FOCUS TOPICS PEDIATRICS • REIMBURSEMENT
Your Middle TN Source for Professional Healthcare News
John W. Brock, III, MD ON ROUNDS
Getting Your Piece of the Pie When providers and medical staff are asked about reimbursement in medical practices today, the first response might be a loud groan. Getting and keeping the reimbursements your medical practice deserve has become increasingly difficult over the past few years because of ever-changing federal and state rules and regulations, as well as the growing change in healthcare culture ... 8
TriMED Conference Set for September Second Annual Statewide Conference will Focus on Opioid Epidemic Clinical and administrative healthcare professionals from across Tennessee will gather next month in Nashville for the second annual TriMED Healthcare Education Summit ... 12
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Caring for Kids
Local Agencies Provide Hope, Healing for Mind & Body By MELANIE KILGORE-HILL
It takes a village to raise happy, healthy children. While there are countless obstacles – from addressing social determinants and cyberbullying to having access to specialty care – Middle Tennessee is fortunate to have numerous resources to help care for body, mind and spirit of the region’s youngest residents to give area children the best chance to grow and reach their full potential. In addition to information on the organizations featured in this article, the accompanying resource box (see pages 5-6) offers a quick reference of services helping children and teens to share with patients and their families.
PHOTO: MICHAEL RIVERA
August 2018 >> $5
Nationally, one in four girls and one in seven boys will experience some form of sexual abuse by age 18, and many cases will never be reported. In Middle Tennessee, victims of sexual abuse find respite at Our Kids, which provides 24/7 expert medical evaluations and crisis counseling services in response to concerns of child sexual abuse. The team of medical and mental health specialists also works to increase community awareness, conducts research and offers education and training about child sexual abuse. “Sexual abuse is so different from physical abuse or neglect because the perpetrator doesn’t want to injure the child or lose
Updating the Way to Pay
CMS Proposes Major Changes to 2019 Physician Fee Schedule, QPP By CINDY SANDERS
Last month, the Centers for Medicare and Medicaid Services issued the proposed rule for the 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP). Billing the changes as ‘historic’ in an effort to ‘modernize Medicare and restore the doctor-patient relationship,’ the proposed rule looks toward administrative simplification to streamline paperwork when billing Medicare and to increase reimbursement options for telehealth services. In releasing the information, CMS officials also said the proposed rule would allow clinicians to document clinically meaningful information into the electronic health record (EHR) instead of information pertaining only to billing purposes. CMS Administrator Seema Verma said the proposed changes to the PFS and QPP underscores CMS’ pledge to put patients over paperwork. “Physicians tell us they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time from patient care,” stated Verma. (CONTINUED ON PAGE 12)
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John W. Brock, III, MD
Monroe Carell Jr. Surgeon-in-Chief Emeritus Cares for Patients & Programming at One of the Nation’s Foremost Pediatric Hospitals By CINDY SANDERS
Growing up in the Chattanooga suburb of Rossville, Ga., John W. Brock, III, MD, was the oldest of five children in a household where curiosity and learning were highly valued. “My parents were very interested in education,” recalled Brock, whose father built a successful insurance business from the ground up and whose mother put her teaching skills to good use, first in a classroom and then with her growing family. Brock said his parents made it a priority for all five of their children to receive a quality education. An excellent student-athlete at McCallie, one of the top boy’s college preparatory schools in the Southeast, Brock headed two hours west to Vanderbilt University after graduation. “I knew very early on I wanted to have some sort of professional development, but there was no one in my family who had ever been in medicine,” he explained. Arriving in Nashville, Brock turned to one of his academic interests when he decided to major in history, while still taking all the courses required for premed students. “I felt strongly I wanted to be well rounded, and that has served me well,” he said, adding, “I’m still a history buff to this day.” Focusing on the sciences and medicine, however, soon became his passion. As an undergrad and later as a medical student, he found the work intellectually challenging and exciting. It was also well suited to his desire to be a servant leader. “I knew it was an incredible opportunity to be able to help people,” Brock said of his life’s work. After graduating from Vanderbilt in 1974, he embarked on the next phase of his training at the Medical College of Georgia in Augusta. It was there that he was introduced to the specialty that would shape his career. “Roy Witherington was chairman of Urology. He was an outstanding physician and an outstanding human being, and it was hard not to be attracted to what he was doing,” Brock said of his early mentor. Brock loved the intricacy of the field and the diversity that comes with deploying both surgical solutions and long-term management in an effort to maximize outcomes for patients. “I get the best of both worlds. I can fix some problems immediately, and I also have some long-time patient relationships,” he noted. After medical school, Brock returned to Tennessee for a surgical internship at Baptist Memorial Hospital in Memphis before accepting a residency position at Vanderbilt University Medical Center (VUMC) in urology. In 1983, he was named chief resident for the discipline. Once his training was completed, 2
Dr. John W. Brock, III - Monroe Carell Jr. Professor, Surgeon-in-Chief Emeritus, Senior Vice President of Pediatric Surgical Services, Director of Pediatric Urology, & Professor & Chief of the Division of Pediatric Urologic Services for Monroe Carell Jr. Children’s Hospital at Vanderbilt
Brock accepted a position in the community while maintaining his surgical privileges at Vanderbilt. It wasn’t too long, however, before he was drawn back to the academic medical center that had played such an important role in his education. “In 1992, Dr. Jay Smith came as the new chair of Urology. He asked me to build the pediatric program from scratch. It was a train that was moving and had a door open … I just couldn’t say ‘no’ to getting on board,” Brock said with a smile. At that time, the Children’s Hospital was embedded within VUMC. It would be a little more than a decade later when the ribbon was cut on the freestanding Monroe Carell Jr. Children’s Hospital at Vanderbilt … but the work of building one of the nation’s top pediatric urology programs began immediately. “We started with a staff of one physician – me – and great nurses,” Brock recalled. “Now we have seven pediatric urologists and are one of the biggest practices in the nation.” It’s also a program that is recognized as one of the best in the nation. The latest U.S. News & World Report ranking of “Best Children’s Hospitals” was released in late June, and Monroe Carell Jr. Children’s Hospital at Vanderbilt earned national rankings in 10 out of 10 pediatric specialty programs (see box). “We’re ranked in all 10 specialties and have been for many years,” said Brock. “My individual program has been in the top 10 since the inception.” Indeed, the pediatric urology program leads the way with a ranking of No. 6 in the country. Brock was quick to say that rank-
ing is only possible through the work of many hands. “We’re a team, and we’re successful because we have a fabulous team,” Brock noted. He added the integrated team includes researchers, techs, and administrative staff, in addition to physicians and nurses, who all pull together to deliver the best possible care to their young patients. Although Brock is very hands-on with urology, he also has oversight of the entire U.S. News & World Report process. Serving as the hospital’s surgeon-in-chief for the past 15 years, he was asked to also take on the responsibility of leading the deep statistical dive required by the publication. “It’s a huge data collection process. We have to have to have data integrity,” he explained. “My role is to shepherd that process, but I don’t do any of the work … that’s done by a lot of great people,” he said with a laugh. While it’s difficult to attain such national status across so many programs, maintaining that level of quality could be equally as difficult without having a mission-oriented group focused on clinical care, discovery and education. The mantra, he said, is: “I can always do better. We can always do better.” Still, during a long and distinguished career, there are many achievements for which Brock is understandably proud. Among his top highlights are developing a world renowned Division of Pediatric Urology, being on the ground floor of building and growing the Children’s Hospital, and being part of a team that has hired dis-
tinguished faculty who have stayed with Vanderbilt. “We are blessed with that continuity,” Brock said. “They have foregone multiple other opportunities at outstanding institutions to be part of this program.” On a personal level, he said, “My greatest honor in my career was when I was asked to be the Monroe Carell Jr. professor. To hold the endowed chair from the family who spearheaded the building of this hospital is an incredible honor that I don’t take lightly.” Outside of his work, the surgeon revels in his family. A father of three daughters, his eldest two are married with children. Elizabeth is a nurse practitioner at the Children’s Hospital, and Grace is a banking executive here in Nashville. He and his wife of almost 20 years, Lisa, are proud parents of Anna, a rising ninth grader at Ensworth High. “My three daughters and my wife are the loves of my life,” Brock said with evident joy. A lifelong athlete, Brock enjoys playing golf and tennis and has run several marathons. “I love the outdoors,” he added. Brock recognizes the importance of recharging outside of the hospital walls so that he returns to work each day ready to care for the most precious people in a family’s world – their children. “It is such a privilege to work in a place that is about one thing … and that’s trying to make the lives of kids better,” said Brock. “That’s an awesome responsibility that we not only accept but that we thrive on.”
Children’s Hospital Earns Accolades In late June, U.S. News and World Report released their annual ranking of the “Best Children’s Hospitals” in the United States. Monroe Carell Jr. Children’s Hospital at Vanderbilt achieved national rankings for the 12th consecutive year in all specialties. The 2018-19 report ranks the country’s top 50 pediatric centers across 10 specialties. Scores are calculated using clinical outcomes across a variety of measures, hospital resources directly related to care, and healthcare delivery including preventive programming and adherence to best practices. Of the 189 hospitals surveyed, 89 ranked among the top 50 in at least one specialty. Vanderbilt ranked in all 10: Ranking Specialty 6 Urology 10 Pulmonology (up from 13th last year) 14 Oncology (up from 16th last year) 16 Orthopaedics 18 Neonatology 24 Gastroenterology & GI Surgery 30 Neurology & Neurosurgery 31 Diabetes & Endocrinology 38 Nephrology 42 Cardiology & Heart Surgery “It is a tremendous achievement and honor to once again be recognized as one of the nation’s best children’s hospitals,” said Monroe Carell Jr. CEO Luke Gregory. “The rankings are a true testament to the commitment and dedication put forth by our doctors, nurses and staff who strive to provide the very best quality and compassionate care to the 1,700 children who enter our hospitals and clinics daily.”
Accounting for ACE to Maximize Outcomes in Pediatric Patients By CINDY SANDERS
Old sins cast long shadows. Bad things happen to everyone â€Ś but for some, an onslaught of adverse childhood experiences translates into physical, mental and emotional health issues that linger long into adulthood. The landmark Adverse Childhood Events (ACE) study was conducted just over two decades ago as a collaborative research project between the Centers for Disease Control and Prevention and Kaiser Permanenteâ€™s Health Appraisal Clinic in San Diego. The study â€“ which was led by Vincent Felitti, MD, and Robert Anda, MD, MS â€“ looked at the data of more than 17,000 HMO members and found a clear correlation between being exposed to adverse childhood experiences and longlasting health issues as adults. Furthermore, risk increased alongside the ACE score, with those experiencing four or more adverse events having a significantly higher risk for later health complications. Jack Levine, MD, FAAP, who sits on the executive committee of the American Academy of Pediatrics (AAP) Section on Developmental and Behavioral Pediatrics and is board certified in the subspecialty, said the original Dr. Jack Levine ACE study included 10 adverse experiences in calculating a childâ€™s score: â€˘ Physical Neglect, â€˘ Physical Abuse, â€˘ Emotional Neglect, â€˘ Emotional Abuse, â€˘ Sexual Abuse, â€˘ Domestic Violence, â€˘ Household Substance Abuse, â€˘ Parental Mental Illness, â€˘ Separation from Parents or Divorce, and â€˘ Incarcerated Household Member. The original findings have been reaffirmed over the last 20 years, and the AAP in conjunction with the Harvard Center on the Developing Child has added to that body of knowledge by highlighting the negative impact of toxic stress, which disrupts and/or damages neural functioning during periods of extreme or repetitive stress. As a result, the AAP created a technical report and a policy statement that included a framework outlining the need for pediatricians and family practitioners to actively participate by helping translate advances in developmental sciences into effective interventions in the home, clinic, and community. A practicing pediatrician in Queens, N.Y., for more than 30 years, Levine said toxic stress encompasses ACEs but is broader. â€œItâ€™s also unrelenting stress â€Ś ongoing stress with no buffer such as poverty and racism,â€? he explained. He added no one is immune to stress, but there are different levels of trauma. Not getting a gaming system for a birthday or holiday might be stressful to a child, but it is transitory. Larger stressors, including natural disasters, nashvillemedicalnews
clearly have a greater impact on children but often lessen over time with family and community supports to help bring back a sense of normality. Toxic stress, however, is relentless. â€œThe response to stress â€“ increased adrenaline, cortisol â€“ is protective. If you see a tiger, you run or climb a tree,â€? said Levine. â€œToxic stress is like when the tiger lives in the house with you. Youâ€™re constantly in this heightened state of awareness and that causes permanent effects on the body and on the brain.â€? Levine continued, â€œThe area of the brain that can be damaged is the prefrontal cortex, which controls impulsivity, problemsolving, and higher abstract thinking.â€? He noted there is also evidence the hippocampus and amygdala, which are part of the limbic system and associated with the functions of feeling and reacting, are also susceptible to permanent damage with toxic stress. Some of the long-term consequences of such damage include higher rates of substance abuse, poor lifestyle choices and impulse control, anger, anxiety, depression, suicidal ideation, developmental delays, lower immune function, early heart disease, and diabetes. The overwhelming evidence of the negative impact of ACE and toxic stress led the AAP to strongly oppose the recent separation of children from parents at the border. In a statement, AAP President Colleen Kraft, MD, MBA, FAAP, noted, â€œSeparating children from their parents contradicts everything we stand for as pediatricians â€“ protecting and promoting childrenâ€™s health.
In fact, highly stressful experiences, like family separation, can cause irreparable harm, disrupting a childâ€™s brain architecture and affecting his or her short- and long-term health. This type of prolonged exposure to serious stress - known as toxic stress - can carry lifelong consequences for children.â€? Levine added, â€œThe thing about the children separated at the border is they have already suffered significant, significant trauma in their home country and on the way here.â€? He added the boys on the soccer team in Thailand, which also dominated recent headlines, were separated from family and endured a prolonged state of fear, as well. However, he noted, the team had the advantage of having strong support from a worldwide audience, knowledge that there were people who cared for them and were trying to rectify their situation, and medical care waiting at the end of the ordeal. Levine was quick to add that doesnâ€™t mean the boys and coach wonâ€™t have emotional issues down the road, but they do seem to have a support system in place to monitor their ongoing progress. For those separated at the border, many of whom had still not been reunited with parents at press time, Levine said, â€œItâ€™s going to take a long time for them to be able to trust people again and be able to form normal social relationships â€Ś certainly without intensive help.â€? While migrant children and a Thai soccer team might seem far removed, Levine said the issues highlighted from these two recent news events mirror what
children face in the local community, as well. Children throughout the area face stressors ranging from ongoing food insecurity to having a parent deployed on active military duty to being part of the foster care system. Considering the evidence of the generational impact of childhood trauma, Levine said he believes physicians should be screening for ACEs. â€œItâ€™s come around slowly that weâ€™re screening for food insecurity and domestic violence now routinely â€Ś and weâ€™re also screening pretty routinely for post partum depression. I think itâ€™s just a matter of time before screening for toxic stress becomes part of the routine well visit,â€? Levine stated. However, he cautioned, providers shouldnâ€™t take on a fatalistic attitude that having four ACEs dooms a child. â€œThe proper intervention can be very productive,â€? he pointed out. In fact, Levine continued, such screening can help uncover misdiagnoses that often occur based on outward behaviors. â€œKids can become very lethargic because of toxic stress, and people think itâ€™s depression,â€? he said. â€œSome of these effects (of toxic stress) look like psychiatric disorders, and kids are being medicated.â€? The good news, Levine continued, is dispensing trauma-informed care and helping connect caregivers with community resources can go a long way. â€œMore and more people are understanding the effects of early trauma and how it can look like other things. Itâ€™s changed the whole course of how we deal with young people. Thereâ€™s a lot of hope,â€? he concluded.
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Caring for Kids, continued from page 1 access,” said Our Kids Executive Director Sue Fort White, EdD. “The dynamics are really different.” An outpatient clinic of Nashville General Hospital, Our Kids evaluated 876 children during the 2017 fiscal year. The clinic is one of the largest of its kind in the U.S. and serves 47 counties in Middle Tennessee with satellite clinics in Cookeville, Manchester, Lawrenceburg Dr. Sue Fort White and Clarksville. Staff members also work with the Department of Children’s Services (DCS), law enforcement, child advocacy centers, pediatric practices, emergency departments and district attorney offices. The Our Kids team works hard to disseminate accurate information in the community and to highlight myths related to child sexual abuse, including the notion that “stranger danger” should be the biggest fear for children. In most cases, the perpetrator is known and trusted, leaving parents to deal with tremendous guilt and confusion. Parents also think their child will always report sexual abuse immediately, or that the suspect couldn’t be a relative or family friend. Another common myth of sexual abuse is that it always involves genital injury. In reality, 93 percent of cases prove otherwise. Those numbers were part of the findings by Our Kids in the
largest prevalence study of its kind in over a decade. Published last year in The Journal of Pediatric and Adolescent Gynecology, their study of 1,500 female children validated findings of other studies. The paper is now recommended as required reading by the American Board of Obstetrics and Gynecology. Our Kids is also setting a gold standard in community awareness. Slated to launch online Sept. 13, the organization’s “What if I told you?” campaign seeks to start a national conversation about the epidemic prevalence of child sexual abuse. Website links include how to report child sexual abuse, resources, and mental health supports for adult survivors. “The theme of the video is to believe and protect the child and embrace the adult because they are courageous,” Fort White said. “We want people to know that it’s never too late to heal.” More information about services is available at OurKidsCenter.com.
Tennessee Department of Health Children’s Special Services
An initiative of the Tennessee Department of Health, the Children’s Special Services program provides medical care for children with physical disabilities from birth to 21 years of age. CSS is coordinated through the local health departments in all 95 Tennessee counties and provides resources for medical and nonmedical services. The program may pay for diagnostic
evaluations, hospitalization, rehabilitation, prescriptions, speech and language therapy, hearing aids, medical and surgical treatment, physical and occupational therapy, braces and artificial limbs, and durable medical equipment such as wheelchairs and walkers. CSS does have financial eligibility guidelines that are based on family size and income level at or below 200 percent of the Federal Poverty Guidelines set each year. For more information, go online to TN.gov/health/health-program-areas.
As one of the largest communitybased mental health providers in the nation, Centerstone is also a leader in behavioral health services for children and adolescents. The Nashville-based, notfor-profit offers mobile, family and group therapy from their pediatric-focused Dede Wallace campus on White Avenue, while more than 60 master’s degree-level therapists are dispersed throughout 300 Tennessee schools. “Schools are a primary area of concern for us, as that’s often where kids are first identified as having challenges,” said Beth Hail, regional vice president of Centerstone’s central region, which encompasses Davidson, Wilson, Williamson and Beth Hail Rutherford Counties.
Staff members also provide mobile crisis consults to counselors and teachers and work to assist kids struggling with drug addiction and depression. Patients run the socioeconomic gambit, from state custody to TennCare and private pay. The majority of Centerstone’s young patients have experienced trauma, and therapists work alongside parents to help them understand their child’s struggles. The campus also is among the few to offer therapists specially trained in child-parent psychotherapy for children from birth to age five. “We use evidence-based practices to work with young children when there’s been a disruption in the family or an event that’s altered parent-child attachment,” Hail said. “We work to restore those relationships, and it’s often difficult to find therapists who will work with those very young children and their families.” Centerstone also offers parent/ child interaction therapy (PICT), which involves monitoring the playing child through a two-way mirror. During PCIT, parents wear ear buds and are coached by therapists in real time how to correct behavior while strengthening the parent/ child relationship. The team also offers adolescent dialectical behavioral (DBT) group therapy for youth who don’t respond well to individual counseling. Long recognized for its effectiveness in adults, DBT has proven tremendously successful for children with boundary issues, difficulty interacting with others, family problems or suicidal tendencies. “These teens often don’t’ recognize their own mental health issues, but they can help each other and challenge each other and work with a therapist specially trained in adolescence,” Hail said. Additional area services and locations can be found online at Centerstone.org.
TriStar StoneCrest Opens Baby Café
TriStar Centennial Children’s Hospital Celebrates ER Successes The Pediatric Emergency Department at The Children’s Hospital at TriStar Centennial has just celebrated its first anniversary of service in Middle Tennessee. Opened on July 24, 2017 to support the growing needs of a growing city, the pediatric ER held a birthday party to mark the completion of a first successful year. Physicians, staff and administrative leadership were also celebrating the good news on their patient satisfaction scores. In the second quarter of 2018, the pediatric ER had the highest patient satisfaction scores for all of HCA in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which measures patients’ perspectives on hospital care. The department was also ranked in the 98th percentile of all hospitals in the country that participate in the survey and 99th percentile in the state. Last month, The Children’s Hospital at TriStar Centennial also announced a new program to better care for young patients with sensory sensitivities. The pediatric ER and the Kids Express Clinic are both piloting autism and sensory friendly rooms to help ease anxiety and provide a smoother experience for families. The sensory-friendly rooms feature adaptable lights, monitor and sound control, specialized toys and visual storyboards to help prepare patients for procedures. The launch of the program also included staff education in Autism Spectrum Disorder and sensory challenges, which included training in best practices for communicating with sensory sensitive patients. A form is available for families to fill out upon arrival to alert the staff to a child’s specific communication abilities and stressors.
TriStar StoneCrest Medical Center recently celebrated the grand opening of the StoneCrest Baby Café in the Medical Office Building Classroom. This new option provides pregnant and breastfeeding mothers a friendly and comfortable environment to learn more about breastfeeding. In the Baby Café, mothers can relax, share tips and techniques, and socialize with other moms. One-on-one help from specially trained health professionals is available, including professional lactation support and WIC peer counselors. Babies can be also weighed and breastfeeding assessed to provide additional support for parents. Baby Café USA has over 45 free drop-in sites around the United States, supporting more than 2000 moms a year. This is the first Baby Café to open in the state of Tennessee.
Middle Tennessee Youth & Family Resources from-scratch meals and snacks with communities across Davidson County.
By MELANIE KILGORE-HILL
Editor’s Note: We recognize the following information is not an exhaustive list of all the service providers helping support our area youth. If you know of additional services and organizations that should be included, please email editor@nashvillemedicalnews. com, and we’ll add the information to the online version of this article. Please feel free to make copies of this information or direct patients and families to our website NashvilleMedicalNews.com to view this resource list.
Help is just a phone call away. A project of the United Way, dialing 2-1-1- connects callers with a real person who can help with connections to area community services resources. The website includes a searchable database of services.
Big Brothers & Big Sisters of Middle Tennessee: mentorakid.org
Provides children facing adversity with strong and enduring, professionally supported, one-to-one relationships.
Boys & Girls Clubs of Middle Tennessee: bgcmt.org
Focused on helping all young people succeed through curriculum-based, targeted programs and high-yield activities designed to help reach priority outcomes.
Catholic Charities of Tennessee: cctenn.org
Assists more than 60,000 people each year in 38 Middle Tennessee counties through more than 50 different programs.
The Children & Youth Homeless Outreach Project: tn.gov (search for “homeless services for children and youth”)
Provides outreach and case management for homeless families or those at risk of homelessness to identify children and youth with Severe Emotional Disturbances (SED) or at risk of SED.
CONNECTUS Clinics: connectus.org
A non-profit community health organization founded on the values of compassion, wellness, community and culturally sensitive care. Services include primary care, pediatrics, social work, and preventive care for the uninsured or those with little financial means. Transgender health and translation services are also available.
Cottage Cove Urban Ministries: cottagecove.com
Works with inner city children between the ages of 5 and 11. Focuses on academics, faith and life skills.
Offers individual and group counseling for children, adolescents, families and young adults.
Dispensary of Hope: dispensaryofhope.org
Dispensary of Hope collects and distrib-
Nashville Health: nashvillehealth.org/ child-health
utes millions of dollars of pharmaceuticals annually to pharmacies and safety-net clinics to dispense needed medications to low income, chronically ill patients.
End Slavery Tennessee: endslaverytn.org
Promotes healing of human trafficking survivors and strategically confronts slavery in Tennessee.
Faith Family Medical Center: faithmedical.org
Provides the residents of greater Nashville who are uninsured or underinsured with affordable, quality primary medical care.
Family & Children’s Services: fcsnashville.org
FCS serves all people in crisis and transition by meeting them where they are, understanding their needs, and connecting them to the resources they need.
First Steps: firststepsnashville.org
The organization provides services and supports for families with children from birth up to three years old, who have a diagnosis or are at risk of experiencing developmental delays.
Hermitage Hall: hermitagehall.com
A residential treatment center specializing in serving children with histories of trauma, neglect, physical and sexual abuse, and trauma-induced experiences.
Interfaith Dental Clinic: interfaithdentalclinic.com
Provides comprehensive and emergency dental services for low-income, uninsured individuals suffering from dental disease.
kidcentral tn: kidcentraltn.com
State-specific information on developmental milestones, health, education and support.
Lifecare Family Services: lifecarefamily.org
A faith-based community mental health center offering individual or family therapy, child and adult psychiatric care and counseling, mental health case management, and in-home child and family services.
Make-a-Wish: middletennessee. wish.org
Serves a unique and vital role in helping strengthen and empower children battling critical illnesses.
Martha O’Bryan: marthaobryan.org
Works to improve the lives of children in our community through a number of collaborative initiatives including participation in the Nashville Infant Vitality Collaborative with the Metro Public Health Department and Meharry Medical College, and efforts to improve health in schools.
K-8 youth development programming featuring rigorous academic interventions, college prep workshops, civic engagement projects, STEM/arts enrichment activities, and health/nutrition programming to vulnerable elementary and middle school students in an out-ofschool-time setting.
Neighborhood Health: neighborhoodhealthtn.org
Matthew Walker Comprehensive Health Center: mwchc.org
Provides a safety net for families most at-risk in order to prevent infant mortality, child abuse and neglect by providing in-home nursing visits promoting health, education and positive parenting skills.
Provides primary medical care, behavioral health services, dental care and health education to approximately 17,000 people annually in Nashville, Clarksville and Smyrna.
Meharry Saltwagon Clinic: mmc.edu/about/community1/ studentclinic.html
The Saltwagon Clinic at Meharry is a student-run, free clinic under the supervision of faculty physicians at Meharry Medical College. Its mission is to address healthcare disparities by providing free, highquality care to Nashville’s underserved populations.
Mental Health Cooperative: mhc-tn.org
For more than 25 years, MHC has helped children with serious emotional and behavioral challenges by offering ongoing support and treatment with both schoolbased therapy and community-based care management.
Metro Nashville Public Health Dept: nashville.gov (search “children”)
Neighborhood Health is dedicated to improving the health of the community by providing affordable quality care to all in locations where it’s most needed.
Nurses for Newborns: nursesfornewborns.org
Oasis Center: oasiscenter.org
Oasis Center is a nationally recognized organization on a mission to help young people in Middle Tennessee move into a happy, healthy and productive adulthood.
PENCIL Foundation: pencilforschools.org
PENCIL is the premier organization linking community resources to Metro Nashville Public Schools.
Project Access Nashville: nashvillemedicine.org
A program under the leadership of the Nashville Academy of Medicine and Medical Foundation of Nashville in conjunction with many community partners, Project Access connects low-income, uninsured residents of Davidson County with primary care and specialty care providers.
Prevent Child Abuse Tennessee: pcat.org
From back-to-school vaccinations and summer food services to the WIC Nutrition Center and child ID fingerprinting, the Health Department is an excellent resource for family care.
A non-profit that works with parents, professionals and communities to provide education, resources and services that strengthen families.
Monroe Harding: monroeharding.org
Middle Tennessee’s oldest and largest riding center offering equine-based programs exclusively for children with disabilities.
Provide services for youth age 23 and younger who are in the foster care system or have recently aged out. Since 1893, Monroe Harding has continually adapted to meet the needs of children who are in, or transitioning out of, state custody by caring for more than 16,000 children who have been abused, abandoned or neglected.
The Nashville Food Project: thenashvillefoodproject.org
Every week, The Nashville Food Project shares more than 4,000 healthy, made-
Saddle Up!: saddleupnashville.org
Safe Haven Family Shelter: safehaven.org
Safe Haven has 30 years of experience in the changing field of family homelessness with proactive programs, evidence-based practices and traumainformed care.
Safety Net Consortium of Middle Tennessee: sncmt.org
Provides connection to area clinics, (CONTINUED ON PAGE 6)
Middle Tennessee Resources, continued from page 5 projects and resources to help the uninsured and underinsured find coverage or services.
The Tennessee Disability Coalition: tndisability.org
An alliance of organizations and individuals to promote the full and equal participation of people with disabilities in all aspects of life. Includes Tennessee Parent-to-Parent, a statewide program established to provide support, information, services, training and leadership opportunities for families of youth and children with special healthcare needs.
Saint Thomas Medical Partners Family Health Centers: sthealth.com As a part of Ascension Health, the largest not-for-profit healthcare system in the United States, Saint Thomas Health is committed to healing and dedicated to service, especially to persons who are poor or needy, reflecting the spiritual core of their mission, vision and values.
Second Harvest Food Bank: secondharvestmidtn.org
Founded in 1978, Second Harvest Food Bank of Middle Tennessee works to feed those facing hunger and solve food insecurity issues in the region.
Sexual Assault Center: sacenter.org
Provide healing for children, adults and families affected by sexual assault and works to end sexual violence through counseling, education and advocacy.
Shade Tree Clinic: shadetreeclinic.org
Provides free, high-quality care to Nashville’s uninsured individuals.
Show Hope: showhope.org
Since 2003, Show Hope has worked to holistically approach orphan care, helping children in Adoption Aid, Care Centers, Pre+Post Adoption Support and Student Initiative. Through Adoption Aid grants, Show Hope has helped more than 6,000 children from more than 60 countries, including the U.S.
Siloam Health: siloamhealth.org
from a program of the Center for Youth Issues with one school site to an awardwinning, evidence-based leader for its program and services in nine counties and more than 160 school and community sites in Middle Tennessee.
Tennessee Justice Center: tnjustice.org/childrens-health
Tennessee American Academy of Pediatrics: tnaap.org
Tennessee Voices for Children: tnvoices.org
A statewide professional membership & child advocacy organization dedicated to the health, safety, and wellbeing of infants, children, and adolescents.
Tennessee Dept. of Children’s Services: tn.gov/dcs.html
For more than 25 years, the faith-based organization has preferentially directed its efforts to those who often have no alternative for healthcare. Translators and culturally competent care are available.
The Department of Children’s Services is Tennessee’s public child welfare agency and establishes statewide standards for performance that reflect best practices for child welfare.
Special Kids Therapy and Nursing Center: specialkidstn.com
Tennessee Department of Health Children & Youth with Special Healthcare: tn.gov/health
Special Kids serves children who simply need a little extra help, children who are medically fragile, and all sorts of diagnoses in between.
Special Olympics: specialolympicstn.org
Provides year-round sports training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities.
Founded in 1984, STARS has transformed
Click on “program areas” for a list of services including Maternal & Child Health, Children & Youth with Special Healthcare Needs, Family Health & Wellness, Farmers Market Nutrition Programs, and many others.
Tennessee Disability Coalition: tndisability.org
An alliance of organizations and individuals promoting the full and equal participation of people with disabilities in all aspects of life.
The Insure Our Kids Campaign is a collaborative effort among area stakeholders to make sure every eligible child in Tennessee has access to care.
Tennessee Voices for Children seeks to become a diversely funded, accredited organization providing best practice in advocacy and services for the emotional and behavioral wellbeing of children and their families.
YouthCAN assists teens and young adults ages 16–24 with educational, training, and career opportunities through various resources and support services. Their mission is to build a better economic future for the state’s youth.
Youth Villages: youthvillages.org
Youth Villages provides help for children and young people who face a wide range of emotional, mental and behavioral problems.
YMCA Y-CAP Program: ymcamidtn.org (Search Y-CAP)
Y-CAP works with children to provide mentors who focus on academics, social skills, community involvement, healthy living and personal growth.
Youth Life Learning Centers: yllc.org
A non-profit that provides educational support in academics, character development and service learning for children.
DCS, TAC Partner to Support Children in Foster Care
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Tennessee Action Council (TAC) is collaborating with the Tennessee Department of Children Services on a program providing ‘Love Totes’ for children in foster care. Helping Hands, a division of Tennessee Action Council, is providing ‘Love Totes,’ a large gym bag with multiple compartments, pouches, carry strap, and an identification badge with the child’s name to provide them a sense of ownership. The ‘Love Totes’ replace the standard issued black garbage bag for moving children within the foster system. The organization is also providing foster children with personal hygiene items including toothbrushes, toothpaste, and bath products. “The truth is, when a child gets moved from one home to the next, and all they have is stuffed into a trash bag, it doesn’t take too many moves until a child begins to think they are simply a piece of trash,” said Rodney Duncan, spokesperson for TAC. “The ‘Love Totes’ are created to give the children a sense of identity, build a child’s self esteem and help them relocate with something that is theirs.” This new program is starting in Middle Tennessee in the counties of Williamson, Robertson, and Cheatham. The TAC team is working to raise funds for the next step – the Mid Cumberland Region, which includes the eight counties around and including Davidson County. Statewide there are approximately 8,553 children currently in the state foster care system.
PHOTOS BY JOHN RUSSELL, VUMC
Learning More About NAS in Nashville
Last month, First Lady of the United States Melania Trump flew to Nashville as part of her ‘Be Best’ platform and visited the Monroe Carell Jr. Children’s Hospital at Vanderbilt where she engaged with young patients and participated in a roundtable discussion on neonatal abstinence syndrome (NAS). Recent research by Vanderbilt found that in areas of the country disproportionately affected by the opioid crisis, treatment programs are less likely to accept patients paying through insurance of any type or accept pregnant women. Focusing on four Appalachian (L-R) Meg Rush, MD, MMHC, Chief of Staff & Executive Medical Director, Monroe states – Tennessee, Carell Jr. Children’s Hospital; First Lady Melania Trump; and Stephen Patrick, MD, MPH, Kentucky, North MS, Director, Center for Child Health Policy, Assistant Professor of Pediatrics and Health Carolina and West Policy, Division of Neonatology at Vanderbilt, participate in a discussion on NAS. Virginia – the study found that while 91 percent of programs were accepting new patients, only 53 percent outpatient buprenorphine programs would treat pregnant women. A review of TennCare data shows a sharp increase in incidence rates of NAS in Tennessee in just under a decade. The state saw more than a 500 percent increase from CY 2008 to CY 2016 in NAS infants. In 2008, 264 TennCare newborns were treated for NAS during the year. By 2016, that number jumped to 1,357. East Tennessee has been the most heavily impacted, but all areas of Tennessee have seen incidence rates on the rise. Vanderbilt has launched a collaborative program across all units of the medical center to change the way nurses and physicians care for newborns diagnosed with drug withdrawal symptoms at birth. Team Hope utilizes an interdisciplinary team, which seeks to improve the care of the opioid-exposed mother-baby dyad through multifaceted, family-centered approach. Team Hope has instituted evidence-based practices in the care of these infants to improve their outcomes, decrease length of stay and improve consistency of care for opioid-exposed infants. A spokesperson for the first lady said she was impressed with the work being done at Vanderbilt to keep mothers and children together and asked how she might use her role to help with those First Lady Melania Trump and patient efforts. Natalayah Fields
Pets & Patients – A Playful New Partnership
Honestly, don’t puppies make everything better? There is plenty of research showing that pets make human lives healthier and happier. For many families, that benefit will soon come at a time and place they probably never expected … during their child’s hospital stay. In mid-July, Mars Petcare and the Monroe Carell Jr. Children’s Hospital at Vanderbilt announced a collaboration to create the Mars Petcare Pet Therapy Fund to support a dedicated facility dog and staff position at the hospital with a goal of showing how pet visits improve the health of patients — thus getting them home faster. The partnership comes as part of Mars Petcare’s BETTER CITIES FOR PETS™ initiative, which aims to bring the healing power of pets to more children and families nationwide. “While the benefits of pets have been well documented, never before have we studied the positive impact of a At the Mars Petcare announcement, members of the facility dog on the length of a patient’s Christison family surround pet therapy dog Will and his hospital stay or the cost of care,” said handler, Bob Wilkins. From front, Reese, 11, Mallory, 9, Mars Petcare North America Regional Maddy, 9 and Gavin, 17. President Mark Johnson. The announcement was made during the hospital’s annual dog show, the “Dog Days of Summer Paw-ty” for patients and families, which featured a dog show and meet-and-greet with several pet therapy dogs and hospital volunteers. “We are so thankful to Mars Petcare for affording us the opportunity to add a facility dog to our team. Facility dogs are experiencing much success in children’s hospitals across the nation,” said Janet Cross, administrative director of Patient- and Family-Centered Care. “The facility dog will add a new tool for normalizing a child or teen’s environment, reducing anxiety and alleviating fears, and distracting from difficult experiences for short periods.” In addition to helping patients, Cross said the facility dog will offer a source of strength and support to healthcare professionals, as well. A key component of this effort is to collect data that demonstrates the health, well-being and economic impact a facility dog, used as a therapeutic tool, can have on patients, families and staff. The facility dog is slated to arrive at Children’s Hospital in early 2019. nashvillemedicalnews
MWCHC Opens New Clinic at Pearl-Cohn High School Matthew Walker Comprehensive Health Center (MWCHC), Nashville’s oldest nonprofit health center, has partnered with Pearl-Cohn Entertainment Magnet High School (PCEMHS) and opened a new clinic on the school grounds. The collaboration provides a full-service medical clinic that is available to students and staff of PCEMHS from 8 am-2 pm every Monday and Wednesday, with expanded hours planned for the coming semester. The partnership between MWCHC and PCEMHS is the latest development in an effort to provide quality and immediate healthcare options throughout the region. The goal is to help staff and students remain healthy, thus improving attendance and educational success. The clinic is staffed at all times with a medical assistant, nurse practitioner, and operations administrator. Services offered include physicals, vision tests, hearing tests, and more, with dental and behavioral health services to be offered at a future time. MWCHC also plans to open clinics at PCEMHS’s sister schools, Buena Vista Elementary Enhanced Option and McKissack Middle Prep, in future years.
HEALTHCARE REIMBURSEMENT, OPERATIONS, CODING & COMPLIANCE SOLUTIONS
Medicare/Medicaid Cost Reports Operational Assessments Coding & Documentation Audits RAC Appeals & Risk Assessments Healthcare Services
HIPAA, HITECH & HITRUST Compliance
Getting Your Piece of the Pie When providers and medical staff are asked about reimbursement in medical practices today, the first response might be a loud groan. Getting and keeping the reimbursements your medical practice deserve has become increasingly difficult over the past few years because of everchanging federal and state rules and regulations, as well as the growing change in healthBy STACEY care culture. What is your STUHRENBERG pie? Your reim- CPC, CPB, CPMA, CPPM, CEMC bursement is your pie, and it comes from patients and payers. The revenue cycle includes everything from the point of initial patient contact for care through the collection of payment for the services rendered. Revenue cycle management success is about the fundamentals. Think zero to zero. Correct reimbursement has many drivers. It includes appointment scheduling, insurance eligibility verification, referrals, precertification, coding, charge capture, claims submission, payment posting, claims rejection reports, accounts receivable follow-up, denied claims management, patient statements, and collection agency account placement. There is a direct correlation between the handling of these items to how and when the practice
is paid and if the practice is paid the entire amount it’s owed. Revenue cycle management is commonly broken into three stages: pre-service, service, and post-service. Everyone, including the providers, should have a working knowledge of the three stages and how they can impact medical practice payments.
The First Slice
The pre-service stage consists of all the activities prior to the patient receiving service from the provider. Following are some very important items that impact reimbursement: Patient demographics: Garbage in, garbage out … if the information in the practice management system from patient registration is incorrect, a domino effect will occur that can dramatically decrease reimbursement. For example, if the patient or insured’s date of birth, insurance policy numbers, name, or address is incorrect, it affects everything from insurance verification to submitted claims to patient statements. Insurance verification: To prevent claim rejections or denial, it’s vital that insurance verification be done prior to patient receiving services. Most practice management systems have a batch eligibility option within the system. Verification can also be checked via most payer websites if needed. The following information should be verified: Patient policy status: Is this policy active? What is the effective date? Who is the insured? Co-pay amount: How much money
needs to be collected from the patient at the time of service? Deductible amount: Has the patient met their deductible? Verification of benefits in advance allows your practice to estimate the total patient responsibility. Patients with a deductible are more likely to come prepared to pay if they are notified in advance the amount due at the time of the service. Type of plan: What type of plan does the patient have? Is the provider in network? Coverage details/plan exclusions: Does the policy cover the service the patient will be receiving? Is there a specific number of visits applicable to the practice’s specific specialty? If so, has the patient met or exceeded that number? Referral/preauthorization/ precertification: Does the patient’s insurance plan require a referral or preauthorization? Always look at the back of the patient’s insurance card; in most instances, information is given to indicate what services require precertification. If in doubt, contact the insurance company. Never assume. It is important to remember when obtaining a preauthorization/precertification via telephone that the first name and last initial of the insurance contact, agent ID (if available), date, time, and call reference (if available) is documented in the patient record. Unresolved patient balances: Train staff on how to communicate with patients effectively. This will help not only in collecting outstanding balances, but it will help patient better understand why the
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balance is due (i.e., coinsurance, deductible, etc.). Payment method on file (PMOF): Many of today’s medical billing software systems have the option to integrate a credit card merchant’s services into the system. Practices with a PMOF process can obtain prior written consent from patients to collect on any outstanding patient responsibility amount after payers process claims. A PMOF process also allows the practice to work with patients who request a payment plan. The practice can set it up in the software to charge the card monthly based on the practice’s payment plan policy. Patients can pick the day to charge the card each month. Some software can allow the total amount owed and number of months to be input into the system, and it will calculate the payment amount and process the credit card on the date specified. The staff should be trained to handle questions such as the ones below in a professional, polite, and courteous manner: “Can’t you just bill me?” “I’m sorry, but I can’t bill you. As indicated in our payment policy, payment is due at the time of service. Payment collection at the time of service keeps our billing process streamlined and helps keep the cost down for our practice and our patients. It’s customary to pay for healthcare services at the time of service, so, would you like to pay by cash, check, or credit card today?” “My insurance covers everything. I don’t owe anything.” This is best handled during the check-in process when verifying information with the patient. “I see here you have XYZ insurance, and your copay is $25. Would you like to pay by cash, check, or credit card today?” If a patient remains adamant, offer to contact his or her insurance company together. “I didn’t bring my credit card or check book.” This can be easily remedied simply accepting multiple methods of payment: cash, check, and all major credit cards. “I’m sorry, but payment is due at the time of service. Would you like to pay via [an alternate method]?” If the patient doesn’t have cash, check, or credit card on hand, consider asking him or her to call home to get the card number. “I can’t afford to pay this right now.” Any patient who has an unpaid balance should be contacted prior to the appointment to discuss payment options. Staff members should have payment plan guidelines that can be offered to patients when appropriate.
The Second Slice
The service stage is the point where the patient receives services from providers and other clinical staff. Things to remember that affect reimbursement during this stage are: Medical record documentation (compliance and reimbursement): Everyone knows the phrase, repeated over and over regarding medical record documentation — “if you didn’t document it, it didn’t happen!” If a service is not doc(CONTINUED ON PAGE 10)
AAHAM: Celebrating 50 Years of Supporting Revenue Cycle Professionals By CINDY SANDERS
Celebrating its golden anniversary in 2018, the American Association of Healthcare Administrative Management was founded in 1968. While the initial goal was to serve the interests of hospital patient account managers, the national membership organization has evolved over time to represent a broad constituency of healthcare professionals involved in all aspects of the revenue cycle. Closer to home, chapter membership provides healthcare managers with access to national professional development programming, legislative updates and certification opportunities, alongside local networking and educational conferences. At the spring meeting held at the Envi-
Get Involved For more information on the AAHAM Music City Chapter – which serves Tennessee, Alabama and Kentucky – go online to MusicCityAAHAM.org or send an email to Andrew Hawkins, chapter secretary, at firstname.lastname@example.org.
sion Conference Center in Brentwood, AAHAM Music City Chapter President Jim Andrews noted, “We want to be a resource to revenue cycle professionals here in the Middle Tennessee area. We want to help provide tools, access to education, access to people who can share best practices, and access to information on regulations that might impact the revenue cycle.” Andrews, who is vice president of revenue operations for SelfRefind Behavioral Health, added planning is in the works for a fall educational conference and noted the local chapter hosts monthly networking meetings and access to educational webinars offering continuing education credits. The next webinar, slated for late August, focuses on “The New World of Healthcare in 2018 and the Top 5 Challenges of Healthcare Leaders.” The late September offering is on the “Fundamentals of Bankruptcy in Relation to Revenue Cycle.” Details on the social events and upcoming webinars are available online at musicictyaaham.org. During the spring conference, George Buck, president emeritus of accounts receivable management (ARM) company FrostArnett, noted the industry is rapidly changing with generational differences in communication preferences, shifting federal regulations impacting consumer contact, and hospital reimbursements being partially dependent
on patient satisfaction scores … which can be negatively impacted by poor upfront communication regarding a patient’s financial responsibility. “If we’re relying on what we knew yesterday, we’re going to be behind the curve … it happens that quick,” Buck said of the evolving ARM landscape.
The goal of the AAHAM Music City Chapter is to not only keep members apprised of changes impacting the revenue cycle but to provide administrators with the necessary tools to effectively meet those challenges and maximize healthcare reimbursements.
MDHA Receives Funding Grant for Youth Homelessness The Metropolitan Development and Housing Agency (MDHA) recently received a $3.5 million grant from the U.S. Department of Housing and Urban Development (HUD) Youth Homelessness Demonstration Program to assist unaccompanied youth and young adults. The grant program supports a wide range of housing interventions including rapid rehousing, permanent supportive housing, transitional housing and host homes. During Nashville’s winter shelter season, community partners identified 353 individuals aged 18-to-24 who utilized designed youth emergency shelters. Looking at a single evening, the 2018 Point in Time Court found 81 youth and young adults were in emergency shelters or on the streets during that one night. “Ending youth homelessness is about building community for young people who are without a permanent, safe place to go and may have never learned what having a home means,” Judith Tackett, director of the Metro Homeless Impact Division, said. “Through this grant, our Nashville community is making a commitment to our youth and young adults who are 23 years of age or younger and who struggle with homelessness. We will listen to you, we will hear you, and we will invest in you.” Nashville is one of 11 communities awarded funding last month. The grant application was a joint effort of MDHA in collaboration with the Metro Homeless Impact Division, the Oasis Center and 21 additional local community partners, including Metro Nashville Public Schools, Tennessee Department of Children Services, the Youth Action Board, and the Metro Juvenile Justice Center.
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The Payer’s Perspective Finding Value in Value-Based Care Results are in from Finding the Value: The State of Value-Based Care in 2018, a recent national study of 120 payers conducted by ORC International and commissioned by Nashville-based Change Healthcare. This most recent research report is third in a series, following 2014 and 2016 studies that established a baseline for healthcare’s transition to value. Below are the top 10 takeaways from the latest report from the payer perspective. The full report is accessible online at NashvilleMedicalNews.com Payers report success in reducing unnecessary medical costs as a result of their value-based care strategies. Medical cost savings topped 5.6% percent on average, with almost a quarter of respondents noting savings in excess of 7.5 percent. Almost 80 percent of payers report improvements in care quality, while 64 percent report improvements in provider relationships and 73 percent report patient engagement improved, making significant headway toward achieving the elusive “triple aim” of healthcare through value-based care initiatives. For the first time, commercial lines, not government lines of business, are leading adoption, advancement, and innovation of value-based care models and strategies. Pure fee-for-service is fading faster than predicted in past studies, now accounting for only 37.2 percent of reimbursement, and projected to dip below 26 percent by 2021. Innovation agility remains a problem, with only 21 percent of payers capable of rolling out a new episode-ofcare program in three to six months. Over a third of payers need up to a year to launch a new program, 21 percent require up to 18 months, and 13 percent need up to 24 months or more. Payers are struggling to engage providers in episode-of-care programs, with 43 percent to 58 percent of payers reporting it is very or extremely difficult to generate interest among providers to participate; agree on episode definitions; and gain consensus on budgets, risk/gain sharing, and performance metrics. Exceptional medical cost savings are motivating 66 percent of payers to invest in administrative staff to support future growth of episode-of-care programs. Between a third to half of payers find episode-of-care models ‘very’ to ‘extremely’ effective at improving care quality, across all types of episodes. Episode models deliver savings from 5 percent to 5.4 percent on average, depending on the episode type. Some payers report savings as high as 7.5 percent or more. Over half of payers are not very satisfied with their current valuebased analytics, automation, and reporting capabilities. This is despite the fact that many of these programs are designed and developed in house. 10
Getting Your Piece of the Pie, continued from page 8 umented, it cannot be coded. If a service can’t be coded, it can’t be reimbursed. Documentation in the MR is a key instrument in planning and evaluating patient care. It is important to be accurate, specific, and thorough. Use these tips to insure compliant medical record documentation: BE specific to the patient. BE specific to the condition at the time of the encounter. REFLECT accurately the services performed. SUPPORT the necessity for the services. IDENTIFY clearly who performed the services and assessments received. IDENTIFY clearly the author of each note or entry. IDENTIFY clearly the date and time note or entry was made. Medical record documentation (malpractice and patient): Proper medical record documentation is the best defense against malpractice. Good medical record documentation is extremely important when dealing with patients who are abusive, don’t follow advice, or present the same complaint without improvement.
The Final Slice
The post-service stage is after service has been provided to the patient, including coding, charge capture, claim submission, accept/reject report, payment posting, patient statements, A/R follow-up, denial management, refunds, collection agency assignments, and financial reports. Coding: The role of a coder is to verify the patient’s medical record transcriptions of doctor’s notes, any ordered labs, requested imaging studies and other sources to ensure the work has been done. Medical codes must tell the whole story of the patient’s encounter with the physician, and they must be as specific as possible. Charge capture: Internal controls are key to this process. Poor charge capture can lead to thousands of dollars in missed reimbursement. In many practices, scheduling is not considered a key component as it relates to charge capture, but it is by far one of the best reconciliation resources available. Most practice management systems today offer the ability to reconcile charges billed to services billed via an unbilled charge report. This report helps determine when a charge has been created but not billed or an appointment is created but no charges have been entered. Acknowledgement/accept/ reject reports: These reports should be worked daily. These reports will let you know if a claim has been accepted or rejected by the payer. If it is accepted/ acknowledged, the claim is allowed in to the payer adjudication system. This is a big difference between rejected and denied claims. A rejection is very different from a denial. Rejected claims are not processed. The payer does not consider them received because they don’t allow the claim to make it into adjudication system. Errors on rejected claims must be corrected and resubmitted. These reports can be used as a vital resource if a payer dispute arises for timely filing or claim never received issues.
Clean claims: The best way for medical practices to improve reimbursements is to insure percentage of clean claims is a high as possible. Each time a claim is submitted, the practice loses money. Most practice management systems offer a rules engine and/or a claims scrubber that should be utilized prior to claim submission to the clearinghouse. The rules engine and claim scrubber should be updated frequently. This can save the practice a tremendous amount of money. Denial management: It’s important to know the difference between a soft denial and a hard denial and have staff trained in both. A soft denial is a claim that has been denied for issues such as medical records not received, invalid codes, unable to identify patient, etc. These claims denials can be easily rectified and resubmitted or routed quickly. Hard denials are claims that may result in an appeal for reasons such as not medically necessary and/or non-covered services. These claims take more time to decide the appropriate course of action. All denials should be worked quickly and efficiently and are often a source of missed reimbursement opportunity. Key performance indicators (KPIs): Key performance indicators tell you how well your medical practice is meeting set goals and objectives. Monitoring key performance indicators will make your medical practice more profitable, efficient, and patient-oriented. Here are just a few that should be monitored closely. Net collection rate calculation (total receipts [minus] refunds, then divided by charges [minus] contractual adjustments): Practices use this calculation to see how much money is lost due to things like non-contractual adjustments, bad debt, untimely filing. In a nutshell, it tells the practice how well it’s collecting on eligible revenue.
Denial rate calculation (total claims denied for a period divided by total claims billed for a period): This helps identify how well denials are managed. Days in A/R (total accounts receivable divided by average daily charge): This gives the practice an idea of how well it manages the A/R. The lower the number of days, the more efficient a practice is in collecting monies due. Adjustment to collections ratio (total adjustments for a period divided by total collections for a period). This is very important and should be monitored carefully. It allows medical practices to monitor fluctuations in adjustments. It will alert you if potential collectible accounts are written off in error.
Recipe for Success
Revenue cycle management is complex and hard to manage. Reimbursements on claims filed and patient balances are the core of your revenue cycle. While this may sound like common sense and easy to accomplish, it’s not. The execution of effective revenue cycle management is a challenge for everyone involved. Many practices don’t invest the time, expertise or internal systems to make sure they get paid the maximum they’re owed as quickly as possible. Here’s hoping you successfully get your slice of pie! Stacey Stuhrenberg, CPC, CPB, CPMA, CPPM, CEMC, CMPE, is a senior consultant for coding and compliance with Kraft Healthcare Consulting, LLC, an affiliate of KraftCPAs PLLC. Stuhrenberg has more than 20 years of experience in the healthcare industry, specializing in revenue cycle management, billing, and evaluation and management coding. For more information, go online to kraftcpas.com.
Blog Log The Nashville Medical News Blog features additional insights and information from a cross-section of industry leaders. The blog can be accessed directly through NashvilleMedicalNews.Blog or from the homepage of the main website. NEW IN AUGUST: George Buck, president emeritus, and Judd Peak, chief compliance officer and general counsel, with Frost-Arnett Company, share a vendor’s perspective on how laws and regulations continue to affect patient pay. Rebecca Donner, owner and founder of Nashville-based healthcare interior design firm Inner Design Studio, works with clients across the country and across the continuum of care. In August, she shares the ways thoughtful design can facilitate healing and hope in a pediatric setting. Rachel Harris, senior manager, and Meghan Campbell, manager, with LBMC Healthcare Consulting, take a dive into analytic dashboards. Canned management reports measure stability but do so in sum totals and with a limited perspective in an industry that needs to use data, not spend time trying to just understand it. Raising the bar on dashboards allows for sharing information in a more intuitive way that considers different outcomes such as how a gain for operations might be a loss for finance to give decision-makers a clearer picture. Kurt Merkelz, MD, senior vice president and chief medical officer of Compassus, discusses key federal legislation for an aging America. Merkelz looks at the potential impact of the Palliative Care and Hospice Training Act to support patients, families, and the healthcare workforce.
Relode: Disrupting the Healthcare Staffing Industry Crowdsourcing Model Eliminates Middle Man By MELANIE KILGORE-HILL
From Airbnb to Uber, crowdsourcing has revolutionized the way Americans live, work and play. Today, healthcare recruitment is no exception thanks to the innovative team at Brentwood-based Relode. Launched in 2015, the tech-savvy startup is helping more than 30,000 agents and 300 employers find the best candidates to hire while saving time and money.
A New Niche
“Relode was born by questioning why the healthcare industry needs buildings full of recruiters all over the country when there are already good people connected to other good people in local markets nationwide,” said Relode founder Matt Tant. “Why does the middle man need to exist?” Matt Tant Healthcare staffing comprises a $23 billion industry, making it one of the largest labor expenses of any healthcare organization. By eliminating the need for a staffing agency, Relode has man-
aged to successfully disrupt the paradigm by using technology and crowdsourcing. The user-friendly website offers visitors the option to connect as an agent, nurse, physician, healthcare IT professional or employer. Referral agents earn money by referring friends or colleagues and receive customized, geo-targeted alerts for crowdsourcing candidates. Anyone can discover jobs and refer friends using Relode’s simple platform. Relode account managers qualify and coordinate all candidates to ensure the pool meets client expectations, and clients utilize a simple dashboard to track job metrics, view candidates, and communicate with Relode account managers. As interest continues to skyrocket, the company is preparing to roll out a new app to help build the freelance clinical workforce by allowing providers to pick up additional shifts at area hospitals. A relative newcomer to healthcare, Relode believes there is a good reason the crowdsourcing model has taken the world by storm. “Airbnb puts the power in the hands of users and hosts, allowing them to manage their own time and locations,” Tant said of the popular crowdsourcing site. “Similarly, healthcare facilities should allow nurses, who may be gainfully employed
elsewhere or perhaps even retired, to manage their own time and schedules. Rather than having one group of nurses at one facility, allow nurses to cover multiple shifts in multiple locations across the city and multiple employers.”
A Promising Investment
While the company was founded in 2015, it wasn’t until the end of 2017 that Relode received its first strategic financing round through Heritage Group and Frist Cressey Ventures, LLC. The investment helped the company aggressively expand its marketing strategy and sales efforts, as well as broaden and accelerate product development. “The response has been amazing, and I’ve never been a part of something that’s received so much interest and excitement from customers,” Tant said. “Customers are thirsty for innovation around traditional staffing agencies, which have limited recruiters and bandwidth in a local market.”
By the Numbers
The proof is in the numbers. In June 2018, Relode signed up 2,100 agents and 30 employers and received more than 4,000 referrals. While the refreshingly simple model may seem like a no-brainer, Tant
said healthcare has lagged behind other industries due to certain complexities. “Everyone’s doing it the same way, but we’re one of only two or three companies doing this in a modern, consumer-branded, technology-driven way,” he said. “We’re delivering key resources at a better price point.”
Spreading Hope & Healing
Tant also views Relode as a catalyst to promote Christian values by delivering care to those in dire need of hope and healing. A percentage of Relode’s profit helps fund medical staff for Mercy Ships, a floating hospital that provides free surgery and medical care to the millions of people living off the coast of Africa. The nurses, doctors and staff members are dedicated to caring for marginalized people who might be ostracized from their communities due to physical deformities. “Doctors and nurses are in the business because they care about others enough to take on years of education and risks, and to bless and save others,” Tant said. “We want to give back by sponsoring them to serve in other countries,” he continued, “and I wanted a brand with the same mission as so many of our clients while disrupting big business.”
It’s time to get back to your bucket list. F
or more than 45 years, NHC has provided quality, rehabilitative care to people of all ages. With skilled therapists and decades of experience providing compassionate post-surgical care in locations close to home, you can get back to what’s important to you. So what’s first on your list?
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TriMED Conference Set for September Second Annual Statewide Conference will Focus on Opioid Epidemic By CINDY SANDERS
Clinical and administrative healthcare professionals from across Tennessee will gather next month in Nashville for the second annual TriMED Healthcare Education Summit. Set for Sept. 14-15 at the Music City Center, the event features 20 hours of education on a variety of healthcare topics across various medical specialties. The event, which was launched last year, is a joint effort of the Tennessee Medical Association (TMA) in conjunction with American College of Physicians – Tennessee Chapter, Count It! Lock It! Drop It!, Tennessee Department of Mental Health and Substance Abuse Services, Tennessee Pain Society and the Vanderbilt Center for Quality Aging, in partnership with the Veterans Administration, Tennessee Geriatric Society and Tennessee Association of Long Term Care Physicians. “TMA is proud to join the other TriMED partner organizations for this statewide healthcare conference. Our collective goal is to give physicians and other healthcare professionals a convenient and cost-effective source for live, proprietary and relevant CME,”
said Tennessee Medical Association CEO Russ Miller, CAE. This year’s conference is particularly focused on best practices for pain management and strategies to move the needle on Tennessee’s opioid abuse epidemic. Miller noted, “The opioid epidemic has gotten a lot of attention within our state and nationally. TMA, the Tennessee Pain Society and our other partners Russ Miller are offering a forum for healthcare providers to share best practices, learn about non-opioid pain management therapies, and continue doing what they can to prevent misuse and abuse. We haven’t seen another event with such robust opioid-focused content in the state.” The conference will cover a variety of other important topics for CME credit ranging from antimicrobial stewardship and perioperative risk assessment for a number of chronic conditions to establishing a geriatric patient-centered medical home and new models of dementia care.
“Attendees will also get exposure to topics in other specialty areas they may not get at another conference,” said Miller. “It’s a great opportunity for learning and professional networking … and it’s a great reason to spend a couple of days in downtown Nashville!” he added. Program highlights include: • A panel discussion with the Democratic and Republican gubernatorial nominees discussing healthcare issues in Tennessee, • An opioid panel with subject matter experts including emergency medicine and pain management specialists, • A wellness course to help physicians better understand the high rates of burnout, stress, substance abuse and suicide within clinical medicine, and • An important update from Tennessee Department of Health Chief Medical Officer David Reagan, MD, on the rollout of Governor Haslam’s TN Together plan. The timely TN Together update comes just as new laws restricting initial opioid prescriptions and dispensing took effect July 1. TMA has produced resources for providers at tnmed.org/ opioids, including a new two-hour online course to satisfy the Board of Medical
Examiners’ requirement for safe and proper prescribing education for all licensed physicians. During the conference, the general public also has an opportunity to join the fight against prescription drug misuse by dropping off unused or expired medications between 7 am and 5:30 pm on Friday, Sept. 14 as part of TriMED’s Prescription Drug Takeback Day. Representatives from Count it! Lock it! Drop it! will be stationed on the Music City Center patio on Fifth Avenue South to help collect unwanted medications. Pharmacists and law enforcement officials will safely dispose of medications, no questions asked. “We thought the drug take back day on Friday would be another good way for our organizations to help fight the opioid abuse epidemic,” said Miller. “We must increase awareness of safe storage and proper disposal if we are going to continue making progress. We hope this event helps with public education and people in Nashville and Middle Tennessee will come to the Music City Center to safely dispose of their unused or unwanted drugs.” For more information or to register, go online to trimedtn.com.
Updating the Way to Pay, continued from page 1 “The proposed changes to the Physician Fee Schedule and Quality Payment Program address those problems head-on by streamlining documentation Seema Verma requirements to focus on patient care and by modernizing payment policies so seniors and others covered by Medicare can take advantage of the latest technologies to get the quality care they need.” The proposed rule includes a number of key changes to the PFS and QPP, in addition to rolling out a new demonstration project and requesting information regarding improved price transparency. Some of the major elements include: Pricing Updates: The proposed 2019 PFS conversion factor is $36.05, which is a slight increase over the 2018 conversion factor. CMS worked with a contractor to conduct an in-depth market research study to update the direct practice expense inputs for supply and equipment pricing, which haven’t been systematically updated for nearly 15 years. The contractor recommended pricing updates for about 1,300 supplies and 750 equipment items. Streamlining Evaluation & Management (E/M) Payment: While physicians applaud the effort to streamline the documentation burden that comes with coding E/M, there are concerns 12
over the proposed changes, particularly for complex office visits. Having heard from stakeholders that the current documentation requirements for E/M codes are unwieldy, the proposed PFS calls for simplifying documentation requirements and offering more flexibility. One option allows clinical decision-making or time spent to be a governing factor in selecting a visit level and documenting the visit, but providers could alternately continue using the current framework. Another part of the proposal would allow providers to focus the documentation on what has changed (or pertinent info that has not changed) since the last visit rather than re-documenting everything, as long as providers review and update the previous information. The proposed rule also calls for reducing physician supervision of radiologist assistants for diagnostic tests and removing functional status reporting requirements for outpatient therapy, as well as new therapy modifiers for services furnished all or in part by a physical therapy assistant or an occupational therapy assistant. Additionally, CMS is seeking comment on creating a bundled episode of care for the management and counseling treatment for substance use disorders. Specifically, the federal agency is asking for comment on methods to identify nonopioid alternatives for pain treatment and management and to highlight barriers to
deploying those alternatives, including barriers related to reimbursement. Virtual Care: “CMS is committed to modernizing the Medicare program by leveraging technologies, such as audio/ video applications or patient-facing health portals, that will help beneficiaries access high-quality services in a convenient manner,” said Verma. The proposed rule supports telehealth efforts including paying clinicians for ‘virtual check-ins’ via telephone or other telecommunications device to decide whether an in-0ffice visit or other services are necessary, paying clinicians for the evaluation of patientsubmitted photos, and expanding Medicare-covered telehealth services through new CPT codes for chronic care remote physiologic monitoring, interprofessional internet consultation, and prolonged preventive services. Drug Costs: Proposed changes would impact payment under Medicare part B with CMS proposing a change in the payment amount for new drugs under Part B to “more closely match the actual cost of the drug.” The change would be effective Jan. 2, 2019, and is anticipated to reduce the out-of-pocket cost for seniors. QPP Changes: In an effort to reduce clinical burden, focus on outcomes and foster interoperability of EHRs, the proposed rule looks to remove MIPS process-based quality measures “that clinicians have said are low-value or lowpriority, in order to focus on meaningful
measures that have a greater impact on health outcomes,” according to information released by CMS. Additionally, the federal agency is looking to overhaul the MIPS “Promoting Interoperability” performance category to support greater EHR interoperability and patient access to align the performance category with a similar interoperability program for hospitals. MAQI Demonstration Project: Another proposal is to offer waivers of MIPS requirements as part of testing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration project. The demonstration waivers would be open to clinicians who participate sufficiently in Medicare Advantage arrangements similar to Advanced APMS but who are currently still bound to MIPS reporting requirements. Request for Info on Price Transparency: CMS is also seeking comment to see if providers and suppliers can and/or should be required to tell patients about charge and payment information. The agency is also seeking information on the data elements that would be most useful to consumers to promote price comparisons when shopping for healthcare services. Comments: All comments are due by Sept. 10, 2018. Go online to NashvilleMedicalNews.com for links to fact sheets and additional information.
GRAND ROUNDS Mark Your Calendars
Health:Further • Aug. 27-29 • Music City Center
The annual summit focused on the future of healthcare returns in August. The three-day event features a host of expert speakers addressing clinical, business, and technology issues impacting the accessibility and sustainability of the healthcare industry with a focus on innovation. Health:Further has partnered with TN HIMSS and includes the 10th TN HIMSS Summit of the Southeast as part of the programing. For tickets or more information, go online to healthfurther.com.
Change of Leadership at Diversicare
Last month Diversicare, the publicly traded skilled nursing facility operator based in Brentwood, announced the retirement of CEO Kelly Gill and appointment of Jay McKnight, who has served as chief financial officer for the company since 2012, as his replacement. Previously, McKnight was CFO of NuScriptRX and held senior financial positions with a number of other healthcare companies. He received his accounting degree from Louisiana Tech University and is a certified public accountant licensed in multiple states.
Lipscomb, Columbia State Partner on Nursing Education
Last month, Lipscomb University President L. Randolph Lowry and Columbia State Community College President Janet F. Smith announced the new 2+2 Nursing Articulation & Transfer Agreement, giving students at Columbia State a new pathway to earning a nursing degree. The agreement allows students who complete an associate degree at Columbia State to seamlessly transfer to Lipscomb to earn a bachelor’s in Nursing.
LifePoint Merges with RCCH, Goes Private
On July 23, Brentwood-based hospital companies LifePoint Health and RCCH HealthCare partners entered a definitive agreement to merge. One of the area’s biggest publicly traded companies, LifePoint will sell to the private equity firm Apollo Global Management, which owns RCCH. Upon closure of the transaction, LifePoint shareholders will receive a cash disbursement of $65 per share of common stock, resulting in a LifePoint enterprise value of approximately $5.6 billion, including $2.9 billion of net debt and minority interest. The combined company, which will operate under the name LifePoint Health, will be privately held and will be led by current LifePoint Chairman and CEO Bill Bill Carpenter Carpenter. The merger of the two owners and operators of hospital networks, post-acute services, and outpatient centers will create a company with pro forma 2017 revenues of more than $8 billion, as well as 7,000 affiliated physinashvillemedicalnews
cians, approximately 60,000 employees and more than 12,000 licensed beds across 30 states. “LifePoint and RCCH are aligned in our missions and commitment to ensuring that non-urban communities across the country have access to quality care, close to home,” Carpenter said at the announcement. “Together, we can extend this shared focus while generating new opportunities for growth and partnerships that will help us navigate the changing healthcare industry dynamics.”
TOA Names Simmons New CEO
Tennessee Orthopaedic Alliance recently announced the appointment of Rob Simmons as new CEO. Simmons previously served as chief operating officer at Twin Cities Orthopedics (TCO) in Minneapolis, Minn., where he was responsible for leaderRob Simmons ship and strategic initiatives for the North Region of TCO. Simmons received his undergraduate degree from the University of Alabama and his Master’s in Healthcare Administration from the University of Alabama at Birmingham. Simmons succeeds Steve Wade, who is retiring after having served as the CEO at TOA for over 13 years. During Wade’s tenure, TOA doubled in size and is now the largest orthopaedic surgery group in the state.
Hess Named CFO of Saint Thomas Midtown & West
Saint Thomas Health, part of Ascension, has announced Pam Hess as chief financial officer for Saint Thomas Midtown and West Hospitals. Prior to her new role, Hess served as CFO of Ascension Florida for two years and brings more than 20 years of comPam Hess bined accounting and finance experience. Hess also previously served at Saint Thomas Health from 2011-2016 in various roles. As CFO, she will be responsible for financial operations, revenue cycle oversight, and decision support for Saint Thomas Midtown and West Hospitals.
TriStar Centennial Now Performing Incisionless GERD Surgery
A new, incisionless procedure to treat gastroesophageal reflux disease (GERD) is now in use at TriStar Centennial Medical Center. Until recently the treatment for GERD was a lifetime of daily medications or an invasive surgery for the more than 20 million Americans suffering from daily heartburn or other symptoms of reflux such as regurgitation, chronic cough, hoarseness and dental erosions. This new procedure offers patients a different option to treat their symptoms. The Transoral Incisionless Fundo-
plication (TIF) procedure is performed without incisions through the mouth with an endoscope and rebuilds the valve between the stomach and esophagus restoring the natural, physiological anatomy to prevent GERD. The procedure provides patients with reduced pain, reduced recovery and no visible scar. “After the TIF procedure, clinical trials show that most patients can eat and drink foods they avoided for many years. Reflux no longer impacts their life like it previously did,” said Jon Schneider, MD, gastroenterologist at The Frist Clinic.
LBMC Adds Three to Healthcare
Nashville-based LBMC, a top 50 firm in the United States with a national healthcare practice, recently announced executive leadership appointments to help accommodate company growth in the areas dedicated to serving a variety of healthcare client needs. Courtney Bach has been named shareholder in Healthcare Services, Audit and Advisory Division. Beginning her career with LBMC in the Healthcare Division, she has more than 10 years of professional experience in healthcare audit and advisory services. Courtney Bach Over the past decade, Bach has directed audit, consulting and due diligence healthcare engagements for hospitals, behavioral health providers, continuing care retirement communities, independent and assisting living facilities, nursing homes and hospice care organizations. Meredith Douglas has also been named shareholder in Healthcare Services, Audit and Advisory Division. The licensed CPA began her career with LBMC and has over 13 years of professional experience in healthMeredith Douglas care audit and advisory services. She manages and oversees teams on audit, review and consulting engagements for all types of healthcare organizations, including hospitals, behavioral health and long-term care providers, healthcare technology companies, ambulatory surgery centers and independent physician associations. Mark Johnson, CISSP has been tapped to lead the LBMC Healthcare Cyber Security Division. He has over 26 years of information security experience providing solutions to commercial companies, non-profit organizations and various U.S. federal agenMark Johnson cies, including the design, development, implementation, and administration of information security strategic programs. He is a nationally recognized leader in information security and comes to LBMC from
KPMG where he led the national healthcare industry cyber security services. His extensive experience includes serving as president and CEO of Catalina Security Consulting, chief information security officer for Vanderbilt University Medical Center, and chief security officer of London Bridge Group.
EC Welcomes 17 to Project Healthcare
Last month, the Nashville Entrepreneur Center announced 17 healthcare startups had been selected for the 2018 Project Healthcare Portfolio program. Project Healthcare Portfolio is a yearround, industry-leading entrepreneurship program designed to accelerate the success of growth-oriented healthcare startups. The diverse group of innovative companies from cities all over the country, including five from Nashville, will receive custom-tailored support combined with immersion into Nashville’s renowned healthcare industry. Project Healthcare partners include HCA, Ascension, LifePoint Health PNC, Bass, Berry & Sims, Launch Tennessee, and Nashville Health Care Council
WholeCare Hires Two
Caregivers by WholeCare, a nonmedical home health company offering continuum of care services, recently added two team members in sales and operations roles. Tara Bloom has joined the company as family care coordinator. She has more than 20 years of sales, marketing and business development experience in home health. Previously, Bloom was president at Like Family Home Care, an independent home health Tara Bloom agency she founded in 2012. She also served in various leadership roles at Sexual Assault Center in Nashville and as director of marketing and business development at Hospice of the Golden Isles in Brunswick, Ga. Prior to that, she founded a marketing communications agency, Taramark, serving clients in professional services, education and healthcare for 10 years. Bloom graduated from Emory University and earned a master’s in communications, journalism and public affairs at American University in Washington, D.C. Adriaunna Fisher has come on board as recruiting coordinator. Previously, she served as scheduler at Comfort Care In-Home Services and held various roles in human resources administration and customer service. She earned her associate’s degree in Adriaunna Fisher business administration and management from Three Rivers Community College in Missouri. Fisher, who relocated to Nashville in March 2018, is responsible for recruiting family-oriented and nurturing caregivers for WholeCare. AUGUST 2018
GRAND ROUNDS Let’s Give Them Something to Talk About!
Awards, Honors, Achievements
HCA hits 50. Nashville-based hospital giant HCA Healthcare is celebrating its 50th year in business this month. In August 1968, Drs. Thomas Frist, Sr., and Thomas Frist, Jr., along with healthcare executive Jack Massey formed Hospital Corporation of America to provide the scale, resources and clinical expertise needed to deliver patientcentered care. Today, the company is one of the nation’s leading providers of healthcare services with facilities including 178 hospitals and 119 freestanding surgery centers across 20 states and the United Kingdom. Amy S. Leopard, a partner in the Nashville office of Bradley Arant Boult Cummings, LLP, has been elected to the board of directors of the American Health Lawyers Association (AHLA). Leopard has chaired the AHLA Health Information and Technology Amy Leopard Practice Group for the past three years. LBMC, PC has been recognized as a 2018 Top 50 accounting firm by INSIDE Public Accounting. The publication ranked LBMC #43 in its 2018 Top 100 largest accounting firms in the U.S. list based on the firm’s revenue and growth of approximately 12 percent. This year’s list places LBMC four slots higher than last year’s position. The Nashville Health Care Council recently announced the appointment of its 2018–2019 board of directors. R. Milton Johnson, chairman and CEO, HCA Healthcare, begins a two-year term as chairman of the board. Robert A. Frist Jr., co-founder, CEO, president and chairman, HealthStream, begins the first year of his two-year term as vice chairman of the board.
Eric Thrailkill has been installed as the new TN HIMSS president and will serve a two-year term. Thrailkill is vice president and chief information officer for Envision Healthcare. Eric Thraikill Kleer recently announced the inaugural 2018 Most Influential Dentists in America Program, naming the most influential dentists in each state. Three Middle Tennessee dentists were included for their clinical excellence and thought leadership in the industry. Area honorees were Jacob Bourget, DDS, of Embassy Dental and David Roach, DDS, of Roach Family Dentistry in Nashville and John Murfree, DDS of Murfree Dental in Murfreesboro. Jason Greene, PharmD, was sworn in as the new president of the Tennessee Pharmacists Association at the organization’s 131st Summer Meeting last month. He will serve as president for a year and continue on the TPA Board for three years. Greene is pharmacy manager for Reeves-Sain. Sharon Reynolds, president & CEO of DevMar Products, a leading renewable products distribution company, recently received a ‘WBEs Who Rock’ Award by Minority Business Entrepreneur magazine at the Women’s Business Enterprise National Council (WBENC) during the National Conference and Business Fair Sharon Reynolds in Detroit this summer. Reynolds was honored for her advocacy of environmental initiatives and developing formulations for green cleaning and safety products. DevMar Products serves multiple industries including healthcare and hospital facilities to create healthier environments for employees, patients and visitors.
Saint Thomas Health, MWCHC, UTHSC Launch Dental Residency
TNHIMSS Graduates 15 from Workforce Accelerator
The Tennessee chapter of the Healthcare Information and Management Systems Society and Belmont University recently announced 15 students had completed the seventh cohort of the Health IT Workforce Accelerator. The program is designed for healthcare professionals of all levels, backgrounds and career paths and teaches participants how the blending of healthcare and IT impacts care outcomes. Throughout the course, students gain exposure to the healthcare provider, payer and vendor settings. Recent graduates included representatives from Ardent Health, Vanderbilt, BCBS TN, Perception Health, CHS, AmSurg and HCA.
IQuity Launches New Analytics Platform
Last month, IQuity, a Nashvillebased data analytics company specializing in predicting, detecting and monitoring chronic disease, announced the launch of a revolutionary data mining and analytics platform that will predict and monitor chronic diseases within large populations. Company officials also announced that two former senior executives of healthcare technology company WPC Healthcare/Intermedix – Ray Guzman and Damian Mingle – have been named advisors to IQuity and will assist in the further development and execution of the new platform. The launch of the new platform represents IQuity’s evolution from a developer of genomic diagnostic technologies to an integrated data science company analyzing many types of information, such as claims data and electronic medical records, to predict, detect and monitor disease. Officials said the technology holds the promise of enhancing outcomes while lowering overall costs of care for large populations.
Saint Thomas Health, Matthew Walker Comprehensive Health Center (MWCHC), and the University of Tennessee Health Science Center announced a partnership last month to launch a new Advanced Education in General Dentistry (AEGD) residency program with the goals of providing greater access to dental care for Nashville communities and providing advanced training opportunities for future dental providers. The AEGD program will be based at MWCHC and launches with four residents with plans to expand to 10 residents in the coming year. The clinic will continue to be owned and operated by MWCHC, which has been serving the Nashville community for 50 years. To accommodate the residency program, MWCHC’s dental clinic is being renovated and expanded, doubling the size of the existing dental practice. Major financial support for the renovations has been provided by Saint Thomas West through the Community Benefit program and from Saint Thomas Health Foundation. The renovation is anticipated to be complete by the middle of August. Katina Beard, CEO of MWCHC, said: “We are very excited about this unique partnership with Pictured (L-R) Robyn Mays, DDS (MWCHC Dental Director and UT AEGD Associate Program Saint Thomas/Ascension and the University of TenDirector); Olawale Osinusi, DDS (Resident); Quintarias Lester, DDS (Resident); Preston Harris, Jr., DDS (Resident); Michael Hicks, DDS (Resident); Jon Vroman (Co-Founder, Front Row Foundation); nessee. As a short-term, immediate action, this Ramon Galvan, DDS (UT AEGD Program Director). type of partnership is designed to increase access for uninsured adults. However, I believe a long-term effect of this partnership will be the number of dentists that will choose to become a provider in our low-resourced urban and rural communities. I also hope we will be able to mentor others in developing such rich private/public collaborations.”
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GRAND ROUNDS Business Briefs
Nashville-based Clearwater Compliance recently announced the company has entered into a new three-year agreement to provide its Cyber Risk Services™ to OhioHealth, a not-for-profit charitable healthcare outreach of the United Methodist Church. OhioHealth has used other Clearwater software and professional services since 2016. Nashville-based b+b® (Better by Giving), a family-owned health and wellness company, recently announced introduction of its pain relief products into more than 1,200 Publix Super Markets. Marketed as “pain relief with heart,” the FDA/USP-approved products – including acetaminophen, ibuprofen and naproxen sodium – are now available in over 2,600 retail locations nationwide. For every b+b® pain relief product purchased, the company donates one to its network of over 1,000 free health clinics and rural health centers across the United States in partnership with Americares. To date, more than 2.5 million doses have been donated. Last month, Canadian investment firm OMERS became the lead investor in Brentwood-based Premise Health, which manages more than 600 health and wellness workplace centers in 44 states. Appello Pharmaceuticals, a Nashville-based startup that has licensed Vanderbilt technology to develop a new treatment for Parkinson’s disease, recently announced completion of a $10.5 million Series A financing led by Deerfield Management and Mountain Group Partners. This initial investment will support the development of novel positive allosteric modulators (“PAMs”) of the metabotropic glutamate receptor subtype 4 (“mGlu4”), which were developed at the Vanderbilt Center for Neuroscience Drug Discovery. The new technology works in a fundamentally different way than current dopamine replacement therapy, instead modulating glutamate, another of the brain’s neurotransmitters. Nashville-based PlayMaker Health, a post-acute care relationship management firm, recently purchased Charlotte, NC-based ViaDirect Solutions, which provides data analytics and market intelligence in the post-acute care space. MD Wealth Management Group has joined forces with the local operations of Janney Montgomery Scott, which is headquartered in Philadelphia. Janney also announced an office relocation with a move of the Cool Springs office to 6700 Tower Circle in Franklin. The MD Wealth Management team includes Bradley Dickens, Jason Minor, and Deidre Ramer. Previously, the three were affiliated with Wells Fargo Advisors. Urgent Care Group, a Nashvillebased urgent care company, recently announced the completion of the acquisition of MEDcare Urgent Care. To
complete the transaction, Urgent Care Group partnered with Capital Alignment Partners and Harbert Management Corporation. Urgent Care Group now owns and operates MEDcare’s seven centers located across South Carolina. Last month, Change Healthcare introduced Member Healthcare Payments, a consumer payment solution that enables health plans to display consolidated patient financial information in a single destination, and helps consumers better understand and manage their healthcare finances. Additionally, the
new payer solution supports providers by collecting patient payments, which can eliminate the provider’s need to collect those payments. Saint Thomas Health announced last month Murfreesboro Surgical Specialists has joined Saint Thomas Medical Partners (STMP), effective immediately. The affiliated surgeons have served Rutherford County and beyond for more than 30 years and offer a full range of care. Wayne Westmoreland, MD, FACS, FABS; Ward Houck, MD, FACS; Lindsay Keith, MD; Mark Atkins, MD, FACS; Mark
Manwaring, MD, FACS,FASCRS; and Stephen Rich, MD, JD,FACS, are now all part of STMP. Community Health Systems has announced a definitive agreement to sell the two-hospital Sparks Health System and related businesses, including physician clinic operations and outpatient services, to Baptist Health in Little Rock, Ark. The transaction is expected to close in the fourth quarter of 2018, subject to customary regulatory approvals and closing conditions.
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Nashville Medical News August 2018