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PHYSICIAN SPOTLIGHT PAGE 3
Katherine E. Hartmann, MD, PhD
ON ROUNDS New Smoking Alternatives Present Challenges for Health Officials e-Cigs, Hookah Particularly Attractive to Teens While overall tobacco use among middle school and high school students declined slightly between 2011 and 2012 in the United States, the percentage of adolescents using e-cigarettes nearly doubled during that same time period according to data from the 2012 National Youth Tobacco Survey ... 9
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Health Assessment
Tennessee Department of Health 2013 Review, 2014 Preview By CINDy SANDERS
For the past several years, the state has been slowly but steadily moving the needle on the health status of Tennesseans. While still far from where the leadership of the Tennessee Department of Health would like to be, there is a conviction that programming and partnerships truly are making a real difference in real lives all across the state. David Reagan, MD, PhD, chief medical officer for the Tennessee Department of Health, recently spoke with Medical News to reflect on 2013 efforts and discuss focal points for the coming year.
Compounded Medications
The fungal meningitis outbreak, identified in the fall of 2012, continued to play out in 2013 in a number of ways. In assessing response to the discovery of the tainted batches of the preservative-free steroid injections, Reagan noted, “It took eight days from the first report of a case to the Tennessee Department of Health to the national recall of the three lots of contaminated medication — methylprednisolone acetate — nationwide.” The quick reaction, he continued, “prevented, we estimate, 368 exposures … 368 patients in (CONTINUED ON PAGE 8)
2014 Council Fellows Named Nashville Health Care Council, Sen. Frist Announce New Class
WMC Breaks Ground on Children’s Hospital Just before Thanksgiving, Williamson Medical Center executives officially broke ground and unveiled renderings of the $65 million expansion project ... 11
ONLINE: NASHVILLE MEDICAL NEWS.COM
Last month, the Nashville Health Care Council and former U.S. Senate Majority Leader Bill Frist, MD, announced the 2014 class of the Council Fellows program. Conducted in cooperation with Vanderbilt University’s Owen Graduate School of Management, the 32 senior healthcare leaders in this year’s class will engage in an intensive, interactive curriculum focused on transforming the nation’s healthcare system and those who lead it. The Fellows initiative, which graduated its inaugural class last summer, engages industry leaders in clearly defining healthcare’s greatest challenges and exploring new strategies to meet issues facing the U.S. healthcare system. This year’s class will engage in eight daylong sessions, held between January and June, that leverage the expertise of the industry’s founding experts in Nashville, as well as nationally-known figures and leading academic institutions. The integrated curriculum includes topics ranging from healthcare policy reform, population health management and shifts in reimbursement systems to disruptive innovation in technology, advances in personalized medicine and use of healthcare analytics. Personalized leadership training and a unique immersion component are also hallmarks of the specially-designed curriculum. (CONTINUED ON PAGE 12)
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PhysicianSpotlight
Never too Busy to be Fit Katherine E. Hartmann, MD, PhD By KELLY PRICE
Time is always an issue for Katherine Hartmann, MD, PhD — any that is available, she tries to fill with something positive. Hartmann describes herself as a wife, mother of four, die-hard researcher, teacher and mentor, blogger, and … by her own definition … a fitness freak. Her day job, make that jobs, include serving as associate dean for Clinical and Translational Scientist Development and professor of Obstetrics and Gynecology for Vanderbilt University Medical Center, as well as deputy director of Vanderbilt’s Institute for Medicine and Public Health where she oversees production of the biennial Women’s Health Report Card. Hartmann is also an adjunct professor of Obstetrics and Gynecology at Meharry Medical College. Growing up in south Florida, her introduction to medicine, as is often the case, first came as a patient. “I remember thinking how amazing it was how they can put people back together,” she recalled. “I said to myself, ‘I think I can do that.’” She earned her undergraduate degree from Johns Hopkins University’s prestigious Writing Seminars department and then went on to earn a master’s in the same field. Naturally, her college friends thought of her as a writer. She recalled they assumed it was a “gag” when the list was published of acceptances to the medical school. After earning her medical degree from Johns Hopkins, she served as OB/GYN administrative chief resident at the University of North Carolina School of Medicine where she also completed her doctorate in epidemiology and served as a Robert Wood Johnson Clinical Scholar. Hartmann’s undergraduate experience made her conscious and thoughtful about why and how people write. Although her friends might not have seen the immediate connection, it is an integral part of her medical career. “We write to explain, convince … write to best convey ideas and to clear a way for others,” she said. “Vanderbilt invests a lot in early career interests and encourages students to pursue excellence, as well as create a bridge between what is learned in research and how to make it applicable to human health so writing is always involved. I still consider myself a writer.” Hartmann has mentored hundreds of students and currently has more than 20 students she advises and consults with regularly. With her emphasis on developing translational scientists, she noted, “It is such fun to sit in a studio group with the nashvillemedicalnews
students to determine and confirm how we should go the next mile.” Hartmann added science is only as effective as the ability to translate an idea from discovery to an applicable tools. “We are constantly pushing to take the process from discovery to practice.” Her students work to move their research from bench to bedside. “This is what we all thought we were going into when we went into ‘practice,’” she observed. Since 1999, Hartmann has been a senior investigator with Right from the Start (RFTS) and is now primary investigator of the cluster of RFTS grants, which examine risks for adverse pregnancy outcomes such as miscarriage, spontaneous preterm birth, and growth restriction. In this cohort, exposures addressed have ranged from caffeine and prenatal vitamin use to chlorinating by-products in water and environmental xenoestrogens like phthalates. A wealth of data is now available with information continuing to be added. Hartmann and RFTS investigators plan to expand the research into areas of maternal and infant genetic markers and nutrition that includes moving into research observation of early childhood development and health status. This cohort could provide a new vehicle to discover subtle influences on brain and neurological development and identify potential targets for preventive interventions that would lower the risk of prematurity and resulting disabilities.
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With her background, it was natural for Hartmann to spearhead the biennial Tennessee Women’s Health Report Card. That work actually led to a big transition in her own life. “A couple of years ago, I was looking at the report and realized how I was unfit, overweight, and teetering on developing diabetes,” she said. “I knew that I had to do something about my own health.” And she did … that personal discovery launched a new phase in her life as a ‘fitness freak.’ “It was all stuff I knew intellectually, but had been ignoring in my lifestyle so I signed up for a fitness boot camp and changed my life,” she said. “It didn’t enter
my mind that it would be so much fun, but it really has been,” Hartmann enthused. “I started getting stronger — crazy strong — and I loved it.” In addition to her teaching, lab work, writing, and family life, she started training as much as possible, lost 35 pounds, and became part of the ‘Fitocracy.’ “I was fascinated by interval training — cycling, swimming, running, rock climbing, and, as part of the routine, I took up kettlebell, an obscure Scandinavian weight lifting sport. I went to Berkeley for training, and began to compete in the sport.” Hartmann continued, “I was beating women half my age, and last year I became the world champion in my division. I’m going to Portugal this year to defend my title. “When I began, I was out of shape. I couldn’t run a mile. Now I am a certified strength coach and help people design their fitness programs,” she said. Hartmann added that she didn’t expect getting fit to be so much fun. She also didn’t realize in the beginning that exercising her body would also give her mind a workout. “It turns out that this is a great way to get problems solved,” she said. “Evidence shows that exercise improves problemsolving skills, improves sleep and general well-being.” Hartmann puts her undergraduate training to good use in her blog (realfitmd. com). “I’ve been writing about what the evidence actually says about fitness and health,” she explained. Hartmann also logs workouts and participates in the Fitocracy motivational community (fitocracy.com) under the handle 2bcrzyft. Doesn’t seem crazy at all.
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HealthcareEnterprise
Corporate Health Partners Reshaping Workplace Wellness By MELANIE KILGORE-HILL
Since 2002, Corporate Health Partners has been reshaping employee wellness programs throughout the Southeast. With offices in Nashville and Atlanta, CHP’s 60 employees work to reduce health risks among participants while improving the bottom line for employers. Rethinking Employee Health “Just like safety policies are often the first thing you look at when you step onto a worksite, corporate wellness requires the same strategy,” said Jeremy Curtis, vice president and partner at CHP. “Employers should be asking themselves, ‘Is what we’re doing as a Jeremy Curtis company helping or hurting our health?’” While corporate health programs are nothing new, CHP’s hands-on wellness model goes far beyond blood tests and body mass index. Healthcare veteran Jack Curtis founded CHP more than a decade ago after seeing the lack of
follow-up care offered to overworked C-suite execs following standard executive medical exams. CHP, which merged with Community Health Network in 2013, services numerous industries and municipalities. With a lengthy client list now expanding beyond the Southeast, CHP has quickly emerged as a major player in workplace wellness – a $6 billion industry with some 500 players nationwide, a recent Reuters survey reports. “Every wellness company tells you what the problem is,” Jeremy Curtis said. “Once we know a person’s health status, we work to make a difference in their lives throughout the year.” Put Me In, Coach! CHP’s clients are typically mid-tolarge, progressive-minded companies that understand the long-term impact of a healthier workplace. Enrolled participants undergo biometric screenings and
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health risk assessments to identify potential problems. CHP then issues results including a wellness score ranging from one to 100 and assigns each participant a personal health coach who provides private coaching sessions – frequently for highrisk employees and less often for healthy individuals. CHP’s coaching team, comprised of trained dieticians and nutritionists, meet one-on-one with employees to discuss the daily challenges of creating healthier lifestyles, from ordering off menus to shopping smarter at the grocery store. They also work with employers to foster a healthier culture in the workplace. “Our coaches are very preventative minded and committed to changing behaviors,” Curtis said. “We focus a lot on improving workplace culture and policy since they work 24/7. We ask, ‘What is the culture of your company, and what sort of environment are you creating?’” CHP coaches take a multi-faceted approach to improving workplace culture. It’s not uncommon for coaches to help create stricter smoking guidelines, evaluate vending machine choices, facilitate wellness competitions, charter wellness teams, and organize education classes and community health events. Flexible Services CHP offers flexible, a la carte services to companies of all sizes, although their popular ROOTS program offers the most comprehensive, scalable and customizable wellness plan. And while some clients opt for participation-based programs (only requiring participants to undergo screenings), Curtis said many opt for outcomebased programs that offer rewards, like lower insurance premiums, to employees who reach personal goals. CHP also offers an ExecTrack Program to help busy administrators live healthier lives. Wellness and the Bottom Line While corporate wellness plans come with a cost (CHP’s range from $18-40 per enrollee per month), Curtis said forwardthinking companies understand the value a strong wellness program has on the bottom line. Still, he said, many companies make the mistake of trying to gauge return on investments based solely on health claims.
Whether teaching easy onsite exercises or smart shopping strategies, CHP strives to help employees adopt healthier lifestyles at work and home.
“Everybody asks me the ROI on a wellness program, and I ask them what the ROI is on offering health insurance benefits. They usually don’t know,” Curtis said. “Reactive companies only know the health of an organization based on the number of claims coming in. If it’s up 10 percent, they think people must be getting unhealthier, which may or may not be true. What we try to do is help an organization understand how at-risk their population is way before the claims process. It’s a very upstream approach.” Successful Wellness Programs 101 Creating excitement around a corporate wellness program means full participation and effective communication from the top down. Helping employees understand this is a service being done for them … not to them … changes their outlook and increases participation, Curtis said. Younger employees are more likely to see wellness plans as an added employment incentive, like medical insurance or 401Ks. Employees also should understand privacy is protected throughout the process and that employers will never see personal health reports. Offering wellness plans to everyone associated with the organization, from spouses to part-time or uninsured employees, also promotes buy-in. “Everyone affects the health of an organization,” Curtis said. “Wellness is a business strategy, not an ancillary program. It’s a way of looking at personnel in a different way. We want employers to understand this isn’t just about cost control, but about helping everyone have a high quality of life. If we help them lower a few risks, that ripple effect goes through the company and into homes where families start to make a change, and that ripples into communities and schools. You multiply those small changes, and there are so many benefits to corporate wellness.” nashvillemedicalnews
.com
Local Experts Weigh in with Timely Tax Advice By CINDY SANDERS
The taxman cometh. While you might not be able to stop the inevitable progression to tax day, at least you can take heart in knowing Nashville has a cadre of highly capable accountants and financial professionals with expertise in the healthcare industry to help minimize your personal or corporate tax liability. Following are a few tips to keep in mind whether preparing for your personal return or looking at business tax burden.
Timing is Important – Get Organized Early
Jan Kolb, CPA Partner Fox, Kolb & Associates, PLLC Most CPAs are exhausted by March 15 and simply do not have the energy they did just a few months before. You are going to get much better service if you get your information to your CPA in January or February when he or she is still at their prime. It is like the difference between writing an essay with a sharpened pencil or a worn out pencil stub. The result will be prettier and much more efficient.
Separating Business from Pleasure
Mark Patterson, CPA Member KraftCPAs PLLC Instead of using old-fashioned paper mileage logs, anyone who needs to keep track of miles driven in a personal automobile should try apps on your smartphone like TripLog or Trip Cubby. Some apps will actually coordinate with a GPS, helping to make record keeping more automatic. Instead of trying to file and save all of your business receipts, try using a small scanner to quickly scan your receipts. Many will offer direct upload to a cloud-based storage solution. When it comes time to file your return, all of your records are in one convenient, digital location. It is best to keep your business and personal finances separate. If you ever have an IRS audit of your business … if they become aware that you were paying personal expenses out of your business account, even if you have accounted for them correctly … it could lead them to dig deeper than they normally would to potentially find personal expenses that were actually deducted.
practice’s form of business and identify the nature of the goodwill that will be transferred to a buyer. It is prudent to get prepared at the start: determine what you have to sell, how best to sell it, and most importantly what will be the net-to-the-pocket value to the physician. After all, it is the net – not the gross – that matters.
And Along Those Same Lines … Corporate Transactions: Stock vs. Assets
Jayme Parmakian, CPA Manager, Tax Services Lattimore Black Morgan & Cain, PC In today’s business environment we are seeing a meaningful increase in transaction volume. If you are the seller in the transaction, here are some key tips to keep in mind. It is generally beneficial to sell the stock of a corporation versus its assets. The highest federal tax rate for long-term capital gains is 23.8 percent (this includes the new 3.8 percent net investment tax). If you were to sell the assets of your corporation, some of the gain would likely be taxed at the highest federal ordinary rate of 43.4 percent (this includes the new 3.8 percent net investment tax) If you sell the stock of your S Corporation and the buyer wants you to make a Section 338(h)(10) election, you need to make sure the acquisition agreement states the buyer will gross-up the sales price to cover the additional tax owed due to making the election. It is going to be the seller’s responsibility to determine and provide support for the step-up. If you sell the assets of your company, you and the buyer should contractually agree to a purchase price allocation. The allocation of the purchase price between the assets will determine the amount of any gain that will be taxed at ordinary rates versus capital gain rates. The important thing to remember is that there are different benefits to the buyer and seller depending on how a transaction is structured. It is likely that if something benefits the buyer, it may increase the tax liability of the seller. So, make sure that you always consult a competent tax advisor while negotiating your business deal.
Your Unique Situation
There are many variables that impact your tax position. Please contact an accountant to discuss your tax burden for 2013 and to plan ahead for the coming year.
Before Consolidating, Know Your Net
Mike Collins, CPA CEO & Managing Member 2nd Generation Capital, LLC Consolidation is in vogue for medical practices of all types. An outright sale of a practice is often seen as a way for physicians to realize some of the value they have built and to transition into a larger organization that can better navigate the changing healthcare landscape. At first glance, what a physician sees as a highly desirable transaction value can quickly turn to seller’s remorse when the after-tax, net-to-the-pocket number becomes a reality Physician practices operate in many business forms (S-Corps, C-Corps, LLC, PLLC, or GP’s). The most valuable asset a physician practice has to sell is the goodwill related in some manner to physician services. Goodwill can be attributable to the business (a business asset), to the individual physician (a personal asset), or to a mixture of each. The form of doing business and the nature of the goodwill, and the type of sale transaction (asset vs. stock) are all factors that influence how the proceeds will be taxed. The answers are highly technical and nuanced. The result however is real money. The outcome could be very advantageous capital gains treatment; the much less desirable ordinary tax rate treatment; or the worst of all cases, two levels of tax where the gain is taxed at both the business and individual level. Too many practices only find out the consequences in the last stages of a deal. By that time, expectations have been built and deal expenses have been incurred. Before practice physicians consider a possible sale as a strategic option, they need to prepare. A professional team of lawyers, accountants, and investment bankers should carefully review the
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Changes to Tax Code Impact the Bottom Line at Work and Home By CINDY SANDERS
As the clock ran down on 2013, a number of deductions healthcare providers have come to depended upon to lessen their tax burden expired. Last year also saw an increase in federal tax rates, including higher taxes on investment income and capital gains. This combination has accountants nationwide bracing for a widespread outbreak of severe sticker shock come April 15. Tom McGuinness, CPA, CVA, of Reimer, McGuinness & Associates, PC in Houston said his firm has run tax scenarios for high net worth individuals for more than a year. “We’re doing this as a service to prepare you for the blow … but the blow is coming,” he stated. For Tom one client whose income McGuinness hit the $2 million mark, there was a six-figure difference in taxes owed. “Looking at 2012 actual income data, the tax differential was 22 percent,” McGuinness said of the $860,000 that would be owed for 2013 as compared to $706,000 for 2012. “It is real money.” He added that many of the changes in 2013 and 2014 will hit healthcare professionals and providers both as businesses and as individuals. McGuinness said at the beginning of 2013, Congress was upset about the fiscal cliff and proud of themselves for ‘fixing’ it. However, he continued, as 2013 tax bills come due, “It’s going to be the taxpayers turn to be mad because they are going to see how the fiscal cliff was avoided.”
Key Business Changes
Beneficial depreciation options take
a big hit in 2014. Changes to expensing qualified purchases, bonus depreciation, qualified leasehold improvements and a new IRS capitalization policy are all anticipated to impact many in the healthcare space. “Congress did not extend the favorable 179 deduction, which allows a taxpayer to expense immediately the cost of an otherwise capitalizable asset,” said Scott Tomichek, JD, CPA, senior tax manager for Carter Lankford CPAs PC, located in Nashville. “The 2013 Section 179 deduction was $500,000 Scott for purchases up to $2 Tomichek million and is set to be reduced to $25,000 for purchases up to $200,000 in 2014.” Accelerated depreciation, which has been heavily used by healthcare providers and facilities to make equipment purchases more affordable on the front end was another incentive that expired at the end of 2013. Tomichek noted that on the purchase of capitalizable assets in 2013, a taxpayer was allowed to deduct 50 percent of that asset in the year of purchase and then depreciate the remainder. The accelerated 50 percent goes away in 2014 and reverts to the regular rules of a more even-based depreciation schedule without Congressional intervention. Another change is in the life of qualified leasehold improvements, which are defined as any improvement to an interior part of a building that is nonresidential property. “Qualified leasehold improvements were able to be depreciated using a 15-year life and included in the previous Section 179 and bonus depreciation calculation in 2013,” Tomichek explained.
In 2014, those improvements return to a 39-year depreciable life, which means the expenditures are depreciated at a much smaller annual amount over nearly four decades and no longer qualify for the other depreciation benefits. Tomichek said the new IRS capitalization policy that went into effect on Jan. 1 is a bit of ying to the yang of losing the other deductions. “The most important part of the rule is the de minimis safe harbors that apply to not only improvements but to certain tangible property purchased,” he said. “The de minimis safe harbor allows a taxpayer to deduct purchases under a certain threshold. For taxpayers with audited financial statements, the threshold is $5,000 per invoice or per item as substantiated by invoice. For those without audited financial statements, the threshold is $500.” He noted that previously, these qualified items had to be depreciated but now can be expensed, which is a tax benefit. However, he added, “To qualify, the taxpayer must have a written accounting policy in place at the beginning of the tax year.” Doug Funke, CPA, a partner with Honkamp Kroeger & Co. PC, a Midwest regional CPA firm headquartered in Iowa, noted a number of other general 2014 tax changes could impact medical practices and hospitals. One example is the transit benefit allowance. Doug Funke “The amount of transit fringe benefits that employers can provide to employees on a pre-tax basis for using public transportation and van pooling will drop from $245 per month in 2013 to $130 per month for 2014.” He said dozens of other extenders, or
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tax incentives, including the work opportunity tax credit for hiring targeted individuals and the research tax credit, as well as various energy credits, expired at the end of 2013. A list of expired provisions is available through the Joint Commission on Taxation at www.jct.gov. For exempt organizations, which includes many hospitals, Funke said the IRS is focusing on compliance, using information reported on Form 990. “Indicators of potential noncompliance that they have identified include the following relationships: • Large fundraising revenues and small fundraising expenses, • Large fundraising revenues and small charitable program services expense, • Large unrelated business income but no income taxes due on the unrelated business income, • Large total compensation to officers, directors, trustees and key employees and small annual gross receipts.” Funke added, “An accurate Form 990 generally decreases the likelihood of being selected for examination.” Also pertaining to some employers, Funke said, “The June 2013 U.S. Supreme Court decision related to the Defense of Marriage Act recognizing same-sex marriages affects employers in states where same sex marriage is recognized. Employer-provided healthcare coverage for same-sex spouses get the same tax-favored treatment.” He added the IRS announced two special administrative procedures for employers to make claims of refunds or adjustments to employment taxes for certain benefits paid to same-sex spouses during 2013.
This Time It’s Personal
Much has been written about the higher tax brackets and rates, but McGuinness said a lot of people will still be surprised at the cumulative effect. “The top tax rate went from 35 to 39.6 percent and that happens starting at $450,000 married filing jointly or $400,000 for single filers,” he explained. However, McGuinness continued, that’s just one of six tax changes that will impact high income taxpayers. A 5 percent increase (from 15 percent to 20 percent) in capital gains and dividends tax has also been instituted for those at the same income levels as the highest tax bracket. For individuals starting at $200,000 and married filing jointly at $250,000, the Affordable Care Act added a 0.9 percent additional FICA tax on wages and a 3.8 percent Medicare tax on investment income. “The rules regarding the 3.8 percent investment income are more complicated than you might think,” he explained in a recent blog for physicians. “You do not include income from S Corporations or (CONTINUED ON PAGE 12)
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Obesity: The New Chronic Disease? Updated Guidelines Encourage PCPs to Focus on Obesity By LYNNE JETER
The new obesity guidelines – updated for the first time in 15 years – are geared to primary care providers (PCPs) and offer an algorithm for managing obesity. The protocol for the management of overweight and obese adults is among four updated guidelines commissioned by the National Heart Lung and Blood Institute, and developed by the American Heart Association and the American College of Cardiology to identify at-risk patients and prescribe appropriate interventions. The timing coincides with the American Medical Association’s recent classification of obesity as a “disease.” To guide weight management decision-making, an algorithm focuses on the identification of patients with excess body weight and those at risk for obesityrelated health problems. Most information is straightforward: Patients with a BMI of 30 or higher are considered obese and need treatment. Patients with a BMI 25 to 30 are considered overweight and should be treated if they have additional risk factors, such as an elevated waist circumference of 35 inches or more for women, or 40 inches or more for men. However, even though research
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soundly shows the higher the BMI, the greater the risk for cardiovascular disease, diabetes, and cancer, the question about the use of BMI as a screening tool has drawn debate. Healthcare providers agree that every 5 to 10 percent of total body weight lost is a milestone that reaps health benefits. But with so many diet programs available – the guideline committee reviewed 17 different plans and concurred that as long as there’s a negative energy flow, and the intake of calories is reduced daily to 1,000 or less, it should work – determining the right one, and the amount of weight that’s safe to lose over the course of weeks and months, has also been the center of controversy. The diet, guidelines say, should be a component of a comprehensive lifestyle intervention including physical activity and behavioral changes, delivered by a trained counselor. The guidelines suggest that patients meet with the interventionist 14 times in the first 6-month period. Donna Ryan, MD, co-chair of the guideline committee and a professor emeritus at Pennington Biomedical Research Center in Louisiana, admitted the current approach is for PCPs to simply tell patients to lose weight but “they don’t really engage in helping patients achieve
weight loss, either through referral or providing counseling or prescribing. They’ve been reluctant … but that’s changing.” What’s not addressed: the reason why some patients make adjustments to lead a healthier lifestyle, but still cannot successfully reach a more optimal weight for their body frame. “It’s not as simple as telling a patient, ‘you need to lose weight,’” said Gus Vickery, MD, a North Carolina family medicine physician. “Sometimes, it takes some investigating to determine the source. It might be thyroid issues, or a combination of medical problems. Unfortunately, we (PCPs) stay so busy … it’s helpful when patients come prepared. It’s OK for a patient to say, ‘I can’t lose weight and I don’t know why. It doesn’t always seem to be a matter of willpower.’” After Vickery talked to a colleague about the colleague’s doctor-supervised weight loss clinic focusing on a wellrounded, low-calorie, low-carbohydrate food plan, he ditched his own in-house program and began referring patients there. One couple, patients of Vickery, lost a combined 140 pounds in less than a year. Other patients returned to Vickery tens of pounds thinner – and much healthier. “My colleague,” said Vickery, “does
the heavy lifting; I monitor the results.” The impetus for the proactive movement of PCPs may be practice for the future, when they may be accountable for patients who haven’t made sincere efforts to lose weight to get healthier. Patients could eventually be penalized by insurers for not taking documented action to achieve a healthier weight. “I could see (insurers) really increasing people’s premiums if they don’t follow certain preventive measures in the future,” said urologist Stan Sujka, MD, a partner of Orlando Urology Associates in Central Florida. “Unfortunately, we’re becoming a society of regulations. A lot of people don’t seem to want take personal re- Dr. Stan Sujka sponsibility for their wellbeing.” Recently, to set an example for patients and to improve his health, Sujka dropped 36 pounds in nine months with the assistance of a diet app on his smart phone, a practice he encourages patients to follow as a first course of action for losing excess weight. “Your smart phone can serve as your (CONTINUED ON PAGE 12)
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Health Assessment, continued from page 1 Tennessee who did not receive contaminated steroids. We believe it probably prevented 69 deaths.” Unfortunately, 750 individuals nationwide, including 150 in Tennessee with 16 deaths, were impacted before the lots were pulled from the New England Compounding Center. To try to prevent a future tragedy, Reagan said a number of steps have been taken on a state and federal level “to make sure Tennesseans receive the safest possible comDr. David pounded medication.” Reagan On Nov. 27, 2013, President Obama signed into law the Drug Quality and Security Act, which more clearly defines the role of the U.S. Food & Drug Administration and state health officials in the oversight and regulation of compounding pharmacies. Reagan said the Tennessee Department of Health worked closely with Sen. Lamar Alexander (R-TN), one of the bill’s chief authors. In Tennessee, a number of changes were approved by the State Board of Pharmacy to improve the oversight and safety of state-licensed compounding facilities. However, a ruling by the attorney general called one of the measures into question. The cease-and-desist provision was deemed to be in conflict with Tennessee’s Administrative Procedures Act. More work will undoubtedly be done on both an administrative and legislative level in 2014 to reach a balance between access to needed medications and public safety.
implemented two significant groups of improvements and a third group is being tested now to make an excellent experience for clinicians using the database,” he said. “The average search only takes a few seconds.” Making it simple to identify patients at high risk for addiction and abuse is critical, he continued. Reagan said the latest data showed 1,093 overdose deaths in 2012. “That’s more than the number of deaths from motor vehicle accidents and more than the number of homicides,” he said. “When you look at the breakdown, the great majority of those deaths are accidental overdoses that involved opioid analgesics.” Also of note in 2013, Tennessee forged collaborative database agreements with Virginia, South Carolina and Michigan. In 2014, the state will actively working on similar agreements with other states, particularly those contiguous to Tennessee.
Pain Management Guidelines
In a related matter, the Department of Health reached out to pain management specialists in Tennessee to convene an expert panel looking at the best methods to help patients while curbing medication addiction. “We’re working really hard on establishing chronic pain management guidelines in Tennessee,” Reagan noted. He said the guidelines are a compilation of innovative ideas and best practices from Tennessee and other states’ programming, as well as national pain society recommendations. Reagan added the practice guidelines should be ready this month. “These guidelines will be a significant help to practicing clinicians who are caring for patients requesting pain medicines in increasing numbers.”
Newborn Health
Prescription Drug Abuse
Addressing the prescription drug abuse epidemic, a number of improvements to the Controlled Substance Monitoring Database (CSMD) and new requirements for prescribers were implemented last year. “Effective Jan. 1, 2013, all prescribers were required to register with the CSMD,” noted Reagan. He added that on April 1, prescribers were required to search the database prior to prescribing controlled substances to look for patient red flags. “What we’ve seen is a three-fold increase in searches since before the law was implemented, and there has been a 50 percent decrease in doctor shoppers from August 2012 to July 2013,” he said. In addition, Reagan said a number of steps have been taken to improve the technology for clinical users. “We’ve 8
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Neonatal Abstinence Syndrome (NAS): In 2013, an emphasis was placed on identifying and curbing the number of babies suffering from NAS, which occurs when the mother is taking opioids while pregnant. “It’s very traumatic for the child,” Reagan stated, adding, “It’s something that should be rare because it is nearly completely preventable.” With the mindset that you must know the scope of the problem to effectively combat it, Reagan said, “We made neonatal abstinence syndrome a reportable condition in Tennessee in 2013, and I think we were the first state in the country to do so.” By early December, there were more than 800 documented cases of NAS in Tennessee. Recognizing there could be reporting bias with the change in requirements, he said the 2013 figure appeared to be a 25 percent increase over numbers gathered in 2011 through hospital discharge diagnoses data. Additional education, combined with the new pain management guidelines for caring for pregnant patients, will be a focus in 2014.
America’s Health Rankings Tennessee Holds Steady in 2013 The latest iteration of the annual ‘America’s Health Rankings’ from the United Health Foundation was released at the end of 2013. Tennessee ranked 42nd in the nation, which equates to no change in the overall ranking for the state when this year’s new methodology is applied to last year’s data set. The change makes it impossible to do a surface ‘apples to apples’ comparison between 2013 and 2012 without adjusting past data to the new methodology. Contributing to Tennessee’s ranking were: obesity in adults (40th), infant mortality (47th), physical inactivity among adults (45th), low birth weight (41st) and high violent crime rate (50th ... making Tennessee the worst in the nation with 644 offenses per 100,000 population). To see the full rankings and Tennessee trend data, go online to www.americashealthrankings.org. Countyspecific data is also available courtesy of the Robert Wood Johnson Foundation at www.countyhealthrankings.org.
Screenings: “We screened about 85,000 newborns in 2013 with a panel of 54 different screenings for genetically-based illnesses,” Reagan said. A law passed in 2012 and implemented in 2013, added bedside pulse oximetry to the panel to screen primarily for a treatable cardiac birth defect prior to an infant becoming symptomatic. “We’ve already had babies who have benefited from this, receiving critical medical care in a timely way,” he said.
Reagan noted he anticipated adding another new screen to the panel in 2014. Eliminating Elective Early Deliveries: One of the Department of Health’s most effective partnerships has been focused on eliminating elective deliveries before 39 weeks. The collaboration between the state, March of Dimes, Tennessee Hospital Association and TIPQC (Tennessee Initiative for Perinatal Quality Care) led to the support of every birthing hospital in Tennessee and included the educational initiative, ‘A Healthy Baby is Worth the Wait.’ “The last month for which I have data is September 2013. There were only five early elective deliveries in the entire state,” Reagan said with clear excitement. “And that compares to 96 in May of 2012.” He said it was a joint effort with all of the hospitals and their staff members pulling together to create a culture change to “make sure babies born in Tennessee have the best opportunity not only to survive their first year of life but to enjoy the best health possible throughout their lives.” Safe Sleep: The ABCs of Safe Sleep campaign — Alone, on their Back, in a Crib — kicked off in 2012 and has con-
tinued to grow since then. Planned in 2014 are continued distribution of door hangers to remind babysitters of the rules, bus signs and billboards, and distribution of a new book on the subject. The latter, Reagan said, is in partnership with the Tennessee Hospital Association. The short, easy-to-read book was written by a Tennessee physician who lost a child to a sleep-related death. In 2011, the campaign resulted in at least 22 fewer sleep-related deaths in the state. Although not a huge number, Reagan was quick to point out it’s an entire kindergarten class. Breastfeeding: “Breastfeeding is quite simply, for at least the first six months, the best nutrition you can provide for your baby,” Reagan said. He noted it improves the immune function and is associated with better child health outcomes and decreased rates of obesity even into adulthood. “The benefits are so compelling,” he stated. In 2013, a breastfeeding hotline was piloted, and Reagan said the plan is to roll the toll-free number out statewide in 2014. Michael Warren, MD, who spearheads breastfeeding efforts for the Department of Health, also is working to make sure employers and companies serving the public understand how beneficial breastfeeding is. Leading by example, the new Department of Health offices include a mother’s room where employees and visitors can breastfeed in comfort. Infant Mortality: In combination, these programs along with other efforts — including a new partnership with First Lady Crissy Haslam that kicked off in the fall of 2013 to support new moms — have helped the state see a steady decrease in infant mortality rates over the past eight years. Reagan said, “Our infant mortality rate decreased to 7.2 per thousand live births, which is the lowest it’s ever been but is still above the national average … so there is still more work to be done.”
Primary Prevention
Last … but certainly not least … are efforts aimed at stopping problems before they start. “Primary prevention is the happiest (CONTINUED ON PAGE 10)
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New Smoking Alternatives Present Challenges for Health Officials e-Cigs, Hookah Particularly Attractive to Teens
Even a doctor
cigarettes so there is a lot of dual use.” In fact, the data showed more than 75 percent of those using e-cigarettes also smoked conventional cigarettes. Often marketed as a safer alternative to traditional smoking, an e-cigarette is a battery-powered device that converts liquid nicotine and other additives into a vapor that is inhaled by the user. Sometimes referred to as ‘vaping,’ the solution cartridges can be purchased with varying amounts of nicotine … including none at all … mixed with flavorings. Although ecigs mimic traditional smoking, the devices don’t use tobacco or tar. Still, the Food and Drug Administration has announced the intention to classify e-cigs as a tobacco product and to begin regulating their use. However, King noted, “We don’t know when or what that will entail.” King said that just because e-cigarettes don’t use tobacco doesn’t mean they are safe. “The nicotine, itself, is not without health risks,” he pointed out. “Studies have shown nicotine can have an adverse effect on brain development in youth.” And, he added, “Nicotine Is highly addictive.”
deserves
As to why the jump in the number of middle school and high school students trying many of these emerging tobacco products, which also includes flavored little cigars, King said there are a number of likely reasons. First, it is still legally permissible to sell these items to minors in most states. Hookah cafes are popping up across the country and appeal to a sense of social connection. In the absence of legislation, e-cigarettes often are allowed to be used in locations where tobacco is restricted. And, King said, price is another factor. Typically, a disposable e-cig is significantly cheaper than a pack of conventional cigarettes, in part because states are still trying to figure out how to tax the devices and solution used in them. Then there is the flavor. Both hookah and e-cig solutions come in a wide variety of flavors ranging from ‘tobacco’ and ‘menthol’ to more youth-friendly options like bubble gum, gummy bears, cotton candy, white chocolate and waffles. King pointed out the FDA banned flavors, excluding menthol, years ago in traditional cigarettes and also stopped other market(CONTINUED ON PAGE 11)
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While overall tobacco use among middle school and high school students declined slightly between 2011 and 2012 in the United States, the percentage of adolescents using e-cigarettes nearly doubled during that same time period according to data from the 2012 National Youth Tobacco Survey. “We found a big increase in middle school and high school students in emerging tobacco products,” said Brian King, PhD, senior scientific advisor for the Centers for Disease Control and Prevention’s Office on Smoking and Health. He added ecigarettes and hookah led Brian King the way. When asked about ecigarette usage in the last 30 days, middle school students participating in the National Youth Tobacco Survey (NYTS) had an increase from 0.6 percent in 2011 to 1.1 percent in 2012. In high school students, the rate rose from 1.5 to 2.8 percent. For
all students grades 6-12, ‘ever’ usage – students reporting ever having tried an e-cig even if not a regular user – rose from 3.3 percent to 6.8 percent during the same time frame. Among high school students, ‘ever’ usage jumped from 4.7 percent in 2011 to 10 percent in 2012. Hookah use among high school teens also rose from 4.1 percent in 2011 to 5.4 percent in 2012. Drilling down further, the NYTS data found from 2011 to 2012 the use of e-cigarettes more than doubled for middle school males (0.7 percent to 1.5 percent), high school females (0.7 percent to 1.9 percent) and Hispanics in both age groups (middle school 0.6 percent to 2 percent; high school 1.3 percent to 2.7 percent). The information was published in September and November 2013 in the CDC’s Morbidity and Mortality Weekly Report. Although the numbers seem relatively small, King said they are troubling. First, nearly 90 percent of adult smokers in America began smoking by age 18 so trends in youth tobacco usage could have long-lasting public health consequences. Also, he explained, “A majority of the ecigarette users are also using traditional
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Feet on the Street
UnitedHealthcare Launches Neighborhood Connections By CINDY SANDERS
There is comfort in familiarity. For some of Tennessee’s most vulnerable citizens, a familiar face is now available to help them navigate a confusing … and often overwhelming … healthcare system. At the end of 2013, UnitedHealthcare launched the Neighborhood Connections™ program, taking care coordination into the neighborhoods where many of their TennCare members at highest risk for serious health complications live. The managed care organization has opened health assistance centers in key areas of Knoxville, Memphis and Nashville and hired care coordinators from within those neighborhoods to help members access needed health services, as well as community resources. Darren Hodgdon, chief operating officer for UnitedHealthcare Community Plan of Tennessee, said the impetus behind the ‘feet on the street’ approach was multifactorial — from meeting higher expectations of care coordination and reducing avoidable hospitalizations to ensuring members understand their benefits and increasing awareness of other resources to help improve members’ health and overall quality of life.
Neighborhood Connections Ribbon Cutting Local officials and UnitedHealthcare mascot Dr. Health E. Hound look on as UHC Community Plan of Tennessee COO Darren Hodgdon cuts the ribbon on the first Neighborhood Connections office in Knoxville in November 2013. Since then, offices have also opened in Nashville and Memphis.
Achieving those goals would be impossible, however, if the health plan couldn’t find a way to reach the targeted members. Hodgdon said some of the most vulnerable individuals in the TennCare population are passively enrolled in their health plan during a hospitalization and
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don’t really know or understand their benefits. “When you are sick and challenged by everyday life, you can’t think proactively about your health … you’re just trying to survive,” Hodgdon pointed out. “To get these members into Darren the system to have better Hodgdon access to primary care, we’ve got to be in the market … we’ve got to be in the neighborhoods.” In choosing the physical location of the health assistance centers, Hodgdon said UnitedHealthcare relied on technology to pinpoint areas where members had gaps in care and frequent emergency room visits. “Those with the highest gaps in care have the highest propensity to have an acute event,” he explained. While geo mapping highlights a hotspot neighborhood, actually locating those in need of the program can be a challenge. Some members have prepaid phones or no phone at all, and many of them are transient. Often, they have significant socioeconomic challenges and complex conditions including mental illness. “It’s very difficult to reach these members by simply picking up the phone,” he said, “but they need better coordination between episodes of care.” By hiring coordinators from within the target neighborhoods, UnitedHealthcare gives Community Plan members a familiar, trustworthy contact and gains insight and institutional knowledge into the local environment and barriers to accessing care. Taking a ‘whole person’ approach, the coordinators visit with individuals to get a big picture view of their life including current health status, religious and cultural preferences, living conditions, financial issues and behavioral
health concerns. Working with the company’s physical and behavioral health providers, the coordinators help identify at-risk individuals who might qualify for the extra level of service and act as the point person to help that individual set health and self-management goals and create and implement physical, emotional and social support plans. Hodgdon was quick to say the program wouldn’t have the chance to succeed without the community partners who round out the infrastructure by providing a range of services from warm meals and shelter to transportation. UnitedHealthcare has hired 12 coordinators, four in each market, to reach a relatively small group of people accounting for substantial cost. “In Knoxville, 1.8 percent of the members represent 37 percent of my total spend. Within that group, 335 members accounted for $24 million in total medical spend with the average cost exceeding over $70,000 per member,” Hodgdon said. He added the current healthcare environment isn’t sustainable for anyone. Instead of just serving those in the waiting room at the local ER, UnitedHealthcare Community Plan hopes to proactively intervene with those at greatest risk before problems escalate to the benefit of everyone involved. “We’ve got to address the social and emotional challenges people have. If those things aren’t addressed, you’re not going to be able to move the needle (on health outcomes),” Hodgdon said. “I think what’s unique is we’re doing it as a health plan. It shows the sea change that’s happening … that accountability is taking hold.”
Health, continued from page 8 kind of medicine,” said Reagan, adding it is also generally considered to be the most cost effective way to spend health dollars. He noted the Department of Health has increased its emphasis on collaborating with community partners to address needs. In addition to running its own programming, health officials across the state also worked on more than 250 community projects in 2013 addressing obesity, tobacco cessation, infant mortality, immunizations and substance abuse. Reagan added his office has been working with Governor Haslam’s Foundation for a Healthier Tennessee and expects to see more programming roll out around the topic of obesity in 2014. He also noted the food code was updated in 2013. “That’s really going to be helpful in the 25,000 food establishments we inspect across the state to protect the safety of the public better,” he concluded. For More Info, Visit: health.state.tn.us
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WMC Breaks Ground on Children’s Hospital Just before Thanksgiving, Williamson Medical Center executives officially broke ground and unveiled renderings of the $65 million expansion project. Slated to open in early 2015, the project includes a dedicated children’s Emergency Department and hospital, as well as expanded surgery and women’s services and surgical suites. Comprised of two three-story buildings, construction officially began Nov. 19 with the placement of ceremonial shovels in the ground at the site of the front door of the children’s hospital, which will bear the name Monroe Carell Jr. Children’s Hospital Vanderbilt at Williamson Medical Center. The name reflects WMC’s partnership with Vanderbilt to bring advanced pediatric inpatient care to Williamson County and its surrounding communities. “This day has been a long time in the making,” Don Webb, Williamson Medical CEO, said at the groundbreaking. “Honestly, I can remember back to 10 years ago
when there was discussion about when would be the right time to begin providing healthcare for younger children in need of inpatient services. The tempo of this discussion picked up within the last two years, and today we celebrate the beginning of this next phase in our journey as we continue to grow to meet the needs of the communities.” Referring to the architectural renderings by Earl Swensson Associates (ESa) for the new project, Williamson Medical COO Julie Miller noted, “We have created a calming environment for families while they are here. This is not going to be your grandfather’s waiting room.” She added, “Our relationship with Vanderbilt is an important one. We could have picked any number of healthcare providers to partner with moving forward. We chose Vanderbilt, and we made that announcement in this very space in 2011 and today’s project is one good example of that relationship.”
New Smoking Alternatives Present Challenges, continued from page 9 ing efforts to appeal to teens. “The tobacco industry will tell you they’re not specifically marketing to youth,” he said of advertising efforts around e-cigarettes. Yet, King pointed out, “Manufacturers are using methods to market that we haven’t seen in decades … the most notable of which is television.” King noted celebrity endorsements also are being used to glamorize the products. Additionally, a heavy social media presence keeps emerging tobacco products in
front of youth. Currently, the CDC is relying on general tobacco cessation messages to cover these emerging products. King said healthcare providers also have an important role to play in educating young patients and serving as a deterrent to tobacco use in any form. “We know that health professionals … and physicians in particular … are an effective means to deliver credible health information about all tobacco products.”
Cigar Use Also Rising Among high school students, cigar use also increased between 2011 and 2012, rising from 11.6 percent to 12.6 percent. According to the CDC, about one-third of cigar smokers are using flavored little cigars or cigarillos. While there was a 1 percent overall increase in the usage of cigars, the increase was much sharper among non-Hispanic black high school students. In this group, 16.7 percent reported smoking cigars in 2012 as compared to 11.7 percent in 2011. Furthermore, the 2012 figure was more than double the estimated usage in 2009 for non-Hispanic blacks.
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SMART. RELEVANT. ENGAGED.
healthier | June In the age of health care reform, success is measured on a wider spectrum that includes everything from wellness to acute care to new delivery platforms. The landscape is being redrawn by a number of alliances between stakeholders addressing the industry’s challenges from different angles. Healthier will explore how those relationships are being fleshed out and what that means for both patients and for the industry as a whole.
AD CLOSE: MAY 2, 2014 MATERIALS DUE: MAY 9, 2014 IN MARKET: MID-JUNE Please contact Tori Hughes at 615.844.9410 or thughes@nashvillepost.com for details. JANUARY 2014
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Changes to Tax Code, continued from page 6
Obesity, continued from page 7
a trade or business in which you are actively involved … but do include interest, dividends, annuities, royalties, rents and net gain from the disposition of non-business property.” When looking at the combination of the increased investment income and capital gains taxes, McGuinness said, “What was being taxed at 15 percent is very possibly going to be taxed at 23.8 percent.” Additionally in 2014, the sales tax deduction goes away … and for single wage earners beginning at $250,000 and married filing jointly at $300,000, itemized deductions and personal exemptions are being phased out. “If you’re taking a deduction away from me, that’s a tax increase,” McGuinness said of the bottom line for taxpayers. He added the itemized deduction phaseout could be quite costly, particularly to those who give large amounts to charity and have significant home mortgage interest they were used to deducting. “The personal exemption is equal to $3,900 (in 2013) per exemption you claim, and all exemptions are lowered by 2 percent for each $2,500 of income above the numbers ($250,000 single, $300,000 married filing jointly),” he explained. “The larger your family, the larger the tax increase.” McGuinness noted there is a growing feeling of frustration. At the same time many of his physician clients are paying significantly more in taxes, reimbursements are shrinking. The net result is people are having to work much harder
personal coach to shed those unwanted pounds,” he said. “It’s easy, free, and studies show it works.” The two most popular free apps are “Lose It” and “My Fitness Pal,” which allows patients to meet pre-set calorie and exercise goals. Sujka’s partner, Albert Ong, MD, gave him a kickstart on the new lifestyle modification by downloading the “Lose It” app on Sujka’s smart phone and programming it to lose one pound per week. Sujka is now very close to his college weight goal of 200 pounds. “Since losing weight, a lot of my patients have asked, ‘how did you do it?’ After explaining to them about using their (smart) phones to lose weight, many of them have come back to the office and told me their doctors for years have been telling them to lose weight but have never told them how,” explained Sujka. “They’ve told me they’ve found the app simple and effective. As a result, I wrote up the principle of using your smart phone to lose weight. A lot of patients appear more excited about losing weight than the effects of Viagra or Cialis!” Overall, the guidelines don’t focus on specific obesity medications. Only orlistat (Alli or Xenical) was available during the committee review process. Since then, the FDA has approved new diet drugs – lorcaserin (Belviq) and phentermine/topiramate (Qnexa) – that are recommended for use as “an intensification approach.” Bariatric surgery for weight loss was the fifth and final recommendation “when other interventions fail.”
simply to make the same money. McGuinness said individuals should have already asked their tax advisors to provide estimates of what their 2013 tax burden will look like. If that hasn’t happened, he suggests doing it now to prepare for April 15, 2014. Quoting one of his colleagues, he said, “It’s not going to be pretty in a lot of cases … but better than finding out on April 10 that you need to either drain your savings or take out a loan to pay your tax bill.”
End Notes & Disclaimer
The experts who contributed information to this article are members of the National CPA Health Care Advisors Association. Headquartered in Nashville, HCAA is a nationwide network of CPA firms devoted to serving the healthcare industry and educating its members about the ever-changing financial and regulatory landscape impacting the industry. The financial professionals stressed the importance of consulting a tax specialist to ensure advice is specifically tailored to your unique business or personal situation to minimize the tax burden while fully complying with state and federal mandates. Additionally, the information in this article was provided prior to the end of 2013. It is possible that some of the expiring tax incentives could be extended through legislative action. However, the consensus opinion was that Congress is unlikely to reinstate all … or even very many … of the sunsetting extenders.
2014 Council Fellows Named, continued from page 1 “This Fellows class includes some of the nation’s strongest healthcare talent and represents a broad spectrum of the industry, incorporating provider, payer, technology, finance, policy and other sectors,” said Frist, who co-directs the nationallyunique initiative with Bill Larry Van Horn, a lead- Senator Frist ing expert in healthcare management and economics, and professor at Owen Graduate School. “Our curriculum, combined with this impressive group of professionals will foster meaningful discussion, and I look forward to working with them as we tackle the complex issues facing healthcare today,” Frist continued. The members of the 2014 Fellows class are: Elizabeth Bierbower – President, Employer Group Segment, Humana Marty Bonick – Vice President, Operations, Division 1, Community Health Systems Charles Byrge – President & CEO, Harpeth Capital Phil Clark – Vice President, Finance & CFO, EnableComp and Complete Holdings Group Will Clark – Senior Vice President,
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Strategy & Brand, Brookdale Senior Living Phillip Clendenin – Executive Vice President, Operations, AmSurg John Dreyzehner, MD – Commissioner, Tennessee Department of Health David Duckworth – CFO, Acadia Healthcare Mitch Edgeworth – COO, Vanderbilt University Medical Center David Frederiksen – CEO, PatientFocus Robert Gallagher – Group Regional Operations Director, DaVita Paul Gilbert – Executive Vice President, Chief Legal Officer & Corporate Governance Officer, LifePoint Hospitals Meaghen Greene – Vice President, Sales, Marketing & Managed Care, American HomePatient Robert Harris – Partner, Waller Daniel Hart – Vice President, Corporate Development, HealthTech Holdings Scott Huebner – President, Operations, Cigna-HealthSpring Angela Humphreys – Member, Bass, Berry & Sims John Maki – Vice President, Regional Sales & Account Management, BlueCross BlueShield of Tennessee Will Morrow – Vice President, Development, HCA Eric Paul – Senior Vice President
& Chief Managed Care Officer, IASIS Healthcare J. Edward Pearson – COO & Senior Vice President, HealthStream Rosemary Plorin – President, Lovell Communications Kirk Porter – Senior Vice President, Bank of America Merrill Lynch Ed Powell, PhD – Chairman, eMD Paul Rein – CFO, Sarah Cannon Research Institute David Rogero – Principal, Cressey & Company Tammy Stephens – Senior Vice President, Operations Finance, Healthways Cathy Taylor, DrPh, BSN – Dean, Gordon E. Inman College of Health Sciences & Nursing, Belmont University Martha Thorne – General Manager, Allscripts David Vreeland – Partner & Cofounder, Cumberland Consulting Group Michael Wiechart – President & CEO, Capella Healthcare Herman Williams, MD – CMO, RegionalCare Hospital Partners The Fellows initiative is presented in partnership with BlueCross BlueShield of Tennessee, Community Health Systems, HCA, Healthways, LifePoint Hospitals and Vanderbilt University’s Owen Graduate School of Management.
GrandRounds Insight Genetics Launches Insight Molecular Labs Last month, molecular diagnostics company Insight Genetics announced the launch of Insight Molecular Labs. The CLIA-certified laboratory offers diagnostic tests that identify specific cancer biomarkers; provides clinical trial support services for targeted therapeutics, assisting in the identification of appropriate patients for trials; and specializes in the detection and monitoring of drug resistance in patients being treated with specific cancer therapies. “The laboratory is a natural extension of Insight Genetics’ work and will help us leverage our scientific expertise and specialized experience in resistance detection and monitoring to assist physicians in Eric Dahlhauser making therapy decisions and help identify patients for clinical trials,” said Eric Dahlhauser, Chairman and CEO of Insight Genetics.
Wishes Granted Vanderbilt University has received a $3 million grant from the GE Foundation’s Developing Health Globally program to fund international medical education and research in Kenya and other low-resource regions of the world. The major focus of the grant is to develop training programs that can demonstrably lower surgical and obstetric mortality, as well as dramatically improve and expand education of anesthesia providers throughout these regions. Centerstone has received a threeyear, $840,000 grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to improve access to substance abuse treatment services for more than 150 individuals living in underserved rural areas in Tennessee and southern Kentucky. With the funding, Centerstone will implement an electronic Recovery-Oriented System of Care, or e-ROSC, an innovative approach to treating substance abuse and addictions involving grassroots and faith- and community-based organizations all working together to help people achieve recovery. Vanderbilt-Ingram Cancer Center’s Breast Specialized Program of Research Excellence (SPORE) has been awarded a third round of funding from the National Cancer Institute (NCI). The SPORE grant renewal will provide more than $11.3 million in funding support over the next five years for breast cancer research.
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GrandRounds Recent Certifications, Accreditations & Commendations
TriStar Summit Medical Center’s Sarah Cannon Cancer Center received a Three-Year Accreditation with Gold Level Commendation from the Commission on Cancer of the American College of Surgeons. Dr. Ellen Wright Clayton The Joint Commission has awarded University Community Health Services (UCHS) both Ambulatory Care Accreditation and Primary Care Medical Home (PCMH) certification. UCHS operates over a dozen clinic sites throughout Middle Tennessee. Sarah Cannon at TriStar Centennial Medical Center has been granted three-year accreditation by the American College of Radiology for providing the highest level of quality and patient safety in radiation oncology. NorthCrest Medical Center has received the Get With The Guidelines®–Stroke Silver Quality Achievement Award from the American Heart Association.
Let’s Give Them Something to Talk About! Awards, Honors, Recognitions
Ellen Wright Clayton, MD, JD, the Craig-Weaver Professor of Pediatrics and professor of Law at Vanderbilt University, has won the David Rall Medal from the Institute of Medicine (IOM) for “exemplary” service to the institute. Clayton currently is a member of the executive committee of the IOM Council and the Report Review Committee, as well as chair of the IOM’s Board on Population Health and Public Health Practice. Avondale Partners’ Wealth Management Group is the nation’s fastest growing Registered Investment Advisor (RIA), according to Financial Advisor magazine’s 2013 RIA survey and rankings. The annual rankings from the leading financial advising publication showed Avondale’s assets at $687.5 million, an increase of 178.45 percent over the previous year. The Joint Commission recently named 10 local hospitals among the nation’s top performers on key quality measures. Middle Tennessee standouts were: Clarksville Health System, Maury Regional Medical Center, Middle Tennessee Mental Health Institute, NorthCrest Medical Center, Sumner Regional Medical Center, TriStar Hendersonville Medical Center, TriStar Horizon Medical Center, TriStar Southern Hills Medical Center, TriStar StoneCrest Medical Center and TriStar Summit Medical Center. In addition, HCA had 110 hospitals and Community Health Systems had 63 of its affiliated hospitals recognized as top performers. The Tennessee Association of Mental Health Organizations (TAMHO) handed out top honors during the annual meeting. Among the winners, Gov. Bill nashvillemedicalnews
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Haslam received the TAMHO President’s Award. Lee Ann Ingram, board member for Centerstone, received the Frank G. Clement Community Service Award for her leadership and volunteer service. Qualifacts Systems, Inc., a cloud provider of electronic health records for behavioral health and human services, won a 2013 NEXT Award as the top Technology Market Mover in Nashville. Lattimore Black Morgan & Cain, PC was the recipient of the Entrepreneurial Partner NEXT Award. The awards are hosted by the Nashville Area Chamber of Commerce and Nashville Entrepreneur Center.
Wiechart Appointed President & CEO of Capella Healthcare
Last month, Capella Healthcare cofounder, board chair and previous CEO Dan Slipkovich announced Michael Wiechart had been named president and CEO effective Jan. 1. Slipkovich said the move was designed to position the company for long-term success and strategic growth. Continuing as executive board chair, Slipkovich added the transition would allow him to dedicate more of his time to strategic market development and growth along with continued responMichael sibilities in the areas of Wiechart investor and government relations. Currently, the Franklin-based company owns and/or operates 14 acute care and specialty hospital facilities in six states. Wiechart has served as senior vice president and COO for Capella since 2009 with responsibility for hospital operations, physician services, quality improvement, supply chain, revenue cycle, managed care, strategic planning, business development, and labor productivity initiatives. He has also been significantly involved in merger and acquisition activities. He began his career in healthcare 25 years ago with the role of controller for a hospital in Statesville, NC. Later, he served as CFO at various HCA hospitals, which culminated in his being named CFO for the Chattanooga market and then the Cumberland Division. In 1998, Wiechart became vice president of Operations for Province Healthcare before moving to LifePoint in 1999 as a founding member. Wiechart is a member of the Nashville Health Care Council’s 2014 Fellows Class.
Saint Thomas Health, Marian University Launch Accelerated Nursing Program
In December, Saint Thomas Health and Marian University announced the launch of an accelerated nursing degree program that will address the rising shortage of nurses in Tennessee and across the nation by educating highlyskilled, compassionate professionals in a concentrated 16-month period. Marian University at Saint Thomas Health offers those with a bachelor’s
degree the singular opportunity to earn a Bachelor of Science in Nursing (BSN) through an accelerated program that combines online courses and hands-on clinical training. The program, headquartered at Saint Thomas West Hospital, is accepting applications for the first cohort, which will begin classes in May 2014. Information is at www.mariannursing.com/nashville.
HCA’s New C-Suite in Effect Jan. 1 Changes to the HCA executive suite announced last fall went into effect Jan. 1. R. Milton Johnson became president and CEO upon the retirement of Richard M. Bracken as CEO at the end of 2013. William B. Rutherford succeeded Johnson as CFO. Previously, Rutherford served as COO of HCA’s Physician Services Group. Bracken remains as HCA’s chairman of the board.
Milt Johnson
Bill Rutherford
TOA Adds Three Surgeons Tennessee Orthopaedic Alliance (TOA), the state’s largest orthopaedic practice, recently added three new surgeons, bringing the number of new physicians added during the past year to seven and the total number of TOA
physicians to 52. Christian Anderson, MD, is a fellowship-trained orthopaedic surgeon, specializing in shoulder, sports medicine and hip arthroscopy. Anderson completed a Sports Medicine fellowship at Stanford Sports Medicine Center, where he served Dr. Christian as a team doctor for the Anderson San Francisco 49ers leading up to and during Super Bowl XLVII. Anderson is based at TOA’s St. ThomasWest care center. Alison Cabrera, MD, is a fellowship-trained orthopaedic surgeon, specializing in sports medicine. Cabrera completed her Orthopaedic Sports Medicine and Shoulder fellowship at Vanderbilt University Dr. Alison Medical Center and is Cabrera based at TOA’s Clarksville care center. Chase Corn, MD, is a fellowshiptrained orthopaedic surgeon, specializing in foot and ankle surgery. He completed his fellowship work at the renowned OrthoCarolina Foot and Ankle Institute in CharDr. Chase Corn lotte, NC. Corn is based at TOA’s St. Thomas-West care center.
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GrandRounds Middle Tennessee’s Primary Source for Professional Healthcare News
TAMHO Elects Leadership The Tennessee Association of Mental Health Organizations elected officers for 2014 at the organization’s recent annual meeting held in Murfreesboro. Robert N. Vero, EdD, CEO of Centerstone of Tennessee, will serve as president. He succeeded Charles Good, president and CEO of Frontier Health in Gray, Tenn., who will remain on the board as immediate past president. Chris Wyre, president and CEO of Volunteer Behavioral Health Care System in Murfreesboro was chosen president-elect. Robert Vaughn, CEO of Carey Counseling Center in Paris, Tenn. will remain on the board as secretary, completing the second year of a two-year term. Mary Claire Duff, chief fiscal officer of Ridgeview in Oak Ridge, Tenn. will serve a two-year term as treasurer.
Ward Joins 2nd Generation Capital James C. Ward recently joined Nashville-based 2nd Generation Capital, LLC, as a principal and director. Previously, the Nashville native was employed by Mars, Inc. in its financial management development program where he gained experience in P&L management, new product launches, business
analytics and internal audit. Ward is an alumnus of Princeton University where he graduated cum laude and the Owen Graduate School of Man- James C. Ward agement where he was a member of Beta Gamma Sigma. While with Owen, he interned at 2nd Generation Capital and worked with multiple start-up companies in the healthcare, energy and music technology fields.
dividual trials. As the Regional Coordinating Stroke Center for Tennessee, VUMC has forged partnerships with Erlanger Medical Center, Fort Sanders Regional Medical Center and Huntsville Hospital to access an estimated 4,300 stroke admissions per year. VUMC can also recruit patients from the Vanderbilt Health Affiliated Network with 32 additional hospitals in the region.
VUMC Joins National Stroke Prevention Research Network
Last month, Avondale Partners, a national investment banking and wealth management firm headquartered in Nashville, announced the continued expansion of the investment banking group with the addition of Robert Tyndall III as managing Robert Tyndall director. Tyndall is focused primarily on the healthcare sector with 20 years advisory experience serving management and shareholders of owner-operator, private-equity backed, and public companies. He was previously a director with Brookwood Associates, a middle market M&A boutique firm, where he completed 20 M&A and capital raise transactions primarily in the healthcare services, healthcare IT, pharmaceutical services sectors. A graduate of the University of North Carolina and Harvard Business School, he began his career in a business development role for MeadWestvaco.
Avondale Partners Adds Managing Director in Investment Banking
Vanderbilt University Medical Center has joined a national network funded by the National Institutes of Health to streamline multi-site clinical trials focused on key interventions in stroke prevention, treatment and recovery. The National Institute of Neurological Disorders and Stroke (NINDS) Stroke Trials Network will include up to 25 academic medical centers and aims to increase efficiency and resource sharing within cerebrovascular clinical research. VUMC received a $1.9 million grant to support network infrastructure and will receive additional funds for the in-
Prostate Cancer Biomarker May Predict Patient Outcomes
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DentaQuest Appoints Project Manager for TennCare Dental Program PHOTO BY SUSAN URMY
Last month, researchers at Vanderbilt University Medical Center and the University of Alberta in Canada announced they have identified a biomarker for a cellular switch that accurately predicts which prostate cancer patients are likely to have their cancer recur or spread. Prostate cancer is the second leading cause of cancer-related deaths among men in North America. While some prostate cancer spreads slowly and does not lead to serious symptoms, in other patients the cancer metastasizes to other parts of the body and proves fatal. Cancer researchers have been searching for biomarkers that indicate which paAndries Zijlstra, PhD, and colleagues are studying a biomarker that can help predict prostate cancer recurrence. tients should be treated aggressively and which patients can be followed through active surveillance. The study, posted online recently in advance of publication in Cancer Research, was led by co-investigators Andries Zijlstra, PhD, assistant professor of Pathology, Microbiology and Immunology and Cancer Biology at Vanderbilt, and John Lewis, PhD, associate professor of Oncology and Frank and Carla Sojonky Chair in Prostate Cancer Research, University of Alberta. Zijlstra and his colleagues have been investigating a protein called CD151 that facilitates the migration of cancer cells. In prostate cancer cell lines, they discovered that CD151 is free from its normal adhesion partner (integrin) — another protein that allows a cell to stick to the surrounding tissue. This form of CD151 called “CD151free” proved to be functionally important in cancer. “It was a big surprise that some of this CD151 protein was now free of that partner, and it turns out that it only occurs when a cancer is formed,” said Zijlstra. “What’s so novel about this discovery is we’re not talking about changing protein expression, which is what we traditionally see. We’re talking about a protein that changes its molecular state … and detection of that molecular state is an indication of disease progression.” In collaboration with Lewis and colleagues in Alberta, the group looked at tissue samples from 137 patients treated for prostate cancer in Canada over the past 12 years. The team determined that if patients tested positive for CD151free their cancer recurred and spread earlier than patients without any detectable CD151free.
DentaQuest, which last began administering dental benefits for TennCare in October, recently announced Steven Brady has been appointed DentaQuest’s project manager for the company’s state of Tennessee program. In this role, Brady will be Steven Brady instrumental in the company’s management of dental benefits for the approximately 750,000 children who receive benefits through TennCare. Brady, who most recently served as associate dean of business and finance at Meharry Medical College School of Dentistry, will be responsible for collaborating with state and local officials on program efficacy and accountability. He will also direct a team of healthcare management and community outreach professionals who are working with providers and TennCare members across the state. He is a graduate of Tennessee State University and has more than 15 years of finance and operations experience.
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GrandRounds PathGroup Expands Footprint with Two New Dedicated Laboratories Brentwood-based PathGroup, one of the largest private providers of pathology services in the U.S., announced last month that it has opened two new stateof-the-art facilities dedicated exclusively to molecular and cytology testing. The new laboratories are adjacent to PathGroup’s current laboratory at Grassmere Park in Nashville. The two additional testing sites have the capability to perform molecular assays for oncology, including Next-Generation Sequencing (NGS), as well as infectious disease and women’s health diagnostics. The new space also includes a CLIA-validation laboratory for test development and implementation. PathGroup will continue to operate out of its existing 40,000 square foot laboratory. These new additions add approximately 20,000 square feet of nearby laboratory space, thereby increasing operational facilities by 50 percent. ReDoc Software Promotes Hobgood, Shafer Brentwood-based ReDoc Software, a leader in therapy documentation and management solutions, recently announced promotions for two employees. Seth Hobgood has been named chief technology officer. Previously, he served as vice president of Integration Services. In his new role, he will look to grow the company’s technology initiatives and will oversee Seth Hobgood the internal and hosted infrastructure. He joined the company in 2010. Ann Shafer has been appointed clinical product owner and design specialist. In her new role, she will be responsible for analyzing and designing clinical components used in curAnn Shafer rent and developing software, as well as assisting with the planning for and conducting of beta testing processes. Additionally, she will serve as a clinical liaison for the product design and development divisions of ReDoc. She joined ReDoc in 2003 and was director of Compliance and Outcomes and clinical advisor for ReDoc.
Lincor Upgrades Patient Engagement Technology, Launches New Product Portfolio Last month, Lincor Solutions Inc. announced the launch of a new portfolio of products for delivering its industry-leading patient engagement technology to hospitals and health systems. Powered by next-generation technology that provides access to clinical, administrative and entertainment systems within a single platform, Lincor’s LINC product portfolio offers a range of easy-to-implement solutions for increasing patient satisfaction scores, improving clinical outcomes, reducing unnecessary readmissions and facilitating electronic health record (EHR) adoption. The LINC product portfolio includes four distinct products. PatientLINC provides access to a suite of tools including interactive clinical information, communication services and entertainment content via a touch-screen monitor at the patient bedside. ClinicalLINC provides secure access to clinical information systems through a wall-mounted terminal adjacent to the bedside. MediaLINC turns the in-room television into a “smart device” capable of delivering interactive patient education, hospital information and entertainment content. MobileLINC provides access to medical information, educational materials, and entertainment content through a patient’s personal mobile device New links between hospitals’ Medi-
Our annual Women to Watch issue and event is coming in April 2014, and we want your input on women in
Merrick Joins LBMC Technologies
Middle Tennessee that are
Last month, LBMC Technologies, LLC, a leading full-service technology firm and a member of the LBMC (Lattimore Black Morgan & Cain, PC) Family of Companies, announced the addition of John Merrick to the Brentwood office. He will John Merrick serve as a business system consultant and will focus his talents on Microsoft Dynamics GP and Intacct
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implementations. He comes to LBMC Technologies with a wealth of experience with large organizations such as Target, Nokia and PWC. Prior to LBMC, Merrick was a geographic analyst at Nokia. He has an undergraduate degree in Economics from Miami University and his Masters of Accountancy is in progress from Belmont University.
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care reimbursement and their performance on patient satisfaction surveys, readmission rates and the Meaningful Use of EHRs have made patient engagement a financial imperative. In the first year of the Hospital Readmissions Reduction Program, for example, the Centers for Medicare and Medicaid Services charged 2,213 hospitals about $280 million for excess readmissions.
that could allow access for everyone. 101 Mobility service technicians are factory trained and certified to install a variety of mobility equipment.
101 Mobility Franchise Comes to Nashville Cecil Raney (retired U.S. Navy) and Jerry Kieffer (retired U.S. Marine) have opened 101 Mobility’s 32nd location – and the first in Nashville. 101 Mobility provides a one-stop-shop for professionally installed mobility solutions that might help Nashville’s elderly age in place and assist the disabled with everyday accessibility. 101 Mobility Nashville is already creating strategic alliances with non-profits and other business owners to educate the public about small changes
The Nashville Health Care Council Board of Directors hosted its annual holiday reception at the Bridge Building on Dec. 4. Nearly 300 healthcare executives representing the Council’s 260 member companies gathered to celebrate a successful year for the industry. Pictured (L-R) Council board members Bill Sheriff, retired CEO, Brookdale Senior Living; Richard Miller, president, Earl Swensson Associates; and Wayne Smith, chairman, president and CEO, Community Health Systems.
Lovell Communications Names Plorin President Rosemary Plorin has been named president of Lovell Communications, succeeding firm founder Paula Lovell, who remains with the 25-year old public relations and marketing communications firm as chairman and CEO. Plorin joined Lovell in 2000 and has been a senior vice president and partner in the firm since 2005. She leads Lovell’s Healthcare Division, a team of senior strategists specializing in healthcare regulation communications, issues management, M&A communications and healthcare marketing. A nationally Rosemary Plorin (L) and Paula Lovell (R) sought after speaker, she has presented to numerous healthcare and business organizations including the American Health Lawyers Association, the Federation of State Medical Boards, Modern Healthcare magazine, and the International Associations of Business Communicators.
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industry suppliers who are changing the way we deliver care are all eligible.
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REGIONS SMALL BUSINESS Name:
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PROMPT AND PERSONAL – IT’S HOW REGIONS KEEPS THE WHEELS OF PROGRESS TURNING FOR SMALL BUSINESS. Dr. Susana Leal-Khouri
began her relationship with Regions in 1996 at the suggestion of her personal accountant. She was just starting her private practice, the Miami Dermatology Center, and needed to furnish the offices. “Regions has been very helpful in allowing us to be able to start and grow the practice. They’ve also helped make it possible for us to hire the right people,” says Dr. Leal-Khouri.
“Regions is always there when I have questions. My relationship with my Regions banker is personal and I have her on my speed dial.” What started as a single location has grown to three with a full-time staff of 17 employees. These days, the Miami Dermatology Center utilizes a wide range of Regions banking tools, from Business Analyzed Checking and Treasury Management to loans and lines of credit. Dr. Leal-Khouri plans to expand parking at her Coral Gables location, and Regions is part of those plans too. To learn more about the Miami Dermatology Center and how Regions can assist your business, visit regions.com/success.
Loans | Checking | Savings | Treasury Management | Wealth Management © 2014 Regions Bank. All loans and lines subject to credit approval.
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