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FOCUS TOPICS CARDIOLOGY • HEALTHCARE WORKFORCE • LEGISLATIVE ISSUES

Your Middle TN Source for Professional Healthcare News

PHYSICIAN SPOTLIGHT PAGES 6 & 7 Women with Heart

Five female Ascension cardiologists share insights & their unique perspective

ON ROUNDS

Workforce Challenges in 2021 Healthcare providers in 2021 are facing unprecedented workforce challenges. As COVID-19 continues to drive changes on all fronts, employers are struggling to leverage patient care with evolving personnel and budgetary constraints

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THA, TMA, TNA Outline Legislative Priorities The 112th Tennessee General Assembly convened in midJanuary. As the state and nation continue to navigate COVID-19, legislators are looking at issues and fallout pertaining to the pandemic. Read more about key priorities for the state’s leading provider and hospital organizations ... 9

Consolidated Appropriations Act The Consolidated Appropriations Act (CAA) was signed into law on Dec. 27, 2020. From the more than 5,000-page legislation, three key provisions were discussed at NMGMA impacting practices ... 13

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February/March 2021 >> $5

Matters of the Heart By MELANIE KILGORE-HILL

VUMC Now Leads World in Heart Transplantation

Vanderbilt University Medical Center’s heart transplant program continues to set records, performing more operations in 2020 than any other center in the world — 124 adult hearts, 23 pediatric hearts and VUMC’s first heart-lung transplant since 2006. Ashish Shah, MD, professor and chair of Cardiac Surgery, credits the program’s success to innovation and willingness to push limits. In 2016, VUMC became the first center in the world to use Hepatitis C-positive hearts, which now constitute approximately one-third of their 90-plus donor hearts a year. Now, they’ve embarked on another discovery expected to revolutionize heart transplant. In February 2020, the adult team used a novel organ preservation technique to transplant a heart from a donor who died from cardiac death (as opposed to brain death) for the first time in Tennessee. Hearts from these donors (often referred to as DCD) are anticipated to expand the donor pool by up to 30-40 percent. (CONTINUED ON PAGE 4)

Vanderbilt University Medical Center performed more heart transplants in 2020 than any other center in the world.

A Fireside Chat on COVID & Health Equity Integration, Innovation & Racial Justice On Feb. 17, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases and chief medical advisor to President Joseph Biden, appeared with Meharry President James Hildreth, PhD, MD during a virtual “fireside chat” as part of the 2021 Meharry Health Equity Convening: “Health Integration, Innovation and Racial Justice: A Call to Action.”  Dr. James Hildreth Both recognized leaders in infectious diseases, the two compared perspectives on COVID-19, with Fauci delivering his outlook on the worldwide pandemic. “I’ve

been through a lot of infectious disease crises,” he said. “I’ve never ... been through one that immobilized the world for a year.” The two spoke at great length about the development and distribution of vaccines, as well as addressing confidence among minorities in taking the vaccine. Of ongoing concern, however, is a distrust among many in the AfriDr. Anthony Fauci can American community about the safety of the vaccine. Fauci, who has been actively addressing

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ACC Releases Latest Information on Treating HFrEF Expert Consensus Updates 2017 Clinical Considerations By CINDY SANDERS

Heart failure (HF) continues to rise alongside an aging population. The most recent statistical update from the American Heart Association notes: “An estimated 6.2 million American adults ≥20 years of age had HF between 2013 and 2016, compared with an estimated 5.7 million between 2009 and 2012.” The report added approximately half of hospitalized heart failure events are characterized by reduced ejection refraction (HFrEF). To optimize heart failure treatment, the American College of Cardiology (ACC), along with its partner the American Heart Association (AHA), published an in-depth heart failure clinical practice guideline in 2013 and produced a focused update four years later. However, since that last update, exciting new therapies for HFrEF have emerged. The ACC has just published the latest evidence-based update, including details on new drugs that have a clinically demonstrable impact on hospital readmissions, mortality and disease progression. Thomas M. Maddox, MD, MSc, FACC, chaired the writing committee for 2021 Update to the 2017 Expert Consensus Decision Pathway for Optimization of Heart Failure: Answers to Pivotal Issues About Heart Failure with Reduced Ejection Fraction. He recently sat down with Medical News to discuss the importance Dr. Thomas of ACC guidance and Madox new opportunities to improve patient management.

Keeping Current

“The College is the largest professional society for cardiac care teams,” said Maddox, who is an incoming American College of Cardiology Trustee and chair of the Science and Quality Committee. “Part of our mission is to provide actionable knowledge and clinical guidance to those teams to optimize cardiac care.” He continued, “The centerpieces of our clinical guidance efforts are the clinical practice guidelines, and we produce those with the American Heart Association.” Maddox added the clinical practice guidelines are major undertakings with enormous literature reviews that typically come out every four to five years. “But four or five years is a long time … so we issue interim clinical guidance, such as expert consensus decision pathways, to bridge the gap between guidelines.” The ACC has made “actionable knowledge” a priority with an emphasis on presenting guidance in a way that is easier to read, share, update and integrate into clinical practice. This clinical guidance is organized into solution sets, which bring together related activities around a specific cardiovascular condition, such as heart failure. Solutions sets include policy updates, decision support and mobile apps. Another key component of these sets are expert consensus decision pathways (ECDPs) like the one just released for HFrEF. “The last five years has seen an explosion of new pharmaceutical targets for heart failure, which is great but dizzying if you’re trying to quarterback a patient’s care,” said Maddox, who is a professor of medicine and executive director of the Healthcare Innovation Lab, a joint effort of BJC HealthCare and Washington University School of Medicine in St. Louis. “One

of the things we try to do with these expert consensus decision pathways is make them really practical for the frontline clinician.” The hands-on information and decision flow charts can easily be translated into machine language and imported into an electronic health record. There is also a downloadable TreatHF smartphone app that puts this latest information at a clinician’s fingertips.

New & Noteworthy

Maddox said the new ECDP highlights the use of two newer therapeutics for HFrEF. “We are now recommending people use ARNIs, which are angiotensin receptor-neprilysin inhibitors,” he explained. “It’s a combination medicine of an ARB (angiotensin receptor blocker), which we’ve had for a long time, and a neprilysin inhibitor.” He said both molecules primarily exert their impact via relaxation of the relative blood pressure and improvement in the efficiency of cardiac function. “We learned that the combination of these two molecules reduced heart failure readmissions and morality by 20 percent compared to the ACE Inhibitors, which was the previous standard of care,” Maddox said of clinical trial results, adding the 20 percent reduction occurred in both outcomes. The second significant recommendation is to incorporate a sodium-glucose cotransporter-2 (SGLT2) inhibitor. “It’s a molecule that blocks the kidney from absorbing both sodium and glucose,” Maddox said. The mechanism behind SGLT2 inhibitors is that patients urinate out glucose and sodium, which is why this particular therapeutic got its start in the diabetic patient pop-

ulation. However, clinicians also observed better heart failure control in patients with both diabetes and heart failure. Since diuretics work much the same way, perhaps seeing some improvement in HFrEF control wasn’t completely surprising. The 2019 DAPA-HF (dapagliflozin) trial focused on the benefits of the SGLT2 inhibitor vs. placebo specifically for heart failure patients. “Only about half the patients (in the trial) had diabetes, but the group that didn’t have diabetes saw the same benefits,” said Maddox. “This drug works on heart failure regardless of your need to control glucose.” The cardiologist added, “In my mind now, this is more a heart failure drug than a diabetes drug.” In May 2020, the FDA approved dapagliflozin specifically for treatment of HFrEF. Barring a contraindication, Maddox said he couldn’t see a reason not to use a SGLT2 inhibitor in HFrEF patients. “We just have such good evidence on this,” he noted. Maddox added that if he had a new heart failure patient not already on a treatment regimen, in short order he would get them on a beta blocker, ARNI, aldosterone antagonist and a SGLT2. The new ECDP also provides guidance on 10 critical issues from how to initiate, add or switch to new evidence-based therapies for HFrEF and how to address challenges of care coordination to ways to improve medication adherence and how to help patients with cost and access to medications. Maddox said the high price tag on newer therapies remains an initial barrier for many patients. However, he added, “There’s a variety of strategies now to try to knock those costs down.” From apps like GoodRx to financial assistance programs from manufacturers, there are a number of routes for physicians and patients to explore to ensure everyone has access to the best care. Maddox noted this ECDP “does not supersede or take away from the clinical practice guidelines but is a bridge between guideline updates. As part of the College’s mission to transform cardiovascular care and improve heart health, we need to provide the best clinical guidance possible as ongoing evidence evolves.”

A Deeper Dive

To fully explore the 2021 Update to the 2017 Expert Consensus Decision Pathway for Optimization of Heart Failure, go to the Journal of the American College of Cardiology (jacc.org) and do a search for ‘2021 HFrEF Update’ or go online to our site, NashvilleMedicalNews.com, for a link to the pdf. The TreatHF app is available through both the App Store for Apple and Google Play. There is also a web version available through the American College of Cardiology site. For more information, go to the “Tools and Practice Support” tab on the ACC.org homepage and click on ‘Mobile and Web Apps’ to access this and other interactive tools. 2

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Cardiovascular care is changing, and we’re leading the way Get routine to advanced care at Ascension Saint Thomas Heart

Ascension Saint Thomas Heart is expanding services across our locations, offering greater access to some of the most innovative technologies to care for your heart. Our doctors and care teams are committed to developing specialty heart programs with you in mind. From minimally invasive surgery which may lead to shorter recovery time to cutting-edge techniques to treat heart failure and programs designed specifically for women’s heart health, the advanced care you need is close to home. We’re maintaining strict precautions to keep you safe in our care.

Don’t delay — get the care you need at ascension.org/SaintThomasHeart

© Ascension 2021. All rights reserved.

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Matters of the Heart, continued fom page 1 Learning What’s Possible

“In the last year, we’ve taken the lead on using hearts from donors whose hearts have stopped beating,” said Shah. “Once they’re declared dead we reanimate those hearts and use them.” Shah said it’s biologically plausible to rescue a heart after 30 minutes without blood supply, and researchers are still learning how far they can push the envelope. “We’ve got multiple labs looking at rescuing whole organs and asking, for example, what are the molecular mechanisms that Dr. Ashish Shah make a heart gone for good? For how long do we have where we can actually rescue it? Reconditioning and resuscitation are more than just CPR.” While Shah recognizes transplantation advances won’t solve the public health epidemic of heart failure, he believes this promising window into organ resuscitation will be a huge win for heart patients. “Yes, we save lives right now, but we can save 10 or 100 times as many by what we’re learning in doing this,” he said. “Right now we resuscitate on pumps and circuits and use preservative solutions, which is nothing new but rather using old ideas in a new way.” The next step is novel therapeutics – combining drugs with novel techniques to better deliver potentially beneficial medications. “The circuits we have that allow us to keep hearts or lungs or livers profused for a long time also create an opportunity to take an organ, put it on a circuit, and start recirculating something very therapeutic or reparative for that organ,” Shah said. “It’s what we’ll be looking at for years to come.”

Improving Outcomes

Shah believes a program of VUMC’s caliber also has the responsibility to

improve outcomes for heart transplant patients post-surgery, meaning improved anti-rejection drugs and longer life expectancies. Today’s adult heart transplant patient has a 90-plus percent chance of surviving one year, with a 70 percent chance of living 10 to 20 years. While those odds are promising for older adults, they’re not good enough for younger patients, said Shah. VUMC’s ability to operate on immunologically complex patients and those in need of multivisceral transplants (more than one organ) means the center receives cases from throughout the U.S. In September 2020, the team performed the first dual heart-lung transplantation of a COVID-19 patient in the world. The Vanderbilt Transplant Center is part of an elite group of heart transplant programs that have performed more than 1,000 transplants. The center’s adult heart transplant program began in 1985, followed by the opening of the pediatric program in 1987. “We do in a month or two, what most programs do in a year, so we have a unique vision for this field,” Shah said. “Transplantation remains for me exciting and unbelievably fulfilling.”

VUMC Study: Arthritis Drug Impact on Cardiac Complication

A drug typically prescribed for rheumatoid arthritis may also be effective in treating a rare, but potentially deadly, heart complication some cancer patients experience after taking immunotherapies, according to a study published in Cancer Discovery and co-led by investigators at Vanderbilt University Medical Center. The researchers demonstrated that the drug abatacept reduced the severity of myocarditis in a genetic mouse model study – responses that have also been observed in three human patients who were given the same drug after corticosteroid treatments failed to reduce heart muscle inflammation. The mouse model

Blog Log & Bonus Editorial 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 MARCH: American Hospital Association: On Feb. 10, the American Hospital Association, joined by member hospitals and health systems and other national organizations representing hospitals, filed petitions asking the U.S. Supreme Court to hear cases on 340B and hospital outpatient payment cuts. The online piece shares some of the background and links to each petition. Kraft Healthcare Consulting’s Stacey Stuhrenberg, Senior Consultant for Coding & Compliance: The 2021 Medicare Physician Fee Schedule Final Rule has been published, and Congress has signed the Consolidated Appropriations Act into law. Are you prepared for a change in revenue, a compliance audit, or both?” Nashville Health Care Council: This issue includes a synopsis of the annual Wall Street Analysts 2021 Predictions panel (see page 11), but go online for a link to the full event, which includes more insights from additional well known analysts: Kevin Fischbeck, Bank of America; Frank Morgan, RBC Capital Markets; Brian Tanquilut, Jefferies & Company; and A.J. Rice, Credit Suisse Securities. Tennessee Justice Center’s Michele Johnson, Executive Director, and Kinika Young, Senior Director of Health Policy and Advocacy, discuss concerns with the new TennCare block grant in its current form and what it means for Tennesseans and access to care.

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revealed the mechanisms for how the drug works. The research received support from Cancer Prevention and Research in Texas, the National Cancer Institute and the National Institutes of Health.

Myocarditis in Athletes Recovered From COVID-19

In a letter published in the December issue of the American Heart Association’s medical journal Circulation, a group of researchers at Vanderbilt University Medical Center (VUMC) dispute the most recent findings of the incidence of myocarditis in athletes with a history of COVID-19. The Vanderbilt study, COVID19  Myocardial  Pathology  Evaluation in AthleTEs with Cardiac Magnetic Resonance (COMPETE CMR), found a much lower degree of myocarditis in athletes than what was previously reported in other studies. COMPETE CMR is the first study that the group is aware of to use an appropriate athletic control group to assess athletes after COVID-19. “The differences in the findings are extremely important. The whole world paused after seeing the alarmingly high rates of myocardial inflammation and edema initially published,” said Dan Clark, MD, MPH, first author of the report, instructor of Cardiovascular Medicine, and an adult congenital heart disDr. Dan Clark ease fellow. The study evaluated 59 Vanderbilt University athletes and compared them to a healthy control group, as well as a group of 60 athletic controls. “The degree of myocarditis found by cardiac MRI in Vanderbilt athletes was only 3 percent, which is really good news,” said Clark. “Since our first evaluation, we have screened almost double that number, and the same findings are holding true.” However, he continued, there was also a piece of disappointing news. “None of the other screening tests helped us to identify the athletes with myocarditis,” he said. “Initially, we hoped that the standard screening tests for athletes would be definitive because we wanted something that was widely available and quick,” said Clark. “We hoped that a cardiac MRI would only be used if absolutely necessary. However, their blood work, clinical exams, EKG, echocardiograms and other cardiovascular screening were normal. All of those traditional screening results would have led us to agree to allow some athletes to participate in a sporting event or practice, while the MRI told a different story.” Myocarditis is a disorder of abnormal inflammation of the heart muscle and is a leading cause of sudden cardiac death among athletes. The findings highlight the importance of considering cardiac MRI in addition to traditional screening measures to detect myocarditis. It is well documented that COVID-19 may affect the heart. “Our data also demonstrated more scarring in healthy heart

muscle than we would have thought,” Clark said. Those findings led the group to dig deeper and compare a healthy, athletic population with normal cardiac MRI values against those who had recovered from COVID. The athletic control group without COVID showed 24 percent (1 in 4) scarring in the heart muscle while the COVID athlete group had a 27 percent (1 in 4) scarring ratio. According to Clark, athletes commonly have a small area of benign scar due to athletic remodeling. This scarring related to athletic changes was evident in both athletic groups studied. “This particular piece of information is very important to share – myocarditis after COVID-19 tends to be in a similar spot,” he said. “Without the knowledge that this area of scarring is common in healthy athletes, clinicians could attribute the scarring to consequences from COVID-19. Those assumptions might unnecessarily restrict some athletes from competition.” Clark says his team’s findings suggest that the addition of cardiac MRI as an assessment tool for athletes may be very helpful in determining safe return-to-play guidelines. The paper was published in the February edition of Circulation.

TriStar Skyline Earns Elite Cardiac Accreditation

TriStar Skyline Medical Center recently earned the Get with the Guidelines® Stroke Gold Plus with Honor Roll Elite Quality Achievement Award, presented by the American Heart Association and American Stroke Association. They earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. Measures include evaluation of the proper use of medication and other stroke treatments aligned with the most up-todate, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Before discharge, patients should also receive education on managing their health, get a follow-up visit scheduled, and well as other care transition interventions. The HCA Healthcare TriStar Health hospitals are nationally recognized for quality outcomes in cardiovascular services, with cardiac surgeons performing complex surgeries with success rates above the national average. Using the latest surgical techniques, equipment and devices, TriStar Health’s cardiovascular specialists continue to explore the latest in surgical procedures. They were the first in Middle Tennessee to offer minimally invasive and beating heart surgery at the TriStar Centennial Heart and Vascular Center, which has advanced to include the establishment of a VAD (Ventricular Assist Device) and ECMO (Extracorporeal Membrane Oxygenation) program. The Heart and Vascular Center was also the first hospital in Nashville to join the National Cardiogenic Shock Network and the first in Tennessee to perform a transcatheter tricuspid heart valve repair. nashvillemedicalnews

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The Science of Stroke Prevention Blood Thinners no Longer the Only Option for AFib Patients By MELANIE KILGORE-HILL

Patients with AFib have a fivefold risk of stroke over those without, often setting them on a lifetime course of blood thinners – and a subsequent risk of bleeding. That all changed in 2020 with FDA approval of the latest WATCHMAN™ Left Atrial Appendage Closure (LAAC) Device, the only permanently implanted device that helps to prevent blood clots in the left atrial appendage from entering the bloodstream. Andrew Goodman, MD, interventional cardiologist at TriStar Centennial Medical Center’s Heart and Vascular Center, said LAAC therapy has taken off since its debut in 2015. The latest model – the WATCHMAN FLX Dr. Andrew – includes improved Goodman safety and anatomical

profiles that previously prevented implantation in approximately 10 percent of patients. “We’re seeing much better outcomes with this device, and providers and the public alike are becoming more knowledgeable of this as an option compared to five years ago,” said Goodman. “It’s been a breath of fresh air.” In 2020 the hospital became the region’s first to implant this latest model in a commercial patient.

More Choices

To qualify for LAAC, patients must be candidates for blood thinners but not longterm use. That means most are at high risk for internal bleeding, falls or in a high-risk occupation. When choosing the best treatment for a high-risk patient, Goodman provides AFib patients with options. The first, he said, is to stay on bleed thinners. “I’ll be the first to tell you that the blood thinners we have today are excellent, and the vast majority of patients tolerate them very well, but it does come with an

increased risk of a bleeding event,” he said. Another option – coming off blood thinners altogether – means accepting the chance of stroke, which is rarely the preferred choice. The third alternative is a WATCHMAN procedure, which patients often choose when they’re between a rock and a hard place. “If someone has a high risk of stroke and a high risk of bleeding, the WATCHMAN is a nice way to get out of that place,” Goodman said. The minimally invasive procedure is well tolerated even by elderly, medically fragile patients, who spend a day in the hospital followed by six weeks on blood thinners. In a clinical study, 96 percent of patients who had the WATCHMAN FLX device implanted were able to stop taking their blood thinning medications after 45 days.

A Welcome Alternative

“The device is inserted into the left atrial appendage, which serves no purpose in the heart except as a reservoir for

blood to collect, stagnate and form clots,” Goodman explained. “When we put the device there, we wall off that area, so it’s completely expunged from the heart or circulation. No blood can get in or out and therefore no clot.” Now, TriStar Centennial is participating in a clinical trial examining whether the stroke reduction tool can be used in a lower risk population – those not at risk for bleeding events. “The technology and results have gotten so good that the question now is, ‘Should WATCHMAN be a front line strategy in more people?’” Goodman said. He also hopes improved outcomes will encourage providers to refer patients earlier. “Often times we’ll evaluate patients for WATCHMAN when they’ve already had a significant bleeding event,” said Goodman. “Where we are with therapy now, we’re using risk tools to get better at predicting who might benefit from the device before bleeding events occur and trying to move the needle toward earlier intervention.”

A Fireside Chat on COVID & Health Equity, continued from page 1 African American churches and organizations, noted this distrust is understandable based on the egregious violations of ethical principles in the past. “The hesitancy that we see in African Americans really relates to something that we need to deal with. It’s an extraordinary, unfortunate history that African Americans have been subjected to under federal programs that related to health issues,” said Fauci of the infamous Tuskegee experiment. The horror of that and other human experimentation on Black populations has been handed down through generations. “You have to respect that hesitancy,” said Fauci, adding you have to acknowledge what happened was real and isn’t something to be simply set aside. However, he continued, the next you do is to say, “Since that time, there have been ethical constraints and guidelines that have been put into place that would make something like that impossible today to happen.” Once the historical fear has been addressed, Fauci said the number one reason for reluctance is a feeling that the vaccines were created too quickly … perhaps corners were cut. Fauci stressed the vaccine candidates have been through exhaustive reviews and are safe and effective. He pointed out the rapid development of COVID-19 vaccines merely reflects the “extraordinary advances in the science of vaccine platform technology.” Hildreth, who sits on the vaccine advisory review board and was recently named to President Biden’s COVID-19 Health Equity Task Force (see box), along with other prominent Black physicians, providers and community leaders across the country have helped address many of those fears by publicly receiving vaccines. Speaking honestly and clearly about where the science has led public health practice is a key factor, as well. nashvillemedicalnews

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Hildreth pointed to a recent award Fauci received from Israel for speaking “truth to power” while serving on the coronavirus task force during the Trump administration. Fauci noted the fact that there was any type of discussion or disagreement over items that should have been purely in the public health realm – masks, congregate settings – was discouraging. He said he was astounded by reports of overwhelmed ICUs filled with COVID patients and people in the same area claiming the pandemic was just a ‘hoax’ and ‘fake news.’ Fauci said one lesson to be learned from the past year is to recognize how the politicization of the CDC and FDA affects public health. “Counterproductive is a mild word,” he said. “I think what we do is remain acutely aware that it can happen … some organizations should be completely free of political influence.” Fauci said the Biden administration’s move to rejoin the World Health Organization is a significant step forward. “Obviously you have to take care of your own country, but we live in a global community,” he pointed out. Fauci added, even if the pandemic is brought under control in the United States, a failure to help the rest of the world means we continually will be threatened by mutant strains from overseas. The evening’s Health Equity Convening was presented by Meharry’s School of Dentistry. Fauci commended efforts within the oral health community to help distribute vaccinations, saying the country will need all the help it can get. The virtual health summit was the first in a three-part series to open dialogue with stakeholders and health experts to develop a community-centered approach that prioritizes prevention of disease, elevates racial justice and equity and eliminates COVID19 healthcare disparities among minority groups across the country.

“These conversations have never been more important,” said Hildreth. “COVID19 has only illuminated the gulf of health disparities that exist between majority and minority communities across our country, particularly in rural communities. Over the last year, we have further focused our collective efforts on addressing these disparities, and this Summit will provide our community with the opportunity to engage around

how best to make long lasting changes that will impact the lives of all people.” The event included a panel discussion on health integration and barriers to achieving whole-person and community-informed care.  Available on YouTube, search ‘Meharry’ for a link to the program or access the video through the digital version of this article at NashvilleMedicalNews.com.

Hildreth Named to National Health Equity Task Force On Feb. 10, President Joe Biden named James E.K. Hildreth, PhD, MD, president and CEO of Meharry Medical College, to a new national task force to address health equity in relation to the pandemic. “I am honored to be chosen by Dr. James E.K. Hildreth President Biden as a member of the COVID-19 Health Equity Task Force,” said Hildreth. “We are facing one of the largest challenges in the history of our nation. COVID-19 has killed hundreds of thousands of Americans, and if adequate steps are not taken, this number will continue to grow. As we have seen, COVID-19 does not discriminate, it does not respect borders, and it does not behave according to our timelines. “The virus has had the largest impact on our communities of color, among Black and brown Americans with underlying health conditions. Without our immediate attention and a national, organized effort to fight this virus, we will be dealing with its impact for years to come. “As the president of a historically Black medical school that was founded to eradicate health disparities between majority and minority communities, this work is a focus for me and my institution. I am committed to working with our national leadership to develop cohesive plans that will address these silent killers – illnesses like COVID-19 that impact our most vulnerable populations at alarming rates. We must address the pandemic together. I am confident that President Biden’s heightened focus on the pandemic will accelerate testing, treatment and vaccinations nationwide – proven strategies that will work to mitigate the virus and protect our people,” Hildreth stated. Bobby Watts, CEO of the National Health Care for the Homeless Council in Goodlettsville, was also tapped to be part of the 12-member task force.

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PHYSICIAN SPOTLIGHT

Women with Heart

Ascension Cardiologists Share Insights, Unique Perspective By MELANIE KILGORE-HILL

Heart disease is no stranger to women, and few understand that better than the female cardiologists of Ascension Saint Thomas Heart. Thanks to initiatives like the American Heart Association’s “Go Red for Women” campaign, more women are recognizing the seriousness - and symptoms of a disease once associated primarily with men. Nausea, indigestion, shortness of breath, upper abdominal discomfort, pain between the shoulder blades and generalized weakness all are common heart attack symptoms in women. While awareness is spreading, the tendency of women to prioritize care of their families, often forgoing their own health, is something providers continue to combat. We asked Drs. Davis, Young, Suryadevara, Edwards and Davis for their insights on pursuing and finding success in what is still a male-dominated specialty, as well as heart-related challenges women face.

staff, I received support from my male counterparts.   What will it take to get more women into cardiology? I think in order to change this, there needs to be more women in leadership roles. Cardiology is a rapidly expanding field, and the innovative advances are enormous. The need for more physicians in this space is growing. With heart disease being the number 1 killer of women, it is especially important for more women to enter this field.  What can women do to combat heart disease? Women should have regular checkups with their primary care providers. It is important to manage risk factors and to know your numbers (blood pressure, cholesterol levels and blood sugar). High blood pressure, high cholesterol and diabetes are major risk factors for heart disease. Women should also not ignore any signs and symptoms. If there are any concerns about your health, please reach out to your doctor.  What is the most rewarding aspect of your career? One of the most rewarding aspects of my career is the relationships I develop with my patients and their families. I treat my patients as if they were my own family and take pride and honor in the opportunity to be a part of my patients’ medical care. Cardiology is a rapidly expanding field, rooted in evidence-based medicine, and there is always an opportunity for lifelong learning. 

Kelly Davis, MD

Interventional Cardiology, Cardiology What drew you to medicine and cardiology? I started developing an interest in medicine during high school and maintained this desire throughout undergraduate training. I was most intrigued by the cardiovascular system in medical school, and heart disease is prevalent in my family, so these were driving factors that led me to the field of cardiology. What was your experience like training in a male-dominated field? The fact that my field is predominantly male did not deter me. I do not think that my training experience was different. Fortunately, I had two female cardiologists who were the directors of one of my fellowship training programs. There were also other female cardiologists at the institution so they provided mentorship and guidance. While there were no female interventional cardiologists on 6

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Britten Young, MD General Cardiology

What drew you to medicine and cardiology? When I was in elementary school, my father developed a heart rhythm problem that required emergency placement of a pacemaker. Because of that, I developed an interest in cardiovascular physiology that stayed with me through the years. However, I did not consider cardiology

as a career until my final year of medical residency. I was fortunate to have mentors – one of whom was the same cardiologist who had placed my father’s first pacemaker 15 years before – who encouraged me to apply for a cardiology fellowship. I am forever grateful for their guidance. What was your experience like training in a male-dominated field? I think that there is a place in medicine for every personality type … as it’s said, you find your tribe. I found mine in cardiology. The majority of my medical education and training experiences were positive. I did have a somewhat different experience than my male colleagues; for example, during my fellowship, one male attending directed me to drive him to a media appearance. I doubt that would have been asked of a male colleague. There were other isolated incidents over the years, as well. However, overall I do not feel my options in cardiology were limited because of my gender. What will it take to get more women into cardiology? More women are definitely needed in cardiology, but we have to wear a lot of hats in our lives; our time is limited. Compared to other specialties, cardiology may be perceived as less likely to offer an acceptable work-life balance. That does not need to be the case. Restructuring cardiology practices to improve efficiency and increased use of telehealth and similar technologies will offer more flexible scheduling options that have never been available in the past. These changes may increase the interest of women in the field. What can women do to combat heart disease? Our grandmothers were right when they said, “An ounce of prevention is worth a pound of cure.” Heart disease is largely preventable, and the earlier you start, the more preventable it is.  The biggest opportunity we have in cardiovascular prevention is to educate young people and encourage them to commit to a lifelong, heart-healthy lifestyle. Then, when they become parents, they will raise their children in a heart healthy environment.    What is the most rewarding aspect of your career? I really enjoy educating my patients about how to control risk factors for heart disease, because it empowers them to take control of their own health. I can always prescribe a medication or order a test, but the impact of that is really quite limited. It’s much more rewarding when a patient leaves my office with actionable knowledge of how to be healthier, and they act on it. The impact of that can be vast.

Ramya Suryadevara, MD Interventional Cardiology, Cardiology

What drew you to medicine and cardiology? I started developing interest in a medical career when I began realizing the positive and pivotal role that my father, who is a physician himself, has played in his patients’ lives. In medical school, I realized my affinity towards cardiovascular physiology. Unfortunately, during the last year of medical school, my father suffered a massive heart attack and cardiac arrest. It is because of a cardiologist that my father is alive today. At that time, we lived in a city where there was no immediate percutaneous coronary intervention (a procedure where we open up a clogged artery and put stents) available, and my father received a clot buster medication to treat his heart attack. At that point, I decided that I wanted to become an interventional cardiologist. What was your experience like training in a male-dominated field? Honestly, I was not aware that this profession is pursued predominantly by men until I entered my training, where there were only two females among 15 trainees. But that did not stop my passion to complete my training in cardiovascular sciences and go on to specialize further in interventional cardiology. I did not face a lot of challenges as a female during my training, and I have been honored to work with mentors who have always encouraged me to pursue my dream. More than education/training differences, I noticed that obtaining my first job as a female interventionalist was challenging. I felt that there were more questions about my young family and my ability to work longer hours when needed for patient care.   What will it take to get more women into cardiology? In interventional cardiology, the number is much lower – around three to four percent of interventional cardiologists are women. Having more female physicians in leadership roles will encourage more women to take on tough specialties nashvillemedicalnews

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in the field of medicine. Given the growing incidence of cardiovascular diseases in women, we need more women to take up our specialty. What can women do to combat heart disease? Often, women are juggling their career, family, and home first and never sit down and think about themselves. I highly recommend all women to take a few minutes to themselves every day to reflect on their lifestyle, their health, nutrition and any symptoms. Take your symptoms seriously – do not ignore them. Seek medical care for early diagnosis and treatment. Taking care of yourself is an essential part of taking care of your family. Prevention by adopting healthy lifestyle changes is very important.   What is the most rewarding aspect of your career? The most rewarding part of my career is the relationships and trust that I develop with my patients. It’s the happiness that I get when patients are able to return to their normal lives after a heart attack, make changes in their lifestyle, and become healthier.  

Stacy F. Davis, MD

Cardiology, Advanced Heart Failure & Transplant Cardiology

What drew you to medicine and cardiology? As a freshman at Stanford University, I told my undergraduate advisor that I was interested in becoming an architect or an orthopedic surgeon. He informed me that since Stanford closed its architecture school a decade earlier, my best option was to become a doctor or study engineering and apply to graduate school for architecture. The summer of my junior year I was awarded an American Heart Association research grant to study cardiovascular physiology. My research advisor, Dr. Steven Horvath, was a wonderful mentor. I presented my research at a conference at UCLA. After that, I was convinced I would be a cardiologist.   What was your experience like training in a male-dominated field? It doesn’t take courage to be successful. It takes drive, ability and, most important of all, great mentors. A cardiology fellowship interviewer at Methodist Hospital in Houston, Texas, asked nashvillemedicalnews

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me, “What makes you think a woman can be a successful cardiologist?” I reminded him that women had successful careers in cardiology going back to Helen B Taussig in the late 1940s. She envisioned the Blalock-Taussig shunt (the first palliative surgery for Tetralogy of Fallot). As a medical student at the University of Minnesota - Minneapolis, Dr. James Moller (a pediatric cardiologist) was instrumental in supporting my application for a research grant from the American Heart Association to develop a computer program to teach students heart sounds. At Stanford University Medical Center, I credit my interest and success in advanced heart failure and cardiac transplant to the support of Dr. Sharon Hunt, Dr. Ann Bolger, and Dr. Michael Stadius. They believed in me and my abilities. At Harvard-Brigham & Women’s Hospital, I had excellent research and clinical mentors including Dr. Peter Ganz, Dr. Gilbert Mudge, Jr. and Dr. Peter Libby. They gave me opportunities to excel and opened many doors for me in academic medicine. They also turned me into a seasoned diagnostician. I received excellent advice as a medical student regarding residency: Choose the most challenging program that you can get into. Then you will learn from everyone there.

What is the most rewarding aspect of your career? The biggest reward of this career is the relationships I have with my patients and their families. In many cases, these relationships span decades. I have several cardiac transplant recipients that I have cared for 25 years. There are families where I care for multiple generations with different cardiac diagnoses. The second biggest reward is the knowledge that I have gained from outstanding teachers. Finally, the relationships I have with my colleagues in cardiology, the medical specialties that I collaborate with such as pulmonary critical care, maternal fetal medicine and nursing are also very rewarding.

What will it take to get more women into cardiology? As a resident in the late 1980s, I was disappointed to see that many talented women I trained with decided against a career in cardiology because they felt that they could not have a family and be a cardiologist. However, I have several friends who have done both. You just can’t have it all at once. I am fortunate that I have a supportive husband, parents and siblings. I do not have children. I never made having children my first priority. In order to increase the number of women in cardiology, it will take more women having excellent mentors (male and female) who encourage them. However, you must have realistic expectations about what this career involves. It is rarely feasible to work part-time as a cardiologist while raising children. You choose a career in cardiology because there is nothing else you find as exciting or interesting. Then, when you are awakened at 2 a.m. with an emergency, you don’t resent it.   What can women do to combat heart disease? My biggest challenge is to get women to make changes NOW before they develop diabetes, have their first heart attack or develop heart failure. I see a lot of deferred health care maintenance. Many women with high cholesterol say that they will start taking a cholesterol medicine after they are done breastfeeding, but they never start the medicine. The same applies to beginning and sustaining an exercise program. If you don’t “lead by example” and make exercise and a healthy diet a priority, it is unlikely that your spouse/partner and children will prioritize fresh fruit and a hike over gummy bears and videogames.

Amber Edwards, MD

ing, creating policies, etc.) and less valued from a surgical, political, and financially compensated standpoint. I was no stranger to this. In addition, as noted above, there are micro and macro aggressions against women, with microaggression being much more common. It is not unusual for people to assume that I am not a surgeon because of my gender, not use my professional title (“Dr. Edwards”), receive mail that assumes I am a man because I am a surgeon, to assume that if I am not available that it is directly related to me being a mother (not true for men who are fathers), and the list goes on and on. Macroaggressions are much less frequent, but have occurred to me personally, and to other women colleagues which included refusal to refer or work with a woman or overt sexual harassment.   What will it take to get more women into cardiology? In cardiac surgery, that number is actually much smaller. I think 15 percent or so of trainees are women and 6 percent of the workforce are women. In order to change this, there needs to be more women in leadership positions and a system structure in place that supports women more (maternity leave, equal pay, work-life balance, etc).

Cardiothoracic Surgery

What drew you to medicine and cardiology? I always knew that I wanted a career which involved public service. Initially, I thought I would become an attorney and pursue human rights or politics in order to do this. However, what I excelled at academically and what I found pleasure in learning were the STEM fields. I put those together and decided I would be a doctor. As far as choosing cardiac surgery, it was very easy for me. I was doing vascular operations on rats in a lab in my first year of medical school and very much enjoyed the technical aspects. I found a surgeon who let me come watch heart surgery, and after that I was hooked. What was your experience like training in a male-dominated field? It never really mattered to me that I was entering a male-dominated field. My whole life I have been somewhat of a tomboy, so it felt natural to work with men. As I progressed through training, and now my career, it started to matter more. Some days the micro and macroaggressions are easy to get weighed down with, and it requires work to not have a “chip on your shoulder.”  I think it’s important for women to continue to enter and (maybe more importantly) advance in leadership in these fields, to make other women more comfortable choosing this as a career path. My education and training are absolutely different than my male colleagues. Women classically are assigned roles and responsibilities that are different from their male counterparts, which are classically more administrative (schedul-

What can women do to combat heart disease? Women should continue to advocate for themselves with their providers, particularly if they know they have risk factors for heart disease or are experiencing symptoms. Women are more likely to die from heart disease. This is multifactorial, but one cause is that women are less likely to have their symptoms associated with a serious diagnosis like coronary artery disease.   What is the most rewarding aspect of your career? The most rewarding aspect of my career is the relationship that I develop with my patients. Patients have to learn to trust me, usually pretty quickly, and they go to sleep and put their life in the cardiac surgery team’s hands. I always try to honor their trust, and do my best job. To see them do well, recover and feel better is immensely fulfilling. I also enjoy mentoring men and women who want to pursue a career in our specialty.

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Workforce Challenges in 2021 Nursing Shortage, Remote Staff Create Unique Challenges By MELANIE KILGORE-HILL

Healthcare providers in 2021 are facing unprecedented workforce challenges. As COVID-19 continues to drive changes on all fronts, employers are struggling to leverage patient care with evolving personnel and budgetary constraints. “It’s a tale of two realities,” said Fletcher Lance, CEO of The Hardenbergh Group, which provides staffing, consulting and business services to healthcare providers. “For many hospitals, a large percentage of staff are still coming to work every day, while a Fletcher Lance large number are also working from home. It’s a complex workforce to manage.” Nursing Shortage Navigating the current surge in nursing need amid an already critical shortage is a struggle for most providers, and Lance said the unpredictable environment often means paying premium prices to remain fully staffed. “I’ve heard of RNs costing as much as $200 an hour,” Lance said, pointing to a nationwide nursing shortage of 20,000. “Right now you might have to meet that peak, as we sort through what it’s going to look like after COVID and how we solve the surge. It’s double level contingency planning: What happens if one nurse gets sick and exposes four more who can’t

work? How do I meet that need financially and resource plan when I don’t’ know if one impact will actually equal four?” Lance said of the thought process for employers and administrators. He said today’s providers also are relying on medical students and other skilled workers to fill in gaps. “People are looking everywhere to meet the demand.” Back to Work For many of Hardenbergh’s 150-plus providers, getting back to work means transitioning to remote services, which are often favored by patients who appreciate the safety and cost savings of telehealth. Still, he said providers should be commended for their willingness to remain on the front lines. “Our medical professionals have a high commitment to serving the COVID population and others. It’s been so impressive,” Lance said. Continuing to support staff also should be imperative to leaders, now on the other side of the PPE and ventilator shortages rampant in 2020. Lance also is encouraged by promising treatment and vaccine development. “The courage providers have shown is amazing,” he said. Hybrid Scheduling An estimated 70 percent of administrative professionals in a healthcare organization are now working from home, often with no end in sight. That’s because the situation hinges on variables like vaccination availability and school schedules. “It’s so uneven across the US, which makes it super hard to

plan,” Lance said. “We want to be thoughtful around coworkers’ needs, which is why we’re not seeing many mandates dictating when someone has to be back in the office.” For many employers, the need for flexibility has led to hybrid scheduling, allowing employees to choose days they work based on personal needs and individual risk factors and allowing them to return when, and how, they wish. Finding Hope As COVID diminishes and remote and onsite staff slowly reunite, Lance said it will be interesting to see how the two worlds come together. “Those are discussions

going on at most organizations, as certain groups are impacted differently,” he said optimistically, noting a recent comeback at The Hardenbergh Group similar to preMarch 2020 numbers. “Everyone I’ve talked to recently has been optimistic about the future,” concluded Lance. “There will be challenges we all face, but the economy will come back; the elective procedures will come back; and telehealth is not just here to stay, it’s become a great addition to other modalities. The executives and leaders I’ve spoken with are all becoming more optimistic about the future, so I’m very encouraged by this buzz.”

A New Role for Lance A well-known Middle Tennessee healthcare leader, Fletcher Lance recently was tapped to lead the Hardenbergh Group, a healthcare holding company in Nashville that provides staffing, consulting and business services to various healthcare providers in the areas of credentialing, privileging, third-party peer review, risk management, compliance and quality assurance. The Hardenbergh Group is owned by Lead Capital Partners, a private equity firm headquartered in Nashville.    Lance joined the company as CEO after spending the last four years at Vanderbilt University Medical Center, where he served as executive vice president and oversaw the medical center’s Vanderbilt Health Professional Solutions (VHPS). During his tenure, VHPS launched and dramatically grew four for-profit portfolio companies: Vanderbilt Supply Chain Collaborative; VHRxS, a specialty pharmacy business; Nashville Biosciences, a genetics company using data to drive R&D; and is in the midst of build a state-of-the-art lab services company for VUMC.  Previously, Lance was the Global Health Care Practice lead and managing director for North Highland, a national management consulting firm focused on strategy, operations and technology. In his 12 years at North Highland, he helped grow the healthcare practice from under $5 million to more than $50 million in revenue for the company.

Translating Science into Practice Centerstone’s SIM Center First of its Kind for Behavioral Health By MELANIE KILGORE-HILL

Simulation training is basic protocol for medical, military and emergency personnel … and now behavioral health providers also have the opportunity to prep for a host of different scenarios. Not-for-profit Centerstone recently launched the world’s firstknown behavioral health simulation training center for community-based providers. The Centerstone SIM Center teaches clinicians evidence-based practices for rapid use in real world care environments. “There is a rich body of evidence supporting simulation learning, behavioral healthcare has largely failed to leverage this training technology for both graduate and professional clinical education. This is certainly something Centerstone’s Research Institute is trying to change through the use of its SIM Center,” stated Bre Banks, PhD, director of clinical education for Centerstone’s Research Institute

High-Risk, High-reward

As project lead for the Centerstone SIM Center, Banks began conversations to add this type of training in 2015. “SIM labs are common in high-risk, high-reward fields 8

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and designed to help prevent costly mistakes financially or loss of life,” she said, noting most real world industry training is available only through academic medical centers. Dr. Bre Banks Banks said Centerstone’s new center is a welcome alternative to theory, role-play and lengthy lecturebased seminars. “We saw what training was available to clinicians, and, while there was some good curriculum, we found several barriers to leveraging those in a meaningful way,” she explained. Lengthy, immersive classes pull providers offline and away from patients, leaving attendees to their own devices afterward with hopes they’ll incorporate learned skills into their practice. “Once the trainer leaves, so does a majority of knowledge,” said Banks. “There’s not a significant emphasis on actually practicing skills, and asking: ‘Can I do this?’ It’s largely theory or knowledge development.” Banks said conference attendees typically retain 30 percent of knowledge after 24 to 36 hours. However, she found SIM

knowledge is increasing 40 to 65 percent from baseline to pre- and post-testing, while self-efficacy is increasing 70 to 80 percent.

Learning Technique

Centerstone SIM Center learners watch informational videos, engage in interactive scenarios where they are able to apply learned information and provide feedback and proof of learned skills through open-ended questions and other clinical competency assessments. The virtual training, utilized by 65 Centerstone providers in its early stage, is coordinated through Philadelphia-based Education Management Solutions, an international leader in SIM training for the medical community. Banks said it puts learners into a telehealth environment as lifelike as possible. “The majority of the learning is done in an engaging and experiential way, without lectures,” she said. “We’re prioritizing technique and skill to help participants reflect on what they are and aren’t doing well.” Following initial training, participants meet with a simulated patient and are asked to demonstrate core skills. The training is recorded and uploaded by Centerstone staff, who review and grade peer learners.

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Partnerships

Centerstone’s Research Institute is actively working to make the SIM Center accessible to as many behavioral health professionals as possible. They have formed a partnership with the University of Tennessee’s School of Social Work to design curriculum to further train interns on the use of telehealth in the delivery of behavioral health services. The group is also discussing a similar partnership with Indiana University. Plans also are underway to create physical SIM lab spaces to accommodate Centerstone’s 2,500-plus providers nationwide.

Science into Practice

“So many things are hard to anticipate and train for in a didactic way, so we throw providers into a simulated environment with a life preserver,” said Banks. “If you’re going to make a mistake, this should be the place it happens. Many participants haven’t been able to see evidence-based practices really broken out into core techniques, so the function is to translate science into practice, since evidence-based psychotherapies have so much science behind them. Showing behaviors are actually changing is the most exciting finding.” nashvillemedicalnews

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THA, TMA, TNA Outline Legislative Priorities By CINDY SANDERS

The 112th Tennessee General Assembly convened in mid-January. As the state and nation continue to navigate COVID19, legislators are looking at issues and fallout pertaining to the pandemic. In addition, hundreds of bills have been filed that intersect with the broad topic of healthcare. While many will never make it out of committee, the major provider and facility organizations – Tennessee Hospital Association, Tennessee Medical Association and Tennessee Nurses Association – will keep watch for those impacting their membership while also pursuing action on their own legislative priorities.

THA

Hospitals are a year into caring for the sickest COVID-19 patients with dedicated but exhausted staff. The Tennessee Hospital Association’s 2021 legislative agenda focuses on bringing relief to hospitals struggling to stay staffed and stay competitive while serving all comers. Joe Burchfield, senior vice president of Government Affairs for THA, outlines three top priorities for the year. Nurse Graduate Licensure: THA looks to codify a curJoe Burchfield rent executive order that allows nursing graduates who haven’t yet taken the National Council Licensure Examination (NCLEX) to begin practice under the supervision of a licensed registered nurse while they await testing and licensure. Burchfield noted new graduates have a gap of up to three months between finishing their studies and being able to sit for the exam and complete the licensure process. “The nurse graduate executive order helped close a fundamental gap in the workforce pipeline that existed before the pandemic but was exacerbated as staffing needs became a critical issue in 2020,” Burchfield explained. “By enabling immediate practice with proper supervision from experienced nurses, nurse graduates are able to complete the orientation and training process at the hospital and are better prepared for full practice upon licensure. Allowing the licensure and onboarding processes to occur concurrently benefits everyone.” CON: While the pandemic pushed back action on CON reform, or possible repeal, last year, Burchfield said THA expects it to be a priority for lawmakers in 2021. Adding to the overall discussion, the Health Services and Development Agency, which oversees the CON program, is up for sunset in 2021. Although THA understands the desire for CON reform and recognizes support exists among legislators to take action, the association believes parts of the program are essential to keep hospitals in business. The CON program assess community need and growth to avoid oversaturation in a nashvillemedicalnews

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market and ensure orderly development. “Certificate of need requirements help level the playing field between hospitals that are subject to federal regulations, requiring them to treat all individuals regardless of their insurance status or ability to pay, and other non-hospital providers – like imaging centers and ambulatory surgery centers – that are not subject to the same requirements,” said Burchfield. “The unique role of hospitals in the healthcare system has never been more apparent than in the current pandemic, as hospitals played the central role in response to the surge in the most seriously ill COVID-19 patients,” he continued. “One of the most significant ways hospitals are able to maintain overall operations and preparedness for any emergency is through the critical revenue generated through outpatient procedures. Unregulated growth of non-hospital providers whose business model is to focus on the most lucrative patients and procedures undermines a hospital’s ability to sustain the money-losing but essential services they provide to the community.” Hospital Assessment: The annual hospital assessment is once again part of THA’s legislative agenda for 2021. The voluntary assessment, which began in 2010, generates $602 million in state dollars and totals $1.7 billion for the TennCare program when adding the federal match. “The impetus for the hospital assessment in 2010 was the Great Recession and a series of cuts proposed to the TennCare program in order to balance an austere budget. The items funded since that time have avoided a number of benefit limits for TennCare enrollees and a hefty provider rate reduction,” Burchfield said. He noted 49 states and the District of Columbia have some type of assessment program in place, so Tennessee is not unique in this funding mechanism. Burchfield added the new TennCare III waiver has no impact on the assessment, which will continue to fund the same items in the budget and in the same manner. Not every hospital is required to pay the assessment, though. Exclusions exist for public hospitals, critical access hospitals,  state-owned mental health hospitals, St Jude Children’s Research Hospital and rehabilitation hospitals.

Graduate Medical Education Funding: Last summer, the Centers for Medicare and Medicaid Services ruled Tennessee must scrap its long-standing formula to fund graduate medical education slots through TennCare and develop a new plan. Griffin said a key concern is the ruling puts millions of dollars and all of the state’s residency program at risk, including additional GME funding TMA worked to get added to Governor Lee’s 2019 budget. She said limited funding and slots are already an issue in Tennessee. Despite putting money towards attracting and educating medical students with outstanding programs available statewide, far too many leave to finish their training. “Over 60 percent of residents end up staying in the state where they actually do their residency,” said Griffin. “We are now an exporter of students.” She said increasing funding and training options in Tennessee should mean many of those young physicians opt to build a life and a practice in the state. “The economic benefit of having a physician in a community is broader than just the care delivery,” she noted, adding that benefit is even greater in rural areas. TMA’s priority will be to have a seat at the table in determining the new formula for resident funding and to preserve the additional slots gained in 2019. Griffin said her understanding from discussions

with TennCare officials is that CMS wants a more streamlined process to ensure the state monies and the federal match flow directly to the creation of residency slots. “We are very concerned about what we’re going to do to ensure those dollars are secure,” she noted. However, Griffin added, Oklahoma went through a similar process a few years ago and ultimately did wind up receiving their full GME match after reworking their funding formula. Balance Billing: Everyone agrees patients shouldn’t be surprised with thousands of dollars in unexpected healthcare costs. TMA is leading a coalition of hospital-based physician specialty organizations to address narrow networks from health insurers that they believe is at the root of the problem. A federal bill passed last year, and there is currently a similar measure gaining momentum at the state level. Griffin said the reason to have a state law on top of the federal act is to ensure there is no gap in patients who are covered under the law. Although there are differing views, Griffin said the concern is the federal language is specific to self-funded ERISA plans and doesn’t apply to commercial markets. Additionally, the state plan puts a mechanism in place for the uninsured to start in the negotiation process for pricing. State-wide listening sessions are being hosted with SB001/HB002 sponsors, Sen. (CONTINUED ON PAGE 10)

Do you have your finger on the pulse of your practice?

TMA

While at the ready to weigh in on any number of bills impacting physicians, the Tennessee Medical Association is heavily focused on three key issues in 2021 – graduate medical education funding, balance billing and scope of practice. Julie Griffin, vice president of Legislative Affairs for TMA, Julie Griffin shared insights on the organization’s stance on each of these top priorities.

Our experienced healthcare team can help you monitor and address critical financial matters so you can continue to focus on what matters most: providing excellent patient care.

Practice Management • Reimbursement • Operations • Compliance 615-242-7353 ext. 184 • krafthealthcare.com FEBRUARY/MARCH 2021

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ACS CAN Applauds Lee on Tobacco Cessation Efforts, Denounces TennCare Waiver In February, Gov. Bill Lee released his proposed state operating budget, which includes a $2 million dollar increase in tobacco prevention program funding. On Jan. 15, he signed the Medicaid block grant waiver into law over patient advocacy groups’ objections. Emily Ogden, director of government relations in Tennessee for the American Cancer Society Cancer Action Network (ACS CAN), shared statements on both. Tobacco Cessation Funding “As an organization dedicated to reducing suffering and death from cancer, ACS CAN is pleased to see the governor prioritizing public health in his proposed budget. Today, the governor proposed increasing funding for the Tennessee Tobacco Use Prevention and Control Program. “Increasing funding for tobacco prevention and cessation is a vital first step to protect Tennessee youth from a lifetime of tobacco addiction and help more tobacco users quit. The program implements evidence-based strategies to reduce tobacco use, the number one cause of preventable death nationwide. This is especially important since over 32 percent of cancer deaths in Tennessee are attributed to smoking.

“This program is also an essential tool in reducing health disparities. The tobacco industry’s marketing strategies have led to significant tobacco use disparities, including higher use of tobacco products among people with lower incomes, Black Tennesseeans and LGBTQ individuals. By increasing funding to the state’s tobacco control program, Tennessee can better address the deadly consequences of tobacco use disparities. “ACS CAN applauds Gov. Lee for a budget proposal that prioritizes cancer prevention and looks forward to working with the governor and the legislature to ensure that the final budget includes adequate funding for this lifesaving program.” TennCare Waiver “For months, ACS CAN and other patient advocacy groups have voiced their concerns and objections to the approval of Tennessee’s Medicaid 1115 Research and Demonstration waiver. This waiver will add additional barriers to health insurance coverage and lifesaving therapies critical to individuals and their families with lower incomes, including those with cancer, cancer survivors and those who will be diagnosed with the disease.

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“The TennCare III waiver will cap the amount of federal funds available to the state to run Tennessee’s TennCare program. Implementation of this policy will reduce TennCare enrollees’ access to lifesaving care, including cancer treatments. “Even as we face this global pandemic, 41,980 Tennesseans will hear the words “you have cancer” this year. Research has proven that individuals without health insurance are more likely

than those with insurance to be diagnosed with cancer at a later stage when it is more costly to treat, and individuals are less likely to survive. “As an organization dedicated to saving lives and improving access to care, ACS CAN finds this action taken by state lawmakers and Gov. Lee unconscionable.” For more on concerns with the waiver, visit nashvillemedicalnews.blog.

THA, TMA, TNA, continued from page 9 Bo Watson and Rep. Robin Smith. Based on a successful model used in Georgia, their bill would only require patients to pay according to their in-network responsibility if they receive a surprise medical bill and would allow out-of-network physicians to pursue fair payment from health insurance companies through an independent arbitration process if the initial payment was unsatisfactory. “We want to take the patient out of the middle and make the decision between provider, payer and arbitrator,” said Griffin. Scope of Practice: An ongoing contentious issue, a three-year moratorium on any scope-of-practice legislation redefining supervisory parameters for advanced practice nurses expired in 2019. The pandemic allowed the issue to simmer for another year, but in 2021, both advanced practice nurses and physician assistants look to make a push for independent practice. TMA has steadfastly promoted physician-led, team-based healthcare delivery as the best model for patient safety and quality of care. “There are things with the current system that absolutely do need to change,” Griffin said of some areas of common ground. “We are always willing to sit down and find ways to reduce barriers to an advance practice nurse or PA who is trying to extend care to patients,” she continued. “However, we do not think the best care for patients is to sever a required relationship with a provider who absolutely has more education and training than the extender seeing the patient.”

TNA

“Our 2021 legislative agenda reflects TNA’s mission is to protect and promote the professional nurse” said Kathleen Murphy, director of Government Affairs for the Tennessee Nurses Association. The statewide organization continues to focus on legislation addressing scope of practice issues in a quest for more independence for advanced practice registered nurses (APRNs). Other agenda items for 2021 include increased funding for school nurses and enhanced attention to workplace safety. Scope of Practice: “We are supporting SB176/HB184 which will allow advanced practice registered nurses to

continue prescribing and caring for their patients without the economic burden of a contract agreement,” said Murphy. “Along that similar line, we are also supporting APRN’s ability to prescribe home health orders in SB478/HB743.” She said the two pieces of legislation go toward addressing Kathleen Murphy access issues for Tennesseans. “These bills allow patients to choose who their provider is and do not force patients to establish new relationships with a provider they have never seen before to meet an administrative requirement,” she stated. Murphy added, “Nurses have always been prepared to step up when needed. As we have seen this year more than ever, nurses answer no matter what the call is.” She noted nurses have worked tirelessly, often at the risk of their own health and wellbeing, during the pandemic. “We look forward to working with the legislature to cut the red tape holding APRNs back and promoting a legislative agenda that provides access to high quality care to all Tennesseans no matter where they live.” School Nurses: The pandemic highlighted a range of unmet needs, including adequate access statewide to school nurses. Murphy said TNA is working with sponsors to increase funding and improve the student-to-nurse ratio. “We know that the health of a student impacts their learning ability. Now more than ever, we need to ensure our students are physically and mentally healthy and able to learn no matter the setting.” Workplace Safety: Murphy noted concerns over safety in the workplace is an issue that needs to be revisited. “People who assault a healthcare provider when they are preforming their duties are no longer charged with increased fines,” she explained. “We believe that increase was a deterrent that is essential to helping keep our workplaces safe. We will be working with sponsors to put healthcare workers back into the Tennessee code that was unfortunately removed in the 2020 August special session.”  nashvillemedicalnews

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Analysts Outline Expectations for the Healthcare Industry By CINDY SANDERS

As President Joe Biden was taking the oath of office in Washington, D.C., healthcare financial analysts gathered via video to share their thoughts on what a new administration and ongoing pandemic might mean for various industry sectors in 2021. The virtual event, which was hosted by the Nashville Health Care Council, brought together three national analysts for a panel discussion to share insights into how healthcare fared in 2020 and where it’s headed in 2021. Chris Holden, former president and CEO of Envision Healthcare, moderated the conversation. Whit Mayo, Managing Director, UBS: Mayo said the sheer velocity and volatility within the market was surprising in 2020 as he and colleagues went from analyzing “a lot of solvency risk” to a quick transition “towards excessive liquidity that was injected into the system.” He added, “I think we saw a corresponding reevaluation to levels, across many asset classes, that I wouldn’t have anticipated.” Mayo also marveled at recent IPO activity. “Maybe a final point in just stepping back and reflecting on 2020 was the material surge we saw in equity capital markets activity.” He noted 11 IPOs were filed in about a two week period in early January. “I feel like I’ve spent the better part of the last decade taking companies private, and so it’s kind of refreshing to see many of these organizations looking to become public.” Mayo said he had a positive bias

over the next six to nine months around the provider market. “I think it’s really underappreciated the sustainability of the cost structure today,” he said, adding that environment has an exceedingly positive skew for certain providers. “Taking a stock like Tenet as an example, it’s not inconceivable they could be generating over 30 percent of their market cap in real, discretionary, free cash in the next 12 to 24 – closer to 24 – months.” Thinking about where stocks are currently trading, Mayo said, “There’s a much more interesting risk/reward, I think, in the provider world.” When it comes to innovation and investment, Mayo said he looks at the topics through the lens of the venture capital market. “Where is a lot of the capital being allocated? And there’s just a lot in the payer solutions-oriented sector,” he said of companies working to provide data analytics, population health intel and solutions for employers. Ann Hynes, Managing Director, US Equity Research, Mizuho Securities USA: Hynes noted she was most excited about how CROs (clinical research organization), hospitals and clinical labs navigated a tough 2020 and positioned themselves going forward. “With the CROs, they were very resilient during COVID,” she said. “Obviously patients didn’t have access to a lot of sites, but they were really able to adjust to telehealth very quickly.” Their participation in vaccine trials kept them busy in 2020, and Hynes thinks that carries forward into 2021. “This group trades on

Top Stock Picks

the IPO market, she is most excited. and it was such “They’ve been a So who do the experts like? The picks follow a hot market huge part of the their observations about which sectors they through the COVD soluthink are well positioned to weather whatever tion with the pandemic, 2021 has in store. Companies getting some love testing. I think and that increinclude: AdaptHealth, Compass Health, CVS, mental funding, one of the things HCA Healthcare, IQVIA, LabCorp, especially in the that has been Option Care Health and biopharma indusunderappreciated Tenet Healthcare. try, is going to propel for both LabCorp and revenue growth … probably Quest (Diagnostics) is that for the next two or three years.” they will probably generate an extra billion to billion-and-a-half of free cash flow With the hospital sector, Hynes said they otherwise wouldn’t have because she was impressed at how flexible and of COVID testing, and they are getting resilient hospitals proved to be. When elevated reimbursement right now,” she admissions went down as elective procedures stopped, hospitals adjusted their pointed out. That extra infusion of cash, cost structures. “But I also think for 2021, she said, gives both companies a lot of just on a political front, there are positive optionality from accelerating growth to headwinds because Biden is in favor of M&A. expanding the ACA,” said Hynes, noting Gary Taylor, Senior Equity expanded coverage only helps hospitals. Research Analyst & Managing “From an operational perspective, I do Director, JP Morgan: Taylor said his think there’s a lot of delayed care,” she work is mostly focused on health insurance and providers. He noted the title of said of procedures put off in 2020 that are the group’s 2021 outlook for these secexpected to be revisited in 2021. “If you tors was ‘Mixed & Complex.’ However, look back historically at recessions, with he added with a laugh, “The feedback delayed care that does come back, and I got was ‘When in the last 30 years has that should benefit the hospitals.” healthcare services not had a mixed and Last, but not least, Hynes said clini(CONTINUED ON PAGE 12) cal labs are one of the sectors about which

Political Considerations With a new administration in the White House and Democrats holding a slim majority in the House of Representatives and the narrowest possible majority in the Senate, what changes do analysts anticipate? Ann Hynes: “I would say even though there is still a lot that’s unclear, I think what is very clear about Biden is that he wants to strengthen and expand the ACA. That’s a very positive sentiment driver for healthcare, but especially for healthcare providers.” She added that in her universe that focuses on the drug supply chain, she has to worry about drug pricing. While there might be some appetite to include legislation to control pricing, she doesn’t think it is likely to happen with the current makeup of Congress. Whit Mayo: “I don’t think we know exactly the direction that Biden is going to take with his entire healthcare agenda, but if he governs any way remotely close to how he campaigns and debates, I think we can just call it ‘slightly left of left of center,’ so I’m anticipating a much more moderate type of approach to policy.” Gary Taylor: “On the conventional wisdom, there’s not a lot he can get done with the Senate makeup the way it is. The only thing Biden has ever expressed support that, in our view, would be harmful to providers would have been the public option, which absolutely seems off the table.” Taylor did add there remains some conversation around lowering Medicare eligibility age but noted such a move comes with a Congressional Budget Office price tag of about $4 trillion. “I think eventually trillions matter, so I’m kind of skeptical there.” Looking at President Biden’s pick for Health and Human Services, Taylor wondered what that might mean for provider consolidation moving forward. Biden has tapped Xavier Becerra to lead HHS. As California Attorney General, Becerra was instrumental in reaching a settlement to resolve antitrust allegations against Sutter Health. In January, the Federal Trade Commission announced the agency would look at provider consolidation in South Florida. “So already, there seems to be some signaling of a more adverse stance out of the FTC with respect to provider consolidation.”

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16th Annual Meeting

Grand Hyatt · Nashville August 18-22, 2021 Cost

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

Cost after 6/1/2021

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

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

REGISTER AT WWW.SCALEMUSICCITY.COM FEBRUARY/MARCH 2021

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The Clear Case for Preparedness

100 Leading Healthcare Organizations Release Disaster Readiness Recommendations By CINDY SANDERS

Even prior to the public health and natural disasters of 2020, experts from across the healthcare spectrum were already looking into policy and regulatory recommendations to improve the country’s ability to prepare for and respond to crises. In February, the Healthcare Leadership Council and Duke-Margolis Center for Health Policy released those recommendations in a report focused on ways to maximize resources and strengthen disaster preparedness infrastructure going forward.

The COVID Impact

Neil de Crescenzo, president and CEO of Change Healthcare, served as executive committee chair of the Healthcare Leadership Council (HLC) during much of the work on this project. “We actually started this process before COVID, but it took on a whole new importance Neil de Crescenzo once the coronavirus was identified,” he said. The members of HLC, a coalition of chief executives across all subsectors of the American healthcare industry, were already aware of policy and communication gaps prior to the pandemic. However, COVID-19 response deeply underscored barriers and a lack of coordination hampering a rapid, adequate response to emerging threats. Calvin Schmidt, senior vice president and worldwide leader for Government Affairs & Policy with Johnson & Johnson, noted every sector of healthcare stepped up to meet the occasion of the pandemic. “But the goal is to put infrastructure in place so we aren’t reliant on heroes but are instead prepared.” He added, “We need to know an overwhelmed hospital can get their hands on what they need

without delay.” Schmidt, who chairs the HLC task force on patient safety and quality, added one section of the report recommendations addresses capacity, modernizing the supply chain and ensuring more resilient stockpiles. “We should never again have a situation where states and healthcare providers are feverishly competing against each other (for supplies),” he stressed. Mark McClellan, MD, PhD, founding director of the Duke-Margolis Center for Health Policy, concurred, noting, “The COVID-19 pandemic and immediate response has exposed vulnerabilities in the nation’s ability to handle a national-scale crisis.” He added, “Fragile supply chains that rely on single sources outside the country were tough. I think there’s broad agreement that we need more robust supply chains that include domestic sourcing, as well as multiple sourcing.” He said the new report is intended to be highly actionable based on shortfalls identified in dealing with the pandemic. “We want to learn from what didn’t work and build on what did,” McClellan stated.

Turning Lessons Learned into Action

“Public emergencies will continue to happen and may become more frequent and severe,” said HLC president Mary

Analysts Outline Expectations for the Healthcare Industry, continued from page 11 complex outlook?” – so touché.” He continued, “I think in the first half of the year, I still think there’s momentum behind providers, particularly hospitals.” He added acuity is high, the commercial mix is strong and agreed there was deferred care that would most likely be addressed in the first half of the year. “I think investors are going to chase that to some degree,” he said. “In the back half, where the comps get tough, I’m not sure that trade continues to have legs.” Taylor said he thinks insurers have a huge amount of uncertainty surrounding them in the face of “historically difficult comps.” He noted UnitedHealthcare put up good numbers in early January and their stock was still trading lower. “I think 12

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managed care has a really difficult first part of the year.” On the flip side, Taylor thinks the interest in 2021 is going to be on thematic growth – companies oriented around value-based care like capitated medical groups and site of care options like home health and telehealth. He said huge interest in these concepts combined with interest rates near zero are big drivers in the market for investment. “There are more IPOs in this sector than I’ve ever worked on in my career by a factor of five or six,” said Taylor. “All of them are telling investors – we can take down unnecessary hospitalizations and ER visits, and we can move more patients to a lower cost site.”

R. Grealy. “The next pandemic, natural disaster, or global crisis can be handled more effectively with better preparedness. That begins with the government at all levels and the private sector taking action now, while lessons from COVID-19 are still being learned.” The recommendations call for some of the temporary steps taken to address the pandemic becoming permanent going forward, particularly in terms of making it easier to create public-private partnerships, streamlining regulations to allow providers to practice where they are most needed without some of the more unwieldy state licensure issues, and enhancing communications and data sharing. McClellan noted the recommendations are a combination of actions that could be ramped up quickly and those that are more aspirational and factor into long-term plans. Experts agree the pandemic exponentially enhanced telehealth adoption for patients and providers. Andrea Willis, MD, senior vice president and chief medical officer for BlueCross BlueShield of Tennessee, said, “Looking at how we did telehealth expansion, we saw a lot of single

providers jump into the fray to make sure patients could get the care they needed. We’re grateful to them. They are heroes in this, and it helped us broaden our thinking on what we can do to support them.” Another area of focus coming out of the pandemic is a heightened sense of urgency to address health inequities. While many clinicians and some in the general population were already aware of disparities in care, the pandemic shone a bright spotlight on the issue. “The exacerbations were right there in our faces,” pointed out Willis, adding social determinants must factor into preparing for future disaster responses. Grealy said the pandemic laid bare the need to improve both our public health and data infrastructure. “I think there’s a real opportunity in the short term to move quickly on this,” she noted. While the gaps are glaring, an appetite to change the status quo seems to be a growing in both the public and private sector. McClellan, who previously served as administrator of the Centers for Medicare & Medicaid Services and commissioner of the U.S. Food and Drug Administration, has been heartened by the information sharing and cooperation seen during the pandemic. “A positive sign was the organizations and people in the healthcare space who typically are competitors showing willingness to work together for the good of all Americans.” Grealy agreed, “There is a commitment on the part of the private sector to work with the government. We need to begin preparing now for what my come in the future.” Links to the recommendations and to a compendium of best practices and lessons learned by HLC members are available online at hlc.org and through our site at NashvilleMedicalNews.com.

Recommendation Highlights Among the report’s recommendations, experts highlighted the following essential changes: • Launching a standing disaster preparedness group, appointed by and working with the White House, that will include private sector expertise in areas such as production capacity, supply chain and distribution, data exchange, financing and acute care delivery.   • Modernizing the healthcare supply chain through digitalization, automation, and predictive analytics, with standardized approaches for allocating resources based on need and equity to prevent bidding wars between states and healthcare providers. • Creating measures to ensure health equity and address disparities, identifying high-risk vulnerable populations and directing resources accordingly. • Improving economic resilience with strategic incentives such as zero percent loans, federally guaranteed purchase commitments, and geographic diversification of production for critical medical products. • Building a 21st century public health early warning system that will utilize all available electronic health records and public health data collection. • Passing legislation and regulatory reform to create rapid response capabilities in areas such as medical licensure portability, telehealth accessibility, and swift access to PPE stockpiles. • Making it easier and more secure for private industry and government to share data by updating anti-trust laws, enacting strong privacy protections, and ensuring broad access to the data. 

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Consolidated Appropriations Act

Impact on HHS Provider Relief Funds, PPP Loans & Employee Retention Credits The Consolidated Appropriations Act (CAA) was signed into law on Dec. 27, 2020. From the more than 5,000-page legislation, three key provisions were By LUCY CARTER, CPA discussed at the K raftCPAs, pllc Nashville Medical Group Management Association February meeting. HHS Provider Relief Fund Reporting Reporting the use of Provider Relief Funds (PRF) has been a confusing process for recipients. Since the initial funding in April 2020, there have been numerous changes in who reports, how to report and what to report. Reporting guidelines issued by HHS on Jan. 15, 2021, confirm that any provider who received $10,000 or more in PRF must report the use of funds on the Health and Human Services (HHS) PRF Portal. The deadline to report was Feb. 15, 2021, but due to the reporting changes in CAA, the deadline has been indefinitely extended. The reporting for PRF consists of two components: • Calculation of 2020 unreimbursed expenses directly related to a COVID response, and • Calculation of lost revenue for the calendar year 2020. • The calculation for lost revenue has

gone through four iterations with HHS. In CAA, the calculation was defined in the legislation and consists of three different methodologies that recipients can use. Option 1 • Comparison of 2020 net patient revenue to 2019 net patient revenue • Report by calendar quarter, by payer Option 2 • Comparison of 2020 net patient revenue to budget revenue for 2020 • Budget must have been approved by March 27, 2020 • Report by calendar quarter, by payer • The CEO of the reporting entity must attest that the budget was approved by March 27,2020 Option 3 • Any reasonable method Option 3 is not recommended. If HHS decides that Option 3 is not reasonable, the entity will have 30 days to refile using Option 1 or 2. PPP Loans CAA included positive provisions and clarifications for the first round of PPP Loans (PPP1). Regarding forgiveness, the legislation provided for simplified reporting for loans under $150,000. In CAA, Congress also clarified that a forgiven PPP loan is completely

tax-exempt and will not create taxable income. Additionally, the Economic Injury Disaster Grant (EIDL), also provided by the Small Business Administration (SBA), will not reduce forgiveness for the PPP loan and, likewise, is not taxable. An additional $284 billion in funding is included in CAA for a second round of PPP loans (PPP2). Applications for PPP2 will be accepted through March 31, 2021. To be eligible for PPP2, employers cannot have over 300 employees. Eligible applicants must have experienced a reduction of 25 percent or greater in gross receipts for one calendar quarter in 2020 compared to the same period in 2019. Gross receipts include all revenue in whatever form received or accrued based on the borrower’s method of accounting. Since they are not taxable, PPP1 loan proceeds are not included in gross receipts. Employee Retention Credit Prior to CAA, if an entity received a PPP loan, they were not eligible to claim the Employee Retention Credit (ERC). CAA provided that all businesses (including non-profits) are eligible for the ERC even if they received a PPP loan, and eligibility is retroactive for 2020. Wages that qualify for the ERC include wages paid in a quarter in which: • Operations were fully or partially suspended due to a government order related to COVID, OR • The business had a 50 percent or greater decline in revenue during a calendar quarter compared to 2019.

In Tennessee, Gov. Bill Lee issued Executive Order 18 to reduce the spread of COVID-19. The order effectively suspended non-emergency/elective medical procedures from March 24, 2020 to April 30, 2020 and non-essential dental services from March 24, 2020 to May 6, 2020. The EO created a partial suspension for healthcare entities providing these services. The 2020 ERC calculation for employers with less than 100 employees (based on 2019 count) includes all wages (including owner wages) paid during the suspension period. Eligible wages include healthcare benefits. The maximum credit is equal to 50 percent of eligible wages not to exceed $10,000 per employee (maximum credit of $5,000 per employee). For the 2020 credit, employers with over 100 employees (large employers) may only include as eligible wages amounts paid to employees (and owners) who were not performing services while the government order was in place. The ERC was also extended through June 30, 2021. In 2021, the credit is equal to 70 percent of eligible wages and the decline in revenue to qualify is 20 percent (quarterly 2021 gross receipts compared to a comparable period in 2019). The definition of large employer was increased to entities with over 500 employees. Lucy Carter, CPA, is a member and practice leader for the Healthcare Industry Team at KraftCPAs, PLLC. A well-known industry expert, Carter has more than 35 years of experience working with healthcare providers and executives. For more information, go online to KraftCPAs.com

GRAND ROUNDS More details on these announcements and others online at NashvilleMedicalNews.com

ArchWell Health Formed to Deliver Care to Medically Underserved Seniors ArchWell Health, a new healthcare company headquartered in Nashville,  has been formed to provide holistic primary healthcare services to Medicare-eligible seniors in medically underserved neighborhoods across the United States.

In an announcement made in late February, company officials outlined plans to establish state-of-theart neighborhood healthcare centers featuring an advanced, senior-focused care model. The company’s goal is to provide seniors access to quality care and healthy living options, irrespective of their economic situation. Its centers will focus on providing comprehensive primary care for seniors enrolled in tranashvillemedicalnews

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ditional Medicare and Medicare Advantage plans. The company has 15 ArchWell Health centers already under development that are expected to open before the end of 2021. ArchWell Health centers will be equipped to provide a new and differentiated level of primary care in the communities the company will serve. Each center’s physicians will have 6x fewer patients per panel than the current national average, ensuring they have more time to work with the patient to solve their individual health challenges. Additionally, physicians and their care teams will be specifically trained to care for seniors to address the more challenging health conditions and chronic conditions typical in older populations. “The healthcare needs of the senior population are often multi-faceted, so our goal is to establish long-term relationships to monitor and respond to physical and emotional needs for achieving the best quality of life,” said Carl Whitmer, ArchWell co-founder and CEO. “The primary care doctors we work with will be supported by social, nutritional, and behavioral health services in each center.”

Cornea & Cataract Consultants Adds New Providers, Acquires Murfreesboro Practice Cornea & Cataract Consultants of Nashville has added Jordan Hill, MD to the practice. He is seeing new and existing patients at the Nashville, Franklin, and Murfreesboro office locations. Hill is a fellowshiptrained ophthalmologist who brings experience Dr. Jordan Hill in cornea transplantation, anterior segment and cataract surgery and refractive surgical procedures to Cornea & Cataract Consultants. Additionally, the practice has acquired the Murfreesboro ophthalmology practice of Harold Akin, MD, who has joined Cornea & Cataract Consultants and continues to see patients at the Highland Terrace location in Murfreesboro. The acqui- Dr. Harold Akin sition further expands Cornea & Cataract Consultants growing network of ophthalmology and cornea

surgical practices in the Middle Tennessee region. Akin is a board-certified ophthalmologist. The growing practice, which now includes six specialists across three offices, provides specialty cornea and cataract eye care and traditional ophthalmology care including LASIK, PRK, and INTACS for Keratoconus surgical procedures along with Lipiflow and other advanced treatment options for dry eye.

K&L Gates Launches Nashville Office

Global law firm K&L Gates LLP has established an office in Nashville with the hiring of more than 25 lawyers across a variety of practices, including healthcare, litigation, corporate, intellectual property, finance, and construction, among others. Officials with K&L Gates said the Nashville office  – the firm’s 24th in the United States and 45th worldwide  –  provides its clients access to one of the nation’s fastest-growing markets, including in such areas as healthcare, technology and investment, and is expected to continue to expand during the coming months. 

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GRAND ROUNDS

Smith, Milner Join LBMC Healthcare Practice Accounting and business consulting firm LBMC recently announced two additions to its senior team. Healthcare industry veteran Matt Smith has joined the company as shareholder to work within LBMC’s rapidly growing healthcare practice. Smith has more than 20 years of experience providing audit and advisory services to investor-owned healthMatt Smith care companies across the Southeast with concentrations in pharmaceutical manufacturers and distributors, skilled nursing operators and behavioral healthcare companies. A former board member for both Leadership Health Care and the Nashville Health Care Council, Smith is a member of a number of professional organizations including the American College of Health Executives and the Healthcare Financial Management Association. He currently serves on the advisory board for the Accounting Department of the Jennings A. Jones College of Business at Middle Tennessee State University and on the board of directors at Mental Health America of Middle Tennessee, where he is the immediate past-chair. Brad Milner joined LBMC as senior director of Healthcare Analytics to work

within the firm’s Data Insights  division. Milner has 20 years of business intelligence (BI) experience helping healthcare leaders drive efficiency and growth through Brad Milner data-driven insights in the areas of finance, operations, data engineering, modeling, forecasting, visualization, governance and documentation. His expertise also includes ad hoc analysis and reporting, internal and external audits and investigations, and process improvement. Milner previously served as BI / Decision Support System (DSS) Director at Tenet Healthcare Corporation. In his role at LBMC, he will work with clients to provide real-time data to decision makers and advise healthcare clients in his areas of expertise.

LifePoint Names Matthews SVP, Chief Diversity, Patient Experience Officer In February, LifePoint Health announced the appointment of Vinitia Mathews, PhD to the new role of senior vice president and chief diversity and patient experience officer. In this role, Mathews will Dr. Vinitia be responsible for the Mathews development and implementation of the organization’s Diversity,

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

Michael Christie, MD, orthopedic surgeon at Southern Joint Replacement Institute and TriStar Centennial Medical Center, was awarded the 2020 Humanitarian Award from the American Association of Hip and Knee Surgeons (AAHKS). He currently serves as the president of the Walk Strong Foundation which he founded in 2008 after being inspired by Operation Walk, a non-profit organization supporting AIDS orphans in Tanzania. The Walk Strong Foundation provides knee replacement surgery at no charge to disadvantaged patients in underserved countries with follow up care provided by well-trained, local surgeons. Each mission makes a 10-year commitment that includes sustained education, training, equipment and infrastructure donations. Christie established the first site at the Hospital de Alta Especialidad in Veracruz, Mexico and added a second site recently at University Hospital of the West Indies in Kingston, Jamaica. HCA Healthcare has been recognized for the 11th time by Ethisphere, a global leader in defining and advancing the standards of ethical business practices, as one of the 2021 World’s Most Ethical Companies. HCA Healthcare is one of only seven honorees in the Healthcare Providers category. Williamson Medical Center has received the 2021 quality award rankings from CareChex® Awards. These rankings list Williamson Medical Center as a leader in the nation, region, state or market for Medical Excellence and Patient Safety in categories including spinal fusion, vascular surgery, cardiac care, spinal surgery, heart attack treatment and interventional carotid care. Well known healthcare technology entrepreneur Marcus Whitney has been named to the board of LaunchTN.

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Equity and Inclusion (DEI) initiatives. She will also continue to lead patient experience programs for the company. Matthews joined LifePoint in 2013, most recently serving as vice president, clinical excellence and experience. Previously, she served as enterprise patient experience program director for Legacy Health in Portland, Ore. She received her MBA in healthcare administration and her doctorate in strategic management from Texas Tech University’s Rawls College of Business.

Ascension Rutherford Welcomes New ED Director

Doris Price, DNP, MSN, RN, NE-BC, has been named director of Ascension Saint Thomas Rutherford Hospital Emergency Department. Most recently, Price served as director of Critical Care Services for Texas Health Harris Methodist Hospital in Fort Worth. Dr. Doris Price In her six years with the state’s largest faith-based, non-profit health system, she oversaw an Emergency Department, Intensive Care Unit, and Catheterization Laboratory, Trauma and Dialysis, as well as overseeing a multimillion-dollar ER expansion and nearly tripled patient and staff satisfaction scores. In addition to a doctoral degree from Chamberlain University College of Nursing in Addison, Ill., Price holds master’s and bachelor’s degrees from Milwaukee’s Cardinal Stritch University.

Finn Partners Promotes Cottrill to National Health Leadership Role

Finn Partners, headquartered in New York and with a large Nashville office, recently announced Nicole Cottrill has been promoted to senior partner and head of the U.S. Health Provider Services Group. The promotion recognizes her ability to mobilize toward client urgencies within a comNicole Cottrill plex and quickly evolving health environment. In this newly created position, Cottrill will serve as senior counselor for the agency’s clients within the healthcare provider sector including hospitals and health systems, physician practices, long-term and post-acute care providers, and specialists in areas including oncology and behavioral health. She will report jointly to Gil Bashe, managing partner, Global Health Practice, in New York and Beth Courtney, managing partner, FINN Southeast in Nashville. Recognized as US Healthcare Agency of the Year by HITMC and a top four PRovoke Media  global healthcare agency, the Finn Partners Health Practice is among the agency’s largest and fastest-growing divisions. Nashville, the nation’s health services capital, is

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More Grand Rounds Online Details on these and other announcements online at NashvilleMedicalNews.com

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GRAND ROUNDS the southeastern hub for Finn Partners, where Cottrill is based. She joined Finn Partners in 2015 with the acquisition of Seigenthaler Public Relations, where she had been a partner for two years. As co-lead of FINN Southeast’s health group, her knowledge of provider organizational structure, institutional reimbursement, and state and federal public health policies made her a highly sought-after counselor. Nashville Medical News named Cottrill one of the city’s “Women to Watch” in 2019.

Aycock Named TriStar Skyline CNO Effective Feb. 15, TriStar Skyline Medical Center appointed Jennifer Aycock MSN, RN, CCRN, as its chief nursing officer. Aycock currently serves as associate chief nursing officer (ACNO) of sister hospital, TriStar Cen- Jennifer Aycock tennial Medical Center. With more than 17 years of nurse leadership experience, Aycock served as ACNO of TriStar Centennial Medical Center since 2018. Her extensive nursing career began at Barnes-Jewish Hospital, St. Louis, Mo., where she emerged as a nursing executive through multiple leadership roles. Aycock earned her undergraduate degree in nursing from Chamberlain College of Nursing and her MSN from Webster University.

OVME Opens Franklin Studio On March 1,  OVME (pronounced “of me”), the rapidly growing national medical aesthetics brand, officially opened the doors to its  second Nashville location.  Located on West McEwen Drive in Cool Springs, OVME’s new  Franklin  studio features a selection of minimally  invasive cosmetic services individualized for each client. The new location includes seven  treatment rooms,  including dedicated rooms for laser procedures and facials.  OVME, which has cultivated a highprofile following for its luxury offerings and developed a reputation as an industry disrupter due to its tech-enabled approach to cosmetic services, currently has a total of nine studios in seven cities across the U.S. with six  more to follow later in 2021.

ner as chief commercial officer. Channer, who has served as an advisor to BehaVR for four years, joined the company from  McDermott Will & Emery,  where he Rory Channer served as chief business and client development officer. He will leverage his experience in marketing, sales, and commercial operations to help expand use of BehaVR products and drive company growth.  In the newly created chief commercial officer role, Channer will provide strategic guidance on business growth initiatives, oversee the sales and marketing teams, pursue novel partnerships, and engage payers, employers, healthcare providers, and consumers to boost adoption of BehaVR’s behavioral health programs. Channer has more than 25 years of experience driving growth. He has worked with venture-backed startups to large, publicly traded companies in diverse fields from artificial intelligence to legal services industries.

Matt Moraski has been named senior managing principal of OneDigital Tennessee. Moraski was formerly with OneDigital Florida and, before that, foundMatt Moraski ed, grew and ultimately sold his own employee benefits consulting firm, Gravity Benefits, to OneDigital. He brings 20-plus years of industry and executive experience, as well as an entrepreneurial perspective. Moraski holds a bachelor’s degree in business management from Clemson University. Heath Holt is joining OneDigital Tennessee as principal and business

OneDigital Expands Leadership Team OneDigital, a leading strategic advisory firm, has recently named two additions to the leadership team. OneDigital, which has been named to the  Inc. 5000 List of America’s fastestgrowing companies  every year since 2007, uniquely converges health, wealth and human resources into a hub of services and business guidance to empower companies to create workplaces that attract and retain talent while fueling innovation and company growth.

Glenn Bradley (L), Nashville Medical Group Management Association board member, presents Nashville General Hospital Foundation Executive Director Vernon Rose with a check to help support the hospital’s unique food pharmacy program. The donation was part of NMGMA’s year-end community outreach.

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Channer Joins BehaVR as Chief Commercial Officer BehaVR, a Nashville-based leading innovator of virtual reality-based HEALTHCARE digital wellness and digital therapeutics experiences, has appointed Rory Channashvillemedicalnews

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development executive. He comes to the company with over two decades of experience in the human resources industry, where he has Heath Holt honed his management and consulting skills in insurance settings. Most recently, he served as principal consultant at Mercer. Previous experience also includes time with Willis and CIGNA Healthcare. In his new role, Holt will be responsible for driving growth through new client acquisition and leading other business development initiatives. A longtime Nashvillian, he will aid the OneDigital team in continuing its expansion across Tennessee.

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Robotics Delivering Innovation, Better Outcomes in Joint Replacement at TriStar Centennial Robotics has revolutionized surgery in 2021, with few specialties impacted quite like orthopaedics. More than two decades since the first robotic-assisted surgery, joint replacement surgeons have embraced the latest techniques delivering unprecedented precision and improved patient outcomes – often in an outpatient setting.

Changing the Paradigm

Despite robotics’ proven track record, Jeffrey Hodrick, MD, orthopaedic surgeon at TriStar Centennial’s Advanced Joint Replacement Institute, said patients are still sometimes hesitant about robotics in the operating room. “While this is semi-automated, where I control the robotic arm, there is still some misunderstanding around what the robot does,” he explained. “I see the robotic arm as an extension of me, and the robot makes me a better surgeon.” Hodrick tells patients the robot allows him to plan and perform the surgery at a level of precision that has never been available before. “While the robot helps eliminate outliers, it does more. It allows me to focus on the most important aspect of knee replacement: balance,” he said.

Creating Balance

While knee replacement is statistically a highly successful operation, there are still a small percentage of patients who are not completely satisfied. “Often times they don’t require another operation, but they’re just not as happy as they thought they’d be,” Hodrick said. While a small subset have underlying conditions like depression or anxiety, known to increase susceptibility to pain, less than satisfactory outcomes are Improved Precision often related to instability The use of robotics in in their knee replacement. any industry revolves “Ideally, you have the around precision, and joint same amount of ligament replacement – particularly tension on the inside knees – is no exception. and outside of the knee,” “When performing knee Hodrick explained. “If you replacement, you’re can balance the knee so focused on alignment that the ligaments have and balancing of the the same amount of soft tissues around the tension through range of knee,” said Hodrick, who’s Dr. Jeffrey Hodrick motion, the patient has a performed more than 750 better chance of feeling robotic knee replacements good and having an excellent outcome. It’s at AJRI. “Robotics helps to quantify those quite complicated, but having a pre-operative measurements, and then execute that plan, and being able to adjust that plan in a plan.” The robotic arm cuts bone within a virtual environment while marrying soft tissue tenth of a degree and within a tenth of a information with planned bone cuts from premillimeter. The software allows for operative CT scans, all help to better balance enhanced 3D preoperative planning, the knee in the OR and create a better result.” custom templated sizing, while respecting the patient’s individual anatomy and Experience Matters deformity. “We can make changes to the Surgeon experience also plays a big role plan based on the patient’s soft tissues in in patient satisfaction. “Patients need to a virtual environment, before cutting any understand the level of training and experience bone. Surgeons love to plan and don’t like a surgeon has, and ask how many replacements surprises,” Hodrick said.

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the surgeon has performed,” he said. “There’s a lot of research that shows the more joint replacements you perform, the better you are.” At SJRI, Hodrick is one of six fellowship trained joint replacement surgeons. They work with designated, specially trained OR staff on a floor specifically designed for joint replacement patients. “Every staff member who comes in contact with our patients are joint replacement specialists in their own area. We are proud to deliver that level of expertise,” said Hodrick. He participates in research and trains fellows on the latest techniques including robotic knee, outpatient surgery and rapid recovery – another buzzword for surgeons in 2021. “Surgical recovery is shortening all the time, with a strong trend toward outpatient surgery,” he said. “It’s pretty amazing to think about.” Shorter recovery times are due partially to advanced surgical techniques that require less soft tissue to be released during robotic-assisted procedures. He also credits advances in pain control, with spinal anesthesia often combined with a regional or local injection around the incision. SJRI surgeons also are committed to limiting opioid use, knowing the side effects can be worse than the discomfort itself. “What we’re learning is that patients can better engage in physical therapy, so they can return to work and become independent faster,” he said. “I have the best job in the world, because I can offer patients a surgery that reliably relieves pain. That’s extremely gratifying.”

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February/March 2021 Nashville Medical News  

your primary source for professional healthcare news

February/March 2021 Nashville Medical News  

your primary source for professional healthcare news