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FOCUS TOPICS HEALTHCARE REAL ESTATE, DESIGN & CONSTRUCTION • DERMATOLOGY & AESTHETIC MEDICINE

Your Middle TN Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 3

Jerry Tannenbaum, MD, PhD, FACP

ON ROUNDS

TOA Hendersonville

If You Build It, They Will Come Recent Additions, Construction and Renovations

Nashville’s unprecedented growth isn’t limited to new restaurants, hotels and office buildings ... 5

Financing the Deal NHCC Panelists Discuss Investment Opportunities On May 22, the Nashville Health Care Council hosted a panel discussion on private equity investment trends and strategies within the healthcare industry ... 10

Vanquishing Varicose Veins

Lease, Build, Buy, Sell Finding the Best Fit for Each Medical Practice By CINDY SANDERS

SCALE 2019 Showcases Latest in Aesthetics Medicine

Drs. Gold, Biesman Team up to Lead International Industry Event By MELANIE KILGORE-HILL

More than 900 medical professionals attended the Music City Symposium for Cosmetic Advances & Laser Education conference May 9-11. Now in its 14th year, SCALE has morphed into an international event attracting practitioners and vendors eager to investigate the industry’s latest treatments and protocols. “This year’s faculty was superb, and we increased attendance and had a larger faculty who covered a wider breadth of topics,” said oculofacial plastic surgeon and SCALE co-founder Brian Biesman, MD, FACS.

There are various reasons individuals wind up with varicose and spider veins … from prior clots and weakened valves to carrying excess weight and a genetic predisposition toward the condition ... 11

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Lease or Own

“There are so many Best practices augphysicians who subconmented by analytisciously believe owning a cal evidence drive the building is the next evodecision-making process lution in their practice. behind clinical care delivSometimes they are absoery. That same informed lutely right – it’s a fanapproach should apply tastic opportunity – but to the complex decisions sometimes it’s not,” said surrounding healthcare Rich Campbell, CCIM, real estate. principal with BirmingFor physicians, the ham-based Veritas Medidecision to build, buy, cal Real Estate Advisors. lease or sell their prac“Our physician clients hire tice space should only us to offer clean, unbiased be made after carefully advice,” he continued. There is no one-size-fits-all solution when it comes to leasing or owning a facility. weighing long-term goals, Campbell said the Firms specializing in healthcare real estate can help with the lease, buy, build or sell decision. needs, market forces and decision to lease vs. own economic realities. What comes with many considmakes perfect sense for one group might be the wrong solution for erations from location concerns to operational structuring. One of another practice. Turning to medical real estate experts with their the most important factors, he noted, is to consider total occupancy specialized knowledge helps physicians sort out the available options cost. “The practice always needs to be considered as an occupancy to make the best decision to meet a practice’s unique needs. (CONTINUED ON PAGE 4)

Treatment Options Improve Quality of Life & Aesthetics

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Dr. Michael H. Gold doing a demonstration at the SCALE meeting.

(CONTINUED ON PAGE 10)

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Breakthroughs Offer New Hope for Heart Failure Patients

Percutaneous treatment option for mitral regurgitation shows promise Approximately 5 million Americans suffer from heart failure. Roughly, half of these have heart failure with reduced ejection fraction (EF), of whom at least half have some degree of functional mitral regurgitation (FMR). Functional mitral regurgitation is commonly found in patients with underlying myocardial dysfunction and results from decreased left ventricular (LV) closing forces and from distortion of the LV geometry tethering the structurally normal mitral leaflets. By Andrew Severe FMR is associated with increased Goodman morbidity and mortality independent of both LV ejection fraction (LVEF) and Interventional clinical markers of heart failure. Cardiologist The prognosis is poor for patients Centennial Heart with heart failure who have mitral regurgitation due to left ventricular TriStar Centennial dysfunction. Conventional treatment Medical Center options have included surgery to repair or replace the mitral valve or medication therapies to mitigate symptoms. Many of these patients are too high risk for surgical interventions. Medication therapies are helpful at treating heart failure symptoms but do not address the underlying structural defect. Despite advances in medical therapy, mortality rates remain high for patients with FMR. Significant and rapidly evolving advancements in the treatment of FMR underscore the importance of ensuring patients have access to a multidisciplinary cardiology team that is not only skilled in treating the entire scope of heart disease, but also is helping to chart the course for innovative therapies, minimally invasive techniques and devices that lengthen mortality and improve quality of life. In the last five to ten years, research has led to less invasive options for patients who are too high a risk for surgical interventions to treat heart disease. A percutaneous approach using the MitraClip in the treatment of degenerative mitral regurgitation has proven effective for high-risk patients or those at increased risk of death or hospitalization for heart failure. A study published this fall in the New England Journal of Medicine indicates a transcatheter mitral-valve repair may also improve clinical outcomes in patients with FMR. The COAPT study enrolled 614 patients at 78 sites in the U.S. and Canada. The study concluded, “Among patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy, transcatheter mitral-valve repair resulted in a lower rate of hospitalization for heart failure and lower all-cause mortality within 24 months of

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follow-up than medical therapy alone.” (NEJM) The trial was significant in that it was the first time any intervention for FMR has demonstrated a mortality benefit. The interventional procedure was performed in a catheterization lab under general anesthesia and patients were typically hospitalized overnight. In carefully selected patients treated with the MitraClip, incidence of hospitalization decreased from 67.9 percent to 35 percent and mortality decreased from 46.1 percent to 29.1 percent. On the heels of this breakthrough news, TriStar

Centennial Medical Center has been named the only site in the region to offer The CARILLON Trial and is currently evaluating the Carillon Mitral Contour System for patients with FMR. This percutaneous mitral annuloplasty technique

allows interventional cardiologists to perform a procedure similar to what surgeons have been doing successfully for years, but less invasively to reduce risks for patients. The trial device is placed in a vessel next to the base of the mitral valve and helps to align the leaflets to reduce the amount of regurgitation a patient may experience. In comparison to other trials of other therapies, this trial includes patients with a moderate leak or lesser degree of regurgitation to help determine if earlier intervention is helpful. While the impact these therapies may have to ‘fix’ the weakened heart muscle is still being determined, it is possible that reducing the amount of mitral regurgitation will prevent further negative remodeling by interrupting the cycle and have a positive impact on a patient’s longevity. TriStar Centennial Medical Center is currently enrolling patients in The CARILLON Trial who have an ejection fraction ≤ 50 percent and 2+ moderate or more mitral regurgitation. Centennial Heart expects to be a top enroller in the trial, which will include 450 patients internationally.

It is critical for patients suffering from complex heart disease to seek treatment where they can be afforded that full spectrum of treatment options. TriStar Centennial Medical Center offers patients a collaborative approach that includes heart failure specialists, structural heart interventionalists and cardiac surgeons who specialize in advanced cutting-edge treatment options to treat the most complex cardiac disorders. For more information about the Carillon Mitral Contour System trial and to refer a patient for enrollment consideration, please call (615) 342-4636.

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PHYSICIAN SPOTLIGHT

Dr. Jerry Tannenbaum: Redefining, Redesigning Nephrology By MELANIE KILGORE-HILL

and expansion of DSI Renal, Inc. (an affiliate of DSI), a company that operated over 110 dialysis centers across 26 states, and served as its chairman and CEO. DSI continued to use the pre-fabricated building methodology to expand its footprint in dialysis.

Nephrologist Jerry Tannenbaum, MD, PhD, FACP, is changing the game for renal failure patients and providers. The founder, president and CEO of Sanderling Renal Services and Sanderling Healthcare is creating a practical, affordable paradigm to bring quality care to underserved communities.

Sanderling Healthcare

Finding his Way

Following in his cardiologist father’s footsteps, the New York native arrived in Nashville in 1967 to begin his own path to medicine. Tannenbaum at Vanderbilt University, where he received his undergraduate degree, doctorate and medical degree. After an internal medicine internship at Vanderbilt University Hospital, he went on to complete an additional internship at Jewish Hospital of St. Louis, followed by nephrology training at Barnes Hospital – both affiliates of Washington University School of Medicine in St. Louis. “I really enjoyed internal medicine; and in those days, Vanderbilt was already a leader in hypertension management,” Tannenbaum said of his career progression. Since hypertension was managed by nephrologists at Washington University, his transition to kidney specialist was a natural one.

Branching Out

After completing his training in St. Louis and a brief time in Dallas, Tannenbaum returned to Nashville in 1985. A serial entrepreneur, Tannenbaum founded REN Corporation-USA, a publicly traded provider of dialysis services, in 1986. He served as president, chairman and CEO of the company until 1993, when he founded Medical Information Management Systems, Inc., a medical software company and developer of the PEARL EMR system. PEARL was the first internet-capable electronic medical record and an early pioneer in community health information networking. In his medical practice, Tannenbaum realized that 80 percent of dialysis patients were commuting from across Middle Tennessee and neighboring states. “Dialysis is required three times a week, and these patients had nowhere to receive treatment in their hometowns,” Tannenbaum said. “That’s a tremendous burden on families who are driving them and on patients who already don’t feel well. I started looking into the construction side of things for how to bring treatment to patients in rural communities.”

Addressing Challenges

In 1998, Tannenbaum founded

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In addition to his clinical and facility development work, Dr. Jerry Tannenbaum (pictured 2nd from left) has created a jobs program for HUD housing residents in multiple Sanderling Healthcare markets to train certified clinical dialysis techs.

National Nephrology Associates, Inc., a nationwide dialysis services provider, where he served as chairman and CEO. During construction of the company’s new clinics, he observed that the sophisticated HVAC systems, stringent electrical requirements and complex water systems sent some general contractors running. Rather than give up, Tannenbaum formed his own specialized construction group dedicated to a standardized approach. As NNA grew and clinics emerged coast to coast, however, he realized the difficulty of managing a sizeable, traveling construction group. “It took us a while to figure out, but after some experimenting, we came up with a solution,” he said. That answer was to build factory-finished clinics in a

modular fashion. “We’d ship them out in big pieces like Lego sets, which allowed us to install sophisticated HVAC, electrical and plumbing inside the confines of the factory, and then find a local general contractor to do site work,” he explained. While the process cost the same as a traditional build, the modular concept significantly expedited the process and assured consistency in quality and design. Tannenbaum left NNA in June 2003 to cofound Diversified Specialty Institutes, Inc. (DSI), where he launched out to help other organizations achieve similar construction goals. One of his first projects was a 24-bed hospital in Pennsylvania, which went from groundbreaking to being licensed in only 14 months. In 2005, Tannenbaum led the formation

In late 2008, Tannenbaum left DSI Renal to found Sanderling Healthcare, LLC, to focus on efficient healthcare facility construction in rural communities. He’s also worked with LifePoint Hospitals on expansions in Arizona and Kansas, with a project in Arizona going from blueprint to state licensing in 16 weeks. In Dodge City, Kan., Sanderling’s 14,000-square-foot addition included complete labor and delivery suites, along with a NICU nursery. “Looking at the end result, you can’t tell the difference in what we built and what was built onsite,” he said. “Construction looks identical, but by fabricating it in the factory, splitting it into 15 sections for transport and installing it onsite, our clients found a faster way to get exactly what they needed.” Sanderling has since developed a more flexible and efficient building technique to accommodate transportation logistics, previously limited by 16-foot high underpasses and flatbeds hauling 30-ton sections. The company’s recent move to panelized construction removed previous prefab building height limitations and simplified flatbed transport. “Whether we’re working with healthcare facilities, physician offices, ERs or (CONTINUED ON PAGE 8)

Great Design Evolves from a Master Plan & Empowered User Ehc shares a lifetime of pre-design planning and programming experience with clients to lay the foundation for beautiful, functional, flexible facilities that serve patient and staff needs today and in the future.

Expertise Includes:

• Master Planning & Functional Program • Process Transformation for Improved Care Delivery • Innovative, Integrated Technology Planning & Deployment • Assistance with Real Estate Needs

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Lease, Build, Buy, Sell, continued from page 1 cost,” he explained. “Even if you buy a building, the practice is always going to be a tenant.” To get a true picture of financial obligation, Campbell said that occupancy cost should be factored into each scenario being considered – lease, purchase, build or buy. “The cost can Rich Campbell vary drastically … not only city-to-city and market-to-market but also street-to-street,” he pointed out. “You have to know how the total occupancy cost in any location affects the operations of the practice.” One factor that shouldn’t play into the decision of whether or not to pursue ownership is emotion. “It’s just another investment opportunity that needs to be looked at completely separately from your practice,” Campbell counseled. That investment, he continued, doesn’t happen in a vacuum so other financial options also should be vetted to decide the best use of each physician dollars – whether that means investing those dollars in a building, technology or equipment upgrades or the stock market.

Buying & Selling

“For a variety of reasons, including low interest rates, medical office building transactions have more than tripled during this decade,” said Chip Conk, CEO of Montecito Medical Real Estate, which is headquartered in Nashville. He added that his company anticipated this trend, and it has fueled Montecito Medical’s growth into the nation’s largest privately held acquirer Chip Conk of medical office real estate. “In addition, we pioneered a model that enables sellers to reinvest in the property – getting a second bite of the apple, if you will – and also to co-invest with Montecito in additional properties we acquire. The attractiveness of that model has played a big role in our growth.” Conk noted an office building is typically the most valuable asset a physician practice owns. “Individual physician partners within the practice often have invested a meaningful amount of their net worth in the property,” he continued. “Selling the property and then leasing it back unlocks capital that the practice can invest to meet a variety of needs – from staying abreast of medical technology, expanding their services or operations, implementing electronic medical records, recruiting new physicians or covering rising salary and insurance costs – all of which ultimately can contribute to improved patient care and satisfaction and the sustained health of the practice group.” Montecito Medical’s investment vehicle, dubbed the Provider Real Estate Partnership (PREP) program, offers physi4

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cians in a practice group the opportunity to reinvest a portion of the proceeds from the sale back into the medical office building. Conk said the investment is typically 10 to 15 percent. “As investors, they enjoy significant tax advantages for the duration of time we maintain ownership of the property,” he explained. “They also receive quarterly distributions from the partnership based on the amount they invest. Then, when Montecito sells the property, they receive a return on their investment.” Conk added many of the same dynamics and principles also apply to hospitals and health systems. “Hospitals in the U.S. collectively own more than $1 trillion in real estate,” he pointed out. “The economic power of those assets is greatly underutilized. Selling office properties that they own enables them to redirect capital for new technologies, improvements in care delivery and even new outpatient facilities such as ambulatory surgery centers.” When deciding what direction to take when it comes to owning, selling and leasing, Conk said it was important to start with an accurate picture of what the real estate is worth and then look at the strategy for addressing important needs … whether that is paying down debt or expanding technology or services. He noted the model used by Montecito helps address the individual needs and interests of physicians, allowing younger providers who might not be able to afford an ownership stake or those simply not interested in the investment to continue

practicing without being required to put up personal funds. “Reinvesting in the property is a decision for individual physicians in the group.” Campbell said when purchasing or divesting real estate as a group, it’s critically important to have addressed buy/sell provisions on the front end. What happens to a physician partner’s shares of the facility when he or she retires or dies? Do they pass to a spouse or children? If so, do those non-physician owners have input on facility decisions? “It gets really convoluted so you have to be really careful with your operational policies, as well,” he said of thinking about the long-term investment.

Reaching Out to a Specialist

Campbell and Conk said partnering with a healthcare real estate specialist is important when considering facility needs. Campbell laughingly noted he recently had to re-read a particular lease amendment “about 17 times” to fully understand what was being required. “There’s no way a client could understand it,” he said. Campbell added, “Never hesitate to make a call and ask for help.” Because the process is complex and often takes time, he encouraged physicians to reach out well before a lease is up to begin considering other options. “If it’s too early, folks will tell you,” Campbell said. More often, he added, physicians wait too long to reach out, which crunches the timeline on an important decision. “Physicians oftentimes have needs that don’t necessarily require a real estate

transaction,” said Campbell, noting it’s one of the reasons Veritas offers advisory services. Campbell said a general commercial real estate broker without medical real estate experience is always happy to help close a transaction, which is their job. However, he continued, “The broker is not trained, nor is he motivated, to step back and ask if this is right for your practice.” Campbell added it’s important to find someone who understands the intricacies of medical practices and the total cost of occupancy. Sometimes, he pointed out, “You need someone willing to say, ‘You don’t need to do this deal.’” Conk noted the same principles apply to physicians considering selling the properties they own. “For some physician groups, it might make more sense to refinance their property rather than sell,” he noted. “But we can help them get a clearer picture of their options so they can come to the decision they think is best for them.” He added that practices mulling over the possibility of a sale should consider timing and the state of today’s market. “Right now, values for medical office real estate are at historic highs, and interest rates remain low … it won’t always be that way,” Conk pointed out. Buy, sell, build or lease – the decision always stays with the practice but having all the facts enables providers to make an informed decision that is best for individual physicians, the practice and patients. “Go in with eyes wide open,” Campbell concluded.

Montecito Growth Continues in Middle Tennessee Montecito Medical Real Estate recently announced acquisition of Murfreesboro Medical Properties, LLC. The three-story, 221,000 square-foot building in Rutherford County is 100 percent occupied by Murfreesboro Medical Clinic (MMC). With more than 80 physicians and over 600 employees, MMC offers services in more than 20 different specialties at the office property and also houses an ambulatory surgery center and radiology department. “We seldom use the word ‘trophy’ to describe one of our acquisitions, but with Murfreesboro Medical Clinic, it fits,” said Chip Conk, CEO of Montecito Medical Real Estate. “We’ve had our eye on this property for some time because it has all the attributes we prize. It’s the flagship medical office of a market-dominant physician group in a rapidly growing market.” He continued, “It’s a beautiful, Class A building in a prime location that is adjacent to the largest hospital in the Murfreesboro market. It enjoys stable, 100-percent occupancy with a long-term lease … and, to top it off, we take a little bit of extra pride owning such an exceptional property when it’s in our own back yard. We could not be more excited about this acquisition.” MMC was founded in 1949. The first phase of the current property opened in 2008 with 78,000 square feet. The 143,000-square – foot second phase, constructed on a build-to-suit basis for MMC, opened in 2013. Conk said the selling physicians reinvested back into the entity acquiring the property, so they maintain some ownership. “We are proud to add to this property to our growing portfolio of premier medical office real estate in Middle Tennessee,” he noted. MMC wasn’t the only recent local addition, however. The company also closed on the Town Center Medical Plaza in Mt. Juliet last month. Built in 2012, the 40,000-square-foot building is fully occupied. Tenants include Children’s Clinic East, Advanced Orthopaedics and Spine, Vanderbilt Health Services, Zoo Crew Pediatric Dentistry and Athena Pharmacy. In addition to MMC and Town Center, other Middle Tennessee investments for the company include Premier Medical Group in Clarksville, Mt. Juliet Physicians Plaza, Saint Thomas Mt. Juliet, and Saint Thomas Bellevue. Montecito Medical is one of the nation’s largest privately held companies specializing in healthcare-related real estate acquisitions and development funding. Since its inception in 2005, the company has completed more than $3.16 billion in medical real estate transactions covering more than six million square feet across 28 states. Headquartered in Nashville, Montecito Medical also has offices in Austin, Portland, and Orange County, Calif.

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If You Build It, They Will Come

Recent Additions, Construction and Renovations Nashville’s unprecedented growth isn’t limited to new restaurants, hotels and office buildings. Middle Tennessee has also seen a flurry of healthcare construction projects and announcements over the last several months. Following are a few examples of recent news regarding additions, renovations and new construction expanding care delivery and services.

Bone and Joint Institute of Tennessee

At the end of April, the Bone and Joint Institute of Tennessee opened a $40 million, 121,252-square-foot facility on the main campus of Williamson Medical Center. The new comprehensive orthopaedic space includes physician offices, clinic space, outpatient imaging services, physical therapy and occupational therapy, nine private rooms for extended PACU patient recovery, an after-hours clinic and bistro dining with an outdoor terrace. BJI providers and specialists offer orthopaedic surgery, arthroscopic surgery, sports medicine, spinal surgery and general orthopaedic care.

Cool Springs Plastic Surgery

The Innovations Group (TIC) of Franklin completed redevelopment of the Cool Springs Plastic Surgery facility in Brentwood earlier this year. TIC renovated the three-story, 16,500-square-foot building, which was originally designed as a spa, into a state-of-the-art facility for plastic surgery including operating rooms, procedure room, clinical space and a nonsurgical spa area. Partners on the project included Integrous Architecture for project design, Casella Interiors for the interior design direction and Deangelis Diamond as general contractor.

Bone and Joint Institute of Tennessee

Chamber of Commerce cut the ribbon at the new facility on Saundersville Road in early April. Part of AdvancedHEALTH, Loven Dermatology has five Middle Tennessee locations.

Monroe Carell Jr. Children’s Hospital at Vanderbilt

At the end of October 2018, Monroe Carell Jr. Children’s Hospital at Vanderbilt broke ground on a new 37,500-square-foot pediatric facility in Rutherford County. The $27 million Children’s Specialty and After-Hours Clinic, located on Garrison Drive in Murfreesboro, will include outpatient surgery, imaging services, audiology booths, and urgent care services, in addition to 22 multispecialty clinic rooms. The new facility is anticipated to open in late 2019.

ovation of part of the Cath Lab to enhance capabilities to function as a hybrid to bridge the gap between Cath and Electrophysiology. The fifth floor is home to the Neurosurgery and Orthopedic Spine renovation, which also created a separate patient entrance. The Spine Institute held a ribbon-cutting ceremony last month to celebrate completion of the comprehensive space specifically designed to care for spine patients from pro-op through recovery. The seventh floor is site of a Gynecology renovation updating pre- and post-op surgical areas, as well as waiting areas. On the eight floor, the new Clinical Decision Making Unit has been completed. The Emergency Department Fast Track renovation is in development to allow a separate pathway for lower acuity patients to receive care efficiently. In addition, the ED has already seen a number

Loven Dermatology

Loven Dermatology (previously Rivergate Dermatology) recently unveiled their new location and new branding. Keith Loven, MD, along with representatives from the practice and Hendersonville nashvillemedicalnews

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Saint Thomas West Hospital

Saint Thomas West Hospital has just opened a new Neuro ICU to complement the hospital’s comprehensive stroke accreditation. The hospital has also renovated and redesigned the Cath Lab and opened a newly designed Clinical Decision Unit for cardiac outpatient and observation patients. Additionally, the Cancer Center has added a new linear accelerator and is in the process of updating the entry and waiting areas. In addition to these recently completed projects, the hospital is in the process of overhauling sterile processing to accommodate new equipment, relocating nuclear pharmacy with updated design and safety measures incorporated into the new space, and fully renovating the 94 med/surg beds, incorporating four units, on the seventh floor of the Patient Tower. Architectural work is also underway to reimagine cardiac imaging to allow for more volume and to upgrade lab equipment and processing areas.

Monroe Carell Jr. Children’s Specialty and After-Hours Clinic in Murfreesboro

Saint Thomas Medical Partners

In April, Saint Thomas Medical Partners opened their latest multi-specialty site in Antioch. The new facility offers primary care, walk-in care, cardiology, lab and imaging services, and outpatient rehabilitation under one roof. In addition to the new Antioch facility, STMP also opened new locations in Gallatin and Hendersonville in the fourth quarter of 2018.

of interior design upgrades with more to come. An EMS breakroom expansion and upgrade more than doubled the size of the previous space to give first responders an updated place to rest and reenergize.

Saint Thomas Rutherford Expansion

Turner Construction began work on an estimated $82 million, 60,000-squarefoot vertical expansion of Saint Thomas

Saint Thomas Midtown Hospital

Cool Springs Plastic Surgery

Rutherford Hospital at the end of last year. The project will add three floors featuring 72 med/surg beds and includes the Clinical Decision Unit, which opened last year in phase 1 of the two-part expansion. In addition to the new beds, the project also includes four new operating rooms.

Saint Thomas Midtown has multiple projects underway in various stages from planning to completion. A number of specialty areas are being reworked and redesigned to enhance patient experience and accommodate new technologies. A hybrid operating room is currently in development for enhanced vascular treatment. The cardiac update also includes MRI replacement, along with ren-

Saint Thomas Midtown’s Spine Institute

TOA Franklin & Hendersonville

Tennessee Orthopaedic Alliance will soon debut new spaces in Franklin and Hendersonville. The new TOA Sports Performance Center will house all physicians and services currently available at the TOA Franklin location at Williamson Medical Center. The new space on Gothic Court (previously A-Game Sportsplex) will feature 8,500-square-feet of space for urgent care, physical therapy, performance training and conditioning for athletes and weekend warriors, alike. The renovated space is slated to open in August 2019. Physicians and services currently located at TOA Hendersonville will move to a new 23,000-squarefoot facility on Saundersville Road. TOA Indian Lake Clinic will feature expanded services including personal training, yoga, fitness classes, advanced imaging, a larger facility for physical therapy and an orthopaedic urgent care to serve Sumner County. The new facility is anticipated to open in September 2019. (CONTINUED ON PAGE 12)

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Wayfinding in Healthcare Periodically Ehc is engaged to conduct work “above and beyond” the traditional campus master plan. Wayfinding is one of those issues with which facilities often struggle, and the result of poor spatial orientation leaves patients, visitors with frustration and a disappointing first impression. Looking back at client studies, the disconnect typically comes By JAMES G. between the desire EASTER, JR. to create an envi- Principal, Easter ronment where Healthcare respect, care, Consulting (Ehc) treatment and healing had been the watchwords and instead creating a maze of doors, elevators, hallways, signs, bells, intercom messaging, large, unfriendly waiting areas, open holding areas, equipment parking, crowded care spaces, and unfamiliar faces. In newer replacement facilities, these conditions have been significantly improved and often eliminated, but many older hospitals still face the wayfinding problem. The future of healthcare transformation points to smaller and more family friendly facilities. This paradigm shift is occurring at a rapid rate as systems merge, consolidate and re-distribute resources into more nimble and accessible shorter stay, ambulatory care styles of design and construction. In our earlier planning engagements, we learned that leadership was extremely frustrated with this growing list of complaints that they received from

patients, guests, family members separate admitting and billing and friends. A loss of customers entrances. For those onsite to became a concern as well, since visit an admitted patient, the newer facilities just didn’t seem to routing might be easier, but have the same problem. Many of the security process could be a the complaints related to signage, nightmare. access, flow patterns/hallways, We have found that on an crowded rooms, slow elevators, acute care campus of medium safety/security measures, inconsize there are 30 or more desvenient disruptions and an overtinating points one might seek all “unwelcoming” image. These out. The good news is there are are also the factors mentioned by a number of ways to reduce the clients when describing the need stress and avoid the negative to conduct a campus master plan experience by improving the (CMP). What are the differences situation. First, assess the situbetween a CMP and a wayfindation, interview the stakeholding plan (WFP)? ers, study the campus conditions A CMP Leads to major hos(buildings, roads, entryways, pital improvements, relocation of signage and existing conditions) departments and the re-sizing of and carefully record the visual Art pieces can add both beauty and a geographic reference point. services. Hallways are re-routed implications. The resulting and major spatial conditions are images tell a story that begins the walkways and pathways, but without the improved. A CMP is more expensive. initial improvement process. benefit of a CMP. A WFP leads to signage updates, The first, immediate intervention for directional support, facelifts, technology this dilemma requires a detailed WFP. The apps and process improvements leading analysis begins with a 40,000-foot look at to better practices and changes in human the market through programs like Google behavior. A WFP is less expensive. Earth and MapQuest to see the regional In most cases, the original hospital aspects of the campus in relationship to that was constructed some 40+ years ago, the larger community. Wayfinding begins has grown exponentially over the years, on the drive from home to the hospital and evolved from the “place where you with community considerations includwere born” to the larger, unwieldy caming signage and bus routes and continues pus you are now visiting. Buildings have with campus considerations including been added, adjacent to other buildings, directional assistance to parking lots and and hallway connectors and elevators garages, front door drop-offs, emergency haven’t been developed to define clear entries, and a myriad of other destinations and navigable traffic routes. The building in and around what might have become has become a “campus of multiple builda sprawling campus with medical office ings,” and the hospital has grown into a buildings, outpatient clinics and imaging “new town environ” made up of numercenters, a freestanding cancer center or ous, diverse buildings and services – all rehabilitation space, laboratory or even vying for entry/exit, convenient linkages,

A Case Study Interviews with stakeholders are revealing and often paint a picture of the campus that is both process and people oriented. The ability to capture this message and relay it to the board of directors, who are typically the ultimate decision-makers when it comes to allocating funds, is key to implementing a wayfinding master plan. Below are several quotes from initial interviews with a hospital client in the Atlanta area, which was a classic example of the smaller hospital that grew into a major campus: “Floors don’t align, elevators are poorly designated, and destinations aren’t understood by staff.” “Why can’t we have clear maps and floor plans with routes designated without extraneous materials?” “Can’t find the Mother/Baby area, and the cafeteria is in an off-beat pathway to the basement.” “All signs are different, seem to be in conflict, and the lighting is horrible.” “We love the plants and flowers and the sculpture … helps us find our way back from the basement.” “We were here to visit my mom, took forever to find the elevators and then we waited and waited.” To address these concerns and improve wayfinding, Ehc took the following 12 steps: • Review the existing CMP, WFP and Strategic Plan (SP ) … integrate the findings, goals and objectives. • Communicate the “agreed to WFP Process” to ensure awareness and understanding of actions to be taken along with best-in-practice milestones. • Inventory existing exterior and interior signage (record visually and prepare impressions). • Identify the words and terms used for messaging (seek consistency and simplicity of message). • Re-align placement of signs, hierarchy of message, building character, and directional imagery. • Prepare a comprehensive interior finish, artwork, and graphic standard. • Develop criteria and recommendations for facelift, branding, and community image enhancements. • Prepare WFP orientation maps, instructional materials, and conduct volunteer staff training. • Work on “wellness” incentives to encourage building user modifications and fitness measures. • Explore music, art and cultural themes that benefit the traveler who is making the trip. • Develop a “green” and sustainability theme for the community. • Develop “universally understood” methods and conduct routine WFP updates.

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Well placed, clearly marked signage is a staple of effective wayfinding.

There are also excellent tools and resources to help with the process. The Veteran’s Administration has developed an “Integrated Wayfinding and Recommended Technologies” program. This report is one of the best example of best practices for the public and private sector. In the introduction, the VA suggests: “An expanded definition of the term wayfinding recognizes that visitors use multiple cures and tools to find their destination … from the spatial relationships manifested by the architecture to the lighting and the interior spaces. A new class of wayfinding tools has emerged with the technology revolution. Global positioning systems (GPS) devices, websites, apps, and on-site touch screens can be effective tools to help people along their journey. The smartphone has become our own personal navigation device.” With forethought and planning, there is no reason why facilities … even those that have grown convoluted over years of expansion … can’t significantly improve wayfinding and the overall experience for patients, visitors and staff.

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HEALTHCARE ENTERPRISE

SWA Brings Innovation, Savings to Headwalls By MELANIE KILGORE-HILL Forty years after opening their doors, Steve Ward & Associates remains an industry leader for commercial casework and millwork. And while the Nashville-based, family-owned company has been a go-to for industrial cabinetry since 1979, their forWard® hospital headwall system was recently the topic of an independent, thirdparty white paper by Layton Construction Company, detailing time and cost savings over traditionally constructed headwalls.

Thinking Outside the Box

“For most of our history, we installed headwalls consistent with architectural design. Frequently, this consisted of 3/4” thick plastic laminate paneling clipped or glued to the face of a gypsum board headwall on conventional metal studs,” explained Andrew Ward, CEO of Steve Ward & Associates. “We stayed in our lane and were doing what the industry was used to doing.” That changed in 2008 with the implementation of lean process improvement, designed to map out Andrew Ward areas of waste in time and resources. “Lean defines ‘waste’ as anything for which the customer isn’t willing to pay, so we started thinking about the installation process with the end result in mind,” Ward said. According to the white paper, a traditional headwall installation in Nashville, using Q4 2018 labor rates, required two men 38 hours (or 76 man-hours) to build, at a total cost of $10,766.09. Ward’s team knew there had to be a better way. “Even though every headwall looks the same on the architectural design, once you get in the field, each headwall is slightly different due to discrepancies in outlet rough-in placement,” he explained. “We knew if we could control field conditions and precut outlets in a manufacturing facility, it would significantly reduce the amount of time we spent installing the headwall paneling.” With cost and time savings in mind, the team set out to design a better way to build headwalls. Soon thereafter, SWA sought a partner who could help them move into the prefabricated headwall space and found one in their own back yard. After partnering with the Nashville manufacturer for several years, SWA gained enough traction to incent them to acquire the company’s assets in 2016. “We were able to take the product and start making a few improvements to overall design, integrate more details into the infrastructure, and reduce our cost to make it what it is today,” Ward said. According to the white paper, the forWard headwall side of the Layton case study was completed by two men in 9.5 nashvillemedicalnews

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SWA’s forWard headwall system features installation efficiency without sacrificing functionality.

hours at an actual cost of $8,698.14 – saving clients nearly 60 total man-hours and approximately $2,000 per headwall. The forWard headwall is a prewired and preplumbed modular wall system complete with a UL listing and chain-of-custody certified med gas lines. Standard forWard panels are 24” wide by approximately 9’2” tall, so they fit easily into buildings and standard elevators, making them a good solution for renovation projects. And while the design’s target is headwalls, Steve Ward & Associates recently customized every patient room wall for the University of Tennessee Heart Hospital in Knoxville.

Changing Minds

For some clients, the idea of “prefab” conjures up images of a pre-stocked, off-the-shelf, take-it-as-you-get-it product. “When we talked to our clients, what we found was traditional construction was frequently specified for one of two reasons: First, it was believed to be more cost effective; and second, it was believed to offer a greater degree of customization,” Ward said. ”Prefabrication, on the other hand, was typically specified for consistency, standardization, efficiency and quality control. We felt like there had to be a way to bridge the gap between the two and offer a product which included all the benefits of prefabrication without compromising customizability or cost effectiveness.”

Durability in Design

Ward said durability is typically a primary concern of clients, as well. The forWard headwall system’s 24-gauge steel panel construction sets it apart from other prefabricated products in the marketplace. When necessary, clients also appreciate the ability to access the interior of the wall without cutting into sheetrock. A panel can be removed, conduit added, and the panel reinstalled with the patient room back online in approximately one to two hours. Ward said traditional headwall construction can close down a patient room for four to five days, impacting revenue and

a healthcare provider’s ability to deliver patient care to as many people as possible.

Impacting Lives

Healthcare represents approximately 50 percent of SWA’s revenue, with recent clients including HCA, Tristar SkyLine Medical Center, Williamson Medical Center and Vanderbilt University Medical Center. The team also works in schools and laboratories as a full-service distribu-

tor, offering design assistance for industrial, commercial grade cabinetry, seating, custom millwork and solid surfaces. “Our products are frequently the ones which define the environment inside a space more than any other element in the room,” Ward said. “We want to make a positive impact on people’s lives by creating environments where people feel comfortable and safe as they restore their health or expand their mind in educational or research settings. Our surroundings inspire us in our learning, researching, healing or whatever it is we’re doing in the space with which we’re interacting.” Ward credits the company’s longevity and continued success to their dedicated staff and faith-based approach to client relationships. “Our people and core values set us apart: the way we care,” said Ward. And while the company’s founder and namesake, Steve Ward, no longer works full time, he still spends several hours a day at the office, checking in on projects and visiting with employees – some of whom have been with SWA for more than three decades. “My dad’s been doing this for close to 50 years and is still the most knowledgeable person in the building,” Ward said of his father. “In his wildest dreams he wouldn’t have guessed SWA would be what it is today.”

Quality.

The Hallmark of Our Practice NASHVILLE VA S CU L A R & V EIN INS T IT U T E Now offering screenings for • Peripheral Vascular Disease • Stroke Prevention • Aneurysm • Varicose Veins DR. PATRICK C. RYAN

We have invested heavily in That’s why NVAVI is the only the Vascular Quality Initiative™ vascular surgery practice in sponsored by the Society for Middle Tennessee that fully Vascular Surgery. The VQI is a participates in VQI. database that measures our results But more than just measuring and compares them with quality, the experienced vascular surgeons and team led by Dr. Patrick practices around the United Ryan uses data to States. We continually believe to be enhance best really serious practices about quality, and improve www.nvavi.com you must measure it. outcomes.

In addition to seeing patients in Nashville, Dr. Ryan is now seeing new and established patients in Pleasant View 330 23rd Avenue North, Suite 100 | Nashville, TN 37203 | 615.321.6100

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LipiFlow®: Advanced Procedure to Treat Meibomian Gland Dysfunction & Chronic Dry Eye Dry eye is one of the most common reasons people seek care from an eye doctor. Symptoms include a gritty sensation, watering, redness, and fluctuation in vision. Dry eye often results in a cascade of inflammation affecting the surface of the eye, which can lead to potential damage including scarring and loss of vision clarity if By MING WANG, MD, PhD uncontrolled over time. One of the most pressing modern risk factors for dry eye is increased time using digital devices, often starting in early childhood. Blinking is essential to spread tears evenly over the surface and promote normal eyelid gland function. Yet, the blink rate has shown to be significantly reduced during the use of digital screens. A landmark 2012 study showed that 86 percent of patients with dry eye have concurrent meibomian gland dysfunction. The meibomian glands line the upper and lower eyelids. Healthy glands produce a free-flowing, oily, lipid solution that helps

to prevent tears from evaporating. Over time in just about everyone, the glands start to produce very thick secretions and become backed up and clogged. This prevents the release of the solution which, in turn, causes tears to evaporate too quickly, leading to dry eye. If the blockage persists for too long, the glands start to function poorly and eventually start to drop out altogether, leading to a complete loss of secretion. Once gland loss occurs, it is believed to be irreversible. The LipiView® and LipiScanTM devices from Johnson & Johnson are advanced technologies to image these glands. This safe, non-invasive technology has recently become available to eye doctors and is similar to how a dentist uses X-rays to image the deeper structure of teeth. High definition imaging of the glands in the eyelid can determine if they are functioning properly or if loss is starting to occur. This loss can lead to a cycle of worse dry eye and worse symptoms. Fortunately, if treatment is initiated, the meibomian glands can be kept flowing properly, thus promoting improved comfort and long-term function. Traditional treatments for meibomian gland dysfunction include home therapies to warm the glands. Patients can use warm washcloths or store-bought masks that are designed to heat the glands followed

by gentle eyelid massage. The difficulty is that the glands line the inner surface of the eyelids, so adequate heat must be applied to travel through the skin and reach the glands. Commonly, patients do not use enough heat and therefore the compresses are less effective. However, patients many see improvements in treatment of the condition if they are diligent about keeping up with these compresses each and every day. A sophisticated and FDA-approved treatment for meibomian gland dysfunction can be administered in the office of an eye doctor in a single session. The LipiFlow® Thermal Pulsation System by Johnson & Johnson has several significant advantages to traditional home treatments. Foremost, the glands are heated from the inside, where they can be most effectively reached. This brings the secretions inside the gland to a temperature that causes them to flow freely, like melting candle wax. A precise, gentle pressure is applied to the eyelids throughout the procedure to help improve the gland output. The treatment takes 12 minutes, is noninvasive and pain free. Small applicators are placed under the eyelids, comfortably vaulting over the delicate structures of the eye surface. Most patients report the procedure is a spa-like experience for the eyes, much like a gentle massage. Patients

can resume all normal activities immediately following the treatment. For many, relief of symptoms is realized within days. Furthermore, the procedure promotes the glands of the eyelids to stay free-flowing and form healthy secretions, which prevents loss of function of the glands. In-office treatments have beneficial effects that can last up to one to two years and might be extended further with diligent home therapy afterwards. These advancements in imaging and treatment provide a sophisticated way to promote good eyelid health and improve dry eye symptoms in the short and long term. The procedure is not covered by insurance, but patients generally feel the cost is worthwhile given the benefits in symptoms they experience after treatment. Harvard & MIT graduate (MD, magna cum laude) Ming Wang, MD, PhD, is the CEO of Aier-USA and director of Wang Vision 3D Cataract & LASIK Center. One of the few laser eye surgeons who hold a doctorate degree in laser physics, Wang has published nine textbooks, holds several U.S. patents and performed the world’s first laser artificial cornea implantation. He is also founder of a 501c(3) nonprofit charity that provides sight restoration surgeries for indigent patients. Wang Vision offers both the gland imaging and LipiFlow® technology described above to new and existing dry eye patients. For more information, go online to wangcataractLASIK.com or email drwang@ wangvisioninstitute.com.

Dr. Jerry Tannenbaum, continued from page 3

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dialysis clinics, the common thread is a lot of electrical wiring, plumbing and complicated HVAC systems, so we’ve learned how to prefab interior walls within those panels,” Tannenbaum said. “Not only does it expedite the process, but it saves time and hassle trying to coordinate the various tradesmen who are often working around each other. It’s all done assembly-line style, so there are no conflicts of trades.”

Sanderling Renal Services-USA

Sanderling still welcomes the occasional outside project but is ultimately in the dialysis business through a sister company (Sanderling Renal Services-USA), with seven clinics in full operation and four more in planning or construction phases. Their focus remains on underserved markets like Crescent City, Calif., where the nearest dialysis clinic was 75 miles away, and Ely, Nev., where patients were driving five hours to the nearest clinic. Since nephrologists tend to live in larger cities, Sanderling has been a leader in the use of telemedicine to bring nephrology and dialysis to rural hospitals. Their 60-plus providers, which include members of their own National Telenephrology Associates P.C., and members of renal division faculty at Emory University, University of Alabama and University of California, makes nephrology

consultation and in-patient dialysis available 24/7 to hospitals in 10 states including Hawaii. “The telemedicine hospital segment has grown so rapidly, and the number of kidney failure patients is expected to double over the next 10 years,” noted Tannenbaum. “Combine that with the shrinking number of people to provide care, and telemedicine will become for nephrology what it became for radiology years ago.”

On a Mission

In an effort to staff clinics and create opportunity for the underserved in Sanderling’s urban communities, the company also has created a jobs training program for HUD housing residents to become certified clinical dialysis techs, both in clinics and patient homes. Tannenbaum said only 2 percent of patients traditionally receive home hemodialysis, but Sanderling has taken that number from 2 to 55 percent in Nashville, reducing hospitalization rates by 50 percent. “When patients are too sick to receive treatment, they often end up in the ER,” said Tannenbaum. “By sending a tech to their homes, they can get the care they need. We’re doing things no other companies have the inclination to do … but we see opportunities for patients, and then we figure out how to make it feasible. We’re on a mission.” nashvillemedicalnews

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Rethinking the Approach to Acne Putting the Evidence to Work for Patients By CINDY SANDERS

New evidence and agents have clinicians rethinking traditional approaches to treating acne, the most common skin condition in the United States affecting an estimated 40-50 million Americans at any given time. While the occasional pimple or breakout might not warrant a doctor’s appointment, dealing with moderate to severe acne takes an evidence-based approach and the recognition that acne often takes a serious toll on self-esteem, as well as the skin. “It can be devastating for anyone,â€? said Linda F. Stein Gold, MD, FAAD, a board-certified dermatologist with Henry Ford Health System in Michigan and member of the American Academy of Dermatology (AAD) Board of Directors and Executive Committee. For teens and young adults, dealing with persistent acne can contribute to isolation, a decreased quality of life, anxiety, isolation and a poor self-image ‌ particularly when surrounded by picture Linda F. Stein Gold, MD, FAAD perfect images of peers on social media. Stein Gold said the emotional impact is very real for older acne sufferers, as well. “Don’t underestimate the effect on adults with acne,â€? she noted. “For a teenager or a 20-year-old, it’s acceptable to have some acne lesions. For adults, it’s not socially acceptable.â€? It is, however, a growing problem. Although dermatologists are unsure why, an increasing number of women in their 30s, 40s and beyond are dealing with acne. The AAD estimates adult acne now affects up to 15 percent of women. While some providers might still subscribe to the theory of just letting acne ‘run its course,’ dermatologists are quick to note that isn’t necessarily the best advice. A growing number of options are available to effectively treat the condition, lessening both the emotional and physical scarring.

Treating Acne

“Our thought process on acne has changed over the past few years,â€? said Stein Gold. Today, she explained, dermatologists are using oral antibiotics in combination with a potent topical treatment for a shorter course of time. “Before, we might have kept patients on antibiotics much longer ‌ maybe a year or two. Now, we understand (antibiotic) resistance is a real problem.â€? Additionally, she said, dermatologists are increasingly considering other hormonal therapies. “For women, we think of spironolactone or birth control pills; and for all patients, we think about going more quickly to isotretinoin.â€? Spironolactone is an androgen blocker used to treat hormonal acne. Isotretinoin is typically a second line treatnashvillemedicalnews

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While the jury is still out on cause and effect of diet on acne, there is significant research touting the overall benefits of consuming foods with a lower glycemic load including whole grains and lentils. “You can never go wrong telling someone to eat more brown, whole grain foods,� Stein Gold pointed out.

When to Refer

ment for cystic acne when other options have failed to yield the desired clearing. When evidence of scarring is present, Stein Gold suggests isotretinoin be started more promptly. â&#x20AC;&#x153;We have a number of agents in the pipeline,â&#x20AC;? Stein Gold added. â&#x20AC;&#x153;For the first time, we have a topical agent that looks like it can reduce excess sebum production. Theyâ&#x20AC;&#x2122;ve just finished Phase III trials on clascoterone. It blocks the androgen receptor; it decreases sebum production and decreases inflammation.â&#x20AC;? This first-in-class androgen receptor inhibitor by specialty pharmaceutical company Cassiopea SpA penetrates the skin to reach androgen receptors in the sebaceous glands. The 1 percent cream quickly metabolizes to cortexolone, which is found throughout human tissue, thereby minimizing any systemic side effects. In the completed Phase III clinical trials of more than 1,400 patients with moderate-tosevere acne across 112 clinical sites in the U.S. and Europe, 17.5 percent of patients assigned to clascoterone and 5.8 percent receiving vehicle cream achieved treatment success at week 12 (P<0.0001).

but one group ate a high glycemic diet while the other consumed foods with a low glycemic load. â&#x20AC;&#x153;By eating a low glycemic diet â&#x20AC;Ś and changing nothing else â&#x20AC;Ś they actually had a significant decrease in their acne lesions,â&#x20AC;? she said of participants in the second group. â&#x20AC;&#x153;There have been some studies that suggest dairy products, especially skim milk, might also be associated with acne,â&#x20AC;? said Stein Gold, adding yogurt and cheese do not seem to have the same associative relationship to excess sebum production.

â&#x20AC;&#x153;Early acne can certainly be handled by a primary care provider,â&#x20AC;? said Stein Gold. â&#x20AC;&#x153;If you start to see scarring develop â&#x20AC;&#x201C; and scarring can occur even in mild acne â&#x20AC;&#x201C; itâ&#x20AC;&#x2122;s time to refer.â&#x20AC;? She added, â&#x20AC;&#x153;Also, take a pulse of the patientâ&#x20AC;&#x2122;s emotional state. The most important thing is to be empathetic with patients and listen for a few minutes.â&#x20AC;? However, Stein Gold noted primary care providers have to cover a lot of ground, and acne can tumble down the priority list when there are other pressing topics to address. If over-the-counter and first line prescription options donâ&#x20AC;&#x2122;t seem to work, or if a patient is exhibiting emotional distress over their acne, a dermatologist can explore other tailored therapies. â&#x20AC;&#x153;With todayâ&#x20AC;&#x2122;s treatment armamentarium, thereâ&#x20AC;&#x2122;s no reason we canâ&#x20AC;&#x2122;t get our patients clear or almost clear,â&#x20AC;? Stein Gold concluded.

'R\RXKDYH\RXUĂ&#x20AC;QJHURQ the pulse of your practice?

Diet & Acne

â&#x20AC;&#x153;The role of diet in acne has been really controversial for decades,â&#x20AC;? said Stein Gold. In the 1960s, she continued, many clinicians and researchers believed diet definitely influenced sebum production. However, diet as a contributing factor fell out of favor in the ensuing decades. â&#x20AC;&#x153;Today, weâ&#x20AC;&#x2122;re coming back to understand diet probably does have an impact on acne,â&#x20AC;? she said. â&#x20AC;&#x153;We donâ&#x20AC;&#x2122;t have any really, really good evidence that proves diet directly influences acne, but a lot of small studies suggests that it does.â&#x20AC;? Most notably, several studies have pointed to a high glycemic diet â&#x20AC;&#x201C; which includes foods like white bread, potatoes, sugar and white rice â&#x20AC;&#x201C; as a potential trigger. Hyperglycemic diets increase insulinlike growth factor 1 (IGF-1) that has been shown to increase sebum production. Stein Gold pointed to an Australian study where two groups of participants consumed the same number of calories,

Our experienced healthcare team can help you monitor and address critical financial matters so you can continue to focus on what matters most: providing excellent patient care.

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Financing the Deal

NHCC Panelists Discuss Investment Opportunities PHOTO: © 2019, DONN JONES.

On May 22, the Nashville which to partner, panelists agreed Health Care Council hosted on two critical prerequisites: coma panel discussion on private pany culture and sector knowlequity investment trends and edge. “To me, sector knowledge is strategies within the healthcare important because it allows you to industry. More than 300 memdevelop relationships without havbers attended the afternoon ing to explain something multiple event at the Loews Vanderbilt times,” DeParle said. “You want to Plaza to learn more about the look for people who understand a state of the market, M&A activbasic knowledge of the industry.” ity, and the outlook for funding Wylly chimed in saying, the growth of Nashville’s $92 “Many companies treat capital billion healthcare industry. raise as a transaction versus the Tom Wylly, senior beginning of a relationship. Focus partner at Brentwood Capisecondarily on price and terms, tal Advisors, moderated the and instead shift the attention on distinguished panel, which (L-R): Moderator Tom Wylly is joined by investment experts Justin Ishbia, Nancy-Ann Deparle, Jeffrey Crisan and Casey West. culture, business objectives, and included Jeffrey R. Crisan, decision-making that results in managing partner, Silversmith Capital fruitful relationships and trust building.” ket opportunities this year. Shore Capital’s interest in exploring the Partners; Nancy-Ann DeParle, partner, While the panelists represented firms It was noted that many investment opioid addiction treatment space, prevenConsonance Capital; Justin Ishbia, manfrom across the country, all have deep firms are approaching deals with younger tive medicine, animal health, orthodontics, aging partner, Shore Capital; and Casey knowledge and ties to Nashville’s healthcompanies, strengthening the existing women’s health, IVF and FDA compliWest, managing partner, SSM Partners. care ecosystem. Each panelist agreed the management teams at those companies, ance, and consulting. The panel started off with a discussion city has unique strengths. With two Nashand developing three- to five-year plans Crisan shared an observation on of trends in deal activity for new acquisiville companies having already gone live focusing on sales and growth. Panelists said healthcare IT by stating, “There’s been an tions. Crisan began with an observation with IPOs this year – Change Healthcare both short-term and long-term value creevolution in the data and analytics market. about market similarities between 2018 and Smile Direct Club – each panelist ation, as well as company culture, talent, Data and analytics is no longer just early and 2019, noting the macroeconomic facexpressed considerable optimism for this hiring and collaboration, are key compostage companies. In fact, we have invested tors are consistent across both years. While year and years to come. nents of the acquisition strategy. in three data and analytics companies that 2019 has gotten off to a slower start in the “I think Nashville is on a run that will Additionally, panelists shared insights have achieved profitability.” West added first quarter, much like 2018, he said he continue for the next 20 or 30 years,” West on sub-industries within healthcare that his firm has an interest in companies expects it will return to 2018 levels over the said. “What sets Nashville apart is the talare on the rise. DeParle spoke of Condeploying technology that can improve course of the year. The panelists generally ent,” Ishbia added. “The people here are sonance Capital’s interest in behavioral processes. agreed, and all expect to see valuable marwhat make the difference.” health and hospice, and Ishbia discussed   When identifying companies with

SCALE 2019 Showcases Latest in Aesthetics Medicine, continued from page 1 2019 Overview

A highlight of the conference was the cadaver workshop, which served as a fullface surgical anatomy and injection course designed to improve the safety of neurotoxin and dermal filler injections. It was the second year for the workshop, which was in high demand following 2018’s debut. “As cosmetic surgeons, we focus on safety and how to get the best effects Dr. Brian Biesman since you have to be particularly careful with injections from the safety standpoint,” Biesman said. “Cadaver dissection is a rare opportunity outside of the university setting, and we want to continue to grow that area for future conferences.” The event also included more than 130 vendors and a variety of sponsored sessions designed to showcase products and educate providers. “This has become one of the largest aesthetics and medical dermatology meetings in the U.S., and vendors realize the benefit of coming since attendees are here from throughout the world,” said SCALE co-founder and dermatologist Michael Gold, MD, FAAD. He noted attendance included registrants from Mexico, Taiwan, Canada and India. 10

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“Although the meeting has grown, it still feels very intimate, and vendors have the opportunity to spend time one-on-one with meeting attendees and faculty. Some conferences are too big and Dr. Michael Gold busy to allow for that,” he continued. Gold also credited Nashville’s reputation as an “it” city for drawing SCALE attendees.

Innovation in Med-Derm

Gold said medical dermatology continues to rank among the most popular sessions for many attendees. “When it comes to medications for acne and psoriasis, we’ve gone from one or two to 10 or 12 in a fairly short amount of time, so we spend a lot of time educating providers on how to use those,” he said. Media coverage also seems to have piqued the national interest in med-derm. “Every other commercial now is about med-derm, so the industry has exploded. We’re getting practitioners who only do med-derm who might not have attended SCALE in the past.” As an industry, progress also is being made in the treatment of acne scarring, which was of particular interest to 2019 attendees. Practitioners are now com-

bining drugs and devices to accomplish better results. “This is an area where we are continually seeing new products and approaches, and that draws a lot of interest,” Gold said.

New Procedures

Biesman also introduced attendees to a popular South American procedure still new to the U.S. but already available at his Nashville practice. Radiesse® is a dermal filler that is FDA approved for treatment of facial lines and folds and facial revolumization in patients with HIV-related lipodystrophy, but it is also beneficial for structural improvements of the face including the midface and jaw line. He has seen success using Radiesse in diluted doses as it spreads throughout the skin and improves quality and collagen production. He said the product has demonstrated especially promising results on the buttocks, neck, thighs and chest – areas traditionally tough to improve otherwise. “One of challenges we always have is for people who want to improve their overall skin quality, which we can do on the face fairly well but struggle with in other areas,” Biesman explained. Meeting faculty also discussed notyet-announced technology that is still in the pipeline but expected to make a sizeable impact on the industry. One non-

invasive, technology-based treatment for cellulite holds an exceptional amount of promise, while a skin tightening device expected to hit the market by early 2020 has potential to be a game changer for patients with loose skin. Another product composed of silver nanoparticles will allow for better laser-assisted hair removal of light or white hair. Attendees also learned about the latest offering in the neuromodulator product line, a Botox-like product known as Jeuveau, which hit the market May 15.

Going Forward

Looking to 2020, Biesman and Gold expect to grow SCALE’s scope, with continued focus on energy-based devices, injectables and medical dermatology, and enhanced emphasis on plastic surgery, while adding sessions that are both unique and educational for attendees. “We’re doing a lot of upstream work and are always looking at what’s coming down the road,” Biesman said. Gold added he wants to encourage local providers to make plans to attend next year’s event, which is expected to be even bigger than 2019. “If you’re in dermatology or aesthetic medicine, you can’t afford to miss this anymore,” he said. “It’s become one of the premiere meetings in the U.S., and it’s right here in our own backyard.” nashvillemedicalnews

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Vanquishing Varicose Veins Treatment Options Improve Quality of Life & Aesthetics By CINDY SANDERS

There are various reasons individuals wind up with varicose and spider veins … from prior clots and weakened valves to carrying excess weight and a genetic predisposition toward the condition. Luckily, now there are also a variety of options to treat these superficial, but often painful, veins. Patrick C. Ryan, MD, FACS, founder of Nashville Vascular and Vein Institute, noted the twisted, knotted varicose veins and flooded capillaries known as spider veins are almost always in the legs and feet and seem to affect women more than men … although both sexes can and do develop varicose veins. “The mildest symptoms are swelling and heaviness in the leg,” he said. “In extreme cases, people get ulcers in their legs that can be limb threatening.” However, Ryan continued, for most people varicose and spider veins don’t pose a deep medical concern. Still, he said, the pain and heaviness can stop people from engaging in activities they enjoy, which might lead to a more sedentary lifestyle. “It definitely

can affect your quality of life,” he stated. For those bothered by either the look of the veins or resulting symptoms that can’t be managed at home, there are a number of medical treatments to address varicose and spider veins. “Back when I was training, there was really only one way to treat varicose veins, and that was to strip them,” noted Ryan of the surgery that requires general anesthesia. “It’s a pretty brutal operation … but effective.” Vein stripping is no longer the ‘go to’ method for treatment. “I’ve done one in the last five years,” Ryan said. “There are so many other good options now.” Laser Ablation: “Laser ablation is where we use a laser inside the vein to cauterize the vein causing it to clot off,” Ryan explained. He added the procedure is done in the office under local anesthesia. A laser is inserted through a small catheter into the vein. As the probe is slowly pulled back out, the laser energy cauterizes the vein, sealing it off permanently. After the treatment, patients wear a compression garment for several weeks as other healthy veins in the

same area take over blood flow. “It’s essentially pain-free,” Ryan said, adding the procedure only takes about 20 minutes and results in no real downtime. “That’s one of the preferred methods, now,” he added. Radiofrequency Ablation: “It does exactly the same thing except with sound waves instead of a laser,” said Ryan. On a similar note, he continued, “There’s a new treatment called foam ablation of the main varicose vein that is very well tolerated.” Ryan said the in-office procedure consists of one injection into the saphenous vein. The foam sclerosant irritates the vein and closes it off before being absorbed into the body. Sclerotherapy: Used on smaller varicose veins and spider veins, sclerotherapy closes the vein off by injecting a chemical that causes the walls to stick together. Ryan said sclerotherapy is one of the most common ways to treat superficial veins. Often done by a nurse in hour-long sessions, sclerotherapy can take several sessions to diminish or rid the appearance of the surface veins. “The number of sessions

depends on the patient, and each case varies,” said Ryan. The treatment is typically considered cosmetic, and sessions are usually not covered by insurance. Phlebectomy: The minimally invasive procedure allows the surgeon to remove the big, bulging, ropy veins through tiny, 1 mm incisions. Ryan said phlebectomy and foam ablation are often used on these larger veins bulging from the skin’s surface. With phlebectomy, the surgeon uses a local anesthesia to numb the area around the varicose vein before pulling out the collapsed vein through the small incisions, which don’t require sutures. With pre-certification, Ryan said most insurance carriers will cover procedures from ablations to phlebectomy aimed at closing off the saphenous vein. Whether to address discomfort, improve appearance … or both … Ryan said multiple good options now exist to easily treat varicose veins. “Done by someone who is good at it, it’s really pain-free; and it’s rare to have a patient who isn’t very, very satisfied,” Ryan concluded.

NMGMATen Minute Takeaway

Addressing the Employee Element By CINDY SANDERS

locations, 140-plus providers and more than The second Tuesday of 600 employees. In such a each month, practice manlarge practice, she said it’s agers and industry service critical that HR act as an providers gather for an eduumbrella with the same cational Nashville Medical rules and expectations for Group Management Assoall to ensure everyone is ciation (NMGMA) meettreated fairly. “We have ing at Saint Thomas West to set the expectations Hospital. globally,” she said. “If you The May meeting covreally want to get yourered “HR: The Human self in trouble on the HR Element” with an expert spectrum, act on how you human resources panel feel,” Tulloss continued. featuring Keith Dennen, “HR has nothing to do healthcare attorney, Farris with feelings. It has to do Bobango; Libby Tucker, with the law and what is HR panelists (L-R) Libby Tucker, Keith Dennen and Deborah Tulloss regional HR consultant, fair and equitable.” Paychex; and Deborah Tucker said it’s Tulloss, employee experience manager, she said. important to have empathy when an Heritage Medical Associates. The trio Dennen added, “Tennessee is an ‘at employee has an issue, but the resolution shared insights and fielded audience queswill’ state, meaning you can be fired for any should go back to the practice’s written tions regarding a range of employee situareason at all … as long as it’s not an illegal policy. “Blame it on the policy,” she added. tions and issues routinely faced by medical reason.” He noted federal law outlines proTulloss agreed, and laughingly told practices. tected characteristics, which include age, the audience of practice managers and “HR – we call the heartbeat of any sex, race and religion, among others. administrators, “I’m going to teach you organization because we set the tone,” Dennen continued, “Every client I three words that will get you through any Tulloss began. “The culture is set by the have, the biggest potential problem they HR situation – the first two are ‘I underlowest level of performance you allow the have is an employee. Every employee is a stand’ and the third one is ‘however.’” company to have.” potential plaintiff in an EOC lawsuit.” In While the moment was lighthearted, Tucker agreed, noting the field has his observation, Dennen added, the inherTulloss said the underlying message was expanded far beyond hiring and firing to ent regulatory and compliance nature of serious when people ask for exceptions encompass strategic vision and helping delivering healthcare has made employees to stated policy. “My rule of thumb has define and deploy the corporate culture, as generally more attuned to laws and their always been that if I can’t make that same well as keeping abreast of employment and own workplace rights than is often found exception for the next 10 people who labor laws. “We’re the ones who are going in other, less regulated industries. come through the door, then I shouldn’t to minimize the risk of the business owner,” Tulloss said Heritage Medical has 14 do it,” she explained. “Those who ask for nashvillemedicalnews

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the most exceptions over the next 10 years become the most exceptional problems … and that’s never failed me.” On the flip side, she noted, if an exception to a rule could be made for the next 10 employees, then the underlying policy … or absence of one … should be reviewed. For example, her practice recently implemented a policy that reflected the changing work world as technology now allows some employees to work from home. Dennen added the biggest takeaway should be to have a policy in place and to make sure information is well communicated to all employees. “Too many people download an HR handbook from the internet and don’t really even know what’s in there,” he said. “Part of the way our laws have been set up is focused on fairness,” he continued. You can’t grant extra leave to one person because you like them and deny another employee because he gets on your nerves. Dennen said if you have written policies in place, then you at least have the ability to answer why an action was taken or denied if questioned. Ever the attorney, he did note having a written policy doesn’t exempt employers from following the law. That’s no easy task, Tucker said, pointing out laws impacting employees and employment frequently change or are added to the complex mix. “We have a team of analysts who do nothing but keep up with the laws,” Tucker said of Paychex. Dennen added, “Trade organizations like NMGMA do a really great job of keeping you up to date on laws and changes.” JUNE 2019

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TMA Wraps Annual Meeting The Tennessee Medical Association assembled approximately 150 of its physician members in Franklin last month for the 184th annual business meeting of the TMA House of Delegates.  “Doctors who are engaged in organized medicine bring different perspectives from their medical specialties, practice environments, and the places across the state where they live and work. We don’t always agree, but we all understand that working together to resolve differences and find common ground on the most important healthcare issues gives us a stronger and more influential collective voice. The policy decisions drive TMA’s advocacy and support a strong climate for physicians to practice medicine, and deliver the best possible care to our patients,” said W. Kirk Stone, MD, a family physician in Union City and newly elected chair of the TMA Board of Trustees.  

TMA Policy Updates

The House of Delegates considered resolutions on a number of healthcare topics. The assembly overwhelmingly approved one emergency resolution calling for a ban on the sale of any flavored vaping products in Tennessee. Past president Nita Shumaker, MD, a Chattanooga pediatrician, authored the resolution to address serious health risks associated with addictive vaping products, which are widely popular among adolescents.  Other notable policies the association adopted or referred to the TMA Board for possible action: • Encouraging state officials to expand access to treatment options and other resources for mental health and substance abuse disorders. • Calling for truth in advertising for cannabidiol and other CBD products sold in Tennessee. • Advocating for more clarity in state law around remote patient monitoring, and for appropriate reimbursement for physicians who manage patients’ chronic conditions via telehealth services. • Addressing gap that exists between the number of medical school graduates and the lack of available spots in U.S. residency training programs, working with the American Medical Association and other national organizations. • Affirming TMA’s position on scope of practice for midlevel healthcare providers and advocacy for physician-led collaborative practice models.    

New TMA Officers

TMA President Elise C. Denneny, MD, FACS, a Knoxville otolaryngologist, was officially installed as the organization’s 165th physician leader at the annual meeting. Denneny will serve as the public representation for TMA’s 9,500 physician members and will hold a seat on the TMA Board of Trustees. In practice for more 12

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Dr. Elise Denneny

than 30 years, she is in practice at Greater Knoxville Ear Nose and Throat. Denneny earned her undergraduate degree from Northwestern University, her medical degree from Rush Medical College in Chicago, and residency at the University of Illinois, where she served

as chief resident for two years before completing head and neck reconstructive surgery fellowship, University of Michigan. A member of American Academy of Otolaryngology, she is board certified in otolaryngology – head and neck surgery. Nashville physician Kevin Smith, MD, PhD, MMHC, FACP was installed as president-elect. Smith practices primary care and teaches general internal medicine at Vanderbilt University Medical Center. Previously, he was in private practice at Saint Thomas West Hospital, including six years in solo practice. Smith earned his medical degree and completed his residency at Vanderbilt and later earned a Masters in Healthcare Management from the Vanderbilt Owen Graduate School of Management. He

was president of the Nashville Academy of Medicine in 2018. The TMA Board of Trustees transitioned its leadership positions for the coming year, and members reelected the speaker and vice speaker presiding over the business of the House of Delegates. Kirk Stone, MD, will serve as chairman of the TMA Board of Trustees. Tim Wilson, MD, a Knoxville plastic surgeon, was elected to serve as vice chair of the TMA Board of Trustees.  John McCarley, MD, a Chattanooga nephrologist, was reappointed as secretary/treasurer. Kevin Smith, MD, an internist in Nashville, will serve as TMA presidentelect. Edward Capparelli, MD, a family physician in Jacksboro, was reelected as speaker of the TMA House of Delegates.  Charles Leonard, MD, a family physician in Talbott, was reelected as vice speaker of the TMA House of Delegates.

If You Build It, They Will Come, continued from page 5 TriStar Centennial Patient Tower Helipad

Last month, TriStar Centennial Medical Center celebrated the ribbon-cutting on the hospital’s new helipad and celebrated first responders during National EMS Week. The 45 x 45-foot helipad sits atop the 12th floor of the hospital’s recently expanded patient tower. Unique features include a heating system to keep ice and snow from accumulating during cold weather, a built-in fire suppression system utilizing foam instead of water on the landing pad, and a new pilot’s lounge that includes real-time weather analysis capabilities to help flight crews assess conditions prior to take-off.

TriStar Horizon Medical Center

TriStar StoneCrest ED Expansion, Renovation

TriStar Horizon Medical Center

TriStar Horizon Medical Center opened a new $4 million Joint Replacement & Orthopedic Center in May 2019, bringing state-of-the-art care to patients from Dickson and the western part of Middle Tennessee. The 11-bed unit is dedicated to patients who require joint or orthopedic procedures and offers a seamless, boutique experience in a patient-centered environment. Additionally, the new space provides special accommodations for patients and caregivers traveling from outside the area.

tures new patient head walls, furniture, flooring, lighting paint and artwork, in addition to new nursing station. The cafeteria expanded offerings and upgraded finishes throughout the space for a modern aesthetic. The hospital has also gotten sign-off by the state to begin construction of a $17 million facility in Brentwood that will house a surgery center and physician offices. The project is expected to be completed by late 2020. In addition, TriStar Southern Hills is breaking ground this fall on a freestanding ED in Antioch.

TriStar StoneCrest ED

TriStar Southern Hills Renovation & New Project

In the fourth quarter of 2018, TriStar Southern Hills embarked on a $2.1 million renovation of the Critical Care Unit and cafeteria with both of the refreshed spaces making their debut in the first quarter of 2019. The updated CCU fea-

TriStar StoneCrest recently unveiled a $10.5 million renovation and expansion of the medical center’s Emergency Department. The project introduced Rutherford County’s first dedicated pediatric emergency space with five new rooms. In addition, the design team created eight clinical decision beds and four new flex behavioral health/exam rooms, renovated existing space and services including trauma rooms, renovated treatment bays for lower acuity patients and renovated the ED lobby and reception area.

And We’re Sure There’s More We recognize these are not all the exciting projects that have recently come online or been announced. If we’ve missed your project, please email details to editor@nashvillemedicalnews.com, and we’ll add information to our expanded online coverage.

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GRAND ROUNDS

HCA Healthcare Launches SPOT Program to Detect Sepsis Last month, Nashville-based HCA Healthcare announced it has developed an algorithm-driven, real-time system to more quickly identify patients with sepsis and help save lives. HCA Healthcare’s Sepsis Prediction and Optimization of Therapy (SPOT) technology, which has been used with more than 2.5 million patients, is estimated to have helped save 8,000 lives in the last five years when used in conjunction with evidence-based clinical interventions. Sepsis, a leading cause of hospital deaths, can rapidly progress without accurate identification … a task that is made more difficult as sepsis symptoms are similar to those of many other illnesses. “With sepsis, minutes matter, and just as we’ve improved safety in our homes with smoke detectors that ‘sniff out’ possible fire, HCA Healthcare’s SPOT technology now helps detect sepsis earlier, accelerating treatment, improving the care provided to our patients and thereby saving lives,” said Jonathan Perlin, MD, HCA Healthcare’s chief medical officer and president, clinical services group. SPOT – an algorithm and alert system created by HCA Healthcare clinical and IT experts using data from tens of millions of hospitalizations – continuously monitors vital signs, lab results, nursing reports and other data that can inform treatment and recognizes critical  data points in patients’ electronic health records. HCA Healthcare’s SPOT links algorithmic sepsis detection with clinical workflow and quickly alerts care teams to important, but often subtle changes, in a patient’s condition so they can take appropriate action. HCA Healthcare officials said SPOT is the first of many initiatives across the

enterprise to leverage data at-scale and in real-time to drive both discovery and clinical improvement as a natural outgrowth of patient care. Clinical and data science teams expect to continue to improve the algorithm by combining real-world experiences and outcomes with techniques of machine learning and artificial intelligence to enhance clinical effectiveness. Building upon the SPOT technology employed in the inpatient setting, HCA Healthcare is developing “SPOT-ER,” which the company plans to begin deploying in emergency rooms this year. Other plans to use machine learning to more quickly detect critical or life-threatening conditions include a focus on shock in trauma patients, post-operative complications, and early signs of deterioration in all patients.

New Centerstone Roles for Shelton, Lockman Behavioral health organization Centerstone recently announced Richard C. Shelton, MD, has been named the chief science officer for the organization and Jennifer Lockman, PhD, has been tapped to lead Centerstone’s Research Dr. Richard Institute as CEO. The Shelton new positions took effect June 1. Shelton served as CEO for the Research Institute for three years, during which time he elevated the role of science in the care being Dr. Jennifer delivered around the naLockman tion. A graduate of the University of Louisville Medical School, he is currently the Charles Byron Ireland Professor, vice chair for Research, and

New Technology Helps Patients Requiring Frequent X-rays Monroe Carell Jr. Children’s Hospital at Vanderbilt has introduced a new X-ray imaging device at the pediatric orthopedic clinic to help patients like Chloie Jacobs, 9, (pictured). Jacobs, who needed a follow-up scan for her congenital scoliosis, and other patients requiring frequent X-rays are benefitting from the cutting-edge technology known as EOS. Although it’s outer space-like design feels a bit more like entering a teletransporter, the real beauty of the imaging system is that it uses ultra-low radiation doses (up to 50 times lower depending on the scan type) to capture 2-D and 3-D images. The scan, complete in about eight to 15 seconds, obtains an image of the body in an upright, load-bearing position, which is more representative of the body’s natural function. “She has X-rays at least three times a year, so anything with less radiation is always better,” said Chloie’s mother Amber Jacobs. Less radiation for high-quality scans is appealing to doctors and parents because the cumulative effects of too much radiation can be harmful to a child, increasing the risk of cancer. If a child can’t stand unassisted in the EOS machine, a chair specifically designed for the machine allows the child to sit while being scanned. nashvillemedicalnews

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head of the Mood Disorders Research Program in the Department of Psychiatry and Behavioral Neurobiology at the University of Alabama at Birmingham. Lockman joined Centerstone in 2007 and most recently oversaw the Research Institute’s clinical research program, serving as a liaison with external researchers and creating new methods for measuring clinical outcomes. After completing her doctorate in counseling psychology from Purdue University, she completed her psychology internship at the University of Rochester Medical Center and a competitive research postdoctoral fellowship at the VISN 2 Center of Excellence for Suicide Prevention. She maintains a research program and professional practice in suicide prevention.

Let’s Give Them Something to Talk About!

Awards, Honors, Achievements

TriStar Hendersonville Medical Center celebrated its 40th Anniversary on May 15 with a community celebration. Barbara Mays, accounting assistant at Encompass Health Rehabilitation Hospital of Franklin, was honored last month at an awards gala in Birmingham as one of only seven finalists out of more than 30,000 inpatient rehabilitation employees in the EncomBarbara Mays pass Health, formerly HealthSouth, network to receive the 2018 Outstanding Employee Achievement Award. Realty Trust Group (RTG) has been ranked as the sixth-leading national healthcare real estate development firm by Modern Healthcare. Ascension Saint Thomas recently announced Colleen Fultz, LPN, a Saint Thomas Medical Partners (STMP) nurse in Murfreesboro, has been recognized as Tennessee’s Childhood ImmuColleen Fultz nization Champion of 2019. The Centers for Disease Control (CDC) and the Association of Immunization Managers (AIM) present this award annually to one exceptional honoree from each state. With more than 45 years of service as a nurse and 25 years in pediatric care, Fultz leads the Vaccines for Children program at STMP’s Saint Louise Clinic. She is also a regular volunteer with the clinic’s mobile health unit, which travels directly to children in underserved areas. Argentine native and long-time Nashville resident Diana SanchezVega (aka Diana Holland) has launched a Spanish, health-themed radio program “Sanos, sabios y prósperos” Diana SanchezVega (Healthy, Wise and Pros-

perous). The educational radio talk show kicked of last month on Christian Spanish radio station WKDA Radio Luz Nashville 900 AM. The show will air weekly on Fridays from 10 am to 11 am.

Clover Health Opens New Local Office

Clover Health, which combines technology with its Medicare Advantage insurance programming to focus on health and preventive measures for covered lives, recently announced the opening of a new Nashville-area office and the intent to tap into the city’s deep pool of healthcare talent. The new space at 725 Cool Springs Blvd. will house healthcare operations experts as the company realigns internal teams to launch the next phase of growth. Those interested in the new positions can learn more and apply through the Clover Careers page of the website (cloverhealth. com). Company officials said they expect Middle Tennessee to be the focal point for hiring in 2019.

Edgeworth Joins HCA’s TriStar Division as CAO South Mitch Edgeworth has been appointed chief administrative officer for HCA Healthcare TriStar Division’s southern region. In this newly created role, Edgeworth will have oversight of the Chattanooga and Northwest Georgia markets and will work with leadership to expand the service footprint utilizing an integrated approach to network access, regional outreach, hospital operations and strategic planning. Edgeworth came to HCA Healthcare from Vanderbilt University Medical Center, where he was the CEO of Adult Hospital and Clinics, focusing on all aspects of operational performance for the adult clinical enterprise. Prior to joining VUMC, Edgeworth was with Quorum Health Resources where he served as regional vice president and was responsible for the operational performance for 12 hospitals located across multiple states.

AdvancedHEALTH Welcomes Lawson AdvancedHEALTH, Middle Tennessee’s largest, independent, multispecialty practice, recently announced the addition of Laura L. Lawson, MD, to its growing group of providers. Lawson sees patients at Nashville Breast Center, along with Pat Whitworth, MD. Lawson received her medical degree from Vanderbilt University School of Medicine and then completed a general surgery residency at VUMC, followed by a breast oncology fellowship also at Vanderbilt. Prior to joining Nashville Breast Center, Lawson developed the breast care program for Saint Thomas Health and will continue to serve as the medical director of the Saint Thomas Breast Cancer program. She previously worked with Whitworth at Nashville Breast Center as part of her fellowship training. JUNE 2019

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GRAND ROUNDS

May Joins Montecito Billy May has joined Montecito Medical Real Estate, the nation’s top privately held acquirer of medical office properties, as vice president of asset management. May has more than a decade of experience in commercial real estate Billy May and will manage Montecito’s growing portfolio of over 135 premier medical office buildings totaling more than three million square feet. Previously, May spent six years with HCP, a Nashville-based Real Estate Investment Trust, where he served as director of asset management. He is a graduate of The Wharton School at the University of Pennsylvania, where he earned a degree in Economics and was a member of the 2003 Ivy League Champion football team.

Johnston Joins Integrative Life Center Anita Johnston, PhD, CEDS has joined community-based behavioral health provider Integrative Life Center (ILS) as executive director for Eating Disorders Programming. In this new role, Johnston will further develop current Dr. Anita programming to include Johnston a detailed, customized program for those in need of treatment

Blog Log The Nashville Medical News Blog features additional insights and information from a cross-section of industry leaders. The blog can be accessed directly through NashvilleMedicalNews.Blog or from the homepage of the main website.

NEW IN JUNE: Brian Howard, senior project executive for Messer Construction, shares vital statistics on building an OR in the midst of ongoing care delivery at busy medical facilities.

Online Bonus Editorial Go online to NashvilleMedicalNews. com for breaking news and additional editorial in June including: • Updates from the American Medical Association’s annual meeting. • Any movement on the bipartisan Lower Health Care Costs Act of 2019 as proposed by the Senate Health Committee, led by Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.). • The seven healthcare leaders selected for induction in the 2019 Tennessee Health Care Hall of Fame.

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for eating disorders. The expanded programming will include integration of Johnston’s approach to treatment and the addition of specialized personnel for aiding recovery. As a leading clinical expert, Johnston’s approach is widely considered best practice for addressing disordered eating. Her best-selling book Eating in the Light of the Moon  and online courses follow her individualized, patient-centered approach to recovery. Prior to joining ILC, Johnston co-founded the Anorexia & Bulimia Center of Hawaii and the Light of the Moon Cafe and served as clinical director at Ai Pono Eating Disorders Treatment Programs.

TriStar Southern Hills Adds Latest da Vinci System TriStar Southern Hills has added the da Vinci Surgical System to the hospital’s surgical service program. The minimally invasive, robotic-assisted surgical technology typically results in less pain, reduced scarring, reduced blood loss and a shorter hospital stay and recovery period. “Robotic-assisted surgery is changing the way surgeries are performed,” said William Yi, MD, a board certified general surgeon. “From the surgeon’s perspective, the highly advanced system offers an enhanced field of view and greater precision, which helps to ensure a better outcome for the complex procedures that I perform.”

Damaged Lungs Regenerated in VUMC Study A new technique to rehabilitate lungs that are too damaged to be considered for transplant could benefit an increasing population of patients with end-stage lung disease. About 80 percent of the already limited supply of donor lungs are too damaged to be considered for transplantation, according to senior author Matthew Bacchetta, MD, MBA, MA, associate professor of Thoracic and Cardiac Surgery at Vanderbilt University Medical Center. Dr. Matthew In May, Bacchetta Bacchetta and colleagues from Columbia University published a study in Nature Communications  that demonstrates a cross-circulation technique can maintain lungs for 36 hours, giving doctors time to rehabilitate the lungs and test new interventions. The regenerated lungs also met criteria for transplantation, which isn’t possible with current methods that provide doctors about six hours to assess the lungs and not enough time to rehabilitate them. “Our work has established a new benchmark in organ recovery,” Bacchetta said. “It has opened up new pathways for translational applications and basic science exploration. We have literally spent years refining this technology to improve the recovery and regeneration of organs.”

Further study will be required to determine how well the rehabilitated lungs function, safety of the method, and how the lungs respond to immunosuppressive drugs given after transplantation.

7 Springs Orthopedics Expands Locations, Services Last month, 7 Springs Orthopedics announced the expansion of its facilities and service lines following its first institutional financing round. The company has begun the process of opening new locations throughout Middle Tennessee, starting with Bellevue and East Nashville, and also adding physical therapy services to its existing clinics in Brentwood and Antioch. Nashvillebased venture capital firms Frist Cressey Ventures and Altitude Ventures co-led the financing round.

Business Briefs

HealthStream has relocated to its new offices in the Capitol View development downtown. Nashville-based Cumberland Pharmaceuticals reported 38 percent revenue growth in the first quarter of 2019. Other highlights include FDA notification the company’s new drug application (NDA) for methotrexate was complete and acceptable for filing, along with a September 2019 date for an approval decision. Cumberland has also reached an exclusive agreement with Hong Kong’s WinHealth Pharmaceuticals to assume responsibility for Acetadote® and Caldolor® in China, the world’s second largest drug market for pharmaceuticals after the U.S. The company recently completed a strategic review of their portfolio, partners and organization to guide decision-making. Omega Healthcare Investors, Inc. and Nashville-based MedEquities Realty Trust, Inc. have announced the completion of Omega’s acquisition of all of the outstanding shares of MedEquities. The transaction represents an enterprise value of approximately $600 million for MedEquities and further diversifies Omega’s assets and operators. Following the acquisition, Omega will continue to be the premier publicly traded real estate investment trust (REIT) focused principally on skilled nursing facilities (SNFs), by adding a diversified portfolio of investments including 34 properties located in 7 states and operated by 11 different operators. Nashville-based BerniePortal announced the launch of the BerniePortal Broker Network in late May. Searchable on the BerniePortal website, this network allows employers to find and access local HR and benefits expertise quickly and easily. Unveiled at BerniePortal’s recent users conference, Weekdays with Bernie, over 100 local brokerage partner firms across the country have already created profiles on the network. Through the Broker Network, employers can search by location and view brokerage descriptions, scope of practice, and client reviews.

Y O U R M I D D L E T N S O U R C E F O R P R O F E S S I O N A L H E A LT H C A R E N E W S

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