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Jeffrey Hodrick, MD ON ROUNDS

Addressing Kids’ Health in Tennessee Programs, Partnerships to Improve Youth Health Scores It’s no secret the health of a community is largely molded by social determinants – factors that take place outside of traditional healthcare settings ... 3

Q&A with New Nashville Health Care Council Fellows Director Lydie Marc Nashville Medical News: After a brief hiatus during the pandemic, the Council Fellows program is back. How has the program been fine-tuned? ... 7

Three Key Considerations for Change Management in Healthcare A lot has changed. You don’t need to know what I’m referencing to agree that is true. Everyone in the healthcare industry knows that, on some level, more change is coming ... 15 Follow us on Twitter

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Answering the Call to Train More Physicians

Nashville Hospitals, Colleges Partner to Address Physician Shortage By MELANIE KILGORE-HILL

REPRINTED WITH PERMISSION OF VUMC.

PHYSICIAN SPOTLIGHT

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Combating a nationwide physician shortage is no small feat, but it’s one Nashville hospitals and medical colleges are tackling hands-on through a growing number of Graduate Medical Education programs and partnerships.

Nationwide Shortage

“It’s really about workforce development and making sure we have physicians to take care of patients,” said Cathryn Rolfe, JD, vice president and COO of Graduate Medical Education for HCA Healthcare. “For the average person, the physician shortage may not be as evident as the need for nurses, but it’s what prompted HCA Healthcare to strongly invest in graduate medical education.” (CONTINUED ON PAGE 8)

Back to School with COVID Delta Undoes Progress as Pediatric Cases Rise

By CINDY SANDERS

As summer break began, it seemed like the worst of the pandemic was behind us. After a tough year of virtual learning, parents, teachers and students were all eagerly looking forward to returning to the classroom in the fall. Unfortunately, the Delta variant has allowed COVID-19 to take root again, particularly in communities with lower vaccination rates, just in time for the new school year. Decisions in Tennessee – from the firing of a vaccination official to fights over mask mandates – have made national news. While Gov. Bill Lee used an executive order under emergency powers to give parents a way to opt out of school mask mandates for their children, pediatric COVID rates hit new highs across the state. On Aug. 19, there were more than 1,000 new cases of

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Spotlight on Sarah Cannon Transplant and Cellular Therapy Program for Blood Cancers, Diseases Delivering unprecedented hope through innovative treatment, trials More than 180,000 Americans are diagnosed with blood cancers each year, while 100,000plus are living with blood disorders like Sickle Cell Disease. Fortunately, the Sarah Cannon Transplant and Cellular Therapy Program at TriStar Centennial is uniquely positioned to treat blood cancers and blood disorders and offers innovative treatment options right in our backyard. The adult program has treated thousands of patients since its launch in 2006 and a pediatric program was added in 2015. Both programs are FACT accredited, which shows they meet the most comprehensive standards in the field. To date, the program performed more than 1,350 transplants, with a record 183 in 2020 alone and slated to surpass that milestone in 2021.

biggest challenges of blood cancers in adults and children – inactivity of the immune system. In CAR T-Cell, specialists collect immune cells from the patient and reprogram them to attack cancer directly. Patients are evaluated, and cells are collected and sent off to a manufacturing facility. When the cells are available, the patient receives chemo for a few days prior to infusion of the cells. It’s a one-time infusion that, in many cases, allows a patient to go into remission. “We basically harness the immune system by collecting the patient’s own immune cells, reeducating them and putting them back in,” said Frangoul, who is part of the team that has performed 177 CAR T-Cell infusions since clinical trials began in 2017.

Today several CAR T-Cell therapies are available at Sarah Cannon through both research and Their success, said pediatric hematologist commercially available Haydar Frangoul, MD, Interim options. Frangoul said patients Medical Director of the who need CAR T-Cell typically Sarah Cannon Transplant have chemotherapy refractory and Cellular Therapy disease or have experienced (SCTCT) Program at TriStar relapse post-transplant. Centennial, is due in part “Unlike conventional to exclusive clinical trials chemotherapy, this new offered through the larger immunotherapy targets Sarah Cannon Transplant and the malignant cells, leaving Cellular Therapy Network, everything else alone,” he said. which operates five FACT“It’s changed the landscape accredited programs in the Dr. Haydar Frangoul of how we treat cancer, offers United States and three in longevity and has actually cured patients.” the UK. He also credits their multi-disciplinary approach to blood cancers, which includes CRISPR –Cas9 Gene Editing Therapy subspecialists to address mental and physical Innovation for Blood Disorders concerns common to patients. In 2019, the program also was among the first to offer a groundbreaking therapy to treat patients CAR T-Cell Therapy for Blood Cancers In 2017, the Sarah Cannon Transplant and Cellular with Sickle Cell Disease and transfusiondependent thalassemia. CRISPR is a geneTherapy Program at TriStar Centennial became editing tool available by clinical trial at Sarah one of the nation’s first to offer CAR (chimeric Cannon Research Institute and has been lifeantigen receptors) T-Cell therapy, an innovative changing for patients with Sickle Cell Disease, cancer treatment designed to harness the a genetic condition causing intense pain and immune system. complications in patients and most common in African Americans. The only curative therapy for Frangoul said CAR T-Cell therapy addresses the

Navneet S. Majhail, MD, MS, FASTCT, was recently named Medical Director of the Sarah Cannon Transplant and Cellular Therapy Program at TriStar Centennial. In addition to his role at TriStar Centennial, Majhail will join Sarah Cannon as Deputy Physician-in-Chief of Blood Cancers for the Sarah Cannon Transplant and Cellular Therapy Network. Majhail previously served as director of the Cleveland Clinic’s Blood and Marrow Transplant Program while also serving as the Vice Chair for the Department of Hematology and Medical Oncology and a Professor of Medicine with the Cleveland Clinic Lerner College of Medicine. He is a past president of the American Society for Transplantation and Cellular Therapy (ASTCT) and has been recognized as a fellow for contributions to the field of transplantation and cellular therapy. He is a respected thought leader in health outcomes research and has published extensively on the prevention and management of early and late complications of hematopoietic cell transplantation and health policy issues such as healthcare disparities, quality of care, survivorship and economic issues related to transplantation and cellular therapy. Majhail joins the staff later this month. Sickle Cell Disease is allogeneic transplant from a matched family members. Unfortunately, 85% of the patients lack an appropriate donor. Frangoul said that CRISPR-Cas9 allows scientists to make precise edits to the human DNA. In utero, the fetus blood is mostly fetal hemoglobin, which eventually switches to adult hemoglobin. “We know that patients with Sickle Cell Disease start experiencing complications at around three months of age once there is a switch from fetal hemoglobin to sickle hemoglobin.” That mystery of how the switch happens was solved with discovery of the BC11A gene, found to activate shortly after birth. In the current clinical trial, physicians collect a patient’s own stem cells and use CRISPR-Cas9 to make precise edits to the BCL11A gene which results in enhancing the production of fetal hemoglobin. Frangoul has welcomed trial participants from across the United States and is still enrolling

patients 12-35 years. The process keeps them in Nashville for approximately two months and requires follow-up for side effects and efficacy for 15 years. It’s also showing incredible promise for patients with beta-thalassemia, a transfusion-dependent blood disease in which the body fails to produce enough hemoglobin. With this therapy, patients become transfusion free. “I really think that these therapies can make a huge impact on patient’s lives” Frangoul said. “We are very excited to offer cutting-edge therapies for our patients with blood cancers and blood disorders like Sickle Cell Disease and beta thalassemia.”

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Addressing Kids’ Health in Tennessee Programs, Partnerships to Improve Youth Health Scores By MELANIE KILGORE-HILL

It’s no secret the health of a community is largely molded by social determinants – factors that take place outside of traditional healthcare settings. While access to high quality, culturally competent care is critical, it’s equally important … if not even more so… to ensure kids have the kinds of resources around them to foster health and well-being. Tennessee is facing its own challenges related to social determinants, as evidenced by the recently released “2021 KIDS COUNT Data Book,” which ranks the state in the bottom half of child well-being. Nashville Medical News had the opportunity to speak with some the state’s key players to discuss what’s working, what isn’t, how to be an ally for today’s children and why it’s mission critical we get this right for the next generation.

A Bigger Issue

“This is a larger strategy issue, because young peoples’ health is much more complex than having a medical home or primary care provider,” said Richard Kennedy, executive director of the Tennessee Commission on Children and Youth (TCCY). “It has to do with economic stability, housing and the community context in which people live, work and worship.” Richard Kennedy Sixteen indicators measuring four domains (economic wellbeing, education, health and family and community context) are used by the Annie E. Casey Foundation in each year’s Data Book to assess child well-being. The annual KIDS COUNT data and rankings represent the most recent information available but do not capture the impact of the past year. While economic well-being and other initiatives saw an overall improvement from 2019, earning Tennessee a national ranking of 36th, the state ranked 39th for health and 40th for community and family, still placing Tennessee toward the bottom nationally.

Lessons from the Pandemic

region, said the notfor-profit behavioral health services provider has seen an unprecedented rise in outpatient pediatric referrals. “Children are resilient and able to go with the flow, but this was such Beth Hail a fearful time for everyone it was difficult to avoid,” she said. Through a partnership with the state, master’s-level therapists were deployed mid2020 to all 95 counties in Tennessee, with Centerstone staff comprising a quarter of those. And while virtual services were a hit with kids early on, Hail and Kennedy said screen burnout became problematic by fall. “Everyone had tech fatigue from online school and work, and the thought of one more meeting was overwhelming,” Kennedy said. Burnout led to increased creative efforts including evening and weekend sessions, while outdoor areas were used for in-person sessions when possible. And since schools are a gateway for children’s health services, Hail’s team also is working with school staff to provide training on behavioral issues and in-class observations. “We’re looking at needs and resources of each county and how they can support what’s going on there,” Hail said. Officials also recently rolled out the Behavioral Health Safety Net for Children, which provides non-income-based gap funding for children ineligible for

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Addressing Rural Needs

Challenges are especially prevalent in Tennessee’s rural communities, which often lack resources for food, transportation, support services, broadband and medical care. “We can get kids on TennCare, but sometime the closest provider is 50 miles away,” said Cobb, who estimated 16 percent of kids in Tennessee lacked access to internet services in 2020. The plight of rural families is one the state is taking seriously, Kennedy said. Working with Tennessee’s Home Visiting Leadership Alliance to examine how agencies work together, the state is currently

working to roll out evidence-based home visiting programs in every county.

Nurture the Next

One non-profit, Nurture the Next (previously Prevent Child Abuse Tennessee), is a voluntary primary prevention organization focused heavily on the early years of a child’s life. “If you think about health and wellness of the future generation, it depends on what we’ve done with kids in the early years while their brains are developing and attachments are forming,” said Kristen Davis, LAPSW, president and CEO of Nurture the Next. “Kids are only as strong as their parents. Many parents themselves grew up in a chaotic, trauma-based environment, and they now have their own children and want to do better but need a little help.” Evidence-based Kristen Davis home visiting, which expanded statewide with a variety of providers during the pandemic, is funded privately, through the Tennessee Department of Health and the federal Maternal, Infant and Early Childhood Home Visiting Program. Established in 1984 as Prevent Child Abuse Tennessee, Nurture the Next also provides crisis intervention through a statewide domestic violence hotline as well as a texting mentorship program for new moms (CONTINUED ON PAGE 4)

more control

On the heels of a pandemic that pivoted a decade’s worth of progress in several key areas, Kennedy said the state continues to be focused on strategies to help kids mitigate and recover from adverse childhood experiences. Dana Cobb, regional program administrator for TCCY, said the state is taking a holistic look across all demographics to address pressing concerns. “Mental health rose to top of the list, and the pandemic still isn’t over,” she said. “There’s going to be a lot of juggling and making decisions along the way, and we’re hopeful we learned enough lessons from round one HEALTHCARE that the transition will be easier this time.” Beth Hail, MSSW, LCSW, regional vice president of Centerstone’s central NASHVILLEMEDICALNEWS

TennCare but without private insurance. “That’s been a huge resource, as staff are going out into communities talking to every person they can who interacts with children and families,” Hail said. “The state’s goal was that if a child needs a service they’d get it, and they didn’t want the financial piece to be a barrier.” As students head cautiously into a new school year, Hail encourages adults to be mindful of challenges children will face including making new friends, food insecurity and school clothing. “They’re worried about a lot of things they’ve not experienced over the last year, so we have to back up since many have missed an entire developmental milestone year,” Hail explained. She also encourages adults to be mindful of other parents who might need extra support during the transition and ongoing pandemic.

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ACS Updates Children’s Surgery Verification Program Standards Over the summer, the American College of Surgeons (ACS) Children’s Surgery Verification (CSV) program announced the release of the second version of its Optimal Resources for Children’s Surgical Care manual. The updated standards are intended to ensure programs can achieve a high level of continuous quality improvement for children’s surgery patients from when they first enter a hospital setting until they are discharged. The updated standards detail principles regarding hospital resources, quality improvement and safety processes, data collection, and the verification process. The CSV program evaluates three levels of care, aligned to the standards and expected scope of practice at the pediatric hospital. The revision process, which began in 2019, aimed to identify new standards that would provide direct benefit to patients,

Nine Standards for Optimal Care • Institutional Administrative Commitment • Program Scope and Governance • Facilities and Equipment Resources • Personnel and Services Resources • Patient Care: Expectations and Protocols • Data Surveillance and Systems • Quality Improvement • Education: Professional and Community Outreach • Research

clarify standards that were not achieving the intended result, and ensure that standards resulted in improved patient care. The latest version of the manual incorporates specialty hospital standards, a verification process overview, and the criteria quick reference guide, as well as the required Children’s Surgery Safety Report. As a part of the new standards, centers seeking verification at all levels will be required to develop detection and reporting processes for all adverse events that occur in children’s surgery and develop a process for improvement and prevention. Through compiling this data, centers will gain a better understanding of the overall quality of care in determining strengths, limitations, and costs of detection methods to be improved as the program evolves. “The purpose of the revision was to incorporate all the lessons that we’ve learned from the more than 35 sites that have already been participating in the program,” said Douglas C. Barnhart, MD, FACS, MSPH, Chair of the Children’s Surgery Verification Committee. “What we did was try to take the lessons learned and incorporate them into consolidated standards, including more Dr. Douglas C. inclusive education Barnhart standards, the catalyzation of optimal care, and incorporating specialty hospitals into the standards.” As a part of the revision, education standards have been clarified for non-academic hospitals in an attempt to remove barriers around education and research requirements for verification. Level I will continue to be a community resource, however, alternative pathways to verification have been created in order to accommo-

date hospitals without resident and fellow training within the department of surgery. Additionally, the new standards set into place new expectations for patient care. Under the new standards, sites must utilize comprehensive clinical pathways that facilitate the standardization of patient care. Clinical pathways are a sequence of orders and therapies describing the routine care for patients from initial evaluation through long-term follow-up. The new patient care standards include new stewardship programs on opioid, perioperative antibiotic, and anesthesia use. The revisions are based on the Nine Standards for Optimal Care (see box) that provide a uniform standard across all ACS quality programs while allowing variation within the individual ACS accreditation and verification Programs. The nine core standards reflect the most important resources for quality and safety and each of these standards include vital areas to

Addressing Kids’ Health, continued from page 3

called NurtureTN. They also provide advocacy and education. “We think it’s everyone’s responsibility to protect children in our community,” Davis said. “It’s not a child advocacy issue. It’s a human issue, and we advocate for system changes that we know will affect families in a positive way.”

Signs of Hope

Leaders also hope 2021’s federal child tax credit will provide a needed boost in Tennessee, where the child poverty rate is 19.4 percent. “We’ve seen tremendous impact with first payments and how it gave families autonomy to choose how to spend it to suit their family best,” said Kylie

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be accessed in the ACS Accreditation and Verification Programs. “Historically, the program had two major emphases: optimal resources and the ability of a center to recognize when they had a problem and create a performance improvement plan to demonstrate that they could close the loop to prevent future problems,” said Barnhart. “These second version standards really bring in a much more specific standard, specifically around what good patient care looks like. These new standards begin to move us towards, not just what an excellent hospital looks like, but toward more excellent patient care.” The new manual was published on July 6 of this year, but the standards will not go into effect until July 1, 2022. All site visits after this date will be assessed under the new standards. An interactive PDF of the Optimal Resources for Children’s Surgical Care is available for download from our site, NashvilleMedicalNews.com.

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Burns, communications and policy specialist at TCCY. “It helps families move out of poverty, access care, pay bills and buy groceries. It’s all so interconnected, because when a family can provide food and health for a child, there’s less stress on the caregiver, and we know stress and child abuse are intertwined.” Going forward, Kennedy is hopeful about the past year’s efforts and has tremendous gratitude for the state’s teachers and healthcare professionals. “These folks have been on the front line from the start and have made sacrifices to look out for public health,” he said. “I want them to know their sacrifice hasn’t gone unnoticed. We know that medical professionals are usually the most trusted folks for parents and caregivers, and they’re continuing to expand their understanding of trauma and adverse childhood experiences and are incorporating that in what they do every day.”

Online Bonus Editorial • Fear of the Unknown: Anxiety & the School Year by Nurture the Next President & CEO Kristen Davis provides smart insights on helping children cope with the return to school and resources for parents, too. • Change in Respiratory Care Strategies for Preterm Infants Improves Health Outcomes recently appeared in JAMA Pediatrics. Senior study author Dupree Hatch, MD, MPH, assistant professor of Pediatrics in the Division of Neonatology at Monroe Carell Jr. Children’s Hospital at Vanderbilt, discusses what it means for care in NICUs and questions that still need to be explored.

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Back to School with COVID, continued from page 1 COVID-19 in children 10 and under and more than 1,800 new cases in the 11-20 age group. The day before, there were 2,500 new cases in the two youngest age groupings and 2,000 the day before that. In just that one three-day period, 7,300 young Tennesseans were confirmed to have the virus, with nearly 3,000 of them being age 10 or younger. Although serious illness and death remain relatively rare among minors, there has been an increase in such cases nationwide. Since the beginning of the year, the state has seen more than a 60 percent jump in hospitalizations in the age 0-10 category, a group not yet eligible for vaccinations. As parents seek answers, pediatricians are stepping up to dispel myths and share the facts on vaccination efforts and mitigation measures. Vaccines & Cardiac Concerns Stuart Berger, MD, FAAP, chair of the Section of Cardiology and Cardiac Surgery for the American Academy of Pediatrics (AAP), spoke with Medical News to address multisystem inflammatory syndrome in children (MIS-C) and parent concerns over reports of myocarditis or peri- Dr. Stuart Berger carditis linked to vaccination in children 12 and up. “There seems to be, indeed, an association with the MRNA vaccination and myocarditis. When it’s seen, it’s typically in the 16-24 age range and in boys more than girls,” he noted. “Having said that, it’s still relatively uncommon to see it … and when it is seen, it’s very, very mild disease,” Berger continued. He added the rare number of children who have been diagnosed haven’t been very sick, and the inflammation has gone away fairly quickly. “Thus far, it has not required any treatment other than one to two days of pain management such as non-steroidal anti-inflammatory drugs.” Typically, the self-limiting condition requires no intervention at all outside of rest and OTC pain relievers as needed.

“This is now in stark contrast with myocarditis that can be seen from an acute COVID infection or in association with MIS-C,” explained Berger, who is the division head of Cardiology at the Ann & Robert H. Lurie Children’s Hospital of Chicago. “Those patients can be very sick and often end up in the hospital and can get a very severe form of myocarditis requiring treatment and a fairly intense therapy for a period of time.” He added, “Many of those patients can require therapy in the Intensive Care Unit and can have morbidity and mortality if they get this.” Berger said data is also being gathered on possible residual issues these children could face over the long term. “In my experience with seeing COVID and MIS-C in young patients and my experience in seeing patients post-vaccine, it is a no-brainer to me that getting the vaccine is critical and what is best for every individual and for society in general,” Berger concluded. Mitigating Risks Anna Morad, MD, FAAP, president of the Tennessee Chapter of the American Academy of Pediatrics (TNAAP), said AAP guidelines call for masking children in the school setting. “We know a significant number won’t be vaccinated,” she said. “We have a fairly large population of unvacci- Dr. Anna Morad nated teenagers, and the ones under age 12 aren’t even eligible, yet.” Therefore, she continued, “The bulk of people entering these schools will be unvaccinated.” Even if more were vaccinated, Morad pointed out most schools don’t have a robust system in place to determine vaccination status. And evidence continues to mount that vaccinated individuals with breakthrough infections can spread the Delta variant more easily than initially thought. “It makes sense to provide that layered approach to mask everyone to protect vulnerable populations,” she

Neighborhood Health Begins Work on East Clinic In March 2020, Neighborhood Health’s Eastside Clinic sustained heavy damage as an EF-3 tornado ripped off the roof and the building flooded. More than 8,100 patients were displaced, being moved to one of Neighborhood Health’s 10 other area clinics. On Aug. 31, the safety net provider took a big step toward bringing those patients back to their local clinic as renovations and repairs began on the East Nashville location. The restored 12,000-square-foot 6

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building will feature a two-story lobby with stairs, an elevator and a small waiting area. The clinic will have a large patient waiting area and a children’s play nook. Nine exam rooms will be divided into pediatrics, general practice and women’s health, with rooms for labs, vitals and a centrally located nurses’ station. Separate check-in and checkout areas are included in the design to improve patient and visitor flow. There will also be offices for providers, special services and behavioral health.

On the Front Line with Parents “There’s a lot of misinformation out there,” said Anna Morad, MD, FAAP. While every parent won’t be convinced to vaccinate their child, Morad said pediatricians have a unique opportunity to debunk myths and share evidencebased information. The first step, she said, is to listen. “You need to hear what their concerns are,” Morad noted of not discounting parents’ fears. One of the biggest is that the vaccines were rolled out too quickly. She said it’s important to explain there was no ‘cutting corners’ when it came to clinical trials and evidence. The speed, she continued, came from streamlining the usual bureaucracy and a collegial work environment in the face of a crisis where researchers shared data and joined forces. Similarly, she said the concerns over myocarditis are often disproportionate to the actual risk. Morad said it’s important to provide context both in terms of actual cases following a vaccine and potential consequences of contracting COVID. Finally, she said pediatricians need to be willing to open the conversation. “In clinic, I routinely ask the family: Have you gotten the vaccine? Do you have any questions for me about the vaccine?” she said. “You need to direct them to reliable sources.” Go online to NashvilleMedicalNews.com for links to resources for both providers and parents.

explained. “You don’t know the health background of every child in that school. You don’t know their vaccination status. But what we do know is Tennessee has incredibly low vaccination rates so everyone should be masking in school,” Morad continued. As important as it is to keep kids and teachers well, it’s equally important to keep them in class. Many students had a tough time last year emotionally, socially and academically. Morad noted, “Kids do well with routine, and kids do well with having their peers around them.” She also pointed out virtual learning has a disproportionate impact on kids who don’t have reliable internet access or a parent who can be home during the day to help. “The most important thing we can do is get our kids back in school,” she stated. Without masks and other mitigation measures, in-person learning could quickly become another victim of the Delta surge. Within two weeks of returning to class, several districts in Georgia and Mississippi had already returned to remote learning. Florida’s Hillsborough County, which includes Tampa, has already seen more than 10,000 students be isolated or sent home to quarantine. In Nashville, it took four days for 1,000 students to be sent home for the same reason. Mask have become highly politicized, although Morad said they simply should be viewed as an effective, evidence-based strategy to prevent the spread of COVID19. While parents have become incredibly passionate about their children’s ‘right’ to be mask free, most kids aren’t terribly bothered by wearing them. “Our experience is most students tolerate mask-wearing beautifully,” she said. Unfortunately, parental passion has boiled over at several heated school board meetings. TNAAP recently released a statement condemning violent rhetoric and aggressive actions towards medical providers following a Williamson County School Board meeting. In part, the state-

ment read: “Everyone should step back and question if this is the behavior we want to model for our children. As parents, we teach our children to have calm conversations and to respect others. The healthcare professionals who attended the meeting were there to provide recommendations based on evidence-based guidelines to allow for in-person schooling while also keeping children healthy and safe.” The statement also said it’s a false narrative to point to low death rates among children from COVID, and those arguments completely discount severe illness, rising hospitalizations, MIS-C, long-term health effects not yet fully understood, and transmission to other vulnerable populations at home or in the community. “The mortality rate for children is not as high as for adults,” agreed Morad. “But these are children … we should not be talking about mortality among children.” She concluded, “No child deserves to have a vaccine-preventable disease because people around them refused to wear masks or get vaccinated.”

The Impact of COVID on Tennessee Families Earlier this year, the Vanderbilt Center for Child Health Policy released “The Vanderbilt Child Health Poll,” which looked at the impact of COVID on Tennessee families. The disruption extends well beyond catching the virus, and the poll outlines economic impacts, access to care concerns, learning loss, mental health concerns, socialization and attitudes toward vaccination. To read the report, go to vumc.org/childhealthpolicy/childhealth-poll or access the final report through our website at NashvilleMedicalNews.com.

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Q&A with New Nashville Health Care Council Fellows Director Lydie Marc Nashville Medical News: After a brief hiatus during the pandemic, the Council Fellows program is back. How has the program been fine-tuned? Marc: We are thrilled to reinstate the Council Fellows program and introduce a new chapter in this top program’s evolution. First, we have established an advisory board made up of nationally ranked experts to support our new, cutting-edge curriculum, as well as recruitment and facilitation. We’ve also created a brandnew position, classroom facilitator, to support and guide dialogue in the classes. A frequent Council Fellows faculty member, Michael Burcham, will serve in this role. As a signal of the program’s next iteration, the Council Fellows will also take on a fresh look and feel with a newly designed logo. Lastly, the coming year’s class schedule will be a hybrid of half in-person and half virtual sessions, recognizing the changes the world has experienced over the past year. Council leadership took advantage of the program’s pause by listening and evaluating the initiative and how we can further drive our industry forward. NMN: How did the pandemic change the Council Fellows’ world view? Has the all-consuming nature of the pandemic impacted coursework or increased emphasis in areas like change management and supply chain logistics? Marc: Through a customized curriculum, Council Fellows have a one-ofa-kind opportunity to share their unique industry experiences and learn from peers leading top healthcare organizations. The COVID-19 pandemic certainly provided extraordinary experiences, showcasing just how fast healthcare can change. Innovators across industries came together to fight the virus, there has been a rise in healthcare transactions and society has rightfully demanded actions that tackle our communities’ health disparities, just to name a few. With the upcoming class, Council Fellows will address innovation from inside and outside healthcare, social determinants of health, transactions in the industry, digital health and the new normal post-pandemic. NMN: Who is the ideal candidate to be a Council Fellow? Marc: The ideal candidate is a

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NMN: What is the general procedure to apply for the Council Fellows Class of 2022? Marc: Interested candidates can apply at HealthCareCouncilFellows.com/ Apply. We ask that applicants include information and statements of interest and a professional bio and resume, in addition to letters of recommendation from their CEO and an industry leader. Applications open Sept. 8, 2021, and will be accepted through Oct. 29, 2021. The 2022 class will then be selected by the Council and announced in early December. NMN: What should the designation of ‘Nashville Health Care Council Fellow’ signify to those outside the program? Marc: The Nashville Health Care Council Fellows is a one-of-a-kind opportunity for healthcare’s brightest leaders that you can’t access anywhere else in the U.S. Nashville has deep roots as the nation’s healthcare capital. With an unmatched legacy as an incubator of healthcare providers, health services start-ups and professional service firms, Nashville provides Council Fellows with exposure both to the leaders who created the biggest healthcare organizations in the world and to those (CONTINUED ON PAGE 14)

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Answering the Call to Train More Physicians, continued from page 1

A report from the Association of American Medical Colleges projects the U.S. will face a shortage of between 54,100 and 139,000 physicians by 2033, due to a surge in both older patients requiring more care and retiring providers. However, a daunting roadblock to GME programs nationwide is a federally mandated cap on GME slots available to residents. “People think physician shortage is about the number of students accepted to medical school or the number of medical schools, but it’s about residency programs,” Rolfe said. “How the country went from too many to not enough can be a bit confusing. When Medicare was established under the Social Security Act of 1965, funding of residency positions through Graduate Medical Education Cathryn Rolfe was included. As persons over 65 were going to have expanded access to healthcare, Congress realized it must have enough physicians to meet this increase in demand. Hospitals who’d been training residents for decades were now getting federal funding and residency slots increased, which tended to be in academic medical centers. “Programs and training spots for residents grew basically unrestricted for over 30 years and sufficient numbers of physicians were being trained. The 1997 Balanced Budget Act changed all of that when it capped the number of new residency slots Medicare would fund so new program creation stalled. The only new Medicarefunded residency programs being built were in hospital’s that never had a residency program and were not capped. Even with CMS funding, hospitals starting GME had to make sufficient capital investments to open new programs thus supply started to lag behind demand.”

Navigating the Cap

For most hospitals, Medicare caps the number of residents it will fund per hospital based on how many residents it funded in 1996. It also gives hospitals starting their first new GME programs five years to establish and grow programs before caps are set. Once set, hospitals’ resident caps are generally permanent. However, stats show 70 percent of hospitals train more residents than Medicare funds — indicating they can train more physicians now than when these caps were set. “It’s not that there are fewer places, but places that do facilitate GME have limitations on growth based on financial restrictions from CMS,” said Tristin Casteel, director of Medical Education at Ascension Saint Thomas. “We can add more trainees, but it’s 100 percent at our expense with no offset from CMS. That makes it challenging to grow training programs, but we realize it’s necessary to Tristin Casteel support not just Ten8

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nesseans but citizens around the country. The investment is worth it, even without reimbursement.”

Residencies by the Numbers

Nationally, Ascension welcomes 2,700 residents and fellows in 154 accredited programs and 66 specialties and subspecialties. In Nashville, Ascension trains 108 residents and three fellows in nine programs including primary care and advanced general dentistry, a program that started in 2018. Their new cardiac fellowship, to launch in 2022, will accept three fellows annually, and leaders are looking for ways to create more opportunities at Ascension Saint Thomas Rutherford. “We’ve been trying to be strategic about how to utilize the cap we have,” Casteel said. “We’re looking at the need for physicians in the communities we serve to determine what type of investment we make and focusing on a strategic approach to building relationships with residents early during the course of training.” As an academic medical center, Vanderbilt provides training to more than 1,100 trainees annually in 100 programs. “We’re in the unique position of providing clinical, research and educational missions on one campus,” said Kyla Terhune, MD, MBA, associate dean for Graduate Medical Education and vice president for Educational Affairs. “There is always a balance of Dr. Kyla Terhune missions, and each of those missions feed one another. There certainly is an advantage of continuing to invest in training programs, because we can’t have a future clinical mission without producing competent physicians from our training programs. Part of it is thinking about current patient needs and growth needs and how training programs can help support other arms in our mission.” Rolfe said the gap between applicants and available positions keeps growing, and HCA is addressing workforce shortage by building residency programs in locations that make sense for HCA. Nationally, the system offers 5,000 GME spots in 61 of their 185 hospitals, with plans to expand to 7,000 residents in 345 programs at 74 hospitals by 2025. In July, TriStar Health welcomed their first GME class with 10 residents in internal medicine and eight in psychiatry at Centennial Medical Center and a class of eight residents in family medicine at TriStar Southern Hills. Rolfe said locally, they plan to grow to 400 residency spots in Nashville in the next five years – a promising goal considering the organization’s growing number of agreements with local colleges.

Local Partnerships

In 2018, HCA announced a partnership with Meharry Medical College, offering GME opportunities at TriStar Southern Hills Medical Center. Meharry has eight other fully accredited Accredita-

tion Council for Graduate Medical Education (ACGME) residency programs within the School of Medicine and the School of Dentistry. Students also gain inpatient and outpatient experience at Nashville General Hospital at Meharry and the Department of Veteran Administration Tennessee Valley Healthcare System, Alvin C. York Campus in Murfreesboro. In 2020, HCA also announced a partnership with the new College of Medicine at Belmont University. According to a school-issued release, plans for the new Thomas F. Frist Jr. College of Medicine at Belmont University are taking shape after the university announced a name, location and founding dean for the school, with plans to break ground on the Wedgewood Avenue site by the end of 2021. TriStar Health will provide residents with clinical experience and elective rotations during their third and fourth years of medical school. Belmont is now pursuing accreditation from the Liaison Committee on Medical Education, which grants colleges the ability to offer medical degrees. Approval would make the Thomas F. Frist Jr. College of Medicine the fifth accredited medical college in Tennessee. “It’s exciting to be a part of a medical school, and there’s a lot of energy and enthusiasm here,” said Reuben A. Bueno, Jr., MD, associate dean for clinical education and professor of surgery at the Thomas F. Frist, Jr. College of Medicine. “The goals Dr. Reuben A. Bueno, Jr. of the medical school will be in alignment with goals, missions and vision of Belmont University, and we’re developing relationships so that students and faculty can serve the local community.”

Serving Rural Communities

Addressing rural healthcare is another challenge for Tennessee’s GME programs, but it’s one lawmakers are taking seriously. Approved May 2021, Senate Bill 298 provides an increase of $5.5 million to fund residencies in Tennessee’s rural communities by establishing opportunities in family practice, general pediatrics, internal medicine and psychiatry. Residencies will be open to all graduates of University of Tennessee schools, Meharry Medical College and Vanderbilt University. Since 60 to 70 percent of doctors stay in the communities where they train, lawmakers hope to offset Tennessee’s current workforce projection, which shows a shortage of 1,050 physicians by 2025. Through its partnership with the University of Tennessee Health Science Center, Ascension also has made it a priority to address needs in rural areas. “We know that when residents train in urban environments, there is a high likelihood that they’ll stay there. If we infuse training programs in rural areas, we believe that same methodology will translate,” Casteel said. “Residents see the impact they have and the need that exists, and we want to recruit them to stay.”

The Rural Pathways Program offered through East Tennessee State University’s Quillen College of Medicine also focuses on producing graduates who will practice in underserved and rural communities. “The state is looking to try to improve on disparity that exists for rural residents,” said Geoffrey Smallwood, MD, chief academic officer at Ascension Saint Thomas. “If steps already in place are coupled with Medicaid Dr. Geoffrey expansion, that’s a big Smallwood lever and would give all Tennesseans the best chance to have a safe, meaningful level of healthcare.” Terhune said residents tend to be devoted to and return to communities where they’re from, and Vanderbilt relies on that fact to encourage careers in rural areas. “One strategy is looking at those who’ve grown up in rural communities and encouraging them to contribute to those areas again,” Terhune said. “Part of training a diverse group of trainees with diverse interests is recognizing and encouraging those who want to work in rural areas.”

Focus on Diversity

Training residents from increasingly diverse backgrounds is critical for all Nashville GME programs. “We work to recruit a diverse group of residents and fellows every year,” Terhune said. “Our trainees are future physicians, so we’re making sure we have a pipeline to ensure physicians are able to reflect, understand and serve our population for years to come.” Rolfe agreed, noting the definition of “diversity” can vary by program and hospital. “The ACGME has been concerned about demographic diversity in residency and fellowship programs by specialty for some time and recognizes that the definition of ‘minority’ may change by specialty and geography,” Rolfe said, noting that hospitals in El Paso or Miami might be underrepresented by Caucasian residents, and that males are predicted to represent only one-third of OB-GYN residents by the year 2028. “You recruit the best students you can to care for the patient populations you serve and mitigate healthcare disparities. Your patient population is best served by people who understand their circumstances of health.” Casteel said today’s awareness of and need for diversity in both resident selection and training is reflected in Ascension’s ABIDE program, dedicated to equality and inclusion. “This allows residents to have meaningful conversations about creating tangible steps to address patient needs,” she said. “If we can create opportunities in Ascension to integrate GME work around diversity, the larger conversations will be invaluable.” The evolution and challenges of GME programs in 2021 are undoubtedly unique, but today’s residents are stepping up to lead and learn as they transform into the physician leaders of tomorrow. nashvillemedicalnews

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PHYSICIAN SPOTLIGHT

An Innovator in Joint Replacement Hodrick Utilizes Robotics, Safer Pain Options for Better Outcomes By MELANIE KILGORE-HILL

Jeffrey Hodrick, MD, is creating new standards in orthopaedic care. Through innovation in robotics and post-surgical treatment, the joint replacement surgeon is improving outcomes with less risk of opioid addiction during recovery. Intro to Ortho Originally from Pennsylvania, Hodrick received his bachelor’s degree from Duke University, where he served as captain of the Blue Devils football team. It was there he’d meet his greatest professional influence: a team doctor who spotted Hodrick’s potential early on. “I was taking an anatomy lab and he told me, ‘Son, you’re going to be an orthopaedic surgeon.’ I didn’t know what that was but told him I’d love to know more about that,” Hodrick recalled. He went on to attend Pennsylvania

State University College of Medicine and completed residency training in orthopedic surgery at Duke University Medical Center, where he received the Duke University Health System Strength, Hope, and Caring Award in 2006. To further enhance his skills, Hodrick completed a fellowship in Adult Reconstruction at the University of Utah Medical Center in Salt Lake City. Robotic-Assisted Surgery Today, the orthopaedics chair at TriStar Centennial specializes in roboticassisted knee replacements and direct anterior hip replacements, and he educates other surgeons on these procedures nationwide. Hodrick said he’s especially excited about the future of robotics in knee replacement and believes there’s still room to improve outcomes. “I’ve been re-energized by this,

because it’s a different way to think about knee replacement with the ability to balance the knee while considering the bone, soft tissue and patient’s native alignment. It’s a level of precision that we have not had access to before,” he said. Part of the team at Southern Joint Replacement Institute, he’s also optimistic about other industry trends, including a younger demographic eager to improve quality of life early on, thanks in part to innovation in outpatient joint replacement. “It’s still amazing to me that we can do a knee, hip or shoulder and they go home the same day,” he noted, remembering the days when patients would stay remain hospitalized up to five days, often requiring blood transfusions. “It speaks to the whole surgery, not just the technical part. It’s a complete team effort with a lot of advances on the anesthesia side, and patients are mobilized a lot sooner, as well.” Better Options for Pain Control A pioneer in outpatient joint replacements, Hodrick promotes a rapid recovery for all of his patients with adjunctive therapies. “In essence, orthopaedic surgery is

a pain-relieving surgery, but it’s also a big one so patients should expect a reasonable amount of discomfort” he said. “Sometimes the treatment for pain can be worse than the original problem, so for a long time the thought was to try to drive pain down to zero. That was a bad idea, because it drove up unwanted side effects and exposed the patient to potential addiction to opioids.” Today, Hodrick’s mission is to use the least amount of narcotics possible, treating patients with anti-inflammatories or topicals that make it reasonable to function. “Our focus now is on recovery, not pain,” he said. “There’s a big difference because these therapies don’t accumulate side effects.” Fortunately, Hodrick said many patients today agree and are hesitant to take narcotics, complaining about nausea, skin crawling and just feeling “loopy.” In many cases, he’s also opting for regional anesthesia to allow for numbness without loss of muscular control. “It’s very reassuring for a physician to see a patient walking around three to four hours after a replacement,” he said. (CONTINUED ON PAGE 14)

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News of Note in Orthopaedics & Pain Management New providers, clinics and services are bringing more options for pain relief and orthopaedic care to Middle Tennesseans. Mid-Tennessee Bone & Joint Welcomes Pharr Mid-Tennessee Bone and Joint Clinic in Columbia has recently welcomed Zachary Pharr, MD, to the practice. Pharr received his degree in biology from Lipscomb University in 2010 and was part of the university golf team. He received his medical degree from University of Tennessee Health Science Center College of Dr. Zachary Pharr Medicine in Memphis in 2015 where he served as an elected member of the class leadership committee, graduated in the top of his class with Alpha

Omega Alpha honors and was selected by his peers to the Gold Humanism Honor Society for his compassionate care. Pharr then completed his orthopedic residency in at the historic Campbell Clinic where he served as a peer selected chief resident during his final year. He completed his fellowship at the renowned American Sports Medicine Institute in Birmingham, Ala., with Andrews Sports Medicine and Orthopaedic Center, assisting with orthopaedic coverage for the University of Alabama 2020-2021 National Champion football team. Throughout his training in residency and fellowship, Pharr has treated athletes at all levels from youth to professional sports, including the University of Memphis and University of Alabama athletics, Memphis Redbirds and Birmingham Barons baseball and the Memphis Grizzlies. He has authored multiple publications, book chapters, and surgical technique videos,

including multiple presentations throughout the country. Pharr is passionate about sports medicine and is looking forward to working with local athletes. Pharr’s primary focus will be sports medicine, including minimally invasive arthroscopic surgery of the shoulder, elbow, hip, and knee, as well as Tommy John surgery, in addition to general orthopedics. IMAC Holdings Launches Acute Care Services for Musculoskeletal Injuries In July, Brentwood-based IMAC Holdings, Inc. announced the launch of its dedicated acute injury service line for musculoskeletal injuries. The acute injury service is available at IMAC Regeneration Center locations in Florida, Illinois, Kentucky, Missouri and Tennessee, which specialize in providing regenerative, orthopedic, and minimally invasive procedures and non-opioid

Ascension Saint Thomas Rutherford Celebrates Opening of New Perioperative Medicine Clinic In August, Ascension Saint Thomas Rutherford held a blessing ceremony to celebrate the opening of its new Perioperative Medicine Clinic on the first floor of the hospital. The clinic will offer general medical clearances for scheduled surgical orthopedic and spine patients, in addition to post-intervention medical care for those patients. “We are pleased to offer a clinic in Rutherford County dedicated to providing a comprehensive experience for the spine surgery or joint replacement surgery patients,” said Thomas Roddy, chief operating officer, Ascension Saint Thomas Rutherford. “Upon a patient’s completion of their visit, they should feel confident and at ease about their upcom- The clinical team celebrates the opening of the new Perioperative Medicine Clinic at Ascension Saint Thomas Rutherford. ing surgical experience.” Following a blessing and anointment of the clinic with holy water, Ascension Saint Thomas Rutherford President and CEO Gordon Ferguson said, “We believe there is no better way to celebrate the promise and healing that these facilities will bring to our community than with a blessing. When all aspects of care are aligned, it makes it more convenient for patients to get the care they need better and faster.” The ceremony marked the completion of the $640,000 investment to redesign and remodel the new clinic area.

therapies that are ideally suited to treat acute musculoskeletal injuries often caused by a wide range of accidents. “This is about patient access. It is important to assess acute injuries quickly and provide proper medical management for the most complete recovery, return to activities and to reduce the risk of chronicity,” states Ricardo Knight, MD, PT, medical director of IMAC Illinois. “Our teams have extensive experience treating musculoskeletal injuries for patients of all skill levels and abilities.” Patients in need of acute injury medical services may also contact the nearest IMAC facility to schedule an appointment for an onsite or telehealth evaluation. IMAC currently delivers workrelated injury rehabilitation services for the United States Department of Labor. According to a 2016 Center for Disease Control survey, 39.5 million people visited doctor’s offices for personal injuries, including those related to car accidents, slip and falls and work-related injuries. TOA’s New Lebanon Clinic Last month, Tennessee Orthopaedic Alliance (TOA), Tennessee’s largest orthopedic surgery group, held an open house to showcase their new Lebanon clinic and sports performance space. Former Tennessee Titan and four-time NFL Pro Bowl safety Blaine Bishop was on hand to help christen the new center. TOA’s Lebanon facility features an orthopedic clinic, physical therapy, walk-in appointment availability, personal training, and specialized sports performance training for individuals and groups. TOA sports performance provides support for high performance athletes, sports teams and leagues, and weekend or casual athletes and is currently offered at their Franklin and Lebanon locations. Specialized sport-specific strength and conditioning programs focus on targeted training to meet the needs of competitive and recreational athletes of all ages, skill and experience levels.

In addition, TOA’s medical providers and athletic performance staff collaborate to offer a return to performance program that bridges the gap between injury rehabilitation and return to activity. Training programs are specifically designed to provide a safe, progressive return to play. Each program can be customized to focus on a patient’s return to activity following an injury, whether operative or non-operative. 10

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HEALTHCARE ENTERPRISE

An Integrative Approach to Pain Management Dixon Blends Best of Chiropractic & Therapeutic Modalities By MELANIE KILGORE-HILL

whole. “Medicine can be very segmented in its approach, as opposed to understanding, for example, the relationship between the digestive track and inflammation, or the alignment of feet and how that affects knees and hips (the kinetic chain),” Dixon said. “We’re starting to see some of that trickle down into medical education. We know vascular problems aren’t just a buildup of plaque from diet but from inflammation, and we’ve seen patients in chronic pain from rheumatoid arthritis or fibromyalgia come off processed foods and immediately feel better.”

An evolution in traditional healthcare – ushered in by a nationwide opioid crisis – means patients and providers alike are turning to alternative methods for pain relief. Andy Dixon, DC, owner and chiropractor at Dixon Center for Integrative Health Care, said he’s seen a dramatic shift in ideals since the clinic’s founding in 1986. “We’ve seen so much disaster come from the opioid epidemic,” Dixon said. “People are realizing there’s got to be a better way than narcotics.”

Blending the Old & New

Today, Dixon’s West Nashville clinic utilizes three chiropractors, massage, physical therapy, dry needling and regenerative medicine, and in 2010 added a nurse practitioner for additional support. He said patients appreciate the integrative approach blending two previously isolated trains of thoughts. “It keeps the patient from being stuck in the middle, with a chiropractor who says, ‘Don’t take that medicine,’ and a doctor who says, ‘Don’t go to a chiropractor,’” he said. “We bring everything together so we’re working collaboratively behind the scenes to develop a unified treatment plan suited for each patient.” The cultural acceptance of more holistic methods is Dr. Andy Dixon evidenced by changes in treatment guidelines published by professional medical organizations. “When you look at treatment of back pain, spinal manipulation is now near the top of nonsurgical recommendations,” Dixon said. “Chiropractors perform 95 percent of all spinal manipulations in the country, making us the primary providers. Those who are aware of newer treatment guidelines know we’re a good choice.” Dixon said integration has evolved tremendously over the past few decades, with chiropractors now on staff at veterans’ hospitals and countless medical centers. “Patient satisfaction speaks for itself, and demand is high for these services,” Dixon said, pointing to chiropractors’ noticeable presence among collegiate and professional sports teams. “We’re now working with more traditional providers, athletic trainers and surgeons in both inand outpatient settings, which used to be rare.” NASHVILLEMEDICALNEWS

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Regenerative Medicine

It takes a village to deliver integrative care.

Surprising to many patients, chiropractic care often is covered as a separate benefit by private insurance plans, Medicare and workers’ comp and is often very cost effective when compared to more invasive procedures such as epidural steroid injections and surgery.

Addressing Misconceptions

While patients are increasingly aware of the advantages of chiropractic care, Dixon still gets questions about antiquated rumors regarding risks of adjustments. “Most of that stems from providers who aren’t aware of updated guidelines, and they’re speaking from prejudices they heard in school 40 years ago,” he said. “We’re always happy to educate patients, as well as providers, to address misconceptions about safety.” In fact, Dixon said malpractice premiums reflect the true efficacy and safety of treatment. “Chiropractors as a group pay very low amounts for malpractice policies due to safety of care,” he pointed out. And while chiropractic can’t resolve every symptom, Dixon frequently works with surgeons and physical therapists to minimize the need for surgery. “Sometimes we can eliminate the need for surgery or just buy that patient more time,” he said. “A lot of surgeons also like patients to have pre-surgical physical therapy because it improves results in everything from back to knee and shoulder pain. It’s no longer just about post-surgical rehab but improving results on the front end.”

Dixon Center is also offering umbilical cord and placenta stem cell injections to treat musculoskeletal pain of the knee, hip and shoulder. “We’re seeing a lot of degenerative joint disease (treated) through regenerative medicine,” said Dixon, who has experienced firsthand the benefit of stem cell

therapy. “This whole field is very exciting, and we’re going to see further development of regenerative medicine to the point that we’ll be able to drastically impact the number of joint replacements performed going forward.” The clinic also treats weight loss patients by providing accountability and education surrounding lifestyle choices. “We’re creating habits that make patients more successful and give them sustainable, long-term results,” Dixon explained. “We’re not looking for quick fixes.”

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Healthy Partnerships

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Practice Management • Reimbursement • Operations Coding • Compliance • Audit • Tax • Accounting AUGUST/SEPTEMBER 2021

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Supporting Value in Healthcare for All Legislation to Support Value-Based Care, Fix Rural Glitch By CINDY SANDERS

In July, major healthcare organizations signed a letter of support for the recent reintroduction of a bipartisan bill to support accountable care organizations (ACOs) and other alternative payment models (APMs), while also addressing an unintended consequence of the ACO formulary, known as the ‘rural glitch,’ that punishes rural hospitals even when they achieve savings. The Value in Health Care Act 2021 was reintroduced in the U.S. House of Representatives on July 20 by Reps. Peter Welch (D-Vermont), Suzan DelBene (D-Washington), Darin LaHood (R-Illinois) and Brad Wenstrup (R-Ohio). That same day, 14 healthcare stakeholders praised the bill, which looks to increase shared sav- Rep. Darin LaHood ings rates, update risk adjustment rules, eliminate an artificial barrier to participation, fix the rural glitch and restart the ACO Investment Model. The bill also extends the 5 percent Advanced APM incentive payments for an additional six years and authorizes a study looking at overlap between Medicare alternative payment programs. Additionally, The Value Act mandates the Government Accountability Office (GAO) produce a report on health outcomes and racial disparities comparing Medicare patients cared for by ACO participants with those cared for by traditional Medicare programs.

The bill comes as participation rates ing care coordination have declined over the past few years. and quality. “Our There were 477 ACOs participating in healthcare system the Medicare Shared Savings Program at should be as healthy as the beginning of 2021, compared to a high we want our patients to of 561 in 2018. Since launching in 2012, be,” she stated. “The ACOs had seen steady growth up until late need for this level of 2018 when the Trump-era “Pathways to care was made clear by Success” policies took effect. the pandemic. Across Rep. Suzan DelBene “Since 2012, Medicare ACOs have our health system, we saved $8.5 billion in gross savings and $2.5 should be incentivizing care coordination billion in net savings,” Allison Brennan, and quality. ACOs show the ability to do vice president with the National Association that.” of ACOs (NAACOS), said during a virtual briefing on The Value Act. “Unfortunately, Fixing the Rural Glitch we have seen a decline in terms of the numThe Value Act and a separate bill ber of ACOs, providers and beneficiaries introduced in the U.S. Senate last fall – The covered.” She added policies enacted in late Rural ACO Improvement Act (S.2648) and 2018 and early 2019 that sped up the risk companion bill in the House (H.R.5212) – profile and cut the share of savings available focus on making financial targets more to ACOs seem to have impacted participaequitable in rural areas. tion. “On balance, I think it has had the Introduced by Sens. Catherine Coreffect of chilling new ACO growth.” tez Masto (D-Nevada) and Pat Roberts Brennan said the reintroduced bipar(R-Kansas), the bill changes the benchmark tisan bill once again incentivizes ACO calculation so rural ACOs aren’t punished growth as participants would “get to keep for geographic location in areas that are more of the savings they help generate.” more sparsely populated. It also gives ACOs three years In 2017, the Centers for before they must take Medicare and Medicaid Mark your Calendar on risk and provides Services began aggresome upfront fundgating spending ing for those who from other providFall 2021 Conference need help in seters in the ACO Sept. 29-Oct. 1 ting up their region to calculate Marriott Marquis • Washington, DC ACO. an ACO’s benchIn person & virtual registration available. Sponsor Rep. mark. The adjustGo online to NAACOS.com/Fall-2021DelBene cited the ment was created Conference for more information importance of finding to reward ACOs with or to register. cost savings while improvcosts below the regional

Medicare ACOs Increased Savings for Seventh Straight Year Medicare’s largest alternative payment model produced its highest annual savings to date in 2020, while continuing to provide high-quality care, as shown by performance data released today by the Centers for Medicare & Medicaid Services (CMS). The Medicare Shared Savings Program, the accountable care organization (ACO) model that served 10.6 million seniors in 2020, collectively saved Medicare $4.1 billion last year, and $1.9 billion after accounting for shared savings payments. Importantly, these ACOs also hit an average quality score of 97.8 percent and 60 ACOs earned a perfect score of 100. This is an improvement over the $2.6 billion and $1.2 billion in gross and net savings MSSP created in 2019, making 2020 the best year yet for ACOs. “Today’s data underscores the need for policymakers to do all they can to grow the ACO model and extend the program’s benefits to more patients,” said Clif Gaus, Sc.D., president and CEO of the National Association of ACOs (NAACOS). “We 12

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currently have the fewest number of Shared Savings Program ACOs since 2017. That trend must be reversed, given continued debate about ways to improve our health system.” NAACOS attributes the drop in ACOs to several Trump-era policies, including 2018 changes CMS called “Pathways to Success,” which gave ACOs limited time before taking on financial risk and cut the share of savings most ACOs are eligible to keep. NAACOS supports the Value in Health Care Act (H.R. 4587), which would increase shared savings rates, create favorable risk adjustment and benchmarking policies, and provide at least three years before being forced to take on risk. NAACOS and other leading healthcare organizations are pushing Congress to include the Value Act in the upcoming reconciliation bill. Other key points from today’s ACO results: • $390 in gross savings per beneficiary • 345 out of 513, or 67 percent, of ACOs earned shared savings

• ACOs earned $2.3 billion in shared savings payments • 75 percent of shared savings-only ACOs produced gross savings and 55 percent earned shared savings • 97 percent of at-risk ACOS produced gross savings and 88 percent earned shared savings During the pandemic-stricken year of 2020, ACOs were valuable assets in managing patient care. Given their accountability to long-term patient care and outcomes, ACOs were proactive in their outreach to high-risk patients to keep them healthy, quickly established telehealth and remote monitoring capabilities to continue to provide care, and effectively managed home visits and post-acute care to reduce COVID transmission. In addition to the positive 2020 results, multiple analyses have shown ACOs are lowering Medicare spending by 1 percent to 2 percent, which translates into tens of billions of dollars of reduced Medicare spending when compounded annually.

Stakeholders Supporting the Value Act A broad coalition of healthcare stakeholders have voiced approval for the reintroduced act. Those signing onto the letter of support were: • America’s Health Insurance Plans • American Academy of Family Physicians • American College of Physicians • American Hospital Association • American Medical Association • America’s Essential Hospitals • American Medical Group Association • America’s Physician Groups • Association of American Medical Colleges • Federation of American Hospitals • Health Care Transformation Task Force • Medical Group Management Association • National Association of ACOs • Premier A section-by-section summary of the Value in Health Care Act 2021 is available through NAACOS. Go to our website at NashvilleMedicalNews. com for a direct link to the summary.

mark and includes an ACO’s own beneficiaries in the calculation. In rural areas, however, ACOs often either had no peers for comparison or were penalized by making up the bulk of the market, thus being compared to themselves. With a lower spending benchmark, rural ACOs often receive smaller savings bonuses compared to their urban counterparts where there are more providers and patients in the pool. To address the unfair adjustment, both bills look to remove an ACO’s assigned patients from the regional comparison to get a truer picture of whether the ACO is creating cost savings compared to other providers in the area. While all ACOs will benefit from the change, the issue is known as the rural glitch because rural ACO participants have been negatively impacted the most by the current spending target methodology. “When ACOs lower their spending, Medicare spending for the entire region also falls,” noted NAACOS President Clif Gaus, ScD. He added the bills correct an unintended flaw that penalizes those who make up the bulk of their market. “Our health system needs to find ways to incentivize the adoption of alternative payment models like ACOs.” Value Act sponsor Rep. LaHood, who represents a mostly rural area, said supporting value-based efforts in healthcare is critical to ensuring access and coordination. “As we continue the transition to value-based care, there are always challenges to address and ways to improve. The Value in Health Care Act is a common-sense proposal to do that.” nashvillemedicalnews

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Council, NCN Host Developing Health Care Ventures Panel Experts Weigh in on Investor, Entrepreneur Collaborations

nashvillemedicalnews

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G.B. Pratt

erated throughout the pandemic. Leedle, an investor in ModifyHealth, expanded on the investor perspective and becoming comfortable with a virtual investment process. He recommended examining opportunities through three specific filters: • Mission Fit: understanding the management team, core values, and the alignment of those values to the company’s work and business • Strategy Fit: analyzing the business model and goals • Performance Fit: reviewing the team’s experience and how they have performed previously Walton guided the conversation to risk profile analysis during the investment process. Lamont and Smith shared their experiences working together on Aspire Health, a network of palliative care practices, and Main Street Health, an organization creating valuebased health care solutions for rural America. “In all of these companies, you have to figure out the delivery model and the financing model. What’s been interesting with both Aspire and Main Street is that the market had one but not the other,” Smith said. “By going into spaces where one of the two is figured out, you decrease your risk a lot.” Lamont noted, “We’ve been an advocate and investor in primary care for a long time. Taking risk with primary care is something we’re serious and passionate about and is a way to solve the

© 2021, DONN JONES

The panel included Annie Lamont, co-founder and managing partner, Oak HC/FT; Ben Leedle, president and CEO, Blue Zones (a subsidiary of Adventist Health); G.B. Pratt, founder and CEO, ModifyHealth; and Brad Smith, CEO, Main Street Health. The discussion was moderated by Leigh Walton, senior partner, Bass, Berry & Sims. Panelists discussed how the pandemic has shifted their business plans and investment strategies over the last 18 months, offered guidance on evaluating an investment opportunity and its risk, and forecasted which healthcare industry sectors will be the most appealing for future ventures. Nashville Capital Network Executive Director Sid Chambless introduced the panel with a brief update on venture capital activity in the Nashville market. As expected, 2020 saw a decrease in transactions and amount invested with 40 local transactions and $300 million

Annie Lamont

© 2021, DONN JONES

Ben Leedle

downstream healthcare problems of cost and access. We see 10 companies for every idea now, and so many knockoffs. [What we’re doing with Main Street Health] is unique and hard, but the right model for this particular sector.” To close the discussion, an audience question surveyed the panel on healthcare industry sectors of interest for upcoming venture capital activity. Lamont said mental health has been neglected and resulted in many startups over the last year and a half, but there is a “huge runway there” for continued progress. “Anywhere you look, there is an opportunity to fix something in healthcare,” she added. “The big beast for healthcare is our environment, where we live,” Leedle said. “At Adventist, we’ve concluded that all the love we pour into patient care is significantly diluted if we don’t make the same investment in the communities we serve. I think there will be growing awareness and subsequent action over the next five years that if we want the very best outcomes, we absolutely have to have great clinical care, hospitals, doctors, extended services and technology, but we also have to shape the environments where we spend our time. This means we have to transform our communities in a manner that makes healthy choices, that improve well-being, easy and accessible for all.” © 2021, DONN JONES

invested. Investment activity in 2021 has “rebounded spectacularly,” Chambless said, led by high-profile investments such as Main Street Health, Monogram Health and others. So far this year there have been 30 transactions worth approximately $350 million, and Chambless predicted there would be continued strong investment activity. In response to Walton’s opening question about the impact of COVID-19 on venture capital activity and entrepreneurial projects, Pratt described how ModifyHealth, an organization aimed at helping patients treat chronic conditions with nutrition therapy, fundraised via Zoom and acquired the perfect partner. “I would guess we were one of the first companies to raise capital in a fully virtual way. Any investment requires close relationships and trust, and you can build it over Zoom if you’re diligent, have frequent meetings and leverage your network,” Pratt said. “The bigger thing we learned is the conditions can change all around you, but if you have a service that fills a need, you’ll grow through it.” He explained that as physicians paused elective office visits and no longer referred to ModifyHealth, the organization lost more than half of its business. To overcome that obstacle, ModifyHealth shifted to marketing directly to patients, and its growth accel© 2021, DONN JONES

In August, the Nashville Health Care Council and Nashville Capital Network hosted “Developing Health Care Ventures: Investor and Entrepreneur Collaborations” at the Westin Nashville. The program offered insights from entrepreneurs and investors who are working together to solve care delivery issues. This event marked the Council’s first in-person panel discussion since the COVID-19 pandemic began.

Brad Smith

The Nashville Health Care Council will continue to offer relevant inperson and virtual events during the COVID-19 pandemic. Hayley Hovious, Council president, said, “We’re all learning how to live with COVID-19 and the Council is committed to doing everything we can to ensure our events are in person as much as possible and our guests feel safe and comfortable while they’re here.” AUGUST/SEPTEMBER 2021

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Study Shows COVID ‘Cocktail’ Discovered at VUMC Protects Chronically Ill A monoclonal antibody cocktail against the COVID19 virus discovered at Vanderbilt University Medical Center and developed by AstraZeneca reduced the risk of symptoms in a study of immunocompromised and chronically ill adults later exposed to the virus by 77 percent, the company announced in late August. Based on the positive results from the PROVENT Phase III trial, AstraZeneca will seek regulatory approval for AZD7442, a combination of two long-acting antibodies, as a one-dose, pre-exposure prophylaxis that for chronically ill people might be more effective than a vaccine. AZD7442 is the first antibody combination (non-vaccine) modified to potentially provide long-lasting protection that has demonstrated prevention of COVID19 in a clinical trial, company officials said. The trial included more than 5,000

Dr. James Crowe Jr.

participants, and more than 75 percent had conditions that can cause a reduced immune response to vaccination. Delivered by intramuscular injection, the antibody treatment was well tolerated with only minor side effects and could afford up to 12 months of protection from COVID-19, according to officials. Prelim-

Q&A with Lydie Marc, continued from page 7 who are introducing new models and innovations to the market. For leaders across the nation, being a Council Fellow is an unmatched designation.

NMN: Share a bit about the alumni programming and why that is important. Marc: One of the biggest benefits to Council Fellows is immediate entry to an exclusive and diverse network of healthcare leaders shaping the industry. For in-demand leaders, every minute matters. The Council Fellows program offers a fast track to form powerful bonds with the nation’s brightest healthcare leaders, and our Alumni Association ensures those bonds are kept. From continued strong connections to new business opportunities and innovative partnerships, the Council Fellows Alumni Association ensures members continue the momentum of collaboration and innovation long after graduation.

Services Policy and Management from the University of South Carolina, bachelor’s in Community Health from Georgia Southern University, and certificate in Project Management from Georgia State University. Prior to joining the Council, I served as a performance improvement coach at the American Hospital Association. There, I developed and provided strategic support for quality improvement and patient safety initiatives to hospitals and health systems across the nation. It helped me understand the various key markets that impact healthcare most, like Nashville and Chicago, and helped polish my skills as a leader. As the director of Council Fellows, I hope to bring my energy and positive attitude that served me well in previous roles. These traits, along with my experience, allow me to foster relationships and identify opportunities to support the advancements in health care and the Council Fellows initiative.

NMN: You are new to the Health Care Council but certainly not new to the healthcare industry. Please tell our readers a bit about yourself, your background and what you hope to bring to the table in this new role. Marc: After having worked in healthcare for over a decade, I’ve fostered passions for public health and furthering diversity in the industry. I’m originally from Boston and have worked all over the country, learning more about the landscape in different geographies. I received my Master of Public Health in Health

NMN: All work/no play is no fun! What do you like to do outside of transforming healthcare, and how are you enjoying the move to Nashville? Marc: Outside of healthcare, you can find me painting. I have always enjoyed painting and find it as a creative way to express myself. This passion was ignited by my 6th grade art teacher who encouraged me to enter a schoolwide art contest, which I won and had my art displayed in Boston City Hall. I am truly enjoying my move to

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inary laboratory findings also suggest that AZD7442 can neutralize recent emergent variants of the virus, including the delta variant. “It’s deeply gratifying to see the antibodies we isolated under challenging circumstances, in the middle of the international lockdown last spring, protecting the most vulnerable amongst us,” said James Crowe Jr., MD, director of the Vanderbilt Vaccine Center who led the VUMC research effort. “This single-shot prevention is likely to be a game changer for atrisk patients.” “The near-term availability of AZD7442 comes at an opportune time,” added Robert Carnahan, PhD, associate director of the Vanderbilt Vaccine Center. “It is clear that we need additional solutions beyond vaccines to protect those most vulnerable members of our society, such as the immunocompromised.” He added, “These studies specifically targeted

patients with comorbidities where interventions beyond a vaccine are warranted.” The original antibodies that were the basis for the engineered long-acting antibodies that make up the AZD7442 twoantibody cocktail were isolated last year at VUMC. Crowe and his colleagues have developed ultra-fast methods for discovering highly potent antiviral human monoclonal antibodies and validating their ability to protect small animals and nonhuman primates. Six of the antibodies were licensed to AstraZeneca in June for advancement into clinical development. In October the company announced it was advancing into Phase III clinical trials an investigational therapy consisting of two long-acting antibodies discovered at VUMC and optimized by AstraZeneca.  The VUMC research was supported by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, the Defense Advanced Research Projects Agency of the U.S. Department of Defense, the Dolly Parton COVID-19 Research Fund at Vanderbilt, and Merck KGaA, Darmstadt, Germany.

Nashville. I especially love how friendly everyone is and the rich history in this great city. I love being able to call Nashville home!

first attracted them to healthcare. They gain relationships with an unmatched network of peers, a deep understanding of the challenges facing the U.S. healthcare system and proven strategies to drive meaningful change. With the state of our healthcare industry, the time to invest in your career is now. I encourage healthcare executives from across the country and from all healthcare industry sectors to apply. Again, the application is at HealthCareCouncilFellows.com/Apply.

NMN: Any final thoughts to share? Marc: In my years of healthcare experience, I have always been in awe of the caliber of the Council Fellows program. With the program, classmates are fueled with the energy and inspiration that

An Innovator, continued from page 9 Crush the Crisis Hodrick took his commitment to lessen narcotics one step further by developing Crush the Crisis, a prescription takeback effort launched at TriStar Centennial in 2017. Today the annual event has been rolled out enterprise-wide throughout HCA Healthcare. “Everyone’s well aware of the dangers of narcotics, and the majority of addicts started with a prescription pain med – sometimes their own, but most have been taken or diverted from a loved one,” he said. “We ask folks to go into their medicine cabinets and get rid of meds they’re keeping ‘just in case’ so that a loved one’s not at risk.” In 2020, residents in 95 HCA Healthcare communities across the nation safely disposed of 13,523 pounds of medication, more than doubling the medications collected in 2019. The event is held in alignment with the Drug Enforcement

Administration’s National Prescription Drug Take Back Day, aimed at educating communities on the dangers of opioid misuse and the importance of safe and proper disposal of expired and unused prescription medications. Hodrick is pleased with the outcome and awareness created by Crush the Crisis, now in its fourth year. “It’s caught on and is a way to make a difference,” said the father of two. “As an orthopaedic surgeon, I do prescribe narcotics so it’s important to be aware of these things. As soon as we even start talking about narcotics, we talk about tapering off and options to get it out of the home. We focus on patient outcomes and how to help them get back to life faster while ensuring they have the most excellent long-term outcomes. The final report card doesn’t come out for 25 years after surgery, so we’re mindful that the things we’re doing now will affect them for a long time.” nashvillemedicalnews

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Three Key Considerations for Change Management in Healthcare A lot has changed. You don’t need to know what I’m referencing to agree that is true. Everyone in the healthcare industry knows that, on some level, more change is coming. The changes that healthcare organizations have been through the past year and a half By LANE NEWSOM have taken a toll on InfoWorks every stakeholder involved, making it critical for leaders to manage future changes carefully. Change management is a strategy that ensures any updates rolled out within an organization are successful. Whether that change is introducing a new electronic medical record, adjusting an HR policy or moving to a different building, it is vital to be proactive. A typical approach to change management involves a combination of communications planning, sponsor coaching, stakeholder training and resistance mitigation. According to leading change management body Prosci, projects with excellent change management were six times more likely to meet objectives than those with poor change management. It bears repeating that a lot has shifted. Healthcare organizations need to take existing conditions into account when considering their next change management initiative. You can no longer entirely rely on your old playbook. Leaders should keep these considerations in mind when proceeding:

Organizational readiness looks different now.

Organizations are at a crossroads of significant challenges and opportunities. They must now reevaluate the “ways they’ve always done things” and adjust accordingly. A thorough and realistic organizational readiness assessment is the foundation that enables organizations to reach a desirable outcome with whatever change they introduce. Organizational readiness assessments need to be updated for the times. In addition to the standard review an organization would conduct in the past before beginning a new project, organizations today need to assess questions, such as: • Will sponsors of this project and the teams needed to implement this initiative have the time and energy to dedicate to this over the specified time period? • Do we have the resources in place now, since we know we’re already facing staffing shortages and hiring difficulties that will make it harder to scale up as we go? • Can the necessary training be conducted safely in person, or will capacity limitations require it to be remote? • If we’re updating infrastructure or a system, can we allow technicians into these areas right now due to visitation restrictions? • Do we have communications channels in place to reach any newly remote teams?

Your people are experiencing change fatigue.

Change fatigue occurs when people experience frequent or significant changes, resulting in apathy or resignation to change.

Even your most resilient employees who thrive in periods of rapid transformation are likely feeling burnt out after the last year and a half. Change fatigue is hard to quantify because it varies from person to person, but it has real consequences. For individuals, it can result in increased stress and fear. For organizations, that can mean reduced productivity, higher turnover and greater resistance to change, all of which threaten the success of the advancement you are trying to instill. A thoughtful change management plan can overcome fatigue and mitigate risk. Organizations have strategies available to them, such as: • Explaining not just the “why” of a change but the “why now.” • Listening to employee feedback to deliver the support employees will need. • Being strategic when choosing a time frame and period for the new project (even if it means choosing to wait to start or extending deadlines). • Centering the benefits of the change in messaging and discussions. Make sure every stakeholder understands “what’s in it for me.” • Overcome change fatigue and improve morale by using the change to serve as a catalyst for excitement and a sense of togetherness.

account for this new challenge. Trust is a component of any change management effort, and the starting line has moved back. Leaders now have further to run to get a project across the finish line successfully. While a decline of trust poses a threat to a project – and an organization’s success in general – a well-executed change can overcome and provide an opportunity to reconnect with stakeholders in a meaningful way. To build back trust: • Start with empathy and meet resistance with compassion. • Listen to employees and act on their feedback – address hesitancy or anxieties about the change. • Provide clear, concise information. Transparency can be powerful. • Choose your speaker/sender wisely – have employees learn about the change from an appropriate spokesperson. For instance, have a clinical change communicated by a respected physician or a CMO rather than a CEO or executive without clinical experience, or have a direct supervisor explain a shift in a day-to-day process. Your people have had to make hard decisions this year. You’ll know your change management efforts were successful if your employees have little trouble supporting your change. Dedicating time upfront to change management will make the process much easier in the long term.

Stress and distrust have moved the starting line back.

Lane Newsom, principal consultant of Healthcare & Change Management in the Nashville office of InfoWorks, has nearly 20 years of experience leading organizations of all sizes, from startups to Fortune 10 companies, through businesscritical transformations. Her specialties include change management, cross-functional process redesign, organizational design and aligning business and operational units with technology. Learn more at www.infoworks-tn.com.

Trust in the U.S. healthcare system dipped over the past year. Unfortunately, this distrust that resulted from the pandemic has affected healthcare workers, as well. Change management strategies must

Galen College of Nursing Opens Nashville Campus In late August, campus is designed to Galen College of cultivate learning with Nursing, one of the advanced classroom largest educators of and simulation technurses in the United nology mixed with colStates, announced its laborative and creative continued expansion space. The Nashville with the announcecampus will offer three ment of a new camprograms – a threepus in Nashville. year Bachelor of SciThe nursing school, ence in Nursing (BSN), which was purchased Associate Degree in by HCA Healthcare Nursing (ADN) and in 2020, also has Licensed Practical campus locations in Nursing to Associate The new Nashville campus of the Galen School of Nursing is enrolling students now for the inaugural January 2022 winter term. Miami and Austin, Degree in Nursing Texas. Bridge (LPN to ADN The 47,700-square-foot campus feaBridge). The first term for all three proage hands-on learning. recruit more prospective nursing students tures resources designed to elevate the grams is scheduled to start Jan. 3, 2022, “We are thrilled to bring our 30 years who will go on to expand and enhance our student experience and prepare future and enrollment is now open. In addition of experience exclusively educating nurses community workforce. With this academic nurses to enter the field. Galen pledges to to the Nashville campus degree proto the community and look forward to propractice partnership, we can also work bring one of the highest levels of nursing grams, Galen offers online RN to BSN viding new opportunities to those called to together to bridge the education to practice education to the greater Nashville commuand MSN programs for nurses aspiring nursing in the Nashville area,” said Galen gap, all designed to provide the best patient nity with a state-of-the-art facility featurto advance their education in support of CEO Mark Vogt. TriStar Health Chief care possible.” ing patient simulation labs and classroom career growth and development. Nursing Executive Bryan Sisk added, “We Located at 1100 Dr. Martin Luther learning environments designed to encourare excited to work with Galen to help King Jr. Blvd, Fourth Floor, the Nashville nashvillemedicalnews

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GRAND ROUNDS ing to researchers, the Farapulse Ablation process thus far has proven effective in permanently silencing abnormal heart signals. The current study looks to provide definitive evidence for a change in how electrophysiologists treat patients with atrial fibrillation.

Ascension Saint Thomas Participates in Farapulse Ablation Trial to Treat AFib Ascension Saint Thomas Hospital Midtown is one of the first hospitals in Tennessee to participate in the Farapulse Advent Pivotal Trial, which looks at a safer, quicker way to treat atrial fibrillation. Robert “Drew” Pickett, MD, and Dan Kaiser, MD, of Ascension Saint Thomas Heart are participating in the trial locally. “The data shows that ablation is significantly more effective in correcting atrial fibrillation than medication,” Pickett stated. “We know that if someone is diagnosed with atrial fibrillation, and you treat them early on, there is a better success rate. Medication is not a long-term fix. You have to take them every day … and the more you take them, the more side effects and long-term risks you develop.” The trial will involve at least 350 patients at more than 30 American medical centers targeting patients from the ages of 18 to 75 who are diagnosed with atrial fibrillation. Patients will be chosen in a 1:1 fashion to either participate in the Farapulse Ablation trial; standard ablation, using the heat method; or cryoballoon ablation, using the freeze method. The ultimate goal is for patients to reach recovery from atrial fibrillation for 12 months after a single ablation procedure.  Unlike traditional ablation where the tip of a catheter generates extreme temperatures, the Farapulse Ablation relies on non-thermal electric fields that are tissue-selective to destroy stray cells by making holes in them with electrical shocks. It can selectively destroy heart tissue without affecting other critical surrounding areas, such as the esophagus or major nerves, which is a downside of traditional ablation procedures. Accord-

Icahn, Meharry Partner to Address Racism in Basic Sciences & Medicine In August, the Icahn School of Medicine at Mount Sinai and Meharry Medical College in Nashville announced the organizations have entered into an agreement that will address racism and bias in the basic sciences and introduce greater diversity and inclusion. The affiliation between the institutions will instill a mutually beneficial exchange of knowledge and training that could include a joint graduate or educational medical education program; research activities by students and faculties; and administrative guidelines allowing students to study at each institution. One important goal of the affiliation is to address the critical shortage of Black physicians and scientists across the country. “Mount Sinai is a renowned clinical enterprise noted for its innovation and expertise, making it the perfect complement to Meharry’s research and healthcare efforts. We are honored to collaborate with the Icahn School of Medicine at Mount Sinai and are eager to begin developing dynamic research and educational programs that will directly benefit minority communities affected by countless health disparities,” said James E.K. Hildreth, PhD., MD, president and CEO of Meharry Medical College. The partnership is part of a broader initiative by Icahn Mount Sinai Dr. James E.K. Hildreth to collaborate with historically Black medical schools, colleges, and universities in a comprehensive, institutional approach. “We are thrilled to be working with Meharry Medical College, one of our

country’s premier historically Black medical colleges. With a strong foundation in health disparities research in critically important areas for the Black population, including sickle cell disease, diabetes, and cancer, Meharry Medical College will be an excellent partner with whom we can share clinical knowledge and enrich each institution’s educational, training, and research enterprise,” said Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean of Icahn Mount Sinai, and president for Academic Affairs at the Mount Sinai Health System.

Nashville EC Introduces Project Healthcare Class The Nashville Entrepreneur Center recently announced the 2021-2022 cohort for Project Healthcare, Nashville’s leading  healthcare entrepreneurship initiative that drives transformation in the industry through tailored programming and critical connections. Hailing from all across the country, this year’s participating entrepreneurs will have access to a comprehensive curriculum that includes meetings with more than 70 industry expert mentors, connections to potential investors, and the opportunity to engage with other healthcare business leaders.  Despite challenges from the pandemic, this year’s cohort has over three times the revenue and almost twice the amount of capital raised from the previous cohort.  The Nashville Entrepreneur Center has also recently launched its new Telehealth Academy, an eight-week program designed for industry professionals and early-stage innovators who are interested in garnering insights from top faculty addressing telehealth, virtual care and digital strategies.  “Without a doubt, entrepreneurs will help shape the future of healthcare,” said Eric Thraikill, chairman of Nashville Entrepreneur Center’s Project Healthcare. “​​We are fortunate to have the sharpest minds in healthcare here in Nashville, and it is paramount we embrace the new thinking and innovative ideas represented by this cohort to continue to move the industry forward.”

NHC Celebrates 50 Years National HealthCare Corporation (NHC) recently celebrated half a century of service. Since 1971, NHC has developed a comprehensive continuum of care to meet the healthcare needs of seniors in communities across 10 states. Founded by physician Carl Adams, the company began with 14 skilled nursing centers. Adams dreamed of creating a campus concept offering inhouse services for seniors as they age with different needs, much like the continuing care retirement communities today. Now with 75 skilled nursing centers, 24 assisted living communities, a behavioral health hospital, five retirement communities, and 35 home care agencies across 10 states, NHC provides services and care to thousands of seniors each day. “Our key to success over the past 50 years is bringing talents from all different disciplines together to deliver the best quality care for our patients, residents, and their families,” said Steve Flatt, chief executive officer of NHC. “As a leader in senior care, NHC has developed the most comprehensive continuum of care. We provide skilled nursing, rehabilitation, long-term care, home care, assisted living, memory care, hospice, and inpatient geriatric psychiatric services. We are grateful for the opportunity to provide care in a better way for the past 50 years.”

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This year’s 14 cohort members, which include three returning teams, represent the breadth and depth of the entire healthcare industry. For more details on the latest cohort and their innovative companies, go online to www.ec.co.

Tennessee Disability Pathfinder Launches New Website An overhaul of Tennessee Disability Pathfinder’s website makes it easier for people with disabilities to find needed services. The statewide portal can now be found more easily at TNPathfinder. org. Updated interactive features match users anywhere in Tennessee with disability resources, service providers and community events. Tennessee Disability Pathfinder (Pathfinder) is a project of the Vanderbilt Kennedy University Center for Excellence in Developmental Disabilities, part of the Vanderbilt University Medical Center. It has been primarily funded by the Tennessee Council on Developmental Disabilities, which also led funding for the upgrade.    More than 3,500 disability resources across Tennessee are accessible on the new website. Searching for information has been made more customized. Users can search based on: Stage of Life: choose from Prenatal/ Infancy, Early Childhood, School Age, Transition/Young Adult, Adulthood, or Aging; Topic of Interest: featuring 20 service categories to select, with a text box to type keywords; Diagnosis: type of disability or health condition; Benefit/Payment Options:  forms of payment accepted by the agency provider, such as health insurance, government program, private pay, or no cost; and Service Area:  select counties where services are provided. For more information about Tennessee Disability Pathfinder or to check out the new website, visit TNPathfinder.org.

The Generosity of Friends & Neighbors Between a global pandemic and extreme weather events, it’s been a tough couple of years for Middle Tennessee … but the generous nature of area residents and companies never seems to flag. Following record rainfall in late August that left 20 people dead, HCA Healthcare and the HCA Healthcare Foundation announced a combined $250,000 in contributions to support relief efforts by charitable organizations in Dickson, Hickman and Humphreys counties that were affected by the disastrous floods in Middle Tennessee. Ascend Federal Credit Union has donated $20,000 to support flood relief efforts in Middle Tennessee, and the credit union has also set up a website for others in the community to contribute, ascend.org/flood-relief. Now through Sept. 15, all donations will support the Tennessee Region of the American Red Cross. nashvillemedicalnews

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NPFI Launches Event Assistance Applications to Help Nonprofits Raise Funds

The Nonprofit Fundraising Initiative (NPFI), a 501c3 based in Nashville, has launched its application process for 2022 event assistance to help Nashville area charitable organizations meet their fundraising goals. While often difficult to produce, fundraising events often provide the biggest opportunities for nonprofits to meet their annual donation and funding goals. NPFI is taking applications for assistance in executing these events, particularly in the midst of an ongoing pandemic. If selected, NPFI will take

on a large amount of labor that goes into the creation, planning, marketing, ticketing, auction solicitation, production, and fulfillment of a fundraising event, while working to increase the amount of money raised – do so allows local nonprofits to better focus on their mission. Nashville area nonprofits with a 501c3 designation may apply at NonprofitFundraisingInitiative.org through Oct. 15.

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

Consuelo Wilkins, MD, MSCI, a leader in health equity, diversity and inclusion at Vanderbilt University Medical Center (VUMC), is the 2021 recipient of the Marion Spencer Fay Award from Drexel University College of Medicine in Philadelphia. The national award recDr. Consuelo Wilkins ognizes women physicians and/or scientists who have made “an exceptionally significant contribution to healthcare.” Wilkins is being honored for her accomplishments  in advancing health equity, for engaging underrepresented populations in research, and for her contributions to community-engaged research and health equity “that will positively impact health outcomes for generations,” award officials said. For the second year in a row, Belmont University’s School of Nursing received the Nurse Faculty Loan Program (NFLP) grant from the Health Resources and Services Administration (HRSA) to train nursing educators. A cost matching award, Belmont was awarded federal funds of $422,317 from HRSA, and the University will match with $46,924. This grant addresses the ongoing shortage of nurse educators by offering Doctor of Nursing Practice (DNP) student scholarships of 85 percent tuition reduction with an agreement that the students will serve as nursing faculty or FNP preceptors for four years after graduation. The American Heart Association, the world’s leading nonprofit organization  focused on heart and brain health for all, has announced new officers to (conrtinued on page 18) NASHVILLEMEDICALNEWS

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Breakfast Honoring the Class of 2021 Thursday, October 14, 7:30-9 am

Noah Liff Opera Center INDIVIDUAL TICKET: $55 • TABLE OF 10: $500

Presenting Sponsor:

Gold Sponsors:

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GRAND ROUNDS serve on the Southeast Board of Directors for the 2020-2021 fiscal year. David Dill, president and CEO of LifePoint Health, will continue to serve from Middle Tennessee. The American Heart Association Southeast region services Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Puerto Rico.  In August, the Doris Duke Charitable Foundation (DDCF) announced the 17 early-career physician scientists receiving a collective total of $8.4 million in 2021 Clinical Scientist Development Awards. Each of these physician scientists will receive grants of $495,000 over three years to advance their important research and support their transition to independent clinical research careers.  Selected from more than 250 applicants, the awardees include Nashville’s Celestine N. Wanjalla, MD, PhD, from Vanderbilt University Medical Center. Wanjalla won the grant for her work in “Understanding the Role of Cytotoxic CD4+ T Cells in Cardiovascular Disease Progression in Persons with HIV.” Aging Media Network, Inc., pub-

lisher of Skilled Nursing News and other national senior care publications, recently announced the winners of the 2021 Future Leaders Awards from the senior housing, skilled nursing, home health and hospice industries. Jason Haney, vice president of Operations for Franklin-based American Health Plans (part of American Health Partners), has been selected as one of these high-performing indiJason Haney viduals who represents an unwavering commitment to the aging population the company serves. With a record number of nominations, Haney is part of the 2021 class recognizing 40 individuals across the continuum of care. The American Academy of Nursing recently announced the selection of 225 distinguished nurse leaders to be inducted into the 2021 Class of Fellows. The inductees will be recognized for their significant contributions to health and health care at the Academy’s annual Health Policy Conference, taking place on Oct. 7-9,

2021. Two of the new fellows hail from Middle Tennessee. Irene W. Bean, DNP, FNP-BC, PMHNP-BC, FAANP, founder and CEO of Serenity Health Care in Madison and William (Dan) Roberts, PhD, RN, APN with HCA Healthcare. In support of National WIC Breastfeeding Week, which was held in early August, the USDA Food and Nutrition Service (FNS) announced its WIC Breastfeeding Award of Excellence winners.  More than 100 awards were handed out across the country, including seven WIC clinics in Tennessee. Metro-Davidson County and the Mid Cumberland Region were both part of the national recognition. IDG Insider Pro and Computerworld recently named Amedisys, Inc., one of the nation’s leading home health, hospice and personal care companies, to their 2021 listing of the Best Places to Work in IT. Cumberland Heights Foundation in Nashville was featured as one of the best rehabilitation centers in the country on Newsweek’s 2021 Best Addiction Treatment Centers list, released in August. Highlighting the nation’s top treatment centers based on peer recommendations, quality benchmarks and accreditations, Cumberland Heights Foundation ranked tops in Tennessee. Two other Middle Tennessee facilities – JourneyPure at the River in Mufreesboro and Integrative Life Center’s Morningstar Women’s Residential in Nashville also made the list.  

Need Meet Need: TJC Finds New Home

Jackson Joins Neuhaus Foot and Ankle

PHOTO COURTESY OF FISK UNIVERSITY.

This summer, the Tennessee Justice Center celebrated the start of renovations on a building that will become the public interest law firm and advocacy center’s new home. With developers starting demolition on their most recent offices to make way for a luxury hotel, TJC searched for a building to own, selecting a former liquor store in Nashville’s Cameron-Trimble neighborhood. The neighborhood has a proud 150-year history of struggle for racial and economic justice, including serving as the original site of Meharry Medical College and a law school that trained the first Black lawyers in the South. TJC Executive Director Michele Johnson noted, “We are excited about the new opportunity to be close to the heroes who work every day to improve their community and make a better future for their children. These are the people who inspire and energize us to work with them for justice so that our state can be a good home for all Tennesseans.” Since opening 25 years ago, TJC advocacy in the courts and legislature has won $2.5 billion in healthcare, nutrition assistance and financial support to improve the lives and advance opportunities of families living in poverty. When renovations are complete next year, the building will be a striking landmark reflecting justice and the proud history of the community.

Fisk, Tech Companies Partner on VR Cadaver Lab This fall students at Fisk University will attend in-person classes at one of the first virtual reality (VR) campuses in the nation. Fisk University, HTC VIVE, T-Mobile and VictoryXR have teamed up to launch a first-of-its-kind, interactive, 5G-powered VR human cadaver lab for students in pre-med and biology-related majors. Fisk University, one of the top-ranked HBCUs in the country, will utilize this new model of learning that combines the in-person classroom experience with 5G-powered VR technology, enabling students to explore the complete skeletal structure, muscle structure and the 11 human organ systems while still engaging in-person with their classmates and instructors.

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Brian Jackson, MD, and his staff at Middle Tennessee Foot and Ankle have joined Neuhaus Foot and Ankle, as the Nashvillebased podiatry group expands into Columbia and Pulaski. Effective Sept. 1, Middle Tennessee Foot and Ankle began seeing patients under the Dr Brian Jackson Neuhaus Foot and Ankle name. During a brief closure at the end of August, Middle Tennessee Foot and Ankle installed new technology, including ab industry-leading 3D digital foot scanner, and trained staff on new equipment before reopening as Neuhaus Foot and Ankle.

TriStar Hendersonville Welcomes Cardiologist TriStar Hendersonville Medical Center recently welcomed board-certified interventional cardiologist Toug Tanavin, MD, to the hospital’s medical staff. Tanavin completed his residency in internal medicine, as well as fellowships in cardiovascular disease and interven- Dr Toug Tanavin tional cardiology at Baylor College of Medicine, Houston. He completed medical school at the University of Texas Medical Branch in Galveston. He is board-certified in internal medicine.

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

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