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FOCUS TOPICS PEDIATRICS • HEALTH LAW

Your Middle TN Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGE 6

Sheila McMorrow, MD ON ROUNDS

Another Option to Address Pediatric ADHD The CDC estimates more than 9 percent of children ages 2-17 have been diagnosed with ADHD. A new FDA-cleared device offers another non-drug treatment option. ... 5

Back to School Reminders for Patients & Providers Late summer is a busy time for many providers with parents squeezing in immunization updates, sports physicals and routine checkups for their children before another school year gets too far underway ... 5

Beating the Odds

Immunotherapy Trial Proves Effective in Delaying Onset of Type 1 Diabetes By MELANIE KILGORE-HILL

Researchers at Monroe Carell Jr. Children’s Hospital at Vanderbilt have completed a clinical trial, which is now hoped to be a game-changer for patients with type 1 diabetes. According to findings from TrialNet’s Teplizumab (anti-CD3) Prevention Study published in the New England Journal of Medicine in June, the drug targets the immune system and delays type 1 diabetes onset an average of two years in children and adults at high risk. With more than 20 percent of participants enrolled, Children’s Hospital at Vanderbilt was the largest of 25 study sites around the world taking part in the trial. The study was part of Type 1 Diabetes TrialNet, recognized as the largest network ever assembled to discover ways to delay and prevent type 1 diabetes.

Promising Results

“This drug has a profound effect in dropping the risk of developing type 1 diabetes; and although (CONTINUED ON PAGE 4)

Hot Topics in Healthcare Law

A Conversation with AHLA President-Elect Designate Cindy Reisz By CINDY SANDERS

Bold Goals in Breast Cancer Susan G. Komen CEO Paula Schneider & Vanderbilt-Ingram Komen Scholar Dr. Ingrid Mayer discuss bold goals in the fight against breast cancer ... 11

Follow us on Twitter

@NashMedNews

Cindy Reisz

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Will the Affordable Care Act stand or fall in the face of the latest court challenges? How does the move to a value-based system impact providers and contracting? What does the 21st Century Cures Act mean for data sharing? How do selfreferral regulations come into play in light of consolidations and partnerships across the continuum of care? What about liability in the face of ongoing cybersecurity threats? The highly regulated nature of the healthcare industry certainly serves as job security for America’s health lawyers as they help clients navigate reams of rules that carry significant legal

consequences from hefty fines and possible exclusion from the Medicare program to potential criminal penalties. Cindy Reisz, who was selected as president-elect-designate of the American Health Lawyers Association (AHLA) this spring, recently shared thoughts with Medical News on hot topics keeping attorneys busy on behalf of their industry clients. Reisz, a partner in the Nashville office of Bass, Berry & Sims, draws on more than three decades of transactional and operational experience in advising healthcare clients. She has served on the AHLA Board of Directors since 2013 and taken on leadership roles with the national organization for more than two decades. Over the course of the next two (CONTINUED ON PAGE 8)

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

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PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357


OPIOID TAKE BACK DAY Saturday, September 7 10 a.m. – 2 p.m. TriStar Health is committed to improving more lives in more ways. On Saturday, September 7, area TriStar Health hospitals are joining HCA Healthcare hospitals and local law enforcement agencies across the nation to host Crush the Crisis Opioid Take Back Day. Opioid addiction can happen to anyone, and unused prescription opioids are a major source of misuse. Crush the Crisis Opioid Take Back events provide an opportunity for the community to properly dispose of unused opioid medications anonymously, with no questions asked.

Take action by turning in your unused and expired medication for safe disposal at any of the following TriStar Health locations: TriStar Centennial Medical Center TriStar Hendersonville Medical Center TriStar Horizon Medical Center TriStar Greenview Regional Hospital TriStar Skyline Medical Center TriStar Southern Hills Medical Center TriStar Spring Hill ER TriStar StoneCrest Medical Center TriStar Summit Medical Center* *TriStar Summit will be collecting medications from 10 am - 1 pm.

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ACCEPTED ITEMS: Tablets, Capsules and Patches Hydrocodone (Norco, Lortab, Vicodin) Oxycodone (Oxycontin, Percocet) Tramadol (Ultram) Codeine, Fentanyl (Duragesic) Morphine, Hydromorphone (Dilaudid) Oxymorphone (Opana) NOT ACCEPTED ITEMS: Needles Syringes Lancets Liquids Inhalers

For more information, please call 833.582.1970 or visit HCAhealthcare.com/CrushtheCrisis

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.com


Vanderbilt Children’s New Program Leaders, Rankings By MELANIE KILGORE-HILL

The Monroe Carell Jr. Children’s Hospital at Vanderbilt recently named new leaders in Pediatric Plastic Surgery and the Division of Pediatric Infectious Disease. In addition, the hospital once again received high marks nationally in the annual U.S. News & World Report’s annual “Best Children’s Hospitals” rankings.

Craniofacial Specialist

Michael Golinko, MD, FACS, has joined Monroe Carell Jr. Children’s Hospital at Vanderbilt as assistant professor of Plastic Surgery, medical director of the Cleft and Craniofacial Center and chief of Pediatric Plastic Surgery. Golinko was previously assistant professor of Plastic Surgery Dr. Michael Golinko and medical director of Arkansas Children’s Hospital’s Craniofacial Program.

“We, as a department, are very excited to have Dr. Golinko join our faculty to lead the multidisciplinary Craniofacial and Cleft Surgery Center here,” said Galen Perdikis, MD, chair of the Department of Plastic Surgery. “We feel privileged to have been able to successfully recruit him and look forward to supporting him in his goal of establishing this as a premier, internationally recognized program.” Golinko is setting up the framework to hold a monthly team clinic for cleft patients and a second monthly clinic for patients with craniofacial disorders. “Our goal is to have a very service-oriented and patient- and family-centered program and to allow patients and families to have ‘one-stop’ to see all practitioners they need to in one day. The fundamental mission is to help children with cleft and craniofacial issues live their best lives,” said Golinko. Golinko earned an undergraduate degree in physics at Massachusetts Institute of Technology and his medical degree from University of South Florida College of Medicine. He did general surgery resi-

Insuring Kids

Concern Remains over TennCare Unenrollment By MELANIE KILGORE-HILL

In April, Nashville Medical News covered a startling statistic regarding the number of children recently unenrolled from TennCare, the state’s Medicaid program. Last month, The Tennessean also investigated why at least 220,000 Tennessee children were cut, or were expected to be cut, from the program. “We’ve heard from TennCare that they believe the problem is fixed because the enrollment system is now online, but we’ve already been made aware of several issues that don’t give us confidence that kids who are eligible will be reenrolled,” said Kinika Young, director of Children’s Health at the Tennessee Justice Center. “People are trying to get reenrolled, but it’s Kinika Young causing a lot of headaches because they’re calling to inquire of status and receiving conflicting information.” Young said one of the biggest problems she’s now seeing is members of the same household not being linked online. That’s causing concern, since eligibility is partially dependant on household size. nashvillemedicalnews

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Katina Beard, MSPH, chief executive officer at Nashville’s Matthew Walker Comprehensive Health Center, said staff is aware of the issue and being diligent to educate parents regarding the need for ongoing communication with TennCare. “We’re telling parents this is something you have to be proactive about and work to make Katina Beard sure enrollment stays intact,” she said. “If you move, you have to reach out and make sure all your information is up-to-date. The biggest issue we see is parents who aren’t self-aware and really have a hard time with this.” Beard said they’ve seen denials for children who clearly meet eligibility requirements and work with the center’s outreach and enrollment staff to pursue reenrollment. “This is almost like the flu epidemic where we encourage everyone to get a flu shot,” Beard said. “This is an insurance epidemic, and everyone on all fronts need to be working together to make sure everyone who’s supposed to be covered is covered.” The application for TennCare, CoverKids and Medicare Savings Programs is online at tenncareconnect.tn.gov.

dencies at State University of New York Downstate Medical Center and New York University School of Medicine, followed by a residency in plastic and reconstructive surgery at Emory University. He also completed a fellowship in craniofacial surgery/pediatric plastic surgery at New York University’s Department of Plastic Surgery. A Fellow of the American College of Surgeons, Golinko has been an active volunteer in countries including India, Nicaragua, Haiti, Thailand, Tanzania and others.

Infectious Disease

Mark Denison, MD, the CraigWeaver Professor of Pediatrics, has been named director of the Division of Pediatric Infectious Diseases in the Vanderbilt Department of Pediatrics. Denison earned degrees in chemistry and English from the University of Kansas, Dr. Mark Denison followed by his medical degree from the University of Kansas School of Medicine. He completed a residency in pediatrics and fellowship in pedi-

atric infectious disease at the University of Iowa Hospitals and Clinics. Following a year directing pediatrics and infectious diseases at Tenwek Hospital in Kenya, his first faculty appointment was at Thomas Jefferson University in Philadelphia. Denison was recruited to Vanderbilt in 1991 and was awarded the Craig-Weaver Chair in Pediatrics in 2011. He has received teaching awards from both Thomas Jefferson University and VUMC, and he has trained more than 20 doctoral students and postdocs, as well as high school students, undergraduates and post-baccalaureate trainees. Recently, Denison was awarded the Vanderbilt University School of Medicine’s Ernest W. Goodpasture, MD, Award for groundbreaking research that addresses the pathogenesis of disease at the cellular and/ or molecular level. Denison’s research program targets coronaviruses, the family of viruses from which the causative agents of SARS and MERS have emerged to cause severe and lethal human disease with pandemic potential. He has conducted more than 30 years of NIH-funded research focused on coronavirus pathogenesis and targets for antivirals and vaccines, resulting in more than 100 publications and several

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Services for Mom & Baby Expanding at TriStar Centennial By MELANIE KILGORE-HILL

Services benefitting both mothers-tobe and their babies continue to expand at TriStar Centennial Women’s Hospital and The Children’s Hospital at TriStar Centennial. Both fall under the watchful leadership of Chief Operating Officer Amber Price, DNP, CNM, who joined the Nashville hospital in January 2019. Amber Price

C-Section Drapes

Rethinking the C-section experience means moms at the Women’s Hospital now have the opportunity for immediate skinto-skin contact with their baby. In July, the hospital rolled out C-section drapes designed to encourage bonding – a welcome approach to an otherwise sterile surgery experience utilized in nearly one-third of U.S. births. Traditionally, a solid drape separates mom and baby, and cold operating room temps mean baby is immediately placed in a warmer for up to 30 minutes.

“Babies can now go directly from incision to chest through a window in the section drape, after delayed cord clamping,” said Price, who noted that staff recently completed training on the new product. “Our goal is always to keep mom and baby together, and these drapes help make that possible.”

desire among families seeking midwifery. “As a hospital system, our goal is to fill our basket with every possibly thing a patient could need, and we’re filling ours with this new specialty,” said Price. “We’re also addressing policies to build an infrastructure around midwifery while safeguarding mom and baby in the process.”

Doula Care

Better Odds for Mom & Baby

Recognized as a valuable … but often pricey … service, doula care is now offered free of charge to women delivering at the Women’s Hospital. “Most people want that extra support person, but it can be very expensive out-of-pocket,” said Price. “Doulas are a great benefit to patients no matter what kind of birth they want and help enhance the delivery experience.” A doula is now available on the floor in 12-hour shifts, and Price said the program has received tremendous interest from patients and doulas alike.

Calling the Midwife

Nashville experiences 2,000 midwife births each year, and that number continues to grow. “Consumers are looking for low inter-

Beating the Odds, continued from page 1 it was completely blinded, we started to immediately notice certain blood lymphocytes dropping in some and not other participants,” said Bill Russell, MD, TrialNet principal investigator and director of the Division of Pediatric Endocrinology and Diabetes at Children’s Hospital at Vanderbilt. Dr. Bill Russell Russell has been involved with the double blinded study since its beginning in 2011, as 85 percent of the almost 3,000 patients in the Children’s Diabetes Program at Vanderbilt have type 1 diabetes. Participants chosen for the study each had a lifetime risk of clinical diagnosis of type 1 diabetes nearing 100 percent. Fifty-five of the 76 study participants were under age 18, and all had a relative with type 1 diabetes, two or more type 1 diabetes autoantibodies and abnormal blood sugar levels. The subject population all had positive diabetes antibodies in their circulation, indicating that their immune systems were targeting their beta cells in the pancreas. They also had impaired glucose tolerance, meaning their glucose response to an oral glucose tolerance test was not normal, but it wasn’t yet in the diabetic range – a phase now referred to as stage two of type 1 diabetes. Russell said people who are in stage two, (antibodies plus impaired glucose tolerance) have an 85 percent likelihood of developing clinical diabetes (stage three) within five years. 4

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According to a release issued by Vanderbilt, participants were randomly assigned to either the treatment group, which received a 14-day course of intravenous teplizumab, or to the control group, which received a placebo. All participants regularly received glucose tolerance tests until the study was completed, or until they developed clinical type 1 diabetes – whichever came first. Seventy-two percent of people in the control group developed clinical diabetes, compared to only 43 percent of the teplizumab group. The median time for people in the control group to develop clinical diabetes was just over 24 months, while the median time for the treatment group was 48 months.

Delaying Diabetes

“The goal for this work is to take people at risk to develop diabetes and figure out how to keep it from progressing to clinical diabetes where you have to treat with insulin,” said Russell, noting the relatively new concept of delaying diabetes. “This trial came out of research in other studies, which showed us there are actually three stages in the progression of type 1 diabetes. That’s been very useful for planning research studies.” Researchers now believe people with specific antibodies and normal glucose tolerance technically have type 1 diabetes, although it hasn’t evolved to the point of needing insulin in that earliest stage. In stage two, there’s a progression of antibodies and glucose intolerance, and enough damage to cause difficulty in maintaining glucose. Stage three is the

vention births, particularly as information on maternal mortality becomes more widespread,” said Price, a nurse-midwife. To that end, the hospital is preparing to launch Centennial Midwifery in September and already has a list of waiting patients. The service will be provided on the Labor and Delivery floor and will include two dedicated midwife birthing suites designed for patients who want to avoid medical intervention unless necessary. Rooms will include birth stools, yoga slings, birth tubs, special lighting and music, large walk-in showers and Murphy beds. The hospital offers nitrous oxide as a pain relief option. Patients also will have the option of early discharge, a common

traditional onset of diabetes. “We now think of it in stages, because if you’re going to prevent a disease you need to stop it in stage one or two,” Russell explained. While this particular trial was designed to start in stage two, Russell anticipates follow-up studies investigating its effect in those with stage one. “If we’re able to delay diabetes two years by starting in stage two, we’re very excited to see what may happen by starting it in stage one when there’s no significant damage to beta cells,” he said. Investigators also are questioning the possibility of opting for a second round of treatment or combining teplizumab with other drugs that target the immune system, effectively hitting two different parts of the pathway. “The pathways leading to diabetes may be analogous to those leading to cancer, in that it’s very rare to have a single drug that can stop a cancer,” Russell said, pointing to the medication cocktails that comprise typical cancer chemotherapy treatments. “Teplizumab targets T lymphocytes,” he explained. “We want to look at other parts of the immune system, perhaps simultaneously targeting the B cells that make the antibodies.”

Searching for Answers

As investigators await FDA approval for follow-up studies, Russell and his team have been reaching out to the families who gave of their time to participate. “These families willingly spent two weeks in a clinical research unit, missing school and work and knowing they may

Tennessee’s infant and maternal mortality death rates far exceed the national average, due in large part to a higher rate of opioid addiction and preterm births. The Tennessee Maternal Mortality report, released earlier this year by the Tennessee Department of Health, reviewed the 2017 data on women who died while pregnant or within one year of pregnancy and found a pregnancy-associated mortality ratio (PAMR) of 96.3 per 100,000 live births. “This is absolutely a crisis in the state,” said Price, who serves on the Tennessee Maternal Mortality Review Board. As an administrator, she regularly evaluates infrastructure and way to improve 24/7 access to obstetric care for high-risk moms, particularly in the ER. (CONTINUED ON PAGE 10)

only be getting a placebo,” he said. “Parents uniformly said how much they appreciated the attention from us and the trials team, and how important it was for their kids to feel some sense of community with others. Everyone wants a cure but no one really appreciates how complicated this is until they’re involved.”

Vanderbilt’s Pediatric Diabetes Program

As one of the largest pediatric diabetes centers in the country, Vanderbilt Children’s Diabetes Program treats those with type 1 or type 2, monogenic diabetes, cystic fibrosis-related diabetes and transplant-related diabetes, and is a destination for families nationwide. Vanderbilt is also a Type 1 Diabetes TrialNet Clinical Center, funded by the National Institutes of Health, which means additional trials are continually underway. Another Vanderbilt pediatric endocrinology researcher, Daniel Moore, MD, PhD, is investigating autoimmunity and the science behind the immune attack of beta cells, while Justin Gregory, MD, MSCI, is exploring the possibility of delivering insulin more physiologically to the liver, thereby decreasing excessive insulin exposure to other organs. “We’re doing quite a bit of work on both the child and adult sides of type 1 diabetes looking at the power and biology of beta cells,” Russell said. “We want to treat patients earlier and in the most effective way possible to prevent disease onset and provide the highest quality of life.” nashvillemedicalnews

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Another Option to Address Pediatric ADHD NeuroSigma Prepares U.S. Launch of First FDA-Cleared Device By CINDY SANDERS

The Centers for Disease Control and Prevention (CDC) estimate a little more than six million children in the United States have … or have had … AttentionDeficit/Hyperactivity Disorder (ADHD). The latest statistics, pulled from the 2016 National Survey of Children’s Health (NSCH), underscore how prevalent the disorder is with approximately 9.4 percent of children ages two-17 having been diagnosed with ADHD. Currently, treatment options for ADHD typically include behavioral therapy, medication or a combination of the two. While the CDC stated there is no single source of comprehensive data on ADHD treatment, parent reports and claims data provide some insight into therapy preferences. Of those ages two-17 with a diagnosis, the CDC estimates: • About 30 percent treated with medication alone, • About 15 percent received behavioral therapy alone, • About 32 percent received both medication and behavioral therapy, and • About 23 percent of children with ADHD receive neither treatment option. On April 19, the U.S. Food and Drug Administration (FDA) cleared a new treatment option for pediatric ADHD – the Monarch® external Trigeminal Nerve Stimulation (eTNS®) System by NeuroSigma, Inc., a bioelectronics company based in Los Angeles. The Monarch eTNS System, the first medical device cleared to treat pediatric ADHD, is a prescriptiononly device cleared for use in patients ages seven to 12 who are not currently taking prescription ADHD medications. “It provides non-invasive, transcutaneous stimulation of the trigeminal nerve through the forehead,” explained Colin Kealey, MD, vice president of Advanced Development & Medical Affairs for NeuroSigma. Used while children sleep at night, Kealey noted the treatment allows users to go about their normal day without having to interrupt school or play time to take medicine. An electrical patch about the size of a large bandage is applied to the forehead before bedtime. The patch is connected to the handheld Monarch eTNS pulse generator, which is similar in size to a cell phone. “That generator creates a gentle electrical signal that stimulates the trigeminal nerve,” said Kealey. While the FDA release regarding the new device stated the exact mechanism of eTNS still isn’t fully understood, the federal agency pointed out neuroimaging studies have shown eTNS increases activity in certain brain regions.

The Road to FDA Clearance

“We submitted our application for FDA clearance via the de novo pathway in 2018, and that clearance was granted in April 2019,” Kealey said. He added the de nashvillemedicalnews

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ness, headache, trouble sleeping, fatigue, increased appetite and teeth clenching. Kealey said the eTNS has been approved in the European Union since 2012. “In all that time, there has never been a serious adverse event with the device that we’re aware of,” he said, adding it has a strong safety profile.

Next Steps

novo pathway is reserved for novel medical devices that are deemed low-to-moderate risk for patients. Even under the best circumstances, it may take years for a novel device to develop the data necessary to obtain marketing authorization from FDA. For NeuroSigma, the trek to FDA clearance began with an open label study enrolling 24 patients. That study yielded positive results that were published in 2015 and set the stage for a larger clinical trial, which was completed in 2017. “Based on those results (from the open label study), the principal investigator at UCLA – Dr. Jim McGough – was awarded a grant from the National Institutes of Health to do a blinded trial, and NeuroSigma provided the devices for that trial,” Kealey said. James McGough, MD, is a professor and child psychiatrist at the Jane & Terry Semel Institute for Neuroscience and Human Behavior at UCLA. The NIH-funded, randomized, double-blinded trial enrolled 62 children with moderate-to-severe ADHD to assess the Monarch eTNS System’s efficacy as a monotherapy to treat the disorder as compared to a placebo device. Kealey said the trial’s primary endpoint was improvement on the ADHD-RS-IV. The ADHD Rating Scale is commonly used to monitor the severity and frequency of symptoms for children diagnosed with the disorder. In addition, the trial also looked at changes to the Clinical Global Impression-1 (CGI-1) scale, which measures severity. Trial results were provided to the FDA last year and were published in the April 2019 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Children were randomized to use the Monarch eTNS or a sham (placebo) device for four weeks while sleeping. Those in the active group of the trial had statistically significant improvement in ADHD symptoms compared to the placebo group. The active group’s average ADHD-RS score decreased from 34.1 points at baseline to 23.4 points (differential of 10.7 points) at the end of four weeks compared to a decrease in the placebo group from 33.7 to 27.5 (a 6.2-point differential). Similarly, between group comparison of the CGI-1 scores also favored the trial’s active group (p = .003). No serious adverse effects were observed with use of the device. The most common side effects were drowsi-

“We’re in the process of preparing for launch,” NeuroSigma President and CEO Leon Ekchian, PhD, said of the next steps. He added a pilot rollout will happen later this year, followed by a full market launch in 2020. “What is important in pediatric ADHD is to be able to offer different options to parents,” Ekchian said. “What we’re offering is a non-stimulant, non-drug treatment to improve a child’s ADHD symptoms.” He noted that at any given time, a little more than three million children are taking ADHD medication and that it is common to cycle on and off of drugs. “Our value proposition is we want to offer parents an alterna-

tive to the drugs. Of course, that’s a choice between physicians and parents, but we now have this alternative that has a strong safety profile and limited side effects.” Pointing to the broader field of neuromodulation, Ekchian continued, “We view this as part of a broader treatment paradigm. These approaches have the potential to provide an alternative to the use of medication and offer a more targeted treatment approach.” He said that while at this time the Monarch eTNS is only cleared in the US for pediatric ADHD, NeuroSigma plans to perform additional studies in the future to explore potential use in conditions such as PTSD, epilepsy, depression. However, he added, NeuroSigma is laser-focused on introducing the ADHD application to providers, patients and parents as the company prepares for the national rollout and partnering opportunities outside the US. “We think there’s a really compelling opportunity for our eTNS system because we believe it’s an alternative to medication with positive efficacy and a favorable safety profile,” Ekchian concluded.

Back to School Reminders for Patients & Providers By CINDY SANDERS

Late summer is a particularly busy time for many providers with parents squeezing in immunization updates, sports physicals and routine checkups for their children before another school year gets too far underway. James Edwin Conley, MD, a primary care physician with Saint Thomas Medical Partners, noted it’s also a great time for physicians and other providers to help young patients and their parents get off to a healthy, happy start. “Starting a new school year can be overwhelming for some,” said the internist. Conley added a number of Dr. James Conley factors can cause additional tension at the beginning of the year including unfamiliar teachers, classmates and buildings. Other stressors, he said, include the fear of failure – either socially or academically – and worries about making friends and being accepted. “The key is to stay positive and take it one day at a time,” advised Conley. “Encourage your child to believe in themselves and instill confidence.” He also said students should be encouraged to ask for help when they don’t understand a subject or if they feel bullied or uncomfortable in a situation. Parents should also be alert to red flags that their child might be struggling. “Warning signs may include worsening performance in school, change in behavior or

mood, lack of interest in doing things that were once enjoyable, poor appetite, concentration, or sleeping patterns, irritability, disinterest in socializing with peers or participating in activities, or increase in sick days from school,” said Conley. He added that he reminds parents to talk to their children often, asking about school experiences and discussing any pressures or concerns that are expressed. “Encourage your child to be open and try not to be judgmental. Provide reassurance and guidance in areas of struggle. It is never wrong to find help to address issues as soon as possible,” he noted. For younger children starting school, Conley said reassurance that they are loved and supported is key. “Let them know that they can lean on you in time of need,” he said. “Not every day will be great … troubling and difficult situations will arise … but everything will get better.” Conley said the takeaway message for kids of all ages embarking on a new school year is that it’s a team effort with a support system that includes parents, teachers, physicians and children working together to optimize physical and emotional health.

More Tips from Ascension Saint Thomas For additional tips to share with families to start the school year off right, go online to NashvilleMedical News.com

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PHYSICIAN SPOTLIGHT

Caring for Kids at The Children’s Hospital at TriStar Centennial Dr. Sheila McMorrow Helping Expand Care, Services By MELANIE KILGORE-HILL

at Vanderbilt University Medical Center, where she remained for her pediatric Caring for kids is nothing new for emergency medicine fellowship. Sheila McMorrow, MD. It’s a role she’s McMorrow stayed at the academic embraced since childhood. medical center as an assoThe Pediatric Emerciate professor of pedigency Medical Director at atrics and anesthesia for The Children’s Hospital at nine years, but she transiTriStar Centennial grew tioned to an exciting new up in a large Irish Catholic role as medical director for family. An Atlanta native, the Pediatric Emergency McMorrow was one of six Department at TriStar children and said the role Centennial Medical Center of caregiver came easily. in 2015. The decision to leave VUMC wasn’t easy, Dr. Sheila McMorrow but McMorrow said the Finding her Niche opportunity came at a key “From the get-go, time in her life – motherhood. I always had a lot of responsibility for “I was starting a family, and this let younger kids, so that was something that me be home more and also be a part of was just natural for me,” she said. “When something that was just starting,” said I did my medical school rotations, I loved McMorrow, now a mother of three. “Part pediatrics, and it became my comparison of pediatrics is having a relationship with for subsequent rotations.” the parents, as well as the patient. And as a After receiving bachelor’s degrees mom and a doctor, I can sympathize when in both philosophy and biomedical parents have concerns. Motherhood has engineering from The Catholic Univermade me a better doctor,” she added. sity of America in Washington, D.C., Additionally, McMorrow had worked McMorrow earned her medical degree previously with several of the providers at from the Medical College of Georgia at TriStar Centennial and considered them Augusta University. She then completed a strong influence on her decision to lead an internship and residency in pediatrics

the growing program. And lead she has. Upon her arrival, TriStar Centennial was developing plans to renovate the main ER to include a separate section for pediatric patients. However, McMorrow advocated for a specialty ER completely separate from the adult population. “Nashville is prime to what a pediatric ER should feel like, and that’s what families here expect,” she said. “It’s really important to have a separate space for

pediatrics away from the adult population, which can be challenging because of the mix of patients.”

The Children’s Hospital at TriStar Centennial ER

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The 6,000-square-foot pediatric ER opened July 2017. The dedicated space is evidenced in the kid-friendly rooms, smaller equipment, and bright, childfriendly décor complementing the hospital’s colorful house logo. The facility also includes autism- and sensory-friendly rooms to help ease anxiety and provide a smoother experience for families. These rooms feature adaptable lights, monitor and sound control, specialized toys and visual story boards to help prepare patients for procedures. The launch of the program also included staff education in autism spectrum disorder (ASD) and sensory challenges. “That extra time and pediatriccentered approach is very unique, and you won’t find that in adult medicine,” McMorrow said.

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Her suggestions, insights and work to extend services have proven successful. TriStar Centennial’s pediatric ER visits have increased from 8,000 in 2014 to just under 15,000 in 2018. Visits are slated to hit 17,000 this year. “Our growth is two-fold,” she said. In addition to Nashville’s rapid growth that has brought more kids to the community, McMorrow noted, “There’s also an increased awareness of pediatric-specific care by families and patients, and they’re realizing that we have many general ERs but only two pediatric ERs within Nashville.” McMorrow said the absence of residents means patients at The Children’s (CONTINUED ON PAGE 12)

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NMGMATen Minute Takeaway

Federal Enforcement Actions By CINDY SANDERS

The second Tuesday of each month, practice managers and industry service providers gather for an educational Nashville Medical Group Management Association (NMGMA) meeting at Saint Thomas West Hospital. The July meeting focused on “Federal Enforcement Actions,” and featured Matthew Kroplin and Jim Hoover, both partners in the Health Care Practice Group for Burr & Forman LLP. Kroplin, who is based in Nashville, outlined some of the key areas that continue to catch the attention of fedMatthew Kroplin eral investigators from a number of agencies ranging from the Department of Justice and Health & Human Services to the Federal Bureau of Investigation and Drug Enforcement Administration. Hoover, from the law Jim Hoover firm’s Birmingham office, discussed enforcement actions and ways to avoid missteps. “Recent trends offer guidance for current risk assessment and compliance planning,” noted Kroplin. By reviewing areas of interest to federal agents and the outcomes of those investigations, practices can learn from the mistakes of others in order to build a better compliance program. False claims, failure to comply with HIPAA privacy and security rules, and violations of Stark Law and the Anti-Kickback Statute, remain major areas of focus for investigators. Under that large umbrella, Kroplin said some recent themes have emerged including increased scrutiny on physician compensation, medical necessity, telemedicine, proper prescribing, laboratory usage, quotas and HIPAA. “Physician compensation agreements continue to be a significant focus of the federal government,” Kroplin said, adding there is an emphasis on relationships that violate or allegedly violate Stark and Anti-Kickback. When physician groups are negotiating a compensation agreement, Kroplin said they need to stop and adequately analyze the terms in light of healthcare regulatory laws. “Make sure it can stand up to scrutiny, looking at fair market value for services rendered and the source of the revenue,” he advised. Along those same lines, he said practices should also beware quotas where salary or bonuses are tied to the expectation that a provider perform a procedure so many times a month. Other recent cases nashvillemedicalnews

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that resulted in multimillion dollar fines, included paying full-time compensation to a specialist working less than full-time hours and providing staff and office space on top of physician salary that resulted in a compensation package in excess of fair market value. “Another notable trend involves medical necessity,” Kroplin continued. “These enforcement actions are based not only on the theory that unnecessary medical services were provided but also on the theory that services actually provided were not adequately documented.” In other words, he continued, a practice can get in trouble not only for upcoding or providing unnecessary services but also for providing services where the contemporaneous record doesn’t adequately document the need. “How do we know this was medically necessary?” Kroplin asked. “There’s more to medical necessity than what we traditionally think about,” he added. Tests ordered but not reviewed, high volumes of specific or similar procedures, unnecessary prescriptions and duplicative coding are all red flags for auditors. A health system recently had to pay more than $60 million for medically unnecessary inpatient stays when an outpatient or observational stay would have sufficed. Hoover said there has generally been an uptick in false claims investigations. He added, qui tam … or whistleblower … cases, where lawsuits are filed in federal district court by private citizens, have made up the bulk of his false claims work recently. Often the whistleblower, known as a relator, is a former employee of the practice. “Occasionally it could be one of the other doctors in the group,” Hoover added. He noted the reason for bringing a qui tam suit varies from legitimate concern over billing and compensation practices to a disgruntled employee. “A relator gets a share of the recovery plus attorney’s fees so there is a financial incentive, as well,” he pointed out. Conversely, there’s little downside to such an action for a relator. “The False Claims Act statute allows for the defendant to recover attorney’s fees if they prevail,” Hoover said of the possibility that a relator would be forced to pay legal fees for the practice or physicians. However, he continued, “I have never seen that in any of my cases.” When an allegation is made, a lawsuit is filed under seal. The U.S. Attorney’s office investigates by interviewing witnesses, analyzing data and obtaining claims records from the affected government agency. Hoover said the government typically issues a CID – Civil Investigative Demand – that is very similar to a subpoena requiring documents, answers to

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Hot Topics in Healthcare Law, continued from page 1 years, leading up to her installation as AHLA president in July 2021, Reisz has been tasked with helping chart AHLA’s financial, educational and strategic planning course.

Payment Models

“The shift from fee-for-service to a value-based payment model is something that is of critical importance to all healthcare providers,” Reisz stated. “No matter what happens to the Affordable Care Act, the value-based structure is going to continue and get more sophisticated with the use of health technology.” What started with federal payers has now reached the commercial market, she noted, so that the shift in reimbursement, contracting and benchmarking has substantially reached all payers. “It requires the ability to take data and analyze that data and essentially prove you have provided value to the patients, to their employers and to the payer, and therefore you deserved to be compensated,” she pointed out. “We have to be familiar with the models and the regulations adopted by CMS [Centers for Medicare & Medicaid Services],” Reisz said of the onus on healthcare attorneys. “We have to be prepared to advise our clients how to interact and work with each other,” she added, noting provider organizations are more interdependent than ever with the shift from episodic care to keeping populations healthy. The Bundled Payments for Care Improvement Advanced (BPCIA) program is an example of an advanced payment model developed by CMS that includes both risk and reward. “There is a lot of contracting that goes with that model between the entity that is a Convener and the entities that are Episode Initiators or NPRA Sharing Partners,” said Reisz. “It’s a particularly complicated model.” While fostering price transparency for patients and a more coordinated approach across the episode of care, bundled payments also present reimbursement risks for participants who fall short of CMS cost targets. Starting in 2020, a recently announced change to the BPCIA model is that the program can be applied to all Medicare ACO beneficiaries as part of the Medicare Shared Savings Program. Each tweak to the program and each new specialty bundle comes with its own set of regulatory requirements and issues to be considered. “CMS keeps putting out new models … so there is always a new model to learn and advise our clients on regarding their participation,” Reisz noted.

Consolidation

“Among hospitals and health systems, I think there will continue to be consolidation there as challenges to reimbursement continue,” said Reisz. She added that for many smaller hospitals and rural facilities, there often simply isn’t a viable way forward without the critical mass that comes from being part of a larger system. Reisz 8

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pointed out deploying artificial intelligence and other new technologies, investing in updated equipment, and recruiting and retaining providers all take significant capital. “On the vertical side, you see more and more insurers buying practices and hospitals and health plans joining together,” she said. “That means we, as lawyers, have to navigate those transactions and alliances with them.” In addition to concerns over creating market monopolies, these vertical integrations have opened up interesting new challenges pertaining to federal and state laws regulating financial relationships and referrals between physicians and other providers. “Almost every state has its own version of the Stark Law and Anti-Kickback Statute, so it’s a fairly complicated analysis of how to put those transactions together,” said Reisz.

Data Protection

“Privacy and security is another area that is continuing to increase in focus,” said Reisz. “Patient data must be protected.” She noted the risk of a data breach for providers is significant both in terms of reputational harm and possible penalties. On the other side, there is great potential for improved quality and efficiency. “When you use cloud-based products, they are vulnerable at times to attack, but it’s a balancing act,” she pointed out of the risk/reward profile. Citing the use of de-identified, aggregated data, Reisz said, “I think the more artificial intelligence allows companies to provide information to our providers, the more the healthcare industry can advance the quality of healthcare and improve patients’ health. The more information you have, the more you can tailor that information to your specific patient.” Healthcare lawyers are called on not only to help industry clients assess and address legal exposure after a breach has occurred but also to create compliance plans to help prevent a cyberattack on the front end and mitigate damage should a breach occur.

Opioid Enforcement Actions

“We have noted the rise in the number of DOJ [Department of Justice] enforcement actions,” said Reisz of crackdowns on everything from pill mills and overprescribing to liability questions for manufacturers and distributors. “The trend appears to indicate plaintiffs’ attorneys are seeking to hold pharmaceutical companies responsible for their marketing practices,” she continued. Reisz was quick to add, however, that it was important to see how some of these high-profile cases play out in court before making a definitive assessment on trends.

Behavioral Health

Reisz noted recent legislative activity at the federal level should result in increased reimbursement for providers of mental health and substance use disorder (SUD) services and new options for Med-

Nashville AHLA Board Representation Befitting the area’s reputation as a national healthcare hub, Middle Tennessee is well represented when it comes to leadership roles with the American Health Lawyers Association. “Currently, five attorneys in the Nashville area serve on AHLA’s Board of Directors, including me,” said President-elect Designate Cindy Reisz. Also serving on the AHLA Board are: Dawn R. Crumel: Managing Counsel, Legal Operations and Administration for Vanderbilt University Medical Center; Amy S. Leopard: Partner, Bradley Arant Boult Cummings, LLP; Kim Harvey Looney: Attorney, Waller Lansden Dortch & Davis, LLP; and Hal McCard: Senior Vice President & General Counsel, Quorum Health Corporation. For more information on how to get involved with AHLA, go online to healthlawyers.org.

icaid beneficiaries to access behavioral health services. “As of 2016, the Mental Health Parity and Addiction Equity Act applies to Medicaid and the Children’s Health Insurance Program [CHIP] and requires managed care organizations, alternative benefit plans and CHIP to provide access to mental health and SUD benefits that comply with parity standards,” she explained, adding those same parity protections were also extended to long-term care services. Reisz continued, “The SUPPORT for Patients and Communities Act provides some flexibility to the IMD [Institution for Mental Diseases] exclusion, which traditionally prohibited states from using federal Medicaid funding to provide mental health and SUD services to Medicaid beneficiaries aged 21-64 in residential treatment facilities with more than 16 beds.” She noted that from fiscal years 2019-2023, states might be able to use federal Medical funds to cover services in cer-

tain IMD facilities, within specified limits.

AHLA

While touching on just a few of the healthcare issues garnering recent attention, Reisz said AHLA offers resources on these topics and many others, as well. “We strive to be an essential resource to our members and the community,” she said of a key objective for the national organization of approximately 14,000 healthcare professionals. AHLA’s “mission is to enable its members to serve their clients more effectively; to produce the highest quality nonpartisan educational programs, products and services concerning health law issues; and to serve as a public resource on selected healthcare legal issues,” Reisz concluded. For more information on AHLA’s educational offerings, publications and other resources, go online to healthlawyers.org.

Vanderbilt Children’s New Program Leaders, Rankings, continued from page 3

hundred presentations. “Dr. Denison is an exceptional investigator who has pursued detailed mechanistic studies of coronavirus replication, pathogenesis, evolution and countermeasures that have impacted both coronavirus research and the broader fields of RNA virus biology, changing the textbooks and approaches to investigation of viral emergence, evolution and inhibition,” said Steven Webber, MBChB, MRCP, chair of the Department of Pediatrics and pediatrician-in-chief of Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Earning High Marks

For the 13th consecutive year, the Monroe Carell Jr. Children’s Hospital at Vanderbilt has been recognized among the best in the annual U.S. News & World Report’s annual ranking of top pediatric hospitals. In the recently released 2019-20 rankings, the hospital was once again nationally ranked in the maximum 10 out of 10 pediatric specialty programs. Pediatric

Urology continues to earn the distinction as a premier destination program, earning the No. 7 spot in the rankings. The program has achieved a top 10 ranking every year since U.S. News began ranking pediatric urology in 2009. Among the other pediatric specialties, four moved up in the rankings. Gastroenterology improved from 24th to 17th; Nephrology jumped from 38th  to 24th; Diabetes & Endocrinology moved from 31st to 23rd; and Cardiology & Heart Surgery improved from 42nd to 36th. Other specialties earning spots in the rankings are: Cancer (14); Pulmonology (15); Orthopaedics (26); Neonatology (28); and Neurology & Neurosurgery (34). “To be recognized for the 13th consecutive year in all 10 specialties is a reflection of the unwavering commitment of everyone who works in Children’s Hospital. I offer sincere thanks and congratulations for outstanding teamwork within and across disciplines,” said Meg Rush, MD, MMHC, chief of staff and executive medical director of Children’s Hospital. nashvillemedicalnews

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Legal Briefs EBG Adds to Nashville Healthcare Practice

In late July, Epstein Becker Green (EBG) announced seasoned healthcare regulatory attorney Julie Watson Lampley and senior executive healthcare policy and compliance professional Machelle Dunavant Shields have joined the firm’s Nashville office. The two previously prac- Julie Watson Lampley ticed with Butler Snow. Lampley, who joins EBG as a member of the firm, has more than 30 years of experience in the representation of pharmaceutical and medical device companies, academic medical centers and other research organizations, hospital systems, physician practice acquisition and management companies, dialysis providers, and other institutional healthcare providers. While at Butler Snow, Lampley developed the firmwide Healthcare Industry Team and previously served as leader of the Healthcare Regulatory and Transactions Practice Group. She is a past board member for the Nashville Health Care Council and a 2015 Council Fellow. Currently, she serves on the board of BioFlorida, a network that includes 6,200 establishments and research  organizations in the biopharmaceuticals, medical technology, healthIT, and bioagriculture sectors. Shields, who is located in Memphis and joins EBG as a strategic advisor with the affiliated consultancy EBG Advisors, previously served as president of Butler Snow’s affiliate focused on regulatory, clinical, quality, privacy, compliance, and reimbursement initiatives for medical device, biologics, and tissue manufacturers. Shields has more than 20 years of experience in all aspects of compliance and ethics, privacy, and reimbursement support and strategy. She previously served as an executive for one of the world’s top medical device companies. A frequent speaker at industry events, Shields is president-elect of the Southeastern Medical Device Association and serves on the executive committee of MedTech Women.  She also serves as a mentor for Zeroto510K and Life Science Tennessee.

Bradley Attorneys Selected for AHLA Leadership Development Program

Three attorneys with Bradley Arant Boult Cummings LLP have been selected to participate in the American Health Lawyers Association (AHLA) Leadership Development Program (LDP). Justin K. Brown from the firm’s Birmingham office and StephaJustin K. Brown nie M. Hoffmann nashvillemedicalnews

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from the Nashville office will participate in the Hospitals and Health Systems practice group LDP, and Janus Pan from the Nashville office will participate in the Regulation, Accreditation and Payment practice group LDP. The year-long programs are designed to cultivate future leaders Stephanie M. Hoffmann of the AHLA, including practice group vice chairs. “We are very proud of Justin, Stephanie and Janus’ selection as participants in the AHLA’s Leadership Development Janus Pan Program, and we are pleased that they will continue our firm’s longstanding tradition of service to AHLA,” said Travis G. Lloyd, Bradley partner and chair of the firm’s Healthcare Practice Group. In the Birmingham office, Brown is a member of the firm’s Healthcare Practice Group. He represents hospitals and healthcare providers in a variety of transactional, regulatory and operational matters. Previously, he was a trial attorney in the Public Defender Division for the Committee for Public Counsel Services in Boston. In the Nashville office, Hoffmann serves clients in the healthcare industry on an array of regulatory, operational and transactional matters. Before joining Bradley, she served in the business development unit of a commercial health insurance company, working extensively on legal and economic issues related to the national health reform law. She also previously worked in operations and development at an international women’s health organization. Pan focuses her practice on assisting hospitals and healthcare providers in transactional and regulatory matters. Prior to joining Bradley, she clerked for the Office of the Attorney General of California in the Antitrust Department on matters related to hospital mergers and acquisitions.

Caring for your business across the continuum High quality healthcare takes a team approach. That’s true both clinically and operationally. As a management services organization (MSO), LBMC features more than 100 specialists touching every point in the business continuum to keep clients compliant, efficient, effective and profitable.

Mark Your Calendar

TBA Health Law Forum October 17-18 The Tennessee Bar Association will host its 31st Annual Health Law Forum on Oct. 17-18 in Franklin at the Embassy Suites Cool Springs. Recognized as one of the premier health law programs in the nation, presentations include updates on TennCare, cyber threats in healthcare, fraud and abuse developments and enforcement actions, legislative and policy agendas, cloud-based vendor agreements and many other hot topics. For more information, go to cle.tba.org.

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Rethinking the Healthcare Business Model to Stay Competitive Across the healthcare industry, from large health systems to individual physician practices, healthcare players are looking for new ways to compete and survive in a challenging and ever-changing environment. Since 2010, M&A activity has been playing an increasingly By DAVID MARKS significant role in health system strategy. While reports from Q2 of this year show a slight decrease in the number of announced transactions compared to prior years, the total revenue of those transactions & ERIC SCALZO has increased dramatically, indicating consolidation among larger groups. This points to another trend: an increase in the size of the seller by revenue in these transactions. Health systems with revenue ranging $750 million to $1 billion are looking aggressively beyond their local and traditional markets. They are expanding, via mergers, acquisitions, and/or partnerships, to serve entire counties or regions. But what about individual physician practices -- how are they staying afloat in a market where the big players are getting bigger? The answer for an increasing number of those practices is private equity investment. While joining a hospital can be attractive – especially if the hospital system’s payor agreements offer higher reim-

bursement rates – many physicians fear they will completely lose their autonomy by joining a hospital. Against this backdrop, private equity firms have emerged with an alternative offer: join forces to combine the business acumen of private equity with the medical expertise, and deep network, of senior physicians who have remained independent to date. The result? Staggering growth in the volume and revenue of PE-backed platforms and affiliations. But not unprecedented growth … we have seen much of this before. In the 1990s, physician “roll-ups” grew spectacularly, only to fail just as spectacularly as a series of scandals revealed industry-wide failures of integration, leadership and financial mismanagement. Now, the smart PE firms are studying history and are trying to find the right business structure that will keep physicians happy while avoiding the mistakes of the past. This has resulted in a number of options, new and old, available for physicians. True, almost every PE-backed platform will value a physician practice based on its total profit – or, more precisely, “EBITDA” – rather than just its raw collections. But the economic options, and culture, of PE groups vary substantially. For specialty areas such as orthopedics, ophthalmology, dermatology and gastroenterology, for instance, the opportunity to use PE expertise and funding to build ancillary services and share in the revenue stream is exciting, especially for physicians with an entrepreneurial mindset. For other practitioners, partnering with PE platforms that require less business input from partner physicians can be a welcome relief from the administrative headaches of practice ownership and can allow physicians to focus on providing excellent healthcare to their patients.

Services for Mom, continued from page 4 “We’ve changed hospital policy to better address the needs of women who come in during or after pregnancy with concerns or issues that could be lethal,” she said, noting TriStar Centennial’s new acuity statement to help staff identify certain risks for maternal mortality. The hospital also hosted the region’s first interprofessional collaborative summit on Aug. 7 – a quarterly event designed to promote communication and education around obstetric and neonatal transfers. “We’re all taking a hard look at the data and looking at how we solve this as a nation,” Price said. “From a hospital perspective, we’re addressing it by looking at safety protocols, communication and access to care. Those are things we can control, and we’re getting more innovative about improving our safety matrix the best we can.” That includes addressing cesarean 10

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rates and postpartum hemorrhage, a leading cause of maternal mortality. While hospitals have traditionally guessed at the amount of blood lost, TriStar Centennial has adopted quantitative blood loss, which provides an exact measurement. They’re also focused on training emergency staff to take the time to listen to patients with concerns to identify potential red flags and are building an opioid program that allows women to receive specialized care for themselves and their baby during and after pregnancy, including resources once they’re home. “We want to make sure we follow up and stay connected, and we’re doing that by building a team of navigators and social workers to make sure every possible resource is being utilized,” Price said. “Everything we do is about keeping mom and baby healthy and together.”

Decreased reimbursements, coupled with an increase in operational compliance costs, have caused many physicians to consider alternatives to the traditional practice model, and forward-looking, entrepreneurial physicians have recognized that the future of their practice needs to be drastically different than what it has been in the past to continue to compete. Physician practice owners should start talking to advisors and lawyers early on to determine if they want to affiliate with private equity or hospital systems and whether either of these strategies would help them achieve the goals of their practice. Most advisors and lawyers welcome

these conversations and will have them off the clock. There may be more options than physician practice owners even realize are on the table. David Marks and Eric Scalzo are attorneys with Waller Lansden Dortch & Davis LLP. Marks’ practice focuses on private equity M&A, and he has extensive experience in healthcare, consumer products and other industries. In recent years, he has played a key role in dozens of middle-market transactions of healthcare practices. Scalzo, a former general counsel at a leading dental services organization, represents founders, private equity companies and established businesses with physician practice management formation, growth and acquisitions. For more information, go online to wallerlaw.com

Federal Enforcement, continued from page 7 interrogatories (written answers) or depositions (oral answers under oath). Because each incorrect billing claim carries a penalty, Hoover said the numbers can get really big in a hurry. “These cases tend to settle if not dismissed because the damage calculations can be so high,” he noted. If a practice is issued a CID, Hoover said the first order of business is to “call their attorney immediately.” He said it’s important that any response or internal investigation be protected by attorneyclient privilege. He added tight timetable requirements mean it is also helpful for the attorney to quickly establish a relationship with the U.S. Attorney’s office to work out scheduling. Of course, Hoover said an even better plan is to avoid False Claims and qui tam actions in the first place. “Review compensation plans to make sure they don’t include prohibited revenue sources and make sure it’s fair market value for services rendered,” he said.

“Have a robust compliance program and proactively audit records in real time,” he continued of catching mistakes and making adjustments before timely billing requirements have passed. However, he noted, that’s not always possible. At whatever point a mistake is realized, it’s far better to proactively be the one to correct the error than to hope no one notices.

August NMGMA The next NMGMA meeting is scheduled for Tuesday, August 13 from 11:30 am-1 pm in the Saint Thomas West Hospital conference rooms. Jackie Boswell, assistant vice president of Medical Practice Services with SVMIC, will address “MIPS 2019: Implementation and Reporting.” Free parking is available in the Seton Garage.

Legal Briefs, continued from page 9 A Great Place to Practice

Last month, three area law firms were recognized by Working Mother in the magazine’s 12th annual “Best Law Firms for Women” list. Baker, Donelson, Bearman, Caldwell & Berkowitz; Bass, Berry & Sims; and Waller were each recognized on the national list of 60 firms that use best practices in recruiting, retaining, promoting and developing women lawyers. Working with the ABA Journal to create the 2019 list, the magazine spotlighted firms where women increasingly take on leadership roles and those where the representation of female attorneys is increasing. According to a release by Waller, firms on the list averaged 37 percent women among new equity partners, compared with only 27 percent five years ago. Additionally, the highlighted firms offer more extended parental-leave benefits, encourage more lawyers to work

remotely and use flexible hours, and are increasingly offering reimbursements for egg freezing and other fertility procedures. Additionally, the Chambers Associate guide recently released survey results, ranking the culture for associates in a number of categories, including recruitment and retention, satisfaction, career opportunities, diversity and commitment to pro bono work. In each category, the guide highlighted the top 40 to 50 firms nationally. Waller led the way in Tennessee, coming in 27th nationally for associate satisfaction, 9th for retention of junior associates, and 11th for both career opportunities and diversity. Nelson Mullins, which has a Nashville office, was recognized as a best firm for pro bono work when it comes to sharpening skills and commitment to pro bono assistance. Epstein Becker Green was also recognized in Law360’s Diversity Snapshot as one of the top 25 law firms for minorities. nashvillemedicalnews

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Bold Goals in Breast Cancer

Addressing Disparities, Deploying Research in a Race to Cure By CINDY SANDERS

What started as a promise to a dying sister has turned into an international force to fight breast cancer. Today, Susan G. Komen is synonymous with efforts to harness education, advocacy, research and global outreach to improve outcomes and race toward a cure for all forms of the disease. Earlier this summer, Susan G. Komen CEO Paula Schneider visited Middle Tennessee and met with Nashville Medical News to discuss the organization’s bold goals and a new initiative to address disparities. Schneider, herself a breast cancer survivor, was joined by Ingrid Mayer, MD, MSCI, Paula Schneider leader of the Vanderbilt-Ingram Cancer Center Breast Cancer Research Program and a Komen Scholar.

Addressing Disparities

Schneider said the organization is rolling Dr. Ingrid Mayer out a focused program in 11 cities across the country, including Memphis, that have the biggest disparities in breast cancer death rates for African-American women. In fact, she stated, “Memphis has the highest disparate death rate of any city in the country.” With a tag line of ‘where you live shouldn’t determine whether you live,’ the project’s goal is to reduce AfricanAmerican breast cancer death disparities by 25 percent within five years in the pilot cities. “We’ve been working in disparities in healthcare for years,” Schneider said, but noted the new initiative builds on that foundation. “We are working in a collaborative way with thought leadership in each city,” she continued of seeking guidance to understand “the story behind the story” in order to launch the most effective interventions and research projects for each community. The new disparities project, she noted, was made possible by a grant from the Fund II Foundation. As an aside, Schneider explained Fund II is part of the philanthropic works of Robert F. Smith, who made headlines in May when he announced he would pay off student loans for the Morehouse College Class of 2019. The project builds off of proof-of-concept work done in Chicago and expands that work to 10 additional cities. After conducting a landscape analysis in Chicago, Schneider said they discovered AfricanAmerican women were getting nearly as many mammograms as their Caucasian counterparts. However, the death rates were completely disparate. Interestingly, she continued, death rates were about the same in the 1980s and ‘90s. “But when they got to about 2003, it was at 68 percent nashvillemedicalnews

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more that you died if you were AfricanAmerican rather than white.” A collective impact study looked at the reasons for the divergent death rates. “It was systemic more than anything else,” said Schneider. While there were myriad issues, including financial toxicity that made it more difficult for African-American women to access treatment, one of the biggest issues was in how breasts were being positioned during mammograms and how the imaging studies were read. “So, a lot of it had to do with training,” Schneider said of the discovery. Because key findings were missed in the early stages of cancer, African-American women tended to be diagnosed later when the disease was more aggressive. Partnering with hospitals and other organizations to address the systemic failures and enhance training, the Chicago project showcased how outcomes could be impacted by tailored interventions. “We changed the death rate and brought it down 35 percent in five years,” Schneider shared. Now, those lessons will be applied to other cities. In addition to Chicago and Memphis, the African-American Health Equity Initiative is targeting Atlanta, Dallas, Houston, St. Louis, Philadelphia, Washington, Los Angeles, Oakland, Calif., and Norfolk, Va. Currently, Komen has established roundtables in each of the expansion cities to lead efforts. Schneider said she anticipates the landscape analysis for each of the pilot cities to be completed by year’s end.

Bold Goals

For all those diagnosed with breast cancer, Schneider said, “There’s a bold goal … very bold … and that’s to decrease the death rates by 50 percent by 2026.” Despite the enormity of the task, she pointed out, “If we don’t have a North Star, no one will aim for it.” To hit that target, Schneider said there are two sides to the coin. “One is dealing with the cancers that kill,” she said. “The second part is disparities in healthcare.” Schneider continued, “There’s really nothing that’s going to cure cancer but research.” However, she noted, even without another medical breakthrough, there is the ability to decrease breast cancer deaths. “You just have to get people to the care that exists today and figure out what the barriers to care are.” The disparities side of the coin is the focus of the new 11-city initiative, and Schneider said the hope is to replicate that work of partnering with thought leaders and organizations in other cities the future. “Ultimately, if we create this business model, and it proves out as (Chicago) proved out, which we anticipate, then we have the ability to be the backbone for a rollout of more cities. It can become scalable,” she stated.

Stopping Cancers that Kill

As for the ‘cure side’ of the coin, Komen supports … and is supported by

… a robust research effort. Calling the Komen Scientific Advisory Board (SAB) the ‘rock stars’ of the field, Schneider said the group is led by George W. Sledge, Jr., MD, chief of the Division of Oncology for Stanford University Medical Center, and Nashville’s own Jennifer Pietenpol, PhD, director of the Vanderbilt-Ingram Cancer Center (VICC). In addition to strategic guidance from the SAB members, the organization also relies on the expertise of Komen Scholars, who are leaders in breast cancer research and advocacy. Chosen for their knowledge and contributions to breast cancer research, the select group leads Komen’s scientific peer review process and serves as experts for the organization’s international network of affiliates. Additionally, the organization helps fund the promising research lines these scientists are investigating. VICC’s Ingrid Mayer, MD, MSCI, was named a Komen Scholar in 2018. “I have a grant to look into a particular type of breast cancer that is very aggressive called triple-negative breast cancer (TNBC). Even though it’s very uncommon in the bigger scheme of things – it’s about 15 percent of all breast cancers diagnosed in a year – it disproportionately kills a lot of people,” said Mayer. Schneider a 12-year survivor of TNBC noted, “It’s the one you don’t want to hear you have.” “It’s an aggressive tumor with very few options,” Mayer concurred. She explained the ‘triple-negative’ designation means the cancer is negative for the hormones estrogen and progesterone and the protein HER2 that drive most other forms of the disease. The most common type of the cancer, and one that is often seen as women age, is estrogen-dependent breast cancer, which Mayer said makes up about 65 percent of diagnosed cancers annually. “The second largest group is HER2positive breast cancer, which is about 30 percent give or take,” she continued, noting there is some overlap with estrogenpositive cancers. “This is a cancer that I would argue may be the one we cure first, even with metastatic disease, because there is a driver for that cancer that is this HER2 gene.” Mayer added, “With the ability to use targeted treatment for this cancer, we

have tremendously impacted how often people recur.” Even though HER2-positive cancer is as aggressive as TNBC, she said the effectiveness of treatment has created a “good problem of not being able to enroll people in metastatic trials because they don’t recur … so that’s an awesome problem to have.” A prolific researcher, Mayer has served as principal investigator on more than 80 clinical trials and leads VICC’s Breast Cancer Specialized Program of Research Excellence (SPORE) alongside Pietenpol. Currently, she is principal investigator for a large national TNBC clinical trial. Unlike HER2, the lack of targets makes it particularly difficult to treat TNBC. “Historically, most of these women have been treated with chemotherapy, which works well to a certain extent,” Mayer said, but added that recurrence is not uncommon even in those with stage 1 or 2 TNBC. Komen is supporting her work in profiling triple-negative cancers. Mayer serves as principal investigator on a large National Cancer Institute study (EA1131), which looks to enroll 750 nationwide, to compare different types of chemotherapies for patients at high risk of recurrence for breast cancer. “We are profiling all those tumors and serially collecting blood from all those women to detect what are the possible mutations or possible findings in the tumor DNA,” Mayer said. “Can we find something that is actionable?” While she continues to search for answers to unlock the TNBC mystery, Mayer is also involved in a study testing the drug ifetroban in patients who have completed cancer treatment for one of five types of cancer, including TNBC, and who show no evidence of disease but are at high risk of recurrence. Instead of “watchful waiting” to see if the cancer returns, the hope is to develop therapies that target tumor cell metastasis to move patients into an era of “proactive prevention.” Schneider said exciting new research lines, effective policymaking, education and outreach are all powerful tools in the quest to stop breast cancer. “There’s a lot to be said about women in pink with pitchforks,” she laughed. “The power of Komen and the power of the brand is everyone understands what our mission is.”

Racing for the Cure Race for the Cure® events are held throughout the world and are one of the most visible ways Susan G. Komen raises funds for breast health education, outreach, screening, treatment and research. Recently, Komen has rolled out the More than Pink Walk™, which is part of the Race for the Cure series but focuses on walking instead of running. Nashville and Chattanooga are two of 26 cities debuting the new More than Pink Walk this fall. Susan G. Komen Central Tennessee is hosting the Nashville area event on Saturday, Oct. 26, at Maryland Farms. For more information on the walk and other area resources, visit KomenCentralTennessee.org.

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Save the Date 23rd Annual Celebration of Life Golf Classic Aug. 15, 2019 • Hermitage Golf Course This year’s event features two tee times, two courses. Choose between at 7:30 am start or a 1:30 pm tee time. Contests, prizes, and a Thursday night pre-tournament auction. For more information, go to Tennessee Breast Cancer Coalition, tbcc.org. Fourth Annual ACHEMT Golf Outing Sept. 20, 2019 • Two Rivers Golf Club Register by Sept. 13 to participate in ACHE of Middle Tennessee’s annual golf outing, the organization’s largest community service event. Check-in is at 7:15 with tee-off at 8 am at Two Rivers Golf Club in Donelson. To register, go online to achemt.org. Neighborhood Health Annual Breakfast Sept. 26, 2019 • City Winery Nashville The annual fundraising breakfast helps Neighborhood Health continue to provide medical, dental, and behavioral health care for over 30,000 patients each year. For more information, go to neighborhoodhealthtn.org.

Frist Launches Healthcare Podcast Last month, transplant surgeon, former U.S. Senate Majority Leader and healthcare entrepreneur Bill Frist, MD, launched the inaugural season of his new podcast: “A

Second Opinion: Rethinking American Health with Senator Bill Frist, MD.”

Dr. Bill Frist

During a time of unprecedented change in the healthcare landscape, the new podcast looks to bring a distinct set of perspectives from policy, business and medicine to the forefront through the exchange of ideas, perspectives and insightful conversations with some of healthcare’s most influential leaders and rising innovators. “In America, we don’t always do health and healthcare well. We have the best and brightest physicians, and we lead the world in pioneering treatments and cures, yet our health outcomes still lag behind other developed nations,” said Frist. “In ‘A Second Opinion,’ we explore why we only get part of the equation right and hear from the smartest minds on what we can do to improve our healthcare system during a period of extreme fragmentation.” Looking beyond the point of care, the podcast will explore diverse drivers of health, including access, nutrition, employment, social determinants of health, costs, and more. Discussion segments span four critical content areas: innovation, policy, technology and leadership. While guests are from across the nation, Frist promised Nashville, as the podcast’s home base and nationally

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recognized capital of healthcare delivery, plays a prominent role in shaping the show. “A Second Opinion” is sponsored by MEDHOST and Tivity Health. Individual episodes have been made possible by the Blue Cross Blue Shield Association, Humana, Waller Law, Belmont University, Change Healthcare, Jarrard Philips Cate & Hancock, and PYA. Learn more at asecondopinionpodcast.com. 

TriStar Centennial Names Jackson CFO Last month, TriStar Centennial Medical Center welcomed Tom Jackson as the hospital’s new chief financial officer. With oversight of financial operations for the 741-bed hospital, Jackson comes to TriStar Centennial from HCA Healthcare’s Parkridge Health System Tom Jackson in Chattanooga where he served as market CFO for six years. He has nearly 20 years of financial management experience and started his career as a senior auditor for Ernst & Young LLP. Jackson first joined HCA Healthcare more than 14 years ago as the associate controller at Research Medical Center in Kansas City, Mo. He held increasing financial roles for the hospital company with positions in Georgia prior to moving to Tennessee. Jackson holds an MBA from Northwestern University’s Kellogg School of Management and a bachelor’s degree from David Lipscomb University. He is a certified public accountant licensed in Tennessee.

American Health Partners Names Bradley COO American Health Partners, a Franklin-based company that operates seven divisions offering postacute care services for seniors, has announced the promotion of Robin Bradley to the position of chief operating officer. Bradley, who has more than 20 years Robin Bradley of experience in the healthcare industry, joined the company in 2016 as COO of its American Health Plans division, which owns and manages institutional special needs plans (I-SNPs) for seniors living in long-term care facilities. In her new role, Bradley will ensure the company has proper operational controls across its divisions: American Health Communities, American Health Plans, Unity Psychiatric Care, Tennessee Quality Care, TruHealth, AmPharm and Rehab America. Previously, Bradley was vice president of administration for Unity Physician Partners Inc., which created a medical home model to improve care and reduce costs for patients with both physical and mental health conditions. She also served as vice president of administration for Windsor Health Plan,

one of the nation’s earliest Medicare Advantage plans, and Vanderbilt Health Plans, a provider-owned Medicaid plan. She earned her undergraduate degree from the University of Georgia and her MBA and MHA from Georgia State University.

Amedisys, ClearCare Forge Partnership Home health, hospice and personal care company Amedisys, Inc., which has its executive headquarters in Nashville, has signed an agreement with ClearCare, Inc., a leading web-based operating platform for home care agencies. The agreement creates an opportunity to establish partnerships leveraging Amedisys’ home health footprint of 322 agencies in 34 states and ClearCare’s technology platform used by more than 4,000 personal care agencies, effectively connecting home health with the growing demand for personal care at scale. “With Americans living longer, the value of both home health care and personal care is increasingly recognized for improving patient outcomes and lowering costs,” stated Amedisys CEO and President Paul Kusserow. “This agreement unites both industries to expand access to and establish a much-needed continuum of care for hundreds Paul Kusserow of thousands of the nation’s most vulnerable patients.” Within 48 hours of the AmedisysClearCare partnership announcement, 167 personal care agencies from 35 states and the District of Columbia that represent thousands of seniors had already enrolled with Amedisys.

Benzodiazepine Use with Opioids Intensifies NAS Babies born after being exposed to both opioids and benzodiazepines before birth are more likely to have severe drug withdrawal, requiring medications like morphine for treatment, compared to infants exposed to opioids alone, according to a Vanderbilt University Medical Center study published in  Hospital Pediatrics. Benzodiazepines are a class of psychoactive drugs, including Xanax and Ativan, commonly prescribed for anxiety and other conditions. The new findings shed light on which factors complicate and intensify signs of neonatal abstinence syndrome (NAS).  People with substance use disorders often report taking a combination of substances. The study shows concurrent benzodiazepine exposure impacts the severity of NAS more so than other legal or illicit substances, said Lauren Sanlorenzo, MD, MPH, assistant professor of Pediatrics, neonatologist at Monroe Carell Jr. Children’s Hospital at Vanderbilt and first author of the study. Infants with NAS and exposed to benzodiazepines were more than 50 percent likelier to require the use of medications to treat symptoms than infants not exposed. (continued on page 13)

Caring for Kids, continued from page 6 Hospital at TriStar Centennial will see either a pediatric nurse practitioner or pediatric ER physician. Their team includes a 24/7 board-certified and fellowship-trained team of pediatric emergency physicians and direct access to the onsite pediatricians and pediatric specialists at The Children’s Hospital. “The initial person you see is the one making decisions, and the smaller volume and community makes it feel tight knit,” she said. “Those relationships translate into the delivery of safe, patient-centered care.” TriStar Centennial’s successful model is catching on. In April, TriStar’s Parkridge East Hospital in Chattanooga rolled out their own sensory-friendly ER to better treat both adults and pediatric patients with sensory challenges. McMorrow hopes other TriStar hospitals will follow suit. “A big, long-term goal for me and the group is to try to make the mindset of care at other hospitals the same as Centennial,” she said. “In a hospital-based system, it’s entirely possible to open dialogue and achieve these results systemwide.”

More Services for Families

As The Children’s Hospital continues to grow, McMorrow said clinicians and families alike are sometimes surprised to learn just how many pediatric services are available onsite. Their NICU and pediatric-focused ICU, cardiology, orthopaedics and pulmonology departments are bustling. And their pediatric hematology/oncology department, where young patients can receive bone marrow transplants, often stays at full occupancy. “People may not think of pediatric cancer care at Centennial, but we have these amazing services coupled with pediatric fellowship-trained doctors with so much experience,” McMorrow pointed out. As more and more people learn about the range of pediatric options available at The Children’s Hospital at TriStar Centennial, McMorrow and her colleagues expect to continue to grow and expand services to meet the needs of Middle Tennessee. nashvillemedicalnews

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GRAND ROUNDS “Our findings reflect the reality that many women who use opioids also use benzodiazepines, which now we know has real implications for the baby, who is more likely to have severe incidence of disease. If we focus just on opioids, we can overlook other medications that can be risky to both the mother and infant,” said Sanlorenzo. Vanderbilt Center for Child Health Policy researchers have shown previously that one consequence of the nation’s opioid crisis has been a sharp increase in the number of newborns who show signs of withdrawal from opioids. From 2000 to 2014, the rate of NAS rose from 1.2 cases per 1,000 hospital births to 8 cases per 1,000 births. In 2014, the average was one infant born every 15 minutes in the U.S. with NAS.

TriStar Health Opens Urgent Care in North Gulch In late July, TriStar Health announced the opening of its 15th CareNow® Urgent Care location on Tuesday, Aug. 6 to serve patients in the North Gulch area of downtown Nashville. The 3,000-square-foot clinic features six exam rooms and provides a wide range of medical services with the convenience of extended hours, walk-in visits and Web Check-In®  to reduce waiting in the lobby. Additionally, the clinics offer X-ray and lab services onsite. CareNow® clinics also provide occupational medicine services to local employers, including examinations and treatment of injured workers in worker’s compensation cases, pre-employment screenings and drug tests.

Wishes Granted

Vanderbilt University Medical Center has been awarded a five-year, nearly $23 million federal grant to continue the coordination of AIDS education and training efforts. The Southeast AIDS Education and Training Center (AETC) coordinates HIV/AIDS education efforts in Alabama, Florida, Georgia, Kentucky, Mississippi, North and South Carolina as well as Tennessee. Since 2015, the center has been based in the Vanderbilt Comprehensive Care Clinic (CCC) at One Hundred Oaks. Despite advances, nearly 39,000 people become newly infected with HIV in the U.S. each year with more than half of the new diagnoses reported in 2017 coming from the South.

TriStar Summit Welcomes New Neurosurgeon In late July, TriStar Summit Medical Center announced the addition of Christopher Storey, MD, PhD, a fellowship-trained neurosurgeon specializing in open and endovascular neurosurgery. He will provide comprehensive spinal and cranial care for patients in Davidson Dr. Christopher Storey and Wilson Counties. Storey received his medical degree from Louisiana State University School of Medicine in Shreveport and received nashvillemedicalnews

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his doctorate in biomedical engineering from Louisiana Tech University in Ruston. He completed his neurosurgical residency at LSU Health Science Center and his open and endovascular neurosurgery fellowship at Thomas Jefferson University in Philadelphia.

Ascension Saint Thomas Partners with Contessa to Bring Hospital-Level Care to Homes Last month, Ascension Saint Thomas and Nashville-based Contessa have announced a partnership to offer patients Home Recovery Care, an emerging healthcare option that brings all the essential elements of inpatient care to the comfort and convenience of patients’ homes. “Home Recovery Care” aligns with Ascension’s Mission-Inspired Transformation initiative, to meet individuals where they are in their healthcare journey by making quality care convenient and accessible in their homes. The MissionInspired Transformation will reimagine new ways of providing care, calling leaders to improve health and well-being, and to advance from the historical strategic focus on healthcare to an expanded focus on healthcare and health. “The aim is to keep people healthy while understanding hospital care is sometimes needed. When hospital level care is needed, we will offer the patient’s home as a site of care to continue serving as the high quality, low cost health system offering an exceptional experience for our providers, patients and families,” said Amber Sims, chief strategy officer, Ascension Saint Thomas. “We are proud to be the first health system in Tennessee to provide a choice Amber Sims on where individuals we serve are receiving hospital-level care.” Nashville-based Contessa is the nation’s leading operator of Home Recovery Care, facilitating hospital-level care for patients in the home by providing three key elements: the clinical model that enables safe delivery of hospitallevel care in the home; the administrative capabilities to be reimbursed by health plans; and Care Convergence, a proprietary technology platform that supports the clinical and administrative functions.  Home Recovery Care is offered to patients with acute, non-life threatening medical conditions, such as congestive heart failure, dehydration or pneumonia. Patients will first be evaluated by a Saint Thomas doctor to determine if they can be safely treated in the home to receive care in a comfortable and familiar environment. The Saint Thomas clinical team will be available 24/7 through telehealth, acute care nurses in the home, and a recovery care coordinator, who is also a registered nurse, serving as the primary contact for patients. Home Recovery Care will be available

for patients at Saint Thomas Midtown and West hospitals this fall, followed by Saint Thomas Rutherford and surrounding communities.

AdvancedHEALTH Welcomes Atwater Last month, AdvancedHEALTH, Middle Tennessee’s largest, independent, multi-specialty practice, announced the addition of Thomas Atwater, MD, to its growing group of providers. Atwater is a board-certified pulmonary and critical care doctor who sees patients at MidState Pulmonary. His areas of Dr. Thomas Atwater clinical interest include COPD, asthma, lung nodules, navigational bronchoscopy and endobronchial ultrasound, novel techniques in diagnostic bronchoscopy and other general pulmonary disorders. Atwater received his medical degree from University of Texas in Houston followed by an internal medicine residency at Vanderbilt University Medical Center, where he was chief resident, and a pulmonary and critical care fellowship also at Vanderbilt.

TwelveStone Health Partners Names Cost Director of Purchasing

vider of comprehensive chronic care medication services, has named Terry Cost, PharmD, director of purchasing. With significant experience in pharmacy, Cost has led Terry Cost pharmacy operations for a Tennessee-based pharmaceutical distribution company and a regional senior living facility organization. Throughout his career, he has owned and operated a consulting company that provided professional consulting to patients, prescribers, and caregivers in long-term care. Cost is a long-time member of the Tennessee Pharmacists Association, serving as a past board member and past president.

Business Briefs

Leaders of Vanderbilt University Medical Center (VUMC) have announced completion of the acquisition of Tennova Healthcare-Lebanon, a two-campus facility licensed for 245 beds, from subsidiaries of Community Health Systems, Inc. (CHS). Terms of the transaction were not disclosed. Last month, Corizon Health, the nation’s leading correctional healthcare company, announced it has entered into an amendment and restatement of its existing credit facility resulting in additional funding in the amount of $25 mil-

TwelveStone Health Partners, a pro-

(continued on page 14)

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Interested in advertising? To reach our audience of 9,300 providers and other industry professionals call 615.397.2836 or email sales@nashvillemedicalnews.com. OCTOBER: Senior Health | CMS NOVEMBER: Oncology | Wealth Management | Tax Issues DECEMBER/JANUARY: Special InCharge Issue

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GRAND ROUNDS lion of new term loans. Additionally, the company secured commitments for $7.3 million of additional term loans, which can be drawn by the company before the end of the year (subject to customary conditions). Corizon officials said the proceeds of the new loan and funding commitments will provide the company with significant financial and operational flexibility, including costs associated with new contract acquisitions and to fund additional growth opportunities. Urgent Team is now an Authorized VA Urgent Care Provider as part of the VA MISSION Act. Passed by Congress last year, this act now allows eligible veterans to visit participating urgent care centers for their urgent care needs without pre-authorization or an appointment, including Urgent Team’s 11 Middle Tennessee  centers. In other corporate news, Washington Regional and Urgent Team Family of Urgent Care & Walk-In Centers announced a joint venture partnership, which will create a branded network of walk-in urgent and family care centers throughout Northwest Arkansas.  Covenant Surgical Partners  has announced its newest partnership

with Arizona Centers for Digestive Health (AZCDH), the state’s leading provider for full-spectrum gastrointestinal care, treating more than 52,000 outpatient clinical patients per year. With this new agreement, Nashville-based Covenant adds 11 new practice locations and two state-of-the-art ambulatory surgery centers to its expanding national portfolio. Integrated Telehealth Partners (ITP) has joined Nashville-based Psychiatric Medical Care, LLC (PMC), a leading behavioral healthcare management company with operations in more than 20 states. ITP leverages telehealth to provide access to psychiatric services in underserved communities across a variety of clinical settings. The company offers both outpatient telepsychiatry services in community mental health clinics as well as 24/7 emergency telepsychiatry consultation services in hospital emergency rooms. PMC manages both inpatient psychiatry units and intensive outpatient psychiatry programs within hospitals. The combination will help serve

patients across the continuum and offer access to a larger pool of providers.

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

Vaccine pioneer James Crowe Jr., MD, director of the Vanderbilt Vaccine Center, was honored last month by the German science and technology company Merck KGaA for his contributions to developing new therapeutics and vaccines against some of the world’s deadliest viruses. Half of the company’s new 1 million Euro ($1.1 million) Future Insight Prize will go to Vanderbilt University Medical Center to support Crowe’s research and the other half to the Broad Institute of MIT and Harvard to support Pardis Sabeti, DPhil, Dr. James Crowe MD, who is developing genetic strategies to stop viruses like Ebola. Merck KGaA, Darmstadt, Germany, is not affiliated with the United States-based Merck & Co. Kelly A. Carden, MD, sleep specialist with Saint Thomas Medical Partners, has been named the 34th president of the American Academy of Sleep Medicine. Carden, who has spent the last year as president-elect of the organization, will lead the AASM to promote excellence in sleep medicine healthcare, education, and research. TriStar Ashland City Medical Center has been named one of the Top 20 Critical Access Hospitals in the country (CAHs) for quality. The top 20 scored best among CAHs as determined by The Chartis Center for Rural Health for quality. Those recognized have achieved success in overall performance based on a composite rating from eight indices of strength: inpatient market share, outpatient market share, quality, outcomes, patient perspectives, cost, charge and financial stability. Saint Thomas Heart recently announced their approval from the Hypertrophic Cardiomyopathy Association (HCMA) Board of Directors as an HCMA-Recognized Center of Excellence. Saint Thomas Heart is the first Hypertrophic Cardiomyopathy (HCM) clinic in Tennessee to be awarded this honor. Acadia Healthcare CMO Michael Genovese, MD, JD, has joined the medical board of advisors for Mindyra, a digital behavioral healthcare company that helps care providers efficiently and more precisely diagnose and treat patients. Change Healthcare Inc. recently announced today Diana McKenzie has been appointed to their board of directors effective Aug. 1, 2019. McKenzie is the former chief information officer for Workday, Dr. Michael Inc., a leading enterprise cloud-based ERP software company, and Genovese Amgen Inc., a manufacturer of human therapeutics. She also serves on the board of directors of MetLife, Inc. The South College School of Nursing has earned accreditation from the Commission on Collegiate Nursing Education (CCNE) for both its bachelor’s and master’s degree level programs in nursing.

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Stratasan, LLC, a Nashville-based healthcare data analytics software provider, has announced completion of a $26 million investment round led by Fulcrum Equity Partners with participation from Frist Cressey Ventures, Blue Heron Capital, Bridge Bank and Company management. Stratasan will use this capital to further expand its product offerings as well as invest in its sales, marketing, and customer success teams.

Brooks Joins Centerstone Centerstone, a national leader in behavioral healthcare, recently announced Shawn Brooks has been named the executive director of special projects and initiatives for the organization. In his new role, Brooks will lead a numShawn Brooks ber of special projects and collaborate with strategic business units, shared services and the organization’s Employee Assistance Program (EAP) team to manage resources, oversee and implement initiatives. Brooks has 20 years of nonprofit experience. He joined Centerstone in 2007 and has held a variety of leadership roles in business development and strategic initiatives. He most recently served as project management specialist, leading continuous quality improvement projects, strategic planning projects, affiliations and growth related projects for Centerstone. He graduated from Austin Peay State University with a B.A. in Psychology and minor in Business Management, as well as Claremont Graduate University with an M.A. dual concentration in Program Evaluation and Developmental Psychology. He is also a certified Project Management Professional (PMP).

Cessna Joins Integrative Life Center Nashville-based Integrative Life Center (ILC), a leading communitybased behavioral healthcare provider, has expanded its executive leadership team with the addition of Christi Cessna, MS, as its first chief development and marketing officer. In her new role, Cessna will be responsible for ILC’s national Christi Cessna outreach, marketing, patient experience enhancement, clinical collaboration and will also oversee the business development team to identify new markets and business opportunities. Cessna has more than two decades of experience in behavioral health marketing and services development. Prior to taking on roles in executive leadership, she spent several years as a practicing clinician. Most recently, Cessna served as vice president of clinical outreach at Constellation Behavioral

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GRAND ROUNDS Health. She holds a master’s degree in counseling psychology from the University of Central Arkansas and a bachelor’s degree from the University of Arkansas at Fayetteville.

HCA Healthcare’s Campbell to Retire, Cohen to Assume Role HCA Healthcare recently announced Jeff Cohen will assume the role of senior vice president, Government Relations effective Oct.1. He will be replacing Vic Campbell, who will retire Feb. 29, 2020. “We’re excited to have Jeff join the HCA Healthcare executive team to lead our GovJeff Cohen ernment Relations activities,” said Sam Hazen, CEO. “Having spent the majority of his career in Washington, DC, Jeff brings a wealth of experience and leadership that will ensure our company is well-represented in legislative discussions at both the federal and state levels.” Cohen has spent the last 20 years with the Federation of American Hospitals (FAH), most recently as executive vice president of Public Affairs where he managed all advocacy, public affairs and communications for the association. In this role, he worked closely with Fortune 500 and privately-held member companies and acted as chief lobbyist for the association.

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: Nancy Anness, chief advocacy officer for Ascension Saint Thomas, shares an op-ed discussing the importance of the 340B Drug Pricing Program to help alleviate the strain created from rising drug prices for those most in need.

Campbell is retiring after a 47-year career with HCA Healthcare. He joined the company’s finance department in 1972 and established the company’s investor relations function in 1976, leading that area until October of 2018. Campbell was named senior vice president in 1994, just one year before being named one of the “Top 10 Investor Relations Officers” in the nation by Institutional Investor magazine. In 1997, Campbell was tapped to lead HCA Healthcare’s Government Relations team. Over the years, he served three terms as chairman of the FAH and

served on the board of the American Hospital Association from 1995-2000. He is also a former member of the board of directors of the Nashville Health Care Council.

TriStar Southern Hills Now Offering Bariatric WeightLoss Surgery Last month, TriStar Southern Hills Medical Center announced the expansion of the hospital’s surgical services program with the addition of bariatric weight-loss surgery, including the latest in minimally invasive techniques that

have been proven to reduce a patient’s postsurgical pain, shorten recovery time and lower the risk of complications and infection. “I decided to get involved in weight-loss surgery because I saw an opportunity to treat a multitude of diseases at once with one procedure,” said William Yi, MD, a board-certified general surgeon with Southern Hills Surgical Consultants. “I’m excited to be able to offer one procedure that assists patients in addressing all these diseases to help them begin their journey to a healthier life.”

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Christopher Jones, MD, a boardcertified, fellowship-trained orthopaedic surgeon with Hughston Clinic Orthopaedics, discusses the prevention of ACL injuries in young athletes … a timely topic as the fall sports season gets underway. Lindsey Keeley, with the American College for Advancement in Medicine, shares information on their annual meeting this October in Nashville. “Collaboration Cures” – a joint effort of ACAM and the American Academy of Physiological Medicine and Dentistry – focuses on the role integrative medicine plays in treating the whole patient with insights from nearly 50 guest speakers and 20 breakout educational sessions.

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