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FOCUS TOPICS ORTHOPAEDICS & SPORTS MEDICINE • TRAUMA & EMEGENCY MEDICINE • PEDIATRICS • SENIOR HEALTH • PRACTICE MANAGEMENT

Your Middle TN Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 4

Ashley Panas,

MD

ON ROUNDS

Health Care Council, NashvilleHealth Host Conversations on Health Equity & Disparities In mid-August, the Nashville Health Care Council and NashvilleHealth hosted the first of a three-part event series, “Conversations on Health Equity ... 10

W2W Event in Print While an in-person event wasn’t possible this year, we’re excited and proud to celebrate the Class of 2020 with the ‘Event in Print.’ ... 11

Kids, Classrooms and COVID-19 As schools reopen across the U.S., pediatricians are scrambling to help parents navigate growing concerns in children’s health. ... 15

Practice Management Q&A with NMGMA Recently, Nashville Medical News had the opportunity to sit down with the current president and incoming president of the Nashville Medical Group Management Association ... 20

August/September 2020 >> $5

Innovation in Orthopaedics Technology Improves Outcomes for Joint, Disc Replacement

By MELANIE KILGORE-HILL

Orthopaedic surgery has come a long way in a half century, with sameday, minimally-invasive procedures replacing oncegrueling surgeries and fusions.

Innovation in Joint Replacement

“The first 20 years of joint replacement were focused on innovation in design and technique,” said William Carpenter, MD, joint replacement surgeon at Tennessee Orthopaedic Alliance. “We’re now trying to refine those techniques.” According to the American Academy of Orthopaedic Surgeons, about 53,000 people in the U.S. have shoulder replacement surgery each year, while more than 900,000 undergo knee and hip replacement surgeries. “With hip and knee replacements specifically, there are two technologies we talk about – computer navigation and robotics,” Carpenter said. Computer navigation provides the surgeon information on patient

anatomy and implant position during surgery. “During hip replacements, the software integrates with intra-operative X-rays to tell the surgeon real time information about the implant positioning,” explained Carpenter. “With knee replacements, the number one goal is to make sure the forces that go through the knees are even inside and out, creating a balanced knee, known as restoring mechanical access. Computer navigation reliably helps achieve that goal.”

Robotics

Robotics is another game changer for orthopaedics. While robotic technology has been utilized for decades, modern computer software converts anatomical information from a CT scan and reconstructs it into a 3D model of the patient’s hip or knee joint, which is used to plan optimal implant positioning.

The Emotional Toll of COVID-19 in the Senior Population By MELANIE KILGORE-HILL

The strain of isolation is taking its toll, with the population most at-risk for COVID19 also being the most likely to suffer depression and anxiety. According to the Centers for Disease Control and Prevention, older adults, especially those in long-term care, are more likely to succumb to COVID-19. In Tennessee, 60 percent of deaths have been over age 70. Frightening Reality “The isolation has been devastating, not only to those living alone but in long-term facilities with families who can’t visit,” said James Powers, MD, program director for the Vanderbilt Geriatric Fellowship Program. Powers, who also serves as the associate clinical director for the VA Tennessee Valley Geriatric Research Education and Clinical Center, has witnessed firsthand the impact of the virus among the elderly, as seven of his

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Addressing the Growing Issue of Firearm Injuries ACS Awarded Grant to Identify Risk Factors By CINDY SANDERS

It’s hard to stop what you don’t understand. To address the growing issue of firearm-related trauma, the American College of Surgeons Committee on Trauma (ACS COT) is launching a multi-center prospective study on individual and community risk factors for non-lethal gunshot injuries in the United States. The new study is made possible by a two-year, $711,218 grant from the National Collaborative for Gun Violence Research. “In the last two years of data available from the CDC, firearm-related deaths exceed vehicular deaths,” said Deborah Kuhls, MD, FACS, FCCM. “And for allcause trauma, it is the leading cause of death up through the first 44 years of age.” Kuhls, who is the immediate past chair of the ACS COT Injury Prevention and Control Subcommittee, has been an integral part of the national leadership team defining a public health approach to firearm injury prevention. A professor of Trauma and Critical Care in the Department of Surgery at the University of Nevada, Las Vegas, Kuhls is also medical director of University Medical Center’s Trauma Intensive Care Unit. She was one of the surgeons on duty when casualties started arriving in October 2017 in the wake of the mass shooting dur-

ing a country music concert that left nearly 900 injured and 58 dead. Kuhls said gunshot trauma – both intentional and unintentional – has been increasing dramatically for several years. She stressed the need to move the dial on research in order to create evidence-based interventions that might turn the tide on injuries … and ultimately fatalities. “When you look at the amount of research allocated proportionately to cause of death, firearm injury prevention research is very underfunded compared to funding allocated to other causes of death,” she noted. Gun violence is one of the five leading causes of death for Americans up to age 64, yet research dollars have lagged far behind allocations to heart disease, stroke and cancer. However, she continued, research funding is beginning to open up with renewed efforts to better understand best practices for prevention, treatment and recovery. “This particular grant is private, but some very exciting things are happening on the federal level, too,” she said. “For the first time since the 1980s, there were federal funds appropriated to study firearm-related injuries and deaths.” Utilizing the ACS Trauma Quality Improvement Program (TQIP) network, the new research project looks to engage current participants by having them collect and input additional data surrounding firearm

we get from this injuries being seen study can inform in trauma centers injury prevention across the country. and be targeted to “We are expanding those most at risk of the data collected to injury,” said Kuhls. include information She added that we don’t currently have in the the two-pronged U.S.,” Kuhls said, approach of public education and adding information on the type of effective policy that weapon, comorbidihelped decrease ties, mental health motor vehicle injury issues and other and death also could data points will help be applied to fireDr. Deborah Kuhls, ACS Committee on Trauma arms. “We didn’t expand the body outlaw motor vehiof knowledge. She cles, but we worked with the industry on a lot added much of the new information that of meaningful federal standards for safety,” will be requested is commonly found in the Kuhls pointed out. “We’re optimistic we medical record so it isn’t anticipated to add can start to gain some insight into how we significant burden to busy trauma centers. can prevent injuries from happening when While statistics on firearm deaths are people are around firearms, as well.” reported, there is currently a gap in understanding about the scope and burden of The ACS COT study is among $7.5 non-lethal injuries. “We want to undermillion in grants recently announced by the stand the circumstances of the shooting National Collaborative for Gun Violence better than we do now,” she explained. By Research to help fund 15 research projects. improving contextual information, the hope The latest round of support by the Collaborative follows $9.8 million in grants last is to create effective upstream interventions. year to fund 17 research projects. “The end game is we hope the data

Gunshot Wounds Requiring Surgery Days after winning a grant to study firearm trauma, the American College of Surgeons released information from a large national study of the increasing frequency, cost and severity of gunshot wounds that require surgical intervention. The study, which appeared as an “article in press” in the Journal of the American College of Surgeons website in August ahead of print, outlines an annual cost to the U.S. health system of $170 billion for gun violence overall, with $16 billion for operations alone. The researchers used the National Inpatient Sample (NIS) to identify all hospital admissions for gunshot wounds (GSW) from 2005 through 2016. The researchers did not look at all adult GSW victims admitted to the hospital, estimated at 322,599, but only at the 262,098 victims who required at least one major operation. “We’re now seeing a lot more on the impact of gun violence,” said lead study author Peyman Benharash, MD, MS, and an associate professor-in-residence of Surgery and Bioengineering at the David Geffen School of Medicine at the University of California Los Angeles. “In the past, gun violence was never really discussed in the open; it was thought to only affect a certain population. However, now we know that it affects everyone. In the hopes of trying to reduce it at a systemic level from top to bottom, we’re reporting, as surgeons, how gun violence in the patients that we treat has changed over the last decade.” Improved survival of GSW patients is a function of improvements in trauma transport from the field, better prehospital resuscitation, and improved techniques, patient management and adjunct therapies once they get to the hospital, Benharash said. “It appears that patients are reaching surgery more often because of reduced mortality before they get to the hospital,” he added.  The study also attributed improvements in survival to efforts by the ACS Committee on Trauma, including the Advanced Trauma Life Support curriculum and Stop the Bleed® campaign. The latter trains the public in techniques to stop life-threatening bleeding in everyday emergencies.  However, Benharash noted those improvements don’t obviate the need for addressing the underlying problem “We hope that our findings are able to better inform policy in terms of violence prevention, as well as reimbursement to hospitals, which are often in underserved regions, that care for these patients.”

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PHYSICIAN SPOTLIGHT

The (Flight) Path to Medicine Ashley Panas Takes her Love for Emergency Care to the Skies PHOTO BY GREG JOHNSON

By MELANIE KILGORE-HILL

Ashley Panas, MD, is taking her passion for medicine to new heights. Now in her seventh year as assistant medical director for Vanderbilt LifeFlight, Panas is helping to grow a transport program that’s touching the lives of patients and providers throughout the Southeast.

Starting Out

A native of West Virginia, Panas followed in the footsteps of her grandfather, a general practitioner in their small town of Kingwood. “He died when I was young, but I grew up hearing stories about him going out during the night to deliver babies,” Panas recounted. In college, she fell in love with hospital care and emergency medicine while volunteering as an EMT for a local rescue squad. Panas received her undergraduate degree from Washington and Lee University in Lexington, Va., before earning her medical degree from Wake Forest School

of Medicine in Winston-Salem. In 2010 she arrived at Vanderbilt University Medical Center for an emergency medicine residency. She completed an EMS fellowship while in Nashville before heading to the University of Wisconsin, Madison – one of the only flight fellowship programs in the nation. “I’d always wanted to fly but had never had the opportunity,” said Panas, who had done a LifeFlight ride-along as a

second year resident at VUMC. “I wanted to fly as a crew member but most flight teams in the U.S. don’t have a physician on board.”

Embracing Challenges

While in Wisconsin, Panas trained under seasoned flight physicians, learning to adjust to challenging time and space constraints – the greatest obstacles of practicing in-air. “When I see a trauma patient at Vandy, I’ve got 10 other people in the bay to help me, so there’s a lot of hands to help me get things done in a timely fashion,” said Panas. “In an aircraft, it’s you and your partner, and the confined space is a challenge but is also something I love - prioritizing what needs done now, and what can wait till the hospital.” She continued, “It’s challenging to shift your mindset and think in a different way than I’m used to on the ground.” Working in sweltering summer temps is another challenge for crew members, who

LifeFlight Expands Crew with NPs, Physicians “They will have the complete Patients treated and transpicture of the patient status and ported by Vanderbilt LifeFlight can modify treatments in real time are now receiving a higher level of without delay and without having care thanks to the credentialing of to contact additional medical conmore than 20 flight nurses as nurse practitioners and the addition of trol,” Russ explained. “The ability a flight physician at several Lifeto make such split-second deciFlight bases. sions in a life-or-death moment is Out of a staff of about 100 important.” flight crew members, more than Flight physicians are now fly25 percent are providing care at ing at five of eight helicopter bases, the nurse practitioner or physiincluding LF 1 (Gallatin/Sumcian level. Vanderbilt LifeFlight is ner County), LF 3 (Clarksville/ one of a handful of flight programs Montgomery County), LF 4 (Mt. across the country that provides Pleasant/Maury County); LF 5 this level of expertise of front-line (Murfreesboro/Rutherford County) emergency care. Most flight proand LF 7 (Cookeville/Putnam County). In all, these physicians are grams offer a critical care nurse/ flying a total of about 260 hours per critical care paramedic care team. month. The flying physicians are The master (MSN) or doctoreither board certified or board eliate (DNP) prepared nurses have specialized training and knowlgible in emergency medicine. Since its inception in 1984, edge. “Our flight crews treat and Vanderbilt LifeFlight has comtransport some of the most challenging and complex cases we see pleted more than 45,000 acciat Vanderbilt,” said Stephan Russ, dent-free patient missions. The (L-R) Dr. Stephan Russ, associate chief of staff for Vanderbilt MD, associate professor of Emerprogram has grown from a single University Medical Center and associate professor of Emergency helicopter to more than eight gency Medicine and associate Medicine, recently spent the day and flew with LifeFlight 3 bases across Tennessee, nine chief of staff for Vanderbilt Uni(Clarksville) Nurses Jessica VanMeter, DNP, and Tony Smith, helicopters, an airplane, two critiversity Medical Center. “We want DNP, along with Pilot Wayne Price. our referring partners and patients cal care ground ambulances and to know that they are getting the 12 advanced life support ambuhighest level of care offered when Vanderlances. All air operations are provided nity hospital and need more advanced care by Air Methods Corporation. All ground bilt is called to transport.” at a larger tertiary care center. LifeFlight and medical services are provided by More than 70 percent of the patients will transport any patient to any medically Vanderbilt University Medical Center. flown by LifeFlight originate at a commuappropriate hospital. 4

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spent this high-trauma summer in N95 masks in addition to flight suits.

Vanderbilt LifeFlight

Vanderbilt LifeFlight first took off in 1984 and has completed more than 45,000 patient missions and counting. Since the program’s inception, there has been tremendous growth expanding from a single helicopter to eight bases across Middle Tennessee. The LifeFlight team celebrated its 35th year in 2019, and in July added nurse practitioners and physicians to their expanded flight crew at several bases. (See sidebar/page xx). “A lot of members have had advanced degrees for a few years but no mechanism to put that to work while on job as a flight nurse,” Panas explained. “This is something management has been working toward over the last few years.”

Recruiting Physicians

Panas said physician interest in the LifeFlight program has grown in recent years, as well, with seven physicians now on the crew. “There used to be maybe one interested resident a year who would fly,” Panas said. “Over the last few years, we’ve had some staying, so it’s been neat to watch that grow.” She attributes part of that growth to awareness, as residents and physicians who had never considered the possibility see other physicians take to the skies. “I’m biased and think it’s the greatest job in the world,” said Panas, who looks forward to sharing her love of flying with her one-year-old daughter. Still, she recognizes air medicine isn’t for everyone – especially those with a fear of flying or with a family, since flight physicians spend an average of 36 hours in the air each month in addition to their hospital duties.

Serving the Community

Panas looks forward to watching the program continue to grow. Recent additions include growth of the Event Medicine team as well as LifeFlight’s Critical Care Ground Program – a high tech ambulance larger than a traditional vehicle but with similar medical capabilities as a chopper. “The whole team can sit up front and have a ton of room in the back, as well,” Panas said, noting the challenges of transporting patients on an ECMO or balloon pump in a traditional ambulance. Currently the ground trucks run two 12-hour shifts each day, focusing on transport between hospitals, as well as picking up patients hours away. Like LifeFlight’s fleet of nine helicopters and one airplane, their ground trucks are available to patients at any hospital. “We serve the entire community, wherever the patient is going,” said Panas. “That’s important during times like this, when hospitals are crowded and patients need shifted to get the best care. We have some of the best pilots and mechanics in the world, and I literally trust them with my life,” Panas concluded. nashvillemedicalnews

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Innovation in Orthopaedics, continued from page 1

“The difference between a robotic device and computer navigation is that robotic devices actually help execute our pre-operative plan with a high degree of accuracy and precision,” Carpenter said. Today’s ortho robots fall into three categories: passive, semi-active and active. Passive robots put the surgeon in full control Dr. William Carpenter and provide no feedback. “Basically, if you’re going too far one way or the other, it won’t cut you off or stop you,” Carpenter explained. Semi-active robots, like the MAKO Robotic Arm-Assisted Surgery used for hips and knees at TOA, allow the surgeon to control the robot and give direct feedback. “We pull triggers to control the arm, but it prevents me from going less than one-half millimeter off the plan I made in the OR,” explained Carpenter. “The goal of technology in any surgery is to optimize positioning, which helps ensure the new joint will last longer.” So far the technology is promising, as MAKO knees have significantly improved functional outcome scores for patients. Among today’s joint patients, 90 percent of knee replacements are still in 20 years later, with a .5 percent yearly revision rate. A MAKO designed specifically for shoulder replacement is expected on the market in the next two years. Matthew Willis, MD, orthopaedic surgeon at the Ascension Saint Thomas Joint Replacement Institute, is part of the development team for MAKO’s first-of-itskind shoulder robot and said shoulder Dr. Matthew Willis innovation has lagged behind knees, primarily from lower volume. “There’s a lot of precedence in knees, which are replaced eight to 10 times more often than shoulders,” he said. ”There’s also a different level of complexity with shoulders. You’re solving a different problem.” While successful knee replacement hinges on precision of placement, shoulder replacement addresses significant deformities in a small area often marked by little bone stock to put parts in. The third type of robot, active robotic systems, perform tasks independently without surgeon manipulation – and are yet to become mainstream in the United States (and will likely require a bit more patient buy-in).

Improving Outcomes

Carpenter said early studies examining outcomes for computer navigation and robotics show patients are faring better than previously expected. “The biggest takeaway is that this technology removes outliers, so the end product is the same every time, without question,” he said, noting the need for longer-term studies to show full effect. Currently, 85 percent of patients with “perfect” knee replacements are satisfied with their new knee, while 95 percent of hip replacement patients are satisfied. “We’re looking at how to capture that other 15 6

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percent of knee patients, even though they appear to be perfect,” Carpenter said. That requires studying how they’re walking and refining techniques to ensure the best robotics and navigation practices. Improved technology also means younger patients with severe arthritis or deformities are opting for surgery earlier. “The whole goal of joint replacement is to improve quality of life and pain, and we have enough data on today’s implants to know they’re lasting longer and providing relief from severe arthritis,” said Carpenter, whose patient demographic is continually evolving. Robotics also will help shoulder surgeons perfect muscle-sparing techniques to protect the rotator cuff, allowing patients immediate use of the arm with little downtime.

Patient-Specific Instrumentation

Previously used for knees and hips, patient-specific instrumentation is now being used for shoulder replacements, too. “A hard part of shoulder replacement is accurately preparing the bone for the parts,” Willis said. “Rather than creating customized implants, it’s more financially feasible to create a guide that helps prep the shoulder, and it works for 99 percent of offthe-shelf implants.” Willis said that’s particularly important when a patient has bone loss or deformities on the socket side of the bone and provides surgeons more options for positioning. Some companies are also incorporating virtual reality into patient-specific instrumentation, providing surgeons with special goggles to practice the surgery beforehand in real time. Willis said the technology is still in its infancy, and that, while novel, may not add a lot to the extensive planning already adopted by most surgeons.

Innovation in Spinal Surgery

Spinal surgery is another field experiencing tremendous innovation. Like joint

replacement, minimally invasive lumbar fusion using computer navigation and robotics is proving a welcome alternative to traditional surgery – in this case spinal decompression and fusion. Casey Davidson, MD, an orthopaedic surgeon specializing in spine surgery at the Bone and Joint Institute of Tennessee, said robotics is revolutionizing the once cumbersome surgery. “Robots allow us to safely place screws and instrumentation and use preoperative CT scans to see where instrumentation Dr. Casey Davidson will go,” he noted. Current spine robots include the Mazor X Stealth Edition and the Globus Excelsius GPS, two respected early adapters in a rapidly growing market. Davidson said the transition to robotic-assisted procedures can be tough for surgeons accustomed to traditional surgery, although the majority of a spinal surgeon’s cases, i.e. degenerative discs, can now be performed in a minimally invasive manner. “Surgeons are moving forward with caution, and research shows it takes almost 50 cases per learning curve to transition to minimally invasive lumbar fusion,” Davidson said.

Motion-Sparing Surgeries

Motion-sparing is another buzzword in spine surgery, ensuring minimal disruption in the natural biomechanics of the spine – a game changer when replacing neck discs. “Motion-sparing surgery means a 35-year-old with disc herniation or stenosis can receive a replacement instead of fusion,” Davidson said. “It’s been phenomenal.” Made from the same chrome or alloy material as total joints, motion-sparing discs last a lifetime while preserving mobility in the discs above and below – segments previously fused for stability. The surgery requires

a small incision in the front of the neck and is typically performed in an outpatient setting. Davidson said that’s monumental from a generation ago, when a small discectomy required 12 weeks of recovery time and multiple nights in the hospital. Now performed routinely at outpatient surgery centers, the procedure requires a one-inch incision with patients home the same day under mild lifting instructions. “This is a game changer for younger patients who don’t want to have back surgery,” Davidson said.

The Move toward Outpatient Care

The transition to outpatient joint replacement also has shifted the paradigm for patients, with outpatient surgery centers now the norm for many groups. While technology has moved ahead full-speed, Willis said changing patients’ minds is often the toughest part. “Many patients think that just because they’re getting a joint replaced, they need to be the hospital,” he said. “The main reason we kept them before was for pain control, but we’ve gotten so good at that.” With the exception of the frail and elderly who require extra medical management, most of today’s patients easily go home the same day. And in an era of rigid COVID19 hospital restrictions, healing at home is a welcome thought.

Changing Demographic

Better technology and improved outcomes also mean fewer reasons for patients to endure years of narcotics for pain relief – a point Davidson hopes to hit home to providers. “The older thought process from initial evaluation for pain was to start patients on narcotics, and that’s a slippery slope, especially with back and neck pain,” he said. “There’s a newer, multi-modal push to minimize narcotics, and providers should realize there’s a lot we can do, from nonsurgical to minimally invasive, to reduce pain and maximize results.”

TOA Announces New Providers, Location, Merger It been a busy year for Tennessee Orthopaedic Alliance. In addition to 17 Middle Tennessee locations, four of which include urgent care clinics, TOA also operates a Sports Performance Center with specialized sports performance training for teams and individuals. On Sept. 1, TOA welcomed two new providers: Jason H. Harms, MD (spine), and Bryan W. Lapinski, MD (foot and ankle). Harms earned undergraduate degrees from Emory University before completing his medical degree at the Medical College of Georgia at Augusta University. After residency in Augusta, he recently wrapped his orthopaedic spine surgery fellowship at WVU Medicine in West Virginia. Lapinski is relocating to Nashville from Illinois, where he spent more than a decade with DuPage Medical Group. The orthopaedic surgeon earned his medical degree from Northwestern University Feinberg School of Medicine, followed by an orthopaedic surgery residency at North-

western. He then completed a foot and ankle fellowship at the University of Washington School of Medicine. Earlier this year, TOA also welcomed Martha P. George, MD (shoulder and sports medicine), Paul D. Crook, MD (sports medicine, joint replacement and shoulder), William E. Carpenter, MD (joint replacement) and Michael C. Bowman, DO (interventional pain management). At the end of last year, the group celebrated the opening of a new TOA facility in Hendersonville. The 23,000 square-foot TOA Indian Lake Clinic takes a comprehensive approach to an active lifestyle with an enhanced clinic, physical therapy, and advanced imaging services, as well as supportive services such as fitness and yoga classes and personal training. In June, the Indian Lake practice added an Orthopaedic Urgent Care clinic for after-hour and weekend nonemergent sports, recreational or workers’ compensation bone and joint-related injuries. TOA expansion isn’t limited to Mid-

dle Tennessee, however. In late August the announcement was made that three Tennessee orthopaedic practices would merge into one of the nation’s largest orthopaedic networks, effective January 2021. TOA, Mid-Tennessee Bone & Joint Clinic (MTBJ) in Columbia, and Knoxville-based Tennessee Orthopaedic Clinics (TOC) will join forces, giving the group 27 locations. At this time, plans call for each entity to retain its current name and employees while sharing best practices and leveraging their combined scale and expertise. “The opportunity to partner with TOC and MTBJ allows us to continue our path forward in creating innovative orthopedic care delivery models for the thousands of patients who span across our respective markets,” said Will Kurtz, MD, TOA president. “We are excited to learn from one another and create high-quality, cost-effective patient outcomes. Ultimately, we feel this merger will accomplish this and much more for the many years to come.” nashvillemedicalnews

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From Pain Management to Pandemic: The Changing Face of Sports Medicine Orthopaedic Surgeons Weigh in on Issues Impacting Athletes By MELANIE KILGORE-HILL Sports medicine is a new ballgame in 2020, with orthopaedic surgeons feeling the pull of quickly evolving athletic protocols, courtesy of a global pandemic. Throw in a nationwide opioid crisis, and today’s providers are wearing extra hats as counselors and coaches while guiding athletes through an unchartered era.

The New Norm

Jaron Sullivan, MD, orthopaedic surgeon at Vanderbilt Orthopaedics, said today’s athletes are under a tremendous amount of stress as they navigate ever-changing rules and expectations. As team physician for the Nashville Soccer Club, Sullivan said athletes are often frusDr. Jaron Sullivan trated as they attempt to navigate new standards – which have been frequently redefined in the past few months with mixed messages sent through the public. “This pandemic has put their careers on hold directly by stopping the season, as well as indirectly by how COVID-19 can affect their health and ability to return to sports participation,” he said. “Currently, professional athletes are tested multiple times per week for COVID, and there is a significant amount of stress that goes with wondering whether today’s test will take an athlete off the travel roster or out of training due to a required quarantine.”

Challenges & Risks

Amanda Martin, MD, surgeon at Elite Sports Medicine and Orthopaedics and chair of the Major League Soccer Medical Symposium and its education committee, said it’s essential to have real conversations with athletes of all levels about expectations and behaviors. “Athletes are athletes, Dr. Amanda Martin and it doesn’t matter if it’s injury or illness,” she said. “They just want to know what they have to do and when they can play.” Martin continued, “Sports have always told the story of a society, and our athletes are our gladiators. We’re helping them understand their risk to themselves and to those around them, so it’s important to discuss why precautions are so important. Yes, they’re invincible in many ways, but the halo effect isn’t. Just like we talk to them about preventing ACL tears, we have to drive home this new health perspective, as well.” nashvillemedicalnews

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And while honest discussions are important, Martin also worries about the burden being placed on athletes, particularly students already struggling with isolation from friends and school. “They’re going through so much with the pandemic, and many are now online all day,” she said. “We know there’s so much anxiety and depression directly associated with being online, and now we’ve magnified that plus taken away sports.” Martin fears outcomes in overall health will continue to decline without ways to improve students’ overall well being. “It’s very important to respect and understand that this is a generational trauma for young people,” she said. “It’s a unique moment in time, and the most important thing is to look at the whole person.” That means acknowledging health risks while also recognizing potentially devastating consequences of social/ exercise losses. “We need to think about overall well being, not just in terms of one virus,” she said. “That can’t be lost in fear, and we really have to balance everything.”

Playing it Safe

As the medical community focuses on COVID-19 prevention and death rates, Sullivan is wary of long-term health risks that could be particularly dangerous to athletes. Reported severe cardiac complications with exercise in patients that have been previously infected with COVID-19 mean all MLS players who once tested positive now receive a precautionary full cardiac evaluation before hitting the field again. “If someone has a history of COVID, they may still have secondary side effects like heart arrythmias that could be life threatening long after the infection has resolved,” he said. “Providers should be aware and work up concerning cardiac findings which may cause major problems if not diagnosed early. Don’t just focus on the acute, life-threatening infection but also long-term side effects, especially in the athlete population.”

Managing Pain in 2020

Pain management is another sore point facing orthos nationwide, but particularly in Tennessee. In 2018, the Volunteer State had the third highest narcotic prescription rate in the nation, with 81 prescriptions written for every 100 resi-

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dents. But an industry-wide push toward over-the-counter meds means providers and patients alike are gaining a better understanding of pain management. “If you rewind the clock 10 to 15 years, the big focus was the pain scale and what level of pain was acceptable to the patient,” Sullivan said. “We took a lot of heat with patient-reported outcomes, and pain was something we had to fix by giving patients narcotics to get their pain below an acceptable number on the pain scale.” Today’s providers are committed to flattening the narcotics curve by proactively talking to patients about the nature of addiction. “Patients will argue that they don’t have an addictive personality, they’re just hurting, and we don’t understand how intense it is,” Sullivan said. “What most don’t understand is they don’t get addicted because it makes them feel euphoric, but because of pain … and the longer they’re on them, the worse they’ll have withdrawal symptoms and become hypersensitive to pain.” Martin said CDC guidelines have been a lifesaver for physicians, particularly in today’s consumer-driven market. “This is one of the true cases where government

oversight has been extraordinarily helpful,” she said. “The data gave us tools as physicians to say, ‘This is a national crisis, so let’s have a conversation about it.’ Being required by law to discuss opioids gives us the luxury of pulling up a chair and really talking to patients.”

Better Understanding of Pain

A 2019 study by the American Academy of Orthopaedic Surgeons showed patients on narcotics for more than six weeks have a 50/50 chance of being on them a year down the road – a sobering reality that’s helping both sides see eyeto-eye. Both Martin and Sullivan discuss those odds with patients pre-surgery, arming them with resources to fully understand the nature of pain and opioid use. “I tell them narcotics are really helpful right after surgery, but we now have really good data that shows they’re also very dangerous,” Sullivan said. Surgeons are emphasizing the very practical role of pain and setting realistic expectations ahead of time. “When you have surgery, you’re going to have intense pain and not sleeping much is acceptable for the first (CONTINUED ON PAGE 19)

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Orthopaedic Round-Up

News & Notes from Nashville’s Ortho Providers By MELANIE KILGORE-HILL

Expanding Care at Ascension Saint Thomas In 2019, Saint Thomas Joint Replacement Institute expanded its program to outpatient surgery centers across Middle Tennessee to make total joint replacements more widely available in an outpatient setting. “This strategy, rooted in service diversification, is a proactive way to anticipate healthcare’s shift to outpatient services in a way that dramatically enhances both patient and physician experience,” said Robyn Morrissey, vice president of Neurosciences and Orthopedics at Ascension Saint Thomas. “This Robyn Morrissey program expansion complements our existing STJRI program, allowing us to continue providing high-quality affordable care to meet the unique needs of each person we have the privilege of serving.” The Ascension Saint Thomas Joint Replacement Institute now provides joint replacement surgery at The Hospital for Specialty Surgery, Ascension Saint Thomas Hospital Midtown and Ascension Saint Thomas Hospital West, all in Nashville. They’re also performing outpatient surgeries at Ascension Saint Thomas Rutherford Hospital in Murfreesboro and Ascension Saint Thomas River Park in McMinnville. The Institute

also has launched GetWell Loop, a patient engagement tool that enables direct communication with patient nurse navigators and the patient’s surgeon and helps guide joint replacement patients through their journey. In August, Ascension Saint Thomas broke ground on their new Surgery & Critical Care Tower, along with the health system’s new Rehabilitation Hospital, which is being built in partnership with Kindred Healthcare. The new facilities on the campus of Saint Thomas Midtown are the first in a series of investments planned to expand services.

The new surgery and critical care tower will be designed by patients, families and clinicians to create a curated patient journey focused on convenience, ease of access and the experience of a boutique specialty environment. The tower includes 198,000 square feet of space, 18 operating suites, an additional six operating suites planned for future expansion, 36 critical

care rooms and 63 post-anesthesia care unit bays for recovery. In each area of the enhanced campus, patients and visitors will benefit from the “hospital within a hospital” model, offering dedicated parking, valet parking, patient registration and family spaces in a quieter, hotel-style environment. Additionally, construction will incorporate systems to enhance clean air flow and best practices to maintain safety and distancing. “We have the opportunity to build the first hospital that leverages what we’ve learned from this pandemic, and we will use that knowledge,” said Michelle Robertson, COO and CNO for Ascension Saint Thomas at the groundbreaking. The new 40-bed acute rehabilitation facility, with all private rooms, will serve patients who require rehabilitation following a stroke, traumatic brain injury, spinal cord injury or similar medical conditions. The 114,500-square-foot, two-story facility will complement the clinical services the hospital and its affiliated physicians offer patients in the areas of neurological, orthopedic and cardiac care.

BJIT Performing Outpatient Joints Bone and Joint Institute of Tennessee, which opened adjacent to Williamson Medical Center in 2018, has started performing outpatient total joints and spines at their in-house ambulatory surgery center. This new center includes the ability for robotics and CT-guided navigation in surgery. A successful shoulder replacement surgery completed by orthopaedic

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surgeon Ian Byram, MD, kicked off the comprehensive total joint replacement program.

Elite Orthopaedics adds providers Elite Orthopaedics and Sports Medicine recently welcomed three new physician assistants and one orthopaedic surgeon to its staff. Brian Dierckman, MD (arthroscopic surgery of the knee, hip and shoulder), attended the University of Notre Dame, where he played collegiate football. He received his doctorate from Indiana University School of Medi- Dr. Brian Dierckman cine and spent four years at Southern California Orthopaedic Institute in Los Angeles before joining Elite. Amy Jean, PA-C, attended the University of Alabama in Tuscaloosa, graduating with a bachelor’s degree in athletic training. She graduated from Trevecca Nazarene University’s Physician Assistant Program with a Master of Science in Medicine. She has nine years of experience as a PA and now works with Amanda Martin, DO, and Sam Crosby, MD. Corban Cressley, PA-C, earned his bachelor’s in athletic training from Liberty University. He also went on to obtain his Master of Science in Medicine from Trevecca Nazarene University and now works with Chad Price, MD, specializing in surgery of the shoulder, hip and knee. Alex Logan, FNP-BC, received his Master of Science in Nursing from Belmont University. Previously, he spent five years as an RN in the operating room alongside Burton Elrod, MD, and other Elite physicians. Logan works primarily with Elrod, specializing in surgery of the knee, shoulder and elbow. Growth at Hughston Orthopaedics Hughston Clinic Orthopaedics is adding to its physician roster. In August, Aneesh Garg, DO, who specializes in non-operative sports medicine, joined the team. In October, the practice will welcome John R. Burleson, MD, a spine specialist. The practice is growing their footprint, as well. Hughston recently opened a new Urgent Ortho after-hours clinic at its Harding Place location. Open 5-8 pm Monday through Friday, the service provides walk-in care for sports injuries, workers’ compensation injuries, acute pain, painful/swollen joints, broken bones and closed fractures, sprains and strains, on-site X-ray and on-site casting/splinting/bracing. The group also opened clinics in White House and Murfreesboro in the past year, and on Sept. 1 celebrated the opening of their Gallatin location, bringing Hughston’s clinic count in Middle Tennessee to 11.

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What the Tennessee COVID-19 Recovery Act Means for Providers

In August, Gov. Bill Lee signed the Tennessee COVID-19 Recovery Act (the “Act”), which offers healthcare providers protection from liability for some kinds of COVID-19 claims. The Act applies to a large number of individuals and busiBy NATE LYKINS, nesses, including Associate, Waller individual and institutional healthcare providers who are “licensed, authorized, certified, registered, or regulated” under titles 33, 63, and 68 of the Tennessee Code. It also protects providers practicing under federal law or an executive order of the governor. Titles 33, 63 and 68 govern many different healthcare providers, including physicians, dentists, pharmacists, hospitals, ambulatory surgical treatment centers, assisted-care living facilities and substance abuse treatment facilities. The Act protects providers for claims of loss, damage, injury or death “arising from COVID-19.” Under the Act, claims arise from COVID-19 if they are caused by or result from the actual or possible exposure to or contraction of COVID-19, or if they result from services, treatment, or other actions in response to COVID19. The Act lists several examples of such claims, including claims based on COVID-19 testing, the delay or modification of scheduling or performance of a medical procedure, and closing or partially closing to prevent or minimize the spread of COVID-19. The Act permits plaintiffs to bring a claim arising from COVID-19 only if there is clear and convincing evidence that the harm was caused by an act or omission constituting gross negligence or willful misconduct, and these requirements are considerably higher than the standards in a typical civil lawsuit. In a typical civil case, the plaintiff must prove her case by a preponderance of the evidence by demonstrating that her allegations are more likely true than false. In contrast, under the clear and convincing evidence standard, the plaintiff’s evidence must eliminate any serious or substantial doubt about the facts. Similarly, the Act raises the burden on plaintiffs by requiring them to prove that the healthcare provider’s acts or omissions were gross negligence or willful misconduct rather than ordinary negli-

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gence. In general, ordinary negligence is the failure to use the degree of care that a reasonably prudent person would exercise in a similar situation, and gross negligence describes a negligent act committed with a complete lack of concern for the safety of others and indicates conscious neglect of one’s duty or an uncaring indifference to the consequences of one’s actions. The distinctions between negligence, gross negligence, and willful misconduct are not always clear, and that is especially true in the context of the COVID-19 pandemic because our ideas about the level of care that a reasonably prudent person should exhibit continue to develop as we learn more about the virus. However, an example from another area may be helpful: negligence might involve speeding on the interstate, and gross negligence might involve speeding in a school zone with significant pedestrian traffic. The Act also imposes certain procedural requirements on plaintiffs. Specifically, it requires them to file a verified complaint that includes a certificate of good faith. The certificate must state that the claimant or her attorney has consulted with a physician licensed in Tennessee or a contiguous bordering state and that

the physician has signed a written statement that he or she believes the plaintiff’s alleged loss was caused by an act or omission of the defendants. Although the Act provides significant protection, providers will be required to understand the timing any COVID-19 claim against them to determine whether they can take advantage of the Act’s protections. The Act is effective Aug. 17, 2020 and does not apply to claims filed after July 1, 2022. Significantly, the Act applies retrospectively to all claims arising from COVID-19 unless a claim was filed on or before Aug. 3, 2020, or a plaintiff provided statutory notice of such claim on or before that date. The Tennessee Constitution generally prohibits laws that apply retroactively, and it seems likely that plaintiffs will challenge the retrospective application of the Act. Although Tennessee courts have permitted the legislature to enact retrospective laws in certain circumstances, the legal analysis can be complicated, and it is difficult to predict whether the Tennessee Supreme Court will permit the Act to apply to claims that arose before Aug. 17, 2020. Providers that cannot take advantage of the Act may still have some protec-

tion from liability for COVID-19 claims under an executive order that Gov. Lee signed on July 1, 2020 (“EO 53”). EO 53 is similar to the Act, but it has its own limitations. For example, EO 53 applies to “healthcare providers licensed, certified, or authorized under titles 33, 63, or 68” of the Tennessee Code, but it does not state that it applies to providers who are practicing under an executive order. Prior executive order have suspended titles 63 and 68 to allow out-of-state providers to practice in Tennessee. Consequently, there is an argument that these providers are not “licensed, certified, or authorized under titles 33, 63, or 68” and are therefore not covered by EO 53. Gov. Lee signed an executive order terminating EO 53 on Aug. 17, 2020, to coincide with the effective date of the Act. Ultimately, although the Act provides significant protection to healthcare providers, the full scope of its protection may not be fully understood for many months. Nate Lykins is an associate in the Nashville office of Waller, which also has offices in Chattanooga and Memphis. Lykins focuses on the regulatory aspects of healthcare from transactions to operational issues. For more information, go to wallerlaw.com.

Miscarriage Risk Increases Each Week Alcohol is Used in Early Pregnancy Each week a woman consumes alcohol during the first five to 10 weeks of pregnancy is associated with an incremental 8 percent increase in risk of miscarriage, according to a study published in August by Vanderbilt University Medical Center (VUMC) researchers. The findings, published in the American Journal of Obstetrics and Gynecology, examine the timing, amount and type of alcohol use during pregnancy and how these factors relate to miscarriage risk before 20 weeks’ gestation.  Impact of alcohol use rises through the ninth week of pregnancy, and risk accrues regardless of whether a woman reported having fewer than one drink or more than four drinks each week. Risk is also independent of the type of alcohol consumed and whether the woman had episodes of binge drinking. Though most women change their alcohol use after a positive pregnancy test, consuming alcohol before recognizing a pregnancy is common among both those with a planned or unintended pregnancy. Half of the 5,353 women included in the analysis reported alcohol use around conception and during the first weeks of pregnancy. The median gestational age for stopping alcohol use was 29 days. Although 41 percent of women who changed their use did so within three days of a positive pregnancy test, those who stopped consump-

tion near their missed period had a 37 percent greater risk of miscarriage compared to women who did not use alcohol. “Abstaining from alcohol around conception or during pregnancy has long been advised for many reasons, including preventing fetal alcohol syndrome. Nonetheless, modest levels of consumption are often seen as likely to be safe,” said Katherine Hartmann, MD, PhD, vice president for Research Integration at VUMC and principal investigator for the Right from Dr. Katherine the Start cohort, from Hartmann which participants were enrolled in the study.  “For this reason, our findings are alarming. Levels of use that women, and some care providers, may believe are responsible are harmful, and no amount can be suggested as safe regarding pregnancy loss.” According to the researchers, one in six recognized pregnancies ends in miscarriage, which brings great emotional cost and leaves unanswered questions about why the miscarriage occurred.  Biologically, little is known about how alcohol causes harm during early pregnancy, but it may increase miscarriage risk by modifying hormone pat-

terns, altering the quality of implantation, increasing oxidative stress or impairing key pathways. Because alcohol use is most common in the first weeks — when the embryo develops most rapidly and lays down the pattern for organ development — understanding how timing relates to risk matters. Risk did not peak in patterns related to alcohol use in specific phases of embryonic development, and there was no evidence that a cumulative “dose” of alcohol contributed to level of risk. The study recruited women planning a pregnancy or in early pregnancy from eight metropolitan areas in Tennessee, North Carolina and Texas. Participants were interviewed during the first trimester about their alcohol use in a four-month window. “Combining the facts that the cohort is large, comes from diverse communities, captures data early in pregnancy and applies more advanced analytic techniques than prior studies, we’re confident we’ve raised important concerns,” said Alex Sundermann, MD, PhD, the study’s first author and recent graduate of the Vanderbilt Medical Scientist Training Program. To avoid increased risk of miscarriage, the researchers emphasize the importance of using home pregnancy tests, which can reliably detect pregnancy before a missed period, and ceasing alcohol use when planning a pregnancy or when pregnancy is possible. AUGUST/SEPTEMBER 2020

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Health Care Council, NashvilleHealth Host Conversations on Health Equity & Disparities In mid-August, the Nashville Health Care Council and NashvilleHealth hosted the first of a three-part event series, “Conversations on Health Equity and Action to Eliminate Disparities,” to explore racial inequities in healthcare and drive discussion about solutions. In opening the virtual event, Council President Hayley Hovious said, “The events of the last few months have highlighted longstanding inequities and injustices across many of our country’s basic institutions. The Nashville Health Care Council recognizes that healthcare is plagued by systemic racism as much, if not more, than other systems … and yet, healthcare is meant to do no harm.” Hovious added the Council is committed to working toward a better tomorrow by taking steps to understand the issues we face as a community and industry. This first conversation was moderated by Bill Frist, MD, founder and chairman, NashvilleHealth. Panelists included Cara V. James, PhD, president and CEO, Grantmakers In Health; and Andrea D. Willis, MD, senior vice president and chief medical officer, BlueCross BlueShield of Tennessee. Frist  offered opening perspective on the role of healthcare at this challenging time, noting the COVID-19 pandemic and calling racial injustice in health disparity an even more “malignant disease.” He referenced statistics from the recent Nashville Health and Wellbeing survey as examples of poor health outcomes in communities of color. Dr. Bill Frist Frist  then asked the guest panelists to define the term health disparities and what they see from their purview.  James  shared health disparities are preventable “differences” that limit

a group’s ability to achieve optimal health. She noted addressing disparities is important because it is estimated their presence resulted in more than $220 billion dollars in economic Dr. Cara V. James losses to the United States over a four-year period. Willis added disparities are often based on groupings around disadvantages. She said the data in her work not only highlights different health conditions by ethnicity but also the relationship different jobs have on health conditions and actions – such as the impact on mental health, available time to seek care, the effect of job stressors and more.  “Even with all the Dr. Andrea D. Willis data we’ve accumulated, one of the most important things we’ve realized is that we can’t just solve based off the data. We really need to listen to the voices of the people we are generating the data from,” Willis emphasized. “It’s not enough to just ask the questions, it’s important to understand the why behind those answers.”  The group discussed income, age, education and sexual identity as part of the broad range of demographics that have a bearing on health outcomes, while noting the impact that food, transportation, housing, neighborhood, social support, and the environment also have on health.  “The majority of health outcomes we see are not related to the healthcare an individual receives. They’re related to the social factors, and it’s important to note that none of us occupy just one box,” said James.  Frist then asked the speakers to weigh in on the state of health outcomes in rural areas where there has been a trend of hos-

pitals closing. With 15-20 percent of Americans residing in rural communities, Willis said there isn’t a ‘one size fits all’ answer. James added 94 percent of African Americans who live in rural communities live in the South, so rural hospital closures across America have disproportionately affected communities of color. She noted, however, when it comes to health conditions in rural areas, it’s not always communities of color who are doing the worst. “When we look at suicide in rural communities, the rates are higher among non-Hispanic Whites compared to communities of color.” The conversation then switched to the need for timely data to develop real solutions.  Frist  noted the  Nashville Community Health and Well-being Survey was conducted to fill a gap in available local health data. Both speakers agreed that improvements on timely data collection and data sharing are needed to address health disparities. James highlighted COVID-19 testing as an example where a lack of data gathering – especially around race and ethnicity for smaller populations such as American Indians, Alaskan Natives, and Pacific Islanders – is hindering the ability to develop effective solutions when decisions are being made. She also noted the importance of educating people about the use of data to build trust that their input will result in programs that meet everyone’s needs. Frist stressed the need for a public-private sector collaboration in gathering data. “The Nashville Health Care Council, NashvilleHealth, Metro Department of Health, companies, and corporations in the private sector also need to contribute to getting this data to be able to tease out the important action items. It’s not just the government’s job,” he stated. The group then discussed the impact of societal racism on public health. Willis led off with the example of pregnancy complications black women face in America. She

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then shared steps BlueCross BlueShield of Tennessee has begun taking to break down barriers in conversations about race, “It starts with leadership,” she said. Frist asked about the role companies and philanthropic foundations can play in making meaningful change.  James  gave insight into the efforts of her organization – Grantmakers In Health, a national support organization that works with more than 240 foundations at the local, state, and national level – to improve the health through better philanthropy. James said, “Philanthropy can step in where government cannot. It can provide seed money to incubate ideas which then can be implemented into broad programs. But philanthropy struggles in terms of being everywhere. There are gaps in areas where philanthropy is not, particularly in local funding.” Concluding the conversation, panelists discussed how C-suite leaders can build a culture of diversity within their workforces and offered closing thoughts on solutions to health equity. James underscored the importance of leadership in cultural diversity coming from the top. “Diversity is about who is invited to public meetings, private meetings and what companies track on their dashboards,” she said. “Never in my career have I see so much focus on addressing racial inequities. We are on the precipice of meaningful progress. We are in a situation where many of us don’t know what’s going to happen tomorrow, we don’t know the right answers, but we need to try something. A journey of a thousand miles begins with the first step. Take that first step,” James implored.  Willis  echoed the sentiment, “Start somewhere. Don’t let perfect be the enemy of good.  Start with asking yourself, ‘How would I like to be treated?’”  Caroline Young, executive director of NashvilleHealth, addressed the audience as well, “NashvilleHealth was founded, with the help of many of you, to tackle our city’s most challenging health issues in a collaborative fashion. From our very beginning we have worked to understand and address health disparities in our city. We hope that today’s conversation will inform and guide our efforts to improve health and wellbeing in our organizations, our businesses, our city, our state and across this country.” 

The Nashville Health Care Council and NashvilleHealth will continue “Conversations on Health Equity and Action to Eliminate Disparities” in part two of the series on September 30 with U.S. Surgeon General Jerome Adams, MD. Watch for more information at healthcarecouncil.com. For a replay of this first conversation, go online to NashvilleMedicalNews.com and click the You Tube link with this story.

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CELEBRATING 15 YEARS

Event In Print

As we blissfully, naively set out to launch our 15th anniversary year for Women to Watch, it’s a safe bet that we didn’t envision the twists and turns 2020 would bring. While a global pandemic has changed so many aspects of daily life and our ability to gather, it has also underscored the importance of the healthcare village and full complement of responsibilities required to keep the system running under pressure. The pandemic has also forced companies to embrace flexibility. The Women to Watch Class of 2020 embodies the innovation and leadership necessary to see our community, state and country through this public health crisis and to make our systems stronger as a result.

We desperately wanted to find a way to join friends and colleagues together to warmly congratulate this year’s incredible honorees. We changed dates … and then changed dates again; we looked at different formats that would afford more space; and ultimately, we recognized there was no safe and responsible way to gather a large group together at this time.

Although it isn’t what any of us originally planned, the t allows us to shine a much-deserved spotlight on the Class of 2020 as we award each leader with her virtual plaque (real ones being mailed!) and to hear their voices as they join a long list of visionary female leaders who have made all aspects of the healthcare continuum better for all of us.

Event in Prin

We also want to extend a huge thanks to our 2020 Presenting Sponsor Cumberland Pharmaceuticals and Gold Sponsors KraftCPAs and the Nashville Health Care Council for their continued support of this important recognition of healthcare leadership. Cheers to the Women to Watch Class of 2020 and to being able to see each other’s smiling faces in person again soon!

Cindy Sanders & Susan Graham Co-Publishers, Nashville Medical News

Presenting Sponsor: Gold Sponsors:

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Cumberland Pharmaceuticals is proud to sponsor this year’s Women to Watch event, honoring this distinguished group of individuals. These incredibly talented professionals have each made their own unique mark on Nashville’s healthcare industry, helping to advance the care and resources provided to Middle Tennesseans. From medical professionals working on the front lines, to educators inspiring healthcare students, leaders supporting their teams and advocates of veterans and mental health patients, this year’s class is composed of 10 remarkable women.

“What an incredible and treasured honor! I am thrilled to be in the company of such an esteemed class of Women to Watch 2020. On behalf of all of us at Music Health Alliance, we are grateful to Nashville Medical News for recognizing the importance of healthcare access for music industry professionals as part of Nashville’s growing and vibrant healthcare landscape.” –Tatum Hauck Allsep

“Being surrounded by such a great group of professionals and partners supports our efforts to promote better mental health and awareness in our communities. Thank you for this recognition on behalf of our staff and our volunteers who inspire me each day.” – Jackie Cavnar

It is an honor to recognize each of these accomplished ladies, as we celebrate the 15th anniversary of Nashville Medical News’ Women to Watch. To the Class of 2020, we salute you!

A.J. Kazimi Chief Executive Officer Cumberland Pharmaceuticals, Inc.

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“In the words of William James, ‘The great use of life is to spend it for something that will outlast it.’ It is my wish to create a legacy of hard work, integrity, and service to others that will persist in each relationship I build and each organization of which I am a part. There are women in medicine all over Nashville and beyond spending life creating their own legacies. I believe each one of those women is a ‘Woman to Watch,’ and, thus, it is an incredible honor to receive this award.” – Nicole McCoin

“I am honored to be listed among a dynamic group of women who are driving the future of healthcare and are impacting our community during one of the most challenging times in our nation’s history. We are learning together, we are partnering in innovation, and we are jointly working towards a healthier tomorrow.” – Amber Price

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“Thank you for this honor! I accept this award in recognition of the more than 115,000 Tennessee nurses working tirelessly during the coronavirus pandemic to care for those affected and keep everyone healthy. 2020: Year of the Nurse has highlighted the significant impact nurses have on leading change and maintaining the health and well-being of all Tennesseans. I am proud to be a registered nurse and implore state leaders to recognize the critical role nurses play by removing arbitrary barriers and antiquated regulations that limit our ability to practice to the full extent of our education and training in Tennessee.” –Tina Gerardi  

“Thank you for honoring me and all these amazing women in the Women to Watch Class of 2020. This year has certainly had its share of challenges – especially within the healthcare industry. But I’m proud to share in this honor with this group of women who have demonstrated courage, leadership and compassion and fought these challenges head-on to make a positive impact in our community and industry.” – Cindy Reisz nashvillemedicalnews

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“Anybody can do the science of dentistry … that’s the simplest part. Caring and loving people is the art. And if you can’t perfect the art, your chair will always be empty. Thank you very much for the honor. I am humbled to be acknowledged amongst such phenomenal women. “ – Julie Gray

“Thank you so much for this award! It means a lot to me because it reflects all the hard work Centerstone’s Military Services has done to ensure military service members, veterans, and their families have access to the behavioral healthcare they may need. We give back to this community because we understand that military service and military life may impact mental well-being and during some points in our country’s existence, we have forgotten that fact. As this cost was incurred by some for the freedom of all, we at Centerstone’s Military Services feel we owe it to our military families to ensure any such impact can be ameliorated.” – Jodie Robison

“It’s an honor to be among these outstanding women leaders recognized by Nashville Medical News. The healthcare environment we face today is vastly different from what it was just a few months ago, and strong, innovative leaders are, and will be, essential in meeting the challenges caused by the COVID-19 pandemic. In Nashville and all over the globe, advanced practice registered nurses have not only unselfishly cared for people with COVID-19 but stepped up to lead in hospitals, practices, clinics, public health units and testing sites. They have spearheaded transitions to technology-based healthcare and begun research into COVID-19 responses and best practices. As the pandemic continues, these nurses and others like them will continue to provide care and find solutions. Now more than ever, I am proud to be a nurse.” – Pam Jones

“Thanks to Nashville Medical News for hosting this ‘event in print,’ and a special thank you to all the people who have supported me through the years, including my family, friends, mentors, colleagues, and clinic staff.  I want to remind everyone that prioritizing the people and things in your life is the key to having it ‘all.’  COVID-19 has put that sentiment into sharp focus for me, and I hope it does the same for others.” – Melissa Scalise AUGUST/SEPTEMBER 2020

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DEVELOPING NEW MEDICINES FOR THE FUTURE

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Kids, Classrooms and COVID-19

Pediatricians Weigh in on Risks, Benefits of Heading Back to School By MELANIE KILGORE-HILL

As schools reopen across the U.S., pediatricians are scrambling to help parents navigate growing concerns in children’s health. But a nationwide decline in routine vaccinations and well-child check-ups – coupled with missed opportunities to aid at-risk kids through spring and summer school programs - have physicians concerned about more than just academics. A New Normal Zachary Hoy, MD, pediatric infectious disease specialist at The Children’s Hospital at TriStar Centennial Medical Center and Nashville Pediatric Infectious Disease, said most practices have returned to normal hours, with a handful of new protocols in place. “In March, Dr. Zachary Hoy our clinics switched to telehealth-based appointments as we worked to figure out how to keep staff and patients safe,” said Hoy. “By now, I feel like most clinics have good policies in place for sick or back-to-school visits, so we’re encouraging parents to schedule those check-ups and vaccinations they might have been putting off.” Meg Rush, MD, MMHC, president of Monroe Carell Jr. Children’s Hospital at Vanderbilt, said routine checkups serve multiple purposes and shouldn’t be ignored. “We know that wellchecks, procedures and health visits are essential to the overall well-being of children and adolescents,” she Dr. Meg Rush said. “During scheduled visits, doctors evaluate a child’s growth and development, assess health issues and manage ongoing healthcare needs. These visits are just as important amid a pandemic as they were before COVID-19 arrived in our community, and so we urge parents not to delay routine care that is vital to their child’s ability to thrive.” Addressing Immunizations From April 2019 to April 2020, Tennessee providers gave 43 percent fewer immunizations – an alarming stat for schools and physicians, alike. Amid a growing trend toward anti-vaccination sentiments, Hoy said it’s essential to continue educating parents. “There are several things that we can’t protect against, nashvillemedicalnews

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so it’s important to get school-related vaccines and physicals,” he noted of risks that can be mitigated. Anna Morad, MD, pediatrician at Monroe Carell Jr. Children’s Hospital at Vanderbilt and president of the Tennessee Chapter of the American Academy of Pediatrics, blames misinformation for confusion about vaccinations. “It really concerns me when I see families declining Dr. Anna Morad all vaccinations,” she said. “Do they really know what each do? Parents need to think about each one separately and to have an accurate source of information.” That’s because fewer vaccinations mean a loss of herd immunity to diseases like measles and pertussis. “It’s one of the most important things we do for children’s health, and no parent wants their child to get sick,” said Morad, recognizing that families who aren’t vaccinating feel like they’re acting in their child’s best interest. “Do they fully understand the risk of contracting one of these illnesses? Until it happens in your child, it’s hard to comprehend. Pediatricians should have a good conversation about vaccinations, and parents should be able to ask questions without feeling judged or attacked.” Keeping Patients Safe Clinics and hospitals have taken lengthy measures to keep patients safe. Hoy’s patients – often high-risk - have swapped the waiting room for the car, are provided masks at the door and are encouraged to wash hands often. Emergency rooms, still avoided by some fearful families, have often been redesigned to keep patients safe. Preventative measures at The Children’s Hospital at TriStar Centennial include two separate waiting rooms in the Pediatric ER - one for children with symptoms of COVID-19 and the other for those with non-respiratory emergency concerns. Patients and visitors are screened with a temperature check upon entry, while pediatric patients are allowed one visitor at a time in the Emergency Room and hospital. Universal masking and frequent cleaning of common areas like waiting rooms also have been implemented. Children’s Hospital at Vanderbilt has taken similar measures, said Rush. “We are working to reassure families that we have public health safety measures in place to protect them against COVID-19 as they seek vital care for their children,” Rush said. “I know community pediatri-

–WELCOMES– JOHN R. BURLESON, MD Orthopaedic Spine Specialist

John R. Burleson, MD, graduated from Dallas Baptist University with a Bachelor of Science degree in Biology plus a Minor in Chemistry, and he earned his medical degree from University of Texas Medical School in Houston, TX. After medical school, he went to the University of Massachusetts Medical Center where he completed his residency in orthopaedic surgery, and spent an additional year completing an extensive research curriculum. Pursuing a specialty in spine surgery, Dr. Burleson was trained as a Spine Surgery Fellow at the Texas Back Institute. Dr. Burleson is a member of the American Academy of Orthopaedic Surgeons, the American Medical Association, and the North American Spine Society. Furthermore, he holds membership in the Society for Minimally Invasive Spine Surgery and the New England Spine Study Group. Dr. Burleson has published in scientific journals and he has published textbook chapters. One chapter covers the new and innovative topic of 3D printing in spine surgery. He currently has several manuscripts under peer review and plans to continue his research in spinal disease and injuries and to present his findings at national and international meetings. Dr. Burleson specializes in orthopaedic spinal surgery with an emphasis on minimally invasive techniques. Many of his patients do not require surgery, and are often successfully treated using nonsurgical options. For those who do require surgery, he uses the least invasive operative solution possible to help the patient heal quickly and achieve the very best outcome. He is also interested in implant design and prototyping and 3D printing and how it can be beneficial to orthopaedic spine patients.

TriStar StoneCrest Medical Center 300 StoneCrest Boulevard, Suite 200 Smyrna, Tennessee 37167 (615) 355-0533 | tn.hughston.com

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Kids, Classrooms and COVID-19, continued from page 15 cians have implemented similar measures at their practices. In our hospital and clinics, we have taken extra steps to ensure safety for children and families, including screenings, requiring that everyone wear masks  and  providing  socially distanced seating areas, to name a few things.” Hoy said most parents understand the new reality, and they’re starting to feel more comfortable coming in with new procedures in place. “Schools will be the same way,” he said. “This school year will look different, but soon everyone will get used to the new normal.” Back to School Returning to school has been an emotional topic for parents and school leaders, and Morad stressed the decision is not one-size-fits-all. “We want to be mindful that returning to school is best done in the context of a local environment and family situation,” she said. “Circumstances are so different for each family and school.” To that end, the AAP has developed guidelines to help mitigate the disease. “We don’t have the ability to eliminate COVID,” said Morad. “We want to mitigate the impact of COVID in the safest way possible for children, teachers and staff. But the AAP does believe we need them back to in-person learning when it is safe to do so.” AAP’s COVID-19 Guidance for School Re-entry notes, “Policies to mitigate the spread of COVID-19 within schools must be balanced with the known

Blog Log The Nashville Medical News Blog features additional insights and information from a cross-section of industry leaders. The blog can be accessed directly through NashvilleMedicalNews.Blog or from the homepage of the main website. Here are the latest additions to the blog: Rhonda Dickman, MSN, RN, CPHQ, clinical quality improvement specialist for the Tennessee Center for Patient Safety, a division of the Tennessee Hospital Association, shares ways healthcare providers and organizations can raise the profile on a silent killer during Sepsis Awareness Month this September. Craig Hodges, CEO of CarePayment, looks at smart ways to increase revenue and cash flow for cashstrapped hospitals and health systems, alongside options to help patients afford the care they need. Ian Oppel, OTR, MBA, DCCT, chief clinical officer for leading-edge telehealth company RESTORE Skills, shares insights into the state of skilled nursing facility therapy during COVID19 and looks at how the current climate might become a springboard for more positive outcomes moving forward.

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harms to children, adolescents, families, and the community by keeping children at home.” Mitigating Risks Morad said masking should still be the top priority for children developmentally able to wear one, but she stressed masks are protective, not preventative. According to the AAP, the CDC’s social distancing guideline of six feet may be unfeasible in schools, where three feet may “approach the same benefits if students are wearing face coverings and are asymptomatic.” Schools also can open doors and windows to encourage air flow, create plexiglass barriers, split classes into smaller groups, avoid assemblies and encourage frequent hand washing. AAP guidelines also suggest adults and adult staff within school maintain a distance of six feet from other persons as much as possible, particularly around other adult staff. Other strategies to increase adultto-adult physical distance in time and space should be implemented, such as staggered drop-offs and pickups, preferably outside when weather allows. It’s an undeniable amount of planning for school leaders, but pediatricians agree the payoff will be worth it. A sobering reality of virtual classrooms is the nationwide drop in reported cases

of child abuse. In Tennessee, reports were down 27 percent during peak stayat-home orders – a result of fewer kids being seen by school staff and trusted adults. Meanwhile, free lunch and backpack programs are a lifeline for the one in seven kids in the U.S. affected by food insecurity. To that end, Morad said many pediatricians are now screening for food insecurity and other socio-economic factors. “It’s important to screen for social determinants of health, things that will improve health for the entire family and child,” Morad said. Parents also should discuss concerns about academic performance with their pediatrician, who can help advocate for additional school services. Likewise, parents of children with underlying medical conditions should discuss risks vs. benefit of returning to class. Morad encourages pediatricians to grow their support network by connecting to resources in their communities. “We need to be coordinating and working within our existing infrastructure,” she said. “Being good stewards and helping to connect people is an important part of being a pediatrician.” And while COVID-19 in some classrooms is ultimately inevitable, Morad said school leaders need to remain flexible. “We anticipate we’ll see cases as schools reopen, so we need to figure out how we react to those in a mindful and

careful way, understanding that completely going back to virtual may put our most vulnerable children at more of a disadvantage,” she said. Links to AAP guidance and helpful resources are available at the end of the online version of the article at NashvilleMedicalNews.com.

New Employee at Vanderbilt Children’s has a Paws-itive Impact It’s no secret that pets make lives happier and healthier, especially in times of uncertainty. For many families, the benefits pets provide will now come at a time and place they may never have expected: during their child’s hospital stay in the middle of a pandemic.

Covering Kids

Concern Remains over TennCare Disenrollment By MELANIE KILGORE-HILL

In March, the Tennessee Justice Center filed a class action lawsuit on behalf of 35 children and adults who they believe were wrongfully terminated from the state’s Medicaid program. However, they also filed a motion for a preliminary injunction asking the court to reinstate coverage for 178,000 children and adults who had been terminated in the year before the March filing. Kinika Young, senior director of health policy and advocacy at TJC, said it could be days … or months … until the court rules on motions for class certification and a preliminary injunction, as  well as the state’s motion to dismiss the original case. “We are just beginning discovery, Kinika Young although it is limited pending disposition of the state’s motion to dismiss,” said Young. She added TJC’s intention was to ask the court to enjoin the state from cutting people from TennCare until systems problems at the root of many of the issues were fixed. “ Fortunately, Congress adopted a provision in its first coronavirus relief package that pays the states more

if they suspend terminations during the pandemic,” Young continued, adding Tennessee has stopped terminations to qualify for the extra funding. Anna Morad, MD, president of the Tennessee Chapter of the American Academy of Pediatrics, said the organization met with TennCare officials to discuss disenrollment and found the conversation to be positive overall. “I think it’s so complicated, because so many different factors went into those numbers,” said Morad. “Our take-home is we need to be proactive and mindful about what people need when they’re trying to comply with governmental applications and reenrollment.” She added that means having enrollment materials available in multiple languages, letting patients know if they’re eligible for Pandemic EBT, and how to apply for resources. Pandemic-related job losses are creating even more need for awareness, and Morad encouraged pediatricians to get involved by providing the TennCare phone number to patients and directing them to the website. “We need to make sure children coming off commercial payers are picked up, that they don’t lose coverage, and that families understand how to access coverage,” she said. “Responsibility falls to every single agency that has the ability to help. We’ve got to operate as a community. We’ve got to help each other.”

Earlier this year, Squid, a Canine Companions for Independence® facility dog, joined the team at Monroe Carell Jr. Children’s Hospital at Vanderbilt, arriving shortly before COVID-19 impacted the local community. With visitors to the hospital limited due to social distancing measures, Squid arrived on the job just in time to engage with patients and staff through this stressful time of unknowns.     As a Canine Companions certified facility dog, Squid, a 2-year-old black Labrador/Golden Retriever cross, has undergone extensive and highly specialized training for the last two years. Squid can perform more than 40 commands designed to motivate and inspire patients to obtain treatment goals. In addition to engaging patients in their treatment, the dog provides comfort and affection to support families and hospital staff experiencing the impact of intense medical situations. The Facility Dog Program at Children’s Hospital was established through collaboration with Mars Petcare to support a full-time facility dog and a staff position for coordination of the program, with the overall goal of showing the positive impact a facility dog can have on patients, families and staff.

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Injury Patterns in Older Adults Study Looks at Differentiators between Abuse, Accident By CINDY SANDERS

When an older adult patient presents with injuries, it can be difficult to distinguish whether the trauma was the result of a fall or physical abuse. For patients with dementia or trouble communicating, deciphering what led up to the injury is all the more challenging. Tony Rosen, MD, MPH, FACEP, assistant professor of Emergency Medicine at Weill Cornell Medical College and director of the Vulnerable Elder Protection Team based at New York-Presbyterian/Weill Cornell Medical Center’s Emergency Department, served as lead author on a recently published study that looks at injury patDr. Tony Rosen terns as a method of helping providers distinguish between unintentional injury and abuse. Rosen, who has focused his academic career on geriatric emergency medicine with a particular emphasis on elder abuse, was awarded the Society of Academic Emergency Medicine (SAEM) Young Investigator Award last year for his research efforts to improve care for this particularly vulnerable population. This most recent work – “Identifying Injury Patterns Associated with Physical Elder Abuse: Analysis of Legally Adjudicated Cases,” published in the Annals of Emergency Medicine – compared injury patterns in legal records of successfully prosecuted cases of physical abuse in victims aged 60 years and older with patients who presented to a large, urban, academic ED after an unintentional fall. “The first place that many vulnerable older patients turn for care is the Emergency Department,” said Rosen. “Emergency physicians have a unique opportunity to identify the ‘red flags’ for elder abuse.” Although it is estimated between 5-10 percent of older Americans are victims of mistreatment annually, the issue is widely recognized to be underreported. “Elder abuse is common and very serious but is seldom identified,” said Rosen. He added the literature suggests as few as 1 in 24 cases of elder abuse is ever reported to the authorities. The analysis matched 78 cases of elder abuse with visible injuries adjudicated between 2001 and 2014 to 78 patients with unintentional falls prospectively enrolled in the study between September 2014 and June 2018. Rosen explained researchers used the validated Elder Abuse Suspicion Index as part of the enrollment process for patients who reported injuries from a fall. Anyone suspected of being a victim of abuse was excluded from the study, with the research team’s concerns reported to the clinical care team and on-duty social worker for nashvillemedicalnews

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appropriate follow-up. The research team used a matching algorithm to align abuse victims and unintentional fall patients as closely as possible based on a number of characteristics. The comparisons resulted in some eyeopening findings highlighting differences in injury patterns between accident and abuse. “Physical abuse victims were more likely to have maxillofacial – face and neck – injuries,” Rosen explained. “Abuse victims were less likely to have fractures and less likely to have injuries to their lower extremities,” he continued, noting 8 percent of abuse victims had scrapes, fractures and injuries below the waist compared to 50 percent of those who fell. “It’s not just the presence of injury but the presence and absence at the same time,” he stressed of the emerging patterns, “so injuries to the face in combination of no injuries to the legs are suggestive of abuse.” Looking at the precise location of trauma, Rosen said abuse victims were more likely to have zygomatic bruising or injury on the left side compared to those who fell. The left cheek would be the side naturally struck by a right-handed person. He added more assailants are right-handed because more people are right-handed. Neck injuries are another red flag for abuse. “When you fall, your face protects

Abuse vs. Accident Abuse victims are more likely than those who fall to have injuries on the face, head and neck area (67% vs. 28%) and are much more likely to have injuries on the face, head and neck area combined with no upper and lower extremity injuries (50% vs. 8%). Abuse victims are less likely to have fractures (8% vs. 22%) or lower extremity injuries (9% vs. 41%). Facial injuries to the left cheek or zygoma are more common among abuse victims (22% present with such injuries) than those suffering falls (only 3%). Researchers found neck (15% vs. 0%) and ear (6% vs. 0%) injuries occurred in abuse patients but very seldom in falls. A potential explanation is that the neck is often protected in an unintentional fall. Of the 100 cases of physical elder abuse examined, 22% of victims had no visible injury recorded. However, in many of those cases, victims indicated pain in the arms, chest, abdomen, back, face and jaw.

your neck, and also your shoulder protects your neck,” explained Rosen. “If you were to see any injuries to the neck in the setting of a purported fall, that should at least raise concern.” Rosen added the reason it’s critical to identify injury patterns aligned with abuse versus a fall is because the most common false story for elder abuse is to claim the patient fell. “We think healthcare providers, and particularly Emergency Department providers, have a real opportunity to identify this (abuse) and initiate intervention. Yet, current research suggests Emergency Room providers very seldom do,” he con-

tinued. “Elder abuse is still a field in which there is so much to be done.” It’s also an area of growing concern as baby boomers are rapidly aging, swelling the ranks of the U.S. senior population. “This is a particularly vulnerable population,” Rosen said. “And as such, this is a population where we can really have an impact.” He concluded, “Recognizing injury patterns helps encourage an environment where more of these troubling cases of harm against some of the most vulnerable, at-risk older adult patients can be reported and addressed.”

Brookdale CEO Shares Industry Response to COVID-19

Address Part of Council’s Health Care Brass Tacks Series On August 13, the Nashville Health Care Council hosted an online member discussion with Cindy  Baier, president and CEO of the country’s largest senior living company, Brookdale Senior Living Inc.  The discussion was part of the Cindy Baier Council’s ongoing Health Care Brass Tacks series. Throughout the COVID-19 pandemic, the senior living industry has been in the media spotlight both for struggles in managing COVID-19 outbreaks and for ‘above and beyond’ efforts to serve vulnerable residents while trying to prevent spread of the virus. Baier spoke about her company’s strategy to manage the pandemic, prevalent misconceptions of the senior living industry, the importance of diversity in leadership and her outlook for the future.  In her earnings call earlier in the week,  Baier  had shared the good news that at the end of July, less than 1 percent of Brookdale residents had COVID-19

positive results, a significant accomplishment as the company has the ability to care for up to 65,000 community residents and also serves 17,000 consumers in home care and hospice across 44 states. She explained her strategy from the beginning of the pandemic was to learn as much as they could about the virus and move quickly against the possibility of outbreaks. “We essentially had to change our business model overnight. In addition to widespread testing of our staff and residents, we had to eliminate large group dining and outings and close to visitors. This meant changing the use of the interior of our buildings to allow proper quarantining as needed and implementing new technologies,” Baier said. “I’m proud of our ability to be a learning organization, that we were able to digest information and translate it into operations swiftly.” Since the pandemic began, the entire healthcare industry, including senior living, made a dramatic shift to telehealth in order to limit exposure while still providing essential care. Baier said new protocols were needed due to the pandemic. For example, Brookdale facilities needed

to manage more healthcare conditions inhouse rather than having patients receive care in hospitals. Baier also spoke to another timely topic – diversity in healthcare leadership. She has led the charge in her own company and now has a board made up of 44 percent women and has welcomed Brookdale’s first African American board member. Additionally, Baier has reached gender parity on her management team. “Diverse companies perform better. I don’t believe in diversity for diversity’s sake, but when you have a diverse slate of job candidates for example, you are getting the best pool,” she said. “What’s easier in the short term is not the easiest in the long term. So, I would advise leaders to demand a diverse slate when hiring for a leadership role. It may take longer to find those candidates, but it is worth it.” The ongoing Health Care Brass Tacks virtual series features prominent Nashville Health Care Council board members and CEOs, offering inside perspectives on the most pertinent aspects of healthcare today. 

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Council on Aging Offers Helpline, Resources for Healthcare Providers As professionals caring for older patients during COVID-19, it’s critical that we stay informed about community assistance available to older adults and their families. The Council on Aging of Middle Tennessee (COA) is a trusted nonprofit that assists By GRACE SUTHERLAND patients, caregiv- SMITH, Executive ers and profes- Director, Council on Aging sionals as they navigate options to find help. Through our comprehensive Directory of Services, free Helpline, and caregiving guides, we connect hundreds of older adults and caregivers with community resources and services. To guide our existing efforts, improve communications and outreach, and pivot services in response to the pandemic, COA convened our Leadership Council in April and surveyed members to assess the challenges and unmet needs of older adults and family caregivers during COVID-19. These members, represent-

ing more than 20 senior service organizations, reported that social isolation, access to food and medication, and supporting caregivers were the biggest challenges. They also said social connection, relief for caregivers, food access/delivery and emergency financial assistance were the needs not being addressed adequately. In response, COA has created a helpful COVID-19 resource list that is available on our website (coamidtn.org). The list will also be available in Spanish, Arabic and Kurdish in September. Additionally, the Directory of Services - an impartial listing of services and resources available in 13 Middle Tennessee counties - may be found online along with our Aging & Caring and Grandparents Raising Grandchildren guidebooks. Hardcopies are also available for healthcare providers wishing to make these available to older patients. Over the past several months, COA has also experienced a 100 percent increase in calls to our Helpline (615-3534235) as older adults try their best to stay healthy and manage the negative impacts of the pandemic. Similar to what we are hearing from our Leadership Council, the following are some of the most frequent concerns and requests we are receiving:

• How to apply for financial assistance like unemployment benefits, property tax assistance and emergency financial assistance, • Where to find and sign up for food and meal delivery, or pick up, • How to seek legal advice related to potential eviction or homelessness, abuse, financial exploitation, or lack of access to benefits, • Moving aging parents to town and needing to know how to enroll them into Tennessee Medicaid/TennCare, • How to pay for in-home and long term care with limited income, and how to apply for the TennCare CHOICES program, • Identifying and preventing scams when contacted by fake contractors or grant opportunities, • The best methods for dealing with stress and maintaining mental health when caring for a loved one with Alzheimer’s or a related dementia, and • What to do about feelings of loneliness and isolation while staying home to avoid exposure to COVID-19. Fortunately, there are many government and nonprofit agencies that are working together to adapt services and

ensure that older residents and caregivers find support during these challenging times. Friendly phone calls, drive through food distribution, distanced porch visits and meal deliveries, and video and phone counseling are just some of the ways that our community is helping older adults and caregivers maintain their health and stay connected. As a community of providers and professionals, we are all working together to help older adults and their families through these unprecedented times. As COA continues to do what we do best, we encourage providers and community organizations serving older adults to use and share our resources with clients and patients. Grace Sutherland Smith is executive director of the Council on Aging of Middle Tennessee, an independent, board directed 501(c) 3 nonprofit that champions informed and positive aging and serves as the area’s catalyst for collaborative solutions. COA provides free information and referral, community education, caregiver resources, elder abuse and scam prevention, advocacy, support for senior transportation and the Directory of Services. Reach out to Smith at gsmith@coamidtn.org or learn more about COA’s scope of work at coamidtn.org.

The Emotional Toll of COVID-19 in the Senior Population, continued from page 1 patients have died from COVID-19. The emotional effects related to the pandemic are inevitable for seniors, so loved ones and providers must remain diligent in the early detection Dr. James Powers of loneliness, anxiety, depression, stress or other mental illness. Social vs. Physical Distancing “We’re all at risk of the mental health and psychiatric consequences that can go along with isolation and the atmosphere of our world right now, but it’s important to realize that those who are a little older may be at higher risk,” said Luigi Cardella, MD, psychiatrist at Centennial Psychiatric Dr. Luigi Cardella Associates and TriStar Centennial Parthenon Pavilion. Cardella said one important thing family and friends can do is attempt to normalize some of their own emotions and thoughts to let seniors know it’s okay to feel sadness, worry and anger. Families should be alert when negative emotions become predominant or overwhelming, or if those emotions begin to impact day-to-day function, especially among those with a history of mental illness. A good strategy to start a conversation 18

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is for family members to voice their own feelings and how they’re dealing with them. “Let them know you’re under stress, too, so they can feel comfortable talking about how they’re feeling,” said Cardella. He also encourages families to reexamine their definition of social distancing. “The whole idea of social distancing is slightly detrimental in a sense,” he said. “What we really need is physical distancing, which is more important than social distancing, especially if we can use other strategies to accomplish socializing.” If it’s reasonable to visit a loved one, Cardella said to make sure they’re comfortable wearing a mask and try to maintain a physical distance. “We need to be a little bit flexible by shifting the focus on the COVID-19 high-risk toward a mental health high-risk,” he added. Loneliness or Isolation? Cardella also stressed the difference between feeling isolated and feeling lonely. “We’re all a little isolated because we have to be, but lonely is a different beast,” he said. “Feeling that you’re alone brings with it anxiety, depression and lots of negativity.” From drive-by parades to virtual birthday parties, families should get creative in reaching out when they’re not comfortable visiting or if long-term care rules prohibit onsite visits. Items sent from home and hand-written letters also resonate well with the older generation. “Think of something from the heart that has a lot of meaning to it that you took the time to write and send,” Cardella said. “That carries negligible risk

and helps make sure the feeling of loneliness isn’t profound.” Don’t Delay Care Providers are urging seniors to continue their routine check-ups to help catch diseases in their earliest stage. Powers still sees two-thirds of his elderly patients via telehealth, and he urges providers to continue offering the service to older adults, particularly for return visits. “CMS is covering 600 CPT codes through telehealth, so if you already know the patient, telehealth visits can be very meaningful,” he said. And while routine labs can often be delayed, Powers said Americans need to learn from patients in Italy, who delayed care out of fear of hospitals and experienced a high volume of athome deaths from heart attacks. “We need to stress to patients that if it’s an emergency, you need to come in because it’s worth the risk,” he said. Advice to GPs Because general practitioners provide the most psychiatric care in the country, Cardella advised them to be extra alert to signs of depression and anxiety. Asking about sleep and weight changes, day-to-day rituals and if patients are engaging in activities that keep up their interests could help uncover subtle red flags. “Make sure that, although their normal day-to-day functioning is different from six months ago, they’re still functioning appropriately,” he said. Cardella also stressed the importance of prioritizing the mental health of

caregivers – an often-overlooked population. “When a caregiver is struggling with depression and anxiety, it impacts the care being delivered,” he said. “You can end up in spiral loop where the caregiver is affecting the person being cared for and back to the caregiver.” And if help is needed, don’t hesitate to find it. “This is a really trying time, but the good news is that the depression and anxiety disorders we’re seeing aren’t new,” Cardella said. “We have effective treatments for them and can help get this under control.” Powers agreed, “We’re all in this together … and together we’ll get

Mark Your Calendars AJMC® Hosts PatientCentered Oncology Care® 2020 • Sept. 25 Virtual Conference

The American Journal of Managed Care® will bring together renowned experts to deliver insights on the future of value-based oncology care during an online conference. Originally scheduled in Nashville, featured speakers will engage in discussions on policy, precision health, chronic care management, biosimilars, the impact of technology and telehealth on value-based medicine, and more. For more information and to register, go to ajmc.com/meetings.

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Economic Effect of COVID-19 Shutdowns & PPP Relief Five months after the initial COVID19 shutdown, it is apparent that most, if not all, industries have been impacted by shutdowns, restrictions and quickly changing guidelines and best practices. Physician practices and other healthcare providers were among the hardest hit, effectively By CALLIE WHATLEY, closing in most Partner, Burr & Forman states for seven LLP weeks (or more), coupled with elective procedures at a virtual standstill. As restrictions have lifted and companies have made appropriate health and safety-related changes to policies and procedures, many people are back to work, but most would probably agree that things look and feel different, and the financial impact of the crisis still remains. Once the impact of COVID-19 became apparent, the federal government implemented several relief programs, and loans made under the new Paycheck Protection Program (“PPP”) became one of the most publicized relief efforts put in place, largely due to the forgiveness aspect of these loans. A part of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) passed in late March, these loans were so popular that the original amount reserved had to be increased. According to the U.S. Small Business Administration (SBA), through July 10, 2020, businesses in the healthcare and social assistance fields received 12.91 percent of all PPP loan funds (based on total dollars loaned), which is the highest among the industries reported. In the first several months after the passage of the CARES Act, the regulations and guidance surrounding PPP loans seemed to change as frequently as information about COVID-19, but that has been leveling out to some extent since late June. PPP loans are only available to businesses that have 500 or less employees or are otherwise considered small businesses under applicable SBA regulations (where, in some cases, a business can have more than 500 employees and be considered a small business), with some exceptions for businesses in the restaurant and hospitality industries that were permitted to count employees by location under the CARES Act. A nuance in the eligibility requirements came in the form of economic necessity, such that in applying for a PPP loan, each applicant is required to certify in good faith that the “[c]urrent economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.” This became a focus of media attention, particularly after it nashvillemedicalnews

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became known that several very large, publicly traded companies received PPP loans. After several weeks of uncertainty, the SBA released guidance providing a safe harbor for borrowers who (along with affiliates) received loans less than $2,000,000, providing that those borrowers were deemed to have made the certification in good faith. This means that those who received loans greater than $2,000,000 will need to be prepared to demonstrate the circumstances facing their respective businesses created a good faith basis for applying for and receiving the PPP funds. The SBA has not provided specific guidance on this point, but borrowers should collect and maintain documentation showing the negative financial impact of COVID-19 on their business, such as comparative sales/revenue reports for comparable periods prior to COVID19, evidence of government mandated shut-downs and other similar documentation. Originally, only PPP funds that were used in the 8 weeks following the loan qualified for forgiveness, but the Paycheck Protection Program Flexibility Act of 2020 (Flexibility Act) provides borrowers the opportunity to elect to extended the covered period to 24 weeks (but no later than Dec. 31, 2020). The CARES Act places restrictions on the use of PPP loan funds, and only the following uses are eligible for forgiveness: (1) payroll costs, (2) utilities, (3) qualified rent (meaning rent under a real property or personal property lease entered into prior to Feb. 15, 2020 with an unaffiliated entity), and (4) mortgage interest on a mortgage in place prior to Feb.15, 2020 (also must relate to real or personal property). Payroll costs include more than just salary costs but do include salary caps and further restrictions on the types and amounts of payroll costs that can be included for employee-owners (which may vary depending on the type of entity and whether the borrower chooses an 8-week or 24-week covered period). Additionally, where only 25 percent of the forgiven loan amount could be used for non-payroll purposes under the CARES Act, the Flexibility Act increased this to 40 percent, meaning that 60 percent of the forgiven amount has to be used for payroll purposes, but 40 percent can be used for utilities, rent or mortgage interest. Expenses that are eligible for forgiveness must be paid during the covered period or incurred during the covered period; provided, however, that in order for incurred expenses to be eligible for forgiveness, they must be paid on the next regular payroll date (for payroll costs) or on or before the next regular billing date (for non-payroll costs). A borrower’s PPP loan forgiveness amount may be decreased to the extent its average number of “full-time equivalent employees” during the applicable period is less than the average number of such

employees per month during one of the applicable measuring periods. Note that various non-PPP-related rules require determination of full-time equivalent employees, and a borrower should take care that the determination of its fulltime equivalent employees for purposes of PPP loan forgiveness follows the method described in the forgiveness application. There is a safe harbor if any reduction is corrected by Dec. 31, 2020, and there is also a safe harbor if the borrower can show that it was unable to re-hire individuals or hire similarly qualified individuals or was otherwise unable to return to the same level of business activity due to compliance with COVID-19 related safety standards. A borrower’s forgiveness amount may also be reduced in the event an employee’s wages have been subjected to a greater than 25 percent cut compared to that employee’s wages in the first quarter of 2020 and such cut is not corrected by Dec. 31, 2020. The application provides a step-by-step worksheet to help borrowers determine whether this forgiveness amount reduction could apply to it. PPP borrowers will apply for forgiveness with their respective lenders, and the applicable lender will make the forgiveness determination (subject to automatic SBA review if the loan is over $2,000,000). As part of its forgiveness application, a PPP borrower must submit a loan forgiveness calculation form and a correlating schedule (known as PPP Schedule A), as well as a host of other supporting documentation verifying payroll costs, showing employee numbers and non-payroll costs that are eligible for forgiveness. Each borrower should be careful to include support for any expense claimed for forgiveness with its application. In addition

to the foregoing, borrowers must maintain other documentation, as specified in the Loan Forgiveness Form, and maintain all such records for at least 6 years after the date of PPP loan forgiveness. The application explicitly contemplates that borrowers should permit the SBA access to such documentation upon request. It is important for PPP borrowers to carefully review the required documentation with their respective advisors to fully understand the documentation and retention requirements. Forgiveness decisions on PPP loans over $2,000,000 will automatically be audited by the SBA, but this does not mean that loans under $2,000,000 will not be audited. Similar to the need to be prepared in the event of an audit by the IRS, all PPP borrowers should keep appropriate documentation and be prepared in the event of an audit of its PPP loan. Undoubtedly, PPP loans have provided a valuable lifeline for many businesses that have struggled and continue to struggle in the midst of these very uncertain times, including physician practices and other healthcare providers. As PPP borrowers continue to operate and enter into the forgiveness phase of their loans, it is important that they keep meticulous and detailed records supporting the use of PPP funds and the forgiveness application, and also maintain open communication channels with lenders and advisors in order to ensure compliance. Callie Whatley is a partner in the Birmingham office of Burr & Forman LLP, which has more than a dozen offices primarily in the Southeast, including Nashville. Whatley, an experienced transactional attorney, advises healthcare clients on corporate matters as well as PPP Loan compliance. She is vice chair of the firm’s Corporate & Tax Practice Group. For more information, go online to burr.com.

From Pain Management to Pandemic, continued from page 7 few weeks,” Sullivan said. “Zero pain isn’t normal, especially after a major surgery. If patients say they can’t function or get up, I tell them it’s their body telling them to slow down. If we get you numbed up to go about a normal day but your body hasn’t healed, it won’t heal.” Martin also discusses the protective nature of pain. “It gives us guidelines,” she said. “We have such a go-go-go society that it’s hard to just rest and recover.”

Finding a Balance

Sullivan said those with anxiety and depression are more likely to struggle with prolonged pain and that it’s important in those situations to be proactive about treating the whole patient … not just the injury. For some, that means additional support networks, like therapy, to help with pain management and recovery strategies. The pediatric and geriatric

populations are generally the most compliant in coming off narcotics. In fact, the majority of Sullivan’s high school athletes stop opiates altogether within a few days post-ACL reconstruction, and those who request more are given a concrete plan for weaning off. He often compares narcotic use to developing a morning coffee routine – and how the same cup six weeks later has a far less noticeable effect – although we feel much more tired if we don’t have it after becoming accustomed to it daily. “Our bodies adapt, and the sooner you’re off narcotic pain killers the less rebound pain you feel,” he said. “Once patients understand the risks associated with prolonged narcotics, it helps significantly. We are on their team, and we want them to reach their goals of living an active life.”

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Practice Management Q&A with NMGMA By CINDY SANDERS

Recently, Nashville Medical News had the opportunity to sit down with the current president and incoming president of the Nashville Medical Group Management Association (NMGMA) to get their take on some of the most pressing issues facing physician practices. Laura Watkins, FACMPE, CPC, senior medical practice consultant for SVMIC, is wrapping up her term as NMGMA president. In October, Kathi Carney, CPC, CPMA, CPC-I, CHC,

director, LBMC Physician Business Solutions, takes the gavel to lead the Nashville affiliate of the national practice management organization. NMN: What new challenges must practice managers address in the midst of disruption from COVID-19? Laura Watkins (LW): With COVID-19, we have witnessed the rapid and exceptional transition of operational processes and protocols in medical practices. From introduction to integration of technologies such as telemedicine and

virtual services, implementation of advanced safety protocols and modifications to staffing, practices continue to fine-tune their operations to ensure patient safety and employee health. In addition, Laura Wakins many practices are experiencing lower patient volume and postponement of elective surgeries and procedures. The result has been decreased or delayed practice

revenue. Depending on the financial situation and resources of the practice, financial viability may pose an additional challenge. Kathi Carney (KC): I think the biggest challenge is being able to think outside the box. The whole work flow of their practices was disrupted ‌ but practices needed to learn how to adapt. Many had to quickly implement telehealth, reduce staffing, modify their schedules and Kathi Carney figure out how to continue to care for their patients. NMN: Outside of the pandemic, what are some of the top ongoing issues managers must address? KC: Revenue is always a source of concern, inside or outside the pandemic. Staying up-to-date on all the regulation and carrier regulations can be a daunting task. New ICD 10 codes and major CPT changes are coming for 2021 (E/M codes), as well as reductions on payments. It’s what keeps most practice administrators up at night. LW: Practices will need to continue the transformation to value-based care and explore ways to optimize and broaden patient access to comprehensive healthcare services by improving operational efficiencies, quality of care and patient experience. While awaiting further guidance on telehealth coverage, practices should investigate additional healthcare delivery and engagement options. Practices should check with their EHR vendor, other technology vendors and payers to evaluate the possibilities.

Foresight in 2020. We believe that your malpractice insurance team should be ready and available when you need them most. SVMIC is built on this kind of reliable and dedicated relationship, so you can focus on your practice and we can focus on protecting it.

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NMN: Realistically, how do you stay on top of myriad functions if you are a small practice? LW: Frequent changes and updates are common in healthcare and demand regular review of governmental, payer, and industry resources. This undertaking can consume a great deal of time, which can prove especially challenging for a small practice with limited staff. If considering outsourcing, managers should begin by identifying, assessing and determining the areas in the practice that would be most cost effective. Potential areas of consideration are IT management, billing, social media or payroll. KC: Within a small practice , the administrator definitely has their hands full. To be able to manage and be in the know, I recommend aligning yourself with others in the same specialty or field. I also recommend outsourcing those functions that make sense to outsource, be it revenue cycle, credentialing or even perhaps bookkeeping. Outsourced companies are laserfocused on the task at hand and can save a practice money, as well as providing peace of mind knowing that this particular task is being handled by experts in their fields. (CONTINUED ON PAGE 21)

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Physician Practice Leadership in a Post-COVID-19 Environment The COVID-19 pandemic and resulting global healthcare crisis have altered physician practice leadership and will significantly change both the way medical practices operate and how providers deliver care. As we look to a post-COVID-19 landscape, LBMC y ANDREW McDONALD, has identified BFACHE, Shareholder & three key areas Practice Leader, , LBMC medical practice Healthcare Consulting leadership should begin evaluating now for optimal postCOVID-19 care delivery.

Patient Access & Treatment Delivery Model Transformation

To support social distancing and risk mitigation, many providers successfully pivoted to telehealth to deliver services for their patients. Regulatory agencies and insurance payers have, for the most part, embraced this adoption by providing additional coverage and expanded flexibility as it pertains to technology and the originating/distant sites. Concurrently, patients have experienced enhanced ease of access with reduced virus exposure concerns and long waits. For those providers that have embraced the shift in delivery by altering scheduling templates and investing in technology, the percentage of ‘no show’ appointments has been reduced, creating enhanced productivity and financial performance. A successful transition to (and continued enhancement of) this new model will position practice leadership for future successes. Practice leadership will need to either acquire and/

or train current staff to fully support this new vertical in the delivery of care.

Assess Potential M&A and Employment Opportunities

Some practices will not have the cash flow or risk tolerance to maintain their practices as a result of COVID-19. In these instances, merging with a larger group or healthcare system or selling their practices represent alternatives to simply closing the practice. Private equity firms have emerged as key players in the industry in recent years, and it is likely they will continue to purchase practices post-COVID-19 as they see enhanced value in the marketplace. As a result, post-COVID-19 purchase price offers will likely be less than before the pandemic. Physician practices reviewing their options to merge or be purchased should conduct sell-side reviews via an experienced consulting firm to assess operational opportunities to improve and to enhance the overall value of the practice. Strategic planning to gain consensus among the group will be critical to map a successful path forward.

Consider an MSO to Provide Back-Office Support

Despite the various CARES Act relief funds (i.e. PPP), many medical practices were forced to furlough key staff or were unable to provide the technology to support a virtual employee model. Many medical practices lack resources due to historically lean staffing levels. For these practices, a management services organization (MSO) can provide support services (revenue cycle, HR, accounting, technology) to maintain operations post-COVID-19 while enabling clinicians to continue to provide care. As many patients may have lost their jobs and associated health insurance, an enhanced focus on patient collections will

Practice Management, continued from page 20 NMN: No matter what the practice size, administrators have to wear a lot of hats. What’s the best advice you’ve received, and what advice do you share with others coming up in the profession? KC: My best advice is that you cannot do it all! You have to have a great support system, such as colleagues in the same specialty groups or MGMA. Having that network is essential … even if it is just for a sounding board when you are looking for a solution to an issue. LW: For me, it was not words of advice but an observation of a leader in my early career that made an impression. This individual exhibited confidence in his employees … and if a mistake was made, he would turn it in to a teaching moment. His goal was to empower our growth and development by providing guidance and learning opportunities. In the ever-changing healthcare climate, administrators should invest in nashvillemedicalnews

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employee training, development and continued learning. NMN: What often gets overlooked but is important to success? KC: I have learned over the years, as I have seasoned in the role, that you need to utilize all the resources you have available to you. MGMA, your specialty professional organization, TMA, SVMIC and others are great resources for education that can make your tasks easier. As you grow in your role, or evolve, never forget to seek out education. If you do not open your mind to new ideas, the practice … and you … will fall behind. LW: The practice management role is challenging. I encourage you to develop and make new connections with others in similar positions. As a member of Nashville MGMA, the knowledge, education and connections I have garnered over the years are irreplaceable, and I welcome you to join NMGMA too!

assist practice leadership in maintaining cash flow. Practices and providers should vet an MSO’s ability and expertise to gain greater leverage with payers and related vendors to optimize the practice’s financial performance. By outsourcing back-office functions, practice leadership can focus on other key sustainability issues within the organization.

Prepare Now for Post-COVID

If you lead a physician practice, your practice is undoubtedly experiencing the effects of the COVID-19 pandemic. As we continue to grapple with the global health-

care crisis, now is the time to look not only how your practice operates, but how you safely take care of patients. There are options available to leverage your valuable resources in order to optimize the financial and operational performance of your practice. Consult an expert to ensure you are prepared to effectively run your practice and provide patient care in a post-COVID world. Andrew McDonald is shareholder and practice leader of LBMC Healthcare Consulting and LBMC Physician Business Solutions. He can be reached at amcdonald@lbmc.com or 615.309.2474.

Meharry, Wharton Partner on Dual Degree Program

Students Earn MD & PhD in Health Care Management By CINDY SANDERS

This summer, two prestigious academic institutions announced they have joined forces to foster greater diversity in healthcare leadership. Meharry Medical College and The Wharton School of the University of Pennsylvania unveiled a new partnership that creates a joined MD/PhD program with students earning their medical degree from Meharry and doctorate in Health Care Management from Wharton. Launching in 2021, the partnership represents the first of its kind for both institutions. Although Meharry has an established MD/PhD program for medicine and biomedical research, this is the first foray into a doctorate focused on the health policy side. “There has been such a paucity of people of color in health policy,” noted A. Dexter Samuels, PhD, MHA, senior vice president for Student Affairs and executive direcDr. Dexter Samuels tor of the Center for Health Policy at Meharry. “There is a real need to increase the pipeline, and Meharry is going to do its part.” While the program is new, Samuels said collaboration between the two schools was already in place. “We’ve had an ongoing relationship with Wharton as part of the Center for Health Policy,” he noted, adding Wharton has representation on the Center’s National Advisory Board.

Faculty from Wharton have presented in Nashville, and Meharry faculty members have participated in Wharton’s Leonard Davis Institute of Health Economics (LDI) annual Summer Undergraduate Minority Research program for nearly a decade. “It’s been a very fruitful relationship for both of us,” said Samuels. With that foundation in place, this next step was a natural outgrowth of the relationship and of critical need. Pointing to current events and the well documented disparities seen during the COVID19 pandemic, Samuels said, “This is a ripe opportunity for our students to be involved on the medical/clinical side and on the research side to really focus on health equity and health disparities.” While the detailed mechanics of the program are still being finalized, Samuels said the plan is to begin recruiting now with a December 2020 deadline to apply for the first cohort in 2021. He added students would likely begin their medical degree in Nashville, go to Pennsylvania for their doctoral work, and then return to Meharry to finish their medical degree before heading to residency. Potential students are being recruited internally on the Meharry campus, but Samuels said there is also a robust recruitment plan nationwide. “Fostering a more diverse healthcare arena has been Meharry Medical College’s goal since our founding,” said Samuels. “We are so proud of the collaboration we have maintained with LDI over the years, and this agreement is another example of our combined efforts to change the landscape of the healthcare workforce.” AUGUST/SEPTEMBER 2020

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GRAND ROUNDS

Let’s Give Them Something to Talk About!

Awards, Honors, Achievements Nashville-based medication adherence technology company AdhereHealth has been named as a finalist in the Fierce Innovation Awards – Healthcare Edition 2020, a peer reviewed awards program from the publisher

of Fierce Healthcare. AdhereHealth was recognized in the category of Clinical Information Management for its  COVID-19 Adherence Solution.  Thomas L. Ely, DO, FACOFP, FAAFP, was installed as the 124th president of the American Osteopathic Association (AOA). Ely, an AOA boardcertified osteopathic family physician and fellow of the American College of

Paslick Inducted into NTC Hall of Fame During the Nashville Tech Council’s recent virtual annual meeting, HCA Healthcare Senior Vice President and Chief Information Officer Marty Paslick was recognized as the 2020 NTC Hall of Fame inductee. Paslick has worked with HCA for more than three decades and today leads the Information Technology Group with more than 5,800 employees across the U.S. In presenting the award, NTC Board Chair Amy Henderson noted, “While Marty’s professional achievements are many, we are also here to honor him today for his leadership and generosity within the greater Nashville tech community. Through his involvement in numerous community organizations and initiatives, Marty has helped shape the direction of IT in the region for more than 30 years.”

Your Advocate & Expert For Practice Management

In an uncertain practice environment, it’s never been more important to have access to accurate, timely information.

Join NMGMA Today Take advantage of a 2020 half-year discount good on new memberships with NMGMA for practice administrators and students. Membership includes access to educational programming including monthly meetings, webinars, online resources and ACMPE information, as well as networking opportunities with industry peers.

To join at the half-year discount rate, go online to www.NashvilleMGMA.org and use the code 2020NMGMA. 22

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Osteopathic Family Physicians and the American Academy of Family Physicians, is a 20-year combat veteran who lives in Clarksville. His inauguration was held virtually during the an- Dr. Thomas Ely nual AOA House of Delegates meeting. Laurie Sprung, PhD, MPH, executive vice president of the Consulting Division at Advisory Board, has joined the the Covenant Board of Directors as an Independent Director. Revenue cycle management services firm Parallon has been named one of  America’s Best Employers for Women 2020  in a collaboration between Forbes and market research firm Statista. Women make up 88 percent of Parallon’s workforce and 74 percent of its collective management team. Nashville technology firm Jeter IT has been named to Channel Futures’ list of top IT Managed Service Providers in the U.S. Jeter IT was ranked 108th national and was one of the top Tennessee companies recognized.

Business Briefs

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

PUBLISHED BY: Graham | Sanders Publishing, LLC PUBLISHERS Susan Graham & Cindy Sanders SALES 615.397.2836 Cindy Sanders Ford Sanders Pam Harris MANAGING EDITOR Cindy Sanders csanders@nashvillemedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com CONTRIBUTING WRITERS Melanie Kilgore-Hill, Nate Lykins, Andrew McDonald, Cindy Sanders, Grace Sutherland Smith, Callie Whatley

emids has acquired information technology firm FlexTech. Warburg

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Pincus and Martis Capital have agreed to merge their respective portfolio companies, Qualifacts and Credible Behavioral Health. Bridge Connector has raised $25.5 million in Series B funding to advance interoperability layer for healthcare. Nashville

—— All editorial submissions and press releases should be emailed to: editor@nashvillemedicalnews.com

business leaders Turner Nashe, Jr., EdD, and Patrick H. Johnson have launched ReCOVer-Health, a COVID-19 management organization delivering customized virus mitigation strategies. Change Healthcare has acquired Nucleus.io to create the first-of-itskind, end-to-end, cloud-native enterprise imaging platform. Ascension

Saint Thomas Rutherford has partnered with Contessa to bring the Hospital Care at Home program first launched in Nashville last year to Rutherford County. Nashville-based behavioral health company Synchronous Health has entered into a strategic partnership with Adventist Health to provide customized behavioral health and well-being solutions.

Stafford Named TriStar Summit CNO Heather Stafford, MBA, BSN, RN, NE-BC, has been announced as TriStar Summit Medical Center’s new chief nursing officer. Stafford, who has been serving as associate CNO since July 2019, started her career at the hospital 16 years ago as a nurse techni- Heather Stafford cian in the Emergency Department.

—— Subscription requests or address changes should be mailed to: Nashville Medical News 105 Spring Ridge Lane Nashville, TN 37221 615.646.3916 (FAX) 615.673.8819 or e-mailed to: subscribe@nashvillemedicalnews.com Nashville Medical News is published monthly by Graham | Sanders Publishing, LLC. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Nashville Medical News will assume no responsibilities for unsolicited materials.        All letters sent to Nashville Medical News will be considered the newspaper’s property and therefore unconditionally assigned to Nashville Medical News for publication and copyright purposes.

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August/September Grand Rounds More details on these announcements and others online at NashvilleMedicalNews.com

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Profile for Medical News

August/September 2020 Nashville Medical News  

your primary source for professional healthcare news

August/September 2020 Nashville Medical News  

your primary source for professional healthcare news