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Your Middle TN Source for Professional Healthcare News

Building Stronger Women


Advancements in Osteoporosis Treatment Prove Promising

Cornelia Graves, MD


Osteoporosis is diagnosed in one in four women age 65 and older. In fact, of the 10 million Americans with osteoporosis, more than 8 million are women, and that number’s expected to climb. According to the Administration on Aging, an operating division of the U.S. Department of Health and Human Services, the population age 65 and older increased from 38.8 million in 2008 to 52.4 million in 2018 (a 35 percent increase) and is projected to reach 94.7 million by 2060.


Leading with Purpose

Vanderbilt’s April Kapu Named AAPN PresidentElect More than one billion Americans visit nurse practitioners annually. As providers scramble to care for an aging baby boomer population on the heels of an unprecedented pandemic, the need for advanced care practitioners has skyrocketed ... 9

Why are Women at Risk?

“Optimally, osteoporosis is a preventive health issue,” said Christian Rhea, DO, FACR, a rheumatologist specializing in osteoporosis treatment at Heritage Medical Associates, “and treatment is started before a fracture ever occurs.” While Rhea stressed osteoporosis shouldn’t be discounted in men, women (with smaller, thinner, less dense bones than men) are the ones usually affected. Women also live longer and precipitously lose bone after menopause, two factors further increasing their lifetime risk for fractures. (CONTINUED ON PAGE 6)

Healthcare Construction & Design Trends

No Surprises

NCI Director Updates Cancer Progress In April, National Cancer Institute Director Norman E. “Ned” Sharpless, MD, FAACR, addressed the virtual attendees of the American Association for Cancer Research Annual Meeting to provide an update on where we stand in the ongoing fight against cancer ... 17


Issues, Considerations Moving Post-COVID



Insight into new legislation intended to address the persistent problem of balance billing patients for the costs of services of facilities and providers who are not in their health plan network ... 15

April/May 2021 >> $5

Slowly but surely, the nation is beginning to emerge from strict COVID protocols and return to some semblance of normalcy. While it’s a bit too soon to craft ‘best pandemic design practices,’ Nashville Medical News recently spoke with two experts to get their take on design considerations and the reemergence of some pre-pandemic trends.

Evidence-Based Design

A blend of form and function, this design by Gould Turner showcases beautiful and cleanable hard surfaces, natural lighting and outdoor elements.

Matthew Griffith, AIA, vice president and senior architect with the Gould Turner Group, a subsidiary (CONTINUED ON PAGE 14)

For more topic-driven information by subject matter experts, check out our blog: nashvillemedicalnews.blog

Beating the Odds

community, so just talking to them, being  honest and explaining risks is so important.”  Despite Tennessee’s shocking one in 1,000  maternal mortality rate, the Nashville hospital  maintains a mortality rate of zero. 

TriStar Centennial Women’s Hospital committed to better outcomes for high risk obstetric patients

Better outcomes

achieve optimal outcomes with a deliberate  High-risk complications occur in six to  focus on prevention of maternal mortality,”  eight percent of pregnancies, leaving  Price said.  women prone to medical complications and  increased risk of maternal  mortality. In fact, the US is the  only industrialized nation with  a consistently rising maternal  death rate, currently 17.4 of  100,000. Amber Price, DNP,  CNM, chief operating officer  at TriStar Centennial Women’s  Hospital, said a programmatic  approach is key to reducing  maternal mortality while  still providing individualized  Amber Price, COO Dr. Harold Bivins birthing experiences for highrisk patients. “Regardless of whether women  Addressing maternal mortality present from a private physician, midwife or  Harold Bivins, MD, medical director of Maternal  the ER, we have a team of experts prepared  Fetal Medicine at TriStar Centennial Women’s  no matter how difficult her situation,” said  Hospital, said African Americans face a  Price. The hospital, which welcomes 3,500  mortality rate three times higher than the  babies annually, also provides dedicated  national average, prioritizing the need for  education and early intervention in minority  maternal and NICU transport regionally via  communities. “Transparency is so important,  ground and helicopter, and is staffed by  so we emphasize really listening to patients  a team of seven high-risk maternal fetal  specialists as well as cardiologists and  when they come in, which is often through the  others trained in obstetrics. Their NICU team  ER where they’re already afraid,” Bivins said.  also is available for deliveries in outlying  “We put ourselves in the shoes of patients  hospitals when transportation isn’t possible.  to understand and address their immediate  “Our infrastructure build is significant,  needs. So much of their comfort level depends  because our team members work together to  on past experiences with the medical 

The TriStar hospital also is making strides in  resuscitation of preterm babies, resuscitating  as early as 22 weeks. Price noted the  hospital’s 42 percent survival rate at 22 weeks  gestation – up from a national average of less  than five percent a few years ago. “We  make sure every baby has an optimal  chance of survival,” she said. Improved  outcomes also require establishing  relationships with outlying hospitals,  including those in rural communities.  A one-stop call from any partnering  physician launches multi-disciplinary  coordination and access to TriStar’s  Transfer Center. “There’s projected to be  more and more high risk pregnancies  based on an increase in pre-existing  medical conditions, so we’re revving  up staff and working with physicians whose  patients might need to see someone like me,”  said Bivins, who works with patients in rural  communities as well as visitors to Music City.   High-risk patients also work with a navigator  to guide them through their prenatal journey.  Navigators coordinate tools including virtual  classes and tours, and connect patients to  specialists when necessary. 

complete by fall 2021. Birthing suites include  murphy beds, slings, squat bars, and walk-in  showers and labor tubs to accommodate  the growing number of women requesting  hydrotherapy during labor. Midwifery – now  preferred by 20 percent of women - also is  available in the ER and L&D. “So many women  want minimal intervention or to be mobile  during labor, so any patient here has that  option,” Price said. As part of their ongoing  quality initiative, the hospital also oversees a  committee focused on avoiding unnecessary  surgeries such as C-section, even when a  woman is higher risk. “Moms often worry  about losing their birth experience, and  extenuating circumstances create a fear that  the birth you envisioned isn’t possible,” Price  said. “With our individualized care experience,  our team sits down to prepare everything  we can before the birth, so high-risk doesn’t  mean you won’t get the experience you’re  looking for. Everyone collaborates to give the  patient the birth she wants with a safety net  in place for assistance if it’s necessary.” Bivins  said today’s OB patients are more informed  than in years past, and that physicians  have adopted a more transparent approach.  “Consumers are looking for shared decision  making,” he explained. “We’re partners in care,  so it’s not a one-way street. We can’t predict  a birth but can commit to the fact that you’ll  have a say in how things will happen. We  have a basket with everything in it, and we  only pull out what we need for each patient.”

Meeting demand

Now in phase two of a four-phase renovation,  the hospital recently completed a high-risk  OB unit and lobby remodel (see below), and  anticipates two more high-risk delivery units 








TFA Affords Women Another Option to Treat Symptomatic Fibroids  Gynesonics’ Sonata System Proving Efficient, Effective & Safe By CINDY SANDERS   

relieve symptomatic fibroids. “The reason is they don’t want that disruption to their life.” In contrast, Toub continued, “Transcervical  fibroid  ablation heats the fibroid by going in through the cervix, so no incisions, and it conserves the uterus.” He explained the Sonata System combines intrauterine ultrasound guidance for advanced visualization with targeted radiofrequency ablation to treat the fibroids. “Because it’s inside the uterus, it’s very high resolution,” he noted. “We can see details that we don’t always see on transvaginal ultrasound or MRI.”  Performed as an outpatient procedure, Toub said women don’t  have to undergo general anesthesia, and about half the cases in the U.S. use sedation.  “The average length of stay in our study was about two-and-a-half hours and that includes the procedure,” Toub noted. The majority of women, he added, return to normal activity within 2.2 days on average, with many able to do so within one day.   Although a few other radiofrequency ablation systems exist, Toub said they have typically required adaptive devices. “Because the ultrasound is part of the device itself, you don’t have to manipulate multiple tools. There’s just one device and one screen,” he explained of Sonata. “It

Almost always benign, women with symptomatic fibroids would be quick to say it doesn’t mean the tumors aren’t troublesome.    In the United States, symptomatic uterine fibroids are the most common reason for hysterectomy, which remains the only cure for the myomas. Since prevalence of problematic uterine fibroids (UFs) are most common during reproductive years, the cure presents an unacceptable trade-off for women who hope to bear a child in the future. As a result, many women live with painful symptoms detrimental to their quality of life for years. While not a cure, there are an increasing array of alternatives to manage fibroids for those trying to preserve fertility. Medication management, myomectomy, radiofrequency ablation, uterine artery embolization and MRI-guided focused ultrasound have all been shown to offer some relief with varying degrees of invasiveness, efficacy, longevity and patient satisfaction. One of the newest options for women is the Sonata® System from Gynesonics®, a women’s health company focused on minimally-invasive solutions for treating symptomatic uterine fibroids. The California-based company first received Food & Drug Administration 510(k) approval to market the Sonata System for Transcervical Fibroid Ablation (TFA) in August 2018, and received clearance for their next generation system last year. The system can be used to treat most fibroid types including submucous, intramural, transmural and subserous.  “Women deserve choices when it comes to the management of fibroids,” stated David Toub, MD, MBA, FACOG, medical director for Gynesonics. “It used to be there were really only two options – hysterectomy, which was curative but precludes fertility, and Dr. David Toub myomectomy, which removes fibroids but preserves the uterus.”  However, Toub continued, open abdominal myomectomy is a major surgical procedure that typically takes four to six weeks for full recovery. Minimally invasive laparoscopic myomectomy  requires a much smaller incision but is still performed under general anesthesia, could include an overnight stay in the hospital and typically takes two to four weeks for full recovery.  “According to the literature, women HEALTHCARE typically wait, on average, 3.6 years and a good percentage wait five years,” Toub said of the delay in seeking treatment to

also doesn’t require advanced ultrasound skills,” Toub continued, noting most physicians using the system are not highly specialized in ultrasound technologies. “Yet, it’s proven in their hands to be very effective and also proven very safe.”    Sonata includes the SMART Guide –  Setting  Margins of  Ablation in Real Time. The Gynesonics literature explains this technology displays a realtime graphic overlay on the live ultrasound image to determine the size and location of the ablation zone, safety borders and duration of the radiofrequency energy delivered.  In April, the company announced publication of a clinical study analysis  assessing  effectiveness of the

system. The peer-reviewed article, “Transcervical Fibroid Ablation With Sonata System for Treatment of Submucous and Large Uterine Fibroids,” appeared in the International Journal of Gynecology and Obstetrics. The analysis focused on a subgroup of patients with those specific types of tumors who had been enrolled in two previously published multicenter clinical trials –FAST-EU, primarily in Europe, and SONATA, primarily in U.S.based centers.  Among 197 women who had been treated for 534 fibroids, 86 percent of patients with only submucous fibroids and 81 percent with large fibroids (>5 cm) had bleeding reduction at three months postablation with sustained improvements over 12 months. Fibroid mapping with MRI in the FAST-EU trial showed an average volume reduction of 68 percent. Toub noted the volume  reduction compares favorably to other uterus-sparing technologies with embolization typically seeing reduction of 50 percent, pharmaceuticals achieving 40-50 percent reduction and focused ultrasound in the range of 15-30 percent reduction.   Furthermore, the rate of surgical reintervention among the women with only submucous fibroids was 3.7 percent in FAST-EU and 0.7 percent in SONATA at the one-year mark. Toub added the reintervention rate on the SONATA trial (CONTINUED ON PAGE 15)

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New & Noteworthy in Women’s Health Ascension Doctors Perform Innovative ‘Hot Chemotherapy’

In April, Ascension Saint Thomas announced Jason Barnett, MD, and Michael Stany, MD, became the first gynecological oncologists in the state to perform a type of chemotherapy treatment known as Hyperthermic Intraperitoneal Chemotherapy (HIPEC) or “hot chemotherapy” when they used it in surgery Dr. Jason Barnett earlier this year.  Research suggests heating a standard dose of chemotherapy and applying directly to the abdomen during surgery increases penetration of the cancerous tissues. Though HIPEC has more frequently been used by Dr. Michael Stany surgical oncologists to manage cancers of the abdomen, Barnett and Stany made state history by employing this technique at Ascension Saint Thomas Hospital Midtown in the treatment of an ovarian cancer patient.  In this particular case, the patient first completed traditional chemotherapy treat-

ments before heated chemo was applied at the time of “debulking,” or surgical removal of the cancerous tumors. The surgery took approximately six hours with additional rounds of traditional chemotherapy planned. The patient, a Middle Tennessee resident, has returned home and is recovering well.  “Any time a treatment is new, there is a learning curve. Dr. Stany and I are excited about this innovative use of HIPEC, and we feel optimistic about its potential for life-saving application in ovarian cancer patients,” said Barnett. 

UnitedHealthcare Awards More Than $276,000 in Maternal Health Grants

UnitedHealthcare Community Plan of Tennessee has awarded more than $276,000 in maternal health grants to six community organizations aimed at improving maternal health outcomes, reducing disparities and expanding access to care. The grants, ranging from $5,000 to $75,000, support programs focused on disparities, prepartum and postpartum education and addressing social determinants of health. “Pregnant women in the U.S. are increasingly experiencing adverse maternal and birth outcomes, particularly Black women,” said Keith Payet, CEO, UnitedHealthcare Community Plan of Tennessee. “UnitedHealthcare believes that we must


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identify and support high-risk mothers early and throughout their care journey including after birth, through partnerships with national and local community-based organizations.” Four of the grants are for organizations covering West Tennessee. Two of the largest grants, however, are for Nashville organizations. Mother to Mother has been awarded $65,964 to purchase car seats, cribs and strollers. Nashville Diaper Connection was awarded $45,000 to purchase diapers and to support program promotional materials. “Nashville Diaper Connection’s mission is to ensure that every baby in Nashville has enough diapers to remain clean, dry and healthy. We leverage Nashville Diaper Connection’s partner network and our diaper donations to improve crucial maternal, infant and toddler health outcomes,” said Doug Adair, CEO and founder of Nashville Diaper Connection. “This maternal health grant allows us to better serve high-risk mothers and babies while working toward our goal of ‘No Child Wet Behind.’” These grants are part of several initiatives that UnitedHealthcare, along with its parent company UnitedHealth Group, is launching to address maternal health outcomes throughout the United States, including over $5 million in recent philanthropic grants to support maternal health and $2.85 million in support to March of Dimes  for a public-private partnership with the Department of Health and Human Services that aims to reduce the Black-White disparity gap and improve maternal health outcomes.

Increased Risk of Serious Opioid Events in New Moms

A new study from Vanderbilt University Medical Center researchers finds that new mothers who receive opioids after uncomplicated vaginal births face an increased risk of serious opioid-related events regardless of the opioid dosage, a finding that could significantly impact care delivery. Andrew Wiese, PhD, MPH, assistant professor of Health Policy in the Division of Pharmacoepidemiology, authored the paper published online April 15 in Women’s Health Issues, with Sarah Osmundson, MD, MPH, associate professor of Obstetrics and Gynecology, and other researchers in the departments of Biostatistics and Health Policy. The study examined roughly 147,000 women enrolled in TennCare between 2007 and 2014 who gave birth and had received one or fewer opioid prescriptions prior to delivery. The median age of the women was 23 years. Most women (68 percent) were white, and most were from Central and East Tennessee. The study found that receiving an outpatient opioid prescription within four days after vaginal childbirth was associated with an increased risk of developing a serious opioid-related event, including becoming a persistent opioid user, develop-

ing an opioid use disorder, or experiencing an opioid-related overdose or death. Even women prescribed less than 100 MME — roughly equivalent to 20 hydrocodone or 13 oxycodone pills (5 mg strength) — faced a 52 percent increase in the risk of a serious opioid-related event compared with those who did not fill a prescription. “We generally assume that higher dosages of opioids are associated with a greater risk of negative outcomes,” Wiese said. “But we wanted to answer the question of whether low-dose prescriptions were completely safe, and it turns out even low dose prescriptions harbor some increased risk of bad outcomes.” Although the absolute risk of these outcomes in the first year after birth is relatively rare, given the large number of births that occur annually, many women may be at risk for adverse outcomes with opioid exposure. This research also demonstrates that many of these negative events occur after the traditional 42-day postpartum period. Wiese also said their primary finding could affect how clinicians, particularly those in obstetrics and gynecology, consider prescribing opioids for women after vaginal births in the future, but establishing best practices is still unclear.

TDH WIC Program Releases Smartphone App

In April, the Tennessee Department of Health announced the release of the WICShopper application for smartphones. As a part of the Women, Infants and Children (WIC) program, the new WICShopper app is another tool to help participants establish and re-enforce healthy eating habits. The app allows participants to scan the UPC barcode of store products determining whether that product is allowable as a WIC food item and on the participants WIC benefits. The app also includes other key features including location of Health Department clinics, WIC authorized store locations, healthy recipes, cooking and shopping tips. ‘’The WICShopper App makes it one step easier to access healthy food and nutrition education resources available through WIC,’’ said Tennessee Health Commissioner Lisa Piercey, MD, MBA, FAAP. ‘The WICShopper App puts resources at the fingertip and is another example of how the Tennessee Department of Health is implementing innovative solutions to improve services for Tennesseans.’’ Since the statewide rollout of the TNWIC Electronic Benefits Transfer (EBT) card in April 2019, the Tennessee WIC program continued to enhance the process for WIC participants to receive benefits and purchase food products for their families with the WICShopper app representing the most recent example of this commitment. Participants can download the free app from the Apple App Store or the Google Play Store. Additionally, participants can visit the TDH website at www.tn.gov/wicshopper  for instructions on how to download the app.




         When Leona Jeans was just 18 years old, she collapsed at work and went into cardiac arrest. After that frightening incident, she began seeing a cardiologist regularly, but her heart problems continued. She said all three of her pregnancies had complications and her heart got progressively worse. “I didn’t have energy to do anything with my kids,” Leona said. “I couldn’t go outside and play with them, walk with them or do anything without being at the point where I thought I was going to die.” Leona had an implantable cardioverter defibrillator (ICD) surgically implanted in her chest to monitor her heart rhythm and detect irregular heartbeats. An ICD is a small batterypowered device that can deliver electric shocks to fix an abnormal heart rhythm. She said she had the device for a few months before it began delivering shocks frequently, due to abnormal heart rhythms. “The machine couldn’t keep up with my heart,” Leona said. Leona was placed on the heart transplant list in the summer of 2020, and she received a new heart that October, at the age of 33. She said the surgery and recovery process has been an emotional experience but that her care teams at Ascension Saint Thomas Heart have been by her side every step of the way. “I couldn’t have asked for better nurses and a support team at the hospital,” Leona said. “Had it not been for the doctors, nurses and care team, I don’t think I would have made it through. They never once looked at me as if I was an inconvenience, and they were always right there.” Leona is getting accustomed to living with her new heart and says the transplant has given her a new perspective on life. “I’m glad I went through with the

“I couldn’t have asked for better nurses and a support team at the hospital. Had it not been for the doctors, nurses and care team, I don’t think I would have made it through.” — Leona Jeans heart transplant because if I hadn’t, I wouldn’t be here to see my kids today,” Leona said. “I’m alive, and I couldn’t ask for anything more.” Ascension Saint Thomas Heart is one of the most experienced cardiovascular medicine programs in the nation. As the largest heart failure program in the state, Ascension Saint Thomas Heart recently relaunched its heart transplant program and is now provid-

ing lifesaving heart care for Tennessee patients who need it most. From minimally invasive surgery, which may lead to shorter recovery time, to cutting-edge

techniques for treating heart failure and programs designed specifically for women’s heart health, the advanced care you need is close to home.


© Ascension 2021. All rights reserved.






Building Stronger Women, continued from page 1 Diagnosing Osteoporosis

Rhea said there are three ways to diagnose osteoporosis. Too often, a patient finds out after experiencing a disease-defining fracture – typically a low impact compression fracture of the spine or a traditional fracture of the hip or arm. More fortunate patients will have bone loss identified pro- Dr. Christian Rhea actively on a DEXA (or bone density) scan, allowing for early intervention and treatment. While half of women will experience a fracture related to a weak bone during her lifetime, Rhea said the majority of women in his practice have never had a fracture. “It’s kind of standard now to order a DEXA scan when a woman becomes post-menopausal,” he said. “The unfortunate truth is that the DEXA only identifies half of women who need to be treated – not a perfect screening tool but it’s the best we have.” Lastly, Rhea uses an online calculation called a Fracture Risk Assessment Tool, or FRAX® Index which improves the sensitivity of the DEXA. The FRAX takes into account specifics that are important factors when considering fracture risk including height, weight, age, certain medications and a patient’s personal and family history, along with DEXA score.

Hope for Patients

The past decade has brought a myriad of innovative therapies that have proven effective for osteoporosis. Patients whose bone loss is identified before a fracture occurs can benefit from bisphosphonates – bone-strengthening medications like Fosamax®, made popular in the 1990s. Rhea said the class is effective but not without side effects and dosing complexities that keep compliance historically around 50 percent. “They’re a good first-line defense, but I see a lot of cases where the patient just can’t tolerate or remember to take them,” he said of the weekly oral therapy. Another option, often better tolerated, is to receive the treatment as a yearly IV infusion. Intravenous therapies like Reclast® bind into the bone and are shown to reduce compression fractures up to 70 percent and hip fractures by 50 percent. A third FDA-approved option is Prolia®, given twice a year as a subcutaneous injection. Rhea said it’s a safer option for long-term use, well tolerated and reduces fractures at a similar rate to Reclast. “Patients often transition to Prolia after three to five years on Reclast. It’s a common progression,” he said, noting that meds like Reclast and Fosamax typically decline in effectiveness after five years. Forteo® and Tymlos® represent a different category and involve daily injections for up to two years. Forteo is a lab-made version of human parathyroid hormone, while Tymlos is a version of human parathyroid protein. “These stimulate bones

Your Advocate & Expert For Practice Management

In an uncertain practice environment, it’s never been more important to have access to accurate, timely information. NMGMA keeps you up to date with monthly speakers addressing pressing practice issues. Join us for virtual meetings until we are all able to gather together in person again. For information on upcoming events or to join, go online to www.NashvilleMGMA.org or email website@nashvillemgma.org 6



May is National Women’s Health Month & National Osteoporosis Month

to grow rather than just preventing loss,” Rhea explained. “I tell patients it’s like a bank account: You can either stop withdraws or increase deposits. Reclast and Prolia stop withdraws but depend on you to make and keep the bone.” Over the past two years, Evenity® has proven to be another welcome option that works by growing more bone and preventing bone loss. The subcutaneous injection is administered once a month for one year.

balloon kyphoplasty product in 1998, the company has continued to evolve the technology with the development of better balloons, an improved cement delivery system and added access tools shown to reduce hand radiation exposure for surgeons over the last several years.

Osteoporosis Myths

After a fracture is identified, physicians start patients on bone building agents to Balloon Kyphoplasty prevent secondary events. They also urge Unfortunately, too many patients learn women to get adequate calcium – preferably from food sources like dairy rather of their diagnosis after experiencing spinal than supplements. fracture, a debilitating result of advanced “One misconception is that extra calosteoporosis in the elderly. Daniel Wunder, cium will help build bones stronger, but it MD, an interventional radiologist at Ascension Saint Thomas and Premier Radiology really doesn’t,” said Rhea. “You need just Tennessee, has performed more than 1,000 enough to not be calcium deficient. Too minimally invasive much may be harmful and lead to kidney Medtronic Kyphon™ stones and possible cardiovascular calcification.” Balloon Kyphoplasty However, Rhea noted, Vitamin D also procedures in the past is essential and should be take as a suppledecade. ment since there are few dietary sources. He Watching a livealso recommends weight-bearing impact X-ray on a monitor, exercises like 20 minutes of walking three he punctures the back times a week. “Just keep in mind that, while with a needle to insert these measures are good and necessary, they a tiny balloon into the Dr. Daniel Wunder have not been proven to reduce fractures damaged vertebra. He like medical interventions have and are not then uses a pump to inflate the balloon, a replacement for treatment but part of a attempting to restore the original height of holistic treatment plan,” said Rhea. the vertebra and create a cavity before then He also frequently addresses the misinjecting acrylic bone cement into that cavity to create an internal cast to repair the conception that a negative DEXA score fracture. following a low impact fracture rules out “It’s probably the closest thing you’ll osteoporosis. “DEXA is irrelevant in determining if the patient ever seen to a tent needs treatment if revival,” he said, noting patients often are there’s an osteoporoticwheeled in and walk defining fracture,” out. “Kyphoplasty is the Rhea said. In the dental world, misinformost incredible thing mation also abounds I’ve seen in 30 years of about risk vs. benefit medicine because of the of osteoporosis treatdifference it can have ment. “Those risks are in just an hour without extremely small, and orthopaedic surgery.” it’s always important Since an injury can to remember that a take weeks to manifest dental complication through pain and on isn’t the same as a hip X-rays, Wunder said Balloon Kyphoplasty fracture,” Rhea said. patients aren’t often “One-third of the referred to him until women who break a hip won’t survive two sometimes the eighth week post-fracture. years. These are life-altering issues, and the “It’s similar to watching a building demolition where the inside walls collapse before risks that are frequently discussed in the the building falls,” he explained. “The fracdental community are very unlikely.” ture is painful before it’s visible on x-rays. Prevention is Key On average it takes two to three weeks for Rhea encourages women to underthe bone to collapse.” stand the treatments for osteoporosis are Wunder stressed the importance of overwhelmingly safe, with benefits far early intervention for first-time fractures, outweighing risks for most patients. “We not only for pain relief but also to retain have multiple effective options available, height and prevent deformation in the spinal column. He added, “It’s important to and we know that preventative care means know, many times after a patient experiup to 50 percent reduction in hip fracences their first fracture, a second fracture ture and 70 percent in spine,” he pointed may occur. However, at this time, the out. “Those are really good numbers and patient recognizes the pain and reaches out should encourage women. Being proactive for help within days.” about preventing fractures is certainly the While Medtronic launched its initial best way to deal with them.” nashvillemedicalnews



An Advocate for Women

Dr. Cornelia Graves Raises Awareness around High-Risk Maternity Care By MELANIE KILGORE-HILL

nancy, she said. “Women don’t know heart disease is the number one killer. In Tennessee, African American women are three times as likely to die from it. We’re trying to empower women to understand risk factors.” According to Graves, 100 percent of pregnancy-related deaths among black women in Tennessee were preventable compared to a national average of 60 percent. She cites navigation, biases, and systemic issues within the healthcare system for women of color not getting the care they need.

Cornelia Graves, MD, is giving hope to high-risk obstetric patients. Now director of Perinatal Services at Ascension Saint Thomas and medical director of Tennessee Maternal Fetal Medicine, the Arkansas native developed a passion for science early on, majoring in chemistry at Baylor University as a precursor to medical school.

Charting Her Own Course

“I made up my mind that medicine was the way to go, because I wanted to have an impact on society in a way that helped women,” said Graves, whose parents were both educators. After attending the University of Arkansas for Medical Sciences, Graves landed at Vanderbilt University Medical Center for her residency and fellowship, becoming the first black female in the school’s Obstetrics program. “When they accepted me in 1987, Dr. Frank Boehm was my mentor, and his example at the bedside made me interested in high-risk care,” she said of the Division of Maternal-Fetal Medicine co-founder. Graves said his mentoring also was instrumental in her becoming the first black woman promoted to senior academic status within Vanderbilt and to her 1993 appointment as medical director of Vanderbilt’s Obstetric Intensive Care Unit. “He wanted to start a critical care OB program,” she explained. “I’d interviewed for fellowships other places, but he came to me knowing I was interested in critical care.” After a period of trauma training, Graves served as the first OB resident and fellow in Vanderbilt’s ICU. “They made a place for me and treated me like any fellow,” Graves remembered. “I became an ICU fellow and then director of the OB critical care unit, which at the time was one of a few freestanding units in the country.” Spending nearly two decades at VUMC in training and service, Graves ultimately became division director of Maternal Fetal Services and assistant dean of Diversity before making a move to Ascension Saint Thomas.

Coming to Ascension

processes patients may have so we can get them through pregnancy safely,” Graves said. She’s also working to educate Nashville’s medical community on the very real problem of maternal mortality, especially in black communities. “Minority communities don’t seek medical care because they don’t feel like the system listens to them,” Graves said, praising the Centers for Disease Control and Prevention’s HEAR HER campaign. The effort seeks to raise awareness of potentially life-threatening warning signs during and after pregnancy and improve communication between patients and providers. Ascension Saint Thomas also has a grant from the State of Tennessee and CDC designed to increase and engage women, especially women of color, in knowledge of cardiac disease and preg-

In 2007, Graves made the move to Ascension Saint Thomas from VUMC. “Ascension is the largest deliverer of babies in the state of Tennessee; so when you talk about a system that knows obstetrics, you know they’re really committed to quality,” she said. “We think of our work as a ministry and not just a job and are ahead on protocols to keep women safe.” That commitment includes Ascension Saint Thomas’s Midtown Level 4 Maternity Center, which serves mothers at the highest risk. They are also a Level 3 Neonatal Center, where preterm babies are resuscitated as early as 22-23 weeks. Graves works tirelessly to bring awareness to the impact of high blood pressure and diabetes, since 25 percent of diabetes cases are poorly controlled. “There’s a lot we still don’t know in pregnancy, so we’re working with thought leaders all over the world on prevention and treatment of diagnoses like preeclampsia.”

COVID-19 brought a unique challenge to Graves, as well. “We rarely saw hospitalizations in women under age 50 unless they were pregnant,” she said. “There’s an inability to handle any increased respiratory stress because there’s not much reserve left. These patients go from needing no support with breathing to falling off a cliff much more quickly where they may require ICU services.”

Touching Lives

Outside of her practice, Graves is a proud mother to Blair Adams, MS, a professional mental health counselor at Nashville’s Zenith Consulting and Psychological Services. She often can be found serving the youth at Payne Chapel AMEC, where she has served as a youth choir director, bus driver, tutor and counselor. When it comes to professional accomplishment, one of her proudest was being named to the Society of Maternal Fetal Medicine Board of Directors. While her term has expired, Graves remains very involved in the international organization and recently presented at a critical care obstetrics conference by Zoom for providers in Ethiopia. “The thing I’m most proud of are the lives I’ve been able to touch,” she said. “Not so much through me as a person, but the fact that we get to spread the love of the Creator to other people. That’s very important to me, because there are a number of women and babies that may not have made it through pregnancy had it not been for some notion or word whispered in my ear from a higher power. Awards come and go, but that is a legacy I really want to leave.”

Pregnancy & Illness

Throughout her career, Graves has worked relentlessly to dispel the myth that ‘pregnancy isn’t that big of a deal.’ “When pregnant women get sick, they’re very sick, which is something we don’t really tell people,” Graves said, noting strides being made locally in awareness and education. She’s also seeing a bigger push for prenatal care education, too often dismissed by patients. “It gives us the opportunity to identify any disease nashvillemedicalnews


During Women’s Health Month, LBMC is proud to shine a spotlight on the female leaders playing a vital role in healthcare for our company and in our community. www.LBMC.COM

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Nashville Institutions Expand Nursing Education, Opportunities By MELANIE KILGORE-HILL

Belmont Introduces Early Entry Program for Graduate Nursing Degree

Health is one of the NGH program’s first apprenticeship-approved employer partners. Executive leaders from Nashville General and TriStar Health held an official signing in April documenting the public-private partnership. “We are excited to partner with TriStar Health, the region’s largest healthcare provider company. As an approved apprenticeship employer, TriStar Health has funding to provide a jump start to those in our community who want to enter the healthcare field. Through Nashville General Hospital’s School of Health Sciences workforce development program, we can help meet the demands of future healthcare jobs,” said Rubin Cockrell, EdD, who spearheaded this project and serves as program and community outreach coordinator for the School of Health Sciences. “We are delighted to be one of the first health systems to partner with Nashville General Hospital’s School of Health Sciences as they launch this CNA apprenticeship training program,” added Bryan Sisk, chief nursing executive for TriStar Health. “This program opens the door to motivated individuals looking to step into a career in healthcare.”

At Belmont University School of Nursing, high achieving Bachelor of Science in Nursing (BSN) students are now eligible to get a head start on an advanced nursing degree from Belmont by completing approved graduate techniques to be practiced again and again level courses within their undergraduate prior to caring for live patients. Clinical skills program of study. The Early Entry Proare refined through extensive practice expegram provides opportunity to earn up to riences in hospitals and community clinics, 14 credits toward either a Doctor of Nursincluding mission opportunities down the ing Practice (DNP) or Master of Science in street and around the world. Nursing (MSN), saving students time and money in a graduate degree designed to Nashville General Hospital prepare them to be Family Nurse PractitioLaunches Apprenticeship ners (FNP). Program for CNAs Eligible students must meet qualificaNashville General Hospital’s School of tion requirements by the midpoint of their Health Sciences was awarded national cersophomore year to participate in the protificate of apprenticeship status for several gram during their junior and senior years. in-house programs from the U.S. DepartStudents have the potential to complete a ment of Labor in early 2021 to create a full semester of graduate coursework while pipeline of trained, motivated workers to fill at the same time earning undergraduate healthcare needs. In launching an apprencredit toward their BSN degree. ticeship program for its certified nursing “There is an increasing need for nurses assistants (CNAs), NGH’s School of Health and nurse practitioners throughout our VUSN Receives $3.2 million Sciences is partnering with federally regcountry, and our School of Nursing is at the HRSA Grant to Increase istered apprenticeship employers to train forefront of meeting this challenge,” noted Diversity in Providers CNAs and fill positions in the Middle TenCathy Taylor, DrPH, MSN, RN, dean of Vanderbilt University School of Nursnessee and Southern Kentucky region. the College of Health Sciences at Belmont. ing has launched a scholarship pro“We are happy to enhance the gram for family nurse practitioner, educational opportunity for nurse-midwifery and dual nursefuture nurse professionals by midwifery/FNP master’s students connecting our undergraduate that aims to increase diversity in and graduate programs in this primary healthcare providers, parway. We hope many of our BSN ticularly in medically underserved students will take advantage of areas. this great new option.” Funded by a new $3.2 million Graduate Nursing Program grant from the Health Resources Director Linda Wofford, added, and Services Administration under “The Early Entry Program is an its Bureau of Health Workforce exciting way to not only introDivision of Health Careers and duce Belmont BSN students to Financial Support Scholarship our graduate programs but also (Seated L-R): TriStar Health Division President Mitch Edgeworth and Program, the scholarship program an innovative way to offer a Director of NGH School of Health Sciences Craig Shepard. provides economically disadvanseamless transition.” taged students from underrepresented “Not yet being a traditional Title racial and ethnic minority backgrounds IV school able to offer direct financial Belmont, Trevecca Nazarene with scholarships, support and education assistance, the Nashville General HospiPartner on Innovative Joint BSN tailored for work in rural or underserved tal School of Health Sciences focuses on Program areas. The program’s intent is to improve partnering with apprenticeship employee Trevecca Nazarene University stuprimary and maternity care outcomes for partners who can offset the cost of tuition dents who wish to pursue a BSN may do vulnerable populations. for our students, who then are guaranteed so through the new Belmont-Trevecca joint “Diversity of healthcare clinicians is employment with the business. This is a degree program. In this program, students linked to improved access to care for racial tremendous benefit for our students and a complete their first two years of course work and ethnic minority patients, improved win-win for everyone,” said Craig Shephat Trevecca and the final two years at Belcultural competence of the general healthard, director of Health Sciences Education mont University. care work force, greater patient choice, at NGH. Graduates are known for high quality better patient-provider communication, Both future students and those curcare, a standard modeled by their profesand better educational experiences as sturently enrolled in the program are eligible sors, both inside and outside the classroom. dents,” said Mavis Schorn, PhD, CNM, for the apprenticeship, which partners them Student learning is enhanced through stateFACNM, FNAP, FAAN, the program’s with businesses in need of CNAs. TriStar of-the-art simulation, allowing treatment 8



primary investigator. “Ethnic and cultural congruence between providers and patients — primarily with vulnerable populations — can result in better care and patient satisfaction. Ultimately, a Dr. Mavis Schorn more diverse advanced practice nursing workforce will improve cultural competency and the overall health of the country.” The scholarship program also is designed to meet the need for primary care providers in medically underserved communities. Currently, most VUSN students obtain their clinical experiences in rural or medically underserved communities. Many students express interest in employment at their clinical locations or similar settings, but student loan debt can be a roadblock. “The investment in a master’s program can be substantial,” Schorn said. “We believe that with decreased debt load, graduates will be more likely to consider employment in rural and underserved areas where salaries are commonly lower than in other areas.” The scholarship program provides career assistance to help students find employment in rural or underserved areas. Because retention of students from diverse backgrounds can be a challenge, the scholarship program also incorporates additional enhancements for the students, including mentoring, peer-to-peer support and affinity student organizations.

Lipscomb Pre-College Programs offer Health Care Academy June 7-11

Lipscomb University’s pre-college summer programs are back for 2021 and include The Health Care Academy June 7-11. Sponsored by HCA TriStar, the program introduces rising sophomores through seniors in high school to a wide variety of health science professions. The program focuses on providing skills that are transferable across multiple health professions. Experiences are led by professional faculty from Lipscomb’s nursing, physician assistant, nutrition, pharmacy and exercise science programs. Students will have some online prework the week before the academy starts and will attend lectures each day in addition to the hands-on learning experiences. Students accepted to the program will be offered experiences including participation in the health sciences simulation center, learning about IVs and injections, stethoscope training, blood pressure training and practice, nutrition label evaluation and healthy meal planning, pharmacy compounding and research, gross anatomy lab, knot tying and suturing skills, and breath and heart sounds.  Due to COVID-19 protocols, this year’s program will be a day program (CONTINUED ON PAGE 11) nashvillemedicalnews


Leading with Purpose


Vanderbilt’s April Kapu Named AAPN President-Elect By MELANIE KILGORE-HILL

More than one billion Americans visit nurse practitioners annually. As providers scramble to care for an aging baby boomer population on the heels of an unprecedented pandemic, the need for advanced care practitioners has skyrocketed. In June, leadership of the industry’s largest professional organization – the American Association of Nurse Practitioners (AANP) – will fall to president-elect April Kapu, DNP, RN, ACNP-BC, FAANP, FCCM, FAAN, of Vanderbilt. With Dr. April Kapu 118,000 members, the AANP represents the largest nurse practitioner community nationwide. A certified acute care nurse practitioner and professor of clinical nursing for Vanderbilt University School of Nursing, Kapu also serves as the associate chief nursing officer for advanced practice nursing at Vanderbilt University Medical Center, providing professional practice support for more than 1,200 Advanced Practice Registered Nurses.

NMN: You’ve had a dynamic career in both the academic and private realms. How has that shaped you as an educator, leader and APRN advocate? Kapu: I have been fortunate to grow within a healthcare organization that employs over 1,300 advanced practice professionals across our hospitals and clinics. My executive leadership and healthcare management growth and development have come from working with world-class healthcare executives from nursing, medicine, pharmacy and other health disciplines. Through my doctoral work and now as a clinical professor, my educational opportunities have provided the underpinning to scholarly research and a better understanding of the patient care and health policy issues that our country faces today. How has the national nursing shortage affected APRNs? There are 3.8 million RNs in the U.S. and nurse practitioners comprise just over 7 percent of the total workforce. Building a robust nursing workforce is critically important as our nation builds back from COVID and plans for the future. More than 10,000 baby boomers become Medicare eligible every day and an increasing number of Americans live with chronic disease. In the last several years, the federal government, state legislatures and healthcare systems have been steadily updating policy to make full use of the knowledge and skills of nurse practitioners. For example, the federal government has recently authorized NPs to prescribe medication to help treat substance use disorder. Since nashvillemedicalnews


then, every state, including Tennessee, has made it easier for patients to get access to these lifesaving treatments. Removing barriers between NPs and their patients is one way to make sure we make the most of the workforce.

Can you share some insights on the ongoing discussion about a push for autonomy for APRNs? Many, if not most, APRNs currently practice autonomously. The issues have mainly centered on outdated collaborative practice agreements and supervisory agreements required by various states, as well as supporting the state board of nursing to be the sole regulatory body for the practice of advanced practice nursing as a profession. Closing the gap between the level of care that NPs are prepared to deliver and the level of care that some state laws allow them to deliver must be addressed. In about half the country, patients have full and direct access to nurse practitioners’ services. These states are referred to as Full Practice Authority States, meaning that under their license, they are authorized to practice to full extent of their education, clinical training and board certification. In the remaining states, outdated state laws make it illegal for NPs to directly provide the care they were educated and nationally certified to provide. States with Full Practice Authority have been demonstrated to have better ability to recruit and retain NPs in rural and underserved communities and maintain high care quality while decreasing healthcare costs and improving access to care. How do you envision the role of APRNs in today’s rural communities? More than 80 million Americans live in Health Professional Shortage Areas – or areas where there are more than 3,500 patients for a single primary care provider. This lack of access means no prevention, screening, immunizations, or primary care for infections, sickness, and inadequate healthcare access. Over the last few years, NPs have increased from 18 percent to a quarter of the rural primary care workforce. At the School of Nursing, more than 40 percent of graduates choose to work in rural or underserved communities. With 30,000 new NPs entering the healthcare workforce each year, NPs are adding high-quality providers and increasing access to care. Has your experience overseeing the APRN division of VUMC’s COVID unit changed the way you view patient care? Over and over again, APRNs stepped up to lead during this pandemic. Whether it was in the early days battling for personal protective equipment or now administering vaccines, APRNs have been, and continue to work, on the frontlines of COVID day in and day out. Working in our COVID command center this past year, APRNs have led in the development of our COVID


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VUSN Prepares to Pass the Torch Norman, Jeffries Transition Leadership Role By CINDY SANDERS

Last fall, Linda Norman, DSN, RN, FAAN, announced her decision to step down as dean of Vanderbilt University School of Nursing effective June 30, 2021. She has served in the role since July 2013 and spent nearly 30 years in academic and administrative roles within the school. In late March, Vanderbilt announced Pamela R. Jeffries, PhD, RN, FAAN, ANEF, FSSH, has been named the next dean for the School of Nursing effective July 1. This leadership transition represents a passing of the torch between two internationally recognized nursing leaders and healthcare education innovators.

Linda Norman

Norman has more than four decades of transformational experience in nursing education, spearheading curricular innovations in blended learning, interprofessional education, quality improvement and distance learning. As dean of the Vanderbilt University School of Nursing, Norman has set the school’s strategic direction, leading its aca- Dr. Linda Norman

demic, clinical practice, research, fiduciary, and administrative initiatives. She oversaw completion of a $23.6 million building expansion in 2019, which added a stateof-the-art stimulation lab and innovative classrooms with technology ideal for remote learning (before anyone knew just how critical that capability would become). During her tenure, VUSN has risen in the U.S. News & World Report  rankings with the school’s Doctor of Nursing Practice program ranked No. 5 and its Master of Science in Nursing program ranked No. 9. VUSN’s psychiatric-mental health and nurse-midwifery specialty programs ranked No. 1 in the U.S. News survey. The school also has been named as the “Best School/ College of Nursing for Men” for the past two years by the American Association of Men in Nursing and has been designated a Center of Excellence by the National League of Nursing. Additionally, VUSN was the recipient of the New Era for Academic Nursing Award from the American Association of Colleges of Nursing. “Under Linda’s leadership, Vanderbilt’s nursing programs have set the national standard for training world-class, researchfocused and practice-focused nurse scholars who are making a difference for their patients and the communities they serve,” Vanderbilt Chancellor Daniel Diermeier said. “We are honored by her service to our university and by the tremendous impact

16th Annual Meeting

Grand Hyatt · Nashville August 18-22, 2021 Cost

$600 for Physician $500 for Non-Physician Provider $300 for Office Staff (Manager/Admin) $0 for Resident/Fellow $150 for Guest

Cost after 6/1/2021

$750 for Physician $650 for Non-Physician Provider $450 for Office Staff (Manager/Admin) $0 for Resident/Fellow $150 for Guest

*Guests are only eligible for the live event in Nashville, and are not permitted to attend any of the sessions. They can visit the Exhibit Hall, Registration area, and any meals that are listed on the agenda.




she has had as scholar, teacher, mentor and leader throughout her remarkable career.” Norman is national and internationally recognized as a leader in nursing education, evaluation and research. She serves on various nonprofit, professional and corporate boards and frequently consults on curriculum and evaluation. She has twice won the Excellence in Education Author Award from the scholarly journal Nursing Outlook.  Norman was inducted as a Fellow of the American Academy of Nursing in 2004. She earned both her undergraduate and master’s degrees from the University of Virginia and earned her doctorate from the University of Alabama at Birmingham. Norman began her nursing career on a neurosurgical unit in Virginia before focusing on nursing education.

Pamela Jeffries

Jeffries comes to VUSN from George Washington University School of Nursing in Washington, DC, where she serves as professor and dean. “Pamela Jeffries has transformed lives with her visionary leadership and expertise in nursing education. We could not be more delighted to welcome her to Vanderbilt, at a Dr. Pamela Jeffries time when the expertise of our nursing faculty, students and alumni is needed more than ever,” Diermeier said of continuing VUSN’s legacy. Jeffries was appointed the second dean of the George Washington School of Nursing in 2015, five years after its establishment as a stand-alone school within the university. A proponent of strengths-based leadership, Jeffries’ priority was to expand the infrastructure and build upon the processes and standards for the young, emerging school, which experienced a significant period of growth during her tenure. As dean, Jeffries also charged a task force with examining issues related to diversity and inclusion, which resulted in the formation of a diversity council and other initiatives to build an inclusive and diverse community. Prior to being named dean of George Washington University School of Nursing, Jeffries served as the inaugural vice provost for digital initiatives at Johns Hopkins University. She also held faculty leadership roles at Johns Hopkins University School of Nursing and Indiana University School of Nursing earlier in her career. “I am honored for this opportunity at a world-renowned university and the Vanderbilt School of Nursing — with its rich history of excellence in nursing education, practice and research,” Jeffries said. “I’m excited to build on the strong foundation provided by Linda Norman and help set the school’s ‘next chapter’ with broad engagement of community partners who champion its mission and vision.” With support from the National League of Nursing, Jeffries developed the major contribution to simulation scholarship — the framework and monograph

now known as the NLN Jeffries Simulation Theory. A strong collaborator, she is the editor of three books, Simulations in Nursing Education: From Conceptualization to Evaluation (2nd edition), Developing Simulation Centers Using the Consortium Model, and Clinical Simulations in Nursing Education: Advanced Concepts, Trends, and Opportunities. Jeffries is a Fellow of the American Academy of Nursing, the NLN’s Academy of Nursing Education, the Society of Simulation in Healthcare and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. Other honors include the Sigma Theta Tau International Edith Moore Copeland Award for Excellence in Creativity, the NLN’s Mary Adelaide Nutting Award for Outstanding Leadership in Nursing Education, the Virginia Nurses Association Foundation Leadership Excellence Award for Nursing School Dean and induction into the Sigma Theta Tau International Researchers Hall of Fame. After receiving her BSN from Ball State University, Jeffries earned her master’s and doctorate in nursing from Indiana University.

Leading, continued from page 9 ICU. as well as our hotline, COVID assessment clinics, vaccination stations and many efforts we have launched to provide care to our patients and our communities.

How has VUSN expanded their offerings/programs to better incorporate APRNs on both the educational and patient care sides? APRN students should seek out the best education for their masters and doctorate programs and look for accredited schools, as well as the critical elements of a robust academic program. According to the 2022 U.S. News and World Report, Vanderbilt University School of Nursing is ranked No. 1 for our psych mental health NP program, No. 2 in the country for our acute and family NP programs, and No. 6 for our doctoral program. Speaking from my vantage point as an employer of NPs, I am thrilled with the level of preparedness of Vanderbilt’s graduate students and their readiness to step into an entry-level role in advanced practice care, especially during a time when our country needs to expand access to primary care more than ever. Reflecting on your career, what achievements have meant the most to you? Being part of the build for Vanderbilt’s generous and comprehensive advanced practice infrastructure has been a defining part of my career. Many APRNs seek us out as an employer because of the excellent environment for advanced practice, education and research. My work in education as faculty with VUSN has only deepened my passion for the APRN role and its importance in expanding access in a healthcare setting. AANP has allowed me to grow in professional advocacy and support of nurse practitioners worldwide. nashvillemedicalnews


Celebrating the Annual Dr. Matthew Walker, Sr., Legacy Breakfast By CINDY SANDERS

After being interrupted by the pandemic last spring, the annual Dr. Matthew Walker, Sr., Legacy Breakfast returned in 2021 in a virtual format that drew a recordbreaking crowd. The event, which benefits Matthew Walker Comprehensive Health Center (MWCHC), celebrated the legacy of service that is synonymous with the center’s founder and namesake. Today, MWCHC operates three locations – North Nashville, Smyrna and Clarksville – and provides physical, behavioral and dental care for nearly 17,000 children, women and men each year. The centers take the ‘comprehensive’ part of their name seriously by offering health education, socialization for seniors, wellness classes, nutritional counseling and community activities to nurture body, mind and spirit for those they serve. “We are excited to once again gather as a community to recognize Dr. Matthew Walker’s legacy,” said Katina Beard, CEO of MWCHC. “It is an honor to continue Dr. Walker and Michelle B. Marrs’ vision for accessible and affordable healthcare in

Nashville Institutions,

continued from page 8 from 8 a.m. to 3 p.m. each day. Housing will not be available on campus this year.

MTSA Launches Neuraxiom. com for CRNAs

Middle Tennessee School of Anesthesia has launched Neuraxiom.com, a revamped website of practical resources to help anesthesia providers learn ultrasound for regional nerve blocks, announced Bill Johnson, DNAP, CRNA, director of the MTSA Acute Surgical Pain Management Fellowship and DNAP Completion program. Originally created by Jack Vander Beek, Neuraxiom.com is now owned and authored by MTSA and includes free content, as well as opportunities for special access to fee-based continuing education modules. The site also features interactive anatomy illustrations and a range of content on subjects such as ultrasound, pharmacologic agents and local anesthetics. In addition, Neuraxiom.com enables CRNAs to participate in continuing education, including current information on acute pain management with options to take a quiz and receive AANA credit. Vander Beek developed the Neuraxiom textbook and website by documenting and illustrating a compendium of Ultrasound-Guided Regional Anesthesia (USGRA) techniques that have been successfully adopted by regionalists over the years. It applies an evidence-based approach in updating the vast amount of knowledge that has been published in USGRA in the last decade. For more information, visit neuraxiom.com. nashvillemedicalnews


2021 and celebrate the community leaders who also support this vision.”

2021 Award Recipients

The Dr. Matthew Walker, Sr., Legacy Award was presented to James E.K. Hildreth, PhD, MD, president and CEO of Meharry Medical College and a member of President Joe Biden’s COVID-19 Health Equity Task Force. “Dr. Walker elevated medicine itself by what he did and how he did it,” said Hildreth. “He inspires me on a daily Dr. James Hildreth basis. For me to receive this award and to be mentioned in the same breath as his name, I’m genuinely telling you this is one of the most cherished awards of my career.” The Michelle B. Marrs Advocacy Award, named for MWCHC’s visionary former CEO and community advocate, went to Harold Moses Love, Jr., PhD, Tennessee State Representative and pastor of Lee Chapel AME Church. Love was selected for Dr. Harold Moses his tireless work on Love, Jr. behalf of his community, constituents and congregation. Under his leadership, Lee Chapel has stepped up again and again to serve the larger community. Never has that been more true than in 2020 when the church partnered with the city and public health entities to assist with tornado relief, COVID-19 testing, addressing food insecurity in the wake of financial hardships and ensuring underserved com-

munities had access to vaccines.

2021 Scholarship Recipients

Four Meharry students won scholarships in recognition of their outstanding work. The Dr. Matthew Walker, Sr., Legacy Scholarships were awarded to Aliah Fonteh, a second year medical student, and Aalieyah Billings, a third year dental student. The Michelle B. Marrs Legacy Scholarships were presented to Ashley Leon, a first year Master of Science in Public Health, and Melissa Bassett, a first year doctoral candidate.

Keynote Address

Coming off a tough year, the 2021 theme was “Shifting Gears: Preventing Burnout and Building Resilience in the COVID Pandemic.” Charlene Dewey, MD, Med, MACP, professor, assistant dean for Educator Development and director of the Center for Professional Health at Vanderbilt University School of Medicine,

delivered the keynote address. An expert on overall wellbeing, stress management, burnout and resilience, she discussed the ethics of self-care and how stress and burnout undermine a culture of safety. Dewey outlined the six sources of burnout as being work overload, insufficient reward, unfairness, breakdown of community, value conflict and lack of control. To build resilience, she said to address the things that could be controlled: self-care through healthy eating, exercising, getting enough sleep, tending to relationships, feeding faith, engaging in hobbies and making time to do whatever feeds the soul; managing energy in all forms including physical, emotional, spiritual and mental; building emotional intelligence by focusing on improving self-awareness, self-regulation, motivation, empathy and social skills of listening and conflict resolution; and practicing mindfulness through meditation, prayer, art, journaling or another outlet that trains attention.

Honoring Dr. Matthew Walker, III Just days after presenting awards in his grandfather’s name at the annual Dr. Mathew Walker, Sr., Legacy Breakfast, Nashville lost a philanthropist, scholar, educator and community activist with the sudden death of Matthew Walker, III, PhD. In addition to his copious volunteer work, Dr. Walker was Dr. Matthew a professor of the Practice of Biomedical Engineering and an Walker, III associate professor of Radiology and Radiological Sciences at Vanderbilt University School of Engineering. A Fellow of the American Institute for Medical and Biological Engineering, he also served as associate director of the Medical Innovators Development Program at Vanderbilt. A statement on the MWCHC website noted, “Matthew lifted the tides around him with every conversation. His long-term support of our health center ensured the continued legacy of his grandfather Dr. Matthew Walker, Sr. in word and deed. Our thoughts, prayers, and deepest sympathy are with his family, today and always.”





Acadia Healthcare CEO Discusses COVID & Mental Health Program Part of Health Care Council’s Brass Tacks In April the Nashville Health Care Council  hosted a member discussion with  Debbie Osteen,  CEO of Acadia Healthcare. This virtual event was the latest installment of the Council’s “Health Care Brass Tacks” series, which invites Council board members and C-suite healthcare leaders to Debbie Osteen discuss their perspectives on the coronavirus pandemic and its overall impact on the healthcare industry. Acadia Healthcare  provides behavioral health care services in 227 treatment facilities across 40 states and Puerto Rico. The company treats 70,000 patients every day. Through four distinct service lines, the company offers multiple levels of care for various behavioral health and substance abuse disorders. The acute care service line offers short term, inpatient psychiatric care for people who need to be in a secure setting. The specialty ser-

vice line includes inpatient and residential facilities for those needing substance abuse or eating disorder treatment. Acadia also operates medication assisted treatment clinics across the country. Last, the company runs residential facilities for children and adolescents in need of mental health care. The COVID-19 pandemic has brought increased need for behavioral health services. “One in five adults will need mental health treatment in their lifetime, but not all will seek it,” said Osteen. “We are seeing increased demand in all of our service lines, and particularly with acute care. As many as 35 million Americans are suffering from depression and anxiety as a result of the pandemic, and we’re seeing a record number of overdoses and suicide attempts. Our staff is working tirelessly to help during this crisis.” When the lockdowns began in 2020 and people were unable to travel to a facility to get care, Acadia quickly strengthened its telehealth platform, expanding it to 100 facilities in just two weeks. At the same time, Acadia had to work closely

with state and local health officials to ensure that they could continue to operate their facilities without care disruption. “We spend a lot of time educating about what we do and why we are essential,” said Osteen. “We are treating life and death conditions. It was critical that we had the most robust safety measures in place so that we could continue to treat our patients with uninterrupted service.” Though there is growing understanding and awareness about the seriousness of mental health and substance abuse, Acadia still feels the pressure to educate the public and policymakers about these issues. According to Osteen, the effects of the pandemic will have prolonged effects on the population’s mental health, including the health of children and adolescents who have experienced major disruption over the past 12 months.  “Luckily, our payers have stepped up to support what we do, making sure that care is covered when it is needed. We are using data to make our treatments better all the time and demonstrate their effectiveness,” said Osteen. Partnerships are an important part

of Acadia’s strategy moving forward. As hospitals seek ways to treat patients who have mental health needs, they partner with Acadia to create joint ventures. In March, Geisinger and Acadia Healthcare formed a joint venture  to address the urgent need for expanded, high-quality inpatient behavioral health services in central and northeastern Pennsylvania. Acadia also partnered with Ascension Saint Thomas in Nashville  to build a 76-bed inpatient behavioral health hospital, which opened in December. “Acadia has an excellent track record for supporting the full continuum of care – providing the right care in the right place,” said Osteen. “Partnerships are a great way to reach new markets and share best practices. When we work together, we can optimize patient care.” On a final note, Osteen stressed the importance of equity in mental health and said more education about its importance is still needed. Some cultures are wary of mental health, so Acadia actively partners with trusted organizations within communities to reach those who may need support or information. 

First-Year Data on TNPSQ Mental Health Screening Tool

First-Year Data on TNPSQ Mental Health Screening Tool An anonymous online mental health screening tool for Tennessee health professionals saw more than three times the activity expected during its first full year. The screening tool from the Tennessee Medical Foundation likely saw higher usage as a result of stress related to the Covid-19 pandemic. “We initially expected about 75 health professionals to engage with the screening tool in its first year,” said TMF Medical Director Michael Baron, MD, MPH, FASAM. “We actually had 238 Tennessee health professionals accessing the site from February 2020 to February 2021.” The TMF Physician’s Health Program initiated the Tennessee Professional Screening Questionnaire (TNPSQ) as part of an effort to become more proactive in the face of increasing mental and behavioral health referrals. It utilizes the Interactive Screening Program or ISP, a platform developed by the American Foundation for Suicide Prevention (AFSP). Baron said the goal was to try to reach those who are struggling before 12



Connect to Help TNPSQ is a non-crisis service, providing a confidential and free online mental health screening with referrals to appropriate mental health resources and optional interaction with a program counselor. The tool is available to health professionals served by the TMF, which include physicians (MDs and DOs), physician assistants, optometrists, chiropractors, podiatrists, x-ray technologists, and veterinarians, as well as students, residents, interns, and other trainees for these professions at all levels. Access the TNPSQ at tn.providerwellness.org. For more information, including FAQs, visit e-tmf.org/tnpsq or contact the TMF at 615-467-6411. If experiencing a mental health emergency, please reach out to Crisis Services & Suicide Prevention through the Tennessee Department of Mental Health & Substance Abuse Services at 855-CRISIS-1 or text TN to 741-741.

an intervention or formal referral was required. The timing of the screening tool was providential, he added. “This tool is needed, especially now when physician and health professional stress is increased because of the pandemic.”

First-Year Data

Data from Feb. 3, 2020-Feb. 2, 2021 showed of 238 TNPSQ screeners, 74 percent opted to log back in to the plat-

form and view the program counselor’s response. Of those, 35 percent opted to dialogue anonymously with the counselor; and of those, 68 percent requested an appointment or referral. TNPSQ user engagement was significantly higher than reported national averages for the ISP, according to AFSP ISP Senior Director Maggie Mortali. “This further highlights how this program is meeting the needs of health profession-

als to connect to mental health services in a way that feels safe and accessible,” she said. Another important result: 84 percent of screeners were not already in therapy or treatment. Users also expressed appreciation for the tool’s anonymity and availability. Baron said this confirms the tool is reaching its target population: health professionals who are not already receiving help, and who likely would not contact the TMF on their own. The tool does not replace the comprehensive assistance, support, and advocacy offered by the TMF Physician’s Health Program, continued Baron, but it is one more resource in its arsenal to help health professionals who are struggling, especially as they cope with challenges related to the pandemic. “The goal is to connect more people to the help they need earlier in the process – to be proactive versus reactive – hopefully before there’s a need for intervention by employers, a TMF referral, or licensing board action,” he concluded.



Blakeford Expansion Focuses on Form, Function & Fun By CINDY SANDERS

A continuing care retirement community, Blakeford at Green Hills is in the midst of a major expansion and renovation project to rethink how residents live, play and interact. “There’s really not an area of the campus not being affected in some way,” Brian Barnes, president and CEO of Blakeford Senior Life, said of the two-year project. Currently, the campus includes 124 independent living apartments, 46 assisted living units, and 83 Brian Barnes licensed beds in the skilled nursing section. When completed, Barnes said there will be 51 new independent living residences, a new state-of-the-art health and wellness center, new full-service aquatics program, exercise gym, group exercise space, new spa and salons, along with numerous reimagined spaces for dining, arts and hobbies. A big physical change for the campus is the addition of a memory care unit. The assisted living units are currently located in two wings. One wing will be demolished and rebuilt as a two-story, secure memory care unit. When completed, there will be 24 memory care and 23 assisted living spaces. “In the skilled nursing area, we are expanding our therapy space, and it will connect with a therapy garden,” he said, adding the outdoor space utilizes different surfaces and levels so residents can practice moving in a real world setting. “Everything is getting an uplift, so we’re not restricted by finishes currently there,” said Marta Lockwood, NCIDQ, project lead with GMK Interiors. Overall, she continued, “It’s got a neutral palette

food production decenwith pops of color over tralized to each area it, allowing the community to stay more timeinstead of all food comless. We’re going to be ing out of one main bringing in a lot of color kitchen. “We’re making each level of care with artwork and furnishings and plants.” more self-sufficient,” “One of the major said Barnes. While items Blakeford wanted COVID wasn’t the primary driver behind that to accomplish with decision, he said it was this project is biophilic certainly a contributing design,” Lockwood conThe Blakeford expansion and redesign introduces more dining options, including creating tinued. “It’s really just factor. smaller, more casual spaces to dine with friends. incorporating the out“Thinking about and being lifelong learners whether that’s at doors indoors in many different ways. She infection control and transference, we age 70 or 90. “We already have Blakeford added the design team is utilizing color, have a building committee that looks at University with guest speakers,” Barnes natural light, patterns and textures inspired pandemic-related design considerations,” noted. However, the expansion allows for by nature. “We’ve incorporated three living Barnes continued. Lockwood added her more flexibility and space for an art studio, walls, and one of them is two stories.” firm specializes in senior living. “Pandemic woodworking shop and other areas handsLockwood said the city’s personality or no pandemic, we are always looking at on activity areas. also subtly plays into the design. “We have materials that are easily cleaned,” she said. The project also is introducing smart wood panels that conceptually look like “We did switch out granite because it’s so home components and enhanced technola guitar fret in the bistro and an abstract porous and switch to quartz, which is more ogy in the new apartments. “Just in the past music staff on signage. There will be a expensive but much easier to clean … and five years, the number of devices used by Nashville wall near pretty, too.” our residents increased tenfold,” Barnes said the front entry with Lockwood noted there are now so of demand. photography and artmany commercial options that stand up to The bottom line is choice. In the indework,” she outlined. wear and tear but are still beautiful. “Any pendent living sector, there is currently a Celebrating their of our hard surfaces, like vinyl planks, are large, formal dining room. Both because of 25 th anniversary, going to hold up to harsher chemicals that lifestyle wishes and COVID considerations, Barnes said it’s imporare being used by maintenance staff. Our the expansion will feature formal dining, a tant to evolve to meet carpets are made of solution-dyed nylon so casual bistro, coffee bar, grab-and-go option new needs and expeccolor goes all the way down and stands up and a terrace with an outdoor kitchen. tations. “We have a Marta Lockwood to bleach solutions,” she noted. Lockwood said the ceiling of the cofdifferent generation of One byproduct of COVID, Barnes fee bar is one of her favorite features. “In seniors coming to us now than could have said, is an increased awareness of isolatheir existing space right now, this area is tion and the need for a support network. been imagined 25 years ago,” he noted. an interior courtyard. The architects closed “There’s an attraction now maybe where “It’s a completely different marketplace. the space but didn’t want to lose light,” she there wasn’t before for community living,” People want options. They want to conexplained. “So they’re creating this atrium tinue to remain active and healthy. he said. “The social aspect in a community ceiling that is kind of like a giant skylight, “The Health and Wellness Center is a like Blakeford at Green Hills is so important and we’ve designed it to have string lights so huge leap forward,” he continued. “It will to the long-term mental health of an older it will feel magical in the evenings.” allow us to provide wellness programs far adult.” And, Barnes continued, more and Assisted living and skilled nursing are beyond what we can do today.” more people are drawn to the easy, active also undergoing dining renovations with Part of wellness is remaining engaged lifestyle.

Construction, Design & Real Estate Rounds Turner Wins National Award for NGH COVID-19 Unit

Turner Construction Company has won a national Excellence in Construction® Eagle Award for work on the Nashville General Hospital COVID-19 Acute Care Unit project. The EIC awards program is the industry’s leading competition honoring both general and specialty contractors. The NGH project included preconstruction and construction services for a 24,000-square-foot, fast-track renovation of two floors of the existing hospital. On the eighth floor, demolition of 15,000 square feet made way for 40 new beds in three-walled rooms, each with negativepressure air space to reduce airborne transmission of the virus. Turner finished this job, which should have taken at least six months, in just 27 days – the fastest project in business unit history – by organizing 24/7 work. nashvillemedicalnews


Gresham Smith CEO Stepping Down

Al Pramuk recently announced he will step down from his CEO role at Gresham Smith at the end of this year. A Al Pramuk licensed professional engineer, Pramuk has served as chairman of Gresham Smith’s board since 2016 and as CEO since 2017. He is also active in the community, serving on the boards of the Nashville Area ChamRodney Chester ber of Commerce and Nashville Downtown Partnership. COO Rodney Chester will step into

the CEO position at the beginning of 2022. Pramuk will continue in his role as chairman.

result, organizations can see data patterns and connections in new ways, then use this information to make informed decisions.

Montecito Medical, SwitchPoint Launch Scout Intel

RTG Providing Property Management for WTH

Nashville-based Montecito Medical Real Estate and SwitchPoint Ventures have collaborated to develop and launch Scout Intel, a next-generation, customized decision support engine focused initially on market identification, business expansion and site selection decisions. The continually evolving platform is designed to serve organizations of all sizes across healthcare and other industries. Scout Intel aggregates and synthesizes large volumes of complex information, then incorporates each client’s unique, experience-driven insights and intuition into a powerful engine fueled by artificial intelligence and machine learning. As a

Continuing an existing relationship with West Tennessee Healthcare, Knoxville-headquartered Realty Trust Group (RTG) has expanded its scope of services to the not-for-profit healthcare system to include property management and property accounting for its 1.2 million-squarefoot real estate portfolio of nearly 100 non-hospital facilities, including medical office buildings, clinics, and administrative buildings. RTG’s Nashville office will oversee the day-to-day property management operations with additional support from RTG’s corporate services team providing property accounting services. APRIL/MAY 2021



Healthcare Construction & Design Trends, continued from page 1 play an important role in patient throughput. For example, he said some areas are using telehealth with EMS to better assess patients in an ambulance to determine if the patient needs to come to the ED or might be better served in another setting.


of Barge Design Solutions, said a number of healthcare design ‘trends’ have actually become core philosophies. Chief among that list is evidence-based design. In fact, EDAC – EvidenceBased Design Accreditation and Certification – is an internationally recognized program of the Center for Health Design. “Biophilic design in definitely a hot-button topic these days,” Griffith said of one example of an evidence-based design concept. Biophilic design seeks to connect the built space more closely to nature by incorporating natural lighting, greenery and other outdoor elements. Budget and the bottom line remain an important consideration, but Griffith said value is increasingly measured in ways other than direct billables. “Healing gardens are a non-revenue-generating space, but I think there’s been evidence over the years of the benefits for patients and staff.” Features leading to improved staff retention and patient satisfaction ultimately do impact the bottom line. “I think more and more owners are seeing benefits in spaces they wouldn’t have 15 or 20 years ago,” he added.

Time, Budget & Contingency

While willing to include amenities and evidence-based design options, money, of course, remains a major consideration. “Everyone is operating on razor thin margins,” Griffith said, adding speed-tomarket considerations loom large for budgeting. “Faster done, faster to use, faster to generate revenue,” he pointed out. That reasoning has led to a growing interest in Matthew Griffith prefabrication modules, which can shave weeks off a construction schedule compared to being stick built on site. Nathan Hines, project manager at Turner Construction, said time and money are taking a hit when it comes to construction supplies. “Right now, I would say the biggest issue we’re having is raw metals,” he explained. “We’re seeing price increases. We’re also seeing lead times growing exponentially.” Hines said it’s never a fun conversation to sit down with a client six months after coming up with a plan only to tell them pricing and timing have changed. Budgeting a reasonable amount for contingencies helps mitigate some of that risk and keeps a project on track monetarily. Since time is money, Hines said it’s important to have plans in place to address scheduling contingencies, too. “If we foresee there may be a potential risk 14



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with securing materials, we try to get that bought out as quickly as possible,” he said. “Sometimes that may be an early release package or paying a premium on the front end to secure the materials on a certain deliverable date.” One of the best mitigating factors, he continued, is for the construction and design teams to work well together. While construction typically receives plans once they have been finalized, Hines said communicating supply shortages or shipping delays with design can help construction get a jump start. With the current issues with metals, he continued, the architectural team might release the steel package before the overall design is completed so that construction can lock in a price and have a longer lead time to secure delivery.


“Cleanability is huge … that’s always been the case, but it’s even more so with COVID,” said Griffith. “Don’t be surprised if you see rounded drywall corners come back,” he said of reviving the oncepopular style. “A curved corner is more easily cleaned.” Happily, Griffith noted, many products that are durable and cleanable are now also beautiful. “In healthcare, in general, hard surface flooring is a code requirement in a lot of spaces,” he said, noting vinyl flooring makes sense. “It looks good and is very low maintenance. And from a longevity standpoint, it’s beneficial to a hospital.” However, Griffith continued, people hear ‘vinyl’ and immediately think of old hospital design or school cafeterias, but that’s not what today’s vinyl looks like. LVTs – or luxury vinyl tiles – come in a range of appearances from stone to wood while still being easily maintained. Griffith added pricing has come down to put highend looks within reach.

Flexibility & Adaptability

Already a pre-pandemic consideration, both our experts agreed one of COVID’s lasting impacts will be an increased emphasis on building for flexibility. “How do we think through the potential of the next pandemic?” Hines questioned. Part of the answer, he continued,

Turner Construction works closely with architects and clients to move projects from first concrete pour to finished product. The company is currently working on the Ascension Saint Thomas Midtown Surgery project.

is to design and build in a way to maximize spaces, but rethinking processes also has to be part of the equation. From considering triage to ED workflows to looking at mechanical systems that control air flow exchanges, Hines said there are opportunities to build in flexibility and adaptability in numerous ways. Griffith agreed, saying he thinks hospitals will look at HVAC systems in terms of being able to section off parts of the building and figuring out how to quickly move from negative to positive pressure as needed. While a hospital provider wouldn’t build a 500-bed critical care facility on the chance that another pandemic might ramp up ICU needs, Griffith said hospitals are building rooms that are acuity adaptable by roughing in mechanical and engineering capabilities at a higher level for easier access if the need arises. “Universal care room was a big buzz word 10 to 12 years ago,” said Griffith. “It lost traction, and now with COVID, it’s become more attractive again.” He noted there is increasing interest in designing spaces to be flexible that traditionally wouldn’t be. “It’s being more proactive on the front end to be more prepared for the next wave.” Hines said there has been an uptick in universal spaces, particularly around emergency departments, to accommodate both overflow and safety. “We want t0™he flexibility of universal spaces, but it’s also a Nathan Hines safety consideration,” he noted. “If there are 20 access points, when a pandemic happens, you can completely lock down certain doors so that maybe you only have one or two entry points for screening and to control flow.” Technology is another point of emphasis. Griffith said COVID illustrated the vital need to have the right infrastructure in place. From telehealth and virtual monitoring to ordering meals on iPads to limit contact, hospitals quickly became very aware of their bandwidth and cabling capabilities. Hines said technology could also


Approachable design extends well past patient rooms, said Griffith. As healthcare trends toward a community wellness concept, he said hospitals are adding more amenities open to all. Especially in rural areas, he said it isn’t uncommon for hospitals to team up with private fitness providers to create a workout site on campus or to tie a hospital walking trail into a city greenway. “Any time we can reduce the institutional feel and take the apprehension out, that’s a big driver of our design,” concluded Griffith.

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 MAY: American Heart Association: Whether sharing with patients or implementing these ideas yourself, the American Heart Association urges everyone to “find your fierce” with five tips to move more throughout the day. Ben Middleton, Regional CEO of Centerstone’s Tennessee, Georgia and North Carolina operations shares his vision for the organization as he steps into his new role. On May 3, the longtime Centerstone executive succeeded Robert N. Vero, EdD, who recently retired from the organization after 40 years of service.

Bonus Editorial Go online for additional editorial coverage and breaking news, including: Nashville Health Care Council recently hosted a discussion with Google Chief Health Officer Karen DeSalvo, MD, moderated by Senator Bill Frist, MD, on topics including Google’s response to the pandemic and the tech company’s role in the future of healthcare. Tennessee Health Care Campaign has released its 2021 report on Rural Hospital Closures, noting Tennessee has the highest per capita rate of hospital closures in the nation. The organization, in collaboration with Vanderbilt University Medical Center, has created a toolkit for communities whose hospitals are vulnerable to closure.



No Surprises: Federal Legislation Addresses Balance Billing Intended to address the persistent problem of balance billing patients for the costs of services of facilities and providers who are not in their health plan network — often with no prior notice — the “No Surprises Act” was signed into law in December 2020 with an effective date of Jan. 1, 2022. While that’s good news for By NATE LYKINS Tennessee resi- Associate, Waller dents covered by the federal legislation, additional state legislation will be required to cover all Tennesseans, including those with no health insurance coverage. To that end, new surprise billing legislation was recently introduced in the Tennessee General Assembly (the “State Legislation”). If passed, the State Legislation would take effect in 2023, one year after the No Surprises Act. Following is an overview of the situation the No Surprises Act (the “Act”) seeks to address, the anticipated ramifications of the Act, and issues to consider as the regulations are developed, as well as some differences between the Act and the State Legislation. The Act seeks to address “surprise billing,” which occurs when a patient receives an unexpected bill after obtaining services from an out-of-network provider at an in-network facility. A typical example might be a patient having surgery at a hospital participating in his or her health plan’s network while the anesthesiologist and pathologist who provided services as part of the surgery do not. In this situation, patients are often surprised to learn that all of the services are not in-network and that they are expected to pay the difference between the providers’ fees and their health plan’s out-of-network rates. The Act is the first comprehensive effort to address surprise billing at the federal level, and it affects health plans, hospitals, physicians and air ambulance transportation companies. The Act requires federal agencies like the Department of Health and Human Services and the Department of Labor to write regulations that further define the Act’s requirements, and some of these regulations must be published as soon as July 1, 2021. Although the full scope of the regulatory scheme will not be known until final regulations are published, the Act itself makes it clear that healthcare providers, insurers and self-insured health plan sponsors should be ready to address budgetary, operational and administrative changes in the near future. Specifically, the Act includes the following significant provisions: Out-of-Network Services & Patient Financial Responsibility When a patient receives out-ofnashvillemedicalnews


network emergency services, the hospital or physician providing emergency services may not hold the patient liable for copayments, coinsurance and deductible amounts that exceed in-network rates. Emergency services must be provided without requiring prior authorization or any other term or condition of coverage and regardless of whether the provider is part of the patient’s health plan network. Health plans must count any costsharing payments for emergency services toward in-network deductibles or out-ofpocket maximums. For non-emergency services, providers cannot impose cost-sharing requirements that would exceed the requirements applicable to in-network services, unless certain notice and consent rules are met. Provider Reimbursement Rates Reimbursement rates will be set by applicable state law or, if no such law exists, a calculation that is based on the median contracted rate among other payers for the same service and in the same market. Although the regulations that implement the Act are still pending, the State Legislation could, if enacted, be the kind of state law that determines the method for setting reimbursement rates instead of some of the Act’s other provisions. An “independent dispute resolution” mechanism will be established to arbitrate claims between providers and payers that cannot be resolved by the parties themselves. Using “baseball-style” arbitration, the independent dispute resolution (IDR) entity must accept one of the parties’ proposals without modification or “splitting” the difference. Other Patient Protections To facilitate patient understanding about pricing, health plans must provide “price comparison guidance” to their members by phone or online. Health plans must provide updated directories that include, among other things, the network status of healthcare providers. The rules and scope of information in “explanation of benefits” documents will be expanded. Patients will enjoy a transition period of 90 days to facilitate continuity of care if a provider terminates network participation during a particular course of care. Transparency rules will require providers to inquire about a patient’s health plan coverage at the time of scheduling and provide patients with a good faith estimate of anticipated charges. These transparency rules will be in addition to the Hospital Price Transparency final rule that became effective at the beginning of this year. Although the Act and the State Legislation are intended to address similar issues, there are differences between them. For example, unlike the Act, the State

Legislation permits individuals without insurance to submit certain billing disputes to an IDR entity. Additionally, the sets of factors that the Act and the State Legislation require IDR entities to consider before rendering decisions are not identical. Consequently, it will be important for parties to understand which factors apply to their dispute. The Act is an attempt to address issues related to surprise billing, but the government must provide more guidance to enable affected parties to comply with the Act by Jan. 1, 2022. For their part, providers, insurers, health plan

sponsors and others should continue to monitor activities related to the regulations and rollout of the Act. Among other things, interested parties will have an opportunity to submit comments to the proposed regulations following the publication of the Notice of Proposed Rule Making. Nate Lykins is an associate in Waller’s Healthcare Practice. Located in the firm’s Nashville office, he works with providers on the regulatory aspects of healthcare transactions, as well as compliance with federal and state healthcare regulations impacting operations. For more information, go to wallerlaw.com.

TFA Affords Women, continued from page 3 at the two-year mark was 5 percent and at three years was 8.2 percent. “It showed great results through 36 months,” he said of the durability of the treatment protocol. Toub noted it isn’t surprising to see the need for additional intervention in some candidates. “We do know that women who have many fibroids at baseline have a proclivity to form more fibroids,” he pointed out. As for patient response to this  new  treatment option, he said, “At three years, 94 percent of patients reported satisfaction.” 

With positive durability and safety outcomes, along with minimal procedure and recovery time, Toub said Gynesonics believes they are offering women and physicians a new option to deal with a condition that is too often minimized. For women who suffer through painful periods, miss work days and skip social activities, UFs are more than just a nuisance.   “By treating the fibroids successfully, you can have such a positive impact in their life,” Toub concluded. 

How Big a Problem Are Fibroids? Epidemiologists have found it tricky to nail down exact incidence and prevalence rates of uterine fibroids (UFs). Since many are small and/or asymptomatic, these muscular tumors in the wall of the womb often aren’t diagnosed or reported.   However, from the studies that exist, general consensus puts incidence rates at upward of 70 percent for developing one or more fibroid tumors over a lifetime. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) cites fibroids as “the most common non-cancerous tumors in women of childbearing age.” An estimated 25 percent of women of in this group have symptomatic tumors that moderately or greatly impact quality of life, and symptomatic fibroids are the most frequent reason for hysterectomy in the United States.  Risk profiles also are not clearly understood, but age is a key factor with UFs becoming more common as a woman ages up through menopause, after which time tumors begin to shrink. Race also plays a major role with Black women having a significantly higher risk of developing fibroids and of having symptoms. Family history, obesity and eating habits have also been linked to UFs. Women who consume a lot of green vegetables seem to be afforded some protection from developing fibroids, while eating a lot of red meat has been linked to a higher risk of tumor development.   Last year, researchers at Michigan State University College of Human Medicine, Van Andel Institute and Spectrum Health uncovered new information on genes associated with fibroid tumors. In releasing their research findings, the group stated one of the genes they discovered, HOXA13, which is associated with uterine fibroids, “appeared to correlate with a transformation of cells in the muscle of the uterus into cells more typically found in the cervix when activated — a process called ‘homeotic transformation.’” The study, funded by the National Institutes of Health and published in Cell Reports, could ultimately lead to new therapeutic targets.  Although many women with UFs have no symptoms, those who do often find the symptoms take a toll on quality of life. The most common issues include heavy menstrual bleeding (sometimes to the point of anemia), menstrual periods a week or more in length, enlargement of the lower abdomen, frequent urination, pelvic pain or pressure, constipation, pain during sex, and pain in the legs or back. Depending on the size and positioning of the fibroid tumors, women might also have difficulty in achieving pregnancy. They also face increased potential for complications during pregnancy, as well as a higher risk for requiring a cesarean delivery. 




New NTT Center Boon for Health Tech By CINDY SANDERS

Breaking new ground When it comes to healthcare liability insurance, MagMutual truly stands out. While other mutual insurers are declaring dramatically lower annual dividends – or nothing at all – MagMutual has been consistently making payouts since 2007.* In total, our PolicyOwners™ have received over $315M in financial rewards. We’re growing where others are shrinking, and making our PolicyOwners even stronger.

magmutual.com/innovation *Dividends and Owners Circle allocations are declared at the discretion of the MagMutual Board of Directors and are subject to eligibility requirements.






In mid-March, Governor Bill Lee and Commissioner Bob Rolfe of the Tennessee Department of Economic and Community Development joined officials with NTT DATA to announce the global IT service provider’s plans to establish an Innovation and Digital Delivery Center at Capitol View in downtown Nashville. A division of Tokyo-based NTT DATA Corporation, NTT DATA Services is headquartered in Plano, Texas with more than 50,000 professionals worldwide helping businesses address their digital needs. While NTT has a handful of regional hubs in the United States, the new Nashville operation is focused on developing and deploying talent and enhancing innovation within the IT sector. Healthcare and advanced manufacturing technology will be points of emphasis. Paul Naquin, senior vice president of operations for NTT Data, said no one knew exactly what might happen with clients at the beginning of the pandemic. However, it didn’t take long to see the role technology played with remote workers spread across the country. He noted clients took some of the savings they realized from the pandemic’s operational disruption to shore up technology. “So we knew we’d continue to see growth from a technology standpoint, and it was already a war for talent in the tech space,” Naquin said. With continued demand and a decision to invest in developing technologists early in their careers, the company began searching in earnest for a vibrant city that would attract young talent. “Ultimately, we thought Nashville checked all the boxes for us,” Naquin noted. In the March announcement, the company touted a $9.9 million investment and plan to create 350 jobs, but Naquin said that number was really just a starting point. “If things go well, we want to quickly get past 350, which we think we can do in three years.” RaeAnn Hancock, healthcare consulting lead for NTT DATA, added Nashville’s industry expertise was another key driver in the decision to locate here. “This isn’t just a building,” she said of the new office space, “We’re at the center of the healthcare ecosystem.” It also isn’t a typical office. The space has the flexibility to allow employees and clients to envision processes differently – whether that’s turning part of the office into an apartment to address digital practices for aging in place or showcasing ways intelligent automation allows patients to access care from anywhere. “Medicine has always been a combination of art and science. We love that Nashville is a hub of art and science coming together,” Hancock said of the city’s reputation for creativity. “There’s no lack of demand for those skills,” concurred Naquin. “The center really is built to service all our clients nationally and internationally.” nashvillemedicalnews


NCI Director Updates Cancer Progress By CINDY SANDERS

In April, National Cancer Institute Director Norman E. “Ned” Sharpless, MD, FAACR, addressed the virtual attendees of the American Association for Cancer Research Annual Meeting to provide an update on where we stand in the ongoing fight against cancer. “We’re living in Dr. Ned Sharpless dizzying and challenging times, but we’re still making remarkable progress in cancer research,” Sharpless said. “We will look back at this era as the golden age of cancer research.” Sharpless noted there have been more than 240 drugs, biologics and devices approved by the Food & Drug Administration for cancer indications since he was named to his NCI post in 2017. He added this remarkable productivity is a testament to the work of basic and translational researchers in academic, government and private industry. He touted the Human Papillomavirus (HPV) vaccine’s safety and efficacy as an example of success. A recently released study out of Sweden of nearly 1.7 million women found girls vaccinated before age 17 had a nearly 90 percent reduction in cervical cancer incidence over an 11 year period (2006-17) compared to the incidence in women who had not been vaccinated. The key to more of these success stories, he continued, is to ensure stable funding for research. “Investigator-initiated science is how we make progress for our patients,” he stated. Sharpless pointed to the Cancer Moonshot, which started in 2017, as an accelerant that has helped fuel recent discoveries and information-sharing. Authorized at $1.8 billion spread over seven years, the program lapses in 2023. Launched while he was vice president, the project is deeply personal to President Joe Biden and First Lady Jill Biden, who lost son Beau to cancer in 2015. Sharpless also noted Vice President Kamala Harris also has a personal connection as the daughter of a cancer researcher who also died from the disease. Not surprisingly, President Biden’s proposed budget for FY 2022, which was released on April 9, includes significant funding increases to address cancer. The budget suggests a total increase of $9.3 billion in funding to the National Institutes of Health. Additionally, the proposed budget includes $6.5 billion in funding for ARPAH. Modeled on the military’s Defense Advanced Research Projects Agency (DARPA), this new Advanced Research Projects Agency – Health would look to speed innovation by investing in new projects and would be housed within the NIH. nashvillemedicalnews


“Congress controls the power of the purse, and the president’s budget is just a suggestion,” Sharpless pointed out. While funding remains unclear, he did say there is broad support for the work being done by NIH and NCI. “There is strong bipartisan support for cancer research. Everyone wants this effort to succeed,” he added. The president has stated his goal is to “end cancer as we know it.” Drilling down, Sharpless looked at what that might mean. “I don’t expect to eradicate all cancer deaths,” said Sharpless. However, he continued, he does believe it’s possible to dramatically impact the tragedy of cancer by developing new treatments, finding cures for pediatric cancers and helping people live longer and more fully even with a cancer diagnosis. One key metric, he continued, is to cut cancer mortality in half from its peak in the 1990s. In the early ‘90s, cancer was responsible for 215 deaths per 100,000 population. Now, that’s down to 150 deaths per 100,000. However, Sharpless said, “A 30 percent decline in 30 years is way too slow.” To meet the goal of cutting mortality in half by 2026, it would require about a 4 percent decrease per year going forward … which has never been achieved to date. However, Sharpless said after historically reducing mortality by about 1.55 percent per year, the two most recent years for which data is available were trending in the right direction. In 2017, the country saw a 2.2 percent decline in cancer mortality and in 2018 a 2.4 percent decline. “I think we can get there by 2026,” he added. However, Sharpless continued, to achieve that lofty goal will require focused efforts including developing large national trials aimed at early detection of cancer in healthy adults through blood-based screening, allocating resources to clinical trials focused on underserved populations and communities, and an increased commitment to accelerating drug discovery using new platforms and machine learning. While the development of the COVID-19 vaccine showcased the ability to rapidly create highly effective measures to combat disease by harnessing information and technology, Sharpless said the pandemic also sharply showcased glaring health inequities in our country. “Underlying all this work is a need for health equity,” said Sharpless. “We can’t leave huge portions of the population behind and expect to make meaningful progress.”

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NGH Celebrates 131st Anniversary On April 23, 1890, Nashville General Hospital opened with one doctor and six nurses. Today, the city-owned, public medical system continues to provide care to all Nashvillians – regardless of their ability to pay. In 2020 NGH provided more than $60 million in charity care. Originally located on Hermitage Avenue and known as City Hospital, Nashville General has grown into an integrated, evidence-based care delivery system. “For 131 years, our campus and our medical services continue to be the heartbeat of this city,” said Nashville General CEO Joseph Webb, DSc, FACHE. “We stand as Nashville’s partner on the path to long-term wellness. When all individuals have access to healthcare, the entire city thrives.”

Middleton Begins Regional CEO Role for Centerstone Centerstone, a not-for-profit health system specializing in mental health and substance use disorder services, has promoted Ben Middleton to regional chief executive officer for its Tennessee, Georgia, and North Carolina operations. Middleton succeeds Robert Vero, Ben Middleton EdD, who retired from the organization after 40 years of service. A substance use treatment provider by training, Middleton has worked for Centerstone and its legacy organization since 1985 and previously held the positions of regional chief operating officer, vice president for core services and director of substance use programming, among others. As regional CEO, Middleton will lead every aspect of the region’s operations. In addition to his new role, Middleton also serves as the executive sponsor for Centerstone’s Black & Brown Professionals Network (BBPN), one of Centerstone’s employee resource groups working to promote diversity, equity and inclusion across the health system. Middleton earned an undergraduate degree in psychology from Oakwood University in Huntsville, Ala., and a master’s in clinical psychology from Alabama A&M University.

Jagasia Tapped to Lead Ascension Saint Thomas Midtown & West Completing an extensive national search, Ascension Saint Thomas has tapped physician leader Shubhada Jagasia, MD, MMHC, as president and CEO of

Ascension Saint Thomas Hospital, Midtown and West campuses. Offering nearly 30 years of clinical and healthcare administration experience, Jagasia most Dr. Shubhada recently served as chief of Jagasia staff for the Adult Hospital and Ambulatory Clinics at Vanderbilt University Medical Center. There, she successfully led the COVID service line as part of the pandemic response, created an innovative discharge and transitions program, and developed a patient and caregiver-centered end-of-life program. She also helped develop multiple new clinical programs, including a specialized service line catering to patients with high healthcare resources utilization. Her prior roles include medical director of the Eskind Diabetes Clinic and vice-chair of Clinical Affairs for the Department of Medicine at Vanderbilt. Jagasia moved to Tennessee in 1994 to complete a postdoctoral fellowship at St. Jude Children’s Research Hospital in Memphis after graduating from King Edward Memorial Medical College in Mumbai, India. She then relocated to Nashville for her internal medicine residency, which she completed on the Ascension Saint Thomas through the University of Tennessee Health Science Center. She then continued her clinical training at Vanderbilt with a fellowship in Diabetes, Endocrinology and Metabolism and also obtained a Master of Management in Health Care from the Owen Graduate School of Management.  She succeeds Fahad Tahir, who has been named to the role of system chief strategy officer for Ascension Saint Thomas.

Rector Joins Enexor as CEO

Healthcare veteran Steve Rector has been named CEO of Enexor Health Systems, a new company spinoff from Enexor BioEnergy, which entered the medical device industry with its innovative ventilator technology in 2020 and will launch an aggressive deployment Steve Rector strategy under Rector’s leadership. Enexor Health Systems, launched last year in response to COVID-19, has built a ventilator that is easy to use and can be deployed anywhere. The machine is unique in its ability to treat patients of every age, from a premature baby in the NICU to an adult ICU patient, reducing training costs and the stress of clinical staff’s learning how to use multiple models. The unit is currently priced at $10,500 and was designed to disrupt the industry not only on the technical side but within the value ecosystem. Rector’s deep pool of experience includes serving as CEO of Corizon Health Service and as an executive at Community Health Systems and Hospital Corporation of America. He also was a director at LifePoint Hospitals, Inc., and Saint Thomas Health Services. APRIL/MAY 2021




Let’s Give Them Something to Talk About!

Awards, Honors, Achievements

Milton H. Jones, vice chairman of the Meharry Medical College Board of Trustees, has been elected chair of the United Negro College Fund (UNCF) Board of Directors. Jones will focus on growing the organization’s endowment, benefiting the 37 Milton Jones historically Black colleges and universities (HBCUs) belonging to the UNCF network of member institutions. Jones is making UNCF history, becoming the first African American elected to the position.

nings, she writes: “During the decade following the Civil War, those charged with the task of providing schools for the freedmen quickly recognized the almost total lack of competent medical service for African Americans, among whom the mortality rate was mounting with alarming rapidity. It was to cope with this situation that Meharry, in 1876, came into being …” The book covers the school’s fascinating history from the first president George W. Hubbard through today’s leadership under the guidance of James E.K. Hildreth, PhD, MD.

Business Briefs

Williamson Medical Center has been named to Newsweek’s 2021 list of Best Maternity Care Hospitals. The distinction recognizes facilities that have provided excellent care to mothers, newborns and their families, as verified by the 2020 Leapfrog Hospital Survey. Nashville General Hospital has earned reaccreditation from The American College of Surgeons Commission on Cancer (CoC). Accredited for 80 consecutive years, Nashville General Hospital is the second-oldest accredited cancer program in Nashville.  Centerstone has been named Community Partner of the Year by Dismas House of Nashville, a 72-bed facility that offers housing and supportive services for formerly incarcerated men. Since early 2020, Centerstone has provided mental health services to Dismas House residents. Walter Clair, MD, MPH, who earned his bachelor’s degree, medical degree and Master of Public Health from Harvard University, is one three 2021 recipients of Harvard University’s highest honor, the Harvard Medal.  Clair, professor of Clinical Dr. Walter Clair Medicine and vice chair for Diversity and Inclusion in the Department of Medicine at Vanderbilt University Medical Center (VUMC), will receive the award virtually from the Harvard Alumni Association at its annual meeting on June 4.

Parham Pens History of Meharry Medical College Sandra Martin Parham, MLIS, executive director of Meharry Medical College Library, has authored a newly published book detailing the history of the ground-breaking medical school. Introducing the college’s begin-




Nashville-based CarePayment, a leading patient financing company offering a 0.00% APR solution to help patients pay for their healthcare, is now available through Epic’s App Orchard  marketplace to help providers deliver a seamless financial experience for patients through MyChart. The CarePayment solution has been implemented by more than 100 hospitals and health systems that utilize the Epic Platform, including some of the largest academic medical centers and integrated delivery networks in the United States. University Hospitals of Cleveland, Ohio, has selected Nashville-based Visuwell as its new principal telehealth vendor. Visuwell provides a complete patient experience and integrates with UH’s scheduling and EMR systems to streamline administrative efforts. UH is an integrated network of 20 hospitals, more than 50 health centers and outpatient facilities and 200 physician offices in 16 counties.

acute care services, has joined Moving Health Home, a coalition of stakeholders that supports changes in federal and state policy to enable the home to be a clinical site of care. As part of the Moving Health Home coalition, Compassus and other members will advocate to expand the services covered in a home-based setting and facilitate whole-person care that reduces stresses on patients and families. Study evaluating impact of SilverSneakers by Tivity Health showed total annual average health expenses, including medical and pharmacy, among SilverSneakers participants to be $4,463 compared to $5,303 for non-participants. Medical component of costs was decreased by 26%, driven primarily by reductions in hospitalization costs. Use of outpatient care was higher for SilverSneakers members combined with less acute care, indicating better health management among participants compared to non-participants. After starting the SilverSneakers program, participants experienced 42% fewer hospital stays, and 18% fewer ER visits  compared to Medicare Advantage non-participants.

TriStar Centennial Welcomes New COO In April, TriStar Centennial introduced James “JW” Newman as the medical center’s new chief operating officer. Prior to his new post, Newman served as COO at HCA Medical City Fort Worth, a 348-bed tertiary facility JW Newman in Texas. Other experience includes serving as associate COO at HCA Medical City Dallas Hospital and Medical City Children’s Hospital. Newman earned his undergraduate degree from the University of Mississippi and a Master of Health Care Administration from Trinity University in San Antonio. He is a 2018 graduate of the HCA Executive Development Program.

SOS to the Rescue

In April, Beam Mobile announced upgraded iPhone SE and XR cases with data-passthrough ports. Beam cases are designed for hospitals using mobile applications and provide battery backup and advanced drop protection. Beam CTO noted, “The key new advantage is a micro USB data port for mobile provisioning and device management in charging cabinets. This helps with large-scale deployment.” Beam works with JAMF and Imprivata provisioning, and Datamation storage cabinets. Brentwood-based Compassus, a national provider of home-based post-

Tamara Stotts, CMPE, formerly practice manager of Nashville Vascular and Vein, PLLC has founded SAVVY Operating Solutions, which looks to fill the niche of delivering personalized hands-on assistance in medical revenue cycle management. Stotts and her team bring decades of experience to this new venture located in Nashville’s Midtown. Services include claims submissions, management of denials and appeals, payment posting and processing, secondary claims filing and accounts receivable management. Additional services include assistance with insurance contract negotiations, fee schedule analysis and credentialing.


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April-May 2021 Nashville Medical News  

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