the enrollment of current employees. However, the requirement only applies to employers that have more than 200 full-time employees. Also, the Department of Labor (DOL) has indicated that employers are not required to comply with this requirement until final regulations are issued and applicable. As of March 15, 2014, the DOL had not issued the regulations. Exchanges One of the key features of ACA was the establishment by Jan. 1, 2014, of American Health Benefit Exchanges, which are now sometimes referred to as Marketplaces. The Exchanges perform a variety of functions required by ACA including certifying qualified health plans (QHPs), determining eligibility for enrollments in QHPs and for insurance affordability programs (e.g., advance payment of premium tax credits), and responding to customer requests for assistance. One type of Exchange is the Small Business Health Options Program (SHOP). SHOPs are designed to allow small employers to offer their employees a choice of QHPs. The Department of Health and Human Services has provided for a federally facilitated SHOP in states, like Tennessee, that do not establish a state-based Exchange. Participation in SHOP is strictly voluntary for small employers. Beginning in 2014, however, purchasing employerprovided health coverage for employees through SHOP will be the only way for qualified employers to obtain the small business healthcare tax credit (described above). Although ACA brings about significant changes for 2014 for most employers, small employers are generally less affected and will have some positive opportunities in 2014. David Joffe is a partner with Bradley Arant Boult Cummings, LLP. He practices primarily in the areas of employee benefits, executive compensation and employment law and is chair of the Employee Benefits and Executive Compensation Group. A graduate of the University of Texas School of Law, he is admitted to the bar in Alabama, Tennessee, Texas and the District of Columbia. For more information, go to babc.com.
GrandRounds Middle Tennessee’s Primary Source for Professional Healthcare News
CMS Grants Portion of TennCare Waiver Request
On April 1, after working with state and federal officials, U.S. Senators Bob Corker (R-TN) and Lamar Alexander (R-TN) announced the Centers for Medicare and Medicaid Services (CMS) has granted a portion of TennCare’s waiver request that provides Tennessee an addi- Sen. Bob Corker tional $80 million for the Essential Access Hospital payments in the absence of Tennessee Medicaid disproportionate share hospital (DSH) program funding for this current fiscal year. Tennessee is the only state in the nation that does not have permanent access to the Medicaid DSH program. In January, the entire Tennessee delegation wrote to Marilyn Tavenner, CMS administrator, expressing strong support for TennCare’s waiver request, which expired on Sept. 30, 2013. When TennCare was created through a waiver in 1994, the state agreed to eliminate the Medicaid DSH payment, believing the majority of the uninsured and uninsurable would be covered through TennCare. However, costs began to escalate quickly, and by 2005, the coverage experiment ended. Tennessee hospitals provided more than $700 million in unreimbursed TennCare costs last year. In addition, Tennessee hospitals provided $970 million in charity care and lost an additional $730 million on services provided to Medicare enrollees. The net result was more than $2.4 billion in unreimbursed care. “While this partial waiver is only a temporary fix, I remain committed to working with Senator Alexander to find a permanent solution as soon as possible so Tennessee patients, doctors and hospitals are not faced with this uncertainty each year,” Corker said.
Let’s Give Them Something to Talk About!
Awards, Honors, Recognitions Acadia Healthcare Chairman and CEO Joey Jacobs was revealed as Nashville Post’s CEO of the year last month. In three years, he has helped guide the behavioral health company to new heights and a valuation of more than $2 billion. Joey Jacobs HCA Chief Nursing Officer Jane Englebright, PhD, RN, has been appointed to The Joint Commission Board of Commissioners as the at-large nursing representative. Englebright also serves Dr. Jane Englebright as patient safety officer and vice president for the Clinical Services Group at HCA. As the company’s CNO, she represents 80,000 nurses working in 165 HCA-affiliated hospitals and 115 ambulatory surgery centers across the United States and in London. For the 14th time, Vanderbilt Uni(continued on page 11)
PUBLISHED BY: SouthComm, Inc. MARKET PUBLISHER Tori Hughes thughes@southcomm.com 615.844.9410 SALES 615.844.9237 Kelley Apoldo, 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 Jenny Harvey, Melanie Kilgore-Hill, Lynne Jeter, David Joffe, Kelly Price, Cindy Sanders ACCOUNTANT Kim Stangenberg kstangenberg@southcomm.com 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. ©2013 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 versity Medical Center has been recognized by Truven Health Analytics as one of the nation’s “100 Top Hospitals” based on performance across 10 areas ranging from inpatient complications, patient safety and patient satisfaction to readmission rates, adherence to clinical standards and mortality. Vanderbilt University Medical School also received accolades during the annual rankings of “Best Medical Schools.” Vanderbilt ranked #15 for research and #29 for primary care and internal medicine. Additionally, Vanderbilt ranked 17th in the publication’s doctornamed “America’s Top Residency Programs” for internal medicine. Juanita Turnipseed, a certified nurse anesthetist (CRNA) for Anesthesia Medical Group (AMG), a PhyMed Healthcare Group Company has been named to the Tennessee Board of Nursing, representing the Juanita 5th Congressional District. Turnipseed Lattimore Black Morgan & Cain, PC was ranked 44th among the top 100 accounting, tax and consulting firms in the United States by . The firm moved up three slots from last year in the rankings, which are based on the annual revenue size. Hospital Corporation of America, a leading healthcare provider with 164 hospitals and 115 ambulatory surgery centers in 20 states and London, England, has been named one of the Ethisphere Institute’s 2014 World’s Most Ethical Companies. Amy Hobdy, Christopher Thompson, MD, and volunteer Gloria Mayfield were honored with TriStar StoneCrest Medical Center’s 2013 Frist Humanitarian Award last month. The Frist Humanitarian Awards recognize an employee, physician and volunteer at each HCA-affiliated facility who demonstrate extraordinary concern for the welfare and happiness of patients and their community. Cindy Harper, CPA, a tax partner with LBMC was recently honored in the Community Supporter category of the “Women of Influence” annual honor. Harper is the leader of LBMC’s Wealth Management SegCindy Harper ment.
Tennessee Charitable Care Network Launches
Charitable healthcare clinics in Tennessee have united to form Tennessee Charitable Care Network (TCCN). The mission of TCCN is to provide support, education, and representation for nonprofit organizations that provide charitable healthcare services to low-income, uninsured and underserved Tennesseans. Efforts will be focused on providing funding, education, training, and technical assistance for the member organizations. Laura Hobson of Faith Family Medical Center has been named TCCN board chair of the organized network of more than 50 charitable clinics across the state. nashvillemedicalnews
.com
Wishes Granted
Vanderbilt University has been awarded a Cooperative Agreement with the Defense Advanced Research Projects Agency (DARPA) and the Army Research Office (ARO) that is worth up to $16.5 million over five years. As part of the Rapid Threat Assessment program, Vanderbilt University will seek to develop mass spectrometry methods for quickly determining how potentially toxic agents, including drugs, affect human cells. Centerstone has received a $200,000 grant from the BlueCross BlueShield of Tennessee Health Foundation to expand the organization’s crisis services by providing essential outreach to individuals at risk for suicide. The funding will help support Centerstone’s Crisis Services HighRisk Follow-Up Project, which improves access to critical treatments, resources and support for those contemplating taking their own lives. The March of Dimes Tennessee Chapter has awarded five grants across the state to address unmet maternal and child health needs. In Nashville, Lipscomb University School of Nursing received funding for their Teen Champions Program.
Recent Certifications, Accreditations & Commendations
Tennessee Maternal Fetal Medicine, PLC recently was awarded ultrasound practice accreditation in the areas of Fetal Echocardiography and Obstetric Ultrasound by the American Institute of Ultrasound in Medicine, making TMFM the only maternal fetal medicine practice with this accreditation in Middle Tennessee. International well-being improvement company Healthways is among the first in the nation to receive National Committee for Quality Assurance (NCQA) accreditation under a new program for complex case management. In addition, NCQA has reviewed and certified Healthways’ Utilization Management functions. Life Care Center of Hickory Woods in Antioch was recently named a Rehab Center of Excellence by parent company Life Care Centers of America for its orthopedic rehabilitation specialty program. Each Life Care center undergoes an annual 111-point audit.
MissionPoint Opens Aegis Clinic MissionPoint Health Partners recently announced a partnership with Aegis Sciences Corporation to provide Aegis employees and their dependents with convenient access to care through an onsite MissionPoint Connect healthcare clinic. The clinic at Aegis’s Metro Center location is available to provide care to more than 450 Nashville-based Aegis employees and their dependents, with plans to extend services to additional employers in the future. “We are pleased to enter into this partnership with Aegis Sciences Corpora-
tion,” said Allison Foulds, MissionPoint’s vice president of Client Services, adding the hope is this will be the beginning of many partnerships with local employers.
TriStar Centennial Announces New Execs TriStar Centennial Medical Center recently announced Cyndi Stroburg, RN, has been appointed chief nursing officer. Previously CNO at TriStar StoneCrest, Stroburg completed her nursing education at the University of Missouri and earned her master’s in Cyndi Stroburg Nursing from Walden University. Additionally, Andrea Gwyn has been named associate chief operating officer. Part of HCA’s COO development program, Gwyn previously served as a performance improvement manager at HCA corporate and oversaw surgical, diagnostic and Andrea Gwyn ancillary support department workgroups. She received a degree in Business Administration at the University of Richmond and a master’s degree in Health Administration from Virginia Commonwealth University.
United Community Bank Names Seeley SVP, Healthcare Relationship Manager Last month, United Community Bank announced the addition of Dwight Seeley as senior vice president, healthcare relationship manager in Nashville. Seeley has more than 20 years of finance experience and has held various senior financial roles in the Dwight Seeley healthcare industry for 19 years. He spent the past eight years as director of cash management at Community Health Systems. Seeley received his accounting degree from Bob Jones University in Greenville, S.C.
Novak Joins LBMC Tax Services Team Jonathan Novak, CPA has joined Lattimore Black Morgan & Cain, PC (LBMC) as a tax accountant in the tax services division. He comes to LBMC from Kraft CPA’s where he served as a staff accountant in Litigation Support and Forensic Accounting. Novak earned his undergrad degree from the University of Tennessee, Knoxville and his master’s from MTSU.
Chollet Joins TriStar StoneCrest Casey Chollet, MD, recently joined the medical staff at TriStar StoneCrest. The board-certified radiation oncologist will provide full-time radiation oncology care for patients on campus through Sarah Cannon, the hospital’s cancer center. Dr. Casey She earned her mediChollet cal degree from University of Tennessee, College of Medicine in Memphis, and completed her residency in radiation oncology at Loyola University Medical Center in Chicago. She most recently served as the medical director for radiation oncology at Maria Parham Medical Center in Henderson, N.C., and as an assistant professor in radiation oncology with Duke University Medical Center.
Riggins Named Bridge2Life Director DCI Donor Services, Inc. (DCIDS) recently announced the promotion of Reva Riggins to director of Bridge2Life for DCIDS. Bridge2Life is a call center facilitating the recovery of organ and tissue donations. In her new role, Riggins will provide leadership in developing key strategies to ensure customer service and satisfaction in the call center environment, which supports the entire company. Previously, Riggins worked with Tennessee Donor Services (TDS), also a part of the DCI Donor Services family of organizations, where she served in the role of hospital services coordinator in Memphis.
Creekside Reopens after $2 Million Renovation Creekside Health and Rehabilitation Center, now a Grace Healthcare-managed facility, recently celebrated a grand reopening after completing $2 million in renovations. Located in the Madison area, the light-filled facility provides skilled nursing care, rehabilitation and respite care and features 59 private rooms and 84 semi-private rooms, a remodeled dining area and 24-hour menu, onsite beauty shop, garden areas and new furniture, among other amenities. APRIL 2014
>
11
What is really going on in health care? And how is it impacting consumers and businesses in Middle Tennessee? The June issue of Nashville Post will tackle these macro subjects and delve in to some of the following topics all with a local angle: • The changing landscape of health care and alliances it is creating • How hospitals have and will continue to evolve • The maturation of accountable care organizations (ACO’s) • How a consumer driven marketplace will alter the rules • New technologies for patients and providers
AD CLOSE: MAY 2ND MATERIALS DUE: MAY 9TH IN MARKET: JUNE FOR DETAILS AND PRICING, PLEASE CONTACT YOUR ACCOUNT EXECUTIVE OR TORI HUGHES AT THUGHES@NASHVILLEPOST.COM OR 615.844.9410.
Middle Tennessee’s Primary Source for Professional Healthcare News
20
Women 14 T O WAT C H
Join Nashville Medical News for the 2014 Women to Watch Breakfast and celebrate ten women who have made great strides in healthcare, clinical or administrative sectors. Meet and congratulate these exceptional honorees who will be profiled in the April edition of the paper. Sponsored By:
Wednesday, April 30 7:30 - 9:00 AM Noah Liff Opera Center
Register online:
NashvilleMedicalNews.com $450 for a table of 10 | $45 for individual tickets