Nashville Medical News May 2014 by FW Publishing

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PHYSICIAN SPOTLIGHT PAGE 2

Bradley Bale, MD

ON ROUNDS Keeping Data Safe & Sound If asked what would be most attractive to thieves, chances are prescription drugs would be the first response of those involved with a medical practice ... 4

Vanderbilt Studies New Option for Treating Stress Urinary Incontinence It’s embarrassing. It’s frustrating. And it significantly impacts the quality of life for more than 15 million women in the United States. “It” is stress urinary incontinence (SUI) ... 7

MedTenn 2014 Bringing Medicine Together By CINDy SANDERS

From April 24-27, physicians from across the state gathered in Middle Tennessee to discuss issues impacting medicine, attend targeted educational courses, vote on key policy resolutions, install new officers, network with colleagues, and support Alzheimer’s awareness during MedTenn 2014. The annual convention of the Tennessee Medical Association featured more than 20 speakers and 20 sessions over four days. TMA President Russ Miller said the theme of ‘bringing medicine together’ speaks to the association’s focus on collaborative practice and communication around patient-centered care. “We feel it’s very important to continue to advocate for doctors and patients to bring everyone together,” he said, adding the annual conference has become more of a true medical convention with a ‘big tent’ feel that includes other medical specialty societies. The multi-specialty meeting included coordinated events, education and activities with

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Marian University at Saint Thomas Health Launches Inaugural Nursing Class

‘Nurses Lead the Way’ at Nursing Leadership in Global Health Conference

By CINDy SANDERS

ONLINE: NASHVILLE MEDICAL NEWS.COM

Cumberland Pediatric Foundation, Tennessee Academy of Ophthalmology, Tennessee Association for Long-Term Care Physicians, Tennessee Chapter of the American Academy of Pediatrics, Tennessee Chapter of the American College of Surgeons, Tennessee Geriatrics Society and Tennessee Psychiatric Association. The four-day conference included hot topics impacting patients and providers in Tennessee. Featured courses included ICD-10 implementation strategies, proper prescribing, workers compensation law changes, personalized medicine, depression secondary to critical illness, health reform, Medicaid expansion, and emerging payment and employment models. Miller noted TMA is keenly focused on the changing paradigm of payment for episodes of care. He added the change from volume to value isn’t threatening to physicians but is concerning in terms of how quality is counted and measured. “Doctors are always about quality and

National Nursing Week

Last month, Marian University at Saint Thomas Health hosted it’s May 6-12, 2014 grand opening. This month, the first classes get underway for the accelerated collegiate program that allows those with a bachelor’s degree to become registered nurses in less than two years. On April 15, Mayor Karl Dean joined leaders from Saint Thomas Health to celebrate the launch of the educational partnership and discuss the program’s role in addressing the national nursing shortage. According to the Bureau of Labor Statistics, employment of registered nurses is expected to increase by 26 percent between 2010 and 2020, but the number of registered

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PhysicianSpotlight

Looking at Heart Health in New Ways Book Details a New Approach By KELLY PRICE

Bradley Bale, MD, was glad to get back to the green grass of home after five years in the less lush plains of West Texas where he served as medical director of the Heart Health Program at the Grace Clinic in Lubbock for five years. Bale grew up in Elizabethtown, Ky. and received his undergraduate degree in biochemistry from Lawrence University in Wisconsin. He returned home to earn his medical degree from the University of Kentucky School of Medicine. An internship led him to Spokane, Wash. He settled in the city and founded a family medicine practice and later the Heart Attack Prevention Clinic. After practicing in the northwest for 30 years, Bale said he got “an offer he couldn’t refuse” to join the Grace Clinic. Now he is glad to be back in the Southeast near where he grew up. “I love having seasons and being near family, especially our young granddaughter,” he said about the move to Hendersonville. Bale has opened a private practice as a heart attack, stroke and diabetes prevention specialist in downtown Nashville with Amy Doneen, MSN, ARNP. Bale and Doneen are co-founders of the Bale/Doneen Method, a new paradigm in tackling

Dr. Bradley Bale travels around the country leading educational sessions on the Bale/ Doneen Method of heart disease prevention. The method was created with his colleague Amy Doneen.

cardiovascular disease that emphasizes preventing atherosclerosis before it occurs. The two clinicians teach the Bale/ Doneen Method to healthcare providers in an American Academy of Family Medicine-accredited preceptorship program. They have given hundreds of lectures at leading medical conferences in the United States and globally and have published their research in many peer-reviewed medical journals. Bale and Doneen recently co-authored, Beat the Heart Attack Gene, published in February of this year, highlighting their findings. Already in its second printing, the book has been ranked number one in sales on Amazon.com in the Health and Fitness section and has been called a revolutionary, personalized guide to preventing heart disease based on genetic factors. Heart disease is the leading cause of death in America. It affects 81 million

Americans and is a factor in one of every two deaths in the United States. Patients often think they are not at risk of a heart attack if they control their cholesterol and blood pressure and are unaware of other major risk factors that might impact their health. In their book, and in their practice, Bale’s and Doneen’s message offers good news: with the right information and strategies, heart attacks are preventable — even if heart disease runs in the family. In Beat the Heart Attack Gene, they present a new model for understanding and preventing heart disease, identifying three different genetic types of cholesterol profiles and treatments tailored for each type. Their cutting-edge Bale/Doneen Method is a simple, comprehensive prevention plan that detects cardiovascular disease (CVD) in the early stages. Beat the Heart Attack Gene includes quizzes and self-

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tests that show how to determine cholesterol genotype and offers evidence-based strategies to apply that knowledge through nutritional and lifestyle changes to live active, healthier lives. The book identifies the hidden causes of many heart attacks, explains and emphasizes early prevention methods, and distinguishes the best and worst heart supplements. Bale advocates patients have an oral glucose tolerance test, which can detect insulin resistance long before the condition progresses to diabetes. Although the A1C test is more convenient, Bale maintains it often fails to detect insulin resistance, which he said leads to inflammation that can trigger plaques to rupture and form clots. Bale said the method they have designed holds the keys to future successes in the fight again coronary inflammation. For heart attack and stroke survivors, the Bale/Doneen Method also purports to help prevent recurrences by identifying and treating what is triggering the patient’s disease, a crucial step often overlooked. Bale noted, “We offer a unique, comprehensive strategy that allows us to treat the individual patient and prevent their heart attack because we are able to identify the root cause of their disease by a thorough investigation of non-traditional drivers of coronary disease, especially that of undiagnosed diabetes, which is often masked by a normal fasting blood sugar.” Bale continued, “The normal standard of care aims to fix the house after it has burnt down, and the Bale/Doneen (Method) seeks to prevent the fire from ever starting.” He added, “We are filling in major holes in our understanding of clinical management of CVD, which starts with life choices that result in marked plaque regression and improvement in the arterial health of patient.” Bale also noted, “There is more to cardiac care and disease prevention than just lowering cholesterol, having stents and bypasses, and waiting for the next event.” One review of the book observed, “The Bale/Doneen Method encourages a ‘mind over metal’ approach by focusing on both primary and secondary prevention.” Bale noted that in 2013, over $300 billion was spent in cardiovascular medicine, and it is predicted that by 2030, that number will exceed $1.2 trillion. “This is not just a medical issue, it is a fiscal problem, also,” he stated. “We have the technology and knowledge to treat this,” Bale said, “and we have to follow that old adage — ‘do the best you can until you know better.’ We now know better.”

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SANS Cyberthreat White Paper Shows Dark Clouds on HIT Horizon Widespread Security Issues Put Systems, Patients at Risk By CINDY SANDERS

Consider yourself warned. A white paper released earlier this year by SANS, a global leader in cybersecurity research, training and certification, painted a bleak picture of where those in the healthcare industry currently stand in terms of keeping protected information safe and secure. The report was created using healthcare-specific data provided by Norse, a live threat intelligence and security solutions firm, from September 2012-October 2013. The eye-opening results underscored the vulnerability of providers, payers, business associates and patients. Authored by Barbara Filkins, a senior SANS analyst and healthcare specialist, the report detailed the widespread problem. In analyzing the Norse data collected during the 13-month sample, the intelligence found: • 49,917 unique malicious events, • 723 unique malicious source IP addresses, and • 375 US-based healthcare-related organizations compromised … averaging

about one a day. Filkins wrote, “The data analyzed was alarming. It not only confirmed how vulnerable the industry had become, it also revealed how far behind industry-related cybersecurity strategies and controls have fallen.” Furthermore, the analysis made it clear that the threats aren’t unique to any one type of healthcare company, but pro-

viders are seemingly the most vulnerable. In looking at the sectors compromised by malicious traffic, healthcare providers led the way with 72 percent. Business associates accounted for 9.9 percent of the malicious traffic, health plans 6.1 percent, healthcare clearinghouses 0.5 percent, pharmaceuticals 2.9 percent, and other related entities 8.5 percent. Most alarming, noted Filkins, was the level of activity found in what was just a sample set. Speaking to Medical News from her California office, Filkins said ‘malicious events’ are defined as an outside threat or event that might have penetrated the system and could range from hijacking contacts to pushing sensitive information outward. She noted that many companies, practices and facilities have policies in place warning employees not to click on an unknown email or link. (And who hasn’t received a suspicious link under the guise of coming from a friend or colleague?) Yet, she said, “People need to be looking at not only what comes into their network, but what

goes out of their network.” To find and address malware typically requires a HIT professional. “A lot of times an attacker will use a very common protocol so it might look like someone is browsing the web, but you might have to dig a little deeper under the covers,” she noted of finding and locating problems. “A lot of these events continued not just for days … but for months,” she added.

Locking the Front Door, Leaving the Back Wide Open

Oftentimes the point of entry for attackers was not the main information system. Instead, those with malicious intent entered through peripheral surfaces like network printers, call contact software, routers, medical devices, and … ironically … security cameras. While the main system was securely locked and password protected, many times, Filkins said, the default password remains on these add-on surfaces. Finding the admin password, she continued, is as easy as doing a quick Internet search for the device in question. “There are some very basic things (CONTINUED ON PAGE 12)

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MAY 2014

Keeping Data Safe & Sound By CINDY SANDERS

If asked what would be most attractive to thieves, chances are prescription drugs would be the first response of those involved with a medical practice. While that answer is probably true, the reality is the street value of their data is likely greater … and frankly much easier to attain. Medicines are kept under lock and key, but as the SANS Cyberthreat article (see page 3) demonstrated, healthcare providers often leave the ‘back door’ to data standing wide open. The white paper’s author advised, “Think like an attacker … and if you can’t do it, get someone who can.” That’s where Thomas Lewis comes into the picture. Lewis is the partner that heads up LBMC Security & Risk Services, part of the Lattimore Black Morgan & Cain family of companies. Offering a range of compliance, consulting and managed security services, the team has helped guide federal healthcare security requirements and has a deep understanding of how to implement complex security frameworks. In other words … they are good guys who are really good at thinking like bad ones. “The bad guys go where the money is. Today data is money, and there’s

The bad guys go where the money is. “Today data is money, and there’s some very sensitive data in healthcare. It’s really the crown jewels. ” — Thomas Lewis, Partner-in-Charge, LBMC Security & Risk Services

some very sensitive data in healthcare,” said Lewis. “It’s really the crown jewels.” He added that healthcare data repositories typically include credit and debit card information, personal health information (PHI) and personal identifiable information (PII) including Social Security numbers and full contact information. “Identities are great business,” Lewis said. “They go from about $10 to maybe $100-$150 for a good identity. When you steal a database with 5,000 or 50,000 or 100,000 names, that’s a lot of revenue.” Interestingly, he noted, data theft is the new target of organized crime. It’s much cleaner with a lower risk and higher return than running prostitution and drug rings. Russia and China are two epicenters of such activity. In Russia, Lewis noted, it is most often organized crime. In China, it might also be motivated by corporate espionage, and the target could be research and other intellectual prop-

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erty, as well as identities. Traditionally, cyberattacks came from breaking through a firewall or external connection directly targeting a server, but Lewis said people are beginning to get wise to that route. “What we’re seeing now is a direct attack through the end user … an employee’s workstation or mobile device.” Rather than going straight for the server, cyberthieves enter through a back door and then making a beeline to the server. “They’re going to the weakest link,” Lewis pointed out. Unlike drug seekers, this type of thief is smart and calculating. Lewis said they now “create their malware with polymorphic traits so it’s constantly changing its state.” He added antivirus software, which mostly works off of a signature-based analysis, has been rendered almost useless. Another entry point is to hide in plain sight. While most employees are savvy enough not to fall for emails that begin ‘my beloved’ or to click on a link from someone they don’t know, the more sophisticated cybercriminals are embedding malware in emails purportedly coming from well-known companies like LinkedIn or requesting personal information through a fake employee benefits survey. “It’s really hard to detect a legitimate request from a malicious one,” Lewis said, adding the easiest way not to get hooked by a phishing expedition is to circumvent the link and go directly to the source. Rather than click on the ‘accept’ button in the email, actually go to the LinkedIn site. If it’s a legitimate request, the invitation will be in your inbox. Similarly, most companies announce when they are doing surveys or updating benefit plans. Pick up the phone and call the HR department if unsure about a request. Lewis added you could also let your cursor hover over the link without actually clicking to see the address where you are being redirected. Even that, though, could be tricky because some of the more sophisticated scammers make the malicious address look very much like a genuine one by using a 1 instead of an “i” or a 0 instead of an “o.” The best advice, Lewis said, is “be a little untrusting of links. When in doubt, don’t click on the link.” Although it might seem like there are an overwhelming number of ways for data to be breached, Lewis said some relatively simple steps go a long way toward protecting your company information and patient records. The first, he noted, is to have a great level of awareness among providers and staff about cyberthreats.

Talk about the types of schemes out there and the dangers of clicking on links without truly knowing the source. Lewis continued, “Knowing where all of your sensitive data is located is critical … and knowing it down to the application and server level is absolutely critical so you can protect it.” Practices and facilities often secure the server but are much less aware of peripheral equipment. Items like printers that are connected to the network provide an entry point to the main server. “You really have to put everything that resides on your network through a strong configuration process,” Lewis stressed. He added an overlooked feature of printers, fax machines and copiers is that they have a hard drive. Sensitive data is copied or faxed on a regular basis. When the equipment needs to be replaced, it is typically just tossed out. “You have to make sure that storage goes through a secure delete … a secure erase process,” he said before throwing it away. No matter how much you educate users, Lewis said criminals are often one step ahead. “Everyone is chasing a silver bullet that doesn’t exist. As long as humans are involved, there are going to be vulnerabilities.” He added, “That’s why monitoring of your outbound communication is absolutely critical.” Using a device placed on the network, an in-house cybersecurity team or hired consultants can monitor inbound and outbound activity. “We can see what’s going on. We can see what types of attacks are happening, and we can push out countermeasures,” Lewis explained. He added such monitoring requires very specific expertise and must occur 24 hours a day to truly be effective. In addition to concentrated attacks, a lot of data is still lost through a laptop being lost or stolen. It doesn’t matter if the thief was looking for PHI or not, once that laptop is gone, it must be reported per HIPAA requirements. “One of the best ways to avoid being on the Wall of Shame and having to send out all those breach notifications is to securely encrypt your data. Encryption solves a lot of your ills and shortcomings,” Lewis said. He added encryption used to be expensive and difficult to do, but there are now a number of programs that are effective and cost efficient. “The federal government has an encryption certification FIPS 140-2,” he continued, noting you should look for software with that compliance designation. Lewis certainly sympathizes with healthcare clients who aren’t as protected as they should be. “It’s hard because at the end of the day, all they want to do is run their business and take care of patients. I completely understand that, but the risk is real. It’s not a question of whether or not a breach will happen … they are going to happen … it’s just preparing yourself to reduce the likelihood, reduce the damage and reduce the cost,” he concluded.

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By CINDY SANDERS

Today there are a multitude of applications and technology solutions to make the practice of medicine safer, more efficient and more connected. Without proper planning on the front end, however, you might find those options are out of reach for you … or, at best, deliver limited performance. Just as a structure is only as good as its foundation, your health information technology systems are only as good the infrastructure you put in place. “Telecommunications provides the infrastructure for healthcare or any other enterprise to connect to your remote locations and the outside world. If that’s not right, nothing is going to be right … and you will be very frustrated,” said Eddie Hooper, director of carrier services for Franklin-based Resource Communications Group (RCG), a telecommunications solutions provider Eddie Hooper with expertise in voice, data and mobility network customization and internal mission critical networks. Whether building a new location or changing and upgrading services, Hooper said considering bandwidth is an important first step. Not only should you think about what your current needs are but also flexibility and scalability to meet future demands. As part of the planning function, he suggested looking out two to five years to think about whether or not you will have the necessary bandwidth to scale up as the practice grows or facility adds technology. “It’s not that it can’t be changed,” he said of expanding down the line, “but it’s much more disruptive. It makes it a lot more seamless if you plan for these things on the front end.” Another consideration is how long it takes to install the type of technology infrastructure that best meets your needs. For Ethernet services, Hooper said to plan 180 days out before occupying the premises or going live with the switchover. With T1, which isn’t as complicated, 60-90 days should be sufficient. “It may not take that long … but it might, and until you start investigating, you won’t know. A lot of businesses get caught off guard by not doing that,” he said of allowing ample time. Businesses must also choose between broadband or dedicated Internet service. First, you must decide how much speed you need and then how to access it. Broadband — cable, DSL (digital subscriber line), UVerse — are much less expensive but are also ‘best effort’ services. Hooper explained that means they offer ‘up to’ a certain bandwidth speed … so service up to 10Mbps means that will be the maximum megabits per second. Many clients mistakenly think that is a guaranteed speed. “It’s cheap for a reason. You share the port,” he said, adding that in order to keep costs low, these services are habitually oversubscribed. He hastened to add that isn’t necessarily a bad thing. For many, sharing nashvillemedicalnews

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an uplink isn’t a problem. “For some businesses, that’s perfectly fine. You just need to know this on the front end.” If, however, your practice or facility relies on heavy data transfer or mission critical services — like being able to transfer an image to an offsite physician — Hooper said you should consider dedicated bandwidth where you aren’t slowed by other people’s traffic. A funny kitten video that doesn’t load at home isn’t a big deal. Not being able to get a video connection for a telemedicine visit might be. Sending data securely and privately is of the utmost importance for all healthcare companies. As with everything else, Hooper said there are choices and decision to be made based on your specific needs. Multi-Protocol Label Switching (MPLS) is a family of standards in which Internet Protocol (IP) networks make forwarding decisions based on a pre-allocated label to set up paths. It’s a viable option for a facility or practice with multiple locations locally or nationally. “It’s an interstate solution so it can go across state lines,” Hooper said. He added, however, with MPLS, you cannot use multiple carriers so all sites would need to be on the same page. Metro Ethernet is a cost effective option for quick, secure data transfer in an existing Local Access Transport Area (LATA). Hooper said this option works well if you are streaming data within a single metro area. For instance, this would work if you had practices in Nashville, Murfreesboro and Franklin. However, it wouldn’t extend to an office just over the border in Kentucky or to a site in Chattanooga or Knoxville. If your enterprise is larger, then Long Haul Ethernet might be the right solution as it allows you to continue to use a familiar technology over a regional or national area. Of course, Hooper added, ensuring security and privacy with so many remote devices now being used requires active management in addition to appropriate technology. Similarly, speed and capability mean little if all that data being transferred isn’t backed up appropriately. “I always say there are two types of people — those who back up … and those who wish they had,” Hooper noted sagely. With so much emphasis on data transfer needs, Hooper said it’s all too easy to overlook voice services. “People like to talk on the phone so voice services are still critical,” he said. Working with a hospital impacted by Hurricane Rita several years ago, those calling in heard a fast busy and thought the hospital was closed. The solution was to get a message up letting the community know that although the phones still weren’t operational, the hospital was. Having that type of announcement feature or a call redirection feature can really serve as a lifeline during crucial moments for an industry that serves a critical need. Unfortunately, Hooper noted, businesses too often try to save money on the infrastructure. “It’s not the place to do this,” he warned. “You are going to get exactly what you pay for … and like anything else, there are no shortcuts.”

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A Robust HIT Platform Begins with Proper Infrastructure

Nashville’s ‘HIT’ Parade Recent Health Technology News of Note Major Changes on the Horizon for HHS Data

platforms this summer. The AARP Health Innovation @50+ LivePitch event in Boston on In late March, U.S. Health May 9 is a showcase of the hottest and Human Services Chief Techstartups in the “50 and over” health nology Officer and Entrepreneur technology market, offering acin Residence Bryan Sivak adcess not only to venture capitalists dressed an audience of Nashand angel investors but to 15,000 ville healthcare leaders to brief members and guests from across them about changes coming to the globe. Healthspek CEO Randy the way data is used as part of a Farr says it’s not only an important discussion on the HHS innovation opportunity for the company, but agenda. also a signal of market demand for At the briefing, Sivak shared a comprehensive personal health his thoughts on disrupting management tool. government culture to enable Healthspek manages all perpathways of transparency and insonal and family health information novation to facilitate the usage (L-R) Caroline Young, HHS Chief Technology Officer Bryan Sivak & Dwayne Spradlin. in one secure place, accessible of data for better health. “Infrom multiple devices anywhere sights from big data offer innoin the world. The unique myDashboard vative healthcare solutions by identifying employee performance and improve pahelps consumers track medications, vitals inefficiencies within the system and by tient satisfaction. and access care – from the app, users can providing an easier way for patients to unThe comprehensive, integrated record physician, insurance and emerderstand and make decisions about their SaaS-based revenue cycle management gency contacts, a personal photograph own healthcare,” said Sivak. solution for the point of service allows and even a signature, as well as allergies, “Big data will lead to a fundamental healthcare providers to “go-live” in a medical charts and images, and more. shift in the nation’s healthcare industry matter of days RevPoint’s technology auThe myInbox receives medical records — the biggest shift since the creation of tomates the registration workflow process and facilitates electronic communications Medicare and Medicaid,” noted Dwayne and guides registrars through each step with providers; with the patient’s permisSpradlin, CEO of Health Data Consorof the patient encounter with dynamic sion, doctors can access records through tium, who provided opening remarks at scripting. The solution integrates insurHealthspek’s chartnow.com. the Nashville Health Care Council event. ance verification, determination of mediSivak discussed the Health Data Inical necessity, real-time quality assurance Tennessee Oncology Launches tiative at HHS, which aims to liberate data edits and the individual facility’s specific Goodsnitch for more practical uses. The agency is inbusiness rules into an intuitive user interLast month, Tennessee Oncology, creasing this effort through an Open Data face. one of the largest physician-owned pracExecution Plan. Increasing access to data tices in the United States, successfully could translate into major shifts in healthHealthspek Invited to Pitch introduced Goodsnitch, an innovative, care. Sivak mentioned CMS’s Virtual ReApp at AARP’s National Expo mobile technology that allows patients to search Data Center, a terminal that offers On the heels of a 2013 provide anonymous real-time feedback secure and large volume data access to filled with honors, develabout the care they receive at clinics. approved users at greatly reduced costs. opers of the Nashville“Promoting our patients’ health in Sivak pointed out that this data could be based personal health a compassionate environment is our top used to revolutionize the way healthcare management app priority,” said Jeffrey Patton, MD, CEO of operates. Healthspek have Tennessee Oncology. “Goodsnitch “As a center of healthcare data, earned another enables us to empower our patients Nashville has a tremendous opportunity significant recby allowing them to provide valuable to lead the nation and set trends in the ognition: an infeedback about use of data to enhance care,” said Carovitation to pitch their care and recogline Young, Council president. the product to nize caregivers includthousands of consumers and prospective ing nurses, doctors and RevPoint Unveils New investors at AARP’s national expo in May. other team members.” Revenue Cycle Solution “This year we attracted 193 excellent Tennessee OncolEarlier this year, RevPoint Healthcare companies that applied to be one of our ogy patients provide Technologies, a leading revenue cycle 10 finalists,” said Jody Holtzman, AARP’s feedback in as fast as management company, launched its next senior vice president of thought leaderDr. Jeffrey 30 seconds using Goodgeneration SmartCycle™ technology, an ship. “After careful consideration, we Patton snitch’s on-site Express advanced revenue cycle management socame away with 10 strong companies who Feedback tablets or mobile app. Patients lution that enables healthcare providers to we think are poised to make an impact in express their opinions on various aspects increase overall cash collections, enhance healthcare for those 50 and over – and for of care such as check-in, check-out and everyone.” cleanliness. Goodsnitch focuses on highHealthspek is a complete iPad tool lighting the good work of others and that can be used to track, collect and privately communicating constructive critisafely disseminate personal healthcism. Also, patients recognize “everyday care information. Last year, Healthspek heroes” who provide great service. Their was featured in the App Store’s Best New evaluations allow Tennessee Oncology Medical Apps, was listed as a Top-Five to improve its practice and celebrate its Best Medical and Health Care app by Tab NASHVILLE employees. Times, and won MediaPost’s 2013 Appy MEDICAL In the first week, more than 60 paAward in the medical category. The comtients used the tablets at one pilot locaNEWS.COM pany plans to release Healthspek versions tion. Carolyn Craig, who is overseeing for iPhone, Android and Windows-based

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MAY 2014

the Goodsnitch rollout, noted that could imply as many as 100,000 points of feedback annually at scale. So far, the feedback has been very positive.

Qualifacts Releases Comprehensive Outcomes Management Tool

In March, Nashville-based Qualifacts Systems, Inc., announced the release of a comprehensive needs and outcomes management tool CareLogic IMPACT. The educational, self-service tool integrates standardized instruments directly into the clinical workflow and automated reporting gives all stakeholders, including clinicians and clients, real-time feedback. The ability to measure and track clinical improvements is a requirement of healthcare reform and value-based payment models. According to Qualifacts Chief Technology Officer Gregg Boyle, the real power of CareLogic Impact is realized through its access to the industry’s largest repository of behavioral health data. CareLogic Impact currently has embedded over a dozen standardized, evidence-based instruments, and Qualifacts is the first vendor to integrate the DLA-20™ assessment, a tool that reliably defines successful functioning in 20 independent activities of daily living and is required in several states.

UnitedHealthcare Embraces Online Bill Pay Last July, UnitedHealthcare launched myClaims Manager, which is available to more than 21 million plan participants nationwide, including 435,000 in Tennessee. The secure, online bill-payment service allows plan participants to pay their medical bills and manage healthcare claims and related expenses from one location. Payments can be made with credit cards, debit cards, health savings account or bank account via the InstaMed payments network. The technology also allows individuals to track medical expenses for tax reporting, check claims for accuracy, make notes or flag claims for follow-up, and mark entries that have been paid. To date, UnitedHealthcare is the only national insurance carrier to enable plan participants online bill-payment capabilities that are fully integrated with their online claim information. By the end of February, more than $20 million in payments had been made to more than 50,000 healthcare providers across the country using the online service. Electronic bill payment has been rapidly adopted by consumers to complete transactions with businesses from all industries. According to the financial industry research and consulting firm Aite Group, 64 percent of consumer bill payments were completed electronically in 2012, up from 49 percent in 2008.

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Vanderbilt Studies New Option for Treating Stress Urinary Incontinence By CINDy SANDERS

It’s embarrassing. It’s frustrating. And it significantly impacts the quality of life for more than 15 million women in the United States. “It” is stress urinary incontinence (SUI). SUI most commonly occurs from the loss of pelvic floor anatomic support of the bladder combined with dysfunction of the urinary sphincter. Those suffering from the condition know all too well that something as simple as a light sneeze can cause urine leakage. The contributing causes to SUI are multifactorial and include muscle weakening from childbirth, some medications, hormonal deficiencies, urethral injury, smoking, obesity, excess consumption of caffeine or alcohol over time, and years of high impact activities. Current therapies range from Kegel exercises and bladder training to inserted devices, bulking agents, and surgical options. Vanderbilt University Medical Center hopes to add to that armamentarium by serving as the principal investigation site for a clinical trial evaluating a new biologic approach to SUI. The Autologous Muscle-Derived Cells (AMDC) for Female Urinary Incontinence Sphincter Repair trial utilizes cells derived from a woman’s own muscle tissue to strengthen the sphincter muscle. The sixth study in the therapy’s development protocol, this Phase III clinical trial is available at 20 sites in the United States. The randomized, double-blind, placebo-controlled trial has begun enrolling qualified patients to assist investigators in efforts to obtain Food & Drug Administration approval to bring the promising cellular technology by Cook MyoSite to market. Roger Dmochowski, MD, professor of Urologic Surgery at VUMC, serves as principal investigator for the Nashville site. Melissa Kaufman, MD, PhD, assistant professor of Urologic Surgery, serves as study co-investigator at Vanderbilt and as the national principal investigator for the entire trial. “Stress incontinence Dr. Melissa really is an astonishingly Kauman common condition,” Kaufman said. She added the projected prevalence between 26-44 percent of adult females is probably substantially underestimated because of a hesitation by women to discuss the condition … even with their healthcare providers. Previous trials were primarily focused on the safety of this new biologic therapy, which requires a biopsy of a participant’s leg to harvest starter cells that are then sent to a lab for expansion before being implanted in the woman’s urethral sphincter. From those earlier trials, Kaufman noted, “We haven’t seen any long term complications of concern – no tumorigenicity and complications from the injections and biopsy have all been transient.” The results, though, have been very nashvillemedicalnews

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encouraging. “In these early trials, a high percentage of patients demonstrated a 50 percent reduction in stress leaks, and it has been maintained at 12 months,” she said. Kaufman added several Vanderbilt patients who participated in the Phase II trial still have complete continence four-five years out from the procedure. To participate in this final phase of investigation, potential candidates must have had some stress incontinence symptoms for at least six months and have tried a more conservative therapy without resolution of the issue. All participants will undergo the leg biopsy to secure starter cells. Then, the women will either receive a reinjection of their own cells or the placebo control dose. Kaufman noted, “We are looking to enroll 267 women in the United States with a 2:1 ratio of cells to placebo.” However, she continued, “Even women who are in the placebo arm can cross over and receive active agent at the 12-month time period.” Using an electronic diary, study participants will record data on voids, leakage, fluid intake, and pad tests for a three-day period around follow-up appointments at one, three, six, 12 and 24 months. Re-

searchers also hope to pinpoint optimal dosing. Compared to lower dose groups in previous studies, those in the 100 and 200x106 groups had the best results in stress leak reduction and pad weight at 12 months. However, all dose groups in the previous studies had statistically significant improvement in quality of life questionnaire scores at the one-year mark. As for the science behind the results, Kaufman said there are several potential mechanisms that explain the improvement. “One can be actual regrowth and regeneration in the sphincter muscle,” she explained. Another might be a paracrine role where the deposited cells augment the muscle that is already in place, allowing for new growth. Because both mechanisms rely on regenerative properties, Kaufman said patients typically begin to see improvement three to six months after the intrasphincteric injection. “It is reconstituting the sphincter so it’s an actual biologic effect rather than bulking,” she explained. “I truly believe this is a new paradigm in treatment for women with stress urinary incontinence.” Kaufman pointed out, “Women need

options and alternatives to surgical treatments. This entire therapy is office-based, which makes it very attractive.” In fact, she said, the FDA has given Cook MyoSite a special protocol leading to expedited approval pending outcomes meeting expectations in this Phase III trial. Assuming earlier findings are borne out in this final phase, she said the therapy could be widely available to women within the next few years. Kaufman added there are numerous other potential applications for AMDC that Vanderbilt researchers hope to explore in the future as part of the quest to bring novel, minimally invasive treatments to patients that are truly disease modifying.

How to Enroll If you have a female patient age 18 or older who might be a candidate for participation, please have them call 866-309-6066 or direct them to researchsui.com for eligibility criteria, more information on the study, and a national pre-screening survey.

Reducing the Impact of Stroke By DR. J MOCCO

There is a killer at work in Tennessee. In 2010, stroke killed almost 3,000 people in our state … and nationally, the damage is just as alarming. According to the U.S. Centers for Disease Control (CDC), almost 800,000 people suffer a stroke each year, and more than half of them are women. In fact, stroke is the fourth leading cause of death overall, but the third leading cause of death for women. Despite these numbers, however, many women remain unaware of their risk. Consider this: while 425,000 women suffer from stroke each year, a recent study found that less than one in three women could name more than two primary stroke symptoms. To address this lack of knowledge about the impact of stroke on women, the American Heart Association (AHA) and the American Stroke Association (ASA) have recently been promoting guidelines aimed at preventing strokes in women. If the past 10 years or so is any indication, this initiative should yield results. From 2000 to 2010, education on risk factors, symptoms and the optimal treatment window shined a spotlight on stroke that worked its way into the public consciousness. It’s not surprising then that within that same time period death rates declined — falling more than 35 percent. But the war on stroke has been waged on other fronts, as well. Since Food & Drug Administration approval of the “clot-busting” tissue plasminogen activator (tPA) in 1996, scientific advancements

have introduced neurointerventional techniques and devices that have expanded the treatment window from three hours to eight. Stroke care delivery has improved, with emergency transport guidelines and certifications that define specific personnel, equipment and treatment criteria that hospitals must meet to be deemed a primary or comprehensive stroke center. Tennessee has also taken on the challenge and is winning. The Heart Disease and Stroke Prevention Program was started in 2002 with a CDC grant to reduce the burden of heart disease and stroke in Tennessee. Since then, our state has worked to develop and implement the Tennessee Heart Disease and Stroke Prevention and Care Plan, which has successfully rallied partners to advance public education, identify barriers in access to care, and ensure emergency medical service personnel are equipped to appropriately assess patients and immediately transfer them to a hospital with comprehensive or primary stroke center status. Stroke — perhaps more so than any other disease — requires a coordinated, multi-disciplinary effort to ensure the efficient deployment of appropriate care. We effect successful outcomes by bringing together physicians from many different disciplines, all of whom contribute their expertise to provide appropriate treatment within a narrow time window. While the results of our efforts in individual institutions, as well as statewide, are commendable, there is still more work to be done. Neurointervention — its success evident in thousands of lives saved

— must continue to be evaluated in clinical trials. Patient registries are critical to ensuring process improvement and better outcomes. And hospitals must embrace coordinated care models that leverage the expertise of specialists from various backgrounds to ensure optimal patient care. To that end, the Society of NeuroInterventional Surgery was in Nashville recently as part of a national stroke summit tour to advance the dialogue among the “stroke team” professionals involved in the diagnosis, treatment and management of stroke. These summits welcome first responders, emergency room physicians, radiologists, neurologists and neurointerventional surgeons, and others who specialize in stroke treatment to discuss trends, treatment advancements and best practices in stroke care delivery in the hospital setting. Someone suffers a stroke every 40 seconds in the U.S. — and our wives, mothers, aunts and sisters are bearing the brunt of this deadly disease. But, researchers, physicians, advocates and lawmakers have proven themselves undeterred in the face of this enemy. I am proud of our work in Tennessee to reduce the impact of stroke. Building on our accomplishments, and with this new initiative to promote collaboration and strengthen the stroke team within the hospital environment, the battle is ours to win. J Mocco, MD, MS, is a member the Society of NeuroInterventional Surgery, an associate professor of Neurological Surgery, Radiology and Radiological Sciences at Vanderbilt University Medical Center, and an associate editor of the Journal of NeuroInterventional Surgery.

MAY 2014

Identity as a Risk Factor Heart Disease and the Feminine Mystique By CINDY SANDERS

Despite the fact that heart disease is the number one killer of women in America and stroke the leading cause of disability, women often don’t identify with the very real dangers the disease holds for their gender, according to Robert Wood Johnson Foundation Clinical Scholar Lisa Rosenbaum, MD. “We all know men drop dead of heart atDr. Lisa tacks … we don’t think of Rosenbaum women dropping dead of a heart attack,” the University of Pennsylvania cardiologist noted of the masculine attributes often attached to heart disease. Furthermore, women tend to fear other diseases, notably breast cancer, more than heart disease. The HealthyWomen 2010 survey, in partnership with the National Stroke Association and the American College of Emergency Physicians, found that women believe breast cancer is five times more prevalent than stroke, and 40 percent of those surveyed were

‘only somewhat’ or ‘not at all’ concerned about experiencing a stroke. Yet, stroke is significantly more prevalent in women than in men, and stroke kills twice as many women as breast cancer each year. “There’s a certain sort of female solidarity around breast cancer,” Rosenbaum stated. In a perspective piece published earlier this year in the New England Journal of Medicine, Rosenbaum wrote about an encounter with a middle-age woman with high blood pressure and hyperlipidemia. When Rosenbaum asked the new patient what was the number one killer for women, she noted the patient “answered in a way that sticks with me: ‘I know the right answer is heart disease,’ she said, eyeing me as if facing an irresistible temptation, ‘but I’m still going to say breast cancer.’” Rosenbaum is quick to say breast cancer is a valid concern, but the emotions linked to the disease go beyond just the facts. She pointed to the controversy surrounding mammography as a clash between data and identity at the social level. Despite a recommendation from the U.S. Preventive Services Task Force to de-

crease mammography frequency for most women under age 50 based on decades of data, Rosenbaum wrote, “So intense was the outrage over these evidence-based recommendations that a provision was added to the Affordable Care Act specifying that insurers were to base coverage decisions on the previous screening guidelines.” No matter where you stand on mammography, most healthcare professionals are united in agreeing lifestyle modifications and appropriate use of medications have been proven to prevent heart disease and save lives. However, Rosenbaum contends that facts alone aren’t enough. Instead, she said the healthcare community needs to find a way to tap into the emotional aspects of heart disease as successfully as has been done with breast cancer. In the her perspective piece, Rosenbaum wrote that although the first decade of educational campaigns such as Go Red for Women “led to a near doubling of women’s knowledge about heart disease, in the past few years, such efforts have failed to reap further gains.” She told Medical News, “Our default in medicine is to give people facts, and then

Expect With Me National Study Looks at Group Prenatal Care By CINDY SANDERS

Vanderbilt University, United Health Foundation and Yale University are collaborating on a national study to evaluate the effectiveness of a new model of group prenatal care designed to improve the health and well-being of mothers and babies during pregnancy, birth and infancy. Initial participants are invited to join a study that will evaluate the model and each mother’s experience with group prenatal care. Expect With Me, is based on clinical guidelines from the American Congress of Obstetricians and Gynecologists and the American College of Nurse Midwives. The design and delivery of the program was created based on evidence from two National Institutes of Healthfunded studies that found that prenatal care delivered in a group setting was associated with fewer preterm births, reduced incidence of infants who are small for their gestational age, and shorter neonatal intensive care unit stays after birth when needed. The program provides valuable social and emotional support in addition to standard prenatal care, education and skills. While expecting mothers typically spend 15-20 minutes with their doctors at each visit in traditional prenatal care, Expect With Me features 10 two-hour care sessions during the second and third 8

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trimesters, with the first few sessions held one month apart, moving to biweekly care later in the pregnancy. Each care session includes a physical assessment by a healthcare provider, an evaluation of the mother’s and baby’s vital signs, and a group education, skills-building, and discussion session. Expect With Me also includes a secure web portal and social networking features that enable expectant mothers to stay connected between care sessions and have access to a strong support network. Incentives, gaming and videos are anticipated to help patients engage, follow care recommendations and promote better health among mothers and babies. This model of care will provide more than 1,000 women ages 14 and older with medical care from a physician or midwife and educational information on having a healthy pregnancy. Participants also benefit from peer support from other expecting mothers who participate in the group sessions. Expect With Me aims to enroll at least 400 women in the pilot in Nashville. Those interested can enroll at either Vanderbilt Health One Hundred Oaks or NorthCrest Medical Center in Springfield, Tenn. “Expect With Me values creativity, innovation and a commitment to always doing what is right for expectant moms and their families,” said Deborah Wage, FNP, CNM, assistant professor of Ob-

stetrics and Gynecology at Vanderbilt University. “Expect With Me is a result of those values – a group care model meeting the needs of women using high-tech, social, web-based tools and the low-tech benefits of support and empowerment from the group. Vanderbilt is proud to be a part of this innovation.” “Our hope is that Expect With Me will be a model for a nationally scalable method of care that works with community-engaged organizations and healthcare partners to meet the ‘triple aim’: better care, better outcomes and reduced cost for prenatal and postpartum care, added Jeannette Ickovics, PhD, professor, Yale School of Public Health. While aimed at women in their first trimester, participants may enroll up to 24 weeks into their pregnancy. Commercial insurance, Medicaid or TennCare will cover Expect With Me as it would any other prenatal care. Vanderbilt has offered group prenatal care at Vanderbilt One Hundred Oaks for several years, which led to the partnership with Yale University and United Health Foundation to create Expect With Me, Additional in-kind support was provided from UnitedHealth Group and the UnitedHealth Center for Health Reform & Modernization. United Health Foundation is currently launching and studying pilot programs in Nashville, Detroit and McAllen, Texas.

we don’t know what to do when we hit the wall. We know how to disseminate facts … we don’t know how to change feelings.” Complicating the issue with heart disease is that in so many cases it is preventable, and therefore comes with built-in guilt. Risk factors, which have been well publicized, include smoking, obesity, high blood pressure, high cholesterol, and sedentary lifestyle. “All of these are embedded with a sense of not taking care of yourself,” Rosenbaum said. “You should have done something differently.” Conversely, breast cancer is imbued with a sense of having a terrible disease visited upon a victim, which is true. Also, because breast cancer kills more women at a younger age than heart disease, there are multiple media images of beautiful, strong heroines fighting and surviving … or succumbing … to a disease that attacks a body part that is so uniquely feminine. Rosenbaum pointed out Angelina Jolie’s message about breast cancer resonated with women across the nation who saw the actress as a lovely, brave, fierce role model. Again, she stated, it isn’t ‘bad’ that breast cancer has pushed its way to the front of female consciousness. It’s smart … and perhaps it’s the type of message the field of cardiology should consider to reach more women. However, Rosenbaum said it isn’t fair to ask healthcare providers to try to change identity beliefs in a brief office visit. Instead, she said the subject requires research regarding social values and group identity. Ultimately, Rosenbaum added, cultural messaging will likely come from a variety of sources including media outlets. Today, she said, “Our biggest challenge is translating what we know into better health of our population. The next phase of evidence based-medicine should be as much about figuring out how to communicate that evidence to our patients … to do that we have much to learn from the methodological approaches of the social sciences.” Rosenbaum added the starting point to address women’s perceptions of heart disease should be to conduct focus groups to evaluate where emotional beliefs currently stand and assess the impact of framing messaging in different ways. “This is decades worth of work,” she stressed, “to ultimately understand not just how they feel and where those feelings come from, but to evaluate whether there are appropriate interventions that help women adopt more heart-healthy behaviors.” While heart disease might have a decidedly masculine feel, there’s no reason why research can’t point to ways to soften the message and appeal on an emotional level to women, as well. After all, women are often identified with their capacity to love … the trick will be finding the right words to help a woman celebrate her big heart while being cognizant of the dangers that come with having an enlarged one. nashvillemedicalnews

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‘Nurses Lead the Way’ at Nursing Leadership in Global Health Conference National By: MELANIE KILGORE-HILL

In late February, more than 225 nurses, students and healthcare advocates from around the world gathered at Nashville’s Loews Vanderbilt Hotel for the first ever Nursing Leadership in Global Health (NLGH) Conference. Coordinated by Vanderbilt University’s Institute for Global Health, the two-day symposium included representatives from 14 countries including Uganda, South Africa, Saudi Arabia and the United Kingdom. The overarching issues facing nursing today are echoed in this month’s annual celebration of National Nurses Week, May 6-12, which carries the theme ‘Nurses Leading the Way.’ A Global Need Conference coordinator Carol A. Etherington, MSN, RN, associate director of Community Health Initiatives for the Vanderbilt Institute for Global Health, said the idea surfaced about 18 months ago with the original intent to host a small summit of 25-50 global health nurses. “The thought was to initiate a debate about how nurses, as a group, Carol A. are continually the people Etherington most often implementing programs, yet least often involved in discussions about how to design and carry out implementation on a local, national and international level,” Etherington recalled. As plans progressed, the idea of assembling an unprecedented group of global health experts seemed amiss without the presence of all those eager to tackle issues hands-on … from recent nursing grads to retired RNs. “Across the career spectrum we really wanted to engage as many people as possible,” Etherington said. Conference Objectives According to the NLGH, nurses deliver 90 percent of healthcare to the world; yet finding them at the upstream end of decision-making and planning is an exception rather than the norm. Etherington said the objective was to focus on vulnerable populations in resource-limited settings — typically the greatest challenge for the global healthcare workforce — by strengthening the presence of nursing in creating health policy and programming. To that end, conference goals included: • Discussing complex and competing forces that influence the health of individuals and populations around the world; • Identifying challenges, barriers, nashvillemedicalnews

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and solutions to increasing nurse leadership and integration in decision-making; • Describing essential components for successful collaboration with traditional and nontraditional partners to impact policy; and • Developing pathways to lead to effective advocacy and activism in improving health of patients and populations. 14 Countries, 1 Common Thread “We planned sessions based on areas we thought were priority,” Etherington said. “We didn’t want to open up a vast menu of issues but wanted to focus on a lot of paths always going back to same thought of, ‘How do we improve healthcare of the population by increasing and elevating the voice of nursing?’ People got that. While they may have attended a session on human rights or healthcare workplace issues, it always came back to same message that it’s important to push the envelope — to voice a louder voice and be a stronger patient advocate.” Speakers from across the globe presented lectures on leadership and management, policy advocacy and field en-

Nursing Week

gagement. Interna“We didn’t expect tionally recognized to walk away with speakers included a 10-point action May 6-12, 2014 Tennessee Senator plan. Outcomes were Bill Frist, MD, and global less about how many nursing advocate Her Royal people came from where or Highness Princess Muna Al-Hussein of what fields they represented. We would Jordan, accompanied by her country’s consider it successful if leadership nursing team. The interdisciattendees went away plinary panel included health advocates having had rich converboth in and outside the field of medicine – sation about the issues leading lawyers, global health experts, and at hand, especially how representatives from groups like Save the to become advocates for Children. this population. Our goal “While we had exceptional speakwas to really get people Amy ers, we also had exceptional attendees, thinking and working Richardson including a lot of people in the audience outside of their comfort who could have been keynote speakers zones and to encourage collaboration and themselves,” Etherington noted. “The vast innovation.” majority saw this as a uniquely different apNetworking was hands-down the proach to carrying out patient care.” greatest outcome, said Etherington, who has already received reports of collaboraResults Please tion among attendees from Africa and the Measuring results of a global conferMiddle East. ence addressing the world’s greatest health “That is one of those real pluses we challenges is no easy feat. While a posthoped would happen, and we feel it has in event survey gave organizers high marks a way we could never have imagined,” she both in content and CEU quality, the goal noted. was to begin a discussion that each attendee While each attendee brought a unique would continue back home. worldview, each also recognized true “Before even talking to potential change in global health requires more than speakers, we looked at how we would lofty goals, rhetoric and words. measure success, as this was the first time “Making a change requires effort to this type of event has happened with this establish relationships and to have people particular focus area,” said Amy Richsee the problem as their own communal ardson, MPH, program manager for the priority, not someone else’s,” Etherington Vanderbilt Institute for Global Health. concluded.

Marian University at Saint Thomas Health, continued from page 1 nurses is not keeping pace with that anticipated demand. Exacerbating the issue is a capacity problem. The American Association of Colleges of Nursing estimates 30,000 or more qualified candidates have been turned away from nursing education programs annually for more than a decade due to space constraints. Marian University at Saint Thomas Health is designed to address the nursing shortage in Tennessee and nationally by launching a new program to educate highly skilled, compassionate professionals

with bachelor’s degrees in other fields. The professional nursing curriculum is concentrated in a 16-month period after the successful completion of prerequisites. The program culminates in a bachelor’s degree in Nursing (BSN) that prepares students to earn their RN license after graduation. Students complete lecture-based courses online and engage in onsite clinical experience at facilities that are part of the Saint Thomas Health network. Classes begin May 12 for the inaugural group of students.

Stauffacher Named Onsite Advisor for Marian at Saint Thomas Amy Stauffacher was recently named Nashville admissions advisor for Marian University at Saint Thomas Health. Stauffacher will manage the expanding number of program applicants, the enrollment process, academic evaluation and applicant advising. She also will be involved in in-person recruiting and community outreach for the accelerated nursing program that was announced last December. “We are excited to welcome Amy to the Marian University at Saint Thomas Health family,” said Julie Smith, regional site director. “Her background will provide a broad base of experience to our organization and the students we serve, which is ideal given the diverse backgrounds of our students.”

“We are thrilled to be officially opening the program’s doors in preparation for welcoming the inaugural class of nursing students,” said Jennifer Elliott, RN, vice president of Clinical Operations for Saint Thomas. “Ours is a partnership between two organizations sharing the same values, the same commitment to exceptional education and the same focus on accelerated learning to help alleviate the projected national nursing shortage crisis.” In addition to being the first program in Middle Tennessee to offer those with a bachelor’s degree the opportunity to earn a BSN through a combination of online courses and hands-on clinical training, Marian University at Saint Thomas Health brings together two organizations with the Catholic roots and spirituallycentered mission of delivering high quality, holistic care. Numerous studies have shown a direct correlation between a nurse’s level of education and the quality of patient care. The Institute of Medicine has recommended increasing the portion of nurses with a baccalaureate degree to 80 percent by 2020.

MAY 2014

TMA Installs Volunteer Leadership The pomp and ceremony surrounding the presidential succession of the Tennessee Medical Association is always a highlight of the annual meeting. This year was certainly no exception as the gavel passed from Chris Young, MD, to Doug Springer, MD, who was installed as TMA’s 160th president with John Hale, MD, stepping into the president-elect position. President: Douglas J. Springer, MD, FACP, FACG, is a gastroenterologist from Kingsport. Originally from Canada, he moved to Tennessee in 1978 as part of a young physicians’ program to move doctors to underserved areas of the state. Now a naturalized U.S. citizen, Springer has practiced his specialty for 35 years in Upper East Tennessee. A Fellow of the American College of Physicians and American College of Gastroenterology, Springer has been actively involved in several professional medical associations and is a past president of the Sullivan County Medical Society and past chair of TMA’s membership committee. He also has held professional service positions including reviewer for examinations for the American Board of Internal Medicine and chairman for the Department of Medicine at Indian Path Medical Center and Holston Valley Medical Center. Springer received his medical degree from the University of Calgary, Alberta, where he also completed his residency in Internal Medicine. He then undertook a fellowship in Gastroenterology at Queen’s University in Kingston, Ontario, Canada. He is board certified in both Internal Medicine and Gastroenterology. President-Elect: John W. Hale, Jr., MD, is a family medicine practitioner in Union City. Hale has been actively involved with the TMA since his student affiliation while at East Tennessee State University (ETSU). A three-time member of the TMA Board of Trustees, Hale has served in the House of Delegates (HOD) for 22 years. Immediately prior to his new position, Hale completed terms as speaker of the HOD and chair of TMA’s legislative committee. He is a past chair of the young physicians group and past AMA delegate in that role. Additionally, Hale has served as a past president and secretary of the Northwest Tennessee Academy of Medicine and is a past IMPACT board member. Hale earned his medical degree from ETSU’s Quillen College of Medicine and completed his residency at Jackson-Madison County Hospital.

MedTenn 2014, continued from page 1 comparative data,” he stressed, adding it is important that decisions are based on clinical data and not just on claims data. The TMA is keeping a close eye on innovation grants tied to TennCare with the recognition that payment reform will ultimately expand to commercial payers, as well. “We realize the success of these pilots is directly in the hands of the physicians doing the Russ Miller work,” Miller said. “We’ve got to get it right at the onset. If we need to take a little extra time to make sure what we measure matters, it will benefit the patient and profession.” From a public health standpoint, Miller said, “There are a couple of issues that need resolution in short order.” One, he continued, is Tennessee’s prescription drug problem. “I think we’ve got awareness at a high level,” he said of past efforts to draw notice to the problem. “Now, our attention is more focused on providing solutions to the misuse and abuse of prescription drugs.” TMA has been closely involved in crafting continuing medical education seminars tied to prescription drugs and opioid use in the state. The latest CME iteration (see article below) was launched during MedTenn ’14 in response to recent legislative requirements pertaining to controlled drug prescribing and licensure renewal. The two-hour course also will be presented around the state in the coming weeks.

Prescribing Guidelines for Pain Management & Patient Safety The fourth in a series of continuing medical education seminars tied to prescription drug use and abuse, the 2014 course fulfills a new legislative requirement that medical doctors and osteopathic physicians take an approved two-hour class in controlled drug prescribing in order to renew their medical licenses in 2015. “Since 2007, the health-related boards have required physicians to have one hour of CME in proper prescribing. Beginning this year, they now require physicians to have two hours of CME,” explained Roland Gray, MD, FAAP, FASAM, medical director for the Tennessee Medical FounDr. Roland dation. Gray Gray has has been instrumental in crafting and presenting all four TMA-affiliated workshops since the educational series was launched in 2007, shortly after the Controlled Substance Monitoring Database went live in Tennessee. The original course was designed to educate prescribers about the growing prescription addiction problem nationally and in Tennessee. The second workshop, Are You Smarter than a Drug Seeker, offered tricks and tips to identify doctor shoppers, scams and problem patients. The third in the series — Epidemic: Prescribers’ Response to Tennessee’s Rx Drug Abuse Crisis — debuted in 2012 and 10

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focused on how the problem has evolved over the past two decades, the proper use and responsible management of pain clinics, and the importance of educating patients about the medications being prescribed. The 2014 edition hones in on new guidelines crafted by a state advisory panel that were released earlier this year and can be accessed on the Department of Health website (health.state.tn.us/providers.htm). Gray, who was part of the guidelines steering committee, said with the exception of cancer pain, there really haven’t been clinical guidelines for chronic pain on a national or state level. “We wanted to come up with guidelines to stem the tide of the complications of overuse and misuse of opioids in Tennessee,” he said. Gray continued, “We recognize these medications have a legitimate place in medicine, and we wanted those with chronic pain syndromes to be able to continue to be treated.” He added highlights of the two-hour course feature a summary of the new guidelines including steps to take prior to initiating opioid therapy, an update on the Controlled Substance Monitoring Database and details about the requirements to be a pain management specialist in Tennessee. Starting July 1, 2016, he continued, to run a pain clinic or work in one as a pain specialist, the guidelines call for the provider to be certified by the American Board of Pain Management or be fellowship trained in pain management. “Right now, we have over 90,000 Tennesseans on really high dose opioids,”

Gray said, adding a provider with specialized training should see those in need of such high dosages. He stressed, however, the new guidelines don’t apply to hospice care, emergency room care, or acute pain management. “We wanted to make sure primary care providers and family physicians would continue to be able to care for the more common forms of chronic pain in their offices,” he added of the guidelines for prescribing 100 milligram morphine equivalent daily dose (MEDD) or less. Gray said the course also includes information on changes in opiate warnings and schedules. With neonatal abstinence syndrome (NAS) creating heartbreaking problems for infants, the Food & Drug Administration has added a black box warning for the use of long-acting or extended release opiates during pregnancy. “And for hydrocodone, which is the most prescribed drug in Tennessee, the FDA is in the process of changing it from a Schedule III drug to a Schedule II drug … that comes with a lot more regulations,” he said. In addition to the CME session held during MedTenn 2014, the course will be presented in Memphis on May 6, Nashville on May 7, and Knoxville on May 8. The prescribing workshop also can be presented live by request at local and regional medical society meetings or taken on demand as part of TMA’s web-based training. For more information or to request a presentation, contact Angie Madden at angie.madden@tnmed.org

Another public health issue on the front burner is the expansion of Medicaid in Tennessee. “As doctors in Tennessee, TMA believes it’s the right thing to do at the end of the day. It’s documented that people with access to healthcare and health insurance lead longer, healthier, more productive lives,” Miller said. He continued, “Healthcare supports expansion … politics has to figure out how to pay for it. Our position comes from what’s right for patients, but we’re going to continue to work with legislators to find a solution we can all live with.” In addition to tackling the serious business of medicine, attendees also got to have a little fun and give back at the same time. Miller noted TMA opted to forego the traditional banquet following the presidential gavel exchange in favor of a fundraiser this year benefitting the Pat Summitt Foundation, which provides grant funding in the fight against Alzheimer’s disease. Miller said physicians generously give of their time and resources throughout the year. The TMA team thought it was highly appropriate to support that spirit by giving back as an organization to a medical issue impacting millions of families across the country.

The Economic Impact of Tennessee Physicians A report released last month by the America Medical Association in conjunction with state medical societies underscores the enormous inﬂuence physicians have on national and state economies. Looking at approximately 720,000 physicians in the United States primarily engaged in patient care (as opposed to physicians focused on research and teaching), the study found physicians create healthy communities in ways that extend far beyond the delivery of medical care. Nationally, patient care physicians contributed $1.6 trillion in economic activity and supported 10 million jobs in 2012. “Physicians carry tremendous responsibility as skilled healers, trusted confidants and patient advocates, but their positive impact isn’t confined to the exam room,” said AMA President Ardis Dee Hoven, MD. “The new AMA study illustrates that physicians are strong economic drivers that are woven into their local communities by the jobs, commerce and taxes they generate.” She added those dollars support schools, housing, transportation and other public services in local communities. In Tennessee, patient care physicians support more than 143,000 jobs and more than $11.7 billion in wages and benefits. Additionally, those physicians contribute to a total of $618.8 million in local and state tax revenues and generate $20.1 billion in economic activity for Tennessee. On average, each physician supported 10.21 jobs with an average of more than $834,000 in total wages and benefits, contributed more than $44,000 in local and state tax revenues, and generated more than $1.4 million in direct and indirect economic output.

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HealthcareEnterprise

May is Mental Health Awareness Month

Mental Health Cooperative Brings Hope, Healing to Tennessee Patients By: MELANIE KILGORE-HILL

tent mental illness and serious emotional disorders. Founded in 1993, the behavioral health agency provides outpatient illness management, rehab and recovery with a focus on the underserved. In 2013 more than 22,000 clients (including 6,600 children) were served through their nine middle Tennessee facilities.

Each May, the medical community pauses to give extra attention to the very real subject of mental illness. According to the National Institute of Mental Health, more than 40 million Americans suffer from anxiety related disorders, while 20 million are afflicted with mood disorders Healing Body & like major depresMind sive disorder and Last year, the bipolar disease. AnMental Health Coother 2 million adults operative (MHC) exhave schizophrenia. panded to include an Add it up, and that’s integrated health clinic more than 26 perto offer primary care Amanda Bracht cent of Americans services for patients. suffering from menMore than 400 have tal disorders any given year. received primary and well woman checkAs experts work to unlock the mysteries of ups since the program kicked off in July. the mind and do a better job of integratMHC also provides wellness education ining mental and physical health, Nashville’s cluding smoking cessation classes, which Mental Health Cooperative is bringing have helped several patients kick the habit. hope to adults and children with persis“We know a lot of people with serious

and persistent mental illness die 25 years earlier than the general public, often due to lack of access to primary care or because they don’t actively seek it out,” said Amanda Bracht, LCSW, chief clinical officer for MHC. Lifestyle choices and medication (with its sometimes negative side effects) also contribute to shortened life expectancy, especially among those who fall below the poverty line. For many mentally ill patients, a lack of primary care means frequent visits to the emergency room, driving up hospitals costs and landing patients in an environment with limited resources for mental health needs. “One thing we noticed right away is that so many are getting physicals for the first time in years,” Bracht said. “Many can’t tell us when they last saw a primary care doctor, and we’ve had 40-yearold women who’ve never a had a well woman exam. We’re focused on increasing overall wellness and healthy lifestyles.” Providing primary care to mental health patients has a unique set of challenges, which MHC’s staff is accustomed to meeting. Appointments require substantially more office time compared to a traditional

primary care clinic, often due to patients’ distrust of medical providers. And while patients might otherwise ignore primary care appointments, MHC’s hands-on case management personnel help schedule appointments and ensure patients follow through. MHC & Pediatric Patients MHC also is integrating primary care and mental health for pediatric patients, who often suffer from severe forms of ADHD. A new initiative locates clinicians inside pediatric offices, allowing patients to receive comprehensive medical care in one location. The program currently is underway at Springfield Pediatrics and Lebanon’s Cumberland Pediatrics, with three more area partnerships in the works. “It’s been a great arrangement, and we’ve had immediate success with patients getting connected to a child psychologist who can consult with the pediatrician to determine the best course of treatment,” Bracht said. “There’s also an element of comfort for the pediatrician knowing they’re doing the right thing for the patient.” (CONTINUED ON PAGE 12)

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MAY 2014

HC Enterprise, continued from page 11 Overcoming Stigmas Bracht, who has been with MHC since 1997, has seen positive steps taken in overcoming the social stigma once attached to mental illness. “More people now understand that mental illness is a disease that affects the brain and isn’t due to bad parenting or lifestyle choices per se,” noted Bracht, who also provides mental health training to the community and law enforcement. “In my time here, there have been wonderful changes. People are more willing to access resources than ever or admit when they or someone in their family has dealt with mental illness.” Hope Through Early Diagnosis Within the greater healthcare community, an ongoing obstacle is getting providers to recognize signs and symptoms of mental illness early on, before crises occur. The sooner diseases like schizophrenia are diagnosed and treated, the better the patient’s long-term prognosis. Bracht encouraged practitioners to educate themselves on mental health resources available in their community and to develop partnerships and an ongoing dialogue with groups like MHC. Their 488 staff members include a large number of bachelor’s or master’s level case managers, and master’s level therapists and crisis counselors. MHC also boasts six full time psychiatrists, 14 nurse practitioners and a peer specialist whose own experience with mental illness supports and encourages patients. “Mental illness can be very scary, but we’re able to educate clients about proper treatment and let them know that there is life after diagnosis, and that our younger clients can go on to college and have a career,” Bracht said. “They just need the right support and to know it’s okay to seek out mental health treatment. The earlier they get it, the better outcomes will be.”

Online Event Calendar To submit or view local events visit the Nashville Medical News website. A user name and password are required to submit an event. Under Member Options, go to “free sign up” to register.

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MAY 2014

SANS Cyberthreat, continued from page 3 that can be done to get started with protection,” Filkins noted. The most obvious … but clearly overlooked … is to change those default passwords. However, she continued, changing to an easily deciphered password isn’t much help. Avoid using your children’s names, street address, pet names, combined physician names, name of the practice, or other easily discernable choices. The best passwords, Filkins said, include numbers and unique characters. Mobile devices can also cause headaches … in part because of unrealistic expectations and policies. “Everyone uses mobile devices,” Filkins stated. “Rather than trying to bury that and say, ‘oh, we never use mobile devices,’ maybe relax the punitive policies and instead say, ‘let’s get honest and ﬁgure out how to make them more secure.’”

Measures to Improve Security

“Know what’s on your network,” Filkins said. “Make sure your network is configured properly and devices are configured properly.” She added it’s important to know who is using what, and how it’s being used. Having a strong password policy is critical to proper configuration. “Think like an attacker,” she continued. “And if you can’t do it, get someone who can.” There are numerous resources and companies that can help with this task. It boils down to being aware, Filkins noted. “It’s basic awareness but in a digital world.” She continued, “Know what your network pathways are for your organization.” Filkins said that often there’s an emphasis on protection for “bad things coming in” … but if something does penetrate the system, there isn’t much monitoring of outbound traffic. Egress filtering is as important as ingress protection.

The Cost of Failure

The healthcare industry is particularly attractive to cyber attackers because of the type of information housed on servers. With medical identity theft, the victim is responsible for costs related to a compromised medical insurance record. A survey by the Ponemon Institute last year estimated that cost to be $12 billion in 2013. Security breaches also represent major costs to the compromised entity. Steep fines, incidence handling, victim notification, credit monitoring for victims, and potential legal action represent direct outof-pocket expenditures. In addition, a data breach could also significantly harm reputation and future business opportunities. The greatest cost, however, is to a patient who winds up with inaccuracies in his medical record that could result in a misdiagnosis or wrongly prescribed medication.

The Takeaway

“Today compliance does not equal security,” Filkins wrote. “Organizations may think they’re compliant, but this data shows that they are not secure.”

GrandRounds Time to Slip, Slop, Slap, Seek and Slide Now that winter has finally been banished, the Tennessee Department of health is reminding providers to talk to patients about the importance of taking sun precautions while enjoying the great outdoors. TDH suggests using the international “Slip, Slop, Slap, Seek and Slide” message: Slip on a shirt and long pants. Slop on 30 or higher SPF. Slap on a hat. Seek shade or shelter. Slide on sunglasses.

Wishes Granted

The Vanderbilt Kennedy Center will serve as the lead site for a $500,000 grant focused on building capacity of faith communities, such as churches, mosques, synagogues and other religious organizations, to support employment for members with disabilities. Funded by the Kessler Foundation, the focus of the project, called “Putting Faith to Work,” is to enable faith communities to address employment needs of members with disabilities by connecting them to quality employment opportunities through the natural networks represented by congregational members. Each research site will invite congregations of varying faith traditions to support individuals with physical and/or developmental disabilities in securing and maintaining employment in the community. Through a $5.5 million donation from San Francisco businessman Bernard Osher, Vanderbilt’s Center for Integrative Health will join the existing group of Osher Centers for Integrative Medicine and will now be known as the Osher Center for Integrative Medicine at Vanderbilt University. “This generous gift will enable Vanderbilt to play an increasingly significant role in the field of integrative medicine,” said Jeff Balser, MD, PhD, vice chancellor for Health Affairs and dean of the Vanderbilt University School of Medicine. “The gift also gives Vanderbilt the opportunity to collaborate with the Foundation’s other centers for integrative medicine as we seek to increase knowledge, develop new clinical programs, and train students in this emerging discipline.”

Recent Certifications, Accreditations & Commendations The Centers for Medicare and Medicaid Services recently gave five stars to Life Care Center of Hickory Woods, a skilled nursing and rehab center in Antioch. The CMS ratings system, designed to help the public choose quality care, calculates the ratings based on results of health inspections, staffing and quality measures (including pain management, pressure ulcers, weight loss and number of medications used). Robert Eddy, CPA, Forensic Valuation Consultant, recently received two professional certifications in the business

valuation industry. He successfully completed the certification process with the National Association of Certified Valuation Analysts (NACVA) to earn his designation of Certified Robert Eddy Valuation Analyst (CVA) and with the American Institute for Certified Public Accountants (AICPA) to earn the Accredited in Business Valuation (ABV) designation.

HCA Partners with Entrepreneur Center HCA Holdings, which has spun of more than a few healthcare companies of its own, has partnered with the Nashville Entrepreneur Center to support startup growth and development within the city’s healthcare sector. “As our healthcare industry continues to evolve, we continually are seeking ways to improve the Milton Johnson delivery of high-quality care and the patient experience,” HCA President and CEO R. Milton Johnson said. “Nashville has a tradition of innovation and entrepreneurship, particularly in healthcare, and we are proud to support the great work by the Nashville Entrepreneur Center.” The EC also recently announced a partnership with Nashville’s CapStar Bank.

Avondale Partners Names Morphett Head of Investment Banking Avondale Partners, a national investment banking and wealth management firm headquartered in Nashville, has named Jonathan Morphett as the head of investment banking. Morphett joined Avondale in 2004 as head of healthcare investment banking, where he helped Jonathan establish the firm as a naMorphett tionally recognized provider of advisory and capital raising services for public and private companies. Since his arrival, the firm has closed $15 billion of assignments for healthcare firms throughout the country. Prior to Avondale, Morphett founded Australian corporate finance advisory firm Rosebrook Ventures. He is a former investment banking managing director at Morgan Stanley where he served in various positions for 14 years, primarily in New York and Sydney, Australia. Morphett is a former board member of the Nashville Health Care Council.

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GrandRounds Meharry Research Day In March, more than 150 Meharry Medical College students participated in the 58th annual Student Research Day. Presentations centered on finding healthcare solutions for diseases impacting underserved populations and included findings on a range of topics from the impact salt intake has on heart health to the effectiveness of drugs for treating aggressive melanoma. Hosted by the School of Graduate Studies and Research, the event featured Goldie S. Byrd, PhD, a 1986 Meharry graduate, as the James A. Pulliam Memorial Lecture keynote speaker. Leah Banks, a 2015 PhD candidate at Meharry, received the grand prize for best overall research for her presentation on olive oil and its protective effect against colon cancer.

TriStar Centennial Names Administrative Director of Surgical Services TriStar Centennial Medical Center recently announced Ricky Yates, CRNFA, CNOR, has been named administrative director of surgical services for TriStar Centennial Women’s Hospital and The Children’s Hospital. Most recently, Yates served as director of Surgical Services at Williamson Medical Center. He brings more than 19 years of nursing leadership experience in surgical services. Yates completed his associate’s degree in Applied Science Nursing from Tennessee State University and earned his bachelor’s in Health Arts from Saint Francis University.

Broome Joins Saint Thomas Endocrine Surgical Specialists James T. Broome, MD, who specializes in endocrine surgery, has recently joined Saint Thomas Health. Board certified in general surgery, he will operate the newly created Saint Thomas Endocrine Surgical Specialists. His clinical interests include the surgical management of diseases of the thyroid, parathyroid, adrenals and pancreas, as well as neuroendocrine tumors. Broome earned his undergraduate degree from Harvard University and his medical degree from the University of Michigan Medical School. He completed his internship and residency at Vanderbilt University and the Norman W. Thompson Fellowship in endocrine surgery from the University of Michigan Medical School.

ReviveHealth Celebrates Strong First Quarter

The year has started off on a high note for ReviveHealth. In March, the Nashville-headquartered strategic communications firm specializing in healthcare clientele received the honor of Small PR Agency of the Year at PRWeek’s annual industry awards dinner in New York City. The national recognition comes on the heels of tremendous growth in 2013

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with the addition of 11 staff professionals in 2013. That growth has continued in the first quarter of 2014. In late March, Valence Health, a leading provider of clinical integration, population health and value-based care solutions, selected the firm its healthcare communications and public relations strategy partner. ReviveHealth has also added four more team members and promoted two in the last several weeks. New hires are Ashley Merchant as account supervisor, Chance Strickland as account executive, Lauren Cerra as account executive, and Andrew Worthing as assistant account executive. Lana Taussig was promoted from account supervisor to senior account supervisor, and Bethany Doty from assistant account executive to account executive.

Last month, nearly 8,000 Middle Tennesseans turned out for the 2014 March for Babies sponsored by Saint Thomas Health and benefitting the local chapter of the March of Dimes. The event raised more than $600,000.

Virtual Reality Simulator Hones Eye Surgery Skills Virtual reality environments are a common feature used in the aviation industry to train pilots, and now they’re also proving to be a very effective tool in educating the next generation of ophthalmological surgeons at Vanderbilt University Medical Center. Vanderbilt is one of a handful of programs in the country using the traditional hands-on teaching mechanism of the wet lab in addition to the newest surgical teaching devices, such as the Eyesi Surgical, a high-fidelity virtual reality simulator for intraocular surgery training. “This is an impressive piece of equipment that will have a positive impact on our resident’s skills in the operating room,” said Laura Wayman, MD, associate professor of Ophthalmology and Visual Sciences, vice chair of Education and director of Resident Education for the Vanderbilt Eye Institute (VEI). “We have already been able to see that their microsurgical skills have much improved. And with 24/7 access, residents are able to utilize the system as much as they need, while getting detailed feedback from the computer about their surgical skills.” The computerized training readies surgeons for cataract and retinal operations, with the goal of reducing complication rates and operative times to Dr. Laura Wayman looks on as Ophthalmology resident Dr. Chris Estopinal uses the Eyesi Surgical virtual reality simulator. (Photo by Anne Rayner) improve patient care, Wayman added. The $250,000 Eyesi was purchased by the Veterans Affairs Tennessee Valley Healthcare System and is housed in their eye clinic for VEI residents and fellows, who also rotate at the VA.

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MAY 2014

GrandRounds Middle Tennessee’s Primary Source for Professional Healthcare News

Vanderbilt, Sumner Regional Announce Clinical Partnership At the end of March, Vanderbilt University Medical Center and LifePoint Hospitals subsidiary Sumner Regional Medical Center announced a clinical affiliation agreement to coordinate programs between the hospitals. Although the partnership will provide additional medical services to Gallatin-based Sumner Regional, the affiliation does not involve any ownership or man-

agement changes. Plans call for development of a teleneurology program and additional pediatric services at Sumner Regional. “We are delighted to launch this affiliation with Vanderbilt University Medical Center,” said Susan Peach, CEO of HighPoint and Sumner Regional. Susan Peach “As we examined ways to bring additional medical services to our

Let’s Give Them Something to Talk About! Awards, Honors, Achievements

Local internist Ryan D. Mire, MD, FACP was presented with the prestigious Walter J. McDonald Award for Early Career Physicians from the American College of Physicians (ACP), at the national organization’s annual meeting last month. Mire is the associate chief of medicine at Saint Thomas Hospital and chair of the medical advisory committee. He is a past-president of Heritage Medical Associates. The Tennessee Kidney Foundation welcomed more than 530 guests to the inaugural Spring Soirée on March 29 at the Omni Nashville Hotel. The evening raised in excess of $300,000 to support the organization’s mission to improve kidney health. HighPoint Health System received national recognition with two awards during LifePoint Hospitals’ annual leadership conference. (L-R) Event co-chairs Keri McInnis of Pinnacle Financial Partners and nephrologist Dr. Anthony Langone of Vanderbilt University Medical Susan Peach, CEO of the Center celebrate the first Spring Soirée with Teresa Davidson, CEO of four-hospital system and the Tennessee Kidney Foundation. of flagship facility Sumner Regional Medical Center, was honored as “CEO of the Year.” Carthage-based Riverview Regional Medical Center was recognized with a “High Five” award, which is the company’s highest honor and is only given to five of LifePoint’s 61 hospitals annually. In other news from LifePoint, Mike Coggin, senior vice president and chief accounting officer, has received the William V. Lapham Award for Extraordinary Integrity. The award was created in 2007 to honor Lapham, a founding board member and former chair of the hospital company’s audit and compliance committee, who succumbed to cancer in 2008. LifePoint Chairman and CEO Bill Carpenter noted Coggin could always be counted on to be “a voice of reason and objectivity on all matters” and praised him for fostering open and honest communication. Mike Coggin Two leaders affiliated with Vanderbilt-Ingram Cancer Center were recently recognized during the 6th Annual Nashville Honors Gala benefitting the T.J. Martell Foundation. Scott Hiebert, PhD, an internationally recognized expert in research on the mechanistic basis of acute leukemia, was celebrated for his contributions to cancer research. Hiebert is associate director of Basic Research at VICC. Also, VICC Board of Overseers member Beth Dortch Franklin was recognized for her work to enhance awareness and support for cancer research and her efforts as an advocate for the educational Dr. Scott Hiebert and outreach needs of cancer patients and families. Music Health Alliance is the recipient of the prestigious 2014 Healthcare Workforce Innovation Award recognizing an employer who is trailblazing workforce trends and innovation impacting the business of Beth Dortch healthcare in Tennessee. Nashville Mayor Karl Dean and Memphis Mayor Franklin AC Wharton presented the award at the 2014 Healthcare Diversity Forum at Vanderbilt University in March. Raymond James Investment Banking was recently honored with a pair of International M&A Advisor Awards in the publication’s sixth annual list of exceptional international deals for M&A Deal of the Year and for Corporate/Strategic Acquisition of the Year. Hoar Construction, with offices in Brentwood, has been named one of the Top Ten General Contractors in the nation by Modern Healthcare. Coming in at #9, Hoar’s ranking makes it one of the top national firms providing construction services to healthcare facilities, based on annual revenue.

MAY 2014

communities, our leadership team explored several affiliation options. Vanderbilt, which is one of our nation’s premier academic medical centers, emerged as the ideal fit for us.”

Healthbox Grows, Solidifies Local Presence Coming off a successful first foray into healthcare incubation in Nashville, Chicago-based Healthbox is looking for a more permanent presence in the city. The healthcare technology accelerator is searching for an executive director and program manager to maintain a permanent staff in Nashville. The local Healthbox outpost is housed at the Entrepreneur Center. Founded in 2012 by CEO Nina Nashif, the company also runs accelerator programs in Chicago, Boston, Tampa and London. Plans have been announced to expand the program to Salt Lake City, as well. Last month, the company closed on $7 million from a collaborative group of leading healthcare organizations to form Healthbox Global Partners, LLC, with a goal of operating six accelerators, growing Healthbox Solutions, building foundries to bring the Healthbox accelerator model inside health systems, and establishing collaborative initiatives by partnering with healthcare organizations to develop unique innovation and venture models to address emerging strategic needs.

Precision Pain Care Opens New Nashville Location In March, Precision Pain Care announced the opening of its new location at 393 Wallace Road, Building A, Suite 403. Graf Hilgenhurst, MD, pain management specialist and anesthesiologist, founded his first interventional spinal pain practice in Smyrna, Tenn. He cited demand from patients and referring physicians as the impetus to open the second location in Nashville. Hilgenhurst is president of the Tennessee Society of Interventional Pain Physicians, a member of the faculty of the International Spine Intervention Society, the American Society of Anesthesiologists and a faculty member of the American Society of Interventional Pain Physicians.

Senior Helpers Expands to Murfreesboro Senior Helpers, a leading national provider of in-home care for seniors, has recently expanded to a new location at 745 S. Church Street in Murfreesboro, Tenn. Owned by Debbie Miller, who operates several Senior Helpers offices across the Greater Nashville area, Senior Helpers of Murfreesboro offers an array of services ranging from basic monitoring to around-the-clock home care assistance, both in the family’s home, as well as in assisted living communities and skilled care facilities when one-on-one care is needed.

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

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News from VANDERBILT UNIVERSITY MEDICAL CENTER * SPRING 2014

Early Lung Cancer Detection Saves Lives

Vanderbilt-Ingram Cancer Center Launches Lung Screening Program

Vanderbilt-Ingram Cancer Center has launched a new screening program to provide low-dose CT scans for patients at high risk for lung cancer. Current or former smokers ages 55 to 74 who have a history of 30 or more “pack years” of smoking (1 pack/day for 30+ years or 2 packs/day for 15+ years) are eligible for the scans. Otis Rickman, D.O., assistant professor of Medicine and Thoracic Surgery and co-director of the new clinic, said the goal of the screening program is to save lives. “The reason to screen is that lung cancer has no symptoms early on and once it has symptoms and is at an advanced stage it is typically not curable,” he said. The benefit of screening a specific group of high-risk patients was confirmed by the National Lung Screening Trial (NLST), which randomized more than 53,000 current or former heavy smokers to receive three annual low-dose spiral CT scans or a standard chest X-ray. The study, published in 2011, was funded by the National Cancer Institute, a division of the National Institutes of Health. Study findings included a 20% lung cancer-specific mortality reduction in high-risk people who were screened with low-dose CT relative to those screened with chest X-rays.

Group 2:

• Age 50 and older • 20+ pack-year smoking history (1 pack/day for 20+ years or 2 packs/ day for 10+ years) • One other risk factor, including exposure to carcinogens such as radon, silica, cadmium, asbestos, arsenic, beryllium, chromium, diesel fumes, nickel, coal smoke or soot)

Diagnostic Evaluation and Care Management

Otis Rickman, D.O., left, and John Worrell, M.D., are co-directors of Vanderbilt-Ingram Cancer Center’s new lung cancer screening program. (photo by Susan Urmy/Vanderbilt University)

John Worrell, M.D., professor of Radiology and Radiological Sciences and chief of Thoracic Radiology, was Vanderbilt’s principal investigator for the NLST. “Nearly 160,000 patients die from lung cancer every year, and if we can save 20 percent of those patients through screening, that’s a big number,” said Worrell, who is also the co-director of the new program.

UROLOGIC SURGERY

Matthew Resnick, M.D.

Specialty: Urologic Oncology Medical School: University of Pennsylvania Residency: University of Pennsylvania Fellowship: Vanderbilt Practice Location: Vanderbilt University Medical Center

Referrals: (615) 322-2880

Vanderbilt University Medical Center Welcomes These Providers

INFECTIOUS DISEASE

Elizabeth Jane Phillips, M.D. Specialty: Infectious Disease, Clinical Pharmacology Medical School: University of Alberta Residency: University of Toronto Fellowship: University of Toronto Practice Location: Vanderbilt University Medical Center

Referrals: (615) 936-2727 SURGERY

Richard A. Pierce, M.D., Ph.D. Specialty: General and Minimally Invasive Surgery Medical School: University of Virginia Residency: Washington University School of Medicine, Barnes-Jewish Hospital Fellowship: Legacy Health System, Portland, OR Practice Location: Vanderbilt University Medical Center

Referrals: (615) 343-5613

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Eligibility Requirements

The National Comprehensive Cancer Network (NCCN) defined two groups at high risk for lung cancer:

Group 1:

• A ge 55-74 • 30+ pack-year smoking history (1 pack/day for 30+ years or 2 packs/ day for 15+ years) • Smoking cessation less than 15 years prior

As with any screening test, there is a possibility of false positive results, which can be expected to occur 20-25% of the time. About 1 in 4 lung nodules will require additional imaging or evaluation. More than 96% will be benign. Comprehensive follow-up care, which may include annual screenings, additional diagnostic evaluation and smoking cessation, are critical to early detection and prevention. Patients whose scans reveal a suspicious nodule in the lung will be referred for follow-up care to a multidisciplinary team of lung experts at Vanderbilt-Ingram Cancer Center. Smokers and ex-smokers who are at high risk should start adding an annual CT scan to their list of cancer prevention strategies. The low-dose CT scans are quick and

painless. They do not require a needle stick; patients don’t have to swallow anything and the scan takes just a few minutes. The radiation dose is similar to a mammogram or six to 12 months of natural, environmental radiation exposure.

Cost

Vanderbilt-Ingram Cancer Center desires to make the screening as accessible as possible, so the out-ofpocket cost to patients is $199. Medicare and private insurance companies do not currently pay for the test, but the U.S. Preventive Services Task Force recently issued a recommendation for the CT scans for high-risk patients that could eventually lead to insurance coverage.

VANDERBILT-INGRAM CANCER CENTER LUNG SCREENING PROGRAM vanderbiltlungscreening.com (615) 936-8422 (877) 936-8422 4 SCREENING LOCATIONS: • Vanderbilt Medical Center Imaging • One Hundred Oaks Imaging • Cool Springs Imaging • Hillsboro Imaging

Stereotactic Radiosurgery Center sharpens its focus

Vanderbilt University Medical Center’s stereotactic radiosurgery equipment was the first of its kind in Middle Tennessee in 2009. Now, a newly organized Stereotactic Radiosurgery Center is making it easier for patients to receive this cutting-edge treatment. “The idea is to treat the tumor with a very high dose of radiation but spare the rest of the tissue surrounding it,” said Albert Attia, M.D, assistant professor of Radiation Oncology and leader of the new center. “Most applications are in the brain,” Attia said. “Sometimes patients can’t tolerate surgery or their tumor is in a place you can’t cut. We also use radiosurgery frequently for brain metastasis, where tumors are spread all over the brain and Albert Attia, M.D., left, and Anthony Cmelak, M.D., at surgery would be too morbid.” Patients are fitted with a tight plastic mesh mask Vanderbilt’s Stereotactic Radiosurgery Center. (photo by John Russell/Vanderbilt University) that holds the head in place without the need for an invasive rigid frame. CT and MRI scans use the “We wanted to gather the troops because it’s always better mask to precisely calibrate the placement of the to have a multi-disciplinary approach. With the radiation beams of radiation within millimeter accuracy. Treatment oncologists and neurosurgeons working together, we can time can range from 30-90 minutes, with very few side effects. create better treatment plans for each patient,” Attia said. “The beams come in from multiple angles with different dose weighting. We optimize the settings to deliver the most radiation to the tumor and spare the other critical VANDERBILT RADIATION ONCOLOGY structures,” Attia said. vanderbilthealth.com/cancer/33745 The new Stereotactic Radiosurgery Center takes a multiRadiation Oncology care coordinator: (615) 322-2555 disciplinary approach to enhance treatment for patients.

MAY 2014

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